Should I test for Cushing's?

[Baguette's mom]

Thank you for the forum. I am a newbie with a basic question about the 15 year old female beagle/basset mix named Baguette.

Here is what recent testing found:
04.03.20:
ALKP 430 U/L (23-212)

ALT 107 U/L (10-125)

BUN 24 mg/dL (7-27)

09.13.21:
ALKP 513 U/L (23-212)
ALT 63 U/L (10-125)

BUN 23 mg/dL 7-27

09.13.21: At-home urine sample in morning before food.
Specific gravity 1.037
pH 5.0
PRO 100 mg/dL

She also has an enlarged liver, all other organs used normal on x-ray. X-ray didn't show signs of cancer anywhere. Been on SAMe (ingredient in Denamarin) for 4 months.

Also muscle weakness in hindquarters (x-rays show bone on bone lumbar vertebrae and knees).

Also lethargic.

Are the test results along with the muscle weakening enough to justify putting my dog through a day at the clinic for testing for Cushing's?

Also, she is having a dental/tooth extraction next week. If I decide to proceed with a Cushing's test, would it be okay to do it while she is at the clinic for the dental? Or would the stress and anesthesia affect the values?

Thank you for whatever insight you can provide!

[lulusmom]

Hi and welcome to the forum. Given Baguettes age, fairly mild lab abnormalities and what looks to be some pretty severe degenerative disc and joint disease, I personally would not test for cushing's. The reason being is that cushing's is a very graded disease, progressing at a snail's pace and even if Baguette were to have cushing's, she would likely pass from old age before cushing's would take her. More importantly, even if you got a positive diagnostic test, treating with a conventional drug like Vetoryl (trilostane) or Lysodren (mitotane) would likely negatively affect her quality of life. Dogs with cushing's have high levels of circulating cortisol in their blood and this steroid has excellent anti-inflammatory properties which would be greatly helping any inflammation and swelling. If you treat and lower cortisol, you remove those properties and Baguette's knees and spine disease would become quite painful for her and could very well greatly affect her mobility. Cushing's does cause muscle wasting but loss of muscle mass is also very common in elderly dogs. Cushing's also causes an increase in the ALKP liver enzyme but mild increases like Baguettes are not uncommon in older dogs. Dogs are the only species on the planet that has a steroid induced ALKP isoenzyme and because this isoenzyme is triggered by steroids and not injury or death of liver cells, liver supplements such as SAMe or milk thistle will have little effect on lowering the ALKP; however, liver support is a good thing as these supplements promote good liver health/function. If Baguette were my dog, I would not pursue a diagnosis because I would not treat with conventional drugs for the reasons I mentioned above. I would simply continue to monitor blood and urine labs and keep an eye out for any persistent protein in the urine as well as monitor her blood pressure. These are two clinical complications of cushing's that can do damage to the body if not addressed. I have provided a link below to a document titled "When should my dog be tested for cushing's" which you might find helpful. Lastly, to answer your question, if you were to proceed with testing for cushing's, it should not be done on the day of the dental. You would need to schedule a separate appointment.

Glynda

https://drive.google.com/file/d/17qtKcoZ-Ql0NucUxfh2Wg6HXBgS28J62/view?fbclid=IwAR2okLsiun4PiZImmBVU8-K6EGvPs1TLe9_AI70T9Rtgw59diRXaSdSigOc

[labblab]

Hello and welcome from me, too! I’m delighted that Glynda has already been here to greet you and to offer her thoughts as well as those excellently links. To cut to the chase, I entirely agree with her recommendation. When it comes to older dogs, my personal priority in terms of Cushing’s treatment is evaluating immediate quality of life as opposed to worrying as much about the chronic systemic problems that Cushing’s can produce over time. If observable Cushing’s symptoms were making my dog uncomfortable, I’d likely opt to treat at any age. But as Glynda has said, if the treatment itself might actually lessen my dog’s outward comfort, I wouldn’t want to also add on the additional stress of frequent vet visits and treatment monitoring that are required alongside the medication. The trade-off just wouldn’t be worth it to me, barring seeing the development of Cushing’s-related hypertension or protein loss in the urine.

So I would likely put Cushing’s on the back burner, myself, if Baguette was my own dog. You can always decide to go ahead and test in the future, if you wish. But as Glynda notes, any diagnostic Cushing’s testing must be scheduled separately from any other procedure or sedation so that the results will be as accurate as possible. Stress will falsely skew the results upward; sedation will falsely skew them downward.

Whatever you decide, good luck to you and don’t hesitate to ask any additional questions you may continue to have.

Marianne