Wondering whether to start my dog on treatment?

[dimber]

Hi, I have just joined and have been so impressed with your site. It is so wonderful to be able to be able to post a query and receive your reasoned, thoughtful and empathic responses. Thank you so much for your work - it helps so much and eases the emotional load we carry with the illness of a beloved pet.

Our beautiful Harriet is a thirteen and a half year old Maltese-Shitzu. Because of elevated liver enzymes about 6 years ago, Cushings was suspected, but as she had no clinical symptoms, no more advanced tests were attempted at that time. Her liver enzymes continued to climb annually. About 3 years ago, an ultrasound showed some inflammation of the liver, again suggesting Cushings, however as she still had no clinical signs, no further testing was undertaken. About a year and a half ago, she showed the first clinical symptom in that she let us know that she only wanted to go for half of her usual walk instead of the whole route (she used to walk for 30 minutes a day and now walks happily for 15 minutes a day). We have a two-story home and she goes up and down the stairs several times a day. She used to bound up the stairs, but now she walks and is able to do so with no trouble. About 8 months ago, her tail thinned, quite dramatically and some time after that, her coat became thinner. For about the last 6 months she has been panting more than usual, although this has lessened a bit in the last couple of weeks (with no change in her treatment regime). Her fluid intake has remained absolutely steady at her pre-morbid rate. There has been no increased fluid intake and no increased urination. She has less energy than she used to have and spends most of the day napping. She loves eating her special treat dog food and will eat it from her lick mat immediately but will take hours to finish her daily dish of normal dog food, so I assume that she is not ravenous? Her abdomen has become larger and tighter in the last six months.

Her test results to date (Oct. 2021) are:
ALT IU/L - 169 (ref interval 13-98)
AST - 38 (ref int. 17-84)
ALP IU/L - 4398 (ref int. 0-182) Lipase 180 (ref Int. --75)
Other blood results were in normal limits.

Currently she is taking Prana Pets Lignans and Melatonin combo
Prana Pets Adrenal support
Prana Pets Immunity Blend Canine Rose-hip powder (for her arthritis in one paw)

The Prana Pets trio of meds seemed to be helpful when she first started taking them three years ago and her liver enzymes stabilised with them, instead of rising year by year as they had been before she started on them.

I have a couple of queries and would very much appreciate your thoughts.

1) What I want most for her is good quality of life. Her breed habitually keeps its tail up and I have been using this as one sign that she is not unduly unhappy or feeling ill - am I right in using this as one of my criteria? On walks, she is alert and interested in sniffing and looking around. Although she spends most of the day napping, she will instantly rouse herself and follow us into whatever room we are going to when we get up (as has been her habit since puppyhood). What other things would you look for to determine how a dog is feeling.

2) We have been turning over whether to start conventional medication. Harriet is normally a happy, confident girl, but is absolutely terrified of the car and also of the vet's and will shake and cry uncontrollably and inconsolably from the time she gets into the car until the vet's visit is over. She gets so stressed and for such a sustained time that I feel worried about initiating treatment that involves regular vet visits. Do you feel at this stage that the intense stress Harriet experiences would be worth the benefits of treatment?

Again, thank you so much for the time and trouble you take with your responses - it is so very much appreciated.

Doris

[Harley PoMMom]

Hi Doris,

Welcome to you and Harriet! So sorry for the reasons that brought you here but glad you found us and we will help in any way we can. Cushing's is a clinical disease and treatment isn't recommended unless clinical symptoms are present, the 3 most common symptoms displayed are: increased drinking/urination, ravenous appetite, and a pot-bellied appearance. Seeing that Harriet doesn't show any of these I would advise to not treat for Cushing's. Did Harriet have a bile acid test performed? If not, if this were me, I would start with that test first.

I truly believe that as pet parents we know are furbabies best and definitely can recognize when our furbaby isn't feeling well. I know with my boy, his ball and food are two things he is obsessed with so if he isn't interested in one of them something is off.

If you have any questions, please do not hesitate to ask them!

Hugs, Lori

[dimber]

Thanks so much Lori. Harriet hasn't had a bile acid test, so I will bring that up when we see the vet next week. Re the pot belly, when Harriet is standing, her profile looks pretty normal, but when she is lying down on her side, you can see that her abdomen is definitely larger than normal, distended and hard. I imagined that a pot belly would look distinctive when she is standing up, not just lying down? I noticed too that her t4 is lower than normal, but I believe this can happen with Cushings? She hasn't had a TSH.

Thanks again for your support!

Doris


]Hi Doris,

Welcome to you and Harriet! So sorry for the reasons that brought you here but glad you found us and we will help in any way we can. Cushing's is a clinical disease and treatment isn't recommended unless clinical symptoms are present, the 3 most common symptoms displayed are: increased drinking/urination, ravenous appetite, and a pot-bellied appearance. Seeing that Harriet doesn't show any of these I would advise to not treat for Cushing's. Did Harriet have a bile acid test performed? If not, if this were me, I would start with that test first.

I truly believe that as pet parents we know are furbabies best and definitely can recognize when our furbaby isn't feeling well. I know with my boy, his ball and food are two things he is obsessed with so if he isn't interested in one of them something is off.

If you have any questions, please do not hesitate to ask them!

Hugs, Lori[/QUOTE]

[Harley PoMMom]

A low t4 is common in dogs with Cushing's, sometimes this can be euthyroid sick thyroid syndrome, generally a measurement of free T4 (FT4), from a blood draw, is performed to distinguish between euthyroid sick thyroid and a low functioning thyroid. One other diagnostic tool that can be done, if feasible, is an ultrasound, however these can be costly and should only be done by a vet or IMS that has a lot of experience in performing them. An ultrasound will allow a vet/IMS to get a look at those adrenal glands and other internal organs.

Hugs, Lori