New and need input on a medical question

[kjc]

Why was he put on the antifungal med?

[kjc]

Okay, back from researching... I think your dog has multiple issues. Polycystic Kidney Disease is congenital and at his age may be getting worse. Also, is he being treated for Valley Fever (fungal disease)? Is he on a prescription Kidney diet?

I think your vet is looking for liver problems, but the kidneys can also cause a high ALKP. The fact that the ALKP rises when he's off the Fluconazole may point to the fungal disease being very active and possibly affecting the kidneys. Also HBP can be a result of kidney problems.

Beyond this little bit of info, IDK. I would get him to a Nephrologist and an Infectious Disease Specialist ASAP, preferably at a vet school.

IMHO, I don't think this at all has anything to do with the liver, or shunting, etc... I think the main concern is the kidneys and the fungal infection, and that these, in turn, may be affecting the liver.

I highly recommend getting him to a vet school ASAP, as all the specialists are there in one place and they will get to the root of the problem quicker than you running from vet to vet.

[Scoobstersmom]

Originally Posted by kjc

Okay, back from researching... I think your dog has multiple issues. Polycystic Kidney Disease is congenital and at his age may be getting worse. Also, is he being treated for Valley Fever (fungal disease)? Is he on a prescription Kidney diet?

I think your vet is looking for liver problems, but the kidneys can also cause a high ALKP. The fact that the ALKP rises when he's off the Fluconazole may point to the fungal disease being very active and possibly affecting the kidneys. Also HBP can be a result of kidney problems.

Beyond this little bit of info, IDK. I would get him to a Nephrologist and an Infectious Disease Specialist ASAP, preferably at a vet school.

IMHO, I don't think this at all has anything to do with the liver, or shunting, etc... I think the main concern is the kidneys and the fungal infection, and that these, in turn, may be affecting the liver.

I highly recommend getting him to a vet school ASAP, as all the specialists are there in one place and they will get to the root of the problem quicker than you running from vet to vet.

Thanks! And I just have to say...wow...you're good! Are you a vet or vet tech? My post was already so long that I felt I needed to draw the line at some point but could have answered many of your questions as things that have already been considered.

First, we do not have a vet school in Arizona. The closest one is on the other side of California about 8-10 hours away. I did take him to be evaluated at ARECA last week, which is a large specialty referral clinic and the closest thing we have to access to a lot of specialists under one roof. The Internal Medicine specialist he saw last week was one of the doctors he was evaluated by at ARECA, and after a full two day evaluation they ruled out a lot of things and still came back to wanting to do a biopsy of his liver.

He does have polycystic kidney disease, although they didn't name it that. He has the fluid filled cysts in his kidneys, and protein loss in the urine. That is probably the cause of his high blood pressure, which is being controlled by Enalapril. We only found out about the kidney issue in September, as an incidental finding on the first ultrasound. His UPC was very high at that time (4.9) but after a month on Enalapril, it has dropped to fluctuating between 1.5 to 1.8 and the goal is to keep it below 2.0. They do consider it to be stage 1 chronic kidney failure and we keep a close watch on it, but it has not affected his kidney function. His creatine in January was 1.0, and his BUN is 17.

Yes, the fungal infection was Valley Fever. Nasty stuff. He was first diagnosed at 9 months of age and had a severe infection. He was treated for a couple of years, then off meds for a few years, relapsed and back on meds, off meds, relapsed and then got back to a negative titer. Because he has relapsed twice, the Valley Fever is considered chronic but we've had no signs of an active infection for over three years. Also because his initial infection and both relapses were in the spring when the fungus is most active in the environment, he has been on a test protocol where they treated him prophylactically with low dose antifungals for the past three years during the spring and summer. (May, June, July and stopped the meds August 1st.) He has a Cocci titer check every four months and has not had a positive titer since 2009. His last negative titer was in December. The vets here are very cautious and aware about Valley Fever issues since it is so prevalent in our area. It was actually the first thing that was considered but has been pretty much ruled out as contributing to his current issue.

We first noticed the rising ALKP in September. In May it sat at 1500 where it had been for several years and his Cocci titer was negative. After stopping the antifungals he always has blood work again and then again a month later. His titer was negative and ALKP at 1500 in August. In September we repeated the titer (negative) and blood work and the ALKP was 1600. He had one other titer check since then, in December, and it was also negative. But the ALKP has continued to rise. He has also had a series of exrays looking for a possible Cocci lesion in the bone, as he had it in his shoulder on his first relapse, because Cocci lesion in the bone can also cause rise in ALKP, but they didn't find anything. His Valley Fever protocol is excellent, as he has been seen by Dr. Lisa Shubitz at the VF Center for Excellence, and our vet has regularly consulted with her on the Valley Fever protocol.

He is not on a kidney diet and both our regular vet and the Internal Medicine specialist have wanted him on a liver diet. He is on Royal Canin Hepatic, and a version of the Dodd's diet, about 50/50.

I am still leaning towards the Cushings issue. It seems like everything else has been ruled out. Do you have any info on that? I've read and read as much as I can understand about it, and he does not have the typical symptoms of Cushings, which is why both vets seem to want to rule it out without testing him for it. I read somewhere that there is a simple urine test that can rule out Cushings, but now I can't find the information I read. Do you know anything at all about that, or could you point me in the right direction? I would hate to think I would have to find yet another vet that was willing to test him for it, but I'm about at that point. It is so frustrating for me because I feel like he has this time bomb lurking in his body somewhere and yet he seems so very healthy. He really doesn't look or act like a 14 year old dog with all these issues.

I thank you so much for all your help. You are awesome!

Diana and the Scoobster

[Scoobstersmom]

Originally Posted by yorkiemini

ScoobstersMama, I vote for you as geriatric-Yorkie Mama Hall of Fame

What a fabulous job you have done through the years caring for this pup, and doing all you can for him. I just love that!

I lost my previous Yorkie when she was 11 years old and had been in renal failure for quite some time. My goal,was much like yours .... To give her the best life possible and lots of love. Clearly, you are a super Yorkie mom to still have your loving baby with you at 14 years of age!

Thanks Cali! And I'm sorry for your loss.

I guess, then, that I might qualify for the poodle hall of fame too. . I also have a tiny 14 year old poodle with more issues than Scooby. Peaches was diagnosed with Chronic Allergic Bronchitis at 10. The vet said she could live another year or so with it. Put her on prednisone and a Flovent inhaler twice daily. Four years later she still takes prednisone every day and uses her inhaler twice a day. Two years ago she got glaucoma and had surgery to remove her eyeball. A year later glaucoma struck her remaining eye. When it couldn't be controlled by drops anymore, we were afraid to put her lungs through another major surgery, so we had a procedure done where they injected something in her eyeball, while awake and with a numbing drop, to kill the fluid producing cells in her eyeball. It left her completely blind. Her CAB hasn't progressed much. She wheezes every once in a while but never coughs, has even learned her way up and down stairs, and has a great life.

Sheesh! What we won't go through for these babies!

Diana and the Scoobster

[kjc]

Good info: Pet Owner's Crash Course in Canine Cushing's Disease

Okay.... interestingly enough, Ketaconazole is used to treat Cushings in some cases.... same class of drug as fluconozole... which suppress hormone production (a side effect).

I can't find the why's or wherefore's, maybe a gut feeling, but reducing the ALKP seems to be a priority and it seems the Fluconozole may have been responsible for doing that.

[107barney]

Sounds like my Barney.

[Scoobstersmom]

Originally Posted by kjc

Good info: Pet Owner's Crash Course in Canine Cushing's Disease

Okay.... interestingly enough, Ketaconazole is used to treat Cushings in some cases.... same class of drug as fluconozole... which suppress hormone production (a side effect).

I can't find the why's or wherefore's, maybe a gut feeling, but reducing the ALKP seems to be a priority and it seems the Fluconozole may have been responsible for doing that.

Good info you dug up. Thanks! Typically the azole drugs are really rough on the liver so it would be weird if it was actually helping his liver.

I just emailed a vet I'm familiar with from the Valley Fever Center in Tucson to get her thoughts.

I'm also considering taking Scooby to a holistic-Chinese herbs-vet that I have a line on. Any thoughts on that? At least she said she would do the darn Cushings test through her office.

Diana

[Scoobstersmom]

Originally Posted by 107barney

Sounds like my Barney.

The elevated ALP? Did you figure out the problem or find a solution?

Diana and the Scoobster

[kjc]

Here's my line of thought: Since the pup has been on hormone suppressing drug a good amount of time, coming off this drug allows his system to start producing hormones again. His body may be reading that as overproduction, causing the rise in ALP (if that iso is responsible... further testing needed). So it's not that the fluconizole is helping the liver directly, but indirectly by suppressing the hormone production. Or his system has gone wacky and is overproducing the hormones. IDK.

Here's a great link: http://veterinarymedicine.dvm360.com...date=&pageID=2

Also rule out Lepto and any tick borne disease. I'd keep him on Denamarin indefinitely. Thinking about Doxycycline but not sure if okay with liver involvement.

[Scoobstersmom]

Originally Posted by kjc

Here's my line of thought: Since the pup has been on hormone suppressing drug a good amount of time, coming off this drug allows his system to start producing hormones again. His body may be reading that as overproduction, causing the rise in ALP (if that iso is responsible... further testing needed). So it's not that the fluconizole is helping the liver directly, but indirectly by suppressing the hormone production. Or his system has gone wacky and is overproducing the hormones. IDK.

Here's a great link: The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities - Veterinary Medicine

Also rule out Lepto and any tick borne disease. I'd keep him on Denamarin indefinitely. Thinking about Doxycycline but not sure if okay with liver involvement.

Hi kjc, just a quick update. I finally received the radiology report for Scooby's ultrasound at the Internal Medicine doctors office from February 14th. After being assured by the vet that there was not an indication of Cushings disease, the very first line on the ultrasound says...Assessment: suspected pituitary dependent hyperadrenocortisoid disease. Hmmm...that's Cushings, right? I feel like that darn vet ordered these tests and then didn't even bother to read the results. I am working on getting the testing scheduled right now.

Diana and the Scoobster