Cooper, 14 year old Puggle

[Joan2517]

Okay, I'm still trying to decide what to do about him. You all know about him from Gable's thread, but I thought he should have his own. I've been putting off this post for the last couple of weeks. Every time I thought I would do it, I just couldn't, so here goes...

Here are the results of his blood work from January 7.

ALT: 226 HIGH ref range: 12 - 118
Alk: 1966 HIGH ref range: 5 - 131
Magnesium: 1.4 LOW ref range: 1.5 - 2.5
Cholesterol: 351 HIGH ref range: 92-324
Precision PSL: 181 HIGH ref range: 24 - 140

He's gained about 10 lbs since Gable died. He's part Pug, so he's always had that little snore, but now it's much worse, and he's panting a lot. The vet wanted to do the Low Dex test, but I know he would have a heart attack if he was left there all day. I'm not even sure just going for the Cortisol testing won't push him over the edge. He's constantly frantic about anyone, any truck, any noise outside, and he has MAJOR separation anxiety. If I go out to put the garbage out he gets hysterical, and Victor says he howls when I leave to go anywhere. With his anxiety level at high speed all the time I don't even know if we could get an accurate reading. Then there's the expense. A third time around with everything else that's going on will put such a strain on us financially.

But I hate seeing how uncomfortable he's getting. Just last year he had such a cute shape and now he's fat and has trouble jumping up on the couch. He's started drinking and peeing a lot. I just bought some low fat kibble and we've started walking. But Victor is doing the same thing with him that he did with Gable, constantly sharing food with him.

He's already as old as Lena was when we started treating her, and she only lasted a couple of months on the meds and I'm just not sure putting him through all of this will be the right thing to do.

What are your thoughts? I was thinking of just doing the ACTH to see where the levels are, but like I said, he'll be such a nutcase going to the vet twice in a couple of hours that he'll be stressed to the limit, and I'm not really sure it's Cushing's. His stomach makes a lot of noise, gurgling sounds. I just wonder if it's all the extra weight that's making him uncomfortable.

I'm in denial, I know....

[Harley PoMMom]

Dearest Joan,

In no way do I think you're in denial, Cooper's case sure is a mystery! Since he has anxiety issues, I wonder if an UCCR would be an option. Do you think trying to capture some urine from him would make him anxious since it should be done 3 times? I believe that's what I would try.

I see that his Precision PSL is elevated which might be the cause of the noises coming from his tummy so I'm glad that you've started feeding him low fat dog food which should help. I sure wish our furkids could talk to us, would make things a lot easier!

Hugs, Lori

[Joan2517]

Thanks, Lori...that's certainly worth a try. I should be able to do it.

He doesn't have the potbelly, just getting fat all over which is making me question Cushing's. I forgot to mention in the first post that the Thyroid levels were good. too. They also suggested Benadryl for the raspy breathing in case it's allergies. I gave him one this morning, we'll see.

Thank you for your thoughts, Lori.

[Squirt's Mom]

Hi Joan,

Based on the labs you shared I would not be looking at Cushing's first but the liver and pancreas...and immediately. The ALT indicates liver damage; the ALT represents dying cells that happen when the liver has been damaged from injury, disease, medication, etc. The ALP is reading living cells and that tells us how hard the liver is working. This value can raise and lower often depending on the stress the liver is experiencing at the time of the testing. But the ALT is concerning to me. The Precision PSL is specific to the pancreas and usually indicates pancreatitis is in the works.

If I were you, I would focus on 1- getting the weight off asap; 2 - the pancreas; 3 - the liver. The excess weight is going to put pressure on the diaphragm making it more difficult to breath ( I know....I'm fat! LOL). The excess weight puts extra strain on the liver and the pancreas. So I would get him on a low fat/calorie food, low fat/calorie treats given on rare occasions, and NOTHING extra plus daily walks at least once a day. Or swimming in the tub...something physical to get the weight down. You may find some of the changes you are seeing are directly related to the weight gain. One pound in a dog Cooper's size is a huge gain.

You are right...his anxiety level will make it difficult to get an accurate reading on any of the blood tests for Cushing's (ACTH and LDDS). If it is determined that the liver and pancreas are ok and the weight loss doesn't bring many resolutions to the signs you are seeing now then that might mean testing for Cushing's will happen. If so, I would talk to his vet and make arrangements for you to be present every time they take blood or give an injection AND that you can take him out of the office/clinic between. I don't know but am concerned that any medication to calm him might also impact the testing but in the other direction so that would be something else to talk to the vet about. Or someone else here might know the answer....sadly I don't.

You are doing a great job as always so don't be hard on yourself. Cooper is a lucky boy to have you as his mom.

Hugs,
Leslie

[labblab]

Dear Joan, I’m so glad you went ahead and started this thread although I surely understand why it might not have been easy. OMG, to have Cushing’s rear its ugly head for you AGAIN????? This is so unfair, and nope, I don’t think you’re in denial. I just think you’re struggling with the best path forward, given the fact that Cushing’s does seem like a real possibility for Cooper. Yep, I went ahead and said it. Given his labwork and his symptoms, he does look like a Cushpup to me. I see that Leslie is expressing special concern about Cooper’s liver. But my own thought is that the moderate elevation in ALT and the more significant elevation in ALKP is pretty commonplace for Cushing’s. As is the elevated cholesterol and even the mild elevation in the PSL. So my own guess is that Cushing’s is indeed the root cause, and the question will end up being what to do about it, if anything.

In terms of Cushing’s, I’m so glad Lori suggested doing a UCCR. I totally agree with that as a reasonable first step if you’re able to collect urine from him. I suspect his result *will* be elevated, and then we’ll need to discuss next steps. But who knows, maybe it won’t be and what a help it would be to find that out. If the result *did* rule out Cushing’s, though, then I’d join with Leslie in wondering what else may be going on to cause those liver/pancreas elevations.

I also agree 100% with Leslie that trying to get some weight off would be a huge benefit, no matter what. I don’t know if you can talk some tough love into Victor, but somehow we’ve got to convince him that loving Cooper means NO SCRAPS!! Good luck with that, my friend!

And I know I’m putting the cart way ahead of the horse, but if Cushing’s turns out to be a reality, perhaps a very low dose of trilostane and the simple pre-pill cortisol monitoring would be something that would seem manageable to at least try. Or maybe not. For sure, this isn’t your first rodeo and I understand why treatment may not be in the cards this time around. I promise, we won’t be judging you either way.

But again, I’m so glad you started this thread so that you don’t have to worry about this all by yourself! And as I say, I think my first step would be a UCCR if that could be arranged. We can certainly tell you more about the specific protocol involved — basically you collect a morning urine sample at home on three successive mornings, you refrigerate and pool the urine, and then take it to the vet for analysis. But we can talk more about that, and anything else, as much as you want.

[Harley PoMMom]

Since you're considering the UCCR test, here is what Dr Bruyette suggest as how to collect the urine. Harley was pretty easy at getting his urine, although some of it did manage to get on my hand I just shoved the plastic jar that the vet gave me under him and most of the pee went into it. Good Luck!!

Yes. The same would apply when looking at urine cortisols in the initial diagnosis of Cushings. Ideally 3 morning pooled urine samples collected by the owner at home and refrigerated.
Dave

[Joan2517]

Thanks, girls! This is all very helpful. One question: if he gets up in the middle of the night to go out, say 2 or 3, would a 7 or 8 still be considered the morning pee?

If it does turn out to be Cushing's, I would definitely start him off at 5mg.

I'll call the vet Monday and see how receptive he is in working with me this route. I always took Gable home in between the ACTH testing. He's been very good about how I wanted things done with Gable, but the owner is not as cooperative. He poo pooed everything I learned here. He will be looking to make money off the testing. I definitely don't want to do the LDDT.

Can fruit and veggies be snacks for him?

[Squirt's Mom]

Well pooh-pooh on him!

Fruits and veggies are great treats! Mine love green beans, green peas, carrots, bananas, mango, and others. This type treat is filling so it is helpful for a cush pup's hunger control and much better for them over all than the commercial treats.

[Harley PoMMom]

I believe what they're looking for is the most concentrated urine, so if the 2am is, than use that. If he is going every 3-4 hours any way, than collecting it at 7-8 would be OK, just remember you'll want 3 samples and than pool them together. I always asked my vet for their urine sample bottles, however if the vet wants to charge for them than I'd use a plastic container just making sure the ones that are used are sterile by washing in a dishwasher.

[Joan2517]

I believe what they're looking for is the most concentrated urine, so if the 2am is, than use that. If he is going every 3-4 hours any way, than collecting it at 7-8 would be OK, just remember you'll want 3 samples and than pool them together. I always asked my vet for their urine sample bottles, however if the vet wants to charge for them than I'd use a plastic container just making sure the ones that are used are sterile by washing in a dishwasher.

Oh, that's good to know, Lori. Thanks!