Getting diagnosed, not an easy process...

[RoxyFoxy]

I was referred here by an awesome lady that I was lucky enough to meet at the vet. Her name is Shannon and her adorable little min-pin is Sunshine. She's just ahead of me on her doggy's Cushings diagnoses and has done her research!
A little back story... my soon to be 6 year old Pomeranian Roxy lost most of her hair over the last 4 years, we did a low dose dex test in 2010 which came back negative. I've been explaining her hair loss as alopecia for the last 2+ years. When I brought her in for a routine dental cleaning her pre-op blood work showed that her liver enzymes were high (ALKP 745U/L and ALT 784U/L). They did pre and post bile acids tests that day (pre 52.7umol/L and post 97.6omol/L) and then referred us to an animal hospital nearby. We have had an ultrasound and liver aspirates. So far we know she has a very large, very bright (how he described it from the ultrasound) liver and probable bilateral adrenal enlargement. Were waiting for results on the liver aspirates.
Other symptoms besides hair loss are definite pot belly, drinks a lot of water, dry, flaky, wrinkly and dark pigmented skin and always wants to eat.
I don't know too much about this disease and don't really understand what the numbers above mean. Any light anyone can shed for me will be greatly appreciated!
I'm grateful to my new friend Shannon for recommending this site!

[Squirt's Mom]

Hi and welcome to you and Roxy! :)

The diagnostic phase can be quite taxing but it is necessary in order to make sure it is indeed Cushing's you are dealing with. Cushing's is one of, if not THE, most difficult canine condition to diagnose because so many other things share the same signs and can cause false-positive/negatives on the testing. So ruling out things like diabetes, hypothyroidism, liver and kidney issues, to name a few, is as much a part of diagnosing as anything else. ;)

Liver enzymes can be elevated for any number of reasons, especially the ALP (or ALKP - same thing) and the liver is an amazingly forgiving organ. It can take quite a bit of punishment then bounce back. ;)

Poms are a Nordic breed and they are strongly represented in the Alopecia group so you may not be off the mark with that after all. Hair loss in Cushing's is typically seen toward the rear of the body - tail, legs, haunches. A "rat tail" is common in cush pups. The bilaterally enlarged adrenal glands are typical in Cushing's and usually indicate the pituitary based form, PDH - pituitary dependent hyperadrenocortism.

Do you have the normal ranges for the values you listed? That will help us help you. I don't know anything about bile acid results but we do have members here who do and I'm sure you will hear from them soon.

Let us know what the results of the liver testing are when you can.

You and Roxy are part of our family now and we will be with you all the way. Never hesitate to ask questions; we will do our best to help you understand. I'm glad you met Shannon and she sent you our way!

Hugs,
Leslie and the gang

[lulusmom]

Hi and welcome to you and Roxy.

I'm a fellow Pom lover and have a 10 year old tiny girl with cushing's who is as bald as a billiard ball on most of her body. Like Roxy, she started losing her hair at about two years old and one year prior to her cushing's diagnosis. She has hair on her face and has retained most of her hair on the top of her head, legs and feet. The rest of her looks like a black rat and her skin fits your description of Roxy's. Lulu brings an all new meaning to "ratted tail". She was diagnosed with pituitary dependent cushing's by an internal medicine specialist a bit over 7 years ago and has done remarkably well on both Lysodren and Trilsotane but neither grew hair for her. I gave up on the notion that Lulu would ever regain her beautiful coat again. I truly do not believe her hair problem is due to cushing's but rather her genetic predisposition to alopecia x.

Dr. David Bruyette is one of our countries leading experts on cushing's and other endocrine disorders and I finally decided to go with his prescription and buy more sweaters for Lulu. :D It's been so long since I've seen her with a full coat, I'm not sure I'd like it. :)

Cushing's is difficult enough to figure out and learning how to interpret lab work isn't a cakewalk either but a lot of us who have been dealing with this disease for a long time, have learned enough to be dangerous. :p What I'm about to say may not register with you, especially if your head is still reeling, but read it anyway. I predict that some day, it'll make sense.

Most dogs with cushing's have moderate to severe elevations in ALKP and mild to no elevation in ALT. Roxy's elevations are not the typical pattern we see in cushdogs nor do cushdogs have post meal bile acid as high as 97.6. I recall hearing a very prominent endocrine specialist saying that post meal bile acids as high as 50 is possible with cushing's but if higher than that and most definitely higher than 75, chances are you are dealing with something other than cushing's. Not all labs have the same reference ranges but most that I've seen have high normal ALT no greater than 118 IU/l. Using that range, Roxy's has more than a sixfold increase which is more indicative of primary liver disease or something else going on that is causing injury to the liver. It will be interesting to see what the aspirate shows.

Can you please round up copies of all testing that has been done so far and post the results here? On the bloodwork, we need only see the abnormal (high and low) values and please include the normal reference ranges. Has your vet done a urinalysis? If so, please post the results.

Shannon, if you are reading this, I want to thank you for referring Roxy's mom to us.

Glynda

[sunshinehoman]

I'm so glad you decided to join the family!! You will get a lot of info.. and defiantly some peace of mind!

Roxy is soooo adorable! She was such a trooper the other day after her appointment :)

I hope you get some answers after the tests come back!! I am still waiting on Sunshines tests. I check my email every hour or so to see if they have sent them to me. Waiting is so hard....

[molly muffin]

Hi and Welcome. Isn't Shannon a wonder! We love her and Sunshine too. :)

I wanted to say hello. Glynda has covered the diagnostic stuff already and all she says is true. Cushngs is the more difficult thing to diagnosis (we still haven't had a clear diagnosis) and that difficulty makes it horrid. I'm thinking those liver values sound off. Not the ALP, that seems pretty typical, but the ALT is higher than expected. So, the liver aspirate might tell us more than some of the other test.

Don't be afraid to ask any question. We're here to talk, to laugh, to cry, whatever works. :)

Hugs,
Sharlene and molly muffin

[sunshinehoman]

Have you gotten any of the test results back yet?

Shannon & Sunshine

[molly muffin]

Hi, just checking in to see how you and Roxy are doing. Hope all is going well.

Hugs,
Sharlene

[sunshinehoman]

No results posted?