First, WELCOME
! So very glad you found us.
And omg, as I was reading the first 5 paragraphs I thought "she needs to check for Cushings"! This was especially apparent for me when you said the little line "he always wants to be fed". That is a red flag sign of Cushings, bc their cortisol is elevated and just like with humans, when our cortisol is high...we want FOOD. My Wylie has Atypical Cushings, so I'm always keenly aware when people describe a certain symptom group. Cushings is SO often missed by generalist vets bc it's a very complicated disease that has generalized symptoms that can appear to be almost anything. A good vet will suspect Cushings after a certain point, so it's great that your Mom's vet even mentioned this.
If it were me, I'd definitely check for Cushings. The first step is a Cortisol Creatinine Ratio Urine Test - that test is *not* firmly diagnostic, but it's the first step bc it's way cheaper than just jumping on in and doing the major Cushings tests. The CC Ratio Test will at least point you in the direction of
whether or not you need to proceed to the next step of actually doing the Cushings test. If the CC test is positive (elevated), then most vets suggest an ACTH Test and an ultrasound of the adrenal glands. If that test is positive and if the clinical signs of Cushings are present, you treat for Cushings. If that test is negative, you keep looking. If that test is borderline, THEN you need to send blood to the Univ of Tenn Endocrinology Lab - they're the preeminent center for dogs w/ Cushing, truly an amazing place. They can diagnose (your vet cannot) Atypical Cushings. And btw, many people's vets will suggest they go to a Vet Internist when diagnosing Cushings, bc it's a very complex disease and is often best managed in the diagnostic stage by an Internist. Just keep that in mind.
Tell your Mom that if it *is* Cushings, it truly DOES need to be diagnosed bc otherwise she will have a dog with continuous miserable skin infections, ear infections, hair loss, loss of muscle mass all over, insane hunger, increased water drinking and increased peeing (!!!), dog may develop a pot belly, lethargy, heat intolerance, thinning of skin all over, leaching of calcium from bones and about 20 more symptoms I'm not thinking of. When cortisol is elevated, it throws off EVERYthing in the body...it's a powerful little chemical. Do these symptoms sound like him?
Given his age, again if it were me....I *might* not get the ultrasound. If the ATCH was positive and the clinical symptoms present, then from there I'd probably just go ahead and treat. In other words, if money is an issue for your Mom - the thing to consider not doing (based only upon strength of results of the other tests) is possibly the ultrasound.
Has his thyroid been checked and has he been checked for Diabetes? Those are both things to check in and of themselves, but also bc they can go hand in hand w/ Cushings too, esp hypothyroid.
Also, I'd get his skin tested ASAP bc untreated / undiagnosed Cushings dogs are notorious for rampant skin infections, and even if he isn't Cushings - it still sounds like a possible infection. You don't want that infection going any further, bc they can really wreak havoc. The vet can do a quick skin scraping and look at it under scope - he will quickly be able to see if there is bacterial overgrowth; if there is, it's likely pyoderma (staph intermedius) and should be treated w/ Simplicef. If fungal is suspected too, then he'd grow out a sample in culture and you'd get results in about 10-14 days.
Cushings is not easy to diagnose or treat. If a kiddo has Cushings and you begin to treat - it can take a long while to get the med titrated. The meds are harsh - and you have to start slow, ramp up, and then do the ACTH test again to see if the dosage is controlling the cortisol. If it isn't, then you have to increase med, wait 6 wks, and ACTH test again. This can go on for quite a while, as you can imagine.
I've probably barraged you with enough info to bore you to tears already so I'll leave you w/ some Cushings links that I think are good, in case you want to do more reading:
Here is a link to UofTenn's endocrinology lab (only if needed later).
This is
my fave Cushings overiew.
This is a yahoo group for Cushings; I don't post there, but I def recommend joining if Toto has Cushings bc the archives are AMAZING. There is a ton of info there, so try not to get too overwhelmed. I had a long learning curve in really understanding Cushings, and this is typical of other pet owners who are dealing w/ Cushings. It's a very complex disease, so it takes a while for things to gel.
Please stay in touch and let us know what happens; if you have any other questions, don't hesitate.