Cushings or not, that is the question. . .

[Daisysmommy]

Hi! I'm new here and really impressed by all the information.

I'm hoping to get some advice, words of wisdom from all of you who had some difficulty with diagnosis of your dogs. I'm so sorry that this is going to be long!!

We have a 12 1/2 sweet "pound puppy" doggy. She's a mixed, mid sized dog and has always been the best, sweetest and very healthy dog who we got from the humane society when she was a puppy.

About a year or so ago we noticed that she began slowing down a bit. She seemed weaker in her back legs with a tremor in one or both of her legs, especially when she was tired. She seemed to be throwing a up more, getting more diarrhea and her stomach got more sensitive. Then about six months ago she started peeing a ton with dilute urine, having potty accidents. She had a UTI which she was treated for, but then she really started slowing down, had trouble jumping on the bed, doing our regular walks, she was shedding a TON, etc.

Her UTI cleared up but the water drinking/pee didn't resolve so the Vet did bloodwork, urinalysis, etc. which ruled out things like another UTI and diabetes (I believe) among other things, then they did more bloodwork and an ultrasound, which found that she had two really enlarged adrenals, though I think the rest of her organs looked okay. It sounded like they were diagnosing her with Cushings but wanted to find out which kind, so they ordered another blood test (I can't remember which one but it's one you that takes a good part of the day). At this point we were so certain this is what she had as she had pretty much ALL the symptoms (excess panting, crazy appetite increase, the leg/hind weakness, the lethargy, insatiably drinking water and pee accidents, etc. etc.)

So we were waiting to find out the diagnosis of which type of Cushings she has when Christmas Eve she had a seizure and then she had more on Xmas day - she would froth at the mouth or puke or pee and have convulsions for a minute or so, and then she would go back to being somewhat normal. It would take her a little while to recover, but about 15 minutes later, she would be doing normal things like wanting food, or walking around. When we took her to the Vet Emergency clinic (our vet wasn't open as it was the holiday), the doctor said that it was likely caused by a pituitary tumor (because we all thought she had Cushings) and put her on medicine to stop the seizures (she had a number of them in a short time period). Also as an aside, about 4 months ago, she had an "episode" that we now think might have been a seizure - she puked/peed/and then collapsed and was really confused/couldn't walk properly and was panting heavily and frothing at the mouth. The whole thing lasted about 20-30 minutes until she was somewhat recovered. We rushed her to the vet, but the vet didn't seem to know what happened and said it could have been a mini-stroke or something because the bloodwork ruled out things like poison, etc. and they kind of shook their heads about it back then. Now I wonder if that was her first seizure, just on a bigger scale.

So anyway, we call our Vet first thing Monday (today) when they are back from the holidays and they have the test results - come to find out that the bloodwork supposedly ruled out Cushings (and Addisons I guess). I'm just so confused as she literally seems like a textbook case of Cushings. I know you'll ask for more details about her test results, and we are requesting them from the vet which I'll post when I get them. Our Vet has pretty much said they are recommending we go to a specialist now. They recommend a neurologist.

I'm just wondering if we should also follow up with an internal medicine specialist to make sure she really doesn't have Cushings, as I understand there can be things like false negatives, etc. I don't want to rule out Cushings prematurely and go down the wrong path as it seems to fit so well.

Anyway, I don't know if anyone has any thoughts on our experience! We'll be following up with the specialists, but this has been so frustrating. We thought we were at least close to a diagnosis and getting treatment for Daisy. It's also hard because all these tests are crazy expensive and it seems as if every time we go to the vet, which is frequent, it's another several hundred dollars. We have pet insurance, but it's with a deductible we have to meet per "issue/diagnosis" and without a diagnosis, I don't know if we can connect these things together to get them covered, if that makes sense. So if anyone has any thoughts on pet insurance or tips - I'd welcome them!

Thanks so much and hope everyone had a lovely holiday season.

[labblab]

Hello and welcome to you and Daisy! You need not apologize at all for all the helpful info you've already given us -- we are a nosy bunch, and we appreciate getting as many details as we can. ;)

Having said that, given all of her Cushing's-consistent symptoms, I agree with you that I'm surprised that Daisy's Cushing's blood test turned out to be negative. It really will be a big help to us once you are able to get copies of the actual numerical results of all her testing so that we can help evaluate the Cushing's test as well as sort through any abnormal values on her general lab panels. When you do get the tests, all we need to see are those values that are marked either high or low, as well as the normal range.

However, we can already guess some things from the results of the ultrasound. Since both of her adrenals were elevated and no tumors or masses were seen on the imaging, if Daisy has Cushing's, it will undoubtedly be due to a pituitary tumor. I suspect your vets proceeded with the Cushing's blood testing subsequent to the ultrasound not to distinguish which type of Cushing's might be involved, but instead for confirmation that Cushing's is actually the cause of Daisy's adrenal enlargement. Other illnesses or health problems can prompt the body to produce excess cortisol, thus leading to adrenal enlargement. So the fact that Daisy tested negative on the Cushing's test does open the door to consideration of other possibilities. However, this is where it will help us a lot to see the actual results of the testing. It may be the case that it would be helpful to perform an alternate Cushing's blood test (there are two different ones), since some dogs will test positive on one of the tests and not the other.

However, the onset of her seizures does add a further complication and worry into the mix. It is certainly possible that a tumor on her pituitary gland or elsewhere in her brain is the cause. However, being the owner, myself, of a non-Cushpup who has suffered from unexplained seizure disorder now for several years, I'm aware that there can be other causes in play ranging from liver abnormalities to hypothyroidism, etc. I think I would agree with you, and perhaps request to first see an internist prior to heading directly to the neurologist. Strictly from a financial standpoint, imaging of the head is quite an expensive undertaking, and I suspect that might be the neurologist's first diagnostic suggestion :o. So to me, it would be worth the cost of at least an initial consultation with an internist to see whether there might be other organ or endocrinological abnormalities that might account for Daisy's entire symptom profile.

These are just my initial thoughts, prior to having a chance to actually view Daisy's test results. So as soon as you can get that info to share with us, that will be great. In the meantime, once again, I'm really glad you've found us!

Marianne

[molly muffin]

I think I would go to the Internal Medicine Specialist first too. They can always bring in the nerologist if they feel the need. Get the copies of all the tests and take them with you. I just have a binder with everything in it and then a summary of test results that I type out.

Having a dog who has tested negative on numerous LDDS test, but has enlarged adrenal glands too, I understand the difficulty in getting a diagnosis. However, 5 % of dogs will test negative on the LDDS. If I remember correctly it is based on where the tumor of the pituitary actually is located that might cause that. So, you can't rule it out. You know she is producing cortisol though and high cortisol can cause things like stroke, seizures, etc.

I am glad I went with an IMS and based on the difficulty getting a diagnosis, think it is probably what I would do next.

Welcome to the forum