Mildly elevated lab values...what to do?

[dogmomof2]

Hi! This is my first post here. I brought my sweet Roxy girl in to the vet a couple of weeks ago. She is an almost 10 year old lab. She has been waking me up at night with her panting. I cannot tell if she is drinking any more water than normal nor urinating more. When she wakes me up with her panting, I let her out in my yard. I don't think she really NEEDS to go as she lolly-gags around the yard, smells the perimeter of my big yard (twice!), and sometimes performs grass angels in the yard...

I should also mention Roxy has arthritis in all legs. She walks with a limp. However, she LOVES her walks! She will give me the look that it is time for her walk and put the leash in the mouth to lead the way! Right now I just have her on Cosequin.

My vet ran a senior blood test on her and found that her alk phosphatase is 256 (<131 is normal). Last year it was 139. We also ran us:ur and that was 13 (14 is abnormal). Since her lab results are so borderline, I am wondering if I should run the other Cushings tests? If I do, I am wondering which test would be the most appropriate for her- the LDDS or ACTH? I read somewhere that one is more sensitive in diagnosing than the other. Does anyone have any experience /advice about this??

Also, a part of me is wondering if Roxy's arthritis is causing her to pant at night? She has slowed down quite a bit within the last year. I am wondering if she is in pain from her joints aching. I am going to call my vet and talk about starting Roxy on arthritis medication.

If anybody has been in a similar boat as me and would like to offer some insight, it would be much appreciated! I am trying to take it all in and do my best to make sure Roxy is getting the proper treatment.

Many thanks in advance,
Mimi

[Trixie]

Hi Mimi,
You came to the right place, there are so many people to help you with your questions. I'm still new myself but I had the exact same thing happen with my mini schnazuer. She had her senior check up and had the same elevated liver level. Ours was way higher than your dog we were up in the 1200's. Is panting the only symptom your dog is showing right now? My dog really started drinking like crazy (very noticeable) and urinating way more too (obviously)...and a ravenous appetite which is kind of harder to notice because she is always ready for food. Her energy and demeanor remains as usual.
We did not test for Cushing's right away. The vet prescribed 30 days on Denamarin-which is a liver medication...primarily Milk Thistle which is really good for the liver. Did your vet mention trying something like that for awhile and see if there is a change for the better?
Denamarin worked to lower the level quite a bit but when we went off of it the levels rose again. After that time..about 6 weeks from the first blood test her symptoms became more obvious, so we did test for Cushings and it was a positive.
But your dog does not seem to have too many obvious symptoms. I'll let the more experienced members here advise you, but just wanted to say how similar our stories are. My girl is 9, still loves lots of exercise and playtime too...very puppy-like for an older dog!
Hope Roxy is doing okay today! ;)
Barbara

[Budsters Mom]

Hello Mimi and Roxy,:)

Welcome! I am so glad you found us.
Many others will be dropping in shortly to say hello and to welcome also.
You have come to the right place! There are many K9Cushings angels to help answer your questions 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. The more they know, the more they will be able help you and Roxy. So Please keep talking to us

Kathy and Buddy:cool:

[frijole]

That alk phos is very low and frankly could be contributed to a number of things and it could be normal tomorrow if you took the test so I would not waste one red cent on cushing's tests. Other than panting I don't see any symptoms and obviously panting could be caused by a variety of things as well.

Also note that if your dog was drinking excessively you'd know it because we are talking BUCKETS of water not just 'alot'. I would bet that it's just old age in your case.

Re arthritis my girl Haley lived to be 16 1/2 so we gave her help for arthritis in the form of adequan shots - very helpful. Hope this helps. Kim

[MsEmilie]

Hi! One of my dogs, who died years ago, started panting more as he aged and one thing that really helped was a doggy waterbed. Sounds funny but it worked for him. In his case he had an enlarged heart, which made him somewhat hotter than normal since his body worked harder.

Anyway, google "canine cooler bed" and the waterbed should come up. They are about the same price as a regular bed ($50ish) and it's basically a flat mat that you fill with water, seal it and the dog sleeps there. It absorbs the body heat and keeps them more comfortable. As long as your dog isn't an obsessive chewer, it lasts years and years. You can empty it out every now and then but it doesn't grow mold or leak or anything. I still have it (over 10 years old now) and one of my girls sleeps on it during the summer. She has no health issues but has a thick coat and she loves it during the summer.

Obviously this won't cure any underlying health problems but it could make your furry buddy more comfy. Good luck!

[Budsters Mom]

What a great idea!!! A doggy waterbed!! Love it!!:D
Hugs,
Kathy and Buddy:cool:

[molly muffin]

Yes it could be arthritis bothering her. Dogs will pant when they aches and pains sometimes too. As Kim as said the ALKP is low for a cushings dog. The other thing you have to think about is even if the cortisol is a bit higher, it probably helps with the arthritic pain. We often find that once you start treating for cushings, and bring that cortisol level down, then even if you didn't know that the dog had arthritis before, you might discover it then because the cortisol is no longer masking that pain. Just something to think about as you go forward.
But with only panting as a symptom I don't think I'd pursue any tests for cushings, as it is very expensive and you are basically treating the symptoms.

Sharlene and Molly Muffin

[dogmomof2]

Aww, what a great welcoming site! Thank you ALL for your advice, it's much appreciated!! You all make me feel better about my decision. A few days ago I was wondering if I was a bad mom...

I talked to my vet today. I don't particularly care for him but I really like the facility he is affiliated with. (I know it sounds silly) I do believe he is a good and knowledgeable vet just very quirky with poor social skills. He likes to paint the worst scenario because, you know, there is always that one percent chance that can be my dog... ugh! His plan of action is to run an ACTH test with sex hormones tested and send it to a lab in Tennessee. Of course it will be expensive but it will definitively tell if Roxy has Cushings or not. Then he also wants to do multiview x-rays of her abdomen to check for liver enlargement. Ultrasound will be the next test.

I asked him today if all of the tests were really necessary as Roxy's lab values are not that elevated. He said that in his 40 years as a vet he has seen dogs that have Cushings w/o elevated liver enzymes but found tumors on the xray. The next sentence he told me how the blood and urine cortisol/creatinine tests (tests she had) were only 'markers' for diagnosing Cushings as I cannot rely on them for diagnosis.... well don't x-rays and ultrasounds fall in that category too?? I guess not when the vet suggests I should have them done. Grrr.

Right now I am leaning towards Roxy getting injections for her arthritis. We know that she has that as it was felt in all of her legs at her last appointment. We talked about giving her adequan shots. Then of course the next sentence out of his mouth is to do x-rays of her joints?! If it's polyarthritis- one thing I need to consider is if Roxy has rheumatoid arthritis. Also I need to consider acl injuries too... ugh.. Once again I personally don't think the x-rays are necessary. At our last visit I had the vet and a resident come in to examine Roxy. I loved the resident!! She was awesome. She actually let me feel what she felt on Roxy when she was checking her joints. I felt the clicking so I know she has issues plus she walks with a limp! It's obvious!

I used to poke fun at my 90 y/o grandfather that would talk about how doctors are only ordering tests to get a kickback...maybe he IS right afterall?

[Simba's Mom]

Welcome Mimi and Roxy, so glad you found us, sorry to hear Roxy is having problems...but now you are not alone, you will get loads of info and many hands to hold along the way! take care and again welcome

[frijole]

I'll just tell it like it is. :D World renowned experts in the field all say if there are no symptoms you do not treat. You don't really have cushing's symptoms. Unless a dog is drinking and peeing buckets nowadays you just don't treat. If you aren't going to treat why bother with the tests? The test he is referring to is a combination of a regular acth test that is used to diagnose cushings' along with a sex hormone panel that can identify if sex hormones are elevated (called atypical cushings). To do that, xrays and an ultrasound on a dog without symptoms is highway robbery. (xrays are not used to diagnose cushings) Unless I am missing something I would do nothing but treat the arthritis.

Here's the deal - even if it were cushing's it takes years to develop and you would notice the symptoms when they occur and you could test then. Bank the money and if you need to spend it you have it. ;)

The numbers on the urine test aren't the same as the UC:CR test which is normally done to rule out cushings. If that is the test that was done then if it is within normal you have ruled out cushings. Again - just keep an eye out. Kim

[dogmomof2]

Kim- thank you for your thoughts! I feel the same.

I have to admit talking to my vet earlier today I felt like such a bad mom! At one point we were talking about if Roxy has a right sided adrenal tumor it may be inoperable because the vena cava may be in the way...that is just a peek into the conversation we had earlier...

Another thing I asked him is if her urine test was normal-and it was. So no signs of urine dilution which is indicitive if she is drinking too much.

Yes, I am going to focus on the arthritis issues first before doing all of the other tests.