My dog might have Cushing's...

[jjm97]

dropped off my Chili-dog at her vet this morning for the low-dose dex test. Chili is a Weim-Lab mix, 12 year old spayed female. She doesn't have all the classic symptoms (no pot belly or skin issues) but she has started to leak urine and has had a few accidents in the house recently. Her most recent blood work showed alk-phos level is off the charts but every thing else was normal. Vet suspects Cushing's. Hoping for some answers today.

[Squirt's Mom]

Hi and welcome to you and Chili! :)

Let us know what you learn. Now is the perfect time to start a new habit - one of always getting copies of the actual test results from now on for Chili. Not the invoice, but the test results, the numbers and comments from the lab(s). It will come in very handy not only to answer the 20 gazillion questions we are going to ask :D but also should you ever need to take Chili to a different vet for any reason, such as vacation or weekend call.

Can you tell us what the ALKP results were? And any other results on that report that are too high or too low. Post the little letters and the normal range as well. When you post them, it will look something like -
ALP 1500 115-300gu/dl (EXAMPLE)

If you could tell us more about your baby that would be great. Any health issues, current meds, etc will help paint a fuller pic for us. How much does she weigh?

I'm glad you found us and look forward to learning more and seeing those test results.

Hugs,
Leslie and the gang

[jjm97]

The ALP was the only one that was out of normal range. Don't remember the numbers offhand. I got a copy of the results.

Chili weighed in at 60 lbs last Friday but had some diarrhea yesterday so she lost a couple of pounds.

No health issues at all until now.

[molly muffin]

Did they do the LDDS test today? (8 hour test) or the ACTH (2 hour test)

Also if you can let us know what the ALKP was, that would be helpful. We often see very high ALKP with cushings, but it can also be due to other things. Gall bladder sludge for one. A liver bile acid test might be helpful to find out, as you want to rule out everything else before going directly to a cushing diagnosis.

Welcome to the forum.

[jjm97]

The 8-hour LDDS test was administered yesterday. Results:

Baseline - 4.8 gu/dL
4-hour - 2.4gu/dL
8-hours - 2.7gu/dL

doctor seemed pretty confident in diagnosing pituitary-dependent Cushing's. Recommended Lysodren therapy with ACTH at 1 week, 1 month, 3 months and 6 months.

I tend to agree with the diagnosis even though not all of the "classic" symptoms are present. Chili did start leaking urine late last year and DES estrogen supplements were of minimal help. More recently she started having accidents in the house on the carpet after being perfectly potty-trained ever since I adopted her. No signs of cognitive dysfunction or other physical ailments.

Thoughts?

[Squirt's Mom]

The testing schedule is off a teeny bit - the first ACTH after starting the load, giving the pill twice a day, depends on when your baby shows signs the load has been achieved. That can be very subtle - like looking up from the feed bowl when eating when she wouldn't before or a reduction in water intake (something you will want to measure before starting the load so you can compare the amounts. ;))

Lysodren works in 2 phases - the load, or induction phase, which is of NO SET LENGTH of time, and second the maintenance phase which will last for life (or as long as the load holds).

During the loading phase, Chili will take a dose AM and a dose PM until you see signs the load has been achieved like those mentioned above and in the link I will give you. Once you see those signs, you stop giving the Lyso and call the vet for an ACTH. If the numbers are right, between 1-5ug/dl, then in a few days she will start the maintenance which is usually the same dose as the load but spread out over a week's time instead of daily. In maintenance she will get a dose 2-4 times a week.

Lysodren loading dose is based on 50mg/kg/day. So at 60 lbs, Chili weighs 27kg (60 / 2.2). So her Lyso dose would be 1364mg a day (27 x 50) which would round down to 1250mg a day. Lyso comes in 500mg tablets so she will get 2 1/2 tablets a day divided into 2 doses of 1 1/4 tablet AM and same in the PM. Then when the load is achieved, she will take 1250mg over a week's time.

It's unusual to see only one abnormal for a cush pup. We see the ALP and sometimes other liver enzymes, CHOL, BUN, and TRIG among those that are elevated a bit. So if the ALP really is the only one elevated that's pretty darn good!

Here is the link on Lysodren from our Helpful Resource section - http://www.k9cushings.com/forum/showthread.php?t=181

[jjm97]

I agree. even the vet mentioned that one of the other vets in the practice said Chili didn't look like a typical Cushingoid dog but the numbers don't lie. Also, she does have the increased water intake and thus the increased urination. Moreover, she is experiencing loss of muscle mass around her hips and lower back so hopefully that will recover as we get this under control.

My concern is the potential side effects during the induction phase. The potential lethargy and anorexia I can handle but the vomiting and diarrhea would be bad.

[lulusmom]

Hi and welcome to you and Chili.

Based on the limited information you have provided so far, I am a bit concerned about the diagnosis. Cushing's is very difficult to diagnose in a dog with overt symptoms and Chili does not even have mild classic symptoms so that raises a flag for me. Leaking urine and having accidents cannot be considered as a symptom, especially if it is the only symptom, without appropriate urine tests to confirming that the cause is due to polyuria/polydipsia (PU/PD). Dogs with cushing's lose the ability to concentrate their urine so they pee huge amounts and drink buckets of water. You never mentioned increased drinking so that raises another flag for me. Does Chili drink huge amounts of water? Your vet should have done a urine test to check USG, which should be low in a dog with PU/PD. A urine culture should also have been done to rule out a urinary tract infection. Dilute urine is a breeding ground for bacteria so most dogs with cushing's will have a urinary tract infection A urine culture must be done to identify the types of bacteria so that the appropriate antibiotic can be prescribed. Was a urine test done and if so, can you please post the results?

The LDDS test results you posted are consistent with pituitary dependent disease; however, the LDDS test is prone to false positives in the face of nonadrenal illness or serious stress. Without the benefit of the urinalysis and in the absence of the common symptoms and usual blood abnormalities, I believe at least one more validation test should have been done. I personally think the abdominal ultrasound is the most valuable as it shows the usual adrenal and liver abnormalities associated with cushing's. It also provides an opportunity to check out other internal organs like the bladder and kidneys for stones that could be contributing to or sole cause of the urine leakage and frequent urination.

Please do get a copy of all of the labs done by your vet to diagnose Chili and post only the high and low values, including the normal reference range. These would be the blood chemistry and complete blood count (CBC). When a vet tells you that a certain value is high but everything else looks good, that doesn't necessarily mean that everything is normal. It could be that there are other abnormalities but they aren't worrisome to him. I'd like know if there were, in fact, other things outside the normal reference range that are commonly associated with cushing's. If so, I'd feel more comfortable with the diagnosis.

Cushing's is a very graded disease with progression moving at a snail's pace so there is no rush to treat. Dogs that do not have cushing's rarely respond to the doses of Lysodren prescribed for pituitary dependent disease so I am less concerned about an overdose with Lysodren than I would be if Trilostane, the alternative drug, had been prescribed. Your answers can help all of us get a much better understanding of Chili's clinicals.

Glynda

P.S. While I was typing, in between work interruptions, I see that you provided a bit more information. In response to your vet's comment about numbers don't lie, I completely disagree. In fact, there is no other canine disease that exists where numbers on diagnostic tests lack more credibility because of their known propensity to lie. As I mentioned earlier, the LDDS test, which appears to have been the only diagnostic test done, lies the most by returning a false positive result if there is something other than cushing's going on. Any type of illness, pain or serious stress can cause a false positive.

[jjm97]

Chili's water is kept in the basement because she's a sloppy drinker and we have 2 small children that would get into it. The door is usually closed so she can't drink whenever she wants. If we're down there or she is there by herself for whatever reason she drinks if there is any water in the bowl. Since the leaking and accidents started I have been limiting her intake. However, I think she does drink a lot of water, especially at night before bedtime I discovered that she loves to get a big drink. I stopped that when she started leaking urine on her bed.

My vet has performed urinalysis every time I've brought Chili in due to the leaking of urine and accidents in the house. Each time the results came back showing showing the tiniest bit of infection but nothing clear-cut. Vet did mention the urine dilution was more each time. An antibiotic was given along with a DES estrogen regimen (7 days, then once/week, now twice/week).

[Squirt's Mom]

Withholding water is risky in any dog but one who is in questionable health it is especially risky because some diseases, like Cushing's, effect the kidneys and those organs are going to work overtime regardless of the amount of water they drink. So withholding water can quickly lead to dehydration.