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[ticketdog]

I have a 9 yr old Australian Cattle Dog, lab work done on Friday, everything normal except for ALP, Alt and Ast, all high. The veterinarian said that he suspects Cushings, excessive drinking and urination, suggests urinalysis, more labs and ultrasound. My husband passed away 5 months ago, my budget is limited. Has anyone used a holistic approach to treating this awful disease. I just don't know what to do...I also want to say that my dog is not interested in food, does not have hair loss or a bloated abdomen. So far the cost has been $400.00, I live in Massachusetts and fees are very high.

[labblab]

Hello and welcome, although I'm so sorry about both the loss of your husband, and also your new issues with your dog. That's a lot to have to be dealing with right now. :o

I wish I could tell you there's a holistic option that has been proven to effectively lower cortisol levels, but unfortunately that's not the case. Anecdotally, we have had a few folks tell us that they've seen some outward improvement, at least for a time, with non-prescription supplements. But inevitably, they typically end up turning to Rx medications as symptoms progress.

Before beginning any treatment, of course accurate diagnosis is the most important piece of the puzzle. It is true that the diagnostic testing can be expensive, though, and I do appreciate why that is a genuine issue for you right now. Since you've already had general labwork done already, can you please ask for copies of the actual results? If you can tell us the exact numbers for the blood or urine results that were abnormal (along with the normal reference ranges), that will be a great starting point.

Depending on those numbers, a preliminary test that is more specialized is the UC:CR, or Urine Cortisol to Creatinine Ratio. It is less expensive than the diagnostic Cushing's blood tests, but it can be a gateway that lets you know whether further testing would be useful. The test involves the owner collecting a urine sample from their dog at home, first thing in the morning (actually, three pooled samples from three subsequent mornings is even better). If the test result is within normal range, it is a pretty sure bet that the dog does not have Cushing's. If the result is elevated, then Cushing's is a possibility and further testing is warranted.

I'm getting ahead of things, though, because the first thing will be for us to see those actual test results, and also to hear more about your dog's overall health history.

Once again, welcome to you both!
Marianne

[labblab]

I'm back with a P.S. after reading the info you just added to your post. Given your dog's lack of appetite, apparent absence of common Cushing's symptoms other than excessive thirst/urination, and elevated combo of multiple liver markers, I'd perhaps be more suspicious of a primary liver problem than Cushing's. Again, it will help us a lot to see exactly how high those elevations are.

Marianne

[ticketdog]

I have the results as follows:
ALP 313
ALT 1009
AST 95
all other values normal
Excessive thirst, urination and not eating as usual. No vomiting, diarrhea and not jaundiced. He has mild focal seizures infrequently, not on meds. as he became very dopey and disoriented.
No other medical problems.

[labblab]

Thanks for these values. Can you please edit your post, though, and add the normal reference range for those values? My guess is that the ALP is mildly to moderately elevated, the ALT is extremely elevated, and I don't know about the AST.

As far as the ALP and ALT, those two results are the opposite of what we typically see with Cushpups. Although I'm not a vet, I believe that marked elevations in ALT and AST would be much more characteristic of primary liver problems. Combining those elevations with lack of appetite and seizures is even more worrisome to me in terms of potential liver abnormalities.

I'll await the reference ranges before commenting further.

Marianne

[ticketdog]

normal range ALP 5-160 u/l
Normal range ALT 18-121 u/l
Normal range AST 16-55

Ticket ALP 313, ALT 1009, AST 95

[labblab]

We're still missing the range for the AST -- you've got 95 typed in both for the result and for the range, as well. :o

[labblab]

Also, can you tell us what medication he took for his seizures? For how long a time and how recently?

[ticketdog]

Phenobarb in 2014, for a very short time. I also want to mention that I use a mobile vet. Ticket is very dog aggressive, causes a a terrible scene when brought into a veterinary clinic. The last time we went the dirty looks from the staff were awful, I wanted to fall through the floor boards, fortunately, he loves people and cats. His behavior towards other dogs is somewhat typical, I've owned this breed for 40 years.

[labblab]

OK, thanks. If the phenobarb use was brief and so long ago, then I'll stop worrying about it as a possible contributor to liver issues.

I must reiterate that I'm not a vet, but given Ticket's symptom profile in addition to the pattern of liver enzyme elevations, I believe I'd want to consider liver-specific testing prior to pursuing Cushing's. As I wrote earlier, highly elevated ALP is common with Cushing's; highly elevated ALT is not. And I don't think that cortisol/steroid exposure typically elevates AST at all. So Ticket's profile is not what we commonly see here among Cushing's dogs. I'm guessing a serum bile acid test might be the next best test of actual liver function, and probably could be performed by the mobile vet.

I am far from a liver expert, and I'm hoping some other folks will chime in here with their thoughts. Meantime, here's a round-table discussion that may give you additional insight:

http://www.idexx.at/pdf/de_de/smallanimal/snap/bileacids/diagnosing-liver-disease.pdf

Marianne

[ticketdog]

Thanks for the information, interesting read.

[lulusmom]

Hi and a belated welcome to you and Ticket.

I just wanted to validate everything Marianne has already told you. The IDEXX Round Table Discussion on Diagnosing Liver Disease is an interesting read and I am hoping that it has helped you understand where Marianne is coming from. Ticket's liver enzyme abnormalities are not the usual pattern seen in cushing's. Ticket's ALT is very high, high enough to warrant liver function testing or at least liver support supplement and a recheck in thirty to sixty days.

Excessive drinking and peeing is a symptom that is not exclusive to cushing's. Did the vet do a urine test to determine if Ticket's drinking and peeing is a legitimate clinical symptoms of Cushing's (or any other disease), as well as rule out a urinary tract infection? Dogs with cushing's lose their ability to concentrate their urine so their urine is like water and specific gravity (USG) is low. If your vet did a urine test, can you please share the results with us?

With limited finances available, I personally would not be chasing a cushing's diagnosis with so little evidence as testing is very expensive. I would be a lot more concerned about getting to the bottom of the almost tenfold increase in ALT. You may want to share the IDEXX information with your vet so that he has a better understanding from the experts on how to interpret liver values, when to test and for what, based on those values. I live in a rural area of Tennessee and have used a mobile vet a time or two and I'm hoping your mobile vet has a lot more depth of experience than the ones I've dealt with, whose primary source of income is from vaccines.

My mom's dog was extremely dog aggressive so I used the back door at the vet's office so as to avoid any frays in the waiting room.

Glynda

[molly muffin]

Hello and welcome. I just want to join in with the concern about that high ALT value. That's my main concern, and I think the bile acid test mentioned might be a good next step.

A liver support with milk thistle and sam-e would be good for the liver and something to discuss with the vet. You can get that off of amazon and don't need a prescription so can check various places for best price. I used amazon myself for it.

[ticketdog]

I tried to get a urine specimen today but was unsuccessful, tomorrow another day.

[ticketdog]

I contacted another mobile vet, I like the one I use but have found most veterinarians to be only vaccine crazy. My only alternative is possibly Tufts, a long ride and I'm sure very expensive.

[molly muffin]

Try a ladle to get a urine specimen. It might sound funny and look hilarious but is sometimes easier.

yea Tufts would be spendy, but they are decent. Just call and ask how much they charge for whichever test you are considering and then ask how much experience with liver/cushings, they might have.

[DeafSheltieMom]

A belated hello and welcome to you and Ticket. I'm a newbie as well, so I defer to others here who have more experience.

But I want to share that I have a 12yo dog who had tested for high liver levels as well, but was asymptomatic. (you can read more details about Alva in his own thread. just search for Alva). An ultrasound showed a mass on his liver. He was drinking more, but not excessively, and peeing was rather normal, considering. We decided it was because of his liver issues. He was put on Denamarin (a liver supplement). However, the liver mass slowly grew over a 6 month period. I was referred to an internal med specialist. She recommended a liver lobectomy, then a biopsy on the removed mass.

Aspiration on liver masses are notoriously inaccurate, so the more inexpensive diagnostic is not recommended... the only way to know what the mass is is to remove the mass altogether, then get the biopsy and examination of the whole. Of course, that is only possible if the mass is well-defined (contained). And, only performed if the mass had not metastasized in other organs. So they did a CT Scan of his abdominal organs (lungs, liver, kidneys, stomach, intestines, etc.) before actually doing the surgery. Alva was clean elsewhere, and his mass was well-defined, so he had the liver lobectomy to remove the mass. It turned out it was a well-defined hepatocellular carcinoma (cancer), but it had not metastasized.

Immediately after the surgery, he starting excessive peeing and drinking. The surgeon and internal med specialist were perplexed by it all. We had tried a bunch of other treatments before deciding to test for Cushing's. As it turned out, he does have Cushing's, as well as a healing liver.

So even though he has a high ALT, that doesn't necessarily discount Cushing's, but there are definitely liver issues going on. The urine cortisol/creatinine ratio test and the specific gravity test will help determine if Cushing's is a possibility, and is a relatively inexpensive test. The article Marianne recommended is a great read.

Good luck to you and keep us updated.
-dayle