sissy may 9 year old beagle needs advice.

[Sissy may]

Hello all,
My name is Jeremy and our dog sissy is a female beagle of about 9 years, she just recently within the past month or so has started to show signs of cushings disease, after a few trips to the vet he says she does not have cushings but possibly atypical addison's. they have done a few blood draws since 2010 her alkp levels have been off the charts. but alll other readings have been in the normal range. they now want to do the acth stim test to try and get this figured out but as of right now we wanted to get her home and comfortable because she came down with a case of pneumonia on monday morning. she seems very exhausted but is doing much better than she was on monday. currently she is on antibiotics and lasix and we are limiting her water intake to 1.2 liters per day per the doc's instructions to try and combat the pneumonia. her most recent blood draw was a ProCyte DX test? not sure what this is but all readings were in the normal range.her last test on 2/14/14 was a Catalyst DX test and she had high GLU. 184 mg/dl. ref. 70-143. she also had high ALT. 102 u/l. ref. 10-100. high alkp. >2000 u/l. ref. 23-212. and high AMYL. 1569 u/l. ref. 500-1500 and a Low Cl. 107mmol/L. ref. 109-122.
All other readings are in the normal range any help is greatly appreciated thanks again.
Jeremy

[Harley PoMMom]

Hi Jeremy,

Welcome to you and Sissy! I am sorry for the reasons that brought you to us but so glad you found your way here.

In order for us to provide you with our best possible feedback we need to know more about Sissy, ok? So here goes the questions :eek:

What symptoms does Sissy display that led you or your vet to test for Cushing's in the first place? What kind of antibiotic is she on? Besides the lasix and antibiotics, is she taking any other herbs/supplements/medications? How much does she weigh? Besides the pneumonia, does she have any other health issues? Was an urinalysis done, and if so, could you post those results? Was an ultrasound done, and if so, could you post those findings?

Cushing's is when a dog's body is producing excessive amounts of cortisol. The high levels of cortisol make their kidneys work harder and thus a dog has to drink large amounts of water to keep up with the urine output from the kidneys. When a dog is suspected of having Cushing's their water should never be retricted as this can be life threatening. Did the vet explain why he wants Sissy's water restricted?

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

Hugs, Lori

[Sissy may]

Our first reason for taking her to the vet was because she started having accidents in the house and in her crate overnight. Sissy loves her crate and will not sleep elsewhere which is helpful during this time for easy clean up. But it was quite obvious that she was not able to hold her bladder. Her current medications are for her bout of pneumonia which are,Clavamox (amoxicillin) 1 tablet 2x a day @125mg. Lasix 50mg. tablet only taking 1/2 of a tablet 2-3x a day depending on how easy she is breathing currently we are only giving her 2 lasix a day. and the last medication is called Zeniquin 1x per day until gone for 14 days @ 25mg. her current weight is 23.0lbs. as of 2 years ago she weighed 26.4 lbs. she does not have any other real health issues she is very prone to ear infections and has been for quite some time now but my wife is amazing at clearing those up for her! Other than that she has had both ACL's replaced a few years ago and she has been doing great with that. She did have a urinalysis done yesterday the results are as follows.
Color-clear, appearance-pale yellow, S.G.-1.020, Glucose-neg, bilirubin-neg, ketones-neg, blood.+, P.H.-6.0, Protein.+++, urobilinogen, normal. nitrates, neg. leukocytes-neg. Sedimentation WBC-0-21 hpf, RBC 0-31 hpf, cells-renal clusters, casts-fine grain. Bacteria-NSF. Crystals-NSF. Trans 0-21 hpf.
There was no ultrasound done but they did do a chest xray but that was to determine her pneumonia and to see if she had a tumor of any sort in her lungs but there were no tumors present. For some reason the vet has ruled out cushings and now thinks it may be atypical addisons. He said his next logical test would be the ACTH stimulation test he also noted to keep her activity level to a minimum to decrease the amount of water intake required , once again I believe due to the pneumonia. He noted with her current S.G. of 1.025 on her urine, it does not rule out diabetes insipidus, it does make it highly unlikely due to the presence of some urine concentrating ability. Her only symptoms have been very thirsty and urination, otherwise she eats normally her coat is very nice looking, and she does not have the pot belly either. With the medication she is on right now she is very sleepy only getting up occasionaly to go outside to handle business. We have very recently changed their pet food from science diet adult lite to an organic brand called newmans own sold at whole foods. She has not taken to it well at all, we have been having to add a small amount of canned pumpkin to get her to eat. All of her blood work since 2010 have had very high ALKP measurements, >2000 off their charts basically but she has only recently started the drinking and urination, the last month or so. She also underwent a Dexmethasone suppression test. Here are those results.
Pre Dexmethasone-4.2 Ref range. 1.0-6.0 ug/dl.
Post 4 Hour. Dex. 0.6 Ref range. less than 1.5 ug/dl.
Post 8 Hour . Dex. 0.6 Ref range. less than 1.5 ug/dl
The vet said he was very confident with the blood draws and times and they were sent in to DEXX laboratories. with those results that has her listed in the normal range ruling out hyperadrenocoticism. I know my wife and I both are becoming very frustrated with the repeat visits and no answers when your paying alot of money to figure things out, I grew up in a home where this dog would not have made it to the first torn ACL surgery, I just don't have the heart right now to let her go when she still seems so young and happy. She is a huge part of our family, but this is becoming very expensive. With that said do you have any reccomendations for the next step? Do you know the life expectancy if they do have addisons? Thanks again for taking the time to read this and for the support truly an awesome website and amazing people.

[Harley PoMMom]

I agree with the vet that Sissy's LDDS test results indicate that she does not have Cushing's. So why is the vet thinking atypical addison's? Are her sodium (Na) and potassium (k) abnormal on her chemistry blood panel? An ACTH stimulation test can rule out/in addison's.

Recurrent ear infections can be attributed to hypothyroidism, does Sissy tend to seek out warm places? Does her skin have any hyperpigmentation? Usually the thyroid is checked on the chemistry blood panel and is known as T4, do you see this on her panel?

I see that blood was found in her urine, this was a a free catch urine collection? Blood in the urine could be from an UTI and this causes increased drinking/urinating.

I am sure the others will be along and share their opinions, just wish I could of been of more help. Please do keep us updated, ok?

Hugs, Lori

[molly muffin]

Hello and welcome to you and sissy.

I agree, blood in the urine, definitely could be a sign of a UTI, you'd want that to be cultured to determine what type of bacteria. I also notice that her protein was +++ in the urine or blood? That would cause frequent urination and accidents.

I agree with those LDDS numbers, cushings is unlikely and if something else is going on then an ACTH will likely be high, but not due to cushings.

With concentrated urine too, which sissy's is, her kidneys are working (so makes the UTI more likely) and are concentrating. Cushings dogs have usually very dilute urine.

I know this is tough to figure out, but rule out the most likely first.

Sharlene and molly muffin