One more question then no vet med for the weekend!
– 11 year old FS Golden-Poodle Cross presented for owner concern of increased appetite, panting more and drinking more water than usual; owner is a worry-wart
– routine blood panel showed midly elevated ALP (200’s), CBC wnl, urine SG 1.024, +1 protein, urine cort:crea 17 (N<13)
– speaking with the owner the next day she thought the dog seemed “better” with less drinking and normal appetite but I recommended further work-up because of the above findings
One more question then no vet med for the weekend!
– 11 year old FS Golden-Poodle Cross presented for owner concern of increased appetite, panting more and drinking more water than usual; owner is a worry-wart
– routine blood panel showed midly elevated ALP (200’s), CBC wnl, urine SG 1.024, +1 protein, urine cort:crea 17 (N<13)
– speaking with the owner the next day she thought the dog seemed “better” with less drinking and normal appetite but I recommended further work-up because of the above findings
– Lyme test negative; BP systolic 135; urine pro:cre ratio pending; another urine SG test 1.035
– u/s normal other than the right adrenal. I know it often hooks around like a boomerang but this looks like a mass in the cranial pole What do you think? I don’t think this pet has Cushings as the urine SG is too high and I know urine cort:cre can be elevated for other reasons. At this stage I am going to recommend monitoring via ultrasound. I don’t think I am going to waste money on a LDDST test at this stage as it is not clear that the clinical symptoms are persisting in the patient.
Comments
Key point the usg is 1035. So
Key point the usg is 1035. So traditional cushings is out. Pheo and hypertension?? could account for clinical signs. Surely the right adrenal merits a recheck in 3 weeks to assess any growth and if so removal. Systemic hypertension? Then the RAD is more important but at 135 systolic im not excited. Otherwise check pain related disease… ortho and such. Adrenals in older dogs get lumped up a bit as an aging process so until the capsule is deviated and inflamed or phrenic vein invaded or a mass effect or power doppler lighting up I tend to ignore the mild adrenal irregularities if I can’t fit the clinical picture with adrenal disease.
At 1.035 typical CCD is
At 1.035 typical CCD is unlikely.
Sometimes if the urine SG is ? I will have the owners do a 3 day measurement of water consumption. Not perfect- but helpful. I will have them place a water bowl the pet cant possibly finish in 24 hours and measure how much they start with and then how much is left after 24 hours. A little is lost through evaporation- maybe 1 oz. I do this for 3 consecutive days and have the owners call me. Of course- only 1 bowl for a pet and no other access to water and no other pets drinking. You will get daily variation – but it nice to know.
Another ?- is there a way to get the play button off the cines. I still need to slow down the cines to see structures. That play button is smack in the center when you try to scroll through slowly. Maybe it doesn’t bother anyone else.
Thank-you and Eric and Randy.
Thank-you and Eric and Randy. My gut is that this is not Cushings either, at least at this stage. I have done exactly what you recommended Randy having the owner measure the amount of water the pet is drinking over the weekend but instead just having her measure how much she puts in a bowl and keeping track of how many times she needs to refill and what is left at the end of 24 hours. I think greater than 100ml/kg in a day is considered to be too much water intake. This also gives the “worried mom” something to do over the weekend. I plan on re-scanning in a month to watch the adrenals.
Randy on the arrow for video
Randy on the arrow for video my IT dept made the adjustment and put it in the left bottom corner and smaller. You are right it was a pain in the middle. Thx for the suggestion.