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wenqyang
08-31-2016, 08:30 PM
Hi Everyone. Newbie here needing help with the next steps in diagnosis for my 11 year old retriever/chow mix, Mollie.

I'm very active when I want to be and Mollie's energy level fits my personality perfectly. We spent the majority of weekends rock climbing and hiking. She is excited when she is outdoors but relaxed and calm and can sleep 20 hours during off peak times. When she was 9 I picked up mountain biking and she was a trooper to run next to me for 12+ miles days. At 10 years old, she started slowing down so I dialed back the mountain biking rides to less than 3 miles. This year, I haven't taken her on any rides. She is still a happy and excited dog and I'm just as happy to have a senior dog as my companion.

Last December 2015, I had several warts removed and cleaned her teeth. In the pre-anesthesia profile my vet at the time commented on elevated ALP of 212 (normal range on report is 0-140U/I). Since this was the only elevated marker and Mollie is in good health and mood, the vet told me to not worry about it. However, recently I noticed Mollie is drinking ALOT of water (approx. 4L a day for a 65lb dog with mild activities) and her pee is watery. She has alwvays been a heavy drinker but this was excessive even for her. And recently she peed in an apartment while we were traveling for the first time ever. I became worried and took her to my new vet who performed a senior wellness blood panel, urinalysis, and stool sample. Her urinalysis showed low specific gravity but otherwise normal. Her bloodwork showed elevated ALP, this time at 515 and slightly elevated cholestrol, 9 months later. Otherwise all is in normal range.

My vet is still considering diabetes, cushings disease, and endocrine disease as possibilities for her recent increase in excessive drinking and urination, though they suspect cushings since there are no indication in other markers.

What would been the appropriate next steps to help confirm diagnosis or rule out other causes?
Are the current elevated levels of ALP a concern? I've seen Cushing's levels in the 1000s rather than the 100s.

DoxieMama
08-31-2016, 09:09 PM
Hello and welcome to you and Mollie! I'm not an expert by any means, but I'm sure others will be along who can provide you some guidance. Ruling out diabetes, thyroid or other issues is often the first step in a Cushing's diagnosis. If Cushing's is suspected, then an LDDS test is the "gold standard", sometimes accompanied by (or replaced with) an ultrasound.

Harley PoMMom
08-31-2016, 09:23 PM
Hi and welcome to you and Mollie!

Increases in drinking/urinating are hallmark symptoms of diabetes and needs to be ruled out first. This is usually checked on a chemistry blood panel and is abbreviated with GLU, the ALP is also commonly checked via the chemistry panel. And you're right, Mollie's ALP is not as elevated as we are used to seeing on the forum, however, all dogs are different.

As Shana mentioned in her post, other health issues that could be the contributing factor for her symptoms should be ruled out before pursuing a diagnosis for Cushing's, and checking the levels for diabetes (Glucose) and the thyroid (T4 on the blood panel) are the first things I would do.

Whether Mollie does get a confirmed diagnosis for Cushing's or not, we are here to help you and your sweet girl in any way we can.

Hugs, Lori

wenqyang
09-02-2016, 06:05 PM
Thanks Harley and DoxieMama for your feedback.

The complete results of Mollie's bloodwork and urinalysis are in from the 8/30/2016 testing.

The elevated markers are
ALP - 570 (normal 5-16U/L)
Creatine Kinase - 460 (normal 10-200U/L)
Cholesterol - 403 (normal 131-345 mg/dL)

Per Harley's comments, the GLU and T4 are normal so the doctor is ruling out diabetes mellitus, kidney disease, thyroid abnormalities, and liver disease since there are no other liver markers that are elevated.

The possibilities still in consideration are diabetes insipidous, Cushings disease, and just behavioral (since Mollie is a heavy drinker from past experience). However the current amount of water consumption is concerning for her size and weight.

The vet plans to LDDS to test for Cushings so we'll see how that goes. Is there anything else I should consider in her diagnosis as I'm getting concerned everyday by her water consumption and incontinence. The vet recommended not limiting her water until we ruled out all medical causes so I just have to wait and see.

Thanks
wen

Harley PoMMom
09-02-2016, 09:14 PM
Since the vet thinks that diabetes insipidous is a likely culprit for the increased PU/PD than you could ask the vet about trying a trial run of the desmopressin eye drops.

Lori