14 year-old Shih Tzu With Recent Cushing's Diagnosis

Hi,

My Shih Tzu, Hannah, who will be 12 tomorrow, was just diagnosed with Cushing's Disease this week. She went into the vet for her yearly dental cleaning, but her bloodwork was concerning and led my vet to suspect Cushing's, so we postponed the dental procedure and he instead did the low dose dexamethasone suppression test. On her regular blood test, everything was in the normal range except for PLT (which I figured out is platelets, and the vet never mentioned this, so he must not be concerned-should I be?) and ALKP. The normal range for PLT is 175-500 and her reading was 618. The normal range for ALKP is 23-212 and hers was 1770. (Last year it was a bit high at 263, but we let it go).

He told me he suspected Cushing's and asked if I have seen any symptoms. She has maybe had a slight increase in drinking (although I never thought she drank enough compared to other dogs previously) and occasionally seems to urinate more. This seems to come and go. Over the last couple of months I have noticed that she seems to eat more quickly and is more often trying to sneak into my other dog's bowl. I increased her feeding amount a little bit since it is winter here, but also noticed that she has lost some weight. She was 10.8 pounds at the vet this week and was 12 pounds 9 months ago.

These are the results he gave me over the phone on the second test: The level he measured at the start of the test (I didn't write down what level this is as I was writing quickly at work, so hopefully you know) was 3.7. After four hours it was 1.9. After 8 hours it was 5.4. He said this can basically confirm the pituitary form of Cushing's. He told me he thinks she is in the beginning stages, as she is showing no major signs, and that it may be a good idea to just watch and see how she does/progresses for now. The medication he recommends we try first (when/if we decide to) is Anipryl because of the low side effects. If that doesn't work he recommends Trilostane. He said the point is really only to treat symptoms and that nothing will add length to her life, which seems to match up with what I read.

I am wondering if you all agree with this diagnosis, and if you think it is smart for me to wait before trying Anipryl since symptoms seem very slight, or if you would start it now. The only other thing that she has started in the last year or so, but has become more frequent is occasional barking at us like she is trying to tell us something (her tail is wagging and she will paw at us), but we can't figure out what she wants-we try letting her out, playing, petting her,etc. Sometimes I wonder if it is old age, and now if it is connected to this. But it also only happens sometimes. She is also a poop eater-she was rescued from a puppy mill and had many litters, and sometimes I think she just wants to go outside because she will dig around in the snow trying to find poop (even though we pick it up). Sometimes this behavior happens more after she or the other dog have recently pooped.

I do like the idea that if there is any cognitive stuff going on the Anipryl could help that too. She doesn't have any hair loss or the pot belly stomach, and no skin infections. She has had allergies for years, but seems to still lick/itch in the winter, and we thought it might also be nerves/mental, as she is a somewhat nervous dog. I now wonder if this could have anything to do with Cushing's...but again, there are no visible signs of problems in terms of coat/skin.

Any advice/opinions you can share will be greatly appreciated. I love my Hannah very much and she is the sweetest most loyal dog I have even known. I want to make the right decisions, but don't want to jump into anything too quickly. I trust my vet, but would like to hear from others too. Sorry this is so long, but I wanted to share everything.

Thank you for reading!

Hannah's Mom

Welcome to you and Hannah!

You have done a wonderful job of summarizing Hannah's situation and your questions. I can often be pretty long-winded in my replies, but given how well you have laid out Hannah's information, I can pretty much leave it at saying that I believe your vet's current recommendation makes a lot of sense. Given the lack of overt symptoms, I believe that most experts would agree with holding off on treatment for the time being. None of the screening tests for Cushing's are fail-safe (it looks as though your vet performed the LDDS test), and until or unless overt symptoms manifest, I believe that a firm diagnosis always remains somewhat in doubt. If and when you do wish to treat, there is probably no harm in starting off with Anipryl, as long as you recognize that only a small percentage of Cushpups respond favorably to it and most do end up requiring a shift to trilostane or Lysodren for effective control of elevated cortisol.

I would make one departure from your vet's comments, though. And that is to say that our experience here has been that many younger dogs who are effectively treated for Cushing's go on to far outlive that "two-year" life expectency that is often quoted. I think that statistic may result from the fact that so many dogs are already older when they are first diagnosed. But for younger dogs, I cannot help but think that their lifespans are extended if the chronic internal organ damage that can be associated with Cushing's is slowed or halted through effective treatment.

At Hannah's age, though, I know her comfort and quality of life are your highest priorities. So I know you will monitor her very closely for the increase in symptoms that would prompt further intervention (or even alternative diagnostics if any problems were not consistent with Cushing's). One additional test that you might wish to consider, now or later, is an abdominal ultrasound. Visualization of the adrenal glands can lend helpful support to a Cushing's diagnosis. And visualization of the other internal organs can help identify any other disease processes that may be going on in addition to, or instead of, the Cushing's.

In the meantime, you may want to consider giving her some benign supplements that support liver function. If others don't beat me to it, I'll stop back by with info in that regard that you can discuss further with your vet.

Marianne

Hi and welcome from me as well. I agree with Marianne - it doesn't appear that there is a need to rush in treating as there are no problematic symptoms. My girl Haley was diagnosed at 12 1/2 and treated for over 4 yrs... she passed in May of 2010 but not from cushing's. We used lysodren.

The other thing I disagree with your vet on is anipryl. There are pluses and minuses to all drugs but it really hasn't been used much in years because it does not work for most dogs. I would read up on it before going there. Most now use trilostane or lysodren. They work differently but seem to be equally effective.

But for now I'd just take it slow because you really don't have any symptoms to treat. You could use milk thistle to help with the alk phos/liver enzymes. It brought Haley's numbers down from 2000 to 700's. Cush dogs typically don't have normal liver enzymes even after treatment.

Glad you found us. Keep us posted on whatever you decide and feel free to ask questions. Kim

Hi and welcome from me and my boy, Harley.

An increase in drinking, urinating more frequently, and weight loss even though one has been feeding more, can be symptoms of diabetes in a dog. Was an Urinalysis done too? If so, were ketones or glucose found in Hannah's urine?

Lori

Hello All-

Thank you so much for your replies. I REALLY appreciate the advice and support of others who have been through this, or are familiar with what we are going through.

I do think I will wait to see what happens before moving forward with any treatment. I also talked with my vet about doing a urinalysis on Hannah, since she has a history of problems with crystals in her urine and has been on a prescription food (Royal Canin Urinary SO) for several years to control the issues, and I would like to see if she is doing okay in that area since now I may not notice problems if she is urinating more often due to Cushing's. Hopefully doing that will also show if there is anything else going on with Diabetes? I don't know if anything in the blood test he did pre-dental would show up if Diabetes was an issue?

My vet does not seem to use Lysodern at all. From what I have read, I have to say I would be a complete nervous wreck about trying it as well. Also, I am gone several hours each day at work (I am a teacher) and I would worry about missing concerning symptoms. I do know his other choice is Trilostane, but he seemed to think trying Anipryl first, to see if it did work in her case, would be less risky. I have to say I agree. I feel very nervous about adverse reactions and these Addisonian issues; however, if Anipryl didn't work, and her symptoms were there, I would try the Trilostane.

Where do I find the milk thistle? I think I ready other information about people trying supplements with some success and I would be open to that as well.

My vet said that Cushing's varies with each dog and each case is different, which makes sense to me. My parents' collie had Cushing's and had to be put to sleep when she could no longer get up and was leaking urine almost constantly. She went very quickly from the time of diagnosis-didn't even make it 6 months, but they determined she had a tumor on her adrenal glands which metastasized to her liver. To say the least, when I heard Hannah's diagnosis, I didn't have very high expectations. After being reassured by my mom and my vet, I realized that Hannah's situation is not as bad. My parents dog was drinking a bucket of water, panting constantly, leaking urine, having trouble with her back legs/end, etc. and everything progressed quickly. Anyway, I asked my vet to give me his best guess on how long Hannah might make it, as I was wondering if she even has a year. He guessed two to three. Does anyone else have any idea, based on her limited symptoms at this point? My concern is that it could progress really quickly, even though she doesn't seem too bad now.

Here are some other questions I have:
-Should I move forward with a dental? He said they can still do one when we are ready. I know Cushing's dogs can be more prone to infection, but I also don't want to spend tons of money not knowing what other treatment, procedures she may need. She doesn't have great teeth, but has had many pulled, and has had yearly dentals as long as I have had her (the past 8 years).
-Does it make sense that she is eating more and losing weight? She is 10.8 lbs. now and was 12.3 in June. (I am wondering if this could be due to muscle loss).
-Do Cushing's dogs lick/itch a lot, even without any visible skin conditions? This seems to be worse this winter (when her allergies have normally subsided in winter). And is the random, but somewhat incessant barking and pawing at us when we have no idea what she wants, something that could be part of Cushings?
-Do you think the LDDS test with the 4 and 8 hour checks does clearly indicate the pituitary form of the disease?
-Would the abdominal ultrasound show anything other than enlarged adrenal glands to show more evidence? Or were you thinking it might show a tumor there, which would mean it is not a pituitary issue?
-Is there any "typical" progression with this disease? Like how long it might be before Hannah shows worse symptoms? I realize all pets are different, but my vet said it is typically slow, and my only experience is my parents' dog, which was VERY quick.

I will definitely be following up with my vet with all of my questions and concerns to make sure I do the right thing for Hannah. I just don't have tons of money to do everything (my husband and I are both teachers) and want to make sure I prioritize my issues and only test what is necessary at this point...as I also still need to figure out if she will get a dental and I have another Shih Tzu to take care of as well. They are both due for their exams and vaccines in April. That is why I thought the urinalysis might be good and not too expensive.

Again, thank you SO much for your help and suggestions. I will check back often and keep you updated.

Hannah's "mom", Julie

Welcome Julie.

Sorry to hear that your baby is having problems.
Hanna may have a while to go. Shih Tzus live long. My Shih Tzu Cushing girl lived to be 15.

Mine had more Thyroid symptoms than Cushings. She never drank a lot or peed a lot (it was only a little bit more), even before diagnosis. She was hungrier and gained weight... In retrospect, I felt that mine had Cushings for a few years before the diagnosis. There was some panting when I walked her for 3-4 years. Basically, I noticed that she was "getting older" and stopped more often during her walks and had some panthing, and hing legs shaking. That's when I took her in for bloodwork. She was diagnosed with Hypothyroid. Her liver enzymes were elevated, Cholesterol and Triglycerides. Then we did the ACTH and it was Cushings. Mine did very well on Trilostane once the adjustment period was done with (approx 4 weeks). Mine had the additional Thyroid which made things a bit tricky loading the Trilo and Soloxine at the same time. It doesn't mean that yours will be the same as any of ours, but you may see some similar symptoms and/or behaviors in Hanna.

Cushings is not a death sentence, but it complicates things; it mimics many other things going on. Many times the dog will have Cushings/Diabetes/Thyroid combos, two or only one of the three. Once the dog gets diagnosed with Cushings many times Vets think that Cushing is responsible for all of it's ills. Sometimes that's true, and other times it's not.

-Anipryl did not work well on my sisters' dog.
-if your Vet starts Hanna on the lowest dose of Trilostane 1mg/lb it may not be so bad. Check ACTH 14 days later to see if an increase is necessary...
-As far as Hanna pawing and barking...is she maybe begging for more food? That may be her new Cushings hunger call?
-Ultrasound will show if there is an adrenal tumor (I don't think LDDS is conclusive for deferentiating tumors. Sometimes there is tumor on the adrenals and pituitary-rare),and other organs like the condition of the Liver, and the bladder stones...
-Dogs need a dental because bad teeth can affect their Liver, kidneys etc. Cushings can affect those organs. In fact, from now on you will probably see some blood work adjustments.
-actually she shouldn't itch with Cushings because the extra cortisol pumped out should keep allergies in check, unless something else is going on...
-typical progression is what I've decribed with my Shih Tzu above. It may not bother some people, but the panting and stopping bothered me. As I said, a few years earlier she had 'some' panting, but that didn't bother me, until she had that depressed, oldish look, and walk. A Shih Tzu should not look or act old at 12. Mine was diagnosed at 13and was full of life until 15....and got cancer.
-IMO, a full chemistry profile, CBC, T4, UA and an Ultrasound is a good idea. You do what's comfortable for you.

You could ask your Vet for a copy of Hannas bloodwork so you have a file for future comparison.

Julie,

I too am confused about the weight loss as it is the opposite of what you see with cushings. I would want to rule out diabetes. You should have a glucose reading from the blood panel if they did a complete one. If not I would go there next to be safe. Diabetes and cushings have similar symptoms.

I wish I could say that there is a natural progression with cushings but I've been here for 6 yrs now and there really isn't. The leading experts in the field all agree that it is not necessary to treat if the symptoms aren't there so I wouldn't start anything at this point in time. You will know if you see an increase in urination, etc.

You can buy milk thistle capsules at any health food/vitamin store. I just poured half a capsule over food in the a.m. and the other half at night.

Cush dogs do tend to lick alot and can have skin issues. (this is all covered in our important info section in great detail) Your friend's dog that passed had an adrenal tumor and sometimes they grow quickly which might be what happened. Your LDDS test result is indicative of pituitary cushings. It is the most common.

I would double check on the blood test to rule out diabetes. The LDDS test is not fool proof. My dog had a false positive on it and four false positive ACTH tests. :o Cushings can be tough to diagnose so you can't really feel comfy with only one test.

Hope this helps. Kim

I see you've already gotten some great information from others. Here's a few more thoughts from me:

Quote:

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Originally Posted by jmac

Hopefully doing that will also show if there is anything else going on with Diabetes? I don't know if anything in the blood test he did pre-dental would show up if Diabetes was an issue?

I'm guessing that Hannah's blood glucose level was part of the pre-dental labwork, and that it was normal. If that value had been elevated, your vet would have suspected diabetes. But you can double-check with him as to what Hannah's glucose level was on that test.

Where do I find the milk thistle? I think I ready other information about people trying supplements with some success and I would be open to that as well.

As Kim said above, you can buy milk thistle in health food stores. SAM-e is another supplement that is often recommended for liver support. Here's a link that gives more info about both these supplements:

http://www.k9cushings.com/forum/showthread.php?t=192

I would not waste my money on other supplements advertised on the internet as specifically "curing" or controlling Cushing's. There is no scientific evidence that they help.


-Should I move forward with a dental? He said they can still do one when we are ready. I know Cushing's dogs can be more prone to infection, but I also don't want to spend tons of money not knowing what other treatment, procedures she may need. She doesn't have great teeth, but has had many pulled, and has had yearly dentals as long as I have had her (the past 8 years).

As has already been said, you don't want infections to get out of control in Cushpups. The one reservation that I would have about a dental is the fact that most anesthetics can be hard on the liver, and we know from her lab results that Hannah does have some liver involvement going on. So in my mind, performing the dental would involve the judgement call as to whether her teeth are currently in a state where it is worth burdening her liver with the anesthetic. Again, something to discuss further with your vet.

-Does it make sense that she is eating more and losing weight? She is 10.8 lbs. now and was 12.3 in June. (I am wondering if this could be due to muscle loss).

While it is true that most Cushpups gain weight rather than lose it, my own boy also lost weight prior to diagnosis even though we even switched to a higher-caloric food in order to try to "beef him up." So I do know that weight loss is possible. He definitely did lose muscle mass during the pretreatment period.


-Do Cushing's dogs lick/itch a lot, even without any visible skin conditions? This seems to be worse this winter (when her allergies have normally subsided in winter). And is the random, but somewhat incessant barking and pawing at us when we have no idea what she wants, something that could be part of Cushings?

Again, while it's true that steroids can aid in controlling the manifestation of allergies in many dogs, my Cushpup was also a "weirdo" in this regard and licked his front paws incessantly for a long, long time prior to diagnosis at a time when his cortisol level was very high. As soon as his cortisol level was controlled with trilostane, the licking magically ceased. I have no explanation for what was going on, but it was a clear and definite change for him.

-Do you think the LDDS test with the 4 and 8 hour checks does clearly indicate the pituitary form of the disease?

The pattern of Hannah's LDDS test is consistent with pituitary Cushing's (suppression at the 4-hour mark with "escape" at the 8-hour mark). In terms of the numbers themselves, she is right at the borderline, because vets are generally looking for either a 4 or 8-hour result that is less than 50% of the baseline cortisol level. So with a baseline of 3.7 and a four-hour level of 1.9, she is hovering right there at the 50% mark that would be diagnostic of PDH. Here is a link to a thread that will give you more info about interpreting LDDS tests:

http://veterinarymedicine.dvm360.com.../detail/580093

-Would the abdominal ultrasound show anything other than enlarged adrenal glands to show more evidence? Or were you thinking it might show a tumor there, which would mean it is not a pituitary issue?

Yes, exactly right, the appearance of the adrenals could give further support for either the pituitary or adrenal form of the disease. But in the absence of overt Cushing's symptoms in Hannah, I was also thinking as much along the lines of making sure that there is nothing strikingly abnormal about her liver (other than the changes that are typical of Cushing's) or other internal organs that might account for her test elevations.

-Is there any "typical" progression with this disease? Like how long it might be before Hannah shows worse symptoms? I realize all pets are different, but my vet said it is typically slow, and my only experience is my parents' dog, which was VERY quick.

I agree with your vet's assessment that Cushing's is generally a slowly progressing disease in the absence of aggressive tumors, which are the exception rather than the rule.

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Thank you all again for your helpful responses. I have done a lot of reading since Thurs. afternoon when I got this news. I was able to find information on the LDDS test and do feel better that Hannah's test is suggestive of PDH. Even though my vet explained it to me it took reading much more on the internet to understand it better.

She did have a CBC done and her glucose levels were normal. I have decided to have a UA done on her this week to make sure there is not a UTI. Also, her cholesterol was normal, as well as her BUN. (I read on some site that those levels typically are involved in Cushing's too; I believe it was high cholesterol and lower BUN). Her other liver level (ALT) was also normal. Everything was in the normal range other than her platelets and her ALKP. Should I post the complete result (I have a copy), or would it not help anything if the other levels are normal?

I will look more at the links you provided (I looked through them yesterday) to find out more info. about milk thistle. I'm hoping it would also tell me the dosage.

I have really paid attention over the weekend and am starting to feel that there are enough symptoms there-the increase in water intake and an increase in the amount of time she pees, as well as the crazy appetite-for me to do something. (I think I mentioned before that Hannah didn't seem to drink/urinate enough in my opinion, compared to other dogs, and it has definitely increased). Therefore, I think I am going to start with the Anipryl first to see if it does anything. I have read a lot and know that only 20-40% of people feel it is really effective, but with low risks, I would like to start there. Then if after that two to three month period it hasn't done anything I will move onto the Trilostane, my vet's other recommendation. Does that make sense to the rest of you, or do you still think I should wait until things get worse? I don't want to wait until she is peeing all over the place if I notice SOME changes. My vet said they have two doxies who are being very successfully treated with Trilostane right now. Is it correct that the main period you have to really be careful/watch your dog closely is that initial "loading" period the first few weeks (when you also get the blood tests done, etc.)?

I don't feel that she really shows any of the other symptoms of liver disease and assume that since her glucose is normal now and if her UA is done we should also be able to rule out diabetes and see if a UTI is present. I think I will talk with my vet about the dental and will maybe wait a little while before doing that. I always got nervous having her anesthetized anyway, and right now I know I would be worse. I feel like I am still a bit skeptical about her diagnosis, but at the same time, many pieces seem to fit at this point, and it sounds like each dog is different.

On a side note, today is Hannah's 12th birthday, so I'm going to spoil her like crazy and try not to think about Cushing's all day. I just want to be educated and make the best decisions for her. . I don't want to ignore the symptoms/changes I have seen, but I don't want to dive into anything either. That balance is tough, so I appreciate your advice.

Thank you again for your help! I GREATLY appreciate it!

Julie

Oh Julie, Happy Birthday to sweet Hannah!!!!!!!!!!!! :D :D :D :D :D :D

I think you're absolutely right to take this day "off" from worrying and instead to totally focus on celebrating with your girl! :) :)

But as far as beginning the Anipryl, if your vet agrees, I don't see any harm in going ahead and giving it a try at this early stage. If Hannah's symptoms do continue to increase and you move on to trilostane down the road, ongoing monitoring via blood testing will continue for as long as she remains on the medication. However, once dogs are stabilized on an effective dose, the testing can become much less frequent.

Marianne

Hi All,

I just have a couple of updates on Hannah. First of all, I checked and her blood glucose level was normal. I also had a UA done on her today and she didn't have any infections or anything really strange. My vet did say her specific gravity was just slightly low. He said hers was 1.023 and normal is 1.025 or more. He said that dogs who are drinking more water have less concentrated urine, but that hers is still pretty good considering I have noticed an increase in drinking. (Sometimes she gets drinks every 15 min., but then she will go for hours without. She goes all night with no drink or trip to go potty).

He told me dogs should drink about 30 ml per pound per day. Hannah is 10.8 lbs. I am guessing she is drinking about 1.5 to 2 cups (which isn't WAY out of control), if my conversion is correct. My other Shih Tzu, Izzy, also drinks from the same bowl, so this is my best estimate.

Anyway, I am glad there was no infection present in the urine. I asked him more about her weight loss, rather than the typical gain. He said all cases are different and said it would be okay for me to feed her more to see if she beefs up at all. I asked him if he was concerned about other liver problems. He said at this point he would try the Anipryl and sew what happens. If it doesn't work in two to three months, then he would want to do an x-ray and abdominal ultrasound prior to starting treatment with Trilostane (or something else) to see how her adrenal glands and liver are looking. I asked why the x-ray was necessary and he said that specialists come in from the U of MN to do this and he would ask if the x-ray needed to be a part of it. (It would run about $615 for both). He said sometimes they see enough in an x-ray not to have to do the ultrasound, but he would look into it.

I asked him about milk thistle and Sam-e, since I have read about it on this site and another one. He said I could try something like that if I want, that it could help support her liver, but not treat Cushing's. I would like to do both, and like the idea of helping her liver. He mentioned Denamarin. Does anyone have any thoughts on this (or any of the others I mentioned)?

I am still debating when to do the dental. Knowing there could be the cost of the ultrasound/x-rays in the near future I am worried about cost, but I also know the dental is important. My thought is that it would be about June by the time we would do further testing (unless something changes), so maybe I will wait to see what happens with that, then get her teeth cleaned. She was only just due in Feb., so I won't be too far overdue. Plus, I teach summer school so we have a little extra income in the summer if there are more procedures.

I think I have calmed down a little in the past few days, but I still feel like I watch her like a hawk. There is always this worry that it is progressing before my eyes and that some new symptom will show up. Then there is the fear that there is something else wrong. Diabetes seems to be ruled out from the normal blood glucose test and the UA. She shows no other signs of liver problems at this point either, but does show signs of Cushing's. There is just the weird weight loss with the increased appetite. I guess at this point I am glad her symptoms are limited and she still seems like my happy girl who follows her mom everywhere.

I have to say again how happy I am to have this site and all of you to help me out.

Sincerely,

Julie & Hannah

My 12 year-old Shih Tzu, Hannah, with a recent Cushing's diagnosis is going to start Anipryl tomorrow (we are going to try it first for a couple of months before Trilostane or something else, if necessary) and my vet is also going to order the chewable Denamarin tablets for her. He said the chewable ones are nice because they are for dogs of all sizes and that Hannah, at 10.8 lbs., will take 1/2 a tablet per day (which is what I found online as well). Does anyone have experience with these tablets? Her ALKP level was 1770 (normal was up to 212, I believe) and I asked to try something that would support her liver. It says they are liver flavored and I'm hoping she'll want to chew them. Otherwise I'm not sure what to do...

Thanks!
Julie & Hannah

Moderator's Note: Julie, I have moved your post with Hannah's update into Hannah's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, when necessary.

Hello again...

I am looking for some other opinions about how to proceed with Hannah. (12 y/o Shih Tzu with recent Cushing's diagnosis). You can read my initial post to see Hannah's test results. The plan as of now with my regular vet is to treat with Anipryl (we started yesterday) for two months and to see if the symptoms have improved. I also asked about something to support her liver and he has ordered Denamarin. We would re-check liver values in two months as well. If the Anipryl is not working, he said he would then pursue other tests (first doing an ultrasound and x-ray) to see how her organs look,and if it still looked like Cushing's, he would then try Trilostane.

I feel good about that for a couple of reasons-the low risk of problems with Anipryl IF it works, and the fact that I am a teacher and this would then be about the time for our summer break and although I teach summer school, I will have more time to watch her closely, and I will also have more income for tests/treatment. However, I am a worrier and I have been wondering if this is a good decision or if I should do something now. I am so worried about not helping her enough, or doing the wrong thing, or her getting dramatically worse during this two month period. I am also still confused about if it for sure IS Cushing's. She did have high ALKP levels (my vet said this is often a marker), which led to the LDDS test, which my vet said showed she was positive for PDH Cushing's. A few of you also agreed; however, I do know that often more than one test is needed to confirm this disease.

I am wondering if you would question if does indeed have Cushing's, or if it could be something totally different....or if it is more that it is Cushing's and there could be SOMETHING ELSE too. She does not have diabetes, as her glucose is normal and her urine sample was as well. I know I have read about false positives, but she does have some symptoms (increased thirst/urination, but not out of control, and definite increase in appetite). She has lost weight in the past 9 months (1.5 lbs.) though, not gained, and has been eating more. She doesn't have the potbelly or skin issues. She has no gastrointestinal issues (I know this is another symptom of liver disease) or any other problems, except she does a lot of itching/biting (which she has always done, although it is a bit worse this winter and is usually only a summer allergy problem).

I did find out there is an IM specialist close to me and for $105 she will meet with us, examine Hannah, and review her other records and make a recommendation. I have spent about $500 this past week and have both dogs due for their exams/heartworm test/vaccines in early April(usually a few hundred for that trip), and still have to figure out when Hannah can/should get her yearly dental (usually about $400). Plus, I know the ultrasound/x-ray is likely in the future (about $650), as well as Izzy's (my other dog's) dental in August.

I can't decide if it is worth seeing the specialist now, or if I should wait out the two months and see what happens as long as we have already started something. My husband will support whatever I decide, but is concerned about how much money we may be spending. I am as well, and don't want to totally drive myself crazy doing everything and anything, but also don't want to NOT do something I should. I also realize the specialist could recommend additional tests, which it sounds like my regular vet might do this summer anyway.

Like I said, I am a worrier (and I analyze everything!) so I would love some other opinions. I am so worried about doing the "right" thing, but of course, I have no idea what that is. If you were in my position, what would you do?


Thanks!
Julie

Julie, When you say increased thirst - can you tell us what you mean? Have you measured the daily intake? Normal intake is about an ounce of water per pound.

A couple of things stood out to me in your post - you said the urine test was normal and that Hanna doesn't have a pot belly, in fact has lost weight. None of these are indicative of cushing's. That said, was it the UC:CR test (urine). I am told that this test is very accurate and if a dog can concentrate their urine they don't have cushing's.

I'm not sure if I shared my story with you but my girl Annie (2nd dog diagnosed with cushing's) was misdiagnosed. I was sure she had cushing's - I'd already had one dog with it. She had a false positive on the ldds test. She had 4 false positives on the acth tests. I took her to Kansas State Univ (the closest IMS to where I live) and she even stumped them. Her urine is concentrated, she has no pot belly, she has lost weight. In her case, she had multiple things going on but she has an adrenal tumor that they believe emits signals resulting in cushings like symptoms.

Also if you read all the intl experts in the field you don't treat a dog without symptoms and that is why I asked about the water intake. Cush dogs drink 'buckets' of water so it is important before answering your question that we know what 'increased' actually is.

If the water intake is minimal I wouldn't treat with anything yet because there aren't enough symptoms. Also if water intake isn't significant I would invest my money in the teeth cleaning and save up to go visit the IMS if and when the need arises. These tests are costly as you know. I spent $8000 last year and still don't have a definitive answer as to what is going on with my little gal.

I'm sure others will chime in but I wanted to share my story in the case that it might help. I know its hard to make these decisions... take it all in but don't feel rushed into making a decision because you don't have to treat cushing's right away. Good luck! Kim

Julie, When you say increased thirst - can you tell us what you mean? Have you measured the daily intake? Normal intake is about an ounce of water per pound.

A couple of things stood out to me in your post - you said the urine test was normal and that Hanna doesn't have a pot belly, in fact has lost weight. None of these are indicative of cushing's. That said, was it the UC:CR test (urine). I am told that this test is very accurate and if a dog can concentrate their urine they don't have cushing's.

Hi-
I have not measured her water yet, as I am gone during the day and I have another dog. I don't think they would do too well separated. I will try that sometime on a weekend when I can watch them both closely. I would guess she is drinking about 2 cups or a little over (so 16-20 oz.)of water per day and she is 10.8 lbs.

I don't know if he did the UC:CR test. I think it was a regular UA because I wanted to see if she had a UTI. He did tell me that her urine concentration was 1.023 I believe, and that normal was 1.025 and above, so he said she was concentrating it pretty well, even though it was low.

So...I am thinking maybe continue with the Anipryl to see how she does. See if we can do the dental (but I am worried about the 1770 ALKP level) and then watch and wait and maybe check in with the specialist this summer (or when things progress)?

I want to start her on the Denamarin to help her liver, but I am worried about doing too many things at once. The vet thought that was a good idea and he ordered it and we're waiting for it to come in. He said that would be the only thing that would help change her liver values; the Anipryl would not.

Thanks again for sharing!
Julie

Just thought I would update all of you that we postponed the treatment with Denamarin (Hannah has been on Anipryl for a week) and have decided to move forward with an ultrasound on (and decided postpone the dental until we know what is going on with her). She will get the ultrasound next Wed. and hopefully we will know more about what is going on and what/how we should treat. I will let you know what the results are.

Julie

Julie, we'll be standing by for our update.

Hello Everyone-
Hannah (12 year-old Shih Tzu) had her ultrasound done this morning. I am going to briefly review our situation so you don't have to go all the way back in the thread:

She had blood work done last month before her annual dental. Her Alk Phos level was 1770 and up to 212 was normal. Nothing else was abnormal except her platelet level was slightly high (which the vet didn't even mention). He asked if I had noticed increased thirst/urination and appetite. I had noticed a slight increase in thirst/urination and she definitely wants to eat and eats quickly.

We postponed the dental and tested for Cushing's using the LDDS test. Here are the results: The level he measured at the start of the test was 3.7. After four hours it was 1.9. After 8 hours it was 5.4. He said this can basically confirm the pituitary form of Cushing's. The following week I had him do a UA just to be sure things were okay in that area, as Hannah is also on Royal Canin Urinary SO (she had Struvite crystals in her urine about 5 years ago and has been on it since). He said everything was normal, with the exception of her urine concentration being just slightly low. Hers was 1.023 and that normal was 1.025 and above, so he said she was concentrating it pretty well.

So we decided to do an ultrasound to see what that would show. I don't have the full report yet, but my vet will be emailing it to me once he gets it from the specialist. (They did have a specialist come in to do the procedure because my vet wanted to ensure that it was done well). Basically, it was normal. The adrenal glands were within the normal size range, as was her liver. There was no sign of any tumors or anything abnormal.

While this is good news, I am left a bit confused. The specialist did say that since we don't have any sort of baseline data on Hannah, it is possible that her adrenals were smaller before, but there is still nothing remarkable about them. I asked if they still think she has Cushing's and my vet said yes-- based on the LDDS test and the clinical symptoms I have seen. He said she is probably at the very early stages. We talked about the current treatment (Anipryl for the past 20 days) and that I could finish out my two month supply and see if I notice improvement or I could stop. It makes sense to me to finish it out and see if I notice anything. He said he would not want to treat with anything else at this point and would just want to watch for clinical symptoms and the doctor who did the ultrasound agreed that he would not do anything else right now.

I was worried about her liver since that value is so high, but since it looked normal I guess that takes care of that. My vet said even a slight increase in cortisol can cause the Alk Phosphate level to go up quite a bit. Awhile back, we talked about trying Denamarin or something for her liver. He said he didn't think we needed to do that right now and that we can finish out the Anipryl and see if I notice anything and then go from there and possibly put her on Denamarin at that point. (I had read about some possible side effects with Anipryl and Denamarin and sent it to my vet. He had never seen or heard that but said it was up to me and we could wait and just try one thing at a time). He said that with a clean ultrasound he feels good about doing her dental whenever I am ready.

What are your thoughts about this? Do you think there could be anything else going on? Or is it possible that she is in the very early stages?

Thanks again for your input!
Julie & Hannah

Quote:

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Originally Posted by jmac

While this is good news, I am left a bit confused. The specialist did say that since we don't have any sort of baseline data on Hannah, it is possible that her adrenals were smaller before, but there is still nothing remarkable about them. I asked if they still think she has Cushing's and my vet said yes-- based on the LDDS test and the clinical symptoms I have seen. He said she is probably at the very early stages. We talked about the current treatment (Anipryl for the past 20 days) and that I could finish out my two month supply and see if I notice improvement or I could stop. It makes sense to me to finish it out and see if I notice anything. He said he would not want to treat with anything else at this point and would just want to watch for clinical symptoms and the doctor who did the ultrasound agreed that he would not do anything else right now.

---

Hi Julie,

I'm sorry it's taken so long to get a reply posted! But I'm very glad to hear that Hannah's ultrasound has not uncovered any worrisome abnormalities. And I do want to tell you that it is possible for a dog to have pituitary Cushing's but not exhibit adrenal enlargement on ultrasound. So I agree with your vet that that absence of enlargement does not rule out that diagnosis. The absence of any visual abnormality does make the adrenal form of the disease highly unlikely, however.

I do think that you have crossed all your "t's" and dotted all your "i's." And I agree with your vet's recommendations at this point. I do believe you have ruled out other obvious sources of trouble, and now the question will be whether or not Hannah ends up exhibiting additional clinical symptoms as time goes on. So at this point, I would carry on as your vet advises. :) :)

Marianne

Below is Hannah's ultrasound report (I knew things were "normal" after they did it, but thought I would post it anyway).

She was in for her yearly heartworm test/check-up on Sat. and I saw in her records that they want to do a NSAID monitoring profile and CBC in May. I was not aware my vet wanted to do another test so I've asked him to call to explain what that is. (She is on Anipryl-for one month now, and we have a two month supply, so maybe he wants to check something after being on Anipryl??? I don't know). If you know more about what this means, or if it makes sense, please let me know. Anyway, here are her results.
Julie & Hannah

forConsult Type: US, SIG: DOB: 20010330, Age: 10 Y, Sex: F ALTERED, Wt: 10.8 kg, Breed: SHIH TZU, Species: CANINE, Images: 1, Case Details: Dog has a history of Cushing's disease. Overall screen of the abdomen.
Findings
An abdominal US was performed (Travis Saveraid). The liver, gallbladder, spleen, and kidneys are normal. The adrenal glands have normal size (Left 0.4cm short axis, Right 0.4cm short axis), shape, and echogencity. The bladder has a mildly thickened cranial wall, but is incompletely distended. The stomach, GI tract, pancreas, and general abdominal cavity is normal.
Conclusion
1. The bladder wall thickening is likely from incomplete distention and less likely residual change from previous urinary tract infection (no current evidence of urinary tract infection). 2. Otherwise the abdomen is normal.
Recommendations
Occasionally patients with biochemical evidence of Cushing's will not have structural changes of the adrenal glands or liver on US. The biochemical testing is consider a more accurate test than US imaging.

According to IDEXX laboratories the NSAID Monitoring Panel tests the levels of the ALKP, ALT, AST, BUN, and CREATININE. This panel is usually ran when a dog is being treated with a nonsteroidal anti-inflammatory drug.

http://www.idexx.com/view/xhtml/en_u...jsf?SSOTOKEN=0

What I am thinking is your vet wants to monitor Hannah's liver and kidney functions without doing a full Chemistry panel.

Love and hugs,
Lori

Hi,

You had asked about my Zoe's licking so thought I would stop by and answer. She has chewed her front feet ever since we adopted her. It stopped for awhile but came back when she was diagnosed with colitis. It seemed at first corn was the culprit. She is on raw turkey diet now and since her Cushing diagnosis, she has increased her licking and chewing. She wants to lick me or my husband all the time. She chews and chews on her Kong toy sometimes for an hour at a time then licks her front legs and sometimes will chew her front pads and dew claw. The last 4 months she has started to want to lick the tile in the bathroom. She has always licked on our sheets and pajamas if she has the chance. The licking and chewing has gotten worse the last six months. Zoe is a reactive, anxious dog, afraid of strangers and thunderstorms. Since her estradiol is now normal, she is less reactive in public.

Sorry to write you a book, just wanted to give you info;) If Hannah is chewing front and back legs it could be allergies.

Hang in there and I am glad you found us.

Hugs,
Addy

Hello,

Hannah is almost done with her two months of Anipryl and my vet wants to do another blood test this week to check some of her values. I am curious to see what they are, regardless, but for some reason, I was under the impression that even if Anipryl works that I wouldn't see a change in her blood work, and instead that I would be looking only for a difference in symptoms-eating, drinking, urinating, etc. Is that incorrect? Will there be a difference if it is "working?"

I am having a hard time telling if anything is different, so I'm not sure where we will go from her. Considering that her ultrasound was totally normal a few weeks ago, we figure she is in the early stages, with only slight symptoms...so I guess I'm not quite sure what to do. There seem to be people who tell me to wait until symptoms are worse and not to do any major treatment until then, and people who tell me I need to do something early, before any more damage is done. Any input about the Anipryl and suggestions on where to go from here would be great!

Thanks!
Julie (& Hannah)

Hi Julie.

It is true that bloodwork in the way of an acth stimulation is not necessary with Anipryl but I believe your vet may simply want to do a complete blood panel so see if liver enzymes and other prior abnormalities have improved. Whatever the tests are, please be sure to post the results here.

If Hannah is not overtly symptomatic yet, then I personally would wait until she is before treating with more effective treatments like trilostane or lysodren. If you aren't seeing any improvements with anipryl by now, chances are you never will. Only a small percentage of dogs with pituitary tumors in the pars intermedia lobe will benefit from anipryl.

What is going on with Hannah at the moment that would prompt people to tell you that you need to start treatment right away?

Glynda

Thanks so much for your reply. I am curious to see if anything has changed with her blood work since early March. We also talked about getting her on a liver supplement (Denamarin or one of the other ones), so I bet he wants to see what her ALKP level is now. (It was 1770 in March) and that was the only thing that was really high. We also decided to try Anipryl alone first before adding anything to help her liver. As I said, her ultrasound earlier this month was normal, so he felt that was a really good sign. The adrenals and liver were not enlarged and looked good. She needs a dental done and he said he was not worried about doing it, even with the abnormal liver value, but after seeing the ultrasound, he said he feels even less worried about any complications.
Had her blood work not been abnormal in March before what was supposed to be her dental, I may not have really noticed anything was terribly wrong. I had noticed that she was pushing into my other dog's bowl more often and was eating a little more quickly. I also noticed a couple of days when she was urinating more and thought about getting her checked for a UTI (she has had struvite crystals in her urine in the past and a couple of UTIs, but it has been well-controlled for a few years on Royal Canin Urinary SO dog food). The other behavior that was new (but probably going on for the last 6 months) was this pawing/barking/vocalizing at us in the evening after she had eaten, been outside, etc. Now I am thinking that is probably her begging for more food. That is the one thing my husband and I definitely agree has lessened just recently-in the past couple of weeks. She may be eating at a slightly slower speed. She doesn't really have any other signs-no panting, no back end weakness, no hair loss (although I had to trim a tangle out of her ear while I was brushing her a couple of months ago and the hair has not completely returned, but she is growing some of her tummy hair back where they shaved her for the ultrasound), no weight gain. She might be growing hair a little slower and loves to eat, was drinking more (for her, but she used to drink very little, so it's not out of control), and seemed to be urinating more-having a couple of house accidents (but she holds it all day while confined to the kitchen with no problem).
Some people tell me that Cushing's is an insidious disease, and that I should not wait for things to get worse since we seemed to catch it early. I think my vet feels that we should be seeing stronger symptoms before he wants to treat with something more. Also, she is currently on 5 mg of Anipryl per day and she weighs 12 lbs. I believe he said we could increase the dose-maybe to 10mg per day and he might want to try that before giving up on it.

Thanks again for your help!
Julie

Hi again,

Thanks for the additional information. It really sounds as though not only does Hannah not have any concerning symptoms at the moment, you are seeing some improvements. Regrowth of shaved belly coat usually does not happen in an uncontrolled cushdog so that's pretty impressive. I'm very interested in seeing what her new labwork looks like so please be sure to get copies of the results and and post them here.

If I were you, I'd keep doing what your doing and not worry about treating with anything other than anipryl until you see a marked increase in symptoms.

Glynda

I totally agree with Glynda, since Trilostane/Vetoryl and Lysodren/Mitotane are very serious drugs I would not treat unless Hannah was displaying some strong Cushing symptoms and her test results confirmed a Cushing diagnosis.

Please keep us posted ;):)

Love and hugs,
Lori

WOW, this story sounds FAMILIAR!!!!! :)

So Hannah has been on 5 mg of Anipryl (she weighs 12lbs.) for 2 months now and we had her blood values checked yesterday. My vet did agree that often we don't see a change in lab values with Anipryl, and usually need to go by symptoms, but he said occasionally it can help so that's why he wanted to do it.

Anyway, there was good news. Things have improved! Last time her ALKP was 1770 (and normal is 23-212) and yesterday it was 689. Her ALT was fine last time (normal) and I don't remember the number, and this time he said it was even lower. Normal is 10 he said and hers was less than 10, but he said that was not a concern, and that he was only concerned if it was high. Therefore, we are going to stick with the Anipryl for now, since we have seem some possible improvements in her behavior and now this improvement in her blood work.

He said he would check again in 3 months to see where she is (and I should monitor symptoms and let them know if anything changes), but didn't think we even necessarily had to do something to support her liver right now. I am going to schedule her for her dental soon (while I know what her values are). I feel great about the change, obviously, but still would like to hear your thoughts. The only thing I am wondering now is if something should be done to help her liver, since 689 is still high.

Thanks again for your help!
Julie & Hannah

Such a great update! I am so happy that Hannah is responding to the Anipryl so well. As far as her liver is concerned, since her ALT level was normal, which is more specific to the liver than the ALP, I would not worry about starting any liver support supplements.

Please keep us posted! Great job!! :)

Love and hugs,
Lori

Wow, that is such great news. It is so nice to hear about positives updates.
xoxo
Cindy and Alex

Go Hannah!!!!!!:D:D:D:D:D

This is wonderful news. I am so happy for you both. Keep up the good work!!!!!


Hugs,
Addy

So Hannah and I are headed to the vet tomorrow because last night I noticed a pink area under her chin-can't tell if it is a bump or an irritation, but it looks to be about the size of the tip of my forefinger or thumb and she does not want me to touch it. It looks like there could possibly be a couple of very small scabs on it as well. The other side looks to be a little pink, but not the same as this.

She just got groomed on Sunday, so I don't know if this is new, or if I could just see it because she has a short haircut. I also don't know if it was irritated from the grooming. It could also be because she licks so often (her feet and front legs) and rubs her face on the carpet. She used to take a low-dose steroid (Triamcinilone)in the summer for allergies, but after I noticed licking in the winter and then found out she had Cushing's, we no longer do that. Much of the time I think it is nerves because she can go for long periods without itching and licking. We tried a couple of different diets to see if it was food with no change, and she is on a prescription food (Royal Canin SO) to prevent crystals.

Obviously we will be seeing the vet in a matter of hours, but any issue makes me so nervous, and I always assume the worst. Last time she was in for a little bump I found in her ear and they thought it was cancerous. Thank God, it was not, but that is my fear with this. I know Cushing's dogs can have skin issues, so I suppose it could be something to do with that as well. She does not have any hair loss in that area; I can just see this bright pink area through the white short hair. She has been itching that area on and off, now that I think about it, but on both sides of her mouth (this is more on her right).

Anyway, there is nothing I can do about it now, and worrying won't help, but I just thought I would post about it to get it out of my system, and to see if any of you have dogs who have had something like this.

Anxious for tomorrow,
Julie & Hannah

I will be anxious with you and the appointment for Hannah can not come fast enough. Most likely it is nothing serious, especially if she just came from the groomers.

My advice:

Breathe in, breathe out, big breath and a deep sigh. You need oxygen:D:D:D

Repeat as needed

Hugs and waiting with you,
Addy

Thanks, Addy. Good advice. Luckily, I was able to let it go last night. We are back from the vet and she thought it was some sort of dermatitis type irritation. She said it is kind of by a lip fold and it just looked a little inflamed and irritated. She thinks the grooming probably made it flare up. She also thought there was a hint of a yeast-like smell, but was glad it was dry, rather than wet. It does look better today then it looked on Tuesday night. We got some wipes that have a fungal med in them and I have to scrub the area twice a day for two weeks, and then as needed. She did not want to give a pill if she didn't have to because of the side effects (I guess they can be hard on the liver), so hopefully we can get it cleared up soon.

Feeling relieved!
Julie & Hannah

Hi Julie,

Glad it turned out to be nothing major and hope the scrubbies will heal it in no time! I know what a relief it was to hear what the vet had to say.

Awhile ago I found several lumps in Squirt's belly about 10pm one nite. By 11 it was cancer, by 8am it had metastasized. :o:rolleyes: It turned out what I was feeling was her BOOBS! :p She's lost weight since starting the Lyso and I hadn't felt them in years...so, of course, I panicked big time! LOL Our vets get quickly used to me flying in the door in tears over some silly little thing or the other. :o:D

Hugs,
Leslie and the gang

Leslie-
I am just like you! I totally go through the cycle of it's probably nothing serious, to it is the worst possible thing, with the worst prognosis. Luckily I didn't have enough time to get too worked up before the appointment. I really like the vet I saw today too. She just joined the practice a few months ago, but she seems to be really on top of research, and really wanted to think and talk about how many vaccines Hannah should get and how we should proceed from now on. I like my other vet too, but might actually try to see this one more often, since I know Cushing's is always at the front of her mind.

She also recommended a Thundershirt for my other Shih Tzu, Izzy, who is terrified of thunderstorms and fireworks, etc. and it has really helped! We went from constant shaking and panting and climbing all over us, to a calmer dog who still shakes occasionally or needs a bit of cuddling, but can pretty much lay down next to us and relax. I have my sanity back! So, if anyone else has issues, you may want to look into the Thundershirt. It has a money back guarantee too. Can't go wrong!

I hope the wipes will work too. I am concerned I am not doing it right. I don't know how much to scrub/wipe/etc., but I guess we'll see how it goes. Also, it is so close to her lip and she is always licking her feet, so I have to try to prevent her from rubbing it on her foot and then licking it. The vet assured me it should be okay and said I could wipe it with a washcloth after if I wanted to be extra safe. What can I say-I don't have human babies yet, so my dogs are my babies and I want them to be safe!

We go in the first week of August for her next blood test, so at least they can take a peek at it again then. I'm always waiting for the next result, as well as the next thing to go wrong...luckily there are usually a few peaceful weeks or months in between!

Julie & Hannah

Hello-

So we're treating the "chin issue" with the medicated wipes and Hannah lets me do that with no problem. My husband and I were out of town at his parents' house for a couple of days and my dogs stayed with my parents. My mom commented that Hannah doesn't seem to be able to/want to go up the two big steps to their porch. She went up them fine when we dropped them off and has always done it before. Then my mom thought maybe it was because she was tired from her walk.

Hannah's had difficulty jumping up on our bed for years, so I have a little stool type thing especially for her. Last night and today she seemed really resistant to use it. She usually just jumps right up and then onto the bed, but it was like she couldn't figure out how to get up there and wanted me to help her. Today I even had a tiny piece of sausage to see if that would make her jump right up (she is very food motivated) and it still took her a little while to do it.

This is a definite change since Thurs. Does the back leg weakness typically come on so quickly? I feel like it is a huge change. Nothing else is different. We haven't started any other new meds. She gets her Anipryl in the morning and now I do the chin wipes twice a day, which shouldn't affect her legs. She still doesn't pant or have the pot belly. Her eating has improved-she still loves to eat, but isn't begging or bugging us for food, or pushing my other dog out of her dish. She still gets a lot of drinks, and she usually gets up to get drinks at night now too, but she isn't going through bowls and bowls of water, and the peeing is still under control, just more often.

She is going to have another blood test in a couple of weeks to check her levels, since her ALKP level did actually drop significantly after being on Anipryl-I believe from 1770 to 680 or something (although that is still high, as I believe the high range was 212 at my vet's office). At this point I'll keep an eye on her and see what the next blood test shows, but I'm worried that we've moved into the next phase of issues with the back leg weakness (unless her legs hurt from something else? she does go up and down the steps willingly) and even maybe with this chin issue.

Just thought I would see if anyone has any other thoughts or recommendations.

Thanks!
Julie & Hannah

Hi Julie,

My Zoe's back leg weakness came on fast and worsened quickly. Of course you need to rule out any underlying problem. Hypothyroidism, arthritis, back problems just to name a few can cause hind leg weakness.

Do you see any trembling in her back legs?

Hugs,
Addy

Hi Julie,

I'm not sure how quickly the hind-leg weakness and hesitancy to jump can come on but I do know this - pups with elevated cortisol are prone to ligament damage, primarily the ACL and cruciate ligaments. These can tear suddenly. Since these pups are already prone to problems, it is best that they not be encouraged to jump, or climb stairs, etc. when they are hesitant to do so. Hannah knows how her legs are feeling and will act accordingly to preserve them under normal circumstances, ie, not in a fear or danger situation. So, if I were you, I would follow her lead and not try to make her jump or climb. ;) They can't speak to us in works but if we watch them, often we can still figure out what they are saying.

I remember when Squirt quit jumping up and down from things like she always had. I tried my best to keep her from jumping down period after her first knee surgery, but sometimes she did. :eek::rolleyes: It has been 2 years or more since she had jumped up on or down from anything. She does still climb up steps, not stairs, most of the time. Some days, her knees are bothering her so she patiently waits at the bottom for me to pick her up. She will occasionally go down on her own, but I usually make her wait for me to carry her. I look at it as giving my arms, back and legs some exercise, LOL, and more opportunities for hugs and kisses. ;)

Quote:

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...since her ALKP level did actually drop significantly after being on Anipryl-I believe from 1770 to 680 or something...

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One of Squirt's wonderful vets in TN told me that she had consistently seen ALKP values lowered in all her patients who were on Anipryl. It had the same effect on Squirt. At the time, I couldn't find any scientific studies, etc. about it and Dr. W said she had never read anything in the journals. But she knew what she had seen over the years and Anipryl lowers the ALKP for some reason. :cool: Thanks for reminding me about this little quirk!

Hugs,
Leslie and the gang