My girl Babbs

[JaneB]

So happy to have found this site and hope that I can do more for my girl Babbs who is 13 1/2 and hasn't fully been diagnosed with Cushings, she has just had the urine test and that was in the Cushing's numbers. I can either opt to have the further testing or wait and see how she's doing. The symptoms are there, excessive thirst, leaking, hunger, losing a tremendous amount of fur, bilateral sores on her legs and between legs, panting, unable to tolerate heat. She is a sheltie and has been having problems for years. Has had ultrasounds because of her high ALT (have ranged from 400's to 900's); ultrasounds show thickening in the intestines so we treat for that with Ursodiol. She's on thyroid meds as well and of course Denamarin for liver support. This Cushings issue was discussed and dismissed way back, but now, after taking predinisone to aid in healing her intestinal problem, she seems to have developed the dreaded disease. I need advice as to whether to go ahead with the testing or to do the very best I can with diet, meds, care, washing, etc. I read about mixed emotions and would love to know more before setting her up with a prescription that will make her worse. I am her advocate...she is my girl. I also have another sheltie that is 8. I have all the labs in a folder and keep close records if someone would like to analyze. Thank you. I will be reading on.

[Joan2517]

Hello and welcome to you and Babbs. if you could, please post the blood work results, Just the highs and lows along with the reference ranges. Those more knowledgeable than I am will want to see them and will do their best to help you through this.

[Squirt's Mom]

Hi Jane,

Welcome to you and your sweet girl, Babbs.

Yes, it would help us a great deal if you would post the abnormal results from her labwork as well as any information from an abdominal ultrasound, ACTH, or LDDS.

The decision to treat is very personal, and gets more so when the dog is getting on up in years. 13 1/2 is at that point when you really want to look at the pros and cons of treating. For example often inflammatory conditions like arthritis are held at bay by the elevated cortisol but when that is lowered back to a more normal level the dog begins to exhibit more signs of the arthritis. Same with allergies and other such conditions. So you really want to look at your baby and weigh the balance. We will be more than happy to help in any way we can no matter what you decide.

I'm glad you found us and look forward to seeing those test results.
Hugs,
Leslie

[Harley PoMMom]

Hi and welcome to you and Babb from me as well!

Is she still taking the Prednisone? It sounds like Babbs had a screening test called the urine cortisol creatinine ratio (UC:CR) and if this was done while she was taking the Prednisone than a false positive result is likely to happen. Ideally when any test for Cushing's is going to be performed all steroids need to be stopped for at least 24 hours beforehand and the steroid has to be slowly tapered.

All of her symptoms could be from the Prednisone, which is known as Iatrogenic Cushing’s, and the only treatment needed is to withdraw the steroid use in a gradual manner.

You mentioned in your post that a diagnosis of Cushing's was dismissed a while back, could you elaborate more on that for us, such as why Cushing's was suspected?

Please know we will help in any way we can and do not hesitate to ask all the questions you want.

Hugs, Lori

[JaneB]

Thank you all for your replies. Babbs was tapering off the prednisone when I brought her in on 7/4 to the ER. They then took her off completely and the urine test for Cushings was done on 7/6 which showed her numbers were elevated and on my last vet appt. he said we should probably do the further testing to see if she has Cushings. His staff told me when they called with the urine results that her numbers were just barely high and that I could elect to do further testing but that if she did have Cushings the treatment would probably be worse for her as a senior dog. He told me in the appt. he didn't say that and would test. Can I post copies of her labs as well as pictures of the ultrasound results here. I just want to make sure it's alright to do that before uploading. Thank you all. Here is a list of her meds to date: Ursodiol, Thyro Tabs, Proin, Denamarin, Pepcid AC and Marin Plus. I also put Desiden to keep her sores at bay. She has just finished two series of Amoxicillin for pancreatitis. I will upload or type in the information for her labs and ultrasounds, whichever is best. Thank you all again.

[JaneB]

Hello Harley PomMom. Babbs was one the prednisone when I took her into the ER, at that time she was tapering down to 1 pill. The vet there took her off and it was two days later that I gave my vet a sample of her urine to analyze for Cushings and diabetes. So it was out of her system for a couple of days. I just posted a quick reply to all of you and do not see it. Could you tell me if you are seeing it? Thank you.

[lulusmom]

Hi Jane and a belated welcome to you and Babbs.

I am not sure you saw Lori's response to you about iatrogenic cushing's which is caused by oral or injectable steroids. If Babbs developed symptoms associated with cushing's after starting the steroids, then I seriously doubt that she has naturally occurring cushing's. Resolution of symptoms after withdrawing from oral or injectable steroids is not instantaneous and can take a bit time. To test for pituitary or adrenal dependent cushing's only two days after withdrawing from steroids, which is the likely culprit, is way too soon. Additionally, Babbs had a lot of stuff going on around that time, any one of which could have caused a high urine cortisol creatinine ratio. that particular test is very sensitive so any illness that causes physical and/or even emotional stress can yield a positive result in a dog who does not have cushing's. Have you had any recent blood labs done and if so, can you get copies and share just the high and low values with us? If not, I personally would make sure all of Babbs' other issues have been completely resolved and if you feel that she is still showing cushing's-like symptoms, then I would have have a complete senior screening done which would include the blood chemistry, complete blood count (CBC) and a urinalysis. Dogs suspected of having cushing's should has have a urine culture and sediment done as these dogs have dilute urine which is a breeding ground for bacteria that is not picked up on a standard urine test. There are definite abnormalities on one or all of these tests that are consistent with cushing's so if those flags are there, then you move forward with additional testing to button up the diagnosis. FYI, I have seen very few Shelties with cushing's in all the years I've been following threads and I've seen a few with gall bladder mucoceles being treated with Ursodiol. Shelties seem to be at the top of the list of breeds who are genetically predisposed to mucoceles. They are also a breed that seems to be predisposed to hyperlipidemia which increases the risk of pancreatitis. I am wondering if Babbs has high triglycerides and cholesterol? When was the last time her thyroid hormone(s) were checked? I will be looking forward to your updates.

Glynda

[Harley PoMMom]

It'll be easier for us if you would were to post the results from her lab work and ultrasound here in Babbs thread, as an example: ALT 155 U/L (5-50), you need only to post those values that are marked abnormal...thanks!

Two more question regarding the UC:CR test :o, was Babbs having the pancreatic episode when the urine was collected and was the urine sample taken when she was at home? I ask because any non-adrenal illness and even stress can yield a false positive result. However, since Babbs UC:CR was just barley high, and if this were me, I really don't think I'd start treatment for Cushing's.

My Harley had chronic pancreatitis and it can be a real bugger to get under control. Some things that can help are feeding several small meals throughout the day, having them on a low fat diet is also highly recommended, keeping them hydrated, and making sure they are at their ideal weight since obese dogs are more prone to pancreatitis.

Oh, and yes, your reply can be seen. ;)

Hugs, Lori

[JaneB]

Harley PomMom,

I will post the results of blood tests and their dates for everyone to see. When I took Babbs' urine it was first thing in the morning here at home. She definitely was stressed still because she had gone to the ER 2 days before and vet's office the subsequent days.

[JaneB]

Here are the result Babbs' labs starting 7/4/17 that were elevated.

7/4/17 -
LYM 1.03 (Low) Ref Range 1.05 - 5.10
BUN 77 " 7-27
ALT 763 " 10 - 125
ALKP 1932 " 23 - 212
GGT 45 " 0 - 11
CHOL 32 " 11- - 320
AMYL 1580 " 500 - 1500
Na 162 This is when I brought her to the ER

7/6/17 -
BUN was in normal range w/subcutaneous fluids
ALT 790
ALKP 1636
GGT 41
AMYL 1645
Na 164.

7/12/17 -
BUN 69
ALT 838
ALKP 1294
GGT 24
CHOL 346
Na 161
Cl 123

7/18/17 -
BUN 43
ALT 732
ALKP 1026
GGT 25

8/25/17 -
BUN 34
ALT 636
ALKP 829
GGT 32
AMYL 2167
LIPA 5492
Was treated to pancreatitis with Amoxicillin 100 mg. - 2 series.

TT4 2.9

It's time for me to bring Babbs back in for labs - I'm worried that she is not feeling so well since she has come off the antibiotic again. The Proin that they put her on is working - no more leaking but more thirst than the usual. If I bring her in I think the vet will want to do that testing that they have to do over the course of the day. He said I could bring her in in the morning pick her up after they inject her with whatever the hormone is, he'd test her blood then, and then I'd bring her back in the afternoon to do similar. I could leave her all day but would rather not. I just don't want to stress her out.

Thanks all.

[Harley PoMMom]

Could you edit your post to include the reference ranges and units of measurement for those values you posted? Thanks so much!

[molly muffin]

Hello from me too.

I'm inclined to think that the cushing symptoms are likely assosicated with the prednisone, as she would need to be off that for a couple weeks (I think that is the wash out period) then tested for high cortisol. However, having said that if she has pancreatis, then it will probably show high cortisol anyway. Any time there is something else going on the cortisol will rise.

Along with pancreatis, the high ALT and GGT indicate a liver issue, likely associated with the thickening of the intestine. So her cortisol will probably continue to be high. You might try to bring that down a bit with some vetroyl, but I would want to discuss that fully with the vet and the manufacturer Dechra before going down that road.

Your baby certainly seems to have some serious issues going on, and either way you are going to want the pancrease to be well before considering cushings in the mix, which I'm not sure is there yet, in light of the other issues and the prednisone.

[JaneB]

Vetroyl is for Cushings correct? I'm very nervous about any other meds for her. I have to give in I guess and go for the further testing. I've put it off, but it's at least time to get bloodwork done first for now. That will tell us where she's at and then I can decide whether to further test. I worry about making matters worse. Hoping the pancreatitis has cleared up. Thank you for your advice.

[molly muffin]

Yes vetroyl is for cushings, but I'm just wondering if bringing down the cortisol a bit would help some of the other issues, like liver. But you wouldn't want to start anything at all with pancreatis going on, and this is only an idea to discuss with your vet.

The liver numbers, ALT and GGT are specific to the liver and that is of concern.

[JaneB]

She's had high liver numbers dating back to 6 mo. prior to her first ultrasound in 2014. Back then the report read she has thinning on her tail, distended abdomen, is overweight and m ild paraspinal and cranial muscle atrophy. Primary rule outs for these signs/findings include hyperadrenocorticism, chronic progressive hepatitis, diabetes mellitus and leptospirosis. Abdominal findings were relatively unremarkable. Urinealysis was unremarkable but for moderate proteinuria. The gall bladder was 1/3 full of uniform amorphous debris, like soft sand.

In a 2015 ultrasound the liver was abnormal mild hepatomegaly, liver parenchyma moderately mixed echogenicity with hyperchogenic blotchiness and also a few discrete hyperemic globoid blotches on spleen. He described hepatic changes relatively uniform throughout all lobes as not dramatic and are most suggestive of low grade mild chronic inflammation. Shortly after I got this report I asked my vet to put her on the ursodiol as the ultrasound vet suggested along with Denosyl and Clavamox.

This last ultrasound on 6/2/17 showed mild thickening to gall bladder. No mucocoele and mild thickening to intestinal wass at 0.3-0.4 cm

At the time I went for the 3rd ultrasound I got scared because she was vomiting a lot and it was a yellow bile. They urged me to put her on Prednisone which I did and things got much worse from there.

I know this is loads of information and I'm putting it out there because I'm trying to give my Babbs a quality of life and am not sure that putting her through the further testing for Cushings will do any good at all. Thanks.

Jane

[Squirt's Mom]

I would insist the liver be looked at very closely before I did anything else. To me that seems to be the area of most concern. Just my 2 cents... ;)

[JaneB]

Her liver continues to be treated, and as my vet said, if it were a cirrhosis she would have been long gone. The big problem lies in her intestines (IBD or Crohns-like), but now she is exhibiting many symptoms of Cushings, and her creatinine test showed it could be Cushings. I have appt. next Friday with vet and we will discuss in more detail whether I want to go further with the Cushings' test. Thank you.

[molly muffin]

Okay let us know what the vet says on Friday.

[JaneB]

Vet appointment is tomorrow morning for Babbs. We're at a pretty good place right now although she is losing fur on her snout and has some sores bilaterally on her thighs and belly. The Proin is working as far as leaking has stopped. She's eating well and defecating well, however, she is on Metronidazole and has 2 left because she was having some diarrhea. I will be discussing with him the further testing for Cushings, but my feeling right now is that testing, which involves a whole day process, may be worse for her as a senior dog and I don't want to set her back in any way. I could ask for another urine and will bring the morning urine in with me to see if it's still tests positive. I may also ask if she can stay on a low dose of Metronidazole because that has helped her in this past week. I'll keep you posted. Thanks all. Jane

[molly muffin]

With the last tests showing that the liver numbers are decreasing.

I would probably continue to do blood work to monitor the pancrease, liver, etc and not go into cushing testing right now either.