Mira, 7yr old Husky - Cushings ruled out; liver cancer (Mira has passed)

[Altira]

My Mira... There is defintally something very wrong but she has almost none of the normal Cushings symptoms yet the vet says itcould be. She recommended I read up on it. I don't think she would say that unless she was very certain. All we are going on right now is the first blood test results. I would love your opinion! I will just note the Highs and lows.

ALK - 1282 (10-150) high
ALT- 110 (5-107) high
AST - 98 (5-55) high
CK- 469 (10-200) high

AMYLASE - 444 (450-1240) low

TV02 - 16 (17-24) low
CHLORIDE - 119 (105/115) high
POTASSIUM - 5.8 (4.0-5.6) high

NA/K RATIO - 26 (27-40) low

ABS NEUTROPHIL - 12551 (3000-11500) high

T4 was done too and came out normal. We are waiting on the urine test. Please tell me what you think so far. Thevet circled the first four in the list. I took Mira in thinking she has allergies and it was nobig deal but I wanted a blood test done just to check. She is coughingand gagging, panting some, has lost fur around her eyes andmouth, sleeping a lot, looks sleepy all the time, has constant discharge fromher eyes, is limping badly, can't really do walks. We had been walking every day up until a week ago. She suddenly wonteat dry food and she is begining to reject thecanned too now. She drinks the normal amount of water which is slightly more than she was. I think she has lost weight. I was brushing her tonight she go up and went to her pillow and peed on it. She is housebroken!! She is acting so strange. And I'm prone to panic. I don't want to loose her so soon.

[labblab]

Hello! I am so glad you've found us, although I am very sorry about the problems that Mira is having. From what you have posted so far, it does sound as though Mira exhibits some of the lab abnormalities and symptoms of Cushing's. However, other pieces do not fit very well into the "Cushing's puzzle." The first four lab values that your vet circled do correspond with Cushing's -- elevated liver enzymes and evidence of muscle wasting are consistent with abnormally high levels of circulating cortisol.

However, Mira exhibits other symtoms that I think may be consistent with Addison's Disease, which is the opposite problem from Cushing's (cortisol/aldosterone levels are too low instead of cortisol being too high). Read this description of the symptoms of Addison's:

Symptoms of Addison's disease are very similar to other diseases and they seem rather vague. Symptoms may include but are not limited too; middle age female dogs, usually over 7 years of age, depression, lethargy, weakness, not eating, weight loss, vomiting and diarrhea, drinking more, urinating more, dehydration, and a fast heart rate in some patients. Many times these symptoms may go unnoticed or correctly diagnosed and the patient finally presents in a Addisonian crisis. During an Addisonian crisis the patient may present in acute collapse and in shock. This is very serious, deadly, and scary to watch. Blood work will show low sodium level, high potassium level [the resulting Na:K ratio will be low], and high kidney enzymes...

You can also read more about Addison's here:

http://www.peteducation.com/article....2+2097&aid=520

Many of these symptoms do sound like your description of Mira. However, apparently her kidney values still fall within the normal range? (BUN, CR or "creatinine"). Anyway, regardless of how her urine test turns out, I am thinking that an ACTH blood test may be the next best test for Mira because it can help diagnose either Cushing's or Addison's. Also, as you will see from reading more about Addison's, it is a treatable disease but can definitely turn life-threatening very quickly if it is not properly diagnosed and treated. If Mira seriously worsens in any way, I'd encourage you to take her back in to the vet immediately for emergency assessment.

Marianne

[Altira]

Gosh I hope I'm doing this right! I can't thank you enough for your imput and for taking the time to read my post so carefully. As I mentioned i am prone to panic. What might be something that would constitute an emergency? Probably not peeing in her pillow but I got to tell you that's all it took to get me here.

[labblab]

Yes, you are replying exactly right!

If Mira starts vomiting or suffering from diarrhea, or becomes even more lethargic or unresponsive -- I would call your vet and/oir take her right on in.

As I said above, the elevated liver values do correspond with Cushing's. Panting, muscle weakness and fur loss are also Cushing's symptoms. And sometimes Cushpups can appear to lose weight due to muscle wasting, even though their actual weight has increased.

But your description of Mira's behavior sounds "off" to me in other ways. The lack of appetite (as opposed to ravenous Cushing's appetite), the rather sudden onset of her lethargy and weakness (could walk up until a week ago), the gagging -- she sounds like something is more acutely wrong, whereas the progression of Cushing's symptoms tends to follow a slower chronic course. That is what is making me wonder what else might be causing her symptoms. When do you think your vet will have the results of the urine test?

Marianne

[Altira]

That's what I'm thinking, this testing is taking far too long... and yes this did happen suddenly. My dogs and i were running the streets two weeks ago with Mira right out front. Well really she's been acting strange for about a month. Oh I forgot to mention she has incontance (sp?) too.

The urine test results Might come in today the vet said. I'm very worried. What should I do?

[Altira]

Ok I'm panicing. I should mention other then the peeing in the pillow thing she had a pretty good night. Only coughed twice and she ate all her canned food last time pretty well and she's be a tad more active. Limping is very bad, seems to be just the front left leg. You can just look at her and tell something is wrong though. My husband thought she looked out of it sort of.

[labblab]

How long ago did your vet actually see Mira? Is he/she aware of these new issues with the picky appetite, lethargy and inappropriate urination? If not, I'd telephone the office to let your vet know what is going on. That way, your vet can help determine whether or not Mira needs to be seen again, regardless of whether or not the urine test results are back yet.

Marianne

[Altira]

Yes she knows about all the things I've mentioned. The blood was taken on the 28th of October. She called the next day and said we needed to rule out cushings. I think that's what your saying too. It didn't seem urgent to her. I talked to her again on Monday and told her of the new symptoms. The limping.

[Altira]

I just talked to the vet. We are going to the next step tomorrow. I'm really upset. She's thinking it might be something else too more serious. She said we wont get the result from this test until next Monday. If it's cushings she said with need to deside to treat or not. She'll die if we don't right?

[labblab]

Did your vet already have the results of the urine test, and is that why you are heading on to the next step?

Is your vet planning an ACTH test? This is a test that involves two separate blood samples drawn 1-2 hours apart. As I said earlier, this test can be used to diagnose both Cushing's and Addison's. Although if Mira's urine test (UC:CR) was abnormally high, that would already be consistent with a diagnosis of Cushing's rather than Addison's.

Actually, treatment for Addison's dogs is much more urgent than treatment for Cushing's. Cushing's is typically a slowly-progressing disease that is not urgently life-threatening. So you can take your time to learn more about the disease and the treatment options. However, if Mira seems to have something else going on, I'm assuming your vet will plan to proceed with some other diagnostics.

It will help us all a whole lot if you'll ask your vet for copies of any test results. That way, we'll be better prepared to help with suggestions and feedback. And one word of caution: an ACTH test can end up with a "false positive" result if a dog is suffering from an illness other than Cushing's at the time that the test is performed. So you may want to ask your vet about that issue tomorrow if the ACTH is indeed the test that she has in mind.

Here's a link to the index of our "Important Information" forum that has a ton of helpful resources about diagnostics and testing. I know it can look very overwhelming at first, but as you start to read through different articles, you'll be amazed at how quickly you'll starting picking up information.

http://www.k9cushings.com/forum/forumdisplay.php?f=10

Marianne