Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

Dr. Feldman isn't receptive to answering questions for us pet owners without an appointment so writing to him is usually a waste of time. Dr. Peterson has a blog and if I can find the time tomorrow, I'll drop him a line. Hopefully he'll think my question is worth answering. It is Dr. Peterson's paper that I refer members to whenever there is a question about starting treatment in the absence of symptoms. He does not treat patients who are not symptomatic. I believe he is, however, open to treating an asymptomatic dog if the dog has an underlying condition that might require that high cortisol levels be addressed.

Glynda

I don't want to rain on anyone's parade about trying to contact Dr. P, but I actually did e-mail him about 8-9 months ago, to which he did respond. I was politely, but firmly told that he did not answer e-mails directly from owners as he did not have the time. If his website for owners will allow questions to be posted, you might have better luck doing that.

Debbie

Well, fooey!

I got the same response from Dechra when I contacted them about body weight and starting dosage. *no talk to pet owners, only the vet in charge. :(

Sharlene

I am planning on posting to his blog and as I recall, he has a page for vets and one page for pet owners. It won't hurt to try. Too bad none of the experts give so freely of their time to us pet owners like Dr. Oliver did. I miss him.

Sharlene
from one canadian to another.
thank you for checking in on me. Canada might have some different options on cushing treatment than the states.
Hugs Sonja and Apollo

Hey Sonja and Apollo.
So far I haven't found anything particularly different in Canada.
Now I'm worried about Trilo causing the rear leg weakness. :(

I'm made an appointment for Molly to have an LDDS test on 3 August. She'll be staying that weekend at the vets (boarding) so might as well do it all at once. She'll also have her yearly vaccines after the LDDS test. Maybe the next day.

Not sure but also might have the urine test done too. As long as I'm going to have a huge vet bill that weekend anyway, might as well go all out.

Sharlene and the Molly Muffin!

well this has me very curious, so since i just saw IMS, had loads of labs done and tests, what do you think if i ask if he has heard any news on this? all he can really say is no or wont reply, or doesnt apply to my situaition. if you think i should as i will be hearing from them tomorrow.....let me know...and let me know how i should word my questions........i am cst, usa.

That would be so awesome! Maybe just a question of whether or not they are aware of any connection cause and effect between taking Trilo and weakness in the rear legs. If so, is there any correlation between dosage amount, length of time on the medicine, etc.
Something like that maybe.

I didn't think about that a possible cause, although I notice so many of the dogs with cushings seem to also have this rear leg weakness and I thought, well, the cortisol has been covering up the arthritis. Now I'm wondering since Sonja made a note of it. And the skin issues. It's all very strange.

Like you said, it might not be relevant to you or he might not know or maybe he will. Either way, I appreciate it!

thanks, thanks, thanks.

Sharlene and Molly muffin

okay will make note of that!
i thought my understanding was rear wasting was likely and the cortisal does cover up alot of discomfort....then when that level does change often other areas that are problematic appear.
but treating cushings with meds before symptoms are severe is what is new to me and was wondering if i should ask about that???

Oh sure! Feel free to mention what my IMS told me. That from a conference she had recently attended, based upon a compilation of studies, that a new report was to be issued, about treatment of cushings in dogs, after tests have ruled out other possibilities for the high cortisol levels themselves prior to symptoms occurring. I'd be interesting if others have heard of this or if it was just something that those at that particular convention are aware of, when and what it will say. My IMS didn't know when it would be coming out, only that she didn't think it had yet, but she seemed pretty assured that a statement would be released.

Thanks again. Sorry I misunderstood. I didn't realize that Trilo would cause the wasting, only that the higher levels of cortisol could cover up other problems, none of which I am aware of molly having currently.

not sure that trilo causes wasteing......but it that was also a symptom of cushings......BUT i am not as knowledgeable as the angels here......they will be more certain of that. always trust the flight of them angels. :)
my little one had the tumor on adrenal gland, so that area i have some experience on and some of the other pet parents here have seen their little ones through that. One of the angels is all over the labs, and others have helpful experience and compounded knowledge that is endless. Truly amazing place. Life long friends for certain!
Reading over your thread......so much of what you express and how you express it reminds me of myself. Especially when you type out "grrrrrr" LOL made me smile and chuckle......ohhhhhh how i understand grrrrrrr. lol

Molly had a horrible night with the thunderstorms we had here. Panting in fear, wanting on the bed, off the bed, under the bed, me on the floor with her, just on and on all night long. I wonder if the elevated cortisol anyway, if any sort of fear is even more exaggerated than before. Has anyone else noticed that their cushings dogs, without treatment, seem to react more to the things that scared them before?
I ended up working from home today I was so exhausted I couldn't even think of driving to work and Molly has slept most of the day.

Zoe was afraid of thunderstorms and funny thing, when I first started to treat her I only used melatonin and lignans. The melatonin calmed that fear away.

Poor Molly, thunderstorms can be hard, I know.

Hi Sharlene,

Our camper got struck by lightening last summer while Squirt was inside alone. No one was hurt, thankfully, but it has had a negative effect on her. She was never nervous in storms unless they were really bad and loud, then we were both nervous. :p But since that incident, she doesn't like them and is getting worse since we moved into the trailer. Her hearing is going so I'm not real sure what she actually hears but she picks up on something and has a hard time relaxing now. We had a very mild thunderstorm last nite - the thunder was distant and just gently rumbling. But she wanted on the bed and right next to me, something she no longer does for the most part.

She was really anxious last nite and she had already had her melatonin dose. I could have given her another dose with no problem but decided to try something else. Several friends have pups who don't handle noises well at all and they have bought Thundershirts for their babies with varying degrees of effectiveness for their babies. Not having a Thundershirt, I took a corner of the sheet and wrapped it around her belly and chest fairly snug then tucked the corner in so it would stay. She looked like a huge cotton sausage! :p But she calmed down, settled next to me and started dozing. After a bit, when it was just raining, she started wiggling to get free; I unwrapped her and she made her nest and went to sleep. Seeing how the snug wrap seems to calm her, I may well invest in a Thundershirt. ;)

http://www.thundershirt.com/

Hugs,
Leslie and the gang

Sharlene
HOpe Molly is feeling better.
thank you for your posts.
There are natural remedies you can give Molly for fear and they also have a calming vest you can buy if it gets real bad. Andy would be able to tell you more, since Zoe is afraid of thunder also. Heck so am I.
Hugs Sonja and Apollo

Hi Sharlene,

Izzy, my non-Cush dog, is terrified of storms and loud noises, and has been since we got her. We have the Thundershirt, which helps a little, but doesn't totally stop her. Many people have complete success with that, however.

After she destroyed a door frame by chewing/scratching one day when my husband and I were at work, my vet finally suggested Xanax. It is much better. It works best if you know it's going to storm (I know, not the easiest, right? :)), but even if I give it when it starts or when she is already shaking, panting, standing on my body, etc., it kicks in between 30 and 60 min. and she is MUCH calmer.

There is another drug...ace something that some people use, but my vet said all it does is drug them, but the anxiety is still there. A woman I work with used it on her dog and the dog acted drunk. With Xanax they actually feel calmer. Izzy is only 7 lbs. and takes .25 mg at a time, but the vet said she could take more if needed, and it seems to do the trick--usually. My mom uses it on her Shi Tzu and it really helps her too. I highly recommend it.

They say dogs sense the pressure change, so Izzy usually is acting weird before it even starts thundering. My parents have a blind, one-eyed dog, and he senses storms too, so they definitely know. The lightning terrifies Izzy too.

We spent lots of nights with the t.v. on or a radio and a light, and without getting much sleep. We're both teachers and I can only imagine our teaching the next day! :) My students love hearing stories about my girls though, so they always knew when I was sleep deprived. :D The Xanax makes it so I have to deal with no more than an hour of a totally anxious dog. It's wonderful!

Whether it's the Thundershirt, Xanax, both, or something else, I hope you figure something out soon!

Julie & Hannah

Hey gang! Thanks for all the awesome suggestions. It just breaks my heart to see her so scared and not be able to sooth her. Hopefully we can figure out something that will work with Molly. I'll try a tightish blanket first, if that works, get the Thundershirt. If that doesn't work, then go to meds, but everyone probably by now knows that giving molly any medicine is ridiculously difficult.

Thanks so much. LDDS test this friday!

hugs,
Sharlene

ugh, the double post gremlins! Wasn't sure how to delete so just edit.

Quick question. LDDS test, fasting right? They told me to not give molly her breakfast and then they'd feed her after the last blood draw.

She gets the LDDS tomorrow, when she is also going to be boarding at the vets till Monday, as we are going to be out of town for the weekend.
She'll get her yearly vaccinations on Saturday.

Depending on what the LDDS shows (I am thinking it's going to show that she needs to start the meds) we'll decide when to start her, or wait and have another ACTH in 3 months to check her and see how it's progressing.

Yes - here's a link from Dr. Bruyette, a world renowned specialists where he mentions it.

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

Thanks, looks like 8 hours fasting.

good luck to Molly tomorrow!

Hi Sharlene,

I just wanted to mention that unless you are forced by law to vaccinate annually, there is absolutely no reason to put a dog at risk, no matter how small the risk, by giving annual rabies. Vaccine guidelines were revised years ago to three years for most vaccines. I'm providing a url below so you can read up on the recommendations. I parted ways with my old vet for demanding that my dogs be vaccinated or risk their refusal to admit my dogs if an emergency arose. We had a knock down drag out in the waiting room when they told me this. A vet who insists on annual vaccines is well aware of the new guidelines but they ignore them to get the dogs into the office every year.

http://www.aahanet.org/PublicDocumen...Guidelines.pdf

I also heartily recommend that you watch Dr. Karen Becker's four part video of discussions with Dr. Ronald Schultz, one of, if not the world's expert on immunology. It was Dr. Schultz who was the driving force behind these revised guidelines. He and Dr. Jean Dodds are in their fifth year of a seven year USDA sanctioned study to prove that rabies vaccines are good for at least seven years. Dr. Schultz already knows this but the government won't look at any supporting evidence that isn't part of a study that has been approved and conducted in strict compliance with USDA guidelines.

http://www.youtube.com/watch?v=xC--bGthNN8
http://www.youtube.com/watch?v=0_Zvg8tIxeY
http://www.youtube.com/watch?v=Fc-6exZcbJ4
http://www.youtube.com/watch?v=sdPhj8Vq9ck

Even if it had been three years since Molly has been immunized, I personally would not risk giving her a vaccine until you are sure she doesn't have cushing's (normal cortisol) or 2) if she is diagnosed with cushing's, she should be stabilized on treatment before vaccines are given.

I'll chime in with an observation. I had to give Koko my non Cush pup his 3 year rabies shot and I titered him for the rest. He was low on distemper. I also started him on his heartworm meds.

Since giving him these 3 things- even though I spaced them apart 3 weeks, I noticed not too long after that, hair has been coming out of his tail , not a lot but strands here and there.

Maybe it is just a coincidence- but makes me nervous. Sharlene, sometimes your vet will give you a rabies waiver due to health reasons. Zoe does not get any vaccines any more.

You have to way the risks your dog may have regarding possible exposure to rabies.

I second Gylnda in thanking you for helping. It has been a difficult few months for a lot of us and we really appreciate your help.

Molly is at the vet. She is scheduled to get her rabies vaccine on Saturday after the LDDS testing today. Here we are required by law to get the rabies shots every 3 years.

I'm also having a full blood panel and the regular urinalysis done while she is there. I just want baselines on everything again since her last Full panel was in March. (I had the ALP and ALT redone in June) So far molly hasn't had any problems with any of her vaccines. No hair loss, upset stomach or anything. She has more issues when she takes pills with upset tummy issues. Which sort of worries me starting her on something that will be life long.

They are treating quite a few dogs there for cushings with success, which makes me feel better. Some have multiple problems, like diabetes and pancreatis. (This by the way was the lab tech I was talking to this morning)

I have an hour to get ready to head to the airport. I spent an hour at the vets before I would leave her this morning.

So for the morning molly funny. I have to walk molly around the corner at the vets, then sort of jump back around the corner out of sight or she tries to dig in and not move. Now she knows that I am going to disappear at that corner, so at the corner, she did a quick maneuver around my legs with her leash and stayed on the side that made it so I couldn't escape her without tripping over her. Even when I tried to dodge into an exam room, she moved into the room with me, keeping her effectively behind me instead of beside or in front. Everyone was laughing and saying she was smart and certainly knew how to keep me with her. She also went straight over to the scale to get weighed, since that too has to be done each trip. She walked onto the scale, sat down and waited for us to acknowledge that she had done and awesome thing on her own.

See you all when I get back. Vet knows to call me if anything comes up on the tests.

she is one smart pup! enjoy your weekend, sounds like Molly is in good hands

Hi Sharlene,

How did Molly do over the weekend while you were gone? I bet she is glad you are back. I hope you had a nice weekend! :)

I want to thank you for posting on my thread with your kind words and support. I really appreciate it, and so does Jasper. There are such good people on this site, it feels kind of like a lifeline when things are so scary and overwhelming.

Hugs to you and Molly,

Tina and Jasper

Hi Tina,

I got home too late to be able to pick molly up tonight from the vets where she boarded and had tons of tests.
I Hate the house without her in it. It feels so empty and quiet. I can't wait till I can pick her up at 11 tomorrow. It's a holiday so they are only open from 11 - 12 for pickups, etc.
You know I'll be waiting for them to open though.
We are all in the same scary boat that seems to rock constantly from the cushing waves. How is that for an analogy. ;) I feel sea sick just thinking about it.

Hugs to you and Jasper too.

Sharlene and molly muffin

Hi Sharlene,

I just wanted to say that you are doing a fine job of navigating that ship of yours. You are a good Captain! :D

Hugs,
Leslie and the gang

Had this whole long thing typed out, somehow hit the "back" button on my mouse and lost it all, so here we go again.

LDDS Test results

Cor1 - Cortisol (base) 79 30 - 300 range nmol/L
Cor34 - Cortisol (DEXA) - 4 hrs <27.59
Cor38 - Cortisol (DEXA) - 8 hrs <27.59

Interpretation for low-dose DEXA:

Normal dogs: Serum cortisol suppresses to <40 nmol/L for the 8-h interval.
Adrenocortical hyperfunction: dogs with HAC do not suppress to <40nmol/L for the full 8 hours. In ~60% of dogs with pituitary tumores, there is suppression to <50% baseline values or <40 nmol/L at 3 or 4 hours.

converted to ug/dl division by 27.59

Cor1 - Cortisol (base) 1.051
Cor34 - Cortisol - 4hrs <1
Cor38 - 8hrs <1

Urine Gravity - 1.038
trace Protein
blood ca. 250 ery/ut
We're still waiting on sensitivity/culture to come back, I don't see anything on this that says cortisol/creatine

Abnormals on blood work as follows:

Albumin 46.8 26-44 range g/L
Protein 74 51-72 range g/L
ALP 1054 4-141 U/L
ALT 144 6-118 U/L

Thoughts anyone?

I'm going to type out her ultrasound results too:

Physical exam, Mild dental tarter. heart no murmur or arrhythmia. Lungs NAF. Abdomen mild distension, tense, no obvious pain. M/S good body condition.

Ultrasound:

Liver mildly enlarged, diffusely hyperechoic and the margins are rounded. The gall bladder has a moderate amount of echogenic debris present. Bile duct normal. Stomach wall measures from .25cm and there is moderate gas present. The spleen is normal. Left kidney measure 4.86cm, there is hyperchoic speckling in the cortex and there is a mild decrease in corticomedullary definition. Left adrenal gland measure .80cm and .68cm and is mildly enlarged with the caudal pole larger than the crnial pole. Urinary bladder wall is mildly thickened at the apex from .32cm to .43cm, although the lumen is not fully distended. Mucosa is mildly hyperechoic and irregular, and there are two small calculi presnet measuring .18cm and .24 cm. Colon is normal. right Kidney is similiar in appearance to left kidney. There is a small non-obstructive calculi present, measuring .28cm. Right adrenal gland measure .56cm and .74cm. and is the upper reference of size to mildly enlarged. Pancreas is normal. Small intestine is normal. Mesenteric lymph nodes are mildly enlarged with one measuring .33cm by 1.97cm. There is no free fluid present in the abdomen.

Thanks,
Sharlene

Quote:

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Originally Posted by molly muffin

LDDS Test results

Cor1 - Cortisol (base) 79 30 - 300 range nmol/L
Cor34 - Cortisol (DEXA) - 4 hrs <27.59
Cor38 - Cortisol (DEXA) - 8 hrs <27.59

Interpretation for low-dose DEXA:

Normal dogs: Serum cortisol suppresses to <40 nmol/L for the 8-h interval.
Adrenocortical hyperfunction: dogs with HAC do not suppress to <40nmol/L for the full 8 hours. In ~60% of dogs with pituitary tumores, there is suppression to <50% baseline values or <40 nmol/L at 3 or 4 hours.

converted to ug/dl division by 27.59

Cor1 - Cortisol (base) 1.051
Cor34 - Cortisol - 4hrs <1
Cor38 - 8hrs <1

Sharlene

---

Sharlene, can you double-check the lab report for Molly's LDDS? It looks like she had 79 nmol/L for the baseline cortisol, but I'm confused by the "Cor34" and "Cor38" lines. I'm assuming those reflect the 4-hour and 8-hour results, but I'm thrown somewhat by the notation. If the lab did not not give specific numbers for her 4-hour and 8-hour results, but instead the report is just indicating that they were both less that 27.59 nmol/L (or less than 1 ug/dl), then those results are not consistent with Cushing's. I just want to double-check that I am interpreting the report correctly.

Marianne

Yes I think you are interpreting that correctly Marianne.
The cor34 = 4 hour, cor38 = 8 hour (I don't now what they actually mean other than the 4 and 8 hours draw)

and yes the number on the result is is is <27.59 or as I did the conversion <1

I didn't think it looked like cushings on that result either. Yes, the ultrasound shows results which could be consistent with cushings (liver, adrnal gland slight enlargement) and the ACTH results are consistent with cushings. This one is not. What about the urine gravity, that doesn't appear to be diluted to me either.

I find this just very weird and confusing.

:( Sharlene, whose boat is acting a bit tipsy right now.

I received a response from Dr. Peterson on his blog and if there are any new studies that show it may be beneficial to treat asymptomatic dogs, Dr. Peterson isn't aware of them. Because we've had so many members with dogs who are asymptomatic but have high alkp, I included a question about that as well: Hopefully his response will set some minds at ease.

Quote:

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I am not a proponent of treating dogs with asymtomatic Cushing's disease, unless they have secondary hypertension or proteinuria.

Low dose trilostane may be helpful, but I am not aware of any studies that even suggest that, let alone prove that to be the case. With any drug, we have to weight the concerns of side effects.

In general, most dogs with Cushing's syndrome develop a high alkaline phosphatase, with is "induced" to rise because of the cortisol excess. In other words, the fact that this liver (and bone) enzyme is high only means that it is a marker for Cushing's and does not reflect liver damage. So to me, that is not a reason to treat, especially since this value rarely normalizes after successful treatment with trilostane or mitotane.

---

Glynda, I'm confused by Dr. Peterson's comment that elevated ALKP is only a "marker" in Cushpups. Just as is the case for Molly, we've repeatedly seen ultrasound reports that note liver enlargement and hyperechoic (fatty) changes in dogs suspected of Cushing's. It seems to me that these represent genuine physical abnormalities resulting from the disease. But not life-threatening, so maybe that is what he means -- that generally there are no serious changes to the liver?

And Sharlene, I am totally stumped right alongside you. I am baffled by Molly's contradictory test results -- especially the conflicting ACTH and LDDS results. In an article discussing interpretation of LDDS results, Dr. Peterson tells us that a "negative" LDDS is very reliable. Only a very small percentage of Cushpups do not return a positive result:

Quote:

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When interpreting LDDS test results, first evaluate the eight-hour postdexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

---

As you can see, he does suggest moving on to an ACTH for a symptomatic dog who has a negative LDDS, but a positive ACTH would then result from a scenario where the dog is suffering from PDH. So what do we do with the finding that Molly may have only one mildly enlarged adrenal? Is the ultrasound missing enlargement in the other gland, too?

It does seem to me that there are still enough remaining question marks that I would be hesitant to start treating. A trace amount of protein was noted in Molly's urinalysis, but I don't believe that would yet constitute "proteinuria" that would warrant immediate Cushing's treatment with so many questions left unanswered.

Sorry that I am not providing any answers here :o. Like you, I am baffled for the moment...

Marianne

Well include me as stumped. :o

Just to cover all the bases - can you confirm that the ultrasound of the adrenals was done on a high resolution machine and that they were able to view both adrenals?

I ask this because my Annie had 2 false positive ldds tests and a host of false pos. acth tests as a result of an adrenal tumor that was not caught on the first ultrasound we did. Her urine was concentrated as well.

Not sure if this helps but at least you know you aren't alone! Kim

Didnt Dr. Peterson have a case study where he said non adrenal disease can also enlarge the adrenal glands? It was the case study of the young collie. I remember being upset because I wondered if Zoe's colitis flare was responsible for her enlarged adrenals.

Addy, I think it's true that the adrenals can enlarge in the presence of any chronic condition that stimulates excess pumping of cortisol. That's why the symptom profile is so critical when arriving at a Cushing's diagnosis. If Cushing's sympoms are absent and/or symptoms are present that are inconsistent with Cushing's, you'd want to do further investigation.

Marianne

Thanks everyone for answering and posting your thoughts. It's a confusing
situtation that's for sure.

I asked about the High Density ultrasound. They said they didn't know what I meant by that
but that their machine could see everything. They did present sizes in cm for all the organs
so I am assuming they were able to see enough to measure.


I'll post her abnormal ultrasound results (abnormal only) and test histories
again, so noone has to go scrolling through pages to find the
information.

Ultrasound July 2012:

Liver: mildly enlarged, diffusely hyperechoic and margins rounded
gall bladder: moderate amount of echogenic debris present
stomach: moderate gas
left kidney: hyperechoic speckling in the cortex and mild derease in corticomedullary definition
left adrenal gland: mildly enlarged with caudal pole larger than the cranial pole
Urinary bladder wall: mildly thickened at the apex, although lumen is not fully distended.
Mucosa: mildly hyperchoic and irregular and two small calculi present
right kidney: similar in apperearance to the left kidney - small non obstructive calculi present
right adrenal gland: upper reference of size to mildly enlarged
lymph nodes: mildly enlarged

Test Histories:


ALT - 54 (10 - 118) May 2010
ALP - 518 (20 - 150) May 2010

Albumin 46.7 (26 - 44) April 2011
Protein 78 (51 - 72) April 2011
ALT - 110 (6 - 118) April 2011
ALP - 764 (5 - 141) April 2011


Albumin 44.1 (26 - 44) (barely out of range) March 2012
Protein 76 (51 - 72) March 2012
ALT - 139 (6 - 118) March 2012
ALP - 1121 (5 - 141)

ALT - 152 (6 - 118) June 2012
ALP - 1003 (5 - 141) June 2012

Albumin 46.8 (26 - 44) August 2012
Protein 74 (51 - 72)
ALT - 144 (6 - 118) August 2012
ALP - 1054 (5 - 141) August 2012

and finally Urine gravity 1.038 August 2012

this could be because I couldn't get her to drink much that morning
after not eating.
trace protein
small amount blood

I think she might have a UTI and we're still waiting on the results of the
culture/sensitivity test to come back.

So, what could be making her ACTH go up like a cushings dog and her LDDS show
normal dog results. I'm rather worried about something like liver disease, but I
thought I read somewhere that any joint issue could also cause high cortisol results.
Does anyone know if that is true? Not sure it would show high on ACTH though.

Her abnormal values seem to be up and down too.

I'm stumped. The good thing is that Molly doesn't know a thing about this
and is running around the house with a shoe in her mouth, which I need to
go retreive. She won't chew it but she will try to fit her entire
body inside of it. (this does not by the way, work).

Hugs everyone and thanks so much,

Sharlene and Molly Muffin

Hi Sharlene,

Thanks for always checking in on my little Hannah. I appreciate your kind words and encouragement.

I have no advice for you, unfortunately. Hannah has never had an ACTH test, but my IMS does not recommend them unless she is using a drug to treat Cushing's. She doesn't feel that there is enough valuable information.

Hannah has had really high ALKP levels in the past and they dropped dramatically after taking Denamarin. She has been on it for about 6 months now. Her ALT has never been high though. I think that infection can cause liver values to be high, but I don't know if that is just ALKP or also ALT. I know sometimes if a dog has a dental infection and gets it taken care of, the liver values can return to normal. Again, not sure if this is one or both.

I'm sure others will be along to help you out soon though. I love the story about Molly with the shoe. So funny! I love that she tries to get in it. What a little cutie! Sounds like she is quite happy too, and that certainly is most important! :)

Julie & Hannah

Hi Sharlene,

Quote:

---

So, what could be making her ACTH go up like a cushings dog and her LDDS show normal dog results.

---

Quote:

---

I think she might have a UTI and we're still waiting on the results of the culture/sensitivity test to come back.

---

May be the answer. Sometimes infections or other abnormalities can cause a higher than normal Cortisol reading.