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LeighHop
10-29-2016, 12:42 PM
Hey There

First, I want to say thank you to all of the wonderful and caring people here who take their time to help and reassure others. I've been lurking for a couple of days and this is an amazing community.

I wanted to introduce myself and my sweet Schnoodle, Finnegan. Finn is 11 years old - a "once in a lifetime" dog - and is in the process of being diagnosed. I have no doubt that it's Cushings, but still working on the formal diagnosis.

I'll detail his history below, but for those of you who might not have time to read everything, I do have a question:

Has anyone experienced fast-growing lipomas along with Cushings? Finnegan has lots of little lumps and bumps, but two very large lipomas (both larger than the biggest egg I've ever seen) that seemed to pop up almost overnight. It scares me to think that he might be filled with these "harmless" lipomas.

Here's the history on my kid:

1. November 2015 - Southern California

Symptoms:

ALP: high 497 U/L (range: 5-160)
AST: high 62 U/L (range: 16-55)
Weight: 23.9
No outward symptoms


Synopsis:
Finn had a blood panel prior to a dental. The vet noted very slightly elevated liver levels. He felt comfortable continuing with the dental. Suggested an abdominal ultrasound if we wanted to be uber cautious. Unfortunately, we were in the middle of a move from California to Chicago, so we decided to keep a close eye on things before doing anything further.


2. May 2016 - Chicago

Symptoms:

ALP: high 531 U/L (range: 5-160)
ALT: normal 55 U/L (range: 18-121)
AST: normal 42U/L (range: 16-55)
Creatine: normal .9 mg/dL (range: .5-1.5)
Cholesterol: high 389 mg/dL (range: 131-345)
Na/K Ratio: low 27 (range: 28-37)
T4: normal 1.4 ug/dL (range 1.0-4.0)
Cortisol: normal 5.5 ug/dL (range 2.0-6.0)
Increased thirst/urination
Ravenous appetite
Panting
Weakness in back legs
Change in demeanor - just a bit slower/more tired
Lumps and bumps - one the size of a grape on his front left shoulder
Weight loss - 22.3 pounds (vet suggested he was underweight)

Synopsis:
While I went through the entire list of symptoms, the vet's only focus was on the lumps and bumps. She aspirated everything she could find. They were all considered lipomas with the exception of the grape sized lump on his shoulder.

Finn had the lump surgically removed. It was found to have traces of a vaccine in it, which was perhaps the cause, and it was removed with clean margins. Finn's liver levels were about the same as they had been in November 2015. Having done some research, I thought Cushing's was a possibility and brought it up to the vet. I can't remember why, but she dismissed this idea and suggested if anything, he might have Addison's. She did an additional test that might indicate Addison's, but it came back with normal levels. (Edited to add: The additional test was for cortisol and came back within the normal range, see above.) The vet seemed to chalk the rest of his symptoms up to old age.

During his post-surgery follow-up ten days later, the lipoma on his chest had gone from barely discernible to the size of a small egg. I pointed this out to the vet, and she dismissed it. Said these can grow quickly and as long as it wasn't impacting his ability to get around, we should leave it alone.


3. June 2016 - Chicago

Symptoms:

Increased thirst/urination
Ravenous appetite
Panting
Weakness in back legs
Change in demeanor - just a bit slower/more tired
Lumps and bumps
Weight: 23.6 pounds

Synopsis:
The lipoma on Finn's chest continued to get bigger, and I decided it was time for a second opinion. The second vet re-tested the lipoma on Finn's chest, again did not see any abnormal cells. He also seemed to think Finn was just suffering from some old age symptoms and suggested we might start him on arthritis meds for his legs sometime in the future. I guess this is what I wanted to hear, because I just let the fight about the other symptoms go.


4. October 2016 - Chicago

Symptoms:

ALP: high 1,835 U/L (range: 5-160)
ALT: high 349 U/L (range: 18-121)
AST: normal 41 U/L (range: 16-55)
Creatine Kinase: high 244 U/L (range: 10-200)
Cholesterol: high 528 mg/dL (range: 131-345)
Na/K Ratio: normal 29 (range: 28-37)
T4: low .9 ug/dL (range 1.0-4.0)
Increased thirst/urination (although less than in May/June)
Ravenous appetite
Quick breathing (no longer panting, just not breathing nice and relaxed)
Weakness in back legs (Sometimes quite bad)
Change in demeanor - just a bit slower/more tired
Weight gain - up to 25.0 pounds. (I do think he looks a bit pot-bellied.)
Lumps and bumps - Including a very large lipoma on his back left flank that grew to be incredibly large seemingly overnight

Synopsis:
The moment I found the new lipoma on his flank (which I think is bigger than the one on his chest, but it is hard to tell because of his muscle) I called the vet for a recheck. Lipoma came back with no abnormal cells and vet suggested we start Rimadyl for suspected arthritis in his back legs. (Any alarm bells going off out there?) He took a full blood panel, but sent me home with the Rimadyl and said we'd keep an eye on the lipomas.

I gave Finn one dose of the Rimadyl that night before I started reading about how toxic it could be for pups with liver problems. I did not give him any more doses. The vet called the next day with the test results. His ALT was 349 U/L (normal: 18-121) and his ALP was 1,835 U/L (normal: 5-160). Told me to stop the Rimadyl immediately and referred me to a specialty vet for an abdominal ultrasound.

We go for the ultrasound this Wednesday and then we will be working on the ACTH stimulation test.

While I like the personality of this vet, I'm concerned about his ignoring of Finn's symptoms back in June and obviously concerned about being given Rimadyl, which could have killed Finn. I'm thinking I need to find a third vet. Both of these vets are young, and I'm concerned they just haven't been around the block enough to know what's best for Finn.

Anyway, thanks for listening and I hope you don't mind if I keep updating this tread to bounce ideas off of all of you. (And just a reminder... I'd love to hear if anyone has heard of these large lipomas in connection with Cushings.)

DoxieMama
10-29-2016, 01:41 PM
Welcome to you and Finnegan! Sorry I don't have answers to your questions; hopefully others will be by later that might know something. Are you going to a specialist for the ultrasound? My vet frequently checks with an internist regarding treatment for Cushing's (though we haven't gone to anyone other than him except for the U/S).

Please feel free to keep this thread updated. Once you have those other test results, by putting them here, we'll have all the info too and can help support you in caring for him.

Shana

Whiskey's Mom
10-29-2016, 04:39 PM
Hi! My Whiskey has many lipomas. 2 of them are really big and Very jiggly. But they don't bother him so I'm leaving them alone. I've never really thought of them being connected to Cushings(which I'm Not sure he even has), but I'm sure it's possible. . I noticed the first one in 2009. Had it aspirated and Was a lipoma. We had several more biopsied about 2 years ago. All with the same results. . The vet has a chart of them so I made one too, but he's really lumpy and they all feel the same. He has elevated liver values too so I wondered if the 2 things were related. I did read that one theory of lipomas are that they are the result of toxins and since the liver isn't functioning properly maybe toxins are building up? And I'm sure all of this would influence cortisol levels. Just a theory of mine. I've learned way more from this forum than my vet, so keep lurking! I wish you and Finn all the best!

judymaggie
10-29-2016, 05:40 PM
Hi -- I wanted to welcome you and Finnegan! I have dealt with lipomas, some small, some large, some constant in size, some which get quite large, with both of my Cush pups, both beagles. Maggie, who has gone on to the rainbow bridge, had very large ones under her elbows and they had to be removed to allow her to walk properly. Abbie has a fast-growing lipoma behind one of her ears which the vet drains periodically so it doesn't press on her ear. I honestly think that lipomas are more related to a dog's age and breed than to Cushing's. Like Whiskey's Mom, the vet only removes those that are impinging on Abbie's movement, etc. He has aspirated some others that were questionable since Abbie has a history of a bilateral mastectomy.

I think it interesting that, in May, the vet thought Finnegan's symptoms represented Addison's and didn't seriously consider Cushing's since there so many overlapping symptoms. Can you find out what test was done at that time to eliminate Addison's as well as the results?

I am glad that you went with your gut and stopped the Rimadyl. In addition to negative effects on the liver, there are many, many stories of severe reactions. At my request, my vet has a big note in Abbie's file that Rimadyl is not to be prescribed.

We will be very interested in learning the results of Finnegan's ultrasound. Not only will you learn whether one or both of his adrenal glands are enlarged, but you should find out the health of other organs, including liver and gallbladder.

LeighHop
10-29-2016, 06:11 PM
Thanks so much for the warm welcome.

@DoxieMaMa - Yes, we will be going to a specialist for the ultrasound.

@judymaggie - I agree, the more I think about it, the more I'm confused about the original Chicago vet's thoughts on Addison's. I need to get Finn's records from the vet Monday. I'll piece it all together and post.

molly muffin
11-02-2016, 06:23 PM
Hello from me too. Well there are some overlap symptoms between addisons (low cortisol) and cushings (high cortisol).
The only test I can think of that would determine addisons is the ACTH. So, would be good to see what those results are and also what an LDDS and ACTH showed now as far as results. LDDS being the gold standard for diagnosis of cushings, but ACTH can show you what the cortisol levels are.
The LDDS basically tells the body suppress cortisol production and then you see the results of that at 4 and 8 hours while the ACTH shows what the resting (pre) level is and then tells the adrenal glands to dump all cortisol into the body and the follow up draw tells you how much was dumped, so how much are the adrenals producing.
These two tests can you give you some answers as to what is going on with the adrenals and cortisol levels and if these are causing the symptoms you are seeing.
Lipomas often do show up as a dog ages and probably one reason the vets keep focusing on age. However, that neither preculdes or excludes a cushing diagnosis which must be determined independently of the lipomas if they are found to in fact be lipomas and not cancerous.
The ultrasound will give you lots of bang for the buck as to how the internal organs look and if there are any tumors inside that need to be addressed, so I think that is a good call to have done.
Looking forward to hearing more about your adorable Finnegan.

LeighHop
11-07-2016, 03:40 PM
Thanks again for the support.

Finn's in for his ACTH Stimulation Test right now. I've updated my original post with his blood results to help me keep a record.

He had his ultrasound with a specialist last Wednesday. The adrenals actually looked normal, but the radiologist felt his bladder, liver and kidneys could be consistent with a Cushing's pup and recommended further testing. I'm working on getting the exact language, but he told me:

Cystitis and small grit/stones in his bladder which Finn should pee out. Grit in kidneys. Enlarged liver w nodules. Adrenals appear normal.

dsbailey
11-07-2016, 04:54 PM
The liver enzymes ALP, ALT progression upwards are typical with Cushings but can be caused by other diseases. I'd also opt for the LDDS inclusive of Ultrasound, and ACTH Test. Normal adrenal glands on an ultrasound are not the norm with Cushings. Because of this contradiction I'd leave no stone unturned before starting any Cushings Medication (Vetoryl / Trilostane or Lysodren). Has your pup been on long term steroids (Prednisone ...)? There's a third type of Cushings besides Putuitary (PDH) and Adrenal (ADH) called Atypical Cushings that presents itself as Cushings symptoms but is actually a result of over or long term use of steroids. There are others here that know more about that than myself and will chime in if this is also possiblity with your pup.

LeighHop
11-07-2016, 06:01 PM
@ dsbailey - Thanks for the thought. I definitely want to make sure we know what we have before we begin treatment. I'm frankly more afraid of him od-ing on meds than of his Cushings like symptoms at this point.

He's never been on prednisone for long periods of time, but tends to have pretty terrible allergies that have caused him to open up gashes from scratching. When he has one of those episodes (1-2 times a year) he is generally given a cortisone shot and possibly a course of prednisone. However, it's been about 18 months since that last happened.

We should know the ACTH results tomorrow. They did take his blood pressure today, which was elevated.

molly muffin
11-07-2016, 06:48 PM
Itrogenic cushings is the one that is due to prolonged steroid use and it doesn't sound like that is a particular issue if it's been 18 months since he was last on it for allergies.

There is a type of Atypical, and this is when the cortisol levels are normal on an ACTH but other sex hormones are elevated, also causing some of the same symptoms.
The only place that tests for this that I know of in the US is the University of Tennessee. They take the blood draws same as for an ACTH and send them to U of T and they run a panel of the sex hormones.

hmmm, BP elevated, did they do a urinalysis and kidney panel on him? BUN, Creatinine etc? how about protein loss in urine? Checked cardiology?

Just things I'm running through my head. What about check for lyme disease?

All things you can ask vet about too.

LeighHop
11-08-2016, 08:05 PM
Well, I think it's time to find another (third) vet.

Finnegan's ACTH test came back "borderline".

Pre: 7.3
Post: 24

The vet then went on to say since Finn isn't "clinical" he thought it was time to stop chasing Cushing's. Now, I am all for getting to the bottom of what's wrong with him - Cushing's or not, but I have been telling anyone who will listen to me at a vet's office all of his symptoms and it reads nearly a textbook definition of Cushing's.

When I questioned the vet on Finn not being clinical, I again ran down his symptoms and he said "well, the increased thirst could be Cushing's..." Ignoring his ravenous appetite, weak back legs, change in behavior and skin, etc. It made me wonder if he even knew the symptoms of Cushing's.

The vet suggested another blood panel and urine test as a next step, which I scheduled for tomorrow. But I'm seriously thinking about cancelling, doing some serious interviewing for a new vet and moving forward from there.

Is there really any point in checking his liver values again, a week later, when they've been showing a steady incline over the past year?

@ Molly... they did a urinalysis. Specific gravity was 1.017, protein was 3+ (300-500 mg/dL).

BUN was normal at 17 (range 9-31 mg/dL)
BUN/Creatinine ratio was 18.9. (I don't see anything that has Creatinine on its own, but a comment says "Both SDMA and Creatinine are within the reference interval which indicates kidney function is likely good.")

We haven't done anything cardiologic yet.

More than anything, I'm just frustrated that I'm not being heard about his symptoms. I don't keep brining him to the vet and getting second opinions for the thrill of it. Something is wrong with my kiddo and I'm having a hard time finding a vet who seems to want to focus on the big picture and not just liver results or lipomas.

Sorry for the rant guys, I know you all understand.

Renee
11-08-2016, 08:28 PM
My pug had similar ACTH results - I went forward with doing an LDDS, which turned out positive and we had our diagnosis.

LeighHop
11-08-2016, 09:37 PM
Thanks Renee. Always good to hear from someone with a similar experience.

LeighHop
11-09-2016, 01:23 PM
I took a deep breath from my ranting last night and Finn is going in for his LDDS test today. Will post results, hopefully tomorrow.

Harley PoMMom
11-09-2016, 09:45 PM
Wishing you and Finn the best of luck with the LDDS test and will checking back for those results ;)

LeighHop
11-10-2016, 07:44 PM
Well... the mystery continues with Finn.

His LDDS test came back normal. Great news from a Cushing's perspective but now we are back to square one on figuring out what's up with his symptoms and gradually increasing liver values over the past year.

I've started him on milk thistle and right now I'm tempted to just take a break and wait about a month and then recheck his blood.

Harley PoMMom
11-11-2016, 04:19 PM
Glad to hear that the LDDS test results were normal, if you wouldn't mind could you post those results for us? A bile acid test may be beneficial, this test measures how the liver functions and performs.

lulusmom
11-12-2016, 01:25 AM
Hi and a belated welcome to you and Finnegan.

Can you confirm that the results of the acth stimulation test you posted are ug/dl? If so, a post stimulated cortisol of 24 ug/dl is not borderline, it is consistent with cushing's. I don't know which lab your vet used but in the U.S. there are two labs that run the majority of acth stimulation tests and the LDDS. Those labs are IDEXX and Antech. I've included a link to the IDEXX interpretation for the cushing's diagnostic tests and the first chart is for the acth stim test which clearly shows that a post stim cortisol of 24 is consistent with cushings. I believe both labs consider borderline results to be less than 22 ug/dl and anything greater than 22 ug/dl to be positive for cushing's. While the LDDS is less likely to yield a false negative, it happens in less than 8% of cushingoid dogs so it's possible that Finnegan has cushing's but is in that minority of dog.

https://www.idexx.com/resource-library/smallanimal/snap-cortisol-testing-guide-en.pdf

Glynda