New here need advice

[Boober]

Hi

My dog Boober was first given the diagnosis of pre-Cushing's back in June 2011 after an elevated ALP of 770, ACTH test in pre- Cushing's range and bile acid test normal. She previously had an elevated ALP of 880 in Feb. 2011. No further info was given to me...watch and see from the Vet.

March 2012 after a CBC revealed elevated ALP now of 1900 and ALT elevated to 190. ACTH test was done again and normal came back, ultrasound was done and nothing specific was noted also low dose dex stim test was done and it came back as normal. Diagnosis was Chronic active hepatitis. Treatment was diet change and liver support supplements and a re-check in 6 weeks.

April 30/12 recheck CBC revealed ALP off the chart and ALT now 290. Vet wanted to do liver biopsy. I declined as Boober is 11.5, healthy and showing no other signs of sickness. I just didn't feel right about a major surgery for her. No other option was given.

May 17, 2012 re-check of CBC revealed ALT 2400+ and ALT now lowered to 150. The vet doesn't want to seem to suggest or do anything at this point. She has the opinion of look at the dog not the numbers. This just doesn't sit well with me as something is making that ALP highly elevated. I'm thinking the liver diagnosis is incorrect and maybe we should be looking at Atypical Cushings possibly or still even Cushings.

Boober has now started to have occasional incontinence while sleeping and I noticed over the past year shaky hind legs when she is standing sniffing on a walk or peeing. I have noticed a slight pot belly over the last couple of years. She is not fat otherwise, she is very active but I notice she is panting more on walks and on cooler days so it's not just the heat.

I do realize that she is 11.5 but she has always been a very active dog without any health issues until this all started last year. I feel compelled to get to the bottom of this is possible. I'm looking for suggestions and advice and hoping maybe someone on the k9cushings forum might be able to help me. My next step is to get a Adrenal Panel Blood test done at the Univ. of Tenn.

Thanks
Sue and Boober

[frijole]

Sue, Do you have a copy of the ultrasound? You said nothing was found. I am interested in knowing if they captured the adrenal glands and what they revealed. If both are normal sized and the same size then it probably isn't cushings. I also ask because oftentimes adrenal cushings does not show up on traditional testing. The ultrasound is already paid for and I was hoping it might reveal something.

If you are thinking atypical cushings I don't think it affects the liver enzymes like we are seeing in Boober's case.

You mentioned a few cush like symptoms but the two major ones we see in cush dogs are either a voracious appetite (I'm talking head butting trash cans even if it hurts to get to food, walking aimlessly in search of food on the floor) or drinking BUCKETS of water. Some dogs only have one of the two. The nightime incontinence might be an early warning but nothing in your case is screaming cushings - just possible...

Is the urine concentrated (yellow)? If it is then chances are it isn't cushings.

I'm hoping someone has some ideas as to why the alk phos would be so elevated. Was there anything else abnormal in the blood panel?

Thanks, Kim

[Boober]

Regarding Boobers urine it isn't a concentrated yellow more clear like. I have a copy of the ultrasound and this is what it says:
(-Urinary bladder is considered within normal limits;
- Spleen is within normal limits. A focal area of increased echogenicity as noted at the periphery of the spleen. This is benign and incidental finding. Further evaluation is not recommended.
- Kidneys: increased cortical echogenicity with preservation of It should the corticomedullary definition is noted. This type of change is common in older patients. I do not appreciate evidence of significant renal adnormalities or an indication for further evaluation of the left or right kidney.
- Gallbladder: a small amount of billary sludge is present within the gallbladder. This should be considered to be an incidental finding.
- Liver is of a diffusely increased echogenicity, The echotexture is normal. Nodular disease or a mass lesion is not present. Although it is difficult to evaluate the liver size on static ultrasound images, definitive evidence of hepatic enlargement is not identified.
- Adrenal Glands were not included on this study. It should be noted however, that it is highly unlikely that this patient has Cushing's disease as the liver is not dramatically enlarged.

That is what the specialist wrote. The Vet who took the ultrasound stated this about the Adrenal Glands.
(Left adrenal appeared normal in echogenicity and is symmetrical but measured within the upper limits of normal (if 7.4 mm is what is considered upper normal for large breeds). I had some difficulty getting to the right adrenal due to patient cooperation (panting/whining), but I believe I had captured a couple of images of the right adrenal which measured within normal limits ( although upper range again).

That's pretty much the ultrasound story for Boober.

[frijole]

It bothers me that they didn't really get good images of the adrenals because there could be an adrenal tumor that was missed. (this happened to me) As I mentioned an adrenal tumor often doesn't respond to traditional cushings testing and therefore can go undiagnosed. That said - the vet who "did not include it on the tests'' indicated that they appear to be normal.

Did the person doing the test not understand you were doing this to rule in/out cushings? grrr... It's frustrating because they are so expensive to have done... like I said - been there myself. And my girl had an adrenal tumor. Kim

[Boober]

Kim when this ultrasound was done in March 2012 it was after the ALT was also elevated and the low dose stim test that was normal and the 2nd ACTH test that came back normal. Once the ALT was elevated the Cushing's theory went out the window with the 2nd Vet I was seeing (the first didn't think Cushing's to begin with). I guess that is why the adrenals were not included as the ultrasound was to look at the liver as now the Vet was saying hat she had a liver issue. My concern is that the ALT is now going down but not the ALP.

I don't even know where to go now. This all started back in Feb. 2011 when Boober had early am stomach rumblings that were so loud. With that came loss of appetite at breakfast on those days. This slowly progressed to some sort of colitis by June and in July she had runny stools with blood in them. This was when the ALP was first elevated. At this time I was feeding her raw and she was also off leash daily out of town on walks where she swan in the ditches by the farmers field and caught mice and ate them, sometimes 2 or 3 a day. I had taken her to the 2nd vet but neither vet addressed this colitis issue or anything. The one was just concerned with her elevated ALP and automatically assumed Cushings. August I took her off of raw (I started this in June 2010) back to Orijen 6 fish that she had been eating prior to raw. Once I did that all stomach issues and colitis stopped. Except now the ALP was elevated and then the ALT in 2012.

I am truly at a loss of what to do now. Neither Vets were helpful.

[LillyMae]

ALP can be elevated from too much Thyroid hormone. Have they checked his Thyroid ? Toxins can also cause the elevations. Are you feeding any treats & if yes , are they from China ? if yes then Stop ASAP & notify your vet.

[labblab]

Dear Sue,

Welcome to you and Boober, although I am sorry for the issues that have brought you to us. I do agree that Boober's symptoms are not generally consistent with Cushing's. So the diagnostic puzzle is, what else might be going on?

I'm going to throw out a total wild card, but has Boober been tested for leptospirosis? This is a bacterial infection that can result in kidney and/or liver damage. There are many different strains of this type of bacteria, and apparently each strain may be associated with particular types of damage.


Course and severity of the disease is often dependent upon the serovar responsible for the infection. Serovars associated with liver infection and symptoms of urine discoloration and/or jaundice (icterus), elevation of liver enzymes, and gastrointestinal symptoms include L. icterohaemorrhagiae and grippotyphosa. The serovar grippotyphosa is also associated with symptoms of renal failure as is the serovar pomona.

Your description of Boober swimming in the farm ditches and eating mice is what triggered the thought of lepto. As you will see from the following article, these would be two prime sources of infection. And apparently the disease can take a variety of courses ranging from acute onset, to a more "smoldering" chronic version, to a dog harboring the bacteria but not exhibiting any symptoms at all.

http://vetmedicine.about.com/od/diseasesandconditions/a/CW-Leptospirosis.htm

Lepto is more prevalent in some parts of the country/world than others, so I don't know if you live in a region where it would be a possibility. But it seems to be on the upswing throughout North America, even in areas where previously it was uncommon. The disease is diagnosed through urine and/or blood testing, but many vets don't even think to test for it, especially in areas where it had been rare. As I say, just a shot in the dark, but I thought I'd mention it. The bacteria are very common where I live in Georgia, and that's why it's especially on my mind.

One other comment...you said that you declined the liver biopsy because you didn't want to subject Boober to major surgery. Is that what your vet said would be necessary? Many times, all that is required is for a needle to be inserted under sedation, and a small sample extracted via the needle. Since Boober's liver seems to remain the focus of concern, I'm just wondering whether or not you'd want to reconsider a biopsy in order to gather the best information possible about the status of his liver.

Marianne

[Boober]

Marianne & Kim thank you for the info. I did mention the thyroid and I certainly mentioned Leptospirosis to both Vets and to be honest I'm talking to deaf ears. One was only concerned about the biopsy and it was not the needle one. He wanted to open her up and do an exploratory surgery by physically looking at the liver and so on then removing a piece of it. In my mind this was way too risky and that was the only option he was doing. I suggested to my other Vet that we should test for Lepto...she said it wouldn't be an issue. How can one say that? It's time for me to get a new Vet so my next move is to the U of S Vet teaching hospital 5 hours away.

[Boober]

I just got the results back today of Boobers adrenal panel from the Univ. of Tenn but I don't understand the results and I'm not sure my Vet does either. Can anyone tell me what they mean? Does she have Cushings or Atypical Cushings? She was diagnosed with Chronic Active Hepatits in March after her ALT also elvated along with her ALP. Since then her ALP is even higher at 2400+ and her ALT has lowered to 150 as of May/12. I made my Vet to the adrenal panel test and this is what it says:

TEST RESULT NORMAL RANGE NORMAL
(Baseline) RANGE (Post ACTH) Range
Cortisol ng/ml 26.3 2.1-58.8 232.3 65.0-174.6
Androstenedione 0.99 0.05-0.57 >10.0 0.27-3.97
Estradiol pg/ml 80.6 30.8-69.9 82.2 27.9-69.2
Progesterone 0.11 0.03-0.49 3.65 0.10-1.50
17 OH Progesterone 0.15 0.08-0.77 2.78 0.40-1.62
Aldosterone pg/ml 363.5 11-139.9 779.6 72.9-398.5

It say that these result indicates presence of increased adrenal activity. (moderate-significant)

Comments: Occasionally aldosterone elevation may be related to Na/K/water balance at testing. Although, estradiol may contribute to clinical signs, it is not a good indicator of adrenal activity, since it is also secreted by peripheral tissues (adipose, skin); in the case the source id not known. Treatment options are attached for your consideration, if symptomatic.

If anyone has any thoughts it would be greatly appreciated.
Sue & Boober

[frijole]

Sue - I can't follow the test results. Can you edit to indicate what the readings are and then put the ranges for normal in parenthesis? Thanks! Kim

PS I merged your post with your original thread as we like to keep it all in one place so we can go back and read the history as a reference.

[Boober]

cortisol pre- 2.3 (normal 2.1-58.8) post 232.3 (normal post ACTH 65.0-174.6)
Androstenedione pre- 0.99 (normal .05-.57) post >10.0 (normal post ACTH 0.27-3.97)
Estradiol pre - 80.6 (normal 30.8-69.9) post 82.2 (normal post ACTH 29.9-69.2)
Progesterone pre - 0.11 (normal .03-.49) post 3.65 (normal post ACTH 0.10-1.50)
17OH Progesterone pre - 0.15 (normal .08-.77) post 2.78 (normal post ACTH 0.40-1.62)
Aldosterone pre - 363.5 (normal 11-139.9)post 779.6 (normal post ACTH 72.9-398.5)

everything is high post ACTH...a few are high pre ACTH

Thanks
Sue and Boober

[lulusmom]

Hi Sue,

Boober's cortisol is definitely elevated and at 232.3 (converted to 23.2 ug/dl) it would be consistent with typical cushing's. Yes, he has other adrenal hormones that are elevated but this is the norm if cortisol is elevated. I think your vet needs to re-evaluate Boomer's file and think about revisiting a possible cushing's diagnosis.

I must admit that I am still confused by the chronic hepatitis diagnosis because 1) the liver enzyme pattern doesn't fit. With hepatitis, the ALT, which is a liver specific enzyme, is severely elevated. This would be due to liver cells being destroyed and 2) I don't see where sufficient testing was done. A liver biopsy is usually necessary to make this determination.

Glynda

[frijole]

I just went back and re-read your entire thread and while I agree with Glynda that cushings is a possibility due to the fact that cortisol is elevated (along with the other hormones)... I'm just not seeing cushings symptoms.

Not sure if you have read the list of symptoms for cushings (it's long and most dogs have just some, not all of them) but I am interested in knowing which, if any your baby has.

Thanks
Kim

[Boober]

Kim to me the symptoms I believe Boober has is drinking lots, incontenience while at rest or even just sitting in the kitchen as this is happened twice, also a somwhat pottish belly (this is where she carry's excess weight) and always wanting to eat. She does pant more while out walking but not in the house. Not countersurfing or anything but she sits in the kitchen waiting to eat. My Vet does not know alot about Cushings or liver issues, do you think it would be wise for me to see an IMS at the teahing hospital. I personally thinking they were guessing with the chronic ative hepatitis as how can you diagnosis this without a biopsy of the liver. If Boober doesn't have a liver issue then I don't want ot have to continue to make her special food and feed her Royal Canin Hepatic as that is awful ingredient food. Plus does she need all the liver support supplements that I'm giving her and a restricted diet?

[lulusmom]

Hi again,

I am always big on getting a second opinion from an internal medicine specialist. My two cushdogs are treated exclusively by an IMS so I would heartily recommend that you have Boober seen by one. You'll probably need a referral from your vet and s/he should be agreeable to that.

[Boober]

I was reading that if there is no elevation of cortisol just any of the other 5 intermediate hormones, this is consistent with Atypical Cushings and if there is an elevated cortisol, even with the elevations in any other intermediate hormones, this is typical of Cushings. The determining factor for diagnois is whether or not the cortisol is elevated. Is this correct?

Since Boober's adrenal panel came back with elevated cortisol and all 5 intermediate hormones elevated post ACTH and 3 pre ACTH do I now assume that she has Cushings and not liver disease like I was told she has. Her last CBC in early May showed ALP 2400+ and a ALT of 150 down from 290.

I have her on liver support supplements as well as Denamarin and feeding her Royal Canin Hepatic and homemade liver diet food. I'm hoping I can feed her normal food again and I'm assuming that she will need to eventually be on Lysoderm to get her cortisol back in check.

I was reading that melatonin and Flax Lignans are usually used to try to control the production of estradoil (Boober's is also elevated) but this doesn't usually have any effect on lowering the cortisol?

Any thoughts?
Sue and Boober

[lulusmom]

Hi Sue.

You are correct. As I mentioned previously, Boober's cortisol is elevated,which is consistent with typical cushing's. In my layperson's opinion, Boober's liver enzyme pattern is consistent with cushing's, not hepatitis.

Melatonin and lignans are prescribed for atypical cushing's. It's efficacy is less than 40% in atypical cushing's and probably nil with typical cushing's so those supplements would not be the treatment of choice for Boober.

If you have the funds and the time to get Boober in to see a specialist, I think it would be optimum to let the specialist review all of the testing done to date, Boober's physical presentation and symptoms, and ultimately confirm a diagnosis.

[Squirt's Mom]

The estradiol can be produced outside the adrenal glands. This is where the melatonin and lignans come into play as they can reach anywhere in the body to work on this hormone. UTK does not recommend treating pups with elevations in these five hormones with Trilostane (Vetoryl) tho many vets are doing so and many of those pups do fine. UTK recommends using Lysodren (Mitotane) when the other five hormones are elevated however the melatonin and lignans may still be needed to lower the estradiol.

There is controversy in the veterinary world concerning the import of elevations in these five hormones, whether the cortisol is also elevated or not. Not enough research has gone into Atypical and the effect these hormones may or may not have on the body. It is known that pups with elevations in only those five hormones and normal cortisol can exhibit many of the same signs as pups with true Cushing's in which the cortisol is elevated. You will find some who say this condition simply does not exist and others who say it is a viable condition. We have to educate ourselves as much as possible and make our own determination as to how we think best to treat our babies if elevations are present other than or along with the cortisol.

In our Helpful Resource Section you will find some links about Atypical that may be beneficial. My Squirt had elevations in all the intermediate hormones only then her cortisol started rising as well. She was treated with melatonin and lignans for nearly four years before she needed the Lysodren. Today, she takes all three and is doing well for an old broad! ;)

Hugs,
Leslie and the gang

[Boober]

I just called the University of Saskatoon Vet College and have an appointment with an IMS on Monday morning. It's a 6 hour drive but I'm so hoping this will lead me to a proper diagnosis. If Boober needs another ultrasound on the adrenals they said that she can probably get it done on Monday also. Thanks again everyone for you help and advice. I'll keep you posted with what the IMS tells me.
Sue and Boober

[Squirt's Mom]

Good move, Mom! :)

[Boober]

I'm curious what people feed their dogs with Cushings? When Boober was given the diagnosis of Chronic active hepatitis I was told that she needed a special diet either Royal Canine Hepatic, SD or I could make a special liver diet. I'm so hoping that isn't the case for Cushings. Those Vet diets have such crappy ingredients and cooking well it's a lot of work. Would I be able to feed her what she was eating before all this Orijen 6 fish like my other dog eats or something like that?
Sue & Boober

Moderator's Note: I have merged your latest post concerning Boober's diet into Boober's original thread. We, normally, like to keep all post on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed.

[frijole]

Cush dogs don't require a special diet - they need food that is low in fat and relatively high in protein. I agree - most vet foods that I tried were just awful. Kim

[Boober]

I just wanted to update on Boober. Today we went to the Western College of Vet. Medicine and saw an IMS and she diagnosed Boober as having Cushings...finally I have a diagnosis. Boober had blood work and an ultrasound and urinalysis done. The blood work wasn't back yet today but she has enlarged adrenal glands both of them and very diluted urine with protein in it. Tomorrow we are going back in the early am so she can have a Low Dex Supression test. I'll know more info tomorrow but talking with the IMS today she said that she uses Trislostane for her patients. The 6 hour drive and 2 nights in a hotel was certainly worth it...finally someone listened to me!

[frijole]

Yeah. Glad you are getting answers. Having someone you can trust means so much. Don't be afraid of the diagnosis.... it is scary at first but really it isn't so bad. You and your vet just need to be up to speed and communicate and it will all be fine. Kim

[lulusmom]

I am so glad to here that your visit with the IMS went well and that you finally have an answer for that big question mark that's been hanging over your head for so long. My dog went undiagnosed for well over year, maybe two and it wasn't until she saw an IMS that a diagnosis was confirmed. That was many years ago but I do remember that the testing was comprehensive and I had to eat pancakes and spaghetti for a while until my wallet recovered. :D

Glynda

[addy]

Glad to hear you are making progress.

Not being sure is hard.

[Boober]

So Boober had her LDDS test yesterday but the results were not back when we had to leave (it's a 6 hour drive home) so the IMS is going to call me today but she said with the enlarged adrenals, the concentrated urine, the elevated ALP it's all looking like Cushing's and the LDDS results should confirm that. She was also briefly talking to me about Trilostane. How do I know that Boober's symptoms are enough to start the drug right away?

[addy]

How worrisome are they to you? The symptoms, I mean.

[Boober]

That's a good question Addy. Boober seems happy I just don't want to make things worse. But I guess they do get worse as that's what Cushing's does but how long does that take. I guess that depends on the dog. I don't think her quality of life is suffering at this point and the IMS said that she was in great shape for almost 12 years old. I notice the small changes over time but if you saw her you probably wouldn't notice any symptoms unless I told you or you were aware of Cushings and knew what you were looking for.

Sue & Boober

[Boober]

I was wondering since Boober had elevated cortisol as well as the other 5 hormones post ACTH on the adrenal panel should I be giving her melatonin and flax lignans starting now to try and help lower the estradiol? I realize that it won't lower the cortisol. The IMS didn't mention anything about it and since I haven't spoken to her yet about the LDDS results I'm not sure. My Vet in town thought I could start on those as she thinks Boober's symptoms are minimal at this point and I shouldn't start the drug.

I also think at this point that Boober Cushings symptoms are minimal and I'd like to hold off on the drug for now. Should I do that even if the IMS thinks I should start. I certainly know Boober more than she does. But I also want to make sure I'm doing the right thing.

How bad should the Cushings symptoms be before the drug is started? Will I make things worse by not starting now on the drug?

To be honest some days I think my golden drinks more and he certainly pants more than Boober and he doesn't have Cushings. Boober actually doesn't pant in the house at all. I've started to keep track of how frequent the incontinence is just to note. So far it's not often.

Sorry for all the questions I just want to make sure I'm doing the right thing for Boober.

Sue & Boober

[StarDeb55]

Sue, any time you have elevated cortisol, it's a sure bet that one or more of the associated hormones will be elevated, too. Melatonin & lignans are normally used to address the non-adrenal production of estradiol. My 2nd boy, Harley, had across the board elevations on his UTK panel, & I used lysodren to treat him. The IMS I was seeing at tht time basically said that trying to get an elevated estradiol under control was basically a "crapshoot", (her words, not mine). I did use the melatonin & lignans for awhile, but stopped them, & saw no deterioration in Harley at all.

Now, when it comes to starting medication, strong symptoms are a huge part of monitoring how well the medication is working. For instance, when using lysodren, you go through a loading or induction period where one of the big things you are watching for is usually a change in appetite or eating habits of the pup. We are usually talking about a pup who will inhale their food in 30 seconds flat, leave the bowl so spotlessly clean, you could probably eat from it. Now, during the loading period, suddenly this pup who ate at warp speed, eats kind of slow, maybe pauses to look at you, before resuming eating, this would be a huge sign that the pup is loaded. By you saying that Boober's symptoms seem pretty mild presently, it may be safer to hold off on beginning medication until symptoms are stronger, & you're more comfortable starting either med. This is a decision that you have to make with consultation from your vet. Just remember that Cushing's is a very slow moving disease, literally taking months, if not years to its damage to a pup's internal organs. The best thing might be to take your time, thoroughly educate yourself on both medications, & how they are monitored. By doing that, you will be one step ahead of the game when you decide it's time for Boober to begin treatment.

Last comment, you are absolutely correct in that you know Boober best. I had to fire the above mentioned IMS when she & I had a major disagreement on how to proceed with Harley's care. I had used this IMS to monitor my first boy's Cushing's, the last 2 years he was with me, & thought the world of her, so firing her was not easy, but I knew my little one the best.

Debbie

[Boober]

Thanks Debbie for that info. Boober does not inhale her food at all, now my golden well he inhales food :) Boober lies on the floor and eats slowly off of a plate. If she thinks she might get something better she'll wait me out before finishing it all so as for eating symptoms I can't say really anything has changed much in 10 years. The water drinking has increased but then again my golden drinks his share so it's hard to tell how much she is drinking on her own. Tomorrow I'm going to start to monitor exactly how much I put in the bowl and how often to get a better idea of how much is being consumed by both.

So at this point I can't say she has strong symptoms so I'm thinking it's not yet time to medicate even if the IMS thinks it is. We'll take it slow and see how things progress over time. It's just good to have a diagnosis so that I know what I'm dealing with when and if symptoms get worse.

[Boober]

I just got off the phone with the IMS and the LDDS test did not confirm that Boober has Cushings. She told me that her ALP is still highly elevated at 2800 and her ALT is 124 (down from 151). She told me that this does not rule out the fact that Boober has Cushings and that I should re-do the LDDS and CBC on her in a Sept. She told me that I should start Boober on the melatonin and flax lignans.

I'm feeling abit disappointed as I thought I would finally get a diagnosis and put things to rest but I guess not. I thought for sure when the adrenal panel came back with everything elevated the LDDS would confirm Cushings.

Does anyone have any thoughts on this?
Sue & Boober

[frijole]

There are other reasons that the liver enzymes were elevated. I'm at work now so can't post a lot but could you please post the results from the entire CBC? Post anything abnormal as well as the ranges. This might help us help you determine next steps. Kim

[Boober]

Kim I'll post the CBC results as soon as they are faxed to me. Thank you for your help. I do know that her cholesterol was high.
Sue

[lulusmom]

I just got off the phone with the IMS and the LDDS test did not confirm that Boober has Cushings. She told me that her ALP is still highly elevated at 2800 and her ALT is 124 (down from 151). She told me that this does not rule out the fact that Boober has Cushings and that I should re-do the LDDS and CBC on her in a Sept. She told me that I should start Boober on the melatonin and flax lignans.

I'm feeling abit disappointed as I thought I would finally get a diagnosis and put things to rest but I guess not. I thought for sure when the adrenal panel came back with everything elevated the LDDS would confirm Cushings.

Hi Sue,

If Boober had really strong symptoms, there is no doubt the IMS would have confirmed the diagnosis and most probably prescribed treatment. For what it's worth, I believe she is being conscientious and following proper protocol. The LDDS is less likely to yield a false negative result but there are a very small percentage of dogs with cushing's who test normal on the LDDS.

My advice to you is enjoy life with Boober and don't even think about Cushing's until Boober gives you a reason to. I personally would not spend money on another LDDS in three months if my dog was still not symptomatic or symptoms were still mild.

Glynda

[Boober]

Glynda thank you for that advice I think that's exactly what I needed to hear and what I need to do now. I've been consumed by this for the last 1.5 and seem to be spending every waking moment trying to find the answer.

As for the CBC these were the things that stood out of the normal range:
Cholesterol - 9.46 Normal Range (2.70-5.94)
ALP - 2818 Normal Range (9-90)
ALT - 124 Normal Range (19-59)
GLDH - 27 Normal Range (0-7)

The Comment on the bottom of the blood;
INTERPRETATION:
Marked ALP elevation - steroid induction could certainly play a role here. Continue with workup for Cushing's as outlined in the history. Otherwise cholestasis is possible. Elevated hepatocellular leakage enzymes - may be secondary to Cushings, though another for of hepatopathy cannot be ruled out.

Thanks again everyone.
Sue & Boober

[Boober]

I was looking through Boober's results from all the tests the IMS did back in June and noticed that the urine prot/creat ratio test results were still pending at the time we left the teaching vet hospital and when I got the discharge notes from the IMS. I wanted a copy for my file so I called this morning to get the results.

Results 2.55
Urine protein 1.16 G/L
Urine creatinine 4029UMOL/L

Would this have any significance since her LDDS test came back negative yet adrenals enlarged and her UTK panel results showed all 5hormes elevated as well as the cortisol. The IMS could not confirm a Cushings diagnosis since the LDDS test came back negative but recommended melatonin and flax lignan and to re-do in the fall another LDDS and CBC. Boober's symptoms are mild so I don't think I'll spend the money on another LDDS test at this point but I'm just wondering if the 2.55 results would be consistent with a dog with Atypical Cushings as I'm thinking that is what Boober has at this point.

Sue and Boober

MODERATOR NOTE: I have merged your latest post concerning the Urine protein/creatinine ratio with Boober's original thread. We like to keep all info about each pup in one thread. That way it is easy to look back through the history if needed. If you'd like the title of Boober's thread changed so it is easier to find, just let one of the admins or mods know. Thanks!

[Boober]

I have another questions and was wondering if anyone had any thoughts. Around the middle of June I noticed one day that Boober was limping slightly on her front right leg. She is always on a leash and I hadn't noticed that she hurt it.

I'm not sure exactly where it's coming from. I've cut her walks way back because of this hoping that it would go away...it hasn't. It hasn't gotten worse but if we walk abit further now I notice she limps more after that or when she get's up from a resting postion. In the morning it's hardly noticable.

My question is could this be related to the cushings/atypical cushings or could a lipoma the size of a golf ball near the under arm of that front left leg be causing this. She has had the lipoma for over 1.5 years and it hasn't caused an issue before then on day out of the blue this slight limp shows up. I would hate to have that lipoma removed if it could be related to the Cushings.

Again she hasn't been firmly diagnosed with Cushings because of the LDDS test being negative but the cortisol as well as the 5 sex hormones in the UTK test were elevated. I was just wondering if this has anything to do with that cortisol being elevated? If anyone has any thoughts it would be greatly appreciated.
Sue & Boober

[Squirt's Mom]

Hi Sue,

Squirt has several lipomas on her chest area close to the front legs. When they were first found, the vet told me not to worry about them unless they started to interfere with her movement or caused her to limp. So, based on that from our vet, I would at least have it looked at.

Typically, we see limping become more pronounced after the cortisol is lowered via treatment in pups with preexisting conditions like arthritis. The reason for this is that the cortisol is a natural anti-inflammatory and it "treats" any inflammation that is present while it is running rampant. Once it is back to normal levels, the inflammation flares more strongly.

As far as I know, the condition of Cushing's does not cause limping.

Do you have the normal ranges for those test results you posted earlier? That would help those who might can offer some insight. ;)

Hugs,
Leslie and the gang

[Boober]

Thanks Leslie for the info. The lipoma has been looked at and we have been watching it hoping that it wouldn't start to interfere with her walking. The 3 vets that I have been using said the same thing as your vet did. We do have an appointment tomorrow with out regular vet to discuss removal of it...I was just reaching hoping I wouldn't have to do the surgery to remove it in such an akward place.

The urine port/creat ratio test doesn't have any normals on the sheet that I got emailed to me just the numbers I wrote in the previous post. It does say on the bottom of the sheet this:

INTERPRETATION
UPC's greater than 2 are predictive of glomerular loss. LDDST testing may be recommended to confirm Cushings first (before working preteinuria up further).

[Boober]

Boober's ALP is also extremely high in the 4000+ range as of May this year. It's been getting higher all the time since we first saw it elevated in Feb./11 and that time is was 700+.

[Budsters Mom]

I probably should know this, but is it Skooter or Boober? Bladder stones again, poor little guy.:( No, I have never heard of an ALP that high.:( Please keep us posted.

Hugs,
Kathy

[KennyJ]

Is Boober being treated for Cushings?

[molly muffin]

I hope you don't mind, that I copied the posts over here into Boobers thread so we can keep everything going on with Boober here.

We have many who come through and have high ALKP. It's good to be able to share experiences.

Sharlene and Molly Muffin

[Boober]

Boober is being treated for Atypical Cushings with melatonin and spruce lignans. Her ALP now is 4000+ and her ALT 350. She was also recently diagnosed with nasal carcinoma so I am treating her with many cancer fighting supplements also including Avemar and AHCC. I still have no idea why her ALP is so extremely elevated and just getting higher.
Sue and Boober

[molly muffin]

That is very frustrating that the numbers won't come down, but I think you are doing everything possible for Boober.

hugs,
Sharlene and Molly Muffin