OK, finally I’m back again! Once again, thanks so much for providing all this helpful information. I know Dozer had several abnormal lab results, but I’m going to focus on the ones that stand out the most to me. Before doing that, let me caution you that I’m not a vet, so my thoughts are based on what I’ve learned over my years on this forum as opposed to professional training. But these are things that have raised questions in my mind.
First, elevated liver enzymes — especially high Alk Phos levels - are characteristic of Cushing’s. Also, changes in the appearance of the liver itself are commonly viewed on ultrasound. So those abnormalities would be consistent with the disgnosis. However, here are my concerns about the diagnosis. First and foremost, just as Leslie wrote earlier, Cushing’s is typically a syndrome that gradually worsens over time. The sudden onset of Dozer’s symptoms immediately subsequent to his surgery raises a huge red flag for me. Not that I’m accusing the vets of anything improper with the surgery itself, but I do have to wonder whether there was any internal trauma, inflammation or infection that lies behind the sudden onset of these symptoms. And if Dozer was/is suffering from any other type of systemic issue, this could easily result in a “false positive” on his diagnostic LDDS test (noted as “Cortisol 3 Serial Dex” on your report). Any illness, injury or stress can raise cortisol levels in the same manner as Cushing’s. That’s why the complete medical history and constellation of symptoms are an important part of the diagnosis.
It is the third cortisol reading on that test that is diagnostic for Cushing’s. Dozer’s third reading was 1.5, which was *barely* higher than the normal cut-off value of 1.4. The fact that he was only slightly out-of-range doesn’t give me a lot of comfort in the Cushing’s diagnosis, especially if you know he was outwardly acting unwell at the time the test was performed.
Adding to my concern are two other abnormally high readings at the time of his test. The first is the Precision PSL reading of 246. I believe a level that high would be considered diagnostic of pancreatitis, which can be an extremely painful and disabling condition, definitely affecting appetite. In addition, his Free T4 reading was quite high, as well, which would indicate hyperthyroidism if it was a valid and ongoing elevation. Here are symptoms of hyperthyroidism, several of which correspond with Dozer’s behavior:
Depression.
Diarrhea.
Enlarged thyroid gland.
Excessive thirst.
Forced breathing.
Heavy, rapid breathing.
Increased appetite.
Increased energy.
Increased urination.
Nervousness.
Rapid heart rate.
Shaggy hair texture.
Vomiting.
Weight loss.
The increased appetite and energy don’t correspond with what you’re seeing in Dozer, but he may be suffering from multiple issues that are combining to present a particular set of problems. For instance, when we move ahead to the June labwork, his Precision PSL has jumped clear up to 514. So perhaps he may be suffering from a smoldering chronic issue with his pancreas. At this point his Free T4 thyroid reading is much lower, but still a tiny bit above normal.
All in all, I definitely agree with holding off on giving him any more Vetoryl for the time being. I’m just not yet convinced about the accuracy of the Cushing’s diagnosis in the face of these other abnormalities. And I would specifically question your vet about the appearance of his pancreas on the ultrasound, as well as the significance of the elevated Precision PSL and thyroid levels. My concern here may be unfounded, but these are issues that do raise big questions for me. And no matter what, please do keep us updated.
Marianne