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Dr. Z.
Dr. Z., Dog Veterinarian
Category: Dog
Satisfied Customers: 6120
Experience:  Over 25 years of experience in caring for dogs and cats.
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Our dog, a 14 year old Maltese, recently had dental work done

Customer Question

Our dog, a 14 year old Maltese, recently had dental work done at the vet where several teeth were extracted.At the time her blood work was normal.Her ALKP was 158. About 5 weeks later she gradually became more and more thirsty and began wetting on the floor. Other than that the dog was doing great.She was acting and looking like a 6-7 year old dog might look. After taking her to the veterinarian all her blood work was normal except for the ALKP which was 407 and her ALT was 105.Cushing's diseaese was expected by the vet.She is eating well and getting around great.As being a Maltese, 14 years of age,is it in our best interest to put her through the tests and treatment which I've heard can be very toxic for Cushing's or have her euthanized?
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Z. replied 1 year ago.

Hello and thanks for trusting me to help you and CiCi today. I am a veterinarian with over 25 years experience and would be happy work with you but need a bit more information if you don't mind.

Do you know what her kidney values were, specifically the blood urea nitrogen and the creatinine? Was a urine sample checked?

Is CiCi on any medications or was she at the time of the blood testing?

Do you have an estimate of how much water she is drinking in a 24 hour period (in ounces)?

Was she on IV fluids during the anesthetic procedure? Was her blood pressure monitored while she was anesthetized?

 

Thanks and I will respond further after you reply. There may be a slight delay while I formulate and type a thorough response.

Customer: replied 1 year ago.

creatinine 0.8 no urine was checked bun18.0 she is not on any medications.64 -96 ounces of water intake per 24 hours. she also began wetting on the floor frequently inthe past 3 weeks.

Expert:  Dr. Z. replied 1 year ago.
Thank you for the reply.

I agree that Cushing disease has to be on the list of rule outs, but that is not the only disease condition that can lead to the symptoms that you are seeing. Even if it is Cushings disease, not every dog with Cushings has to be treated and it depends on the symptoms they are showing and the quality of life they are experiencing as to if treatment should be considered.

The very first thing I would do is to have a urine sample analyzed and cultured to look for possible bacterial infection. Urinary tract infections are very common in dogs with Cushings and if she in fact did have one, it may be contributing to the urinary symptoms and if treated, may improve them. Not all dogs with Cushings show any symptoms and if her symptoms were due to a secondary problem, like a urinary tract infection, she may be able to live with the Cushing untreated once the infection was resolved. I would at least have the testing done to confirm Cushing or not as well. This is best done with the test called a low dose dexamethasone suppression test (LDDS). It really is no ordeal at all to have the test done and requires only 3 blood samples drawn over an 8 hour period. Even if you choose not to treat the Cushings disease if present, it is a good idea to confirm if it is present or not as it does put her at an increased risk of other health conditions, including infections and hypertension. On all of our Cushing patients, we monitor for these conditions twice a year as when they do occur, they usually occur "silently" and with no other outward signs. Here is a like that describes the tests used to diagnose Cushings. LINK HERE

The treatment for Cushings itself is not toxic and many dogs handle it very well. It is true that the initial treatment protocol involves monitoring bloodwork while the treatment drugs are introduced, but that is the reason why the blood is monitored so that the pet being treated does not experience any adverse effects of correcting the increased cortisol levels. Here is a link that better explains treatment options. LINK HERE

One other very possible scenario besides Cushings is that she may have developed early kidney failure to the point that her bloodwork is not yet affected, but that her kidneys are no longer able to concentrate the urine well. The increase in water intake is then more of a compensating mechanism due to the presence of a more watery urine. This is not seen frequently, but it can occur and if so, her Cushings tests will be normal. It would be important to differentiate the two as if it is related to loss of concentrating ability by her kidneys, there really would be no treatment. As long as she is still feeling well, eating and maintaining her weight, I wouldn't see a reason to euthanize, but living with a pet who drinks excessively and thus experiences urine accidents in the house can be a challenge. In any case, better defining her disease would be beneficial and help you in making choices for the future.

I hope this is helpful. My goal is to provide you with excellent service – if you feel you have received anything less, please reply back as I am happy to address follow-up questions. Kindly rate me when you are done. Thank you for allowing me to assist you.

Dr Z

Dr. Z., Dog Veterinarian
Category: Dog
Satisfied Customers: 6120
Experience: Over 25 years of experience in caring for dogs and cats.
Dr. Z. and 5 other Dog Specialists are ready to help you
Expert:  Dr. Z. replied 1 year ago.
Thank you kindly for the positive rating and the generous bonus! It is truly appreciated.

Dr Z

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