New & Waiting for Testing / Diagnosis

Hi k9cushings forum!

I have been reading your articles and posts all weekend. Thank you for being such a wonderful resource.

My dog Zoe is a 6 y/o lab mix who recently went in for bloodwork that presented with high levels of ALP (~800) despite everything else being normal. Our vet put her on Denemarin for 1 month and then took a blood draw again on Friday, and her ALP was still elevated / increased (~950). Needless to say this was not the news we wanted. Vet is going to have her do a low-dose dexamethasone suppression test (LDDST) on Thursday this week. I could not be more nervous. Luckily, Zoe is fine otherwise and not really presenting any of the typical Cushings symptoms. We are holding out hope. I am worried with her being so young and having the diagnosis more than anything! We want her to have a great quality of life and keep her around as long as possible.

Thank you so much. Hope everyone is staying safe and having extra time with the doggos during this quarantine.

Kristen

Hi Kristen,

Welcome to you and Zoe! We are glad you found your way here and will do our best to help in any way we can. If this were me, since Zoe is not exhibiting any of the normal Cushing's symptoms, such as excessive drinking/urinating, ravenous appetite, and hair/skin issues, I wouldn't bother having any testing for Cushing's performed as of yet. My reasoning is if there are no symptoms than probably her cortisol isn't high enough to start treatment. The goal of therapy is to control elevated cortisol and alleviate those bothersome symptoms so if Zoe has neither than treatment should not begin.

Many things can elevated ALP, such as nodular hyperplasia which is commonly found in elder dogs and is completely benign. Gallbladder and/or a gut issue is another cause for a high ALP, so instead of the LDDS test I would put my money into having an ultrasound done to get a good look at those internal organs.

Lori

Hello and welcome to you and Zoe from me, too. I “second” what Lori has written above. Because there is no single definitive test for Cushing’s, most specialists caution against rushing into treatment for a dog who is showing only lab abnormalities in the absence of observable clinical symptoms that are commonly caused by the disease. The most accurate diagnosis takes into account the whole picture: labwork in conjunction with the symptom profile. Otherwise, the diagnosis remains more questionable since other conditions can elevate ALP, and can also result in “false positives” on either of the two Cushing’s-related blood tests.

Having said that, there are a couple of exceptions. If a dog with elevated liver markers also exhibits high blood pressure and/or proteinuria (protein is found in urine samples), we’ve seen Cushing’s testing and treatment undertaken more aggressively. That’s because Cushing’s can be the root cause of those two conditions, and if left untreated, either of those conditions can cause progressive internal damage.

All in all, it’ll help us if you can tell us more about Zoe’s overall health history, and also whether you’ve been noticing any changes at all in Zoe’s behavior or appearance.

Thanks in advance for any additional info, and once again, welcome!
Marianne

Thank you so much Lori & Marianne! It's so great to have your input. We certainly don't want to move too fast on this and would like to ensure a proper diagnosis, whatever it may be. Our vet recommended the LDDS test and we have confidence in her, but I would like to know more about potentially doing an ultrasound instead as you suggest. I will be giving her a call and also will see if I can get access to the lab results.

Zoe is generally very healthy. She had a cruciate ligament replacement a couple of years ago (TLPO) and the leg has been fine since then although she does have a touch of arthritis now because of it. Her coat is very shiny and thick, she sleeps well, is energetic, no problem with overeating or drinking, normal weight for her size, and her BM's and frequency of urination are normal. Now that I'm listing all of this off, it does give a bit of encouragement as I understand the Cushing's symptoms are fairly distinct. We will work on getting to the root of the elevated ALP issue. Will update soon! Thanks again. - Kristen