Cushings?

I am a new subscriber and would value your opinion. My 9 year old 75lb Huskey/Lab mix went to the vet a couple of months ago to get lab work done prior to having a broken tooth (which had become infected) extracted. We noticed this when one side of his mouth swelled. The lab results came back with a dramatically elevated ALKP (1600). The first thought was Cushings. However, he has no outstanding symptoms (no weight gain, bloat, increased water intake, urination, lethargy, etc). He has a good appetite and has been normal and active in every way.

He had the ACTH Stim test and showed no signs of Cushings. The Vet put him on Demarin and Actigal for a month just to see if it would help. Aside from the Demarin making him very lethargic, we noticed no effects. The ALKP did go down to 1400 but the Vet thought that insignificant. We retested in another month and the ALKP was 1700. The next step was an ultrasound and x-rays. Chest and abdominal x-rays were normal. No issues on the ultrasound with respect to the liver, stomach, heart, lungs, gall bladder, etc. so no biopsy was done. The ultrasound did show symmetrically enlarge adrenal glands. This would certainly indicate a potential for Cushings but with no other symptoms or diagnostics pointing that direction, we are all stumped.
For now, we are taking a “wait and see” approach. We have our beloved family member on Purina Liver Diet with cottage cheese every day or two. He also takes ~375mg of milk thistle daily. His activity level is normal (a little slower in our hot Florida summer but it’s the same every year). We started him on a walking program over two years ago for general health. He still walks 2-2 ½ miles 5 days a week with no changes in ability or demeanor.
By history, he has never had any health issues (other that the broken tooth he originally went to the Vet for) or surgeries (other than neutering). We are at a loss and would certainly value your opinion on what, if anything, we should be doing. Thank you!

Richard

[ginger899]

There are many things which can cause the alkaline phosphatase levels to rise. A whole range of things, ranging from the very serious such as cancer, to the very ordinary, such as a bacterial infection, or a response to certain toxins. By toxins, that could even mean high levels of food additives (maybe in the past) or exposure to environmental everyday 'toxins'. It would depend on the liver's sensitivity to such things, and the levels of exposure.

One thing that rang a bell just then was that you mentioned there had been a tooth infection. Bacterial infections can cause the ALKP levels to rise. Knowing dogs, and how stoical they are, it could have been bothering him maybe a bit longer than you are aware of? Enough to cause bacterial toxins to enter the bloodstream?

Obviously I don't know if it IS this, but it certainly sound like you are checking every possible thing out very thoroughly.

Milk Thistle is a very good herb, and safe for dogs when used in the appropriate dosage. It has a very positive effect on liver enzyme levels.

[Ghilly]

What Ginger said about bacterial infections causing alkalinme phosphatase levels to rise, and about the tooth being bad for considerably longer than you were aware of, was the first thing that came to mind for me.  

If everything else appears normal, I would just continue to do what you are doing and maintain the "wait and see" philopsophy.  

Also, as far as Cushings Disease goes, I just wanted to mention that you can also look for bilaterally symmetrical hair loss on the body.  In other words, he will lose hair, but it won't be in random patches.  If he loses is on his right flank, he will also lose it in the same place on his left flank.  But I don't think this is what you're dealing with.  I'm pretty convinced that it had to do with that tooth.

Please keep us posted as to his progress.  And welcome to the Dogs Community!

Ghilly