Grey Zone Test Results

[Bridget]

Hi Everyone:
I am new to this website and from what I have read so far it sounds really great. My dog Biscuit IV, a 7 year old pointer mix, had a UCCR sent to the lab and the results were in the grey zone. Then, we did the ACTH Stimulation and those results were in the grey zone too. Has this ever happened to anyone else? My vet was having me measure Biscuit's water consumption on a weekly basis. Biscuit was also drinking a lot, urinating a lot and panting excessively while not being active. I noticed that she's drinking even more water so I called the vet and we decided to start Biscuit on Trilostane 40 mg once daily. I'm hoping to see a difference with the medication. Also, does anyone else have a really itchy dog right now? Biscuit is constantly scratching and I know that cortisone drugs are not an option for her. We have tried Benadryl and Chlorphenirame antihistamines to see if they would help but they have not. Does anyone have any suggestions on what else I can try for this? Thanks.

[MiamiThom]

Welcome Bridget. I am new here to, and let me tell you our friends on here are wonderful, informative and very generous with their sharing.

For what it is worth, I went through the same itching with Ebon before he was diagnosed. For about a year he was thought to have itching and hair loss due to issues with seborrhea, which was originally thought to be part of his hypothyroidism. When we didn't see changes in his skin after getting his thyroid regulated, I did research and told them I felt he had Cushing's. They said, "hey, that could be it." And here we are. After a month on Vetoryl Ebon is relatively itch free and all of his hair has grown back in. Water intake is still a bit high and he too is still panting, especially at night (keeps us awake).

His seborrhea (and associated itching) is virtually in check, but we maintain it with weekly baths using a tar shampoo alternated with Selsun Blue prescription strength (recommended by our doggie derm). Additionally, we condition his coat with coconut oil and give daily fatty acid supplements (also suggested by our derm) for healthy skin and coat. His hair is coming in beautifully and he is soft and snuggly again. If we could just get the panting to reduce we will be almost back to normal.

Good luck Bridget. I am sure that the wonderful moderators and others on here will have some thoughts and questions related to the "grey zone" and other tests.

[Harley PoMMom]

Hi and welcome to you and Biscuit IV!

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

We love details, so if you would tell us more about Biscuit it really help us to provide you with better feedback, so that means we will be asking a lot of questions, and here are some of mine. :eek::D

How much does Biscuit weigh? Can you get your hands on copies of all testing that was done by your vet and post the results here. With respect to the blood chemistry & complete blood count (CBC), we need only see the highs and lows, and please include the normal reference ranges. Additionally what diagnostic tests were performed and can you post those results too? What was going on with your girl that prompted you to take Biscuit to the vet and what prompted your vet to test for Cushing's? Did your vet tell you which form of Cushing's Biscuit has? There are other conditions that have overlapping symptoms with Cushing's, such as hypothyroidism and diabetes, did your vet rule these out? Besides the scratching, does your girl have any other underlying diseases and if so what are they and what meds is she taking for it? Regarding her itching, has the vet mentioned about performing a skin scraping? Increases in drinking/urinating can be caused from an UTI, has this been checked and ruled out? Was an urinalysis done and if so could you post those findings too?

Unfortunately Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed. One of the things that makes Cushing's so challenging to diagnose is because not one test can 100% accurately identify it, so vets have to perform multiple diagnostic tests to validate a Cushing's diagnosis not just one. A lot of vets are clueless when it comes to the diagnosis and treatment protocols for Cushing, and some of us learned the hard way that placing blind faith in our vets can carry a heavy price tag for our dogs and that is why we encourage all members to educate themselves. It takes an experienced vet and an educated pet owner to facilitate safe and effective treatment. It is when one or both is missing that dogs get into trouble. On that note I am providing a link to our Resource forum which has a wealth of information regarding Cushing's and the treatment protocols: http://www.k9cushings.com/forum/forumdisplay.php?f=10

Looking forward to hearing more about sweet Biscuit, and if you have any questions please do not hesitate to ask them.

Hugs, Lori

[labblab]

When you say that Biscuit's UCCR and ACTH test results were both in the grey zone, that leads me to believe that neither were actually sufficiently elevated to be consistent with Cushing's. If so, that does make me feel nervous about starting Biscuit on trilostane -- in the absence of test results that confirm the diagnosis. Can you find out the actual numbers for those test results and post them here?

Not all dogs with Cushing's test positive on the ACTH, but a negative result on the UCCR typically does rule out the disease. In Biscuit's situation, I think it would have been best to perform an alternative diagnostic blood test before starting treatment, the LDDS. That test is less likely than the ACTH to miss making the diagnosis in a dog who truly suffers from Cushing's. If none of these three tests return a genuinely positive result, then I fear the Cushing's diagnosis is quite questionable.

As Lori has asked, does Biscuit have any other lab abnormalities? There are certain abnormal readings that are typical of Cushpups. If Biscuit lacks those abnormalities, too, that is another big question mark.

I realize you are anxious to relieve Biscuit's thirst and urination, but these issues can be caused by health issues other than Cushing's. I really believe you need more confirmation of the diagnosis before advancing to treatment. Please do give us those actual test results so we can see where they actually fell within the diagnostic range.

Marianne

[Squirt's Mom]

There is NO WAY I would start my baby on this very powerful drug based on those test results. What you are seeing could be caused by many things that have absolutely nothing to do with Cushing's. And, honey, this drug can take your baby's life if misused....and giving it based on those test result is misuse in my book. ;)

Before I even thought about Cushing's I would rule out every other possibility like diabetes mellitus, hypothyroidism, diabetes insipidus, kidney disease, and on and on and on. Cushing's would be my LAST thought based on what we know so far.

If you can provide the test info Lori asked for that will help us help you and your sweet baby. So I am looking forward to seeing those test results and hearing much more about your baby. But for now, PLEASE do not give the Trilostane, 'k?

Hugs,
Leslie and the gang

[Bridget]

Hi Everyone: I will try to call the vet on Monday to get a copy of all of Biscuit's lab panels. What caused the vet to suspect Cushings is that we did a complete blood profile on her as pre-anesthetic blood work prior to having her teeth cleaned. Trying to remember back when I got her test result, the vet said that everything on her labwork looked good except that her liver enzyme were slightly elevated. She asked me if the dog was drinking and urinating a lot and I told her yes. This was in March and the excessive panting hadn't started yet. After the dentistry we first did the UCCR and got the grey zone result of 35 and a positive result starts at 36. Hoping to get a better answer we did the ACTH and that came back in the grey zone too. At that point the vet was having me monitor her water consumption on a weekly basis and I would report back to her. At that time the plan was to run more lab work in August. But, about and a week and a half ago, I noticed that she has started panting a lot and that the ounces per day of water being consumed was increasing. I called the doctor and she wanted to start her on the Trilostane. As of yesterday, I have noticed that Biscuit's excessive water consumption has decreased as well as her urine output and thatsome of the panting has subsided. In general, she seems more comfortable. My vet mentioined to me that she,s had a few patients just like Biscuit who stayed in the grey zone for about a year before they eventually tested positive for Cushings. She feels that Biscuit is in early in the onset of the disease. I trust this vet completely and I have been with her for over 20 years.

[judymaggie]

Hi, Bridget! Welcome to you and Biscuit. I am treating my second Cush pup, both beagles. You have already received great guidance from our in-house experts. I wanted to respond to the last statement of your recent post:


I trust this vet completely and I have been with her for over 20 years.

I have used the same vet for almost the same period of time. My first beagle, Maggie, had serious health issues throughout her life which required several surgeries. In spite of these issues and advanced Cushing's, she lived to almost 14 years of age. I adopted Abbie five years ago when she was 7. Two weeks after the adoption she underwent a bilateral mastectomy, the first of several surgeries. My vet and his staff have been superb caregivers. That said, when going through the diagnostic stages of Cushing's with Abbie, my vet deviated from well-accepted testing protocols. As hard as it was for me to question him, I did bring articles for him to read from our Resource section and he agreed to do things differently (at least for Abbie and, I hope, for his other Cushing's pups). We started treatment with Lysodren which was the only Cushing's medication my vet had used. Although I encouraged him to learn about Vetoryl, he was reluctant because he had no experience with it. Fast forward seven months and Abbie's cortisol is not controlled with Lysodren. My vet is now treating her and two other dogs with Vetoryl. Unfortunately, whoever he is consulting regarding treatment is not following the correct protocol as specified by the drug manufacturer and the veterinary experts. Last week I again brought information to his attention and, after consulting with the manufacturer, he is going to change his approach with Abbie.

I have learned that my vet, and I expect others, does not respond positively when given information from an on-line forum but does respect what the veterinary experts in the field are recommending. I suspect there will be other times down the road which will cause me to question my vet's treatment but I am Abbie's best advocate and will continue to speak up on her behalf!

[molly muffin]

Apoquel is a new allergy medication that we have been hearing good things about and so far everyone that I know of who had given it to their dogs has had good results with it.
It is sometimes hard to get your hands on, but ask your vet about it.

[Bridget]

Thanks for the heads-up about Apoquel. I've never heard of that medication before. I'm supposed to check in with the vet to give her an update next Wednesday. I'll certainly ask her about it. I'm willing to try anything to help Biscuit with this constant itching.

[molly muffin]

Did you get to see the vet yesterday? Is she able to get Apoquel? Everyone I know that has put their dog on it, just raves that it is wonderful for their allergies. Just darn hard to get sometimes, as they didn't realize the demand would be so high, but considering world wide, it is what everyone wants, I hope that supply will be ramped up to meet demand.

[Bridget]

Just an update on Biscuit. She is now on 80mg of Trilostane and she seems to be doing very well on it. Water consumption is near normal and panting very little. After consulting with a few specialists, my vet has placed her on 75mg of Atopica to control the itching, chewing, redness, etc. We have been on that for about a week and I am seeing a huge difference with that. Just wish these meds were not so expensive but I do what I have to do to get Biscuit what she needs.

[molly muffin]

Are you ordering your trilostane and Atopica through one of the online pharmacies? That is usually a cheaper way to go. Diamondback is one of the ones several use on here.

Glad to hear that Biscuit is doing better and the Atopica is making a big difference.