Thoughts??

[MastiffB]

Greetings everyone,

Recently my dog has had some issues with his anal glands and blood in his stools. I provided a stool sample (nothing found), then went in for an appointment. It was suggested he start antibiotics and anti-inflammatories for possible anal sacculitis. Two weeks later, no change and did a follow-up in which a flush was suggested. Prior to the flush, they did blood work and found his ALP was three times what it was in March 2014. Additionally, she said it was "mildly" elevated back then and he may have Cushings Disease. I was then told to schedule an abdominal ultrasound which is this weekend.

I am slightly miffed, as last year we started having some issues with the dog around the time his annual check up was. Reading through the file I expressed he had been drinking more than usual in 2014. Additionally, he started having some accidents in the house. They did three urine samples for bacteria and whatever else then placed him on Amoxicillian from what I always thought was a UTI. Now, going through his records I don't see any evidence that a UTI was conclusive. We concluded incontinence from old age and adjusted his outdoor schedule. Furthermore, looking back at his ALK U/L it was at 472, with an Lipase 883 U/L .

I have not see the current lab results for myself but if it is 3x's the last one in March 2013 that is 1416 U/L!!! Given the accidents, bathroom problems in the house, and stating that he was drinking more than usual- should have the vet pieced this together with a 472 U/L?

I'd appreciate any opinions before I bring this up. I certainly don't want to be confrontational out of emotion.

Thank you!!

[budindian]

I'm new here so can't give much advice but you have come to the right place, the people here are going to ask lots of questions and are very knowledgeable . Someone will be along in a while to answer your questions. I don't think a lot of vets are familiar with cushings disease and sometimes tests can be other things. Welcome and the best of luck to you and your furbaby. I hope its not cushings but if it is you are in the right place.

[Harley PoMMom]

Hi and welcome to you and your boy!

Sorry to hear that your sweet boy is having some issues :( lets see if we can get some things figured out. Yep, increased drinking/urinating can be attributed to Cushing's but other illnesses have these same symptoms such as diabetes and a thyroid problem and should be ruled out. Does your boy have diluted urine and a low specific gravity, if so, than a regular urinalysis may not be sensitive enough to pick up the bacteria in his urine so an urine culture and sensitivity test is recommended. Could you get copies of all tests that were done on your boy and post those results here? With respect to the blood chemistry and CBC, you need only post the highs and lows and please include the normal reference ranges. Is he taking any other herbs/supplements/medications? Does he have any other underlying illness? I apologize for all these questions but the more we know about your boy the better our feedback will be.

Other common clinical signs of Cushing's are a ravenous appetite, skin/hair issues, exercise intolerance, and difficulty or unable to go up steps or jump on furniture, does your boy display any of these?

Cushing's is probably the most difficult canine disease to diagnose. Physical symptoms associated with Cushing's are shared by many other diseases, blood and urine abnormalities are shared with other other diseases and the diagnostic tests to measure circulating cortisol are flawed and can yield false positive results in the face of non adrenal illnesses or even stress. All of these things make it very challenging to correctly diagnose Cushing's which makes it one of the most misdiagnosed canine diseases. There isn't one test that can accurately identify it so multiple tests are needed to validate a diagnosis for Cushing's.

Cushing's moves at a snail's pace so one does have time to get a confirmed diagnosis for their pet. The medications used for Cushing's do not to cure it, the sole purpose of treatment is to remedy problematic symptoms. Regarding an ultrasound, they can be a very useful diagnostic tool, as other abnormalities may be found on the internal organs, such as gallbladder mucocele, kidney issues, pancreatitis...etc. Also if the adrenal glands are visualized, this can aid in the diagnosis for adrenal or the pituitary type of Cushing's. Our motto here is you get a lot of bang for your buck with an ultrasound. However not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it. Usually a Board Certified Veterinary Specialist is the best choice to perform an ultrasound.

Sorry for the reasons that brought you here but sure glad you found us.

Hugs, Lori

[MastiffB]

Thank you for the reply. His Thyroid was okay in 2014 and in the most recent testing. He does exhibit the frequent urinating, excessive thirst (always refilling his bowl), and in the past year its been increasingly difficult for him to jump up on the bed or into the car. As far as the eating, he is a picky eater. He won't eat kibble plain. I dress it up with no sodium chicken broth. He does beg for extras nightly.

In 2014 the abnormal results that I see:
Alk Phosphatase (ALP) 472 U/L Range: 5-131 U/L
Lipase 883 U/L Range: 77-695 U/L


2015:
AST 13 U/L Range: 15-66 U/L
Alk Phosphatase (ALP) 1233 U/L Range: 5-131 U/L
Potassium 5.7 U/L Range: 3.6-5.5 U/L
PrecisionPSL 720 U/L Range: 24-140 U/L

I guess my big hangup is, if he showed abnormalities in 2014 why was this not something that was marked to check up on within a couple months? Particularly if he was peeing in the house, and it was indicated that he was consuming more water. A quick search of the web reveals problems related to spiked ALK's. Is a 472 U/L generally something a vet would turn away from or is it a red flag?

If you were in my shoes, would you not be questioning the vet on this? Also, I go to a practice so sometimes vets may change. The one who saw him in 2014, is no longer with the practice. This could mean nothing....but worth noting.

Thank you for all your help!!

[lulusmom]

Hi and welcome to the site.

To answer your question, I personally would not be upset with my vet for not pursuing possible cushing's in 2014 when the ALKP was mildly elevated. Lipase is a pancreatic enzyme that can increase with even the slightest inflammation of the pancreas and with this inflammation, you can see an increase of ALKP. This liver enzyme can be triggered by steroids which can cause huge elevations but gut problems like pancreatitis can also cause elevations in ALKP. So in the absence of any other lab abnormalities, I do understand why your vet was not concerned. Fast forward to 2015 and I would be more concerned with the very high PrecisionPSL results. This is indicative of a brewing problem with the pancreas which can easily cause the increase in ALKP. Was your dog experiencing any sickness when this test was done? Any vomiting or diarrhea, lethargy?

With respect to the symptoms you feel may be associated to possible cushing's, it would help if you could share your dog's age? I assume he is a Mastiff which is a very large breed and a lot of large breeds are genetically predisposed to hip dysplasia. Has your vet ruled this out as a reason for your dog's difficulty in jumping up on the bed or other furniture? Dogs with cushing's become weak in their hindquarters due to muscle wasting. You can usually get a good visual on this in short haired breeds so can you tell me if your dog's hips and lower spine are pronounced and rather bony looking? I should mention that muscle wasting is not exclusive to cushing's as older dogs who are otherwise healthy can experience some level of muscle wasting. Again knowing your dog's age would help.

With respect to the excessive drinking and accidents in the house, dogs with cushing's lose their ability to concentrate their urine so they pee lakes and must drink great volumes of water to stay hydrated. In order to determine if your dog's problem is being caused from the effects of excess cortisol on the kidney's filtration system, your vet would need to do a standard urinalysis as well as a urine culture. Dogs with cushing's who truly have polyuria/polydipsia will have low urine specific gravity and very dilute urine. Dilute urine is breeding grounds for bacteria which is why a good number of cushdogs have a urinary tract infection at the time of diagnosis. The standard urinalysis will not pick up all of the white blood cells in dilute urine which is why a urine culture should be done. The culture will identify the actual strains of bacteria so that appropriate antibiotics can be prescribed.

Based on the information you have provided so far, I don't see anything that is screaming cushing's to me. I am assuming that it has been well over 90 days since the last blood labs were done so you may want to consider having a full senior screening done which includes the blood chemistry, cbc and urinalysis.

Glynda

[MastiffB]

This is helpful information. He will be 11 in June. He has arthritis in the back legs, and very little signs of hip dysplasia. He's lazy but active when he needs to be. He actually caught his first squirrel last year at 10....which is impressive considering mastiffs are notoriously slow.

As far as what you said regarding the urine, the first urinalysis back in March 2015 was too diluted to determine anything. So like you mentioned, they did two different bacteria cultures then placed him on meds to clear a UTI. This was being addressed at the same time that he had blood work done in 2015 too. Which is why I assumed they would have said something about the elevated levels and taking a look at his pancreas and liver. Especially, since I mentioned the additional water consumption too....

The 2016 (I'm sorry I just realized I put 2015 above in my posts, it should be 2016!!!) chemistry I posted above was from last week, so the blood work is just about as recent as you can get.

Is the Precision-PSL and Lipase pretty much the same test? And do you know what the threshold is as to when to alarm an owner of elevated test results like these? Do vets typically wait until an ALP is over 1000 U/L before suggesting more testing? Lastly, can an elevated Precision-PSL test be attributed to Cushings?

Thank you and apologies for all of the questions and mixing up the years. I am talking about March 2015, and March 2016. My brain is all over the place right now with this. I appreciate your objective opinions on this matter.

Best,
Rebecca

[molly muffin]

The PSL is considered a more sensitive test for pancreatis. You still would want to follow that up with an ultrasound to look at the pancreas.

I think every vet is different as to when they mention something or what their concerns are to a dog owner. My vet mentioned to me when we saw the ALKP in the 800's.