Tests reults negative-what else could it be???

[Buddys Mom]

Help! I need advice. I got Buddys Dex-reults back today. My vet says they are negative. I am in shock! I would have bet the farm that he had Cushings. Except hair loss and questionable bot-belliedness, he is classic. We are even having to take up the water periodically. He cannot hold his urine over2 hours (while awake). This a brand new problem. He has been an excessive drinker for a while but he still held his bladder at least every 4 hours. The vet said he will draw some blood to check for diabete and kidney disease. I am almost certain he has had these basic tests drawn before at his old vet. Are the Dex-tests nearly always right?? I was hoping to get started on medication to ultimately help with the incontinence. I am frustrated. Any advice out there?

[Kate]

Buddys Mom-
What Dex. test did your vet do- the Low or the High? And, do you know what the results/values were? Sometimes you can have an inconclusive result with the Low dose Dexamethasone test, and if that's the case you would need to do a ACTH stimulation test and/or a High dose Dexamethasone test. Many people have all 3 tests done just to cover everything. The High dose Dex. test is an 8 hour test that can differentiate between pituitary or adrenal dependent cushings. I think it's a good idea that your vet is doing other lab tests also. You may also want to consider taking your dog to a Specialist Internal Medicine Vet for a second opinion if you haven't already done so.

Here is a good web site where you can find possible diagnosis by looking up specific signs/symptoms:
www.vet.cornell.edu/consu...onsult.asp (http://www.vet.cornell.edu/consultant/consult.asp)
(Choose the link "search by signs")

Let us know what happens.
Take care,
Kate and Ace

[Audrey]

Hi, Buddy's Mom,

Is the dex suppression test the only test your vet did for Cushing's? Any single test might give inconclusive results; if you're still concerned that Buddy has Cushing's, you could ask your vet to perform an ACTH stim test, which is another common test for Cushing's. An ultrasound, although expensive, would allow the vet to look at Buddy's adrenal glands and see if one or both are enlarged (consistent with Cushing's). Also, he would be able to look at other internal organs, which might -- in conjunction with the other bloodwork he's doing -- give some indication if the problem lies elsewhere.

ALso, did you mention earlier that Buddy had recently had bladder stones removed? If so, it might take a little while for his bladder control to return to its former level. My dog Malthus had bladder stone surgery last December. He had a couple of accidents the first few days after surgery (very unusual for him). After that, he could hold it until he got outside, but once he started going, he couldn't stop -- it took a few weeks before he could save some for the next zillion pitstops like a boy dog likes to do!

Best of luck getting a diagnosis for Buddy.

Audrey

[Buddys mom]

Thanks kate and Audrey for responding so quickly. I don't know which Dex-test the Vet did. I know they kept him there from 8;30am til 5:30pm. I am going up there tomorrow to pick up some new dogfood and I will ask for the results and ask a few questions. I am kind of 'chicken' to tell him I am going to get an internist. But if I don't tell him I will be even more chicken to come back. I'll know more tomorrow-look for me tomorrow. Thanks Buddys Mom-Angie

[acushdogsmom]

Hi Buddy's Mom,

Most Internists will ask for a referral from your Vet, although there are some who will take on a case without a referral. The Specialists are not "competing" with the GP Vets, Specialists are an extra source of knowledge and expertise in certain areas of Veterinary Medicine and they usually will work together with your own regular Vet on a case in order to get to the bottom of what's going on and they will recommend a treatment plan that your Vet can follow, unless you have a reason why you want to keep your dog in the Specialist's direct care.

It's like if you had a heart condition, your own regular doctor would send you to a cardiologist for a second opinion and treatment recommendations. Most people do return to their regular doctor after they get the expert advice of the Specialist and although some may continue to see the Specialist on a long term basis regarding the heart condition, they still go to their regular doctor for checkups too.

Your Vet shouldn't be upset if you want to get a second opinion from a Specialist. An Internist can provide extra input and expertise which can be helpful to you and Buddy but also will help your Vet to pin down the diagnosis.

Maybe you can let your GP Vet do whatever other tests he thinks he should do on Buddy, and see if he gets a more definite answer as to what might be going on. Then if you still feel you want a Specialist's opinion, your Vet can refer you to an Internist and can send along all of the test results to the Specialist for evaluation.

I think an Ultrasound should definitely be done to have a good look at the adrenal glands and the other internal organs, so maybe you can have that done at the Specialist's after your Vet runs a few more blood tests.

The problem with urination could be related to the recnt bladder stone surgery, but it is definitely a good idea to run some more tests, including ultrasound, just to be sure.

[Susan]

Hi Buddy's mom,

Listen to what these good people are telling you. It was because of them I went to see a specialist. My gp vet had no problem giving me a referral to an internal med. vet. Most gp vets don't have the vast testing equipment that a specialist has. My gp vet was sure that my Dukie had adrenal cushings (more than likley a tumor). Well with altrasound it was found that Dukie didn't have adrenal cushing's but he had pituitary cushing's. Together with my specialist and my gp vet working together I'm hoping my Dukie will be on his way to recovery. Any tests that can be run by your gp vet, let him do, it might save you some money. Take all your test results and x-rays with you when you go to see the specialist. I wrote down lots of questions to ask him too. Good luck.

Dukies mom, Susan

[EllenF]

Hi Buddy's Mom,
I am with the rest. Please do not be afraid to ask for a referral to a specialist in Internal Medicine. It would be well worth it and could save the life of your furbaby. The specialist should be able to find out what is wrong quickly, and treat it.
Please update us when you can.
Ellen & Snowdrop

[Buddys mom]

Hi to those helping me follow my Buddy. I went to the vets office today to get his new W/D food.I spoke witht he vet. He told me Buddy had the low-dose Dex-test. I got a copy of the results. It says baseline 2.5 (normal) and Cortisol 0.6. No reference. It doesn't say much. The Dr. says it's normal. I asked him about an internist. He wants to run a little more lab on hm next week and then he didn't seem to have a problem with a referral. This is my 2nd GP vet and he also doesn't seem really motivated to "think" about what this could be. I probably expect too much "gumption". It's another week of hoping Buddy doesn't have many accidents. Thanks!!!

[sachimom]

Hi Angie,
I found an interesting article by a testing lab that discusses a different test to help diagnose Cushings that you might want to pass by your vet. I had never heard of it before - and don’t know any thing further about it - but since Buddy is testing normal but still has the clinical signs - it wouldn’t hurt to discuss with your vet.
“DIAGNOSING ATYPICAL CUSHING'S SYNDROME (17-Hydroxyprogesterone)
As summarized in Antech News (September 2001), serum 17-hydroxyprogesterone (OHP) concentrations can be helpful in the diagnosis of atypical cases of hyperadrenocorticism (HAC), namely, those with normal ACTH stimulation and LDDS test results. Some dogs with HAC could have deranged steroid production pathways, such that certain steroid precursors may be abnormally increased and responsible for the presenting clinical signs, whereas cortisol concentrations are normal.”
The full article and website:
www.antechdiagnostics.com...r03_02.htm (http://www.antechdiagnostics.com/clients/antechNews/2003/apr03_02.htm)
I truly sympathize with the pee accidents. It is so frustrating. When Sachi gets a UTI (as she has now) I almost pull my hair out. I have considered the doggie diaper - and they have the bands for boys! Something to think about when the Nature’s Miracle is getting low.
Take care, Mary Ann

[Kate]

Buddys Mom-
Is the 0.6 cortisol the 8 hour result? If so, then yes, that is normal. If that's the case, then you can be hopefull that it may not be Cushings after all. I would still consider seeing a specialist if you are still worried about Buddy. What other labs does your vet want to do? Depending on how you feel, and on how Buddy is feeling, you can either do the extra labs with your GP vet and wait till those results come back; or you can go directly to the specialist for a second opinion. Good luck and keep us posted.
-Kate and Ace

[Buddys mom]

Hi Kate- The results sheet just had the one result value on it. I'm assuming it was drawn after 8 hours. I don't feel relieved about the negative diagnosis because the vet doesn't seem to know what it could be. I think he just wants to draw blood for basic chemistries. I feel sure we will end up at a specialist office-SOON. Buddy is actually peeing a little less often the past few days. Some of it might have had to do with the bladder stones removal he had 2+ weeks ago. But he is still lappng up the water etc. ( did I mention that his ALKP from his chemistries before surgery was 1268- normal is 38-126) My old vet was suspicious that this may be inaccurate and a sign of hypothryriodism. He has been on thyroid pills for 3 weeks. (thyroid level 1.8-low normal) My husband is having to take 2 vacation days because I have to go out of town on MOn and Tues and we don't want to board Buddy since has been out of sorts and I can't ask anyone to keep my 'peeing' pup. Hope we get answers soon. Thanks to all!

[Kate]

Buddys Mom-
Yes, I definately would get a second opinion, and take Buddy to the Specialist.
-Kate

[Audrey]

I agree, I think it would be a good idea to take Buddy to a specialist, since you're having trouble getting a diagnosis and feel the GP vets aren't too motivated to find out what's wrong. Maybe they aren't too sure what to do, and are just kind of fishing. But it sounds like you need an answer as quickly as possible -- living with the "peeing pup" must be very frustrating. (I think the bladder stone surgery might help explain why he's having more trouble controlling his bladder when it's full, but not why he's drinking and needing to urinate so much in the first place.) A specialist should have a much better idea of what might be causing Buddy's symptoms and the best tests to perform, and can probably get you a better answer more quickly.

Good luck,
Audrey