New with questions.

[Anne2]

I'm relieved to hear that the Vetoryl hasn't been started, no rx medications for Cushing's should be administered until a diagnosis is confirmed.



Yes, dog's with Cushing's commonly have elevations in those levels but there are also other health issues that can cause those same elevations. Also, Buddy doesn't have other abnormalities that are usually found on a chemistry/CBC blood panel, such as what is referred to as a "stress leukogram," which refers to a specific white blood cell distribution in the blood. This includes a high total white blood cell count with increased numbers of neutrophils (NEU) and monocytes (MONO) and decreased numbers of lymphocytes (LYM) and eosinophils (EOS).

Anything you don't understand please do post and we will try to help!



Both of these tests require blood samples. I'm including links with info regarding those two tests:
Bile acid - https://www.thesprucepets.com/bile-a...t-mean-3384801

SDMA - https://www.idexx.com/en/veterinary/...dma/sdma-faqs/

Lori

Hi Lori
Thanks for the links and yes I'm still confused,but reading tests results have always been an issue with me as far as understanding results.
I do see the Platelet Count is high 510 (High) Ref Range 170-400,but does the platelet count have anything to do with white blood cells in the blood?
I also see Monocytes are 992 8 Ref Range 0-840 so that would be high?
And I can't find a Stress Leukogram or anything called Neutrophils (Neu) on the tests results.
I'm sure it is there and that I'm missing the information on the results.

[Anne2]

Marianne
According to MedVet Buddy does have a nodule on his left adrenal glad.
And thanks for the link.
Some of the things in the link seem to apply to Buddy.
Abdominal Enlargement
Panting with mild exercise ( a short walk of a few blocks) and panting at random without exercise.
His fur seems fine. No patchy spots or thin coat. He does have some very small dry flakes of skin on his rump and back that he loves to have scratched.
Not really noticed until he comes over to get scratched.
He also has bouts of limping and a few times he has held his front leg up but it never lasts very long.
He is sadly lethargic. He had one good day this week when he seemed his old active self.
He loves going for walks though and responds well to that and at times,not lately he will play with his toys without prompting.
He is taking Gabapentin for pain at 100mg twice a day and that does seem to help but not always.
The reason that was prescribed is because he would whimper and whine as though in pain when lying down.
A few other things I have noticed is that at times he will get what I call a scared horse look while lying down as though he feels terrified. You can see the whites of his eyes shifting around and nothing is going on as far as any disturbances to cause this.
Also have noticed that while at the vet due to the bright lighting that Buddy has very red gums and the white part of his eyes appear reddish colored.
Very strange all of these different symptoms.

[Anne2]

Next up three pages of test results. Not sure how to read these as some of them have the word no and could mean not tested and there is a rectangular box that has grey shading that goes more to the right or to the left or to the middle and in some not even half is shaded. Also has a black bar in the box at different levels so I will at least post the numbers if they look high or low or may post the whole thing.
Starting with the in house Urinalysis.This was drawn from Buddy at the vet versus using the sample I had brought in.

Leukocytes - Negative
Nitrate - Negative
Urobilinogen -Normal .2
Protein - Negative
ph - 6.5 This number is in a white box.
WBC per hpf 0 Also number in a white box.
Epithelial cells - No
Casts- No
Crystals - No
Bacteria - No
Blood - No
Specific Gravity 1.020 Number in white box
Ketone - Negative
Bilirubin - Negative
Glucose - Negative
RBC per - 0 Number in white box
Appearance yellow clear
End of urine test. The reason I'm not sure if all theses things were tested was that he said no bacteria as though that was all he had tested for, so sounds like I need to have a convo with him to make sure.

[Anne2]

Blood Tests 3-19-20
I'm going to post all and just ignore the boxes with the grey shading and black line at different levels.

GLU 112 Range 70-143mg/dl

Crea 0.6 Range 0.5-1.8 mg/dl


BUN 12 Range 7-27 mg/dl

BUN 20 no range listed

Phos 3.1 Range 2.5-6.8 mg/dl

CA 10.4 Range 7.9-12.0 mg/dl

TP 7.8 Range 5.2-8.2 g/dl

ALB 3.5 Range 2.2-3.9 g/dl

GLOB 4.3 Range 2.5-4.5 g/dl

ALB/GLOB 0.8 no range listed

ALT 145 (High) Range 10-125 U/L

ALKP 478 (High) Range 23-212 U/L

GGT 0 Range 0-11 U/L


TBIL 0.4 Range 0.0-0.9 mg/dl

CHOL 282 Range 110-320 mg/dl


AMYL 771 Range 500-1500 U/L

LIPA 713 Range 200-1800 U/L

Na 155 Range 144-160 mmol/L

End of pg 2 Page 3 coming up.

[Anne2]

K 3.8 Range 3.5-5.8 mmol/L

Na/K 41 no range given

CI 114 Range 109-122 mmol/L

Osm Calc 306 no range mmol/kg

TT4 1.4 Range 1.0-4.0 ug/dl

RBC 7.41 Range 5.65-8.87 M/uL

HCT 45.8 Range 37.3-61.7%

HGH 16.8 Range 13.1-20.5 g/dl

MCV 61.8 Range 61.6-73.5fL

MCH 22.7 Range 21.2-25.9 pg

MCHC 36.7 Range 32.0-37.9 g/dL

RDW 18 Range 13.6-21.7%

%RETIC 1.9 Range %

RETIC 140 (High) Range 10.0-110.0 K/uL

RETIC-HGB 24.5 Range 22.3-29.6pg

WBC 11.12 Range 5.05- 16.76 K/uL

%NEU 73.7 Range %

%LYM 16.5 Range %

%MONO 5.0 Range %

%EOS 4.6 Range %

%BASO 0.2 Range %

NEU 8.20 Range 2.95-11.64 K/uL

LYM 1.83 Range 1.05-5.10 K/uL

MONO 0.56 Range 0.16-1.12 K/uL

EOS 0.51 Range 0.51 Range 0.06-1.23K/uL

BASO 0.02 Range 0.00-0.10 K/uL

PLT 457 Range 148-484 K/uL

MPV 13.4 (High) Range 8.7-13.2 fL

PDW 12.5 Range 9.1-19.4 fL

PCT 0.61 (High) Range 0.14-0.46%

At last done with the tests I have for now.

[labblab]

Anne, thanks for this final list of lab results. Interestingly, aside from mild/moderate elevation in the two liver markers (ALP and ALT), it looks to me as though most everything else is within normal range this time around, including cholesterol. So I’m remaining focused on the existence of the adrenal nodule, and what issues it may be causing. In particular, I’m wondering if it may be a particular type of tumor known as a pheochromocytoma. Here’s an excerpt from that article I cited above that describes pheos:

Pheochromocytoma (Pheo) is the second most common adrenal tumour in dogs. It is of neuroectodermal origin arising from chromaffin cells of the sympathoadrenal system. Clinical signs result from excretion of excessive amounts of catecholamines and rarely from the direct presence and space occupying nature of the tumour. Pheo is identified most commonly in older dogs (> 7 years). There does not seem to be a sex or breed predilection. Symptoms are subtle, episodic and often complicated by concurrent disease. The most common clinical signs are generalized weakness and episodic collapse. Further symptoms include intermittent agitation, pacing, excessive panting, pu/pd. Systemic hypertension may occur leading to retinal detachment or retinal haemorrhage or hemorrhage into the retroperitoneal space, the abdominal cavity or the CNS. Vomiting, diarrhea, inappetence, weight loss, tender abdomen and cardiac arrhythmias may also be seen. Signs related to a space-occupying process are a palpable mass, enlarged abdomen, ascites and rear limb edema. Collapse and death from a sudden, massive and sustained release of the catecholamines and massive haemorrhage due to sudden increase in blood pressure or rupture of the tumour is possible. Many of the clinical signs caused by pheo are unspecific and vague and may be associated with a variety of more frequent diseases. There are no consistent abnormalities on haematology, serum biochemistry and urinalysis which would raise the suspicion of pheo. Up till recently the majority of cases were therefore only diagnosed at necropsy and were not suspected antemortem. However, due to the fact that abdominal ultrasonography including adrenal imaging is increasingly used as part of a diagnostic work-up, the situation has started to improve. Often, pheo is only considered after an adrenal mass is identified on abdominal ultrasonography. Although normal sized adrenal glands do not rule out pheo, there seems to be a relationship between tumour size and severity of clinical signs. In most dogs with obvious clinical signs the tumour is easily detectable. Different to the situation in human medicine the majority of pheos in dogs are malignant. Ultrasonography can provide information regarding local invasion to surrounding tissue and vessels, tumour thrombi and metastasis to other abdominal organs. In more than 50% of dogs with pheo tumour thrombi and/or metastasis are present at the time of diagnosis.

I’m especially wondering about the “wild-eyed” episodes that Buddy sometimes experiences, since they might represent the sudden release of adrenaline surges due to a pheo. His reddish eyes might also signal episodic high blood pressure from a pheo. As the article states, though, some of the other symptoms can be caused by hormone-producing adrenal tumors, as well. So it would really take a specialist who’s knowledgeable about adrenal tumors to be able to tell you more, and to help with making a differential diagnosis. The Vetoryl could indeed help with a hormone-producing tumor. But I believe that different medication would be prescribed to help treat the effects of a pheo.

At this point, even though you’ve already been dealing with multiple vets, you may want to seek out yet one more consultation. You may want to talk directly, yourself, with a specialist. If, for instance, you’re anywhere near a veterinary school, you’d have a whole staff of experts available with whom to consult and the cost might be less than at a private specialty vet practice. Having said that, I know the COVID-19 crisis is really putting a lid on the opportunity to schedule appointments right now. So an in-person visit may need to wait. But if Buddy were mine, I believe I’d be mostly focusing further diagnostic questions on the nature of that adrenal nodule. And that’s what I’d really be asking the vet about this week.

[labblab]

I wanted to come back to add that, as you probably already know, surgical removal is the only complete cure for any adrenal tumor, including a pheo. However, this type of surgery is very risky and very expensive. I don’t know whether I would choose this surgery for my own dog, even if I could afford it. There would be an awful lot to weigh. So I do understand if surgery is not an option you’d consider for Buddy. Without surgery, though, your sole goal is indeed to keep a dog as comfortable as possible, for as long as possible. So perhaps that’s what your one vet was attempting to tell you, but unfortunately without a thorough explanation.

Of course I am totally speculating with everything I’ve written this morning. And if you already know that surgery is not an option, then perhaps it’s not even worth it to pursue more specialized diagnostics about the nature of the adrenal nodule. But if it would give you more peace of mind to gather more information, then I’d encourage you to do so. And that way, you might get a better handle as to which medication would be most helpful. The dose of Vetoryl that’s been prescribed is quite a low dose for his weight (10 mg. for a 40 lb. pound dog), so the risk of side effects might be minimized. If the tumor is indeed secreting hormones, the Vetoryl might help with symptoms. But if it’s a pheo, then something to help control blood pressure and/or the adrenaline release may be even more important.

OK, I guess that’s all I can think of for now ;-).

[Anne2]

You all have been a wealth of information and support and I appreciate all your suggestions and help.
I never would have found all of this info searching the net.
I'm going to come back later and make some notes so it will be fresh in my mind while speaking with vets in the future.
The vet from the first clinic didn't call me yet so will try again tomorrow regarding the synthetic versus the gel.
I think surgery isn't something that I would consider unless they have any procedures that are less invasive.
I do want Buddy to be comfortable but also if there is any treatment (meds) obviously that would be my choice.
The Covid-19 is making things a little difficult but I think we are set to open up in May and I actually have been leaning toward a specialist at MedVet.
In the meantime I still have my always in a hurry,don't like questions vet,but I will just have to be more forceful in my dealings with him.
Thanks so much all for your help and I will check back in later if or once I do find answers about Buddy.
As said it may be a bit before I can get him in to a specialist.
Thanks again and wish you all luck with your fur babies.