Please help! Possible Cushing's in 14 year old Boxer mix

[turtle221]

My dog is about 14 and she is very healthy and happy.  There are no outward health issues.  She is on a strict diet of veggies and lean chicken cooked at home and she takes vitamins.  She does not have any peeing accidents or frequency problems.   She has a great attitude and loves to play.  One day we took her to the vet for a skin tag on her tummy that suddenly swelled up.  The vet said that she may have irritated it and that we should remove it.  They tested her blood and found that her ALKP was 1115.  He believes that it may be Cushing's.  I am taking her for a Dexamethasone (sorry about the spelling on that one) supression test on Monday.  I am very nervous about the testing and the Cushing's.  I will do whatever is necessary to help her but I don't want to make her sick as she is currently healthy and happy.  I am looking for information on Cushing's, the Dexamethasone supression test side effects and other possible reasons for the elevated ALKP.  Any help is greatly appriciated.

[turtle221]

Thanks for the input.  I will definately get a second opinion.  

[Ghilly]

I wouldn't panic too early in the game.  Cushings is the type of disease that, at the age of 14, will not kill a dog any earlier than old age will.  If she is healthy now, if the vet wants to institute treatment, I'd hold off and decline it and tell him that when she starts to show symptoms and it begins to affect her life, THEN you'll start treatment.  But as long as she appears and acts fine, leave well enough alone.  Remember, the vet works for YOU.  You don't have to do anything he suggests unless you want to.  I'd also get second opinions on whatever it is he comes up with, just to be sure.  I'm not saying he's not a good vet, but when it comes to something like this, it's always better to have the input of more than one brain.  

Ghilly

[turtle221]

Thanks for the reply.  She has not been on any meds.  I don't see any signs of Cushing's that you mentioned.  She doesn't have a pot belly and her fur and skin seem normal.  The vet today said that he doesn't think it is adreanal Cushing's because usually a dog with her ALKP level that has Cushing's would be sick and showing physical signs and as I mentioned, she is not.  She does sometimes have some trouble with her back legs when getting up.  I heard that this may be a sign.

The vet said that if her Cushing's test comes back negative then we will monitor her ALKP and if it goes up she will need to have some more complex blood tests to determine why the level is rising.  You mentioned that you work in a vet's office and I was wondering if this sounded right to you.  I will ask about the other test you mentioned when he calls with her results in about a week.  Any other advice you can give is greatly appriciated.

Thanks for your help.

Turtle

[ddeiman]

There can be other reasons for an elevated ALK phos. Has your dog been on any steroids for anything? What about arthritis drugs like Rimadyl? Longterm drug use can cause this and usually once the medication is stopped they will return to normal levels; hence the reason vets say not to keep a dog on prednisone or any other steroid for a long time. Cushing's can be treated with drugs like Lysodren or Trilostane but needs to be monitored closely to keep levels right. We usually use an ACTH stim test to diagnose Cushing's in our office so I am not as familiar with the Dex test. I have heard that test can produce more false positives than other tests so you may want to ask about ACTH stim test.  Also is your dog showing any other signs of Cushing's? (swollen belly, thinning skin and hair, etc)  If not then it's probably not best to give any medication just based on high levels because they only treat and control the "symptoms" of Cushing's they don't cure it. Based on his age I'd be hesitant to think cushing's if no other symptoms are there. Another thing to throw out there is Nodular hyperplasia which can cause high alk phos levels in older dogs but is completely benign and just occurs. There is no treatment required. Maybe doing a bile acid test for the liver would just reassure that functions are still ok. Many older dogs live with high alk phos levels but they should be monitored closely to make sure the liver is continuing to function properly. Good luck!