13 3/4 yo Lab with possible Cushings Dx

[ToppersMom]

Hi, I am new to the forum after receiving a possible Cushings Dx in my Lab. Topper will be 14 in December. I have noticed him slowing down in the past few months, which isn't unusual considering his age. He also has lost hair off of his tail. He is slow to get up and lay down but is still able to go up and down stairs. I took him to a new vet for an exam and we did bloodwork. His Lym was low at .46 (range 1.00-4.80), MCHC was high at 37.2 (range 31-34), Alp was 1225! (range 20-150), Alt was high at 158 (range 10-158), T4 was 1.1 (range 1.1-4) and cholesterol was 388 (range 125-270).

Topper does pant some in the evening but sleeps all night and isn't peeing in the house or drinking a lot of water. He has fecal incontinence sometimes but I believe that is just age related.

Because he is a geriatric dog, I am honestly unsure what to do. has anyone with a geriatric large breed dog chosen palliative care over treatment? He doesn't appear to be in pain and he still enjoys his meals. Of course, he is a Lab!

Thanks for any input or advice.

Amy and Topper

[Harley PoMMom]

Hi Amy,

Welcome to you and Topper! I am sorry for the reasons that brought you here but so glad you found us.

Dogs with Cushing's disease generally have a ravenous appetite, drink copious amouts of water and pee rivers, from your post it seems that Topper does not display those common Cushing's symptoms, so I question Topper's diagnosis of Cushing's. It would help us if you would get copies of the tests that were done to diagnose Topper's Cushing's and post those results here.

I do see that you have posted Topper's abnormal values from his CBC/chemistry panel and those elevations are often seen in dogs with Cushing's, so I am a bit stumped right now. Was an urinalysis done too, and if so, could you post those findings here? How about an ultrasound, was this done?

An ultrasound would be my recommendation because all the internal organs can be seen and abnormalities that may be found could be the reason for Topper's symptoms and then they could be addressed.

I am providing a post made from on of our staffers, Marianne, to a member who was seeking advice regarding treating her elderly dog for Cushing's:
Dear Lisa,

Welcome to you and Pepper, and WOW you've done a great job of keeping your girl healthy and happy up to age 17! First off, even though folks here do give various supplements to support healthy body functioning, there are no nonprescription drugs that will address the root cause of Cushing's and lower cortisol sufficiently to control the disease. So it really will take treatment with either trilostane (or Lysodren, the other Rx option) to control the Cushing's, assuming it truly is the cause of her symptoms. Having said that, at age 17, you may want to consider pluses-and-minuses of Cushing's treatment before rushing in to treat Pepper.

Cushing's is typically a slowly progressive disease but it does have the potential to cause systemic damage over time (from high blood pressure, vulnerability to pancreatitis and infections, high cholesterol, kidney damage, liver inflammation, etc.). So for a younger dog, I'd certainly recommend effective treatment so as to eliminate some of these risks, improve longterm quality of life, and allow the dog to live out his/her normal lifespan. However, for a dog of Pepper's age, immediate quality of life issues seem of paramount importance to me. And there are some trade-offs to treatment, especially for an arthritic dog since the arthritis may actually worsen as the cortisol level drops, necessitating the introduction of additional drugs to better manage the discomfort. Also, especially at the beginning, there can be numerous vet visits and blood draws which can be less than pleasant for a dog who's nervous at the vet (and also hard on the owner's pocketbook :o).

I don't tell you any of this to dissuade you from treating if you and your vet agree this is the best path forward for Pepper. But I do think you are the best judge as to how uncomfortable her current symptoms are to you both, and if they are not bothering Pepper all that much -- as I say, you may want to hold off on treating for the time being.

First things first, though -- as Lori says, it'll be great if we can take a look at those test results.

Marianne

Please know we are here for you both and we will help in any way we can. If you have any questions at all do not hesitate to ask them, ok?

Hugs, Lori

[ToppersMom]

Thank you so much for the welcome! I honestly cannot afford an ultrasound right now. I am in such a different spot than where I was years ago... single and more money! Do you still want me to post his bloodwork? The ones I posted before were the only ones that were abnormal. I just don't want to be a "bad parent" to my sweet boy! I love him so much. But I just don't want to subject him to the tests and the stress. He doesn't like the vets office. I have heard various opinions as to whether to treat and not to treat. I really have a big decision to make. I appreciate your sharing with me the other info on an elderly dog and deciding on treatment. Thanks again!

Amy and Topper

[ToppersMom]

Oops, no urinalysis. Vet did mention having that done.

[lulusmom]

Hi and welcome to you and Topper.

As Lori mentioned, cushing's is misdiagnosed frequently but hypothyroidism is probably misdiagnosed more. The severity of that error boils down to the medication and cushing's medication is much more serious than synthetic thyroid supplementation. The problem is that a good many of the symptoms, as well as blood abnormalities associated with both conditions, overlap. In Topper's case, I suspect hypothyroidism over cushing's at this point. I assume that your vet has not yet done an acth stimulation test or a low dose dex suppression (LDDS) test yet???

Given Topper's age and absence of the problematic symptom associated with cushing's, I don't think I would fork out the high bucks for an acth stimulation test or LDDS at this point, because I would not opt to treat. If you are compelled to move forward with testing, You might consider a urine cortisol creatinine ratio to try to rule out cushing's. If normal, you can pretty much rule out cushing's. If high, you would have to do additional testing. It's a fairly simple and inexpensive test. I just back up and clarify simple. You would have to collect the urine at home, preferrably the first pee of the day before any meals or medications. Get it to the vet asap but if it's not possible to get it there within an hour or two, refrigerate it until you can. Many of us have used pie tins, tupperware and ladles to collect the urine.

If you could afford it, you might consider having your vet do a full thyroid panel. If you can't afford it, I'd talk to the vet about putting Topper on a trial of Levothyroxine to see if he responds. All of Topper's symptoms are associated with hypothyroidism. I've had two dogs with hypothyroidism and their first symptoms were lethargy and hair loss on the top of their tails. Depending on the climate where you are, it may be difficult to tell but does Topper appear to be sensitive to cold? My two girls, including one that also had cushing's were always cold, despite their heavy coats.

Glynda

[ToppersMom]

Hi Glynda,

Thanks for the welcome and the input. No tests yet. When I talked to her a few days ago, we discussed options and I told her I wanted to gather more information before making a decision. Part of me doesn't want to test because I don't think that I would opt to treat BUT I think I should purse the thyroid testing. And maybe actually start with the urine cortisol test. I'm so torn.

I haven't really noticed him being cold although we're at the end of summer now. He doesn't like to be outside much when it's super cold, though. My hubby thinks it's funny but maybe it's his thyroid.

Thank you so much. I will call the vet and talk to her about the thyroid.

Amy and Topper


Hi and welcome to you and Topper.

As Lori mentioned, cushing's is misdiagnosed frequently but hypothyroidism is probably misdiagnosed more. I assume that your vet has not yet done an acth stimulation test or a low dose dex suppression (LDDS) test yet???

Given Topper's age and absence of the problematic symptom associated with cushing's, I don't think I would fork out the high bucks for an acth stimulation test or LDDS at this point, because I would not opt to treat. If you are compelled to move forward with testing, You might consider a urine cortisol creatinine ratio to try to rule out cushing's.

Glynda

[molly muffin]

Hello. I just wanted to welcome you and Topper to the forum. I can't really add anything to what Glynda and Lori have already said, other than, if it is cushings and you bring down the cortisol, then any problems with joints, arthritis, would likely be felt more, so it would be a delicate balancing act.
Check the price on the urine cortisol test with the vet, it should be cheaper and as Glynda mentioned would definitely rule out cushings if negative. Then you would most likely be looking at thyroid which could be treated fairly easily.

I know it is much harder to know which road to choose when you are dealing with age and quality of life too.

Welcome again!

[ToppersMom]

Hi, Thank you for reply. I did end up calling the Vet back and she said that a thyroid panel would run about $275 which seemed high to me. I held off. Yesterday, I decided to have the urine test run and called and asked if I could drop off a sample. Was told yes. I took it by to drop it off and was told that they can't accept urine samples because " not that we don't trust you but we don't really know who's urine it is." I said, Thank you, I will find another vet and I left. I just find that absurd. From what I read about this urine cortisol test, it's best to get the sample from home and take it in. She just saw Topper recently and car rides/vet visits make him nervous now.

I made an apt with another Vet that I used to see but it's not until tomorrow at 330. The problem now is that Topper's panting/breathing has changed. He'll go through these episodes where he breathes really heavy and his sides are really sucked in but he doesn't appear to be distressed in the least. I was up with him late last night and early this morning freaking out but every time, he calms down. I am guessing that there is something else going on so hoping I can get in to see the vet today. We just had to put our 16 year old Chow mix to sleep a week ago so to lose Topper now would be extra hard. Especially on our kids who are 4 and 6 years old. Thanks for reading.

Amy and Topper, soon to be 14 yo black Lab

[ToppersMom]

Oh and I should mention also that the Vet said no to putting Topper on thyroid meds bc she thinks it's from the Cushings.

[LauraA]

Hi ToppersMom. Sorry to hear about your boy, trying to find out what is wrong is the worst bit. All those tests and waiting for results while our pups suffer along. I just wanted to say my girl used to pant really bad before her Cushings diagnosis. She still pants now but nowhere near as bad. I would spray some cool water on her and turn the fan on (or air con if that didn't work) and she would usually stop after about 10 minutes. If I did nothing it would go on for hours. I think the panting is quite common in dogs with Cushings. Really hope the new vet is the start of getting some answers for Topper and starting treatment to make him more comfortable.

[Squirt's Mom]

Let us know what the vet says, sweetie. I agree - that was absurd over the urine collection. Tell you yes then refuse it because they don't know whose it is?! That is almost funny. geez.... I hope the new vet is just what you and Topper need.

Hugs,
Leslie and the gang

[ToppersMom]

Hi LauraA,

Thank you for your reply! I just heard from the vet. They did a chest x-ray which looks great, abdomen looks great. She is pretty positive it's Laryngeal Paralysis so they are going to do the test and then the only option is surgery. She did say that she looked at his bloodwork and because he doesn't show any clinical signs of Cushings, she wouldn't purse that right now. I am in agreement. I really hope that Topper does well with surgery. I'm not ready to say goodbye, although we NEVER are!

Thanks again.

Amy and Topper

[judymaggie]

Hi, Amy! I've been following Topper's story. Am curious about the tentative laryngeal paralysis diagnosis as my vet and I have discussed that regarding my Abbie as she chokes whenever she drinks water even with a raised bowl. Since she is fine with her food, my vet thinks it is more of her throat muscles weakening due to aging and, hopefully, it will not get any worse. Has Topper had any problems eating or drinking-- not referring to quantity but having problems swallowing?

[Dixie'sMom]

I've read Topper's story and I wanted to welcome you both to the group. The thing that jumped out at me was your vet's attitude. Regardless of what is going on with Topper, you both need a caring vet who is willing to work with you. I can tell you love your boy and want to do what is best for him. Good job standing up to that vet, Mom!

I'll be following along to see how things are going and please accept my condolences for the loss of your chow mix. It is always so difficult to let them go. :(

[LauraA]

Well it looks like you have found a much more caring and thorough vet than your last one. Hopefully Topper is now closer to feeling a bit better.

[molly muffin]

I'm glad you found a vet that is interested in Topper first and foremost. That is always a good sign. It is important to work together as a team for the best out come. We all do what we can, but it sure does help if you have a vet on the same page as you. This one sounds much more like a better fit than the last one.

Keep us updated. We want you and Topper to both have a much longer time together too. :)

hugs

[mtexas7]

My sweet Star was thought to have LP. There are several forums/groups online you could join. After doing the tieback surgery there is a risk of aspiration pneumonia. I have forgotten the percentages, but I believe you could easily find it online. Dogs with LP have a difficult time cooling themselves, so it is real important to keep them comfortable in that regard. I got Star some cool pads and kept them under him when he was sleeping, or on the sofa. K & G Manufacturing is what I got online at Amazon. You can also sponge their legs and ears and keep them under the fan. I had the AC at 68 lots of times. Check their temp too to be sure they are not overheated. Here is a link to one of the groups. There is also another group specific to geriatric onset of LP. Good luck to you all.

https://groups.yahoo.com/neo/groups/LPAlternatives/info

Mary

[ToppersMom]

Hi everyone,

Just now have a chance to log on and update. Topper is 3 days post-op now and did great with the surgery. The interesting thing is that since the surgery, he has only panted twice, and only for a few minutes. Which leads me to believe that the panting was not due to Cushings but to the LP. The only signs of LP that (looking back on it) he had were panting and a hoarse bark and then the strider in the two days before I took him in to the vet. I think the other vet was so fixated on him possibly having Cushings that she didn't look at anything else.

He never had any issues with choking before. Now, I am watching him like a hawk and trying not to panic.

You all have been so wonderful and this is an amazing group! I'll hang back and read when I can but knowing this is a Cushings group, I don't want to keep posting about the LP. I did find one group but will look at this other one.

Thanks all! Hope everyone had a wonderful Thanksgiving.

Amy and Topper

[Squirt's Mom]

So glad to hear Topper is post-op and doing well! Do keep in touch and let us know how he is. Besides, you can teach us a thing or two about LP...never know when it could be another of our babies with this. ;) If you'd like to start a thread in the Everything Else section on LP I think that would be wonderful!

[molly muffin]

That is a wonderful idea Leslie.

We have all sorts of things other than cushings come up on the forum and educating is never a bad thing. We all learn from each other.

hugs, so glad Topper is doing well. Long may he continue to improve

[Dixie'sMom]

Great News! Go Topper! And I also think the thread on LP is a great idea.

[LauraA]

So happy that Topper is doing so well :)