Wondering about time of progression

[winger]

Hello. I have a 12.5 year old female lab who has been in great shape up til now. A little arthritic but still jumps in car and boat. In summer checkup with vet was great, with only mild elevation in liver enzymes at 150. Vet said to keep any eye out for tendency to drink more water. While the water increase was gradual, she weighs about 60 pounds and is drinking about 8 to 10 cups a day now. What triggered me to take her to the vet was the sudden onset of needing to go out to urinate. This has lightened up a bit over the past few days but she is still going out more regularly and drinking water a lot (also has minor ear infection). Went in for blood test and liver enzymes are in the 400's now. Vet suggested test for cushings with injection and response measured over 8 hour period which would be followed by treatment with lysodren or trilostane

As she is 12.5 years old and otherwise in decent shape with no hair loss or potbelly and still holding it while away at work and overnight, I am wondering at what point it is best to initiate treatment and also wondering how slow the cushing progresses in months from this point so I can make a decision whether or not to treat her with the suggested meds or just wait a bit and try some less aggressive solutions first (anipryl or homeopathic) until things advance further. I am still planning on having the test done. Thanks to all that reply.

[doxiesrock912]

Welcome to the group!
You'll learn more than you ever wanted to know about Cushings here so please stick around:)

So far, your vet is right on target. Treatment for Cushings alleviates the symptoms by controlling Cortisol production; thirst, hunger, being prone to infections etc. Cushings is not curable but without treatment the resulting elevation in Cortisol makes our furlets prone to infections and organ damage. At some point your vet should recommend an ultrasound to monitor the conditions of your dog's organs which is a good idea.

There are no homeopathic treatments that are effective but many members here use supplements to compliment the medical treatment of Cushings which is a good idea. Especially glucosamine chondroitin for dog's with arthritis and joint issues because high Cortisol levels mask symptoms of other health conditions.

Every animal responds differently to treatment but if your vet is recommending to start, your dog will fare better now in my opinion rather than waiting to see if more symptoms develop, especially the skin infections which can be difficult to resolve.

Once the ear infection is gone, I would definitely do the 8 hour test and please post the results here as we have several members who are really great at interpreting them for you which will help you to decide on the best course of action. Also, we'll need to know how much your dog weighs. It is important to be sure that there are no other health issues or infections present before you test because many health problems can make the tests less accurate. Anipryl is only effective in 10% of Cushings cases and this is because in 90% of the cases of dogs with pituitary based Cushings, it is the anterior portion of the pituitary gland which Anipryl won't reach.

Most importantly, Cushings is treatable and most dogs do not pass from this disease. My honest opinion is once a firm diagnosis is confirmed and other health issues are ruled out, starting treatment before your dog has more bothersome symptoms is the way to go. Getting Cushings under control as quickly as possible is paramount as symptoms can snowball and the rising Cortisol creates health risks for the dog due to organs being compromised.

We have a section in the forum called "helpful resources". Please read through the articles there as the information is invaluable. Many of us have had to educate our own vets with some of this because there is no common case. Every dog is affected differently which makes treatment for Cushings based on individual cases.
Your best defense is to learn as much as you can and the information that you'll find here is accurate and current. Members here have a varying degree of knowledge and feel free to ask any questions or concerns. Someone will have the right answer.

[Junior's Mom]

Welcome to the forum. As anything else going on can skew the results of the low dose test, I would make sure your vet rules out everything else first. Was a urine culture done to rule out a urine infection? Many other problems can mimic cushings, so it is best to rule them out first. It is a slow progressing disease, so there is no rush to treat.

[Renee]

Welcome to the forum from me as well.

I just wanted to pop in and say that some dogs will go to nearly herculean efforts not to have accidents in the house, which is turn can be quite stressful on the bladder and kidneys, which can result in infections, etc. If she's drinking that much water, even without accidents, I would want to find out why. It may not be a good sign that she can 'hold it so long'.

Also, my suggestion is to not jump into treatment with lysodren or vetoryl yet. You'll want to do more than just one diagnostic test, and in order to have accurate results, you'll need to rule out all other possible infections / illnesses first.

[molly muffin]

Hello and welcome to the forum.

As the others have mentioned you'll want to make sure that other possibilities are ruled out first. Diabetes, Thyroid, UTI (done by culture).
Can you post what the abnormal results were on the most recent blood work, and the normal range for them.
Have you had a urinalysis recently and if so what is her specific gravity?
As others have said, first you want to rule out any other potential problems, which might mimic cushings symptoms.
I would have a chat with the vet about a good liver supplement, often Denamarin or milk thistle is used to support the liver.
I wouldn't do any cushings tests until you know for sure that all infections have cleared up.

Welcome to the forum.
Sharlene and Molly Muffin

[winger]

Thanks to all that replied. I appreciate the input. Will wait a couple weeks until infection clears up before testing and also pursue the liver supplement. I will also obtain the test results.

[goldengirl88]

Welcome to the forum. I am so sorry your baby is having problems, but this is a great place to help her.The others are right you need to rule out the things Sharlene mentioned before thinking about Cushings. If you dog has any of those you need to get them under control before testing for Cushings. Blessings
Patti

[winger]

I was able to get the blood and urine test results and posted them to my album. Its interesting though that in the last two days, they symptoms have basically gone away. Drinking normal amount of water for her weight and frequent urination doesn't seem to be an issue. She does make a groaning sound every time she plops down on the floor but not when getting up and activity seems normal once she's up as far as her legs are concerned. Still dealing with ear infection so not scheduled to go for low dose test for another two weeks.

thanks again to those that replied.

[molly muffin]

I'll just copy and add the pertinent results that are off and the specific gravity which is great.

ALP 408 u/l 10. 84.
ALT 89. u/l 5.0 - 54.
Albumin - Globuln Ration 1.29 .60 - 1.20

Specific Gravity: 1.031

Looks like there is a 1+ crystal, so keep an eye on that. It can contribute to developing UTI's (this happens with my dog too)

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Just a short post from me today and I just wanted to say after you get the other things under control and them test for Cushings just know the facts before deciding to treat or not. Just know if you do not what to expect as this disease will affect all your dogs organs etc. It can be managed with the help of drugs that is the only way to control the cortisol. These dogs can live out their natural life while managed on these drugs. Blessings
Patti

[AngelToto]

I've heard anywhere from 2-6 years

[winger]

So ear infection is just about cleared up now but she has exhibited no symptoms recently. I have measured water consumption for the past week at 5 and 1/2 cups per day which is about right for her weight and frequent urination has stopped and energy level returned. Should I still do low dose cushings test given no symptoms? I realize liver enzyme level is up but maybe something else is causing the problem?

[molly muffin]

It is possible that the UTI's have been causing the problem. I would, not worry so much about cushing testing right now. Get her on a good liver supplment (her actual results are Not that far out of range) and continue to monitor. If she starts to display symptoms again, check for a UTI first (culture) and see if that has cropped up again.
She doesn't have a pot belly, ravenous hunger, drinking and peeing in the house, back leg weakness (other than normal age related) so that is all good! :)
Congratulations.
hugs,
Sharlene and Molly Muffin

[winger]

Just went in for a follow-up after three months on denosyl, milk thistle and melatonin For the past 3 months, there have been no symptoms except for her arthritis and water consumption is within normal range per vet. However, ALP has now risen to 700. She did have a rimadyl the morning of the blood test which we have discontinued now and put her on zeel. I guess we will now take her in for the cushings test to either confirm or rule out cushings. We are not inclined to treat her if she has no symptoms. We would appreciate any input or suggestions. Thanks

[addy]

Hi,

Since there is no one test that is 100% accurate to test for Cushings
and because it is so hard to correctly diagnose, history and symptoms play a huge role in receiving a correct diagnosis.

If my dog showed no symptoms but had an elevation of 700 for her ALP, I personally would not test for Cushings. Just my opinion.

Rimadyl or any NSAID is very hard on the liver as you know.

I am sure others will pop in and give you their thoughts.:):)

[molly muffin]

I am with Addy, and in fact, I am not treating, due to lack of symptoms at this point also. 700 isn't too bad for ALP.

Sharlene and Molly muffin

[lulusmom]

I agree with Addy and Sharlene. I would not test for cushing's for two reasons. 1) The elevated liver enzymes can easily be attributed to the Rimadyl. I've researched this drug many times and it is not uncommon for older dogs to have elevations in alkp in the 600 to 1000 range. 2) The goal of cushing's treatment is to remedy the problematic symptoms so if my dog was not symptomatic, I wouldn't incur the heavy expense of putting my dog through all the stress of testing for nothing.

I also want to mention that dogs with cushing's have increased levels of circulating cortisol, which is the body's natural steroidal anti-inflammatory so they are self medicating themselves. In other words, uncontrolled cushingoid dogs shouldn't need Rimadyl.

Glynda

[winger]

thanks for your input. I really hadn't been giving her any rimadyl for months, just cosequin ds and fish oil (wellactin) for joints. she just happened to slip on a hill after a heavy rain and was limping so I gave her one for pain. When I went to the vet, I asked vet for rimadyl substitute for pain and received tramadyl which is reportedly less toxic to liver for any pain episodes and vet suggested zeel as substitute for cosequin ds.

[lulusmom]

Alrighty then, we can eliminate my number 1 reason for not testing. If pursuing a diagnosis is something you and your vet feel strongly about, I personally would want to spend my money wisely and would follow Dr. Mark Peterson's recommendations and have an abdominal ultrasound done. You can read the rationale for that choice by using the link below to one of Dr. Mark Peterson's blogs. This particular blog involves a pet owner whose dog presents as almost a mirror image of your dog.

http://animalendocrine.blogspot.com/2013/09/working-up-asymptomatic-dog-for.html

[winger]

thanks. that was very helpful