Possible Cushing Diagnosis

[Bailey's Mommy]

Hi guys. I'm so overwhelmed I don't know what to do. Our baby, Bailey is 5 1/2 yrs old. He had dental work 6 months ago and the vet said his cholesterol and Alkaline phosphatase were high.

Cholesterol. Normal Range 110-320. Bailey 422
Alkaline Phosphatse. Normal Range 23-212. Bailey 247
Bun/Creatinine Ratio. Normal Range 4.0-27.0. Bailey 30.0

We decided to follow up with repeat bloodwork in 6mo and monitor him for symptoms.

He had his repeat blood work yesterday and his Alkaline phosphatase was still 247.

The Vet went ahead and tested his thyroid which came back normal. Now the vet wants to do a Dexamethazone Suppression Test. Bailey isn't significantly exhibiting any symptoms. Now that they've told me symptoms, I worry he's at his water bowl too long but he seems to only drink 2-3 times a day. We have 2 dogs so it's hard to tell exactly how much he's drinking. He doesn't have accidents. There are times we feed him and he still wants more. I wouldn't say daily but maybe once a week. But we also went from free feeding with one dog to scheduled feeding with two dogs. He still romps around with our younger puppy at least a couple times a day. He is slightly overweight and has gained a lb in the past yr. He's a ShihTzu/Maltese mix and weighs 18.7lbs. The vet said if it's Cushing we can start him on Vetoryl, but it's $100 a month plus 4x a yr testing. My husband and I are expecting our first child in Sept and are overwhelmed with the possible expenses. My husband doesn't want to spend $100 a month for the medication and doesn't think anything is wrong since Bailey acts fine. I'm just so overwhelmed and scared and unsure what to do next.

[Squirt's Mom]

Hi and welcome to you and Bailey! :)

First thing I want you to know is that IF this is indeed Cushing's it is not a death sentence. Cushing's is a very slowly progressing condition so there is seldom need to rush into treatment...and based on what you have told us so far, you have more than enough time before you even think about treating. ;)

I know those values being over the norm are scary but they are very, very mild elevations compared to most we see here - my own cush baby, Squirt, often has ALP (Alkaline Phosphatse) values so high the can't register on the machines. And she's not the only one. ;) Squirt's values worry me to pieces but her vets are not concerned. Her IMS (Internal Medicine Specialist) told me the ALP tells about living cells and as long as the other liver values are ok, he doesn't worry about the ALP. So the mild elevations in Bailey are not cause for concern. The ALP can be elevated for numerous reasons that have nothing to do with Cushing's. It can be elevated due to dehydration as can the BUN which could result in the elevated Bun/Creatinine Ratio. I need to ask - was the creatinine alright? Was it within normal range? Was the BUN within normal range? These are kidney values and if they are both elevated, this is where your focus needs to be for now - on the kidneys.

Can you tell us more about Bailey? Especially any health problems he has had, any medications he is on or has been on recently. The more you can tell us the better. We LOVE details! ;)

For today, I wouldn't worry about the LDDS - the low dose dex test. I would take some time to learn all I could about Cushing's and the treatments used to treat it - Vetoryl (Trilostane) and Lysodren (Mitotane). Trilo is the drug of choice for many vets these days, Lyso is the one that has been around the longest. Trilo can be more expensive to use as it often requires dose tweaking and with each tweak you have to start the monitoring testing schedule all over. Lyso is the one most feared but it is no more risky than Trilo. It is important to know which drug your vet has the most experience and success using, too. ;)

But based on what we know so far, you are not ready to start thinking about treatment just yet. Cushing's is one of, if not THE, most difficult canine condition to correctly diagnose. The signs are a big part of that diagnosis so with a pup who has few signs, it becomes even more difficult to confirm Cushing's. To help you understand the signs associated with Cushing's, here is a good list from Kate Connick -

The most common symptoms include:
• increased/excessive water consumption (polydipsia)
• increased/excessive urination (polyuria)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (polyphagia)
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• bony, skull-like appearance of head
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled, fragile, and/or darkly pigmented skin
• easily damaged/bruised skin that heals slowly
• hard, calcified lumps in the skin (calcinosis cutis)
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures

That difficulty in diagnosing I mentioned? There are many other conditions that share many of these same signs so signs are not a confirmation of Cushing's either but they are a good guide.

Take a deep breath and try to relax. IF this is Cushing's then you and Bailey are in the very best place for support and education. We will be with you every step of the way. You are NOT alone on this journey. You and Bailey have a new family here with us now and this family sticks together.

I'm glad you found us and look forward to learning more as time passes.
Hugs,
Leslie and the gang

[molly muffin]

Hello and welcome to the forum.

You sound like you are right there in my world. My molly has ALKP, higher than Bailey and she too isn't exhibiting any symptoms yet. We've been in this stand by mode for a couple years now, from when my vet first told me she suspected cushings.
Everyone arrives here scared to death and worried for their baby. I don't think based upon what you have said that you are in at the place of where you need to think about treating just yet. This is a slow progressing disease and you have time to think about what you want to do and make a decision. The best thing that you can do is to take this time and learn what you can about cushings. The more you know the less scary it is.
We have a resource section and you can read member threads and find out all kinds of stuff. If you have any questions, feel free to ask them. We'll be around to answer and to help you through this, whatever you decide.

Sharlene and Molly Muffin