Bellas diagnosis

[Bellabean]

This time around Im going to get right to the symptoms and test results even though there is a long story.


Bella is 10 and weighs give or take 4#. Her symptoms started about three weeks ago. In this order

Her belly was growing, thought it was weight gain from lack of exercise, she teetered backwards when I picked her up.

Started drinking lot of water and would bark to get off the bed to get water, and yes appetite was voracious.

Having more accidents and waking up at night to drink or relieve herself

occasional vomiting she likes to eat grass and now will scour my garden for it but will go for anything green, in which I take it away as it may be poisonous.

Belly getting bigger changing her food daily finally refuses food, fast hard breathing starts. really tight tummy when gently wrapped with my fingers she winces in pain.

No fur loss but in the past has had 3 or four fungal/yeast infections. Dandruff, little pimples, and that yeasty smell. Reluctantly treated with antibiotics not sure about cortisone? need to look into that one.

She spends two nights at Pet hospital over a weekend. They aspirated her tummy and removed fluid but not enough. Gave her Cortrosyn Iv and she was eating again and alert
Sunday.

Monday morning I pick her up she is still puffy and breathing heavy, take her to my vet and they give her a dueritic to reduce fluid 5 yes she peed out 5 os in a few hours. She gets a B12 shot and extra fluid.
fluid collects in thin pockets on her belly but reabsorbed itself with 24 hours.

Suspect Cushings or Protein wasting atrophy??? ACH stim Borderline Cushanoid pre 13.8 Post 20.7. Then LDDex test Sample 1. 4.9 low 1.0 high 5.0
0.5 0.0 1.4
3.0 0.0 1.4
All her other tests had over 25 highs and lows not sure what you need to see. I do know he was mostly worried about her albumin which in hospital was 1.5 2.7 4.4
then it came only a few points in a few days.

Recommends Trilostane 1.5 mg 2x daily not sure if it says with food cause I did not fill script, all I know is its a dollar a pill, and it scares me. Follow up tests are $375 and are 10 to 15 days then 30 then 6 months.

Should I have them them do the Creatine urine test? I want to make Bellas food what is best cant find posts.


As of now, the ascites is gone, she can go up and down steps, she drinks not as much but what I think is what she should, prefers ice water. Sleeps a lot and buries her treats in the garden and look for blades of grass to eat, which there are none but tries to nibble on other green things. Gets up to come see if im home frequently between naps. Feels boney and definetly lost weight and muscle.

And now I pray this goes through and looking forward to hearing back,

Thank you so much for being here

Laurel

[labblab]

I’m so glad you were able to complete your posting this time around! I’m so sorry, though, for Bella’s problems. There’s a lot to think about and talk over, but first and foremost — I would NOT yet start the trilostane because I have serious doubts that Cushing’s is the correct diagnosis. Both the ACTH and LDDS can register “false positives” in the presence of other, nonadrenal illnesses. And the pattern of symptom onset that you’re describing is not generally consistent with Cushing’s. When Cushing’s is the culprit, observable symptoms such as excessive thirst and urinarion tend to gradually worsen rather than acutely striking almost overnight. Of greatest concern to me is Bella’s abdominal ascites. That is not typical of Cushing’s at all. With Cushpups, the “pot belly” is the result of the wasting of abdominal ligaments and/or liver enlargement, and not the presence of actual fluid build-up. Since Bella actually needed to have fluid drained from her belly, that signals to me that something else is also going on with her. Can you tell us whether her albumin level was high or low? I couldn’t tell exactly what those three different numbers you gave us represented. If it was low, then the combo of low albumin and abdominal ascites could signal primary liver disease of some sort, for instance.

If Bella were mine, I would not bother with the urine test measuring the ratio of cortisol to creatinine. Just as is the case with the ACTH and LDDS, the result can be elevated due to stress or illness other than Cushing’s. What I would probably want to ask for now would be an abdominal ultrasound to get a good look inside that tummy of hers. I would want to see images of her liver, kidneys, spleen, gallbladder, and adrenal glands in order to see whether there are any visible abnormalities that would explain her symptoms and lab abnormalities.

It really will help us a lot if you can give us all those abnormal lab values, along with the reference range. If it’s too tedious to type them all out, perhaps you could upload a digital image of the results to a personal photo album that you can create here for yourself. With Cushing’s, we typically see elevations in liver markers and cholesterol levels. Certain blood cell counts can also be involved. But if Bella had 25 different abnormalities, her poor little system was greatly out-of-whack at that time. Again, it will help us to take a look.

OK, I’ll end at this point. But again, I’m really glad you girls have found us, and we’ll do our very best to help you sort things out.

Marianne

[Squirt's Mom]

Hi and welcome to you and Bella,

I second Marianne - DO NOT START TRILOSTANE. I will add for any reason, no matter who insists that you do.

When I first heard the word Cushing's it was when my Squirt was getting prepared for a dental and they found her cortisol elevated. So we started the testing process and I have every test available run because I wanted to be as sure as possible this was truly what we were dealing with. Her abdominal ultrasound proved it was NOT Cushing's but rather a tumor on her spleen causing the high cortisol readings. Once that tumor was removed her cortisol returned to normal and remained normal for several years after. Had I started treatment in the beginning without knowing about that tumor, she could easily have died when that tumor rupture her spleen. Not to mention giving her a VERY powerful drug when she didn't need it at all. So please, I beg you for Bella's sake, do not start the Trilostane.

What I would be working on this morning is finding an IMS (Internal Medicine Specialist) to see Bella ASAP. She simply has too many things going on for me to feel comfortable with a Cushing's diagnosis at this stage.

I am glad you found us and look forward to learning more about you and Bella.
Hugs,
Leslie

[Bellabean]

I have the files in an email is there and email for this forum? Still cant figure out how to upload the large file

[labblab]

We do have a forum gmail account. If you want to try to send the files there, we can try to figure out how best to publicly post the information. Here’s our address:

k9cushings@gmail.com

Marianne

[lulusmom]

I just wanted to chime in and echo both Marianne and Leslie. They are giving you some very sound feedback.

[labblab]

Laurel, I want to let you know that your email came through and I’ve had a chance to make a first pass through Bella’s files, but WOW, there is a lot there and a lot of very abnormal findings :-(((((. I must say that with the exception of the actual ACTH and LDDS results, very little seems consistent to me with Cushing’s. While hospitalized, among many other abnormal readings, Bella had low liver enzymes, low cholesterol, low blood glucose, that very worrisome low albumin, positive result for pancreatitis, and fluid build-up in her lungs/chest as well as her abdomen. I see the hospital vets were originally considering actual liver failure or Atypical Addison’s as possible causes, but it looks as though they backed away from both those options. Suspicion of Atypical Addison’s is probably why they ran the ACTH in the first place. But there is so much to try to sort through in conjunction with these reports that I don’t know that we can truly do them justice since none of us here are vets. Among the many questions I have is the timing of these Cushing’s tests in conjunction with steroids that were being given to her, because supplemental steroids alone can skew the test results.

Has Bella been seen by any specialists since her hospital discharge, or has she only been seen back at her regular vet’s office. Is your local vet the one who has prescribed the trilostane? I don’t ask this with the intention of criticizing the ability of your local vet, but as complicated as Bella’s situation is, I really think you need to have a specialist look things over. More than ever, I think something other than solely Cushing’s is in play here (if Bella even has Cushing’s at all). From their notes, it looked as though the hospital was considering a variety of different serious ailments that could be causing Bella’s symptoms, and this is part of her hospital summary:


Advised the owner that the final diagnosis will be based on the internal medicine specialist diagnosis. Further testing including UPC ratio, GI profile (Cobalamin and Folate, TLI), ultrasound, possible liver biopsies and further organ function testing will be necessary.

I’m not seeing any actual final diagnosis on the hospital papers, so that’s why I’m wondering who is now prescribing the trilostane, and whether Bella has actually had this follow-up testing done aside from the LDDS. Also, the subsequent vet visit notes a worrisome lump on her side that may warrant more diagnostics? Last but not least, it also sounds as though her thirst and urination is now at least temporarily back to normal — is that true? If so, that’s one more inconsistency with Cushing’s. Those types of symptoms just don’t quickly start up and then go away again. I really am worried that there is something more acutely wrong with Bella that is causing all these lab abnormalities, and I think you’d be best served by consulting an internal medicine specialist.

For sure, I would not start the trilostane until more questions have been answered. Even if Bella does actually have Cushing’s, it is not safe to give trilostane to a dog who suffers from significant liver or kidney dysfunction. As far as I can tell, the vets do not yet know how significantly Bella’s liver is impaired. And the bottom line is that I don’t see the trilostane helping with many of her more serious problems, anyway. These lab abnormalities just are not consistent with the disease as we know it here.

Marianne

[labblab]

Also, by the way, is it “Protein-Losing Enteropathy” that the vets were mentioning as a diagnostic possibility? I just now Googled it and the symptoms sound a whole lot like Bella!! I also see that Yorkies are a breed that seems to be especially vulnerable. Are the vets no longer considering this as a possibility? Given Bella’s symptoms, it sure sounds more likely to me then Cushing’s...

http://www.pethealthnetwork.com/dog-health/dog-diseases-conditions-a-z/protein-losing-enteropathy-ple-dogs