Angel, 10yo rescue boxer

[pansywags]

Hi All, I'm back regarding a 10 year old boxer our rescue has taken in. Angel has some teeth that need extraction, a mass in her mouth that needs removal and support for spondylosis/arthritis in her spine. She is drinking and peeing excessively and has the pot bellied appearance. I will be speaking with her new foster mom later today to get more information.

The vet says her labs came back with possible indicators for pancreatitis and Cushing's. The pancreatitis indicators are not conclusive so the vet's recommendation is to try to address via diet and retest in several weeks, with the next diagnostic test being an abdominal ultrasound. Vet has recommended against giving any NSAIDS, primarily due to the prospect of pancreatitis.

As for the Cushings's concern, the values in question are the alkaline phosphatase and protein in her urine. This vet is with a VIP wellness center and recommends following up with a full service vet for followup testing on this issue.

Attached are the abnormal values from Angel's labs with the normal range listed on the right. You all are the experts, what would be the best next steps on further diagnostics given Angel's current known issues?

Rescue dollars are, as always, tight. Thanks in advance for your guidance.

From superchem:

Alk Phosphatase 298 IU/L 5-131 HIGH

Amylase 1,490 IU/L 290-1125 HIGH

PrecisionPSL 1,038 U/L 24-140 HIGH

Urinalysis:

Protein TRACE NEGATIVE HIGH

Urine Microalbumin:

Microalbuminuria 5.1 mg/dL <2.5 HIGH

[pansywags]

I've already flagged that if Cushing's is diagnosed, a choice may need to be made regarding treatment that takes into account comfort/quality of life related to her arthritis. She is being fostered about an hour away from UC Davis so I have recommended that the foster take her there for the Cushing's clinical trial if possible.

[Harley PoMMom]

PrecisionPSL 1,038 U/L 24-140 HIGH

Hmmm...to me those results point to pancreatitis, with that elevated PrecisionPSL level I wonder why the vet feels that this isn't conclusive to pancreatitis.

Diabetes, UTI, and any kidney/bladder issue has been ruled out?

[pansywags]

Here's the text of the Vet's message regarding Angel's test results:


Now on to Angel. First off, her kidneys are doing great, her thyroid is normal, she's not diabetic and she is negative for heartworms. However, she does have a few abnormalities that should be followed up:

First of all, she has elevations in two values that are consistent with pancreatitis. Has she been vomiting or having a poor appetite since you've had her? If she is not showing signs of pancreatitis there are a few possible explanations for these results - she could have some sort of GI disease, she could have pancreatitis and just not showing severe signs or it could be nothing. Unfortunately these two values are not totally specific for pancreatitis so interpreting them isn't the easiest in a dog that is not showing signs consistent with pancreatitis (vomiting, painful abdomen). The next step to diagnose pancreatitis would often be an abdominal ultrasound which would need to be done at a full service vet office. IF she is not showing any signs of pancreatitis, I would recommend rechecking these values in 2-4 weeks.

Secondly, she has elevated alkaline phosphatase and protein in her urine, both of which can be seen in dogs with Cushing's disease. Cushing's can usually be easily treated but in order to diagnose this she would need additional testing that would best be done at a full service vet.

At this point, I would not recommend starting her on meloxicam given that those values that are consistent with pancreatitis can also be due to GI disease and giving meloxicam, or any NSAID could exacerbate that. Hopefully the Adequan will help her!

[labblab]

Hello and welcome back!! What a gift you are giving Angel by involving yourself in her diagnostics in this way. You know, after reading the vet's assessment, he/she really sounds "spot on" to me. And I agree with you 100% -- it would be great if Angel could participate in UC Davis' clinical trial. To me, that would really be a win-win situation. I do think Cushing's is a distinct possibility, and I'm confident she would receive a thorough and appropriate evaluation there at Davis. Barring that, it does sound as though an ultrasound performed by a local specialty vet would be the next best option.

Please keep us updated, OK? (And it's really good to have you back here ;))
Marianne

[pansywags]

Thanks for sharing your thoughts, I really appreciate it. I'm hoping the foster family will be willing to cart her off to Davis and I will let you all know when I find out more.

Edited to add that I also thought the vet sounded sensible and measured, at least about the Cushing's possibility. I don't know much about pancreatitis (thankfully) so I can't speak to that. It's sad that I have such low expectations when it comes to GP vets and Cushing's.

[molly muffin]

I just want to say hello and great job you are doing with Angel and going through the options.

A clinical trial at Davis would be great, but I also want to address the teeth issue that will need to be taken care. Those might need to be taken care of sooner than later and at least get some antibiotics started in case of infection. As that can also affect other areas.

[pansywags]

Angel's oral issues will be addressed before we move along to considering her possible Cushing's. She is having surgery this week - here's hoping this senior girl gets through it with no troubles.