Bonney (4 year old scottie)

[npettitt]

4 year old scottie just diagnosed with cushings. High ALP's then urine test and then ATCH. Tested positive. No signs other than 2200 ALP. Started melatonin and flax seed. Just 3 days ago started her on Anipryl 15mg. She weighs 30lbs. Vet wanted to start her on Vetoryl. I think Anipryl is less risky for such a young dog. Any suggestions ?

[molly muffin]

Scotties are known to have some very high ALP numbers. I know another who has a scottie with numbers in the 2000, not cushings though according to the LDDS test.

It depends, the problem with Anipryl is that is works in a very small percentage of dogs. When do you plan to retest her?

Sharlene and Molly muffin

[npettitt]

Will be retesting in a month. If ALP is not down will have to decide if I put her on Vetoryl

[goldengirl88]

Hope it all works out for you and your baby. Blessings
Patti

[labblab]

Hello and welcome to you and Bonney. I must tell you that I would be very wary about beginning Cushing's treatment for a dog whose only abnormality is elevated ALP. I could try to explain in my own words, but I think this quote from noted Cushing's expert, Dr. Edward Feldman, carries more weight. :o


The decision to treat a dog for Cushing's syndrome should never be based solely on laboratory information. Cushing's syndrome is a clinical disorder with clinical signs. If a dog has no clinical signs of Cushing's syndrome, treatment is not recommended. This concept gains importance when it is understood that no screening test is correct all of the time, i.e., as previously stated, sensitivity and specificity is never 100%. Some dogs with non-adrenal disease and many with polyuria and polydipsia due to a condition other than Cushing's syndrome can have false positive screening test results for hyperadrenocorticism. Because false positive test results have been observed with any commonly used screening test, the definitive diagnosis of Cushing's syndrome should never be solely on screening test results, especially in dogs without classical clinical signs or in those with known non-adrenal disease. In our experience, the most sensitive, specific, and reliable screening tests for hyperadrenocorticism in dogs are history and physical examination...

Elevated ALP can be caused by conditions other than Cushing's, and if Bonney truly does not evidence any overt symptoms consistent with the disease, I think the accuracy of the diagnosis remains questionable. Even if she does have Cushing's, I think that many clinicians would still hesitate to intervene in the absence of abnormalities other than ALP. Here's a quote from another Cushing's expert, Dr. Mark Peterson:


I am not a proponent of treating dogs with asymtomatic Cushing's disease, unless they have secondary hypertension or proteinuria.

Low dose trilostane may be helpful, but I am not aware of any studies that even suggest that, let alone prove that to be the case. With any drug, we have to weight the concerns of side effects.

In general, most dogs with Cushing's syndrome develop a high alkaline phosphatase, which is "induced" to rise because of the cortisol excess. In other words, the fact that this liver (and bone) enzyme is high only means that it is a marker for Cushing's and does not reflect liver damage. So to me, that is not a reason to treat, especially since this value rarely normalizes after successful treatment with trilostane or mitotane.

Marianne

[labblab]

Just a P.S...you may already know about the high incidence of elevated ALP in Scotties, as Sharlene has mentioned. But if not, here are a couple of interesting articles.

http://www.stca.biz/index.php?option=com_content&view=article&id=431:those-pesky-elevated-liver-enzymes-what-are-they-and-what-do-they-mean&catid=327:liver-disorders&Itemid=100

http://scottishterrierhealth.com/2013/01/21/elevated-liver-enzymes/

Marianne

[npettitt]

ATCH test was positive and urine test also was positive,could This still mean she may not have cushings? Very confused

[goldengirl88]

I think what Marianne posted is great guidance for you as your dog has no other symptoms other than the high ALP. I would definitely heed that information from Dr. Feldman. Blessings
Patti

[addy]

The UC:CR urine test cant diagnosis Cushings, it can rule it out or tell us further testing is required.


Even if she does have Cushing's, I think that many clinicians would still hesitate to intervene in the absence of abnormalities other than ALP. Here's a quote from another Cushing's expert, Dr. Mark Peterson:


If our goal is to control symptoms caused by this disease, in the absence of symptoms, we would hesitate to treat the dog.

No one test is perfect to diagnosis Cushings. If your dog has no symptoms, just elevated ALP-, the wold reknowned endocrinologists are saying they would hesitate to treat as per Marianne's quotes.

If it were me, I would print those exact quotes out and discuss them with my vet.

[labblab]

I'm so glad that Addy has stopped by to talk with you! I want to post a bit more clarification, too, but it will have to wait until later today. Just didn't want you to think I was ignoring your question!

Marianne

[npettitt]

She has been on Anipryl for about 4 days. No signs of any reaction.Her eating has slowed down. I know Anipryl does not have good success rates but has anyone had any luck with it? I was hoping to lower her alp. It does not seem nearly as risky as the other drugs. I was wondering if I should keep her on it for a few more weeks and then do lab work to see if it has helped her. I am very worried about those high alp, it can do a lot of damage also . Thanks so much for your input. Also if not treated will the pituitary tumer grow and give her problems? I read that Anipryl may help shrink the tumer.

[molly muffin]

I don't know how long it takes for Anipryl to work. I'd ask the vet about that. There is a small percentage, I don't remember what the percentage is, in the 20% range I think that Anipryl does help. It seems to be dependent upon which area of the pituitary the tumor is located. If the tumor is in the pars intermedia it is more likely to help.

No, not all dogs pituitary tumors grow, some do and they become macro tumors, but I don't think that is the majority.

If this works and if the ALP comes down, did the vet thing it might help with the ALP? then it isn't bad to try it. I don't know of any harm it causes. There are some possible side effects but in the studies, that was like maybe 4% of dogs, so most have no side effects and you base if it is working on clinical symptoms. If those lessen then it is most likely that it is working.

This is a members thread from a few years back that went with Anipryl

http://www.k9cushings.com/forum/showthread.php?t=368

Sharlene and molly muffin

[Budsters Mom]

Cushing meds are designed to treat symptoms. They do not cure Cushings. In the absence of troublesome symptoms, I would not treat with any Cushings meds, regardless of high ALP or test results. I would probably start some type of liver support such as Milk Thistle or Denamarin to help bring down the ALP level. Many on here have had remarkable results using these supplements. Your baby would need to be monitored. Cushings meds can always be started once symptoms appear, if they do. There really is no rush to treat. Be thrilled that you baby is symptom free. Rejoice in the moment! This is something to celebrate. :p:)

[lulusmom]

Hi and belated welcome to you and Bonney.

I've read through your thread and it appears that Bonney has no symptoms commonly associated with cushing's and treatment with anipryl was initiated solely to address the high ALP. Is that correct? You also mentioned that your vet did an acth stimulation test and a urine test which were consistent with cushing's. Can you please obtain copies of those tests and post the results here?

With respect to Anipryl, I see that you already know that it's efficacy is not great. Most specialists will not prescribe Anipryl for their patients who are overtly symptomatic as it's not worth the cost. Dr. David Bruyette, a renown endocrine specialist, is the developer of Anipryl and even he does not prescribe Anipryl unless the dog has very mild symptoms or he'll give it a try if the pet owner cannot afford the acth stimulations tests that are necessary to monitor treatment with Vetoryl. Anipryl is a nonadrenalytic drug, meaning it has no effect whatsoever on cortisol levels. As it does not inhibit the over secretion of cortisol, there is no danger of Addison's and no need to do an acth stimulation test because there won't be any change. If Bonney's high ALP is truly caused by cushing's, you won't see any improvement in that either.

According to Dr. Edward Feldman, another renown endocrine specialist, noted increase in activity level and reduction of appetite in dogs treated with Anipryl is due to the fact that it is partly metabolized to L-methamphetamine. You mentioned that Bonney's appetite has decreased so this could be the reason for that. Did Bonney have a voracious appetite before starting Anipryl?

As others have mentioned, Scotties are known to have elevated ALP but the reasons for this remains unclear. Scotties can have ALP as high as 2000 IU/L and be completely normal, and they do test negative for cushing's. The only thing that doesn't fit for Bonney is that the ACTH stimulation test was not negative.

I look forward to seeing the results of the ACTH stim test and the urine test. Can you also confirm that both a blood chemistry and a complete blood count was done and that there were no other abnormalities?

Glynda

[npettitt]

Thanks to every body that has comment to help me. I will get test results from ACTH and lab and urine. Very interesting about Anipryl not lowering ALP's. Yes Bonny's appetite was very big. I do have her on S-Adenosyl 225 for the last year. She is not having any signs of symptoms. Seems very happy, just eating a little less. I am also giving her Melatonin 3mg twice a day and adding flax seed in her diet. Maybe I should try Denamarin instead of what I am using. Will post results tomorrow.

Thanks so much!!

[lulusmom]

Denamarin would be a much better choice than anipryl for the liver. However, if elevation in ALKP is due to cushing's, Demarin won't have much of an effect on bringing the ALKP down but it will aid in general liver health and function. You can read more about liver support in our Helpful Resources subforum. I've included a handy link below:

http://www.k9cushings.com/forum/showthread.php?t=192

[npettitt]

Lab results on Bonny, Urine first catch drawn in the morning. Specific gravity 1.014 negative everything else PH 7.0 ,WBC 2.5, RBC 0.2, EPI cell 3+

ACTH Pre-ACTH 5.2 Post ACTH 24.8

Total health plus
ALP 2229, ALT 44, AST 93, Creatine Kinase 1753 Amylase 1348, Total protein 8.2, Albumin 4.4, Cholesterol 265, Calcium 10.7 Chloride was low 106, T4 was 2.2 Everything else was pretty much normal. Please let me know if you need anything else.
Thank you so much!!
Nancy

[molly muffin]

Can you post the units that the results are in, for instance ug or nmol and the normal range for each item you listed? It should be on the results sheet.

That would be quite helpful, as different labs have different ranges.

Sharlene and molly muffin

[npettitt]

I have an appointment with Dr. Nelson a UC Davis endocrine specialist on July 15th for Bonny Doon.

[molly muffin]

Oh that is great. UC Davis is very good, especially in relation to cushings. They have done some of the leading research on the disease. So glad that you got an appointment to see them. Several of our members have worked with them with good results.

Cheers,
Sharlene and molly muffin

[lulusmom]

Hi Nancy and thank you for posting the test results. I am very happy to hear that you will be seeing Dr. Nelson at UCD. I assume that is Dr. Richard Nelson? He is a well known, well published internal medicine specialist who is a contributor to many chapters in veterinary medical textbooks. You will be seeing one of the best. Dr. Edward Feldman, the endocrine expert I mentioned in my prior post, is also a professor at UCD. I'll be anxious to get your update after Bonney's appointment with Dr. Nelson.

Glynda

[npettitt]

Yes, I can't wait to see him. I will have lots of questions, and I am sure he will have the answers. Will update you after our appointment.

Thanks again!!

[addy]

We will be waiting for your update. Good luck with the appointment!

[jxeno13]

I have an appointment with Dr. Nelson a UC Davis endocrine specialist on July 15th for Bonny Doon.

Great! That's where I would have been myself had I still lived in N. Cali! I used to live in San Jose and Mendocino County. I sure do miss home! Good luck tomorrow! :D

[npettitt]

Good news from Dr. Nelson, he took an ultra sound of Bonny's adrenal glands and both are normal size. He wants me to take a urine sample on Sunday morning and again on Monday morning and take urine sample to my Vet and have him run a urine creatinine ratio on each sample. This will again help rule out cushings. He was not concerned about her ALP or her test results of 24 on ACTH. He said he has seen dogs test up over 50 on ACTH test that are not cushingnoid dogs. He was so nice and friendly. I truly do love that place, took my horse there for a surgery many years ago. I cannot believe how reasonable it is also. Just $315.00 for her ultra sound. Wants her off of Anipryl, likes melatonin and flax seed.
Will keep you updated on her urine samples and his recommended treatment if needed.
Thanks to all,
Nancy and Bonny

[molly muffin]

That is excellent! I have just started the lignan and melatonin on my dog at my specialists recommendation. I went with the HMR klignans rather than flax seed though as it is easier digestion.

Sharlene and Molly muffin.

[npettitt]

I like flaxseed milled, it is all lignans, but my Scotties need the fiber. The fiber also absorbs the cortisol. I give 3 mg of melatonin twice a day. He also recommended Denamarin . I was giving them s-adenosyl with milk thistle. We started eating flax seed also, it is great, tastes like walnuts to me.

[molly muffin]

I both they both work for both of our furbabies. :) Crossed fingers.

Sharlene and molly muffin

[npettitt]

Good news from Dr. Nelson from UC Davis. Bonny is fine, not concerned with her ALP's and urine was fine. He said he has seen ALP's as high as 5000 with no problem. I also took my 11 year old scottie to be checked for atypical. After looking at his lab work ACTH test and urine he said he does not need to do anymore testing. Atypical is very rare. So glad I went to a specialist. I could have had her on very toxic medicine. I will continue with the flax seed and melatonin and denamarin.
Thanks to all of you for helping me and recommending further test.

Nancy and Bonny Doon

[molly muffin]

That is so awesome! I'm glad you got such good news for both of your furbabies.
Yes, those Scotties can be tricky with their ALKP's that's for sure. I'm sure you are feeling much relieved tonight with those results and reassurance from a specialist!

We couldn't be more thrilled for you.
Sharlene and molly muffin