Wondering if my Golden Gracie could have Cushings?

[Fellasmom]

Hi!
I have been researching and lurking here for the last few weeks.I hesitated to post because back in 2013 you all were so helpful and supportive when my Fella died and I gave nothing back!I feel awful,wasn't my intention, but it was just too painful at the time to return here.But I don't think I would have survived his death if it weren't for all of you-you were amazing!!Unfortunately,I have very little faith and trust in vets,so I'm back with questions for the experts about Gracie,my 11.5 yr old Golden Retriever.

She has never been the same since my 14 yr old cat Buster died this past Nov.He was her very best friend.They slept together,ate together and she bathed him from tail to ears several times a day.I couldn't quite put my finger on what was different but she was off.It wasn't until about 3 wks ago when I brought her into VCA wknd emergency services for a presumed UTI,that I wrote down all the subtle and not so subtle changes since Nov.They include 2 UTI's,increased panting,urination,water intake,skin lesions/warts,hind leg tremors and weakness,8 lb wt gain,increased shedding w/hair falling out in area of wart.Decreased endurance,eyes appear altered,maybe a bit glassy.Appears depressed sometimes,not as engaging,doesn't greet me at the door most days which is huge change,less curious,less playful.Sleeps in the corner of room on tile floor instead of her bed,and seems very restless at night.I don't know how all these changes and symptoms cannot be connected!I have mentioned them here and there to the vet but never connected all of them and they were chalked up to changes in older dogs.They reminded me alot of the same symptoms of Cushings so I requested testing from my local vet office.She DID have a UTI with the following results:
ALT. 156 (12-118)
ALKP 223 (5-131)
BUN. 34 (6-31)
CHOL 368 (92-324)
TRIGLYCERIDES 538 (29-291)
AMYLASE 1595 (290-1125)
Precision PSL 275 (24-140)
CPK 57 (59-895)
PLT 457 (170-400)

URINALYSIS
PH 7.5 (5.5-7)
PROTEIN 3+
BLOOD 3+
BACTERIA RODS 26-130
SPEC GRAVITY 1.015 (1.015-1.05)
ORGANISM ECOLI ABX X10 days

I recvd above copies of lab results after VCA called me with the results but VCA vet said"labs came back good,kidneys good,BUN tad over normal but I would expect that in an older dog,same goes for the LFTS,but you can always follow up with an U/S. (She never mentioned the elevated AMYLASE as it looks like pancreatitis but she has no symptoms)At that point,I'm convinced she has Cushings so we proceed with some more testing.Local vet says do UCCR test first which comes back as "borderline,just over the threshold"
Btw,I DID post on the Cushings FB page and they were wonderful and cautioned me of those lab values possibly interfering with Cushings test results.However,both local vet and VCA didn't feel they were all that significant,with the exception of the UTI.She was still on Abx when UCCR obtained.Yesterday,I went ahead with the LDDS test (off abx x 4 days)and just recieved the call that she does NOT have Cushings!

PRE DEX 5.8. (1.0-6.0)
POST 4HRS 0.5. 《1 nl
POST 8HRS 0.2. 《1 nl
Also,during our appt last wk,I asked them to check her BP-220/120!!She was started on Enalapril BID with very small improvement which surprised me as the panting and restlessness at night seemed to lessen since taking the med.I started her on Amlodipone today and also haved an abd U/S sceduled and will get a CXR.

I was convinced it was Cushings!I don't know of any other disease process that would cause this constellation of symptoms.I'm trying to calm my anxiety about a tumor.I would be devastated but it wouldn't be shocking to learn she had a mass as she is 11.5 but even then,I don't know it would be the cause of so many of these symptoms in a relatively short period of time.Even the vet said that if somehow she had a mass,she would expect to see a sicker dog with likely wt loss,not gain.She eats like a pig,loves her treats,still OBSSESSED with her tennis balls and though tires easily,she still runs after them.Sorry for blabbing but I remember you ladies love details!Plus I wanted to see what your thoughts were.Based on the info above,can I be certain she does not have Cushings?Somehow I'm not convinced,so need to hear it from the experts.(I just remember so many dogs here either misdiagnosed or not being diagnosed for quite some time)Should I do additional testing with IME?I do plan on exploring why her BP so high.I'm giving her the meds because I'm worried but feel perhaps a cardiologist would be best.

Anyhow,thanks for listening.I hope you all are doing well.I've been reading a few threads and have been teary right along with you!You guys are so wonderful,loving and compassionate to your babies as well as complete strangers!Though once you've bonded over the death of your precious baby,strangers become like family.I sure do miss seeing Trish on here but great to see so many of you are still here!
Thank you once again!
HUGS
Patty

[Harley PoMMom]

Hi Patty!

It's good to hear from you, just wish it was under better circumstances, sorry that Gracie is having some issues. Yep, her symptoms do sound like Cushing’s and although her LDDS test results are negative for Cushing's there is a small percentage of dogs that do have Cushing's but test negative on the LDDS test. Was her thyroid checked and was diabetes ruled out?

So, if this were me, I would have her urine cultured to make sure that nasty UTI is completely gone and you definitely want to have her BP rechecked because uncontrolled high BP can cause all kinds of damage to a dog's heart, kidneys, eyes...etc. If her symptoms persist after both of these health issues are resolved than maybe a revisit to a Cushing's diagnosis is in order.

Hugs, Lori

[Fellasmom]

Hi Lori!
Nice to hear from you and thanks for the input.I'm not entirely sure her UTI is resolved.She seemed back to normal for a few days but today urinated a few extra times than usual.I hear that Ecoli can be difficult to effectively treat sometimes.

I decided today that I am going to switch all her care to VCA.They are much too corporate nowadays,overcharge and often do unnecessary tests,BUT they are specialists and have every service in house that the IME can consult with.I'm VERY worried about her BP and the local vet just didn't seem as concerned as I think she should have been.In addition,when I picked up her new med,the instructions read"One pill every 12-24 hours"...THAT needs to be clarified.It's not as if I have a BP monitor at home that I can dose her as needed based on results.I gave her one and will call in the morning.

Interesting that some dogs can still have Cushings but have a negative LDDS.She sure has alot,if not all,of the symptoms.Her BS was nl in the 80s and they only did a T4 which was nl.

Incidently,I learned that she is prone to UTIs as she has a hooded vulva...who knew!!Lol-Preventative instructions were to keep area dry and air out her vulva as often as I can!!She has no problem with that as her daily ritual is to drop her tennis ball in the yard,she then lies on top of it,rolls back and forth,and then lies motionless,legs spread in the air!!Just airing out the vulva!:)As my mom always says,there's nothing GRACEful when it comes to Gracie!:)

Thanks again for getting back to me so quickly.Hope you are doing well and enjoying your summer.
Hugs,
Patty

[labblab]

Hello Patty, and welcome back to us! I am so very sorry, though, to learn of Buster's death and Gracie's problems. Hearing how Gracie has grieved for Buster brings tears to my own eyes. :o

As far as Gracie's health issues, though, I have to agree with you that Cushing's surely does "check all the boxes" and those negative LDDS results are a surprise. Like you, I'm also puzzled as to why no mention has been made of the possibility of an ongoing issue with pancreatitis, since not only was Gracie's amylase elevated, but so was the Precision PSL, which is a specific test for pancreatitis. I don't believe age has any bearing on that particular result, and a positive is a positive. However, even though pancreatitis could account for a few of Gracie's abnormalities, I agree with you that the overall picture is indeed suggestive of Cushing's.

One additional test that you might consider is the good old ACTH stimulation test. For dogs who are strongly symptomatic but test negative on the LDDS, the ACTH may offer useful information. Here's a quote from noted endocrinologist, Dr. David Bruyette.


When interpreting LDDS test results, first evaluate the eight-hour post-dexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

If an ACTH also turned out to be negative, then we'd be back to feeling pretty stumped. But if is was instead positive, then you'd have better reason to believe that pituitary Cushing's is actually at play, after all.

Please do keep us updated, OK? Sending my best wishes to you alongside loving memories of your sweet little Fella, and also my sincere sympathy over your loss of Buster.

Marianne

[Fellasmom]

Hi Marianne!
So nice to hear from you and thanks for the great advice.I was really surprised that the LDDS was negative as well.She has ALL the symptoms!And thanks for your condolences about Buster and Fella.She misses him so much.Great advice about obtaining an ACTH.She is scheduled for an ABD U/S and I'm going to VCA for more precise BP readings as well as addtl labs-I will ask them to do the ACTH too.Most concerning is her high blood pressure.I'm hoping that will improve with the new meds.

I hope you are doing well.Happy to come back and see many of you are still here.This group has been amazing to so many.As always,thanks for your infinte wisdom and I will keep you posted.Thanks again!
Hugs
Patty