Zoe By My Side- Our Journey with Cushings

[addy]

Hi, my name is Addy and I have two dogs Zoe and Koko. Zoe may have Cushings and I need advice. Here is the long history. I am at work so won't be able to post again for 5 hours. Thank you.

Rescued Zoe, a Lhasa Apso, on 4/17/07 from animal control. She weighed 19 pounds and was 11” high at the shoulder. Probable age 5 years but not sure. Put her on Canidae all stages dog food. Had a bit of a touchy stomach. New food gave her soft stools. Only other problems were reverse sneezing and paw chewing.

August 08 brought home nine month old male dog from animal control. Zoe hurt her paw and had trouble walking, took her to emergency before picking up new dog. Thought it was just strained, rest and pain killers. Saw regular vet, gave her Rimadyl. Had bad reaction to drug. Could hardly stand up. Lots of stress in house with new dog who is sick with kennel cough. Then Zoe ate something in the park, her Canidae formula changed unbeknown to me. Got diarrhea. Vet put her on flaygl and canned Hill’s ID. Told me to pick out new food and transition. Should not be a problem. Was a problem, could never get her off the canned ID. Sometimes even one piece of kibble would cause water stool. Had to supplement canned ID with rice and pumpkin. All blood work normal back then.

April 09 both dogs had vomiting and diarrhea. Put Zoe back on Flaygl but stools never got to be 100%. Went to new vet, blood work again normal. Gave me more Flaygl and Panacur. Two months later went to holistic vet also trained in western medicine and asked for help. She thought Zoe had stress colitis. She did thyroid panel sent to Michigan State. Said Zoe was in the low range, treatment not recommended. However, she wanted to try a glandular thyroid drug called Armour. She put Zoe on a raw commercial diet, Shen Calmer and Armour along with Culturelle probiotic. Zoe went on new diet cold turkey. She said I went too slow trying to transition, and had me journal. We went up and down with water stool but most days she only had one small stool a day. Energy level went up, she lost weight, sore paw was better. She ran into trouble a few months later, put her on Flaygl. Tapered her off it according to new vet, added some Honest Kitchen to her diet and a miracle happened. Zoe was normal again and stayed that way all last winter until we took her to groomers in February. Noticed her coat was very thin after the groom, like she lost her undercoat.

March 10 went back to holistic vet, asked to take Zoe off Armour, I had read drug had been reformulated in Spring of 09 and humans were complaining of hair loss as a new side effect. Thought it was affecting her coat. Thought she may also may a urinary infection as has been licking her potty since last August. She said do urine test for Cushings. Also did panel for thyroid but only checked Free T4 and T3, not full panel. Test came back that Armour really wasn’t affecting her levels, said ok to stop it but that Urine Creatinine test came back positive with very high numbers and she said dogs with that high of numbers always have Cushings, wants to do low dose dex test. She is already picking out what drug to use. I told her I did not even collect urine specimen correctly, no one told me it had to be first urine of the day. Zoe had eaten breakfast, drank water, went for a walk, urinated a few times and then I took the specimen around 10:30am. She is very reactive on walks. She said that did not matter and Zoe had to have Cushings drugs or her hair would all fall out in 2 months. Told vet she would be too stressed all day to stay in cage at vets and worried it would not be accurate test. Vet said stress would not affect the test.

Everything I read tells me the opposite of what this vet says. HELP! She has no other symptoms except a poor coat. She hasn’t even had a physical exam. If I post her test numbers could anyone give opinion? I feel like I need to start all over with blood work, exam, chemistry panel, etc before testing again for Cushings.

[zoesmom]

said ok to stop it but that Urine Creatinine test came back positive with very high numbers and she said dogs with that high of numbers always have Cushings, wants to do low dose dex test. She is already picking out what drug to use. I told her I did not even collect urine specimen correctly, no one told me it had to be first urine of the day. Zoe had eaten breakfast, drank water, went for a walk, urinated a few times and then I took the specimen around 10:30am. She is very reactive on walks. She said that did not matter and Zoe had to have Cushings drugs or her hair would all fall out in 2 months. Told vet she would be too stressed all day to stay in cage at vets and worried it would not be accurate test. Vet said stress would not affect the test.

Everything I read tells me the opposite of what this vet says. HELP! She has no other symptoms except a poor coat. She hasn’t even had a physical exam. If I post her test numbers could anyone give opinion? I feel like I need to start all over with blood work, exam, chemistry panel, etc before testing again for Cushings.

Hi and welcome -

Well, here come the questions - pretty standard for new members so bear with us. Can you post the results of the urine cortisol:creatinine ratio test. That test will rule out cushings if it is negative. However, a positive result just means that you need to do more testing to confirm cushings and your vet is suggesting the LDDS (low dose dex test) next, it sounds like. (That might be premature . . . has general bloodwork been done yet?) I suspect you are still a long way from a firm cushings dx. And you are also right . . . more definitive testing is probably in Zoe's future.

Cush dogs will usually have certain elevated enzymes. If bloodwork has been done, then also please post anything that was high or low - out of normal range. (If you didn't have copies of all her test results, start asking for them and keeping a file.) You are also right that stress can skew a dog's cortisol levels on testing. With Zoe having few symptoms, there are other possibilities besides cushings. Hypothyroidism can cause coat issues as can atypical cushings. It could be any number of things. But do give us whatever details you can. Zoe's weight, age, other meds, recent test results, other suspect symptoms - if there are any. Cush pups usually have a voracious appetite and thirst (causing excessive urination), those elev. liver enzymes, are prone to infecctions, weakness in legs, poor coat, muscle wasting, some have skin issues. Not all cush dogs have all the symptoms, and some will only present with a few - but they can mimic the symptoms of several other conditions, which is why it's not always easy to diagnose. Do check out our resource section and start reading as much as you can. You'll get lots of pointers here on what to ask your vet but we do need more info from you. Sue

[StarDeb55]

I am so sorry that Zoe has been having so many issues, but welcome both of you to our group. I will warn you that we tend to ask a lot of questions of new members but that simply helps us to give you the best advice possible from the group's collective experience. From your post, it's not clear as to which vet is in the rush to test/treat for Cushing's, is it the holistic vet or regular vet? You are correct about the way you collected the urine not being ideal. Was the urine test a urine cortisol:creatinine ratio? If it was simply a urine creatinine, that will tell you nothing about Cushing's. High levels of stress with a vet visit can certainly affect a low dose dex test. A lot of members who have dogs who stress at the vets will take the dog with them during the 4 hours between blood draws, go to the park, go home, whatever you want to do as this will lower the stress levels.

Is the hair loss, poor coat condition the only symptom that Zoe has? Some of the other symptoms can include excess drinking & urination, pot belly, muscle wasting especially in the rear end, & an absolutely voracious appetite. We can most definitely help you understand the labwork that Zoe has had done already. In fact, I'm a medical lab tech with 30+ years experience. If Zoe has had something like a senior wellness panel or super chemistry panel, could you please post only the abnormal results, along with the normal ranges, & reporting units.

When it comes to the low dose dex test (LDDS), this test is considered to be the gold standard to diagnose Cushing's, but it has one big drawback as it can give a false positive result in the presence of non-adrenal illness such as diabetes or thyroid. This is why it's very important to get these other 2 medical issues ruled out. It is also crucial to get a positive LDDS results confirmed by a 2nd test, usually an abdominal ultrasound.

Looking forward to hearing more.

Debbie

PS-I see Sue was posting at the same time, so sorry for any duplication.

[Roxee's Dad]

Hi Addy,
Just wanted to chime in and welcome you and Zoe. You have been well advised and we are looking forward to the details of testing. Don't let any vet push you into treatment until there has been a proper and thorough diagnosis. Also find out if your vet has had experience treating a cush pup. Sometimes we find that you can get to the bottom of some of these mysteries by consulting with an Internal Medicine Specialist.

[Dutchboy]

i am very new at this, in fact, just found out that my dog probably threw a false positive. he saw an internal med specialist yesterday that said absolutely, stress can make a difference in the test results. my dog had a low dose dex test and was extremely agitated at the vet's that day. he pooped his run; ran around in it and painted the walls. i cried and worried for 5 days that he had an adrenal tumor.
maybe your vet could refer you to a specialist, as well. they could look at the bloodwork, etc. you have already had done and give an informed opinion.

[addy]

Thanks to all of you for responding. Latest test
Michigan State-4/13/10
Urine Cortisol 422
Urine Creatinine 4.0
Urine Cortsol/Creatinine Ratio 106 H ref range 8-24
Total Thyroxine TT4 27 ref range 15-67
Total Triiodothyronine TT3 1.1 ref range 1.0-2.5
Free Thyroxine Ft4 9 ref range 8-26
Free Triiodothyorine FT3 2.5 L ref range 4.5 -12
Thyroid Stimulating Hormone 7 ref range 0-37

she was taking Armour Thyroid (glandular) 30 mgs 2 times a day for 7 months.

Original thyroid panel 8/21/09

Total Thyroxine TT4 17 ref range 15-67
Total Triiodothyronine TT3 .9 L ref range 1.0-2.5
Free Thyroxine Ft4 13 ref range 8-26
Free Triiodothyorine FT3 1.2 L ref range 4.5 -12
Thyroid Stimulating Hormone 12 ref range 0-37

Zoe is possibly 8 years old, could be older. She currently weighs 18.5 pounds. I measured her water intake, does not even drink average amount, she finishes her food in the same amount of time as my other dog, she begs for food the same as my other dog, they are clicker trained with food, her stomach seems different than younger dog but I don't think it looks like the pictures. She jumps on the bed just fine. I see no other symptoms. She has gained one pound since I weaned her off the Armour. I started that process one month ago and she has been 100% off for 2.5 weeks. I was worried the drug was making her hyperthyroid or causing the hair loss.

here is the thing, she got into a plastic bag with turkey in it and ate some of the plastic and had a bout of diarreha 2 weeks before the test. I gave her Flaygl to stop the inflammation caused by the plastic. That plus not collecting the urine correctly makes me doubt the validity of the urine test and since I feel we have not been taking a detailed approach, I don't trust the validity of the low dose dex test when I know how badly stressed Zoe will be. When she went for her dental they had to put a towel over her head to even get her in the crate.

I have been misdiagnosed by the human medical community, over dosed on drugs I should never have been given. I am cautious of any doctor or vet.

We have only one internist in town that I can find. I don't know how good she is.

I feel I need to start with a chemistry panel, complete blood count, urinalysis and a physical exam. I don't care if I have to pay all over again. I just need to know I am doing right by my Zoe. I do NOT want the holistic vet to do these tests as she already has made up her mind on the diagnosis.

Am I just putting my head in the sand? Am I just afraid to see what is in front of me? My gut is telling me to start over. I do not feel good about this test the holistic vet wants to do. I want to start at the beginning which is what I keep reading to do.

Thank you. Some times my brain is going faster than I can type

[StarDeb55]

First of all, please don't let any vet rush you into treatment. Cushing's is a slowly progressing disease, literally taking years to do its damage to a pup's internal organs. You need to take the time to learn & educate yourself about the disease, including such issues a diagnostic testing medication, & monitoring tests for either medication that is used to treat, trilostane or lysodren. You also need a vet that is willing to work with you as a team for Zoe's best interests. A vet who is willing to listen to your concerns, & answer any & all questions.

Now, the Urine creatinine cortisol ratio (UCCR) does, indeed, point the finger towards Cushing's. I must stress that a positive UCCR test simply indicates that Cushing's is a possibility, but further testing is required. If I were in your shoes, I would be really concerned about letting this vet rush me into treatment. I think it would be in Zoe's best interest to ask for a referral to an internal medicine specialist as a large number of general practice vets, simply do not have the in depth knowledge required to accurately diagnose & treat Cushing's. If you have copies of the general labwork that has already been done on Zoe, as I said earlier, if you will post the abnormal results, I can take a look at them, & see if there is anything else that might point toward Cushing's. Most cushpups have abnormal liver function test results, so I would be especially interested in seeing those results. I don't think it would be necessary to repeat the general labwork. Get that referral to a specialist, & you can take all of Zoe's records with you for their review, letting them decide on how to proceed.

One last thing, a Cushing's savy vet usually will not treat a pup who doesn't have strong symptoms. Monitoring a change in symptoms is one of the primary ways of determining how a pup is responding to the medication.

Debbie

[addy]

Thank you Debbie. The problem is the blood work is one to two years old and I am afraid may be irrelevant. I could get the 2 year old blood work but last year's test was done by a very stange vet. He was so odd, I really don't want to call there. He claimed to know Zoe and said he treated her as a puppy. I found the whole visit extremely uncomfortable. That is why I moved on to the holistic vet. She was recommended by a friend.

Do I have to have a referral to an internist? One cannot just make an appointment?

Also, is it better to just present Zoe with her hair loss and let the internist start from scratch or tell her about the Cushings link? I have found with human doctors, they seem to dwell on the previous diagnosis and let it influence them.

I am trying to read all I can. I am not retaining alot at the moment, I am too upset, I think. I am afraid of the drugs but I know that seems to be a common reaction. I certainly won't give them to Zoe if I could not even tell if they were working that was one of my concerns. How would I know? I was looking at the melitonan and flax hull treatments, wondering about that.

Could the hair problem be from her diet? Will her hair really fall out in 2 months? Why would the vet want to scare me like that? Are her numbers that bad?

I am like everyone else. Zoe is my life. All I have done for 3 years is try to help this little dog. I leave and breath Zoe 24 hours a day, seven days a week.

Thanks again.
Addy, Zoe and Koko's Mom

[addy]

Hi All,

I have been in the process of waiting six weeks after the withdrawal of the USP thyroid medication-brand named Armour-natural glandular product. We see the internist tomorrow. Zoe's hair is starting to grow back-so much for her vet saying it would all fall out in 2 months because of her possible Cushings diagnosis. One thing I was not expecting was to see a flare up of her colitis. Has anyone experienced loose stools after withdrawing thyroid meds? Perhaps it is unrelated but I sure had hoped I would not have to focus on her colitis tomorrow with the internist. Zoe was being treated for hypothyroidism because her numbers were on the low side, although Michigan State did not recommend treatment. Her hair started thinning and her tail started looking bad after a groom in February. She then had urine cortisol - ceatinine ratio that showed 104. I did not collect urine correctly and suspected a false positive. She had a colitis flare up going on then as well. I don't think it ever resolved. With so much going on I am worried which way the internist will approach and I want to be thorough. Any suggestions?

Thanks for your help. Hopefully I explained everything. Wasn't sure if you needed by previous post so started a new one. let me know the proper way to do it.

Thanks,
Addy
---------------------------------------

Moderator note: Addy, we have merged this post (originally posted in the "How to and Comments" Forum) with your original thread here in the Questions and Discussions Forum. We like to keep all posts about each specific dog in one single topic, so that we can easily look back through the topic to see what was posted about them previously. It's just easier for everyone that way!

[addy]

Hi Addy here,

I first posted probably 3 months ago but had to wait for testing further. I have also cried for 3 months while waiting and today I am falling apart after speaking to internist last night. I need to get it together but it is so hard. What does it mean when they have not just high cortisol but four other hormones high?

Finally have results back so started new post. Original Urine creatine test was 106. History is on first post but thought I should start new one now with all the test results. New tests done through internist.

Does she fit diagnosis? Do I treat the symptoms or the diagnosis? UTK says lysoderm so does internist. I don't know what to do. Lhasa apso maybe 8 yrs old but unknown, has been with us for 3 years, came from Animal Control. on raw commerical diet for 1 year
Blood work does not seem what it should be for Cushing dog, why is Platlet so high?

symptoms: thinning skin on belly, thinning hair, rats tail, exercise intolerance, back legs getting stiff, water intake below normal, food intake- eats as fast as other dog, begs the same, wants to lick EVERYTHING and chew alot on her Kong, does seem hungrier since starting raw diet, not as active, does not do well in heat, only pants when colitis is bothering here and has bad poops, on Shen calmer, was taking armour thyroid natural glandular product and was taken off drug when I noted thinning hair. thyroid tests from Michigan test did not indicate thyroid treatment but she was on the low side so vet tried it. Needs Flagyl frequently for chronic diahrrea and vet wants her on it to maintain stools so has been taking 125mgs 1 time, every other day for 3 weeks. Helps her.

ultra sound- adrena glands larger than normal with one being slightly larger- nothing of signifigance with other organs

cbc, gastro panel from texas state, urinalysis, serum chenistry, full adrenal panel utk, acth test to UTK

SubTest Name Normal Values Results
SP-TY Collection Method Cysto
Hyl None Seen None Seen NORM
Fine None Seen See Notes ABNORM
Coarse None Seen None Seen NORM
Renal Epi Casts None Seen None Seen NORM
WBC None Seen
RBC None Seen
Squam None Seen See Notes ABNORM
Mucus None Seen None Seen NORM
Bacti None Seen None Seen NORM
Urinalysis-Microscopic Thu, 5 /27/2010 11:23 AM
Results/Comments
Fine: Rare/LPF
WBC: Rare/HPF
RBC: Rare/HPF
Squam: Rare/HPF
Vol: <5
Amorphous: None seen
SubTest Name Normal Values Results
Glucose 74 - 145 mg/dL 88 NORM
AST(GOT) 13 - 81 U/L 18 NORM
ALT(GPT) 14 - 151 IU 46 NORM
Alk.P.Tase 13 - 289 IU 325 HIGH
Total Bilirubin .1 - .5 mg/dL 0.1 NORM
Cholesterol 98 - 300 mg/dL 503 HIGH
Total Protein 5 - 8.3 g/dL 6.2 NORM
Albumin 2.6 - 4 g/dl 3.5 NORM
Globulin 2.7 - 4.4 2.7 NORM
Urea N 8 - 30 mg/dL 15 NORM
Creatinine .5 - 2 mg/dL 0.6 NORM
Phosphorous 2.5 - 7.9 mg/dL 3.4 NORM
Calcium 8.7 - 12 mg/dl 9.7 NORM
Sodium 141 - 159 mmol/L 149 NORM
Potassium 3.4 - 5.6 mmol/L 4.4 NORM
Chloride 100 - 118 mmol/L 107 NORM
Bicarbonate 16 - 31 mmol/L 23 NORM
Anion Gap 15 - 25 mmol/L 23 NORM
GGT 3 - 19 U/L 9 NORM
A/G Ratio 1.3
Animal Profile 1 Thu, 5 /27/2010 11:24 AM
Results/Comments
No significant hemolysis or lipemia present.

SubTest Name Normal Values Results
Red Blood Cell Count 4.48 - 8.53 M/ul 7.50 NORM
Hemoglobin 10.5 - 20.1 g/dl 18.0 NORM
Hematocrit 33 - 58.7 40 53.5 NORM
Mean Corpuscular Volume 63 - 78.3 fL 71.3 NORM
Mean Corpuscular Hemoglobin 21 - 27 pg 23.9 NORM
Mean Corpuscular Hgb Conc. 30.8 - 35.9 g/dL 33.6 NORM
Red Cell Distribution Width 11.9 - 18.1 % 15.7 NORM
Platelet Count 140 - 540 K/ul 589 HIGH
White Blood Cell Count 4 - 18.2 x 10^3/ul 5.4 NORM
Seg. Neutrophil Absolute # 2.5 - 15.7 x 10^3/ul 4.05 NORM
Band Neutrophil Absolute # 0 - .2 x 10^3/ul 0.11 NORM
Lymphocyte Absolute # .3 - 3.9 x 10^3/ul 1.08 NORM
Act Lymphocyte Absolute # 0 - .9 x 10^3/ul
Monocyte Absolute # 0 - 1.4 x 10^3/ul 0.16 NORM
Eosinophil Absolute # 0 - 1.3 x 10^3/ul
Basophil Absolute # 0 - .1 x 10^3/ul
Other Absolute # 0 - 0 x 10^3/ul
Blast Absolute # 0 - 0 x 10^3/ul
Promyelocyte Absolute # 0 - 0 x 10^3/ul
Myelocyte Absolute # 0 - 0 x 10^3/ul
Metamyelocyte Absolute # 0 - 0 x 10^3/ul
Hemogram Thu, 5 /27/2010 11:24 AM
SubTest Name Normal Values Results
Segmented Neutrophils % 75
Band Neutrophils % 2
Lymphocytes % 20
Activated Lymphocytes %
Monocytes % 3
Eosinophils %
Basophils %

SubTest Name Normal Values Results
Folate 11.3
Serum Cobalamin (Vit B12) 962
TX AM B12/Folate Thu, 5 /27/2010 11:26 AM
Results/Comments
Normal Ranges:
Folate Fasting: 7.7-24.4 ug/L
Serum Cobalamin: 251-908 ng/L
Printed on: 6/17/10 at 9:09 PM *VL1 3
UT Adrenal Panel Thu, 5 /27/2010 11:27 AM
Results/Comments
Endocrinology Lab Case# EN 10-4088
Test: Result: Normal Range** Result Normal Range**
(post ACTH)
Cortisol ng/ml 47.7 2.1-58.8 304.4* 65.0-174.6
Androstenedione ng/ml 1.05* 0.05-0.57 7.69* 0.27-3.97
Estradiol pg/ml 114.8* 30.8-69.9 102.2* 27.9-69.2
Progesterone ng/ml 0.99 0.3-0.49 5.91* 0.10-1.50
17 OH Progesterone ng/ml 1.18* 0.08-0.77 20.33* 0.40-1.62
Aldosterone pg/ml *** 33.9 11-139.9 357.1 72.9-398.5
* Above or below reference range
** Mean normal range values for spayed female dogs (N=36). QNS = Insufficient sample.
*** Normal range values for male and female dogs (N=72 baseline, N=23 post-ACTH.
These results indicate presence of increased adrenal activity. (SIGNIFICANT)
Comments: Values are increased as indicated.

I have had no sleep so I hope I did this all correctly. Is it too much info?

Thank you all so much.

Moderator's Note: Addy, I have merged your new thread with Zoe's test results into Zoe's original thread. We prefer to keep all posts on a pup in a single thread as it makes it much easier for other members to refer back to the pup's history, if needed.

Debbie