Re: Diagnostic Plan to Rule Cusahings In/Out
As Lori shared, my first dog diagnosed with Cushing's, Squirt, tested positive on the LDDS, HDDS, and ACTH. But when the ultrasound was done a tumor was found on her spleen. Once that tumor was removed and she had fully recovered all those test results returned to normal. The tumor had caused false positives. She also had very few signs. Had I started treatment instead of having the tumor removed the odds are she would have died either when the tumor ruptured or from the treatment itself because at that point in her life she did not have Cushing's.
My second dog diagnosed with Cushing's had COPD, anal gland disease, allergies, pouches on either side of her rectum that had to be manually emptied and other health issues. Her ACTH was too high to register - >50ug/dl. When she passed I had a necropsy (autopsy for animals) performed...it proved she never had Cushing's - her adrenal glands were normal. But like my first pup, all those other health issues caused the ACTH to register as if she did.
Cushing's is one of, if not THE, most difficult canine disease to correctly diagnose. Cortisol is a fight or flight hormone and it's job is to elevate naturally in response to any stress, internal or external. The tests for Cushing's can only tell us IF the cortisol is elevated but not WHY. For this reason it is very much a process of ruling out all other possible causes for the elevated cortisol. And you know there is another cause present with your sweet girl.
In your shoes I would insist the tumor be removed then give my baby plenty of time, a few months, to recover. Then, IF signs were present I would look at Cushing's again. But for now, Cushing's would be forgotten and I would focus on that tumor and her recovery. Just so you know what you would be looking for, here is a list of common signs seen with this disease:
*increased/excessive water consumption (polydipsia)
*increased/excessive urination (polyuria)
*urinary accidents in previously housetrained dogs
*increased/excessive appetite (polyphagia)
*sagging, bloated, pot-bellied appearance
*weight gain or its appearance, due to fat redistribution
*loss of muscle mass, giving the appearance of weight loss
*bony, skull-like appearance of head
*exercise intolerance, lethargy, general or hind-leg weakness
*excess panting
*seeking cool surfaces to rest on
*symmetrically thinning hair or baldness (alopecia) on torso
*other coat changes like dullness, dryness
*slow regrowth and/or failure to regrow of hair after clipping/shaving
*thin, wrinkled, fragile, and/or darkly pigmented skin
*thin, crepey, easily damaged skin that heals slowly
*dark, bruised looking skin
*hard, calcified lumps in the skin (calcinosis cutis)
*susceptibility to infections (especially skin and urinary)
*diabetes, pancreatitis, seizures
If, after she has had plenty of time to recover, you aren't seeing quite a few of these signs I would continue to watch and wait to see if she did develop signs. Cushing's is a very slowly progressing condition so there is rarely need to rush into diagnosis or treatment....especially when it is known that something is present that can and does cause false positives on all the tests for Cushing's AND that is much more pressing.
Hugs,
Leslie
"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.