Hi again, Steve, and thanks so much for this additional info about Guido. I’m glad he seems a little better again, but I know you’ll be hoping for consistently good results. In answer to your question, yes, my understanding is that Guido should always have access to water 24/7. Hopefully once his cortisol levels are stabilized, he’ll be sleeping peacefully throughout the night and drinking water won’t be an issue. But in the meantime it should be available to him.

And as for his cortisol, I think we’re kinda on hold until you get the new results on 7-23. When you take him in then, it would be great if you can request copies of his past lab results, including the diagnostic testing and cortisol levels. I’m puzzling a bit over the fact that aside from the cortisol and rather sudden excessive urination, apparently Guido doesn’t exhibit any other outward symptoms or lab abnormalities that are consistent with Cushing’s. It typically is a slowly developing disease, marked by certain lab abnormalities such as elevated liver enzymes and a combination of issues such as excessive hunger, hair loss, hind leg weakness, pot belly, etc. I don’t mean to cast doubt on your vet’s diagnostic process, especially since Guido has also been seen at Tufts and it sounds as though they think it’s Cushing’s, as well.

However, if none of these other typical abnormalities remain absent and Guido’s urination doesn’t improve, perhaps your vet may end up exploring some other diagnostic avenues. Cortisol can be elevated due to other bodily stressors, as well as Cushing’s. That’s one of the things that can make Cushing’s a challenge to accurately diagnose. I’ll mention one other ailment that we’ve seen in a few dogs here over the years who have struggled with excessive thirst/elevation and that is “Diabetes Insipidus.” This is entirely different from the much more common “Diabetes Mellitus,” and has nothing to do with elevated glucose levels.

But for now, I’m putting the cart way in front of the horse. Let’s see how Guido does during this next week, and also how is cortisol level turns out on the next recheck.

Marianne