New here, Pomeranian maybe has cushings disease

[AmyP]

Hello everyone! I have an 11 year old Pomeranian named Gucci who may have cushings disease. We had suspected it last year because of high alkaline phosphatase (I think), but since he was not having many symptoms we declined to pursue any further testing. Yesterday I brought him in to the vet to have blood tests done for his dental tomorrow and the vet called me telling me that his alkaline phosphatase level was at 1500 and that he recommends doing a low dose Dexamethosone suppression test for cushings.

Gucci does drink a lot of water, but he doesn't urinate noticeably more than usual. He has never had an accident in the house and is able to hold it all night, even when we sleep in. He does pant quite a bit, which I didn't know until today can be a symptom of cushings. He has very dry skin and hair, but he is not losing his hair nor does he have any bald spots. However, since we live in the dusty desert, we keep his fur pretty short for his comfort and to keep him clean, but when he goes a little too long between grooming appts his fur comes in normally. He has a voracious appetite, as long as its something he likes. If its plain dry kibble, he'll pick at it all morning/evening. He still has a lot of energy for an old man, even initiating play and wrestle sessions with our 4 year old poodle mix. But he will tire quickly and does nap a lot.

So, my question is: is the LDDS test the right one to start with? I don't have his most recent blood test results but I will ask for a copy when I drop him off for his dental tomorrow morning and can post them then. I'm so new to this, I don't even know what questions to ask! Thank you everyone!

[mytil]

Hi and welcome to our site.

I am wondering if any others conditions were ruled out - for instance, thyroid problems or even diabetes. I say this because the symptoms are very similar and many rules these out first.

Here are some links to read through to help in understanding Cushing's, the testing and the treatment options http://www.k9cushings.com/forum/showthread.php?t=180 - see especially http://www.kateconnick.com/library/cushingsdisease.html.

Cushing's can be very hard to diagnose and it seems dogs do not follow rule books on this ;) You do have several options here.

There is an inexpensive screening test you can have performed that RULES OUT Cushing's (does not diagnose it) it is the UC:CR (Urine Cortisol/Creatinine Ratio Test) - you can read more about it in kate connick link. It is very non-stressful for dogs.

Or if you are able I would go ahead and have the LDDS performed as well as an abdominal ultrasound to have a visual of the adrenal glands and liver.

I would not jump the gun yet about a final Cushing's diagnosis (and starting meds) given the lack of strong symptoms and additional testing does need to be performed.

Keep us posted
Terry

[3bostons]

Hi Amy, Oh I love poms, had one as a kid she was such a comedian and a snuggler !
I hope you can find she does not have cushings, but you will find alot of help here to guide you to find out one way or the other.
Good luck,
hugs, kona and deb

[AmyP]

Thank you for your replies! Yes my little Gucci is quite the clown, but he's never been much of a snuggler!

I will talk to his vet when I pick him up this afternoon from his dental. The vet that was there this morning said it could be a thyroid problem, but his T4 last year was 1.8 with the normal range being 1.0 - 4.0, and he hasn't changed much since then as far as symptoms. Looking at his blood test from last year, his ALP was in the 1700s, while this most recent shows it went down to 1503. Still really high. His WBC are all in the normal range, but his platelets are high.

How should I post the results of his blood test? Should I post all the results, or just the ones that are high or low? Thanks!

[Harley PoMMom]

How should I post the results of his blood test? Should I post all the results, or just the ones that are high or low? Thanks!

Hi and welcome to you and Gucci,

From a wellness blood panel, we would like to see any abnormalities listed with the reference ranges and units of measurements...example; ALT 110 U/L (5-100).

If any tests for Cushing's were done, could you post these results also.

Cushing's is a slow progressing disease so one does have time to get a confirmed diagnosis for their furbaby, and we are here to help. :)

Love and hugs,
Lori

[AmyP]

Ok. We did just the pre-anesthetic a cople days ago and here are the abnormal values.

Total protein 7.5 (high) 5.0-7.4 g/dL
Alk Phosphatase 1503 (high) 5-131 IU/L
BUN/Creatinine Ratio 34 (high) 4-27
*note: both BUN and creatinine are within the normal ranges
Platelet Count 511 (high) 170-400

His WBC are all in the normal range. Last year his trglycerides were 562 mg/dL (high) with the normal range 29-291. Cholesterol and triglycerides were not included in his most recent test.

[lulusmom]

Hi Amy and welcome to you and Gucci.

I have an 11 year old Pom named Lulu. She was diagnosed with pituitary dependent cushing's in 2005 and hypothyroidism 2003. She is one of the rare ones who was diagnosed at a very young age. I have some comments and questions which I have typed in blue text below within your post:


Hello everyone! I have an 11 year old Pomeranian named Gucci who may have cushings disease. We had suspected it last year because of high alkaline phosphatase (I think), but since he was not having many symptoms we declined to pursue any further testing. Yesterday I brought him in to the vet to have blood tests done for his dental tomorrow and the vet called me telling me that his alkaline phosphatase level was at 1500 and that he recommends doing a low dose Dexamethosone suppression test for cushings.

In the absence of symptoms, I am not sure why your vet is pressing for an LDDS. Symptoms are an important component of a confirmed diagnosis and most certainly the most important reason to start treatment. So even if the LDDS were to be consistent with cushing's, I personally would not start treatment until the dog has overt symptoms associated with cushings.

Gucci does drink a lot of water, but he doesn't urinate noticeably more than usual. He has never had an accident in the house and is able to hold it all night, even when we sleep in.

Drinking a lot of water is not considered a symptoms of cushing's unless the dog has true polyuria/polydipsia (excessing peeing and drinking). Cushdogs drink more to stay hydrated because their kidneys have lost the ability to concentrate the urine and if they don't stay hydrated, things can go south really fast and can be life threatening. Your vet should have done a urinalysis to check urine specific gravity, sediment and a culture should have been done to determine if Gucci has a urinary tract infection. Did your vet do a urinalysis yet? If not, I would think that would be a much better place to start diagnostics.

I see you posted a few values from a pre surgery blood draw. I believe this is a mini panel that is done inhouse and provides only liver and kidney values. With the last comprehensive bloodwork being done a year ago and Gucci's age, your vet should have done a full blood chemistry and cbc in addition to the urinalysis before opening the book on testing for cushing's.


He does pant quite a bit, which I didn't know until today can be a symptom of cushings. He has very dry skin and hair, but he is not losing his hair nor does he have any bald spots. However, since we live in the dusty desert, we keep his fur pretty short for his comfort and to keep him clean, but when he goes a little too long between grooming appts his fur comes in normally.

Pomeranians are a breed that is not predisposed to pituitary or adrenal dependent cushing's but are predisposed to hormonal imbalances. Aside from the usual skin and coat issues, these imbalances don't always present a problem for a dog and it sounds like that may ring true for Gucci. As Dr. David Bruyettes always says, "I can grow hair on a Pomeranian but the best treatment really is a sweater." LOL I personally have doubts about cushing's as it would be highly unusual for a dog to regrow hair after being shaved.

He has a voracious appetite, as long as its something he likes. If its plain dry kibble, he'll pick at it all morning/evening. He still has a lot of energy for an old man, even initiating play and wrestle sessions with our 4 year old poodle mix. But he will tire quickly and does nap a lot.

Dogs with cushing's don't pick at their food and really don't have discerning tastes. They are driven to eat just about anything, including dog poop, cat poop, any and all crumbs on the floor and used napkins or paper towel that may fall on the kitchen floor. My cushdogs, prior to treatment, would have inhaled kibble or anything I else I put in their bowl. They would have eaten until they exploded if I had let them.

So, my question is: is the LDDS test the right one to start with?

As I mentioned earlier, I wouldn't start testing for cushing's in the absence of symptoms. It really sounds as though your vet wants to test for cushing's based solely on elevated alkaline phosphatase. This is not the natural progression of testing, plus there are other factors to consider before launching into diagnostics for cushing's. If Gucci had really severe dental disease, that alone can raise alkaline phosphatase. Diabetes can cause moderate to severe elevations in alkaline phosphatase so glucose should have been tested right away.


I don't have his most recent blood test results but I will ask for a copy when I drop him off for his dental tomorrow morning and can post them then. I'm so new to this, I don't even know what questions to ask! Thank you everyone!

[AmyP]

Thank you so much for your reply! The lack of symptoms is what made me skeptical last year about cushings, and I actually brought him to this new vet for a second opinion. Him coming up with the same conclusion made me think that maybe we should test for it. I'm just worried about maybe he's in the very early stages and early treatment always seems to be best with anything. I don't want to not test and have the disease progress to the point where other organs and systems are damaged. But I also don't want to treat if not needed or put him through unnecessary tests. I'm just very conflicted. He's always been a healthy little guy.

He's overweight right now, 15 lbs up from 12 lbs last year. Im wondering if most of these problems stem just from that? His glucose is in the normal range and last year his total T4 was at 1.8 with the normal range 1.0-4.0.

I was talking it over with my husband and I think right now we're going to focus on getting his weight down and supplementing with milk thistle or SAM-e or some other liver health supplement to see if that brings his ALP down some. Does that seem reasonable? Thanks again!

[AmyP]

The pre op blood test is the only test we've done so far. I'm thinking change up the diet, supplement then retest with a full blood panel and urinalysis in 6 months.

[lulusmom]

Hi Amy.

I think your plan is an excellent one. Just remember that the sole purpose of treatment is to remedy problematic symptoms and that cushing's moves at a snail's pace. You would definitely see overt symptoms way, way before any organ was damaged. My Lulu was overtly symptomatic for two years before being diagnosed by an internal medicine specialist. Her then gp vet knew as much as cushing's as I did, which was zero, zilch, zip! She was starving for two years, had two bouts of oxalate bladder stones, requiring surgery within eleven months of each other, lost hair, was peeing and drinking buckets and seriously impaired my mental health. In hindsight, somebody should have bitch slapped some sense into me and I thank the stars above that cushing's gives us lots of time to make sure all the i's are dotted and t's are crossed. I just wish I had pulled my head out sooner. :o

Glynda

[molly muffin]

Hello and welcome Amy and Gucci. (love the name)

It's very hard to get a good diagnosis on this cushing thing. We were told cushings in June, then subsequent multiple testing including ultrasound and finally LDDS, said no cushings at this time.
I'm watching her like a hawk though for symptoms to show up. Currently I've started her on some liver supplements and we'll retest in a few months to see how things are going. 2 years ago, they also thought cushings and again, LDDS test showed she was suppressing cortisol just fine, so not cushings then either.
So usually it's slowly progressing and I'm not quite there yet either. It could be early stages, but it's hard to know for sure. We're just taking it slow. I worry about the same things you are, organ damage, etc if we don't treat. The treatment however wouldn't be good if they aren't fully into cushings yet.

[AmyP]

Thanks everyone! I'm just concerned about the high alkaline phosphatase. What else could cause such high levels if not cushings? His teeth weren't too bad considering it was his first dental in 11 years (embarrassed to say...). No teeth needed to be pulled and no gum disease. He's always been a prolific chewer. His glucose was fine on the pre-op blood test (it was not fasted). The only thing that really caught mine and the vets attention was the ALP, since it was so much higher than the top of the normal range.

Could being overweight alone cause a high reading? Should I be concerned its a liver or bile duct or gallbladder issue? His other liver enzymes were in normal ranges. WBC were all normal, but high platelets. I'm just worried that it might be something more serious that we shouldn't wait on if it's not cushings since he doesn't have really any of the cushings symptoms other than high ALP. Thanks again everyone!

[AmyP]

Hello and welcome Amy and Gucci. (love the name)

It's very hard to get a good diagnosis on this cushing thing. We were told cushings in June, then subsequent multiple testing including ultrasound and finally LDDS, said no cushings at this time.
I'm watching her like a hawk though for symptoms to show up. Currently I've started her on some liver supplements and we'll retest in a few months to see how things are going. 2 years ago, they also thought cushings and again, LDDS test showed she was suppressing cortisol just fine, so not cushings then either.
So usually it's slowly progressing and I'm not quite there yet either. It could be early stages, but it's hard to know for sure. We're just taking it slow. I worry about the same things you are, organ damage, etc if we don't treat. The treatment however wouldn't be good if they aren't fully into cushings yet.

What supplements are you giving your pup? I've started Gucci back on his fish oil. He was on flaxseed oil, but I didn't see any improvement in his skin or coat so we stopped it. Then I read that flaxseed may not be the best to give to dogs since they have to convert it to DHA and EPA. So were trying fish oil now. I just ordered some denamarin chewables and Phosphatidylserine to see if they help. He's also going on a diet to bring his weight down. He's also getting a joint supp, and I'm going to start him on B vitamins and glutamine (his back legs shake sometimes but it could be due to arthritis or his luxating patella, I figure extra glutamine can't hurt though).

Any suggestions would be great! Thank you!

Hopefully when we retest our babies their levels are more normal, but I also worry that the supplements will just mask the problem and not really solve what's causing the high levels in the first place.

[Steph n' Ella]

Lots of people here give Milk Thistle to help out the liver. :D

[molly muffin]

Molly takes a glucosomine treat for her joints and I started her on Hepato Support Supplements, which has the milk thistle Vitamins B and a few other ingredients which is for the liver.

Molly has had high ALP's for years, and the vet told me that could be because she is prone to crystals and has had a couple UTI's. So, we have to keep a lookout for that always. That is why she is on an SO food from vet, medi-cal I think it is, to get her to drink more water. Water keeps urine more diluted and that helps prevent the crystals from forming. Did they do a unine test for dilution on Gucci?

So, a high ALP test, wouldn't send me into a cushings diagnosis, although it has made my vet test at least twice now for cushings (she really seems to be convinced we're going to eventually get a positive test) but the LDDS test always shows her suppressing, so negative.

We'll see how her liver ALT and ALP are when retested in a few months.

Sharlene

[AmyP]

No they didn't do a urine test. I'm not sure he has a uti though. He doesn't go out to pee a whole lot, and he's never had a problem with drinking water.

I also give a joint supp chew for his luxating patella.

Cushings doesn't sit well with me since he has no symptoms other than panting, and that could be just from being overweight. And the ALP. Is it possible to have such a high ALP (1700 last year and 1500 this year) and not show any other signs of cushings? Assuming he does in fact have it, maybe early stages?