PDA

View Full Version : Hi and question about atypical Cushings



MsEmilie
04-20-2013, 08:00 PM
Hi! This is my 1st post here. I have 2 lovely girls, Darcy and Emilie, both mixed breed rescues. Darcy is about 9 and she has been with me for the past 8 years. She is medium size, about 35 pounds with the cutest underbite.

In late 2010 she had bloodwork done. Everything was normal except for the ALKP, which was slightly elevated. Vet said not a big deal, just to monitor things. About 1.5 months ago she went in for her senior citizen check-up and had more bloodwork. This time there were a few problems. Her ALKP was higher than last time (sorry, don't have the original results) now at 478, she appeared to have a bladder infection and her T4 was low. I was surprised she had a bladder infection as she displayed no licking behavior or unusual potty action. She received antibiotics and a test to check for hypothyroidism.

One more blood test indicated her "free T4 ED" was within normal range at 15 (normal 8-40), so no hypothyroidism. I asked about putting her on milk thistle and the vet gave her Denamarin.

Just took her in last week for additional blood work. Bladder infection is gone and ALKP is still high but lower than before (now 314 vs. 478).

Given that her liver enzyme was slightly high in 2010, then higher still, now lower but still elevated, I don't know what to think. She has absolutely no symptoms of Cushings: she is slim with a flat belly, beautiful, thick, shiny coat, and no other symptoms. None whatsoever. She is perky and playful and a dainty eater. Vet thinks it may be in the early stages of Cushings and would like to do the LDDS test.

I am wondering if, at this point, I could try keeping her on the Denamarin for 2-3 months and then testing to see if the ALKP has gone down further. But at the same time, I don't want to not give her the best treatment or get an official "yay/nay" diagnosis of Cushings just to save some money and save her from a stressful day at the vet. She would not like being cooped up there all day even though they are very nice.

Her vet is nice and reasonable, not the pushy type, but I'd appreciate any thoughts or suggestions. Thanks!

Harley PoMMom
04-20-2013, 08:08 PM
Hi and welcome to you and Darcy,

Sorry for the circumstances that brought you here but so glad you found us.

A huge part of making a Cushing's diagnosis are strong, obvious symptoms. If Darcy is not displaying the clinical signs of Cushing's such as increased drinking/urination, ravenous appetite, skin/hair problems, muscle loss, then I would be reluctant to have any tests for Cushing's done.

I believe the best approach right now is to monitor Darcy and see if her symptoms change and to have another blood panel done when this change occurs.

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

Love and hugs,
Lori

Budsters Mom
04-20-2013, 08:10 PM
Hello and welcome from me too,:)

You have come to the right place! There is a huge arsenal of K9Cushing's angels to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better.

So again welcome to you and you precious girls:)

Kathy and Buddy-Lizard Hunter!

MsEmilie
04-21-2013, 06:53 PM
Thank you both for your advice and kind words!

I will contact the vet tomorrow and speak with him about her options. I do think at this point I will try to stick with the Denamarin for a while and see if that helps to bring down her ALKP levels. And no more French fries!

Thanks again. :)

NoonelovesmelikeNorman
04-21-2013, 06:57 PM
Just stopping in to say welcome to you and Darcy. You have found a wonderful informative site. Many wonderful poeple to help through the cushing journey. Sending thoughts and prayers to Darcy and you.

Sharon, Norman (cushings -Doxie) and Millie (mini-yorkie pooh)

addy
04-21-2013, 06:59 PM
Hi and Welcome,

I think no more french fries is a good plan:):):):)

I really dont think you are at a point for Cushing testing but that doesnt mean you should go anywhere. You can still hang out:)

MsEmilie
04-27-2013, 02:38 PM
Update on Darcy.

I spoke with the vet this week and he doesn't think she needs to be tested for Cushings at this time. Since she seems to have responded to the Denamarin well, he suggested keeping her on that for about 3 months and then retesting the liver values.

Whew! :) I purchased the pills online as the vet's office was out (even Amazon was running low) so we are set for the next 3 months. She hasn't had any problems with it and I give it to her on an empty stomach as recommended. I am hoping that her next set of blood work shows an improvement.

Thanks to all for the posts and for the great information on the website. Hope to have more good news in the coming months!

Budsters Mom
04-27-2013, 02:48 PM
This is great news!:) Please keep us updated on Darcy's progress!
I hope Denamaren is all that is needed!
Hugs,
Kathy and Buddy:cool:

doxiesrock912
04-27-2013, 03:31 PM
Any infection can skew blood tests so I wouldn't take the current result as being 100% correct. No symptoms = no treatment :)

molly muffin
04-27-2013, 07:14 PM
Hello and welcome. Somehow I missed when you first came on the forum.
I agree, without strong symptoms of cushings, then I wouldn't test right now. My dog doesn't have strong symptoms either and we are treating with a liver supplement too and seeing where that takes us.

Welcome and happy to hear that Darcy is doing well.

Sharlene and Molly Muffin

Squirt's Mom
04-28-2013, 10:01 AM
Hi and welcome to you and Darcy! :)

I agree with everyone else - enjoy Darcy and don't worry about Cushing's right now. Trust me, if it ever becomes an issue for her, you will notice drastic changes in her eating, drinking and peeing. ;) That cush appetite is something to see!

In your title you ask about Atypical Cushing's. I wanted to explain what that form of Cushing's is and how it differs from conventional Cushing's. In Atypical, the cortisol level is normal but the pup has elevations in one or more of the intermediate hormones - Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. This form is treated with melatonin and flax lignans, and / or Lysodren. Trilostane (Vetoryl) has been shown to cause elevations in the intermediate hormones involved in Atypical so Lysodren is the recommended drug for Atypical - tho many do use the Trilo even with elevated intermediates present.

Conventional Cushing's, which most pups have, means the cortisol is elevated. Some or all of the intermediates may also be elevated but if the cortisol is elevated, then the pup has conventional, not Atypical, Cushing's regardless of the status of the intermediates.

Often pups are deemed Atypical in cases like Darcy's - early detection - or if the testing isn't clear. There is one lab in the world that we know of who does the testing for Atypical - the University of Tennessee in Knoxville (UTK). Unless a pup has testing through UTK, there is no way to know if the pup is Atypical or not. Atypical is a controversial diagnosis - some vets don't believe in the condition or if they do, they don't believe it poses any real harm to the pup. Most pups who are diagnosed as Atypical via testing at UTK eventually develop elevated cortisol and at that point are no longer considered to have Atypical, but rather conventional Cushing's.

Hopefully, you won't need this info but just in case - here ya go! :D
Hugs,
Leslie and the gang

goldengirl88
04-28-2013, 04:23 PM
Just a quick hello, and welcome to the forum. You are in the absolute best place to get help and support for your babies. God Bless You and the babies
Patti