Yorkie (Update 2/17/13. Riley in dire condition)

[O'Riley]

Hello everyone. I’m new to the board, and have been reading about Cushing’s Syndrome and canine diabetes for the past several days. I’m very grateful for this valuable forum, and to all of you who so generously share your knowledge. My faithful companion, Riley, and I would value your input tremendously.

To start with, Riley is a 10-year old male Yorkie. He was always very healthy until 2006 when he was neutered at age 6. Up until that time, he weighed a perfect-for-him, 13 pounds. By 2007, he weighed 19 pounds, even though we were still taking three walks a day for a total daily distance of five miles. My little fellow was better than having a personal trainer! Thyroid tests were negative. Our vet said he was one of those dogs who just gain weight after neutering. Thinking back on it, I realize that this the point where his gradual descent into ill health began, into what has now turned into a crisis situation.

Aside from the weight gain (hovering now at around 20 pounds), his other symptoms that have developed over the past 18-to-24 months are: sagging, bloated, pot-bellied appearance; lying next to the toilet on the cold bathroom tile; when he lies down, he pants very, very fast; body abnormally warm to the touch; he does this upwards tongue-licking-the-air thing repeatedly; his normally shiny coat is very dull and dry (but he has NO hair loss at all); he has a ravenous appetite; and, the skin on his normally pink tummy is now darkly pigmented; he stopped jumping up on furniture and the bed.

Beginning several days ago, he started drinking copious amounts of water, has excessive urination, and has had two “urinary accidents” in the house. He has since been diagnosed with diabetes. Just in the past two days, he now hesitates when coming down the stairs, as if he can’t quite take that first scary step.

His first lab-measured blood glucose on Feb. 26 was 227. Yesterday, my new “One-Touch Mini” meter reading was 270. Ketostix now show ketones in his urine; there were no ketones on Feb.26. Riley has started insulin (Humulin N) (4 units, twice a day). A fasting Low-dose dexamethasone suppression test was performed before starting on the insulin. The vet wants to see if the LDST was giving a false positive for Cushing’s, and whether Riley will respond at all to insulin, explaining that if he does have Cushing’s, he will be insulin resistant. If he doesn’t respond to the insulin (and so far, he has not), the doctor will give the go-ahead Monday to start Riley on Trilostane (10mg, 2X/day).

Here are Riley’s test results from Antech. Just for the record, Riley's last complete blood test was in 5/2007, and everything was within the normal range except for Lipase, which was way above the normal range (normal range was given as 200-1800) on the graph that was supplied, but in the actual list where Riley's lipase number should have appeared, it was blank. That blood work was done by our old vet at a non-Antech lab judging from the way the information is presented on the report.
--------------------------------------------------------------------------------------------------------------
Low Dose Dexamethasone Suppression Test (3/4/2010):
Time 800
Time 1200
Time 400
Cortisol Sample 1 4.5 Reference range 1.0-5.0 ug/dL
Cortisol Sample 2 Dex 1.5 (HIGH) Reference range 0.0-1.4 ug/dL
Cortisol Sample 3 Dex 2.9 (HIGH) Reference range 0.0-1.4 ug/dL

---------------------------------------------------------------------------------------------------------------
SUPERCHEM Panel (2/27/2010):
Total Protein 7.0 Ref. Range: 5.0-7.4 g/dL
Albumin 3.4 Ref. Range: 2.7-4.4 g/dL
Globulin 3.6 Ref. Range: 1.6-3.6 g/dL
A/G Ratio 0.9 Ref. Range: 0.8-2.0
AST (SGOT) 48 Ref. Range: 15-66 IU/L
ALT (SGPT 173 (HIGH) Ref. Range: 12-118 IU/L
Alkaline Phospha. 323 (HIGH) Ref. Range: 5-131 IU/L
GGT 13 (HIGH) Ref. Range: 1-12 IU/L
Total Bilirubin 0.1 Ref. Range: 0.1-0.3 mg/dL
BUN 42 (HIGH) Ref. Range: 6-31 mg/dL
Creatinine 1.1 Ref. Range: 0.5-1.6 mg/dL
BUN/Creat Ratio 38 (HIGH) Ref. Range: 4-27
Phosphorus 6.0 Ref. Range: 2.5-6.0 mg/dL
Glucose 280 (HIGH) Ref. Range: 70-138 mg/dL
Calcium 11.0 Ref. Range: 8.9-11.4 mg/dL
Corrected Calcium 11.1
Magnesium 1.8 Ref. Range: 1.5-2.5 mEq/L
Sodium 142 Ref. Range: 139-154 mEq/L
Potassium 5.6 (HIGH) Ref. Range: 3.6-5.5 mEq/L
Na/K Ratio 25 (LOW) Ref. Range: 27-38
Chloride 104 Ref. Range: 102-120 mEq/L
Cholesterol 422 (HIGH) Ref. Range: 92-324 mg/dL
Triglyceride 463 (HIGH) Ref. Range: 29-291 mg/dL
Amylase 6166 (HIGH) Ref. Range: 290-1125 IU/L
Verified by repeat analysis
Lipase TEST RESULT GREATER THAN 9,000 Ref. Range: 77-695 IU/L
Verified by repeat analysis
CPK 266 Ref. Range: 59-895 IU/L
Comment: Hemolysis 2+, the following results may be affected by this degree of hemolysis:
-INCREASE-
ALT may be increased up to 45%
AST may be increased up to 20%
LDH may be increased up to 50%
Total Bilirubin may be increased up to 30%
Potassium may be increased by 20-25%
-DECREASED-
Direct Bilirubin may be decreased up to 90%
Triglyceride may be decreased up to 10%

The specimen has been centrifuged at high speed to decrease lipemia
CBC:
WBC 11.8 Ref. Range: 4.0-15.5 Units: 10-to-the-3rd/uL
RBC 6.8 Ref. Range: 4.8-9.3 Units: 10-to-the-6th/uL
HGB 16.8 Ref. Range: 12.1-20.3 g/dL
HCT 51 Ref. Range: 36-60 %
MCV 75 Ref. Range: 58-79 fl
MCH 24.9 Ref. Range: 19-28 pg
MCHC 33 Ref. Range: 30-38 g/dL
Comment
RBC Morphology NORMAL

Differential: Neutrophils Absolute: 7434 (63%) Ref.Range: 2060-10600 /uL
Lymphocytes 3304 (28%) Ref. Range: 690-4500 /uL
Monocytes 708 (6%) Ref. Range: 0-840 /uL
Eosinophils 354 (3%) Ref. Range: 0-1200 /uL
Basophils 0 (0%) Ref. Range: 0-150 /uL
Platelet Estimate Adequate
Platelet Count 382 Ref. Range: 170-400 Units: 10-to-the-3rd/UL

[frijole]

Welcome! I am glad you found us. I am dealing only with cushings so I can't offer first hand advice but I'll share what I have read. First off - there are many dogs who have successfully battled both diabetes and cushings. It is more challenging. Are you working with a specialist or regular vet? I ask because we have seen many switch because general vets often do not have the experience needed to treat both.

The symptoms for diabetes and cushings often mimic each other and there are frequently false positives on tests as a result. I will let those with firsthand knowledge give more specifics. I would want to be totally confident that my dog had cushings prior to starting trilostane or any other cushings meds.

I see where you did the LDDS test and a complete blood panel. Did the vet do the acth test? It measures cortisol levels and would be required to confirm the LDDS results.

Not sure how you heard of us but we have a "sister board" www.k9diabetes.com that you might want to check out as well. We have quite a few shared members.

Again, I am no expert but I would not be convinced yet that your dogs has cushings - despite all the symptoms. Also I am confused on the vets' comments that if your dog has cushings he will be insulin resistent. Did he mean it would more difficult or impossible?

Sorry for all the questions ---- just trying to get the big picture. Welcome to the board! Kim

[Harley PoMMom]

Hi and welcome from me and my boy Harley! I am so sorry for the circumstances that brought you here but I am so glad you found this forum. I was such a mess when my boy was dx'd with cushings :eek: and these wonderful and knowledgeable people have helped and guided me.

My boy, Harley, also has pancreatitis which can be common with a cush pup. Now I see on Riley's lab results his amylase and lipase, which are pancreas enzymes are very, very elevated. Other things can make these enzymes elevated but if Riley were my pup I would get pancreatitis ruled out by getting a cPL or a cPLI test done. You see, acute pancreatitis may produce temporary diabetes mellitus, so you want to be sure of what you are dealing with. Please ask your vet about this.

Love and hugs,
Lori

[Nathalie]

Just wanted to welcome you and your boy Riley as well. :)

I don’t have any experience with diabetes so I can’t comment on that. However, I wanted to second what Lori said that it looks like that Riley might have pancreatitis.

“he does this upwards tongue-licking-the-air thing repeatedly; “

If one of my dogs would be doing this it would mean they have an upset stomach and perhaps are nauseous. Some dog ‘air-lick’ while others may compulsively lick the floor.
My Phillip does the exact same thing when his pancreas acts up.

Has your vet said anything to you about the very elevated amylase and lipase?

The seeking out of cool surfaces and the very fast panting could also be a sign that Riley is in pain due to pancreatitis.
If Riley where my dog I would be on the phone with the vet first thing Monday morning and reduce his fat intake as much as possible until pancreatitis has been ruled out. My dog Phillip had 2 acute pancreatitis attacks in the past in it is very painful and can be potentially life threatening.

When you gently palpate his abomen, does he seem to be in pain?

“Our vet said he was one of those dogs who just gain weight after neutering.”

I would understand a slight increase in weight eg. 1 or 2 lbs but almost doubling its weight can hardly be dismissed as 'gaining some weight after neutering'.

Welcome again,
Nathalie

[frijole]

Hi again from me! While I have not yet dealt with diabetes, my aunts' dog was recently diagnosed. The dog had pancreatitus that was discovered along with the diabetes so I think this is common. It is very serious and nothing to ignore if that is the case. The dog was in the hospital on electrolytes for 3 or 4 days.

Has Riley been sick or have you found signs of vomit? Is he eating ok? Big hugs to him, Kim

[StarDeb55]

I can't comment to much on the diabetes that Riley is dealing with, as I have no experience. The one thing I will comment on is that the low dose test frequently yields a false positive in the presence on non-adrenal illness, meaning diabetes. The low dose may be indicating cushing's but with the diabetes, you absolutely can't be 100% sure of this result. It must be confirmed by a second test, meaning the ACTH, which Kim has already mentioned. The ACTH is less likely to have a false positive in the presence of non-adrenal illness than the low dose. As to the vet's comment about insulin resistance, I'm not real sure about that either, but let's wait until some of the members who have more background with both diseases offer their input.

I do have one question, is your normal general practice vet trying to treat Riley? If so, this may not be in Riley's best interest unless your vet has tons of experience treating disease of the endocrine system. With the likelihood of both Cushing's being present along with the diabetes, I would strongly suggest you consider going to an internal medicine specialist. These are the vets with the necessary advanced training to manage complicated cases like Riley.

Debbie

[k9diabetes]

Hi!,

I'm the administrator of the diabetes forum mentioned (www.k9diabetes.com (http://www.k9diabetes.com) and www.k9diabetes.com/forum (http://www.k9diabetes.com/forum)) and thought I'd add a few comments here.

It is true that a dog who has both diabetes and uncontrolled Cushing's disease will be resistant to insulin. At 20 pounds and 4 units twice a day, it's too early to say whether that is the case with Riley.

He's currently at a pretty typical starting dose and he would not be considered insulin resistant until he was getting something like 13-20 units per injection and still had high blood sugar.

It does seem like Cushing's is a possibility given your description so I assume they are going to continue to look at that possibility while they see what the insulin will do for him. The ACTH test is the preferred one in this case and you'd get the most for your dollar by having a full University of Tennesse Knoxville adrenal panel done with the ACTH as that would check all of the relevent hormones.



His first lab-measured blood glucose on Feb. 26 was 227. Yesterday, my new “One-Touch Mini” meter reading was 270. Ketostix now show ketones in his urine; there were no ketones on Feb.26.


I am a little surprised that he's showing ketones at relatively mild blood sugar elevations... and it's always important to consider that maybe he has "only" Cushings and the diabetes is secondary to that since his blood sugar really is not that high. Many dogs when diagnosed have blood sugar in the 400s, 500s.

Ketostix can also give false readings. How high is the ketone level on the sticks?

Did the vet find evidence of ketones in a urinalysis?

Was this before or after he started insulin?

I personally would not want to start treating Riley for Cushing's at this point. In part because the other tests would better assess whether he has it and in part because of his relatively low blood sugar levels and low dose of insulin - it's far from clear at this point that he's insulin resistant either.

And I also wouldn't want to up the insulin dose until there's more information about his blood sugar because it is only mild elevated in the current tests.

Clear as mud... short version: to my mind, more testing is needed before making any decisions.

Natalie

[O'Riley]

I really appreciate the open and welcoming atmosphere on the board. It’s a relief to have found others who are working their way through these complex diseases. Thank you very much for your interest in Riley, and for all of the suggestions. I’ll try to answer the questions as best I can that have been posed so far.

Riley is being seen at a general veterinary practice. The vet is concerned that the LDDS may be showing a false positive, and wants to give the insulin several more days to kick in. What I meant by saying that Riley would be insulin resistant if he has Cushing’s – the vet said the insulin won’t be very effective if Riley does, indeed, have Cushing’s. So IF he has Cushing’s, and it can be controlled with drug therapy, then the insulin will be effective at that time. I didn’t mean that it would be impossible to treat– just not possible until the Cushing’s is under control (if it ends up that he does have Cushing’s). The other side of this would be, if the insulin IS effective at regulating his blood glucose, then he probably doesn’t have Cushing’s. Also, I misspoke earlier when I said the plan was to start the Trilostane on Monday, as the vet told me today that a week is needed to give the insulin a chance to work, and then a curve will be done. No ACTH test has been performed. I will most definitely ask the vet about pancreatitis and the cPL or cPLI. Yes, he has been vomiting off-and-on for a few weeks, but his appetite is very good. He’s so heavy that I thought his discomfort was due to the pressure of all his weight on his stomach when I pick him up. The doctor tried to palpate his abdomen, but his abdomen is hard to the touch, and difficult to examine because of his girth.

[BestBuddy]

Hi and welcome.

I was one who dealt with diabetes and cushings and it can be done. Our story is a little different because Buddy had been diabetic for many years before the cushings diagnosis. Buddy's perfect weight was around 12lbs but just before a bad case of pancreatitis he had ballooned to around 16lbs and then dropped back to around 7.5lbs in a week. He was hospitalized for a week and nearly didn't make it but once we started insulin he improved and it was nearly 4 years before cushings problems.

I would give the insulin a week or two (with increases as needed) before doing anything about the cushings. Then an ACTH test would be a better indication to see if Riley has cushings and if yes it will also give you a starting point for the monitoring of trilostane. (If that's the intended treatment).

Jenny

[O'Riley]

Natalie…thank you very much for taking the time to respond with your comments and questions. You’ve given me a lot to think about! To answer your questions, I’m using Keto-Diastix, and Riley was registering at 40mg/dL, also known as “Moderate”. He did drop yesterday to the next level down, but now is back to the “Moderate” color. Also, if it helps to know…his glucose reading on those same sticks is all the way to the right (2000 or more mg/dL). The vet also used sticks to determine that there were no ketones in his urine when I first took Riley in. Is there better information that can be obtained from a urinalysis performed at a lab? To answer your question about whether ketones were present before or after starting on the insulin, the vet found no ketones in his urine using their sticks, and this was before Riley started on the insulin. I found ketones present on my sticks that I purchased the next day, also before starting on the insulin. Now that he's on insulin, the sticks continue to show ketones. When you said that more information is needed about Riley’s blood sugar, is that information that would come from the Tennessee test, or some other test?

[O'Riley]

Good news this morning on Riley's ketone level, which is now registering in the "Trace" category...the lowest level of ketones (5 mg/dL)when using the Keto-Diastix.

[Harley PoMMom]

I will most definitely ask the vet about pancreatitis and the cPL or cPLI. Yes, he has been vomiting off-and-on for a few weeks, but his appetite is very good.

Harley's pancreatitis was diagnosed with his first ultrasound :eek: and I almost fell over from the shock...not only did my poor boy have Cushings but pancreatitis too! :eek::confused::eek: Harley's vet then ordered a cPLI test and his results came back at 528 (0-200). Since then I have had a diet formulated for him and we are trying to get his cortisol in the desired range...his last cPLI test done 2/26/10...well his mom is really happy with his results...303!

Here is some info for you on the cPLI test and pancreatitis.

Pancreatitis in Dogs and Cats
Pancreatic lipase immunoreactivity (PLI)
http://www.cvm.tamu.edu/gilab/research/Pancreatitis.shtml

Best of luck to you and Riley, and please remember we are here for you and Riley so ask all the questions you want and we will answer them the best we can. ;):)

Love and hugs,
Lori

[rhodesian46]

I had a dog with diabetes, cushings and hypothyroidism.

I noticed that Rileys lipase and and amylase were high.This could be very well pancreatitus. A mild case maybe. Riley should not be throwing up at all.

My concern is that the proper testing is not being done. An ACTh stim test I think would be a great idea. Was an abdominal ultrasound done . This is also a god thing to get as the vet can see if his adrenal glands are enlarges , liver etc. I would be not be comfortable starting trilostane at all unless I a definitive diagnosis.
Also if I may add that Trilostane is not started 2x a day unless the clinical signs such as drinking more or urinating more is still there.


Marianne (http://caninesupportgroup.com/)

[frijole]

My concern is that the proper testing is not being done. An ACTh stim test I think would be a great idea. Was an abdominal ultrasound done . This is also a god thing to get as the vet can see if his adrenal glands are enlarges , liver etc. I would be comfortable starting trilostane at all unless I a definitive diagnosis.
Also if I may add that Trilostane is not started 2x a day unless the clinical signs such as drinking more or urinating more is still there.


Marianne (http://caninesupportgroup.com/)

I just wanted to point out that I am positive you meant to say you would NOT be comfortable starting trilostane....Just wanted clarify for Riley's mom/dad . Kim

[rhodesian46]

Sorry thanks for bringing that typo to my attention, I edited it : )

[frijole]

Sorry thanks for bringing that typo to my attention, I edited it : ):D:D:D:D Not a problem. I have been known to hit a wrong key or two myself. ;)

[O'Riley]

Question for Lori...AND Squirt's Mom, Leslie!

....I've tried a lot of homemade diets (most recently the Wendy Volhard version). I'll spend all day in the kitchen cooking for my dogs if that's what it takes, but they absolutely WILL NOT touch anything that isn't meat, meat, and more meat. The taste/smell of the apple cider vinegar, the B-vitamins, the grains (I have every kind of grain Whole Foods sells just sitting in my pantry), the bonemeal (not just any bone meal, but bone meal from South American cattle that aren't subjected to the growth hormones, antibiotics and environmental toxins that our U.S. cattle is exposed to), Brewer's Yeast, etc. No matter how much I spend and how high quality all of the ingredients are, it's all a deal killer.

Bouncing my dogs around on homemade diets all these years is one (big) reason Riley's in such bad shape, I'm sure.

Is the diet that Harley's on actually good tasting and smelling? I'm at my wits end about what to feed my dogs (in addition to Riley, I also have two other picky eaters: a Basenji and a Rat Terrier). I tried Wellness Core the other day just because someone on the board said their dog likes it, but it was soundly rejected.

Any advice would be greatly appreciated.

~Rosey, slave to Riley, Asha & JoJo

[Harley PoMMom]

Is the diet that Harley's on actually good tasting and smelling? I'm at my wits end about what to feed my dogs (in addition to Riley, I also have two other picky eaters: a Basenji and a Rat Terrier). I tried Wellness Core the other day just because someone on the board said their dog likes it, but it was soundly rejected.

Any advice would be greatly appreciated.

~Rosey, slave to Riley, Asha & JoJo

Hi Rosey!

Harley's diet does actually smell good when I am making it, he is in the kitchen with me just waiting for anything to fall on the floor! His diet consists of the following ingredients: skinless & boneless chicken breast, chicken gizzards, potatoes, rice, carrots, yogurt, and squash, plus various vit. and minerals.

His diet was formulated by Monica Segal, now his first diet had no potatoes in it just the rice, but it seemed Harley didn't like all that rice so Monica reformulated his diet to include the potatoes and less rice.

We have another member here, Leslie (Squirt's mom) who is very knowledgeable about canine diet and nutrition. She also home-cooks for her furbabies, and I do believe, is studing canine diet and nutrition.

Here are links to her web site so that you can find info about Monica Segal, just incase you might be interested:
http://www.monicasegal.com/aboutus/index.php
http://www.monicasegal.com/aboutus/aboutus.php

All pups are different, and what might entice one to eat might not another. Harley can get finiky sometimes, like right now, I have to heat his food up before giving it to him. :)

Hope this helps.

Love and hugs,
Lori

[StarDeb55]

The 2 most worrisome results are the lipase & amylase as Lori has already mentioned. I would be extremely concerned about pancreatitis, if Riley were my pup. Lori is the forum expert on pancreatitis & cPLI testing. I would confirm what she has already said about pancreatitis as lipase can be excreted from other sources in the GI tract besides the pancreas. Riley's results are so grossly abnormal, though, I would almost bet pancreatitis in play, & would encourage you to investigate this further with your vet, especially cPLI testing.

Riley show the typical elevations in liver function tests that the great majority of our cushpups usually do, the thing about it is, I'm not familiar enough with how diabetes affects liver function to say for sure that these elevations are strictly cush related. Alkaline phosphatase is usually the one liver function test that will clue a vet into looking at Cushing's. Riley's result is a pretty mild elevation compared to some of the one's I've seen in my 2 pups, along with other members pups. It is absolutely nothing for this value to run in the several thousands when Cushing's is diagnosed. With such a mild elevation, I'm wondering if this isn't more related to the diabetes. Again, something to ask the vet. Finallly, BUN & creatinine are kidney function tests. The more important of the 2 is the creatinine. As long as the creat is normal, IMO, the BUN is not too terribly concerning. BUN can be affected something as simple as a high protein diet or dehydration. I see you mention that Riley could be considered to be on high protein diet. Also, if he was fasted for this labwork, that could be another explanation for the elevated BUN. All of the points I have mentioned will give you some ideas as to the questions you need to formulate for your vet.

Hope this helps.

Debbie

[O'Riley]

Debbie,

Thank you for taking the time this evening to analyze Riley's test results. I appreciate it very, very much.

Some questions: Is the "hemolysis 2+" towards the end of the report something to worry about also? What does hemolysis mean within the context of lab results? Since Riley's Lipase was also greatly elevated in 2007 (unfortunately, there is no indication on the 2007 test that Riley's amylase was tested for), is it actually possible to have chronic pancreatitis for two years?

My vet thought the alkaline phosphatase result was low for a Cushing's diagnosis, and that's why she wants to give the insulin a good try before starting on the Trilostane. We're going to do a curve on Friday to see if the insulin injections are having any impact on the blood glucose levels. Is it at all possible there is something that is unduly supressing or diluting the alkaline phosphatase level, thereby allowing it to appear lower than it would be if there were nothing interfering with its expression? Does this question even make sense?

Also, the vet agrees with the suggestion to do the cPLI test, and will send the sample to the GI lab at Texas A&M for analysis. We're going to get an abdominal ultrasound, and I will ask for the ACTH test, which will either back-up the positive-for-Cushing's low-dose dex test results, or bring those results into question.

For Lori....are dietary adjustments the only way to try and manage chronic pancreatitis?

[AlisonandMia]

Is the "hemolysis 2+" towards the end of the report something to worry about also? What does hemolysis mean within the context of lab results?

I believe that refers to the condition of the blood sample. When blood is drawn it is possible for some of the blood cells to be damaged (they are delicate little things)and this is called hemolysis. (Hemolysis means (approximately) "blood broken open" in Greek). This hemolysis can skew some results of some (but not all by any means) tests so it is necessary for the lab to mention it and take it into account. There are some forms of hemolysis that can occur in a living animal that are very serious but when it is mentioned like this ("hemolysis 2+") on a report it refers the state of the sample rather than having anything to do with the patient.

This explains it - see the bit under "In Vitro" particularly: http://en.wikipedia.org/wiki/Hemolysis

Alison

[Harley PoMMom]

Hi Rosey,


Since Riley's Lipase was also greatly elevated in 2007 (unfortunately, there is no indication on the 2007 test that Riley's amylase was tested for), is it actually possible to have chronic pancreatitis for two years?

Harley's pancreatitis was dx'd from his first ultrasound; according to the ultrasound it showed he had prior bouts of pancreatitis. For how long he had this disease before it was dx'd, I have no idea...a good while tho is my guess.


Acute pancreatitis occurs suddenly and is more often severe, while chronic pancreatitis refers to an ongoing inflammation that is usually less severe and may even be subclinical (no recognizable symptoms).
http://dogaware.com/articles/wdjpancreatitis.html

The trouble with diagnosing pancreatitis just by the lipase enzyme level alone by the chemistry blood panel, altho that it is a good indicator, is that Lipase is non-specific because there are digestive lipases, intestinal lipases, lipoprotein lipase and heptic lipase, hormone-sensitive lipase, and lysosomal acidic lipase. But with the cPL or the cPLI test, they can test for the lipase that specific for the pancreas only.

Having a diet formulated for Harley's particular needs (cushings, pancreatitis, high blood pressure), giving him L-Glutamine, trying to keep him at his ideal weight, and making sure that no one gives him something that he is not supposed to eat; ie...very fatty, high protein food/treat. I keep a very watchful eye on his pancreatitis and Thank God it is paying off. He also gets 3-4 small meals a day, which helps the pancreas not work so hard. It is a guessing game, I believe at first, because IBD, colitis, and food allergies can go hand in hand with pancreatitis. A pup can have all of these or just pancreatitis.


are dietary adjustments the only way to try and manage chronic pancreatitis? So, my answer is: dietary changes are a big part of the healing process and are for a lifetime.

Hope this helps,

Love and hugs,
Lori

[O'Riley]

Alison,

Thank you for this explanation. Very, very interesting.

So if one wanted to prevent future hemolysis that degrades the blood sample, what is the solution? How can I take control of the blood sample so that the cells remain undisturbed? It looks like this is something that can happen at any stage of drawing the blood, in transporting, storing? I've noticed that many offices (human and vet), have pick-up boxes outside for the lab messengers to retrieve samples from after-hours. Since high and low temperature plays a role in hemolysis, leaving blood samples out in the elements doesn't seem like such a great idea. The Wiki article mentions potassium. Since Riley's potassium is high, could this be the culprit causing the hemolysis, or am I misunderstanding the article?

Thanks again for your help. I truly appreciate your input.

~Rosey

[AlisonandMia]

I think the hemolysis causes the potassium to read high (rather than the other way round) - because the damaged cells release potassium into the serum (where it is measured) whereas normally it would be locked up within the blood cells and therefore not get measured. What these tests are looking for is serum levels of electrolytes like potassium and sodium.

There is not much you can do regarding this - as you said it can happen for variety of reasons and sometimes it is probably just bad luck. If it is really severely hemolysed (I've seen some with at least four +'s) and it was going to affect a test being run then it is likely the lab would ask for another sample to be drawn.

One of our moderators, Debbie (Stardeb55), is a lab tech and she'll probably be able to tell you more about this than I can.

Alison

[O'Riley]

Lori,

Thank you for educating me about pancreatitis together with Cushing's. Further testing is most certainly in order. I need to make immediate dietary changes, because even though my pups have been on a high protein diet, some of the meat they are eating is also high in fat. For instance, the butcher grinds a whole chicken for my dogs (skin, bone and meat). This is a no-no, correct? I'll get a meat grinder, and skin the chicken, then grind everything up, including the bone. The ground beef on their current diet is supposed to be 80-20 (20% fat). I'm now sure that isn't lean enough. I think the complicated part will be, if Riley has both pancreatitis AND diabetes AND Cushing's, finding the right balance with a high fiber, low fat, high protein diet. Yikes. Is this even possible? I do like the idea of potatoes rather than grain. None of my dogs will eat grain. I think they will go for potatoes. Dumb question, but what exactly would be an example of a fiber ingredient?

Do you cook the chicken, or serve raw?

Thank you!

~Rosey

[AlisonandMia]

A whole chicken (skin, fat and all) would have a lot of fat. My dog cannot tolerate even a small amount of chicken fat (other fats are fine - it's just chicken fat with him). Knowing what a small amount of chicken fat does to him I can't imagine what even a few ounces of "whole chicken" would do to him - and his immediate environment.:eek:

One really good source of carbs and fiber, particularly for a diabetic, is thoroughly cooked sweet potato (the orange ones). It is said to be very good for regulating BG (slow release carbs and high fiber) and is recommended for human diabetics. Normal potato tends to have very quickly released carbs (and not much fiber) and can cause the BG to spike very rapidly which is not normally what you want. Normal potatoes can be a problem for many human diabetics. What suits a particular dog varies though - but I'd start with sweet potato myself, introducing it very gradually.

I was once told by a vet that sweet potato was very "friendly" and soothing for their insides, too.

Alison

[StarDeb55]

Alison has been dead on with her answers to you about hemolysis. Hemolysis will frequently occur when a blood draw is considered to be "traumatic" or a difficult draw to put it simply. This can be due to the pup being a difficult draw such as small vessels or even an inexperienced person doing the draw. Hopefully, lack of experience is not the case, here. Potassium will indeed be increased in a hemolyzed sample. The degree of increase will depend on the amount of hemolysis. When a sample is flagged as "2+" hemolysis, that is the equivalent of moderate. The other value that will be increased is the ALT. The last blood panel that Harley had done showed a sharp increase in his ALT over his result from 6 months ago. There was a notation that hemolysis can increase an ALT result as much as 20%. I, initially, didn't panic quite as mention about the increase until I actually did the math, & the result was very much increased compare to the last ALT. Most of the time on CBC results, complete blood count, a sample will have to be grossly hemolyzed before any of these specific results are affected. In that situation, it's usually just the hemoglobin, RBC count, hematocrit, & sometimes the platelet count.

Hope this helps.

Debbie

[Squirt's Mom]

Hi Rosey,

I have been swamped lately but have started looking at the diet issue. One thing for sure, use the sweet potatoes (not yams) VS the white fleshed ones like Russett/Yukon/Red. White fleshed potatoes are inflammatory while sweet potatoes are anti-inflammatory. Plus Alison is on the mark with the sweet potato's ability to help regulate blood sugars. They will also provide some of those fibers.

On the grains, have you tried long-grain brown rice? Did you cook it to a paste? Have you tried quinoah? Was it the white or red variety?

What foods does Riley like? One of mine is so picky her taste changes from day to day at times. :rolleyes: But I have found a few things she really enjoys so I can add them when she is being snooty about what's in her bowl and she'll eat it then. So it may be that you need to build on his taste preferences especially at first.

One other point, the food that is right for Riley may well not be good for your other babies so be prepared to have at least 2 different menus to make if you want to cook for all of them. What needs to be addressed and controlled in Riley is unique to him, his dietary needs are unique to him and him alone. ;)

I'll so some more looking at your thread as soon as I can. Please feel free to ask any questions and I will try to help you. You can PM if you prefer, too. I am by NO MEANS an expert but just a student of canine nutrition...one of several canine passions! :D

Hugs,
Leslie and the girls - always

[Squirt's Mom]

Hi,

Me again. :) Just dashing by the office and wanted to drop off a few more thoughts.

It is critical that the pancreatitis be address asap. Not only does that effect the diet, it can cause permanent damage if left untreated. Those enzymes Lori talked about will eat away at the pancreas, liver and other organs if not stopped. One of the first steps in treatment of an acute attack is to withhold all food and water.

Even tho Riley has multiple problems, the diabetes is what will drive the diet he is on. That is paramount to all other concerns so don't try to focus on what each condition needs and try to bring it all together. Focus on the diabetes.

Since Riley does have multiple issues and one is diabetes, I strongly suggest you contact someone who can design a diet specifically for Riley that will address all his problems. There will be an initial cost for the consultation but if you can get a menu or two that Riley likes and that works for him, it is well worth it! My Squirt has been on a home cooked diet designed by her for over a year and has done beautifully on it! Her diet addresses her Cushing's, arthritis, and pancreatitis (she has one acute attack after surgery).

Ok...running off again but will pass by the way again! :D

Hugs,
Leslie and the girls - always

[O'Riley]

It is critical that the pancreatitis be address asap. Not only does that effect the diet, it can cause permanent damage if left untreated. Those enzymes Lori talked about will eat away at the pancreas, liver and other organs if not stopped. One of the first steps in treatment of an acute attack is to withhold all food and water.

Even tho Riley has multiple problems, the diabetes is what will drive the diet he is on. That is paramount to all other concerns so don't try to focus on what each condition needs and try to bring it all together. Focus on the diabetes.

Hi Leslie, thanks for your posts! Are you saying that Riley should be on a diabetes-friendly diet even if he has chronic pancreatitis? Wouldn't a diet that addresses diabetes conflict with what a dog should be eating if he also has chronic pancreatitis? I thought the dietary requirements were opposite each other? I haven't consulted with anyone yet about developing a personalized diet for Riley. As an interim measure, I have cut the fat from all my dog's food. They are all eating the same thing right now: A dab of brown rice, baked skinless chicken breast, sweet potato and steamed fresh green beans. They love it. I add a scant amount (less than 1/8 tsp)of PHD's "Unleash" digestive powder, which is apparently working because chicken always used to result in loose stools, but no problems in that area now. I know I can't keep them on this forever. I'm going to change it up a bit by substituting ostrich meat and buffalo meat...both naturally low fat. I was speaking with a very thin woman at the meat counter who was buying ten pounds of ground buffalo, and I thought surely it was for her dog, so I asked her...She said, definitely not for a dog...she eats the ground buffalo herself, instead of eating hamburger.

I realize now that all of my dogs were getting way too much fat. I was also adding safflower oil and cod liver oil per the Volhard diet, and I'm not sure that's harmful, but I'm stopping it now for the time being.

Thanks very much, Leslie, and everyone. I continue to be amazed by the spirit of caring here.

[rhodesian46]

Just wanted to add the ‘Spec cPL’ test that Pebbles g=had one she was at Texas A & M with problems came out positive.So the Dr's treated her for the symptoms of pancreatitus. When she passed afew later the necropsy stated that she did not have pancreatitius. So the test can be wrong.

Treating 3 endocrine disorders is difficult. Maybe switch to Royal Canin LF20 and add some fiber such as sugar free Metamucil or 100% pumpkin. I would freeze some for Pebbles and she would get her pumpkin as a treat after she ate her food.

As far as pancreatitis you can try to prevent it with low fat foods. But dogs with all of these problems such as with your and mine are more prone to getting it. I wouldn't be giving ground beef as a meat. I would stick with white chicken breast( no ribs or skin) or 99% ground turkey. And maybe add this to the kibble. And as far as the diabetes goes trying to keep the food consistent is the key. Adding different variables such as different foods can skew your curves. You could add chicken broth. But do read the labels Some broth has sugar in it. I would buy Wal Mart's brand in a 32 oz carton and add a wee bit to her food. Or you can cook the chicken in a crock pot. Refrigerate and skim off any fat and use that broth.

I don't mean to confuse you. We have complicated dogs. THat is is one of the reasons why I traveled to Texas A & M because Pebbles was more complicated than most. I felt strongly that an IMS needed to treat her and balance her disorders. There would be no way I would of let a vet in Austin treat her. They just don't know a lot about these diseases especially with all 3 diseases.

[StarDeb55]

Be very careful using any type of canned broth including chicken. The great majority of canned broth contains onion powder which can trigger a life threatening hemolytic anemia in our pups. Karen's Jed has a near fatal episode of hemolytic anemia when he was suffering a period of inappetance that Karen was trying to keep him hydrated using canned broth. Hardly anyone on these boards were aware of this issue with canned chicken broth until Karen nearly lost Jed, so this is why we urge strong caution when using canned broth. It's better to simply make homemade broth.

Debbie

[O'Riley]

Debbie....I just read your reply in another thread about the hemolysis making the blood test not worth sh**. This very thing has been on my mind since Riley's "superchem" also had hemolysis 2+ causing the ALT to possibly "be increased up to 45%, AST may be increased up to 20%, LDH may be increased up to 50%, Total Bilirubin may be increased up to 30%, Potassium may be increased by 20-25%, Direct Bilirubin may be decreased up to 90%, Triglyceride may be decreased up to 10%. The specimen has been centrifuged at high speed to decrease lipemia"

I recall the blood draw very clearly. It was done by the young, new vet in the practice and she had difficulty drawing Riley's blood and tried a couple of places (neck, leg) before getting any blood. It stood out in my mind later because the older, experienced vet did the blood draws for Riley's LDDS, and it was quick and effortless and he got it on the first try.

So to ask this question so all will benefit, since hemolysis renders most of the blood test results inaccurate, should not the vet have offered to repeat the test? Why wouldn't they call my attention to this rather than have so many posssibly life and death decisions about what diseases my dog may or may not have, being made based on useless results? Not to mention the cost of the test was over $200 (including the office visit). If your dog were the patient, how would you handle this?

Thank you for any advice you can offer on this troubling subject.

[frijole]

Thanks for asking this question! I'm the one with the xxitty results and I was so upset I had to gather my thoughts to be smart enough to ask the question. ;) Look forward to Deb's answer.

[StarDeb55]

I think how this situation is handled will be up to the individual vet. My Harley has had a couple of blood draws that were flagged as 2+ hemolysis which would be considered mild to moderate. I can live with that as Harley is a pretty small little guy who is getting cranky about being handled around his face & head. I would hope that the vet would take the hemolysis into account when reviewing results, but I can't speak for them. In the response I gave to Kim earlier today, I suggested her asking for repeat testing at no charge because the samples that were drawn for her Annie were 4+ hemolysis which is what we term "grossly hemolyzed". If it were a human patient, we would be redrawing the patient. I would ask this question of your vet, "Do you take into account the presence of hemolysis when reviewing lab results, & basing your treatment decisions on less than desirable results?" I would hope they do.

Debbie

PS-Kim, in your situation, as I stated, Annie's samples were grossly hemolyzed, & IMO, the testing needs to be repeated. As I said, if it were a human patient, we would be redrawing the patient.

[O'Riley]

Thanks, Debbie, but I must admit that I'm confused by the levels of hemolysis. Since results of hemolysis can affect some of the values by what I think are huge percentages in Riley's case, isn't the blood draw pretty useless, no matter how many plus marks the lab assigns?

[frijole]

Rosey,

Deb just posted on my thread again and said she was signing off for the night - my take is that your draw was moderately "crappy" and mine was "way more crappy" ;) and that those nos. up or down are the margin of error.

She instructed me to ask the vet to call the lab to ask if it affects the outcome. You could do the same. Especially given all you have going on - better safe than sorry. I am just lucky I typed that part of the report up or I'd have never known... learn something new once again. Hugs, Kim

[O'Riley]

I really could use some help in interpreting Riley's latest test results. My concern right now is his breathing (not panting), which is rapid fire FAST and very, very shallow. I think he's in a lot of pain. Still has the pendulous belly. After all this time, his glucose is finally normalizing somewhat. It's taken this long to get him out of the 300's & 400's. He became completely blind during this time. Now, his blood glucose is even scary low at times -- as low as 20 to 40. Part of the change I can attribute to Walmart's switch from Humulin to Novolin. But I don't think that's the whole story where his glucose is concerned.

If you could refer to the LDDS results in one of my first posts, you'll see that the results show positive for PD Cushing's. But that test was done when his glucose was running as high as the high 400's. I spoke with the doctor at UTenn, and he didn't have any faith in the results either, due to Riley's off-the-charts glucose. It was decided not to try to treat the Cushing's at that time, and to see if his glucose would come under control.

The bloodwork I first posted when I joined the board was so skewed by hemolysis that I had no confidence in the results. I switched to a new vet practice and one of the first vets there to see Riley said he could tell by looking at him that he had Cushing's. So I looked at photos online of dogs with Cushing's, and Riley looked nothing like a Cush pup to me because his coat was perfect, shiny and no shedding at all. He did have the fat belly, and still does, but he started gaining weight at a pretty fast pace after he was neutered.

Appetite-wise, he can go from completely ignoring food, to being ravenously hungry. Beginning about two months ago, he started with PD/PU again, like when he was first diagnosed with diabetes.

Riley had new boodwork done in 2010 with the new vet, and I've put the values in parentheses next to his current results so you can see the changes he's undergone (both good and bad).

His vet just diagnosed Riley with Atypical Cushings and prescribed lignans and melatonin. I started him on it right away, but only did it for a couple of days and stopped. The vet also said Vit. E and Omega 3's would help with the pancreatitis, which I also started and then stopped. The vet did say that if I wanted to speed up Riley's recovery, I could add Trilostane, but I felt like we were kind of scattershotting (is that even a word?) without anything to back up the atypical diagnosis (the UC:CR was 13). It was my choice not to run more tests since my paycheck evaporated pretty fast on the latest visit.

So here are his results, which seem to go all wonky when I "Preview Post", but please keep in mind that the numbers in parentheses are from the non-hemolyzed blood test done in 2010.

I would be so grateful for any advice. I would like to add that Riley's dentition is an absolutely, unbelieveably horrible mess, and has been for three years. The vet couldn't do anything under anesthesia because of the risk. Is it possible that all of his current problems are from dental pain? I believe we're at a crossroads, and that his breathing is telling me that he is suffering greatly.

2/7/13
Superchem Results Reference Range
Total Protein 6.9 5.0-7.4
Albumin 3.6 2.7-4.4
Globulin 3.3 1.6-3.6
A/G Ratio 1.1 0.8-2.0
AST (SGOT) 37 15-66
ALT (SGPT) 273 (171) HIGH 12-118
Alk Phosphatase 352 (240) HIGH 5-131
GGT 7 1-12
Total Bilirubin 0.1 0.1-0.3
BUN 48 (33) HIGH 6-31
Creatinine 1.2 0.5-1.6
BUN/Creatinine Ratio 40 (25) HIGH 4-27
Phosphorus 4.4 2.5-6.0
Glucose 120 (245) 70-138
Calcium 11.3 8.9-11.4
Magnesium 2.4 1.5-2.5
Sodium 151 139-154
Potassium 5.4 3.6-5.5
Na/K Ratio 28 27-38
Chloride 112 102-120
Cholesterol 371 (469) HIGH 92-324
Triglyceride 134 (493) 29-291
Amylase 1426 (5742) HIGH 290-1125
Lipase 908 (6448) HIGH 77-695
CPK 85 58-895

Pancreatic Lipase 668 (>1000) HIGH 0-200
Immunoreactivity
(Consistent with pancreatitis. Treatment can be monitored by repeated serum cPLI analysis)

CBC Results Reference Range
WBC 14.2 4.0-15.5
RBC 5.6 4.8-9.3
HGB 15.7 12.1-20.3
HCT 45 30-60%
MCV 81 (74) HIGH 58-79 fL
MCH 28.3 (23.5) HIGH 19-28 pg
MCHC 35 30-38
Polychromasia Slight
Platelet Count 469 (315) HIGH 170-400
Platelet Est Increased (Adequate)

Differential Absolute % Adult Reference Range
Neutrophils 8804 62 2060-10600
Lymphocytes 3408 24 690-4500
Monocytes 994 (535) 7 0-840 HIGH
Eosinophils 852 6 0-1200
Basophils 142 1 0-150
(Comment: Blood smear reviewed by technologist)

Urinalysis Results Adult Reference Range
Color Yellow
Appearance Clear
Specific Gravity 1.017 1.015-1.050
pH 6. 5.5-7.0
Protein 3+ Negative HIGH
Bilirubin Negative Neg To 1+
Occult Blood Negative Negative
WBC 0-1 0-3 HPF
RBC None 0-3 HPF
Casts/LPF None Seen Hyaline 0-3 LPF
Crystals None Seen HPF
Bacteria None Seen None Seen HPF
Squamous Epithelia 0-1 0-3 HPF
Glucose Strip Negative Negative
Ketones Negative Negative

Urine protein:creatinine ratio testing is recommended (if the sediment is inactive) to help determine the clinical significance of proteinuria.
Urine Cortisol/Creatinine Ratio Results: 13
Cushing's syndrome is highly unlikely in dogs with Urine Cortisol:Creatinine Ratio <.=13

Ova and Parasites with Centrifugation: None Seen

[O'Riley]

I'm afraid my post looks totally incoherent. Can someone pass along advice as to how I can edit my above post in order to keep the numbers from running together?

[Squirt's Mom]

The post is fine, honey. I can see it just fine, but can't offer much input on it. I do see that both the amylase and lypase are elevated. Did your vet say anything about pancreatitis? Kidney function?

Pancreatitis can cause quite a bit of pain and I would certainly want to talk to the vet about this possibility asap. Hopefully others will be on soon who will have more to offer. :o

Hugs,
Leslie and the gang

[labblab]

Welcome back from me, too, but I'm so sorry that Riley isn't doing well. I am not an expert at lab values, but like Leslie, the two things that jump out at me are the "positive" results on the specialized test for pancreatitis (cPLI) and also two specific kidney results: elevated BUN and 3+ protein on the urinalysis. Even though Riley's pancreatic lipase immunoreactivity (cPLI) result is somewhat lower than before, it is still elevated way above normal and this is a definite indicator of ongoing pancreatitis. As Leslie says, pancreatitis can be extremely painful, and it can cause loss of appetite, and vomiting and diarrhea as well. Can you tell us what Riley is eating right now, because there are dietary adjustments that are recommended for dogs suffering from pancreatitis. I know this may be a sticky issue since Riley is also diabetic, but I'm really anxious to know how your vet may be addressing the pancreatitis.

The other issue is Riley's kidney function. Based on the protein in his urine, the lab has recommended an additional test to try to clarify whether or not the preliminary result is really an issue. This is the urine protein:creatinine ratio. Has your vet talked with you about testing Riley's kidney function further? Because kidney issues can account for excessive thirst and urination.

I would put Cushing's on the back burner for right now. If Riley is in pain or feeling poorly from other issues, then any blood testing for Cushing's is not going to be accurate. I'm not sure how your vet has diagnosed "Atypical Cushing's" anyway, since it looks as though the only recent related test is the UC:CR urine test for which Riley's result was not definitive of anything. Atypical Cushing's is only diagnosed by performing an ACTH stimulation test and sending the results to the University of Tennessee in Knoxville for analysis. I'm confident you'd know if that test had been done. And the frosting on the cake is that trilostane is not recommended for treatment of Atypical Cushing's anyway.

So given the fact that Riley seems to be in pain, I'd first jump on the pancreatitis results and then also the kidney abnormalities. Definitely keep us updated as to how he's doing, OK?

Marianne

[frijole]

I'm just chiming in to say Marianne hit it out of the ballpark. Focus on pancreatitis. No matter what the vet says he couldn't have diagnosed atypical cushings unless he sent it away to TN. Glad you ceased all that.

Focus on pancreas and kidneys. And keep changing vets til you find one that gets it. If you need help finding one - tell us the general area where you live and perhaps one of us can help.

Kim

[O'Riley]

Hi Leslie....Yes, the vet said Riley has pancreatitis, and the Vitamin E and Omega 3's would help with the inflammation. It worried me to add oil supplements at this time, so I only did it for a day or two. The vet said Riley's kidneys were okay based on the spec. gravity result.

Marianne....I put Riley back on the Jean Dodds pancreatitis diet a few weeks ago to see if he improved, but he's only gotten worse. There have been a few recent vomiting episodes....very unusual for Riley....they were mustard-yellow colored. I, too, question the "atypical" diagnosis, since it's based on...well, nothing. I quit the lignans and melatonin until I could post here. There wasn't a lot mentioned about the pancreatitis, other than that it was improved over last time. Most of the visit centered on "the Cushing's". I personally don't believe Riley has had a solid Cushing's diagnosis.

[O'Riley]

I've just read online that acute pancreatitis can cause breathing problems due to chemical changes that affect lung function, causing the level of oxygen in the blood to fall to dangerously low levels. Also, that pancreatitis can cause kidney failure, and that inflammation from long standing chronic pancreatitis can cause pancreatic cancer.

[labblab]

Here is an article re: pancreatitis that may give you more helpful info:

http://dogaware.com/articles/wdjpancreatitis.html

You'll see that the article lists companion links to additional articles, such as healthy lowfat diets for dogs suffering from or recovering from pancreatitis. I am not familiar with Dr. Dodds' diet, but you can compare it to the dietary recommendations given here by Mary Strauss. What are you currently feeding Riley?

I see this article lists a recommendation for giving fish oil and vitamin E during treatment for acute pancreatitis episodes, so your vet's advise in that regard may actually have been on the mark. How recently has he seen Riley? Does he know how ill he seems to be right now? Given his apparent discomfort, breathing issues and vomiting, Riley may now need more urgent evaluation -- even perhaps hospitalization. Do you have a specialty hospital nearby where Riley can be evaluated if your vet isn't available to do so?

(We can address the kidney issues in another reply).

Marianne

[O'Riley]

Marianne....that's the best article I've read about pancreatitis. The diet recommendations are much different than the meals I had been preparing for Riley. Starting yesterday, he's had nothing but white rice....boiled for hours and hours, and boiled white meat chicken. 75% rice, 25% chicken, topped off with Vitamin E. Knock on wood, Riley's improvement is noticeable. A Ketodiastix dip first thing this AM shows protein down one notch from the high end, and spec gravity much better. I fed four small meals over 24-hours. He slept soundly from midnight to 6:00AM, still having difficulty breathing, but the rate has slowed. No PU since yesterday morning....all pottying being done outdoors at his request.

I know Riley's condition is still fragile, but aren't these positive signs?

I am so grateful for this Board and its wonderful members.

[labblab]

I do think these are positive signs, too. :)

The mooshy white rice and chicken really helped my girl, too, when she had an acute pancreatitis attack last year. Just like the article says, it isn't a balanced longterm diet, but in the short run, it is sufficient nutrition and can really help settle the GI issues. For what it's worth, after a couple of weeks and after my girl had improved from her acute episode (vomiting and diarrhea!), I transitioned her over to the California Natural Lowfat Rice and Chicken kibble that is listed on the commercial food chart in that article. I picked that food because the analysis is similar to the prescription pancreatitis foods but the ingredients sounded of better quality to me. Once again, I know that Riley has additional issues associated with his diabetes, so another food choice might be better for him. And I'm not trying to "push" California Natural, by any means. But my Peg did really well on that after shifting from the homemade food, so I just want you to know that there are options out there.

Please keep us updated, OK?
Marianne

[addy]

I hope Riley is feeling better, the breathing stuff is scary. My daughter's pom just went to the emergency room a few weeks ago, he was conjested and having trouble breathing and he was making a high pitched wheezing sound they called "stridor". Turned out it was from some really bad teeth.

http://www.petmd.com/dog/conditions/respiratory/c_dg_noisy_breathing

But he was not vomiting and he does not have pancreas issues.

[O'Riley]

Addy...how is the little Pom? Was the diagnosis made by a dentist, or a general vet? We have a wee Chihuahua who eventually had all of her teeth removed, and now has what my sister lovingly refers to as "brain worms". Even though the tiny thing came through the dental procedure with flying colors, a week later she developed neurological complications. the vet couldn't come up with a diagnosis. I suspect it's an oral/nasal fistula resulting from the dental surgery.

As a last resort we put her on Augmentin and as long as she gets her dose twice a day, she acts perfectly normally. I've tried to skip a dose to see how she does, but within hours she gets very clingy (a sign that she's scared, I think), starts running into walls, tries to drink from her water bowl but misses it by a mile, even goes temporarily blind. It's a mystery. Thank goodness for antibiotics.

Riley's teeth are seriously bad. I'm sure they are contributing to his pain burden, but he's not a good candidate for anesthesia, that's for sure.

[addy]

My daughter's pup is much better, thank you. Diagnosis was made at ER, not by a dentist wilth follow up by her regular vet who concurred. He is 16 years old and they pulled five of his teeth while he was under light sedation at the ER. Weird thing though, he didn't really need his Tramdaol for pain.

How is Riley today?

[molly muffin]

Checking in on Riley. Hows the breathing doing?

Sharlene and Molly Muffin

[O'Riley]

Riley's condition seems to be worsening. He has a Duragesic (fentanyl) patch on his rump to see if his pain can be alleviated and hopefully get a slower breathing rhythm going. It's been on for two days....so far, no noticeable improvement. Tramadol was tried at first, but it increased his rate of breathing which I've since learned can be a problem with Tramadol. Unfortunately, fentanyl can do the same thing.

His PU has increased, but on a good note, his urinalysis reagent strips are showing much, much less protein in his urine, much better (more concentrated) specific gravity, and everything else is normal too.

I keep coming back to two things that maybe you can help me with. The UC:CR is <13. Doesn't this rule out regular Cushing's? His vet said, "we know he has Cushing's"; that it was a surprise to see the UC:CR result; and, that he has atypical Cushing's, and prescribed melatonin and lignans. I don't quite understand how a dog can have a normal UC:CR result and also be thought to have Cushing's. I know the vet is going by his original LDDS from 2010, but his glucose was running very high (high 200's, 300's, even into the 400's at that time). Dr. Oliver told me the LDDS result was not reliable in the presence of Riley's non-adrenal illnesses (diabetes diagnosed that same week, and pancreatitis ... with PLI >1,000 just a few weeks later).

The other thing I keep coming back to is the severely deteriorated condition of his teeth. He must be in excruciating pain. He lets me push around on his stomach to see if there are any areas that are painful, but there don't seem to be any. But when I try to go anywhere near his mouth, he runs away. I know this doesn't explain the PU & PD, but his teeth are making him miserable. Can the pain from his teeth be the cause of his rapid breathing?

It seems like the atypical test would be a waste of time, given the dental disease, the pancreatitis and the diabetes, unless maybe the test used to determine atypical Cushing's isn't affected by concurrent illness?

[frijole]

You are spot on. That urine test would rule OUT cushings. The LDDS test done when diabetes wasn't controlled would certainly explain a false positive for cushings.

My dog had different problems (a pheo tumor that caused high blood pressure) and the vets refused to clean her teeth as they were worried about her handling the anesthesia. Well one day a pimple like thing showed up on her face and didn't heal - long story she had a tooth infection that had gotten so bad it ate through her skin all the way to the outside of her jaw bone! At that point they made a tough decision and cleaned it all up and stitched up the hole and gave her antibiotics and she healed just fine. Scary stuff but shows how serious oral hygiene is.

And you are right - the UTK panel is the least of your worries.

Kim

[addy]

My daughter's dog was breathing rapidly as well as noisy, they even put him on oxygen at the ER. It was his teeth. After he was on oxygen for awhile i n the ER,he started having yellow nasal discharge so they flushed his nasal paage with saline solution. So yes, the teeth issues if severe can cause quite a few problems.