Duffy - Cushing Testing

Hi All,

I am new here and trying to seek out some help.

My dogs liver ALT and ALKP have always fluctuated all of his life. His liver biopsy did not show anything conclusive and they do not believe he has liver disease.

Last summer he had increased drinking and heavy panting with exercise intolerance. They did an ACTH test which came back normal. He was recently diagnosed with a slight leak in Mitral Valve with no treatment needed at this time. He was also diagnosed with Partial Laryngeal Paralysis and is on Doxepin which he is doing well on.

He had a bad episode of diarrhea and vomiting so I took him to my Vet who did a whole slew of tests as I told him he has increased thirst and urination also. He is also having accidents in house and has to go out in middle of night. He was always 13lbs and now up to 16lbs. He will eat anything at this point if i let him.

His blood work including kidney tests came back normal. SDMA test came back normal also.

I ended up taking him to the VCA ER in the middle of the night two days later as he stopped eating and started vomiting worse. They kept him overnight and took an ultrasound the following AM which showed slight thickening in small intestine wall and was diagnosed with IBD. They put him on Hills Z/D. I am in the process of trying to get him off of. It worked well but the ingredients are so unhealthy and it is not even FDA approved.

I received the last blood work test back from my Vet. His profile came back with "indicative presence of adrenal activity" "4 out of 12 values are elevated ranging from mild to significant".

The increased levels were:
Androstenedione-Pre ACTH - .63 (Normal- .05 to .36)
Progesterone - Pre ACTH - 3.39 (Normal -.34 to 2.90)
Progesterone - Pre ACTH - .31 ( should be less than .25)
Progesterone - Post ACTH - 1.94 (Normal- .0.22 to 1.45)
The labs were done by University of Tennessee

They state these values are indicative of early stage hyperadrenocorticism. They also state that the "Steroid profiles Diagnosis of Atypical Cushing's". They recommend Ultrasound or Endogenous ACTH. Endogenous ACTH was also done in blood work which had a result of .28 The panel states if Cushing is diagnosed over .15 is consistent with PDH. First treatment they want to do is Melatonin.

My problem is my Specialty Vet who did the liver biopsy, scope for bronchial disease and last month ultrasound and diagnosed IBD says he does not need treatment for this and my regular Vet says he does. I am in the process of making an appointment with a recommended Vet for a third opinion.

Do any of you have an experience like this or with what they are labeling "Atypical Cushing's" ?

Any help is much appreciated!

Thanks!
Lynn

I am headed out the door shortly but wanted to let you know I have merged this latest post with your baby boys' original thread. We like to keep all info about each pup on one place so it is easier to look back thru the history if needed. ;)

Very quickly - treatment for Atypical Cushing's (in which 2 or more of the intermediate hormones you have listed are elevated but the cortisol is NORMAL) is the combination of melatonin and lignans from either flax or spruce. This can take a minimum of 4 months to show changes so patience is required with this form of Cushing's. Some vets do not believe in Atypical, some believe it is a precursor to conventional Cushing's with elevated cortisol. My Squirt started out Atypical and did become true Cushingoid over about 3 years at which point we added Lysodren to her lignans and melatonin. UTK does not recommend Vetoryl for Atypical pups because it has been proven to cause elevations in the intermediate hormones.

Hopefully others will be along soon to chat with you!

Hi Lynn,

Sorry that Duffy is having some problems on top of the health issues he already has :( In all honestly, with all that is going on with Duffy I really wouldn't try the treatment (melatonin & lignans) for Atypical Cushing's. This type of Cushing's is really debated among the top veterinarian endocrinologists because they have found that dogs with non-adrenal illnesses can have elevated adrenal hormones and according to one study high estradiol levels were noted in healthy dogs.

Regarding the increased drinking/urinating; was his urine cultured to make sure that an UTI is not brewing?

Lori

Thanks John. I made an appointment for Thursday night with a new Vet. Hopefully we can get to the bottom of what is going on.

Hi Lori,

I made an appt. with a new Vet on Thursday night who came recommended to me.

They took a urine test by Cystocentesis. The IDEXX SDMA came back normal at 7. Here is what the rest of the urine report reads as:
Color: Dark Yellow (but it has been looking more clear since all of this water drinking)
Clarity: Cloudy
Specific Gravity: 1.035
PH: 6.5
Urine Protein: Negative
Glucose: Negative
Ketones: Negative
Blood/Hemoglobin: Negative
Bilirubin: Negative
Urobilinogen: Normal
White Blood Cells: 0-2
Red Blood Cells: 0-2
Bacteria: None Seen
Epithlial Cells: None Seen
Mucus: None Seen
Casts: None Seen
Crystals: None Seen

I am assuming if no bacteria was seen there was a culture taken? I don't really know the answer to that?

The results look pretty normal and the Vet said the slight blood in urine is probably due to taking it with a needle?
Maybe I should have the test repeated by the new Vet?

Usually he goes to his Wee Wee Pads if he has to go. Now he is just peeing on my area rug even when I am home. He is drinking tons of water. They switched me over to the Hills Food Z/D and I am mixing it with new food now to see if I can get him off of it with no diarrhea. So far he is doing good with that. I am wondering if the change from a home cooked turkey and oatmeal food for the Liver (which we no longer think is the problem and he was taken off of due to the diarrhea) to a dry food is part of the problem?

I feel like I am spinning my head but worst of all I feel bad for my happy little boy. :(

Thanks for any help!
Lynn

Lori,

One more question:

I understand how a UTI can cause the excessive urinating but would a UTI cause the excessive drinking?

Thanks!
Lynn

An UTI will absolutely cause a dog to drink more. And if the urine is dilute than a regular urinalysis may not pick up bacteria that is in the urine which is why an urine culture and sensitivity test is recommended.

When Duffy pees, is it coming out in a strong stream or does it seem to dribble out?

I just did a quick Google search about the Hills Food Z/D and it seems that increased drinking in the dog is a complaint.

Normal water intake for dogs is 1 ounce per pound, how many ounces is Duffy drinking and how much does he weigh? Also, dry dog food can increase a dog's thirst because of the lack of moisture.

Hi Lori,

I just walked him and he appears to be peeing normally but now when I clean it up it is not so yellow. I have read that about Hills Z/D also and have read the same thing. One of the many reasons I am trying to get him off of it. I have him half way converted. Today I worked from home and gave him only the other food at lunch and he didn't have diarrhea but had lots of stomach noise and soft stool but far from diarrhea. I may have to experiment with the food but don't want to upset his stomach to much. I will wait until he sees the Vet Thursday night but that food is horrible. Although the Vets love to give it out and I can't argue it worked but to what extent of lack of nutrition/and or damage am I doing to my dog? But that is a discussion for another day.

Duffy is 16lbs (gained 3lbs in last few months) has always been about 13lbs.

He is drinking about 23oz of water a day. I have been filling up a 16oz water bottle and putting it in to his bowl.

My major concern is the peeing where not appropriate. He is not even using the wee wee pads which is just not him. Maybe from the large amount of water he is drinking he just can't control it.

Do any of you have dogs with IBD or Colitis or Sensitive Stomach? What food do you feed them?

I always fed Duffy Wellness Core but my Vet switched him to home cooked turkey and oatmeal due to what they believed was liver disease altho after liver biopsy it appears that the liver is not the reason ALT/ALKP is going up........

Thanks,
Lynn

I always fed my dogs the Wellness Original formula and my Gable always had diarrhea or pudding poops. My vet recommended Hills w/d formula and the next day he was pooping normal and has been since. His drinking did increase with this food, but he hasn't had an accident.

Thanks Joan! Glad to hear that Hills W/D is working good for you. I will say it did stop the diarrhea but I would rather find something else if I can as the ingredients in Z/D are not good in my opinion and the peeing and drinking is excessive, especially with the accidents.... Right now I am mixing it with Petco Whole Hearted Grain Free Salmon as it is the only hydrolyzed food with decent ingredients I can find other than Royal Canine and Hills Z/D.....