Overwhelmed by the possibilities... (Ginger may have cancer)
I don't know where to start, but I have a lot of questions before I have an appointment with a dermatological vet and they're supposed to call today to schedule me.
I apologize in advance for the length of this post, but I want to give you as much information as I can. I'm very worried about our dog and freaking out about this a bit.
Our dog, Ginger, is a 10 year old-mixed breed 47 pound dog. She has a history of liver problems of unknown origin, and is on prescription hepatic diet food. She had an abrupt rise in one of her liver numbers a number of years ago with no known reason. Treatment with several prescription medications and Milk Thistle brought her numbers back into the higher ranges of "normal" within a couple of months. As it edged up a bit, we added Milk Thistle back in once a day as maintenance and her numbers have maintained high normal.
Last August or September, we noticed that she had tiny tufts of hair coming out in a few places that had bits of dry skin attached. There was a small area of hairless skin with dark pigmentation. We took her to the other vet in our office, since our regular vet was out and she did a skin scraping and thought it was a bacterial infection and gave her antibiotics. We had a dog years ago who had that happen and it turned out to be a food allergy, so we weren't terribly concerned. The spots we noticed seemed to disappear and we didn't think about it again until we noticed several more spots. At that point, our regular vet decided to send blood out for an allergy test, which would take four weeks. He told us that if it wasn't an allergy, it could be something like a particular type of skin cancer. He felt that it was most likely an allergy. Our mistake at that time was that we didn't search through her coat to see how much there was. I feel like an idiot now. But between our previous allergy experience with another dog, and not wanting to freak ourselves out about skin cancer, we just didn't do it.
The allergy tests came back negative, and he doctor called us in and said that he wanted to do a ringworm test just to eliminate the possibility. It was supposed to take up to two weeks to turn positive but turned within two days. It turns out that underneath her fur, she was just covered in these dark areas with hair coming out. We started topical treatment, but it would take us two hours with a flash light and q-tip with ointment to do her, and we just couldn't possibly keep that up -- either for us or for her. And we couldn't put the ointment in any place she could lick. So, our vet consulted with a dermatological vet to find which of the anti-fungals was the least hard on the liver. By then she was so covered that we were warned that it would take months to clear. She's been on Fluconazole for almost 5 months.
She's also being treated with anati-fungal shampoo, and now just once a new topical which is supposed to kill both the spores and the fungus in a single application for less severe cases. The ringworm seems to be going away, the skin healing and starting to return to its normal color in some places and getting much worse in others. We have been cleaning clothes, bedding (ours and all the pets), and carpets with anti-fungal additive. The disruption of all the excessive cleaning has caused stress-related (the vet suspects) UTIs in a couple of our other pets. This ringworm just won't go away and we can't have people with pets visit us, can't have our parents over because we've been advised that people who are older or have weakened immune systems are very susceptible. It just isn't going away and it's taking a toll on us.
Finally, we asked for a referral to the dermatological vet, which we also should have done before this. I didn't even realize that the derm vet was local, and again I feel dumb for not doing this sooner. Our regular vet also ran a panel of blood tests to send to the derm vet for us. This is when we found out we may have another problem.
Blood tests after 6 weeks or so showed no change in liver tests. Blood tests this week DID. Her Alk Phosphatase is now 718, when it had been 67. Her ALT which should be between 10 - 100 is at 101. I believe the ALT is the number that was bad several years ago, but I can't find that info offhand. The other thing ithat has changed is that her Thyroid number which was 1.8 in November is now only 0.8. This is when our vet called us back and told us that it could be Cushings Disease. The medication side effects I've read about here scare the heck out of me.
He told us that the derm vet will probably want to run a ACTH stim test and do further thyroid blood tests as well.
Ginger doesn't have many of the symptoms of Cushings and some she does have seem likely to have a different explanation as follows:
1) Low thyroid numbers.
2) Black patches on skin, hairless areas. Was presumed to all be caused by the ringworm.
3) Food guarding. She has ALWAYS done this, but it seems to have increased slightly in the last couple months.
4) Paper eating. I honestly don't think this one is related. She has done this most of her life, and though it has increased lately, it is not a hunger thing. She will do this when she has food available, but only when we leave the house. She's had separation anxiety issues before, and we think that the issues surrounding the ringworm -- excessive house cleaning, less petting so we don't spread it, etc... are making the separation anxiety worse. She has gone through phases on this before.
5) Hind leg weakness -- she has always been a dog that has no sense of self-preservation and will continue jumping on an injured leg (We absolutely try not to let her do that!). She has a partially torn ligament in a back knee and arthritis, so that could be responsible for most or all of this problem.
6) Increased panting. My husband and I differ on how different we think this is from her norm. She is definitely not panting all the time or at night.
7) Food stealing. She will steal our other dog's food if we leave it down when we're gone. But again, this is something that she has always tried to do. We have only had a second dog for a little over a year, but when she was young, she used to do that with the cat's food if we didn't put it in an inaccessible place. I really believe this one is solely personality. She's not hungry so much as wants something other than her prescription food which may be in her own bowl untouched.
She doesn't have the sagging belly, excessive thirst or urination, or excessive hunger.
Sorry this has been so long, but I'm trying to figure out before we go to the dermatologist what we should ask to have tested? And what other questions we should ask. We've got four pets, three of whom have medical issues (the other two are an 18 year old cat who has a variety of things going on that we almost lost last summer and a dog whose eyes don't produce tears). Between the three of them, we haven't had a week since August or September that we haven't had 1-3 vet appointments. And this ringworm just won't go away and is taking a toll on us all. We want what is best for all our pets, and our goal is to get Ginger treated for whatever it is that is wrong with her and to get her off this medication that may be responsible for the rise in her liver numbers if that can be done and still deal with the ringworm. I would rather pay more for additional tests up front if you think that is wise and wouldn't be hard on her, rather than go through iterations of inconclusive tests.
So... Besides the ACTH stim test and additional thyroid testing, what tests do you recommend I ask for? What other questions would be pertinent for me to ask that I haven't covered here?
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Especially in a multi-pet household. Ringworm is so extremely contageous that once 1 animal has it, all animals need to be treated. And the fight to stop the spores is a real battle 
Spores can survive for one to several years in the environment so that needs a very thouroug and strict cleaning routine that must be kept up a long time after the ringworm has gone (visiually) Also, from what you wrote, it seems that Ginger might have a long(er) coat? In that case it is advised to shave the entire coat off. 
Originally Posted by Squirt's Mom
