Newly Diagnosed Bowie the Wonder Dog - Seeking advice

[JulieDavis]

Hi everyone,

I'm new to this group. My dog Bowie was diagnosed with Cushing's last Wednesday but there seems to be more to the story. My primary vet has advised we hold off on traditional medicines for now and I was interested in find out more on holistic protocols for Cushings. I'm also interested to know about treatment options for hind-leg stiffening/lameness (although we're not entirely sure that Cushing's is the culprit). Any insight in general would be appreciated as there seems to be a lot going on with my poor boy. Any advice from personal experience (especially regarding holistic care) would be amazing. I will be making a consult with a Holistic clinic next week.

From what I've read so far in this group I understand that it helps to share as much info as possible, so here goes. Test results at bottom.

Basics on Bowie
10 years old (approx....rescue dog)
17 lbs
Rat Terrier Mix

A little about our story:
The entire time we've had Bowie up until a year ago he refused to drink water from a bowl. We'd always have to mix it in with his food to get him to drink enough. We also fed him a home-cooked diet (organic oats/chicken base....Dr Pitcairn's recipe from the Guide to Natural Pet Health). He was on this diet for 8 years and always had rockstar bloodwork.

Early Summer 2017
We noticed our dog started getting tired during walks. He was always super active and could go with us for a few miles. Where we live it gets super hot during the summer so we kept it to evening walks but he'd end up out of breath and panting heavily. We stopped his long walks but even on short ones he'd take a while to recover afterwards (excessive panting). We chalked it up to old age. He also became thirsty as well and started to drink from a bowl. His nose looked dry and he was shedding more.

Late August 2017
While we were out at work (we believe) he jumped off the couch onto the coffee table and fell off (there were papers everywhere that were on the table before we left). When my husband came home he was limping (back left leg). We took him to our vet and while he noticed inflammation he didn't see anything broken or torn on the xray and prescribed Carprofen/Rimadyl for 14 days (rechecked after 7). I live in the US near the tropics and the week we were supposed to return for a checkup was when Hurricane Irma was coming so there was a lot of chaos in preparation and power outages after it passed. Long story short, he went back to the vet about 10 days later. Not seeing a difference and not knowing the cause he was sent to an orthopedic specialist who didn't know and referred us to a Neurologist. The neurologist believed it to be both orthopedic and neurological and prescribed Gabapentin. He was also put back on Rimadyl for the pain. After he finished his course of Gabapentin and still hadn't improved they recommended an MRI but suggested we see a second orthopedic specialist first in case something else was the cause.

Mid October
The second orthopedic diagnosed the ankle as having a torn ligament and put a cast on him (8 weeks) and kept him on Rimadyl. During this time Bowie presented with diarrhea which lasted for months. We did the bland diet and made changes and our vet prescribed Metronidazole. Liver or pancreas problems were suspected but the vet advised diet changes first.

November 2017
He was still having dietary issues so we were advised to change to Prescription Diet i/d canned food and white rice.

December 2017
The cast was on for about 2 months and once removed he was walking better but very stiff. He remained on the inflammatory until January. During this whole time he still had an increased amount of thirst/panting but we thought it might be the drugs. After the cast was removed the specialist recommend he stay on anti-inflammatories until January (2018) as well as the Metronidazole (was still having diarrhea). Early January we stopped the NSAID.

February 2018
It was time for his annual. We had a senior profile. It showed his ALK (SGPT and Alk Phostaphase) were elevated/out of range as well as his magnesium. I expressed concern to my vet about Cushings due to his behaviour (excessive thirst/panting/hair lost/dry skin/dry nose). We were also concerned about there being something internal/gastro as well...liver disease/pancreas problems as his diarrhea was still present. My vet said he did not have Cushing's. Possibly there could be liver disease, but most likely it's that he's just getting old (based on the bloodwork). We were referred to an Internal medicine specialist

March 2018
The specialist thought it might be a developed allergy. We were told to switch his food to a different protein carb source and were recommended tilapia/sweet potato. He did ok on this but still had soft stools. We also began him on Denamarin (liver support) a vitamin supplement, and a probiotic/d

April 2018
With all symptoms still present our vet advised we switch to Ultamino kibble (highly digestible) and continue the metronidazole.

June 2018
Bowie went to stay with my Dad for the evening and he accidentally gave him Parkinson's medication mistaking it for his Denamarin (it was a giant misunderstanding and a very expensive ER visit). They treated him and he was thankfully fine. We were scheduled to have more bloodwork done 2 weeks after this episode but it's hard to trust the results as his liver was still processing things from the ER incident. His ALT/Phostaphase were still elevated. His WBC was under as was his absolute lymphocytes. His Neutrophils were elevated and there was trace protein in his urine. At this time he had great stools for a few weeks so I gradually decreased the metronidazole (without vet's permission)

August 2018
His stools remained solid so we kept him off the Metronidazole. Over the summer I gave Bowie massages on his left leg and did some pool therapy. I went out of town for a week and upon return I noticed he had lost some range of motion with his right leg now as well which made us rethink what inititally caused all of this. I wasn't aware of this but the neurologist originally believed he might have damage to his spine based on the way he was carrying his legs.

Early September 2018
I ordered more bloodwork and the results returned with his ALT SGPT, ALK Phostaphase, and GGTP even more elevated. His ALT SGOT was also elevated, and his Cholesterol had jumped out of range as well. Out of his CBC his monocytes were elevated. We received the results the following week. The vet finally agreed that it may be Cushing's and recommended a low dose Dex test.

September 18th, 2018
Bowie went in for his Dex Suppression test. Based on the results my vet confirmed it was Cushing's. He recommended an Ultrasound to diagnose the type of Cushing's.

September 24th, 2018
He had his ultrasound today. I'm still waiting on the official report but my vet followed up and said the ultrasound showed enlarged adrenal glands (equally enlarged/ and no tumours present), a tumour on his liver (based on size/shape he believes it to be benign), and thickening of the bile in his gall bladder. I might be quoting that last one wrong. He also said, based off the ultrasound he is diagnosing the Cushing's as Pituitary based.

He recommended we continue Denamarin, and he has prescribed Ursodiol for the gall bladder, and hold off on treating the Cushing's with any drugs for now. I spoke to him about the dex test returning a false positive, but he said it wasn't likely due to his enlarged adrenal glands. Since this whole adventure started we have discontinued his use of Heartworm Preventative/Flea medicines as he's mainly indoors and never had problems)

Below are his test results. Only including things outside of range. Please let me know if other numbers are needed

Feb 2018 Blood work
ALT (SGPT) 147 (Range 12-118)
Alk PHostaphase 254 (Range 5-131)
GGTP 23 (Range 1-12)
Magnesium 2.7 (Range 1.5-2.5)
Urinalysis: Specific Gravity 1.004 (Range 1.015-1.05)


Sept 2018 Blood work
AST (SGOT) 79 (Range: 15-66)
ALT (SGPT) 208 (Range 5-131)
GGTP 43 (Range 1-12
Cholesterol 529 (Range 92-324)


Dex Suppression test
Cortisol Sample 1 2.5 (1 - 5 ug/dL)
Cortisol Sample 2 Dex 1.7 (0 - 1.4 ug/dL)
Cortisol Sample 3 Dex 2.7 (0 - 1.4 ug/dL)

Please let me know if I can provide other information, and thank you for any help or support.

[Squirt's Mom]

Hi and welcome to you and Bowie!

I am sorry you found need of us but am very glad you are here. The Cushing's diagnosis is highly suspicious in my mind due to the tumor on the liver. When my Squirt was first diagnosed she tested positive on the LDDS, HDDS (no longer used), the ACTH, and the UTK panel (a specialized ACTH that looks at other hormones). However an abdominal ultrasound found a tumor on her spleen and once that tumor along with half her spleen were removed her cortisol returned to normal and remained normal for several years to follow. That tumor on her spleen had caused her cortisol to rise naturally in response to the stress and caused false-positives on ALL her Cushing's tests.

Cortisol is one of the hormones that is designed to react to stress, internal or external. The LDDS and ACTH can only tell us that the cortisol is elevated but not WHY and the LDDS is well-known for returning false-positives in the face of any non-adrenal illness, like a tumor. None of the cush tests are 100% reliable as a diagnostic tool sadly - it takes the tests plus signs PLUS ruling OUT any other reason the cortisol may be elevated (such as a tumor) as well as other diseases that can mimic Cushing's like diabetes, kidney and liver disease. Bowie's lab work is mildly elevated compared to many cush pups - we typically see the ALP in the 1000's, very very much over the upper normal range. His is only slightly elevated but all his liver enzymes are out of whack, in keeping with a stressed liver. The adrenals would be enlarged in response to the stress the tumor is causing which is telling the pituitary to tell the adrenal to work HARD to release more and more cortisol - same scenario found in Cushing's but not limited to Cushing's. So in my book, Bowie falls into the category of questionable Cushing's diagnosis and I agree whole-heartedly with his vet that said to hold off on treatment.

FYI - Rimadyl is known to cause the liver to be extremely stressed so I would not use that drug ever again. There are other options that work just as well if not better without putting such strain on the liver.

I am sure others will be along soon to share their thoughts with you, too. You and Bowie are family here now so never hesitate to ask questions or just come and talk should you need to lean on an understanding shoulder.

Hugs,
Leslie

[Harley PoMMom]

Hi and welcome to you and Bowie!

I am so sorry that your sweet boy is going through so much and we will do our utmost to help. Thank you for all the detailed information on Bowie as it really does enable us to provide you with our best possible feedback. And of course, I do have a few questions Does Bowie have diluted urine? Was an urine sample collected for an urinalysis, and if so, could you post those findings? Has the vet mentioned performing a bile acid test to see if the liver is functioning properly? Was the pancreas visualized on the ultrasound?

I'm just not totally sold that Bowie has Cushing's even though some of his symptoms can be associated with that disease. My reasons for saying this is because any chronic illness can cause the adrenal glands to be enlarged. Also, the low-dose dexamethasone suppression test can give a false positive result if other nonadrenal illnesses are present. My recommendations would be to have Bowie's urine cultured to see if an UTI is brewing which would cause an increase in drinking/urinating and have a bile acid test performed to check the functionality of the liver. The ALT, SGPT, ALK Phostaphase, and GGTP are liver enzymes, however if something is going on with the bile duct/gall bladder than those levels can be elevated and treating with the Ursodiol is generally what is prescribed initially. So, after an UTI is ruled out, the bile acid test is normal, and Bowie has been on the Ursodiol for a few weeks, I would have his blood work (CBC/chemistry) redone and go from there.

Again, I am sorry for the reasons that brought you to us but glad you found your way here, and remember, your not alone on this journey as we are right there beside you both.

Lori

[JulieDavis]

Thank you for your in-depth reply Leslie. We are considering doing a biopsy/removing the tumour entirely as it is operable. However my vet doesn't think this is the best plan as he is pretty confident it is benign and would be an "invasive surgery for peace of mind." I am aware now about Rimadyl so it will not be used on my pups ever again. I initially asked about side effects but was told they were mild if any. Of course we are not given brochures/detailed pamphlets for medications for our pets as we are for our own medications. I fear that if he doesn't have Cushing's, this may be what started this whole process. I'm wondering if the tumour on the liver could be contributing to the thickening of the bile in his gall bladder. I'm also wondering or Urositol is the best first approach or whether we should go ahead with the surgical route. Because of his mild elevation on his bloodwork our vet was very cautious and not very confident to pursue Cushing's but seems more confident now. I however feel the opposite.

Hi and welcome to you and Bowie!

I am sorry you found need of us but am very glad you are here. The Cushing's diagnosis is highly suspicious in my mind due to the tumor on the liver. When my Squirt was first diagnosed she tested positive on the LDDS, HDDS (no longer used), the ACTH, and the UTK panel (a specialized ACTH that looks at other hormones). However an abdominal ultrasound found a tumor on her spleen and once that tumor along with half her spleen were removed her cortisol returned to normal and remained normal for several years to follow. That tumor on her spleen had caused her cortisol to rise naturally in response to the stress and caused false-positives on ALL her Cushing's tests.

Cortisol is one of the hormones that is designed to react to stress, internal or external. The LDDS and ACTH can only tell us that the cortisol is elevated but not WHY and the LDDS is well-known for returning false-positives in the face of any non-adrenal illness, like a tumor. None of the cush tests are 100% reliable as a diagnostic tool sadly - it takes the tests plus signs PLUS ruling OUT any other reason the cortisol may be elevated (such as a tumor) as well as other diseases that can mimic Cushing's like diabetes, kidney and liver disease. Bowie's lab work is mildly elevated compared to many cush pups - we typically see the ALP in the 1000's, very very much over the upper normal range. His is only slightly elevated but all his liver enzymes are out of whack, in keeping with a stressed liver. The adrenals would be enlarged in response to the stress the tumor is causing which is telling the pituitary to tell the adrenal to work HARD to release more and more cortisol - same scenario found in Cushing's but not limited to Cushing's. So in my book, Bowie falls into the category of questionable Cushing's diagnosis and I agree whole-heartedly with his vet that said to hold off on treatment.

FYI - Rimadyl is known to cause the liver to be extremely stressed so I would not use that drug ever again. There are other options that work just as well if not better without putting such strain on the liver.

I am sure others will be along soon to share their thoughts with you, too. You and Bowie are family here now so never hesitate to ask questions or just come and talk should you need to lean on an understanding shoulder.

Hugs,
Leslie

[JulieDavis]

Hi Lori,

When his urine was originally checked it was extremely dilute which would make sense as he was extremely thirsty. But I believe my vet said it was negative for UTI. This was back in February a few months after this all started. He doesn't have accidents though and is on controlled amounts of water (measured and given with each meal on the side/after walks/and whenever he asks for it). I am hesitant to leave water out for free drinking because my other dog has a history of getting UTI's with free standing water (Me and my vet have no clue why but she's been like that for 9 years).

Here are his Urinalysis results from Feb 2018. Only one number was out of range.
Color: Yellow
Appearance: Clear
Specific Gravity 1.004 (range 1.0145 - 1.05)
pH 6.5 (range 5.5-7)
Protein - Negative
Glucose - Negative
Ketone - Negative
Bilirubin - Negative
Blood - Negative
WBC -None
RBC - None
Casts - None Seen
Crystals - None Seen
Bacteria - None Seen
Epithelial Cells - None Seen

A bile acid test has not been done. The only thing I'm aware of is thickening of his bile in the gall bladder. I will check about the pancreas. My concern about Urosodiol is that it shows one side effect is worsening of liver disease. Although we're not even sure if he has that. Also it seems that a bile acid test cannot be done if the gall bladder is being treated with Urosodiol (he isn't yet as we're waiting on the medicine). I will look into that and reach out to my vet about it.

Thank you for your response!

Hi and welcome to you and Bowie!

I am so sorry that your sweet boy is going through so much and we will do our utmost to help. Thank you for all the detailed information on Bowie as it really does enable us to provide you with our best possible feedback. And of course, I do have a few questions Does Bowie have diluted urine? Was an urine sample collected for an urinalysis, and if so, could you post those findings? Has the vet mentioned performing a bile acid test to see if the liver is functioning properly? Was the pancreas visualized on the ultrasound?

I'm just not totally sold that Bowie has Cushing's even though some of his symptoms can be associated with that disease. My reasons for saying this is because any chronic illness can cause the adrenal glands to be enlarged. Also, the low-dose dexamethasone suppression test can give a false positive result if other nonadrenal illnesses are present. My recommendations would be to have Bowie's urine cultured to see if an UTI is brewing which would cause an increase in drinking/urinating and have a bile acid test performed to check the functionality of the liver. The ALT, SGPT, ALK Phostaphase, and GGTP are liver enzymes, however if something is going on with the bile duct/gall bladder than those levels can be elevated and treating with the Ursodiol is generally what is prescribed initially. So, after an UTI is ruled out, the bile acid test is normal, and Bowie has been on the Ursodiol for a few weeks, I would have his blood work (CBC/chemistry) redone and go from there.

Again, I am sorry for the reasons that brought you to us but glad you found your way here, and remember, your not alone on this journey as we are right there beside you both.

Lori

[Harley PoMMom]

When his urine was originally checked it was extremely dilute which would make sense as he was extremely thirsty. But I believe my vet said it was negative for UTI. This was back in February a few months after this all started. He doesn't have accidents though and is on controlled amounts of water (measured and given with each meal on the side/after walks/and whenever he asks for it).

When urine is diluted a regular urinalysis may not pick up bacteria in the urine so in this case an urine culture and sensitivity test is recommended.

When a dog has Cushing's their body is producing excessive amounts of cortisol. This over abundance of cortisol makes their kidneys work harder, meaning it increases the volume of urine and number of times a dog has to pee. To keep up with those over loaded kidneys a cushdog has to drink more water, it is vital not to restrict water if a dog has Cushing's or is suspected of having this disease because they can become dehydrated really quick.

Also it seems that a bile acid test cannot be done if the gall bladder is being treated with Urosodiol (he isn't yet as we're waiting on the medicine). I will look into that and reach out to my vet about it.

If a dog is taking Ursodiol it is recommended that they stop taking it for 4 days before a bile acid test is performed.