Bonnie needs help (MishMish 2½ year old dachshund)

[papaoats]

Moderators Note: Hi Bonnie, :) I copied your post and started a new thread for you so members can respond directly to you. This will be your and MishMish's thread.


Hello Karen

My name is Bonnie. I came across this thread and wanted to contact you to see how you dachshund is doing? I have a 2 1/2 year old dachshund and I noticed him drinking more water and peeing more over the past 10 days. I also noticed a big beer belly so to speak.
I took him to the vet today and they noticed an enlarged liver through an xray. Blood was drawn and I will find out tomorrow if he has Kidney issues, Diabetes, Thyroid,etc....or maybe need tests for cushings.
can you fill me in oh how your experience has been? I feel sooooo very sad for him. The Vet told he his liver is enlarged and pressing on his organs and I can'r bear to think of how much pain he is in...if any at all.

I feel so lost as far as diet, and life style with him. I don't know what I did wrong and what to do going forward.

Any literature you recommend or any meds?

Thanks you so much!

[papaoats]

Thank you so much! My Dachsy's "MishMish" and I are waiting and ready to learn all we can.

[lulusmom]

Hi Bonnie and welcome to you and MishMish.

Two and half is pretty young for a cushdog but I happen to have a cushdog that was diagnosed at 3 years old and her specialist felt she went undiagnosed for at least a year. It's a rare occurrence but there are reported cases as young as two years old.

It will help immensely to have a complete history on your baby so please make sure that you get copies of all of the test results and post them here. We ask lots of questions but since MishMish hasn't had the testing done yet, I'll save mine for after the results are in. Of course, that doesn't mean that I won't think of something in the meantime so I may be back to pick your brain. :D

The fact that you are here says to me that you are a great mom so I don't think you'll find anybody here that is going to think you did anything wrong to cause the issues your vet is trying to work through right now. The minute you became part of our community was a guarantee that you won't have to handle this alone. We're all here to help in any way we can.

I'm truly sorry for the circumstances that brought you here but I'm sure glad that you found us.

Glynda

P.S. I just noticed that you are in Irvine. We are neighbors....I'm in Rancho Cucamonga.

[Casey's Mom]

Hi Bonnie - I just want to welcome you to our group. You will find a lot of knowledge and support on this site.

Let us know your results when you can and the wonderful people here will help you make sense of everything and hold your hand along the way.

One word of advice is do not restrict water intake - cushings causes them to pee more so they have to drink more (not the other way around) and to withhold water can cause them to become dehydrated.

Love and hugs,

[papaoats]

Thank you Casey and Lulu's mommas...
I am feeling much anxiety right now. It happened so fast. I noticed this beer belly last week and thought maybe he has out on weight so I switched his food from Origin to Innova low fat and have extended his walks.
Then something new happened over the past week. He has been coming up to my pillow at 1:00 am and at around 4:00 am, he puts his paw on my face and somehow makes a cry sound. He then walks a few steps and turns to make sure I follow him. He leads me to the door so he can go out to pee. This is unusual for him because he always sleeps through the night. I let him out but as soon as he walks in the door he guzzles up his water dish.
:(
He is reluctant to jump and his appetite has increased. He is sitting next to me on the couch and he is feeling warm/feverish.
Today he squeeeled a lot at the Vet as they drew Blood and took urine sample.

Are there any holistic remedies I can try? What food do you recommend? I am sooooooooo confused with diet, do I stick to fiber/protien/????
I have not slept in days..Ifear waking up to a cold baby. I love him sooooo much. He is such a love bug with so much emotion. I would love to post his pic but at this point I do not know how.

Thanks again for helping me.

[littleone1]

Hi Bonnie,

Corky and I also want to welcome you and MishMish. I second what others have said.

I know Cushings is a very frightening disease, but it can definitely be controlled.

There is a section on here called Helpful Resources for Cushng's Dogs. You will find some very valuable information there. Also, You will get information and advice from many of the members. They have a wealth of knowledge and experience dealing with Cushings.

Corky has been treated for about 3 1/2 months now and is doing really good with the treatment. I personally don't believe that he was in any pain due to it. He's back to his normal self again.

I hope all goes well for you and MishMish. We'll be looking for any information you can give us about him. It really does help others to provide feedback that will help you and to help ease your mind. We're all here to help.

Terri

[labblab]

Welcome from me, too!

Here's a couple of hints to help you add some photos of MishMish so that we can all see his sweet face! :)

First of all, in order to add his photo as an "avatar" to accompany your username at the top of all of your replies, these are the steps to follow:


Go to your Public Profile Page (just click on your own username and you will be taken to your Profile page);

Click on the "User CP" option on the upper left-hand side of the page;

Find the "Your Control Panel" menu on the left;

Go down to the "Settings and Options" heading, and then click on "Edit Avatar." You'll then be able to upload a photo to serve as your avatar.
Additionally, in order to set up a complete album of photos, here's a link that will tell you how:

http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_albums

I can surely understand how upset you are right now. But the symptoms you are describing are ones that are very familiar to us as parents of Cushpups. And I am happy to tell you that if MishMish does have Cushing's, these symptoms can and should resolve with appropriate medication. So hang in there!!!!! We are all here to help you.

Marianne

[Squirt's Mom]

Hi Bonnie,

Welcome to you and MishMish! :)

Sweetie, first and foremost, you have done nothing wrong. Ok? So just file that thought in the garbage and toss it out!

We are going to do our best to help MishMish from now on, but right now I want to help you. It is so painfully obvious from your posts that you love your little guy so very much and will do just about anything to help him and give him a good life. That makes you a very good mom and MishMish a very lucky boy. Don't forget that, 'k?

I know just how you feel. When my Squirt was first diagnosed I was a complete basket-case! :eek: That was the worst thing I had ever heard and was sooo terrified for my Sweet Bebe. I cried and screamed and cried some more for weeks and weeks. She probably thought I was trying to smother her because I just couldn't stop squeezing her and hugging her for dear life. And I felt just like you - what have I done?!?!?! :( The guilt, fear, anger, frustration, and hopelessness consumed me, making me a total mess and completely useless to everyone in my life. :o I kept trying to understand what was happening to her, but my mind was in such a state I couldn't comprehend anything. Someone would tell me blue and I heard pink; they would say up and I heard down. :rolleyes: But once I got here, with these wonderful, kind folks, they took my hand and gently led me along until I could start to function a bit again. Then they began to teach me, and have continued to teach and support me every day since. I knew Squirt and I were home, that we were safe here, and that we would be alright - no matter what. Two years later, this is still our home, our safe haven.

You and MishMish are home now, too. :) You are part of our family and we will stand by you both - no matter what. Ya'll are not alone, we will be with you every step of this journey, helping in any way we can even if that is just to listen. So take a deep breath, let it out slowly, and try to relax just a bit....easier said than done, I know. But it is ok to let your guard down a bit now, you are home and we will help you watch over things from now on.

There will be many questions coming at you over the next few days and weeks, but we do this so we can get a better picture of what is happening with MishMish. We won't get really nosy til we know you a bit better. :p Just answer to the best of your ability at the time and if we need to know more, we will just keep asking. :) Details are important, you can never give too many details...we really LOVE details! You will also be getting some very helpful tips in the coming days. Make note of them and keep them close until they become part of your daily routine.

One tip for you today - get copies of the tests he has had done recently, the actual tests results, not the invoice that says what was done and how much it costs. Make this a habit every time he has a test and start a file for him at home. This way you will always have his records in hand no matter what vet you have to see. Also, you will be better able to answer some of the many questions we will have. ;):D

Innova is a good food, as is Origen, but don't be changing things just yet. If you do that, it may confuse the issue so let things ride right now as far as his diet. We can tackle that a bit later if need be.

So today you have 3 "assignments". :p 1) get copies of the test results; 2) post them here; 3) relax and BREATH.... ;)

I am so glad you and MishMish are here and look forward to getting to know both of you better.

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

[papaoats]

Thank you Leslie:
I appreciate all of the kind words. You know what kills me is that for a year I have been instructed to put MishMish on a high protein diet because he is over weight and has chrinic ear infections. So what do I do??? I feed him a high protein diet origin and give him Salmon and Duck snacks. Now the poor baby has an enlarged liver!
How am I to feel? I am an idiot!
Well here are some results until I post everything..

Liver Enzyme 322
Kidney Function 37
kidney 150
He has low glucose so he is not diabetic
Cholesterol 404
Bad cholesterol 587

[papaoats]

:( I have the results but do not know how to post them by attaching the link.
Also MishMish is to have this 8 hour test tomorrow and I am terrified. Will he be ok? Will he be asleep? I don't even know how much this will cost. I need to get it together , I know.
:(
:confused:
PROTEIN 7.0 5.0-7.4 g/dl
ALBUMIN 3.9 2.7-4.4 g/dl
GLOBULIN 3.1 1.6-3.6 g/dl
A/G RATIO 1.3 0.8-2.0
AST (SGOT)63 15-66 iu/l
ALT(SGPT)322 12-118 iu/l
Alkaline phosphatase 150 5-131 iu/l
GGT 11 1-12 iu/l
BILIRUBIN 0.1 0.1-0.3 mg/dl
BUN 37 6-31 mg/dl
CREATININE 1.1 0.5-1.6 mg/dl
BUN/CREATINE RATIO 34 4-27
PHOSPHORUS 4.6 2.5-6.0 mg/dl
GLUCOSE 62 70-138 mg/dl
CALCIUM 10.3 8.9-11.4 mg/dl
MAGNESIUM 2.4 1.5-2.5 meq/l
SODIUM 150 139-154 meq/l
POTASSIUM 5.1 3.6-5.5 meq/l
NA/K RATIO 29 27-38
CHLORIDE 107 102-120 meq/l
CHOLESTEROL 404 92-324 mg/dl
TRIGLYCERIDE 587 29-291 mg/dl
AMYLASE 445 290-1125 iu/l
LIPASE 365 77/695 iu/l
CPK 168 59-895 iu/l

LIPEMIA 2+

[acushdogsmom]

Also MishMish is to have this 8 hour test tomorrow and I am terrified. Will he be ok? Will he be asleep? The 8-hour test is called the Low Dose Dexamethasone Suppression test. It takes 8 hours to do because they need to take a blood sample three times within an 8 hour period, but it's really a simple test and no, the dog does not need to be sedated in any way for the test, just available for the three blood draws at specific times within an 8-hour time period.

My Vet actually let me stay with my dog throughout the 8 hours. We (my dog and I) sat in our car and listened to music in-between blood draws. :)

They take one blood sample before starting the test, then inject a small amount of dexamethasone (which is a steroid). Then they take another blood sample at the 4-hour mark and a third sample at the 8-hour mark. Each of the three blood samples is then sent to a Lab for analysis, and the cortisol levels are measured in each of the three samples.

For more info on the LDDS test, look here in our Resources Forum:
http://www.k9cushings.com/forum/forumdisplay.php?f=10

Or, more specifically, look here:
http://www.k9cushings.com/forum/showthread.php?t=217

Or here, where the LDDS test is nicely described (that site is written by a Cushing's dog owner, in "layman's" terms) as follows:
http://www.kateconnick.com/library/cushingsdisease.html


Low Dose Dexamethasone Suppression Test: This is considered the best test with an estimated 90-95% ability to diagnose Cushing's disease. A fasted dog has a blood sample taken as a baseline in the morning. A small amount of dexamethasone, a synthetic glucocorticoid, is injected, and follow-up blood samples are taken 4 hours and 8 hours later. A normal dog's body will perceive the presence of dexamethasone and suppress cortisol output throughout the test. Cushingoid dogs will not suppress blood cortisol in response to the dexamethasone injection, because their feedback mechanisms are not working properly as explained above. This test does not differentiate between forms of Cushing's disease (adrenal vs. pituitary), although it may be suggestive. Dogs who suppress at 4 hours and rebound at 8 hours usually have pituitary tumors.

Also for more "newbie" Cushing's info, look here:
http://www.k9cushings.com/forum/showthread.php?t=180

Hope this helps. :)

[Squirt's Mom]

Hi Bonnie,

Thanks for posting the lab results for us! Now if you can flesh it out a bit that would be great!

After the numbers you have posted should be some weird little letters like ug/dl, mnol/L, etc. And after that should be what are the normal ranges for each value so that the complete thing would look something like this:

Protein 7.0 ug/dl (3.0-11.0)

The 3.0-11.0 are figures I just pulled out of the air and are not meant to be fact, but to show you what we need to see to complete the picture. Told you we would have questions for you! ;)

You don't have to retype all that info you have already provided but can go to the bottom of that post, click "edit" and add in the units of measurement (ug/dl, mnol/L, etc) then the normal ranges the lab gives. Each lab can have different norms so that is why it is important we know what they are.

Like Cushy said, the test tomorrow is more than likely the LDDS and MishMish shouldn't need sedation. If he gets really stressed at the vets, tho, it might be a good idea to take him out of the clinic between draws, usually taken 2-4 hours apart. If you live close, take him home, or go to a park, or just sit in your vehicle with him. That will help him stay calmer and help make the test more accurate as stress can affect it. It isn't a difficult test, simply 3 blood draws and one injection. If you vet has told you he needs to fast tomorrow for it, then if you do take him out between draws make sure he doesn't eat anything.

You are doing just fine so hang in there and know we are with you and MishMish even tho you can't see us.

Hugs,
Leslie and the girls - always

[MiniSchnauzerMom]

Bonnie,

Wanted to offer my belated "Welcome" to you and MishMish. Bonnie, you've done nothing wrong nor do I consider you an idiot!! Please don't beat yourself up. I do understand how you're feeling though as I was in the same place at one time. Now you'll learn all about the disease, treatment, etc. and become MishMish's advocate.

Remember, you and MishMish are not alone on this journey and you'll have lots of support and help from the members here. Hope the testing goes smoothly tomorrow. Will be looking for your updates.

Louise

[labblab]

Yay!!!! I see you've got a photo of MishMish up as your avatar...what a cutie pie!!! ;) :p :)

Marianne

[papaoats]

So I have spent the past five hours educating myself on Cushings. Thank you all for all of the valuable info you sent me. This fort is BRILLIANT!
I am of course over whelmed. My baby is having his test tomorrow. I did ask if I can take him home in between tests (blood draws) and was told a big fat NO!

He has not had an utrasound yet. is this normal? I read an article that suggested he should have an ultrasound.
Also he has had about five ear infections and each time was perscribed otomax...which I noticed is on the listof cortisone meds.

Does anyone have any opinions about his results so far?
I would love to know what you are feeding your pets..

[littleone1]

Hi Bonnie,

I know this is overwhelming.

When Corky had the LDDS test done, I was allowed to take him home in between the blood draws.

He has also been on Otomax for 14 days because of his ear infections. I was also concerned about this, but his vet reassured me that it wouldn't have any bad effects on him. I know that it does contain a steroid, but he has treated Cushings dogs before with Otomax. Even though the treatment is recommended for 7 days, because of the Cushings, it sometimes takes longer to fight off the infections.

Corky has had 3 U/Ss. The last ultrasound did show that Corky has an adrenal tumor.

I totally understand about the research that you are doing. Corky has been being treated for about 3 1/2 months, and I am still learning .

I wish you the best.

[Franklin'sMum]

Hi Bonnie,

Just wanted to offer a belated welcome to you and MishMish from me and my little boy Franklin. You will find that the people here are truly incredible, very supportive and have a wealth of knowledge. Good Luck with the LDDS test, will be looking for the results.

Jane and Franklin xx
________
VISA GIFT CARDS (http://bestfreegiftcard.com/visa-gift-cards/)

[papaoats]

Thanks to all! I am a nervous wreck. Wish MishMish luck today.
It is 9:00am, we are on our way to the Vet

[frijole]

Good luck! And report back in! Kim

[papaoats]

Has anyone tried


Cushex Drops™

Promotes adrenal and pituitary gland balance and health

http://http://www.nativeremedies.com/petalive/cushex-adrenal-support-dogs-cats.html

[StarDeb55]

Bonnie, I have not posted to you previously, but I must tell you that Cushex, Supraglan, & a number of other so-called herbal remedies for Cushing's that you find are a huge rip-off. The people who make & promote these products are out to line their pockets with your money at the expense of you & your baby. If any of these "natural remedies" truly worked, all of us would be using them on our pups in a heart beat. Glynda, Lulu's Mom, has even contacted these companies, requesting their scientific documentation through the appropriate testing that these products successfully lower a pup's cortisol. She has never gotten a response to these direct questions.

Debbie

[papaoats]

Debbie, Thank you so much for the prompt reply. I appreciate it. You know I took care of my dad while he had a harsh painful battle with Cancer. I remember buying him hollistic treatments, in the end nothing worked. He did have more short term relief from the medical treatments than the hollistic. I guess your reply brought that back to me. Thank you from the bottom of my heart.

[papaoats]

hello all,

I am worried because my vet told me that Mishmish's kidney enzyme is VERY VERY bad and same for his liver!
I posted teh results but no one has responded to me.
Is it that bad?

Can anyone take a look?

[littleone1]

Hi Bonnie,

I'm no expert in interpreting test results, but I do know that Corky's liver function test was high, and it did come down within the normal range after he started his treatment with Trilo. When he had his kidney values tested in October, they were also high, and his IMS started him on half a tablet of Pepcid AC, as there could have been some problems with his stomach that could have attributed to his kidney values being high. When he had his kidney value test done in November, it was still high, but closer to the normal range. His vet also said that flare-ups with his teeth could also have been one of the reasons why they were higher.

What I am saying applies to Corky, and that this might not be the reason why MishMish's levels are high.

Did your vet give you any suggestions as to what to do?

I'm sorry you didn't get any responses. I'm sure one of our members can offer you advice that I know I can't. I'm still in the learning process.

[StarDeb55]

Bonnie, I am also the medical lab tech that may have been mentioned previously, & I have plenty of experience looking at these kinds of numbers.

When it comes to the kidney function tests, we are talking about BUN & creatinine. Creatinine is actually the most important of the 2 tests, & MishMish has a normal creatinine. BUN can be easily affected by a number of things including something as simple as dehydration or a high protein diet. If this blood work was drawn fasting, that could easily explain the slightly elevated BUN.

The liver function tests are AST, ALT, alk phos, & cholesterol. All of these test show mild elevations which is quite common in our cushpups. An elevate alk phos is frequently the test that will tip off a vet to start looking at Cushing's. MishMish alk phos result is very slightly elevated. We have seen pups in this group with alk phos values in the several thousands, so you can see that MishMish alk phos is actually pretty good. The liver is overstressed in cushing's because it has to process the overproduction of cortisol coming from the adrenal glands. With treatment of the Cushing's, these values should start improving. There are also a number of supplements that can be used for liver support including milk thistle, vitamin E, & denamarin. A number of us in this group do use these supplements. You will need to ask your vet what he/she might recommend for liver support for MishMish.

Debbie

[Squirt's Mom]

Hi Bonnie,

StarDeb55 is our resident lab expert so hopefully she will be on later today and look at MishMish's results for you. You can contact her via a PM and ask her to look if she doesn't respond pretty soon. Glynda is pretty good with these things, too.

I know very little but the kidney results for MishMishyour vet is probably referring to include these:

BUN 37 6-31 mg/dl
CREATININE 1.1 0.5-1.6 mg/dl
BUN/CREATINE RATIO 34 4-27

The BUN/creatinine ratio is what is the important one I believe and it is elevated. Our lab expert can tell you more about what that means. I will also contact one of our members who dealt with kidney issues in her Corgi for some time and see if she can help you as well.

Here are some links on kidney disease in canines that you might find helpful.

http://www.2ndchance.info/kidney.htm
http://www.vet.uga.edu/vpp/CLERK/mckee/index.php
http://www.vetinfo.com/dbloodwork.html
http://www.vetinfo.com/dkidney.html
http://www.dogaware.com/kidney.html
http://www.vetprof.com/clientinfo/KidneyDiseaseInDogs/diet.htm

The primary liver values for MishMishare:

AST (SGOT)63 15-66 iu/l
ALT(SGPT)322 12-118 iu/l
Alkaline phosphatase 150 5-131 iu/l
GGT 11 1-12 iu/l

None of these values are what I would consider "bad". We have seen much, much higher values in many of our cush babies. But again, our expert can tell you much more.

Keep your chin up! You are doing a fine job in the face of much turmoil.

Hugs,
Leslie and the girls

PS. I see our expert was responding at the same time I was! YEAH!!!

[corgipallie]

Welcome from me too.

Has your vet tested for just a common UTI?
Being that your creatinine is normal and BUN is only slightly up, MishMish's kidneys aren't in danger right now. As Debbie said, creatinine is the most important indicator of the two and it's in normal range -- whew! That's great.

Have you also gotten a urine protein/creatine ratio (UPC)? It's part of a urinanalysis, not blood work. It's actually a pretty decent indicator of any decrease in kidney function. It measures how much protein is being leaked out of the kidneys, whereas it shouldn't be. It would be worth checking into for your next urinanalysis, as well as perhaps a bacteria culture.

Earlier in your thread, you mentioned MishMish felt warm and possibly feverish. The best way to indicate a fever is through their ears. They won't just feel warm-- they will feel HOT -- like one of those handwarmer packs.

Good luck with all your testing. I hope it doesn't come back positive for Cushings and it's either something very treatable and not dangerous.

Stephanie, Gypsy and Apollo
(and forever Pallie)

[Harley PoMMom]

Hi Bonnie,

And a very belated welcome from me and my boy Harley. I have been following your story with MishMish and I do have a question. :eek::)

From your previous post you said that MishMish has had at least 5 ear infections. Frequent ear infections can be a symptom of hypothyroidism, now, on the lab results you had done on MishMish is there a result for a "T4"?

My boy Harley has cushings, PDH and elevations of all the intermediate/sex hormones. On Jan. 4 he started taking 80mg Lysodren 3X a week, this is called a maintenance dose. Harley's GP started him on this kind of treatment plan because Harley has pancreatitis and we did not want to "load him" the traditional way in fear that his pancreas would not be able to cope. Lysodren is not a drug to fear, but one does need a GP or IMS who is cushings savy or a GP or IMS who will at least work with you as a team.

The best advice I can give you is to learn everything you can about this disease...so read as much as you can, ask as many questions as you want and we will answer them as best as we can.

Just remember you are not alone anymore on this journey, we are here for you and MishMish, always.

Love and hugs,
Lori

[littleone1]

Hi Bonnie,

I just want to chime in with Lori about hypothyroidism and ear infections. Before Corky was diagnosed with hypothyroidism, over six years ago, he was constantly getting ear infections. Once he started taking Soloxine for his thyroid, he hadn't had an ear infection for over 6 years. Recently he's had ear infections in both of his ears. His thyroid level was too low. At the present time he is doing good, and his ear infections have been eliminated with an increase in his thyroid meds and an antibiotic for his ears.

[papaoats]

Hi, just checking to see how Corky's ear infection is doing? He is sooooooooo super cute and I hope he is doing much better. MishMish gets an ear infection every quarter. I was told it is because of his big floppy ears and his allergies to grains which is why I had him on a grain free diet!
hope your baby is healing

[littleone1]

Hi Bonnie,

Thank you for checking on Corky. I know you have enough on your plate at the present time. Corky's ear infections have now cleared up. His ear infections were due to his low thyroid level. I now have a different ear flush that I have to use twice a week.

This is so very sweet of you to check on him. Bless your heart.

[littleone1]

Hi Bonnie,

Thank you for checking on Corky. I know you have enough on your plate at the present time. Corky's ear infections have now cleared up. His ear infections were due to his low thyroid level. I now have a different ear flush that I have to use twice a week.

This is so very sweet of you to check on him. Bless your heart.

[papaoats]

Hi Lori, Stephanie, Terri and Debbie
Thank you all for your assistance and the kind words.
The vet said MishMish urine was very diluted and this was not a good sign. he did not mention thyroid at all.

T4 is 1.0 1.0-4.0 ng/dl
T4 (RIA)
Free T4(RIA) 0.56 0.45-2.06 ng/dl

From urinanalysis :
ph 6.5
protein negative
glucose negative
specific gravity 1.009 (LOW) 1.015-1.050

The Vet told me that he is very concerned with his Kidney and liver results. he basically said we can control it if it cush related, which is why I am so worried. He said MishMish is very young for Kidney and liver disease and that was a big concern for him.
I am worried it is cancer or something else like that. Today I noticed a buldge above his back leg, kind of at bottom end of his spine to the right side. Could be me...could be organs moving around from the enlarged liver..don't know?
Thanks so much you guys!

[littleone1]

I understand how worried you are, Bonnie. Corky developed a growing mass on the right side of his stomach which turned out to be a fatty deposit.

My thoughts and prayers are with you and MishMish.

[StarDeb55]

The diluted urine is another sign of Cushing's disease as a cushpup can't concentrate their urine. The elevated liver function test, if MishMish does have Cushing's, will improve with treatment.

When it comes to the mass you have noticed, I have my doubts that an enlarged liver would be causing other organs to shift position. The liver would have to be tremendously enlarged before this would happen. I would have the vet take a look at that mass to see whether or not it's something to worry about.

Debbie

[Harley PoMMom]

Hi Bonnie,


T4 is 1.0 1.0-4.0 ng/dl
T4 (RIA)
Free T4(RIA) 0.56 0.45-2.06 ng/dl

In order to know if MishMish has what is known as a sick thyroid, one has to run a Free T4 by equilibrium dialysis not (RIA) radioimmunoassay. If it were me I would ask him to run the Free T4 by equilibrium dialysis, seeing that MishMish's T4 was at the lower end of normal. This is JMO, of course, so the others might differ! :)

Love and hugs,
Lori

[papaoats]

Hi Lori,
Happy Friday to you and Harley!
Is this new analysis require more blood drawn from MishMish? Or is it something they can do based on what they have?

Thank you for the help.

[papaoats]

Good Morning All

I had a tough night with MishmMish last night. He did not sleep, kept moving around and crying every now and then. He was restless.
I am not sure if he is in pain or has gas...etc.
Did anyone experience this and if so, what did you do?
Does the enlarged liver cause pain? I know this is not an exact science , just need some guidance.

Thanks

[corgipallie]

Sorry you had such a rough night and MishMish isn't feeling well.
Has your vet ultrasounded the liver? Or maybe look into an IMS to ultrasound it.
Pallie had a large inflamed area of her liver in Dec 08. My vet aspirated it and we sent that to the lab and thank goodness it was benign (scary moments for a few days). It ended up to be an infected and inflamed area. It was about 4cmx4cm at the largest and it was causing pain and pressure on her other organs. She went on Tramadol and Denamarin and an antibiotic and it started to shrink and the infection went away. 4x4cm doesn't sound like much, but it did push her organs a little out of alignment as well as put pressure on them because of this enlarged area that normally isn't there. Her liver enzymes were elevated and they went down with the treatment.

An x-ray showed an area of enlargement but it wasn't til the ultrasound and pathology sample that my vet determined what was going on.

[Harley PoMMom]

He has not had an utrasound yet. is this normal? I read an article that suggested he should have an ultrasound.


Hi Bonnie,

I am so sorry also that MishMish isn't feeling well and you both had a rough night. I agree with Steph and highly recommend an ultrasound being done on MishMish. This has to be done on a well-equipped ultrasound machine and read by a qualified person...probably not found in your GP office. I have to drive 2 hours one-way to MJR Veterinary Hospital of the University of Pennsylvania in Philadelphia to have Harley's ultrasounds done, his GP does have an ultrasound machine in their office but his GP has told me that their machine can not pick-up what the MJR University of Penn. ultrasound machine can. Ultrasounds are not cheap but they are worth every penny spent.

Will be keeping you and MishMish in my thoughts and prayers.

Love and hugs,
Lori

[papaoats]

Hi All

I just spoke to the Vet. he told me that MishMish is borderline Cushings. He suggests to do another CBC in 4-6 weeks.
I asked him about the thyroid and he said we can put him on a .01 pill twice a day.
Not really sure what to think right now?
I told him that MishMish had a restless night and he asked me to bring him in for a peek.

I will get actual results from him later and post them.

[Harley PoMMom]

Hi Bonnie,

If MishMish does indeed have what is known as a "sick thyroid" then no meds are needed. That is why a Free T4 by equilibrium dialysis is done to determine this. If I were you I would not put her on thyroid meds unless she does actually need them.


The first scenario is called the sick thyroid syndrome or nonthyroidal illness (NTI). In this situation the thyroid gland is normal, but there are factors that are suppressing it from secreting a normal amount of thyroxine into the bloodstream. These factors include medications like cortisone, valium, anticonvulsants, and sulfa antimicrobials. Diseases like Cushing's disease, diabetes mellitus, chronic renal failure, liver disease, and addison's disease can also cause NTI. When these factors are corrected, or these diseases are treated, the apparent hypothyroid problem corrects itself. No treatment with supplemental thyroxine is needed.

http://www.lbah.com/canine/hypot4.htm

IMO, if it were me, I would spend my money on an ultrasound instead, unless of course both are in the budget and can be done.

Love and hugs,
Lori

[papaoats]

Ok so I need a ultra sound and Fre T4 test.
Is the T4 test another Blood test?
How much do these ultrasunds run? My husband is not too happy with all the cost MishMish is bringing...but I love him and to me he is priceless.

[StarDeb55]

As Lori has said, Bonnie, you will need to have that ultrasound done on a high resolution machine to make sure the adrenal glands & all internal organs are clearly visualized. I would think that the free T4 by dialysis could be added on to the blood that was already drawn a few days ago as most labs usually keep samples for several days. Whether or not you can add this test on will depend on how long the lab that your vet uses stores their samples.

I'm thinking that a high quality ultrasound will probably run approximately $350-$400 depending on where you have it done. Several other members will probably weigh in on the cost, too.

Debbie

[Harley PoMMom]

Harley's ultrasound at the University of Penn. was...you are sitting down, ok...$373.00, yes, very expensive but let me tell you just some of the things it showed and this is just a short list:

Confirmed: Gallbladder wall hyperplasia.
Confirmed: Right adrenal nodule (7.3 mm at caudal pole).
Confirmed: Small splenic nodule.

His u/s also showed an enlarged liver, and that he had prior bouts of pancreatitis. His u/s goes into much greater detail but I can not fit all the words here. :eek::)

The Free T4 by ED will have to be another blood draw taken from MishMish, if you are going to have another CBC done in a few weeks, if I were you, I would just wait until then to have the Free T4 by ED done.

Bonnie, if it were me and I had to choose between the u/s and the Free T4, the u/s would be the diagnostic tool that I would spend my money on. I am so hoping the "others" will voice their opinions as well.

Love and hugs,
Lori

[gpgscott]

Bonnie,

The thyroid profiles are blood work. It is important. I think my pup was hypo for a long time and it was not diagnosied until she began to have larengeal issues.

The u/s is also an important tool, I am sorry but I really think you need both.

You already know you have a dietary issue and need to be addressing it. Reduce Fats!. But at the same time fats are important so you need to be controlling which fats .

Scott

[StarDeb55]

Lori, I respectfully disagree about the requirement for another blood draw for the free T4, both of my boys have had low T4 results on general screening labs in the past year. After my vet alerting me to this, we both agreed that the free T4 needed to be done, & he simply called the lab & had them add the test to the sample they already had. I did not have to bring either pup back in for a repeat blood draw.

Debbie

[Harley PoMMom]

I'm simply stating that if they don't have MishMish's blood that Bonnie will have to bring her back in...I think the blood draws were done for the CBC/Chemistry panel around the 18th?

[StarDeb55]

Most labs keep there sample from 5-7 days, so a new sample may not be needed. If the draw was done on the 18th, we are getting to the outer limit of the above timeframe, though.

Debbie

[papaoats]

Hi Guys:

Thanks a million for helping me today. I appreciate all of your input. I will now try to fill you in on my latest.
I had to work all day and so my husband was trying to take care of MishMish matters.
The Vet told me over the phone that MishMish is borderline cushings and needs to be re-tested in 6 weeks. he suggested to put him on Thyroid meds in the meantime.
I had asked my husband to take MishMish into the Vet because he was sooooooooooooo restless last night and I wanted him looked at.
My husband did take MishMish in and apparently the Vet could not find anything wrong with him, however he did send my hubby home with Thyroid meds. I of course flipped out and asked to return them immediately and request the thyroid analysis. The Vet said that we should try the meds for 6 weeks and re-test him at 6 weeks-only then we should do the analysis.
He also said that they do not have enough blood left at the lab and that he was not planning to run this test.
I had the meds returned and now at home with MishMish who is laying next to me snoring. He seems much better today so I am hoping things will get better. The Vet said to monitor the mass on his back side over the next days. It doesnt seem to hurt him at the touch so he said just keep an eye on it for now. He does not recommend an ultrasound as of yet.

Here are his results :

cortisol sample 1 <0.7(low) range 1.0-5.0
cortisol sample2 dex < 0.7 range 0.0-1.4
cortisol sample 3 dex < 0.7 range 0.0-1.4

Thank you again for your feedback and thoughts. I now do not know what is wrong with MishMish...I am keeping a very close eye on him.

I would love to pick your brains about his results. I am going to do an US soon, can't afford it this week.
Past two days he is still low energy but better spirits overall. He is now sleeping straight through the night.
I am feeding him chicken and rice, with innova low fat kibble.
He is still on his meds from his ear infection two weeks ago. he is taking Atarax and Cephlex.

[papaoats]

Hello

So I have been giving MishMish rice/chicken/vegetable diet. He just finished his last Atarax and Cephlex today ( for his ear infection) he still has ear drops left.
I wanted to see if anyone has had simislar results to mine:

cortisol sample 1 <0.7(low) range 1.0-5.0
cortisol sample2 dex < 0.7 range 0.0-1.4
cortisol sample 3 dex < 0.7 range 0.0-1.4

My Vet feels I do not need an ultra sound and he prefers I put him on Thyrpid meds and that we do not need the equilibrium analysis.
I of course do not want mishmish on meds unless necessary.

I plan to do the ultrasound soon. Simply can not afford this week.

[StarDeb55]

I'm not sure where your vet get a "borderline Cushing's" diagnosis from these results. All of the reading I've done states that when the 4 & 8 hour results are both <1, this is perfectly normal. Let's see what some other members have to say.

Debbie

[AlisonandMia]

Those results are strange - all three very low cortisol numbers. It is very unusual to see a baseline (the first number) so low - even in a non-Cushing's dog. Maybe the vet is saying borderline Cushing's because there is no "suppression". But it looks like there was nothing to suppress - ie the baseline was very low and so couldn't go any lower. Interpreting the LDDS test can be very complex (and not really my strong point) but to put it very simplistically usually the baseline is something around 3 to 5 and then, in a non-Cushing's dog the other three numbers will drop below 1.4. In a Cushing's dog either both numbers (4hr and 8hr) remain elevated (above 1.4) or the 4 hour number drops but the level rises again with the 8 hour draw. MishMash's baseline was so low (less than 0.7 apparently) that it really couldn't have gone any lower. As Deb says. it will be interesting to see what others have to say.

Have you had an ACTH stim test done? With such a low baseline number Addison's (the opposite of Cushing's) is a possibility - strangely enough excessive urination and drinking can also be a sign of Addison's so it may be worth following up. An ACTH stim test (which is also one of the Cushing's tests) is the test for Addison's. Addison's is more common in younger dogs than Cushing's. The other possibility is that something went wrong with the assay at the lab and there was cortisol present but for some reason their test didn't measure it.

Alison

PS:




So I have been giving MishMish rice/chicken/vegetable diet. He just finished his last Atarax and Cephlex today ( for his ear infection) he still has ear drops left.


You mentioned ear drops - what ear drops are they and what are the listed ingredients? If they contain a steroid (particularly if it is dexamethasone) then that could well explain these test results - even if he does have Cushing's and particularly if he doesn't. Has he had these ear drops before and how often?

[lulusmom]

I just want to validate what Debbie and Alison have already mentioned. The results of the LDDS are not only not indicative of cushing's, it looks like MishMish may have the opposite condition called Addison's. I am also flabbergasted that your vet does not think an abdominal ultrasound is necessary but then I am even more flabbergasted that he could possibly interpret MishMish's LDDS test as borderline cushing's.

Not sure if I mentioned before but my first cushdog was less than two years old when she started showing symptoms of hypothyroidism and cushing's. In her case, our gp vet diagnosed hypothyroidism but missed the cushing's altogether. After a year on thyroid meds, progressing symptoms and two bouts of bladder stones, she was finally diagnosed with cushing's by an internal medicine specialist. I wanted to drop kick my gp vet for continuing to tell me she needed a dermatologist. Lulu was finally diagnosed by a wonderful internal medicine specialist at VCA All Care in Fountain Valley, CA. They saved Lulu's life and my sanity. They are open 24/7, don't require a referral and they treat 100's of cushdogs. Please, please, consider taking your MishMish there. I live 50 to 60 miles away from Fountain Valley but I know my babies are in good hands, plus I can make appointments for anytime on Sat or Sun. I've provided a link to VCA below.

http://www.acarc.com/

Glynda

[jrepac]

I'm not an expert w/the LDDS, but certainly those #s do not indicate Cushings disease. Perhaps something else is "up"....ultrasound would be a good step.

Jeff

[papaoats]

Hello Jeff, Glynda, Allison and Debbie:

Thank you so much for your help. I am so very grateful.

The ear meds Baytril Otic and they were perscribed on January 11,2010 for his ear infection. he ussually gets Otomax but this time they elected to give him something stronger.
I have no idea what Addisons disease is but will look into it right away. I am so afraid my baby is going to die because of misdirection.

My Vet told he is borderline Cushings and that he should be on Thyroid meds for 6 weeks and then we can test again. I feel so cheated now. I paid that man $1050 for all the tests and visits in a 10 day period.

OK, so what do you guys recommend I do first?

[StarDeb55]

Addison's is the exact opposite of Cushing's. Cushing's= too much cortisol, Addison's= too little cortisol. Cortisol is used by the adrenal glands to make aldosterone. Aldosterone is critically important as it's the hormone that controls electrolyte levels, sodium & potassium, in the bloodstream. If an Addisonian crisis is severe enough in a cushpup, they will not be producing enough aldosterone to properly control electrolytes which can be fatal.

Frankly, if I were in your shoes, I would not take my pup back to this vet under any circumstances. Why don't you go to the IMS clinic that Glynda recommended earlier? I know she takes both Lulu & JoJo there, & thinks the world of the IMS vets at the clinic. I believe she also said that they will not require a referral from your primary care vet which is even better. If you decide to get a consult with an internal medicine specialist, you need to make absolutely sure that copies of all of MishMish labwork & everything else that was done by this vet goes to the specialist.

Debbie

PS- When you say the vet wants to retest in 6 weeks, are you talking about the thyroid bloodwork or repeating an LDDS? Thyroid medicine would not do anything to help with Cushing's, & a repeat LDDS right now, IMO, is a waste of time & financial resources. If this is, indeed, Addison's, the next logical step would be an ACTH stim test. An IMS can get this sorted out for you as they have the speciality training needed to handle all endocrine disorders.

[papaoats]

Hi Miss Debbie

I wish I know as much as you do...
OK, I will take him to Glynda's Vet in Fountain Valley.
Do you think I should at least ask my Vet about addison? I feel I paid him all this money and he is getting away with it. Maybe the fool does not know how to read results? He wanted to run the same tests again in 6 weeks. I want to run and scream at him..

[StarDeb55]

I would tell him that you want a second opinion about MishMish's care & that you will need copies of all of MishMish's records for the specialist, that's all I would say. I would not even say anything about what clinic you are going to take MishMish.

Debbie