Advice and diagnosis for Reagan

Hello everyone,

I'm hoping to get some advice and guidance from this wonderful community. My dog, Reagan, is a 14-year-old Border Collie mix, and we recently took her to the vet after she had two episodes of an upset stomach with diarrhea and vomiting.

While at the vet, we mentioned a few other things we've noticed over the past six months: she has increased urination, seems a bit more lethargic, and has some muscle weakness in her back legs. Our vet examined her and noted she has an enlarged liver and arthritis. We did blood testing and saw increased levels of liver enzymes. Based on all of this, the vet suspects Cushing's disease and has recommended additional testing, possibly including an ultrasound.

This is a tough situation for me. I want to do what's best for Reagan, but my wife and I just got married a month ago, and money is extremely tight. I'm trying to make the most responsible decision for Reagan, especially considering her age and the fact that she gets very anxious at the vet. It also seems like she doesn't have some of the other common symptoms of Cushing's, which is making me wonder how necessary all the testing is right now.

I've attached her recent lab results below. Any insights, advice, or personal experiences you can share would be so helpful. I'm feeling a bit overwhelmed and just want to make the right choice for her well-being.

Thank you so much in advance for your help and guidance.

She had a urine analysis twice. These are from 4/8/25.
AST 17
ALT 130
ALK 129
Calcium 11.8
Colesterol 347

These are the full results from Aug 14th

GLU 91 mg/dL
SDMA 10 pg/dL
CREA 1.1 mg/dL
BUN 16 mg/dL
BUN/CREA 15 P
HOS 4.0 mg/dL
CA 11.0 mg/dL
TP 8.0 g/dL
ALB 3.7 g/dL
GLOB 4.3 g/dL
ALB/GLOB 0.9
ALT 374 U/L
ALKP 1916 U/L
GGT 11 U/L
TBIL 0.4 mg/dL
CHOL 311 mg/dl
AMYL 1056 U/L
LIPA 639 U/L
Na 156 mmol/L
K 3.9 mmol/L
Na/K 40
CI 118 mmol/L
Osm Calc 308 mmol/kg
TT4 0.8 ug/dL

RBC 8.71 M/uL
HCT 48.1 %
HGB 16.6 g/dL
MCV 55.2 fL
MCH 19.1 pg
MCHC 34.6 g/dL
RDW 25.9 %
%RETIC 0.4 %
RETIC 34.5 K/pL
WBC 7.91 K/pL
%NEU 72.4 %
%LYM 15.6 %
%MONO 8.4 %
%EOS 3.7 %
%BASO 0.0 %
NEU 5.72 K/uL
LYM 1.23 K/uL
MONO 0.66 K/uL
EOS 0.29 K/pL
BASO 0.00 K/HL
PLT 450 K/uL
MPV 13.9 fl
PDW 14.7 fL
PCT 0.62 %

Hello, and welcome to you and Reagan (and congratulations on your wedding!). I’m sorry that Reagan is having any problems at all, but like you, given her age and moderate symptom profile, I’m not sure I’d proceed with a lot of additional testing right now, either. But I’ll give you my thoughts in greater detail in another reply. For right now, it’ll help us a lot if you can identify any of her lab results that are marked as being abnormal, along with the normal range. You’ve done a great job of giving us her complete profile. However, it’ll be good for us to now focus on any specific results that are out of range.

Thanks in advance for giving us this additional info. And once again, welcome to you and your sweet girl!

Marianne

Hello,
Thank you so much for your help! I hope the image shows in the following link, but the higher than normal tests are the ones below
PCT is high at .62%. Normal is .14-.46
MPV is high at 13.9 Normal is 8.7-13.2
RDW is high at 25.9%. Normal is 13.6-21.7
ALT is high at 374u/L. Normal is 10-125
ALKP is high at 1916. Normal is 23-212



https://imgur.com/a/AqOVBJf

Thanks so much for this additional information. I’m not really familiar with the significance of the lab values of PCT and RDW. But elevations in platelet counts (MPV) and liver enzymes (ALT and especially ALKP) are commonly associated with Cushing’s. So I do understand why your vet is suggesting that Cushing’s may be present. However, we’re left with the question as to what to do about it. I’m going to repost a reply that I previously gave to a member in a similar situation with an older dog

Quote:

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In my own mind, the decision whether or not to treat any dog depends on a number of factors:
age of the dog, apparent discomfort, severity of symptoms (both external and internal), etc. Cushing's is typically a slowly developing syndrome, and the decision to actively treat may come sooner or later in the process. The primary goals of treament are to control the troublesome observable symptoms (things like excessive thirst, urination, hunger, panting, muscle wasting), and also to halt/delay silent internal damage. Untreated Cushing's can make dogs more vulnerable to things like high blood pressure, high cholesterol, protein-losing kidney disease, blindness (as a result of high blood pressure), pancreatitis, ligament damage and slow healing, chronic infections and skin issues, GI disturbance, etc. Not every dog will suffer from all or even many of these issues, but the disease can make them happen. For a younger dog, I would want to provide as many quality years of life that I could, and that would mean putting a stop to the development of the internal systemic damage as well as relieving the uncomfortable outward problems.

However, since the damage usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly. Instead, my biggest concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I might choose not to treat, especially if my senior dog suffers from inflammatory conditions like arthritis that may actually be soothed by the elevated cortisol level of Cushing's. Treatment also involves frequent vet visits and blood draws, especially at the beginning. So again, if vet visits are really stressful for a senior dog, I'd also factor that into my treatment decision.

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So I think that if Reagan were mine, given her age, my primary focus would be on her overall current quality of life. If she doesn’t seem to be outwardly too uncomfortable, I’d likely hold off on further diagnostics at this point, knowing that you can always change your mind at any time in the future. But please feel free to ask any additional questions you may have about the testing process and treatment protocols should you decide to proceed.

Marianne