Yohnny 11 year old Shih-tzu with Cushing-like problems

[Jayessi]

Hi Lulusmom and thank you so much for taking the time to write.

Regarding the urine cortisol creatinine ratio (UC:CR). I collected them myself at home on our regular morning walk. I am pretty sure he was not stressed.

I am seeing vet next week so trying to get info and come prepared when I talk to her.

Basically why it has been several months is that the vet does not really understand what is wrong with Yohnny. Because I read a little about the LDDS test Iand saw it is not 100% test I asked her about this. But she said no if he has cushings it should show on the test. She has not discussed ACTH test or any other test with me. So I am wondering if I should look for another vet?

I will consider everyone's input so I am glad you are giving yours about testing for atypical cushing's, even though others don't agree. At this point I am gathering as much info as I can.

Again, thank you.

[Jayessi]

Thank you so much Marianne for this info. and follow up of my question. I am going to have to read it a few times as it is hard to wrap my brain around all those fancy words but it is something I can also show my vet. Will read the links too.

Yes, he did an abdominal ultrasound in conjunction with removing his testicles. But I am not sure if she actually looked at the adrenal glands because she has not written anything about it in the report. She may have said it to m but I do not remember. I will ask her. This is what she wrote in her US report (it as my translation of swedish so please excuse me if it does not make sense)

bladder moderately filled aneloic urine normal wall, spleen homogeneous parenchyma normal ecogenicity, kidney approximately 4.2 cm normal bark/marrow, ventricle empty normal wall, liver overview: homogeneous parenchyma normal echogenicity, gallbladder thin-walled anechoic bile, right kidney same as left, small intestine normal motility sparing filling. Summary no deviating findings

I am definitely going to ask for a urinalysis.

THANK YOU!!!

[Jayessi]

Noted Marianne. I really want to do all that is possible for my boy. Even though we are still reeling from nine months of serious vet bills during the his bother's illness.
I think I am going to try and sum up all the suggestions in a post in this thread that I will be talking to with the vet and would be really grateful if you can have a peek at it so that I hve understood correctly.
with deep gratitude. /amanda

[Jayessi]

I have one more though that I cannot understand. The vet said she had talked with experts at the Swedish veterinary university and also with IDEXX who do the LDDS test.
She said sshe thinks there is "no correlation between urine creatinine and blood creatine".

She noted that in the blood test they took for the LDDS test the cortisol was in normal range 88.9 (24.8-124.2) while in the two urine tests it was very high 115 and 117.5 (<33)

What could that mean?

[labblab]

I think it’s good that your vet has already consulted with specialists at the university as well as IDEXX. That shows that she’s both interested and willing to learn more about what may be going on with Yohnny. I’m not exactly sure as to why his urine cortisol test was high but his blood cortisol test was normal. However, we do know that they are measuring cortisol levels in two different ways, and the LDDS is the test that is more specific for Cushing’s. The LDDS is the test that is generally considered to be the best choice for testing for Cushing’s here in the U.S., too, even where the ACTH stimulation test is available. This is because the LDDS is less likely to miss diagnosing Cushing’s in dogs who truly have the disease (fewer “false negatives”). There are a few situations, though, when a Cushing’s dog will test negative on the LDDS but positive on the ACTH. That’s why, if you have the option to do an ACTH, it would be a good idea. However, if your vet has already talked with the vet school and IDEXX and the ACTH has not been mentioned to you, my guess is that there is difficulty in performing that test there in Sweden. IDEXX does provide analysis for the ACTH here in the U.S. So I’m assuming it would have been discussed with your vet if it’s also available in Sweden. But you’ll find out by asking your vet.

As far as the ultrasound, the adrenal glands can be hard to see clearly unless very high powered equipment is used. Many general practice vets here in the U.S. don’t have equipment that’s powerful enough, so referral has to be made to a specialist’s office. That may also be the case with your vet — she couldn’t see Yohnny’s adrenal glands very clearly on the earlier ultrasound. So that will be another thing to ask about: whether or not another ultrasound performed at another location might be helpful.

All in all, it sounds as though what your vet has done so far has been reasonable. The question will just be whether or not there are any additional tests available to you that might be helpful.

Marianne

[Jayessi]

Thank you Marianne. This is very helpful. Thing are getting clearer

/Amanda & Yohnny

[Jayessi]

Hi!

I was recommended to read up on this thread that discusses “Atypical Cushing’s.”

https://www.k9cushings.com/forum/sho...Hyperestrinism

But could not open any of the links in the first post of that thread.

Is it just me or are they not working anymore?

Thank you!

[Budsters Mom]

The links open for me. You might want to check your settings in your browser. Check the box allowing links/pop ups from websites visited and see if that helps.

[labblab]

I think I see what you mean — the links now all connect to the same homepage of the U of Tennessee veterinary school instead of to the individual articles that are listed :-(((((.

I’ll check on this today and try to reset those links as soon as possible!

Marianne

[labblab]

OK, I’ve now updated all the links in the first post in that thread. I suspect links in other replies on that thread will need updating, too. I’ll work on that later today. But at least the first post should now be OK!