Appropriate to test for Cushing's?

[LoveMyPup]

Hello,

After browsing the boards at K9cushings.com I quickly noticed that there are some very knowledgeable members on these boards. I am writing to hopefully get some input on my dog's situation.

My dog is about 9 years old. Being a rescue, his exact age is unknown. He may be a German Shepherd/Lab/Golden Retriever mix. He is approximately 73 lbs with a normal appetite and he drinks about 1/3 to ½ gallon of water a day, depending on his level of activity and outside temperature. For the past year or so he has been suffering from bilious vomiting syndrome for which he gets 20 mg famotidine twice a day.

A few weeks ago, a month or so after we moved apartments, he started panting and having a generally increased respiratory rate, even at rest with this mouth closed. I would describe it as shallow, rapid breaths. Around this time he was also having a flare up of his bilious vomiting. He became somewhat reluctant to go for walks at times. Often times he will try to turn around to head home. Since we moved to a very busy street it is hard to tell whether it is traffic and noise that scares him, or if his behavior is a sign of an illness.

We took him to the vet and ran blood and urine tests as well as x-rays. The x-rays were unremarkable and the blood work (including thyroid) was normal with the exception of elevated eosinophils (1931, range is 70-1490 /uL). Urine sample came back as follows:

COLLECTION METH FREE-CATCH
COLOR YELLOW
CLARITY CLEAR
SPECIFIC GRAVITY 1.010
GLUCOSE NEGATIVE
BILIRUBIN NEGATIVE
KETONES NEGATIVE
BLOOD NEGATIVE
PH 6.0
PROTEIN NEGATIVE
WBC 0-2 (0-5)
HPF RBC 0-2 (0-5)
BACTERIA NONE SEEN
EPI CELL 1+ (1-2)
MUCUS NONE SEEN
CASTS NONE SEEN
CRYSTALS NONE SEEN
OTHER DNR
UROBILINOGEN NORMAL


Due to the low specific gravity and his increased respiratory rate/panting the vet thinks performing a LDDST would be the next step. He has not suggested doing a UC:Cr.

A few days ago we were prescribed Cerenia to help calm the bilious vomiting. The day after starting the medication he started having periods (hours) of normal respiration. This has continued for two consecutive days.

I would greatly appreciate any input regarding our situation. Is testing for Cushing's appropriate in this situation? Based on the signs and symptoms, is it at all likely that my dog has Cushing's?

Thank you in advance.

[Harley PoMMom]

Hi and welcome to you and your sweet boy!

Oh, Bless you for giving him a loving forever home!!

I have only a moment to post, sorry :( But based on his symptoms Cushing's does not come to my mind. Has he ever been checked for pancreatitis?

I definitely would not have a LDDS test done because any underlying illness or even stress, can create a false positive result with the LDDS test. I believe if I were in your shoes I would contemplate having an ultrasound performed, they can be a very useful diagnostic tool, as other abnormalities may be found on the internal organs, such as gallbladder mucocele, kidney issues, pancreatitis... Were there any abnormal findings on the blood panels, I'm assuming these are a CBC/chemistry blood panel?

I will try to get back later, hang in there, ok ;)

Hugs, Lori

[LoveMyPup]

Hi Lori!

Thank you for the warm welcome and for taking the time to read my post and provide your advice.

The blood test was a standard CBC. Only eosinophils were out of range (1931/uL, normal range is 70-1490/uL). Kidneys and liver seemed fine:

ALP 132 (5-160 U/L)
ALT 48 (18-121 U/L)
ALBUMIN 3.6 (2.7-3.9 g/dL)
TOTAL PROTEIN 6.7 (5.5-7.5 g/dL)
GLOBULIN 3.1 (2.4-4.0 g/dL)
BUN 19 (9-31 mg/dL)
CREATININE 0.8 (0.5-1.5 mg/dL)
GLUCOSE 100 (63-114 mg/dL)
ALB/GLOB RATIO 1.2 (0.7-1.5)
BUN/CREATININE R 23.8
SDMA 9 (0-14 ug/dL)

He has not been checked specifically for pancreatitis.

The vet said if negative for Cushing's, an echocardiogram of the heart would be what he would suggest next. He did not mention ultrasound imaging of internal organs. He seems fairly competent, but maybe it's time for a second opinion?

Once again, thank you for your input. :)

[labblab]

Welcome to you from me, too! Thank you so much for this additional information, and I have to say that I agree with Lori 100% -- I would not proceed with Cushing's testing at this time. Quite honestly, there is nothing about your dog's profile that is consistent with Cushing's other than dilute urine, and that one finding is actually a bit of a puzzle since his water intake does not exceed normal amounts. He does not exhibit any of the bloodwork abnormalities that are typical of Cushing's, and in fact, his elevated eosinophils are the exact opposite of what you'd expect in a Cushpup.

I just now Googled possible causes of elevated eosinophils in dogs and came up with possibilities such as internal parasites, allergic reactions, GI issues, and even Addison's Disease (which is the opposite of Cushing's wherein cortisol and/or aldosterone levels in the body are too low). Given your boy's high eosinophils coupled with his respiratory issues and exercise intolerance, one thing I'm thinking about is heartworm infestation. But I assume he has been regularly blood-tested for the presence of heartworms?

Anyway, chronic vomiting is also not typical of Cushing's but might be associated with some of the issues above. So at this point, I would definitely direct my diagnostic dollars in a different direction. Perhaps consulting with an internal medicine specialist, if you have one nearby, would save you some money in the long run. Although perhaps more expensive up-front, a specialist may be better able to pinpoint the diagnostics that would be most beneficial.

Whatever you decide, please keep us updated, OK?

Marianne

[molly muffin]

I too agree with Lori and Marianne. This isn't presenting as Cushing's. Remember that cortisol can be elevated in light of other chronic issues which he has with the vomiting. So I don't know that I would trust any positive result on the Cushing test. If the breathing is being helped by the additional med then it appears that this might be more gastric or pancrease related.

[LoveMyPup]

Hello Marianne and Molly!

Thank you so much for responding.

He is on a heartworm preventative (Iverhart Max) and he tested negative for heartworm as far as I know. The HW results were pending at the time I requested a copy of the lab results. I have not heard from the vet since, so I assume the test came back negative.

His fecal sample did show presence of Cyniclomyces Guttulatus aka Saccharomycopsis Guttulata (non-pathogenic yeast). From what I can tell the yeast has no clinical significance.

I was also thinking that his cortisol may be elevated if he is not feeling well from vomiting, pain (?) etc. which may contribute to a (false?) positive Cushing's test.

We live in Los Angeles so there should be several internal medicine veterinarians in the area. I think this will be our next step.

I will definitely write an update as soon as there are any news.

Thank you for sharing your knowledge and experience. This is such a great community!

Best wishes to all,
Mary