Thankful for this site! (almost 9 y/o min schnauzer - Sophie)

[Kristine]

Hello everyone. I stumbled upon this forum during my many hours of researching Cushings. I am so impressed with the number of knowledgeable people on this site. Everyone seems so helpful. I think I have learned more from reading this forum during the past hour than I have during the entire week.

I have a min schnauzer Sophie that will be 9yrs old in May. She had noticeable muscle mass loss that I brought up during her annual visit in October 2012. I insisted upon a blood test for a baseline due to her age because I had a min schnauzer previously that died of kidney failure at 8yrs old. I did not want to be blindsided and ignorant of any possiblities, however I was not prepared for the results of my request for the routine blood work.

My (conservative) vet stated Sophies liver enzymes came back extremely elevated indicating liver disease. I was sort of in a state of shock and asked what I do next. They started her on prescription science diet L/D (which I am not a fan of) and S-Adenosyl225 once daily and stated come back in 2 months for follow up.

I returned in January and was told the liver enzymes were still elevated but if my girl was feeling and acting well then we are good and to continue on the current feeding regimen and would follow up with lab again in 6 months or so. I asked (due to my research and not knowing which "liver enzymes" were elevated if they felt it could be cushings or something like that. They said no, they really didn't think that. I left the office with a very unfuzzy feeling and was not at all happy with the response. I pondered this loyalty to my long term vet and ended up getting copies of the labs (shocked) and going for a second opinion this month.

Went for my second opinion. Feel so much better that I am able to do something for my baby even if it means she has cushings. Long story short, loved the new vet and advise. He ran new labs, xrays and gave me several options to start with. Liver is enlarged no noted nodules on xray

Sophie goes Thursday for her 8 hour Dex Supp 3 Sample test. I opted not to do the ultrasound yet but after reading several posts think maybe I should. (?) What would be the reason if I do this test?

October 2012 abnormal labs
ALT 80
ALP 435
LDH 284

January 2013 abnormal labs
ALP 656
TBIL 0.7

March 2013 abnormal labs
ALT 147
ALP 962
GGT <5

I will know more after her 8 hour testing on Thursday. So stressed about everything I am reading but glad to be on the right path and thankful for this forum.

[Harley PoMMom]

Hi and welcome to you and Sophie,

So sorry for the reasons that brought you to us but so glad you found your way here.

Cushing's is really a slow progressing disease so one does have the time to get a confirmed diagnosis for their furbaby. Cushing's is one of the most difficult diseases to diagnose and unfortunately, it is also one of the most misdiagnosed. There isn't just one test that is conclusive, so a vet has to rely on more than one diagnostic and validation test.

The tests that are usually performed to diagnose Cushing's are the LDDS (8 hour test), ACTH (2 hour test), and/or an ultrasound. I feel the ultrasound is one of the most useful diagnostic tools, especially considering it's non-invasive. There is no other tool that can provide so much info and an "inside look" so simply. The U/S is used to evaluate the size and shape of the adrenals, and check for symmetry. If bilaterally normal-sized or large adrenals are visualized in a dog diagnosed as having Cushing's, this is considered strong evidence of Cushing's due to PDH. If one, large, irregular and/or invasive adrenal is visualized and the opposite is not seen, adrenal tumor may be suspected. In addition, it evaluates the abdomen for any unexpected abnormalities urinary calculi, masses and it views the liver, gall bladder, etc.

Strong symptoms are a huge part of making the diagnosis, and a Cushing's savvy vet will not initiate any treatment without strong symptoms and a proper diagnosis. Could you tell what symptoms Sophie is displaying? Also how much does she weigh and is she taking any other herbs/supplements/medicines? Does she have any other health issues? I am sorry for all these questions but the more we know about Sophie the better our feedback will be, ok?

Non-adrenal illnesses such as diabetes and any thyroid issue should be ruled out before running any Cushing tests. Diabetes and thyroid problems do share some of the same symptoms as Cushing's and non-adrenal illnesses can create false positive results on all Cushing tests.

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

Love and hugs,
Lori

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[Kristine]

Thank you for your additional information Lori.
You have definately given me some additional things to think about. I will look at getting the ultrasound done as well then.

Sophie has been healthy all of her life. She weighs 23.5 lbs. No issues until the past year. She had a bout with her ears once. She developed a nodule (which is benign) under her front armpit against the ribcage. She started getting little bumps on her back that were like clogged pores and they gave me special shampoo for that. One of them has recently developed into a sort of skin tag (dont recall the actual name) and one on her eyelid. These will need to be removed once we figure out what is going on with the liver. I can't say as I noticed an increase of water consumption but possibly. I have two schnauzers and they have access to the doggie door so I have not noticed increased urination other than she does get up during the night to go at least twice. She has not been on any meds other than Heartgaurd from April to December every year. She started the S-Adenosyl225 in January.

I will definately bring up the question of diabets and thyroid when I go in on Thursday. I really appreciate the help and support. There is so much information. It can be so overwhelming.

[Harley PoMMom]

A bile acid test is usually performed when a dog is suspected of having liver issues. Did your vet mention having this test done?

Does Sophie have elevations in her triglycerides and/or cholesterol?

I completely agree with you, it can be so overwhelming but we are all here to help you and Sophie. ;):)

[lulusmom]

Hi and welcome to the forum.

Lori has already given you some good feedback, including asking about a bile acid test. I personally don't think the abnormal values are that alarming and in my layperson's opinion, in the absence of a bile acid test, they don't warrant putting a dog on a severely restricted protein diet. Even if bile acids were mildly elevated, you can expect that with cushing's. If Sophie has cushing's, she needs to be on a good quality higher protein, low fat diet.

As dogs age, they do lose muscle mass so if this is the only symptom Sophie has, your new vet should not automatically launch into expensive testing. Even if tests were consistent with cushing's, it is ill advised to start treatment in an asymptomatic dog. While I don't understand your old vet's rush to diagnose liver disease and to severely restrict protein, based on the limited amount of information you've provided, I do agree with his advice to take a wait and see approach. If Sophie were mine, I'd get her on a good diet and watch her for symptoms.

Glynda

[frijole]

I agree with the others. Wanted to add that schnauzers are infamous for getting those bumps. I switched to a better food and alot of them went away. Regardless they are often like pimples and nothing to worry about.

Kim

[Dodie]

Hi,

I'm quite new to this site also, so I know how overwhelmed you feel. The people on here are wonderful and they will help in anyway they can to arm you with knowledge. I'm especially learning that our regular -however well meaning Vets don't seem to know an awful lot about Cushing's. My ShihTzu Molly has had these small what I thought were like a very small pimple or boil mostly on her back for years and sometimes the vet would sqeeze them and they would pop. I was always told they were nothing.
Dodie & Molly

[Kristine]

Goodness. So much to think about. I have gone from one extreme to the other with the two different vets. Neither one had mentioned a bile test. Her cholesterol and triglycerides were not elevated except the LDH in October was 284 and then it went back down to normal range.
This second vet did say Sophie did seem hyperlipidemic from visually looking at blood and he would recommend a high fiber low fat diet and not the prescription l/d. So am I jumping the gun by going straight into the 8 hr test for Cushing's and maybe need to look at diet a little longer first? I just want to do the right thing for my baby and don't want to neglect something nor give her something unnecessarily. I appreciate all of the support and information.

[frijole]

I'm going to repeat what Glynda suggested above - hold off on testing as there are not symptoms and there is no need to treat cushing's if there are no symptoms. Chances are it isn't even cushing's and the tests are expensive. I'd focus on the diet and if you see cushing's symptoms (excessive eating/drinking) you can test then. The 8 hr test you were considering can have false positives if something else is going on so that's another reason I wouldn't do it. Not yet anyway. Kim

[molly muffin]

Hello and welcome. Without symptoms it is very hard to 1) diagnose cushings and 2) know if treatment is working if you were to start.

I'd rule out the other things, like liver (bile test as mentioned which might be mildly elevated due to cushings, but you'd also see other things high if there is liver disease and I do mean consistently high) you can things go high for some random reason and then return to normal. To me that means something to keep an eye on, but nothing to specifically treat.
I'm having some of the same issues with my Molly. High liver enzymes, but no other high abnormal values to suggest liver disease and no symptoms to treat for cushings, and negative LDDS tests. I've been on this road for over a year and Molly is still displaying no symptoms.
It is so scary, that it is easy to want to jump right in and treat something, but you really have to know what you are treating and what your goal of treatment is before you start.
So, deep breathes and we'll figure it out, one step at a time.

Sharlene and Molly Muffin

[Kristine]

Thank you Glynda & Kim for the information. And yes Sharlene, I do feel like I should jump in and do something right away but everything everyone is saying makes sense. I am so sorry you have been battling this very dilema with your Molly Muffin. I guess in my mind I felt that if I did nothing and the ALP continued to climb that I was just leading her into a shorter lifespan. I guess I thought she would have some sort of liver failure or something. I really am confused about everything.

[molly muffin]

ALP in the range she is in, isn't all that bad. Molly's started going up when she first got crystals. It's the other values that you have to keep an eye on. Those don't seem to be there at this time.

Hang in there. Knowledge is your best weapon against anything going on with your precious baby.

Sharlene and Molly Muffin

[Simba's Mom]

Sending hugs from Simba ( almost 11 mini doxie ) and me too!!

[Kristine]

Thank you Simba and Simbas mommy! Hope all is going well with Simba. I too live in a small rural community but am fortunate enough to have a local vet but am also limited in my choices. I had made several 2 hour trips with my other girl Bella to get her specialized help when she was having problems. It can become quite expensive. My head is still spinning with all of this information.

[lulusmom]

Hi Kristine,

I only have a minute but wanted to try to put your mind at ease about the elevated ALKP. Dogs are the only species on earth with a steroid activated ALKP isoenzyme. High levels of cortisol does not damage or kill liver tissue but rather it causes an over accumulation of glycogen in the liver. So the liver may be working harder because of the demand placed on it by high levels of cortisol but it does not cause liver disease. Because liver cells are not being damaged or dying, most often liver support like milk thistle and SAMe does not lower ALKP but it is still good to give it to your dog as it does help support liver function and encourage healthy cells. I hope this makes you feel better.

Glynda

[Kristine]

Thank you Glynda. This has been so overwhelming. When they did the xray her Liver was much larger than normal. So from what I gather from all of the comments the wait and see method should be the approach to take unless symptoms start to develop. I am going to ask about the bile test and see what food reccomendations they have. They stated a low fat, high fiber diet is what she needs. So much information.

[molly muffin]

Hope all is going well with Sophie and you. :)

Sharlene and Molly Muffin

[Simba's Mom]

Hey Kristine, I know how overwhelming this cushings stuff is, the more you know the more empowered you are....just take one day at a time and remember you are not alone, we are here for you and your fur baby....sendings hugs!

[molly muffin]

Hi Kristine,

I wanted to check in and see how you and Sophie are doing. Hope all is well.

Let us know when you get a chance.

hugs,
Sharlene and Molly Muffin