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View Full Version : My Cocker, Darby, has Cushing's



Cockermom
09-24-2010, 10:25 PM
Hello Everyone,
I am the proud Mom of two Cocker girls. Bailey is a blk/wht parti and is 10 yrs. old. Darby is a red/wht. parti and is 61/2. Both of my girls came from the same breeder. Bailey's sister is Darby's mother. Both dog's parents were certified clear of any eye or hip problems and they both have excellent pedigrees. Along with all that, they are just awsome dogs! Bailey is a sweet, laid back, loving little lady. Darby is just the opposite. I got her at 8 weeks and she became the alpha immediately. She is a very confident dog with a strong will and a loving personality. My girls are a very huge part of my life. My husband and I are both retired so we get to spend most of our day spoiling these two!

Our diagnosing journey started on June 18 when I took Darby for her annual physical and lab work. She hadn't really been acting sick but something just wasn't right. Her physical exam was normal, no problems with ears or skin. Urinalysis showed a 30+ protien, specific gravity of 1.040 and otherwise normal. Her labwork showed WBC was 40.0 10^3/ul norm 6-17: Lymph 0.40 10^3/ul norm 1-4.8:Gra
38.5 10^3/ml norm 3-12: GR% 96.3 norm 62-87: MCH 26.0 pg norm19.5-24.5:MCHC38.3g/dl, norm31-34:PLT670 10^3/ul,norm 200-500:MPV12.1 fl, norm 3.9-11.1: ALP 157,norm 20-150.

Her Vet put her on Cefpodoxime 100mg x 14 days. We were planning a family vacation for 3 weeks and Darby still wasn't acting right. I took her back to our vet on 6-23. Another physical exam showed nothing abnormal. Another urinalysis was done as well as a repeat CBC.

The urine showed protien 100+, few bacteria, few bilirubin crystals. Lab results WBC 40.3, mon 1.7 norm 0.2-1.5:GRA 36.7 norm 3-12:MO%4.2, norm 2.4:RBC 5.18 10^6/ul, norm5.5-8.5: HCT 35.8%, norm 37-55.:MCH26.4pg, norm 19.5-24.5:MCHC 38.2g/dl,norm31-34:PLT 646 10^3/ul, norm 200-500.

So the week that she had been on antibiotics, didn't affect the WBC's. We did an abdominal x-ray to see if there was an obivious cause for the infection. X-ray conclusions were: Mild hepatomegaly, rule outs should include metabolic/endocrine disease, extramedullary hematopoiesis, nodular regeneration and diffuse infiltrative inflammatory or neoplastic disease. By this time I am very concerned and am suppose to leave for the mountains for three weeks. The first thing I did was locate the nearest vet and emergency vet hospital, but all went well.

Returned from vacation, back to the vet for a repeat lab. Darby is drinking 3x what she normally does and urinating every 10 minutes. She is also panting a lot, but no other symptoms. This time labs were sent out to a lab in Illinois. I will just list the comments by the Dr. who read her speciman. Comment: ANISOCYTOSIS+2, POLYCHROMASIA +1, ROULEAUX Present: Platelet Count: Platelet clumps are present...Comment: Blood Smear, The moderate leukocytosis is confirmed. Please note the amended differential to reflect a regenerative left shift. Low numbers of neutrophils and band neutrophils contain Dohle bodies, indicating toxicity, which further supports the inflammatory leukon. There are occasional intermediate lymphocytes with one or two prominent nucleoli and increased amounts of lightly basophillic cytoplasm. Platelets appear to be mildly increased, indicating a reactive thrombocytosis. These could reflect reactive lymphocytes secondary to nonspefic antigen or underlying lymphoc liver disease. If atypical lymphocytes persist, bone marrow evaluation and evaluation of peripheral and internal lymphoid organs would be recommended. Clinical investigation for an inflammatory nidus is also suggested.

On 8-31 Darby had surgery to finally get her spayed, and for an abdominal exploratory. I know she should have been spayed much earlier but until now, I didn't have a vet who would let me bring her home on the same day. I refused to let her stay unsupervised all night, so I never had it done! Our vet had another vet from her practice join her for the surgery just to get another opinion. The abdomen was clean but her liver appeared swollen and rounded on the edges.

A liver biopsy was done and the report is: There is moderate to marked diffuse swelling of hepatocytes with pale amphophilic granular to highly vacucolated cytoplasm. This change is most prominent in hepatocytes around the central veins. Mutiple foci of extramedullary hematopoiesis are present near the central veins. No infectious agents or neoplastic cells are seen. Comments: The lesion is consistent with reactive hepatopathy. Reactive hepatopathy is non-spefic reaction by hepatocytes to a variety of mild metabolic dearangement such as hyperadrenocorticism, diabetes, anorexia,or cachexia. If there is no history of corticosteroid or anticonvulsant drug therapy, I would suggest screening for the possibility of pituitary and adrenal dependent hyperadrenocorticism. The extramedullary hematopoiesis( which means the body is making wbc's by means other than the bone marrow) could be associated with compensatory hematopoietic hyperplasia secondary to underlying anemia.

Last week Darby had a low dex test done. I don't have a copy of those results but our vet told me that she tested positive for Cushing's and that it indicated she was Pituitary dependent. Yesterday she started on Trilostane 30mg. daily . She is a little more sleepy than usual but I think that's normal.

Darby is also hypothyroid and takes levothyroxine. She has also been struggling with her weight. We tried several diets including the Hills Rx diet food, which I hated! She started smelling like the food.

Last december we started her on Selentrol, she lost weight but very slowly. Both my girls have been raised on Solid Gold or Wellness and are presently on Wellness Core. Darby has never been overly interested in food and is picky about what she does eat. When she was diagnosed with Cushing's, the Selentrol was stopped until she gets regulated on the Trilostane.

I am also a menber of the Zim Family Cocker Forum and several members suggested that I come here for expert help in dealing with this disease. I need to understand this disease from every angle, my baby's health is at stake. Her vet is amazing and I trust her 100%. I'm confident that we have the right diagnosis and that we just happened to catch it early. I know that we still have a bone marrow issue to solve but Darby has been through a lot in the last few weeks. I know her vet will solve this puzzle too, it's just the whole diagnosing process that tries my patience.

I welcome any opinions or comments especially for a proper diet for Cushing's . I would really like to feed home cooked organic food but so far, I can't find any info on what the proper ratio of protiens, carbs, and fats should be. Any ideas on where to look?

I apologize for the long post and I hope I haven't bored everyone with all the test results. I look at this disease like I do most other unplesant things. It's bad but it could be worse and I'll do what I have to do to deal with it.

Blessings to all of you and your furkids who are on this path.

Connie

StarDeb55
09-24-2010, 10:57 PM
Connie, let me tell you that I'm a medical lab tech with 30+ years experience, speciality area is hematology. Your girl's CBC results are severely abnormal, indicative of some type of bacterial infection, IMO. Were any type of cultures done such as a urine culture, or cultures done on any of the tissue take during the liver biopsy? Has a chest x-ray been done to see if there is any problem in her lungs? Since a low dose dex test was done to make the Cushing's diagnosis, it has a huge problem in that it can return a false positive result in the presence of non-adrenal illness. There is something going on with Darby that I don't think is Cushing's & until someone gets to the bottom of it, if I were in your shoes I would not be giving her any medication for Cushing's.

The urine specific gravity you have posted is not consistent with Cushing's. Our pups can't concentrate their urine & the specific gravity is almost like water which has an SG of 1.000. Do you have results of a chemistry profile or liver function profile? If you do can you post only the abnormals along with the normal range & reporting units. We would also like to see the actual results of the low dose dex test, if you can get them.


The extramedullary hematopoiesis( which means the body is making wbc's by means other than the bone marrow) could be associated with compensatory hematopoietic hyperplasia secondary to underlying anemia.

This is a grossly abnormal finding that needs to be investigated. Was anything said about any enlarged lymph nodes being found on physical exam or during her surgery?

I am not a vet, but I have serious doubts about the accuracy of the positive low dose test in light of everything you have posted. I can't see where you have mentioned whether the vets that have seen Darby are general practice vets or an internal medicine specialist. If they are GP vets, I really think you need a referral to an IMS as you need to get to the bottom of this ASAP. I don't want to alarm you but all of the findings you have posted have raised huge red flags for me, & those red flags are not pointing at Cushing's.

I'm very concerned for Darby, so please keep us posted.

Debbie

frijole
09-24-2010, 11:24 PM
Hi and welcome! I have had 2 dogs diagnosed with cushings. The first was accurate and I treated her for over 4 yrs. The current situation has been a nightmare. I also had a ldds test that showed pdh cushings. I had the acth test done and it showed cushings. I started treatment. That was 6 months ago. My dog had a nasty bacterial virus, I ended up firing my vet and going to the closest specialist which is Kansas State - 5 hrs each way - to find out that they don't think she ever had cushings.

I'd tell you to read my thread but it is long and depressing because we are still trying to figure her out. I just wanted to share firsthand that if you have all those other things going on (from the cbc panel) - I would not treat cushings. I would figure out what else is happening and treat that first. And maybe the diagnosis if false. Cushings is not life threatening.

You can search for a specialist here:
http://www.k9cushings.com/forum/showthread.php?t=182

Or if you tell us where you are located, maybe one of us can help refer you.

Good luck!
Kim

Cockermom
09-25-2010, 12:27 AM
Hi Debbie,
Thanks for the quick response. In answer to your questions. Darby's vet is in a practice with an Internal Medicine Vet. He was present during her surgery and has been consulted on all her test results. He agrees with the Cushing's. They found nothing visibly abnormal within her abdomen except her liver. There wasn't a culture done from the biopsy, but there was one done from one of her ears. It came back with 3 different bacteria growing. She was on antibiotics and ear drops and is fine. The only xrays that were done were a lateral and ventrodorsal on 6-23. Her vet actually called the radiologist to make sure there were no signs to indicate a pyometra or an obivious cause of infections. The only abnormality was the size of her liver. Her last Superchem panel that I have a copy of was done on 7-22. Here are the following abnormals:
Phosphorus 6.1 2.5-6.0 mg/dl
Potassium 5.7 3.6-6.5 mEq/L
Na/K ratio 26 27-38

Differential results Absolute %
Neutrophils 22960 82 2060-10600/ul
Monocytes 1120 4 0-840/ul
Eosinophils 1960 7 0-1200/ul
Platelet Count 583 179-400 10/ul

CBC
WBC's 28.0 4.0-15.5 10/ul

They did an electrocardigram before her surgery and it was fine. All they have said about her lungs is that they sounded clear. I understand what you're saying about something else going on with Darby. The pathologist that read her biopsy indicated that there were two seperate issues and suggested Cushing's as being the cause for one of them. The other is what's going on with her bone marrow. Neither of the vets think they are related . She will be having a bone marrow, I just wanted to give her a little time to recuperate before we start the process again.

I really appreciate your feed back and opinions . It's always hard when the patient doesn't present with textbook symptoms. Based on recent experience, I know that her vet will stay on top of things until all the puzzle is solved.

Connie

StarDeb55
09-25-2010, 06:43 AM
I still have a serious doubt about Cushing's as Darby demonstrates none of the typical liver function abnormalities on her chemistry panel, including alkaline phosphatase, cholesterol, & ALT. Elevated results in one or more of these are almost universally found among our pups.

I would be asking the vet about the normal specific gravity & normal liver function studies not being typical for a Cushing's baby. Cushing's is a slowly progressing disease, so there is no super rush to start treatment. I don't see where you mentioned about anything being said about any enlarged lymph nodes being found anywhere. The most common places to find them are in back of the knees, & along the jawline.

Debbie

Cockermom
09-25-2010, 10:47 AM
Debbie,

I looked back over Darby's bloodwork and the only time, that I'm aware of, that she had an elevated ALP was on 6-18. It was 157 U/L with normal being 20-150. She has never had enlarged lymph nodes on physical exam and none were found during her surgery or on her x-ray. Could the specific gravity be explained if it was the first morning specimen. As a nurse, that's the one we were taught was the most accurate and that's the ones I collected for Darby. If the urine had been in her bladder for a longer period of time(overnight) would it be more concentrated? I have noticed that her urine gets more dilute looking as the day goes on. She is litterbox trained for potty and recently I have had her pee on pee pads so I can watch for any bleeding or other changes. I will ask her vet about that and about doing a liver function panel.

Thanks again for the feed back.

Connie

StarDeb55
09-25-2010, 03:34 PM
You are correct, the first morning pee is more concentrated in a healthy pup or human, healthy being the key word. Our pups can't concentrate their urine at any point in time, so this is why I'm questioning the result. Of course, being a nurse, you, also, know with all that Darby is drinking throughout the day, her urine is going to become more dilute as the day wears on.

Debbie

Cockermom
09-25-2010, 04:44 PM
Hi Debbie,

You're absolutely right, I did know that. I guess I'm just not thinking really clearly these days. I keep comparing Darby's test results and symptoms to those I know about for humans. That doesn't always work! There is so much to learn and be aware of with this disease and it's treatment. Darby has always been a very healthy& happy pup with a huge personality. She still is pretty much like that and it's hard to accept that she has some serious health
issues. I will keep reading and learning and asking questions to make sure everything is being done that needs to be done for my Darby girl!

Thanks,
Connie

Harley PoMMom
09-25-2010, 05:00 PM
I will keep reading and learning and asking questions to make sure everything is being done that needs to be done for my Darby girl!

Thanks,
Connie

Hi Connie,

A belated welcome from me and my boy Harley! As parents of cush-pups, educating ourselves about this disease is very important. So glad to see that you want to keep reading and learning, and with that in mind :eek: I will provide a link to our Resource Thread, it has a vast array of information about Cushing's and other related material.

Please ask all the questions you want and we will do our best to answer them, ok? :)

Love and hugs,
Lori


Helpful Resources for Owners of Cushing's Dogs
http://www.k9cushings.com/forum/forumdisplay.php?s=&daysprune=&f=10

gpgscott
09-26-2010, 07:31 AM
Welcome Connie,

I know most of us relate to this comment:D


You're absolutely right, I did know that. I guess I'm just not thinking really clearly these days. Connie

It is important to make the distinction when evaluating numbers that you have a pup in some form of distress which of course means normal baselines may not apply.

Best wishes. Scott