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trishlhk
07-27-2016, 11:18 AM
Good Morning All,

I am Trish and my fur-baby is Kody (short for Kodiak). Kody is a soon to be nine year old Golden Retriever and our second son if you will.
I have found myself here after scouring the internet researching Cushing's Disease as our vet mentioned there are some signs point to this being a probability. We have been taking Kody to the vet for recurrent skin infections, and had a senior lab panel done. We perhaps suspected maybe thyroid or diabetes issues, but that wasn't the case. (I am including labs here). Based on low Lymphs and dilute urine, and of course his signs and symptoms, she suspects Cushing's. (after reading about symptoms, he has skin issues and infections, always drinking and peeing, I don't know if he has a pot belly?? Skin is gray/black in some areas, hair grows back weird from clipping, pants most the time. I believe he seems hungrier more often now too.)
The initial test she wants to run is the LDDS, and they have quote this at $315 (includes stay at vet for day etc.) Very pricey in my book in comparison to some, which is disappointing. But I feel like we need to confirm this.
I am open to any comments, learning, etc. as this is a totally new path for us.

Thanks!

HCT 47.0 % 38.3 - 56.5
HGB 18.0 g/dL 13.4 - 20.7
MCHC 38.3 g/dL 32.6 - 39.2
WBC 8.9 K/uL 4.9 - 17.6
LYMPHS 9.3 %
MONOS 4.7 %
EOS 3.8 %
BASO 0.0 %
RBC 7.35 M/uL 5.39 - 8.70
MCV 64 fL 59 - 76
MCH 24.5 pg 21.9 - 26.1
NEUT SEG 82.2 %
PLATELETS 270 K/uL 143 - 448
RETIC CNT 0.7 %
ABS BASO 0 /uL 0 - 100
ABS EOS 338 /uL 70 - 1490
ABS LYMPHS 828 /uL L 1060 - 4950
ABS MONOS 418 /uL 130 - 1150
ABS NEUTS 7316 /uL 2940 - 12670
ABS RET 51 K/uL 10 - 110
ALB 2.9 g/dL 2.7 - 3.9
ALKP 46 U/L 5 - 160
ALT 23 U/L 18 - 121
AST 27 U/L 16 - 55
BUN/UREA 15 mg/dL 9 - 31
Ca 10.1 mg/dL 8.4 - 11.8
Chloride 112 mmol/L 108 - 119
CHOL 243 mg/dL 131 - 345
CK 122 U/L 10 - 200
CREA 1.1 mg/dL 0.5 - 1.5
DBIL 0.1 mg/dL 0.0 - 0.1
GGT 3 U/L 0 - 13
GLU 105 mg/dL 63 - 114
PHOS 3.7 mg/dL 2.5 - 6.1
Potassium 4.3 mmol/L 4.0 - 5.4
Sodium 147 mmol/L 142 - 152
TBIL 0.1 mg/dL 0.0 - 0.3
TP 6.4 g/dL 5.5 - 7.5
GLOB 3.5 g/dL 2.4 - 4.0
ANION GAP 17 mmol/L 11 - 26
BICARB 22 mmol/L 13 - 27
IBIL 0.0 mg/dL 0.0 - 0.2
A/G Ratio 0.8 0.7 - 1.5
B/C Ratio 13.6
Na/K Ratio 34 28 - 37
SDMA 7 ug/dL 0 - 14

DoxieMama
07-27-2016, 12:15 PM
Hi Trish, welcome to you and Kody. I only have a moment (peeking in from work! :p) but wanted to say hi. I'm sure others will stop by later today and provide their insights.

Are low lymphs and dilute urine the only abnormalities indicated? Everything in the bloodwork appears to be within the normal ranges you listed, though I'm far from an expert and might be missing something.

You've found a great resource joining here. We'll stand beside you in this journey so you don't have to go through it alone. :)

Hugs,
Shana

trishlhk
07-27-2016, 12:28 PM
Correct, the low lymphs and Dilute urine was all that was indicated. Again, I don't know much about this, so of course my Husband and I are freaked out. I guess perhaps she is taking into consideration his symptoms too. She said based on the lymphs/urine, she would guess 60% that he has it. I think she said if he had something with kidneys or liver it would make her think 80%. I assume the LDDS is to be sure?
Pardon any of my ignorance on al of this. I have been digesting it all in in the last couple days.
Thanks for saying hello!

DoxieMama
07-27-2016, 02:22 PM
Hi again Trish, if you haven't already found it, here's a link to our Helpful Resources forum: http://www.k9cushings.com/forum/forumdisplay.php?f=10 That has all kinds of articles and other info that might help.

It is interesting to me that most of his numbers are within normal limits, other than those you mentioned. Hopefully one of the admins or other knowledgeable folks will be by to provide their insights.

For what it's worth, the LDDS is the "gold standard" for diagnosing Cushing's when other things have been ruled out (as thyroid and diabetes have been ruled out for Kody). It is what I had done for my pup. In addition, many have an abdominal ultrasound done, as that provides a lot of information at once. I chose not to do so at the time (and kind of wished I had, though it was even more expensive than the LDDS test for us).

Shana

trishlhk
07-27-2016, 02:31 PM
Thank you again! He is scheduled for the LDDS tomorrow. I am trying to stay as rational and level headed as possible. My husband is a wreck on the other hand. My husbands dad passed a year ago and his step dad a few months after that, then some family issues because of all that. He is mortified that something is going on with the dog and fears the worst.

judymaggie
07-27-2016, 03:18 PM
Hi, Trish & welcome to you and Kody! Thank you for providing so much info about Kody -- this helps us in turn help you. I will say that Kody's symptoms and lack of significant lab results do not scream Cushing's to me. That said, not every Cush pup follows the same symptom pattern. Typically, Cush pups will have elevated liver enzymes as well as elevated cholesteral and triglycerides. This is probably why your vet mentioned a higher likelihood of Cushing's if these labs were abnormal. Was there anything else of significance on the urine tests other than dilute urine?

Shana gave you the link to our Resources forum -- to get you started, here are two links to specific articles, one is a column written by Kate Connick -- I like it as it is written in "plain" English. The other link is to a pamphlet provided by Dechra, the manufacturer of one of the drugs used to treat Cushing's. Pages 1-5 give good general info about Cushing's.

http://www.kateconnick.com/library/cushingsdisease.html

http://www.dechrace.com/pdfs/vetoryl/VetorylClientBrochure5mg.pdf

I would recommend that you start a file with hard copies of all of Kody's test results. This will help you answer our questions and will also be beneficial to you. The LDDS test tomorrow will have three numbers (a baseline, a 4 hour and an 8 hour) that we will need to see.

You are now part of our family. Hopefully, we can reassure you and your husband as you travel down the diagnostic path and, if necessary, beyond.

dsbailey
07-27-2016, 03:32 PM
The initial test she wants to run is the LDDS, and they have quote this at $315 (includes stay at vet for day etc.)

Maybe you could save a few bucks by bringing your pup home or out and about between blood draws. I took mine to grandmas for 4 hours then second draw, home for 4 hours, then back for the final. Also may relieve some of the stress.

Just an idea - Darrell and Lolita

trishlhk
07-27-2016, 04:00 PM
Thank you Judy, Darrell and Lolita!

On saving some money for the test, the office charge is 41- not a huge savings and the vet, work and home are pretty far apart.

As far as the other tests, I was surprised there were no other indicators as well. Based on my reading so far, the liver is usually affected, or can be?? She did not go into anything further on the urine, except that is was hazy. I mean, I really hope that the test is all for naught. If he does happen to be going down the Cushing's path, we sure what to know and do what we can.

When I drop him off in the morning, I am going to ask for the urine info, I don't think it was in that list of results was it? Same with thyroid. She told me it was 1.4 which was in normal range (1-4). As I am going over my notes from my phone call with the vet, I have a note to the side that says PH Slightly high. Does that help at all??

molly muffin
07-27-2016, 07:47 PM
Hello and welcome from me too.

The lab work doesn't scream cushings, but as Judy stated, not all dogs show the same symptoms either in general or on lab work, most do have a slight to large increase in ALKP. Good that he doesn't have that.

I'd be interested in seeing the urine results, like the specific gravity, which is what I'm guessing is low (dilute) But I think I might want to see if that is consistently low or not and maybe take in a first catch of the morning and have a full urinalysis and culture done. I'm not totally on board that this is cushings yet.

Does he have allergies causing the skin infections and has that ever been under control? I'm wondering about other things being the root problem with his lab work actually being very good.

Whiskey's Mom
07-27-2016, 09:51 PM
Hi & Welcome from a fellow Golden who is my third child-My daughters call him their baby brother:) you've come to the right place, I've learned so much. Good luck with everything!
Annie and Whiskey

trishlhk
07-28-2016, 01:39 AM
Hi Sharlene and Annie! Thanks for the welcome! Sharlene, I agree it isn't screaming Cushings, but of course now I am all crazy paranoid :( he has had the skin issues the last three years now, definitely worse in the summer. He is fed non grain, fish based food (taste of the wild) and I give him omegas on top of that to help. I assumed it was always allergies. It is tough though cause the meds don't always clear up the skin issues. It ends up spreading like wildfire all over him, then the hair falls out and grows back odd. We are on a rouine of washing with duoxo and supplementing in between baths with the foam or spray. This last visit he had yeast in the ears. Aside from an occasional ear infection when younger from swimming, he has always been healthy minus the last few years of skin issues. When I watch him now though, he pees all the time, drinks a ton, lays around kinda pouty like. His skin has changed color under the fur, kinda gray now. I am not sure what to think. While I don't really want to lose the $300, I guess it might be better safe than sorry at this point??? I tell you what, emotions over our fur babies are no joke!!

molly muffin
07-28-2016, 08:21 AM
Was he given prednisone for his skin issues?
Yep we do run the full gamut of emotions around here. :)

trishlhk
07-28-2016, 09:56 AM
He has been given a steroid injection twice now for the skin infections. Not back to back, but over he last three years, that has been in the last year. Due to itching I think?

trishlhk
07-28-2016, 01:34 PM
Well- Kody is at his vet today for his LDDS test. I felt so sad leaving him there. I am a sissy and brought his little baby for him to have in his kennel. (I think I uploaded a picture of him sleeping next to it- lol)
Crossing my fingers that this was just a very very cautious test for him and that he is ok.

DoxieMama
07-28-2016, 03:01 PM
You're not the only one... I brought my dog's blanket for him when he had his LDDS test. The vet's office took his picture in the kennel because he was so relaxed and cute. :)

Kody will do great today mom!

trishlhk
07-28-2016, 03:10 PM
Thank you so much. My poor husband too, I am trying to keep him calm. He is so so sad thinking Kody might have this and is having a hard time keeping his head above water. He has lost a lot in the last year and this is not something he is ready to deal with. I keep telling him to be positive. Even is Kody has cushing's, we will work with it.

DoxieMama
07-28-2016, 04:18 PM
Yep. Cushing's is treatable and though scary at first, it's not so bad after a time. Hang in there.

trishlhk
07-31-2016, 03:37 PM
Well, I missed the vet's call yesterday and she didn't call back before she left. I called back this morning and was able to wheeze info out of the tech. The Vet is waiting to speak to an internal specialist because Kody's findings are borderline. Has anyone gotten those type of results? I will know more details tomorrow.

lulusmom
07-31-2016, 06:02 PM
Hi Trish and a belated welcome to you and Kody,

I agree with the others that nothing is screaming cushing's to me either. It would be very odd if Kody had cushing's as his blood chemistry is perfect and the only other abnormality is the low lymphocytes on the cbc which can be explained by lymphatic atrophy that can come with age. I would have danced on my dining room table if either of my cushdogs had those kind of results before or after treatment. You mentioned that the urine was dilute. It would be helpful if you would please ask the vet for a copy of the urine test and post the urine specific gravity (USG) for us. If high levels of cortisol is causing Kody's kidneys to stop concentrating his urine, the USG will be very low. Is Kody have accidents in the house and is he drinking buckets of water? Does he have a voracious appetite, as in constantly foraging, whining and begging for food? You mentioned that when Kody's hair falls out due to his skin issues, it grows back but the regrowth is different. If a dog with uncontrolled cushing's loses hair or is shaved, the coat is very, very slow to regrow, if at all. The change in coat is common but that happens after the dog is stabilized on treatment and the hair finally starts to grow. We've had many members report weird color and texture.

Dogs with cushing's have very high levels of cortisol in their blood and as the disease progresses, the immune system is compromised which would explain the chronic infections; however, I'm not convinced that with such great blood labs, Kody has high levels of cortisol that is tamping down his immune system. Some dogs have chronic skin problems due to autoimmune issues which is completely different. Has your vet done skin scrapings and/or biopsies to identify the skin problem to rule out other causes or is s/he convinced that Kody has cushing's because he is drinking and peeing too much? If so, I will be very interested to see if the USG supports this assumption. Cushdogs can actually mask symptoms of wildly itchy skin caused by autoimmune problems so the itchy skin isn't something we see here very often and when it does, it usually happens after treatment is started.

I note that your vet is calling a specialist to consult on the results of the LDDS test because it is borderline. I was very happy to hear this and hope that your vet fills shares Kody's entire history with the specialist so that if a cushing's diagnosis is to be confirmed, your vet is validated by an internal medicine specialist who has been fully informed. FYI, there is really no such thing as a borderline LDDS response. The results are either consistent with cushing's or they're not so I will be very interested to hear what the specialist has to say.

With the exception of excessive drinking and peeing, I've had rescue dogs with horrifically itchy skin that could only be controlled with steroids. They were very lethargic because they were worn out from the constant itching and scratching. It is heartbreaking to watch and I've spent many sleepless nights with them because they are constantly scratching and biting. My best friend adopted one of them and was able to achieve some control through diet but the flares were frequent. Then Apoquel hit the market and it was like a miracle drug for this dog who had been plagued with itchy skin his entire life. He was like a new dog, more active and much happier. I am afraid that even if Kody has elevated cortisol, effective treatment will not help his itchy skin. As a matter of fact, it could get worse as cortisol is a very effective anti-inflammatory so a lot of cushdogs with itchy skin and arthritis can be quite miserable once cortisol is reduced to much lower levels with treatment. If the LDDS truly is negative for cushing's, which would not surprise me, you may want to consider talking to your vet about a trial of Apoquel to see if it helps Kody. Of course, that won't help resolve the excessive drinking and peeing if that problem is being caused by cushing's or any other underlying issue.

I'm sorry for writing a novel but I wanted to cover all the bases because based on what you have shared so far, Kody does not present as a cushingoid dog. I'll be looking forward to your updates.

Glynda

trishlhk
08-01-2016, 02:33 PM
Hi Glynda and thank you so much for all of the information. I don't have the urine test on me, but I know the specific gravity was 1.010- which from what I am finding, that is JUST low compared to normal results.

I haven't heard back from the vet yet this morning, but as far as symptoms, the drinking water and foraging for food is constant. I was paying attention this morning between 5-7 when I get up and ready for work, and Kody had gone out to pee three times in that time. He has not yet had any accidents. As far as appetite, I actually have to be hyper vigilant now, he has been begging and searching more, and then I caught him trying to eat poop the other day!! We decided to feed him and extra bit of food in the evening and he seems "OK" with that.

With the hair, when it comes out with the skin issues, it does grow back, but it is thinner and just different from the rest of the hair. Almost like the area is scarred?? Not sure how to explain that. There are patches on his belly where it is just gray skin.

He has been treated a couple times with steroids for the skin, but I don't know if I want to continue that route. The scrapings confirmed bacteria on the skin when it is inflamed and infected. That part does clear up with antibiotics and specialty shampoo bathing.

We recently changed his diet some to cater to allergies in case that was the cause, but it has only been about a month and I know it can take a few months for it to show. I have added omegas and changed his food to fish based versus chicken/beef. It has always been grain free, etc. (Taste of the wild- altantic I think?)

I will keep you posted on what I hear today and also get info from the urine tests. I can't recall anything other than the specific grav- OH, his PH was elevated to 8- other than that, nothing was off from when I looked at it.

Talk to you soon. Keeping my fingers crossed on all this!

trishlhk
08-02-2016, 12:27 PM
Good Morning All. So, Kody's LDDS was inconclusive based on the labs parameters I guess....

Here are the values:

Start: 6.2 (6.0 lab) - Slightly elevated
4Hrs: 1.3 (1-1.5) In the "gray" area for lab- usually under 1 confirms cushings
8Hrs- Also 1.3 (not sure on range here, waiting on paperwork)

As far as the initial urinalysis here are the values- again clear aside from the dilute urine.

Bacteria- none seen
bilirubin- neg
blood- neg
casts- none seen
clarity- clear
color- yellow
cyrstals- none seen
epi cell 1+ (1-2)/HPF
Glucose- neg
Ketones- neg
Mucus-none seen
other- see notes
PH 8.0 (vet said is high??)
Protein- neg
RBC 0-2HPF
SP Gravity 1.010 (slightly low per vet??)
UROB Normal
WBC 0-2HPF
Other: Note- amorphous debris present

So, what the vet said, is watch and wait, perhaps we caught things just as they started etc. Not sure how on point this is as of course this is my only experience so far.

DoxieMama
08-02-2016, 02:30 PM
I'll be interested in hearing what others think - but that looks to me like a negative result for Cushing's.

labblab
08-02-2016, 03:34 PM
Start: 6.2 (6.0 lab) - Slightly elevated
4Hrs: 1.3 (1-1.5) In the "gray" area for lab- usually under 1 confirms cushings
8Hrs- Also 1.3 (not sure on range here, waiting on paperwork)

I think that when you actually get ahold of the paperwork, you will find somewhat different notations. It is actually the 8-hour response that determines whether or not the result is consistent with Cushing's. It would appear as though this lab's cut-off value is 1.5 -- meaning that an 8-hour result lower than 1.5 is "normal," a result higher than 1.5 is consistent with Cushing's. If the 8-hour result points to Cushing's, then the 4-hour result becomes of interest because it can help differentiate between the pituitary and adrenal form of the disease.

In Kody's case, if his 8-hour result had been higher than 1.5 and therefore consistent with Cushing's, then his total profile would point towards pituitary Cushing's. But at 1.3, his result doesn't fall within the range that is consistent with the disease. It's close, but not actually there. So that's why I suspect your vet is labelling it as being borderline.

Marianne

trishlhk
08-02-2016, 03:48 PM
All so very confusing. With the gray/borderline findings, does this indicate that perhaps he will show for it later? Or if it is considered borderline/neg, he won't develop it?

Really the only way to be sure is watch symptoms etc and test again later right??

labblab
08-02-2016, 04:03 PM
Yes, that's really pretty much true: watch and perhaps retest. It is possible that Kody is in the early stages of the disease, as your vet has noted. If so, his test results could shift later on down the road into the positive zone. There is another diagnostic blood test that can be performed to test for Cushing's, the ACTH stimulation test. A small percentage of dogs who test "negative" on the LDDS will turn up as "positive" on the ACTH, especially if the disease is in the early stage. However, in glancing back at your thread, it looks as though Kody lacks other abnormalities that are pretty common with Cushing's, although I see now that his urine does have a lower specific gravity.

It will be interesting to see whether the specialist recommends an ACTH at this point, or instead just watchful waiting at this stage.

Marianne

trishlhk
08-02-2016, 07:34 PM
Hi Marianne! Thank you again so much for your help and guidance. I mean, the vet did talk about some of this with me, but I feel like I understand better in real people speak from someone who has gone through this from the non-vet side.
The vet did originally give me a quote for the ACTH (I think I got that right). After my discussion with her yesterday, she suggested waiting a little bit, and keeping a sharp eye on symptoms. She said she is afraid that more tests may just come back inconclusive at the moment and end up being more expensive than anything. But yes, that was suggested initially.
Looks like we will kind of pencil in the test for the next maybe 6 months? Or of course if symptoms make an intense turn.

If no one minds, I wouldn't mind hanging out on the site may say hello and check in and read on about others as we slowly walk through this new area in our lives. Does anyone suggest anything as far as natural changes we can make for him to support him as this progresses?

I am so glad I found you all.

Squirt's Mom
08-03-2016, 09:24 AM
Of course, you must stick around! You and Kody are family now! ;):)

If I were you I would try my best not to worry about Cushing's but keep the signs in the background just in case. Most of all, I would enjoy every minute with my baby, creating as many new memories as possible. Should the signs start to appear, your sweet baby will be subjected to more vet visits, pokes, and prods than you can imagine - so for now, let him simply enjoy life with his family and hold off on any more testing unless you have strong indicators something has changed. ;)

Meanwhile, you can read the threads and posts in order to learn, and talk with others who may be unsure of a diagnosis, sharing your experiences as well as hope and support. And we will want updates on what Kody is up to from time to time! :D

Hugs,
Leslie and the gang