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

[Jayessi]

Amanda, I think all of your questions are excellent ones! Lori has given you some very useful quotes re: the LDDS and the effect of stress on that test. As far as the preferability of performing the LDDS vs. the ACTH, I cannot argue with first repeating the LDDS. This is because, of the two tests, it is more likely to produce a positive result if a dog does have Cushing’s. However, if Yohnny *again* tests negative on the LDDS, I’d want to give the ACTH a try since he has so many symptoms that are consistent with the disease. Since the two tests are measuring different aspects of adrenal function, occasionally one will be negative while the other is positive. Here’s a quote by noted endocrinologist, Dr. David Briyette:

So as you can see, it’s only a small chance (5 - 10%) that a dog with Cushing’s will test negative on the LDDS, and that’s why the LDDS is preferred by most specialists to be run first. But in Yohnny’s case, if he tests negative again, I’d want to give the ACTH a try. As far as the ACTH and low cortisol, yes, it’s true that the ACTH is the preferred test for Addison’s disease — your vet is right about that.

Regarding Cushing’s and proteinuria: if Cushing’s is the underlying cause, you definitely want to treat the Cushing’s to keep the condition from worsening. However, Cushing’s treatment alone may not resolve the existing proteinuria, so the two conditions may be treated in tandem. We’ve had several dogs here who have received both treatments. One note about that: I mentioned earlier that Ace inhibitors can elevate potassium levels. Vetoryl (trilostane), the medication that you’d undoubtedly use to treat Cushing’s, can also elevate potassium. So when the two medications are prescribed at the same time, you do have to regularly check blood chemistries to make sure that the potassium level isn’t getting too high. But we’ve had dogs here who have done fine with both.

Overall, aside from performing other tests at the same time as the LDDS, I think the steps that the new vet has recommended are reasonable. And who knows, maybe she intends to do the other tests after the LDDS has concluded (drawing additional blood at the end of the test, for instance, and drawing the urine afterwards). If so, that should be fine and shouldn’t affect the LDDS results. But I totally understand why you don’t want to leave any stone unturned. I’d be the same way if Yohnny were my own. If you’d always wonder whether you would have had more confidence in the recommendations of the other vet, and consulting with the other vet is possible, then you may well wish to do so. I definitely suppprt you 100% whichever way you choose to go!

Marianne

Thank you Marianne. I now understand a little better. And get a little teary that there are such lovely people like you helping me. The quote from Dr. David Briyette is useful, and the other info you have shared. Have a nice Sunday.

[labblab]

Awww, you're very sweet to say that, Amanda! Over the years, Lori and I have received so much help and support from our members here, ourselves. We're just grateful to have an opportunity to pass on the info we've learned.

Also, I made a typo in my earlier reply. The doctor's name is Dr. David Bruyette, not Briyette. Oops! Anyway, here's a link to an article that he has written about interpretation of the LDDS test, and that's where I got the quote that I gave you earlier.

https://www.dvm360.com/view/clinquiz...n-test-results

[Jayessi]

Awww, you're very sweet to say that, Amanda! Over the years, Lori and I have received so much help and support from our members here, ourselves. We're just grateful to have an opportunity to pass on the info we've learned.

Also, I made a typo in my earlier reply. The doctor's name is Dr. David Bruyette, not Briyette. Oops! Anyway, here's a link to an article that he has written about interpretation of the LDDS test, and that's where I got the quote that I gave you earlier.

https://www.dvm360.com/view/clinquiz...n-test-results

Excellent! THANK YOU!!!!

[Harley PoMMom]

I do want to share my experience with checking the blood pressure on a dog as my angel Harley did have high blood pressure. What I would do was schedule this procedure when the office didn't have many appointments because Harley would get excited seeing a strange dog. Also I made arrangements with the staff that when we arrived we would be put in a room right away. Harley had anxiety at being at the vets and I believe he suffered from what is known as "white coat effect" meaning that his blood pressure rises at the vet's office.

Once we were in the room, no one would come in that room for about 15 minutes so that I could try to calm him down a bit. When the tech came into the room she would talk very calmly and softly to Harley and they would take 3 readings and get an average from that. Another tip I did was when we were home I would often take his paw in my hand like the tech does when she is taking his BP so he would get accustomed to this kind of handling. Harley took Amlodipine for his BP.

Hugs, Lori

[Jayessi]

I do want to share my experience with checking the blood pressure on a dog as my angel Harley did have high blood pressure. What I would do was schedule this procedure when the office didn't have many appointments because Harley would get excited seeing a strange dog. Also I made arrangements with the staff that when we arrived we would be put in a room right away. Harley had anxiety at being at the vets and I believe he suffered from what is known as "white coat effect" meaning that his blood pressure rises at the vet's office.

Once we were in the room, no one would come in that room for about 15 minutes so that I could try to calm him down a bit. When the tech came into the room she would talk very calmly and softly to Harley and they would take 3 readings and get an average from that. Another tip I did was when we were home I would often take his paw in my hand like the tech does when she is taking his BP so he would get accustomed to this kind of handling. Harley took Amlodipine for his BP.

Hugs, Lori

hank you Lori, this is so helpful. I am talking to vet today so amd going to ask about checking BP and will ask to have a similiar set-up as your angel Harley. hugs and hugs from Yohnny and I.

[Jayessi]

Update after talking with vet:

Vet really wants to give Yohnny something to help his kidney´s as she is worried about irreversible damage to them. She said there are alternatives to Fortekor but they are not as good. She asked me to wait 2-3 days to make sure Yohnny is totally ok and then give him half a tablet (vet had prescribed 1 whole tablet) and see if there is any reaction.

I asked vet if she would be doing the BP test and cysto for protein/creatine after the LDDS test and she said no, they have time in-between the LDDS test to do this. When I asked about the stress this might cause she said that the LDDS tests other kind of stress so it would not be a problem.

I feel totally confused and don't know what to do. Shall I do as vet says? Or say that I am not going to leave him at the hospital but instead come in for each blood draw - and that they do the other test after LDDS text is done?

Not sure if I am being too critical of this vet or if I should trust my gut feeling. also feel like a really lousy avocate. help please.

/Amanda

[labblab]

Amanda, don’t ever doubt that you are great advocate for Yohnny! Because you *are*!

I’m really sorry the vet is making the testing situation so awkward for you. In reality, probably taking his blood pressure wouldn’t be that big an issue. I’d worry more about the cysto, but it may be the case that even that may not skew his LDDS results significantly. But given all the hurdles you’ve had to confront in terms of a diagnosis, I know you want this test to be as accurate as possible. If it’s not a hardship to you to take Yohnny back again on a second day, perhaps you’d feel comfortable just saying as much to the vet: that you understand that she doesn’t think the test will be compromised, but you want Yohnny to be stressed as little as possible after all that he’s been through. Therefore, you prefer that the diagnostics be spread over two days.

As far as taking him home between the blood draws, you know him the best of anybody. I know several of our members have said that this keeps their dogs as calm as possible. For my own dog, I’m honestly not sure whether or not just leaving her there would not be better. This is because it’s actually the driving to the vet and the coming and the going in-and-out of the waiting room that seem to get her the most agitated. It’s about a 20 minute drive, and she starts pacing and getting anxious in the back of the car just as soon as we start off in that direction. Same thing when we enter the reception area. So in truth, my dog might actually be calmer just taken back and forth between a cage during the day of the test. It’s really hard for me to know. In Yohnny’s case, you know him the best of anyone, though. So whichever way you think he’d be stressed the least amount, that’s the way I’d want to go.

Marianne

[Harley PoMMom]

Oh Amanda, YOU are an excellent advocate for Yohnny!! Do not ever doubt that! If this were me, I would insist that no other procedures be done while the LDDS test is being performed. Stress can skew this type of test, as stated in those articles I linked to, and stress can cause blood pressure to rise so doing both of those on the same day, I believe, should not be done. The cysto could possibly be performed after the LDDS test is done.

I also believe that since his LDDS test results were negative the first time that this shows that taking him home in between draws may be a good idea, could be that this is less stressful for him, but only you know him best so go with your gut on this one.

Hugs, Lori

[Jayessi]

Amanda, don’t ever doubt that you are great advocate for Yohnny! Because you *are*!

I’m really sorry the vet is making the testing situation so awkward for you. In reality, probably taking his blood pressure wouldn’t be that big an issue. I’d worry more about the cysto, but it may be the case that even that may not skew his LDDS results significantly. But given all the hurdles you’ve had to confront in terms of a diagnosis, I know you want this test to be as accurate as possible. If it’s not a hardship to you to take Yohnny back again on a second day, perhaps you’d feel comfortable just saying as much to the vet: that you understand that she doesn’t think the test will be compromised, but you want Yohnny to be stressed as little as possible after all that he’s been through. Therefore, you prefer that the diagnostics be spread over two days.

As far as taking him home between the blood draws, you know him the best of anybody. I know several of our members have said that this keeps their dogs as calm as possible. For my own dog, I’m honestly not sure whether or not just leaving her there would not be better. This is because it’s actually the driving to the vet and the coming and the going in-and-out of the waiting room that seem to get her the most agitated. It’s about a 20 minute drive, and she starts pacing and getting anxious in the back of the car just as soon as we start off in that direction. Same thing when we enter the reception area. So in truth, my dog might actually be calmer just taken back and forth between a cage during the day of the test. It’s really hard for me to know. In Yohnny’s case, you know him the best of anyone, though. So whichever way you think he’d be stressed the least amount, that’s the way I’d want to go.

Marianne

Thank you for your kind words Marianne. I lost it a little after I had talked to the vet. The whole situation just got to me. Now that I have had a good long cry, a nap, some homemade banana cake, and read your email I feel a little better. Really value your thoughts. Will keep you updated. Take care.

[Jayessi]

Oh Amanda, YOU are an excellent advocate for Yohnny!! Do not ever doubt that! If this were me, I would insist that no other procedures be done while the LDDS test is being performed. Stress can skew this type of test, as stated in those articles I linked to, and stress can cause blood pressure to rise so doing both of those on the same day, I believe, should not be done. The cysto could possibly be performed after the LDDS test is done.

I also believe that since his LDDS test results were negative the first time that this shows that taking him home in between draws may be a good idea, could be that this is less stressful for him, but only you know him best so go with your gut on this one.

Hugs, Lori

Thank you Dear Lori! What you write makes so much sense. It feels so good to be able to ask and vent and be so supported by you. I have some time to thin about it so that is what I will do. Take care. Hugs. Amanda