Brandy - 11 yo Boxer, Atypical on Lysodren - Brandy has Passed Away

[brandysmom]

Hello Everyone:

My name is Brenna and my dog is Brandy. She is a 10½ year old Boxer. She was diagnosed with "borderline" Cushing's 2 years ago. I don't have all of her records in front of me right now but will. I wanted to post anyway. She has been on Flax Seed Oil and Melatonin, but no medications. Her symptoms are the usual, except for one. She does not have the "pot belly". Actually she has lost weight (12 lbs the past year) without any explanation. Is this normal? In addition to this, she does have a lot of GI issues. She has for a while now, but they do not know what the cause is. I have an appointment with an internal medicine vet next week. Any feedback would be great and I will post tests and results as soon as possible. I am so grateful to have found this site! From everything I have read so far, there is a lot of knowledge and support out there. Thank you...

[littleone1]

Hi Brenna,

Welcome to you and Brandy from Corky and me. You have found a wonderful group of very caring, supportive, and knowledgeable people.

That would be great to post Brandy's test results. This would enable the group to better answer your questions. It would also be helpful if you let us know what tests were done to help determine if Brandy does have Cushings.

Others will be along, who know much more about this than I do. Corky has now been treated for Cushings for a little over two months.

I'm glad you are going to see a specialist.

Terri

[Harley PoMMom]

Hi Brenna,

Welcome to you and Brandy from me and my boy Harley. I am so glad you posted but I will warn you that we tend to ask alot of questions to our new members, only because that is the best way we can offer the most accurate advice for your precious Brandy. :)

As far as the Flax Seed Oil and Melatonin, that is usually rx'd for Atypical Cushings, but the Flax Seed Oil has been changed to lignans from Flax Seed Hulls or HMR lignan. The Flax Seed Oil can exacerbate pancreatitis in dogs (triglyceride levels may increase) and the lignan content is very low. This statement is from the treatment option sheet from Dr. Oliver, he has the only lab that does the testing for Atypical Cushings. I have included a link to the treatment option sheet below for you.

Now getting back to those questions that we need to ask you, :eek: so are you ready for them? ;):)

We need to know exactly what symptoms Brandy showed that led you or your vet to test for cushings. What tests were performed to confirm her cushings, if an ACTH or LDDS test were performed, could you post these results with the units, ie (ug/dl), here. Was a CBC or Chemistry Blood Panel done on Brandy, if so, could you post anything on there that is marked "abnormal" with the units of measure. Was an ultrasound done on Brandy, if so, could you post the results here. Is Brandy on any herbs or supplements?

I believe I have asked enough questions from you, I know others will be along to ask more.

Cushings is a slow progressing disease so you do have time to get a proper diagnosis. A proper diagnosis is vital to a proper treatment plan, so in the meantime, learn all you can about Cushings. Remember you are not alone in this journey, we are here for you and Brandy, ask all the questions you want and we will try to answer them as best we can.

The links:

Treatment Option Considerations
Steroid Profiles in the Diagnosis of Atypical Cushing’s Disease
Clinical Endocrinology Service/College of Veterinary Medicine/University of Tennessee
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Treatment%20Info,%20Atypical%20Cushing's,%20revise d,%20Oct.,%202009.pdf

Helpful Resources for Owners of Cushing's Dogs
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Hugs,
Lori

[frijole]

:D Since you already have alot of reading and questions.. I'll keep it simple. Glad you found us! Welcome. We'll help you thru this. Kim

[brandysmom]

Hi again and thank you for the warm welcomes. I apologize if I ramble on, but this is a lot of info...

What is Atypical Cushing's? Brandy first started with GI problems, then elevated protien and blood in her urine. They put her on a low protein diet. She then started with the usual symptoms: drinking more, urinating more, panting, losing fur, dark spots on skin, and an appetite that will not quit. Her fur is the only thing that has improved. It's very soft now and she does not shed. She has never been a "healthy" dog, but we've worked through everything for the most part.

Per the advice from the vet, the Flax Seed Oil is "Barleen's Highest Lignan". Is this bad? She does also have pancreatitis. I am very worried now that I have been giving her something that is causing another problem. Other supplements are - a probiotic since October (Total Biotics from Ultra Pet Products) and Cushex drops since May. The Melatonin is 3mg/2x day.

Here are her most recent test results. I only listed the red flags - not too sure what any of this means. She has also had a chronic UTI from June - November. We went through 5 rounds of antibiotics and 4 urine cultures to be UTI free.

All fecal tests since 2007 contain budding yeast

All urinalysis since 2007 contain elevated protein, blood and crystals

3/20/2008 Ultrasound w/ Echo – all ok

4/14/2008 LDDST w/INJ (ACTH Stimulation Test)
Cortisol pre 7.2 ug/dl
Cortisol 2 (4 hour) 1.4 ug/dl
Cortisol 3 (8 hour) 1.6 ug/dl

6/10/2009 Senior Screen
ALK Phosphate 1073 (10 - 150 U/L)
ALT (SGPT) 120 (5 – 107 U/L)
Cholesterol 386 (112 – 328 mg/dL)
Amnion Gap 25 (12 – 24 mEq/L)
MCHC 37 (32 – 36 g/dL)
Lymphocytes 11 (12 – 30%)
Eosinophil 15 (2 – 10%)
Absolute Eosinophil 1695 (100 – 1250 /uL)

8/1/2009 Urinalysis
Blood 1+ (negative)
Protein 3+ (negative)
Crystals 2+ AMM MG PHOS (3 – 5)

8/19/2009 Ultrasound – stone in bladder, liver fibrosis - no cancer

10/26/2009 GI Panel Texas A & M
Pancreatic Lipase Immunoreactivity Fasting >1000 ug/l (0 – 200)

I hope this info helps. I will provide any other information I can. I am sure I forgot some as Brandy's medical file is huge! Thank you so much. Brenna and Brandy

[brandysmom]

I was just reading another post and it made me think of something else to add. Brandy's ultrasound was in August and her fur still has not completely grown back from where she was shaved. Just another piece of info...

[ChristyA]

I too am glad you are going to see a specialist. Is he/she an endocrinologist by any chance? What did they see in the ultrasound, do you have the results, if so can you post what they saw?

You are in good hands here, so many people with a lot of knowledge. You won't find a more caring, supportive group.

Christy

[Harley PoMMom]

Hi Brenna,

Atypical Cushings - may or may not involve a tumor, and is caused by an elevation in the intermediate or sex hormones which are estradiol, androstenedione, 17-hydroxyprogesterone, progesterone and aldosterone and is treated with melatonin and lignans; Atypical does not involve cortisol. Most of these hormones are secreted from the adrenals with the exception of estradiol, it is secreted from the adrenals and other places too.

My boy Harley has pancreatitis too, altho his last PLI done 11/09 was 464 (0-200), he shows no symtoms. I found out about his pancreatitis on his ultrasounds, talk about a shocker :eek: If I were you I definitely would not be giving Brandy any Flax Seed Oil since she has pancreatitis. One of the supplements Harley gets is L-Glutamine, this is per his vets approval, I buy mine thru Monica Segal's website and here is an excerpt taken from there about them.


L-Glutamine 500 mg
Description:
L-Glutamine is a component of cells that are plentiful in the epithelial lining of the gastrointestinal tract. L-Glutamine can help conserve muscle glycogen stores, support the health of nerve cells, and cross the blood-brain barrier where the brain uses it for fuel.




The Cushex drops are a rip-off too, one of our Administrators, Glynda, had written to the company and asked them for proof that their product worked, here is her actual quote.


I am the member that wrote to PetAlive, as well as other companies claiming to have natural remedies that are effective in treating cushing's. None of these companies have done any testing to prove their claims. PetAlive ignored my very direct question about testing and provided a list of wonderful things their natural remedy would do for my dogs. They also mentioned that it is safe to use with conventional treatment. Well duh, the point of my email to them was to ask them to provide supporting documentation that their product's efficacy would allow a pet owner to avoid conventional treatment. It is pretty disturbing that these people get away with such blatant fraudulent advertising.

Pet owners with cushdogs, especially those new to the disease, are overwhelmed and very vulnerable which makes them huge targets for these unscrupulous companies. I would suggest that any member that is contemplating treating with anything other than conventional treatment, to do their own research and ask questions of any company that claims to have an effective treatment for cushing's. It is only effective if clinical trials have been done to prove its effiicacy by way of acth stimulation tests, low dose dexamethasone suppression test, urine cortisol:creatinine ratio, etc.

Glynda

Now, I definitely would not start Brandy on anything new unless approved by her vet/IMS.

One thing about pancreatitis, it can skew LDDS and ACTH tests, so I am doubtful about her cushings diagnosis until you can get her pancreatitis/GI issues under control. Any non-adrenal illnesses can create false positives on these tests.

The melatonin you are using, it is the regular melatonin...not the fast-acting or rapid-releasing kind, right? My boy Harley takes melatonin and flax hulls with lignans too. He has elevated intermediate/sex hormones and PDH cushings.

Has Brandy been tested for hypothyroidism? This disease shares similar symptoms with cushings, especially the slow growing hair.

Her elevated protein in her urine in 2007, has anything been done to correct this? Has her blood pressure been checked? My boy Harley was losing protein in his urine and it was due to elevated blood pressure, but I see she is also has blood, is she spayed? or was this a UTI?

I have read alot about pancreatitis since my Harley has been dx'd with it since I missed his symptoms and it was caught on his u/s. Since then he had a diet formulated for him and supplements to help him. I watch him very closely for any signs that his pancreatitis is rearing it's ugly head and I have a PLI done on him every 6 months, sooner if I think it's needed.

If you have any questions, don't hestitate to ask. I know this cushings journey can be a confusing and frustrating one but we are here to help you sort things out, ok.

Hugs,
Lori

[brandysmom]

Hello Lori and Harley, Terry and Corky, Kim, and Christy:

Again thank you for all the questions and feedback. I am already learning so much more.

Brandy is spayed. The reason why she had her most recent ultrasound was because she urinated alot of blood for 2 days. They found a bladder stone. Her ultrasound also indicated liver fibrosis - scarring is what the vet told me. Everything else looked normal. She had a UTI during this time that was very resistant to antibiotics. It took 5 rounds of treatment. They are not sure if the stone caused the bacteria in her urine or if the bacteria caused the stone.

Her senior blood work did do a T4 test for her thyroid. The result was 1.0 with an acceptable range of 0.9 - 3.9 ug/dL. There were many other tests in her bloodwork where her results were right on the low or high range - not in the middle range. Should I have posted these also?

The melatonin is regular melatonin from Physiologics. I give her 3mg twice a day. I stopped the flax seed oil and am looking for the other you mentioned.

When they discovered her elevated protein in 2007, they just put her on a prescription food Royal Canin Renal LP. It changed nothing and since September she has been off that food in an effort to try to figure out her GI issues. Her blood pressure was checked once and it was normal. They then put her on Hills Z/D Ultra Allergen food for 2 - 3 months to try to rule out an allergy. That did nothing either. My vet gave up and referred me to an Internal Medicine Specialist. Since then, I switched her food to Natural Balance Fish and Sweet Potatoe and she has not had an episode yet - it's been 3 weeks. Brandy's GI episodes have been occuring and average once every 2 weeks for the past few years.

I hope I answered all the questions. Does anybody have any suggestions as to what tests I should be asking for from the IMS? We go on Monday. Thank you again. Everybody is so helpful and I am sorry for anyone else who is going through any kind of illness with their pets. It's so difficult because they depend on you for everything. I feel like I am obsessed with finding out what's wrong with her so that I can make the rest of her life as comfortable and happy as possible.

Happy Holidays to Everyone!
Brenna

[labblab]

Hi Brenna,

I only have time for a quick welcome and reply, but one test that you may want to discuss with the IMS next week is an "extended adrenal panel" analyzed by the lab at the University of Tennessee at Knoxville. Any vet can draw the blood for the test, and then ship it to Knoxville for the testing. This full adrenal panel consists of an ACTH test to measure cortisol levels, and also tests all the other intermediate hormones that Lori discussed above. This test will cost somewhat more than an ACTH alone, but it will help clarify the advisability of the melatonin/flaxseed treatment as well as shedding more light on the overall Cushing's diagnosis.

Although we don't have the "normal" reference range for Brandy's 2008 LDDS, I am guessing from what you've said that her suppression was right at the "borderline" value for that particular lab. And if so, given the pattern of her suppression, the results would be consistent with the pituitary form of Cushing's. But as Lori has pointed out, diagnostic blood tests can be skewed by other, nonadrenal ilnesses. I am thinking that the advantage of performing an ACTH this time around is that of the two tests -- the ACTH and the LDDS -- the ACTH is less likely to return a "false positive" if a dog does not actually have Cushing's. Plus, by performing the full adrenal panel, you will also have a better picture as to whether her other adrenal hormones are elevated enough to be causing problems in their own right.

You did not note any adrenal abornomalities seen in the August ultrasound. Do you know whether the adrenals were able to be viewed clearly? If both adrenal glands had been enlarged, that would give us a lot more confidence in the diagnosis of pituitary Cushing's. They are not always enlarged with PDH, but it is a helpful diagnostic indicator when they are.

Unfortunately, the pancreatitis does muddy the diagnostic testing. Once again, as Lori has said, active pancreatitis could certainly skew the blood testing results. But it is a bit of a "Catch-22" situation, because untreated Cushing's dogs are more vulnerable to pancreatitis, and it may be difficult to get a handle on the GI issues until the Cushing's is under better control. I will say this -- Brandy certainly does exhibit a lot of classic Cushing's symptoms. So I can definitely see why Cushing's is suspected.

Before closing, here's a link to a thread that explains more about those elevated adrenal hormones, as well as the related testing:

http://www.k9cushings.com/forum/showthread.php?t=198

Hopefully, the info there will make more sense of what I've been "blabbing" about...:o

Once again, welcome to group!
Marianne

[brandysmom]

Hello Marianne:

Thank you for the welcome and lots of information and advise. I will discuss the extended adrenal panel with the IMS.

The docter that did Brandy's ultrasound did say her adrenal looked normal and didn't think she had Cushing's.

I just pulled out her test from 2008 again. At the bottom it has this interpretation:

Normal: Cortisol level less than 1.4 ug/dl 8 hours post-dex.
Hyperadrenocorticism: Cortisil level greater than 1.4 ug/dl 8 hours post-dex.
If the 8 hour post-dex cortisol level is greater than 1.4 ug/dl, the following can be used to differentiate PDH from an adrenal tumor.
1. Cortisol level less than 1.4 ug/dl 4 hours post-dex is consistant with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistant with PDH.

Brandy was at 7.2 Cortisol pre, 1.4 at 4 hours and 1.6 at 8 hours.

If I am reading this correctly, it definitely supports what you said. Thank you so much. You just made a lot more sense than my vet ever did! I can't believe the amount of information I've received from everybody in such a short period of time. I can't thank you enough..

Brenna

[Harley PoMMom]

Hi Brenna,

First, let me say, I think you are doing an excellent job taking care of your precious Brandy. I realize the parent of cushingnoid pup is not an easy one, it is a expensive, frustrating, confusing and sometimes scary one, but when you look into your pups eyes and can see all that love there, it makes it all worth while, doesn't it?

Usually pancreatitis and GI issues go hand in hand, so you will need to get a handle on both. Any dog food that has grain/corn in it as it's top 5 ingredient, you don't want. This makes the pancreas work too hard because the pancreas has several jobs that it performs for the body. One of those jobs is that the pancreas produces digestive enzymes that break down food into molecules that can be absorbed from the intestine. Also I feed my boy Harley 3-4 small meals a day because of his pancreatitis, this really helps.

Now about the protein in her urine, was a UPC (Urine Protein/Creatinine Ratio) test done on Brandy? However, both the dipstick method and the urine protein creatinine ratio can be inaccurate and can yield false positive results due to contamination of urine with red blood cells. But if she no longer has blood in her urine, then I would get an UPC done on her and see what her protein loss really is.

Here are links about the UPC test.
http://www.vetcontact.com/en/art.php?a=685&t=

http://www.idexx.dk/animalhealth/analysers/vettest/chemistries/upc/faqs.jsp#1

Here is a link for the Flax Hulls with lignans that I use.
http://www.flaxhulls.com/lignans.htm

Hugs,
Lori

[ChristyA]

Hi Brenna,
I'm so glad you are here. I know it is alot learn, but you are doing a great job. It is great that you have kept records of all Brandy's test results. Take those with you when you go to see the IMS. I agree completely with Marianne regarding the "extended adrenal panel" from UT Knoxville. I believe they are the only lab doing this test.

Any questions ask away your in good hands here!

Christy

Brandy is a beauty!

[brandysmom]

Christy - I am so glad I am here too. Everyone else in my life thinks I am going overboard to help her, but I don't care. She has given me so much more back. I didn't have her records until recently because I wanted to bring them to the IMS we are seeing on Monday. I think she is a beauty too - even with her lumps, bumps, warts and stinky eyes... Are your dogs Boxers too?

Lori - You sure do know your stuff! I have received much more information and advice than that of my vet. And thank you for the words of encouragement... The vet never seemed concerned with her GI issues. I had to push for the pancreatic testing - they never offered it to me. Her GI issues are a combination of many things (pancreatitis, IBD, Colitis) but I still do not know the root cause. An episode last for several hours. Sometimes she spits up bile, sometimes not. She will not eat or drink and seems very distressed. Her stomach makes these unbelievable noises. She usually has diarrea. Once she feels better she wants to eat and drink and is completely normal. Once she does feel better she has the worst gas you ever smelled! And her first normal bowel movement will have a big bloody blob in it. Like I said, she was having an episode, on average, once every 2 weeks. The worst was 3 times in 5 days. I really think this new food is helping. It's the only thing she has been eating since Nov 30th and she hasn't had an episode. I'm very happy with that. I o give her 3 meals a day, mostly because she wants to eat constantly, except for when she has an episode. She will wake me up in the middle of the night to eat.

No, she never had UPC testing. I will request it - not sure if there is still blood in her urine. Every urinalysis comes back with it having a trace of blood and elevated protein. I am confused - if the protein is elevated, why is there a measure of protein loss?

Do you happen to know anything about yeast problems? She does get frequent ear infections. In addition to that, she has had this lump on her belly for maybe 2 years now. It's not big, but it has grown a little. During my last visit, the vet stuck a needle in it and looked at the fluid under a microscope. It was yeast. The vet seemed puzzled...

Anyway, I've babbled enough. Thank you for everything. Brenna

[Harley PoMMom]

Hi Brenna,

Sometimes when it comes to GI issues, whether it be IBD/IBS, pancreatitis or colitis, one can find the root cause to food. That is when an elimination diet is started, but this needs to be done under your vet/IMS or certified veterinarian nutritionist care. If the dog food you are giving her is agreeing with her, only give that and nothing else. I believe I would hold off giving her the flax hull with lignans too until you get her GI issues under control, the flax hulls with lignans contain alot of fiber and I'm not sure Brandy's tummy can handle that right now.


Every urinalysis comes back with it having a trace of blood and elevated protein. I am confused - if the protein is elevated, why is there a measure of protein loss?

Protein is used throughout the body in a variety of ways, and is especially important for growth and repair. Maintaining adequate levels of protein is critical for the long-term health of a dog, and any persistent loss of protein in the urine represents a waste of a precious resource that is difficult to replace. What they are measuring is the protein that is lost in the urine, which should be none or minimal.

Our cush pups are prone to infections because excess cortisol weakens the immune system. But frequent ear infections are a symptom of hypothyroidism, has Brandy been tested for this?

Oh, Brenna, Sweety, you can never, never ask too many questions, ok. ;):) This is your precious furbaby, believe me when I tell you, we understand how you feel about your pup. So ask away!! The more we know the better we can help you help Brandy.

Love and hugs,
Lori

[lulusmom]

Hi Brenna,

I just wanted to comment on elevated protein in case you were concerned. I've read that approximately 75% of dogs with cushing's will have elevated protein in their urine. This is usually secondary to the cushing's and most dogs never experience complications. I have two cushdogs and my littlest one, Lulu, has elevated protein but her specialist is not concerned as everything else is normal.

Glynda

[Squirt's Mom]

Hi Brenna,

Just dropping by to issue a belated welcome to you and Brandy! :) I don't have anything to add to the great info already given but just wanted to say "Howdy!"

Hugs,
Leslie and the girls - always

[ChristyA]

Brenna,
Those are boxers in that picture! Just gotta love those goofy faces and the woowoo talking they do!
Merry Christmas and hugs to Brandy.
Christy

[ChristyA]

How are you and Brandy doing?
Christy

[brandysmom]

Hello all and Happy Healthy New Year! I just wanted to update... haven't had internet access for over a week, but all is good now.

Brandy had her appointment with the IMS last Monday. He was great and suggested everything I had in mind. We decided together to test for the following:

- Recheck ultrasound for bladder stone she previously had - negative!
- Blood test for Thyroid - normal!
- Blood test extended adrenal profile - still waiting
- EKG because her heart didn't sound too good - she is now on
heart medication (Sotalol) for Boxer Cardiomyopathy:(

As far as her GI isuues, he decided not to do anything because she has been perfect since she has been on this new food. Ironically, she had one of her "episodes" on Saturday. I still think this is good though because before it would happen once every 1-2 weeks and this time she went almost 5 weeks without an episode. Something is definitely better.

I will keep you posted... Thank you, Brenna

[ChristyA]

Sounds like you found a good Dr. That is one of the most important things you can do, other than keep a close eye on Brandy - which you already do!:D

Thanks for keeping us updated, if you have any questions please ask. We are all like family and will worry about you if we don't hear from you.

Christy

[clydetheboosmom]

Hey there -

Just wanted to pop on and say Hi! You're in Rhode Island? I'm in one of the border towns in Massachusetts - let me know if I can help you at all....

I have two cushie pups - one with Trilo, one Atypical - so I understand :)

Lynne, Clyde & Bailey

[littleone1]

Hi Brenna,

I'm glad you found a good vet. It means so much when you find a good one that you can trust and work with.

Terri

[brandysmom]

Hello. Still waiting on the results for the extended adrenal panel... Other than that, Brandy is good this week so far.

I really liked this vet and I'm glad he was referred to me too. One thing - he did not seem too concerned with the protein in the urine.

Hi Lynne - yes I'm in RI! What town in MA are you in? I'm sorry you have 2 puppies with Cushing's. That must be very difficult. One seems hard enough...

Brenna

[brandysmom]

Finally the results for the extended adrenal panel came back. We had the follow up appointment with the IMS today. She is definitely Atypical. Here are the numbers with the normals:

Cortisol baseline 16.6 (2.1-58.8)
post ACTH 157.7 (65.0-174.6)

Androstenedione baseline 1.07 (0.05-0.57)
post ACTH >10 (0.27-3.97)

Estradiol baseline 115.1 (30.8-69.9)
post ACTH 101.6 (27.9-69.2)

Progesterone baseline 0.58 (0.03-0.49)
post ACTH 2.2 (0.10-1.50)

17 OH Progesterone baseline 0.09 (0.08-0.77)
post ACTH 4.23 (0.40-1.62)

Aldosterone baseline <11 (11-139.9)
post ACTH 82.6 (72.9-398.5)

The IMS suggested staying with the melatonin and flax hulls, but he also wants me to consider Lysodren to give her a better quality of life. I have to agree, but am also afraid. I've heard so many bad things, along with good things. Any thoughts?

I also want to thank everybody for giving me the advice to get this test done. I actually finally have some answers.

Brenna

[lulusmom]

Brenna, since cortisol is not elevated, I am sure your vet is recommending a "maintenance dose" of lysodren. Loading a dog with lysodren is worrisome but most dogs don't even skip a beat on a maintenance dose. If it makes you feel any better, both of my very little dogs, 4.5lbs and 6.5 lbs loaded on lysodren more than once and are doing great at their current maintenance dose for quite a while. The key is proper administration and monitoring. You're a great mom so I think you've got both of those areas covered.

I see that Brandy's estradiol is up there and lysodren doesn't always resolve this problem because unlike the other adrenal hormones, estradiol can be found in tissues outside of the adrenal glands. How long has Brandy been getting melatonin and pressed flax hulls and what doses is she getting? Often times, Dr. Oliver (UTK) will recommend that the dose(s) be increased if improvements are not noted.

Glynda

[Franklin'sMum]

Hi Brenna,

I am one of the people who chose to treat with Trilo, because what I had read about Lyso scared the be-geebers out of me. After joining the forum here, and reading everyone's stories, and the info about Lyso, I have become much more rational and reasonable ;).

So happy you have some answers now, and wishing you luck on this journey with whichever way you choose to proceed,

The somewhat less un-educated then before Jane :o and Franklin xx
________
Health Injuries &Amp; Problems Advice (http://www.health-forums.org/health-injuries-problems/)

[labblab]

Dear Brenna,

I am so glad that Brandy's test results are back, and that you are now armed with more helpful information! I just want to "second" what has already been said -- most dogs adjust to maintenance doses of Lysodren without any problems at all. And most certainly, Lysodren will act to lower almost all of those pesky intermediate hormones as well as cortisol. Since Brandy's "post" cortisol result was up there at the high end of normal, if she were my dog, I would definitely consider the Lysodren. But whatever you decide, please continue to keep us updated!

Marianne

[Squirt's Mom]

Hi Brenna,

I hear what the IMS wants to do, but what does Dr. Oliver recommend at the bottom of the results sheet? Dr. O is the premier researcher in the area of Atypical and his is the advise I would follow above all others in regard to this form of Cushing's. Also, I will ask what Glynda already did, how long as Brandy been on the melatonin and lignans? Also, could you tell me specifically how much of each she is getting? Is the melatonin regular or time released, extended, etc? How much SDG is in the lignans you are using? The SDG is what makes the lignans affective on Atypical.

I ask these questions because they can directly affect how the treatment is working on these hormones. Also, these treatments can take up to 4 months to work. They are not as fast as Lyso. So you have to be patient. Not easy for most of us. ;)

If you do start the Lyso, it will be a maintenance dose ONLY! DO NOT agree to do a loading on Brandy as her cortisol is normal. A loading with Lyso is to get the cortisol down and Brandy does not need that. The Lyso will work on all the intermediate hormones except estradiol in some cases. This is because estradiol can be produced in areas other than the adrenals, like hair follicles, skin, and other organs. Lyso is made to work only on the adrenals so the melatonin and lignans will work on the estradiol when the Lyso won't.

I am so glad you had the UTK panel done and now know what you are dealing with. Just to reassure you, this is the best form of Cushing's you could ask for as it is easier to treat, less expensive, and much less stressful on both of you.

Hang in there! Ya'll are on track now and have a plan!
Hugs,
Leslie and the girls - always

[lulusmom]

Just to reassure you, this is the best form of Cushing's you could ask for as it is easier to treat, less expensive, and much less stressful on both of you.

Doh!!!! Sure wish I'd known that when I asked for the other type of cushing's....twice. Sorry Leslie, I couldn't resist. :p:p:p

[brandysmom]

Hello. Thank you for the many responses and words of encouragement.

Brandy weighs 65 lbs. She has been on melatonin and flax since May. Her melatonin dose was too low at 3mg 2x/day. Yesterday I started with 6mg 2x/day. It is regular melatonin - Physiologics is the brand name. Now the flax was Barleens High Lignan oil. I changed that right away once you educated me that was the wrong kind. I purchased Flaxhulls. It contains 35mg of SDG per gram and I have been giving her 1 tsp daily.

The comments at the bottom of the test result were from Hugo Eiler, not Dr. Oliver. He gave an attachment with the various treatment options.

Comments: Values are increased as indicated. Sex hormone pathway is affected. Although estradiol may contribute to clinical signs it is not a good indicator of adrenal activity. Various treatment option considerations are attached. Some veterinarians consider items 2-4 (melatonin and lignans), for estradiol control if symptomatic.

The IMS does want to do a "conservative" loading dose and then do another ACTH. He said 1/2 tablet 2x/day initially and then move on to maintenance. Does this sound right? Should I contact the lab first? I am so worried I am doing all this too late. I think she has had this for a couple of years now. I wish the vet I was going to at the time was more proactive and that I was more educated. I am so grateful to have found you all here. I wish I found you sooner. Thank you again. Brenna

[labblab]

The IMS does want to do a "conservative" loading dose and then do another ACTH. He said 1/2 tablet 2x/day initially and then move on to maintenance. Does this sound right? Should I contact the lab first? I am so worried I am doing all this too late. I think she has had this for a couple of years now. I wish the vet I was going to at the time was more proactive and that I was more educated. I am so grateful to have found you all here. I wish I found you sooner. Thank you again. Brenna
Hi again, Brenna.

Two quick questions...first, can you tell us what treatment options were listed on the attachment that Dr. Eiler included?

Secondly, did the IMS tell you more specifically what he meant by dosing Brandy with 1/2 tablet 2x/day "INITIALLY"? Does he want you to dose her in that manner for a set number of days?

Marianne

[Squirt's Mom]

The IMS does want to do a "conservative" loading dose and then do another ACTH. He said 1/2 tablet 2x/day initially and then move on to maintenance. Does this sound right?

Hi Brenna,

Brandy would weigh 29.5kg. The recommended loading dose of Lyso is 50mg/kg/day so a normal dose for Brandy would be 29.5x50 which would be 1477mg/day. Lyso comes in 500mg tabs so 1/2 tab would be 250mg/dose, or 500mg a day. That is about 1/3 of what the normal loading would be for her, so it is a conservative loading dose. The problem I have with this is that the purpose for loading is to erode the adrenals rapidly to lower the cortisol. Then the maintenance is to keep the erosion at that level. It is NOT standard protocol with Atypical Cushing's to do any loading at all as the adrenals are not over-producing cortisol and in general do not need the erosion process.

I am not telling you to disregard what the IMS is telling you, just to do your homework before you agree to this approach. If it were me, I would not do any loading at all.

Others with more experience and knowledge than I may differ we me on this. But as an Atypical mom, I wouldn't let me Squirt be loaded...period. ;)

Just my 2 cents worth!.
Hugs,
Leslie and the girls - always

PS. Another ACTH will not pick up the intermediate hormones. You will have to do another UTK panel but not for several months. It sounds to me as if your IMS may not be understanding the difference between true Cushing's and Atypical. It is protocol to do an ACTH after the loading with TRUE Cushing's to see where the cortisol is, but you are not dealing with cortisol so I am a bit worried here.

[labblab]

I do appreciate what Leslie has said above, and I have no personal experience whatsoever with either Lysodren or Atypical Cushing's treatment -- so you can take my comments with a grain of salt...;)

But here's a couple more "musings" on my part. In checking back, I remember that Brandy did actually test "positive" (barely) for pituitary Cushing's on the LDDS test. And given the fact that her post-ACTH cortisol result was at the high end of normal, I am wondering whether your IMS is wanting to keep her cortisol tamped down a bit in conjunction with lowering the intermediates. This might account for a limited loading period at a very conservative dosage (which 500 mg. per day would be). And that could also account for wanting to do a straight ACTH after a brief loading period -- in order to make sure that the cortisol hasn't been lowered too much.

Once again, this is purely speculation on my part. But that's why I'd be curious to know more specifically about the proposed duration of the loading protocol, and also what Dr. Eiler suggested.

Marianne

[brandysmom]

Marianne - you said it perfect! That was what the IMS was getting at. I should have been more detailed... He said we had room to drop the cortisol a little. He wanted to try this dosing for 1 week and then call him to see if anything has changed with her.

The treatment options on the handout were:
1. Ultrasound and/or Endogenous ACTH to rule out tumor presence.
2. Melatonin
3. Melatonin implants
4. Lignan
5. Maintenance dose of Lysodren
6. Lysodren traditional treatment
7. Trilostane
8. Ketoconazole
9. Anipryl
10. Hormone cream exposure
11. Ovarian remnant detection
12. Retained testicle detection
13. For clarification - contact Dr. Oliver
14. For further information refer to website

[Harley PoMMom]

Hi Brenna,

My boy Harley is Atypical + PDH, his treatment plan consist of melatonin and the flax hulls with the lignans and beginning Jan. 4th he also started a maintenance dose only of Lysodren. Harley's cortisol is slightly elevated but since he suffers from pancreatitis his GP had misgivings about loading him with the Lysodren, she then conferred with Dr. Oliver about this concern and they both agreed that this was too risky and that a maintenance dose of Lysodren would be alot safer and this would work better for Harley's situation. With Brandy's GI's issue's, you might really want to keep this in mind, Lysodren is alittle rough on our pup's tummies, and especially the ones that already have issues going on with their digestive tracts.

So this is my 2 cents worth! :eek::)

Love and hugs,
Lori

[brandysmom]

I appreciate the advice from everyone... It's worth much more than 2 cents to me!

Lori - has this been helping Harley? Have you noticed any differences in his symptoms? Has the Lysodren affected his tummy at all since you started?

I am definitely going to look into further before I give her anything. If I am reading correctly a maintenance dose for Brandy would be approximately 1450 mg/week? It said 50mg/kg per week.

[Harley PoMMom]

Hi Brenna,

When Harley was stimmed in Sept. 09 and his post was 12 ug/dl, his IMS wanted to load him at that time, Harley's GP and Dr. Oliver talked and felt that Harley did not need Lysodren at all and wanted to give the Melatonin and flax hulls with lignans more time to work.

When Harley's full adrenal panel results came back on Nov. 09 and showed that his cortisol had risen to 26 ug/dl then his GP knew we had to do something. This is when she discussed his case further with Dr. Oliver, which I highly recommend that your IMS do. His GP informed Dr. Oliver about Harley's pancreatitis and he then recommended that we do not load him but we start him out at 80mg 3 times a week. This is a low dose, but we can always adjust it higher, giving his digestive system time to balance itself with this drug. I really won't know how well this dose is working on his cortisol until he gets an ACTH stim test, but I can tell you that this is working with his pancreatitis.

Usually if you are just doing a maintenance dose it is started at 25 mg/kg/day.

This is how Harley's is done: Harley weighs 23lbs, = 10.45 kg x 25 mg =261.36 mg of Lysodren he should get weekly, it should be split up 3 days per week...like Monday, Wednesday and Friday. Now Harley is only getting 80mg, 3 times a week, which equals to 240 mg of Lysodren a week, which he does get every Monday, Wednesday and Friday.

Hope this helps.

Love and hugs,
Lori

[labblab]

If I am reading correctly a maintenance dose for Brandy would be approximately 1450 mg/week? It said 50mg/kg per week.
Brenna, that would be the approx. dose to maintain a dog diagnosed with conventional Cushing's subsequent to a "full" load. In Brandy's case, even the maintenance dose may be at a signficantly reduced dose. I'm not sure about dosing rates in this type of situation -- hopefully our Atypical "parents" can better guide you.

And just to muddy the water even further...it might be the case that Brandy's GI issues could show some improvement with a slightly lowered circulating cortisol level. It is a paradox, but even though one of the treatments for inflammatory bowel-type conditions is steroids, my IMS told me that consistently high levels of circulating cortisol can also trigger bowel issues for some dogs. My own Cushpup suffered from intermittent diarrhea for months prior to being diagnosed and treated. Unlike Brandy, his diagnostic ACTH test result was sky-high for cortisol. But if Brandy's cortisol level is consistently in that high-normal range, maybe there's a possibility that her GI issues might even show some improvement with a bit of a cortisol decrease? Once again, pure speculation on my part. But I just wanted to mention what my own IMS told me in the event that your specialist has anything similar to say.

Oh, if only we had that crystal ball to tell us exactly what the right thing is to do!!

Marianne

[brandysmom]

Hello again... I still have not started Brandy on the Lysodren out of fear. I ended up sending Dr. Oliver an email explaining everything. He responded very quickly. He did suggest a maintenance dose of Lysodren, along with the melatonin and lignan and to recheck cortisol in 4-6 weeks. He also suggested the possibility of using ketoconazole instead. Does anyone have any experience with this drug? I plan to have him discuss everything with my IMS.

To make matters even worse, Brandy collapsed last night. I think she fainted. She was recently diagnosed with a heart condition (boxer cardiomyopathy) and fainting is usually a symptom, but I've never seen it happen and it scared the crap out of me. I thought I lost her. The IMS put her on heart medicine (Sotalol) in December and up until this time she never showed any symptoms whatsoever. I think I'm going to lose her to this disease before anything else and a gut feeling tells me it's going to be soon. I know my dog and I can see it in her eyes. Anyway, thank you for listening. Brenna

[littleone1]

Hi Brenna,

I'm so sorry to hear what you and Brandy are going through. I'm sure you were really scared when that happened.

My thoughts and prayers are with you and Brandy. I'm hoping that things will get better for the both of you.

[Squirt's Mom]

Hi Brenna,

Sweetie, you can't give up hope. Brandy can sense your emotions and she needs to know that you are strong and that you believe in all the tomorrows ahead. And I know just how hard that is to do when you know there is something majorly wrong. I really do. :( But we have to give them hope and strength; as long as they are able to try, we have to try.

There is a group called Boxer World, and I'm sure they can give you some good info on boxer cardiomyopathy. If you aren't already a member, it might be worth checking out.

I'm glad you got to talk with Dr O. Isn't he wonderful?! He has been such an inspiration and source of great help for us over the years.

My thoughts are with you, Brenna. That look in the eyes you mentioned is so very painful to see, but let Brandy see courage, hope and love in your eyes, not despair. And like I said, find someone who is facing the same cardio diagnosis as Brandy and fight it to the very end.

And don't sit there letting your mind drive you nuts with worry and grief...we are here and we can listen, always. Talk all you want...anytime.

Hugs,
Leslie and the girls - always

Boxer World
http://www.boxerworld.com/

[brandysmom]

You guys are the best support ever... Thank you for the thoughts and prayers, along with the words of encouragement.

Leslie, I haven't given up hope. I am always hopeful. I just know something is different when I look in her eyes. It's like she knows. I will show her love, strength and courage. I consider it a blessing to still have her in my life and I will cherish every day I have left with her. She is almost 11 and for a Boxer that is really a milestone. Thank you so much for your kind words.

The vet just called me back. He gave me a description of when they faint and when they have a seizure. Brandy sounded like a cross between the 2, but he is going to call it a fainting episode based on her heart problem. He is upping the dosage of Solatol. I also discussed the Lysodren dosing concerns. We both agreed to start at the maintenance dose of 25mg/kg/week and do an ACTH in no more than 2 weeks or sooner if she shows signs. Thank you everybody for the advice on that.

Dr. Oliver is wonderful. I can't believe how fast he responded!

Thank you - I did check out Boxer World briefly. I will look at it better later today. Right now, I'm going to go home for lunch to check on my girl.

Brenna

[ChristyA]

Hi Brenna,
My Boxer boy Dexter had pituitary Cushing's along cardiomyopathy, he was on Solotal also. He did fine with the heart medication it seemed to really help him. Once his lysodren and solotal were regulated and his cortisol was within range he was like a pup again, running, chasing - back to his healthy self.

I belong to Boxerworld and it is a wonderful site. It's a lot like this site only they are all Boxer owners and know ALL about Boxers. If you join the site and ask questions you will get answers.

Dexter did pass away in June of 2008, but it wasn't from heart complications. He developed a macroadenoma (large tumor in his brain) and there was nothing we could do. He was such a huge part of my life and to this day I love him as much as if not more than ever. He brought so much joy and love into my life and I am so glad I have these wonderful memories of him. Boxer's are wonderful, loving, soft-hearted, companions. I'm sure you already know that!

Maybe I'll catch you on Boxerworld, they are a great bunch of Boxer lovers!
Christy

[brandysmom]

Christy,

It's always comforting to hear from another boxer mom. I'm sorry about you boy Dexter. It's sounds like he had a wonderful life with you. How old was he? Thank you so much for sharing with me.

Brandy seems ok now. I started giving her 60mg Sotalol 2x/day - it was 40mg 2x/day. I hope it helps her. Tomorrow I'm going to give her first dose of Lysodren. I hope she does as well as your Dexter did.

They are great breeds. They seem to be prone to so many illnesses, but the joy they bring to us is worth going through the pain. Brandy is my first Boxer, actually my first dog as an adult and she will not be my last Boxer. They are a very unique breed.

Thank you for your post - it made me feel better.

I did join Boxer World so I hope to see you there.

Brenna

[ChristyA]

Brenna,
Dexter was almost 10 when he passed away. He was my first dog as an adult also. I alsohad a female Sophie who was a sibling of his but I didn't get her until she was 9 months old. A guy that lived a couple of blocks away had her and used to bring her over to play with Dexter since I had a fenced in yard. They got along right from day one, it was amazing. One day he said he needed to find a home for her and I took her without hesitation. The 2 we inseperable, Sophie always looked to Dexter to lead the way. It was until they had both passed away and I was looking at their AKC papers that I saw they were from the same litter. It was so ironic that I had Dexter for 9 months before I got Sophie and she lived 9 months longer than he did. They were both so great.
I hope Brandy does well with the lysodren. Just keep a close eye on her, as I have no doubt you will. She looks like my Sophie girl.
Christy

[brandysmom]

Christy,
I love that story about Dexter and Sophie! So far, Brandy is doing fine with the Lysodren. Today was her 2nd dose.
Brenna

[frijole]

Brenna, Congrats on day 2. Keep a close eye out for changes in eating and drinking habits. Watch when she goes potty - you do NOT want to see diarrhea as it is a sign of too much lysodren. Any questions just ask. We have been there and understand. Keep the good news coming! Kim

[ChristyA]

Hi Brenna,
Dexter's sign of being loaded was diarrhea, on day 4. She looks a lot like my Sophie girl with the black mask. But, by the time Sophie was Brandy's age her face was pretty much all gray.
Take Care & a big HUG to Brandy,
Christy

[labblab]

Hi Brenna,

Just to double-check with you, I'm thinking that you and your vet decided against any "loading" phase with Brandy, and you are instead starting out with only low-level maintenance dosing? Can you tell us exactly what your dosing schedule is? Thanks so much! And here's hoping that Brandy won't have any ill effects whatsoever from her Lysodren -- only GOOD effects...;)

Marianne

[brandysmom]

Brandy is on the low dose maintenance plan, instead of a loading dose. She is starting with 750mg/week. I gave her 250mg on Friday and 250mg today. I plan to do Monday-Wednesday-Friday. The IMS wants to check her cortisol levels no later than 2 weeks after 1st dose, or sooner if she shows any signs. So far, she seems ok. I hope it stays that way. Thank you everybody - I am keeping a very close eye for any possible symptoms or side effects.
These pills do not cut so easily. I used a pill cutter and it still seemed to crumble a little - not a clean cut. Is this ok? I gave it to her with a little peanut butter, which was a real treat :p for her because her diet is so limited now. Brenna

[littleone1]

Hi Brenna,

I am glad to hear that Brandy seems to be doing good with the Lyso. I hope she continues to do good.

Terri

[ChristyA]

Hi Brenna,
Just checking in to see how you and Brandy are doing. Hope all is well.
Christy

[brandysmom]

Thanks for checking in Christy. So far so good:) just walking on eggshells... Hope all is well with you too.

Does anybody know if I should be seeing anything with Brandy on such a low maintenace dosage (750mg /week - split into 3 doses)? Again, she weighs approximately 65 lbs. This morning was her 5th dose and everything seems the same - no changes good or bad.

[Harley PoMMom]

Hi Brenna,

With the maintenance dosing, like I am doing with my boy Harley, as long as I see nice formed poop, no vomiting and a good appetite ~ I'm happy. The plan you will have to take (adjusting the maintenance dose) will show in the ACTH stim test.

Glad Brady is doing so well, keep up the good work! ;):)

Love and hugs,
Lori

[ChristyA]

Glad to hear things are going well. :D Check in with us once in a while so we don't worry :p. When is Brandy's ACTH scheduled?
Christy

[brandysmom]

Thanks. Her many poops are normal, no vomiting and her appetite is still as crazy as ever! I was planning on bringing her in on Thursday for the ACTH test. Her IMS said no longer than 2 weeks and it will be this Friday. I will keep you posted...

[brandysmom]

Hi everybody :)

Brandy had her ACTH response test yesterday after being on the Lysodren low dose maintenance plan for 2 weeks now (250mg 3x/week). They just called with her results. Her cortisol was 2.5 at start and after the ACTH gel it was at 12.5 (2 hours). They said they like to see it below 5. I am really confused now because I thought her cortisol was normal when she had her extended adrenal panel done. There is something I am not understanding... :confused: They want her to now start 250 mg every day for 7 days and then 250 mg every other day for another 7 days then repeat this test unless she shows signs during the 2 weeks. If anyone could clarify this for me I would appreciate it very much :) Brenna and Brandy

[labblab]

Brenna, did you get to speak directly with your IMS or did somebody else relay these instructions to you? I can sure understand why you are confused, because I am too! Presumably, the point of the maintenance Lysodren dosing was to lower Brandy's elevated intermediate hormones without also lowering her cortisol to a great degree (because you're right -- her initial ACTH cortisol result was in the high end of the normal range). And her cortisol HAS already come down a little bit -- from 15.7 to 12.5. So I'm not sure why they would be aiming at lowering her cortisol clear down to the 1-5 range...

I'll be interested in hearing what other folks have to say about this change in plans.

Marianne

[brandysmom]

My IMS was not there. His assistant spoke to me. I am going to call him on Monday and I also want to get a copy of these results for my records. This whole thing is confusing me...

[ChristyA]

I wouldn't make any changes until you speak directly to the IMS. Remind the IMS of what is going on and what the goal was for Brandy given her previous adrenal panel results.

How is she doing? Are you getting hit with any of this snow? It's coming down here now, a little later than they expected. Dexter and Sophie used to like the snow when it was not in the low 20' or teens.

Christy

[Harley PoMMom]

Hi Brenna,

I definitely would not make any changes without talking to your IMS first and then making sure that your IMS remembers that Brandy is an Aypical Cushings pup ~ Atypical Cushings pups have elevations in the intermediate/sex hormones but not the cortisol, which is why Brandy is on a low-dose maintenance dose only.

To me, she may be a tad sensitive to Lysodren, since she has only been on her maint. dose for 2 weeks and her cortisol is lowered already. Hopefully the others will voice their opinions on this as well.

How's Brandy's digestive issues been lately?

We are getting hit here with a big snowstorm-12-20 inches :eek: Looks like I'll be shoveling my butt off tomorrow!

Love and hugs,
Lori

[brandysmom]

Hi Christy and Lori:

Sorry you are getting hit with a lot of snow :( I think it just missed us. I see a couple of flurries now, but I think that's it. Brandy used to love playing around in the snow - not so much in her old age. And forget about rain... she is a little princess who does not want to get wet. I have to actually go out with her to get her to do potty in the rain - so we both get soaked! I think it's a Boxer thing.

Her GI issues have been better, but not perfect. She has had 3 belly aches (that's what I call them) since she has been on this new food. It's Natural Balance Sweet Potato and Fish and she's been on it since early December. So, it has helped but not cured. Thanks for asking. How's Harley been?

I do plan to call the IMS on Monday. I may even drop Dr. Oliver an email too.

Take care, Brenna

[labblab]

I do plan to call the IMS on Monday. I may even drop Dr. Oliver an email too.

Take care, Brenna
Brenna, I think that would be great if you do go ahead and email Dr. Oliver. It would be a big help to us all to gain more perspective regarding the acceptable ACTH range for "Atypical" pups with normal pretreatment cortisol levels who are being given Lysodren to lower intermediate hormones.

Marianne

[ChristyA]

I agree I think an email to Dr. Oliver would be a great idea.

Dexter would go out and stand in the wind before a storm and sniff the air. Sophie didn't like wind at all, she didn't even like the windows open in the car. Lulu (my boxer mix) tries to climb out of the car window. None of them like the rain. Now my flat-coat retriever loves the rain, snow, wind, all of it.

I used to feed Dexter the Natural Balance Sweet Potato and Fish. He did really well on it. Sophie did great on Innova Senior Plus - I mean GREAT. Sophie was the one with the very bad GI issues. Lulu is allergic to peanut butter of all things, if she has to take a pill I have to put it in a mini marshmallow.

Let us know what Dr. Oliver has to say.
Take Care,
Christy
We got over a foot of snow last night!:eek:

[brandysmom]

Just a quick update (sort of)...

Well, I emailed Dr. Oliver earlier today but haven't heard back yet. I called the animal hospital to get the actual test results faxed to me. I have not spoken to my IMS yet, but after reading the test results, I think I know why he instructed what he did. At the bottom it states:

*POST-LYSODREN: pre and post cortisol levels after Lysodren loading or while on maintenance Lysodren should be between 1-5 ug/dL.

I want to see what Dr. Oliver says before I call my IMS.

[brandysmom]

Christy,

Brandy doesn't like the wind either or thunderstorms - forget it! She is a big baby, but that's ok. It's funny though - if she is in the car "going for a ride" she loves to stick her head out the window, even if it's pouring rain...

I thought the Natural Balance was doing the trick, but it seems like she has gone right back to where she was. Her belly aches are getting more frequent it seems. What symptoms did Sophie have with her GI issues?

Sorry you had so much snow. We are supposed to get hit tomorrow.

Take care, Brenna

[ChristyA]

Hi Brenna,
Those values are for a dog that has pituitary cushings.

Sophie couldn't eat anything other than her dog food, even one crumb of bread she would have terrible diarrea that would look like jelly. Her stomach would rumble like crazy. We gave her pepcid tabs to help, they worked most of the time. Although when I switched her to Innova Senior Plus she did better than when she was on any other food.

Christy

[brandysmom]

Christy,
I have no idea what causes Brandy's belly aches. I've tried to relate them to something, anything but I can't. When she gets one she won't eat or drink. Her stomach makes these horrible noises. Sometimes she will spit up and sometimes she will have diarrea or sometimes neither. She appears very uncomfortable and distressed when this happens and within several hours she will be fine and want to eat like nothing ever happened. After she is back to normal, her first poop is usually a bloody jelly one and she will have the worst gas ever. They have called it pancreatitis (blood test confirmed), colitis and IBD or a combination of these, but no known cause... Maybe I will give the Innova a shot. I've tried almost everything. Thanks for the info.

Dr. Oliver still has not responded - maybe he is away? The IMS explained it as this - there are several layers of the adrenal gland and the Lysodren has to work to get to the layer where these sex hormones are, which in turn is monitored by the cortisol levels. I don't know... I just want to completely understand this.

Now it's our turn to get hit with snow :eek:

Take care, Brenna

[brandysmom]

Hello everybody:

I just wanted to give an update... haven't posted anything in a while.

Dr. Oliver never responded to my email. I don't know why. I did speak to the IMS and followed what he said. Brandy took 250mg of Lysodren for 7 days and then 250mg every other day for 7 more days. A repeat ACTH response test was done and her results came back at 2.4 pre and 7.1 post. They also checked her urine concentration and it was 1.022. The IMS was very happy with that result because it showed she was drinking less water. He was also happy with the results of the ACTH test. He told me to stay on 250mg every other day and repeat test in 2 months. Any comments?

Meanwhile, she seems to be tolerating the Lysodren ok. I can not see any difference in her water intake or appetite - she woke me up at 4am today because she wanted to eat! Her fur seems better. She has not had any more collapses from her heart. She is having more of a hard time with her back legs, especially her right leg. The IMS said it is neurological. She tends to fall a lot. She had one bad fall and was put on Rimadyl for a week and it did help. Her pancreatitis is no better. She averages one episode every couple of weeks and it kills me to watch her because I know she is not comfortable, but once it passes she is fine. I don't get it... I am slowly trying to change her food once again. This time I am trying the Innova Senior dry. I really don't know what else to do. It seems like so many things going on at once. All I know is that I am trying to keep her as comfortable and as happy as I can. She will be 11 on April 5th, so we are looking forward to that! Anyway, thanks for listening.

Brenna

[brandysmom]

Also - can the title of this thread be changed or do I have to start a new one that is updated?

[labblab]

Hi Brenna! Yes, any one of the staff members here can revise your current thread title for you. Just let us know how you'd like it to read, and the first one of us who sees your reply can make that change for you (unfortunately, this is not a change that you can make yourself).

Marianne

[brandysmom]

Hi Marianne,

Thank you so much for answering my question! It would be great to have the title changed. Something like this would work for me...

Brandy 11 yo Boxer, Atypical on Lysodren, Pancreatitis, ARVC

Thank you!

Brenna

[Harley PoMMom]

Hi Marianne,

Thank you so much for answering my question! It would be great to have the title changed. Something like this would work for me...

Brandy 11 yo Boxer, Atypical on Lysodren, Pancreatitis, ARVC

Thank you!

Brenna

Hi Brenna,

I have changed your thread title to exactly what you have mentioned. ;):)

Since Harley's been on his formulated diet by Monica Segal, his cPLI numbers have come down significantly - from 528 to 300 (0-200). Brenna, I don't know if home-cooking for Brandy will fit into your daily routine or your budget because it does take time to do it and it is somewhat costly but I just wanted to toss the idea out to you.

Love and hugs,
Lori

[labblab]

Lori, you just beat me to the punch!! I think I was just a few minutes behind you as far as the thread title change...:D :) :D

Marianne

[brandysmom]

Hi Lori,

Thank you for changing my title. Home cooking would be a challenge. I work 2 jobs and find it hard to cook for myself at times. Is it possible to make a big batch and freeze? I may have to look into it anyway. When I had Brandy's cPLI testing it came back off the charts (>1000 ug/L), but she also had her worst week ever prior to that with 3 episodes. That was in late October and I haven't had it retested yet. Thanks for the advice. I will take another look at Monica's website. I did add the L Glutamine back in December. Do you give Harley any enzymes or probiotics?

Brenna

[Harley PoMMom]

Hi Brenna,

Big batch's freeze perfectly and Monica can tell you what and if any vit/minerals can be mixed in and froze too. I do 2 weeks worth of Harley's food and freeze it, but I don't add any of the vit/minerals until the day he needs them.

Harley gets 2 ounces of skim milk yogurt daily and that's part of his formulated diet.

Love and hugs,
Lori

[Annie's Mom]

Hi Brenna, I have been reading your thread and wanted to add my 2 cents worth. My Annie had a severe pancreatitis attack in September. I switched her to Innova Senior Plus dry food (after trying several other foods after she recovered from the pancreatitis) and she has done well on Innova. I use the Innova canned food to give her meds and as a treat. I also give her probiotics (Purina Vet diets FortiFlora -- recommended by my vet), and I give her 10 mg Pepcid when her belly is upset. I am clueless about what brings on her belly aches too. When I was searching out a new dry food, Innova Senior Plus was the lowest fat content I could find. Sometimes I will add 1/4 C of water to the food and let the food soak up the water so it expands before it hits her belly. I feel the probiotics are very important. Others on the forum have much more experience than I; we are so lucky to have found these wonderful folks! All the best to you and Brandy. Will keep thinking positive thoughts for you :)
Barb and Annie

[brandysmom]

Hi Barb and Annie,

Thank you for your post. I really do appreciate your 2 cents worth...
I am sorry your Annie had to go through such a terrible attack. Was that the only attack where she had to be hospitalized (I read in your thread about Annie)? How often does she get her "belly" aches? Brandy has never been hospitalized, although I thought I was going to have to bring her last night. She had another episode, except this time I think it affected her heart as well. Her heart was beating erratically and I thought she was going to have another collapse, but she snapped out of it and slowly started to feel better. Her belly aches only last for several hours - they just happen so frequently and each time seems worse than the last. I first purchased a bag of Innova Senior Plus and worked it into her current food. I then read on their website that the Senior had less fat. So I bought a small bag of that. She is still eating 50/50 with her old food because I had a big bag of the old. You are the second person, along with ChristyA that said their dog did good on Innova Senior Plus, so I think I will give that a good solid try. Is the Fortiflora by prescription only? I will try anything that could help her. Thank you so much for your advice. We are lucky to have all these knowledgeable people! All the best to you and Annie too!
Take care,
Brenna and Brandy

[Harley PoMMom]

Hi Brenna,

I am so sorry that Brandy is having such a difficult time with her pancreatitis. This can be a deadly disease if one does not get a handle on it. Is Brandy vomiting before, during or after these episodes? Brenna, I really don't mean to scare you, but, Brandy might need to see the vet ASAP, she might need extra care right now. I really don't think her pancreas has healed completely and that is why she constantly has these episodes.

Hoping and praying Brandy feels better soon.

Love and hugs,
Lori

[brandysmom]

Hi Lori,

Thank you for the concern. I am concerned too. I am going to call her IMS. I was originally referred to him for her GI issues, but at that time she was pretty good. He concentrated on her heart problem and the Cushings. But that was over 2 months ago and she is now like she has been for the past 3 years or so. Nobody ever came out and said she has pancreatitis, but it was evident on her cPLI test. None of the vets ever seemed concerned about it. How does a pancreas heal?

I'm probably repeating myself, but... her episodes occur on average once every couple of weeks - sometimes more sometimes less. They last anywhere from 4-6 hours. She won't eat or drink, except for maybe grass. Her stomach makes terrible noises. Sometimes she spits up and sometimes not - either in the beginning or at the end of an episode. Sometimes she has diarrea and sometimes not. I can tell she is miserable, but when it finally passes, she is completely normal and wants to eat and drink and be happy. The next day she will have the worst gas ever and sometimes she will pass a bloody jelly like poop (colitis). Doesn't this sound like pancreatitis to you, along with her numbers? I hope this IMS takes this seriously and not dismiss it like other vets. I can't watch her go through this anymore.

Thank you for listening (again). I'll let you know what I hear...

Take care,
Brenna

[Harley PoMMom]

When Harley's cPLI test came back at 528, his vet and I were very concerned, even tho he showed no symptoms of pancreatitis.

Depending on the severity of the pancreatitis: whether it is acute or chronic, which both can be mild or severe is how pancreatitis is treated. Many dogs suffering with a severe bout of pancreatitis will be put on antibiotics, which Brandy might need. They also might need extra hydration because of fluid loss due to vomiting and diarrhea. They are usually given a very bland diet for a while then slowly introduced to a very low-fat diet. Here is an article on pancreatitis that is very informative:

http://dogaware.com/wdjpancreatitis.html

Alot of times, pancreatitis and IBD go hand in hand.

Please keep us updated, I am a big worry wart! If you have anymore questions, please, please ask, ok.

Love and hugs,
Lori

[Loladog]

Hi Brenna,

So much of what you are going through sounds very familiar. Lola has been off of Lysodren for close to a month and she's been on .5mg of Prednisone with a short break ever since due to low Cortisone levels.

Ever since her diagnosis, I've tried a variety of low-fat foods but we've never been able to get her Pancreatitis completely under control. She has always had a sensitive digestive system so certain foods will cause her to have a noisy, gurgling stomach and toxic gas. Post diagnosis, I tried Wellness Core Reduced Fat but the high fiber content caused her to have loose stools and anal gland problems. We also tried Innova Large Breed Senior along with some Spot's stew canned but I stopped this combination after a high Spec cPL test. I thought this combination was low-fat but apparently it wasn't low enough.

My vet highly recommends a home-prepared diet for Lola and I completely agree that it would be best for her. However, I really hate to cook and I'm limited on time. Despite this, I decided to sign up for a consultation with Monica Segal. I've read her books and I really like her philosophy. She also seems to be very knowledgeable in terms of Cushing's and Pancreatitis. While waiting for her consultation, I was feeding Lola just a very bland diet of boiled chicken, rice and some low-fat cottage cheese. This worked for about a week and then she started having diarrhea and other issues again. I became desperate and decided to buy a bag of California Natural low-fat Rice and Chicken Meal. Immediately, her stools firmed up and the gas was drastically reduced. For two weeks now, I've been feeding her this food along with some fresh boiled chicken with one of her meals. She was doing so well on this combo that I considered canceling the consultation with Monica Segal (I actually e-mailed her regarding a possible cancellation but I haven't heard back). Unfortunately, Lola started having diarrhea again yesterday. She even had an accident in the house while we were at work. :( I don't know what brought this on all of a sudden. Her appetite is still great so she doesn't have the usual symptoms of her Cortisone levels being too low.

To make a long story short, I fully understand what you're going through in terms of finding the right diet. Like you, I know that home-prepared will be the best option but I just don't feel completely capable of it. When they have their episodes, it's so worrisome to not know if it's the diet or an imbalance with the medications (Cortisone Levels, etc). Please let me know how the Innova Senior Plus works out for Brandy. It's interesting to hear how others on this site have had such good experience with it.

[brandysmom]

Hello Aimee and Lola,

I only have a quick minute to spare, but I wanted to thank you for posting. I have actually seen some of your posts on Boxerworld. Your Lola does sound very similar to my Brandy. I'm sorry you have to be going through this too. The link that Lori posted yesterday was very informative about pancreatitis. It's definitely worth checking out. I will post more when I have a little more time to write.

Take care,
Brenna and Brandy

[brandysmom]

Hi Aimee and Lola,

It's funny you mentioned that Lola had an accident in the house. Monday night when I came home to Brandy, she did the same thing and she never goes in the house. I spoke to our IMS and he feels that her episodes have more to do with her heart than pancreatitis. I don't agree. She has been having these issues for several years now. Monday night was heart related, but she had another episode last night and that was clearly the pancreatitis. He is supposed to be leaving me an Rx for a pain medication to give her for next time. Next time this happens, I am bringing her straight in to have another cPLI test done. I liked this vet at first, but now I am starting to question him.

I don't know what to do about the food. I did what you did and made her some boiled chicken and rice to feed her for a couple of days. She was fine this morning. I think once I get my tax money I will schedule a consultation with Monica Segal also.

How is Lola feeling? I hope she is doing better. Her picture is beautiful! She looks like Brandy but with a longer nose.

Take care,
Brenna and Brandy

[O'Riley]

I've noticed that some dogs are getting the cPLI, while others are getting the spec cPL. How did you decide which one to get? Is one more precise, or are they equally reliable and give the same information? If I've read correctly, the cPLI has to be sent to Texas A&M for analysis, but the Spec cPL is performed at an IDEXX lab in Illinois. Do results arrive faster from one over the other?

[brandysmom]

O'Riley:

Brandy had the complete GI panel done - Texas A&M. I got the results back in 2 days. I read that the spec cPL gives results quicker and is supposed to be more accurate 95% vs 82%. The website Lori listed a few posts back has all this information in much greater detail. It is very informative.

http://dogaware.com/wdjpancreatitis.html

[Harley PoMMom]

I've noticed that some dogs are getting the cPLI, while others are getting the spec cPL. How did you decide which one to get? Is one more precise, or are they equally reliable and give the same information? If I've read correctly, the cPLI has to be sent to Texas A&M for analysis, but the Spec cPL is performed at an IDEXX lab in Illinois. Do results arrive faster from one over the other?

Here is a link to a comparison chart for the cPL, cPLI, and other diagnostic methods for pancreatitis.
http://www.idexx.co.uk/animalhealth/laboratory/speccpl/compchart.htm

The only reason I've stayed with the cPLI test for Harley is because I like comparing "apples to apples." Do you know what I mean? I know that probably sounds a little stupid :confused::p:eek: :) I believe both tests are very reliable because Dr. Jörg Steiner did help develop both of them. Dr. Jörg Steiner also serves as Director of the GI Laboratory at Texas A&M University.

http://www.cvm.tamu.edu/gilab/

Hope this helps.

Love and hugs,
Lori

[Loladog]

Hi Aimee and Lola,

It's funny you mentioned that Lola had an accident in the house. Monday night when I came home to Brandy, she did the same thing and she never goes in the house. I spoke to our IMS and he feels that her episodes have more to do with her heart than pancreatitis. I don't agree. She has been having these issues for several years now. Monday night was heart related, but she had another episode last night and that was clearly the pancreatitis. He is supposed to be leaving me an Rx for a pain medication to give her for next time. Next time this happens, I am bringing her straight in to have another cPLI test done. I liked this vet at first, but now I am starting to question him.

I don't know what to do about the food. I did what you did and made her some boiled chicken and rice to feed her for a couple of days. She was fine this morning. I think once I get my tax money I will schedule a consultation with Monica Segal also.

How is Lola feeling? I hope she is doing better. Her picture is beautiful! She looks like Brandy but with a longer nose.

Take care,
Brenna and Brandy

Hi Brenna,

Lola ended up having two accidents in the house this week. The 1st was on Monday. I didn't contact the vet on Tuesday or Wednesday because she improved. Then Wednesday night, she had a loose stool and she was straining a lot around her yard. Thursday morning she didn't have a bowel movement at all and then while we were at work, she had another accident in the house. Poor thing seemed to feel so guilty when we came home both times. It's definitely not something she would choose to do unless she REALLY had to go. We felt terrible and called the vet right away after the 2nd accident. The vets office asked that we bring her right in w/ a stool sample which we did. She seemed fine upon examination except she's lost 4 lbs. in the past two weeks. They sent her stool sample out to test for bacteria and Giardia and I got the results today. No Giardia or bacteria but there was a large amount of yeast which is odd. This probably indicates that her immune system is compromised (a result of the Cushing's?)

The vet wants her completely off of commercial food now so she's back on just boiled chicken and rice. The vet also prescribed Flagyl and recommended we give her Probiotics from now on. I'm waiting for the Monica Segal consultation and I'm not sure how long that takes. I placed my order with her a month ago. She probably thinks I'm crazy because I sent an e-mail two weeks ago requesting she cancel my order and then I sent another asking that she disregard the cancellation request. I'm a little concerned because I haven't received a response to either e-mail.

I definitely think trying home-prepared is the best option for Brandy now too (as hard as it is!). It sounds like you've tried a lot of good commercial foods without much success. My biggest problem right now is trying to figure out a balanced diet while waiting for the consultation. There's really good info in the books "K9 Kitchen" and "Optimal Nutrition" but I still get very overwhelmed when trying to put it all together.

I would be worried about the advice of your IMS too. I don't know much about the heart issue but I can't imagine that being the cause of Brandy's accident Monday night. It sounds more like she's having gastrointestinal issues too. Do you know if there was any blood or mucous in the stool? If so, that indicates colitis according to our vet.

How is Brandy doing now? Her picture reminds me a lot of Lola too. Their little gray faces are so cute! Brandy is a beautiful girl. Lola's nose is a little longer because she's technically 3/4 Boxer and 1/4 pit bull. The 1/4 pit bull slightly stretched out her nose :).

[brandysmom]

Aimee,

I'm sorry Lola still has not been herself. As far as the yeast, every single stool sample Brandy has had for the past few years has contained yeast. Again, the vet never seemed concerned. I think she is loaded with yeast - her poop, her ears on occasion and she has a cyst on her belly that the vet stuck a needle in to draw out some of the fluid just to see what it was....it was yeast too! I don't get it. The vet didn't get it either. It must have to do with the Cushing's?

Brandy's accident poop from last Monday was normal, but huge. She has had blood and mucous before, usually after one of her episodes. Since I started giving her the chicken and rice, her poop is not as frequent - maybe once a day instead of 3 times a day. It is also very orange and mushy. Have you noticed anything like that with Lola? Did your vet recommend a probiotic in particular? There are so many out there.

I think the episode from Monday night definitely affected her heart. She has a bad heart to begin with and she gets really stressed out when she has an episode, especially when she spits up. I think the stress of it made her heart have too many arrythmias. Thank god she did not collapse again. That was the worst experience I ever had.

Brandy is ok for now. I held off on her Lysodren dose for Friday. I hope Lola is feeling better. It is awful watching them go through any of this.

Take care,
Brenna and Brandy

[Harley PoMMom]

Aimee,
It is also very orange and mushy. Have you noticed anything like that with Lola?

Brandy is ok for now. I held off on her Lysodren dose for Friday. I hope Lola is feeling better. It is awful watching them go through any of this.

Take care,
Brenna and Brandy

Hi Brenna,

The orange colored poop made me think of another member here. Her pup, Barney, pooped an orange tinged color poop too. Barney has IBD and pancreatitis...here is a link to that particular post:

Barney 12 Year old Border Collie PDH/Lysodren
http://www.k9cushings.com/forum/showpost.php?p=11577&postcount=218

Love and hugs,
Lori

[Loladog]

Hi Brenna,

Lola hardly poops at all with the Chicken and Rice diet. It's max once per day when she used to go about 3 times daily also. I think she's even missing some days. It's also orange and mushy but at least she's not having toxic gas or diarrhea. She doesn't really care for the rice either and a lot of it is ending up spread all over the house. As Lori has suggested in the past, we may have to switch to peeled, boiled potatoes. I can't tell you how much I'm looking forward to the diet consultation because I'm so confused!:confused:

The yeast problem that Brandy and Lola both have may be from compromised immune systems due to the Cushing's??? The vet gave us a 30 day sample pack of Purina Forti-Flora probiotics but I don't care for this because it contains Animal Digest for flavoring. I ordered some Jarrow Pet-Dophilus to give her instead since they seem to be a very reputable brand with human Probiotic Supplements.

I feel so bad for Brandy since she has to experience heart issues too.:( How scary for you as well. Hang in there........Brandy is lucky to have such a great mom watching out for her.

[brandysmom]

I spoke way too soon... About 30 minutes after I posted yesterday, Brandy got up from the couch from sleeping all day and spit up. It was the start of yet another episode. 3 in 1 weeks time now. She also had diarrea - poor thing was standing out in the pouring rain and she hates to get wet! I called the animal hospital where her IMS is affiliated and asked to bring her in to have a new cPLI test done. I brought her in and luckily the IMS' assistant was working and she is very familiar with Brandy. At least she got to see her feeling miserable and I know the test will come back very elevated. Maybe now the IMS will get it... She started to feel better around 9pm and wanted to eat. Does anybody think that maybe the more frequent episodes may have something to do with the Lysodren? The past 3 times happened to be the day after she had her dose. Maybe it's getting to be too much for her?

Lori - thank you for the link about Barney.

Aimee - maybe I should try potatoes too. Have you heard back anything regarding the diet consultation? I am anxious to hear too. Thank you, I think Lola is a very lucky girl too:)

[Harley PoMMom]

Does anybody think that maybe the more frequent episodes may have something to do with the Lysodren? The past 3 times happened to be the day after she had her dose. Maybe it's getting to be too much for her?


When Harley first started his Lysodren, he threw up a few times the next day after he had his dose. His vet recommended giving him Pepcid AC not only before his Lysodren meal, which we were already doing, but the morning after too. This has stopped his vomiting episodes...knock on wood...;):)

Love and hugs,
Lori

[Loladog]

Hi Brenna,

The answer to my next questions is probably in your post somewhere but I couldn't find anything in what I re-read. First, what exactly is Brandy's Lysodren dosage again and how often? Also, when was the last time she had a resting Cortisol or ACTH stimulation test? The reason I'm asking is because when Lola's Cortisone levels were brought too low, she had symptoms similar to what Brandy is showing (diarrhea, spitting up, vomiting, loss of appetite). It was one of those things where I was asking myself "is it the diet, Pancreatitis or the Lysodren". As it turned out, it was the Lysodren and her Cortisone levels were too low. That being said, she also had similar issues after a month of being off the Lysodren which turned out to probably be diet related.

Did the IMS order any other labs today besides the cPLI test? It would be interesting to find out how her electrolytes and Cortisone levels look.

I heard back from Monica Segal today. She said that it should be about another week. She's currently ill so it might take a little longer. We fed Lola boiled potatoes and chicken tonight and she seemed to like it. We'll see how it goes with her tummy.

[brandysmom]

Aimee - Brandy's last ACTH stim test was on 2/19 after a mini loading of 250 mg/day for 7 days. Her resting cortisol was 2.4 and post ACTH was 7.1. She is currently taking 250 mg of Lysodren every other day, so 875 mg for the week which is on the lower side of a maintenance dose. Her cortisol was never too high because she is atypical. One thing I have been noticing is her water intake has decreased. Her appetite is still the same as far as she eats all her food and wouldn't turn anything down, unless she is having an episode, but she is not bugging me prior to her mealtimes anymore. She would start crying and begging for her meals ½ - 1 hour prior to when I normally feed her (3x/day). I have to wake her up now to eat, which I kind of like :) Is Lola still taking the Prednisone?

The IMS did not order any other tests. I brought her in because I wanted the test done. These episodes are definitely the same as what she has been experiencing for several years now, which I believe is pancreatitis. I just wonder if the Lysodren is making it worse and more frequent. I don't know if I will ever know.

I'm glad you finally heard back from Monica Segal. How long did it take since you first purchased the consultation? The website says 3-4 weeks. I hope you get to start real soon. Let me know how the potatoes work out for Lola. Brandy loves the chicken and the rice, but her poops are still orange and mushy. I don't know if that's good.

Lori - thank you for the advice on the Pepsid AC. I'm so glad it is working for Harley. I starting giving to Brandy this morning. I hope it helps her too ;) I have given it to her in the past when she was prescribed an antibiotic that would upset her tummy and it helped than.

[Loladog]

Hi Brenna,

Lola's last dose of Prednisone will be tomorrow and then I'm taking her in for a re-check next Wednesday. We ran out of Potatoes and I haven't had a chance to go to the store so Lola got Rice with her Chicken again tonight. She picked at her meal and rice ended up all over the house. I need to get to the store tomorrow to buy a big bag of Potatoes because she definitely seemed to like them better. Your lucky that Brandy likes her Chicken and Rice.:)

The orange mushy poop sounds like it must be a result of the Chicken and Rice because that's how Lola's has been looking too. I have no idea what this means either. Also, today I noticed there is almost a greenish/black coating on the outside of her stool. I poked at it with a stick to try and get a better look and underneath was just mushy orange again. Sorry to be so graphic. :eek: My husband and I are worried that the outer green/black tinge might be dried blood so we need to get a good look at her next fresh poop.

Do you think you're going to schedule a consultation with Monica Segal? I originally placed my order on 2/14 but then she took me off of her waiting list two weeks ago when I asked her to cancel (when I stupidly thought everything was great with Lola's diet).:o She e-mailed me today and said that she expects to have something for me next week. I would say that a 3 to 4 week wait is a good estimate.

I look forward to hearing about whether you think the Pepcid AC helps when you give it before the Lysodren. Once we start the Lysodren again, I think I'll give that a try too.

[ChristyA]

Hi Brenna,
Just a quick note, Dexter used to get peeled boiled potatoes and 99% fat free ground turkey breast. He did really well with that,, he couldn't handle the rice.
I'm actually in Florida on vacation so I'll catch up with your thread when we get back.
Take Care!

[brandysmom]

Aimee - I wish you luck with Lola's visit to the vet next week. It's funny how she doesn't like rice. I don't think there is anything that Brandy won't eat :) You weren't too graphic with the poop. I tend to get into the same details, after all these are our babies. It's funny you did mention about the greenish black on the outside and still orange on the inside. Brandy had the same thing, but you only see it if it sits for a day or so, not with a fresh one. I also noticed white specs in a fresh one. I think it's the rice not digested well, which is odd because rice is supposed to be easily digestable right? Anyway, I have been slowly adding her Innova back into her meals. When she has another episode I will try the potatoes. I am definitely going to purchase the consultation with Monica Segal, probably tomorrow. So far, the pepsid ac has been good. She had a Lysodren dose Monday and Wednesday and she has been fine :D

The IMS called me today regarding Brandy's test results from Sunday. They ended up doing the spec PLI, which had the same exact results as the cPLI she had in October. She is still off the chart at >1000. Now the IMS admitted to being wrong about these episodes having to do with her heart. She still has her heart problem and I think these episodes are not helping because she gets very stressed from the pain. I just went and picked up pain meds for next time, but in a syringe. I tried to give her the other pain med on Sunday, but it didn't work. She foamed at the mouth and spit it out. He also wants me to switch her diet to a prescription diet for pancreatitis, but I refuse to. I think all those "prescription" diets are not good. The ingredients are terrible. Please keep me posted on Lola.

Christy - So glad to hear from you! Thank you again for the advice. I will try anything. Did you boil the ground turkey breast too? Enjoy your vacation and take care.

[Harley PoMMom]

Hi Brenna,

What I do is: Take the bone-less, skin-less chicken breasts (about 8-10 of them) and put them in a roasting pan and cover the breasts with distilled water. Throw a lid/foil on top of the pan and roast at 350 degrees for approx. 2 hours. When done, take breasts out, and put the rice in the chicken-broth and put back in the oven and roast again until the rice is mush. Alot of times I have to add some more distilled water to the rice to get it to that mush consistency.

PS The chicken breast are 99% fat-free.

Hope this helps.

Keeping you and Brandy in my thoughts and prayers.

Love and hugs,
Lori

[Annie's Mom]

Hi Brenna, My apologies for being so delinquent in replying. Sorry to read that Brandy continues to have problems. My experience has been that it is a long slow process. Annie has only had the one major incident of pancreatitis (Sept 2009) that put her in the hospital for 7 days. She had never had a problem previously, and her belly hasn't been completely "normal" since then. I give her a Pepcid AC every day (recommended by the IMS at the hospital); I have a friend who is a retired vet and she recommended the FortiFlora, and it is what my vet recommends as well. She gets gas frequently but there is no rhyme or reason as to why she has bad gas one day and not another day. She has bouts of very soft stools about once a month. I am now keeping a daily diary of her "problems" to see if this is cyclical. I tried 3 different foods after the pancreatitis bout, and the Innova seems to be working well for Annie. Keeping Brandy in my thoughts and prayers. Barb and Annie

[Loladog]

Hi Brenna,

I'm sorry to hear that Brandy's Spec cPL results were still through the roof.:( The only time Lola's levels were that high was when she was 1st diagnosed (prior to putting her on a low-fat diet). I'm glad that your IM specialist finally understands.

I spoke too soon the other day about Lola liking potatoes. She now treats them just like the rice and spits them out. She picks out all of the meat and leaves the carbs behind. I think I'm going to try Lori's method of roasting the chicken and cooking the rice along with it in the broth. That way, the rice will have to be tasty.:)

I agree with you that the prescription diets are not good although the past couple of days I've been very tempted to go that route.:rolleyes: As I'm constantly cleaning up rice and potatoes from the floor I have to keep reminding myself how much I love Lola and would do anything for her.:D

[Squirt's Mom]

Just a note on cooking rice for dogs...cook the rice until it is a paste, no individual grains left but all are broken open and the consistency is gooey, almost like lumpy wall-paper paste; also brown rice is better than white in most cases so if you used white and the dog didn't tolerate it, then try the long grain brown rice....again cooked to a paste.

Hugs,
Leslie and the girls

[ChristyA]

Actually since I used 99% FatFree all white meat turkey breast I just cooked it on the stove top. There was no fat and I rinsed it with water before he ate it.
Christy

[Harley PoMMom]

The only reason I use the roaster and roast/bake the chicken breasts is bc I do batches of Harley's meals in advance. I can do 2 weeks worth of breasts in the roasting pan...take them out and then throw the rice in and slowly roast it. I believe it's whatever works for that person. ;):D Stove-top or oven, I really don't think it matters how it's cooked, just so the pup eats it!! :)

Love and hugs,
Lori

[Annie's Mom]

I had to laugh at your comment about picking up rice and potatoes off the floor! I know what you're talking about -- and cleaning it off the wall, and the wall across the room!! I just realized that it is Innova Senior (not Senior Plus) that I am feeding Annie. She still has bouts of gas and I am clueless what brings it on. I hope Brandy is feeling better real soon. Barb and Annie

[brandysmom]

Hello. It was a very long weekend. I worked most of it and of course the weather was beautiful... Brandy had yet another episode Saturday evening. I don't know what's going on. She has never had them this frequent. I have been giving her the Pepsid daily and she seemed good all week. It's strange. I was with her at 2pm on Saturday and she was happy and fine. I came home 3 hours later and she was in distress - the usual no eating or drinking, loud noises in her belly and she had diarrea this time, but no spit up. She didn't start to feel better until around 12am. I gave her half of one of those shots for pain. I was afraid to give her the whole syringe - worried that the meds might cause a problem with her heart. It's a drug in the morphine family. It did seem to relax her a little. Yesterday she had the worst toxic gas ever and pooped her usual colitis like bloody thing. I am at a loss...

Barb and Annie - Thank you for responding, the thoughts and prayers, and for the advice. Do you use the Fortiflora? If so, How is it working for Annie. I am so sorry she had to spend 7 days in the hospital. That must have been awful. I can't even imagine 1 day.

Lori, Leslie and Christy - Thank you all so much for the advice on the rice, chicken and turkey. I will try anything. I do like the idea of roasting a batch at a time. I don't even know how much I should be feeding her. It isn't the same amount as her dog food. Does anyone have any suggestions? She now weighs 63 lbs and I feed her in 3 meals (thinking about going to 4). And what should the ratio of meat to rice be?

Aimee - Lola really doesn't like her carbs does she? I was thinking maybe if the potatoes were mashed and mixed in with the chicken they would taste more like the chicken and I think it would be difficult to spit out mashed potatoes.

Although the prescription diet is extremly low in fat, I do not like the ingredients. I also don't like the sodium content. Brandy is supposed to have low sodium due to her heart issues. I am still researching possible low fat foods until I can have the Monica Segal consultation, but will probably stick with home cooked bland diet until then.

Best of luck Wednesday. I hope Lola has a good visit with the vet :)

[brandysmom]

Also, has anyone ever tried or had any experience with Seacure?

[Loladog]

Hi Brenna,

I'm so sorry to hear that Brandy had such a difficult weekend.:( There is nothing harder than not knowing what's going on with them and what to do about it. I wish that I could offer you some good suggestions but I'm at a loss myself with Lola.

In terms of the Probiotics you're looking at, the vet gave us a months supply of Forti-Flora but I stopped giving it because I found one I like better. The Forti-Flora contains a by-product called Animal Digest for flavoring which I don't really like feeding Lola. I just switched to a Probiotic called Pet-Dophilus made by Jarrow. I bought it on Iherb.com but you might be able to find it in a health food store. I unfortunately live in a rural area where it's hard to find anything so I often have to order online.

I'm also curious about the Seacure. There is a Boxer on the boxerworld.com forums that is doing really well with it. Have you been following her posts too? :)

[brandysmom]

Aimee,

I really hope Lola is doing better now. I am anxious to hear how you made out at the vet today.

Brandy was totally fine today and it was a Lysodren day :rolleyes: I take back what I said before about her appetite. She woke me up at 2am this morning because she wanted to eat!

Thanks for the info on the probiotic. I went to Whole Foods tonight to look for it but only saw the people version. I was was wondering about the animal digest in the Fortiflora too and it's the first ingredient? But I have also heard many good things about it the product too :confused: I ordered the Seacure today to try. I did see a little of the that post on Boxerworld. I would like to read more when I have the time.

Take care. I know you're worried about Lola and with good reason, but she is in very good hands. She is a very lucky girl to have you for a mom :)

[Loladog]

Hi Brenna,

I'm so glad that Brandy is feeling better today.:D Can I ask where you ordered the Seacure from? Please keep me posted on how it works for her.

Thank you for the kind words about Lola. I added an update to her post.

Take care.:)

[brandysmom]

Brandy still seems to be ok this week. Today was another Lysodren day.

I actually purchased the Seacure on ebay - free shipping too. I can't wait to give it a try after reading more of the posts on Boxerworld :)

[Loladog]

Hi Brenna,

Hopefully Brandy is still doing well this week.:) I'm curious to know what you're feeding her now and how is it going? Are you still feeding some of the Innova Senior Plus or are you doing strictly home prepared only?

I got the diet plan from Monica Segal a couple of days ago. It calls for starting off w/ just Ground Turkey and Rice and then gradually adding in some boiled Zucchini, carrots and vitamin and mineral supplements. If Lola tolerates everything ok, she might replace some of the supplements w/ food that contains the necessary vitamins (for ex, Beef Liver). So far, Lola will eat the Turkey and Rice but only if it's warm. I don't know what she's going to do once we add the vegetables because she will usually do whatever she can to pick around veggies. I have to say that the diet plan first looked VERY overwhelming to me. Some of the food needs to be measured in ounces so we had to purchase a kitchen scale. I really hope that I can get a good routine going.

Take care and I hope you don't have to work all weekend again!:(

[brandysmom]

Aimee,

So far, Brandy has been good all week :) Her last episode was 1 week ago today. We started the Seacure the other day. It really smells, but she loves it! She seems to have a little more energy. I have been feeding her the combination of Natural Balance Fish and Sweet Potato mixed with the Innova Senior. I want to get back to trying the home prepared, but have to get myself organized - it is very overwelming :rolleyes: It will be a challenge, but I need to do what's best for Brandy. I'm glad you started with Monica Segal and I wish you luck with Lola's veggies :D I'm glad she is feeling better. I am working all weekend again :mad: but it helps pay for all these vet bills ;) Let me know how Lola does on her new diet. Take care.

[Squirt's Mom]

Hi ya'll,

You two are just carrying on over here all by yourselves, huh? :p So, tell me about this Seacure. What is it? What's in it? Who makes it? What's it for? (nosey old broad, huh?)

Hugs,
Leslie and the girls - always

[brandysmom]

I think it's a boxer mom thing :)

Seacure is a hydrolyzed protien made out of white fish. It is for people and animals and is supposed to help digestive disorders, among many other things. The website can explain it much better than I can :) It is really smelly, but they do have a capsule form that I plan to purchase next time. Brandy loves it and so far so good ;)

www.propernutrition.com

[brandysmom]

I just wanted to wish my very special boxer girl a Happy 11th Birthday!! It's been a tough year with all her health problems but I am so grateful to have her in my life :D

[lulusmom]

Happy Birthday, Brandy!!!

[Casey's Mom]

Happy Birthday Brandy!!!

Love and hugs,

[ChristyA]

happy birthday brandy!!!!

[Squirt's Mom]

Happy 11th Birthday, Brandy!

[Harley PoMMom]

Happy 11th Birthday Brandy!!

You are such a sweet and beautiful girl, and I am sure your mom is going to make this day very special for you.

Love and hugs,
Lori and Harley

[MiniSchnauzerMom]

:D:):D Happy 11th Birthday to a Very Special Boxer Girl!!! :D:):D

Munchie sends Brandy some extra-special Birthday slurps in honor of the occasion!

Louise

[Loladog]

Happy Birthday Brandy!!!

[brandysmom]

Thank you everybody for the warm birthday wishes for Brandy! I usually don't make a big deal about it, but this year was different. She had a perfect evening with us and was spoiled as usual :D

[brandysmom]

Hello everybody - just wanted to give an update on Brandy.

She has been doing really well on her new food (so far) and hasn't had any pancreatic episodes in over 3 weeks! I hope this continues. She went for her 2 month follow up ACTH test yesterday. I will post the results once I have them. She seems to be feeling well, except her hind legs are getting worse. I have 3 steps down to the backyard and she now hesitates before going up or down them and when she does she seems very uncoordinated. The vet previously said she has neurological issues, which I believe is true, but I also believe she is very arthritic due to her age. Anyway, the vet wanted to prescribe her Rimadyl for the arthritis, which she has taken on 2 occasions before - most recently in February. She never appeared to have any side effects. We decided to have some bloodwork done before we give her any Rimadyl, because it can affect the liver. Her ALP came back at 2121 u/L (20-150 normal). It was at 1073 this time last year. I know it can be elevated due to Cushings, but this high? Also, how do you know if it is from the Cushings or it is really liver damage? The vet attributed it to the Cushings and prescribed the Rimadyl anyway. I do NOT want to give her this. I did some research online and on Boxerworld and heard many horror stories with side effects and death. Does anybody have any suggestions? And for her arthritis? I hate to see her have such a hard time.

I also want to see if there may be any feedback form something that happened 2 weeks ago. It was over the weekend and I didn't have to work, so I got to spend a lot of time with her. She had these episodes while she was sleeping or laying down where her entire body shivered like she was cold, but it was not cold. It happened every time she breathed in. I have only seen this during 2 occasions in the past - during thunderstorms (she is very afraid) and when she has one of her pancreatic episodes (due to the pain?). I haven't seen it since, but it was very scary and strange. I hope it was not her heart.

I also want to note another thing that was elevated in her bloodwork. Her glucose was 128mg/dL (60-110 normal). The vet didn't even mention it. I found out when I received the report. Should I be concerned? How high is an indication of diabetes?

Sorry this was so long. :(

[frijole]

I would call the vet right now regarding that glucose reading. I would believe that anything over normal should be looked at. Perhaps he has a reason for it but I wouldn't assume anything. Call them and ask. Vets make mistakes too.

Thanks for the update on everything. You are doing a great job. Kim

[Nathalie]

The ALP is not an indicator of liver health - it is a 'dump enzyme' - it is basically telling you that the liver is working quite hard. eg. due to excess cortisol, medication, illness etc.

ALT is indicative of liver health.
Is ALT elevated as well?

Last time I had my Phillip's liver enzymes checked his ALP was over 2000 (at one point it was over 4000) but his ALT was right in the middle of the normal range.

Sorry, I can't help with the 'shivering episode'
Nathalie

[brandysmom]

Thank you Kim. The vet should be calling me with the ACTH results and when he does I am going to ask him about the elevated glucose.

Thank you for the information Nathalie. Her ALT was 106 u/l (10-118 normal). Last year it was high at 120 u/l (5-107 normal). What does Albumin indicate? Brandy's was borderline at 4.4 g/dl (2.5-4.4 normal).

[Nathalie]

The below info is from http://www.broadwayvh.com/site/view/83223_AssessmentDescriptions.pml

"

Albumin is the most important protein in the blood. It is made by the liver. A high albumin level is not a concern. Mild dehydration is the most common reason for this finding. "


Cheers,
Nathalie

[Loladog]

Hi Brenna,

Our vet prescribed Tramadol for Lola for her arthritis pain instead of Rimadyl because it doesn't harm the liver and blood work monitoring is not required. However, it's not as strong as Rimadyl so it might not work. It might be worth a try for Brandy though as a first step. Unfortunately, I can't tell you whether or not it has helped Lola because she's been on Prednisone so much lately. Her arthritis has been much better but I'm sure this is due to the Pred.

I'm sorry that I don't have any ideas as to what might be causing the shivering episodes. Does it definitely appear to be shivering or could it be some type of convulsions. Did the vet have any ideas as to what this might be?

That's great to hear that Brandy hasn't had any Pancreatitis episodes.:) What food did you find that's agreeing with her? Is it the Innova Senior Plus?

It was great to see an update from you!!!:D

[brandysmom]

Nathalie - Thank you for the info and that link. It is very useful with all these results and trying to understand what means what.

Aimee - How is Lola doing? I actually have some Tramadol the vet gave me for pain during her pancreatic episodes. I could never use them because she will not eat when it happens and I can't give her a pill without food :rolleyes: I can't talk to the vet about it until tomorrow. I also need to ask about the glucose level.

The "shivering" or shaking, trembling... I hope it's not convulsions. I hope it's nothing. It may be when she has her heart arrythmias (multiple) and it scares her. When it did happen her gums were very pale. The vet said if it happens again to bring her in for ER visit. I haven't seen it since.

After much research on food, I am using Artemis Fresh Mix Weight Management. I have to special order it as nobody around here sells it. I found it to have excellent ingredients and the lowest fat % I could find while still maintaining good protien levels. This is my last effort. If it doesn't work, I am definitely switching to home prepared. How is that working out for Lola?

I got Brandy's ACTH test results faxed over to me. The tech left me a message last night. They are good and her Lysodren dose will remain the same at 250mg 3x/week.

Cortisol pre 3.4 ug/dl
Cortisol post 6.2 ug/dl

2 months ago it was 2.4 and 7.1. They recommended a recheck in 4-6 months.

[Loladog]

Hi Brenna,

Did you get a chance to talk to your vet about the Tramadol? I looked up the food you mentioned out of curiosity and noticed it contains Green Tea Extract. I got a little worried about this since Brandy has heart problems. I'm sure the amount is miniscule but you might want to double check to make sure it's safe. I personally get heart palpitations and anything Green Tea related causes me problems. However, I'm sure you will not want to change foods since this one is agreeing with her. I get paranoid about these things so feel free to ignore me if you want!:D Those shaking episodes sound really scary especially since her gums go pale. Hopefully it will not happen again but if so, I agree with your vet that she should be seen asap.

I put an update on Lola under her section since you asked how she's doing.:)

Take Care!

[brandysmom]

The vet said the Tramadol is ok to try. I gave her 1 pill (50 mg) last night, but she slept so much I really couldn't tell if it was helping or not. He also was not too concerned with her glucose level because she had her breakfast that morning. He said if I want a repeat test or a urine test I could do that.
Aimee, you got me worried about the green tea extract so I did some homework. I actually read that it can be good for the heart, but needs to be decaffeinated. I emailed the food company to find out if it was. They confirmed that it is decaffeinated and the amount of green tea extract is quite small - 7mg per 8oz serving. I feel much better! And I would never ignore what anyone has to say because I am a huge worry wort too :D Thank you for bringing it to my attention.
I have been keeping an eye on the "shivering" but still haven't seen it again - thank God!

[Boxer_lover]

I just wanted to stop by and say I hope Brandy is doing better. We are in the boxer club! I have 2 others in addition to my cushpup Ben. I love them. I would have 10 if I had the room for them.

Please keep us updated!

Wendy

[brandysmom]

Thank you Wendy. I recently started following your thread. I am so glad Ben is responding to treatment so well. They are a very unique breed aren't they? Brandy is my first Boxer, but I am hooked. She is everything to me. I would have more, but she is not good with other dogs :( Have you ever looked at the group "Boxerworld.com"? ChristyA told me about it and I think it's a great network for Boxer people. I look forward to hearing about Ben's progress :D Take care.

[Boxer_lover]

Boxers are great. All three of mine have totally different personalities. I will look at that website. Thanks for the suggestion.

[brandysmom]

Quick question... Is the onset of a thyroid problem gradual? Or can it be sudden? I am asking because Brandy's thyroid test was ok in December, but she is starting to show more symptoms that point in that direction recently.

[Harley PoMMom]

What symptoms is she showing that point to a thyroid problem? If you are suspecting Hypothyroidism, was a Free T4 by equilibrium dialysis test done to differentiate between true hypothyroidism and the sick thyroid syndrome that our cush pups can have?

Love and hugs,
Lori

[brandysmom]

Lori,

She was tested back in December and I was told that her thyroid was normal. I had them fax me the lab results yesterday. From what I've researched I think I need to have the complete thyroid panel done to include tgAA. Below are her results from December:

T4 1.4 ug/dL (1.0 - 4.0) LOW NORMAL
TSH Level 0.75 ng/mL (0.00 - 0.60) HIGH
Free T4 20 pmol/L (8 - 40) NORMAL
* an elevated TSH concentration in conjunction with a low or low normal T4 or free T4 concentration is consistent with primary hypothyroidism. Euthyroid dogs can occasionally have elevated TSH concentrations.
Comments: Not consistent with hypothyroidism.
Free T4 20 pmol/L (8 - 40) NORMAL

Last year just the T4 was tested and she was 1.0 (0.9 - 3.9). Besides all the symptoms that are the same as cushings symptoms (a lot of hair loss, frequent ear infections, skin issues, etc.) she had another issue the other night. Below is a thread I started on Boxerworld.com to try to get some input.

A little background...

Brandy is 11 and the only aggression she has ever shown in her lifetime is with other dogs, until recently. She has been diagnosed with several health problems including ARVC (collapse in Jan), atypical cushings disease, chronic pancreatitis and something neurological causing her to occasionally stumble. She is also starting to show signs of arthritis. And recently she had a weekend where she was doing this shivering/shaking thing. While she was laying down or sleeping and everytime she breathed in her whole body shivered but it wasn't cold. It hasn't happened since. With all these problems, she has never cried in pain. She is a typical boxer and LOVES people.

Recently, on 2 occasions she has snapped once at me and once at my partner Jay. She dropped a piece of kibble and it fell where she couldn't get it. We would get down and try to get it for her and she snapped. Not like her at all. I could take a bone, steak, etc out of her mouth before without any issues. Well last night she attacked Jay and it had nothing to do with food. She had a brown spot on her bottom gums and we were both on the floor trying to get a peek. She wasn't thrilled but she let us. Then we got up and I grabbed my camera to try to take a picture of the gums. I asked Jay if he could try to get her to look my way. He started to get down with her, but did not even touch her yet and she attacked - not snapped, but attacked him. I screamed and she stopped and then seemed fine. Her tooth grazed his neck and did break the skin.

I plan to call the vet this morning, but I just wanted to see if anyone else has experienced this with an older boxer. Sorry so long...

I should get a phone call from the vet today.

[Loladog]

Brenna,

I'm so sorry that Brandy is starting to show some aggression towards you guys. That must have been so scarey when she snapped at you and attacked Jay.:confused: When I first read that the reason you don't have more Boxers is because Brandy doesn't get along well with other dogs, I laughed because that's the same reason we're a single dog family! Lola has always been dog aggressive but like the typical Boxer, she adores all people. I can't imagine how it would be to have that change due to a health condition.:(

It seems like there could be a number of things causing what's happening with Brandy. I would definitely do some more testing and research into whether or not she has a Thyroid problem. Also, it could be related to her neurological problem (maybe a tumor?). The next two things that come to mind are dementia due to her age or pain related to her other issues. Maybe she's experiencing pain that causes her to not want to be touched. I'm glad that you contacted your vet to get his opinion. I really hope that it's related to something treatable such as her Thyroid.

I was happy to hear that you researched the Green Tea Extract and verified that it's decaffeinated. I guess you can never be too careful.:D

I'll be watching to see what your vet has to say about the new developments with Brandy. My thoughts are definitely with you.

[ChristyA]

Brenna,
Brandy's aggression towards you guys could be due to neurological issues or something is causing her pain. I really wish they could talk and let us know what is going on, it's all such a guessing game.

I would ask the vet if the shivering/shaking could be a neuro thing too.

Christy

[brandysmom]

Hi Christy, I really wish they could talk. I think she would have a lot to say! :)

Aimee, It's funny, Brandy got along with other dogs in her first year and then she just snapped and decided she wanted to attack them instead. Going to the vet's is always a challenge. I have to leave her in the car and go in first to check out how many dogs are in there and I usually have to leave through a side door to avoid a bad situation.

I am really starting to get annoyed with this vet (IMS). He had his technician call me back yesterday and she said he would call me today. He hasn't called. I know it's not an emergency, but really? His technician said he may refer me to a neurologist. I told her I wanted to have the full thyroid panel done too. She has been shedding the worst I've ever seen. She also gained 4 pounds in 2 months, which is good but nothing has changed. She lost 12 pounds last year, again unexplained. She is still hungry all the time. I also read that a thyroid problem could cause heart arrythmias. She does have a lot of the symptoms and I hope that's all it is. :(

[Harley PoMMom]

Hi Brenna,

If you are really considering having a thyroid panel done on Brandy, then I would have it sent to Dr Dodds. Here's some info about her.


The main reason for sending Dr. Jean Dodds / HEMOPET the serum samples instead of having the testing done locally, is that HEMOPET is the only group routinely offering expert clinical interpretive diagnostic comments that take into account the age, sex, and breed type of the animal. This often means an expected normal reference range for an individual pet that differs from the test lab's generic broad reference range. Practitioners usually are unaware of these differences, which have been established by published research and Dr. Dodds' many years (46 years this year - 2010) of clinical and research experience.

http://www.itsfortheanimals.com/HEMOPET.HTM

Love and hugs,
Lori

[Loladog]

Hi Brenna,

I can understand your frustration with the vet. Even though it might not seem like an emergency to them, it's urgent enough that they need to take you seriously asap. Brandy has a lot going on and much of it is probably connected. With the amount we must all spend at our vet clinics, it seems as though they need to roll out the red carpets when we need help!:) Your vet should be calling you directly instead of having the technician call. I would stick with your gut instincts and insist on the Thyroid testing. As Lori recommended, I've also read a lot of good things about the Dr. Dodds Thyroid testing.

The neurological consult also sounds like a very good idea.

I think Lola's dog aggression issues started when she was about a year old too. It's weird because she has had a few "friends" over the years that she would be totally fine with and then she wants to attack everyone else. She attacked our landlords dog once when she was young which was a nightmare. Fortunately, they were very understanding about the situation. We tried to adopt a male dog from a rescue group once and Lola definitely said "NO" when we did the "meet and greet". Even now, I don't always know who she's going to react to because she will sometimes act civil towards small dogs or large, un-neutered males. She loves all Boston Terriers because my mom has them.:confused: I've done every obedience class known to man plus agility and she will act like a perfect angel in class. Then when we're in a "real life" situation, everything changes. On walks, she will scream and lunge at other dogs who pass by which is extremely embarrassing. My biggest pet peeve is when off the leash dogs run up to us because this will turn into a disaster. Taking Lola to the vet can also be a challenge at times too. When I ask people to keep their dogs back they always look at me like I'm crazy. I wish our vets office had a back door that we could use! Right now, we live in a rural area where a lot of people just let their dogs roam free so this makes going for a walk very difficult. Fortunately, Lola has a very large fenced yard. Over the years, we've learned to accept that this is how she is and we know how to manage it. Despite all of this, she definitely makes up for it with her love for humans (and our five kitties).:)

Keep us posted on what your vet's office says and I hope you get some answers soon.

[brandysmom]

Well Brandy gave me one of the best Mother's Days ever!

5 weeks was the longest she has ever gone without one of her pancreatic episodes and as of yesterday, she has officially passed that mark. :D:D:D I am so happy and I hope I didn't jinx myself.

It's been a good week. No other signs of aggression, but I am still waiting on the vet... :mad:

Lori, thank you for the information about Hemopet and Dr. Dodds. I will definitely request the sample be sent there for testing. :)

Aimee, your lucky that Lola gets along with some dogs, but it must be difficult not knowing when or who. I don't have that option with Brandy. She hates them all, especially the little ones. But like Lola, she does make up for it with her love for people and I have learned to accept it. I love her just the way she is! :)

[zoesmom]

Hi Brenna -

The thyroid might well be the cause of the aggression in Brandy. I recall reading that it's often a frequent presenting symptom of dogs who then will test low on their thyroid levels. Oddly, I also seem to recall that Zo got a little nippy once upon a time when she was already on thyroxine. Not real aggressive but certainly out of character for her. And quite restless simulataneously. It turned out that she was getting too much of her thyroid medicine at the time (so hyperthyroid instead of hypothyroid.) So maybe all that's going on with Brandy is hypothyroidism. (Dogs are seldom hyperthyroid unless they're getting too high a dose of thyroxine.) If it isn't that, then I'd be suspicious of pain. Sue

[Annie's Mom]

Hi Brenna,
So glad to hear Brandy's pancreatitis issues are resolving! It took many months for Annie's to resolve too. Are you giving her Pepcid AC? The IMS from the hospital recommended I give Annie 10 mg, twice a day when Annie was recovering. Annie's amalyse and lipase have come down, but still are high, and just yesterday my new regular vet recommended I give Annie 20 mg per day, every day, to help her belly feel better. It's very cheap to purchase from Costco. When Annie was very sick and not wanting to eat ANYTHING, I used Pill Pockets for her meds. I could get away sometimes with using 1/2 a pill pocket. Fortunately, she's never been fussy with pills (I can even put it down her throat, if necessary. RE pain: Annie has severe arthritis and bone spurs. I have had 3 vets tell me she CANNOT go back on NSAIDS (Rimydl, etc), due to the elevated amalyse/lipase, etc. I give her 50 mg Tramadol morning and night, and mid-day 150-300mg Gabapentin for the pain. How much it helps, I dunno, but I suspect it must help. With the pancreatitis, she was prescribed up to six 50 mg Tramadol per day for her weight (65#). I want to give Annie minimal pain meds, but I also want her to have the least amount of pain possible. If only they could talk! Now that she is feeling better (Cushings under control and pancreatitis symptoms resolved), I don't see any negative side effects to the pain meds. Least expensive cost I have found is Costco. Did you know you don't have to be a member of Costco to get RX's filled there?! If you don't have a Costco near you, I wonder if you can order through their website? Tramadol and Gabapentin work differently, so that's why I alternate throughout the day. So sorry to hear Brandy is getting aggressive. I deal with that too. Annie loves all people and never snaps at me but she has had aggressive issues with dogs, when I am with her, for the past 6 years. I have to avoid free roaming dog parks. Interestingly, if I am not with her, she is not aggressive towards other dogs (my friend took her in the car with her 2 dogs for 2 hours -- unbeknown to me -- and Annie was nuzzling and licking her dogs face -- it's a "mommy" issue....). I hope Brandy continues to feel better and that you can get some answers and solutions to her current issues. Hugs, Barb and Annie

[brandysmom]

Sue, I definitely want to pursue the thyroid testing. Brandy has also been gaining some weight even though she is eating very low fat food for her pancreatitis. I've been doing alot of reading and I've read that a dog's T4, TSH and free T4 can all fall within the normal range, but the dog can still have autoimmune thyroiditis with the same symptoms. Brandy's T4 was low normal, the TSH was high and the free T4 was normal. I need the full thyroid panel done - if only the vet would call me back!! I hope that's all it is.

Barb and Annie, I do give Brandy 10 mg Pepsid 2x day. When I talked to the technician last week, she stressed again that there is no problem with Brandy taking Rimadyl, even with her age and health, but I still won't do it! I have the Tramadol, but I am trying to only give it to her if she absolutely needs it. I'm not too familiar with Gabapentin. I'll have to look it up. You would never know she is in pain, but she has a hard time getting up after laying down and she hesitates at our 3 steps in the backyard. I wish they could talk too! We do not have Costco out here. I've been getting everything at Walmart and it seems to be the cheapest. Thank you for the well wishes! I hope Annie continues to do well too. Take care.

[brandysmom]

I don't have the actual numbers in front of me yet and I didn't want to post until I did, but I can't wait for that. There is definitely something going on with Brandy's thyroid, but it's not being caused by the most common "thyroiditis". I am unfamiliar with all this and I am trying to learn, but there is a lot I do not understand. Brandy's T4 and free T4 have dropped considerably since December, both well below normal. Her TSH is still high, but the thyroid antibody they also tested for was normal and from I do understand this is the most common cause of hypothyroidism. With that being said, the IMS is puzzled. He said she can be one of those "rare" cases and she is a true hypothyroid dog or she has something called euthyroid sick syndrome in which some other illness is causing her numbers to be low (cancer, renal failure, diabetes, hepatic insuffeciency, heart failure :(). I also read thst excess cortisol can cause this too, but Brandy's cortisol is ok, even better since being on the Lysodren. I also read this "congenital defects of the pituatary gland, pituatary destruction and pituatary suppression can cause secondary hypothyroidism". I hear pituatary and I think of Cushing's. Everything is so related :confused:

What it comes down to is that he said we can try a very conservative dose of thyroid medication for 2 weeks and if we see some improvement, we can assume she is truely hypothyroid. If not, then it's something else. He wants to be very conservative because he said the medication can cause heart arrythmias, which is what she already has and caused her collapse in January. I don't know what the medication is yet. He called it into Walmart pharmacy last night and I will pick it up today. He also said if the aggression does not improve that it is most likely caused by a brain tumor - another thing very common in Boxers :mad: I don't know what to do. I feel like I get one thing under control and something else comes along. Meanwhile, she is having a harder and harder time with her legs. I had to help her up 3 stairs yesterday :( I know I can't fix everything, but I just want her to live the rest of her life happy and comfortable.

[littleone1]

Hi Brenna,

Just a thought. You might want to give Dr. Jean Dodds a call. She was very helpful when I called her. She is really an authority on the thyroid and autoimmune diseases. You can call her on M/T/F between 10 A.M. and 6 P.M. Pacific time. Her number is 310-828-4804. This information is on the web. There is alot of information about her on various web sites. She also has a web site. She might be able to shed some light as to what is going on with Brandy.

I hope this helps.

Terri

[Loladog]

Hi Brenna,

I don't have any good advice to offer but I just wanted to say hang in there.:) It's all so overwhelming and I can imagine how you're feeling right now trying to figure everything out. Lola is having multiple issues right now too and there is nothing more frustrating than not knowing the exact cause or what's related to what. I can also understand how you feel since Brandy is your first "adult dog" as you put it in a previous post. Lola is also our first dog as adults and she's like our child. We have kitties too but Lola is our baby. Trying to prepare for what might be coming is unbelievably difficult.:( You're doing a fabulous job caring for Brandy and she's very lucky to have a mom like you. I truly hope that you're able to obtain some answers soon.

Maybe it's time to switch from Tramadol to Rimadyl for the pain? It's hard to think of possibly causing liver damage but if it works to ease the pain, it might be worth the risk. I know others have mentioned injections but I can't remember the name right now. I'll go back through my posts to see what I can find.

Take care,

[Nathalie]

Hi Brenna,

“He said she can be one of those "rare" cases and she is a true hypothyroid dog or she has something called euthyroid sick syndrome in which some other illness is causing her numbers to be low (cancer, renal failure, diabetes, hepatic insuffeciency, heart failure ). I also read thst excess cortisol can cause this too, but Brandy's cortisol is ok, even better since being on the Lysodren. I also read this "congenital defects of the pituatary gland, pituatary destruction and pituatary suppression can cause secondary hypothyroidism".”

My Phillip has Hypothyroidism.
If your dog’s cortisol has been controlled for at least 2 weeks and still tests ‘hypo’ then the low results are not due to excess cortisol as you stated in your post.

As Terri suggested, please contact Jean – if you can’t get her on the phone I would suggest you send her an email today hemopet@hotmail.com (hemopet@hotmail.com)
I have emailed her several times on the weekend and she responded to me the very same day or the day after.

If Brenna’s thyroid values are very low it could contribute to joint paint, hind end weakness etc. etc. and if not addressed become very dangerous.

“What it comes down to is that he said we can try a very conservative dose of thyroid medication for 2 weeks and if we see some improvement, we can assume she is truely hypothyroid.’

I am going to assume you are referring to Soloxine .. not sure what you mean by conservative dose but if the dose is not high enough to replace what Brenna can’t produce herself you will not see improvements.

Eg. either your Lysodren maintenance dose is adequate or it is not.


A dog does not have to be 'true' hypothyroid in order to respond well to thyroid replacement.

Again, I do suggest that you contact Jean – she is very nice and does care.

Nathalie

[Harley PoMMom]

Hi Brenna,

This article, which I will provide a link to, is by Dr Dodds and it is about Thyroid disease, Diagnostic and Treatment Misunderstandings. It does also have some writing about how thyroid function affects behavior.

Here is a quote from this article:


Furthermore, these reference ranges are intended as general guidelines and may not apply to individuals that are athletic, performance animals; under general anesthesia; undergoing sex hormonal change; a pregnant or nursing mother; obese; a patient that is ill or recovering from illness, or taking specific drugs that might influence thyroid function (e.g. corticosteroids, phenobarbital, potentiated sulfonamides, dietary soy and soy phytoestrogens, insulin, narcotic analgesics, salicylates, tricyclic antidepressants, furosemide, phenylbutazone, and o, p-DDD ). Daily diurnal rhythm fluctuations and the presence of circulating thyroid autoantibodies also changes basal thyroid levels. However, knowledge of these variables that affect thyroid function and circulating levels of thyroid hormones does not preclude their measurement.

http://www.k9cushings.com/forum/showthread.php?t=1627

According to Dr Dodds Lysodren may influence thyroid function. That is why when sending samples to her one has to tell her every medicine/herb/supplement that their pup is on.

This is a quote from the same article but this is about aggression and thyroid dysfunction:


In dogs with aberrant aggression, a large collaborative study between our group and Dr. Dodman and colleagues at Tufts University School of Veterinary Medicine has shown a favorable response to thyroid replacement therapy within the first week of treatment, whereas it took about three weeks to correct their metabolic deficit. Dramatic reversal of behavior with resumption of previous problems has occurred in some cases if only a single dose is missed. A similar pattern of aggression responsive to thyroid replacement has been reported in a horse.

Please read the full article because there is more information that I'm sure you'll find interesting.

Hope this helps.

Love and hugs,
Lori

[brandysmom]

Aimee, thank you so much for the kind and supportive words. It is overwhelming and I'm so sorry you are having issues with Lola as well. I can relate to everything you've said. Brandy is like my child too and everyone probably thinks I'm nuts, but she means everything to me and I would do anything to make her happy and comfortable. Everything I do in my life revolves around her. I still need to think about the Rimadyl. I am hoping that maybe her back legs will start to get better when her thyroid levels get better.

Teri, Nathalie and Lori, thank you so much for the advice and information. There is so much unknown. Her medication is the generic version of Soloxine and she is prescribed (2) 200mcg 2x/day. I really want to contact Dr. Dodds, but I have to admit I didn't have the testing done there. The vet's technician guilt tripped me into using their lab. Do you think I could still contact her for her feedback?

[Nathalie]

" I really want to contact Dr. Dodds, but I have to admit I didn't have the testing done there. The vet's technician guilt tripped me into using their lab. Do you think I could still contact her for her feedback? "

Absolutly :) - lots of people contact her.

200mcg = 0.2mg

Normally you would start off a dog on 0.1 mg per 15 lbs 2x per day

If I have done the conversion correctly I can't see that you will be getting a good therapeutic response especially since you mentioned the lab results came back 'very' low.

In your previous post you wrote:
"He wants to be very conservative because he said the medication can cause heart arrythmias, which is what she already has and caused her collapse in January. "


Untreated/poorly controlled Hypothyroidism can, among other things cause Cardiac Abnormalities
such as slow heart rate (bradycardia) / cardiac arrhythmias / cardiomyopathys


more here http://www.canine-epilepsy-guardian-angels.com/ThyroidDisease.htm


If I where you, I would be concerned too. Unfortunatly only you have all your dogs details otherwise I would be more then happy to email Jean for you.
Nathalie

[littleone1]

Hi Brenna,

I just want to let you know that when I spoke with Dr. Dodds, Corky's tests were done by his vet. She still provided me with some great feedback and information. She definitely won't mind you contacting her.

I hope you'll be able to get everything resolved.

Terri

[brandysmom]

Again, I can't thank you all enough for your help. It's been a great comfort to me.

I just compiled a list of all Brandy's ailments, medications, supplements, syptoms and thyroid test results. I just want to be prepared with all the information. I am going to email her shortly.

So if 200mcg = 0.20mg she is getting 0.40mg 2/day? That doesn't sound conservative. It seems to be right with her weight at approximately 66 lbs. I gave her the first dose last night. Is it correct that it should be on an empty stomach?

Here are her thyroid test results:

May 2010 T4 0.7 (1.0 – 4.0)
FT4 8 (8 – 40)
TSH 0.85 (0.00 – 0.60)
TgAA 1% <10% = Negative

Dec 2009 T4 1.4
FT4 20
TSH 0.75

[Nathalie]

So if 200mcg = 0.20mg she is getting 0.40mg 2/day? That doesn't sound conservative. It seems to be right with her weight at approximately 66 lbs. I gave her the first dose last night. Is it correct that it should be on an empty stomach?"

I just went back to your previous threath and I previously did not see the (2) - sorry.:o

Again - math is not my strong point ...

0.4 mg 2x per day is a good starting point for a dog of about 60 lbs.
My Phillip is on the same dose and weighs 64 lbs.

The Soloxine insert recommends to start with 0.1 mg per 10 lbs 2x per day.

Yes, thyroid replacement should be given on an empty stomach. Either 1h before or 2h after meals 12h appart.

Just a reminder to include the unit of messaure with all test results when emailing Jean.

Keep us posted,
Nathalie

[brandysmom]

Thank you!! Thank you!! I'm so glad I emailed Dr. Dodds. She did respond quickly and gave me a lot of information and advice. I am feeling so much better now. :D I will give a donation to Hemopet. I still haven't seen much improvement in Brandy, but I know it's probably too soon. Here is what Dr. Dodds wrote:

Dear Brenna: This diagnosis is potentially all mixed up. Your dog has had two thyroid profiles with a significantly elevated TSH – although that test alone is nor diagnostic of primary hypothyroidism in dogs, unlike people. Her latest test, however, clearly shows a low T4, low freeT4 ED, and even higher TSH. The normal TgAA means that her hypothyroidism is not due to heritable autoimmune thyroiditis.

To my mind, this is not likely to be an artifact of her Cushing’s disease and does not represent euthyroid sick syndrome. The results are compatible with concurrent hypothyroidism and atypical Cushing’s disease.

At this point, my recommendation would be to treat her hypothyroidism, but a t an even lower dose than the one you were prescribed. For a geriatric dog weighing 66 pounds and with cardiomyopathy, 0. 4 mg twice daily would be her maximum dose – thyroid needs and levels gradually decline in old age. See attached.

So my suggestion is to be more conservative and give her just 0.2 mg twice daily [i.e. one half of the prescribed 0. 4 mg dose]. Thyroxine should also be given apart from meals to ensure abortion – at least an hour before or three hours after meals. Vets are never taught this; only physicians tell their patients about it.

After 6-8 weeks on the half dose of thyroxine twice daily, retest the T4 and fret4 at 4-6 hours post-am pill. Also, she should eat a grain-free diet and treats – this means no wheat, corn or soy [and no prescription foods]. I would not give her Rimadyl with her cardiac issue as it can compromise the liver. Also, would not give booster vaccines of any kind, including rabies – she’ll need an exemption from rabies because of ongoing chronic disease. Best wishes, Jean

I started giving Brandy the 1/2 dose this morning. It is extremely difficult to give her the medication 1 hour prior to meal time, but I am doing it ok so far. She is used to eating as soon as she wakes up and as soon as I get home from work, and then again later at night. I'll do whatever it takes. ;)

[Nathalie]

I just wrote this long winded response and my internet explorer crapped out on me ..:mad:

Anyhow, I am so glad Jean was able to sort things out for you – I think she is just wonderful.

“Also, would not give booster vaccines of any kind, including rabies – she’ll need an exemption from rabies because of ongoing chronic disease.”

Right on – I wish other vets had as much common sense.
If you are looking for a grain free treat .. I dehydrate sweet potatoes in a cheap dehydrator I bought at Walmart and everybody loves it.

What is the title of the attachment Jean send you? If I don’t have it yet, would you mind emailing it to me?

Thanks for posting Jeans response.
Cheers,:)
Nathalie

[littleone1]

Hi Brenna,

I'm so glad that you got such a great response from Dr. Dodds. I totally agree with Nathalie. She is wonderful.

I also agree with her letting you know that Brandy should not get any more vaccine boosters. Corky will no longer be getting them. His IMS even wrote this on Corky's last test results.

I hope all goes well with the lower dosage. Please keep us posted as to how Brandy is doing.

[brandysmom]

Nathalie, Thanks for the tip on dehydrating sweet potatoes. I think Brandy would love it! I have to go to Walmart tomorrow to pick up her heart meds, so I will check it out.:)

The attachment was a Word file "FAQs Thyroid Diag & Rx". I will email to you shortly.

Terri, I agree with the vaccines too. Although Brandy got her last rabies in November, I refused to get any of the others. I just figured she had enough going on and she didn't need them. The vet actually agreed with me. I only got rabies because of the law.

Thank you again! I will keep you all posted :D

[lulusmom]

Brenna, make sure that you check out your states law on rabies vaccine requirements. Many states now allow three year rabies and a good number of city and county entities will accept a waiver from your vet and/or a titer test showing acceptable level of rabies immunity so that you don't have to give Brandy any more rabies vaccines.

Glynda

[Nathalie]

There is no scientific or medical difference between 1 and 3 year vaccines. The only difference is what the label says. Vets and big pharma can sell 3 times the amount of product when 1 vials labeled "1 year" are used.

Brenna, I would make sure that your Rabies cert states it is a 3-year if that is what is 'allowed' in your area.

At the end of the day, a Rabies cert is nothing else then a piece of paper.

Nathalie

[labblab]

Brenna, I would make sure that your Rabies cert states it is a 3-year if that is what is 'allowed' in your area
Even if 3-year vaccines are allowed in an area, I don't believe the certificate can legally state that the vaccination is good for a 3-year period unless the vial was also so-labeled. In other words, if the vaccine was drawn from a "1-year" vial, that's the way the certificate must read. That's why it's really important to have this conversation with your vet BEFORE the vaccine is administered. Make sure to discuss all the options and considerations before the injection.

Marianne

[Nathalie]

That's correct Marianne.
Point I was trying to make is 1 year label or 3 year label = no differance what is in the bottle. A lot of people are not aware about this, nor do they know what questions to ask or that they should question their vets.

Reality is that most vets vaccinate simply because a certain amount of time has passed since the last shot because they have done so for a long time - dog is 'due' and out comes the needle.

Hopefully Brenna is 'lucky' that the bottle says 3-years.
Nathalie

[littleone1]

I'm sorry to be posting on your thread Brenna. I know this can get very confusing. A couple of years after we got Corky, his rabies shots were due in 3 years from the last one he had.

Terri

[brandysmom]

I would have to do some checking around, but I am pretty sure RI is every 2 years. At least that's what the certificate is good for. The rabies vaccine Brandy received in November will be her last.

Last summer I tried a holistic vet and she told me that I could receive a waiver for Brandy due to her illnesses. I don't know how true that is for RI and I stopped going to that vet after a few months. If Brandy is still with me in 2 years, I will look into a waiver. If they don't accept a waiver, she is still not going to be vaccinated.

[Harley PoMMom]

Rhode Island

Citation Code: Code of Rhode Island Rules
12.020.036
§4.00

Vaccination Requirements: All rabies vaccinations shall be administered by or under the direct supervision of a licensed veterinarian.

Frequency of Vaccinations: One year after initial vaccination and then in accordance with the stated duration of immunity on the vaccine product label

http://www.avma.org/advocacy/state/issues/rabies_vaccination.asp

My boy Harley is exempt from all shots, including rabies, which his vet has to write a waiver for. Harley's vet and I had a talk about this and this is what we, mainly me decided. But she was in agreement with me that Harley's immune system wasn't strong enough to handle any kind of vaccinations. Talk this over with your vet and YOU do what you think is best for Brandy.

Love and hugs,
Lori

[brandysmom]

Thank you Lori! You always have such good information and I do appreciate it.

Brandy will not get any more vaccinations of any kind. When the time comes, I am pretty sure my vet will give me a waiver.

[Loladog]

I'm so happy that you finally got some good medical advice.:D I definitely agree that you should never administer vaccinations again. I don't plan on ever vaccinating Lola again. I'm curious to know if you considered Dr. Dodd's suggestion to feed a grain-free diet or if you plan to stick with the Artemis since it's working well for Brandy? For a while after Lola was diagnosed, I fed her Wellness Core Reduced Fat. She'd done well on grain-free diets prior to her diagnosis and this was the only grain-free, low-fat option I could find. Unfortunately, I had to discontinue it because I think the high fiber content (8%) caused her to have constant anal gland issues. She kept expressing her anal glands on the couch and our bed and this had never happened before. I've since read that dog's w/ Pancreatitis should be on diets not only low in fat but also low in fiber.

On one of my posts, you said that you supplement w/ 175 mg of Milk Thistle twice daily as recommended by your regular vet. I plan to follow this recommendation and I was wondering what brand you use?

Again, I'm so happy that Dr. Dodds gave you such great information! I look forward to hearing about how everything goes with her plan.

[brandysmom]

Hi Aimee,

Thank you. I am very happy for a change. I am going to stick with the Artemis. Dr. Dodds said grain free (no corn, soy or wheat products). I wrote back to her telling her how well Brandy has been on Artemis and that it doesn't state grain free but it also does not have any of those type of ingredients. She seemed to think that was ok. Today is 8 WEEKS since her last pancreatic episode!! I still can't believe it :D I would honestly check out the Artemis web site. The food is called Fresh Mix Weight Management. It is very low fat and low fiber. The ingredients are very good and I know it is rated as a 5 star food.

I purchase the Milk Thistle at the Vitamin Shoppe. I know they have an online store too. I hope this helps! Have a great holiday weekend! Take care.

[brandysmom]

Hello everyone... I just wanted to give a little update. Brandy is going in tomorrow to have her thyroid retested and to have another ACTH with the full adrenal panel. We spent 3 hours in the emergency vet yesterday, but got no answers. She started to not be right Friday night. I came home late from job #2 to find that she vomited - mostly clear, but some food. My first thought was one of her pancreatic episodes, which Saturday would've been 10 weeks without one. I'm not sure if that's what it was. Usually when that happens, she won't eat or drink anything. She wouldn't eat at all, but she drank and drank and drank. Saturday's mealtimes were very different from the norm. Usually she inhales her food, but she ate each meal very slowly. She looked like she didn't want to eat but she did. She was very hesitant. Same thing Sunday morning. All I can think of is maybe her cortisol is going too low, but what about the drinking? They checked her glucose, sodium and potassium and all looked ok. This morning she seemed better. I did not give her her Lysodren dose today, just in case. Hopefully her visit tomorrow will bring some answers.

[Harley PoMMom]

Hi Brenna,

This is just a thought but Brandy might have a bladder infection. These infections can sometimes make a pup feel nauseated and they will vomit. Does her urine have any odor to it or blood in it? Bladder infections are common in our cush-pups and drinking more water than usual is one of the symptoms of an UTI.

Keeping you both in my thoughts and prayers and hoping Brandy feels better real soon.

Love and hugs,
Lori

[brandysmom]

Hi Lori,

Thanks. They did extract some urine from her yesterday to keep in the fridge in case her IMS wanted to run a culture. She has had many UTI's, last year being the worst with several rounds of antibiotics and cultures. It was caused by a needle shaped bladder stone that poked her bladder. She urinated pure blood for a couple of days. The stone eventually passed. But anyway, I haven't noticed anything unusual about her urine and I watch her everytime she goes potty. I will keep a closer eye though. I hope Harley is doing better too. I haven't been on here in a few days, so I haven't read any updates lately. I'll keep you posted. Take care.

[Loladog]

Hi Brenna,

The slow eating as you explained it sounds exactly like what Lola does when her Cortisol levels get too low. She eats very slow and constantly stops to look at me. The way she looks at me I imagine her saying "you really want me to do this?"

I hope you get some answers tomorrow. I'll be thinking about you two.

Take Care,

[brandysmom]

Aimee, you and Lola were my first thought because I remember you describing how she would act and that is exactly what Brandy reminded me of when she was eating. That's why I am worried about the cortisol being too low also. And I was also wondering if maybe now that she is on thyroid medication it could be causing her to metabolize the Lysodren differently :confused:. I don't know.

I dropped her off at 7:15 this morning. She used to love going to the vets. Now that she is there so often I think she has had enough! She is now very stubborn when they try to take her away from me. She won't budge for anything. I actually have to walk back there with her. It kills me every time I have to leave her there :(
It will probably take a while to get the results back. Last time the adrenal panel took over 2 weeks! :eek:

[Loladog]

Lola used to love going to the vet too and now she starts trembling when we get within about 2 miles of the vets office. They have to drag her to the back and it absolutely kills me too.:( I really wish there was some other way to do the testing without having to leave them there.

I can't wait to hear the results of Brandy's tests. Does she seem to be feeling any better?

[ChristyA]

Dexter used to be a really good patient, until all the testing started. Then I think he just got tired of being poked. You know sometimes I wonder if they (the vets and techs) stop thinking of our pups. Instead of talking to them and taking a few minutes they just start to poke and prod.
Any results?
Christy

[Bichonluver3]

Hi Brenna!
Welcome! Chloe, my 11 yo bichon has atypical Cushings. The latest news from University of Tennessee is that the flax oil elevates triglycerides so they have changed their recommendation to flax hull lignans. I, too was giving Chloe the barlean's but have switched her to flax hull lignans (SDG). My vet suggested low residue diet (we use Eukanuba since he says his dogs have done well on trhis) as it is easier on the digestive system.
Carrol

[brandysmom]

Aimee and Christy,

Hello. Brandy seems to be doing better. She is more excited to eat :) This heat is really hard on her though :(

I still don't have any results back yet. We are holding off on Lysodren until we get the results back.

As much as she now hates going to the vets, there is one thing I have noticed... She doesn't seem to care about the presence of other dogs anymore. She would go absolutely crazy before and now she just looks and then ignores them:confused: It makes the trip a little easier.

Carrol, Thank you for the welcome. How are you treating Chloe's atypical cushings? I did change to the flax hull lignans back in December, but recently I read that they also recommend HMR lignans. I just started trying that because they it is lower in fiber, which helps with Brandy's pancreatitis.

[Loladog]

Hi Brenna,

So much of what you say about Brandy is true of Lola too. Lola is better around other dogs at the vet's now as well and I think it's because she's too scared to think about anything else.:( It makes things easier to take her in but it breaks my heart.

The heat has been rough on Lola over the past few days here as well. I worry so much about her with the extreme temperatures. We moved from the coast (moderate climate) about 6 years ago and I kick myself everyday for the decision. We will be going on a road trip up the Oregon and Washington coast in August provided Lola is healthy enough for the trip. I can't wait to get out of the heat!

[Harley PoMMom]

Aimee and Christy,
As much as she now hates going to the vets, there is one thing I have noticed... She doesn't seem to care about the presence of other dogs anymore. She would go absolutely crazy before and now she just looks and then ignores them:confused: It makes the trip a little easier.


Harley is the same way! He used to get sooo excited when he saw a dog at the vets, now, he doesn't even care. :( I think it's because he is so scared and they do make a fuss over him before doing anything to him...our poor pups, I wish they could understand that we are doing this because we love them so very, very much.

Love and hugs,
Lori

[brandysmom]

She doesn't even care for the car anymore. She used to love it. Now it takes her 10 minutes to stop shaking and the rest of the time she seems so nervous. I hate watching this whole aging process and with all the health problems it makes it even worse :( She is such a different dog now. It seems in the past several months she has aged another 5 years and it's breaking my heart to watch it happen. I am trying everything I can to make her life more comfortable and enjoyable, but sometimes I don't feel like it's enough.

[Squirt's Mom]

Hi Brenna,

Something I do to help with the car phobia that seems to develope from so many vet visits is to take Squirt with me as many places as she can go. She has always loved riding but got like Brandy for a bit...she thought every car ride meant the doc! Crys was the same way, too. So they would ride all over the place with me...even just down the street and back to take mis-delivered mail to a neighbor! It did seem to help.

Keep your chin up, sweetie!
Hugs,
Leslie and the girls - always

[brandysmom]

Leslie,

Thank you for the advice. I will start taking her for more rides. She does still get excited when I say "do you wanna go for a ride?", but as soon as she gets in the shaking starts :confused:

I am still patiently waiting for her test results. I am going to follow up tomorrow.

I just interviewed for the first time a pet sitter. I have to go to a wedding in NH next weekend. My Mom has always come over and watched Brandy for me, but now with all Brandy's health issues (especially the heart) she is afraid something will happen to her under her care. She is afraid if she collapses again, she won't be able to pick her up to bring her to the emergency vet. I am scared to leave my girl overnight, but I don't have any other options.

[brandysmom]

I finally have Brandy's test results in hand.

Her latest T4 came back at 3.29 (1.0 - 4.0) and her last T4 prior to the thyroid medication was 0.70. This is good news! Although it has done nothing with her mood. She had a little aggression moment the other day. I'm just going to attribute that to old age and not feeling so well.

Her adrenal panel:

Cortisol baseline: 17.4 (2.1-58.8) last time was 16.6
Cortisol post ACTH: 80.7 (65-174.6) last time was 157.7
Androstenedione: 1.0 (0.05-0.57) last time was 1.07
Androstenedione post ACTH: 3.2 (0.27-3.97) last time was >10
Estradoil: 100.8 (30.8-69.9) last time was 115.1
Estradoil post ACTH: 121.7 (27.9-69.2) last time was 101.6
Progesterone: 0.87 (0.03-0.49) last time was 0.58
Progesterone post ACTH: 1.75 (0.10-1.50) last time was 2.2
17 OH Progesterone: 0.29 (0.08-0.77) last time was 0.09
17 OH Progesterone post ACTH: 2.19 (0.40-1.62) last time was 4.23
Aldosterone: 29.6 (11-139.9) last time was <11
Aldosterone post ACTH: 219.8 (72.9-398.5) last time was 82.6

So some things have improved, but the Estradoil didn't. I emailed Dr. Oliver for his input. His only suggestion was to increase her Lysodren dose to 4x/week instead of 3x. He said her cortisol post ACTH should be below 50 to have better results with the hormones. He said her melatonin and lignan doses were good for her weight and to be patient with the Estradoil - that it takes time. I should retest in 6 months. He did also suggest a melatonin implant. I really like that idea and want to ask the IMS about it.

Other than that, Brandy has been about the same. She is having a hard time with this heat. I'm trying to keep her as cool as possible. Her legs really worry me because that is the only thing that I can see she is having a hard time with. I'm going to start giving her Adequan injections, but am shopping around for a good price before I get prescription. Her tummy has been good, except for last Saturday, but I think that's because we left her with a pet sitter. I think she was upset. :(

[Loladog]

Hi Brenna,

I'm just checking in to see if you've started Brandy on the Adequan injections? I decided to wait with Lola because she's having so many other issues right now.:( However, I did order some Dasuquin w/ MSM and I'll let you know whether or not that helps at all. The cheapest place I could find it was Amazon.com and I honestly don't know whether or not that's a safe place to buy supplements from.:confused: I couldn't pass on the price and free shipping so I hope there's no difference from other vendors.

Is Brandy's Pancreatitis staying under control and what about her occasional aggression? I really hope that everything is going well for you guys.

Take care,

[brandysmom]

Hi Aimee,

Thank you for checking in. Brandy actually had her first injection today. I had an appointment at 2pm with a technician and she showed me how to give her the shot. I did it and it was much easier than I thought. It was nothing and I don't even think Brandy felt a thing :) I still don't know if I can supplement her with oral glucosamine while taking the shots. The technician didn't know either, so I need to call the vet on Monday. I also purchased the Dasuquin with MSM. I have bought some things through Amazon before and I think it will be fine. How much did you pay? I paid $75.05 through Pet Nutrition Products for 150 tabs for large dogs. The shipping was free over $75.

Her pancreatitis attacks have been very minimal. She has had 2 since being on the Artemis and I think both were stress induced because one time was with my mom when she watched her for a day and the other time was when I had a pet sitter stay overnight with her a few weeks ago. I don't think I should leave her with anyone :confused: I left you a post on your thread about Lola.

The aggression has been ok, not perfect, but ok. Thank you again for checking in :D I do hope Lola is feeling better and back to herself soon. It's so hard watching them age and not feel well a lot of the time. They never complain, but we know.

[Loladog]

I purchased the Dasuquin w/ MSM at Amazon.com for $75.98. This was also for 150 Large dog tablets and the shipping was free. Looks like you found a great price!:D

When the vet tech taught you how to give Brandy her Adequan injections, was it Sub Q or IM? That's great that it's easy and Brandy didn't seem to notice.:) I sure hope it helps her.

I'm so happy to hear that Brandy seems to be doing ok right now except for when you left her and she got stressed. I can truly understand this because we're unable to leave Lola. The only time we left her was when my husband and I got married and we boarded her for two days.:o She didn't eat or drink the entire time we were gone and when we picked her up, we had to take her to the ER the same night. She was diagnosed with Stress Gastritis at the time (this was about 8 years ago). Since then, we've only taken vacations that we can take her on with us (lots of road trips).:D

[Bichonluver3]

Hi Brenna!
I ask Dr Oliver what the difference in lignans was. he said "no difference" just that if Chloe didn't react well to the SDG (loose stools etc) to go to HMR. She has had no side effects at all. So, you are probably better with the HMR with the pancreatitis. I can't believe how well (and I thank God) Chloe has done.I have her on the hulls & melatonin regime with glucosamine twice a day for her joints (it really made a difference) and ocu-glo gel cap at night for her eyes (to prevent her tiny cataract from increasing. At our last vet visit the doc said he believes her hind legs look stronger. She jumps around, runs with her brothers and prances around her food dish.
We have heat here in the California desert - triple digits:eek:. I have the AC on and, at night, to keep her sleeping peacefully in our bed, I have the ceiling fan going as well as a fan on a stand that blows on her. She loves it!:D
Carrol

[brandysmom]

Aimee,

The tech taught me to give the injection IM. I gave Brandy her 2nd one last night and it worked out fine :) I realy hope this helps her but it may take up to a month to see any improvement. I still don't know if I can give her the Dasuquin at the same time. I doubt it, but maybe when the injections are done? I still need to call the vet to ask.

I think it's great that you take Lola on vacations with you. I never tried that before. Brandy never had a problem whenever my Mom used to dog sit her, but that was a while ago when she was feeling better anyway.

Carrol,

Wow I thought we were hot here! No triple digits, but a lot of heat and humidity :( I have been giving Brandy the HMR now for a little over a month. I'm so glad Chloe is doing so well :D My Mom has an older adopted Bichon named Lucky and he is nuts but very adorable.

I am noticing some not so good changes in Brandy. She has been a little "off" since Sunday. She normally gobbles her food and drinks her water very sloppy and messy. I have to talk her into eating her food and she will eat but very slowly. She will eat her treats no problem, which they are her food. She is drinking a lot. She will stand at the water bowl and just drink for 2 minutes without stopping, but it's a very slow drink - not normal. She has been panting a lot, even when it's been cooler and she is laying still. She has also been a little distant from us. Everything else is ok. I am so worried her heart is getting weaker. I hope I am wrong.

[Bichonluver3]

Hi Brenna!
I am sorry that Brandy is under the weather. Did she stop eating and start drinking more as the temperature went higher?
Sometimes, I have trouble with Chloe eating and so I put a dab of peanut butter on my fingers and rub her kibble with it. Or, I take a piece of something we have eaten and do the same thing. The smell seems to do the trick. How about hand feeding her? Or leaving her kibble out and letting her snack as she wants to.
Oh yes, Bichons ARE nuts but very endearing!! The "bichon buzz" is something else. When Chloe was young, she would zoom so fast around the dining room table she became just a white streak.
Waiting to hear more after you talk to vet........
Carrol & Chloe

[brandysmom]

She actually slowed down her eating and started drinking more water when it was starting to cool off here. Today it's back to being real humid again. She is eating, but not like normal. I did hold her bowl for her last night which helped. She just seems absolutely exhausted with everything she does lately and not interested in too much either.

My Mom's Bichon is estimated to be around 12-14 years old, but you would never know it. He acts like a puppy!

[Loladog]

Hi Brenna,

I'm so sorry to hear that Brandy isn't feeling well.:( Do you know if there are any side effects to the Adequan that might be contributing to this? Lola has also been drinking a lot more water lately coinciding with the loss of appetite. It's so strange because she'll have one day where she eats ok and seems to feel good and then the next day she'll be distant as you mentioned about Brandy and she will not want to eat. Lola has been panting a lot too but it's been in the high 90's here. I really feel for you because with the way things have been with Lola, I'm making myself sick with worry.:(

I hope she starts to feel better soon. We'll be thinking of you guys.

[Loladog]

Brenna,

I just wanted to give you some information real quick just in case you're interested. Last weekend, I e-mailed Artemis in order to obtain the actual or "as fed" fat % of their Weight Management food as well as the Carb %. I finally received a response today and the info they gave me is as follows:

fat- 9%

Carbs- 53.6%

I'm always amazed by the difference between the "as fed" fat % and what the companies list on the bags as the minimum %. It's very misleading.:mad:

[brandysmom]

Aimee,

I think Brandy and Lola must be distant cousins ;) They seem sooo similar. Brandy is having good days and bad days too. Right now she seems mostly normal, for her anyway... It's hot again here too and I'm trying to keep her as cool as possible. It's like pulling teeth to even get her to go outside to go potty. I don't know how she holds it for so long :confused: The Adequan should not have any side effects like what's been going on with her. I gave her the 3rd shot on Sunday. Thank you for the concern. It helps a lot and I can understand how worried you are about Lola too. I hope her ultrasound brought nothing but good news for you :D:D

Below is the response I got from Artemis:

Originally when we introduced our Weight Management Formula, it was formulated with Rice as the first ingredient. About 1 ½ years ago we had switched to Chicken as the first ingredient. Unfortunately it was very hard to hit our target numbers of lower fat, protein, and calories with Chicken as the first ingredient. We had switched back to rice as the first ingredient recently so that we can reach our target numbers more effectively.

I really don't want to change her food again, but I will if she starts to have any issues.

[Loladog]

Hi Brenna,

I'm just checking in to see how Brandy has been over the last few weeks. Do you think the Adequan injections are helping her? I hope all is well.:)

[brandysmom]

Hi Aimee,

Brandy seems to be doing pretty good. I do think the Adequan shots are helping. She is done with the 4 week course of 2 shots a week. We are on to the next 4 week course of 1 shot a week. She isn't 100%, but better. She is back to occasionally getting up on the couch, which she wasn't even attempting for a while now. She seems to "feel" better, which is more important to me than anything else :D Thank you so much for checking in.

[Loladog]

I'm happy to hear that Brandy is doing good right now. That's great that she's sometimes able to get up on the couch again!:D You are right that them "feeling good" is what's most important.:)

[Boxer_lover]

Hi Fellow Boxer Owners :)

My Ben just started jumping up on the bed again (I have a very high bed). That was a great sign that he is feeling better.

I am glad Brandy is doing better.

Wendy

[mypuppy]

Hi Wendy,
That is so wonderful to read. I remember when Princess first jumped on bed again after not doing so for so long. I was so thrilled for her, what a great feeling. yehhhhhh Ben. Xo. Jeanette

[Loladog]

A couple of years ago after Lola had a TPLO to repair a torn ACL, we actually removed the boxed springs to our bed so that it would be lower for her to jump up on. During the immediate healing process, we even took the bed apart and put our mattress on the floor.:D We knew that if we didn't do this, she'd still try to jump up and end up hurting herself. It's definitely pointless to buy "dog beds" in our house!:D

[brandysmom]

Although Brandy is feeling better, I don't think she will ever be able to jump on our bed again. She hasn't been able to for quite some time now, but it's still her favorite place to be:) She puts her front paws up on the bed and waits for me to lift her up by her bottom. She loves it!! She actually gets mad when she is ready for bed and we are not.

Wendy, I am so happy for you that Ben is doing so well! That is great to hear.

Aimee, I love the idea of removing the box spring. I just might have to try that. Then I'll never be able to get her out of bed :D

[littleone1]

Hi Wendy,

I'm glad that Brandy is doing better. I hope that everything will continue to improve.

Terri

[gpgscott]

Hi Wendy,

Sorry I have not posted previously but I am glad to hear that Brandy is feeling better. Please continue to keep us up to date.

Scott

[brandysmom]

Hello:

I haven't posted in a while because Brandy was doing so well. She had a slight set back and is slowly recovering. I'll start from the beginning.

Her stools started to get real soft, orangish yellow and had white specs in them. I brought a stool sample to her regular vet and it came back negative, but had yeast. It always has yeast present for some reason. I thought that maybe it was because the food she has been doing so well on changed their formula (Artemis Weight Management). I started to add in Wellness Core Reduced Fat (50/50) and nothing changed at all, except now she was vomiting bile on occasion. I called her IMS and he prescribed Metronidazole and 10mg of Prilosec for 5 days. We also scheduled an appointment to see him (10/15). She was no better, but no worse. During her exam, she snapped at him several times which was not like her. She was obviously in pain. She snapped when he felt her abdomen, knees and spine. He also tried to do a rectal, but she snapped, ran in the corner and growled at him. He suggested an ultrasound of her abdomen and I agreed, except at that point she was so stressed they had to give her valium for the procedure. The ultrasound came back with almost everything normal except her gall bladder has sludge, her pancreas is thickened and inflammed and her duodenum is spastic, thickened and inflammed. The assessment was mild to moderate gastritis, duodenitis and suspect pancreatitis. The IMS now put her on Cipro and Tylan powder for 14 days. She was better up until last Wednesday. She voimited bile like I never saw before. It was white, yellow and brown. She tried to eat but just picked at it and then didn't eat at all. She drank water like crazy and was drooling non stop. I brought her to the emergency room on Thursday, which is where her IMS is located. He wasn't there so we saw someone else. They did bloodwork. She was dehydrated, so they gave her fluids but not too much because of her heart. The bloodwork came back with the following abnormalities:

ALKP 2000 (23-212)
ALT 849 (10-118)
Glucose 113 (60-110)
WBC 19.1 (6.0 - 17.0)
MA 2.3 (0.3 - 1.5)
GA 14.3 (3.5 - 12.0)
RDWR 17.9% (12.0 - 17.5)

I don't know what the last 3 are. I need to call to verfiy. They also sent out a spec cPL, but I do not have those results yet. I know it will be off the charts again. They wanted to do another ultrasound to look at the liver even though it looked ok a week earlier. Oh and she lost 3 pounds in 1 week. They said to continue the Cipro and Tylan and to come back if she gets worse. She was the same Friday and Saturday. Sunday she started to be more like herself. Her stool has been normal since on the antibiotics and no more vomiting bile. I have been adding a little canned to her dry (Wellness Senior) to entice her to eat and for the softness. She also has a gingival hyperplasia on her front K9 tooth and now it's been bleeding. That's everything in a nut shell!! I'm sure I forgot some information and will add as I remember. It's been a very stressful few weeks. I don't think they really know what's going on with her and I truely believe there is more there than her pancreatitis flaring up. I expect to hear from the IMS tomorrow.

Sorry this is so long. I would really appreciate any feedback from the experts. Thank you.

[Harley PoMMom]

Hi Brenna,

I am so sorry to hear about the issues with Brandy, poor girl and poor you.

Although I'm no expert, the orangish poop could be indicator of liver problems.

Someone has notified Debbie about your bloodwork and I am sure she will be along as soon as possible to talk to you about that.

I will be keeping you and Brandy in my thoughts and prayers and remember we are here for you, ok?

Love and (((hugs)))
Lori

[brandysmom]

Hi Lori, Thank you, as always. Her poop still has a little orangish tinge to it, but it looks so much better.

I forgot to mention that I haven't given her any Lysodren in 3 weeks either, but I'm going to ask the IMS if I can start back up.

One question I have is - can the liver develop issues within 1 week? Her liver was ok in her ultrasound the week before.

Her blood will be rechecked next Tuesday. I searched high and low to find a regular vet who does house calls for "routine" things like blood work. Brandy just gets too stressed out now when she goes to the vet.

[happydogs]

Hello Brenna and Brandy,

So sorry to hear about Brandy's issues. I thought I would chime in, as our Randall had liver issues and some of what you're seeing with Brandy sounds familiar.

The way it happened with us, Randall went from a happy bouncy dog one day, to a very nauseous dog who wouldn't eat in about a week's time. It was shocking. The way the internist explained it to us was that the ultrasound "isn't a microscope" -- there could be liver damage that wouldn't show up on the ultrasound until it progressed.

Right after the ultrasound, Randall went downhill very quickly. His poop also had an orange-ish tint to it and was also soft. He lost about 2 kg (a lot on a small dog like him). He was nauseous a lot, vomited bile 1-3 times/day, and did not want to eat.

The good news is, the liver can regenerate. Randall's liver function has improved greatly in the last 6 months, so much so that his last test showed almost normal function. He was on a bunch of supportive supplements / meds (Zentonil/samE, Marin/milk thistle, ursodiol, metronidazole, etc). He goes in again today for another test.

I understand how difficult it is for Brandy to go to the vet now... Randall, who used to trot into the vet with his tail up, ready to greet everyone, now also hates going to the vet. I hope that you're able to get Brandy diagnosed so you can figure out what to do next. We'll be thinking of you.

Angela & Randall

[brandysmom]

Hi Angela and Randall,

Brandy has been on Milk Thistle. I had to stop the Sam E because it interacts with Tramadol, which she is on for pain management. Do you think it's better to give her the Marin instead of just regular Milk Thistle? She was on the metronizadole but it didn't help. If anything that's when she started to feel worse. They still don't know if her high numbers are a result of her liver or pancreatitis or both for that matter. I left a message with her IMS yesterday and am still waiting for a call back.

I'm sorry you had to go through this too with Randall. How did they diagnose his liver damage and how long did it take for him to feel better when you started treatment? I hope his tests went well yesterday and you get nothing but good news :D Thanks for chiming in. I really do appreciate it. Take care.

[happydogs]

Hi Brenna and Brandy,

We use the Marin because it has a combination of things that are good for the liver, as well as the milk thistle. The internist also said that the milk thistle in the Marin is probably better absorbed by dogs then the stuff you can buy in a health care store. Here's a link about Marin: http://www.drugs.com/vet/marin-for-dogs.html

In Randall's case, we first got suspicious that something was wrong when his appetite went a little 'off' (still eating very well, but not as fast). We did a complete blood panel which showed extremely elevated ALKP and ALT plus other stuff, so followed up with a bile acids test. The bile acids test is a test that shows how well the liver is actually functioning although it can't tell you the cause. Anyhow, the bile acids showed significant liver damage. Then we did an ultrasound, where the vet saw his liver covered in nodules.

It was about a month from the time the ultrasound was done to the time he started to turn around. It was a horrible month and we were preparing ourselves to let him go if he started losing interest in going out for a run. During that month, our entire days were centred around him and trying to get him to eat. He never did lose interest in going out, and then one morning he ate breakfast! It was only a teaspoon or so, but that's when things started to turn around for him. Another month passed and he was nearly back to normal again.

So there is hope... I hope that you have a good chat with your IMS. Is Brandy taking tramadol for arthritis? If so, you might want to consider using Zeel, a homeopathic remedy. I don't think Zeel works for every dog but it's worth a shot. It has really helped Randall continue to feel good and enjoy his walks. Hope your chat goes well with your IMS, and give Brandy a pat for me.

[brandysmom]

Thank you again Angela. I am so sorry you had to go through that with Randall. Reading it brought tears to my eyes. I am so glad he recovered. He sounds like a very special little guy :)

Brandy is on Tramadol for arthritis. We just increased the dose 2 weeks ago and it seems to be helping. I also give her Adaquan injections. Thank you for the info on Zeel. I will look into it further. Anything to keep these babies comfortable and happy - right? I read about Marin and just ordered a box to try instead of the milk thistle.

I still haven't heard from the IMS, but when I do I will ask if he thinks we should do that bile acids test. I will keep you posted.

[brandysmom]

I now know why I haven't heard from the IMS. He is having his own emergency and has been in the hosptal with his wife :( So, the ER vet Brandy saw last week called me back instead. We have sort of good news and sort of not so good news. Her spec cPL came back in the 400 range which is amazing to me. She has always been >1000. So she is still in the pancreatitis range, but not as bad as it has been. So with that being said, he doesn't think her elevated liver enzymes are from pancreatitis. Her blood will be rechecked next week and if they are the same or have gotten worse we need to explore other possibilities, which would include the bile acid test Angela mentioned.

Tomorrow is her last day of the Cipro and she will continue with the Tylan powder for now. He still doesn't want her on Lysodren until we recheck her liver enzymes. She has been eating well, no spitting up bile and has had normal poops. They still have a little orange in them but nothing like before. We just take it one day at a time for now :)

[Harley PoMMom]

That 400 range is good news, the lowest that Harley's spec PL test ever was...303! His highest was 900!!! :eek::eek:

That orange tint in her poop would concern me but it could be a possibility of many things...her liver, IBD, what she is eating...anything orange going in may make the poop come out orange too!

I will definitely be watching for your updates and keeping you both in my thoughts and prayers. Sending healing thoughts and positive energy your way.

Love and (((hugs)))
Lori

[Loladog]

Hi Brenna,

Lola went through a stage where her poops were orange and it was right after she was first diagnosed with Cushing's/Chronic Pancreatitis and I was trying to find a low-fat diet that would agree with her. It seemed like the more a food wouldn't agree with her, the more orange her stools would be. Oddly enough, the worst was when I was feeding her home-prepared Turkey and Rice.:confused: Seeing how the color and consistency is starting to improve with the change in diet, maybe that was the culprit? Although she's been on the Cipro and Tylan powder too now so maybe that's what is helping. I truly hope that the repeat blood work shows improved Liver values. I was so happy to read about Randall's improvement and to know that there is hope even if there is Liver damage. I wish I had some good advice for you but I'm at a loss. I hope you get some answers soon and I'll be thinking about you two.

[brandysmom]

I have never been so confused :confused:

Brandy had her "house call" appointment yesterday with a new regular vet. I liked him. He spent a lot of time with us and we went through her complete history. He tested her liver enzymes and they are still high, although ALT came down some. He seems to think that she has 2 meds that could be causing this - Lysodren and/or Tramadol. He suggested keeping her off Lysodren and trying something else and no more Tramadol. Instead he recommended Zubrin for her arthritis.

Ok, now I had to fax everything over, along with a note, to her IMS. I explained everything this vet said and asked for his input. He called me back today. He said that neither Lysodren or Tramadol would cause her liver enzymes to be elevated. He said I should continue both meds because both were helping with each condition. He said I could add Zubrin if I really wanted to. Of course monitor her and if anything changes to let him know. She seems to be feeling well, eating like a pig, normal but frequent poops and no spitting up bile. She has lost weight though. October 15th she weighed 67 lbs and yesterday she weighed 63 lbs. Her IMS said to feed her more if she will eat it. Doesn't weight loss indicate something is wrong??

I looked up all meds and they all say something about the liver.
Lysodren: May cause liver damage.
Tramadol: Use with caution in animals with sever kidney or liver disease.
Zubrin: Use with extreme caution and continued monitoring in older animals and those with dehydration or stomach, intestinal, liver, kidney, heart, blood disorders, or diabetes mellitus.

Now what do I do? I have 2 vets telling me 2 different things. I just want to do what's right for Brandy.

[brandysmom]

Here are her ALT and ALP numbers for the past year and a half (most recent first):

11/02/10
ALT 507 (10-118)
ALP 2800+ (20-150)
Spec cPL 438

10/21/10
ALT 849
ALP 2000+

04/26/10
ALT 106
ALP 2121

03/16/10
Spec cPL >1000

10/28/09
Spec cPL >1000

06/11/09
ALT 120
ALP 1073

She started Lysodren in Jan 2010 (250mg every other day) and Tramadol in May 2010 (50mg 2x/day). Ironically, I haven't given her Lysodren since Oct 8th and her ALT has dropped since then. I have also increased her Tramadol to 100mg 2x/day on Oct 16th and again he ALT has dropped since then. The IMS also said her numbers are not at the liver failure range and he wouldn't do a liver biopsy given her age. What is the liver failure range? Has anyone seen liver issues with Lysodren? Should I ask Dr. Oliver about this? I definitely don't think it's Tramadol seeing I've doubled her dose. I feel like I'm on my own with these doctors.

[happydogs]

Hi Brenna,

Sorry to hear about the confusion... it's so hard to know what to do when getting conflicting advice.

I don't want to sound like I'm harping -- because I'm just about to repeat myself :) -- but I would really strongly suggest you do a bile acids test for Brandy, if it's available in your area. There are too many similarities between what you describe with Brandy and what we went through with Randall, and I wouldn't wish the horrible time we had 'fixing' Randall's liver issues on anyone.

Randall had a blood panel done prior to starting Lysodren. It showed mildly elevated ALKP. After loading him on Lysodren, and then starting maintenance therapy (regular ACTH stim tests done), we did a bile acids and it showed significant liver damage. ALKP was somewhere in the 2000 range and ALT was somewhere in the 800 range. We were told to immediately stop the Lysodren because it's never to be given to an ill animal.

Please don't be afraid to ask questions from your vets.

Have you thought about doing an ultrasound, to see if any further information can be gleaned from it?

We have only used Tramadol very lightly and infrequently, so I can't really comment on it. You might want to try something else for her arthritis, though, maybe Zeel tablets or an injectable Zeel and see if it helps her.

Hoping you get answers soon... we'll be thinking of you.

Angela and Randall

[Harley PoMMom]

Hi Brenna,

Pancreatitis is hard on our poor pups and the liver has to work harder because of it:
Several biochemical changes, in addition to amylase and lipase elevations, can occur in patients with pancreatitis. Liver enzyme activities can be increased because of hepatocellular damage, whether from local pancreatic inflammation, the transport of pancreatic enzymes in the lymphatics, concurrent multiple organ failure or decreased hepatic perfusion due to hypovolemia. Alkaline phosphatase (ALKP) may be two to 15 times normal and alanine aminotransferase (ALT) may be two to five times normal.

http://www.banfield.net/journal-archive/2007/nov-dec-2007/01-diagnosing-canine-pancreatitis.pdf

Although Brandy's spec PL is 438, which is good but still high, she did have those months of her spec PL numbers > 1000. And in my non-expert opinion I believe this may be the main reason for the elevations in the liver values...but an ultrasound of the liver and/or bile acid test are really good ideas too.

Love and hugs,
Lori

[brandysmom]

Angela,

Thank you and I don't think you're harping. I need harping!! I do hate all this confusion though. I want to trust the IMS. I like him because he always says the most important thing for Brandy is her comfort and quality of life. He doesn't try to push anything. But I don't agree with everything either. I really want to keep that relationship going because he works out of our local, state of the art 24 hour emergency facility, but yet I still need to have a "regular" vet.

I'm not afraid to ask questions. Neither vet seems to think a bile acids test is needed. I would have to insist on one. She had an ultrasound on 10/15 and the only comment about the liver was "gallbladder sludge". I posted her results previously. She has been on the same dose of Lysodren since January and her ALT in April was good. Her ALP has always been high, but not this high. The fact that her ALT has improved from Oct 21 to Nov 2 makes me feel better. It also makes me feel better that she is doing so well. I am not ready to start her back on Lysodren though. I think I am going to see how she does for the next couple of weeks and then have her enzymes rechecked and go from there. I was already planning on having all her retesting done in December (full senior panel, adrenal panel and T4). Pending her next enzyme level check, I may have them all done sooner, along with the bile acids test. I still need to look into Zeel. She also gets Adequan injections every other week for her arthritis.

Lori,

Thank you so much for your input. I do consider you an expert because I've learned so much from you already. You have given me lots of very useful information. The only thing that really confuses me is that when her spec cPL has been off the charts, her ALT was ok and like I said earlier her ALP has always been high. Now her spec cPL is better and ALT and ALP are higher :confused::confused: I really don't get it. I just wish there was one clear answer. I know she is old (for a Boxer) and I can't work miracles, but it's so hard and I just wish I had a vet that gave me every answer that I need.

While I'm thinking of it - did I ever mention that she seems to be obsessed with eating dirt?

[brandysmom]

I just wanted to give an update on Brandy. Right now she is in ICU fighting for her life. She stopped eating Sunday morning and was completely lethargic so I brought her to the ER and they said she has pancreatitis. They gave her fliuds, pain meds and anti nausea meds via injection. Monday she was no better so back we went and they did the same thing except they added blood work but I wouldn't have any results until the next day. Tuesday she was no better and based upon that and her blood work (many abnormalities) they admitted her to ICU. They performed a chest xray and found some fluid down near the abdomen, so they then did an ultrasound and found she had a lot of fluid. She has the most severe form of pancreatitis called necrotizing pancreatitis. They said they can't rule out cancer because there is so much fluid in there that they can't get a clear picture of her pancreas. I do not understand how this happened and neither do they. She was doing so well, the best ever with her chronic pancreatitis. She has always been a fighter and I hope she keeps fighting through this. She seemed a little better when I went to go see her last night. They seem to think she will pull through this but will it happen again and how soon? Everything I've read about necrotizing pancreatitis sounds terrible. They can have liver failure, kidney failure, heart failure, shock, etc. I hope my baby makes it. Life is not the same without her at home.

[Casey's Mom]

Oh Brenna, sending love and healing prayers your way.
(((hugs)))

[Squirt's Mom]

Hi Brenna,

What a terrible time for both of you! :( I know it is hard to not have her home, but Brandy is where she needs to be for now and is in good hands. I hope she is back with you soon, tho. Meanwhile, if you have a shirt or something with your scent on it that you could leave in her cage at the vet's, it might help her feel a bit calmer.

Know we are all with you, Brenna, and if you need to talk, just holler!

Healing white light, prayers, belly rubs and hugs,
Leslie and the girls - always

[zoesmom]

Oh Brenna -

Sending lots of prayers and positive vibes for Brandy - and you. Sue

[brandysmom]

Thank you all for the thoughts, prayers and support. It means the world to me. The first day she was admitted I brought back her bed and pillow, my blanket and a toy so she would feel comfortable in her temporary home. Right now I'm waiting to go see her today. I've been trying to go twice a day. Last night she ate some boiled chicken and I was never so happy to see her eat!

I decided to post her abnormal blood results in case anyone is interested or has any feedback.

Albumin 2.4 (2.7 - 4.4) LOW
ALT 652 (12 - 118) HIGH
ALP 5847 (5 -131) HIGH
GGTP 22 (1 - 12) HIGH
Calcium 8.3 (8.9 - 11.4) LOW
Magnesium 1.2 (1.5 - 2.5) LOW
Cholesterol 579 (92 - 324) HIGH
WBC 21.2 (4.0 - 15.5) HIGH
Neutrophils 92% (60 - 77) HIGH
Lymphocytes 2% (12 - 30) LOW
Eosinophils 1% (2 - 10) LOW
Absolute Neutrophils 19504 (2060 - 10600) HIGH
Absolute Lymphocytes 424 (690 - 4500) LOW
Absolute Monocytes 1060 (0 - 840) HIGH
T4 0.2 (1.0 - 4.0) LOW * she didn't have her thyroid meds since Saturday evening

They were going to do an ACTH stim and a bile acids test when they admitted her, but then changed their mind after they found the fluid.

Thank you again.

[frijole]

Brenna, I join the others in sending huge hugs and best wishes to dear Brandy. I'm glad she is a fighter and will have both of you in my prayers. Hang in there and do keep us posted. Sorry I can't help with the reading of the blood panel. xoxoxoxo Kim

[labblab]

Brenna, I'm beaming healing thoughts, too! When you are able to see Brandy today, please tell her she's got a whole family of well-wishers who are sending her prayers. (And tons of strengthening hugs are being sent to you, too!).

Marianne

[lulusmom]

Hi Brenna,

I'm not a lab tech but I think the blood abnormalities you posted are most definitely indicative of a dog with severe pancreatitis. Delaying the bile acid and acth tests was most definitely the only call that could have been made given Brandy's severe pancreatitis and it's stressful effects on cortisol, the liver, and other internal organs.

I will be thinking postitive thoughts and will keep you and Brandy in my prayers. Please give your girl a big hug for me and tell her that all of us here want her to get better real soon.

Hugs,
Glynda

[happydogs]

Hi Brenna,

Just wanted to stop in as well and add my best wishes to you and Brandy. You'll be in our thoughts.

Angela

[labblab]

Dear Brenna,

Thinking of your sweet Brandy this morning and hoping that she is doing better and is back home again. When you have the chance, we will surely welcome an update.

Continuing hugs,
Marianne

[brandysmom]

Thank you Marianne and everybody. It's been a little crazy catching up on everything.

Brandy is home where she belongs :) She was released Friday night. They did another ultrasound and said there is still evidence of pancreatitis, but not as bad and the fluid was gone. She is doing ok. Each day seems to get a little better but I truly doubt she will ever be the same. To me, this affected her mind some. She is very different. She is eating but not much. First she wouldn't eat any kibble, only canned. Now she will eat some kibble but not all the time. You may offer her food and she will turn her nose and then 5 minutes later she wants it. She has lost a lot of weight and now weighs 59 lbs. Her back end is all boney. She looks terrible, seams pretty weak at times and sleeps a lot. They sent her home on 2 different anti nausea meds, but I had to stop one of them because it was making her poop a little in her sleep. She will be done with the other one tonight. She is also on 1/4 baby aspirin to avoid any blood clots. She is off Lysodren until she is better. I brought a urine sample to her regular vet yesterday because her urine looks like it may have blood in it. She may have a UTI. She is drinking a lot. Her stool was ok at first, but it is now yellow and mushy and very frequent. We have a follow up with the IMS the Friday after Thanksgiving, unless we need to see him sooner. I still think there may be something else going on with her. I feel like her body is slowly shutting down :( Although she has proven to be a real fighter through this ordeal. I didn't think she was going to pull through this. I've never broken down so much as I have during this past week or so and I am the one who usually holds everything in - not the case with her. Well, that's everything in a nutshell! I will keep everyone posted and thank you again for all the support. It really helped :D

I do have just one question regarding her blood test results and pancreatitis. Why wouldn't her amylase and lipase be elevated with such a severe case of pancreatitis? They were well within the normal range. I don't understand and I am hoping someone could educate me. Thank you again :)

[labblab]

Brenna, thank you so much for this update!! Although it sounds as though there are still worrisome lingering issues, what a relief to know that Brandy is back home again. I'm so sorry that I can't help with your questions about pancreatitis, but I know that others who are more knowledgeable will soon be looking in.

I do want you to know how deeply I sympathize with your distress over her illness, though. For me, the helplessness of watching my pups in pain -- and them not being able to tell me where they hurt and me not being able to tell them why all those icky things are being done to them -- it just rips my heart out. So please know that you can come and vent to us whenever it feels like too much! Hopefully, though, you've weathered the major storm and Brandy will continue to improve and regain her strength.

Continuing hugs to you and your sweet girl,
Marianne

[Squirt's Mom]

Hi Brenna,

So glad to know that Brandy is back home by your side where she belongs. I hope she begins to feel better and regain some strength as each day passes. Thank you for the update!

Honey, you can talk with us any time about any thing. We may not have any answers, but we do have strong shoulders and warm arms. Please, don't sit and worry alone...let us worry with you.

Hugs,
Leslie and the girls - always

[Harley PoMMom]

I, too, am glad that Brandy is home with you. Will be keeping you both in my thoughts and prayers.


I do have just one question regarding her blood test results and pancreatitis. Why wouldn't her amylase and lipase be elevated with such a severe case of pancreatitis? They were well within the normal range. I don't understand and I am hoping someone could educate me. Thank you again :)

To answer your question I took a quote from an expert, Dr. Jörg M. Steiner:


Serum lipase activity

Serum lipase activity has been used for the diagnosis of human and canine pancreatitis for several decades. However, it has long been recognized that serum lipase activity is neither very sensitive nor very specific for pancreatitis in either species.
Serum lipase activity has been reported to decrease in dogs after pancreatectomy, indicating that some of the lipase activity present in the serum does originate from the exocrine pancreas. However, considerable serum lipase activity is still present in these dogs after pancreatectomy, indicating that lipase activity must originate from additional sources. It should be noted that there are many cell types that synthesize and secrete lipases. These lipases of different cellular origins share a common function and thus can not be differentiated by use of a catalytic assay such as the ones that are being used to determine lipase activity in serum. To further illustrate this phenomenon serum lipase activity was measured in dogs with exocrine pancreatic insufficiency (EPI). These dogs have no significant pancreatic functional reserve yet in this group of 25 dogs with EPI mean serum lipase activity did not differ significantly from that in 74 healthy dogs and only one dog with EPI had a decreased serum lipase activity below the lower limit of the reference range.
In addition, many non-pancreatic conditions are associated with a significant increase in serum lipase activity, leading to false-positive results. In summary, serum lipase activity is neither very sensitive nor very specific for diagnosing pancreatitis in dogs and should thus only be used if an in-house assay is available and until the diagnosis can be confirmed by another, more specific, diagnostic modality. Finally, if serum lipase activity is analyzed it should be interpreted cautiously and only elevations of 3-5 times the upper limit of the reference range should be considered suggestive of pancreatitis.
In one study not a single cat with pancreatitis had a serum lipase activity above the upper limit of the reference range. These data would suggest that serum lipase activity is of no clinical usefulness for the diagnosis of pancreatitis in cats.

Serum amylase activity

The diagnostic utility of serum amylase activity for canine and feline pancreatitis is very similar to that of serum lipase activity. Some dogs with spontaneous pancreatitis have an elevated serum amylase activity, but others have serum amylase activities in the normal range. Furthermore, dogs with non-pancreatic conditions can have elevations of serum amylase activities. In contrast to its effect on serum lipase activity, the administration of prednisone and dexamethasone to clinically healthy dogs led to a decrease in serum amylase activity. These data would suggest that, as for serum lipase activity, serum amylase activity should only be used for the diagnosis of pancreatitis if an in-house assay is available and until the diagnosis can be confirmed by more accurate diagnostic modalities.
In a study serum amylase activity was not significantly different between cats with spontaneous pancreatitis, clinically healthy cats, and cats with non-pancreatic diseases. This would suggest that serum amylase activity has no clinical usefulness in the diagnosis of pancreatitis in cats.

http://vetmed.tamu.edu/gilab/research/pancreatitis

Hope this helps.

Love and hugs,
Lori

[brandysmom]

Thank you again everybody for the warms thoughts, prayers, support and information. I can't tell you how much it has helped me through this. Brandy is getting a little better each day. She is eating more, although still not gaining any weight, and her personality is coming back too :D She seems happy now, not sick. She didn't give up and I am so proud of her :D:D She has a follow up appointment this Friday, so I will keep you posted on how she makes out.

Happy Thanksgiving!!

[Harley PoMMom]

This is great news, Brenna, and we are so proud of Brandy too! She is such a fighter!! Please give her some gentle hugs and kisses from Harley and me...still keeping you and Brandy in my thoughts and prayers.

Love and hugs,
Lori

[brandysmom]

I can't believe I'm writing this, but you all have been such a huge support to me throughout all this and you deserve to know. Brandy is gone. She left me yesterday. She was doing so good and got to spend Thanksgiving with all the people who loved her most. Saturday she started to decline and very quickly. I had to let her go. There was no making her better this time. She's been the love of my life and I don't know how to get through this. I will write more when I am able to. Thank you again.

[happydogs]

Brenna.... I'm so sorry to hear this. I know words will be small comfort to you right now, but we are thinking of you and hope you find peace in your heart. You were a great mom to Brandy and she knows she was very much loved.

Angela

[lulusmom]

Brenna, I am so incredibly sorry for your loss. Please know that you and your family are in my thoughts and prayers.

Godspeed sweet Brandy.

(((Consoling Hugs)))
Glynda

[mypuppy]

Dear Brenna,
I was so saddened to read your post, and I am so sorry you lost your sweet girl. May your precious memories with her sustain you through such difficult time. God Bless you and Brandy and may she rest in peace. Tight hugs. Xo Jeanette and Princess

[Roxee's Dad]

Dear Brenna,

I am so very sorry for your loss of your sweet Brandy.

Rest in Peace sweet Brandy.....You are our newest and Brightest star in the sky.

[jrepac]

I'm so very sorry for your loss; I am sure Brandy knew that everyone loved her very much.

Jeff & Angel Mandy

[k9diabetes]

Hi Brenna,

I just read through your thread about Brandy's many struggles this past year. You took wonderful care of her and were a strong advocate to make sure she always got the best. I know she felt your love through and through.

I'm so sorry for your loss.

Natalie

[BestBuddy]

Dear Brenna,

I am so very sorry Brandy is no longer with you. And yet another angel gets their wings.:(

Jenny

[littleone1]

Hi Brenna,

I'm so sorry to hear about Brandy. Rest in peace sweet Brandy.

Hugs,

Terri

[Sophie's mom]

My sympathies on your loss, Brenna.
Sandra

[Harley PoMMom]

Dear Brenna,

I am so sorry for the loss of your precious girl, Brandy. I know these mere words do not help ease the pain you feel but please know that we do understand and share your grief...we will always be here for you. Keeping you and your family in my thoughts and prayers...(((HUGS)))

Godspeed sweet Brandy.

With Heartfelt Sympathy,
Lori

[ChristyA]

Brenna,
I am so sorry for your loss. We are all here for you.
Christy