Olivia and possible Cushing's diagnosis

[francielle]

Hi all!

My name is Francielle and I own beloved Olivia, she is a 8 1/2 yo Shihtzu. Olivia is pure joy.
About 3 years ago, Olivia had a health scare, after taking her to the vet, we found out she had bladder stones and an enlarged adrenal gland. We did our first Cushing test back then and it was negative. Olivia had surgery to remove the bladder stones, and after analysis, it was confirmed to be ammonia urate. With this, we had done an MRI which showed Olivia had a portosystemic shunt (PSS). Last March Olivia had her shunt surgery performed, she was in the ICU for a month because of a bacterial infection, we almost lost her, but she is a tough warrior! We did a lot of blood work last year and her liver levels were good, despite suffering all those years because of the shunt. We also did another Cushing's test because of the enlarged adrenal, and again it came back negative, her endocrinologist said we could leave Cushing's behind until she showed symptoms (if any).

Fast forward to yesterday, when we did blood work and her ALKP levels are at 1200 (upper limit is 156). The last time we measured her ALKP was last August, and the level was 109. BAck in August and October since all her liver levels were fine, we had stopped taking any supplements (SamE, Milke Thistle and Ursodiol). Olivia has a new ultrasound tomorrow and we have an appt with her gastroenterologist and her endocrinologist on Tuesday. We will probably have another suppression test done, but I'll talk to the vet appt treatment options. Other than gaining weight, Olivia is fine and her usual cheerful self.

Putting her under surgery for adrenalectomy is totally out of the picture based on the experience we had last year, it was emotionally and financially really difficult. I'll probably just handle her with medication.

[labblab]

Hello and welcome to you and sweet Olivia. What a little warrior, indeed! Thanks so much for all this information you’ve given us. It’ll be very interesting to find out what your specialists recommend after your consultation next week. But in the absence of uncomfortable observable symptoms of Cushing’s, I’m wondering whether they’ll still hold off on treatment regardless of the outcome of the diagnostic testing. While the elevated ALKP is indeed a marker that implies elevated adrenal activity, we’ve been told that it does not necessarily indicate actual impaired liver function. So it may be the case that the supportive supplements will be restarted at this time, but without more aggressive treatment yet.

I certainly understand your reluctance to consider another major surgery. As I’ve aged myself, I’ve come to understand that just because a medical treatment exists, it may not always be the best option for everyone. Canine adrenal surgery is indeed risky and expensive, and not necessarily something I would want to put my own dog through, either. It’s wonderful that you have a team of specialists to support you in your decision-making, though. So as I say, we’ll all be anxious to find out what you learn next week. But in the meantime, we’re so glad you’ve found us and introduced little Olivia to our K9C family.

Once again, welcome!
Marianne

P.S. I’ve just now fully approved your membership request, so you can ignore any email you receive asking for a confirmatory reply.

[francielle]

Just got back the results from Olivia's US.

Her left adrenal has hyperplasia.
Her right adrenal has an echogenic area on the cranial side which could be myelolipoma or a nodula hyperplasia.

We have our endochrinologist appointment this afternoon, pretty sure she'll ask for another Cushing's test.

[Harley PoMMom]

Please let us know how the endocrinologist appointment went!

Hugs, Lori