Unsure About My Dog's Symptoms

[sibemom]

Hello everyone .....I'm glad to have found such a knowledgeable group. I have a 9 yr old siberian husky that my vet suspects has Cushing's but I am not convinced and need your help.

He does have a poor coat ....very harsh looking and has lost most of the guard hairs and his tail has thinned considerably. It started when he was young and has slowly gotten worse and I have always thought it sounded like follicular dysplasia or alopecia x. When he was about 3 yr old he also had symptoms of zinc deficiency and skin biopsies were done ....the tests came back negative but the specialist said to try him on zinc supplements. We did and they helped so we kept him on them.

In June 2011 he had a complete blood panel and T4 done. Everything came back normal except for a slightly increased ALP. It was at 117 and the reference range was 4 to 113 and the comments said "Marginally increased ALP of dubious significance - possible biologic variation. All else normal".

In Nov 2013 he had a small growth removed from his tail. The vet couldn't put in stitches as there wasn't enough skin so his tail was bandaged which were changed twice weekly until it completely healed two months later but the hair wasn't growing in very quickly.

In Feb 2014 he had an ACTH Response test and a senior blood panel done and the vet sent her comments "poor hair coat, failure to regrow surgical site hair clipped for procedure". The results came back with three elevated liver enzymes .....

ALP was 1371 (reference range 21-122)
ALT was 168 (reference range 0-113)
GGT was 22 (reference range 1-18)

The comments from the lab were "Marked increase alk phos with mild increased ALT and GGT and exaggerated adrenal response to ACTH administration could fit with Cushings. Are there other clinical signs besides alopecia/poor hair growth?"

The only other symptom of Cushings he has is that he drinks and pees a lot but he has always done this since he was a puppy and at the time my vet said some dogs do that if they like to mark their territory which he definitely does.

We put him on Milk Thistle and SAM-e for a month and then ran more bloodwork in March/14 and the liver enzyme results were .....

ALP 1310 (reference range 21-122)
ALT 187 (reference range 0-113)
GGT 16 (reference range 1-18)

The lab's comments were "Marked increased alk phos and mild increased ALT could fit with untreated Cushings. No other abnormalities.

My vet wants him to have the LDDS test for Cushings but I'm just not convinced enough as from what I've read neither test for Cushings is completely reliable plus the fact the haircoat and water consumption/peeing symptoms are debatable. We are seniors living on senior's pension income and any other tests like ultrasound are not available in the small town we live in so would also have to travel which is beyond our budget.

Is the LDDS test more reliable than the ACTH test? I've taken him off his zinc supplement and was thinking of getting just another blood test done to see if it it makes any difference but my vet said she thinks I'd be better off spending my money to do the Cushings test.

I am confused and at a loss about what I should do.

[sibemom]

I just thought I would add that the zinc supplement he was on for the last 5-6 years was the NOW brand which contains 30 mg zinc monomethionine and 300 mcg copper HVP chelate and he got 1 capsule per day. Does anyone know if either the zinc or copper would cause his liver enzymes to be elevated?

He has always been given salmon/fish oil capsules and Vitamin E as well. He also has always had digestive issues which I can control with digestive enzymes and l-glutamine ...he has never been tested as he only has one or two symptoms of IBD/IBS, SIBO, etc. He is fed premium brands of kibble and I rotate them on a regular basis.

[Squirt's Mom]

Hi and welcome to you and your baby boy! :)

On the 2014 lab work that shows the ALP, ALT, and GGT - was his thyroid checked then, too? Hypothyroidism shares many of the same signs as Cushing's as does diabetes, kidney and liver disease to name a few.

Husky's are part of what are called Nordic breeds which are prone to Alopecia X so your thoughts along this line are certainly possible. However, I'm not familiar enough with this condition to be able to tell you what other signs you might see with it or what abnormal lab results it might cause.

In your shoes, I would be worried about the liver itself and want that looked into further. Has he had a bile acid test? Ideally, the ultrasound could be performed but I understand your limitations and the need to work within your parameters. As one who has to live on disability, I understand only too well. ;)

Have you noticed any changed in his appetite? Cush pups typically have a voracious appetite that is NEVER satisfied no matter how much they eat. It is a pitiful thing to see. :(

As for which test is the most reliable - none. Cushing's is a difficult disease to correctly diagnose because so many other things share the same signs and can cause false positives on the Cushing's tests. So diagnosis is in part a process of ruling out other things. So one test cannot reliably diagnose Cushing's; it usually takes several. The LDDS is a good starting point once other possibilities have been ruled out. If I had to chose only two tests to have done, it would be the ACTH and the ultrasound but we know you cannot do the ultrasound. So the LDDS and ACTH is probably the way I'd go in your shoes.

To share a story making my point about the testing and difficulty of diagnosing Cushing's - my Squirt had the LDDS, HDDS, ACTH, UTK panel and two ultrasounds. All were positive for the pituitary form of Cushing's. HOWEVER after the second ultrasound I was told about a tumor on her spleen. Once that tumor and half her spleen were out, her cortisol returned to normal. That tumor had caused false positives on all those tests. So from our experiences, I cannot recommend the ultrasound highly enough - it not only prevented me from treating Squirt with powerful drugs she did not need at that time, it also saved her life. Today I couldn't do all that testing due to financial restraints so I can empathize with your position. We simply do the best we can with what we have at our disposal. Remember this above all else - YOUR love is the very best medicine of all.

I'm glad you found us and want you to know that you and your sweet boy now have a new family here at K9C. We will be with you all the way. Never hesitate to ask questions and we will do our best to help. You are not alone.

Hugs,
Leslie and the gang

[sibemom]

WOW, you certainly went through a lot to find out your dog didn't really have Cushing's .....it must have been so hard on your pocketbook and your emotions but glad you were able to find the real cause and hope that Squirt is still doing well.

Thank you so much for your reply and to answer your questions, no Logan didn't have a thyroid test done with his last bloodwork in 2014. And, Alopecia X is a term used to cover a number of haircoat conditions ....it is folicular dysplasia when it affects huskies, coat funk when it affects malamutes and I can't remember any of the others. Anyways, it only affects the dog's appearance and not their health at all.

Logan does not have a voracious appetite nor does he have a pot bellied appearance. He does drink and pee a lot but as I said he has always done that as he likes to mark his territory. Also, when he drinks he does not gulp water, he drinks quite slowly.

You are right, I am mostly concerned about his liver enzymes being so high and that is why I've kept him on the milk thistle supplement. He has not had a bile acid test done. I've done a ton of reading and my old lady brain was stretched to it's limit but I think I remember reading that bile duct disease causes the GGT enzyme to be elevated the most and since that enzyme came back in the normal range the last time I stopped looking into that further.

Do you know if zinc or copper supplements would elevate liver enzymes? Logan hasn't had that supplement for a little over a month now and has been fine without it. If they do affect them, I was thinking of getting his values checked again but don't know how long it would take to get out of his system after taking it for over 5 years.

And, since the LDDS test takes so long I hate to stress him out going through it. Also, is the drug they administer harmful in any way? I know my vet is really leaning towards Cushing's but it seems like she is basing it mostly on his coat condition and it is unfortunate that so little is known about all the conditions that fall under Alopecia X. If I get the LDDS test done then she will want to give him the Trilostane and I am so scared to do so since, if he doesn't need it, he could end up getting's Addison's.

[Harley PoMMom]

Hi and welcome to you and Logan,

Medical treatment for Cushing's is used to help control the symptoms, it is not a cure. Since Logan does not display the usual obvious strong Cushing's symptoms, such as excessive drinking/urination and a ravenous appetite, I would not initiate any treatment or diagnostic tests for Cushing's.

I'm not sure is zinc/copper supplementation would increase the liver enzymes but gut issues (IBD/IBS, SIBO) can cause elevations in the liver enzyme levels.

If this were me I would have his values checked again in about 3 months and if the liver enzymes have gone up and no Cushing's symptoms have appeared I would ask the vet about having a bile acid test done.

Hugs, Lori

[molly muffin]

Hello and welcome to the forum.

Many vets won't treat for cushings at all, even if they suspect it, if there are no symptoms, like the out of this world appetite, guzzling water by the buckets and having accidents in the home. So, in that respect I don't know that I would start cushings treatment anyway.

I don't know if zinc and copper would raise the liver enzymes or not, but what you could do is to monitor the liver enzymes, by retesting those every 3 months to see if they go down with not giving him the zinc/copper and putting him on denamarin, a liver supplement.

That might give you a better idea of what is going on in that department. Also, fish oil for his coat.

I'd ask for a thyroid test. His glucose Should have been checked on the cbc. I don't see you mention it as abnormal, but take a look at the test results and make sure. That can rule in or out diabetes.

A cheaper way to check for cortisol is to do a urine UC:CR. It will tell you if there is cortisol levels high in his body, but it won't tell you why or if it is cushings. It can however, rule cushings out if the levels are normal. So that is a possibility too.

Welcome
Sharlene and molly muffin

[sibemom]

Lori, thank you for replying. Logan has never shown a lot of the IBD, IBS or SIBO symptoms either so I've never had him tested ....it just seems like fat bothers him the most as he will get loose stools quite easily and sometimes will strain as well. I just watch what I feed him and add the digestive enzymes and l-glutamine which help tremendously to keep everything coming out smoothly.

Logan prefers to be outside most of the day and even if it is raining he will stay in the garage .....we have an old rollaway cot out there for him and there is a door that opens to the back yard. We do go for our walks twice a day and I do check on him all the time to see if he wants to come in but he rarely will. If he was really thirsty or hungry I would presume that he wanted to come in but he doesn't.

I just wish my vet wasn't so leaning towards Cushing's. She did say to me that some people choose not to treat it but then she also said "I hope you don't have to come to me when it's too late to treat him" ....it just kind of hurt as I would give up all I could to do whatever I could to help either of my dogs.

[Squirt's Mom]

You might tell your vet that you hope she does all she can to see BEYOND her tunnel vision. ;)

[molly muffin]

Well that isn't a very nice thing for a vet to say. I guess that she is on the side of you treat no mater what.

Lori and I were typing at the same time I think, looks like her and I agree on what we would likely do.

I just think that there are some ruling out that needs to be done first.

Sharlene and molly muffin

[sibemom]

Thank you for your reply, Sharlene.

I just looked at his last blood test results and Glucose serum level was 6.1 mmo/L and the reference range given is 3.0 to 6.6 so that appears to be getting close to the high end.

If I remember correctly, the ingredients in Denamarin are milk thistle and SAM-e so I would just have to get some more of the SAM-e to add again as I ran out.

I never had his urine checked but the ACTH test came back saying ....

Pre Cortisol 90.6 mmo/L and the reference range 0-280
Post Cortisol 784 mmo/L and the reference range 221-650

[sibemom]

LOL @ the "tunnel vision" comment .....wish I had the nerve to say that to her. :D

[molly muffin]

Yes, you'd just need to get the sam-e.

The results of the ACTH, converted from nmol to ug (what most are use to seeing)

PRE - 90.6nmol = 3.2ug
POST - 784nmol = 28.41ug

So the post cortisol is high, but again, we don't know for sure why.

As far as the gluclose, it's not in danger range, just at the high end of normal, so just keep an eye on it.

Sharlene and molly muffin

[sibemom]

I don't understand any of the medical terms used but is the mmo/L an older way of measuring and the ug more modern? I live in a small town in rural BC although the tests are sent to a lab in Vancouver and it is their report that I have here.

[sibemom]

So the post cortisol is high, but again, we don't know for sure why.



Sharlene and molly muffin

Are there other things that cause high cortisol as well?

[molly muffin]

No, it isn't older, it is just the unit of measurement that you'll find here in Canada, or the UK or Europe. Our US members are more use to seeing numbers in the ug measurement.

Anything that is wrong can cause the cortisol to go up. It is the bodies natural defense mechanism, a surge of adrenalin for instance. So any kind chronic problem in the body or injury will cause an increase.

My dogs cortisol is high, they still don't know why. My vet swore cushings, but she doesn't have the regular symptoms, yet it is high, we know that and high cortisol for whatever reason, long term, causes the adrenal glands to enlarge and the liver to enlarge. We've been going back and forth now for a few years, with no firm diagnosis. This is what we mean when we say that it is very hard to diagnose cushings, especially if something else is going on.

Sharlene and molly muffin

[sibemom]

Thanks for explaining the measurements ....so it's the same thing as The US using Fahrenheit and Canada using Celsius.

How often do you get Molly tested and what tests do you have done each time? Is she on a supplement for her liver? How do her cortisol and liver enzymes numbers compare to Logan's?

[molly muffin]

Yes, basically the same thing as Fahrenheit vs Celsius.

I was doing every 3 months, then things seem to settle down, so we went to every 6 months, now numbers are going up again, so she'll be getting another full blood test soon I think. Tomorrow we're doing an ultrasound to compare to last ultrasound.

As far as a comparison to Logan, keep in mind, molly is shitzu/llhaso mix, but we're pretty close to your numbers.

Molly's test in Dec was abnormal:

Albumin 44.9 (26.0 – 44.0) – December 2013
ALP 1479 (5 – 141) – December 2013
ALT 167 (6 – 118) – December 2013
Urine specific gravity 1.032 protiens all fine – December 2013

No raise in Molly's GGT, that has never been off for her and is a liver enzyme.

Molly's ACTH in 2012 was:

ACTH (2 draws - this is due to the agent used by the vet) June 2012
Cor1 - Cortisol (base) 172 (30 - 300) 6.23 ug
Cor 21 - Cortisol (ACTH) - 1 hour 924 33.49 ug
Cor 22 - Cortisol (ACTH) - 2 hour 1014 36.75 ug

So actually higher than Logans.

She doesn't have any of the cushing symptoms other than the pot belly, which is from a moderately enlarged liver and adrenal glands. Which is what we are checking out tomorrow, along with the gall bladder (checking for any increase in sludge)

Molly's numbers all started to go up when she first got crystals in her urine and was having UTI's from that and they have never gone down. They haven't ever been this high before either, so the reason we're checking more things out.

We've been on this path since 2011 and it is certainly nerve wrecking. We all understand how it drives a person crazy trying to stay on top of what can be going on.

Sharlene and molly muffin