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Bobbi Bob
04-14-2016, 05:45 PM
Hi my name is Gail and my dog is Bobbi. Firstly thank you for having this wonderful forum it is amazing. I have read and read lots of different posts and information but I am feeling a little overwhelmed and confused so I would be grateful for any advice and even just to help me get his symptoms clear in my head so I can be of more help with his diagnosis.

Bobbi is a collie/lab/? approximately 10 years old, we got him 3 1/2 years ago from a SPCA shelter. He was there for a year during which time he was adopted and sadly returned twice. All we know about him was that he was very overweight when arrived at the SPCA and that he suffered repeated ear infections during his time there.
When we got him home it was apparent that he had not been socialised and I think not really walked as everything was just overwhelming for him for the first 6 months. His anxiety tended to show as really high excitement level and lots of noise, crying and barking and he was preening himself to excess every morning passing infection from one private area to another for quite a while. However, he settled down really nicely and turned in to a bit of a father figure to other dogs and he was often used to help other dogs that needed socialised with a calm dog. Then 6 months later we began to think he was too calm in fact he appeared tired and depressed. Then his hair began to fall out just at the top of his tail. I think it would have been around that time we noticed he drank a lot and urinated a lot too. So his thyroid was tested and it was in the low normal level but as he had some symptoms the vet suggested trying him on thyroxine to see if it helped. It did appear to, his hair grew back and he appeared to have more energy.

We were aware that he had a bit of a funny walk and it was felt that he had a undiagnosed hip/back problem but he was not in obvious discomfort and it was felt that x-rays wouldn't really change treatment so it remains undiagnosed. However, what we have noticed is that over the 3 1/2 years we have had him he has lost a lot of muscle mass in his back and hind legs. Even with physio and hydrotherapy this has not changed much.

He doesn't have a pot belly but he does have what I would describe as a sagging belly and if you look at him side on his belly is almost level with his chest a bit like the boxer Dempsey on Kate Conniks website.

So the other symptoms he has:
He drinks huge amounts of water and I think it has increased over the time we have had him.
He can pee for more than a minute at a time (his urine is very dilute)
He pants with very little exertion
He has a huge appetite and always appears hungry so we have split his meal into 3 times a day so that he always has something to look forward to and we bulk it up with veg he likes.
He has had some partial seizures

One of the things that has been worrying me lately is his behaviour change and I am not sure if this is related. I thought he was going deaf and I think he is as he doesn't hear us come home and his sense of which direction the sound comes from is poor. However, he also does this thing where I shout him and he does not register at all then suddenly after a few seconds he will look at me as if to say did you shout me. This delay seems to be happening more often and it has been taking longer to get a response. (?seizure related).
He has also become more anxious again sometimes very similar to the way he was when we first got him and his behaviour can be erratic sometimes just running off really quickly for no reason.

His behaviour changes started last year and I took him to the vet wondering had he somehow become hyperthyroid or was something else going on. His thyroid was normal and we even stopped the meds and had him re-checked and his levels remained normal so we discontinued it. At the same time the vet checked his urine which was very dilute, he then did some bloods and said that there was nothing to worry about his kidneys and liver were fine so it must just be that he drinks a lot. I thought at that point that they would have considered Cushing's so didn't even think to question.

Anyway it is now a year later and his behaviour change continues to concern me as he is becoming more anxious and excitable in any situation outside the house. He is drinking and peeing much more. I would say he drinks at least 4 large bowls of water per day plus drinking in streams/puddles. He has begun to need to get out after his meal urgently and if we forget to let him out immediately then he will bark in a bit of a panic. He has also just recently started to walk away while he is still peeing a little.

So I went back to the vet mainly about my concerns with his behaviour she talked about the seizures and a possible brain related problem. I think she was thinking brain tumour. She suggested we try an anti-epileptic, Pexion to see if that helped I guess wondering if the delay responding was seizure related. So he has been taking them for 7 days I haven't noticed much of a difference.
So when I got home I did some research and felt he had a lot of Cushing's symptoms so called the vet to ask if he could be tested. She had taken a urine sample and noticed it was very dilute and had been thinking about it herself although she said all the bloods done last year were fine and usually something would have shown up in them if it was Cushing's.

So yesterday she did a new set of bloods including thyroid and the ACTH stimulation test. I know you like to see results so I will get as much as I can at the beginning of next week and post them for you to see.

I really do apologise for the length of this post and thank you for reading and caring so much about our dogs.

labblab
04-14-2016, 08:19 PM
Gail, welcome to you, and to your handsome boy!! I love your avatar of Bobbi, and I want to thank you so much for adopting him and for obviously taking such good and special care of him. He is so very lucky that you welcomed him into your home and your hearts!

I apologize that I don't have time right now to add a lengthier post of my own, but I will be back tomorrow if not earlier. I just want to reassure you that we thrive on details, so you need never apologize for writing too much. You've done a great job of introducing Bobbi to his new family here. :)

So I fear I must sign off for now, but I'm so glad you've found us and I look forward to learning much more about Bobbi in the coming days.

Marianne

molly muffin
04-14-2016, 08:37 PM
I love Bobbi's picture! What a cutie and such an inquisitive look to him.

Do you happen to have copies of the blood work they did? I'm curious about any abnormal high/low blood or urine values. Have they ruled out any sort of chronic UTI infection by culture?

It certainly does have some of the signs of cushings as you have stated. Normally we tend to see signs of high ALKP in dogs that are cushings or that have high cortisol. When did they say the ACTH results will come back?

Welcome to the forum!!

Harley PoMMom
04-14-2016, 09:56 PM
A thyroid problem seems more likely to me, behavioral problems, ear infections, seizures, all of these can be attributed to the thyroid not functioning as it should.

If I thought my dog was having a thyroid issue I would send the blood work samples to Dr. Jean Dodds. Dr Dodds is a world-renowned expert on thyroid disease in pets, more information about her and her lab can be found here: http://www.hemopet.org/veterinary-diagnostic-laboratory.html

Hugs, Lori

Bobbi Bob
04-15-2016, 07:09 AM
Thank you so much for your kind welcome. Bobbi is a beautiful dog and has such a fun personality. He has given us so much more than we can ever give to him, it is such a privilege to have him in our lives. We have another rescue from Bulgaria (we live in Scotland) she is amazing too and they just love each other.

I should get the results back at the beginning of next week so I will let you know. I will also check about possible chronic UTI he certainly did have recurring infections due to excess preening when we first got him but we managed to get that under control and he hasn't obviously shown signs of infection since then but I am not sure it has actually been checked.

Thank you for the hemopet link I will certainly look into that. We will get results of the thyroid test next week too.

Thanks again
Gail

molly muffin
04-17-2016, 09:11 PM
We will be looking forward to seeing what the test results show. :)

Bobbi Bob
04-20-2016, 06:52 AM
Hi there I got Bobbi's results back yesterday and all were fine except that his red blood cell count was slightly high. The vet put the high count down to dehydration which she feels shows that the excessive drinking and dilute urine does have a medical cause but she doesn't know what that is. She suggested doing the LDDS test but I wasn't sure as everything else has been fine? She also suggested testing for diabetes insipidus.

What do you think about trying the LDDS test is it worth trying? These tests are very expensive so I don't want to do it unless it would be worth it although I would do it in a second if I thought it would benefit him.

Thank for your help.
Best wishes
Gail

lulusmom
04-20-2016, 05:04 PM
You mentioned that an acth stimulation test was done as well as other labs. Were the results of that test normal as well? That test can yield false negative results but with all other test results being normal, a normal acth stimulation test would not be unusual. Can you please get copies of all of the testing that has been done to make sure that a CBC, blood chemistry and an acth stimulation test were done. It would be very unusual for a dog with cushing's to have only one abnormality on the CBC which can be explained away by dehydration. A dog with polyuria/polydipsia could most certainly have elevated rbc but not if the polyuria/polydipsia is caused by cushing's. Your pup has most of the symptoms that are commonly associated with cushing's so that makes normal blood labs very, very odd. Can you share the results of the last urinalysis? I would be most interested in the urine specific gravity (USG).

If you are able to confirm that there are absolutely no other high or low values on both the blood chemistry and cbc, then I personally would try a trial of desmopressin (DDVAP) eye drops to rule out central diabetes insipidus (DI) as the cause for the polyuria/polydipsia. DI is very rare but if your pup's problem is being caused by an antidiuretic hormone (ADH) deficiency, he should respond to the drops. My second cushdog never saw a resolution of his drinking buckets of water and peeing lakes with lysodren or trilostane so we tried the eye drops and he did not respond. He was ultimately diagnosed with nephrogenic diabetes insipidus. The treatment for that is make sure you make fresh water available at all times and deal with the voluminous amounts of pee. My boy would try to make it outside and almost always made it to the hospital pads I kept down for him.

Once you get copies of the tests and you can confirm that there are other blood abnormalities that are commonly associated with cushing's, then I would recommend that you start with a urine cortisol creatinine ratio (UC:CR). You would need to collect the urine specimen at home, preferrably the first pee of the day, and get it to the vet's office as soon as you can. If you can't get it there right away, refrigerate the specimen until you can. The reason for collecting the urine at home is to make sure the dog is relaxed. Most dogs are very anxious at the vet's office and when dogs get anxious or stressed, they will dump cortisol in response to that stress. Therefore if the specimen were to be collected at the vet's office, it would be shocking if the results were not high.

I'll be anxiously awaiting for more information on your sweet Bobbi.

Glynda

Bobbi Bob
04-21-2016, 08:09 AM
Hi Glynda thank you so much for your advice regarding Bobbi.

This is a list of the lab work done on Bobbi. We are in the UK so I have listed them all individually CHEM 7 = ALB, ALB/GLOB, ALKP, ALT, AMYL, BUN/CREA, BUN, Ca, CHOL, CREA, GGT, GLOB, GLU, LIPA, PHOS, TBIL, TP. T4 and HAEM, ACTH STIM.

The vet reported that everything came back normal except the RBC which she put down to dehyrdation I don't actually have the result for it but all the results are being emailed to me later in the week.

A urine sample was taken at the vet visit and the vet said all it showed was that it was very dilute but again I don't have the written report yet.

If all his blood work is normal would that rule out Cushing's?

Should my next step will be discussing a trial of the eyedrops you mentioned.

It has been slightly warmer here for the last 2 days. I am in Scotland so still cool really 14C/57F and he was panting a lot and was slow and tired looking on our walk so there is definitely something going on. I have been taking water with me on walks as I have noticed he is sometimes looking for it urgently we are often not far from a little stream but at times he looks quite desperate.

Thank you so much again it has been really helpful to be able to discuss this with you. I feel my vet is a little unsure about what to do next to be honest I am not feeling that confident.

Best wishes
Gail

lulusmom
04-21-2016, 05:02 PM
Hi Gail,

Thank you for your response and I will be looking forward to your confirming the actual results when you get the paperwork. To answer your question, it would be very, very odd for a dog with cushing's to have completely normal blood labs, which is why I asked you to review the actual results and confirm with us.

When the kidneys are not concentrating the urine, a dog must drink water to stay hydrated. Critical dehydration can occur rather quickly if water is not available so until you know what is going on with Bobbi, try to take water with you when you go for walks. I've seen that look of desperation in my own dog.

Diabetes insipidus is quite rare but if Bobbi's blood chemistry values are all within normal range and all but the rbc on the complete blood count are within normal range, then I'd try a trial of desmopressin eye drops. If there are blood abnormalities that your vet didn't mention that can be associated with cushing's, then I'd forego the drops and start with a UC:CR. In the meantime, I hope others will chime in and share their own feedback.

Glynda

glfprncs
04-24-2016, 10:07 AM
While all of the bloodwork has come back within normal limits, dogs don't always follow the rulebooks. My TC was such a case.

When we first began trying to diagnose what was going on with him (excessive drinking/urination, always hungry, anxiety, and, though we didn't put two and two together at the time, the inability to heal simple wounds very well), his bloodwork was perfectly fine and within normal limits. We then suspected diabetes insipidus and gave him the meds (the drops in his eye) and ran a trial of that for 2 months to no avail. I finally pushed for LDDS, and those results came back positive for pituitary type cushing's. We followed that up with an abdominal ultrasound which confirmed the Cushing's diagnosis.

During my 4 years with a Cush pup, with the exception of the last 2 months of his life, TCs basic labs always came back within normal limits except low urine specific gravity. When he passed, my vet sent me a card that even said that TC refused to follow the book and forced him to be a better vet because of it.