Did your vet do a creatinine/cortisol ratio test before testing for Cushings?

[janchan]

I have a 12 yo Shih Tzu that vets have been pressing me to test for Cushings for five years now. At that time, I was seeing a vet who wants to test for Cushings so much that it's a joke with his staff and long-time clients. When it was discovered that my dog had high blood pressure, he really started pressing me to let him do the test. After another vet at another clinic commented while taking my dog's blood pressure that other than the BP, he didn't show any signs of Cushings and that personally, she wouldn't put her dogs through the suppression tests until they showed more symptoms than my boy was showing, I said no to the test.

I'm with a different vet now and he also wants to test for Cushings. I'm suspicious, however. He and his staff really messed up with this boy a year ago and very nearly created a superbug with him. You see, my dog also has IBD -- something that vets routinely ignore but which generally is found to be the root of problems whenever he has a stomach upset. When this vet and his staff were called on their irresponsible use of antibiotics with this boy, the vet became obsessed with finding something wrong with my dog, and hit upon that he probably had Cushings and intestinal cancer.

Because of the number of times my dog has been misdiagnosed due to ignoring the IBD, I want the vet to do a creatinine/cortisol ratio test and perhaps even the new test done with their hair done by VetGuard in Canada before launching into full-bore ACTH suppression testing. None of the vets in my area seem to be doing that, however. How about you folks? Did your vet do the creatinine/cortisol test before doing the test where they inject chemicals in your dog's system? Also, did your vet test more than once even if the first test was positive? My current vet said that if one test comes back positive, there's no need to do another and that he would start my dog on Cushings meds immediately if the test came back positive. What do you think about the reliability of the Cushings' tests? Do you think that since they aren't the most reliable indicators that some vets may be taking advantage of them to run up the bill on their clients? I apologize if I offend anyone by that question, but I have had some bad luck with vets who value money more than the animals. Thanks.

[Harley PoMMom]

Hi and welcome to you and your boy,

My goodness, sounds like you've had your slew of incompetent vets, and to me this recent one is no better :eek: Unfortunately a lot of vets are clueless when it comes to canine Cushing's and the treatment protocols. Many of us have had to fire our vet and find another one and since we as pet parents are the voice and advocate for our furbaby we do what we have to do because we love them so much. Cushing's is probably the most difficult canine disease to diagnose. Physical symptoms associated with Cushing's are shared by many other diseases, blood and urine abnormalities are shared with other other diseases and the diagnostic tests to measure circulating cortisol are flawed and can yield false positive results in the face of non adrenal illness or even stress. All of these things make it very challenging to correctly diagnose Cushing's which makes it one of the most misdiagnosed canine diseases.

Since your boy already does have IBD the urine cortisol:creatinine ratio (UC:CR) test would be useless to do because any non-adrenal illness and even stress causes a dog's body to produce extra cortisol and the UC"CR can not differentiate between Cushing's or any other issue that would be creating the high cortisol that is in the urine.

There isn't one test that can accurately diagnose Cushing's so multiple testing is required to validate a diagnosis of Cushing's. Generally the common clinical symptoms seen in cushdogs are: excessive drinking and peeing, I mean peeing rivers and drinking buckets upon buckets of water; voracious appetite, they are like little hoover vacuum cleaners looking for any crumb they can find; panting; loss or thinning of coat; skin issues; muscle wasting; muscle weakness, especially in the hind quarters; exercise intolerant; difficulty or unable to go up steps or jump on furniture. Strong symptoms play a huge part in the diagnosis for Cushing's and if your boy is not displaying obvious symptoms I would not pursue any tests for Cushing's.

Could you get copies of all tests that were done on him and post any abnormalities that are listed with the reference ranges and units of measurement..i.e...ALT 150 U/L (5-50). Is the elevated blood pressure being addressed and if so what medication is he on? When BP is high it can wreck havoc on a dog's system especially the kidneys. Is your boy taking any other herbs/supplements/medications?

I am sorry for the reasons that brought you here but I'm sure glad you found us and we will help in any way we can.

Hugs, Lori

[janchan]

You don't know even a fifth of it, Lori! This poor boy has been getting shoddy vet care, incorrect diagnoses, and downright lies from vets all of his life. The only place where I've felt that I have always received good, honest care has been the vet teaching hospital at Ames, IA, which is where his IBD was diagnosed after four years of vets saying his upset tums were either parasites (even though they couldn't find any, they'd worm him anyway) or that I wasn't paying enough attention to him on walks and he was picking up stuff that upset his tum. The lying came from a vet at a clinic where I had taken him and another dog for grooming while I had to go out of town to close on a house. My regular vet's groomer had realized she'd overbooked at the last minute and she got me in at this other place. So I had never gone to this vet before and at that time, really didn't have any reason to do so. When I got back in town and went to pick up my dogs, the receptionist told me the vet wanted to talk to me, but she wouldn't say why. I had to wait about 20 minutes and all I could think was that something awful must have happened to my dogs that day. Finally, the vet came out to talk to me. She said that she had "taken the liberty" of examining my dogs while they were there and sadly, she said that Kop, my dog, had a slightly enlarged prostate which, she said, meant that he had cancer. Then she started telling me what a horrible death he was going to suffer because I had been so irresponsible as to leave him intact. Now, I was showing him and to show a dog in a conformation show, they must be intact. But I was beyond being offended by her rudeness at that moment. My heart was racing with the thought of my beautiful boy having cancer. Then sanity clicked in while the vet droned on and on about what a terrible person I was. My boy was in his prime. He was handsome and proud. My regular vet complained that if all of his clients' dogs were as healthy as mine, he'd be out of business. So I asked this vet if there was anything other than cancer that might cause his enlarged prostate. She stammered and said yes, that it could be because he had a lot of testosterone. I asked her how I could test for that. She said that if he had shown mounting behavior at an early age, that meant he had a lot of testosterone. I couldn't help but laugh in her face as I recalled Kop, at 8 weeks old, with his "girlfriend," a green stuffed froggie. Later, another vet confirmed that the prostate of ALL intact male dogs is slightly enlarged.

Your reply just confirmed what I think I know already -- I don't trust my current vet and that means I need to find someone else.

To answer your questions:

Water consumption. He was drinking more than usual last weekend when his WBC count was over 30,000 (btw, his WBC count was this elevated last year when he was on antibiotics and it really puzzled the vets because the count went up instead of down with the antibiotics.) Then after three days, his extra water consumption stopped and has been normal since. Current vet asked the same thing about increased water consumption and at the time he asked, Kop was drinking more than usual. Current vet was like "See--that proves he has Cushings," while I was going, "No, that proves that he has some kind of inflammation going on."

Peeing. Ever since he was neutered a few years ago, he no longer feels the urge to mark and instead just has a couple of good long pees. Nothing has changed there, even when he was drinking more. He doesn't have accidents in the house and doesn't ask to go outside.

Eating. Kop's a big boy, but he's never been a voracious eater and that has not changed. He's very leisurely about eating his food and even before he was put on antibiotics, sometimes just doesn't feel like eating his breakfast sometimes.

Panting. He hasn't been panting, but he (and the other dogs) obviously is more comfortable since I cut them all down last week.

Loss or thinning of coat. My boy definitely doesn't have any hair loss or thinning of his coat. In fact, it seems to me that his coat and nails grow faster than normal and his coat is thick and luscious.

Skin issues. None other than a couple of bumps.

Muscle wasting. None noticed. Current vet said my dog has a slight pot belly, but I just don't see it. I've seen dogs with Cushings and his belly doesn't look anything like theirs.

Muscle weakness, especially in the hind quarters; exercise intolerant; difficulty or unable to go up steps or jump on furniture. He does have these things, but I've attributed it to the arthritis he has in his right hip due to an injury, plus he's always been a lazy boy, even as a pup. He's also a hard head. If I take him out and let him just lie there and look around for several minutes, then he'll get up and be ready to go for a nice walk, but he will not be hurried!

Kop's been taking two 5 mg Enalapril and half of a 2.5 mg amlodipine pill every day for his HBP since he was diagnosed. His blood pressure is checked 3-4 times a year.

Kop's not taking any other herbs, supplements, etc. other than a probiotic and dasiquin for his hip. At one time, I got a product from Hannah Labs called Rejuvenate that was wonderful for his hip. Within two days of starting it, he was running around like a pup. Unfortunately, I got it at Banfield and Hannah Labs won't even return my vets' calls.

I'll see if I can get copies of Kop's tests, but it may take a few days.

I'm glad to be here too, Lori! Thanks again for your reply.

Janet

[molly muffin]

Hello and welcome to the forum. It will be good to see the test results but it just doesn't sound like he has Cushing symptoms. My girl too is on benazepril (much like enalopril) and amoldipine.
I think there are vets who do go straight to a Cushing's diagnosis forgetting that symptoms are much the same with other problems and that with no symptoms liver values alone does not determine or diagnose Cushing's. It is not only although some probably are money motivated as much as it is willful ignorance and looking for easy solutions. A pill to solve any problems. The real problem for me in what you have mentioned is completely overlooking the IBD diagnosis which took so long to be figured out anyhow. IBD is not easy and it can also affect liver numbers kidney values (have a gastro issue and we always seen any UPC be elevated for a couple to number of weeks).
So I don't know why they would jump on the Cushing bandwagon other than what I mentioned mostly willful ignorance.

I don't know of any vet that is using the ACTH hair test but I would certainly love it if they did so and we could get some values compared to ACTH testing to validate the info. I don't know if it just takes time or what for some new ideas to catch on or what. The test is $100 Canadian I think and you do it yourself if you want. But I do think that ACTH will be elevated anyhow with the IBD and not really worth your time to do.

[janchan]

Thanks for your reply, Sharlene! I really appreciate your thoughts and advice.
Here are some pics of him that I took this morning with my cell phone.

(Sorry-- the pictures didn't show up)

Does it look like he has a pot belly to you? I may be blind to it, but it doesn’t look like it to me. My vet says yes, he has a pot belly like a Cushings dog. But then, he also said that I’d brought Kop in every few weeks for diarrhea (last time was a year ago and another of my dogs had the same thing at the same time), that the ear infection Kop had a few months ago was a sign that his immunity is down ( I was recovering from open-heart surgery and forgot to pluck the hair out of his ears – and he has a LOT of hair there). Last year, when he was determined to find cancer in Kop and at that time also felt that he had Cushings as well, I took Kop to the oncologist who reviewed Kop’s records after his spleen was removed due to a mass a few years ago. She had said then that due to it being the kind of cancer that doesn’t metastasize, is very slow-growing, and had been caught at a very early stage because it was discovered while preparing Kop for surgery to remove a cyst on his thyroid, Kop was, for all intents and purposes, completed cured of that cancer. I took Kop to her because I wanted to verify that I’d understood her correctly since my vet was insisting that no matter what she said, if he had cancer once, it could come back again. To get the records, I told my vet’s office that I needed to take Kop to the oncologist for a routine checkup. She said Kop really looked great and saw no physical reason why my vet would suspect he had cancer or Cushings. Then she discussed the tests and treatment that my vet’s associates had done. First, she said that my request for them to hospitalize him and put him on an antibiotic drip for the first 24 hours in his treatment would have helped prevent a lot of his pain and have given him a good start toward recovery without upsetting his tum too much. That's because of his IBD and was the reason I requested this. She said too that the changing of the antibiotics on a weekly basis undoubtedly added to his pain -- and added that "every vet" knows you can't do that with an IBD dog, then asked if I had told them he had this condition. I told her I told them every time I took him in to see them, but they had not listened to me and instead had downplayed Kop's not feeling good and been condescending toward me. At the end of the day, she said that his bloodwork and sonogram were very indicative of the IBD, not cancer. Most interesting, she said the high white blood cell count was mostly comprised of the kind of cells that are created when the dog is fighting an infection, and that the kind of cells that are created when the dog is fighting cancer were much lower than is normal (3 percent vs. 10 percent). And since this bloodwork was done before he was started on the prednisone, she was confident that the high count was due to the clostridia plus his inflamed tum.
I was shocked when she told me about the different kinds of white blood cells and how clearly, Kop had a lower number of those you would see if a dog had cancer. I asked her if the knowledge of what kinds of white blood cells one would see for different things was new knowledge for vets or only perhaps known by specialists like her. She said no. All vets should have this knowledge and it’s been known for a long time.
So, either my vet is trying to manipulate me into letting him do what he wants to do, or he isn’t as good as I thought he was.
I’m planning to buy a house on the other side of town in a few months, so I’m just going to put off doing anything and when I move, start going to a vet over there. When I asked the emergency ER about holistic vets, which is what I think Kop needs, they recommended one that would be close to me there so I’ll probably go ahead and check him out.

[molly muffin]

I looked at the pictures of Kop. What a cutie. Although they don't really show a belly. I can say that he doesn't have a sway to his back or a belly hanging down. Belly so for Cushing dogs usually exhibit those signs as they are due to enlarged liver and a loss of muscle firmness. Kop doesn't appear to have those to me and I tend to agree with the specialist that he isn't presenting as a Cushing dog.
I have two gp vets available to me but for Cushing's and other serious issues I use my specialist exclusively.
I think your plan is a good one.

[janchan]

No. He definitely doesn't have a sway back and his belly doesn't hang down. I think your model is a good one to follow -- have a couple of GPs for the standard stuff, and then go to specialists for the tough stuff. I've kind of been doing that for the past year, taking them to Blue Pearl for tougher stuff. And for the really tough stuff, I drive five hours to Ames, IA.

Thanks for your advice and response, Sharlene!

Janet