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Thread: Not convinced my dog doesn’t have Cushings! (Cesar has passed)

  1. #1
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    Default Not convinced my dog doesn’t have Cushings! (Cesar has passed)

    Hi everyone

    New to this forum and hoping to get some advice about my dog. I have a rescued 7 year old male cane Corso. We rescued him in 2018 from Romania. The first year was great. Healthy, loved his walks, happy dog! Then in October 2019 I noticed he’d become quite greedy then started drinking lots of water. A few weeks later he stopped running, jumping up and just generally lethargic not wanting to exercise etc also he keeps staring at the floor. Took him to the vet where they did blood tests expecting Cushings. Results came back and showed high liver enzymes (70) and high cholesterol. However didn’t show Cushings as usually it would be a much, much higher result. So tested him for hypothyroidism. His results came back low thyroid but TSH normal. As his symptoms got worse my vet done a trial on thyroxine but this made no difference so we took him of it. He has had 2 lots of scans and xrays which all came back completely normal. I’ve swapped him to a raw food diet as he has put on so much weight through not exercising. However I’m still seeing little difference in his symptoms. I’ve even changed vets for a second opinion but they still don’t think he has Cushings. I’ve seen little improvement in his symptoms. He has every symptom apart from panting and hair loss although weirdly he has stopped moulting completely since all this started. The vet thinks it’s all behaviour related I.e the excessive water drinking etc. Personally I don’t. He is like a totally different dog. Any advice? What would you do? Specialist next possibly? Thank you!
    Last edited by Ryles; 06-16-2020 at 10:20 AM.

  2. #2
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    Default Re: Not convinced my dog doesn’t have Cushings!

    Hello and welcome to you and your boy! You’ll see that I’ve moved your thread to our main Questions and Discussion forum — this way, our members are more likely to see your thread and join in the conversation.

    My first question is whether or not your dog has been given an actual diagnostic blood test for Cushing’s. It sounds as though your vet ruled out Cushing’s based on general blood chemistries — that the elevation in the liver marker didn’t seem high enough. However, given your dog’s observable symptoms as well as a low thyroid result that is most likely secondary to another condition (like Cushing’s), I agree that Cushing’s remains a likely candidate.

    The two diagnostic tests are the ACTH stimulation test, and the Low Dose Dexamethasone Suppression test. For a dog with no other known illnesses, the LDDS is the preferred test because it is less likely to register a “false negative” in a dog who truly has the disease. Here in the U.S, the LDDS is an 8-hour blood test. In Europe, I believe it is sometimes conducted as a urine test over a 3-day time period. Both the ACTH and the LDDS can be skewed by the stress of other physical conditions if they are present. But they remain the two tests that are most specific to making a Cushing’s diagnosis. So if neither of those tests has been performed on your boy, that’s what I’d be requesting right now. If one of those tests has been done, it’ll be great if you can give us the results.

    And once again, welcome!
    Marianne

  3. #3
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    Default Re: Not convinced my dog doesn’t have Cushings!

    Quote Originally Posted by labblab View Post
    Hello and welcome to you and your boy! You’ll see that I’ve moved your thread to our main Questions and Discussion forum — this way, our members are more likely to see your thread and join in the conversation.

    My first question is whether or not your dog has been given an actual diagnostic blood test for Cushing’s. It sounds as though your vet ruled out Cushing’s based on general blood chemistries — that the elevation in the liver marker didn’t seem high enough. However, given your dog’s observable symptoms as well as a low thyroid result that is most likely secondary to another condition (like Cushing’s), I agree that Cushing’s remains a likely candidate.

    The two diagnostic tests are the ACTH stimulation test, and the Low Dose Dexamethasone Suppression test. For a dog with no other known illnesses, the LDDS is the preferred test because it is less likely to register a “false negative” in a dog who truly has the disease. Here in the U.S, the LDDS is an 8-hour blood test. In Europe, I believe it is sometimes conducted as a urine test over a 3-day time period. Both the ACTH and the LDDS can be skewed by the stress of other physical conditions if they are present. But they remain the two tests that are most specific to making a Cushing’s diagnosis. So if neither of those tests has been performed on your boy, that’s what I’d be requesting right now. If one of those tests has been done, it’ll be great if you can give us the results.

    And once again, welcome!
    Marianne
    Thank you so much for the response Marianne!
    You are correct both vets ruled out doing the specific tests for Cushings as his blood chemistry seemed to rule it out. However I’m not sure if maybe he had a false reading? I know my boy isn’t well, I just know! But at the same time I don’t like telling my vet that I think they’re are wrong. They are the professionals at the end of the day what do I know! He did say that his recent scans did not show he had Cushings as both glands looked normal and so did his liver. But his symptoms just haven’t improved if anything they have got worse. His whole body has changed shape. His belly hangs and his back really dips down which I’m assuming is due to muscle wastage? His lost all of his muscle in his back legs. I think I’m just going to ask for the LDDS test and if that comes back negative then I agree I could most likely rule Cushings out.

  4. #4
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    Default Re: Not convinced my dog doesn’t have Cushings!

    Hi again! There is one other alternative “gateway” test that you could consider. It’s called the UC:CR, or urine cortisol to creatinine ratio. We’ve been told that the best method by which to conduct this test is for the owner to collect a urine sample at home on three successive mornings, pool the samples together, and then take them to the vet for analysis. The samples should be collected with the least amount of stress involved as possible. This is why they should be collected at home and *not* at the vet’s office. If the ratio comes back within the normal range, Cushing’s can pretty much be ruled out definitively. If it shows an elevated proportion of cortisol, then Cushing’s is a possibility, but not proven, and you’d then still have to advance to either the LDDS or ACTH. However, I did want to offer this test to you as an additional possibility. It’s likely much less expensive than the LDDS if it rules out Cushing’s, but it would be an added expense if you have to move on to the LDDS in addition.

    However, it’s just a thought, and here’s a link that explains it in more detail. One note: the link only references collecting a single urine sample for analysis. As mentioned above, we’ve been told by experts that a pooled sample from three mornings is more accurate.

    https://vcahospitals.com/know-your-pet/urine-cortisol

    Marianne

  5. #5
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    Default Re: Not convinced my dog doesn’t have Cushings!

    Quote Originally Posted by labblab View Post
    Hi again! There is one other alternative “gateway” test that you could consider. It’s called the UC:CR, or urine cortisol to creatinine ratio. We’ve been told that the best method by which to conduct this test is for the owner to collect a urine sample at home on three successive mornings, pool the samples together, and then take them to the vet for analysis. The samples should be collected with the least amount of stress involved as possible. This is why they should be collected at home and *not* at the vet’s office. If the ratio comes back within the normal range, Cushing’s can pretty much be ruled out definitively. If it shows an elevated proportion of cortisol, then Cushing’s is a possibility, but not proven, and you’d then still have to advance to either the LDDS or ACTH. However, I did want to offer this test to you as an additional possibility. It’s likely much less expensive than the LDDS if it rules out Cushing’s, but it would be an added expense if you have to move on to the LDDS in addition.

    However, it’s just a thought, and here’s a link that explains it in more detail. One note: the link only references collecting a single urine sample for analysis. As mentioned above, we’ve been told by experts that a pooled sample from three mornings is more accurate.

    https://vcahospitals.com/know-your-pet/urine-cortisol

    Marianne
    So back to the vet today as my boy has gone really downhill over the last 2 weeks. Done more blood tests. These are the chemistry’s that came back high:
    Albumin 41.0
    A:G Ratio 1.8
    ALP 366
    ALT 356
    Gamma GT 25.0
    Cholesterol 9.2

    He is so depressed and has absolutely no energy. The vet still doesn’t want to test him for Cushings so is going for full thyroid profile including antibodies.

    I honestly think we are running out of time. It’s almost like he is giving up. What does anyone think? I’m thinking of getting him referred to a specialist now as we are going around in circles and getting no answers. 😔

  6. #6
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    Default Re: Not convinced my dog doesn’t have Cushings!

    If I were you, I’d indeed go ahead and request a referral to a specialist. Obviously something serious is going on, and given all his symptoms, I do think that Cushing’s remains a possibility for your boy. At this point, you really have nothing to lose by having a specialist take a look at things, and you may have a lot to gain. Please let us know how things develop, OK?

    Marianne

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    Default Re: Not convinced my dog doesn’t have Cushings!

    Definitely see an IMS - Internal Medicine Specialist! And if you are in the US you have the right to tell the vet what tests to run. This is YOUR dog and YOU will live with the results of what the vet does or does not do on his behalf. If this vet won't do as you as, find a new GP vet asap along with that IMS.
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  8. #8
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    Default Re: Not convinced my dog doesn’t have Cushings!

    So after 6 months we finally have a diagnosis of Cushings. Unfortunately he also has hypothyroidism as well and has been on treatment for 4 weeks at the moment for that. He has started vetoryl today. His dosage is 90mg and his weight is about 44kg. Does this sound about right? Thank you

  9. #9
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    Default Re: Not convinced my dog doesn’t have Cushings!

    44kg = about 97 lbs. The suggested starting dosage for Vetoryl is 1mg. per pound of weight. Since he weighs 44kg/97 lbs. , 90 mg. would be a reasonable starting dose.
    Last edited by Budster's Mom; 06-05-2020 at 04:53 PM. Reason: To clarify
    Kathy and Angel Buddy. The mightiest of all lizard hunters!

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    Default Re: Not convinced my dog doesn’t have Cushings!

    Kathy is right, however, there is a published study that has found that larger dogs require less of the recommended dose of Trilostane to control cortisol, so if this were me I wouldn't start out any higher than 40 mg of Trilostane. Here's a link to that study:https://onlinelibrary.wiley.com/doi/...6.2012.00956.x

    Lori

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