Confused in the uk 🇬🇧

[Hevva106]

Hello everyone I do hope I am posting this in the correct place apologies if I am in the wrong
Just about 13 days ago my dog went for routine dental clean and one extraction and due to her age my vet runs a check on older dogs bloods. My dog is a jack Russell cross who turned nine in May - she’s a rescue and she’s always been on the podgy side even when on restricted food intake - we have done the canine equivalent of fat club several times plus been down the vet food routes too all to no avail but I digress
Her bloods showed very high values relating to the amount of cortisol she was chucking off so whilst she was knocked out for her dental my vet did an ultrasound and found her spleen and liver were very enlarged, he also took some urine whilst she was under to send off for testing - now that too came back full of cortisol . The next step was that my poor dog underwent LDDS testing and the results of that came back and again appeared off the scale but all pointing to cushings.
Now my girl had previously been on apoquel as she was ripping her paws apart and we stopped giving her chicken and beef as they are two common foods that dogs appear allergic too - prior to her dental she had stopped apoquel for a week.
To look at her she has none of the symptoms associated with cushings as she wasn’t eating ravenously wasn’t excessively drinking (her intake was marginally up but it’s been very hot in uk) she is fat but doesn’t have what I call a pot belly like some pics I have seen?
She’s also been prone to ear infections in the past however over the last 24/48 hours her ears have flared up she has redness to her paws again but also has redness in her armpits and insides of her back legs .she also seems quite down t present
My vet wants to start her on low dose 10mg of vetoryl (she weighs 13.7 kg) and check her in ten dats then do a PVC check at thirty days

I do have all her results that I could post if I can figure out how to load pics �� but wonder if anyone has had a dog with similar issues symptoms I also may have to consider putting her back on apoquel or medrone v tablets (if a cushings dog can have these?)

Sorry for the long post but I am terrified of losing her I lost my other dog four months ago and today is also eight years since I lost my old boy- I am far from wealthy and know this is a costly disease but she’s my family so cost although an issue will be found somewhere even if I live on toast for the next five years ��*♀️
Thanks in advance
Heather

[Squirt's Mom]

Hi!

Welcome to you and your baby girl!

I want to say first that I am sorry for the loss of your furbaby. I've been in your shoes many times and know your pain. Just remember that you are now being watched over with that same love the two of you shared in this life. One day we will see our precious babies once again.

A question - How long after the dental was the LDDS performed?

You just type out the abnormal results for us; it would look something like this:

ALP 800 ug/dl 110-220
BUN 28 mnol/L 13-21

Be sure to include the little letters and normal ranges for each abnormal (too high or too low) value you list.

The first time I heard the word Cushing's was when my Squirt had pre-surgical labs for a dental also. Her ultrasound found a tumor on her spleen and once that tumor and half her spleen were removed her cortisol returned to normal. So anytime the spleen shows as anything other than normal on an US my warning bells go off. ;) Her vet had done the UC:CR, LDDS, HDDS (no longer in use) plus the ACTH and based on all those tests she had the pituitary form of Cushing's...until the ultrasound. In time Squirt did actually develop Cushing's but when she was first diagnosed she didn't have it, she had a tumor on her spleen. My second dog to be diagnosed with Cushing's had numerous things going on with her and her necropsy (autopsy for animals) proved she never had Cushing's at all - it was the stress of all those other things going on in her little body that caused false positives on all her testing too. Anytime there is stress on the dog, external or internal, the cortisol rises as a natural response and can cause false positives on all the cush testing. The LDDS is notorious for false readings if a non-adrenal issue, like the tumor on Squirt's spleen, is present. The ACTH can come back positive in a dog who simply gets very stressed going to the vet's office. So the signs are a critical part of the diagnostic process. The fact that you say she has none of the signs associated with Cushing's makes those alarm bells ring harder. Another thing dinging those bells are her allergies. Cortisol is a natural anti-inflammatory and will "treat" things like arthritis and allergies. It is when the cush pup starts treatment and the cortisol is lowered down to a more normal level that we will see those inflammatory conditions rear their heads....not typical prior to treatment. So there are several things here that make me hesitant to say your baby girl definitely has Cushing's and in your shoes I would not start treatment just yet.

I am sure others will be along soon and chat with you as well but there's my 2 cent's worth! :D

I'm very glad you found us and look forward to learning more soon!
Hugs,
Leslie

[Hevva106]

Hi Leslie Apologies for the lateness of my reply but night shifts and internet issues are to blame! I have now uploaded to my computer the photos of all the tests she has had done and hoping i can load to here. Any advice/comments/observations welcome :-) ACtually not sure i can get them to load onto here (not very tech savvy)

So i have tried to type them out/copy and paste below best i can




Test Results Reference Interval LOW NORMAL HIGH
RBC 7.26 x10^12/L 5.65 - 8.87
HCT 44.1 % 37.3 - 61.7
HGB 15.3 g/dL 13.1 - 20.5
MCV 60.7 fL 61.6 - 73.5 LOW
MCH 21.1 pg 21.2 - 25.9 LOW
MCHC 34.7 g/dL 32.0 - 37.9
RDW 19.0 % 13.6 - 21.7
%RETIC 0.3 %
RETIC 23.2 K/μL 10.0 - 110.0
RETIC-HGB 23.3 pg 22.3 - 29.6
WBC 8.86 x10^9/L 5.05 - 16.76
%NEU 80.4 %
%LYM 8.9 %
%MONO 7.1 %
%EOS 3.6 %
%BASO 0.0 %
NEU 7.12 x10^9/L 2.95 - 11.64
LYM 0.79 x10^9/L 1.05 - 5.10 LOW
MONO 0.63 x10^9/L 0.16 - 1.12
EOS 0.32 x10^9/L 0.06 - 1.23
BASO 0.00 x10^9/L 0.00 - 0.10
PLT 380 K/μL 148 - 484
MPV 11.9 fL 8.7 - 13.2
PDW 11.2 fL 9.1 - 19.4
PCT 0.45 % 0.14 - 0.46
ProCyte Dx (16 July 2019 08:29)
1. Likely stress leukogram (glucocorticoid response)
Printed: 16 July 2019 08:36 Page 1 of2

3 of 4
Patient Name: Letty
Species: Canine
Client:(whitecliffs-Client2609)

Test Results Reference Interval LOW NORMAL HIGH
GLU 6.70 mmol/L 3.89 - 7.95
CREA 66 μmol/L 44 - 159
UREA 2.7 mmol/L 2.5 - 9.6
BUN/CREA 11
TP 76 g/L 52 - 82
ALB 36 g/L 22 - 39
GLOB 40 g/L 25 - 45
ALB/GLOB 0.9
ALT 58 U/L 10 - 125
ALKP 945 U/L 23 - 212 HIG



Urine Cortisol Creatine Ratio - Sample obtained whilst under GA for dental work on 16 July 2019 tested on 17 july 2019

Cortisol/Creatinine Ratio 86.0 1 x10-6
COMMENT Alexander Jeffcott-Davis BSc
Clinical Pathology Group
On behalf of David Maguire MVB BSc MVetMed DipACVP (Clinical
Pathology) FRCPath MRCVS
Comments:
1. The urinary cortisol:creatinine ratio is considered a highly sensitive test and
it is recommended to use this test to rule out hyperadrenocorticism. If the
urinary cortisol:creatinine ratio results are < 34 x 10-6, hyperadrenocorticism
is unlikely.
In dogs with clinical signs suggestive of hyperadrenocorticism, and urine
cortisol creatinine ratio of >34 x 10-6, further investigation (low dose
dexamethasone suppression or ACTH stimulation test) is indicated. The urinary
cortisol:creatinine ratio is not a specific test for hyperadrenocorticism, and
should not be considered a sole diagnostic test for this condition, or indication to initiate trilostane therapy


Low Dex Test results - This was done ten days after her dental

Client: Moore
Patient:Letty
Species:Canine
Breed:
Sex:FEMALE NEUTERED
Age:9Y
Sample Receipt:27/07/2019
Requisition #:123693503
Accession #:1005671794
Ordered by:Dr. Chris Reichmann


LOW DOSE SUPPRESSION TEST

Test Result Reference Range Low Normal High

Cortisol (Basal) 63.5 25.0 - 125.0 nmol/L

Cortisol post low dose
(4hr) 42.8 nmol/L

Cortisol post low dose
(8hr) 128.0 <= 40.0 nmol/L HIGH

Comment The sample order has been checked and is as labelled.
Results consistent with hyperadrenocorticism where there are
compatible clinical signs.
Mariana Serra DVM DipECVCP FRCPath MRCVS
Clinical Pathologist

[Harley PoMMom]

Hi and welcome to you and your girl from me as well!

Thanks so much for posting those test results as it does help us to provide you with more meaningful feedback. One question I have is; was her thyroid levels tested too? Although some of anomalies in her blood-work can be caused from Cushing's, a thyroid issue may show abnormal results such as hers, also reoccurring ear infections are a known symptom of hypothyroidism.

Lori

[Hevva106]

Hi sorry shift work is not conducive to replying quickly to things so apologies
She has previously had thyroid testing t4 some years ago when she was also checked for cushings but I don’t believe a specific t4 test was done this time around? I have her check up this morning so I will ask
My poor girl is red raw in her arm pits and groin areas and under the base of her tail and she smells yeasty too so am debating putting her back on apoquel her ears tho lucky looking are not bothering her and I clean them regularly but will have to wait and see what vets say this morning and I will ask about thyroid
Thanks heather x

[Squirt's Mom]

Let us know what you learned at the last vet visit when you can. As for the yeasty smell and redness - is the vet sure it's allergies? If so ask about a new allergy treatment called Cytopoint. It is an injection that I have used with two of my babies and it worked miracles for them both. Neither one had to keep taking the shots either - one got 3 shots and the other got 2 shots and their allergies never came back.