Max test results help — Sweet Max has passed

Hello everyone. I am hoping you all might be able to help me interpret my boy Maximus's LDDS test. His vet said Cushing's was ruled out, but when I look at the results and have read up on interpreting it I feel like the 8 hour number is elevated. I am hoping you all might be able to shed some light on this for me. We also did a T4 panel and she feels it is hypothyroidism based on his T4 1.2, Ft4 1.0 and elevated tsh .65 and wants to start low dose meds for thyroid. He also had elevated ALP (700), low hemoglobin(12.0), and his MCH and MCHC right below normal (21.1, 30.4)

Here goes:
Pre Dex: 5.1 ug/dl (1.0-6.0)
4 hour: 0.4 ug/dl
8 hour: 6.7 ug/dl

Looks to me like pre dex cortisol was normal, he suppressed at 4 hours, but the 8 hour is above the range from IDEXX 1.0-6.0.
I am so appreciative for anyone willing to take the time to review these and chime in. I just want to make sure I understand everything and can be the best advocate for him.

Hello Elizabeth, and welcome to you and Max! To cut right to the chase, you are right that Max’s LDDS results are consistent with Cushing’s, and unfortunately your vet is incorrect. Max’s results are consistent with the pituitary form of Cushing’s. Here’s a link to some IDEXX test interpretation charts. If you scroll down past the ACTH stimulation test that’s listed first, you’ll come next to the LDDS.

https://www.idexx.com/files/snap-cor...g-guide-en.pdf

The normal ranges printed on Max’s labsheet may vary slightly from this table. One important point: the normal cortisol range up to 6.0 relates only to the first baseline blood draw, prior to the administration of the testing agent. With the LDDS test, the baseline cortisol level is of little importance — the 8-hour level is what determines the overall Cushing’s diagnosis. Both the diagnostic 4-hour and 8-hour results are compared to a very different “cut-off” number from the baseline range. Commonly it’s either 1.4 or 1.5 ug/dL. On the IDEXX chart listed here, the cut-off number is 1.5. Since Max’s 8-hour result greatly exceeded that cut-off, the result was consistent with Cushing’s. And since his 4-hour result was *less* than both 50% of the baseline reading as well as less than 1.5, his result is consistent with the pituitary form of the disease. I know this formula may seem complicated, but if you compare Max’s results to the chart, I think you’ll see what I’m talking about.

The really unfortunate part of this is that your vet’s unfamiliarity with the correct test interpretation leads me to fear that he/she is not at all familiar with testing or treating Cushing’s patients. This is a major interpretation error. Max may well suffer from hypothyroidism in its own right, but this LDDS additionally points to Cushing’s. His elevated ALP would also be consistent with the disease.

May I ask what prompted the testing in the first place? Does Max exhibit observable symptoms that are worrisome. Any additional info you can give us about his overall health history will be very helpful. And I’m sorry about delivering the bad news about your vet, but as I say, this is a major fumble :-(.

Marianne

Double posted removed...sorry! :(

Hi Marianne! Thank you so much! He initially went in for a dental cleaning and his yearly exam. My vet was very concerned at first about his low rbc, hematocrit and we did a repeat...it came up slightly. At the same time she said his ALP is consistent with Cushing's and noted he had gained some weight ( ore on that in a bit). She added on a cort/creat screen to his urine that has been sent off and when it came back she said it was very suspicious of Cushing's to her (urine cortisol : 12.3, Urine Creatinine 41.4, ratio 93) and she recommended a LDDR test. I requested to add the thyroid panel because he was low/normal 1.2 (1.0-4.0).

I'm not sure if she misread the results?? She spoke to me in depth about Cushing's and signs of it. I chalked it all up to being a 9 year old boxer. I noted he's been shedding a good bit, he is normally tired (9 year old boxer, but has energy bursts), Drinks but not what I would call excessive (hes 82 pounds). He's gained from 75-82# since March, but I changed his food to Royal Canin HP vet diet because he has "gulpy" digestive issues thye've never been able to figure out except possible reflux, but we have never done a scope to see if it could be IBS, etc. The HP food seems to agree with him even though I do not think it is the "best" type of food out there. He does love to bask in the sun...but gets hot easliy (again he's a boxer and the summer heat gets him)...so all of these things she said yes we need to look at Cushings.

I can attach all of his lab work if it would be helpful, but I feel like that LDDR test was pretty clear. I will be calling tomorrow asking for her or another vet in the group to pull up his test and look at it and explain why they feel it is negative. I am not someone who takes what anyone tells me at face value, I read and I learn so I can understand and discuss things in an educated manner...maybe thatis the teacher in me.

I am a little terrified of Cushings, and the medications used to treat it. I have been lurking here listening and learning and I do appreciate all the knowledge and time you all give to each other. AND, I am trying to not be scared...I am trying to look at statistics and be rational...

Where do I go from here? Much appreciated!

Hi again, Elizabeth. This additional information does indeed make Cushing’s seem like a strong possibility.

Question: do you have the actual lab sheet with the LDDS results listed? If so, the lab sheet ought to have the exact interpretation criteria written out. Having that exact language in front of you will hopefully make it easier to talk to the vet tomorrow. Remember that the focus first needs to be on the 8-hour value, not the baseline value. The baseline value only becomes significant for comparison purposes if the 8-hour value is elevated. At that point, you’re checking to to see whether sufficient suppression subsequently occurred which would point to the pituitary form of the disease.

And I know this is far easier said than done, but please don’t feel terrified about the Cushing’s meds if they end up being prescribed. As careful and observant as you clearly are with Max, you’ll already have a great head start in terms of monitoring how he’s doing. We’ve had many success stories here, and there’s no reason why Max shouldn’t be one!

Marianne

Yes, I do have it. I kept looking at it thinking I was missing something. I have spent the last week researching that exact chart you linked as well as studying the types of medications and the new starting doses of those.

Max is a dog that my vet's words "does not fit the book in veterinary medicine". He has been reactive to a couple of antibiotics in the past with adverse affects, and reacted badly to a cytopoint injection given last summer for allergies. So, she is very cautious with him, but I just have so much doubt now.

Do you think there is importance to get him in with an internist to correctly diagnose? We have a wonderful group near us where he went to have obstruction surgery. So, Tmy plan is to call and ask them to recheck his LDDS results as I feel there was an error in reading them due to the fact that his 8 hour value is >1.5...and the 4 hour is less than 1.5 and less than 50% of the baseline as outlined in the IDEXX chart? Does that sound right? THANK YOU so much!

That sounds exactly right! And what I would do if I were you depends a great deal on the response you get tomorrow about the test interpretation. If the vet seems defensive or argumentative, I would take that as a giant red flag. If the vet is instead appreciative that you’ve been educating yourself and apologetic for missing the diagnosis, that would be better, for sure. If you do feel uncertain, though, that’s terrific that you have a good specialty group nearby. Especially dealing with the combination of hypothyroidism and Cushing’s, both you and your vet may welcome the input of an internist. As you may have read, hypothyroidism can actually be secondary to Cushing’s. If Cushing’s is the primary culprit, the low thyroid readings may spontaneously resolve once the cortisol becomes well controlled. Since Max’s TSH was elevated, I *think* that makes it more likely that he’s genuinely hypothyroid, as well. But that might be an area where you’d welcome an internist’s expertise prior to launching into thyroid supplementation. And you could diplomatically ask your vet if a consult might not be helpful, given this dual diagnosis.

I certainly don’t want to borrow any trouble for you, but I do want to mention that our experience here is that boxers seem to be over represented among the group of Cushpups who may develop a particular skin disorder known as Calcinosis cutis when their cortisol levels are untreated and running high. This disorder manifests as calcium deposits that work their way up through the skin, finally erupting as uncomfortable plaques. This might be another reason to get treatment guidance from a specialist, in order to prevent this issue from ever getting started.

But first things first — let’s get that LDDS interpretation clarified. Definitely let us know how things go!

Marianne

Thank you, Marianne!

In my reading I have read that with the values he is showing in his T4, free T4, and tsh that is "could be" a non-thyroid illness causing it because his T4's are not falling below range, but low average....OR it COULD also be hypothyroid. I think I do feel better knowing we could have multiple things going on here that consulting in internist would be in Max's best interest. He's always had some immune type issue and I want the time he has left to be enjoyable whatever that may be.

I have read a little on the calcinosis cutis, I believe a few posts on the forum. I will continue to follow up on and do more reading on that.

Can the LDDS test signify the progression of the disease?

I will most certainly update as I am very appreciative of you taking the time to answer my questions. All the posts I have read left me noting that everyone is very positive in their thoughts. I am happy to have found the forum! I apologize for not properly introducing myself: You picked up on my name quick! :o Max is our beautiful 9 year old boxer who is our third child...we have two human kids as well!

I spoke with Max's vet and she was extremely embarrassed and very apologetic about the misreading of his results. She said you are 100% correct! She feels his thyroid is primary as well b/c of the tsh. I did mention that from some readings I have found, a percentage of cushing's dogs thyroid regulate upon treatment and she said that beginning cushing's treatment then retesting thyroid later would definitely be an option.

Since she knows Max's history she did feel like me taking him to an internist who can unfold everything would be a great idea. She spoke very highly of the group near us and said they work together and will often help by running tests, etc so he can go to his home vet for easier things, but the internist treat, diagnose, etc.

We discussed that they would be helpful with looking at his immune issues (chewing paws, digestion issues/food) as well as we begin this journey.

They will be sending a referral to the specialists tomorrow by lunch time and hopefully it won't take us too long to get in. I would love any advice, reading material, in the meantime... Thank you for all reading our story!

I’ve been watching all day for your report, and I’m so relieved to hear about your conversation with your vet. I think it went as well as I could have asked for. Your vet’s response was what I would have hoped to hear, and I think the consultation with the internist will offer you the best of both worlds — you’ll benefit from the input of the specialist while still maintaining your ongoing relationship with Max’s regular vet who knows him so well after all her years of caring for him.

As far as preparing yourself in advance of the appointment, it sounds to me as though you’ve already done a terrific job of educating yourself about both hypothyroidism and Cushing’s. As far as the Cushing’s, you may want to focus more now on treatment, which you may already have done. However, if you visit our “Helpful Resources” subforum, near the top of the index you’ll find several threads related to the two medications, Vetoryl (trilostane) and Lysodren (mitotane). I’m assuming the specialist will recommend one of these two meds if he/she feels as though the diagnostics are sufficient to move forward.

As far as the hypothyroidism, one of the most complete explanations that I’ve read related to testing parameters is found on the website of the Michigan State Vet School Endocrinology testing lab. This blurb is quite technical, but it does discuss advanced testing options in great detail.

https://cvm.msu.edu/vdl/laboratory-s...nction-in-dogs

Good luck with your specialty visit. Good job, mom, for your tenacity in advocating for Max! And I love your avatar photo of your sweet boy — what a handsome boy he is ;-).

Marianne

Our vet sent over the referral, but they are unable to get us in until August 11th. I am definitely worried about waiting another 5 weeks. We did have them put us on the waiting list for a cancellation. Is waiting that long detrimental or in the long run typical and ok? I know beginning treatment as soon as possible is obviously the best option. Any advice is appreciated!

Hey Elizabeth, I don’t think I’d worry unduly about the wait. Cushing’s is typically a disease that progresses slowly, so I wouldn’t expect to see significant worsening in another month’s time. As long as everything stays pretty much status quo, I’d think you’d be fine. The one exception is if by any chance you started to see skin lesions appearing. If there’s evidence of calcinosis cutis setting in, then starting treatment might take on additional urgency.

I’d also hold off on starting the thyroid supplementation until Max has been seen. This is because the supplementation would invalidate any additional diagnostic thyroid testing. I don’t know that the internist will be interested in pursuing any more thyroid testing right now, but if so, the supplementation would have to be discontinued for a period of time before the testing could be done.

Hopefully things will stay pretty quiet for you two, though, until August rolls around!
Marianne

Thanks so much!
His main issue right now is "allergies"...licking and chewing feet and licking belly area. He is on Hydroxyzine which honestly I am not sure it helps. He sometimes vomits if he takes Benadryl. We also rinse his paws and apply a mousse for calming the skin. Summer allergies are always worse for him. He does seem to cry for food as well. I thought it was just that he wasn't getting full on the Royal Canin HP since the daily feeding guidelines at 4.5 cups for his size and it is lower in protein than he's used to. Any recommendations for healthy snacks that might help? He's normally happy if I acknowledge him and give him a few pieces of kibble or a "cookie". Thanks for your input!

To all reading...please know whomever you are...we are sending good vibes to all those going through tough times! :o

We are indeed, and that's so kind of you to reach out to others who are struggling, too!

Reading about Max's allergies make me doubly glad that you'll be meeting with the internist. It's a bit odd that Max would be suffering so much at a time when presumably his cortisol level is elevated. As a natural steroid, you'd think that his allergies would be somewhat under control right now. The more typical scenario with Cushpups is for allergies or other inflammatory conditions to worsen or become "unmasked" *after* cortisol levels have been lowered -- not before. So Max's situation does trigger some question marks, but we shall see what the specialist suggests.

I wish I had some great ideas re: healthy snacks. I've seen green beans or carrots suggested before, but hopefully some other members will have some better suggestions in that regard.

Marianne

Hello everyone! We were able to get an earlier appointment for Monday 8/3/20 with the internist! So thankful to get in a little quicker, but nervous. I am spending the weekend double checking all points I would like to go over and getting a list of Max's history and supplements on paper. Anything tips as a newbie on things I might not think to ask?

My top questions are:
-Medications and amounts as he is sometimes reactive to medications (would like to start at the lowest dose possible) I have found a few articles about dogs >30kg and lower doses but would love to see solid research based articles that are recent.
-Diet (moving from hydrolyzed protein diet to a better quality kibble or home cooked)
-Supplements for his issues with his right leg at times (has happened a few times over the last few years cruciate ligament is always ok when they check, but does show an area on back for osteoarthritis in xrays) and will favor his left with a little limp at times (has done this a few times over the last few years) It doesn't keep him from running like a maniac in the yard; which I wish he'd slow down a tad. Currently takes Dasaquin with MSM chews...bumped back up to 2 a day since he seems to be having issues with his right leg over the last week. Stiff upon rising and lowering, but once he starts walking seems better. Trying to have him rest which has always helped in the past. He did the same thing this time last summer almost to the day, but we were able to give a few days of anti-inflammatory meds which helped.
-blood work from previous tests (the "anemia" or lower blood levels on some tests)
-additional tests (his urine ratio test was done incorrectly, urine from the clinic not collected over time..I know the LDDS test he took was pretty straightforward, but I want to mention the urine may not be accurate)
-hypothyroidism and his slightly raised tsh and thoughts on that

I just want to not forget any big things...most important to me is treatment plan and NOT starting a dose that is too high. I am advocating for a much lower dose to start. Any advice appreciated! Have a great weekend everyone!

I’m so glad to hear that your appointment has been moved up! I think you’ve got all the important points already covered— good job! But I’ll continue to give it some thought and check back again by this evening if anything more comes to mind. But for sure, good luck!!

Marianne

Thank you so much!

It’s me, back again for a quick moment. I really do think you’ve done a good job of identifying your central questions, and I still don’t have a lot to add. I’ve spent a few minutes trying to find more recent studies re: the efficacy of especially lower doses in large dogs, but all the summaries I’ve found keep referring back to that original 2012-13 research. In the process, though, I did find this 2018 Canadian literature review covering a wide range of accumulated info (and remaining questions) re: the use of trilostane, generally. I don’t know whether you want to spend time reviewing all this tonight, but it does seem to offer a helpful summary of a variety of research conducted up through that time.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855282/

Once again, good luck with your appointment tomorrow, and we’ll be so anxious for an update when you get the chance.

Thank you so much! I did read that study as I was looking for info in general for trilostane. I am definitely hoping that being a specialty group they are diligent in their continuing research education. I have all of my info ready and on paper to take with us. I will definitely drive home the point that I am not comfortable going over 1 mg/lb if that is the medication route he wants to go. I would rather start lower and will definitely ask. I also am also relieved in reading his bio online that his special interests include endocrine issues.

I will absolutely touch base with you all tomorrow evening...tomorrow starts the first day back to school for teachers in our area! Whew...busy next few weeks, but thankful my husband is home until October to keep an eye on Max! :) Happy Sunday everyone! Have a great evening!

Hi everyone! We had a pretty good visit with the internist today. I liked him very much even though with Covid they are only allowing patients in the building so we talked over the phone. I sent in all of my notes for him to review before speaking to me. He asked why my vet decided to screen for Cushings to begin with due to his alkaline phosphate being the only marker elevated to 700. I told him my vet knows Max very well and knew that was off for him. She immediately thought a blood or immune disorder/cancer or possible Cushings.

He said Max looks to be in perfect health. He said his muscle tone, coat, teeth, etc look great and his weight isn't too low or high (84 lbs). He said at this point he is not showing any symptoms of Cushings. He said in that Max may or may not show symptoms in the future as he knows that there are dogs who have Cushings "on paper", but never experience issues that require treatment...he also said or he could begin having symptoms as time goes on. He described him as being in a grey zone at this point. He said that he did not think treatment is warranted at this point with no overt clinical symptoms. He explained the whole reason to use the medication is for managing the symptoms. He felt that I am an observant pet owner and would quickly identify changes such as the ones that go along with Cushings. He calmed my biggest worry which was beginning a medication before he actually needed it. I am ok with being watchful and waiting.

Thyroid: he looked over his labs and said boxers are known for hypothyroidism, but felt that his tsh number wasn't enough to consider it at this point. He said we typically use tsh in humans to treat, but his other levels were fine and doesn't feel we should medicate at this point...again be watchful of it! There was something he mentioned about the tsh and how sometimes it can run a tad high...but again I cannot remember. I was trying to remember everything and talk on the phone. :(

We did go ahead and retest his PCV/TS which is still low normal about 39/8.6. He also wanted to check his blood pressure which once he calmed down was great as well as sent urine to IDEXX to check protein-Creatinine ratio. Since Max has had some protein in his urine at times. I cannot remember exactly why, but in his notes it says, "looking for problems (proteinuria, hypertension) that occur concurrently with Cushings disease and will treat accordingly.

As of now we will wait for the UP:C results to see if any suggested treatment is needed.

Thoughts....have there been others who has had a conservative internist that didn't rush to treat when a dog is not showing symptoms? Curious about that as my vet was ready to treat both that and thyroid. I feel that for us it is the right thing to do. We are working to boost his immune system at home just with a mushroom complex and fish oil as well as a blood support vitamin which he said was fine. Just trying to keep him as healthy as we can! I welcome any thoughts, or concerns.

I received an email on his UP:C which showed some protein loss. They want to start him on telmisartan to help control the loss of protein. I’m off to do research now as I’ve never heard of this. Dr will call me tomorrow to discuss.

Elizabeth, thanks for all these updates! I’ve really been mulling over Max’s situation and that partially accounts for my delayed reply (along with some darn internet issues...). For the most part, I cannot argue with your new internist’s recommendation to hold off on Cushing’s treatment for now. Given Max’s age and lack of outward symptoms, his comfort and quality of life are paramount. So if he’s not visibly suffering from ill effects that are hampering him in his daily life, I understand why the vet is not rushing you into treatment that requires careful monitoring, frequent vet visits, risks of side effects, and of course not insignificant financial expense.

My only reservation relates to the proteinuria. Again, I am not a vet, so my thoughts are totally that of a layperson. But over the years, hypertension and/or proteinuria are two specific conditions which we’ve seen triggering Cushing’s treatment in their own right, even in the absence of significant outward symptoms. I believe this is because, if Cushing’s is the cause, these two problems may be difficult to manage if the underlying root cause is not addressed as well. From what you’ve learned from the vet, it’s clear that he’s aware that Max’s proteinuria may be associated with Cushing’s. However, it sounds as though he wants to see whether it can be managed sufficiently without leaping into Cushing’s treatment.

Again, I cannot argue with that recommendation since he has Max’s full picture in front of him. I’m confident he’s weighing the various considerations as they currently present themselves. But if it turns out that Max’s proteinuria significantly worsens over time, Cushing’s treatment may well be back on the table (which you probably already know).

In the meantime, I hope the telmisartan will help. I’m afraid I don’t know much about the medication myself, but I do know that we’ve had at least a couple of Cushpups here who have indeed been given it for treatment of proteinuria. So good luck, and do continue to keep us in the loop!

Marianne

Thank you, Marianne. I am nervous about the Telmisartan especially since his blood pressure is great with not signs of hypertension...all blood chemistry values are great as well. Here is his response...I didn't have time to attach last night:

Quote:

---

The urinalysis for Maximus returned with mildly elevated urine protein levels. We see this in association with endocrine
disease like Cushing's or even a "pre Cushing's" state as we discussed for Maximus. Historically we didn't treat this mild of
a degree of protein loss in the urine, but recently it has been recommended to do so. I would consider starting telmisartan
(20mg tablet- 1 and 1/2 tablets by mouth once daily) to help reduce the protein loss in the urine. This medication usually
has minimal side effects and isn't expensive. We do recheck the kidney values one week into therapy to make sure there
is no increase and that the electrolytes are still normal. Most of the time this degree (very mild) of proteinuria doesn't
always resolve, but we can keep it from progressing and causing a problem with this medication. In theory, once started,
this medication would be used indefinitely with adjustments based upon response with regard to urine protein levels

---

I am interested to see what the value of the proteinuria is. I do feel like this is the first step to make sure we "control" the loss of protein. He mentioned it may not resolve it, but hopefully keep it from getting worse. I am encouraged by the several mentions of "very mild". Now I remember that he wanted to do the UP:C test and see how his urine was and treat if needed. Very glad he ran that test! So I am guessing like you were saying, what he wants to do is see if the Telmisartin keeps the proteinuria stable. Perhaps if we notice an upward trend then he may decide to begin treatment for Cushings? All great points...thank you!

I think your vet is “right on” with this assessment. It does make his plan of action clear, and it does indeed reflect the treatment trends we’ve been seeing. I’m so glad to know that he’ll be monitoring the kidney values and electrolytes after a week’s time. I surely do understand your concern about starting off with the new medication, but it sounds to me as though you’re in excellent hands.

I am so appreciative. I hope over time I will be able to contribute more to others. Just having someone who is positive and supportive is so helpful. Reading others' posts, I see how helpful everyone is. Thank you for giving your time to others!
Will report back soon!

It has been a few months, but I wanted to update everyone on Max. He is holding steady with the telmisartan treatment for proteinuria. After initial work up after starting the medication all bloodwork was fine. He has had not ill effects from the medication. After the 2 month checkup his proteinuria values has not gone up and the remained low. Our internist was pleased and with the fact that Max has not other symptoms of Cushings. We will recheck urine protein to creatinine ratio in January and continue to monitor him closely.

Merry Christmas & Happy Holidays to everyone!

Omigoodness, this is really great news! I’m so relieved that Max has responded well to the medication thus far, and we’ll definitely be anxious to read your January update. Since we’ve only had a few dogs here treated with telmisartan, your experience will really be helpful for us going forward. Thank you *so* much for taking the time to check back in, and truly, please let us know how his labwork turns out next month.

In the meantime, I hope you guys have a wonderful holiday season, as well!!
Marianne

Hi everyone! Dropping by to update. Max has recently had his UPC recheck and full labs. His internal med dr said he looks great. He’s still responsive to the telmisartan and it is continuing to keep his levels controlled. All bloodwork was great except his ALP went from 700-1100. His dr said this could likely be from Cushings and said we will just watch it. Worries me , but I trust their expertise. He was not overly alarmed as he said many Cush dogs do have higher ALP. He has gained weight since changing his food this time last year. He is showing some hip discomfort and his whopping 89 pounds probably isn’t helping that. So, I’m definitely hoping to help him shed some pounds; which does normally decrease some in the warmer months. He still does not show any Cushings symptoms except on lab work so our specialists still recommend monitoring until he does. He does love food, but it’s not excessive. He only cries for extra food when I’m around and near the food bin. He spends the day with my husband at home and never “asks” him. ����*♀️

Hope everyone is well!

Thanks so much for letting us know how things are going, and I’m so pleased to hear how well Max is doing! It really sounds like you guys are staying on the right track, and that is great :D. Your vet is right that we’re very used to seeing even much higher ALP readings with Cushpups, so I’d encourage you not to worry unduly about that, either.

I can sure sympathize about his weight gain. Especially when food is being changed, it’s hard to keep calorie counts consistent. And different foods just seem to be metabolized differently, too. My elderly Lab girl has been having chronic GI issues all winter and we’ve changed her food several times. I’m sorry to say she’s gained weight, too, which doesn’t help her arthritic legs, either. And now, it’s really hard to get the weight off since her exercise tolerance is pretty compromised due to her stiffness. Heck, thanks to all my loaves of pandemic banana bread and our short dog walks, *my* own waist has expanded quite a bit, too...<SIGH>

But back to Max, I think your vet’s treatment strategy continues to make sense and I’m just so glad that things are going well for your sweet boy — and for you! Please keep the updates coming, it’s great to hear from you ;-).

Marianne

Thank you, Marianne! We switched him to Royal Canin HP and he’s done fantastic on it. We too switched due to GI and allergy issues. I fought a “science based” diet for a long time, but it has been very good for him so far. I’m just trying to trust his team and know that they are the experts...while I’ll be there asking lots of questions along the way.

I totally hear ya about the food! The ingredients of many of the Rx diets are often so off-putting that I’ve always kind of turned up my nose at the suggestion. But after several weeks of no-luck experimentation with different commercial foods alongside plain chicken and rice, I gave in and started my Luna on Hill’s i/d digestive care. Within 24 hours, she finally had a solid stool and for now, I’m leaving her on it. She really likes it and even though she still relapses a bit every couple of weeks, I’ve had the best luck with it of anything so far. Thanks for mentioning the Royal Canin, though, because I do think that would also be an option for us to try if she continues to backslide on the Hill’s. I’m so over having to worry every day about how poop patrol is gonna turn out!!

Absolutely! Max has always been on “high end” food with higher protein. I balked at the ingredients, but after him having the worst gulps and strange allergies last February we switched him and the change has been remarkable. We have to go very slow with him if I add supplements. He’s always had “gulpy” issues which our vet and ER vets finally said is reflux. Episodes have been greatly controlled with food. I moved him off of dasaquin with msm chews to movoflex and green lipped muscle powder (super snouts) because I worried about his liver and the glucosamine and msm. Oddly enough his alp levels rising I guess it hasn’t helped. I’m sorry your girl has had a rough go. This is my first dog and aging is really tough. I just want him to be happy and not be in pain. We also have luck with Prilosec when he has a gulping episode.
Another thing that is wonderful for dogs with GI issues is raw goat’s milk. We tried it, but it wasn’t a fix for us. I pray Luna’s continues to get better each day. These dogs deserve all the best!! ❤️

Hi everyone! It has been a while, but I still like to update as it may be helpful to others by reading different stories! Max just had his recheck with the internist and all is well. We did start him on thyroid medication in October as his thyroid was low. Our home vet and Internal docs have been watching it and agreed it was time to try a low dose of levothyroxine after viewing his T4, tsh, and pcv. He’s doing well on it. Coat is not dry anymore and his last two checks have him in the therapeutic range 2.0 and 2.6. We’ve been able to stay on the lowest starting dose!

We also started Galliprant about 8 months ago because he was limping and then began yelping when moving from back pain. It has been so helpful. He is able to run and play, jump on the bed again and no limping or yelping. His ALP is holding steady, but still higher than I like. It actually dropped a tad at this appointment. Internist said it’s probably from the galliprant and extra cortisol from Cushings.

His Cushings is still asymptomatic except for the proteinuria which has remained steady with treatment with Telmisartan. His pcv is 37 which that’s where he hovers (between 37-39) over the last couple of years. I don’t like that these numbers are lower, but I’m going to look at adding sardines and egg as a treat just for some extra iron.

Overall a good visit as my boy is coming up on his 11th birthday in April. Great shape for a boxer! We just look at every day a blessing! Hope this is helpful to some navigating through Cushings with their pup!

Omigish, we’re so glad to have you back and to read this excellent report! Absolutely, it’s a help to all of us to continue to read about Max’s treatment journey, and his success on these various medications. It definitely gives us helpful info in terms of offering options out to other parents. You’ve done such an excellent job of advocating for him, and we’ll surely be joining you in spirit to celebrate his upcoming birthday!

Best wishes to you and to Max, and thanks so much for the update :-)))))))
Marianne

Hi Elizabeth,

What a great update on your sweet baby boy! I am so happy to hear he is doing so well and that your visit with his vet went well! How nice to have such a great vet! I hope the specialist can bring even more joy and comfort to you and Max.
Hugs,
Leslie

I cannot believe it has almost been 3 years since diagnosis! Here is our check in! We appreciate everyone reading our story and hope it can give hope and hep to others!

We had our 9 month check in with our internal vet. She has noted that his ALP has increased and he is showing some higher potassium and anemia (which anemia is not new, he has hovered lower for a while). His labs showed ALP 1547 in July, 1920 in Dec at our vet and 2152 yesterday at internist. Our vet said possibilities for the high ALP could be uncontrolled Cushings or a liver mass. Max is on medication for proteinuria; which has been controlled by medication and has not outward signs of Cushings except labs. He is also on thyroid meds for hypothyroidism. He has also in the last 6 months been diagnosed with ARVC and is doing well on a low dose heart anti-arrhythmic.

We are going to do a fecal occult test to see if there could be gi bleeding from galliprant which could be contributing to the anemia or if no bleeding it could be a liver or adrenal mass. Can Cushings drop hematocrit with no bleeds? I'm thinking an ulcer bleeding which would be an easier fix... no bleeding could indicate a mass (guess that's worse possible case?)

This is where I am torn. He will be 12 in a few weeks. I just want to keep him comfortable and happy as almost 12 is ancient for boxers. He is the last one in his litter. I know we just need to rule out the gi bleeding first and then go from there. I am torn about an ultrasound. He doesn't do well with procedures and has to be knocked out. An ultrasound would only be beneficial so we would know whether it is his time or not...I would not treat a mass at this point given his age. I know this is speculation at this point and I should probably only be thinking about steps from here and facts of what we know. Just wanted to share and get hear anyone's thoughts who might be willing to share.

Thanks so much for the update on sweet Max, and to answer your question regarding the relationship between Cushing's and hematocrit, elevated cortisol generally raises red blood cell counts.

How is Max's appetite and how about his attitude, I mean does he seem to be happy? If he does than, if this were me and taking in account his age, I would not have any tests for Cushing's performed, and probably not even the ultrasound since he gets a lot of anxiety with it. I sure do wish you both the best of luck and please do keep us updated.

Sending you both huge loving hugs, Lori

Welcome back, Elizabeth, and I agree 100% with what you and Lori are both thinking. Given his age and overall situation, if Max were my own boy, I’d likely forego the ultrasound as well. Just as you say, keeping him comfortable and happy would be my top priorities. If noninvasive lab testing can give you some answers to help guide you in that regard, then I’m all for it. But at this stage, anything that will stress him unduly is probably not worth the trade-off in terms of info gained. For sure, though, we’ll be happy to continue to talk over your options with you. I do hope the anemia turns out to have a relatively easy fix, such as altering his med regimen. Please do let us know what more you may find out. And please also give Max a big hug from his K9C family here!

Best wishes to you both,
Marianne

Thank you, Lori! He seems great! Happy, but slowing down. I really appreciate your feedback!

We know he does have Cushing's...but in the beginning it was recommended to not treat it specifically as he did not have symptoms. All speculative at this point until we get the fecal back, but his internal Dr has said based on changes in bloodwork (high potassium, increasing ALP, anemia) he may do better with beginning treatment for Cushing's.

I know I need to just take it one step at a time to see what tests results show. No real decisions can be made until things are clearer. I am just a thinker and it's my way of working through it all! :)

Thank you, Marianne! I appreciate that!

I think the only reason I would do an ultrasound would be to have definitive answers. If he were to have a mass (depending on dx) I would not want to put him through pain and more suffering.

So so tough!