Hi,
I found this forum while looking up info on Cushings in dogs, and am hoping you all can help. My dog Bella is looking at a potential Cushings diagnosis, and am wondering A) if her combination of symptoms sounds familiar to anyone, and B) What are the risks of treatment vs waiting, since right now she doesn't have very much in the way out of outward symptoms.
To back up a bit, Bella is a ~50 lb Husky/Samoyed/northern breed mix. We rescued her 5 years ago, and the vet estimates her current age is around 8-10. she was diagnosed with hypothyroidism about 2 years ago about 6 months after a severe bout of acute Pancreatitis, Gall bladder infection, UTI, and a blood clot (all at the same time). For the 6 months after that her energy level was low, losing fur, skin turning black, etc, recurrent diarrhea, plus another UTI. I asked our vet to perform a thyroid test, and her T4 levels came back very low (<50). After starting the thyroid supplement, it was like she was a new dog, fur grew back, energy back up, stomach problems went away. Since then she's been doing great except for another gall bladder infection about a year ago and 2 additional UTIs within the past year. She's also had 2 blood clots to go along with the gall bladder infection.
Fast forward to now, and a month ago we took her to get her first dental cleaning in about 3 years, and when they did the pre-anesthesia blood work her ALKP levels came back high (432 vs 212 max normal range). They were elevated on her previous blood work as well but not as high, although the ref max was different for that test (275 vs 131 max normal range) All other liver enzymes and other blood test levels came back normal. Our vet recommended a followup to a specialist given her history of gall bladder disease. We went to her internal medicine specialist who did an ultrasound. Ultrasound showed no issues with her liver or gall bladder (other than some stones that were pre-existing but not obstructing anything) but did show another blood clot. To try to determine the source of the recurring blood clots, the doctor did a urine cortisol/creatanine test (sample collected in the morning about 5 days after the initial visit). I just got back the results, which showed an high level of cortisol (22 vs <13). Based on this, the recurring blood clots, and the elevated ALKP levels, the Dr is thinking it may be Cushings and wants to do the LDDS test next Monday. Other than the internal readings, she's not showing a ton else in the way of symptoms. Her appetite is completely normal, although she has been drinking slightly more water over the last month or so, but we had just chalked that up to summertime heat. She doesn't drink a lot of water normally, so its not a huge total amount of water she's drinking, but it has been maybe a 25% increase from her usual. She's also been panting a lot more over the past several weeks(waking up panting during the night occasionally), but has seemed better the past few days, so not sure if that's just the heat as well. She's not peeing more frequently (she has always "marked" like a boy dog on walks, but otherwise only needs to go out once or twice in addition to her two daily walks). She has been having intermittent incontinence issues for the past few months. We put her on Incurin for a bit, but she got ALL of the side effects, so now we're just doing a tiny (.5mg) does once a week (vs 1 mg/day dose she was on that caused side effects), and that seems to be enough to limit those issues for the most part, but no side effects. Her energy levels seem pretty normal (active bursts around morning and evening walk and then dinner time, pretty relaxed and chill most of the rest of the time).
Hoping I can get some advice on whether this might actually be Cushing's or just some weird coincidences and false positives. Given her complex medical history, its hard to tell what's causing what, and I definitely don't want to have her end up on any drugs that she doesn't need (already taking enough drugs as is!). Sorry for the huge info dump, and thanks for any help. Also definitely don't want to put her through more tests than necessary, so understanding what's worth doing and what isn't would be helpful.
-David