Cushings is a disease that affects humans, dogs and horses. An overproduction of the cortisol hormone by the adrenal gland(s) is caused by either a pituitary or adrenal tumour, leading to a range of clinical signs. Any old dog that is eating, drinking and urinating excessively, has a 'pot belly' and hair loss - including a 'rats tail' - should set off alarm bells in any vet's brain (especially if it's white )(the dog, not the brain).
- The first step is to take a general blood test. ALP is a liver enzyme that increases significantly in Cushings....most of the time. Other diseases including liver disease and bile stasis can also increase the ALP. Depending of the level of suspicion we might then do:
- A Urine-Cortisol-Creatinine Ratio - a test that is good at ruling out Cushings. If the result is negative, Cushings is unlikley. If it's equivocal or positive... well.... it may or may not be Cushings. In which case...
- An ACTH-stimulation test or a Low-Dose-Dexamethasone-Suppression test may be required to rule Cushings in. If positive, Cushings is very likely (if stress wasn't a compounding factor) (because vet clinics are always the most relaxing of places....for the animals and humans...). But if equivocal or negative...well.. you can't say it's not Cushings. So....
- An abdominal ultrasound (or CT) can look for other signs of Cushings - including an enlarged liver and adrenals - but it is not a confirmatory test. However it can pick up other concurrent diseases.
- A High-Dose-Dexamethasone-Suppression test can differentiate between a pituitary or adrenal cause - but only once Cushings is confirmed.
Try explaining that to a client in the clinic car park, wearing a mask, at 1.5m distance whilst the patient is barking its bald butt off. (Me, yesterday at 640pm).
Understandably, the client looked bewildered.
'So.....how do we know if Pumba has Cushings?' she finally said.
I sighed and summarised: 'Its complicated.'
Yesterday was also 'RU OK? day' - a mental health and suicide prevention initiative where we're encouraged to connect with those around us using 'Are you OK?'. I thought about this. And I thought about Pumba.
See, the questions of Cushings and OK-ness are important, valid questions.
The problem is in the answers.
- Are you OK because you've only cried twice this week, instead of every day, over nothing (or everything)?
- Are you OK because you've only needed one coffee today, instead of four...before noon? Or are you OK precisely because you've had four coffees... and does that indicate you're not OK?
- Are you OK because you swore under your breath at the kids/hubby/dog (that may or may not have Cushings) instead of out loud?
- Are you not OK because spilling the milk makes you more angry than a group of illegal party goers spreading the virus?
- Are you OK because this month you've managed to pay the rent on the business and books are out of the red - even though only God knows what next month will bring?
- Are you OK because 'At least you have a job, your health, a warm bed and a loving family'? Or does it kinda not work that way?
- Are you not OK because the vaccine side effects made you dull and weak, but you were glad because for a few hours your body felt how your mind has been feeling for months?
Does Pumba have Cushings? RU OK?
Sigh... its complicated.
