Kathy & Honey (Atypical; now needs gall bladder removed)

[Kathy (Lulabelle)]

Hi! Thank you for allowing us to join. I'm not sure what/how much detailed information you'd like so I'll just start with the most recent. I'm Kathy and my ~15 lb, 15 yr old "Honey" Shih Tzu just received a 27 on the UC:CR test where the normal range is below 13. We have an ACTH test scheduled for Wednesday, Jan 13th.

I'm also a member of K9K as I had a previous pup pass from Kidney Disease so I'm on the alert for any changes in my pups' behaviors (I currently have 4 unrelated pups at home on my small farm). Honey has high BP & recieves 2.5 mg of Benazepril twice a day. I also have her on 1/2 tablet of Cholodin daily and CoQ10 10mg twice a day. Her diet varies greatly (as she use to be very "picky") but normally includes Merrick's Working Dog Stew, boiled liver, boiled dark meat chicken, cooked egg whites (4 whites mixed with 1 yolk) and some vet prescribed JM (Joint Mobility) for extra glucosamine. I've had her spine x-rayed - no arthritis but she does have hip dysplasia yet remains VERY active. She shows no obvious symptoms of Cushing's - no loss of hair yet I do believe she drinks a bit more water (purified) than she use to but it's not what I would call "ALOT". We went through a 1 yr period of not eating well but recently (within the last month) this has changed...although dinnertime is much less frustrating, I know this is a "change". I've had dental cleaning done in Nov 09 where she was on IV fluids before/during/after the procedure...she has COMPLETE blood work (panel & CBC) & urinalysis done every 6 months and although not everything is within the normal range, nothing really jumps out at me either other than a consistently high ALP (Oct 09 was 358 which is the highest since Oct 08). In Oct 09 her T4 was .08 (low) so then did a freeT4 which was 10 (rr 8-40). I know that many pups in the neighborhood have been diagnosed with Cushing's throughout the years and just had a nagging feeling about it...which is what prompted me to ask for the UC:CR.

Honey's USG has always been good but 10/08 Microalbumin was low while 3/09 result was high (15.0). Also, she has had some protein (2+) in her urine on the 10/09 test. Urinalysis is always from first pee of the morning and blood work is always 12+ hr fasting.

I wanted to touch base with others who deal with Cushing's on a daily basis so I can carry on an intelligent conversation with my vets and get an idea of what to ask for/look for. I know with straight Kidney Disease, we have some "tricks of the trade" so to speak and want to learn as much as I can about Cushing's.....been reading numerous links on this Disease but I also know there's no comparision to actually talking to people who deal with it daily.

It may be too early to ask for specific help but, then again, maybe not...so here we are. I like to be pro-active whenever possible. My dogs are my life-line and will do all that I can to keep them happy & healthy. I know some ailment is inevitible at some point but I'd still like to keep them enjoyuing their quality of life for as long as possible.

Thank you very much for anything you can offer -- I'm open to all thoughts/comment/suggestions......

Kathy with my sweetest little Honey Bunny

[littleone1]

Hi Kathy,

Welcome to you and Honey from Corky and me.

You have found a very caring, supportive, and knowledgeable group of people. We have a great family here.

Others will be along that have much more experience and knowledge about some of the issues that Honey is dealing with.

Before Corky was diagnosed with Cushings, he started exhibiting all of the clinical signs that are related to Cushings. He was drinking excessively, eating voraciously, had a pot belly, was losing his hair, had weakness in his hind legs, was looking for cool places, was having difficulties walking distances, wasn't sleeping well at nights, as he had to go potty very frequently, and started having accidents in the house, which he had never done before. He has arthritis in his hind legs, and use to hop on three legs when he first started walking on colder mornings. Last year, he wasn't hopping on three legs. Because his cortisol level was high due to Cushings, it helped his arthritis.

I hope this will give you a better incite to the Cushings related symptoms.

Terri

[Harley PoMMom]

Hi Kathy,

Thank YOU for joining our cush-family and a very big welcome from me and my boy Harley. Although I am so sorry for the circumstances that brought you here, I am happy you found this forum with these amazing and knowledgeable people and we will help you and Honey in any way that we can.

The UC:CR test is the best test to start with because it is the least stressful on your pup, you see, Cortisol is a stress hormone, one of the "fight or flight" hormones, so high stress and any non-adrenal illnesses will cause false positives results on any Cushings tests.

Excessive thirst and excessive urination are symptoms of hyperthyroidism and diabetes, these two diseases share some of the same symptoms of cushings. This is why cushings is so hard to diagnose and why it is so very important to get a proper diagnosis.

Strong symptoms are a huge part of making the diagnosis, and a Cushing's savy vet will not initiate any treatment without strong symptoms and a proper diagnosis. Not one test can confirm cushings or the type of cushings, thats why you need a qualified GP or IMS for this disease.

Now for the types of cushings: Atypical Cushing's involves only the hormones Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone. A pup with Atypical will not have elevated cortisol.

Conventional, or what is also called true Cushing's, does involve elevated cortisol and may also involve any of the other hormones - Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone but not always.

If a pup has only elevated estradiol, it is called Hyperestrinism.

You said Honey had dental cleaning done, which is a very good thing to do but was the bloodwork panel done relatively close after this procedure. The reason I'm asking is because the anesthesia will reek havoc in the pups system for a while and it will make alot of your pups lab results abnormal. I just had my boy Harley's teeth done, now he had to have 3 teeth extracted too but he wasn't eating very well and since my boy has pancreatitis his GP reran his CBC/Chemistry panel again...we had one done in Nov and now one in Dec, and boy what a difference, :eek: I like the Nov panel better. :)

If you could post any abnormal results of Honey's CBC/Chemistry panel with the reference ranges that would be helpful to us. Also when you have Honey's ACTH test done could you post those results here also.

You are doing an excellent job taking care of Honey, and it seems to me you are doing alot of research on Cushings which is the way to help her too. I am including more links for you to read and you may print out anything you want for yourself and/or to take along to Honey's GP.

Remember you are not alone on this journey, Kathy, we are here to help you and Honey in any way we can, you are family now. So ask as many questions as you want and we will try to answer them as best we can.

Hugs,
Lori

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

Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's"
http://://www.k9cushings.com/forum/showthread.php?t=198

Links to Cushings Websites (especially helpful for new members!)
http://www.k9cushings.com/forum/showthread.php?t=180

[Kathy (Lulabelle)]

Terri & ori,

Thank you sooo much for the warm welcome! Yes, I strongly believe in the "we're all family here" atmosphere and you've already put me at ease...THANK YOU!

Honey has ALWAYS searched for the cooler spot in the house to call her own and she has ALWAYS felt warm to the touch, although she never has a temp.

The Oct blood work was done about 2 weeks prior to the dental work. Along with the ACTH on this Wed, I'm also having them re-do super chemscreen & CBC -- I'll just feel better seeing the results, not to mention it's now been about 3 weeks since we increased her 2.5 mg of Benazepril to twice a day instead of just once a day.

The abnormals from the blood work on 10/22/09:

ALP: 358....(5-131 ref range)
Cholesterol: 333 (92-324)
Platelet Count: 522 (170-400)
Platelet Estimate: Increased (Adequate)
T4: 0.8 (1.0-4.0

Like I said, she always had a high ALP

Oh - I forgot to mention previously that I currently have her on Denamarin (for medium size dogs) for liver function support...I've been giving this daily for approx 1 1/2 months with my reg vet's approval. I'll consider continuing it depending on Wed's blood results.

I guess I do have 1 question, but I might be premature...without more clinical signs of Cushing's, is it a good option to not treat with medication? Is there any good reason to wait until test results are higher or until she is sicker (I don't like the idea of waiting till she's "sicker" but I hope you know what I mean).

Again, thank you....knowing there are kind, warm people to go to & who understand...it's a HUGE help!

Kathy

[Harley PoMMom]

Hi Kathy,

My boy Harley has elevated blood pressure too, he is on Amlodipine 2.5mg once a day, we did have him on 2.5 mg BID but his eating really halted and he had to start Lysodren, so we backed it down to once a day and his eating has picked up...thank goodness. Now has Honey had a UPC test done to see specifically what the protein loss is?

Since the two main treatment meds, Lysodren and Trilostane, can be lethal to a non-cush pup it is vital that they not be given until a proper diagnosis is given. Cushings is a slow progressing disease so you have plenty of time to get a proper diagnosis, some dogs go untreated for years. When these dogs, that have not been diagnosed for years, finally get treatment they are like their pre-cushing days, so please take the time to get a proper diagnosis for Honey.

When and if the ACTH test comes back positive then I would suggest a LDDS test and an ultrasound. The ultrasound has to be done on a state-of-the-art machine and read by a qualified person to be accurate...but it is well worth it. It will tell you what is going on inside of Honey...if her adrenals are enlarged, if her liver is enlarged, if she had prior bouts of pancreatitis...it tells so, so much. I did not know about my boys pancreatitis until it showed up on his ultrasound :eek: talk about a shocker!

Honey's lab results, in my opinion, don't look too high for a cush-pup, my boys ALP was 761 and this is on Denamarin and Marin his ALP was 1289 before tho :eek:. You can give both as long as they are given 12 hours apart (I have Harley's GP approval too :)) If Honey does have cushings she is probably in the early stages and once the ACTH test is done and you post those results for us, and then we will be able to give you more meaningful advice.

If you want more info about the UPC test, let me know, Harley gets the UPC test done regularly.

Hugs,
Lori

[Kathy (Lulabelle)]

I hope I'm doing this right -- should I continue under this thread or make new ones?

Anyway, I just rec'd today's mail with a copy of the UC:CR test results and already I'm confused! :(

It was done at IDEXX Labs (if that matters). When the vet called me, he told me that Honey's result was "27" but that doesn't show up anywhere on this form...it says "Urine Cortisol: 5.8 result" and "Urine Creatinine: 68.5 result" So how do ya end up with #27??? PH was 5.5 and USG was 1.026. The UC:CR was a combination of 2 consecutive first pee of the morning samples (again, don't know if that matters). Both samples were refrigerated prior to taking them to the vet's office.

[Harley PoMMom]

You keep posting here in your thread. There is a specific formula to do this:

"Urine Cortisol: 5.8 result" and "Urine Creatinine: 68.5 resultTake the urine cortisil 5.8 and times by 27.6 and then take the Urine Creatinine 68.5 and times by 0.0886 you should get urine cortisol 160.08 and Urine Creatinine 6.0691, now divide the Urine Cortisol 160.08 by the Urine Creatinine 6.0691, and I got 26.37.

[Squirt's Mom]

Hi Kathy,

Welcome to you and Honey! :)

You are off to a good start with the info provided and it is GREAT that you are already researching this condition! :cool: Keep it up! You are Honey's first and last defense, her advocate, her only voice; so the more you know, the stronger you will be in these roles.

I have a couple of suggestions in the testing phase, which you are just beginning. One, instead of a plain ACTH I would have the full adrenal panel through the Uni. of TN in Knoxville (UTK). This test will check not only what a plain ACTH will, but it will also evaluate the intermediate sex hormones involved with Atypical. If Honey already has elevated sex hormones (Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone), this will effect the treatment options you have. Trilostane always elevates one or more of these hormones so Lysodren may be a better choice in that case. If the cortisol is not involved but the other hormones are, then the treatment is much different. Melatonin and lignans are used to treat Atypical, with Lyso as a maintenance in some cases.

Here are some links on Atypical and the testing involved:

Atypical Cushing’s*

(Estradiol, Androstenedione, 17-Hydroxyprogesterone, Progesterone and Aldosterone – an elevation in one, all, or any combination of these hormones, without elevated cortisol.)

http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=485128&sk=&date=&pageID=1

Beware of false positives, negatives in canine hyperadrenocorticism testing
http://www.vetcontact.com/en/art.php?a=132&t

17-Hydroxyprogesterone
http://en.wikipedia.org/wiki/17-Hydroxyprogesterone

UTK Panel*

Explanation of hormones
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php


Next, I strongly recommend you have the ultrasound that Lori mentioned...an abdominal ultrasound done on a high-resolution machine and read by specialists. Not only will the US give you a good look at the adrenals it will also let you know about the liver, kidneys, gall bladder, spleen, stomach, intestines, and more. My Squirt had elevated cortisol and was first diagnosed with PDH, true Cushing's. But subsequent US found a tumor on her spleen and since it has been removed, her cortisol has returned to normal. She is Atypical, tho. So, to me, an US is invaluable in testing for Cushing's as well as other conditions.

As Lori said, Cushing's is a slow progressing condition, taking years to cause damage. So please, please take your time in the diagnostic phase before starting Trilo or Lyso. It is best to know from the beginning exactly what you are looking at.

As for signs, they are critical not only for diagnosing but for monitoring once treatment has begun. If you are unsure of the signs, Kate Connick has a great list on her site. Here is the link to her site:

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

Some tips to help you - get and keep copies of all of Honey's test results, which you probably already do! Also, keeping a daily diary of her behaviors can be very beneficial to you and the vets. Note her eating habits, diet, pee and poop history, sleep patterns, moods, water intake, and, of course, any odd behaviors or changes in behaviors. That way you don't have to try to remember when she vomited that weird purple stuff last month! :eek::p You will find that poop patrol is a fairly big deal around here so find yourself a nice twig, or limb if you prefer, and get ready to poke at poop! :D

I am so glad you and Honey are here and hope to learn much more about you both in the future.

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

[lulusmom]

Hi Kathy and welcome to you and Honey,

It is apparent that you are a very proactive participant in your dogs' medical care so not only am I impressed, I am happy to say that Honey is a very lucky girl to have you as her mom. I do have a few comments and a few requests which I have typed in blue text below. I have a horrible memory so doing things this way helps eliminate a lot of extra reading.


Hi! Thank you for allowing us to join. I'm not sure what/how much detailed information you'd like so I'll just start with the most recent.

The more information, including posting of all test results, the better. There's is no such thing as providing too much information so please don't worry about being long winded. It's tough to provide meaningful feedback without knowing Honey's history so lay it on us. We're certainly not vets but none of us cushparents are strangers to reading labwork and interpreting abnormalities to the best of our ability.

I'm Kathy and my ~15 lb, 15 yr old "Honey" Shih Tzu just received a 27 on the UC:CR test where the normal range is below 13. We have an ACTH test scheduled for Wednesday, Jan 13th.

I must say that in my experience on the forum, Shih Tzu's are a breed that seems to be over represented here and I am sure you will be hearing from a few of our Shih Tzu lovers, myself included. I love all dogs but after being a long term foster parent to a beautiful little Shih Tzu named Mabel, I found an all new appreciation for the breed. Mabel was in the middle of being tested for Cushing's when she first came to our home and was ultimately diagnosed.

As others have already mentioned, the UC:CR test is certainly a great place to start; however, we are all mindful of the fact that many underlying illnesses as well as stress can yield a high ratio. I am, therefore, happy to see that your vet is following up with an ACTH stimulation test. Based on information I read farther down in your post, I'd like to give you my thoughts on how I would proceed based on the fact that Honey really has no overt symptoms associated with cushing's. Even if the ACTH stimulation test was positive for cushing's, in the absence of symptoms, the vet truly could not confirm a diagnosis and s/he should certainly think twice before prescribing treatment for a dog with no symptoms. I therefore wonder if perhaps doing an abdominal ultrasound might not be more beneficial at this point in time. If a dog is cushingoid, the ultrasound most often will show signs of hyperadrenal activity in the way of enlargement of one or both adrenals. This also gives the vet an opportunity to check out the other internal organs. If there is evidence of hyperadrenal activity, then you could continue with additional testing. Just my two cents.

I'm also a member of K9K as I had a previous pup pass from Kidney Disease so I'm on the alert for any changes in my pups' behaviors (I currently have 4 unrelated pups at home on my small farm). Honey has high BP & recieves 2.5 mg of Benazepril twice a day. I also have her on 1/2 tablet of Cholodin daily and CoQ10 10mg twice a day. Her diet varies greatly (as she use to be very "picky") but normally includes Merrick's Working Dog Stew, boiled liver, boiled dark meat chicken, cooked egg whites (4 whites mixed with 1 yolk) and some vet prescribed JM (Joint Mobility) for extra glucosamine. I've had her spine x-rayed - no arthritis but she does have hip dysplasia yet remains VERY active. She shows no obvious symptoms of Cushing's - no loss of hair yet I do believe she drinks a bit more water (purified) than she use to but it's not what I would call "ALOT". We went through a 1 yr period of not eating well but recently (within the last month) this has changed...although dinnertime is much less frustrating, I know this is a "change". I've had dental cleaning done in Nov 09 where she was on IV fluids before/during/after the procedure...she has COMPLETE blood work (panel & CBC) & urinalysis done every 6 months and although not everything is within the normal range, nothing really jumps out at me either other than a consistently high ALP (Oct 09 was 358 which is the highest since Oct 08). In Oct 09 her T4 was .08 (low) so then did a freeT4 which was 10 (rr 8-40). I know that many pups in the neighborhood have been diagnosed with Cushing's throughout the years and just had a nagging feeling about it...which is what prompted me to ask for the UC:CR.

I have two cushdogs and luckily, neither have hypertension issues so I am not well informed on how Benazepril might affect laboratory values. I therefore did some research and discovered that this drug definitely impacts the liver and can cause elevated liver enzymes. Honey's ALKP elevation would be considered mild in comparison to what we've seen here. We have some members reporting those numbers in the thousands. Dental issues can cause elevations in ALKP as well so can you let us know if the labwork was done prior to the dental work?

Having had a furbaby with kidney disease, I am sure you have done a ton of research and are already aware that any disease and/or active infection can affect thyroid levels. We often see low T4 with cushings but values usually return to normal once the disease is adequately controlled with treatment. Did your vet do a full blood thyroid panel? I ask because Honey's free T4 would be considered low normal and if she had a high TSH level, there is a possibility that she could truly be hypothyroid. You may want to ask your vet if the Benazepril could be responsible for the low T4.

Honey's USG has always been good but 10/08 Microalbumin was low while 3/09 result was high (15.0). Also, she has had some protein (2+) in her urine on the 10/09 test. Urinalysis is always from first pee of the morning and blood work is always 12+ hr fasting.

Low microalbumin and the +2 protein you posted would not be an uncommon finding in a cushingoid dog, including one of my own. However, any condition that impacts the renal filtration plant in our dogs' bodies can also cause these types of abnormalities. Hypertension most assuredly can, as can diabetes mellitus. I also noted that Honey was hydrated before dental surgery. Depending on when the blood was drawn, overhydration can cause transient low microalbumin and can also cause a dilution effect in the liver enzymes, meaning elevations could actually be higher. Can you provide us with the timing of all testing?

I wanted to touch base with others who deal with Cushing's on a daily basis so I can carry on an intelligent conversation with my vets and get an idea of what to ask for/look for. I know with straight Kidney Disease, we have some "tricks of the trade" so to speak and want to learn as much as I can about Cushing's.....been reading numerous links on this Disease but I also know there's no comparision to actually talking to people who deal with it daily.

I gotta tell you that I thought I was pretty educated on the subject of cushing's before I became member here but boy was I deluded. :D With the help of these wonderful folks and the resources available in the Resources section of the forum, I have become a most excellent advocate for my dogs. It sounds like you are too and you've certainly come to the right place to learn anything you want to know about cushing's so before long, you might just turn out to be like me, the biggest pain in the butt your vet has ever had in his/her office. :p

It may be too early to ask for specific help but, then again, maybe not...so here we are. I like to be pro-active whenever possible. My dogs are my life-line and will do all that I can to keep them happy & healthy. I know some ailment is inevitible at some point but I'd still like to keep them enjoyuing their quality of life for as long as possible.

Too early? Pashaw! :D

Thank you very much for anything you can offer -- I'm open to all thoughts/comment/suggestions......

Kathy with my sweetest little Honey Bunny

I think I speak for all of us when I say that I'm so sorry for the circumstances that brought you here but I'm glad that you found us. It's so much easier to handle the frustrations and fear when you have hands to hold and make no mistake, you won't find any better hand holders than you have here. We're delighted that you've chosen to become a member of our community and we'll all look forward to learning more about your sweet little girl.

Glynda

P.S. I'm at work and it took me forever to complete this post with all the interruptions so I am now seeing that you have posted some additional information which I am going to read while eating my lunch.

[Harley PoMMom]

Hi Kathy,


I hope I'm doing this right -- should I continue under this thread or make new ones?

You are doing a fantastic job with the forum, and yes, just keep posting new information about Honey in her thread here.

Anyway, I just rec'd today's mail with a copy of the UC:CR test results and already I'm confused! :(

It was done at IDEXX Labs (if that matters). When the vet called me, he told me that Honey's result was "27" but that doesn't show up anywhere on this form...it says "Urine Cortisol: 5.8 result" and "Urine Creatinine: 68.5 result" So how do ya end up with #27??? PH was 5.5 and USG was 1.026.

Hopefully I explained that to you in my previous post and I didn't confuse you more. :eek:

The UC:CR was a combination of 2 consecutive first pee of the morning samples (again, don't know if that matters).

Yes it does, and please check out the posts I've included below from Dr. Bruyette who is a reknown cushings expert.

Both samples were refrigerated prior to taking them to the vet's office.


Yes. The same would apply when looking at urine cortisols in the initial diagnosis of Cushings. Ideally 3 morning pooled urine samples collected by the owner at home and refrigerated.


Dave




Urine cortisols can be a problem. Many studies have shown that the only way to accurately gauge urine cortisol levels is to obtain the first morning voided urine sample on 3 consecutive days and then pooling the urine to run a UCCR. When done in this fashion it is likely an accurate test. Otherwise there is likely too much day to day variation to make a single random cortisol very helpful.

Dave Bruyette DVM DACVIM

Your doing an excellent job!

Love and hugs,
Lori

[lulusmom]

See my comments in blue below


Oh - I forgot to mention previously that I currently have her on Denamarin (for medium size dogs) for liver function support...I've been giving this daily for approx 1 1/2 months with my reg vet's approval. I'll consider continuing it depending on Wed's blood results.

Your vet may have that the Denamarin was a good idea considering the effects of Benazepril on the liver as well as the elevated liver enzymes.

I guess I do have 1 question, but I might be premature...without more clinical signs of Cushing's, is it a good option to not treat with medication? Is there any good reason to wait until test results are higher or until she is sicker (I don't like the idea of waiting till she's "sicker" but I hope you know what I mean).

Kathy, cushing's is a very slowly progressing disease and it takes a very long time for the effects of excess steroids on the immune system and internal organs to debilitate a dog. Because it's such a graded disease, the red flag for many pet owners doesn't go up until the dog has overt and very troubling symptoms such as increased drinking and peeing with resultant low urine specific gravity, loss of coat, bad skin and almost always an increased appetite. Even with all those symptoms, dogs are not suffering but a once active dog can become very lethargic. I was just reading a medical book co-authored by a reknown expert on cushing's and it stated that a good majority of dogs that are diagnosed have had the disease from 1 to 6 years so that should give you an idea as to how slow this disease moves. I know that my first cushdog went undiagnosed for almost two years as she had an increasing number of common symptoms in that time. Thank goodness for our internal med specialist that finally diagnosed her and drat the stupid gp vet that was as ignorant as I of the disease.

Honestly, Honey has very few symptoms and certainly not the most common ones, so I would be very hesitant to treat and I would absolutely not treat based solely on the results of an acth stimulation test. If you have done a fair amount of research on the subject, I am sure you have read that clinical signs are a huge component of a confirmed diagnosis and Honey doesn't seem to have many.

Again, thank you....knowing there are kind, warm people to go to & who understand...it's a HUGE help!

Kathy

[Kathy (Lulabelle)]

Oh My Gosh ---THANK YOU sooooo mcuh for all this information! I'm breathing so much better now...lol

Question: I understand that there are 2 variations of ultrasound testing... one is less expensive and 1 involves dye & is considerably more expensive (hate to differentiate them this way but I know there's a substantial difference). Is it the expensive one that would be necessary? I have a local vet who does ultrasound diagnostics but that one does not involve the dye. I'd have to go up to NY state for the other type of ultrasound. Just want to me sure which type is necessary.....$$$is always part of the budget process and my vet bills are ALWAYS in the budget! LOL

I have always requested & rec'd copies of all test results (at one point I had 9 dogs so I always have my "Dog Binder" with me when I go to the vets -- they think I'm weird. They got alittle stressed when I always asked for the Client Information Sheet on any medication they prescribed....now I just print it out from petplace.com Yes, they think I'm a pain in the butt but they know I'm involved & somewhat educated so they bear with me...I have 3 different vet offices that I frequent depending on the pup's current health concerns & they're all "OK" with that).

Question: I haven't had the UPC done with Honey...since the last urinalysis showed no protein, is this still recommended?

The October blood work was done prior to the dental by about 2 weeks....I always request the full panel beforehand and want plenty of time to review it myself before the actual procedure...none of this "yeah it looks ok to me and then proceed in the next 10 mins with the dental procedure". Also, I always require gas anesthesia for my pups.

So nice to know other people are on "poop patrol"! Since I'm use to so many pups, I've always picked up the poop right after they "go" and I know who's is who's. Honey is easy because she now goes out in a different area of the property from the other 3...if there's any change in consistency or color, I get the plastic gloves out & investigate. So far, she's been pretty consistent for the last several months. No vomiting (thankfully). It's hard to judge water intake as they all (currently 4 pups in the house) use the same water bowl (I change the water several times a day too...I have well water & went to "purifiying" the dog's water about 2 years ago). During the winter, I'm home all day and take note of any changes in who might be drinking more. I will say that Honey's intake has increased over the last several months, but still not what I would consider "ALOT". She doesn't wake me up during the night to go "out". She sleeps on the bed with the rest of us (I'm single) most nights but will ocassionaly get up during the night to sleep under the bed (it's cooler under there).

I will ask tomorrow morning about having the ACTH sent through the Uni Of TN...don't honestly know if that's an option with this vet or not...but I'll be asking when I walk in the door! I'll also be having complete chemscreen & CBC done so will post everything when I rec them.

One thing that my vets have learned about me...I do not like to "assume" anything. I will not treat one of my pups with something from a "guess"...I want to KNOW(time permitting of course). One vet had already said to me that they treat Cushing's as Pituitary because most cases are that anyway...that didn't sit well with me & they are not who we're going to tomorrow. I see no reason to treat something that my pup might NOT have! I know all the testing gets expensive but, again, there's the budget....since it seems that I have "time", I can budget for some of this and take it one step at a time...there's no sense of urgency in Honey's particular case, right?

Thank you for all the links...I'm going to get to reading right now and will come back with any questions, ok...there's always questions, right? LOL

I can't tell you how wonderful it is to have you all here...thank you so much for giving your own time to help us who are floundering out here! You're very special people and VERY much appreciated!! I already feel so at ease & comfortable -- not all support groups are like this. For me, hand holding is not optional...it's a necessity...especially in the beginning. Right now I'm just a babe in the Cushing's woods. Bless you ALL!

Kathy with my precious Honey

[Casey's Mom]

Kathy you sound like a very dedicated pup parent and you will do fine. You have found a fantastic group here with a ton of knowledge and support.

Love and hugs,

[Harley PoMMom]

Hi Kathy,

The 2 ultrasounds that were done on Harley did not require the use of any dye, the ultrasound uses waves and echoes not dye to form its images:


The language of ultrasound
The language of ultrasound is made up of descriptive words to try to form a picture in the reader’s mind. Ultrasound waves are formed in the transducer (the instrument the radiologist applies to the body), and reflect from tissue interfaces that they pass through back to the same transducer. So at every change in tissue type (eg. fat to kidney), some echoes pass through the interface and some are reflected. The reflected ultrasound waves form the image that we see on the screen.

Echogenicity
Because we are dealing with ultrasound waves, the descriptive terms are based in “echogenicity”, or the way the ultrasound wave is reflected back to the transducer. Each tissue type, such as liver, spleen or kidney, has a particular echogenicity in its normal state. In diseased states, the echogenicity of an organ can be altered, either more echogenic (hyperechoic) or less echogenic (hypoechoic) than usual. These observations can help the radiologist to categorize the type of disease process involved.

http://www.veterinaryradiology.net/146/what-do-hyperechoic-and-hypoechoic-mean/

This is why it is so important that it is done on a very qualified machine and read by a very qualified technician. I have to travel 2 hours one-way to have Harley's ultrasounds done. His GP does have an u/s machine in their office but she has told me that theirs cannot pick-up and produce what the u/s can at the other place I take Harley.

Re; the UPC: Since Honey had no protein loss then a UPC test would be a of no value, I have it done because Harley continues to have protein loss due to his high blood pressure and I want to know exactly how much protein he is losing in his urine.

I used to have well water then got forced to hook-up to city water :eek: so I have been buying distilled water for my boys to drink for a long time.

Most likely your vet will not know about the Atypical Cushings or sending anything to the lab in Tennessee so I will include the links, I suggest that you print these out and take them along with you. Harley's GP did not know anything about Atypical Cushings and her office had never dealt with doing the blood draws, so I took all the printed material into her and she called Dr Oliver (he heads the lab there) and she got all info she needed to perform the tests.
She continues to confer with Dr Oliver on Harley's case because he is Atypical + PDH.

Links for Lab in Tennessee.
CLINICAL ENDOCRINOLOGY SERVICE
The University of Tennessee Phone: 865-974-5638

General Infor

3. ADRENAL FUNCTION:

g. Adrenal Panel for Dogs and Cats (ACTH Stim) -Test for congenital adrenohyperplasia-like syndrome (dogs, cats), or Alopecia-X, Atypical Cushings Syndrome

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info.pdf?r2

Submission Form

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endosubform06.pdf?r2


For me, hand holding is not optional...it's a necessity...especially in the beginning. Right now I'm just a babe in the Cushing's woods. Bless you ALL!

Oh, Kathy, we are Pros at hand-holding :D

Love and hugs,
Lori

[lulusmom]

Hi Again,

Just thought I'd check in on you and Honey before turning in for the night. Listen, girlfriend, you are way ahead of the curve in educating yourself on this confounded disease so if you're floundering, you're doing baby flounders. :D I'm so glad that you feel better now. I agree that it is nice to have somebody hold your hand but when you have a ton of folks holding your hand, it's the greatest feeling in the world to know that you are not alone. The good news is that we usually have pretty good hand holding coverage 24/7 thanks to our wonderful and very experienced Aussie friends that are wide awake when us Yanks are snoring and drooling on our pillows. Ha, I guess I should speak for myself. :o

FYI, I understand your vet's approach to treating, if the time comes, as if Honey has PDH. Approximately 80% to 85% of dogs have pituitary based cushing's and the other 15% to 20% with an adrenal tumor have the option of surgery; however, it is probably one of the most risky veterinary surgical procedure done. Surgery may be an option but not having a very experienced, board certified surgeon is not an option, it's a necessity. You need the best there is. Having said that, I'm not sure with Honey's advanced age, surgery would be an option; however, that would be for you and your prospective surgeon to decide, if an adrenal tumor were involved.

If your vet were to treat for PDH without the benefit of knowing whether Honey had an adrenal tumor, Lysodren would be the drug of choice because it erodes the adrenal cortex which presumably can shrink a tumor. I will tell you that everything I've read indicates that dogs with an adrenal tumor are normally diagnosed at an older age and a good number of those dogs are females. If the time comes that you have to decide to treat, please don't be afraid of Lysodren because it can be a blessing. Adverse reactions can be minimized and totally avoided if your vet follows proper protocol and you educate yourself on how to properly administer the drug and closely monitor Honey. It takes team work and what your vet doesn't know is that once you got here, Honey's team got much much bigger. :D I don't remember if I told you but I have two cushdogs, both treating and stabilized with Lysodren.

With respect to the ultrasound, I'll let others that are more knowledgable than I weigh in on the subject but I don't believe dye is involved in an abdominal ultrasound. I stands to reason that if a dye is used, they would be looking for a blockage of some type whereas an abdominal ultrasound that is normally done for suspected cushing's is to image the internal organs. You need a good quality, high resolution machine, which a lot of gp vets do not have, so if you are going to spend the money, make sure it's done right the first time. Another FYI, they will shave Honey's belly and if the hair doesn't grow back in a reasonable period of time, this would be a good indication that she probably has an endocrine disorder.

Okay, I'm off to bed now but will be checking in on you from time to time.

Glynda

P.S. It's a good thing you're single cuz with your herd, there probably isn't any more room in the bed. :D

[littleone1]

Hi Kathy,

You're doing an excellent job of gathering information about taking care of Honey.

I just wanted to let you know that Corky has had three U/Ss done and none of them involved the use of dye. Corky does have an adrenal tumor, but surgery is not a good option for him because of his age and his medical conditions. I know that many vets and specialists say that treating an adrenal tumor with Lysodren is the way to go, but there are also many that recommend using Trilostane. Corky's IMS is treating him with the Trilo.

I know that there is so much to learn about Cushings, but as others have said, you are not alone. I have gotten so much help here.

I wish you and Honey the best.

Terri and The Corkster

[Roxee's Dad]

Hi Kathy,
Just a belated welcome to you and Honey :) I have nothing to add as you have done your homework :) and have recieved some good advice already.:)

I just wanted to comment:

So nice to know other people are on "poop patrol"! Since I'm use to so many pups, I've always picked up the poop right after they "go" and I know who's is who's. Honey is easy because she now goes out in a different area of the property from the other 3...if there's any change in consistency or color, I get the plastic gloves out & investigate.

When I read this, I laughed and immediately thought, yep, she's family. :D;):) Honey is in good hands!:)

BTW- special place in my heart for Shih-Tzu's and looking forward to a pic :)

[Franklin'sMum]

Hi Kathy,

Belatedly welcoming you and Honey. :o

Jane and the gang xxx
________
Iolite portable vaporizer manual (http://vaporizer.org/reviews)

[Kathy (Lulabelle)]

Hi,

Again, thank you all for the warm welcomes and all the good advise & information.

I took Honey to the vet's on Wednesday & requested the following:

Full Thyroid panel (from U of Mich) $105.00
Adrenal Profile (fr U of TN) $350.00 This is suppose to include ACTH & all the sex hormones.
Cardiopet-bmp & CBC & chem screen (fr IDEXX) $148.00 I've never gotten this before..usually just the chem & CBC so the add'l heart info will be interesting.
Blood Pressure screening $32.00

I wasn't quite prepared for the expense of the Adrenal Profile but at least I think I'm getting the information that was suggested here,right?

I thought I'd include the prices for each because I'm unsure if this is "reasonable" or should I look around for future reference? This particular vet does an "in house" ACTH test ($135.00) but I opted for the more extensive one because I thought it would be more informative and I really wanted a more definitive result (if possible). Patience isn't one of my strong points and I really dislike getting those test results that are "inconclusive", especially at these prices.....thoughts/comments?

The BP is still elevated (ave of 5 readings was 230/105 MAP:155 BPM:135)so the vet has increased Honey's Benazepril to 3/4 5mg twice aa day...this is a tad higher than the "high dose recommendation" that I read on petplace.com -- should I be concerned about this? Or is it time to request an add'l BP medication, such as Amlodipine?

I was told that I probably won't have all the results until later next week but they'll mail copies to me as they come in so when the vet calls me, I'll be able to be somewhat intelligent during our conversation. :)

I'll let you know what the results are when they come in.....now back to my reading.....just got a new ink cartridge so I'm printing it all too...I'm alittle anal about things like this...lol

Thank you!!

Kathy with my little Honey (who is back up to her normal weight of 16.2 lbs)

[AlisonandMia]

Paying $350 for the full adrenal panel looks very reasonable to me.:) (It is an expensive test though with the ACTH stim involved being the largest component - the stimulating agent is just very costly.)

Some people have paid that much, or close to, for a straight ACTH stim (just measuring cortisol)! I can't comment on the other prices but I'm sure others will.

Alison

[Kathy (Lulabelle)]

Thanks Alison,

Then I wonder what I'd be getting from the "in house" ACTH test for only $135.00? Guess I'll ask once I see the U of TN form....

Kathy

[littleone1]

Hi Kathy,

I paid $350.00 for Corky's adrenal panel. I pay about $250.00 for his stim tests, since Corky can't tolerate the gel and his IMS has to use Cortrosyn, which is more expensive than the gel. His last CBC, including a urinalysis, was $121.50. He didn't have to have the cardiopet or blood pressure done. His last T4 was $60.00, but he didn't have the full thyroid panel done. The pricing information that you were given is just about what I've paid.

Terri

[Squirt's Mom]

Hi Kathy,

The in-house ACTH tests only for cortisol levels. The UTK panel tests for cortisol plus the other five hormones involved in Cushing's. So if testing for one hormone, cortisol, costs $135 and testing for five more only increases that by $215 rather than $135/hormone....that's a real bargain! ;) And, this is one test you will be glad you had done, I promise.

$350 is a real bargain. UTK's charge for the panel is $140, then your vet tacks on their charges for the draws and supplies, including the stimming gel used, plus shipping, which is very meticulous. That's not bad at all!

I didn't see mention of an abdominal ultrasound. That is the next test for Cushing's I would have done, in fact, the UTK may recommend that one be done depending on the results.

Hang in there! You are doing a great job for Honey!
Hugs,
Leslie and the girls - always

[Kathy (Lulabelle)]

Thank you for the specific info on the different tests...good to know.

The vet tech called me today about the cardiopet-bmp & cbc & chem from IDEXX...she said there were a few elevated levels and that the cardio part was really high but that IDEXX couldn't double check to re-verify because the blood wasn't in the right container. She had spoken to them the day of the blood draw & was told it was "OK" to use a different container which is what she did...but now they want to do a new blood draw to submit to double check/re-verify with the correct container....which is OK by me (no charge for this). The vet should have the shipment of correct containers on Monday...she'll call me & I'll bring Honey in. She put today's results in the mail to me so I should have them tomorrow.

So spent part of this afternoon reading up on congestive heart failure. I've decided to wait for the rest of the test results before scheduling an ultrasound...looks like I might have a few more organs involved. Geez, and Honey's been so "normal" lately...no coughing, no lethargy, normal activity and she's been eating all of her breakfast/lunch/dinner...I thought maybe everything would just come back and say she's "fine". I know we all play this game with ourselves...before we actually get the test results, it's still OK to pretend that everything is "fine"....it's when we see it in writing that we KNOW.

I already have Honey on CoQ10...think I'll look into Taurine and possibly L-carnitine. I plan on keeping her "fine" for as long as humanly possible!

Kathy

[Harley PoMMom]

Hi Kathy,


I already have Honey on CoQ10...think I'll look into Taurine and possibly L-carnitine. I plan on keeping her "fine" for as long as humanly possible!

When I was looking into L-carnitine I found this website, don't know if it would interest you or not but here is the link just incase. :)
http://www.dog-health-care-information.com/heartdisease

Love and hugs,
Lori

[Kathy (Lulabelle)]

Thanks Lori! I've heard a lot about 5 Leaf but have never used their products...until now...just put my order in! :) Can't hurt, right? I'll run it by Honey's vet when it arrives.

Kathy

[Franklin'sMum]

Hi Kathy,

My little boy Franklin (almost 5) is on Co Q10, Taurine and Carnitine, (among many other goodies ;)). I figured if we start early, it may (hopefully, fingers crossed) head off any problems down the track that might occur with advancing age.

Hugs to you and Honey, and thinking positive thoughts,
Jane, Franklin and Bailey xxx
________
Yamaha tg77 history (http://www.yamaha-tech.com/wiki/Yamaha_TG77)

[Kathy (Lulabelle)]

These are Honey's blood results from IDEXX (blood drawn on 1/13/2010):

ALK Phos...........443..........10-150 HIGH
ALT....................102..........5-107
AST.....................31...........5-55
CK......................66...........10-200
GGT....................12...........0-14
Albumin..............3.4..........2.5-4.0
Tot Protein.........7.1..........5.1-7.8
Globulin..............3.7..........2.1-4.5
Tot Bilirubin.........0.1..........0.0-0.4
Direct Bilirubin.....0.1..........0.0-0.2
BUN...................21...........7-27
Creatinine..........0.7..........0.4-1.8
Cholesterol.......337..........112-328 HIGH
Glucose.............98...........60-125
Calcium............11.1.........8.2-12.4
Phosphorus.......2.5..........2.1-6.3
TCO2 (Bicarbonate).28...........17-24 HIGH
Chloride............105..........105-115
Potassium..........3.6..........4.0-5.6 LOW
Sodium.............149..........141-156
A/G Ratio...........0.9..........0.6-1.6
B/C Ratio...........30.........non given....HIGH
Indirect Bilirubin..0.0..........0-0.3
NA/K Ratio.........41...........27-40 HIGH
Anion GAP..........20...........12-24

WBC.................11.4.........5.7-16.3
RBC..................8.09.........5.5-8.5
HGB.................17.9.........12-18
HCT..................52.8.........37-55
MCV..................65...........60-77
MCH................22.1.........19.5-26.0
MCHC..............33.9.........32-36
Neutrophil Seg...71...........60-77
Lymphocytes.....22...........12-30
Monocytes..........4............3-10
Eosinophil............4............2-10
Basophil..............0............0-1
Auto Platelt.......509..........164-510
Absolute Neu....8094.........3000-11500
Absolute Lymp..2508.........1000-4800
Absolute Mono...456..........150-1350
Absolute Eos......456..........100-1250
Absolute Baso......0............0-100

Cardiopet pro-BNP..>3000........<900 HIGH

">2700: NTproBNP concentration is significantly elevated. Congestive heart failure is highly likely."

The urinalysis was done on 1/8/2010 from a first pee of the morning (The UC:CR was done from samples collected on 1/6 & 1/7/2010 by IDEXX):

USG: 1.026
PH: 5.5
Glucose, Bilirubin, Ketones, Blood, Protein: negative
WBC, RBC, Bacteria, Mucus, Casts, Crystals: None seen
Epi Cell: rare(0-1)
Urine Cortisol: 5.8
Urine Creatinine: 68.5
UC:CR: 26......<13.5 rules out hyperadrenocorticism; >13.5 indicates elevated serum cortisol, but may be adrenal or non-adrenal illness.

The Cardio part is going to be re-verified next week...I'm bringing Honey in for another blood draw on Monday. I'll bring in a urine sample for a culture due to the WBC of 11.4 (from my experience anytime the WBC is 10 or higher, there's been a UTI brewing).

Her BP was still elevated on Wednesday so the vet has increased her Benazepril to 3/4 5mg twice a day.

The full thyroid panel test results should be back sometime this coming week. The ACTH full adrenal panel results should also be back sometime this coming week.

She's currently taking: Denamarin(for medium size dogs...1 tablet per day for the last 1 1/2 months), Cholodin (1/2 tablet per day), CoQ10 (10 mg once or twice a day...not consistent). She still gets cooked egg whites daily, some cooked chicken/beef liver along with dry kibble (JM....Joint Mobility) and now 3/4 5mg Benazepril twice a day (prior to 1/13/10 it was 1/2 5mg twice a day).

I've ordered some L-Carnitine & Taurine for congestive heart failure support - will discuss with the vet next week.

I'm planning on an abdominal & chest ultrasound and the vet will probably request a chest x-ray to check for fluid build-up/enlarged heart.

Honey is eating well (a recent change that I thought was a good sign), she has no diarrhea, no vomiting...I have noticed some tummy grumbling in the later afternoon/night but she doesn't seem to be in any discomfort or even aware of it. Occasionally she has some potent gas. She's not lethargic -- still runs around outside like a happy puppy...still following me from room to room and napping next to me while I'm on the computer. I thought things had improved...I know, "treat the dog, not the numbers" but these numbers need some kind of attention.


Any thoughts/comments? Thank you so much for giving your time to my precious baby!!!

Kathy & sweet little Honey Bunny

[Squirt's Mom]

Hi Kathy,

I cannot read or interpret the lab results but I was wondering if there was any mention of a diuretic to help with any fluid that may be building up around the heart. CHF is alarming to me, but I don't know very much about it.

Louise told me the other day how a dog coughs, and it is nothing like I expected. They will sound like they are trying to get a hairball up, if you've ever heard a cat do that. They don't cough as we do, but more like a hair is in the throat. I do know that coughing is a sign for some heart problems, including CHF, so watch/listen for that hairball sound.

If the B/C ratio is BUN/creatinine ration, that can indicate kidney problems so you may want to have that checked out as well before it gets much higher.

Hopefully, our lab expert will along soon to help with these numbers and she will have much more info than I. ;)

The UC:CR is high and that can, but not necessarily indicate Cushing's....it simple indicates there is a problem of some sort and that further testing is needed to find out what/where. Hopefully the ultrasounds and xrays will provide some more concrete answers.

You are doing a superb job for your sweet Honey and deserve a huge pat on the back!

Hugs,
Leslie and the girls - always

[Kathy (Lulabelle)]

Thanks Leslie,

I've heard Honey "cough" ...being a Shih Tzu - this isn't unusual...but the last time was like 4 months ago (or so) so it's not something that's chronic. My Mom has congestive heart failure so I'm somewhat up on that condition...will be talking to the vet about a possible diuretic but I think we're basically waiting for ALL the test results before trying to address things "piece-meal" so to speak. I'm sure we'll be having a few more office visits and at least 1 other second opinion, possibly 2 before I go at everything "whole-hog". I know diuretics will not have a positive effect on the kidneys...but certainly will not let the CHF go untreated either! Right now my head is swimming in "print-outs" of numerous links...for a pup who basically acts "normal", my little Honey is causing considerable knowledge cramming on "Mommy's" part! LOL

Again, thank you for your input & observations!!

Kathy

[Squirt's Mom]

...my little Honey is causing considerable knowledge cramming on "Mommy's" part! LOL

That is certainly a familiar feeling! "Knowledge cramming" has become the norm for me over the last 2 yrs! It seems as understanding in one area settles in, a whole plethora of related tangents opens up that send my little mind on other quests with which to grapple. :p But I enjoy every minute of it!

Still hoping our lab expert will see this today. I know she can help you.

Hugs,
Leslie and the girls - always

[Harley PoMMom]

Still hoping our lab expert will see this today. I know she can help you.

Hugs,
Leslie and the girls - always

Debbie is our Lab expert here on the forum and I am sure she will be along shortly, but in the mean-time if you would like to look at this web site I go to for a generic look at lab assessments, here is a link to it:


Broadway Veterinary Hospital & Laser Surgery Center "These documents describe in greater detail some of the "assessment" portions of the lab work that you received from your doctor. Please keep in mind that these are general explanations of specific laboratory findings and have not been tailored to your pet."

http://www.broadwayvh.com/site/view/83223_AssessmentDescriptions.pml

Love and hugs,
Lori

[lulusmom]

Hi Kathy,

I just wanted to take a minute to comment on the labwork you posted. I've gone over Honey's results and I'm still not convinced that cushing's is at play. Honey has no symptoms and most dogs with cushing's don't come close to concentrating their urine to the extent that Honey did. To remind everyone, I believe her U.S.G. was 1.026. Every abnormality, including the UC:CR, can be explained by congestive heart failure and/or the benazapril. FYI, congestive heart failure is high on a list of nonadrenal illnesses that can yield a high UC:CR.

Have you joined a CHF support group yet? If not, you might want to consider doing so since the CHF is a priority. However, you can only join a CHF forum under one condition....you can't, I repeat, can't leave us. :D:D:D You're part of our community and you and Honey are part of our family now. Besides, why not have two resources and two groups of handholders available to you. I'm really not familiar with CHF forums but I know that there is a Yahoo group. Why not join, pick their brains and gain access some reference material.

http://pets.groups.yahoo.com/group/CanineCongestiveHeartFailure/

Glynda

[Kathy (Lulabelle)]

Thank you Lori & Glynda,

Yep, I've got the Broadway link already in my list of "favs"...but thanks for thinking of me.

Yes, the USG was 1.026 and her history over the last 3 yrs has been between 1.023 - 1.030 .

Not to worry, Glenda, you're stuck with me now! LOL Actually, I find it somewhat encouraging to think I might only be dealing with one condition for Honey and CHF would certainly hold the upper hand (priority)...again, showing no symptoms of that either. Maybe I'm just too early on all the testing -- wouldn't THAT be different. LOL I will look into the CHF group but, I know from recent experience, that all yahoo groups are not created equal -- this one is FAR above the other yahoogroups one (oops, I'm not allowed to say that, right?...I'll understand if somebody bleeps me out). I'd be more interested in looking at a CHF group that somebody can recommend from personal experience.

You guys are REALLY a family and I'm so comfortable here. Also -- your files are easy to access and everything is so well labeled (as a Moderator of K9Kidneys, I'm VERY jealous!! -- I've already given out your link to several of our members who have finally been diagnosed with Cushing's Disease). I've been doing a ton of reading and am actually retaining some of it -- becoming so much more Cushing's knowledgeable -- it'll only help to make me a better MOM to my other pups, should Honey not have Cushing's.

I spoke to my vet this morning (none of the other test results are in yet) and he says Honey's lungs sounded clear to him during the last visits (full exam on 11/25/09 and mini-exam on 1/13/10) and isn't comfortable prescribing any type of diuretic just yet but I should try to stay with a low sodium diet. Hopefully, by the end of this week, we'll have a handle on what's going on. I'll keep you all posted....and, again, thank you soooo much for your continued help & support -- this group is really wonderful!! :)

Kathy & my little Honey

[StarDeb55]

Kathy, I'm the lab expert that several of the other members have mentioned. I don't have a whole lot to add to what Glynda has already said, but want to re-emphasize a couple of her points. The congestive heart failure & blood pressure medication can pretty much explain practically all of the elevated results you have posted. Cushpups simply aren't able to concentrate their urine to the extent that Honey has shown, (SG= 1.026). The only other thing that catches my eye is the low potassium. I'm not sure of the effects benazapril on electrolyte levels (sodium & potassium), other than to comment that a large number of blood pressure & heart medications in humans do affect the potassium levels in the blood. This might be something to ask the vet about, the potassium is not terribly low but something to watch. Do you know if the potassium might be trending downward? Monitoring of electrolytes in any human or pet with cardiovascular disease is quite important.

When it comes to the alk phos levels, this is frequently the first abnormal lab that will clue a vet into looking at Cushing's. Honey's ALP level is really only moderately elevated as my 1st boy, Barkley, could have an ALP level between 1200-1500, even when his Cushing's was well controlled. Prior to diagnosis, his ALP level was approaching 2000. We have seen other pups in this group with ALP levels in the several thousands.

When it comes to Honey having few, if any clinical symptoms of Cushing's, I will tell you that any Cushing's savy vet will not want to treat a pup who is not demonstrating a clinical signs of Cushing's. Symptoms are a major part of making the diagnosis.

Right now, even if Honey truly had Cushing's, (& I agree with Glynda that I have strong doubts), the CHF is the absolute priority. I would get that under control, see how Honey is doing over several months. Once the CHF seems to be stabilized, IMO, for your piece of mind, you might want to consider repeating at least the UC:CR, & possibly an ACTH.

Please keep us posted. I'm always interested to hear how our Shih Tzu's are doing as my Harley is rapidly approaching his 15th birthday & the 2nd anniversary of his Cushing's diagnosis. (Tzu's are long-lived little devils;):p). Barkley, my 1st cushpup, was a Lhasa/Tzu mix. He was treated successfully for nearly 8 years, crossing the bridge at 15 years old.

Debbie

[Kathy (Lulabelle)]

Well, I've finally received all of Honey's last round of test results which, naturally, bring up more questions. I'd sincerely appreciate any/all comments/observations from the information below:

The Urine Culture showed a slight UTI and we are treating it with 250 mg Ampicillian for 14 days.

The complete Thyroid panel showed nothing out of the normal range -- nothing was low/normal of high/normal -- basically all smack in the middle range of "normal".

The re-test of the Cardiopet BNP was 2950...so basically the same as the first one at >3000. Honey is scheduled for a re-test of BP next week along with new chem screen blood work. I am still considering the echo cardiogram but need to pay off this latest round of vet bills before starting any add'l major testing.

The results for the Cortisol and full adrenal panel from the U of TN in Knoxville, TN is what really has me stumped -- this is where I'd really like your opinion as how to view the results:

Test.................Result.......Normal Range**..Post ACTH.....Normal Range**
.......................Baseline
Cortisol...........36.6.......21.1-58.8...............138.5........65.0-174.6
Androstenedione..1.67*...0.05-0.57...........>10.0*.......0.27-3.97
Estradiol..........87.5*......30.8-69.9..............73.5*........27.9-69.2
Propesterone...0.15........0.03-0.49.............1.62*........0.10-1.50
17OH Progesterone..0.26...0.08-0.77..........4.87*.........0.40-1.62
Aldosterone***....11.0......11-139.9..........<11.0.........72.9-398.5
* Above or below reference range.
**Mean normal range values for spayed female dogs (N=36). QNS = Insufficient sample.
***Normal range values for male and female dogs (N=72 baseline, N=23post-ACTH)

These results : indicate presence of increased adrenal activity and indicate precense of adrenal hypofunction.

Comments: Values are increased as indicated. The aldosterone levels would indicate a primary Addisonian condition, although low aldosterone levels are also seen in the presence of a primary adrenal tumor. Consider items 1 through 5 on the treatment option sheet attached. Item 8 would also be a consideration.

1) Ultrasound and/or Endogenous ACTH. Procedures to rule out primary adrenal tumor presence.
2) Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or Internet.
3) Melatonin Implants
4) Lignan. Use lignan from Flax Seed Hulls (or HMR lignan)
5) Maintenance dose of Lysodren
8) Ketoconazole - Alternative Cushing's disease treatment.

I have an appointment with my vet to further discuss/review all of the above but we did have a brief telephone conversation (I had not yet had time to seriously review all the test results). Basically, he's not "in favor" of any of the recommended options at this point but has nothing against #1,2 & 4 but is against #3 & 5 & 8. His comment about #1 is that while an ultrasound would be of interest, if Honey has an adrenal tumor, he wouldn't be recommending surgery at her age. I was left with the impression that he, as well as 3 other vets within their office, feel, in Honey's situation, it's best to do "no treatment" at this time.

I am CLUELESS what these results imply...is Honey on a fine line between Addison's and ATypical Cushing's??? Personally, I would like to KNOW if she has an adrenal tumor but will need to review current expensies (I have 3 other larger breed geriatric pups who also receive medical attention at home). I need to understand how serious Honey's rsults indicate. Do these numbers confirm that she has ATypical Cushing's??? If we go with "no treatment", what should I be on the look-out for? What testing should be re-done on what type of time schedule in the future? With so few symptoms showing, how could I assess if Melatonin is helpful or not?

As a refresher: Honey, canine, Shih Tzu, 15 y/o, ~16 lbs., F/S,
High BP(2.5 mg Benazepril BID, 10 mg CoQ10 BID),
hip dysplasia, low vision, hearing impaired, 1/2 Cholodin SID, 225 mg Denamarin SID; Merrick's Working Dog Stew, Joint Mobility prescription kibble, cooked egg whites, cooked dark meat chicken/chicken liv...
..current blood work was previously posted. Her UC:CR was 26 on 1/8/10.

Thank so very, VERY much for your time and involvement with my Honey as well as all the other members here -- it's a blessing to know I'm not facing all of this alone! I also want to thank you for advising me to have the full adrenal panel...a straight ACTH test wouldn't have told me what I was looking for....so any re-testing of ACTH in the future won't be worth it either, right? I'll have to always have the full adrenal panel done, right?

Thank you, thank you, THANK YOU --- I'd really be flipping out if I didn't have you guys to bounce this all off cause my brain isn't straight on sooo much of the stuff I've read recently. Cushing's is one VERY complicated condition, IMO.

Kathy with my little Honey Bunny

[Harley PoMMom]

Hi Kathy,

I know the "others" with much more knowledge than me will be along to share their wisdom with you but I wanted to add this post from Glynda that I found very informative. Leslie was asking which one; melatonin or lignans, worked on estradiol:


Geeze, Les, you might as well ask why the earth is round. :D You cannot believe how many times I've read the UTK info on this and how many times I've accessed the dictionary to try to understand all the big words. One big word begat another big word and so on and so on until my eyes roll back into my head and I start cussing. There is no way that I could ever explain the actual process by which those six adrenal hormones magically appear but I'll try to give you a quick and dirty that I hope you can understand. So here goes nothing.

Aromatase is an enzyme that is involved in the production of estrogen. It acts by catalyses (big word – look it up) the conversion of testosterone to estradiol, which is an estrogen by the way. Aromatase enzyme is located in the estrogen producing cells in the adrenal glands, ovaries, placenta, testicles, fat tissue and the brain. Note to self: Lysodren only targets the adrenals so it has no effect if the estradiol is being produced in the latter five areas of the body. Melatonin, a naturally occurring hormone in the body that we cushdog parents buy in a bottle, is an aromatase inhibitor. UTK always recommends Melatonin and phytoestrogen treatment when estradiol is elevated. [Phytoestrogens, sometimes called "dietary estrogens", are a diverse group of naturally occurring non steroidal plant compounds that, because of their structural similarity with estradiol (17-β-estradiol), have the ability to cause estrogenic or/and antiestrogenic effects] Lignans, found in the flaxseed, has the highest concentration of phytoestrogen found in plants. Lignans is also an aromatase inhibitor and with its phytoestrogenic activity, competes with estradiol for tissue estrogen receptors. So the quick answer to your question is if estradiol is elevated, UTK recommends both Melatonin and Lignans

21 hydroxylase is an enzyme which is involved in the biosythesis of aldosterone and cortisol. Melatonin inhibits the 21 hydroxylase enzyme.

3-beta-HSD is an enzyme which catalyses the synthesis of progesterone from pregnenolone, 17-hydroxyprogesterone from 17-hydroxypregnenolone, and androstenedione from dehydropiandrosterone in the adrenal gland. Note: the synthesis of all six adrenal steroids requires 3beta HSD. Melatonin and lignans inhibit 3-beta-HSD

So there ya go.

Glynda

Now, when Harley's had his last full adrenal panel done his Aldosterone was very elevated, Aldosterone is the hormone that balances the electrolytes in the pups body, and I was very concerned so his GP called Dr Oliver and he told her that as long as Harley's electrolyte level numbers on his chemistry panel come back fine then not to worry. We have members here that have pups that had the full adrenal panel and their Aldosterone levels have come back very low, like Honey's, Terri's Corky for one, she spoke with Dr Oliver herself and he told her the exact same thing that he told my GP.

Hope this helps.

Love and hugs,
Lori

[Squirt's Mom]

Hi Kathy,

An emphatic YES! Honey is Atypical! Her cortisol is well within normal range on both pre and post so she is pure Atypical.

Does she need to start treatment, another emphatic YES! And I agree with your vet for the most part - #'s 1,2 and 4 for now. I do disagree with him on the ultrasound tho. To me, this is one of the most important tests our pups can have and tho I do completely understand since no action would be taken if a tumor was found to remove it, there would still be things to learn and perhaps other options to consider based on what the U/S found.

For now, you will want to get regular melatonin, not the time released, extended, fast release, etc...just plain melatonin in the 3mg dose. The hulls are a good thing to use as are some of the purified capsules, but steer clear of FSO - flax seed oil with lignans. If you need help finding sources, please ask and we will help you.

It can take several months to see any improvement with the treatments for Atypical so don't get discouraged. As for retesting, you will want to have that done in about 4 months unless something comes up. I would hold off on trying the Lyso for some time, giving the melatonin and lignans time to work. Since estradiol can be produced in areas of the body other than the adrenals, Lyso is sometimes needed to get that hormone under control using a maintenance dose only...no loading.

You are doing GREAT and now that you have a diagnosis and a plan to follow, things will get better for you both.

Hugs,
Leslie and the girls - always

[lulusmom]

Hi Kathy.

Thank you for posting the UTK adrenal panel results. I have not changed my mind and still feel that all the abnormalities, including the adrenal panel are likely a result of the CHF and the Benazepril. Adrenal tumors can cause a decrease in aldosterone but based on all other factors, I'm more inclined to believe that the decrease is being caused by the Benazepril. Benazepril is what is called an angiotensin converting enzyme (ACE) inhibitor and studies have shown that ACE inhibitors have a direct effect on adrenal cortical function, in particular it can cause an acute decrease in aldosterone levels.

Usually when a dog is diagnosed with atypical cushing's, the dog has some serious overt symptoms, including coat and skin issues. Honey just doesn't have any of the symptoms we're used to seeing so with all things considered, I'm inclined to agree with your vet on all counts. I'm not sure I'd spend the money for an abdominal ultrasound, especially since you and your vet have decided that neither surgery nor treatment with Lysodren would be an option anyway. Yes, an ultrasound would give your vet a good look at the surrounding organs in addition to the adrenals but again, if something were to be discovered, would you opt for surgery on any of the other organs either?

Melatonin slows a dog down and our senior babies are already running low on batteries so I'd be hard pressed to opt to treat for atypical cushing's in the absence of symptoms. Some members may very well disagree with me but that's my two cents worth.

Glynda

[Squirt's Mom]

Hi Kathy,

After reading Glynda's reply, I skimmed back through your thread and didn't find where you state any of Honey's signs; of course, it is entirely possible I over-looked them, too.

I did see where I gave you Kate Connick's site, tho. This is her list of signs seen in cush pups:

*From Kate Connik*

"The most common symptoms include:
• increased/excessive water consumption (polydipsia)
• increased/excessive urination (polyuria)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (polyphagia)
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• bony, skull-like appearance of head
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled, fragile, and/or darkly pigmented skin
• easily damaged/bruised skin that heals slowly
• hard, calcified lumps in the skin (calcinosis cutis)
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html

Can you tell us which, if any, of these things you have observed in Honey?

As much as I respect Glynda, I want to comment on this statement based on our experience:


Usually when a dog is diagnosed with atypical cushing's, the dog has some serious overt symptoms, including coat and skin issues.

Squirt is Atypical and didn't have many signs at all. Those she did have were mild and not constant. She isn't the typical cush pup, tho. Her original diagnosis was PDH, then PDH with elevated intermediate hormones; later a non-adrenal tumor was found and removed, and she is now simply Atypical. Even through all that her coat and skin have remained good and she never had the pot-belly. However, she wasn't on any prescription meds at the time either, so that may well make a difference.

If Dr. Oliver wasn't aware of the med Honey is on for her heart, her age, etc., it would be worth it to contact him yourself, explain things in a bit more detail and ask his input. He is a wonderful man and has been really good about getting back to us when we write him.

Hugs,
Leslie and the girls - always

[Kathy (Lulabelle)]

Hello to all,

I can get the Melatonin from Puritan's Pride and the Lignan from www.flaxhulls.com

Are these reputable suppliers?

I'm in the process of putting together a (lengthy) email to Jack Oliver from U of TN about Honey, including all blood work & urinalysis results from the last couple of years and the current test results as well, including what little symptoms Honey exhibits and what medications she's taken.....is there anything else I should include?

From all the reading I've done, I have doubts that Honey is a "true" ATypical Cushing's patient....seems like more of adrenal imbalance possible caused by unknown origin. Maybe medical knowledge hasn't progressed far enough yet, but I understand they have to "call it" something and ATypical Cushings probably comes the closest. I want to double check that giving her these 2 supplements certainly can't cause any harm at this point.

Any thoughts, input about the supplements or anything at all? I can't tell you how much I've learned from all your files & links and comments! "Thank you" simply isn't enough!!!!!

Kathy

[StarDeb55]

Kathy, I would not start treatment until you get a response from Dr. O. When it comes to sources, a number of us do use the flaxhulls from flaxhulls.com. This is what my Harley has been using for close to a year & has had no problem with it. The melatonin you can get from anywhere, you just don't want timed or extended release. I get mine at Target.

Debbie

[Kathy (Lulabelle)]

Just a quick update....I had Honey's BP checked again on 2/1/10 and it's STILL high. I had a chem screen blood test done and should have the results by Wed...didn't want to increaese/change BP meds until I know what it's doing to her blood levels already.

Also -- I have an appointment for an ultrasound and Echocardiogram & another re-test on the BP (I figure it doesn't hurt to have it donw by a different person & different equip) on Thurs 2/4 . Will let you know the results. I have not started any supplements for addressing the ATypical Cushing's yet (although I did order them).............there have been no new symptoms/changes with Honey.

Thanks for being here for all of us "newbies" .

Kathy with my little Honey

[Kathy (Lulabelle)]

Hello All,

I'm thinking you may have thought you lost me, but it's just that some things seem to take a whole longer than I'd like. Anyway...Honey had her Ultrasound and Echo Cardiogram. The Echo showed nothing indicating CHF (very little leakage but the Cardiologist said he wouldn't recommend any treatment...no murmur). The Ultrasound showed an assumed benign tumor in her gall bladder near the bile duct but not blocking it (yet) and a tumor on her right adrenal gland. So I wrote back to Jack Oliver at the U of TN with copies of EVERYTHING from the last couple of years and asked for input. Tonight, this is what I received from him:

"Hi Kathy,

I have just finished reviewing your historical documents regarding “Honey”. Honey does obviously have increased adrenal activity and elevated hormone levels that are likely coming from the adrenal tumor. Clinical and biochemical signs associated with hyperadrenocorticism in dogs include some of those that you listed, including: including the problem that has been ongoing with high blood pressure, which likely is also associated with the microalbuminuria. Getting the hormone levels down will undoubtedly improve controlling the blood pressure. Benazepril probably has minimal effect, if any, on the hormone levels. The high blood pressure problems over time could very well mean this tumor includes a pheochromocytoma component. If possible, and you would agree to this, I’d like to have a blood sample collected and have catecholamine levels run on “Honey”. This would confirm that a pheochromocytoma is, or is not, present. It does take a special preservative that must be in the blood draw tube that I would have to supply to your veterinarian. My theory has been that low aldosterone levels in dogs with a primary adrenal tumor have a pheochromocytoma component that secrete the catecholamines (epinephrine or adrenalin) that the cause the high blood pressure. The other hormones that are elevated come from a different part of the adrenal gland. One problem with pheo’s is that they can grow fairly rapidly, and also metasticize to other tissues such as the spleen and liver. If you thought you would like to maybe have this test run, I could talk to your veterinarian about doing it (I’d need the vet’s phone number). There would not be any charge associated with doing this, since the test has not been run. Actually, the only place that I know of in the U.S. that runs this is the hormone assay lab at Vanderbilt University that only supports their researchers. The lab director has agreed to run samples for me, but strictly as a research project. After a sample is collected, then treatment should begin. I’m not real clear about the best treatment, but maybe a combination of melatonin, lignan and ketoconazole. I could discuss that with your veterinarian as well.

Let me know what you think of what I’ve said above. Regards, Jack."

I spoke to Honey's vet this evening and he's willing to do the blood draw at no charge for this. As long as further testing doesn't case any harm to Honey (& I don't have to mortgage the house!), I believe I should progress plus, if Honey can help any further research, then that's a good thing as well. I do not want to simply increase the BP meds as I believe they will only cause possible damage to other organs. I certainly don't "want" to hear that she's got cancer but I "want" to "know" so I can do whatever possible to keep her comfy.

BTW... I had her to the vet (this was a different vet -- I use 2 different offices - 1 for the "routine" items and 1 for more serious stuff - the expense difference is mind boggling!) today for a torn toenail (she was lame yesterday and obviously in pain) so now she's on Clavamox...the toenail was pulled out and may or may not grow back but she's feeling better - no pain meds. I still have not started any supplements for the ATypical Cushing's but they're here, ready to use. I did have new blood work done today in preparation for changing BP meds (she's due to have it re-tested next week) and will recieve the results by Wednesday.

It's been a while since I posted, but I believe this is enough "new news" and wanted to keep you up-dated and would love to hear any comments/thoughts. Honey is still acting like the happy puppy she is...still eating & drinking well....good activity level.

Thank you so much --- I need help in understanding all the "long words" so I'm off to "google" now.

Kathy & my precious little Honey (15 yr old, spayed/female, 16 lbs Shih Tzu)

[Roxee's Dad]

Hi Kathy,
Thanks for comming back and updating us. I continue to be very impressed with Dr. Oliver. For him to take the time to go through Honey's information and reply back to you makes him a saint in my book.


I believe I should progress plus, if Honey can help any further research, then that's a good thing as well.

I hope and pray all goes well with your Honey and Dr O's theory. I am also impressed that Dr O, your vet and Vanderbilt have agreed to do this research at no charge.

Please keep us updated.

Belly rubs to Honey. :):):)

[Kathy (Lulabelle)]

Thank you ! I was pretty impressed as well....Dr O really makes ya feel like you're a "somebody" and that Honey isn't just a number on a file. He spoke with my vet today and all is set in place to proceed with his "mini-research" project.

I do have a few questions about the treatment plan....giving Honey: 3mg of Melatonin twice a day, Flax Hull Lignan 16 mg once a day and Keto 1/4 of 200mg pill twice a day ---- what (if any) changes in Honey might these cause (other than hopefully lowering her BP levels)...positive and/or negative?

Kathy & my little Honey Bunny

[Squirt's Mom]

Hi Kathy,

What great news that Honey will be able to help further research in this area! Especially great news that you will be able to learn something about her condition....and it won't cost an arm-n-a-leg! :cool::p As a friend here told me early on, "more information is always better."

With the treatment for Atypical you may see some digestive upset when the lignans are first started, they are high in fiber and could cause some problems. You could start her off with a lower dose and build up to the appropriate level is she is prone to those type issues. If Honey doesn't seem to adjust pretty quickly, talk to your vet. Squirt has had no problems with the hulls and she sometimes has a finicky tummy and gut.

The melatonin may cause Honey to sleep more than is usual, especially at first. It has a mild sedative-like effect and is often used in humans to aid in sleep. I take it myself from time to time. It has caused Squirt's hair, especially the undercoats, to really thicken, and I am about to decide it is responsible for her nails that grow so fast and so hard....but that is just my mind fiddling around....no research or proof on that one. ;)

If you start the Keto, you will want to keep a close watch on her liver enzymes as Keto can be rather hard on the liver. I have used Keto for Crys when she first came home but it was for her skin issues. It made me uncomfortable but primarily because of her overall health status, which was not good, so she didn't get much of it. We do have some members here who use Keto to treat Cushing's and hopefully they will along to share their experiences with you.

At the moment, that is all my mind has to offer on what you may see with the treatment. The lignans and melatonin really are a much easier, less stressful treatment than Lyso or Trilo. You will do just fine, Kathy, just fine!

Hugs,
Leslie and the girls - always

[Kathy (Lulabelle)]

Thanks Leslie,

How often/soon do you think I should recheck her liver levels once I start the Keto...is there any reason to do a full blood panel or is it really OK to do the abbreviated levels as long as it includes AST, ALT, ALP, Total Bilirubin, GGT, Cholesterol, Proteins & Albumin?

Is giving the Melatonin right before bedtime a good idea then? Is it OK on an empty stomach?

I will start the Lignan slowly...she hasn't had problems in the past but I don't want to start any either. She does have some nasty gas once in a while (so I've started FortiFlora).

With the treatment of these 3 new items, it there a chance that Honey could go into an Addison's situation? This thought really scares me but I can watch her like a hawk as I'm currently not working.

Kathy

[Squirt's Mom]

Hi Kathy,

As far as I know, there is no reason to fear Addison's with the melatonin and lignans. With the Keto, I am not sure about that.

I would ask my vet about how often to test with the Keto but I would think just the pertinent values could be checked, however, I have no idea how those things work so your vet could tell you more about that for sure. Here are some links found in our Resource Section that can tell you more about Keto:

http://www.marvistavet.com/html/ketoconazole.html

http://www.drsfostersmith.com/product/prod_Display.cfm?siteid=13&pCatId=9728

In doing some reading just now, it does appear the Keto can cause an Addisonian crisis:

From DVM360:
http://veterinarynews.dvm360.com/dvm/Medicine/Testing-for-Addisons-disease/ArticleStandard/Article/detail/574393?ref=25


Primary adrenal failure may be caused by a number of drugs, including mitotane, trilostane and ketoconazole. Adrenal suppression caused by ketoconazole and trilostane is reversible in most cases...

Squirt gets 6mg of melatonin a day - 3mg in the am with breakfast (and the lignans) and 3mg at nite with supper (no lignans). This has worked well with her and with our schedule. I mix hers in the food as she is on a home cooked diet and it is plenty moist enough. If Honey is on kibble, try wrapping the melatonin in some cream cheese. You might mix the hulls in with some plain low-fat yogurt or cottage cheese and putting that as a topper on the kibble. Squirt has had both melatonin and lignans on an empty tummy with no adverse reaction. The lignans at that time were purified and in a capsule form, tho.

Hope this helps and doesn't confuse you more.

Hugs,
Leslie and the girls - always

[Kathy (Lulabelle)]

Hello,

I haven't heard back from Dr O @ the U Of TN yet....but I've got a couple of quick questions....

1. Is there a good way to "hide" the Fall Hull Lignan's?

2. This isn't related to Honey but are there any known concerns about Wickliffe's Trilostane product? I have a friend who recently started with this product and just wanted to double check with people "in the know". I believe I recently read that a different brand did have concerns ("Wedge" something or other??)

Thank you all! :)

Kathy

[lulusmom]

Hi Kathy,

1. I mixed the pressed flaxseed powder into my dog's food and it was never a problem. If you are having a problem with it, you can try getting the large sized pill pockets and mushing it up in the pocket. This has always worked for my dogs. If that still doesn't work, you may consider going with the purified lignans in capsules which are easily hidden in creamcheese or peanut butter. I think any number of members can give you the information on where to find those. I am having a senior moment and cannot remember.

2. I think what you are talking about is the compounded version of Vetoryl which is called Trilostane. Wycliff and Wedgewood are both compounding pharmacies so this makes sense. I purchased my compounded Trilostane from Diamondback Drugs and never had a problem. As I recall, we may have had one member who had a problem with compounded Trilostane but I think they figured out it was a filler, not the drug itself.

[AlisonandMia]

As I recall, we may have had one member who had a problem with compounded Trilostane but I think they figured out it was a filler, not the drug itself.

I think it was actually compounded Lysodren that caused the problem but it could have just as easily been trilostane (or anything else) as it was indeed the filler or more precisely a coloring that was added. I think it was probably compounded locally at the direction of the treating vet rather than being prepared by one of the larger compounding companies like Wedgewood, Wycliff or Diamondback and I've never heard of any of those type of companies adding colors etc.

As I recall, there have been cases where a compounder has been investigated by the FDA not necessarily because of actual problems with a product but because of some possible irregularity with sourcing the raw product. That is just my recollection though - so don't quote me on that! Marianne (Labblab) will almost certainly be clearer on that.

Some people seem to have problems with liquid formulations but then again other people have found liquid formulations to be wonderful. Liquids don't keep that well either which can be a factor.

Alison

PS: Actually:o, here's a link to trilo information which includes info on compounding: http://www.k9cushings.com/forum/showthread.php?t=185

[Kathy (Lulabelle)]

Hello to all. I wanted to give you an update...I finally heard back from Dr. Oliver fr the Un. of TN...their latest blood work test on Honey is showing no cancer in regards to the adrenal tumor. I had her BP recently tested and had the tech come out to the truck to do it -- it was much improved! When we went into the office for her exam, it was back up so Honey is a classic case of "white coat" reaction, I guess...lol

I've continued the Melantonin twice a day and have started 1/4 tablet of 200 mg Keticonozole twice a day. Still having trouble getting her to eat anything I mix the fax hull Lignan with though. She still has the short bouts of panting but, other than that, seems like her happy little self.

So, we continue on...............thank you all for your previous help and wisdom :)

Kathy with my little Honey

[ohh]

Hi Kathy,

I'm new to this site (today) and I read some of your posts regarding Honey..I'm happy to read she's acting like herself, she sounds like a delight! After all I've gone through with my dog Brophy, it's a relief mentally and physically when they seem to improve.

I noticed that Honey wasn't showing major signs of Cushing's, she is also taking Denamarin and Benazepril. Brophy is taking the same plus a few more, and I've also just started him on the Merrick food. His appetite has been pretty good.

Well, I just wanted say hello, and I'll continue to follow you and Honey, since our dogs sound slightly similar in a few ways.

Onalisa and Brophy

[Kathy (Lulabelle)]

My Honey is an ATypical Cushing's pup who, I believe, now needs her gall bladder removed. The follow-up ultrasound is next week but I'm trying to get as educated about this surgery as I can now -- trying to prepare for what decision I should make in her best interest. She's 16 years old and has beautiful blood work/urinalysis except for all the liver levels. The previous US showed a tumor in her gall bladder but it wasn't causing any blockage at that point -- I'm thinking it's starting to be a more serious problem now. Has anyone had this surgery done? Everything I've read after Googling is soooo "general".

Thank you for any information you can share.

Kathy with Honey

[Bichonluver3]

Hi Kathy!
Welcome to our family. My Chloe has Atypical Cushings but we have not encountered the gallbladder problem (except I had mine out last September!). However, Chloe & I wanted to welcome you & Honey. Someone will be along who can give you the advice you are looking for. We are all here to support the two of you.
Love & hugs,
Carrol & Chloe

[Kathy (Lulabelle)]

Thank you for the warm welcome but actually we are not new members. We joined last year when Honey (16 yr old Shih Tzu) was first diangosed with ATypical Cushing's. This group was extremely helpful and supportive and I thought I would check to see if anyone here had any experience with gall bladder removal surgery. Nothing is certain yet as the next ultrasound will give me more to go on -- I'm just trying to get a jump on my research befoe my emotions start to take over...

Kathy with Honey

[lulusmom]

Hi Kathy,

I have merged your latest posts with your original thread so as to keep all of Honey's information in one place. My dogs have been through a lot of procedures buy gall bladder removal isn't one of them so I can't help you out there. Hopefully, another member has gone through this procedure and can share their experience with you.

Glynda

P.S. Sometimes our original threads are difficult to find so I'm going to send you a PM with a link to this thread. Save that link as a favorite, or bookmark it or just refer back to my PM and click on it.

[Cushpup]

My Honey is an ATypical Cushing's pup who, I believe, now needs her gall bladder removed. The follow-up ultrasound is next week but I'm trying to get as educated about this surgery as I can now -- trying to prepare for what decision I should make in her best interest. She's 16 years old and has beautiful blood work/urinalysis except for all the liver levels. The previous US showed a tumor in her gall bladder but it wasn't causing any blockage at that point -- I'm thinking it's starting to be a more serious problem now. Has anyone had this surgery done? Everything I've read after Googling is soooo "general".

Thank you for any information you can share.

Kathy with Honey

Kathy,

I had my 15 yo Shih Tzu PTS Feb 28th while doing and exploratory surgery because we found cancer of the Gallbladder spreading to the Liver. The gallbladder was 'missed' on the Ultrasound by a BOARD CERTIFIED RADIOLOGIST. My babys' GB was huge and not emptying. The irony is that her Biliruben was normal, and her stools were BROWN. Go figure. Although, it was huge on a regular radiograph....

Regardless of the Ultrasound, my GP and I decided to go after that golf-ball density on the regular radiograph.
I was in the room during the exploratory surgery. The Vet took out each organ and we discussed it.

Here's what I know about the gallbladder (its connected from the Liver to the small intestine by tubes):
-GB gets the bile from the Liver
-GB contracts and spills bile into the small intestine for digestion, breaking down the 'fats'.

-the Biliary Connection goes like this: GB is attached to the Liver. Then the GB is attached by a tube, going through the Pancreas into the Small Bowel(Duodenum), right where the stomach empties.

Many Vets think that the dog is having Pancreatitis, when in essence it could be having either (Pancreatitis or GB problems). My own theory is that one of many functions of the Adrenals is the fat distribution and that is why the GB/Liver/Pancreatitis are strangley affected in Cush dogs. IMO, the inappetence is different in a GB vs Pancreatitis dog (here they can but not often loose their appetite). In a GB problem it's more like they want to eat, but cannot. They stop eating abruptly.

My understanding is that some dogs (50%) survive the GB surgery but it's a tough go if there are other complications...cancer, Cushings, Blood pressure...ect.

Here's why I had to let my baby go (GB):

We could have attempted to take it out and see, but here were the problems:

-She had Cushings. That means she had a greater chance of getting Pancreatitis. The GB breaks down the FATS. Now we wouldn't have that organ, so the fats would not be digested, and that would inflame the Small Intestine and Pancreas....like constant Pancreatitis. M-a-y-b-e Carafate or Pepsid would help. M-a-y-b-e she would get some appetite back. The diet would be a constant struggle. Foods would not be digested well.
-Her Lymph nodes by the Liver were inflamed (ca spread to the Liver).
-The small intestine(Duodenum) had a wall thickening for about 6-7 inches; It was swollen. Removing the GB and attaching the bile duct from the Liver to the SWOLLEN Sm Bowel was nearly impossible.

Also, this told us that for a while no bile was getting into the small intestine and that is why it was inflamed and that is why she intermittently vomited/loose stool, no matter what I fed her (Sweet Potato/baby food). Beef as opposed to chicken made it worse (more fat in it). She was in pain.
-The blood supply in the liver could have thrown her BP high.

Knowing and seeing all this allowed me to make the best decision for HER. I am not telling you to do that. I'm just sharing my experience.
Good luck with your baby.
M

[Kathy (Lulabelle)]

Glynda -- Thank you so much for steering me in the right direction!!


M -- I can't thank you enough for sharing this with me. I'm certain it wasn't easy to do -- my deepest sympathy on your loss but honeslty believe you DID make the best decision for her...even though it was the most dreadfully painful one for YOU.

Right now, Honey's Bilirubin is also well within the noraml range and her stool is also brown...I've kept a close eye on this over the past year -- waiting for it to turn lighter/whiter but that has never happened. The mass that was seen in the ultrasound in Feb 2010 was suspected to be cancerous & I tried to come to terms with losing her within a few months -- that hasn't happened either. She eats well enough but I feed hardly any fat (I home cook all the time for her for the last year). She shows no signs of pain and I DO look for any possible signal. But she has nasty gas that hasn't been controlled with numerous different attempts.

Anyway, it sounds as though I really need to control myself and wait for the ultrasound...patience has never been one of my strong points when it comes to finding out information. But you've given me an insight into things I had not considered and I thank you very much for that.

I will be back after the ultrasound to give you the outcome...and maybe it'll be something entirely different...........

Again, I'm so deeply sorry for your loss...you're truly a very special person to reach out for me and re-live those painful memories.

Kathy & Honey

[Cushpup]

Glynda -- Thank you so much for steering me in the right direction!!


M -- I can't thank you enough for sharing this with me. I'm certain it wasn't easy to do -- my deepest sympathy on your loss but honeslty believe you DID make the best decision for her...even though it was the most dreadfully painful one for YOU.

Right now, Honey's Bilirubin is also well within the noraml range and her stool is also brown...I've kept a close eye on this over the past year -- waiting for it to turn lighter/whiter but that has never happened. The mass that was seen in the ultrasound in Feb 2010 was suspected to be cancerous & I tried to come to terms with losing her within a few months -- that hasn't happened either. She eats well enough but I feed hardly any fat (I home cook all the time for her for the last year). She shows no signs of pain and I DO look for any possible signal. But she has nasty gas that hasn't been controlled with numerous different attempts.

Anyway, it sounds as though I really need to control myself and wait for the ultrasound...patience has never been one of my strong points when it comes to finding out information. But you've given me an insight into things I had not considered and I thank you very much for that.

I will be back after the ultrasound to give you the outcome...and maybe it'll be something entirely different...........

Again, I'm so deeply sorry for your loss...you're truly a very special person to reach out for me and re-live those painful memories.

Kathy & Honey

Thank you.

A LOT of GAS is a sign of something not functioning properly within the digestive tract. The Radiologist said that gas makes it more difficult to see things on the Ultrasound.The IMS (Feb 16, 2011) thought she had IBD. Sure she did, but WHY? Her digestion was messed up from the GB not functioning. That's why his diagnosis didn't sit well with me. In his defence, he looked at her US report and her bloodwork and that's the only logical conclusion he could come up with. I asked what about her inappetance-he didn't know. It's a good thing I didn't stimulate her appetite (something told me not to). Her GB could have burst...

Mine had a small problem for 4 weeks back in September 2010. Her appetite was waning for no reason. She didn't have Pancreatitis. Although her stool had some softness and mucus. Anyway, I thought it was the new bottle of Trilo causing it. Then I thought she needed a dental because her appetite was strange. She would eat smaller pieces. Coincidently things got better after the dental. In retrospect it was a GB attack and bad digestion. She had some gas back on Sept Xray, but not bad. Now, in Jan & Feb 2011 she had A LOT of gas. When it got bad, she would have noises in her belly and she would burp (just like people when they have GB problems!). Between Sept 2010 and Jan 2011 she was totally fine;no pain, playful, eating very well. I'm describing this so you could see how resilient and tough Shih Tzus are. By the time they show distress, they are pretty far gone. I've had other Shih Tzus and they are tough little cookies ;)

The Biliruben and stools being normal threw us off. Only the Liver enzymes being off is consistent with Cushings, and that is what the Radiologist impressed upon - it must be the 2 nodules on the adrenals throwing numerous signals to the brain and her Cushings is off.... If either the Bili or color of the stools would have given us a hint we would have known right away that the Radiologist missed the GB.

For Honeys' sake:

-Make sure that the Radiologist has the latest US machine, a high resolution one. They make NEW and better US machines every year.
-TELL him to get a good look at the BILIARY TUBES(the tubes that connect the liver,gb, pancreas, and small intestine), the Gallbladder, and the Liver. Don't settle. Be persistent. Have your questions ready.You are paying good money for this test.

Ask your Vet to palpate her cranial aspect of the Abdomen. The key is to DIG IN deeply, not just feel her. If it's painful, you have your answer-it's the GB.
In the meantime, Milk Thistle and Flagyl(Metronidazole)may help the digestion. It will kepp her more comfortable. Ask your Vet for Flagyl. The maint. dose is 10-20mg/kg per day. 1kg=2.2lbs.