Abby the Cocker Spaniel

[abbynhp]

Hi, I am the owner of a 10-11 year old black cocker spaniel.
I adopted her from a shelter 9 years ago. She is a needy little sweety.She has lately been drinking and peeing quite a bit. Has a huge appetite. She has had a few accidents in the house. Very unlike her.I took her to the vet and the vet did some blood work and urine test.Based on the blood tests the vet thinks that she may have cushings disease. ALT in May 2014 was 32, it is 186 now. ALP was 54 in May and now is 151. GGT in May was 6 now 25. Cholesterol in May 239 now 308. It was suggested that a low dose dexamethasone test be done. the vet that I spoke with was not Abby's regular vet. I spoke with him today and he agrees that her tests point to Cushings but he said that she has low albumin and that concerns him. I will be dropping her off on Monday for a low dexamethasone test and abdominal ex-ray. He will also examine her.Is there anything else I should be doing?Comments/suggestions would be appreciated. Thanks!

[StarDeb55]

Welcome to you & Abby! A lot of Abby's symptoms do point at Cushing's, but they may also be caused by other problems. Were diabetes & thyroid ruled out, their symptoms are similar to Cushing's. I will say that Abby's elevation in liver enzymes are very mild. The typical cushpup can have an alkaline phos in the thousands.

It would help us a lot if you could get copies of all the preliminary blood tests that have been done. Please post only the abnormal values, along with normal range & reporting units. You can post something like this:

Glucose 155 mg/dl Range: 70-110 mg/dl

The low dose is the gold standard to diagnose Cushing's, but it can have false positives in the presence of non-adrenal illness. This is why it's very important to confirm any initial positive tests with a second test. I would completely skip the abdominal x-rays as they really will not show the adrenal glands. You will need to consider an abdominal ultrasound, making sure it's done on a high resolution machine, so all internal organs are visualized. We like to say around here that the ultrasound will give you more "bang for the buck" as you will be able to see all of Abby's internal organs, giving you a better idea of her overall health.

Last but not least, it would be a good idea to make sure you get copies of all of Abby's testing starting, now, so you can keep a file on her at home. Many members have done this as the file can come in pretty handy if you should happen to end up at a strange vet, such as an emergency clinic, & you give them Abby's history right there.

I don't want to bombard you with anything else as I sure your head is spinning at the moment.

Please keep in touch. We are here to help you & Abby in any way we can.

Debbie

[labblab]

Debbie has done a great job of welcoming you, and I just have a couple additional thoughts to add. As she has said, if you can post all abnormal results found on both bloodwork and urinalysis, that would be great. As it turns out, I am in the midst of trying to diagnose the cause of low albumin in one of my non-Cushpups right now and I know there can be several different causes. For a dog who truly has Cushing's, however, one cause could be the effect of elevated cortisol on kidney function whereby protein is being spilled into the dog's urine. Can you check back on the urinalysis to see whether there is a notation re: the level of protein found in the urine, if any? Thanks!

Marianne

[abbynhp]

Hi,

the protein in Abby's urine was negative, so were the glucose,ketones,blood hemoglobin,billirubin, White/red blood 0-2, nothing significant according to the doctor. this urine sample was a late day one, not sure if that makes a difference. I did suggest the ultra sound in lieu of exray and the vet thought for now ex ray is the better way to go.

thanks for all your suggestions, I will post the rest of the blood work as you suggested after work today.

[Squirt's Mom]

Vet is wrong - xray will not show what is needed to be seen with the adrenal glands nor will it show other organs and their status. ;)

[abbynhp]

so I understand the exray vs ultra sound, the vet wants an exray to look at other organs to see if there is something else going on. Abby will be having low dose dex on Monday along with the exray.so are you saying skip the exray and insist on ultra sound.is the exray of no value. Abby is feeling just fine so I am a bit confused by all of this but for sure if something is going on I would like to catch it early. thanks.

[Squirt's Mom]

I wouldn't waste money on an xray myself when the ultrasound will show the organs MUCH better than the xray but not everyone feels the same way. An ultrasound saved my babies life by finding a tumor on her spleen. I'm not sure an xray would have shown that. ;)

[labblab]

One issue may be that your vet is not equipped with ultrasound equipment that is sophisticated/sensitive enough to do a good job of visualizing the hard-to-see adrenal glands along with other internal organs. Many general practice vets have to refer their patients to specialists for the appropriate ultrasound imaging. Perhaps this is why you vet is opting to proceed with x-rays instead?

X-rays do have a place as far as assessing some conditions, like looking at the chest and lungs. But our experience here is overwhelmingly that an abdominal ultrasound offers better info re: the organs typically affected the most by Cushing's: adrenals, liver, kidneys. And as Squirt's Mom has said, the spleen. So before spending money on x-rays, I would pin your vet down as to why he thinks x-rays are preferable in this situation.

Marianne

[molly muffin]

If I have a choice, I'd take ultrasound over xray and don't think I'd spend the money to do both, unless there is a skeletal issue you want looked at with xray. The ultrasound should show you everything you need to know and more than the xray would.

That is my thought and what I have personally chosen.