Need help understanding ACTH test

[Iluvhannah]

I'm new to the group. My name is Tiffany, I have 1 baby named Hannah a whippet/lab mix she just turned 8, 40lbs. Recently I took her to the vet for increased panting and increase in drinking. She has a dog door so I don't know about increase in bathroom habits, no accidents. Definitely she doesn't look like a cushing's dog.

My Vet ran blood work the abnormal results where:
Creatinine 2.1mg reference range .4-1.4
Total Bilirubin .8 reference ranges .0 to .5
HGB 20.6g reference range 11 to 19
MCH 27.4 reference range 20 to 27
MCHC 39.6 reference range 30 to 38

The Vet said that when he views the blood work as a whole he isn't concerned about anything showing up abnormal. He said by these tests he ruled out diabetes and a few other things. I asked about Cushing's since I read about symptoms briefly online. He suggested we do the ACTH test, I was hesitant since Hannah hates being away from me and noisy environments.

Her test results are Baseline Cortisol 4.6 (no units)
Post ACTH Cortisol 13.3

Prescribed Trilostane 60mg, retest ACTH in 3 weeks.
There are also no reference ranges. I could not help but be emotional when hearing the test results. I did have enough sense to ask what testing needed to be done to see where the excess was coming from, again just briefly read about it online. He said that the trilostane would take care of it despite the location.

Here are my questions, does anyone know what the reference ranges are for the test and what units he used? Seriously I'm all for keeping cost down but does she definitively have this diagnosis and we don't need any other test? I'm just asking for your opinions are based on ya'll experiences. I did give her the medicine for 2 days but she didn't seem happy and started to have diarrhea. Which has sense gone away. It being a holiday weekend and I live an hour away from an emergency vet and have no prednisone, I decided to stop the medicine until I decide what I'm doing, which is abnormal for me I airways follow the vets orders but this medicine has me so worried. I have been taking her to work with me and watching her 24/7.

[Renee]

Forgive me for this --- DO NOT, UNDER ANY CIRCUMSTANCE, GIVE YOUR PUP ANYMORE VETORYL!!

You did the right thing by stopping the meds, so very good job mom. I understand that you followed your vet in the past, but I am so glad that you knew your girl wasn't doing well and withheld the meds. The diarrhea she was hit with is a sure sign of too much of the medication. Is she okay now? Any other symptoms? Lethargic?

Your post ACTH result of 13.3 is NORMAL according to every single range I have ever seen listed for a lab in the US. Based on the baseline and post figures, I assume your lab uses ug/dl measurements. Most labs have a reference range that goes up to 22 ug/dl before cushings is considered.

There are so many things going on here that I want to comment on, but I do not want to overwhelm you. Please do not give any more meds. We will help you sort out Hannah's medical and help you get through this.

Welcome to our family. I am glad you found us!

[Iluvhannah]

Thank you so much for the quick reply and for letting me know I didn't do anything wrong. I started to question my vets quick response to putting her on the medicine without further testing.

She is doing much better now that it has been 2 days off the medicine, no more diarrhea. The fireworks this weekend has made her a little upset but she does seem to be happier and more excited doing her nose work/hunt activities. Since it is so hot here in SC I try and exercise her in the house hunting for food.

Im so relieved to have some help figuring this out. Hannah is very important to me, as I'm sure all of ya'll feel the same way about your dog's.

[kanga]

Don't have any good information about that! But I know there's so many member here who can help you with that hope you get some information soon about that.

[labblab]

I agree 100% with what Renee has written, and I would not give Hannah any more trilostane until you get things sorted out. The lab value that would be of greatest concern to me is the elevated creatinine at 2.1. That value relates to kidney function, and kidney abnormalities can definitely cause increased drinking and urination. I do not understand why your vet is not concerned about that abnormality and is not considering kidney problems as opposed to Cushing's. That is the area that I would want to pursue in terms of additional diagnostics.

Marianne

[Iluvhannah]

I can't tell you how appreciative I am to have ya'lls help!

Any chance ya'll would tell me how I could nicely explain to my vet that I don't agree with his diagnosis and please look into the elevated Creatinine? What test should I ask to be run? I have no issues being an advocate for my dog and asking the Vet to look further but I just need to know what to ask for.

With hugs from me and Hannah!

[DoxieMama]

Hi Tiffany, welcome to you and Hannah. I'm glad you went with your gut on this one. I too used to always follow my vet's instructions, though he has always been very good about explaining everything rather thoroughly. Sometimes it's hard to comprehend all that they tell us in the office, especially when you hear scary or worrisome news. I'm very, very glad you found us and hope you keep us updated on what you find out for Hannah.

Hugs,
Shana

[DoxieMama]

Hey - I didn't see your latest post until I posted above. If it were me, I'd call the vet and let him know about the diarrhea and other response that Hannah had to the Trilostane. You brought up Cushing's as a possibility and he followed that... so I'd say I'm not sure that's really what it is. Are there any other possibilities given the elevated Creatinine?

Hopefully others will be along to provide their suggestions, too.

Hugs,Shana

[labblab]

Sorry I have only a moment to post right now, but take a look at this chain of replies posted on another member's thread. Her dog is exhibiting elevated creatinine, as well.

http://www.k9cushings.com/forum/showthread.php?p=191244#post191244

Marianne

[Iluvhannah]

Thank you all!
I did call the Vet, Hannah's was out of the office so I was able to get another one of the Vets there take a look at all of her numbers. Yay, for a very easy second pair of eyes on her file. I have seen this Vet for emergency check ups before and trust their experience.

He did say that she was not high for her post ACTH levels but said that my vet might have made the suggestion of the medicine based on her symptoms, obviously he was not able to speak for the other ones actions. However he told me to stop the medicine, which I had already done. He also wants me to bring the remaining medicine (28 pills) back and he is going to credit me my money back. (I didn't even ask for that but yay)

He said that he wasn't to concerned with Hannah's Creatinine because she has greyhound/whipppet in her and that might just be high based on breed. But also because her other numbers the BUN and Phosphorus were very normal. He suggested I take her off the medicine and study her for a few weeks. Noting down anything that is abnormal specifically to her and then come back in. He said that based on my notes and how we both feel we can run additional blood work then and go from there.

Let me know if this sounds wrong but I must say it makes my heart happy and puts me at ease, after having ya'lls input and his.

[DoxieMama]

How great to get a second opinion so easily - and a credit for the unused meds - awesome! Please do keep us updated on how Hannah is doing. :)

[molly muffin]

Thank goodness for that second pair of eyes! And a credit for the unused medication!!! Whoo hooo! That never happens or rarely at least. Good for him.

You know....wouldn't maybe hurt to just move over to that there vet instead of the one who prescribed medication not needed. Just a thought of course, but I like this one better just from what you've said. :)

[Iluvhannah]

I thought I would give an update and ask another question.

I agree with you about maybe easing over to that other Vet. He was extremely thorough and I almost couldn't shake him off the phone he said he doesn't mind speaking to Owners that call in because it shows how much they care and have put thought in to what to say. :D

Hannah doesn't seem to be panting more than normal for summer here. However I think I forgot to mention that before all of this happened she was having some diarrhea and gas from the wet version of her normal food. I decided to change her to wet food since I'm trying to make sure she doesn't over eat. We have always just left her bowl full and she could free feed but know that she is considered a senior and not over weight but has gained 1-3lbs since her last check up I tried to limit her to the amount of dry food for her weight from the vet but she wouldn't eat it some days. Therefore I switched to wet because she loves that and I could make sure she is eating adequately. However she had horrible gas and diarrhea :eek:
We were out of town to make matters worse and with limited places to shop I found a Petsmart and searched the labels as best I could on my phone and came up with Nutro Max. It took care of her problems immediately. I asked the vet at my last appointment and he said that was a good choice and if she was doing well to keep her on it. However now her stomach is making noises sometimes and she has had a little gas just a handful of times. She isn't eating super fast but I didn't know if this would be normal or if I should try a different brand.
I'm open to all suggestions and price isn't really an issue. I know that quality food pays for itself with good health. Thanks for everything!

[Harley PoMMom]

Those gurgling noises could be from the change in food or a small intestinal bacterial overgrowth and/or even IBS.

If those gurgling noises didn't happen before than I would bet my money that the change in her diet is the culprit, there just might be something in the Nutro Max that her system can't tolerate. :( Is there a big difference in the ingredients from the Nutro Max and her old food?

Hugs, Lori

[Iluvhannah]

She had the occasional gas but nothing like what she experienced on the Diamond Naturals wet food. Her stomach noises started with the wet food as well. It isn't daily now just a couple times a week.

Yes, I looked at that and her previous food was Diamond Naturals, it was on my vets approved dog list and was very reasonable. She used to alternate between diamonds naturals and call of the wild. Here is the ingredients list for both if anyone wants to look at ithe. I did the leg work to find them. I appreciate everything!

Diamond Natural chicken and rice
Chicken, chicken meal, whole grain brown rice, peas, cracked pearled barley, pea flour, chicken fat, dried beet pulp, egg product, natural flavor, fish meal, flaxseed, salmon oil (source of DHA), potassium chloride, salt, choline chloride, dried chicory root, kale, chia seed, pumpkin, blueberries, oranges, quinoa, dried kelp, coconut, spinach, carrots, papaya, yucca schidigera extract, dried Lactobacillus acidophilus fermentation product, dried Bifidobacterium animalis fermentation product, dried Lactobacillus reuteri fermentation product, vitamin E supplement, beta carotene, iron proteinate, zinc proteinate, copper proteinate, ferrous sulfate, zinc sulfate, copper sulfate, potassium iodide, thiamine mononitrate (vitamin B1), manganese proteinate, manganous oxide, ascorbic acid, vitamin A supplement, biotin, niacin, calcium pantothenate, manganese sulfate, sodium selenite, pyridoxine hydrochloride (vitamin B6), vitamin B12 supplement, riboflavin (vitamin B2), vitamin D supplement, folic acid.
Contains a source of live, naturally occurring microorganisms.


Nutro Max chicken rice & turkey
Chicken Broth, Chicken, Beef, Beef Liver, Cod, Chicken Liver, Ground Rice, Rice Bran, Turkey, Guar Gum, Brewers Dried Yeast, Salt, Potassium Chloride, Carrageenan, Sodium Ascorbate (source of Vitamin C), Calcium Carbonate, Ferrous Sulfate, Choline Chloride, Vitamin E Supplement, Zinc Oxide, Copper Proteinate, Manganese Sulfate, Sodium Selenite, Thiamine Mononitrate (Vitamin B1), Biotin, Vitamin A Supplement, Potassium Iodide, Vitamin D3 Supplement, Vitamin B12 Supplement, Riboflavin Supplement

[arentspowell]

I'm not very family with Cushings since I am new here myself but I can chime in on the food concerns.

It seems like the weight gain was due to free feeding. Other than the weight gain was the food working and agreeing with her? If that's the case I would go back to that food and stick with it. The food roller coaster is not a fun ride to be on and switching between different formulas without a slow transition can cause gastro issues in some dogs. Since you have been free feeding up till now you will have to transition to set meal times. You can even use warm water or low sodium broth to make the food more enticing.