Sausage Dog with ? Cushings

[Pinkcat]

Hi I’m new to this and forums but need a bit of help. I have a 5 and a half year old sausage dog who has many symptoms of cushings, so much so that a vet specialist said if she had a room full of students she would expect them to diagnose her through looking at her alone. She is having the tests this week to confirm but has significant hair loss, pot belly some muscle weakness around her head and no longer wants to go for walks but is eating drinking can do the stairs and happily plays with toys running round and chasing them at home and isn’t excessively urinating. My questions are how do we know how long we will have with her approximately (ie what stage is she at) and we’re trying cbd oil does anyone have experience of it. We also know she will need medication but has allergies she’s been treated for her whole life so the extra steroid has left her skin much better than before. Thank you for any advice

[Joan2517]

Welcome to the forum. Could you post any blood work she has had done here, please? Just the highs, lows with the reference ranges. You mention that she's been on steroids her whole life, is she still? And on what dose? Steroids will skew any testing for Cushing's as it raises the cortisol anyway. Cushing's dogs will drink and pee excessively, does she do that? Others who are more knowledgeable than I am will need this information to try to help you and answer some of your questions.

We look forward to learning more about your little girl.

[Pinkcat]

Welcome to the forum. Could you post any blood work she has had done here, please? Just the highs, lows with the reference ranges. You mention that she's been on steroids her whole life, is she still? And on what dose? Steroids will skew any testing for Cushing's as it raises the cortisol anyway. Cushing's dogs will drink and pee excessively, does she do that? Others who are more knowledgeable than I am will need this information to try to help you and answer some of your questions.

We look forward to learning more about your little girl.

Hi she’s getting the blood work done on Wednesday I’ll ask for results and post. She’s been on apoquel since being about 15 weeks old but I believe these are NSAIDS - she’s had the odd injection of steroid when skin flared up over the years and some topical use of human steroid cream during flare ups - but nothing excessive - she also tried densensitisation through injections but was stressful. She drinks a fair bit maybe 4 small bowls a day but doesn’t excessively wee - had one episode of weeing indoors in October but under care of our dog nanny so stress levels up and had a bad urine infection in august which had blood in for a while treated with antibiotics. I’ll get blood work this week - thanks for replying

[labblab]

Hello and welcome from me, too! I’m so glad Joan has had the chance to greet you already, and I’ll also be back, probably tomorrow, when I’ll have more time to write. But I wanted to be sure and say hi to you and your sweet girl today!

We’re so glad you’ve found us, and I’ll be back.
Marianne

[labblab]

OK, here I am back again! Mainly, right now I want to reassure you that we’ve had many dogs on the forum who have done well and lived out their natural lives subsequent to starting Cushing’s treatment. For a dog your little girl’s age, not only are we hoping to improve observable symptoms, but we’re also hoping to halt the progression of possible longterm internal damage that the disease might cause. So it’s great that you’re going forward with the testing at this stage. You’re right that for dogs with allergies, lowering the elevated cortisol can be a double-edged sword. But hopefully some additional skin treatments can end up being added if her allergies start to flare again.

Right now, the most important thing is to gather as much information as you can, which is exactly what you’re doing. Before launching into a lot more discussion, though, it probably makes sense to wait until we get the results of her tests on Wednesday. That will help us to focus our attention on the most pressing issues. So once again, I’m going to hold off on saying a lot more today.

Do let us know how the testing turns out, though, and we’ll go from there!
Marianne

[Pinkcat]

OK, here I am back again! Mainly, right now I want to reassure you that we’ve had many dogs on the forum who have done well and lived out their natural lives subsequent to starting Cushing’s treatment. For a dog your little girl’s age, not only are we hoping to improve observable symptoms, but we’re also hoping to halt the progression of possible longterm internal damage that the disease might cause. So it’s great that you’re going forward with the testing at this stage. You’re right that for dogs with allergies, lowering the elevated cortisol can be a double-edged sword. But hopefully some additional skin treatments can end up being added if her allergies start to flare again.

Right now, the most important thing is to gather as much information as you can, which is exactly what you’re doing. Before launching into a lot more discussion, though, it probably makes sense to wait until we get the results of her tests on Wednesday. That will help us to focus our attention on the most pressing issues. So once again, I’m going to hold off on saying a lot more today.

Do let us know how the testing turns out, though, and we’ll go from there!
Marianne

Daisy had the tests yesterday for thyroid and to test for cushings - two tests for cushings an hour apart. The vet has rang and said that both have come back normal but she herself would have predicted they would be positive from looking at her. She has offered a third test that may pick it up which daisy has to go in for the day and have three tests done throughout the day. We will pay to have this done but it will be traumatising for Daisy - any advice please ? How can she look so cushings like but be negative - any differentials anyone may know of please ? Thanks

[labblab]

Thanks so much for returning with Daisy’s test results, and yes, I hope I can help you make more sense of things. There are two different blood tests that vets can perform when attempting to confirm a Cushing’s diagnosis. Each one has different strengths and weaknesses. It sounds as though Daisy first had the ACTH stimulation test, which involves first taking a baseline blood sample, then injecting an agent designed to stimulate the production of cortisol produced by the adrenal glands, and then taking a second cortisol reading one hour later. The strength of this test is that a “positive” result on this test is pretty specific to Cushing’s, meaning you can place a fair amount of trust that a dog with a positive result truly has Cushing’s. The weakness is that a significant number of dogs who *do* have Cushing’s will turn up with a “false negative” result on this test, especially if their disease is caused by an adrenal rather than a pituitary tumor.

The second test, a Low Dose Dexamethasone Suppression test (LDDS), reverses this scenario. This means that it is less likely to miss making a Cushing’s diagnosis in a dog who does have the disease. But it is more likely than the ACTH to come back with a “false positive” result in a dog who is suffering from some disease or illness other than Cushing’s that is placing stress on the dog’s system. This is the 8-hour test that your vet wants Daisy to take now. It involves a baseline cortisol draw and then two subsequent blood draws after an agent is injected that suppresses cortisol production in normal dogs. In Cushpups, so much cortisol is being produced that it ultimately breaks through the suppression by the end of the test.

Since Daisy seems to exhibit many outward symptoms that are consistent with Cushing’s, I do understand why your vet is suggesting this further testing for confirmation. For Daisy’s sake, if she does have Cushing’s, it’s too bad that she didn’t test positive on the ACTH the first time around to save the additional testing. However, one additional advantage to the LDDS is that the pattern of the test results (if positive) can often differentiate as to whether the dog has a pituitary or adrenal tumor.

Subsequent to Daisy’s ACTH, the only alternative to the LDDS that I’m aware of would be a urine test called a UC:CR, or Urine Cortisol to Creatinine Ratio. This test involves measuring cortisol that is found in the urine. We’ve been told by specialists that the best way to get reliable results on this test is for the owner to collect a sample of the dog’s urine first thing in the morning on three successive days — at home — and then to pool and refrigerate the three samples to be taken to the vet for analysis. There should be as little stress as possible for the dog or else the test will be skewed. This is why the samples should be gotten at home and not at the vet’s. Cushing’s can be definitively ruled out for a dog with a normal result on this test. A dog with an elevated cortisol result may have Cushing’s, but a further test would be required for confirmation. In Daisy’s case, this would be the LDDS that we talked about above. So since you might find yourself right back at this place again, I don’t whether the intermediate step of the urine sampling would seem worth it to you to even consider or to discuss further with your vet.

I hope all this makes some sense to you, but please don’t hesitate to ask any more questions that come to mind. I know all this testing is stressful to both you and Daisy, and for that I’m so sorry!

Marianne

[Pinkcat]

Thanks so much for returning with Daisy’s test results, and yes, I hope I can help you make more sense of things. There are two different blood tests that vets can perform when attempting to confirm a Cushing’s diagnosis. Each one has different strengths and weaknesses. It sounds as though Daisy first had the ACTH stimulation test, which involves first taking a baseline blood sample, then injecting an agent designed to stimulate the production of cortisol produced by the adrenal glands, and then taking a second cortisol reading one hour later. The strength of this test is that a “positive” result on this test is pretty specific to Cushing’s, meaning you can place a fair amount of trust that a dog with a positive result truly has Cushing’s. The weakness is that a significant number of dogs who *do* have Cushing’s will turn up with a “false negative” result on this test, especially if their disease is caused by an adrenal rather than a pituitary tumor.

The second test, a Low Dose Dexamethasone Suppression test (LDDS), reverses this scenario. This means that it is less likely to miss making a Cushing’s diagnosis in a dog who does have the disease. But it is more likely than the ACTH to come back with a “false positive” result in a dog who is suffering from some disease or illness other than Cushing’s that is placing stress on the dog’s system. This is the 8-hour test that your vet wants Daisy to take now. It involves a baseline cortisol draw and then two subsequent blood draws after an agent is injected that suppresses cortisol production in normal dogs. In Cushpups, so much cortisol is being produced that it ultimately breaks through the suppression by the end of the test.

Since Daisy seems to exhibit many outward symptoms that are consistent with Cushing’s, I do understand why your vet is suggesting this further testing for confirmation. For Daisy’s sake, if she does have Cushing’s, it’s too bad that she didn’t test positive on the ACTH the first time around to save the additional testing. However, one additional advantage to the LDDS is that the pattern of the test results (if positive) can often differentiate as to whether the dog has a pituitary or adrenal tumor.

Subsequent to Daisy’s ACTH, the only alternative to the LDDS that I’m aware of would be a urine test called a UC:CR, or Urine Cortisol to Creatinine Ratio. This test involves measuring cortisol that is found in the urine. We’ve been told by specialists that the best way to get reliable results on this test is for the owner to collect a sample of the dog’s urine first thing in the morning on three successive days — at home — and then to pool and refrigerate the three samples to be taken to the vet for analysis. There should be as little stress as possible for the dog or else the test will be skewed. This is why the samples should be gotten at home and not at the vet’s. Cushing’s can be definitively ruled out for a dog with a normal result on this test. A dog with an elevated cortisol result may have Cushing’s, but a further test would be required for confirmation. In Daisy’s case, this would be the LDDS that we talked about above. So since you might find yourself right back at this place again, I don’t whether the intermediate step of the urine sampling would seem worth it to you to even consider or to discuss further with your vet.

I hope all this makes some sense to you, but please don’t hesitate to ask any more questions that come to mind. I know all this testing is stressful to both you and Daisy, and for that I’m so sorry!

Marianne

Thank you so much for explaining this. We will just go ahead with the next set of tests and see what that brings - thanks again - so good to be able to run this by someone who knows ! Xxx speak soon

[Pinkcat]

Thanks so much for returning with Daisy’s test results, and yes, I hope I can help you make more sense of things. There are two different blood tests that vets can perform when attempting to confirm a Cushing’s diagnosis. Each one has different strengths and weaknesses. It sounds as though Daisy first had the ACTH stimulation test, which involves first taking a baseline blood sample, then injecting an agent designed to stimulate the production of cortisol produced by the adrenal glands, and then taking a second cortisol reading one hour later. The strength of this test is that a “positive” result on this test is pretty specific to Cushing’s, meaning you can place a fair amount of trust that a dog with a positive result truly has Cushing’s. The weakness is that a significant number of dogs who *do* have Cushing’s will turn up with a “false negative” result on this test, especially if their disease is caused by an adrenal rather than a pituitary tumor.

The second test, a Low Dose Dexamethasone Suppression test (LDDS), reverses this scenario. This means that it is less likely to miss making a Cushing’s diagnosis in a dog who does have the disease. But it is more likely than the ACTH to come back with a “false positive” result in a dog who is suffering from some disease or illness other than Cushing’s that is placing stress on the dog’s system. This is the 8-hour test that your vet wants Daisy to take now. It involves a baseline cortisol draw and then two subsequent blood draws after an agent is injected that suppresses cortisol production in normal dogs. In Cushpups, so much cortisol is being produced that it ultimately breaks through the suppression by the end of the test.

Since Daisy seems to exhibit many outward symptoms that are consistent with Cushing’s, I do understand why your vet is suggesting this further testing for confirmation. For Daisy’s sake, if she does have Cushing’s, it’s too bad that she didn’t test positive on the ACTH the first time around to save the additional testing. However, one additional advantage to the LDDS is that the pattern of the test results (if positive) can often differentiate as to whether the dog has a pituitary or adrenal tumor.

Subsequent to Daisy’s ACTH, the only alternative to the LDDS that I’m aware of would be a urine test called a UC:CR, or Urine Cortisol to Creatinine Ratio. This test involves measuring cortisol that is found in the urine. We’ve been told by specialists that the best way to get reliable results on this test is for the owner to collect a sample of the dog’s urine first thing in the morning on three successive days — at home — and then to pool and refrigerate the three samples to be taken to the vet for analysis. There should be as little stress as possible for the dog or else the test will be skewed. This is why the samples should be gotten at home and not at the vet’s. Cushing’s can be definitively ruled out for a dog with a normal result on this test. A dog with an elevated cortisol result may have Cushing’s, but a further test would be required for confirmation. In Daisy’s case, this would be the LDDS that we talked about above. So since you might find yourself right back at this place again, I don’t whether the intermediate step of the urine sampling would seem worth it to you to even consider or to discuss further with your vet.

I hope all this makes some sense to you, but please don’t hesitate to ask any more questions that come to mind. I know all this testing is stressful to both you and Daisy, and for that I’m so sorry!

Marianne

Hi again, daisy is booked in for second round of tests on wed next weekbut I ve just noticed something on daisy tonight - it’s top of her chest into her neck a purple black big what looks like a thick bruise ! Has anyone experienced this - id upload a pic but not sure how - just checking this isn’t an emergency really

[labblab]

It does sound like a bruise, but I don’t know why she’d be bruised in that location. Since she had blood testing done on Wednesday, I’d think she might have bruising from that, except I think this would be a strange location for them to have given her an injection or drawn blood. To be on the safe side, I’d contact the vet if you can in order to get their thoughts about it.

Marianne