Vet says it's cushings, with only a urinalysis...

[Kawigurl]

Hello everyone. I'm so thankful that I have found this forum as my little man Ben is having some problems right now. About a year ago I had to take our Boston Terrier Ben to the vet to have a growth on his stomach looked at. Before I knew it, I was getting a phone call saying that they were going to perform surgery to remove the growth. Long story short, the vet never had testing done to see what it was. Now here we are around a year later and he had another, just like the first, only twice the size. I took him to the vet a few days ago to have x-rays taken, supposedly to see if they could see an underlying cause of these growths. I was spoken to by the vet, and shown the x-ray of his abdomen, which showed a small airway, large heart, and enlarged liver. She told me that all the things I was seeing in the x-ray was leading her to believe that Ben has cushings. A sort of physical exam was done while I stood watching and listened to a bunch of medical terms that I couldn't keep up with. She pulled his skin, told me it was thin. Felt his feet and ears, said they were cold. Ben was at that point sick of waiting for over an hour, and he peed all over the floor. This is where I became a little shocked. The vet decided that she wanted to suck up the pee off the floor and use it for a urinalysis. Mind you, before myself and Ben went into the exam room there was another woman, as well as 3 other dogs. So, she sucked up some of his urine and put it through the process of the urinalysis. The next day she called me and said that his levels were abnormal. Now I'm no medical whiz, but wouldn't taking a sample of urine off of a dirty floor that's had everyone walking on it cause the specimen to be messed up? So anyway, she says because his levels are abmormal, he must have cushings. She then tells me to start to monitor his water intake every day. Because he weighs 30.9 pounds, he should have no more than 3 to 4 cups of water a day. If he drinks more, that's not good and must be because he has cushings. She also tells me that doing the blood tests isn't the best way to diagnose this disease. That goes against pretty much everything I have read. I'm really confused and hoping that someone here can help give me advice and help me along the way. She wants to eventually start him on trilostane, but I'm not willing to do this until I know for sure he has cushings and not something else that acts like the disease. So I'm really curious if anyone can maybe help me out by letting me know of other things that this could be? Oh, she had me start giving him enalapril 1/2 pill 2 times a day because she said his blood is thick and has a hard time getting to his skin, feet, and ears, and that's why they are cold. I plan on getting a copy of his urinalysis results and his blood work, although his blood work was from when he had his surgery to remove the lump. As soon as I get them, I will post them. Maybe someone can give me some insight. Sorry if I am jumping around from one thing to another. I'm just so confused, and stressed about all of this. Thanks for any help

[mytil]

Welcome to our site and I am truly sorry for the circumstances; specifically with the vet. We are all here to help.

I agree with you - not sure a correct analysis can be done from the urine taken like this. AND to say that "doing the blood tests isn't the best way to diagnose this disease" is the most absurd and unprofessional remark I have ever heard. This vet does not appear to know a thing about Cushing's - did she make any mention of the appearance of the adrenal glands from the x-ray?

Cushing's is difficult to diagnose and its symptoms mimic many other conditions (thyroid problems, liver disease, diabetes for example). Please list out the symptoms your Ben is showing.

And she prescribed Enalapril because the blood was too thick? This drug is given in cases of congestive heart failure and in some cases high blood pressure - it helps dilate the blood vessels and helps the oxygen flow to the body. Please question her on this for sure.

Please read through these links to get a better understanding of Cushing's yourself --- http://www.k9cushings.com/forum/showthread.php?t=180, and if your current vet has no experience with Cushing's (meaning has not treated numerous cases successfully) I would seek out another vet or specialist.
Keep us posted
Terry

[labblab]

Welcome from me, too, and I'm so glad you've joined us! I agree with everything Terry has already written, and frankly, I am very scared about your vet's approach to diagnostics and treatment. There are so many questionable things that she has done. Doesn't bother to have pathology done on a lump that she removed (the obvious best way to diagnose it), and then has x-rays done to figure out why there are more lumps that she hasn't even bothered to biopsy either? That is crazy. The lumps could just be benign fatty lipomas, or they could be something more sinister, but x-rays are not going to tell you that. Actual cells from the lumps should be analyzed.

Then, trying to analyze urine sucked from a dirty floor...what???? Telling you Ben has "thick blood" (whatever that means) without performing bloodwork, and then diagnosing Cushing's, to boot -- honestly, I would run to find a new vet as quickly as I could. There is nothing about this scenario that sounds safe or healthy.

Do you have any other vet options in your area?

Marianne

[Squirt's Mom]

Sweetheart, don't waste your time and energy asking this vet anything. Get your baby's records and RUN as fast as you can to another vet and never ever darken the door of this one again. Taking urine from the FLOOR?! and diagnosing anything based on that?! Who knows how clean that floor was or how many other animals had peed on it?! Don't give your baby one single pill that was prescribed either. Let an intelligent, responsible, ethical vet look at your baby first. geez...I am so sorry you and your baby have been treated so haphazardly.

[DoxieMama]

I'm really at a loss for words, although put me in a room with that vet for just a few minutes. I'm sure I could think of some things to say to her.

I sure hope you have another vet that is nearby. If not, the term "nearby" becomes relative... I wouldn't trust any of my animals with that woman, and would be willing to drive some ways to a real vet.

Please let us know!
Shana

[Kawigurl]

Thank you all so much for the warm welcomes and the advice. One of you asked what symptoms Ben had... Not really any of them, honestly.
After we had looked at his x-ray, she asked about what kind of food he ate, how much he ate, and about his water intake. I told her that we feed him 2 cups of food a day. 1 in the morning, and 1 at night. He has always been the normal dog that sits at your feet and begs for human food, or looks on the floor in the kitchen to see if I have dropped anything while cooking. He doesn't go for the trash, or anything like that.
I told her that he started to drink a little more water than usual, but it was more like he was going for water less often, but drinking more in one shot than he used to. He doesn't empty his bowl when he gets a drink. I did my first measurement of his intake yesterday starting when we woke up at 8am to bedtime at 10:30 pm. during the course of the day I put 4 cups of water in his bowl, and he only drank 2.5 cups! When I woke up this morning, I measured what was remaining in his bowl and it went from 1.5 cups at 10:30pm to 1.25 cups at 7:30am. He more or less only drinks a large amount when he wakes up from a nap or after he eats. Other than that, he doesn't go for his water bowl...and he doesn't get water from anywhere else.
He has no hair loss, but does have dry skin. No pot bellied look, and no other symptoms.
Now, about the heart meds... This is what she told me, and that I could understand from her near whispering and jumping all over the place while explaining. She told me that because his heart was large (his heart VHS is 11) and his liver is larger, she said it was a danger for heart failure and liver failure. Because the heart is so big, and his trachea is small, he has a difficult time cooling off, and the blood has a difficult time making its way to the outer extremities like his feet and ears. She felt both, and looked at his skin (this is where she said it was thin, and looked spotty...I didn't see spotty) and she said that she wanted to put him on the meds to help the blood move easier to these areas. Ive never heard of this, but ok... She's a vet so I feel like she should know what she's doing.
She never once mentioned anything about his adrenal glands on the x-rays, only said something about how the pituitary gland can get a tumor causing cushings.
She did speak of many other dogs that had come in to her because they had cushings, but nothing much about an outcome. The only reason that we went to her in the first place was because she has a very good reputation in our area for knowing her stuff when it comes to dogs... crazy after all of this, I know! I should mention that she is a vet that prefers curing and helping in a natural way. She has made it very clear that she hates using drugs, and keeps a very minimal supply in office.
Aside from the x-ray done, she also did a urinalysis, and a urine cortisol / creatinine ratio test. I have no idea what the outcome was of either of them as she called me with results and only said that they were abnormal and that she thinks cushings because of this.
There are a few vets that I can take him to, but we refuse to take him to one as they almost killed him when we took him for an eye injury...
I am going to contact this vet and get copies of tests done, and whatever else I can get and see if I can get them to his old vet (which was awesome) to see what their thoughts are. I am so unhappy over all of this right now! Thanks again for all of the advice, and I am sorry that I just keep rambling on and more than likely saying things several times.

[labblab]

I should mention that she is a vet that prefers curing and helping in a natural way. She has made it very clear that she hates using drugs, and keeps a very minimal supply in office.

No need at all to apologize -- all the info you're supplying is very helpful! Based on your comment above and also your description of her diagostic approach (no pathology or bloodwork?), I do now wonder whether she is actually a fully accredited doctor of veterinary medicine (DVM). I think there are an increasing number of bona fide vets who choose to incorporate "natural" treatment methods alongside more invasive or scientifically-researched treatments. But proper diagnostics are essential either way. If you don't know what you are treating, how can you possibly design a safe and effective care plan?

I'm also puzzled when I read about practitioners who are happy to prescribe "herbal" methods but disdain Rx medication. Chemicals are chemicals, and if an herbal method contains a chemical that is strong enough to actually produce results, then what makes that chemical any safer or gentler than one found in an Rx med? I just don't get it. Anyway, now I'm the one who's genuinely rambling!

As we've already discussed, there are so many question marks about what your vet has told you. But I'm gonna focus on one main issue re: her diagnostics (or lack of them). She performed a urinary cortisol:creatinine test on Ben's urine which she sucked off the floor, after he had been thoroughly stressed by being at the vet's for an hour along with x-rays and an exam. There is absolutely no way in which that result is valid, and she ought to know that if she uses this test as a screen for Cushing's. Here is an excerpt from a technical brochure published by Dechra, the manufacturer of the brandname form of trilostane ("Vetoryl"). As you will see, the UC:CR is very likely to be skewed by stress, and test samples should always be obtained only at home, under very calm circumstances.

To avoid the influence of stress and false positive results, urine should be collected at home, at least two days after a visit to a veterinary clinic. Although a UCCR sample can be collected at any time of day, morning urine is preferred because it usually represents several hours of urine production.

The sensitivity and specificity of this test are greatly reduced when urine collected at a veterinary hospital is tested. (sensitivity ranges from 75 - 100% and specificity 20 - 25%) Specificity and sensitivity can be increased when urine from 2-3 days is pooled and collectively tested, and when the test is performed on dogs showing symptoms consistent with HAC [Cushing's].

So, yup, the bottom line is that I think you'd really do well to get Ben's file copied and then high-tail it to another vet. And if you have other friends who are using this vet, I'd also caution them to explore her background and training. There are just so many red flags about the things she has told you re: Ben.

Marianne

[My sweet Ginger]

You can also go on their website and write your personal experience factually as a warning for other unsuspecting patients. They have to meet the minimum standards in treating and testing protocols and I don't think testing some sucked up urine from the dirty floor is going anywhere near it.

[molly muffin]

hello and welcome to the forum.

I'll just say wow. I've never heard of such a thing by a vet.

Not to say your dog does or doesn't have cushings but I'd want some valid tests, also a blood workup to see what if anything is going on.

Even a fine needle aspiration of the lump to make sure of what it is would be good to know. It is most likely a lipoma (fatty cells, quite common) but you Do want to know.

[Sadielove]

Welcome to the forum. I am sorry to hear about your experience. I agree your vet's action are extremely questionable. I made a change from Sadie's vet due to what I now know now a lipoma when her last vet said it was fat and nothing to worry about and never did any blood work at all. When I took her to the new vet and i was skeptical that they knew what they were doing or talking about when they hit me on our second visit with wanting to test for cushings. They had checked blood work and thyroid first. Surgery was postponed for the lipoma. But I can actually say I am relieved they took all the test and recognized the signs. She came back positive for pituatary Cush. And we have started txmt. I am in full trust wit them now. It is so important to have trust in your vet. I spoke to both doctors at length and they reassured me they have treated many patients successfully for years with Cush. He even admitted in his years of treating this disease he only has lost 2 patients to addisons. Best of luck to you and your furbaby. But RUN to a new vet.