I'm new! Need some advice!

[Sunshine717]

Hi!

Dakota is our rescue min pin/chi mix and she is approximately 8 years old. Over the past couple of years her thirst, water consumption, urination, and leaking have increased as well as her panting. She is a little overweight and had gained another pound at her biannual visit last night. Her ALP level has also continued to increase. I am waiting for the vet to email me all the previous dates of blood tests and what the values were. I do know that her previous blood panel test (unsure of date at this time) showed her ALP level at 451 (5-131 normal). I received her results tonight from her blood test yesterday. This time her value has increased to 639! My vet still suspects Cushings because of her symptoms and her cholesterol and platelets also being elevated, but not too high. Over the past year plus she has had 2 low dex tests and 1 urine cortisol test. They all showed negative for Cushings despite her symptoms and elevated ALP. I am worried and at a loss for what to do next. We decided to do one more test with the blood the lab already has that will show if there is any cortisone (I think - so much info to remember and my notes are scratch). If there is cortisone present in the blood, then my vet said she does have Cushings. When her ALP was first elevated, but not crazy high like now, we did 2 months worth of Denamarin and retested blood to see if it was related to her liver. The ALP did not go down, but increased, so she has not been on that medication since then because it didn't seem to help. She is, however, on a mess of other drugs due to other issues, including Enalapril because of protein in her urine. Last protein creatine urine test showed .09 and its highest was 1.5 I believe. Kidney blood values normal at this point. She is also incontinent and this has been managed by Proin. Dakota takes Glycoflex due to a luxating patella and mild arthritis. She also takes fish oil. Her heart measured enlarged on xray, but measured normal on echo. Other than that, she is healthy!

I need some advice on the following:

What testing (if any) would you recommend next? An ultrasound of the liver?

Do you think that although she has had 3 negative Cushings tests, she could have it?

Should she start taking Denamarin again and do you think it has hurt her not being on it this past year since her ALP value increased more?


Thank you in advance,
Carrie

[frijole]

Hi Carrie,

Interesting and informative post. Yes we will need to see all the blood results and the two ldds tests would be helpful just to make sure they were read right.

While the alk phos is elevated and rising that doesn't necessarily mean cushings. Sometimes vets get so focused on one thing that they miss other things. Alk phos can be elevated by many illnesses not just cushings so we need to see the entire panel (anything high or low)

The LDDS test is actually prone to false positives when other illnesses are present so assuming that you had two negatives I would say it could be because it isn't cushings you are dealing with. I assume the test you just had is the acth test.

Yes an abdominal ultrasound would be helpful but not just of the liver - you want them to look at all organs and in the case of cushings you want them to film both adrenal glands. If one or more are enlarged that can indicate cushings. We have had several members (including myself) who had dogs wrongly diagnosed with cushings and after ultrasounds were done it was discovered the had tumors that were causing the problems - remove the tumors and the problems go away.

You mentioned incontinence that is controlled with Proin. I will tell you that typically cush dogs drink and pee so much Proin wouldn't make a dent in it! They drink buckets of water - way more than is normal for their weight (1 oz per lb is the rule of thumb). They also are starved at all time and they inhale food - don't chew it. they have rounded tummies, sometimes they have skin issues, often they have weak hind limbs... the thing is alot of these symptoms are the same as diabetic dogs, hyperthyroid dogs, dogs with kidney problems to name a few. You must continue testing and might need to go to a specialist if your vet can't help you.

Cushings is caused by either an adrenal or pituitary tumor that send messages to produce cortisol when in fact it isn't needed. Their kidneys work overtime to produce the cortisol and this makes them pee all the time. Because they pee alot they must drink a ton of water so you can't withold water with a cush dog.

I am going to link you to some basic info on cushings and would be interested in what symptoms your dog has other than incontinence. Glad you found us - collectively there is a ton of experience here. Kim

http://www.k9cushings.com/forum/showthread.php?t=180

[Sunshine717]

Thank you for replying! I think we will do the abdominal ultrasound. My vet had suggested it after the last blood test about 6 months ago I believe. At that point since the ALP wasn't terribly elevated and everything else was coming back negative, we left it alone. How long after being originally diagnosed with Cushings before the tumor was discovered in your doggie? Was it cancerous? I'm worried there is something like that going on and we have let all this time lapse without proper treatment. I just want her to live a long happy life.

[frijole]

Annie did NOT have cushings but was misdiagnosed (many false positive tests) and it took me like a year before I went to a specialist because it was a 5 hr trip each way. Worth every mile. Should have done it earlier. She had a rare adrenal tumor and it was not cancerous. My other dog Haley had pituitary cushings and pituitary tumors are not cancerous and teeny little things.

I think you are fine as the alk phos really isn't that high. Cush dogs can have alk phos reading in 4 digits. So don't sweat that. Most cases cushings is discovered by accident as it mimics old age symptoms.

Keep us posted and ask questions. The reference section of the forum is real helpful - tons of info there. Kim

[goldengirl88]

Welcome to the forum. The first thing I would tell you is to get your dog off the Proin. Please talk to our Leslie about this, and research it, it has killed many dogs, and should not even be used. It really did a number on her Squirt. I think I would be getting an Ultra Sound from a high definition machine, I go to the hospital for mine, otherwise the ones in the vets office are not too great. Hope all goes well for your baby. Blessings
Patti

[Sunshine717]

Dakota is getting her teeth cleaned Monday and can have her ultrasound then. As far as the Proin...I have definitely researched it and read horrible stories, but then again you can find that about any mediation. Dakota has been on Proin for about 5 years now with no known issues/side effects. I have read about dogs that have become sick and even died, but that seems to be an adverse side effect that happens shortly after starting Proin and Dakota has been on it for years. Are there any research studies that show Proin can have long term health impacts on animals? I wasn't able to find anything correlating her elevated ALP with Proin. Any info would be appreciated.

Thanks
Carrie

[Squirt's Mom]

Squirt was on Proin for around 9 months. She started showing signs of problems fairly soon but I was a bad mom - I didn't research the drug before giving it to her and didn't recognize the things I was seeing as connected to the drug and neither did our vet. She started taking it in Sept, and in March had a seizure and almost didn't survive. For the next 2 1/2 - 3 months she simply wasn't right and I thought I was losing her several times but is finally more like her old self tho she does seem to have some permanent damage in how her mouth works.

She has not had any drugs to help with her incontinence since March, only herbs, and has very little problem with leaking now. When the Proin was stopped, she didn't leak - she FLOODED then that slowed to a leak and now that rarely happens at all.

I'm glad your baby has done ok on Proin and pray that continues. But Proin will never enter this house nor be used again on anyone. ;) They will wear diapers if needed, take herbs, and Mom will wash beddings and mop floors day in and day out instead. :D