Possible cushing's disease

[jlw1010]

Hi all! My name is Jessica and I have an 8 year old pit bull mix, Lily, that is showing signs of Cushing's Disease. We haven't done all the testing yet. Lily has had a complicated health history. She had Lyme disease and went through the treatment for that. She tore her ACL and had that repaired with a plate put in. This was all before I adopted her from a friend. About 2 years ago the plate in her leg got reinfected and we had to go back in and take the plate out. She gained quite a bit of weight and even with exercise the weight wouldn't come off. So we checked her thyroid and found that her thyroid hormone was not functioning. The vet started her on a "standard" dose which ended up making her hyperthyroid. During that time she started with what I thought were symptoms of hyperthyroidism. She had polydipsia and polyuria. The symptoms never really went away. We just went to the vet and did blood work and urine test to see if we could figure out what has been going on. Urine was fine and her blood work had some issues. Two liver enzymes were slightly elevated and her ALK Phosphates was 500. According to my vet, he has seen the ALK Phosphates higher but all these results together are raising a red flag. He recommended doing a cortisol to creatinine level and we did that. Lily's level came back at 30(I think). I know that doesn't mean she has Cushing's Disease but it seems like all the signs are pointing there. I'm just not sure what to do given her health history and unfortunately the cost of all this testing. I don't want her to suffer and just want what is best for her. Any advice? Sorry this is long.

[Squirt's Mom]

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[Harley PoMMom]

Hi Jessica,

Welcome to you and Lily! Glad you found us and we will help in any way we can.

Increased drinking and urinating are symptoms associated to Cushing's but also to other non-adrenal illnesses such as diabetes or an UTI, were these ruled out? Other common signs of Cushing's are a ravenous appetite, skin/hair issues, exercise intolerance, difficulty or unable to go up steps or jump on furniture, does Lily display any of these? The goal of treatment is not to cure Cushing's but to help control the symptoms from Cushing's, that is why strong symptoms are a huge part of a diagnosis. Could you get copies of all tests that were done on Lily and post those results here? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. Is her thyroid level normal now with medication? Did the vet have an urine test done to check USG, which should be low in a dog with PU/PD.

We totally understand about the cost with Cushing's, the initial expense is during the diagnostic phase, the cost of treating usually goes down significantly after you've got the diagnosis confirmed and the treatment underway.

Dogs with Cushing's generally are not in pain because they have extremely high levels of cortisol in their blood and since cortisol is our body's natural anti-inflammatory, cushdogs are self medicating themselves. Also Cushing's is a very slow progressing disease and it takes a long time before that excessive cortisol will cause harm.

If you have any questions please do not hesitate to ask them and remember you are not alone on this journey.

Hugs, Lori

[jlw1010]

Hi Lori!

Thank you for the welcome. I will have to ask my vet if they can fax me Lily's results. We did do a urine that was negative for everything but we are treating her for a UTI just as a precaution.

It's been hard to tell with her symptoms. She has always been a hungry dog and if I would let her she would eat all day. But I can see signs of her being hurgier than normal. She does have skin issues and has a hard time going up the stairs. My biggest problem is the excessive thirst and urination and the accidents that go along with that. Her thyroid levels are now normal with her levothyroxine.

[jlw1010]

Here are Lily's test results:

From her urinalysis:
Specific gravity - 1.013 (1.015-1.050)
Blood - 2+(high)
Microalbuminuria - 8.9 (<2.5)
Creatinine - 61.5 (100-500)
Cortisol/Creatinine - 35 (<13)

Blood work:
AST(SGOT) - 79 (15-66)
ALT(SGPT) - 279 (12-118)
ALK Phosphatase - 490 (5-131)

That is all the blood work we have done so far.

[Harley PoMMom]

I'm assuming the urine sample was a free catch method? If so, the blood found is indicative to an UTI and/or possibly to a stone formation which would cause increased drinking/urinating. If the UC:CR was done while she has an UTI this can make those results be falsely high.

Since her urine specific gravity (USG) is low I would ask to have an urine culture and sensitivity test performed to see if any bacteria is present, and if is than the proper antibiotic can be prescribed.

Hugs, Lori

[jlw1010]

My vet said that there was no sign of anything in her urine besides the blood which he found weird. He didn't think she really had a UTI but we are doing antibiotics now just as a precaution.

[Renee]

When the urine specific gravity is low, it is difficult to 'pick-up' bacteria in an in-house urinalysis. And, regular urinalysis can result in false negatives quite often. It's best to get a culture sent out. That way, the specific bacteria is identified (no false negatives) and the appropriate abx are used. You may be using a broad spectrum abx, but if it is not specific to the bacteria that is present, you'd be wasting your time.