I'm new here and can use some advice.

[AimesFarm1]

Hi everyone, I am the proud adoptive mommy to a wonderful lab mix whom is estimated to be 11-13 years old. His name is Milo and he is the most loving old man you'd ever want to meet. :) I'm sorry this is going to be long, but I'll throw it all out there and hope someone has any advice for me!

Every since I adopted Milo almost two years ago he has had slightly elevated blood work:

Cholesterol: 361 Jan 2011, 342 June 2011, 391 May 2012
ALKP: 438 Jan 2011, 498 June 2011, 1383 May 2012
ALT: 95 Jan 2011, 74 June 2011, 143 May 2012
MCV: 73 Jan 2011, 74 June 2011, 73 May 2012

He also has a significant heart murmer and was treated in March for a protruding vertebral disk. Milo has always had severe anxiety to thunder and loud noises as long as I have had him. He receives xanex 30 min prior to predicted thunderstorms.

Recently Milo has had frequent inappropriate urination in the house. At first the vet dismissed it as Milo being an older dog and a by product of aging. After pressing the issue, the vet finally looked at his blood work and decided that Milo probably has Cushings and seemed to ignore the possibility that anything else was wrong. I had him cultured on my own and found out he had a pure E. coli urinary tract infection and took the results to the vet whom prescribed Baytril.

Milo's frequent urination improved significantly, but he still has accidents in the house, and drinks lots of water. He does not have a pot belly, he is not short of breath, his appetite is regular, he is very energetic (more so than my younger dog).

I had a Thyroid panel run on him
T4: 0.82, T3: 1.00, Free T4: 0.84, TSH 0.326, TGA: Neg.

I had a urinary cortisol/creatinine ratio run
UCCR: 2.6

My vet now insists that I now have an ultra sound done, even though the research I've done said that it is only helpful in less than 15% of cases. I am on a limited budget and I am doing the best I can to provide the best care I can for Milo. Is further testing for cushings appropriate when he doesn't show physical signs and the UCCR test was completely normal? Are there other diseases I should be asking about?

Thank you for any help you can offer!

[frijole]

I have approved this post but please respond to the email you get so we can activate you and then all of your posts will appear without moderation.

I am responding because I had a dog with similar bloodwork, the disc problem, the intermittent urination issue, normal urine etc... only in her case she did a cushings test and it came back positive... many times... but it was a false positive.

I would do what your vet asked and get the ultrasound. While they are not cheap - they answer alot of questions and could save you alot of time, frustration, and other unnecessary tests that do add up also. In my case my gal Annie had an adrenal tumor. It was not cushings but gave her some similar symptoms. If caught early enough these tumors can sometimes be removed.

Anyway,even if something else is going on the ultrasound takes a look at the organs and can give you answers. Be sure the machine is a high definition one - not all vet offices have this and so you might have to go to another office for the reading. Get copies of the reports too~!

Kim

[AimesFarm1]

Thank you, I will call around and see if any office around me has a high definition ultrasound. A non cushing's tumor would make much more sense, since he doesn't have a single physical sign. I had radiographs done when he injured his spine, should I see if I can get copies for the vet to compare or is that not helpful?

[Squirt's Mom]

Hi Aimes,

Welcome to you and Milo! :)

What a lucky guy to end up with such a great home!

I agree with Kim about the ultrasound - one saved my Squirt's life by finding a tumor on her spleen. ;) As a result, I cannot recommend them highly enough.

An xray and an ultrasound won't show the same things so comparing them wouldn't be of much benefit in looking for a possible problem in an organ, which is what the ultrasound can see vs bones as in an xray. However, it could be a good idea if the doc that will be seeing him has all his records...I would call and ask if they would like them sent prior to Milo coming in.

Keep in touch whether Cushing's is in play or not - you and Milo are family now! ;)

Hugs,
Leslie and the gang

[frijole]

You are welcome! Just trying to save you the frustration I had! Leslie's dog was misdiagnosed also - and the ultrasound is what proved it.

Are you near specialists? I'm in a rural area and had to drive to the nearest university teaching school to get all this figured out. But it was worth it.

Kim

[AimesFarm1]

I am quite close to Cornell so I'm sure my vet will give me a referal to there. Can you give me a ball park figure of what a big university like that would charge for an ultrasound? I'm sure it won't be exactly the same at every university. I grew up on a dairy farm so I end up with serious sticker shock when I hear the cost of some of these procedures. Just last night I was ordering things for the farm and found the exact same baytril tablets my vet prescribed, except at half the price. Sometimes I forget that small animal medicine has a 100% mark up as opposed to the tiny mark up in cattle medicine.

[frijole]

I can tell you I was shocked to find that Kansas St Univ Teaching Hosp was way cheaper than the specialist I visited in Omaha. (I am outside of Omaha about an hour)... I paid $500 for an ultrasound in Omaha and they didn't even capture both adrenal glands so we missed it the first time. K State charged me $150 and they did a much more extensive set of film.

Not sure that helps you other than to give you a range. :D Kim

[AimesFarm1]

I appreciate the range. I am quickly learning between his expensive emergency trip to Cornell for his spinal injury and treatment and now all this testing, visits, and antibiotics that winning the lotto any day now would be incredibly helpful...:rolleyes: Don't worry, I'd definitely share!

[molly muffin]

Hi, I'm new too. My dog, molly, also has the high ALT's that has caused the cushings alarm to be pushed. Did they tell you if there were any other possibilities other than cushings that woud cause the ALT's to be elevated, so quickly?

Hugs to you and Milo.

[AimesFarm1]

Hi Molly's mommy!

I am awaiting a call from the University near me to see if a specialist can see him, but I suspect that his enzymes spiked due to the raging E. coli urinary tract infection he was suffering from at the time. I want to have his levels rechecked now that it has cleared up. I think his ALKP will be back down in the high 400's, still not good, but much better than nearly 1400.

I definitely plan on continuing the testing for cushings, but I'd like to explore the other possibilities that fall under the polyuria/polydipsia category. So far my list of rule outs includes: cushings, chronic renal failure, pyelonephritis, hypercalcaemia, atypical leptosporosis, liver disease and acromegaly.

[molly muffin]

It sounds like you have things well organized and a good plan to find out what is going on with Milo.

Thumbs up!

Sharlene and Molly

[jmac]

Hi there!

I just wanted to say a quick hello and welcome you!

You have found a wonderful place with knowledgeable, helpful, caring people! We will be here to support you on your Cushing's journey.

Please ask us any questions you have and keep us updated with how Milo is doing!

Julie & Hannah

[AimesFarm1]

I've been looking into suppliments and prescription diets. Does anyone have any experience with Hill's Science Diet Prescription L/D ? I believe that it is supposed to offer hepatic support too.

[Squirt's Mom]

Take a look at the ingredient list - you will find that all Hill's Science feeds are primarily corn and sodium.

[Squirt's Mom]

What is Milo eating now? Is he having issues with it? I'm not sure I would start looking into prescription diets just yet until there was a firm diagnosis. Then you have a better idea of what you are targeting via diet. If Milo is having digestive issues on what he is eating now, then that's a different story. ;)

[AimesFarm1]

He is on Science Diet Active Longevity. He really has no health issues other than elevated liver enzymes, polydypsia and he now wakes me up to let him out to urinate at 4am instead of 6am. All of the testing thus far has been negative (cortisol/creatinine ratio, LDDS, urine specific gravity...) for Cushing's but my vet is absolutely insistant that he has it, the only test left to run is an ultra sound.

I would like to lower the liver enzymes that are steadily climbing though.

[molly muffin]

Strange that the vet would insist it is cushings, if all the cushings test are coming back negative and it is just the ALT's going up. I never seem to know what anything means though and seem to be playing the second guessing thing all the time,so I'll be interested to see what those who have dealt with this much longer think.

[Squirt's Mom]

Have you looked into Milk Thistle for the liver? It can help sometimes. ;) Here is a link to a thread here where it has been discussed -

http://www.k9cushings.com/forum/showthread.php?t=2948&highlight=milk+thistle

Hugs,
Leslie and the gang

[AimesFarm1]

Sorry It's been so long since I've been on! Last week I took Milo to Cornell and they literally laughed at the very idea that his vet thought he had Cushing's. Even the students there were commenting on how thick his coat was as they were shaving his tummy for the ultra sound and how strong his abdominal muscles were. The chief of imaging, Dr. Margaret Thompson, performed the ultra sound.

She and the students were absolutely wonderful with my baby throughout the whole procedure. The ultra sound revealed that his adrenals are completely normal and there are no signs of Cushing's.

It did reveal large nodules in his liver and kidneys. Cytology showed that some of the nodules in the liver were benign, but the majority are malignant. The nodules in the kidneys would require laproscopic surgery to get biopsies because of the positioning. I elected to not do this to him. The ultra sound also showed many smaller matastacies spread throughout the liver.

Basically, my poor baby has cancer all through his liver and kidneys.:( The only physical symptom he has been presenting with was pd/pu. His appetite and energy level are great. So we have decided to put him on the precription liver support diet and Denamarin. When he starts showing signs that his quality of life has decreased and he is in pain (inappetence and change in behavior) then it will be time for "end of life" care.

His polyuria has already started to improve after just a week on this treatment combination. So I'm hopeful that this treatment is giving him the quality of life that I want for him for whatever time it is he has left. He seems happy right now and that is all I can ask for. I am grateful for everyday I have with him :)

[molly muffin]

I'm so sorry for that Milo has cancer. I think though that it is good to at least know. I know that you and he will enjoy all the time together that you have.
HUGS
Sharlene (and Molly Muffin)

[lulusmom]

I'm so sorry to hear that Milo has cancer but I'm glad to hear that he is feeling better with his new diet and liver support regimen. I was just reading somewhere about a dog who was diagnosed with liver cancer and the vet said only two months to live. It had been almost a year and this dog was still with us and doing better than expected.

I'll be keeping fingers and paws crossed that Milo continues to do well and better than expected. Positive thoughts are being sent your way as well as prayers a plenty that you two have a lot more quality time together.

Hugs,
Glynda

[jmac]

I'm so sorry to hear about Milo's cancer. :( I'm sure it was very tough news, but I am glad you now know what is going on. I'm glad to hear Milo is still feeling well and is happy. I'm also glad the new diet and Denamarin are helping. Enjoy this time you have with him and make some memories, and of course, spoil him!

Thanks for the update, but I wish it was better news.

Julie & Hannah

[AimesFarm1]

Thank you all for offering support, even while you are all experiencing canine struggles of your own!

Although the news was heartbreaking, I realized that this is not the tragedy that I felt it was. Milo isn't in any pain yet, and may have many happy pain free days left of being spoiled rotten. The most important thing is that there is a difinitive answer so he doesn't have to keep being tested for everything under the sun. I know that was stressful for him.

Thank you for your support and we wish you all courage and strength for your families as to face the challenges of Cushing's.

Hugs to you all!:)

Aimes and Milo

[Squirt's Mom]

You have a great attitude about this and I am sure Milo is going to enjoy every moment he has with you and his family.

Do stay in touch and let us know how things are going. We are always here anytime if you wish to talk.

Hugs,
Leslie and the gang