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Dr. Stacy
Dr. Stacy, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 1555
Experience:  10 years of experience in general practice.
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my 14 year old dog is very tired. Total T4 is 0.5 ( but did

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my 14 year old dog is very tired. Total T4 is 0.5 ( but did have one dose of cortisone drops in ears before test) Free t4 is 12 and the thyroglobulin auto antibodies is 1. The free T4 is on the low side I think ( range 8-40). Would giving her thyroid medicine help? If so, how much?

Additionally, her Alk Phoshate has been running high for at least a year. Last august it was 1208 and this August, 1703 Alt last August 74 this August, 157. All other bloods are normal, including her liver and calcium numbers.

Thank you.

Dr. Stacy :

I don't think this is a primary thyroid problem and I don't think thyroid medication will make a huge difference. Has your veterinarian discussed Cushings with you?

Dr. Stacy :

Cushings is a hormonal imbalance.... one of the most common ones in older dogs. It often causes increases in the AP such as you have been seeing in the last year.

Customer:

I apologize, I forgot to state that she just had the whole cushings test , she does not have cushings.

Dr. Stacy :

Symptoms of cushings include: increase thirst and urination, increased appetite, decreased energy, decreased muscle strength, increased panting, decreased coat quality, sometimes they develop a 'pottbelly'.

Dr. Stacy :

Which test can I ask? ACTH stimulation or Low dose dex supression?

Customer:

she got either 3 or 4 blood draws, so i think dec supression

Dr. Stacy :

That sounds like Dex supression. Does she have increased drinking and urination?

Customer:

No symptoms, I know all about cushings symptoms and all vets say--- she doesn't have it.

Dr. Stacy :

Does she have any other symptoms of thyroid disease other than being tired? Has she gained weight or does she have a poor hair coat?

Customer:

not really,just very tired. She seems nauseous though she doesn't throw up. drink and appetite good.

Customer:

urine tests good too

Customer:

her nose is very dry!

Dr. Stacy :

Cases like this are frustrating. Your veterinarian has done a good workup. I agree, it does not sound like Cushings.... It also does not sound like hypothyroidism either. Thyroid hormones are very susceptible to other problems in the body. The free T4 is less susceptible to other problem in the body and is in the normal range. I'm pretty satisfied that the thyroid is normal even with this low normal number.

Dr. Stacy :

I don't think thyroid is the primary problem, I don't think thyroid medications will help much, however, they are very safe and if you wanted to try them I don't see any risk in doing that.

Dr. Stacy :

I suspect that she has disease elsewhere in her body and it is just not severe enough to show up on any of the routine tests your vet has done. You may get an answer with more aggressive testing, such a a liver biopsy.

Customer:

any surgery would be too hard are her. her liver numbers are good and sono looked good.

Dr. Stacy :

I would consider trying some supplements that can support her liver and immune system. I like milk thistle and SAM-E. You can get them at a health food store or some vets carry them. Fatty acids can help too. I have seen theses things help when we know that the liver is struggling, but can't find a cause.

Customer:

what makes the alk phos high?

Dr. Stacy :

alk phos come from the liver. There are 2 types... one that is just liver related and another that is produced in response to cortisone in the body. That is why we always consider cushings when a dog has an elevated AP.

Dr. Stacy :

Any 'stress' on the liver... from toxins to cancer... can cause it to go up. It is also elevated in dogs that have cushings or are being given oral steriods. Steriod in the ear can cause it too, but only after very long term use.

Customer:

do you think ginger root is good for a little nausea? She is on milk thistle. While would vet thinking Bile duct blockage? l

Dr. Stacy :

Yes, ginger is good for nausea. Your vet might thing that because Alk Phos is in a higher concentration in the cell that line the gall bladder and bile ducts than in other part of the liver. He may have also thought the gall bladder looked distended on the ultrasound.

Customer:

vet is a she! gall bladder fine on ultra sound. She wants me to use Ursodiol, 1ml a day

Dr. Stacy :

That I would absolutely do. We don't entirely understand all the ways that ursodiol works, but we know it has a lot of beneficial effects in the liver, especially with the gallbadder.

Customer:

She also want me to give her DHEA, a daily small dose, for energy, do you think that is a good idea?

Customer:

Anyside effects with Urosodiol? ( don't worry, my last question)

Dr. Stacy :

There used to be some concern that it could cause pain and problems if it caused the gallbladder to contract to hard, but it is not something we see in real life. DHEA is good, I would also ask if she has a milk thistle supplement.

Dr. Stacy :

Best of luck to you.

Customer:

Thank YOu!

Dr. Stacy :

Your welcom

Dr. Stacy :

welcome

Dr. Stacy and 2 other Dog Veterinary Specialists are ready to help you
Hi Chris,

I'm just following up on our conversation about Honey. How is everything going?

Dr. Stacy