Vet thinks Cushings - I'm not sure

[Raven]

I took my 9 year old female lab mix to the vet in February 2011 because of a mass on her back leg. She had also been drinking more, panting, and waking me up at night, so we ran some blood work.

The mass was benign, but her blood work showed ALK at 2850 (ALT was around 120). The vet ran a Cushings test (ACTH Stim test I think). It came back fine. We then ran an ultrasound which showed an enlarged liver. After Denamarin for a month, we retested the blood work and the ALK was 2400 and her ALT was at 160. So we did Cushings test #2 (Low Dose), and a bile acid test. Both were fine, so I stopped and kept her on Denamarin for a few months. I also tried mixing her food (Science Diet) with some prescription L/D food from Science Diet.

Retested her blood in July, when her ALT was back to 120, but the ALK was now at 4600. She had seemed fine, but started waking me up again and was drinking more, so the vet advocated Cushings Test #3. I really didn't want to, but he said things could change in the 3 months since her last test and the next step was the biopsy. With the biopsy invasive and the vet advocating another Cushings Test, I opted to go with it. Test came back fine again, so we have an appointment with an Internal Medicine Specialist.

Has anyone had any experience with ALK levels this high? I see a lot of reference to 'high' levels under 2000, so I do not know what to make of my dog's bloodwork. She had previously been diagnosed with Inflammatory Bowel Disease, but other than that, a benign chest lump and the leg mass (which went away on its on), she's been healthy.

She HAS been drinking more and waking me up at night to go to the bathroom, but what I never thought to tell the Vet is that she goes about twice a day, twelve hours a part - so adding one bathroom break at night doesn't seem that bad in that context. Also, she does not have the behavior changes or hair loss of typical Cushings patients. The drinking and bathroom go in phases - sometimes she's fine for a few weeks, then for a few weeks we have the issues. She's been lethargic for a while.

Cushings experts - does this sound like typical or Atypical Cushings?

(and for anyone who is a dog food expert, I have thought of changing her food to something else, but wanted to wait until after the Internal Medicine doctor saw her before changing anything.)

Thanks for any thoughts!

Raven

[Harley PoMMom]

Hi and welcome!!! I am so glad that you are taking your furbaby to see an IMS. Even though drinking and urinating more are some of the clinical signs of Cushing's, these symptoms coincide with other non-adrenal illnesses such as liver disease and diabetes.


Retested her blood in July, when her ALP was back to 120, but the ALK was now at 4600. Just want to get this straight for my feeble mind :confused::)...is her Alanine transaminase (ALT) 120 and the alkaline phosphatase (ALP) 4600?

Many things can cause the ALP to be high and IBD can cause an elevation in the ALP.

Is your sweet girl on any other herbs/supplements/medicines?

This article has good information about liver issues:The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities (http://veterinarymedicine.dvm360.com/vetmed/Medicine/ArticleStandard/Article/detail/325515)

Please know we will help you in any way we can so feel free to ask any and all questions.

Love and hugs,
Lori

[Raven]

Yes, ALT (sorry, I used the wrong letters!) was 120 and Alkaline Phosphatase was 4600.

She does not take any medication other than Comfortis, heartworm, and Denamarin. Loves rawhides (though I assume this would not cause liver issues). Had broad spectrum antibiotics back in April when bile acid test came back fine.

Around the diagnosis of IBD, her Alkaline Phosphatase was 2400. ALT at that point was 52.

I am thinking it is liver oriented - cancer, hepatitis, something. I thought you Cushings experts could help me eliminate that at least - even though I think my vet would put money on it!

[Harley PoMMom]

Cushing's is one of the most difficult diseases to get a confirmed diagnosis because not one test is 100% accurate so multiple testing is usually done. If you could get copies of all the testing that was done and post the results here that would really help us.

Strong symptoms are a huge part of the diagnosis and a Cushing's savvy vet will not initiate any treatment without strong symptoms and a proper diagnosis.

Love and hugs,
Lori

[mytil]

Hi and welcome to our site. I too am looking for those test results as Lori mentioned above.

What tests has your vet performed, other than the x-ray, in regards to the possibility of liver cancer? You did mention a biopsy, was that performed?

Here are the typical symptoms of liver cancer:
Lethargy
Weight loss
Vomiting
Loss of appetite
Bloody stools
Excessive thirst
Excessive urination
Pale gums
Jaundice
Anemia

I am glad to read you are seeing an IMS who can point you more as to whether you are dealing with Atypical or not.

Keep us posted
Terry

[Squirt's Mom]

Hi and welcome to you and your baby! :)

One test I strongly recommend before she has any invasive procedures is an abdominal ultrasound on a high resolution machine. This will allow them to see not only the adrenals (two of the main organs involved in Cushing's), they will also see the liver, kidneys, intestines, gall bladder, bladder, stomach to name a few. This test saved my Squirt's life when it found a tumor on her spleen. The pup is usually sedated to keep them still on the table for the images and their bellies shaved, but that is all they are subjected to. If they see a possible problem with the liver, then they can do a biopsy at that time...but they will be better guided to the problem area with an U/S imaging. ;) Having a biopsy is not going to determine if she has Cushing's or not, but it can determine cancers and other issues.

On a non-Cushing's note - I learned from my vet a couple of weeks ago that the heart worm med I have been using for years (HeartGard) is not effective and the company has known this since 2002. All three of my babies are going to have to be tested next month and then started on a new treatment if they are worm-free. :( So talk to your vet about the worm med you are using to be sure it is as effective as the company claims. Here is a link to a thread about this -

http://www.k9cushings.com/forum/showthread.php?t=3579

What distinguishes typical, or true, Cushing's from Atypical Cushing's is the cortisol. With true Cushing's the cortisol is elevated but with Atypical the cortisol is normal while one or more of the intermediate hormones (Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone) are elevated. A pup can, and many do, have elevations in both cortisol and the intermediates but these pups are considered to have true Cushing's, not Atypical, because of the elevation in cortisol. The only place that does testing for Atypical is the University of TN in Knoxville (UTK). The test is performed just like the usual ACTH but sent to UTK for the assay. At this point, I wouldn't put my money on the UTK panel, tho. Once we see the tests she has already had we will be able to give more meaningful feedback but based on what you have shared so far, the ultrasound would be my next step. ;)

Please let us know what you learn from the IMS. Keep talking and sharing - we love details! :p Ask any questions you may have - I can assure you we will ask lots of questions! :D We are not vets but the collective experience and first-hand knowledge found here is amazing...and yours for the asking. The moral support is beyond compare - we will be with you and your baby through thick and thin. You are not alone, ya'll are family now and I am glad you found us.

Keep your chin up!
Hugs,
Leslie and the gang

[Raven]

She has had 3 Cushings Tests, an ultrasound, and a bile acid test in the last 6 months, as well as bloodwork.

Low Dose Dexamethasone Test was done in August. Readings were 7.4 ug/dL, then less than .7 ug/dL, and less than .7 ug/dL.

Last bloodwork:

ALKP 4534 U/L
ALT 120 U/L
GGT 1 U/L
TRIG 552 mg/dL
B/C Ratio was 28

It says something about the Na/K ratio - not sure what that is about.

Bile test was 6.5 umol/L pre and 9.3 umol/L post.

Looks like in February they ran cbc - platelets increased, Blood was 2+ (don't know what that means), PH was 8, Protein was 1+.

If there is a specific value you need to refer to, let me know - I've got pages of labwork.

Thanks!

Raven

[Harley PoMMom]

ALKP 4534 U/L
ALT 120 U/L
GGT 1 U/L
TRIG 552 mg/dL
B/C Ratio was 28

It says something about the Na/K ratio - not sure what that is about.

Na/K ratio is the dog's sodium level (NA) divided by the potassium level (K). The Na/K ratio- that should be between 27-40.

The B/C is the BUN level divided by the Creatinine level, are her creatinine and BUN within the normal ranges?




Looks like in February they ran cbc - platelets increased, Blood was 2+ (don't know what that means), PH was 8, Protein was 1+.

These results look like they came from an urinalysis: Blood 2+ means there was blood in the urine and they found protein in the urine also. Since blood was found in her urine has an UTI been ruled out? Was this a free catch urine sample?

[Raven]

Na/K ratio is the dog's sodium level (NA) divided by the potassium level (K). The Na/K ratio- that should be between 27-40.

The B/C is the BUN level divided by the Creatinine level, are her creatinine and BUN within the normal ranges?

These results look like they came from an urinalysis: Blood 2+ means there was blood in the urine and they found protein in the urine also. Since blood was found in her urine has an UTI been ruled out? Was this a free catch urine sample?

Na/K was 30 it seems, so that is okay. Bun was 22 and Crea is .8 0 the ratio's normal limits were 4-27, and her ratio was 28.

Well, the vet has never mentioned the blood or protein. This was back in February. I was not present when they took a sample, so no idea where the values came from. She had antibiotics after this testing and her ALKP level still went up. Vet has not run another urinalysis that I see since February.

The most recent bloodwork notes Lipemia 2+ and Hemolysis 2+ - what do these mean?

[Harley PoMMom]

Lipemia is the presence of fats or lipids in the blood; Hemolysis is the breakage of the red blood cell’s, Lipemia and Hemolysis can cause inaccurate laboratory tests results.

If the urinalysis was a free catch, then the blood would concern me. If the urine sample was done by Cystocentesis, a procedure where they place a needle through the abdomen into the bladder and draw urine, then most times blood can be detected this way. If it were me, I would ask your vet about the blood found in her urine.

[Raven]

Lipemia is the presence of fats or lipids in the blood; Hemolysis is the breakage of the red blood cell’s, Lipemia and Hemolysis can cause inaccurate laboratory tests results.

If the urinalysis was a free catch, then the blood would concern me. If the urine sample was done by Cystocentesis, a procedure where they place a needle through the abdomen into the bladder and draw urine, then most times blood can be detected this way. If it were me, I would ask your vet about the blood found in her urine.

It had to be free catch - the other option does not sound familiar at all.

Vet has focused on Cushings; the issue with the blood and protein in her urine has never come up. I will mention it to the IMS.

[Raven]

Just a quick update. The IMS did more tests, most of them repeats (for both a baseline and to see what has changed.) Her Alk Phos is 3000 according to the IMS, though the other numbers are normal. ALT is on the high side of normal.

So the IMS said that my dog is not fitting the typical profile for the typical diseases. There is a test that they can do to identify whether the issue is liver, bone, or steroid related. If the aspirates do not come back with a diagnosis, then we will send that test off.

So I am still at square one. I can say that the Atypical Cushings test at Tennessee according to the IMS is around $250, for anyone who is curious.

Raven

[Raven]

The isoenzyme test came back pointing towards steroid based liver issues. My next step is the University of Tennessee panel to determine if it is Atypical Cushings. My IMS said this is not 100% steroid, but we have a direction.

A note for anyone looking into their dog's testing. At this point, my dog has gone through 4 sets of labwork, 3 Cushings tests, 2 bile acid tests, 2 ultrasounds, a liver aspirate (and a partridge and a pear tree). Her ALKP was consistently extremely elevated, but as the IMS pointed out, she did not have corresponding elevations or symptoms that would help point us in a certain direction.

My home vet was sure it was Cushings. I researched and was aware of the possibility of atypical Cushings and the Tennessee testing from the Internet - but my home vet never mentioned that possibility to me. If your dog has elevated liver ALKP enzymes and the initial Cushings test comes back negative, I would strongly suggest doing this test, called an alkaline phosphatase isoenzyme test, prior to the extensive testing outlined above. I was charged around $70 per the IMS (the bill is in the mail), and have had more direction from this one test than all the other Cushings tests combined. Cost wise, it would have been worth it to spend it in the beginning instead of going through all the non-conclusive testing we have had.

Raven

[Raven]

I have scheduled the serum withdrawals for the UT testing, but in light of the confusion at the vets' office on what to test, how to test it, and the cost, I think I need to continue my own research.

I have read that melatonin and lignans are the typical recommended treatment. I do not plan on starting her on anything until the testing is done, but I wanted to find out exactly what these are designed to do, and if there is any harm to starting the meds before the UT result is back. Are they something I can pick up at a Walgreens or Walmart?

Also, I was thinking of changing her diet. She's been on Science Diet Light to manage Inflammatory Bowel Disease - is there another dog food that is recommended for Atypical Cushings? The IFB requires high fiber. I started her out as a puppy on Ole Roy, so I'm learning the ways of kibble! I am not changing anything until after the diagnosis, but like to research ahead of time.

Thanks!
Raven

[Harley PoMMom]

These quotes come from the UTK website:


Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity (effective for ferret adrenal disease), and it inhibits aromatase enzyme in tissues (decreases androstenedione and testosterone conversion into estradiol) and 21-hydroxylase enzyme (effectively lowers cortisol level). Allow at least 4 months for treatment effects to be effective. Response time is variable between dogs. Monitor treatment effectiveness by improvement in clinical signs, biochemistries or by repeat of steroid profile.
More information can be found here: Treatment Option Considerations (http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201107.pdf)


Lignan. Lignan has phytoestrogenic activity, and competes with estradiol for tissue estrogen receptors, with less biological effect. Lignan also inhibits aromatase enzyme (lowers estradiol) and 3-beta HSD enzyme (lowers cortisol). Use either FLAX HULL (SDG) lignan, or HMR lignan. See LIGNAN at our website under TREATMENT for details. DO NOT USE flax seed oil as the lignan content is very low, and the flax oil can increase triglycerides. SOURCES OF APPROPRIATE PRODUCTS are listed at the website. Lignans are safe, so doses don’t have to be exact. Suggested doses: SDG lignan; one milligram/lb B. Wt./day. HMR lignan; 10-40 mg/day for small to large dog.

The melatonin can be purchased at a Walmart, Walgreens, or Health food store, just make sure you get the plain Melatonin not the fast-acting or rapid releasing kind.

The information about where to purchase the Lignans can be found here:LIGNANS (Phytonutrients) (http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20100810-LIGNAN-Write-Up-Revision03.pdf)

[Raven]

Just got the UT testing back:

Result Baseline (Normal), Result Post (Normal)

Cortisol 110.8 (2.1-58.8), 134.4 (65-174.6)
Andro 3.27 (.05-.57), 2.85 (.27-3.97)
Estradiol 83.8 (30.8-69.9), 71.1 (27.9-69.2)
Progest 1.74 ( .03-.49), 1.34 (.1-1.5)
17 OH Prog 1.08 ( .08-.77), 2.55 (.4-1.62)
Aldosterone 273.5 (11-139.9), 290.5 (72.9-398.5)


She has significant increased adrenal activity.

I have recently changed her to Blue Wilderness Healthy Weight (from Science Diet Light). I plan on adding the melatonin and lignans, and retesting in a few months.

I recall reading that Trilostane was not a good choice for Atypical Cushings - my vet treats Cushings with this. Since this increases values and her values are already high, I am really thinking his inexperience is coming in to play.

He also wants me to stick with Denamarin - thoughts on this?

She is not too symptomatic, so I am happy with the holistic supplements at this point.

Hopefully the end of my liver journey now that I have something to treat!

Raven

[lulusmom]

Hi Raven,

It looks like your dog has atypical cushing's. Treatment for this is usually melatonin and lignans, which you can buy over the counter. I believe Lori already provided you with information on these supplements. Trilostane would be a moot point since your dog's cortisol is normal. This drug should never be given if cortisol is normal.

I think continuing with the Denamarin is a very good idea. This supplement helps increase glutathione, which is important for liver health. It also helps protect the liver cells and promote regeneration of cells.

Glynda

[Squirt's Mom]

Hi Raven,

As Glynda said, your baby has Atypical Cushing's. This is a form of Cushing's in which cortisol is normal but one or more of the intermediate, or sex, hormones are elevated. For Atypical pups, the first approach is simply the lignans and melatonin. This combination can lower all the hormones with the sometimes exception of estradiol - which is slighty elevated in your baby. Estradiol can be produced in areas of the body other than the adrenals, like hair follicles and fatty tissues to name a few. The lignans and melatonin will work in these other areas but Lysodren/Trilostane can't.

It takes the lignans and melatonin a few months (3-4) to work so you will have a break from testing for a bit! :) If the lignans and melatonin don't bring the values down the next step is a maintenance dose of Lysodren - NOT Trilostane. As Glynda said, Trilo should never, ever be used in a dog with normal cortisol - which your baby has. Stand firm on this point with your vet - NO TRILOSTANE! But this isn't something you need to worry about for a while yet. ;) Give the lignans and melatonin a chance to work first.

My Squirt is Atypical and was well maintained on the lignans and melatonin for over two years. Her signs became much stronger this year so we have now added the Lyso maintenance and she is doing great!

Hang in there! You're doing a great job!
Hugs,
Leslie and the gang

[Raven]

Can someone help with a website where I can purchase the medicine? I have not purchased anything online medicine wise so would prefer a website that people have used - I would like to be able to get the Denamarin, Melatonin, and Flax hull all at one place.

Thanks!

[Raven]

Cortisol is elevated pre-test and normal post. Why is this 'normal' cortisol levels? I would think we would want to lower her pre-test level.

On another note, I'm continuing with the Denamarin but am having problems with when to give it to her. Breakfast worked - until she started eating her morning meal immediately. This did not give me the hour on an empty stomach. So I started giving it to her as soon as I got home from work - but if work runs long, I don't want to make her wait another hour before feeding.

My solution is to feed her then give the medicine right before I go to bed. Is her stomach 'empty' enough? IE, if I feed her at 6 pm and give the medicine at 9 pm, is that 3 hour period long enough for her stomach to empty so she absorbs all of the medicine?

Raven (and Daisy)

[Squirt's Mom]

Hi Raven,

The high pre number can be from any number of things but is usually attributed to stress being at the vets. The post number is the one that counts. So don't worry about a higher than normal pre.

Canine digestive transit from the stomach to the intestines can take 3-8 hours, depending on what they are digesting. The more grain, veggie and fruits they get, the longer the digestive process is. If meds are to be given on an empty stomach, it is best to give them at least an hour before meals.

Hope this helps!
Hugs,
Leslie and the gang

[Raven]

Okay, I'm confused. What makes her Atypical - the fact that all of her hormones are elevated in the baseline, or the fact that two are elevated post ACTH test?

My understanding of Atypical is that there is an adrenal tumor causing her to secret too much hormone - is that correct?

I guess I do not understand if I am treating the baseline hormone results or the ones post ACTH. The ACTH stimulates the adrenal to produce cortisol, which in my dog post ACTH, is normal. So the conclusion is that the adrenal is producing the correct amount of cortisol (and therefore there is no need for Lysodren). How does that work with the other hormones though?

As a side note, my IMS has been great at responding to questions via email. It was expensive, but at least she has experience in this area!

Thanks!

Raven

[Squirt's Mom]

Hi Raven,

Atypical Cushing's does not mean a tumor on the adrenal glands. If there were a tumor on her adrenals that was causing elevated cortisol, Daisy would be considered to have a form of true, or conventional, Cushing's called ADH - the "A" indicating it was the adrenal based form. PDH means the tumor is on the pituitary gland, which is the most common form of Cushing's - 85% of cush pups have PDH.

Atypical pups have normal cortisol levels while some or all of the intermediate hormones are elevated. If the cortisol is elevated along with the intermediates, then the pup has conventional Cushing's - usually PDH.

Estradiol, androstenedione, progesterone, 17 OH progesterone, and aldosterone are the intermediate, or sex, hormones involved in Atypical Cushing's.

Here are Daisy's UTK results -

Cortisol 110.8 (2.1-58.8), 134.4 (65-174.6)
This value is normal, so she does not have true Cushing's.

Andro 3.27 (.05-.57), 2.85 (.27-3.97)
Estradiol 83.8 (30.8-69.9), 71.1 (27.9-69.2)
Progest 1.74 ( .03-.49), 1.34 (.1-1.5)
17 OH Prog 1.08 ( .08-.77), 2.55 (.4-1.62)
Aldosterone 273.5 (11-139.9), 290.5 (72.9-398.5)

Her estradiol and 17 OH progesterone are elevated so these elevations make her Atypical. All of her pre-stimmed values are elevated. I know an elevation in the pre cortisol is more than likely the result of simply being stressed by the vet visit and testing. The elevations in the pre intermediates indicates to me that her adrenals are releasing these hormones at a "significant" level - ie "significant increased adrenal activity".

But saying the adrenals have increased activity doesn't mean there is tumor on those glands. There is loop between the hypothalamus, pituitary gland and the adrenal glands that regulate cortisol as well as the intermediates. If there is a glitch somewhere along that loop, the pituitary will tell the adrenals to start releasing excess hormones. It is this "glitch" that is Cushing's. The adrenals are always over-working regardless of where the glitch occurs because they are the "work horse" in this loop - the hypothalamus and pituitary give orders and the adrenals do the work. So "increased adrenal activity" doesn't necessarily mean there is a tumor on those glands.

PDH means there is a tumor on the pituitary gland; ADH means there is a tumor on the adrenals; Atypical means there may or may not be a tumor on the pituitary. As long as cortisol remains normal in an Atypical pup, the odds of tumor are much lower. There is some question as to whether all Atypical pups will eventually become PDH or not.

The lignans and melatonin work together to help lower all the intermediate hormones. This can take several months, 3-4. This is the only combination that will work on estradiol if it is being produced outside the adrenals - which is possible. If this combination does not lower the intermediates after a few months, that is when the Lyso comes into play. It will lower all the intermediates that are being produced in the adrenals...but the lignans and melatonin continue to be used even with the Lyso in most cases. For example, my Squirt is Atypical and the combination of lignans and melatonin lowered her estradiol but not all of the others - so that means her estradiol is NOT being produced in the adrenals and therefore the Lyso can't help with that since it works only on the adrenals. So the lignans and melatonin are regulating her estradiol and the Lyso is working on all the others. So you are treating all those numbers with the lignans and melatonin EXCEPT the cortisol since it was normal.

Are you thoroughly confused now? :D I encourage you to have a look at the thread in our Helpful Resource section about Atypical and the links posted there -

http://www.k9cushings.com/forum/showthread.php?t=198

Dr. Oliver at UTK was always so good to talk with us via email or phone but he passed away this year. I don't know if anyone has contacted them since, but it would be worth a shot. They are the leading researchers in this area. Send a copy of Daisy's results, if you contact via email, so they can discuss her case with you easily.

I hope I have helped and not muddied the waters even more for you!

Hugs,
Leslie and the gang

[Raven]

Daisy has been on her medication regimen and seems to feel better. However, her joints are acting up - especially when visiting family (who have stairs). I notice her hind legs still 'slip' out from her occasionally for no reason. She has arthritis in 3 legs, and I have added Cosequin supplements for that (you should see her daily pill regimen).

I wonder if I should get some pain medication for her legs as well. Thoughts? Any idea if this is related to her Atypical Cushings?

Thanks!

Raven

[Cyn719]

Hi Raven - Penny is a shephard - pit - akita etc mix 77 lbs - has cushings was on and off trilo - off at the moment - she has lots of arthritis and lumbar problems - takes Dasaquin (which is what you are giving ) she takes a tramadol at night for pain and we recently added Adequan Shots - alot of members said they work very well - so we are trying - its only been a few weeks so I cant tell you how good they work -- but she hasnt gotten worse -- her back legs are very weak and it is hard for her to jump on the couch or do the stairs - but she manages when she wants to --

That is what I use and I know others will be by to tell you what they are using - hope it helps --- hugsssssss

[jrepac]

Cortisol is elevated pre-test and normal post. Why is this 'normal' cortisol levels? I would think we would want to lower her pre-test level.

On another note, I'm continuing with the Denamarin but am having problems with when to give it to her. Breakfast worked - until she started eating her morning meal immediately. This did not give me the hour on an empty stomach. So I started giving it to her as soon as I got home from work - but if work runs long, I don't want to make her wait another hour before feeding.

My solution is to feed her then give the medicine right before I go to bed. Is her stomach 'empty' enough? IE, if I feed her at 6 pm and give the medicine at 9 pm, is that 3 hour period long enough for her stomach to empty so she absorbs all of the medicine?

Raven (and Daisy)

this is going to sound counter-intuitive, but if you want to avoid the "empty" stomach rule in the morning, shift from Denamarin to giving Marin and Denosyl separately. Denamarin is just a combo of those two; it's the Denosyl component (SAM-e) which needs to be given on an empty stomach. By giving the drugs separately, you can then do Marin in the am and Denosyl mid-day/early evening, well before a meal.

[Raven]

Just a quick note - Daisy's ALK levels have dropped from around 4000 to around 2000. I got some pain medication for her legs to use as needed (since the liver has to process it). We're not at normal, but we're on our way!

[Skye]

thats great that things are getting better, but i felt i should share something with you.....it is unhealthy for a dog to hold its bladder for that long, there are complications to their health that can happen from that. It is recommended they are allowed potty breaks at least every 5 hours.

[Raven]

Well, I'm back.

Went for Daisy's annual exam, and pre op blood work to check levels shows that her ALP is above 2400 again (that's as high as the test would show). ALT is now 165 (normal if I recall was 125ish), I believe BUN is elevated as well as one other thing.

Testing before had extremely elevated ALP but everything else was fine. These levels are new. She also has a cataract and has a molar that split and needs to be removed. (related? No idea).

Experts, please weigh in. Could she have developed Typical Cushings? Doctor said something about the kidneys. They won't touch the molar until the figure out the bloodwork. :confused:

Her regimen for the last few months has been lignans, melatonin, denamarin, Cosequin.

[Harley PoMMom]

Hi and welcome back!

When a dog has elevations in the intermediate hormones most likely, down the road, the cortisol will also rise.

What symptoms does Daisy display?

Concerning the kidneys, could you post the levels for the creatinine, phosphorus and potassium.


We are here to help in any way we can, so just know you are not alone on this journey.

Love and hugs,
Lori