Mariah, 12yo Standard Poodle, Anipryl (Update - Bladder Cancer)

[gloryb49]

I googled cushings diet and found this wonder full group with so much help and compassion out there. Thank you!
I am Mariah's mom, she is a 12 year old Standard Poodle diagnozed with Cushings less than a year ago. She is on anipryl. She is having bouts with loose stools and peeing a lot. I am concerned with her having diabetes. I have already seen your suggestions for the test strips and the chicken/mushy rice diet. Can it be brown rice? I will go first thing tomorrow morning. I don't see anyone giving anipryl. Can you fill me in on that please? Also I am concerned about the proper diet. I am going to try and get a urine sample and rule out an infection.
I am on a limited income so it is impossible to go to the vet constantly. I have 4 dogs and 7 cats, I can't say no to an animal in need. But it has to stop, it is getting to expensive as they grow old. I put my needs on the back burner and try to give them what they need.
Thank you so much for your support.:)

[jrepac]

I googled cushings diet and found this wonder full group with so much help and compassion out there. Thank you!
I am Mariah's mom, she is a 12 year old Standard Poodle diagnozed with Cushings less than a year ago. She is on anipryl. She is having bouts with loose stools and peeing a lot. I am concerned with her having diabetes. I have already seen your suggestions for the test strips and the chicken/mushy rice diet. Can it be brown rice? I will go first thing tomorrow morning. I don't see anyone giving anipryl. Can you fill me in on that please? Also I am concerned about the proper diet. I am going to try and get a urine sample and rule out an infection.
I am on a limited income so it is impossible to go to the vet constantly. I have 4 dogs and 7 cats, I can't say no to an animal in need. But it has to stop, it is getting to expensive as they grow old. I put my needs on the back burner and try to give them what they need.
Thank you so much for your support.:)

Hi Mariah's Mom,

I currently use Anipryl (generic). Definitely seek out the generic if you can; it is much cheaper. For example, 3 month supply from Walmart costs me $118; if I bought regular brand name Anipryl it would be $80/month= $240 for 3 months.

Anipryl is pretty low in terms of side effects; how much are you giving your poodle? Usually it is about .5mg per pound = 10lb dog gets 5mg per day, 20lb dog gets 10mg/day, etc. It is possible for it to cause tremors, vomiting, diarrhea, but it's not typical (adverse side effects were 4% or less of dogs tested). Here is the link to the drug sheet from Pfizer

http://vetmedicine.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=vetmedicine&cdn=homegarden&tm=7&f=10&su=p284.9.336.ip_&tt=2&bt=1&bts=1&zu=http%3A//www.anipryl.com/PAHimages/compliance_pdfs/US_EN_AR_compliance.pdf

You may want to use white rice instead of brown; oatmeal and/or bananas are good for loose stools as well. You can also give a bit of Pepto Bismol liquid if needed. I use 1/2tsp per 10lbs of doggy...Is your poodle taking any antibiotics (or other drugs)? I've found that sometimes the antibiotics give my terrier the runs...

[jrepac]

I meant to ask, re: peeing, is it an abnormal increase? Or is Mariah suddenly drinking a lot more? Eating a lot more (which could indicate that the Anipryl is no longer working)? As you say, could be a UTI. I have found w/UTI's that my terrier will pee A LOT in terms of frequency, but in very small amounts of pee.

Anipryl is used less frequently nowadays, since lysodren & trilostane are felt to be more effective in terms of cortisol; but you will find a handful of us out there who have had some good luck/good results with it. As I mentioned, it has low side effects, is considered safe, and may be preferred for an older dog less likely to tolerate the stronger medicines.

Oh, and regarding diet, you will find a lot of different opinions out there. It's very debated....many have had luck with home cooked diets. Flakey white fish and potatoes are recommended by some (this is a diet that is supposedly good for the liver, an organ which is taxed by Cushings). Some folks like the "raw" diet or a specialty kibble based on only real meat ingredients. What did your vet recommend?

I am currently using low fat canned food and low fat kibble...as my vet suggested a diet lower in protein and fat, if at all possible. It's a bit tough to get both in one formula, I will tell u. I read all the cans and bags before I buy. Oddly, a lot of the soy-based products are lower in fat content, but as with anything else, many people feel soy is not good for dogs. After trying (and throwing out) many bags/cans of higher end dog food that my Mandy simply would not eat, I finally pulled back and tried to find one that she will eat that is reasonably good in terms of protein and fat levels.

Jeff

[StarDeb55]

Welcome to you & Mariah! I must warn you that we tend to ask a lot of questions of new members, but that simply helps to give you the most appropriate feedback from the group's collective experience, so here goes. Could you tell us the symptoms that Mariah was being troubled by that led you to take her to the vet? What diagnostic testing was done to determine that she had Cushing's? If at all possible, could you get copies of Mariah's tests from your vet so you can post the actual results for us. Did she have any general labwork such as a senior wellness panel or super chemistry panel? We would like to see only the abnormal results from those tests along with normal ranges & reporting units. Was diabetes & low thyroid ruled out? I ask about these 2 conditions as their symptoms can overlap with Cushing's.

When it comes to using Anipryl, it is only effective in about 15% of pups diagnosed with Cushing's. To be effective, the lesion in the pit gland must be located in the pars intermedia. There are some advantages to anipryl as it does not require the follow-up/monitoring tests that the 2 standard meds do. The main way that determines whether or not anipryl is effective is improvement in clinical symptoms. Yes, you are right, the great majority of members treat with either lysodren or trilostane. I, now, have treated 2 pups with lysodren. My first pup, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15, due to causes not related to his Cushing's. My 15 yr. old Shih Tzu, Harley, has been on lysodren a little over 2 years & is doing well.

Believe me, we all understand the financial strain that treating Cushing's can be. This is why I haven't been on a vacation in probably 7 or 8 years & am driving an 8 year old car.;):p:(. Once you get the pup stabilized on one of the 2 standard medications, costs usually go way down. The following link is from our Helpful Resources section of the forum which will give you some information about other resources available for help with vet bills.

http://www.k9cushings.com/forum/showthread.php?t=212

Looking forward to hearing more.

Debbie

[gloryb49]

Test was done with Michigan state U, Raymond F Nachreiner, DVM Phd.
Endocinology Interpretation was as follows, The sluggish suppression is a bit borderline, but very close to a range where we are confident of the presence of Cushings disease.
Cortisol Baseline, 218H
Cortisol low dose dex 4h, 77 H
Cortisol low dose dex 8 H, 46H
Thoughts? I will send more.

[gloryb49]

Mariah had test done through Michigan State U last June. by Raymond Nachreiner, DVM PHD
Endocrinology interpretation as follows, The sluggish suppression is a bit borderline, but very close to a range where we are confident of the presence of Cushings disease
Procedure,
cortisol baseline 218 H
cortisol low dose dex 4h, 77 h
cortisol low dose dex 8 hr, 46 H

Symptoms before were fever and high liver and high alp and alt. She was home and about 3 days later started a cough, thought she got kennel cough. Went on for weeks and went through 1 antibiotic after another. To find one that would work.

[lulusmom]

Hi and a belated welcome from me.

Thank you for posting the results of the LDDS. Most of us are used to seeing these numbers in ug/dl so I've made the assumption that the numbers you posted are nmol and have done the conversation below:

cortisol baseline 7.90 ug/dl
cortisol low dose dex 4h, 2.79 ug/dl
cortisol low dose dex 8 hr, 1.67 ug/dl

These numbers are certainly consistent with pituitary dependent cushing's; however, one LDDS test is insufficient testing to confirm a diagnosis, especially in light of the fact that Mariah may have been had kennel cough at the time the test was done. Any non adrenal illness can cause false positives on the LDDS. Did your vet do an other testing to confirm the diagnosis. Can you get your hands on a copy of the bloodwork and post the high and/or low values, along with the reporting units and normal reference ranges? Also, can you tell us exactly what symptoms Mariah had besides the excessive drinking and urinating? I believe Debbie has already asked you these questions but thought I'd ask them again in case you missed it.

I have two cushdogs so I understand only too well how expensive cushing's can be. Fortunately, the diagnostic phase carries the heftiest price tag and once stabilized on treatment the cost goes down quite a bit. I'm way behind on my own routine testing so I can get my two a long overdue acth stimulation test.

As others have already mentioned, Anipryl is rarely effective in treating cushing's and it's usually reserved for dogs that 1) can't tolerate the more effective treatments like Lysodren and Trilostane; 2) dogs whose pet owners cannot afford the routine acth stimulations tests that are necessary to monitor Lysodren and Trilostane; 3) dogs with very, very mild symptoms. It sounds as though one or two of those criteria may fit for Mariah. How long ago was she diagnosed and how long has she been on Anipryl. Have you noticed any improvements at all since starting treatment?

I realize that you came here looking for answers to questions about diet but it seems like there are more issues than diet going on with Mariah at the moment. Unless a dog is in chronic renal failure or has serious primary liver disease, the ideal diet for a cushingoid dog is one that is higher in protein (good quality protein) and is low in fat. I see that your vet has recommended a lower protein for Mariah. Does she have kidney issues?

Looking forward to getting more information on your sweet girl.

Glynda

[lulusmom]

Mariah's mom provided me with Mariah's blood chem results which I am now posting here.


don't know of any other tests performed.
here are the other results. She really never went over them so I don't know a lot about them.
WBC 24.56+ ( 6 - 17) normal
MON 0.13 - (0.2 - 1.5) normal
NEU 22.56+ ( 3- 12) normal

LY% 7.1 - 12- 30 normal
MO% 0.5 - 2-4 normal
NE% 91.9 + 62-87 normal

MPV 12.8+ 3.9- 11.1 normal

ALP 1350 + 20-150 normal
ALT 262 + 10-118 normal
GLU 115+ 60-110 normal

and again
Cortisol Baseline 218 H ref range 15-110
Cortisol low dose dex 4h, 77 H ref r 0-30
Cortisol low dose dex 8h, 46H 0-30

[StarDeb55]

Glynda, PM'd me, asking me to take a look at Mariah's labs. Her total WBC count, along with % NE, indicate that Mariah had a major infection going on, probably bacterial. If her LDDS test was done with an active infection present, this puts the postive LDDS result in serious question.

Debbie

[gloryb49]

Mariah had an accident this am in the house and noticed the urine had a lot more blood in it than last week. She was at the vet on Monday to rule out kidney stones or crystals. I am really concerned. Any one else had a similar problem? Of course I am having rummage sale today.

[AlisonandMia]

Urinary tract infections are very common in Cushing's dogs so a UTI is a strong possibility. One of the symptoms is blood in the urine.

Was her urine tested for an infection the other day? Even if it was and it was negative it would be worth the vet having another look. I think I have read somewhere that sometimes very dilute urine can give a false negative on testing for a UTI. Sometimes vets will give antibiotics on spec when there are symptoms consistent with a UTI, even when tests come up negative.

Alison

[Squirt's Mom]

Hi and welcome to you and Mariah, :)

The blood in the urine could be an UTI or could be crystals/stones. If she hasn't seen a vet, she needs to asap. One of mine has struvite crystals which are an on-going battle to prevent stones from forming but she is doing well for now on anti-biotics and diet.

Crystals are like teeny pieces of glass going through the urinary tract and cause pain as well as bleeding. There are several kinds of crystals, each with their own shape, cause and treatment so seeing a vet to determine which type is important.

UTIs can lead to crystal development so another reason to bite the bullet and see a vet asap. Trust me I DO understand! My bullets are riddled with teeth imprints! :eek::p

Until this issue is cleared up, further testing for Cushing's would be a waste of money IMHO. Once this is gone, then we can talk about what you see that may indicate a progression in her Cushing's and what options you have, k?

Glad you are here and look forward to reading more of yours and Moriah's story in the future!

Hugs,
Leslie and the girls - always

BTW - I am an ardent Anipryl supporter for certain cases and have had good results in my own cush pup. ;)

[gloryb49]

Thanks for the info.
I did take her to the vet last week and we did xrays to rule out stones and crystals. She put her on Baytril. She is 5 days into script.
The vet wants to do a sterile urine recovery to see what specific drug to treat the infection with. What our your thoughts on that? Just don't want to compromise her. She is such a great dog!

[Harley PoMMom]

My boy Harley has had two ultrasound guided cystocentesises. Normally they don't use the ultrasound machine but with my boy...well he gets a bit tense so they need some help finding his bladder.

They preform the Cystocentesis so the lab can determine the type of bacteria and the most effective antibiotic to use.

Hope this helps.

Love and hugs,
Lori

[gloryb49]

Thanks so much for the info. I am scared to death of needles. Would rather be in a room with a snake!

[AlisonandMia]

Here are some results of Mariah's urine test. There are two pages the actual results are on the second page:

[judymaggie]

Maggie had several cystocentesis procedures done during her later years. The idea of it creeped me out but she never let out a peep at any point. I usually accompanied her to the vet's back room for her various procedures but I passed on these -- one, I don't think I could have handled watching the needle go in and, two, the vet thought she would be more relaxed if I wasn't present.

Mariah will handle the procedure with ease, I'm sure! :)

[StarDeb55]

Alison, it's a little hard to read that report as the results are not posted against what test it is.

Debbie

[AlisonandMia]

I know - I did it by toggling between the two and counting rows. Not the easiest and not the best. I could email it to you if you like so you can print it out and have a better look.

Alison

[lulusmom]

I couldn't make heads nor tails of those two pages. I tried to tie them together by line and that didn't work either. The only thing I was able to determine was the USG and PH.

[StarDeb55]

Alison, send them on. I may not get to them tonight, though.

Debbie

[gloryb49]

Thanks you guys for looking at them. I cannot make heads or tails out of them. Maybe when I go to the vet this week I can get copies.

[AlisonandMia]

Ok here's my interpretation - I've typed it up in Word for formatting purposes:

[AlisonandMia]

Oops - I should mention that the HPF/LPF stuff appears on the original - I haven't put it in my table.

Alison

[gloryb49]

There is one more urine test they did not complete, I was going to take a sample in and have that test done. But if it shows transitional cells that is possibly a growth or cancer in her bladder right?
Now from experience does anyone know if an ultrasound or the dye and gas test would be better? I am trying to save myself some money and doing the one that will tell me the most.
Thanks!

[StarDeb55]

The good news is that Mariah does not have a bladder infection. The bad news is that with 3+ blood, along with >50 RBCs, & 4-10 WBC, something is going on in Mariah's urinary tract. I can't wager a guess as to whether it's her bladder, kidneys, or somewhere else on just a UA report. These results are very abnormal, & I would question the vet about this, asking that since it's not an infection, what else could it be.

Alison is correct about the meaning of HPF & LPF.

Transitional epithelials are not tumor cells. They are simply a specific kind of epithelial cell found in the urinary tract, mostly in the bladder. There presence is not abnormal unless seen in elevated numbers. I would not consider 2-3 to be too elevated.


Now from experience does anyone know if an ultrasound or the dye and gas test would be better?

I have no idea what the dye & gas test is for or what it's testing for, so if you can give me some more information on that test, I may be able to offer some input. I'm a big believer in an abdominal ultrasound as this will check all of Mariah's internal organs & you will get a better idea of her overall health. When my Harley had his ultrasound when his Cushing's was diagnosed, the IMS found a previously existing gallbladder problem including a dilated common bile duct that I had no idea was there. A US really gives you more "bang for the buck".

Hope this helps.
Debbie

[gloryb49]

Debbie thanks again.
I found an internal medicine specialist not too far away. My neighbor used her when her vet could not find the problem.
I will ask for an abdominal ultrasound, thanks for the suggestion.
Gloria

[gloryb49]

Deb,
Just got the results back on the third urine test. (Urine Microalbumin) Cannine
Her results were 8.0 with reference range <2.5

I understand that it can run high with Cushings right? She did have a problem with lose stools for a while also. I read that can do something to the test also.
I am taking her to a specialist this Thursday.

I will have the ultrasound done and report back? Anything else you can suggest?
Thanks
Gloria

[Harley PoMMom]

Deb,
Just got the results back on the third urine test. (Urine Microalbumin) Cannine
Her results were 8.0 with reference range <2.5

I understand that it can run high with Cushings right?
Gloria

Hi Gloria,

Diabetes mellitus, Cushing’s disease, hyperthyroidism, and hypertension are known to cause Microalbuminuria in dogs. Usually getting the disease/illness under control will result in resolution of the Microalbuminuria.

Has Mariah's blood pressure ever been checked? My boy Harley was losing protein in his urine. Through the wonderful guidance of these amazing people here on the forum and suggesting that I have Harley's blood pressure checked is how I found out that he indeed does have hypertension. Harley now takes amlodipine to control his elevated blood pressure which in turn has resolved the protein loss. His vet and I are hoping that once we have his cortisol under control that maybe his blood pressure meds will not be needed, but one must treat the condition if needed.

Love and hugs,
Lori

[gloryb49]

Well just got home form the internal medicine Doctor.
Not good news. Mariah has bladder cancer. The tumor is almost obstructing her kidney so it can't function. She said she is in such good health otherwise.
So now I have to set inevitable. Her sister and I will miss her and her kisses. I have been so lucky to have had her, I don't want her to suffer .
Thank you for your support.

[labblab]

Gloria, I am so very sorry to read this news about Mariah's cancer. Please do remain with us, to keep us updated and to allow us to offer you our support. We care very much about you and Mariah, and we will do everything we can to help you through this.

Many (((hugs))),
Marianne

[jrepac]

I am so very sad to read this...my thoughts are with you

Jeff

[frijole]

I too am so saddened to hear this. Please do keep us posted on how are you doing when you are up to it. Know you did all you could and then some. Again I am so sorry. Hugs, Kim

[sunimist]

I'm so sorry Gloria. My heart goes out to you.

Shelba and Suni