16 y/o beagle with odd lab results

[Squeakslm]

Hi! New to this forum and hoping to get some advice. I have a 16 year old beagle who has over the past year or so developed a huge pot belly, constantly is terribly thirsty and hungry and just constantly pees. Took him into the vet for these concerns and she immediately thought cushings. She did a full senior wellness panel and his liver enzymes were slightly elevated, but his kidneys, thyroid and glucose were great so we did a creatinine/cortisol ratio test which was off the charts as she put it. We then went ahead and did the atch test which she was so positive was going to confirm the cushings we already started figuring out dosing for meds and such, and the test came back completely normal other than a slightly elevated baseline cortisol. She is just as flabbergasted as I am. Anyone have any similar experience or advice?

[labblab]

Hello and welcome to you and your baby! One suggestion I might make is to administer an alternative diagnostic blood test, the LDDS (Low Dose Dexamethasone Suppression test). Both the ACTH and LDDS have different strengths and weaknesses, but one weakness of the ACTH is that it is more likely to return a "false negative" even when a dog truly has Cushing's. The ACTH has a particularly poorer record of identifying Cushing's in dogs who suffer from the adrenal form of the disease (as opposed to having pituitary tumors).

The flip side of the equation is that the LDDS is more easily skewed by other, nonadrenal diseases, and thus will more often return "false positives" for dogs who are actually suffering from something other than Cushing's. However, for dogs with no other known health problems, the LDDS is probably the preferred of the two diagnostic blood tests because it will more often identify Cushing's in dogs who truly have the disease.

In the meantime, one other diagnostic option would be an abdominal ultrasound, because it could reveal the actual status of your dog's adrenal glands (and whether a mass or tumor is present), as well as potential problems with other internal organs.

One thing you could do that would help us a lot is to post the actual urine test results, as well as the ACTH numbers. Also, the other abnormal lab values would be of interest. You only need to post the results that are too high or too low, along with the normal range.

Once again, I'm really glad you've found us, and we will do our best to help you sort things out.

Marianne

[lulusmom]

Hi and welcome to you and your boy.

Marianne has covered the bases but I wanted to mention that if the urine specimen for the urine cortisol creatinine ratio (UC:CR) was collected by the vet, whether by free catch or cystocentesis (needle in the bladder through the abdomen), one would have to expect that this breach of testing protocol would yield off the chart results. A urine cortisol creatinine ratio (UC:CR) must be done using a specimen collected at home, preferably the first pee of the day, before a meal or medication. Cortisol, the hallmark adrenal steroid in naturally occurring canine cushing's, is a fight or flight steroid so any time the dog is stressed, he will respond to that stress by dumping cortisol into the bloodstream. Food and certain medications can also cause a transient increase in cortisol, hence the first pee of the day. Most dogs are very stressed at the vet so if collected in the office, you can be fairly certain of a high ratio, rendering that test null and void. If your vet collected the specimen, you should not be charged for their breach of protocol. I have seen two dogs in the last few months with UC:CR results off the charts, being well over 100 and in both cases, the vets collected the urine specimen.

Your dog is definitely a breed we see in the top ten as being over represented in cushing's here as well as in credible veterinary white papers. With your boy's symptoms being commonly associated with cushing's, it is very possible he does have cushing's and as Marianne mentioned, the acth stimulation test could very well have been a false negative result.

I will look forward to hearing a lot more about your boy and seeing the test results. We love to get as much information as possible so that we can provide you with more appropriate feedback.

Glynda

https://www.veritasdvm.com/documents/24501/56065/1346421998710_24501_210.pdf

[judymaggie]

Welcome to a fellow beagle parent! As Marianne said, beagles are among the breeds that are frequently seen with Cushing's. I now have my second beagle and she is my second Cush pup. Has your pup been healthy up to this time?

[Squeakslm]

Thanks for the replies! I will work on getting the actual lab values from my vet this week (I am a paramedic who works overnight so it's tough) and will be sure to update once I get them. We just inherited bud from my husbands parents who decided that either we take him or they were putting him down. They took him to the vet for vaccinations but that's about it. They are very old school farm types who didn't ever spend money on pets. The only other problems we know of are cataracts, and tumors on his feet that we haven't gotten biopsied yet, they are relatively small and don't seem to bother him so we put that further down the priority list on the vets advice.

[molly muffin]

Looks like the others have you off to a good start so I just want to say welcome to the forum.

BUN/Creatinine, where all good on the blood test also?

[lulusmom]

Bless you for saving Bud from euthanasia. You have a big heart and I'm glad that your drive to save lives extends to our canine friends. I am not sure if you saw my post and if not, please do check it out and answer any questions you can while waiting for copies of the labs.

Glynda

[Squeakslm]

Glynda,
Yes she did take his urine sample there, in the middle of the afternoon. So I'm sure that was not they way it was supposed to. I will talk to her about that as well on Monday. We have an appointment for an abdominal ultrasound on Monday. Hoping that can get us some more answers. Thanks again!

[lulusmom]

Thank you for responding. Yes, do speak to your vet because you should not have to pay for the UC:CR. I've included links below to credible sites that clearly state the reason for pet owners collecting the urine specimen. Hopefully your providing this educational material will help your vet understand and not repeat this mistake in the future.

http://veterinarymedicine.dvm360.com/practical-matters-urine-cortisolcreatinine-ratio-most-useful-normal-test-around

https://www.marshfieldlabs.org/sites/ltrm/Vet/Pages/455.aspx

http://www.marvistavet.com/testing-confirming-cushings-syndrome.pml

[Squeakslm]

Thank you all for the advice. We ended up getting results on his tumors and his abdominal ultrasound. He has mast cell cancer which has metastasized to his kidneys and several other internal organs. We are now just going to make him comfortable until he tells us he's ready. Anyou advice on the constant thirst? I have to imagine he's not very comfortable.

[Joan2517]

I'm sorry you received such bad news....

[labblab]

Thank you all for the advice. We ended up getting results on his tumors and his abdominal ultrasound. He has mast cell cancer which has metastasized to his kidneys and several other internal organs. We are now just going to make him comfortable until he tells us he's ready. Anyou advice on the constant thirst? I have to imagine he's not very comfortable.
Like Joan, I am so very sorry you've received this news. How fortunate, though, that you opted to have the ultrasound performed so that you know the true source of the problems. :o

I wish I had some suggestions about the thirst, but assuming it is a result of the abdominal tumors, I don't know that there is a solution other than making sure he always has water available.

Once again - and especially now - thank you for taking care of this sweet boy during his final days. Please feel free to continue to update us as to how things are going for you all, OK? You are now honorary members of our family, regardless of whether or not Cushing's is part of the equation.

Marianne

[judymaggie]

Hi -- I am so very sorry that you have received such a disturbing diagnosis. Please know that I am sending gentle hugs to your pup!

[molly muffin]

So sorry to hear this. :(

I think the drinking is part of the issue with the cancers and there isn't much that can be done about it. :(

Sending you big hugs.