My 13.5 year old Sheltie

[Candy]

Hello all,

This is my first time posting here, as I see alot of useful information about Cushing diseases.

My dog teddy is almost 14 years old, he went under for a surgery to remove a lump from his neck and he had routine blood and urine test done. All went well but the blood test shows he has elevated liver enzymes, ALP/ATL (?) it is 7 times higher than normal. Plus, there are proteins in his urine. The vet suggested Cushing disease and kidney disease. He is currently on medication for his kidneys hoping to prevent futher damage. But I heard Cushing disease can cause proteins in urine? He doesn't drink excessively, or show signs of extreme hunger. He is even picky about his food and sometimes will turn down dog food unless I add in white rice. He doesn't seem to urinate alot more and he is still very energetic, for a senior dog. His coat is slightly thinner but I am guessing it might be due to old age.

I'm not sure what I should do. Im worried sick everyday thinking he might have a liver disease but yet afraid to start treatment because he is very old and I want his last years to be comfortable and happy. Do you guys think maybe he doesn't have Cushing? Except for elevated liver enzymes and proteins in urine, there's nothing wrong with him. The vet says nothing needs to be done until he shows more clinical symptoms, but I don't want to ignore it if it really is Cushing.

Any advice or suggestions or past experience would be GREATLY appreciated. He's my baby and I want what is best for him.

Thank you!
Candy

[mytil]

Hi Candy,

Welcome to our site. Am glad you found us.

Firstly, with elevated numbers (liver values and protein in urine) and no clinical signs I do not think your boy has Cushing's. These elevations can mean a number of things - such as infection, reduced kidney function (not failing), thyroid conditions and even diabetes for example. Has your vet tested for any other condition?

I am very glad your vet did mention that no treatment (meds) until there are definite symptoms. But I will say that I surely hope he mentioned additional testing needs to be done to confirm Cushing's.

Cushing's is a slow progressing disease and here is a good link that will help you understand more about it. http://www.k9cushings.com/forum/showthread.php?t=180

What are you giving for kidney support? Also what type of food are you feeding? Kidney friendly?

Terry

[addy]

Hi Candy, a big welcome from me as well.

Terry has you off to a good start. I only wanted to add the UC:CR Creatinine Urine Test will rule out Cushings or indicate further testing is needed. What I am not sure of is if kidney disease would affect the test. If not, at least it is an inexpensive way to perhaps rule out one of your worries.

Our Lori's pup had kidney problems so I am sure she will stop by and chat.

A big part of diagnosing Cushings is the dog's history and symptoms because other diseases can mimic the disease and there is no one test that is 100%. Non adrenal illnesses can cause false readings.

My pup was diagnosed and I waited a year to start treating her as she also had colitis which was more of a concern than her Cushings. She had very few symptoms at the beginning, mostly skin/coat issues and the start of hind leg weakness. I waited a year to start treating her and have had to go very slowly because of her other issues.

I am so glad you found us. Hang in there and ask as many questions as you can.

hugs,
addy

[Roxee's Dad]

Hi Candy and welcome to you and your pup:)

Cushings medications are made to treat the symptoms of cushings as in most cases there is no cure. By your post it seems the only indicator is the high ALP. While cushings can cause this, so can many other things.

One of the first things that come to my mind these days are chicken jerky treats. They are so readily available on the market and dogs just love em. I don't know what you feed your baby but maybe take a look at what he may be eating. The FDA has put out multiple warnings on chicken jerky treats. There may also be other dietary considerations to check into.

As Terry has already mentioned..if it is cushings, it's very slow progressing and treatment is mainly used to treat the symptoms.

Hope to hear more from you about your baby boy :)

[Candy]

Teddy is currently taking Benazepril hydrochloride for his kidneys. He has been on a dog food only diet since he had serious stomache issues 7 years ago. He eats the hypoallergenic dog food from Medi-Cal and freeze dried chicken breast.

The vet suggested we can do more testing to make sure it is Cushing, however it is very stressful on the dog and on the family. Without any symptoms other than proteins in urine and elevated liver enzymes, I'm not comfortable in pursuing more testing.

I'm very worried for his health, but without any symptoms that suggest cushing disease, I'm also very clueless as to what I should do next. He's almost 14, is treatment a good idea? I heard the drugs are quite toxic to the body and I don't want him to go through so much discomfort and pain :(

Thanks everyone for the warm welcome!
Candy

[mytil]

Hi again Candy,

Well your vet seems on top of this by suggesting additional testing to confirm. There is one test that does not actually confirm Cushing's but it rules it out. It is the test Addy mentioned - UC:CR. It is non stressful for the doggie.


Urine Cortisol/Creatinine Ratio Test:
Considered a screening test, this cannot diagnose Cushing's, but it can rule it out. A urine sample is examined for the relative amounts of cortisol versus a normally excreted protein metabolite, creatinine (the latter is used to control for the degree of dilution of the urine). The greater the ratio, the higher the cortisol level. High cortisol in urine is suggestive of high cortisol in the bloodstream. Many conditions other than Cushing's disease can cause false positives, so this test is not considered diagnostic. Nonetheless, if the cortisol/creatinine ratio is okay, the dog is not likely to be Cushingoid, so this is a good screening test. ... http://www.kateconnick.com/library/cushingsdisease.html

I would like to point out that unless symptoms are visible enough for the owner and/or vet to see, treatment with medication is withheld.

What does your vet say about the elevation in liver values? It could be that the liver is just having troubles. There are also some options regarding lower protein food which is easier on the kidneys.

Keep us posted
Terry

[Harley PoMMom]

Hi Candy,

A belated welcome from me to you and Teddy. I was just wondering how the kidney disease was diagnosed, are Teddy's creatinine and BUN elevated? What about his phosphorus levels? Has Teddy's blood pressure been checked?

Concerning the protein-loss, was an Urine Protein: Creatinine Ratio Test (UPC) performed? The UPC test measures how much protein is being lost through the kidneys, and all one needs to do this test is an urine sample.

Please know we are here to help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[Sage]

With the kidney apparently having an issue, and a recent surgery, further testing for Cushing's could indicate Cushing's, even if Teddy is 100% Cushing's free. Cushing's drugs are heavy hitters and in my opinion they are out of the question.
With behavioral symptomology at zero for Cushing's, I would concentrate on the kidney diagnosis.

[Candy]

The only reason the vet told me Teddy requires medication is that there are proteins in his urine? Should I ask the vet for a copy for his blood/urine test records so I can share the results with you all and hopefully obtain more useful information?

I was so happy when I went to pick up my doggy after he stayed overnight after surgery, alot of information was missed. All I got was, liver enzymes ALP/ALT is high, suggesting Cushings. And possible kidney problems due to proteins in urine.

I read that if Teddy has Cushing he would drink excessively. He is 41-43lbs and he drinks around 700ml to 1L of water everyday, is that excessive?

[lulusmom]

Hi Candy and welcome to you and Teddy.

Yes, It would be very helpful if you could get copies of the blood and urine tests and post the results here. Were the blood/urine tests done in preparation for surgery? Did your vet tell you what the growth was on Teddy's neck?

Most dogs with cushing's do drink more because their kidney's lose the ability to concentrate the urine. They pee more, so they drink more. Is Teddy urinating more? Accidents in the house? Does his urine look clear with no smell? If yes to all those questions, then I believe Teddy is probably drinking so as to stay hydrated. The urinalysis results will be helpful in figuring things out.

Looking forward to hearing more about your sweet boy.

Glynda

[Sage]

1 oz per lb of body weight.
So 42 oz per day is "normal".
1 L is 34 ounces of water.

Post all your tests here and you will have many valuable opinions to read. And I would postpone all decisions until you have a better personal understanding of this recent blood/urine test.
Liver enzymes could be high for many reasons, but without behavioral symptoms I think further Cushing's testing is premature. Have a full blood/urine panel done in a few weeks. Give the dog's body and chemistry a chance to recover from the surgery. In my opinion, there is no need here to rush into any decisions for Cushing's tests. But it is time to rush into a bit of personal research.
And this is a great place for just that.

[Candy]

I contacted Teddy's vet and they will have copies for me to pick up in a few days.

The growth on Teddy's neck is benign, just a tissue mass. The blood and urine test was indeed done as preparation for surgery therefore I wasn't expecting anything to be abnormal.

To me, Teddy does not seem to be drinking more water and his urine is actually quite concentrated. However since he started the medication he seems to be drinking a little more than usual. Again, it is hard to tell because it is just 100-200ml more and it is not everyday. He has no accidents in the house and he doesn't seem to be eager to go to pee as he sleeps through the night very well.

I have even tested out to see if he is especially hungry by giving him food that I know he isn't too fond of. He immediately turned it down and walked away. If he is extremely hungry, the vet says he would not be picky about food.

He is almost 14 years old and his hind legs seems to be weaker (it does shake at times and it has been this way for 3-4 years). He can still jog with me and play fetch! (he almost runs at full speed but of course trips and falls more often now)

I can't seem to tell if his symptoms are due to cushing, or just old age.

[Sage]

I have not read about any behavioral Cushing’s symptoms with your dog. Fourteen year old hips on a Sheltie who can still run full speed and jog are not symptoms of anything but having lived a long active life, in my book.
I think a blood/urine test just prior to surgery weakens an accurate Cushing’s indication for a few reasons. The endocrine system could have been hard at work on the reason for the surgical procedure. A concurrent diagnosis was given for a kidney condition. And above all else, there are no behavioral symptoms to warrant taking the chance of false positives landing a misdiagnosis of 14 year old dog.

[Harley PoMMom]

The only reason the vet told me Teddy requires medication is that there are proteins in his urine? Should I ask the vet for a copy for his blood/urine test records so I can share the results with you all and hopefully obtain more useful information?


The presence of protein in urine can be caused by inflammation or bleeding somewhere in the urinary system. Bladder/kidney stones, an UTI, among other issues besides kidney disease may cause protein loss.

An urinalysis is a very informative tool and would help us to provide you with better feedback.

Love and hugs,
Lori