Any thoughts on Gable's blood work? Next steps?
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Any thoughts on Gable's blood work? Next steps?
Do you have the results of the other bloodwork that was done? Thyroid numbers... etc etc. I'm assuming a UTI was ruled out, as well as diabetes. An xray might help but hopefully one of the other more knowledgeable folks will see this and pop in soon.
Shana
Gosh Joan, I'm afraid I don't have any great suggestions since the LDDS was negative. If you wanted to spend the money :o, I suppose you could advance to an ACTH since there is a small percentage of Cushpups that test negative on the LDDS even though Cushing's is present. However, I don't know whether you'd want to take that additional step or not.
Are all of Gable's kidney and liver results within normal range? If so, I guess the only thing I still wonder about is whether he could possibly be oversupplemented with the soloxine, since excessive thirst/urination/panting can be associated with hyperthyroidism...
Marianne
Yep, all that was ruled out...these are the thyroid results from the 1st test and we put him on soloxine.
T4: 0.5, ref range 0.8 - 3.5
T4: (Equilibrium Dialysis) 6, ref range 8 - 40
The second test he was still low, so we increased the soloxine.
The last one came back where it should be.
Well, I truly am stumped. I can't remember whether you had a full thyroid panel performed prior to starting the soloxine, or at least enough of a comprehensive panel to point to whether Gable's hypothyroidism looks to be a primary disorder or instead secondary to another condition. I think the TSH level factors into that, and I also think that Antech may have included that on an earlier comprehensive Chemistry panel. At any rate, if it's available, that may be a useful piece of info: whether or not there is some other condition that underlies the hypothyroidism. If so, that may make it seem as though advancing to an ACTH might be more worthwhile, especially since Gable's 8-hour LDDS reading was so close to the diagnostic cut-off.
Quote:
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.
His panting started wayyy before the soloxine, Marianne. He only started on the soloxine a few months ago. I guess I'll just have theQuote:
Originally Posted by labblab
x-ray done and see if it shows anything.
Has an UTI been ruled out? Also, how about kidney or bladder stones?
What tests would we do to diagnose those? Would they show up on an x-ray?
When my Crys had urinary crystals seems like they showed up in the urine. For larger stones I would think either an xray or ultrasound would be needed to see them since they are internal and don't pass in the urine as easily as the crystals can.
Thanks, Leslie~
With my boy, Bear, those stones showed up with an x ray and also in an ultrasound.
Gable's panting is worse than ever and he pees for about 3 - 5 minutes when I get home from work. How he holds that in all day astounds me. I think I will have them do the ACTH test. Or do you think an ultrasound might reveal more? I start working in the city tomorrow and can't bear the thought of him having to hold it in, or go in the house, if the trains aren't running on time.
Since he's not on Vetoryl, do I need to do anything in particular before he gets tested if I go for the ACTH?
I'm assuming he was checked for crystals in the urine and that a UTI has been ruled out? If he hasn't had a wellness check recently (showing BUN, ALP, T4, etc) I would want that done before the ACTH. If any urinary issues are ruled out and things like hypothyroidism, then I would opt for the ultrasound before the ACTH. The US give us the biggest bang for the buck because it shows most of the organs and can pick up things like nodules, enlargements, tumors, etc. Remember - the ACTH can be elevated simply because the dog is stressed going to the vet or riding in a car....or because of the presence of a tumor. So I would opt for the US first myself...after you are sure there is no UTI or crystals present.
Hope you enjoy your new workplace but am sorry you have to be gone from home so much.
Hugs,
Leslie
Hi Joan, is Gable still taking his thyroid supplementation and has that level recently been checked? If you do decide to proceed with the ACTH, I’m not aware of anything special that needs to be done on test day. You can check with the vet to see if he/she prefers that Gable is fasted. Since this is not a monitoring test for Vetoryl, a fasted sample is fine if that’s what the vet prefers (and if other blood work will be done at the same time).
As Leslie says, an ultrasound can always supply a range of useful info, however. Since Gable previously tested negative on the LDDS, an ultrasound might actually be a good place to start in order to see whether there’s anything else amiss that might account for these symptoms. But I can’t argue with an ACTH, either. I believe that his LDDS result would imply that if Gable does turn out to have Cushing’s, it would be pituitary in origin. But you still may end up wanting to do an ultrasound, regardless of the ACTH result. So either way, you may end up doing both tests in whichever order suits you best.
How’s that for a totally wishy-washy reply??? Sorry to be so noncommittal. And especially, I’m sorry that you have anything to be worrying about right now. I know how stressful it is to have to worry about traffic or travel time interfering with getting home in a timely fashion. That’s a lot of stress for you to shoulder every working day :-(((((((.
Thanks, Marianne and Leslie. He is still on the thyroid meds. He will need bloodwork to remew his meds. I am so convinced it is Cushing's. And yes, I could be just paranoid. I don't know what to do!! The panting, drinking and peeing makes me nuts! I don't want him to be uncomfortable. He is such a good boy...to pee in the house upsets him so much. He doesn't even lift his leg; he just spreads his legs and pees when he can't hold it in anymore.
How much more money, and how many more tests do I have to do to confirm Cushing's?? Next to Lee, he's my darling...what should I do??
After looking back through your entire thread once again, I believe I would go ahead and perform bloodwork — including the ACTH — at this point in time. I’m reminded that Gable previously exhibited elevations in ALKP and triglycerides along with his low thyroid. All three of these findings can occur in conjunction with Cushing’s. Since Gable is also due for monitoring of his thyroid supplementation, I believe I’d want a repeat of his blood chemistries and cell counts. I’d be curious to see whether his ALKP and triglycerides have changed, and I’d also want to see whether there are any new abnormalities.
As Leslie has suggested, it might be useful to first review the basic blood panels before moving forward. But if you’d prefer to gather all the info at once, I’m assuming sufficient blood could be drawn to perform these general panels at the same time as the baseline draw for the ACTH. Then the ACTH stimulation agent could be injected and that test subsequently completed an hour later.
It is true that the ACTH can return a false positive when an animal’s body is sufficiently stressed by another illness or disorder. But the estimate of “specificity” for the ACTH ranges between 86-93%. A statistics expert can interpret this more accurately than I can, but I believe this means that 86-93% of the positive results on this test are truly caused by Cushing’s as opposed to something else. So this means that a positive result on this test is generally pretty trustworthy, and would be helpful info to consider in conjunction with Gable’s previous LDDS. If he were my boy, this is probably how I’d proceed since his symptoms have continued unabated for quite some time now.
In the meantime, I wonder if there’s any place in your home where you might be able to put down pee pads for Gable to use if he needs to relieve himself while you’re away? I definitely realize we’re talking about a LOT of urine from a big dog. I’ve only used pee pads for puppies, so I don’t know if this would be any sort of reasonable option at all. But just thought I’d throw that idea out there, or maybe other folks will have some better suggestions to offer out...
We had pee pads down before. When Lena had it, then we kept them down because of Sibbie. I've been trying for the past few months to stop using them. I was off all last week and we finally got Sibbles to let us know she had to go out, so wee wee pads haven't been down all week.
But now that I have to work in the city, I may have to put them down again which really pisses me off. The two times Gabe peed in the house, one was on a runner by the back door, and the next time was on the wee wee pads, so he did try. But the problem is Cooper. He will mark wherever Gable or the girls go and he doesn't always hit the pads. He will lift his leg and pee on whatever is around, or go in another room and try to hide it. It's so frustrating! I'm used to coming home to Cooper's mess and having to clean that up, but I will be exhausted commuting back and forth into the city and have to spend the first hour doing that.
My husband and I were even thinking of keeping the greenhouse open when the weather gets warmer and leaving both boys outside, but Cooper is a nuisance barker and I'm sure the neighbors will complain. Now the Trazadone is not working either. We've tried Prozac, Elavil, and now the Trazadone. I'm thinking of trying the CBD oil. I just bought a big bottle of Hemp Oil for dogs to see if that would calm him down, but not sure if I should wait until I wean him off of the Trazadone first. I'll have to ask my vet. It must make Gable so uncomfortable when Cooper lets loose and he has to hold it in until I get home.
I'll take him for the bloodwork this weekend and see what we're looking at.
Thanks for all the advice...have to run! Got a train to catch! UGH!
Oh my goodness Joan. What a time you are having and sounds like it's pee city at your house these days.
I'd get the full bloodwork done and ACTH and just check him out, also a urinalysis to check for crystals and infection.
It's a starting point any way and you'd need to check thyroid levels before new meds anyhow. It could just be the thryoid is acting up, or it could be something else.
At least it's a starting point. We've had other say that CBD oil, helped calm their dogs. Isn't Chance the golden on that too?
Yes, that's what made me think of it when I saw that Chance was on it. When I bring Gabe in for his bloodwork, I'll ask about the CBD oil for Coop. I found some meds for Cooper that we had tried way back in 2012, so this has been ongoing.
I wonder if a doggie diaper may help. After a quick search I found a particular diaper made for a large dog.
https://www.amazon.com/SnuggEase-Was...s=pet-supplies
Found this too: http://www.tinkletrousers.com/?gclid...SAAEgJGkfD_BwE
He hasn't peed in the house except those two times, once when i was late and the other I'm sure my husband didn't let him out before he left for work. And with Cooper, forget the diapers...he managed to get out of the ones I got for him even with the underpants that went with them!
I'm going to have Gabe tested again with all of your concerns mixed in with mine and talk to them about the CBD oil for Cooper probably this weekend.
Okay, we didn't do the ACTH test, but here are his results from regular blood work from a couple of weeks ago. Just the Highs. His thyroid was still low, so we raised the dosage. He did more blood work today to make sure it's not too much. Gable was up all night with bloody diarrhea and threw up bile twice. I brought him a stool sample, checking it for giardia. Gable hasn't had a normal poop in so long that I can't remember the last time it was normal. I'm thinking he has pancreatitis. That could explain all the gastro issues.
Superchem
Alk Phosphatase: 572 / ref range: 5 -131
Total Bilirubin: 0.4 / ref range: 0.1 - 0.3
Magnesium: 2.6 / ref range: 1.5 - 2.5
Triglycerides: 732 / ref range: 29 - 291
PrecisionPSL: 179 / ref range: 24 - 140
Complete Blood Count
Platelet Count: 491 / ref range: 170 - 400
Neutrophils: 11234 / ref range: 2060 - 10600
Thyroid was 1.2 / ref range: 2.5 - 6.0
Thoughts?
Pancreatitis could definitely be a possibility considering the elevated PrecisionPSL, triglycerides and taking in account of the vomiting episode and diarrhea. Small and several meals being fed throughout the day is recommended for pancreatitis, starting off with a bland diet is usually required too. Does his diarrhea have an organish color?
In terms of the acute issues, yup, pancreatitis sure seems like a consideration.
In terms of the other lab abnormalities, I’m afraid several are consistent with Cushing’s: elevated ALKP, platelets, neutrophils, and triglycerides; ongoing low thyroid. Now, at least a couple of them could probably also be caused by pancreatitis as well — I just don’t know about that. But in the absence of the pancreatitis, I’m afraid I would think these abnormalities would warrant moving onward with a more specific Cushing’s test. How about his urine? Was that analyzed by chance?
Not orange, but kind of tan...I'm not home all day and even though sometimes kibble is still left over from breakfast, no one seems to eat all day. I feed them Wellness grain free original, sometimes with the freeze-dried turkey bits.Quote:
Originally Posted by Harley PoMMom
Yes, I was not happy to see all of those Highs. I'm not sure if his urine was ever tested. How does the ACTH test work with him not being on Vetoryl?Quote:
Originally Posted by labblab
In terms of urine, it would be good to rule out any urinary tract infections and also to check the specific gravity and see how dilute it is. As far as a diagnostic ACTH, it’s fine for a dog to be fasted if that’s what the vet prefers. Of course the LDDS is the other option, and I don’t know whether you’d prefer to do a LDDS or not. Everything being equal, most clinicians view the LDDS as the diagnostic gold standard. But it’s always kind of a toss-up in my own mind. The LDDS returns fewer false negatives, so you’d be less likely to “miss” making the diagnosis if Gable truly has Cushing’s. Plus, it may help distinguish between pituitary and adrenal versions. But if the ACTH is positive and you move on to treatment, it’s really nice to have that initial stimulated cortisol result to use as a baseline against which to judge treatment effectiveness. So each test had it’s own pros and cons. Of course, either way you’ll want him to first recover from any acute illness.
We did the LDDS and it came back negative for Cushings. I'm not sure if I got a copy of the results from them. I'll have to look. So far the Metronidazole is not doing its job. He doesn't seem to have to go as much, but when he does it's still diarrhea.Quote:
Originally Posted by labblab
Duh! I’d completely forgotten about the LDDS — so sorry!
Not orange is good! Has he been eating this food for a while? And if so, I wonder if they changed the ingredients in that food, as these manufactures can do that with dog food without notifying the public. :mad:Quote:
Originally Posted by Joan2517
Funny you should say that. I told my vet Saturday what brand i feed them and he said a dog with a sensitive stomach would get soft stool from the Wellness, which he wouldn't recommend anyway, that I've been feeding them for years. Vet told me to get Science Diet w/d and the urge to go seems to have stopped, he doesn't seem as agitated and is sleeping better. But of course the others want it too and I've tried to keep them from eating it, but they still managed to get some and now the little girls are pooping out rocks!Quote:
Originally Posted by Harley PoMMom
So glad that the new food is working for him, how are his stools?
So much better the past few days. This morning I wasn't paying attention and I had put the other food down for the rest of them before I put the new food down for him and he was busy eating it. Soft poop was back...so it is the food. Picking up normal poop really is so much better! :)
It's so nice to finally have a solid clue for what is going on, huh? :) I hope the new food continues to work well for your sweet boy!
Thank you all for your advice and thoughts. Next step will be the ACTH as soon as I can afford it, financially and emotionally!
Excellent detective work to find out what the cause of the soft stools was. If only there was something that they could All eat, so you didn't have to buy two brand and try to keep Gabe out of the girls food. Nothing is ever easy eh. :)
I know, Sharlene! I have to stand guard while he eats it! I let the others have a piece of two so they don't feel left out. The Wellness has been fine for the rest of them and I'm a little leery of changing their's. Every time I have tried something new, Doree gets diarrhea. She's the oldest (14 or 15) and I always go back to the Wellness. Maybe I'll try one of the other Science Diets to see if she can tolerate that.Quote:
Originally Posted by molly muffin
He's still drinking like crazy, but hasn't let loose in the house while I'm at work...I don't know how he does it! The panting is still worrisome. I can't believe how much he's aged in the two years since Lena's been gone. Cooper is the same age, and you'd never know it.
It's very hard having dogs on different feed for dietary/medical reasons. You can't ever leave food down and have to feed separately, which is hard for working parents. I have had the same challenge when caring for friend's dogs. I can't imagine having to do it all the time. Having said that, I would probably continue to feed seoarately, particularly if I had a senior dog or one with allergies. I don't think I would mess with trying to find something they all could eat. I would probably just continue with whatever is working at the time. I'm not one to rock the boat. Just my thoughts.....
That's probably what I will do, Kathy. I hate to waste money on a bag of food only to find out one of the other three can't eat it! So far this is working as long as I stand and watch. I let Sibbie have one or two pieces of Gable's just to make her happy.Quote:
Originally Posted by Budster's Mom
Okay, so tomorrow I am taking Gable to have the ACTH test done at 10:15. He's drinking more, and panting so much we're afraid he's going to have a heart attack. Since he's not on any meds for Cushings, does he have breakfast in the morning or not? Thanks!