Bailey may have Cushings ?

[Wendy]

Hi, I am a new member from the U.K
My dog Bailey, a working cocker spaniel has been drinking more than usual and also had 3 small urine leakages.I took him to the vet who tested his urine for diabetes (which was negative) and did a blood test which she said indicated Cushings.
Bailey went in Monday for a ACTH test which has come back as very suggestive of Cushings but not conclusive (vet says she is 80% sure).
He has gone back today for a test for liver disease to rule that out.
These are the results that she wrote down for me of the ACTH test
Cortisol pre test 176 nmol post test 590 nmol. Can someone tell me if this is very bad ?
Bailey will be 10 in Dec and to me seems very well, no more urine leakages and is not drinking excessively. He has no other symptoms
whatsoever. I need help and guidance please.
Thanks Wendy

[lulusmom]

Hi Wendy and welcome to you and Bailey.

Symptoms are huge component of a cushing's diagnosis and I see that Bailey really has none that we commonly see. Some of our members report that it is very difficult to get copies of test results from their vet but it would be very helpful if you would please try. I don't understand why a vet refuses to release test reports because we pay for them and they are invaluable if we ever need to take our pup to an er. Vets on call are very happy to have a dog's history at his/her fingertips. With respect to the blood chemistry and complete blood count (CBC), we need only see the highs and lows, and please include the normal reference ranges. It would very helpful if you could get a copy of the urinalysis. Dogs with cushing's usually have dilute urine and low urine specific gravity. A culture should be done as the urine is diluted out and a normal urinalysis will not pick up the real number of white cells nor identify the type of bacteria in order to determine an appropriate antibiotic.

The acth stimulation test is borderline and in my opinion, 80% sure a dog with no real symptoms has cushing's is a stretch. Of course, that percentage may be more realistic if Bailey has all of the usual blood and urine abnormalities. Please try your best to get copies of all the tests that have been done so far.

With respect to symptoms, can you tell us if he has a voracious appetite; having accidents in the house (other than the leakage which has resolved); panting; loss of coat; skin problems; exercise intolerance; muscle wasting; pot bellied appearance; weak in the hindquarters and no longer to go up steps or jump on furniture?

The goal of treatment is to remedy symptoms so if you answer no to all the symptoms I listed above, I don't know why your vet is pursuing a diagnosis at this time. If Bailey has cushing's, it will become apparent at some point. Cushing's is probably the most difficult canine disease to diagnose which makes it one of the most misdiagnosed. A chances of a misdiagnosis is greatly increased if a vet pursues a cushing's diagnosis based solely on elevated liver enzymes so I am very interested to see the results of Bailey's blood labs.

I'm sorry for the reasons that brought you here but I'm glad you found us. We're here to help in any way we can.

Glynda

[Wendy]

Thank you for your reply Glynda.
Bailey has only had a dipstick test on his urine, a blood test, the ACTH test, and today a bile acid stimulation test (which I have not got the results for yet). I have not got the results of the blood test, she just said that it pointed towards Cushings. ( I will ask for them )
He is not urinating in the house and he is,and has always been a dog that will go for ages without going for a wee, especially if it is raining.
His coat is good, no varocious appetite or panting, still very active, no pot belly, in fact no symptoms at all except drinking more.
If my Vet suggests putting him on medication for Cushings I am wondering if it will be detrimental to Bailey if I say no and to wait and see what happens ?
I did have a job getting the results of the ACTH test, which as you say should not be such a big deal.
Wendy

[lulusmom]

Since Bailey has no symptoms associated with cushing's , I don't know why your vet decided to tests for cushing's. I do hope it wasn't based soley on Bailey's elevated liver enzymes as this would be misguided. I deducted that Bailey's liver values were abnormal because your vet ordered a bile acid test. It will be easy to figure everything out once you get copies of the tests and post the results here. In the meantime, I am providing a link to Dr. Mark Peterson's veterinary blog entitled, "Working Up the Asymptomatic Dog for Cushing's Disease". Dr. Peterson is a renowned endocrine specialist who maintains this blog to educate veterinarians who need an expert opinion....and it's free.

Glynda

http://animalendocrine.blogspot.com/2013/09/working-up-asymptomatic-dog-for.html

[Wendy]

The results of the test on Bailey's liver have come back as normal
The vet said based on this and the other tests she had done she wanted to start him on medication for Cushings
I said I was not happy doing that as he did not have symptoms of
Cushings. She obviously did not like my reaction and said she had come to her diagnosis on the lab findings and her years of experience at vet school, not from the Internet (dig at me).
I asked her for the results of all of the tests and she said that I would have to call in and ask at reception for them !
I have emailed for a printout but it has not appeared yet.
I told her I would be happy for Bailey to have the medication if and when symptoms of Cushings appear.
I will post results when I get them
Have I done the right thing ?

[mytil]

Hi Wendy,

A belated welcome from me. I would say that yes IMO you are doing the right thing. You will be the one actively administering the medicine and monitoring your Bailey (your vet is probably prescribing Vetoryl as Lysodren is not available in the UK) and I would want things crystal clear in understanding and I am sorry your vet does not understand this.

Did your vet rule out a urinary tract infection?

Cushing's is a very tricky disease as Glynda has pointed out and symptoms are a big key in treating and not treating. You mentioned earlier the ACTH results and the post is high, but there can be false positives if there are other things going on.

Terry

[addy]

Hi and welcome,

If this test was borderline and we have a dog showing no symptoms then the prudent thing to do would be to wait and observe Bailey for the next maybe 4-6 months and then retest.

However, we are left wondering why she is drinking more than usual and drinking more. I can tell you that my dog did also start out with few symptoms other than skin coat issues but her test was not borderline, but quite high. I still waited a year to treat her.

It may be that Bailey does have Cushings and down the road things won't be borderline but more clear cut. History and symptoms play a huge role in diagnosis and this disease is often misdiagnosed,

I received the same lecture from our general vet so I yook Zoe to another doctor who was willing to work with me and wait to start treatment.

[BettyF]

Hi Wendy and welcome from another new member in the UK!

My vet also had a dig at me for using the internet, but if I hadn't he would have started my dog on 30mg of Vetoryl daily, three times the amount she should have had. He has told me many things about Cushings which are not correct but I don't argue with him, I just do what I have learned from forums and groups like this one.

I ask for all blood and urine tests to be emailed to me and they have never refused to do this. I know it is a problem with some vets but mine doesn't seem to care and just goes along with whatever I ask for.

If I could find a vet who really understood Cushings then I would change, but my dog is doing fine, thanks to the internet!

[Wendy]

Thank you to everyone for your replies, they have eased my mind a lot knowing that delaying treatment will be O.K
Of course I will be closely monitoring Bailey for further signs and symptoms and I will still pursue those test results!
Thanks once again
Wendy

[lulusmom]

Hi Wendy,

You have absolutely done the right thing so good for you! Your vet is a bit too self righteous in her sarcastic response to you and that's just so wrong on every level. We seem to be having a bit of a run on egotistical vets lately. :mad:

The experience acquired by a general practitioner in vet school is woefully inadequate to provide the hands on experience and extensive understanding of the endocrine system, both of which are required to safely and effectively diagnose and direct treatment of any endocrne disorder, including cushing's. Internal medicine specialists receive this kind of training and as I recall, your vet isn't a specialist. If she is a specialist, I'd have to assume that she slept through many of her classes. :p We've seen gp vets misdiagnose dogs over and over again. We've seen them ignore proper protocol, overdose dogs and almost kill dogs. Your vet poo-poos the internet, yet most veterinarians use it in their daily practice. It is an undeniable wealth of information for all trades and most certainly those involved in veterinary medicine. It can specifically aid general practitioners in 1) expanding their knowledge of advanced medicine in areas not taught in vet school and 2) keeping up with the latest trends in endocrine disorders, which is extremely important if a gp chooses to treat a patient instead of referring them out to a specialist who knows what they are doing. Dr. Mark Peterson maintains a blog on the internet for vets like yours but apparently she thinks what she learned in school is sufficient. It is not! We pet owners can find a lot of credible resources on the internet, even with our limited access. Vets have unlimited access to articles, clinical trials and opinion pieces that we don't so there really is no excuse for laypeople to know more than they do. When you think about that, it's pretty scarey, huh?

I may sound like a broken record but it's worth repeating......clinical signs are an important component in confirming a diagnosis. That's not me saying it, that's what the text books say and that's what renowned endocrine specialists like Drs. Mark Peterson, Edward Feldman and David Bruyette lecture to their audience. Based on what you've told us thus far, Bailey does not present as a cushingoid dog in any way, shape or form. That leaves the abnormal values on the blood chemistry as the red flag, which by the way cannot confirm a diagnosis by themselves. I provided you with a link to Dr. Peterson's blog earlier and you may want to share that with your vet so that she can educate herself and quit placing dogs like Bailey at high risk of misdiagnosis and subsequent serious complications of treatment that never should have been prescribed.

Having said all that, it could very well be that Bailey is in the very early stages of cushing's and if that's the case, he'll let you know for sure when he becomes symptomatic. If and when that should happen, just remember that the key to facilitating safe and effective treatment is an experienced vet and an educated pet owner. If either of these are missing, the risk of misdiagnosis and overdose is greatly increased. There is no doubt in my mind that k9cushings members have saved many, many lives. It makes me sad to think about how many dogs die because their owners didn't reach out to support groups or research the internet to help them learn, instead choosing to place blind faith in their vets. That is completely normal behavior for most pet owners and most of us were in that group until we reached out for help after our dogs paid the price for our vet's utter ignorance. I will tell you right now that I experienced no residual guilt when I helped my cushdog cross over but I'll always carry the guilt of letting her suffer for my blind faith in my vet for well over a years before she was correctly diagnosed by a specialist. Nobody should have to carry that kind of guilt around so when I tell you to never let your vet place her ego above Bailey's welfare, I mean it with all my heart because no dog should have to suffer and no pet owner should have to experience the guilt I did because their vet was clueless yet righteous in their indignation when questioned. When you don't know anything about cushing's, that unmerited righteousness is very effective in shutting us down and making us comply with their wishes. That is exactly what your vet did to you when she responded to your legitimate concern with a ridiculous statement about arriving at a diagnosis based on lab findings and her years of experience at vet school, not from the Internet. She intentionally set out to make you feel small and to shut you up instead of appreciating that you have taken the time to educate yourself. :mad:

Keep up the good work, stand your ground and don't ignore your gut...ever..... but make sure you educate your gut so that you don't have to take anybody's word for what is best for your boy. You can find some great reference material in our Helpful Resources sub-forum to help you understand the steps in diagnosing a dog, the treatments used, adverse reactions to those drugs and even a great deal of information on concurrent diseases like diabetes and hypothyroidism. There is always something new to learn. Because the information in our library is science based and can be supported with credible citations, feel free to share any information you feel might validate your concerns with your vet. You wouldn't be the first member to educate their vet. :)

Glynda

[camval1]

I was also made to feel small when I questioned my vet's decision to treat my Airedale with a dose of trilostane twice his body weight.

I stood tough and she capitulated and ordered the 60mg capsules at my insistence.

I fear that this will strain our relationship, but the health & welfare of my dog is more important that that relationship.

Just remember, you have to live with the consequences of any treatment given to your pet. The vet doesn't.

[Wendy]

I have collected the results of Bailey's blood test this morning
The only thing that I can see that is not within the reference range is
GGT result is 9 U/L ref range is 00-7.0
Hope that makes sense
Thanks Wendy

[Wendy]

I have just had the results of the Liver test for Bailey emailed to me
(I did not bother to collect these as the vet told me that they had come back as normal).
Now I am even more confused as the way I read the report it is not normal.
Bile acids 16.6 umol/l High
Bile acids post 37.2 umol/l High
Then it says : This result provides evidence of
1. Congenital portosysyemic shunt (PSS) or an acquired PSS due to chronic portal hypertension associated with chronic hepatitis, cirrhosis or portal vein thrombosis.
Or interference with hepatic function.
What to do now ?

[Squirt's Mom]

Call your vet and ask where you go from here - is there another test? ultrasound? medication? diet? specialist?

GGT is a liver enzyme. ;)

[molly muffin]

Did they by any chance give the range to go with those liver values?

[Renee]

How old is Bailey?

Also, sounds like your vet may need to take another look at the bile acid test results.