View Full Version : Alivia was recently diagnosed with Cushing's - Alivia has passed
I am so very sad that I need this site, but since I do, I'm thankful that I found it. My 13 year old, 18 pound, Jack Russell Terrier, Alivia, was recently diagnosed with an Adrenal tumor causing Cushing's. She had dental surgery for 2 abscessed teeth and at a follow up appointment I told her dentist she did not seem to be herself, so she did blood work. Many of the values were outside of normal ranges so I took her to her internist for further testing.
Alivia had an ultrasound which showed an adrenal mass and that side was approx. 4x the size of the other one. She also had a Dexamethasone Sup. Test that day. A week later she had the full Adrenal Function testing (sent to U. of Tenn.). Post ACTH reslts were Cortisol-249.0, Androstenedione-7.84, Estradiol-65.4 (one in the normal range!), Progesterone-2.55, 17 OH Progesterone-3.25 and Aldosterone-414.5. I cried for two days and also started researching options. Her internist said she could attempt surgery or treat her with Lysodren. Because of Alivia's prior health issues and age, I am terrified to attempt the surgery. When Ali was 7 years old, she had IMHA and almost died. At the time there were no specialists in Pittsburgh, so I drove her back and forth to Ohio State University, where she was in intensive care several times. Long story short, she made a miraculous recovery but has some residual health issues, which she is still monitored for. She takes amlodopine for elevated blood pressure and a low dose compounded aspirin daily to help prevent any clotting issues. Lysodren therapy also seems impossible because Ali's tumor is apparently causing her levels to fluctuate - sometimes her appetite and thirst are increased, sometimes they are normal for days and every so often she has no appetite for several hours to a full day. There is no way I could accurately judge the loading dosage. Plus, I have read that dogs on Lysodren have an average survival time of only 16 months? :(
Ali still seems to have a good quality of life, but tires easily. My goal is to keep her as comfortable as possible for as long as possible. I adore this little dog! My regular vet suggested Trilostane, but my understanding is that although it does tend to lower the cortisol, it increases all the other hormone levels and may even cause the tumor to grow more rapidly. I have started her on melatonin (3mg 2x a day) and Flax Hull (SDG) lignans (about 20 mg per day) and am considering asking her vet to prescribe Ketoconazole. She took this before for a skin problem with no bad effects - in fact, in hindsight, she had no Cushing's symptoms while on Ketoconazole. For added measure, I started giving her The Missing Link Canine Food supplement. I'm desperate.
Sorry this post is so long, but I was trying to give some background info. My question is: Does anyone here have any experience using the combination of Melatonin, Flax Hulls (SDG) Lignans and Ketoconazole for symptom tratment in a dog with an adrenal tumor? Any insight into ANY of this would be greatly appreciated.
Moderator's Note: I have moved your thread to the main discussion forum where other members who are dealing with both forms of Cushing's will see your post, & drop by to respond to your questions.
Hi,
Welcome to you and Alivia. I think we are all sad when we first come here but once we learn and become knowledgeable and have support from others walking in the same shoes, it somehow gets easier. I know you don't think that now. I am sorry to hear about your pup, it is so hard to hear the Cushings diagnosis but we have members that have had surgery and/or have treated with Lysodren. The moderators will all be along soon with questions for you. They will want to know what your test results were, if you can post them it helps. The more information you can give, the better; how much Alivia weighs, etc.
My Zoe is on melatonin and lignans and it has brought her estradiol down to normal and brought some of the other hormones down alot.
Hold tight and we'll get things sorted out with tons of good advice. Our administrators and moderators are pretty darn smart:)
Take a deep breath and if you feel like reading, our reference section has a lot of information.
Welcome again and I am so glad you found us.
Hugs,
Addy
littleone1
04-23-2011, 09:38 PM
Corky and I want to welcome you and Alivia.
Corky has a right adrenal gland tumor and is being treated with Trilostane since he is not a good candidate for an adrenalectomy due to his age and other health issues. He's been on Trilo for 1 1/2years. Some of his intermediate hormones are slightly elevated, but they have not caused any problems for Corky. His tumor has increased in size, but the last ultrasound he had showed that the tumor was the same size as his previous U/S. Corky will soon be 14years old, and he still enjoys his walks every morning.
I know cushings is very frightening, but with treatment, our furbabies do live to their expected life span, and they do have a good quality of life.
Terri
asgparrish
04-23-2011, 09:40 PM
I'm a newbie to the site so I can't really offer any advice (though I have read good things about melatonin and lignans).
I just wanted to let you know I'll be pulling for you and Alivia :)
Tammy
Thanks to each of you for your optimistic responses. I so needed to hear something good...or at least not so bad. Alivia is my first dog. I got her quite by accident when she was 8 weeks old. I wasn't looking for a dog; didn't even know I wanted one. I went to look at a house for sale and she was there with her mom and 2 littermates. I didn't buy that house, but I fell in love with her immediately and made arrangements to pick her up as soon as she was old enough to leave her mother! That was 13 years ago and Ali has been such a sweetheart and an important part of my family. I got a second JRT almost 11 years ago, too. His name is Maxwell and fortunately he has always been very healthy.
Welcome,
Addy is spot on. The knowledgeable folks here have a wealth of experience to pass on. They were right so many times when I questioned the information I was given by the professionals.
I don't have much to offer but I have a little experience with the Lysodren. Many pups here have gone on for several years on Lyso and my Snoop has only gotten better, when she probably would not be here without it. According to Dr. Oliver at UT it will also lower your hormones/intermediates.
I researched the Melatonin, Lignans and Ketoconazole at first also because my Snoopie got diagnoised with pituitary cushings, after her gall blatter and spleen were removed. Her elevated hormones reaked havoc on her organs! I was also concerned about the Lysodren being too hard on already delicate system. Her food and water habits were fluctuating also. (They must feel awful with elevated hormones. She is more constant now.) Unfortunately, her Estradiol was sky high along with everything else, so we had no choice. We tried the HMR lignans and melatonin but, she needed the Lysodren as well because she was so high.
I was told lysodren is a selective drug which only targets the outer cortex of the adrenal glands, blocking the the cortisol. That made me feel a little better...so we went ahead. When we got loaded it wasn't so much the water and other indicators but her attitude. I expected her to feel bad when I started loading her, as it is a chemotherapy drug. However, she actually started acting like her old self as her cortisol got into the normal range. As she got closer to the 1-5 ug/dl for loaded lysodren it was then I noticed that she became less active and was acting a little lethargic and less her old self. Thats how I knew she was loaded.
We had a few ups and downs as she had to be loaded twice as she didn't hold and we have had a hard time with her maintaince dosage. None of this was due to the Lyso...just learning experiences...and the sound advise of the group got us through. However, because of all of her other issues and in the long run not being able to judge her dosage the traditional way I have been able to tell easly by just her attitude and activity.
Sorry for the lengthy post but what I wanted convey was don't rule out the Lysodren just yet because you think you might not be able to judge if Alivia is loaded or you feel it may shorten her life. Lots of members have had great results with just a maintaince lysodren dose, lignans and melatonin for Adrenal Cushings.
The proper use of lysodren doesn't shorten or put an expiration date on our pups...Cortisol and Intermediates do!
Big Hugs to you and Ali,
Rene & Snoopie
Thanks, Rene. No need to apologize for a long post - I GREATLY appreciate everyone's insight and experience with this. I am fortunate to have good vets, but their opinions can vary and I really need to hear actual experiences from people who have been through this with their pets and which treatments worked and which ones not so much. I thought I had ruled out Lysodren, but you have given me reason to reconsider. What about Trilostane v. Lysodren for a dog with an adrenal tumor? Anyone have any opinions on this?
Thanks again, Rene. Happy Easter to you and Snoopie!
Grateful for advice,
Mary Beth and my sweet Alivia
I really do feel for you....Maya was diagnosed just a few days ago, so any advice from me would be like the blind leading the blind! I can offer hugs and moral support. Maya has been put on Vetoryl which is Trilostane. She has started off on a very low dose to see how she reacts to it. I suppose that it's a case of all dogs are different, so it's trial and error. We will just have to watch them like a hawk and have frequent follow up tests done to see if they are coping with the drugs ect.... Although it's very difficult, I am trying not to obsess about it cos it's not good for either of us.
Hugs from leah and Maya
Hi, Leah,
Sorry to hear you are also going through the same thing with Maya. What kind of dog is she? How old? Is her Cushing's pituitary or does she have an adrenal tumor, like Alivia?
We may not be able to offer any advice at this point, but since they were both diagnosed about the same time, we certainly can offer each other much need moral support!
Please keep in touch. I hope Maya's treatment goes well!
Warm thoughts,
Mary Beth and Alivia
cairncrazy24
04-24-2011, 02:59 PM
Welcome from Jodi and Misty.. I cant offer much in knowledge. Misty just had her LDDS test last week. I will know results on Monday. Hoping for the best for all of our furbabies!
Hi, Leah,
Sorry to hear you are also going through the same thing with Maya. What kind of dog is she? How old? Is her Cushing's pituitary or does she have an adrenal tumor, like Alivia?
We may not be able to offer any advice at this point, but since they were both diagnosed about the same time, we certainly can offer each other much need moral support!
Please keep in touch. I hope Maya's treatment goes well!
Warm thoughts,
Mary Beth and Alivia
Hi Mary Beth, Maya is a cross breed ( a mutt, I guess you could call her) She was 12 on the 1st of April. We think that she has pituitary type Cushings as no tumours were found on the ultrasound scan. Her adrenal glands were on the large side, but still within the normal range. One was slightly bigger than the other.
I'm sure you'll find all the help and support you need here, they are a great bunch!:)
Best wishes to you and your little babe
Harley PoMMom
04-24-2011, 06:27 PM
What about Trilostane v. Lysodren for a dog with an adrenal tumor? Anyone have any opinions on this?
Grateful for advice,
Mary Beth and my sweet Alivia
I think you will find this article interesting:
Cushing's disease and other adrenal gland disorders (Q&A with Dr. E.C. Feldman). (http://veterinarynews.dvm360.com/dvm/Internal+medicine/Cushings-disease-and-other-adrenal-gland-disorders/ArticleStandard/Article/detail/672663?contextCategoryId=40534)
Dr. Edward C. Feldman is a renown Cushing's expert, also this is the Editor's note:
Edward C. Feldman, DVM, Dipl. ACVIM, is the chair of the Department of Medicine and Epidemiology at the University of California-Davis School of Veterinary Medicine. He is a co-founder and former president of the Society of Comparative Endocrinology, a special interest group open to all veterinarians, and is a co-author of the Textbook of Veterinary Internal Medicine with Dr. Stephen Ettinger and Canine and Feline Endocrinology and Reproduction with Dr. Richard Nelson.
When deciding to treat with Lysodren/Mitotane or Trilostane/Vetoryl, IMO, either medication is safe when monitored appropriately and with owner observation and each med can have similar adverse effects. So "owner observation" is always a crucial component of treatment.
Each has it's pros and cons, they work differently, they are both safe when monitored appropriately, yet they both can have the same and serious risks and adverse effects.
One or the other may work better for an individual dog.
Another important consideration is the degree of experience your vet has with whatever treatment he/she chooses. Cushing's requires a good partnership with one's vet.
Love and hugs,
Lori
Hi Mary Beth,
This was also helpful to me when I first started out...if you haven't already seen it.
http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php
You were correct in your post that the trilo may elevate the intermediates. I have learned that the lyso will lower them. I had
e-mail conversations with Dr. O at UT re: this subject. You can e-mail him with general questions. He is very good about getting back to you.
joliver@utk.edu
Take Care,
Rene & Snoopie
Hi Mary Beth,
Choosing treatment can be agonizing for us so don't feel you are all alone in that regard. We are the ones administering the drug to our pups so we can find it overwhelming.
Knowledge will make you feel more comfortable with your decision.
My dear friend Sonja, Apollo's mom has always given me sage advice. "Go with your gut". I pass that advice on to you:)
Hugs,
Addy
Thanks, Addy. Just when I think I am leaning towards one treatment, I change my mind.
I'll post Alivia's test results and if anyone has any opinions, I'd love to hear them. Alivia is a spayed female Jack Russell Terrier, 13 years old and 18 pounds.
LDDS Results:
Cortisol Pre - 7.1 ug/dl
Cortisol 2 - 0.9 ug/dl
Cortisol 3 - <0.7 ug/dl
I think these results were all in normal limits, but I am having a hard time reading the reference range information.
Ultrasound
I haven't received a copy of the report but was told there was a mass on one adrenal gland and that it was about 4x larger than the other side.
Adrenal Panel (U of Tenn)
Baseline / Result
Cortisol ng/ml 115.8* / 249.0*
Androstenedione ng/ml 3.90* / 7.84*
Estradiol pg/ml 68.8 / 65.4
Progesterine ng/ml 1.09* / 2.55*
17 OH Progesterine ng/ml 0.91* / 3.25*
Aldosterone pg/ml 222.1* / 414.5*
"These results indicate presence of increased adrenal activity. (severe)"
Blood tests (abnormal results only)
Result / Ref Range
Glucose 129 H / 75-125
Cholesterol 351 H / 120-310
ALP 203 H / 0-140
Amylase 2093 H / 100-1500
Lipase 436 H / 0-225
Triglycerides 238 H / 30-120
Sodium 104 L / 141-152
Potassium 2.8 L / 3.8-5.3
Chloride 74 L / 102-120
WBC 17.5 H / 6.0-17.0
GRAN 13.9 H / 3.5-12.0
HCT 35.1 L / 37.0-55.0
PLT 596 H / 200-500
Not sure if there is any significance to this, but handwritten on the blood results it says "Serum-cloudy/white"
So, how bad is all of this??
Terri, since your dog is about the same age as Ali and also has an adrenal tumor, could you tell me why you chose Trilostane over Lysodren? It sounds like you are having good results?
Sorry for such a long post, but I am at a complete loss as to what to do. It's 1:30 A.M. and I get up for work at 5:30, but I can't sleep. The only thing I have ruled out completely is surgery - that terrifies me due to her age and prior history of IMHA. The more I read, the more confused I get....wish I had a crystal ball.
Thanks all,
Mary Beth and Alivia
One last test result:
Urine Protein/Creatinine Ratio 4.5 / Ref Range <=0.5
Thanks again,
Mary Beth and Alivia
littleone1
04-26-2011, 07:57 AM
Hi Mary Beth,
Corky has been doing good on the Trilostane. Originally, when Corky was first diagnosed with cushings over two years ago, his vet was putting him on Lysodren, which really scared me. Due to two UTIs, Corky couldn't start treatment due to the antibiotics he was taking. In the imeantime, his symptoms went into remission for seven months. When his symptoms started appearing again, his IMS is the one that recommended that we use Trilo with Corky instead of Lyso. She felt that it would be easier on Corky because of his other medical issues. He hasn't had any problems with it. His dosage has had to be adjusted, but that is to be expected. She started him at the low end with 1mg per pound.
Hopefully Deb will come by and look at your test results for your blood work. Glynda and others can make sense of your UTK panel in the mean time.
Don't forget you can always switch between Lysodren and Trilostane as long as you do a 4-6 week wash out period if you have ruled out surgery. Boy, I know that "change your mind" every day!!!! I still do it even with food:rolleyes:
Terri will stop by too to discuss Corky and Trilostane or you can read her thread "Little One".
You have some time to decide.
Hugs,
Addy
Harley PoMMom
04-26-2011, 12:24 PM
One last test result:
Urine Protein/Creatinine Ratio 4.5 / Ref Range <=0.5
Thanks again,
Mary Beth and Alivia
Many dogs that have Cushing's do have protein-loss but also blood pressure that is elevated or not controlled properly can cause the the protein-loss to increase. Has Alivia's blood pressure been checked recently, as I seen from your prior post that she does have elevated blood pressure which amlodipine is being given to control.
My boy, Harley, was on amlodipine for a while for his elevated blood pressure but this medicine ceased to control his high blood pressure, we had to add benazepril along with the amlodipine to bring his elevated blood pressure down to the normal ranges.
Love and hugs,
Lori
Hi, Addy and Lori. Thanks for the replies.
Addy - So funny you should mention the changes in food!! I spend so much time in the pet stores reading labels. I won't give my dogs anything not made in the U.S. and since I have a hard time committing to any one food, I vary the (premium) brands I give them. Fortunately neither of them have sensitive stomachs and actually seem to enjoy the variety! I often bake them homemade treats because I feel better knowing exactly what they are eating.
Lori - Alivia gets her blood pressure checked every couple of months and the Amlodopine seems to be keeping it in check so far. The protein in her urine is due to glomerulonephritis, a residual from when she was 7 years old and had IMHA. So her kidney function has been a bit compromised for awhile.
Currently, I am leaning towards starting Trilostane, but still am very undecided so any opinions are welcome!
Thanks,
Mary Beth and Alivia
Harley PoMMom
04-27-2011, 12:00 AM
One needs to be cautious when using Trilostane/Vetoryl or Lysodren/Mitotane in a dog that has renal insufficiency. I would ask your vet/IMS about this.
Love and hugs,
Lori
lulusmom
04-27-2011, 03:30 PM
Hi Mary Beth and a belated welcome to you and Alivia.
I have looked at the abnormal blood values you posted and I'm going to ask Debbie, our resident expert, to take a look at everything. Debbie has 30+ years experience as a lab technician so I'd like her to comment on a lot of the abnormalities that we don't normally see with cushing's.
You mention that Alivia had IMHA when she was 7 years old. Most dogs with this condition don't recover and are on life long medications, usually prednisone. Did your vet determine what underlying condition triggered the IMHA six years ago? Was Alivia on long term prednisone? Is she currently receiving any medications to suppress the immune system? Can you also post the values for creatinine and BUN. If the IMHA caused kidney damage, I would think there would be some abnormal kidney values in addition to protein in the urine.
The ultrasound findings indicate an adrenal mass on one of the adrenal glands. Before I go into my very layman's opinion, can you please confirm that the other adrenal gland was shrunken or atrophied? Sorry to answer your questions with more questions but the waters get murky for me when a dog has an underlying condition like IMHA.
Glynda
Hi, Glynda and thank you,
You are correct that most dogs don't recover from IMHA. There is an 80% mortality rate. I had no clue Ali was even sick until she had a siezure. Fortunately, I was at home and rushed her to her regular vet's. Her PCV was 12 (normal is around 50) and he immediately made the diagnosis. At the time, the best place to go was OSU, so we made the 4 hour trip - many times. Alivia was in intensive care there several times. She received a couple of blood transfusions, was treated with Prednisone, Imuran and Heparin injections for awhile. High doses of Prednisone are the first line of treatment for IMHA, but Ali did not do well with that. As soon as she was stable and her PCV was higher, the prednisone was stopped. It was ironic that the Prednisone saved her life, but also seemed to be killing her with side effects from the drug! While she was critical, she also developed Protein Losing Nephropathy. She defied the odds, surprised her doctors (they said she did things they could not medically explain) and recovered for the most part. Her regular vet here is wonderful and would draw blood (sometimes twice a week!) and ship it to OSU so that the results were always run by OSU and would be more consistent. Then OSU would call me with any medication adjustments or changes. I think she survived because her regular vet worked with OSU, allowing them to direct her care, and we all worked as a team. Plus, Alivia had to have a strong will to live and I wasn't about to let her die! ;)
Alivia has residuals of high blood pressure, treated with Amlodopine and usually has some protein in her urine (although this recent result was higher than her usual) and her "normal" PCV is now a bit lower than most dogs. She is not on any immune suppressants and is never prescribed Prednisone because of not handling it well. What caused the IMHA? They could never say for certain but she had routine immunizations about one month prior and that may have triggered it. To this day, she is not permitted to have any immunizations, boosters, etc. Not even for rabies.
She has been monitored pretty closely since the IMHA. If I even think she is a little pale or lethargic, I take her for blood testing. She's remained pretty consistant.
The additional results you requested on 3/19:
BUN 24.4 (9.0-29.0)
Creatinine 1.0 (0.4-1.4)
On 3/24 (different vet):
Creatinine 1.0 (0.5-1.6)
BUN/Creatinine Ratio 21 (4-27)
Her regular vet who has monitored Alivia since prior to the IMHA said today in an e-mail "Alivia doesn't seem to have kidney or liver problems". Which confuses me based on things her IMS (who is difficult to talk to) has said in the past. Since her IMHA days I have always requested copies of all of Ali's test results and I did request everything from the last bunch but they did not include an ultrasound report. Unfortunately, all I know is what the IMS told me on the phone, that the one adrenal gland was about 4x the size of the other. I will call them again tomorrow and ask for the report.
Ali's regular vet conferred with an internist friend of his and has recommended Trilostane as he believes that would have the least chance of negative effects. I e-mailed Dr. Oliver last night and his repsonse today seemed to favor surgery but he admitted that would be risky (I will NOT take that chance) and his other suggestion was Melatonin, Lignans and a maintenance only dosage of Lysodren WITHOUT the loading dosage. So, of course I am even more confused!
Thank you again for your time. I really appreciate any insight you can give me.
Mary Beth and Alivia
Glynda -
The first blood testing results I posted were from 3/19 and were drawn by Alivia's dentist (a whole different story!) because I said she was not acting like herself. Since there were so many things out of the normal range, I took her to her IMS as soon as I could get her in, 3/24.
Looking at the 3/24 results, the reference ranges are different and these don't seem nearly as bad! The only abnormal ones are:
Alk Phosphatase 205 (5-131)
Amylase 1393 (290-1125)
Hematocrit 34.4 (36-60) This is normal for Ali.
WBC 17.4 (4.0-15.5) She was getting over an abcessed tooth with severe infection.
Platelet Count 563 (170-400)
Neutrophils 80 (60-77)
Lymphocytes 11 (12-30)
Absolute Neutrophils 13920 (2060-10600)
Absolute Monocytes 870 (0-840)
Actually nothing is unusual for Alivia except the ALP and Amylase and these are higher than blood testing she had on 2/9 (pre-surgical for the abcess). Now I see why OSU wanted all the blood testing done at the same place!!
You are probably ready to kick me off of here because of these long posts! I'm so sorry. I just want to be sure you have as much detail as possible.
Thanks so much,
Mary Beth and Alivia
Melatonin, Lignans and a maintenance only dosage of Lysodren WITHOUT the loading dosage. So, of course I am even more confused!
I don't want to confuse you any more than you feel you are. I have this treatment choice as an option for my Zoe. She has colitis and takes metronidazole to control it. I have searched everywhere to find another doctor who might think this was truly an option for us, eveyone tells me, including my internist, it doesn't work, yet Dr. Oliver does believe it is an option. It is confusing, I totally agree.
Hugs,
Addy
Hi Mary Beth,
When I mentioned it earlier it, was Dr. O that told me that the Maintenance lyso could be used along with the lignans and melatonin without loading. My IMS confirmed this. However, Snoops cortisol was too high (104.8/426.4 ng/ml) and she had to be loaded. I believe Ali's is much lower and according to this theory, you could try this. I believe the course was to administer for three months and retest the cortisol and intermediates.
I was really hoping after I posted that, that someone who has actually tried this succefully would come along and post their experience. It did not work for Addy but I am curious what Zoe's Cortisol was when they started? Supposedly, it is only an option for cortisol that is not really high.
I am also skeptical and would love to know if this actually worked for anyone and what the cortisol was before and after the 3 months if it did...anyone?
Your doing a great job with your research...hang in there. Any decision is a good decision!
Rene and Snoopie
apollo6
04-27-2011, 09:21 PM
Dear Mary Beth and Alivia
Welcome from Sonja and Apollo.
Apollo is 12.5 years has the pituitary cushing and is on Trilostane, and does have the elevated hormone readings but I am still trying to figure it out. He has done well on the Trilostane.
We are hear for you and will support and guide you along.
Hugs Sonja and Apollo
was really hoping after I posted that, that someone who has actually tried this succefully would come along and post their experience. It did not work for Addy but I am curious what Zoe's Cortisol was when they started? Supposedly, it is only an option for cortisol that is not really high.
Zoe 's cortisol was 40 last UTK panel. I have not tried this option so I am not stating it did not work for me. I said it was an option for me but I keep being told by others that it does not work including my IMS. I just posted on my thread what Dr. Mark Peterson told me about. He is a highly respected published specialist. I have been trying to research this option for 3 months.
My only point was, I too have been told it is an option for my dog but noone seems to think it works for a dog with increased cortisol except for Dr. Oliver. I would love to believe it could work.:)
Hugs,
Addy
Thanks Addy,
I misread...I thought u tried skipping the loading phase and it failed. I would love to believe it works, also. But, I am like Mary Beth...I want to hear from the group on real life experiences!
Mary Beth, what I do know that works if you decide on the Lyso, break down your maintenance dose in three or four doses a week and give with food. Its easier on them and does not give the adrenals a chance to regenerate in between a single weekly dose. The food helps more of the drug to be absorbed properly by the adrenals. I learned this because Snoop was having a hard time rebounding on her cortisol and these little things had helped her to hold.
Rene & Snoop
StarDeb55
04-27-2011, 10:31 PM
Mary Beth, I believe that Leslie's Squirt has been on maintenance lysodren dosing for a couple of months. I don't know if she has had any repeat testing done, but Leslie has been reporting that Squirt's symptoms have show great improvement. Squirt had been on only melatonin + lignans the past couple of years.
The thing about this disease is that the great majority of dogs who demonstrate elevated cortisol will also have one or more intermediates elevated. Once you bring the cortisol within range, this will also resolve the intermediates in a large majority of cases. There is a lot of debate among the professional community as to the significance of elevated intermediates & using trilostane, so it's kind of hard for us to weigh in on it when even the experts don't have a consensus opinion. I can tell you this that with the number of dogs in this group on trilostane, keeping in mind that not all of them have had a UTK panel done, we see very few that have problems with intermediates causing increased symptoms with trilo.
Personally, when my Harley was diagnosed my GP vet used a UTK panel to make the diagnosis. I took him to my former IMS for confirmation. All she did was an ultrasound, & the US along with the UTK panel made the diagnosis. Harley had some pretty spectacular elevations clear across the board on the UTK panel, & at that point in time, the IMS would not even consider putting him on trilostane. This was 3 years ago, so her opinion may have changed. I had a serious disagreement with her over how she was handling Harley's care, & basically fired her, so I can't say what she's doing, now. My GP managed Harley's care, & we used lysodren. I had successfully treated one boy with lyso for nearly 8 years, so it was the drug I was familiar with. My GP kind of suggested trilostane, but I think Harley would have been his "guinea pig" first trilo pup. I was not in favor of that. Interesting point, I asked my GP about a month ago, if he was using trilo with any of his Cushing's patients, his response was not a single one. My GP vet has tons of experience with Cushing's so that tells me something.
Debbie
I started Alivia on Melatonin and Lignans last week. I figured that wouldn't hurt no matter what option I end up going with.
Rene, are you saying that Ali's cortisol level at 115.8/249.0 ng/ml is not extremely high as cortisol levels go with Cushing's? If so, I am going to take that as a tiny glimmer of good news.
This is such a confusing desease and it is even more complicated when well known endocrinologists like Dr. Peterson and Dr. Oliver have such completely different opinions. I read an article written by Dr. Peterson where he says suppresion tests (LDDS) are best for diagnosing hyperfunction and the ACTH is best only when the adrenal glands have been suppressed (with medications) or destroyed (Addison's). If my IMS had followed that protcol, Alivia would not have a Cushing's diagnosis because her LDDS was negative for Cushing's.
Maybe Dr. Peterson and Dr. Oliver's opinions cancel each others out and we need a third knowledgeable Endocrinologist's opinion! :confused:
I appreciate the dialogue here and any opinions/comments/suggestions are welcomed!
Thanks,
Mary Beth and Alivia
My Dear Mary Beth,
The only thing I can offer you is my experience with Snoop. Her numbers were very high and she was very very sick. Her ALKP was over 2000 and unknown because that was the cut off and upper end of the chart. She lost her gall bladder (described as "mush") and her spleen due to these numbers. She also had all the outward symptoms, poor coat, pot belly, rear end weakness, premature aging, ect. So in comparison, your numbers look great to me!
Cortisol ng/ml 104.8 baseline 426.4 post
Androstenedione ng/ml 2.44 baseline 10.0 post
Estradiol pg/ml 125.1 baseline 125.7 post
Progesterone ng/ml 0.97 post 20.8
17 OH Progesterrone ng/ml 0.99 post 26.8
Aldosterone pg/ml 30.5 post 152.9
As sick as she was she is an amazing girl and bounced back immediately after her surgery at 12 years of age! In fact a few weeks later, when having her stitches removed she open herinated her intestines out because the surgery site had not healed properly and endured yet another surgery to replace them. She bounced back again. They are truly amazing creatures.
Additionally, since getting her help and starting medication (surgery was not an option/pitutary cushings), she is acting like her old self. Something I thought I would never see again. Truely, the root of her problems were her elevated numbers across the board!
She still looks like a cushing dog with the poor coat and such, but with time I am hopeful she will continue to improve.
As far as the doc's opinions...they are all highly educated professionals with varying experiences. Some folks have a tendancy to shop around until they find one that will tell them what they want to hear!
Just keep doing your research. Sit with it. And do what YOU BELIEVE is best for both you and Ali. There is no wrong decision.
There is nothing but hope! The folks here will get you through this!
Take a time out and watch a movie together tonite!
Hugs,
Rene & Snoop
Thank you, Rene, for the kind words and encouragement! I am trying to do as you suggested, to slow down and take more time to do the things Alivia likes to do. And, to treasure the time I have left with my old friend. As they say, to be the kind of person my dog thinks I am.
It sounds like your little girl Snoop has been through a lot! They are amazing, aren't they? Alivia surprised her doctors once before and survived another serious illness (IMHA) when they didn't expect her to live. I keep telling myself we'll get through this one, too.
Has anyone ever heard anything about a product called Supraglan, sold by www.petwellbeing.com? It has very good ratings and rave reviews (if they are legitimate). I try to keep an open mind and do believe that there are some natural holistic/herbal things that can be beneficial. Unfortunately, there are probably many more that are just false hope.
Alivia has had Cushing's symptoms off and on for at least 2 years before her recent diagnosis. This is the longest she has been symptomatic, though. Something just occurred to me! Alivia had dental surgery, with anesthesia, on 2/14 for two abcessed molars. It was shortly after that when her symptoms returned. In fact, it was her dentist who did the initial blood testing and an abdominal x-ray because I had told her Ali wasn't her normal self (her IMS then made the Cushing's diagnosis after more testing). Is it possible that the infection, surgical trauma, anesthesia and/or 5 weeks of antibitotics could have caused her relapse? Could that have caused a change in her adrenal tumor?
I truly appreciate everyone's comments and opinions here. It is an ENORMOUS help.
Keeping each of you in my thoughts and wishing all of your babies good test results, better health and long belly rubs,
Mary Beth and Alivia
StarDeb55
04-28-2011, 01:11 AM
Mary Beth, Supraglan & Cushex, 2 of the most widely circulated products for Cushing's on the net, are pure & simple "snakeoil". They really dont' work. Glynda, one of our administrators has written to one of these companies requesting scientific proof, such as ACTH testing to confirm that cortisol is being lowered by these products, they could not provide any documentation. Believe me, if there were any naturopathic cures that worked, we would all have our pups using them in a flash.
Debbie
lulusmom
04-28-2011, 01:27 AM
Hi Mary Beth,
Here is the response I got from Pet Well Being regarding Supragland's effectiveness. It's pretty outrageous that these people get away with borderline fraud. They have absolutely nothing to support their claims but I do give them credit for being honest about being shameless.
Hi Glynda,
Unfortunately no scientific tests or trials have been conducted on this product to support the claims you inquired below about.
The items we offer on www.petwellbeing.com are not drugs or medicines, but rather all natural herbal alternatives. Please be aware that these products are not guaranteed to cure or treat all animals, as each individual animal and their situation's are different.
PetWellbeing Customer Service
1-877-633-2401
http://www.petwellbeing.com
Thanks, Debbie and Glynda. I thought it sounded too good to be true, but, I was hoping!
Mary Beth and Alivia
Alivia's GP vet worked closely with OSU and me and truly helped to save her life when she had IMHA. My point is we developed a great relationship then and I know he cares about Ali. Anyway, he did his own research and talked to an IMS friend of his (not Ali's regular IMS). He told me he will support whatever decision I make and wanted what was best for Alivia and me, but that his recommendation was Trilostane.
Mary Beth,
Just my opinion but sounds to me like you have a pretty special vet and that is the most important part, I think. If he says Trilostane, I say, go for it:D:D
Thank you for posting on my thread. I appreciate your input.
Hugs,
Addy
Dear Addy,
Yes, Alivia's GP vet is very special. I think he has a vested interest in Alivia, since he was such an important part in saving her life. Everyone in his office knows and loves Ali. Any time I call for any concern, as soon as I say "Alivia", they tell me to bring her right in. He has been a vet for a long time, but really seems to keep up with the latest research and seems to enjoy a challenge. The fact that I can walk to his office and be there in about 2 minutes is an added bonus!
Her IMS is very knowledgeable, and may even be more experienced with Cushing's (although, maybe not since she is much younger), but she is not so easy to work with. I think she likes to be fully in charge and doesn't like when I do my own research. Her examinations always take place in another room, away from me, which I have never been comfortable with. Her recommendation was surgery and I said I was not willing to go that route. When I said I was afraid of Lysodren (because of Ali's fluctuating appetite), she said the third option was to do nothing. I called her the very next day to ask a question about Ketoconazale (Ali had been on it before for a skin problem) - that was two weeks ago and she STILL has not returned the call!
I see from everyone's posts here that the relationship with the vet seems to play a large part in the success of the treatment. I know her GP vet has reviewed Ali's records, knows her full history, has researched all options, and has talked to at least one colleague about her. He is always willing to listen to me and understands my concerns. I respect and value his opinion. That is probably half the battle.
Thanks to all of you for listening, commenting, offering support and helping me arrive at my decision (I think!). :cool: Each of you are quickly becoming very important to me.
Much appreciation,
Mary Beth and Alivia
Sabre's Mum
04-28-2011, 11:49 AM
A belated welcome from me Mary Beth and Alivia.
You are truly lucky to have a fantastic vet. You are absolutely right with regards to the relationship with the vet being so important with treatment for cushings. I believe that in reality ... the vet only prescribes the meds and does the check-up and the tests but the owner is in fact the person who technically treats the dog ie you are the one there 24/7 who has to monitor the dog and ensure that if you see symptoms of rising cortisol or those of too " low" you then get the dog to the vet.
Our vet was not overly experienced in cushings and was extremely dogmatic and would not listen to me for some time. Even though we live in a small city we do not have a lot of options and the only IMS clinic here in NZ is SO expensive. But as time went by she realised that in fact I have done a lot of research and that my suggestions were actually pretty much where we should go. This was due to the fact what I said before ... you are the one that sees the dog everyday. But Sabre did have his ups and downs.
Sabre has now passed away but we have another Vizsla who was diagnosed with Steriod Responsive Meningitis and IMHA when he was 6 months old. So I can truly relate to Alivia's battle with IMHA. Our dear ... but very naughty ... Flynn just came off his meds this week after being on them for 16 months.
All the best
Angela and Flynn
Hello Angela and thanks for the welcoming post. This site has been such a saving grace. I am very sorry for the loss of your beloved Sabre. My heart aches for anyone that has gone through that.
I am so sorry to hear that your new guy is also having serious health issues. I am new to Cushing's, but I can definitley understand what you must have gone through these past 16 months. The first months are especially scary with IMHA, so hopefully, the worst is way behind you. Alivia was on various meds - Prednisone, Imuran, Heparin to name a few. At one time I had to give her Heparin injections twice a day and she was such a trooper! Flynn must be doing well to be off medications now, so that is very good to hear!
After going through IMHA and PLN with Alivia, you are absolutely right about getting to know their symptoms and when there is the least bit of change. I watch Ali like a hawk. I still continue to check her gums on a regular basis to make sure she is not pale. Her PCV remains a little lower than "normal", but it has not dropped in a VERY long time. My GP vet trusts me when I say there has been any change in her and I realize how important that is.
I hope Flynn's health continues to improve from here on out! They are with us such a short time that it just doesn't seem fair that any of their time is spent being sick!
Thanks again for your post.
Mary Beth and Alivia
lulusmom
04-28-2011, 12:17 PM
Hi Mary Beth,
Thank you for all the information you've provided on Alivia. I'd still like to know if the other adrenal gland is normal in size. Maybe you can just call the vet and ask?
Glynda
Hi, Glynda.
Your post reminded me that I needed to call them and request the ultrasound report again. Thank you! I just got off the phone with them and they are to fax it to me, so hopefully I will have it in a little while and will post the info. The receptionist wouldn't be able to tell me anything and I am still waiting for a return call from the IMS from two weeks ago, so that would have been useless! :mad:
Thanks again for your time!
Stay tuned....
Mary Beth and Alivia
Hi, Glynda.
I finally received Alivia's ultrasound report that was done by her IM. It is not really long so I will type it in its entirety. I am not at all happy that it contains things she never even mentioned! Here goes:
Ultrasound Abd - liver- course echotexture throughout with small hypoechoic lesions scattered throughout
GB - single stone noted along with other echogenic debris in lumen
spleen and kidneys unremarkable
urinary bladder WNL
left adrenal: 2.29 x 0.35 x 0.42 cm
right adrenal: 2.43 x 1.21 cm x 0.5 cm
suspect adrenal mass, right side, cranial pole
Looking forward to your thoughts and anyone else who would like to comment as well!
Thanks,
Mary Beth and Alivia
Janette
04-30-2011, 12:27 AM
Hi Mary Beth,
When I mentioned it earlier it, was Dr. O that told me that the Maintenance lyso could be used along with the lignans and melatonin without loading. My IMS confirmed this. However, Snoops cortisol was too high (104.8/426.4 ng/ml) and she had to be loaded. I believe Ali's is much lower and according to this theory, you could try this. I believe the course was to administer for three months and retest the cortisol and intermediates.
I was really hoping after I posted that, that someone who has actually tried this succefully would come along and post their experience. It did not work for Addy but I am curious what Zoe's Cortisol was when they started? Supposedly, it is only an option for cortisol that is not really high.
I am also skeptical and would love to know if this actually worked for anyone and what the cortisol was before and after the 3 months if it did...anyone?
Your doing a great job with your research...hang in there. Any decision is a good decision!
Rene and Snoopie
Hello,
I just wanted to relay my experience with Max - a maltese who was initially diagnosed with Atypical Cushings. I was resistant to doing a full loading so tried the Maintenance dose of Lysodren only route (with Melatonin and Flax hulls).
3/27/09 adrenal panel from Univ of Tenn cortisol levels:
pre 22.1 ng/ml
post 192.7 ng/ml
Max at the time I started was 11.5 lbs, and, 4/10/09 I started him at the low end of the Maintenance dose range at approx 25 mg/kg - so Max got 62.5 mg of Lysodren twice a week (mondays and thursdays)
5/16/09 ACTH stim results:
pre 4.4 ug/dl
post 21.4 ug/dl
5/20/09 - did a "mini load" of 62.5 mg per day for three days (wed, thursday and friday)
5/25/09 (monday) - changed his dose to 62.5 mg three times a week (mon, wed, friday)
8/7/09 ACTH stim results:
pre 3.2 ug/dl
post 11.9 ug/dl
Aug 2009 Max was diagnosed with a heart murmur
Sept 2009 Max tested positive for Lyme Disease (treated successfully with antibiotics)
in Feb 2010 Max had his spleen removed and biopsied and liver biopsied (both biopsy results were benign)
still maintaining Max on the 62.5 mg three times a week
6/11/10 ACTH stim results:
pre 3 ug/dl
post 16.5 ug/dl
by this time, Max had lost some weight and was down to 8 lbs, 12 oz
still maintaining Max on the 62.5 mg three times a week
3/18/11 ACTH stim results:
pre 3.8 ug/dl
post 28.1 ug/dl
You can see the Maintenance Dose only did not work for Max.
However I DO think I wasn't as focused on the Lysodren treatment as I could have been. What I mean is that after the May 09 "mini-load", Max's cortisol levels did drop somewhat. But then they went up again by the time of the next ACTH stim. In August of 2009 I should probably have done another "mini-load" and seen where that took us. But at that time Max was diagnosed with the heart murmur and that led to visits to the cardiac vet, and then he tested positive for Lyme, and then came the spleen removal - and I let all those things distract me from trying to control the Cushings.... :(
After the 3/18/11 ACTH Stim being so high, I decided to go the full loading route. This was mostly because of Max's heart murmur - the cardiac vet suggested I get the cortisol levels under control.
If you are interested, you can read the rest of Max's story under his thread - but for a quick summary: I loaded Max at the 50 mg/kg rate (he got 93.75 mg twice a day) and stopped after 4 1/2 days. The ACTH stim results were pre 0.8 and post 1.1 ug/dL. A little too low since Max was very lethargic. He was eating, but was very lethargic and not the normal Max. I gave him prednisone for 4 days. Retested with another ACTH stim this past Monday and he was pre 1.6 and post 2.4 ug/dl. Am now starting Maintenance at the low end of the range - giving him 31.25 mg three times a week. Just started the first dose today.
I hope our experience is helpful to you. I know I was/am eager to hear actual experiences of other people, and I think this site helps one do that.
Janette
Hi, Janette,
Thanks for your post, but I am really confused.
I am looking at Alivia's results from University of Tennessee and the normal cortisol baseline range is: 2.1-58.8 ng/ml and the normal range post ACTH is: 65.0-174.6 ng/ml
According to what Alivia's results say, your Max's are almost always way too low. Or, are the normals that much different for a male dog?
I will read your thread later on to see if I can figure out why your numbers are so low.
Thanks,
Mary Beth and Alivia
StarDeb55
04-30-2011, 06:33 PM
Mary Beth, the results that Janette posted are in ug/dl. Ali's results are in ng/ml. That's why Max's results appear low, & I think that might be what is confusing you. To convert Ali's results to ug/dl, simply move the decimal one place to the left. For example, the normal ACTH range you posted would be 6.5-17.5 ug/dl. The other thing to keep in mind that the normal range on an ACTH for a healthy pup is much, much different than a cushpup under treatment. A pup under treatment needs to have their ACTH from 1-5 ug/dl.
Hope this helps.
Debbie
Thanks, Debbie -
I see now where her first results from U of Tenn were in ng/ml and the others were in ug/ml. I guess the testing must have been done elsewhere. Can they make this any more confusing?? :confused:
Alivia's first ACTH test was $410. That was for the test only, no examination. The breakdown was actually $322 for the test and $88 for a .2 ml injection of Cortrosyn. So expensive for one test! Is that about standard? I know things vary geographically, but if she has to keep having this test done, I may have to drive her to a different location!
Thanks for all the information everyone!
Mary Beth and Alivia
Harley PoMMom
04-30-2011, 07:10 PM
$410.00 for an ACTH stim test sounds high to me. My vet was charging me $160.00 for Harley's stims.
StarDeb55
04-30-2011, 07:14 PM
That is outrageously high for a stim. My GP vet was charging about $250.
Wow! That is a HUGE difference. I have been suspecting that Ali's IMS is extremely expensive. It is bad enough that she charges a fortune for testing, I just found out when I requested a copy of Alivia's ultrasound report that she fails to tell me things that the tests show - she NEVER mentioned a gall stone. Not happy about that.
littleone1
04-30-2011, 07:19 PM
Hi Mary Beth,
I was paying $250.00 for Corky's stim tests, but the last two he had were higher. The cost of the Cortrosyn and lab fees went up. I am now paying $315.00
Terri
So far I am still the highest! :p But, that's definitely not a good thing!!! It might be interesting to start a thread with just what people are paying for the ACTH tests and where they are from.
StarDeb55
04-30-2011, 07:31 PM
Mary Beth, I'm going to give you a link to Dr. Peterson's blog. He is one of the foremost endocrine experts in the country. Your IMS may be using what they need from a whole vial of cortrosyn when doing Ali's stim, & tossing the rest. He has instructions on how to make up the whole vial then separate it into smaller doses, freezing what is not used at the time. The frozen cortrosyn can be used for up to 6 months. This can cut the cost of a stim considerably as the drug is the most expensive part of the test. When you pull up the blog, go to the links on the right side of the page, click on the one for Cushing's, go to the post for 3/22/11. If you have trouble finding it let me know. I will tell you that when my Harley was first diagnosed, & my former IMS did his stims, she was charging in the $400 range.
http://endocrinevet.blogspot.com/
Debbie
PS- We already have an on-going poll about what people are paying for various tests. If you will go to the sub-forum below the main Cushing's forum, there are a number of different polls listed pricing on various tests. They are usually listed by country.
Thanks, Debbie. I will check out the link, but according to my invoice I only paid $88 for the Cortrosyn and $322 for the test itself!
Thanks for the info on the poll threads. I voted, but it doesn't seem like a lot of people have participated in it. :( I am still definitely on the high end for all testing!
Hi,
Was that just for the stim or for the UTK panel? I don't remember exactly what I paid for Zoe's UTK panel but I think it was pretty close to the numbers you listed drug plus the test.
Hugs,
Addy
Hi, Addy -
This is all new to me so I am not quite up to speed on all the lingo. No idea what a "UTK panel" is! The invoice lists: "Adrenal Function Testing - Tennessee $322" and "Cortrosyn Inj per .2 ml. $88" for a grand total of $410. Obviously this is the test that went to Dr. Oliver and included a check on Cortisol and 5 other hormones. Is there something less that can be done in between to check on whether treatments are working?
At the moment, I am still leaning towards watching and waiting a bit before beginning any treatments (other than the natural supplements), as Alivia's symptoms do not seem nearly as severe as many I've read here. In fact, they seem to be lessening. In the past she has been totally symptom free for long periods of time, so I am hoping that occurs again.
Thanks for your concern,
Mary Beth and Alivia
Sorry, I get so used to calling it UTK :o University Tennessee Knoxville=UTK panel:D
Then that is about what I paid- I believe that full adrenal panel is more money than just an ACTH test which does not check all the other hormones, only the cortisol.
Once you start treatment- I am not sure how often they run the full adrenal panel verses just a stim to check cortisol. I am hoping that the full panel will not need to be done every test but maybe others can chime on on that.
I believe there is also a test to just do a post stim not a a pre measure of the cortisol but it would probably depend on the vet and where you are in the treatment phase.
We will all be eating popcorn for dinner soon:D:rolleyes:
Hugs,
addy
Harley PoMMom
05-01-2011, 11:56 AM
Hi, Addy -
This is all new to me so I am not quite up to speed on all the lingo. No idea what a "UTK panel" is! The invoice lists: "Adrenal Function Testing - Tennessee $322" and "Cortrosyn Inj per .2 ml. $88" for a grand total of $410. Obviously this is the test that went to Dr. Oliver and included a check on Cortisol and 5 other hormones. Is there something less that can be done in between to check on whether treatments are working?
Mary Beth and Alivia
I can now see why you paid more, the UTK (University of Tennessee) Adrenal Function test that gets sent to Dr. Oliver's lab is quite more expensive than just a regular ACTH stimulation test.
The "regular" ACTH stimulation test is used sometimes to help diagnose Cushing's and used primarily to monitor treatment with Lysodren and Trilostane.
So, Alivia has had a UTK panel! Who knew?! Glad to hear that when (if) I begin treatment there are less expensive tests available for monitoring!
Pocorn for dinner? I may have to see if I can find a generic brand of popcorn at the rate of Alivia's medical bills! :rolleyes: Oh, well. Thank goodness her vets all accept plastic!
Thanks to both of you for clearing up one thing I was confused about....now for the 3,000+ other things! :confused:
Happy remainder of the weekend!
Mary Beth and Alivia
HELP!!!!
As much as I was hoping they would, this time Alivia's symptoms are not going away. She is having rear leg weakness. I have steps for her to get on my bed and this morning she sat at the bottom of them staring up for several minutes. Eventually she made it up them, but it was like she knew she had to work up the strength. Her appetite is increased. Her water consumption seems to be a bit increased, but not as much as it has been (maybe this has something to do with the humidity being so high, as it has rained here almost every day for the past 6 weeks!). Her fur is hardly growing at all. Her leg was shaved 2 1/2 months ago for an IV and it is still bare. She has also has a pot belly, which is now also bare from having the ultrasound. She seems restless sometimes, like she can't get comfortable. I think I have to face the fact that it is time to start treatment. :confused:
Initially her regular vet thought Trilostane would be easiest on her (Alivia has an adrenal tumor but is not a good surgical candidate). I was concerned because of the potential of Trilostane elevating the other hormones and also the risk of it enlarging the adrenal glands. Dr. Oliver, via e-mail, suggested the possibility of using a maintennace dose of Lysodren, without loading, lignans and melotonin. I asked if he could direct me to any studies where this was proven to be successful. He said there have not been any, but he has seen test results improve, using this treatment. I wasn't comfortable with this.
I came across this quote from Dr. Mark E. Peterson:
“In dogs with Cushing's disease, you must use a daily loading protocol in order to adequately destroy enough of the hyperplasic adrenal cortex. It's quite unlikely that starting with a weekly maintenance dosage of mitotane would do much at all to lower the high serum cortisol concentrations in your dog.
But you don't necessarily have to use the standard loading dose for mitotane of 50 mg/kg per day. You could try a lower daily dosage of 20-25 mg/kg (with food) to evaluate the effect. “
I just got off the phone with Ali's vet. Between his research and mine, we agreed that this "Low dose mitotane loading" sounded like a reasonable treatment compromise (I REALLY hope so). Alivia weighs 18 pounds and he is going to start her on 200 mg per day. Has ANYONE had any experience with this?
I'm just plain terrified of starting ANY treatment.
littleone1
05-02-2011, 08:23 PM
Hi Mary Beth,
I know all of the treatments scare us, but cushings does need to be treated. There is nothing that says you have to stick to one of the meds. If one does not help, with a washout period, you can always switch.
Corky has only taken Trilostane with his adrenal tumor, and was started at a low dose. He's had two adrenal panels done, and his intermediate levels were elevated, but not much. They have not caused any problems for him.
Hi Mary Beth,
We are all scared in the beginning. They are serious drugs and it is no wonder we are scared out of our minds when we have to start them. :( It is a normal response from us, I think.
That was my post from Dr. Petersen. Zoe's cortisol went up on her last UTK to 40 she was at 32 last June. She has colitis and has been sick alot this year and has shown a low tolerance to some drugs in the past so that was why I was looking for options for her.
Alivia's post cortisol was no where near as high as Zoe. I think it is a reasonable option. I have heard it can mean it may take longer to load the dog. I felt better having the suggestion come from Dr. Petersen since he is so highly regarded.:D
We'll see what others come along to say. But the low dose load option is what I am looking at too for Zoe.
If I did the math right, it looks like your dose is a tad less than 25mgs per kg. I'll go recheck my math, not one of my strong subjects:rolleyes:
Hugs,
Addy
Hi, Addy -
I am reading so much stuff that I forget where some of the info comes from! Alivia has not done well with some medications when she was treated for IMHA, so I worry giving her any drugs. She had an especially hard time with Prednisone. What is Zoe on now? (I need to start a speadsheet with who's who and what treatment they are on!)
How long does the loading period usually take? Ali was 18 pounds when she was last weighed, but since she has been eating more, she is probably around 19 or so. Since her Cushing's is not pituitary, if the mitotane successfully lowers her cortisol levels, can it be stopped after awhile? I hate the idea of giving her something so strong for an extended period. Plus, I think with the tumor, her cortisol levels seem to fluctuate and are not always high because there are times when she has no symptoms.
Hi, Terri -
Alivia's baseline Aldosterone was pretty high, so that's why I was afraid of Trilostane. Her only normal level was the Estradiol. How long has Corky been on Trilostane? Did his symptoms improve significantly? I am so conflicted about which to use. Wish I had a crystal ball.
Zoe is only on melatonin and lignans. We had work to do with her colitis and because her blood work is all normal and her symptoms were mild, we postponed treatment with lysodren. My IMS does not use trilostane.
Each dog is different when it comes to loading. In my opinion, I think underlying illnesses come in to play there as well. Kim's dog took over a month to load and some others loaded in 3-4 days. Seven to nine is the average, if I remember correctly. Alivia weight is like Zoe's.
We have so many members that have loaded and will be here to guide you and support you if you go that route.
I don't want to confuse you or make you second guess yourself. If you go to Apollos's thread, our Glynda laid out a case about Trilostane and increasing intermediate hormones. It was last week.
I have to learn how to copy the threads and post numbers for people:rolleyes::rolleyes:
I know this is a hard decision but you will make it and it will all work out. You have to feel comfortable with the treatment. My IMS has stressed that to me.
Hugs and love,
Addy
littleone1
05-03-2011, 11:28 AM
Hi Mary Beth,
Corky's been taking Trilostane for 19 months. Most of his clinical signs were resolved in a short period of time. Within the 1st ten days, his cortisol level was down to 2.1. His dosage has had to be adjusted several times since he started taking the Trilo, but he has been doing very well with this treatment.
Hi Mary Beth,
I am just stopping by to say hi to you and Ali.
hugs,
Addy
Hi Addy and Terri -
Thanks for checking on me and Ali. I am still crying a little bit every day. It is just awful to realize that my precious little Alivia is getting up in years and our time together is getting shorter.
I went to a seminar the other night called "Living With Aging and Ailing Pets". The speakers were a vet, a pet loss grief counselor and a funeral director (a human one but they actually do complete pet funerals, too!) Sometimes I have some really bad ideas and this would be one of those times! HUGE MISTAKE!!! They were collecting donations on the way in for the animal shelter that sponsored the seminar. When the program started, I started crying and just could not stop. If I had been sitting in the back, I would have quietly slipped out the door. :o But, unfortunately, I was towards the front. They were filming it, so I didn't want to create a commotion by getting up and leaving. So, I sat there with tears streaming down my face for what seemed like hours, but was actually only about 45 minutes! About halfway through the presentation I realized I had written my donation check out to the WRONG animal shelter! When the program finally ended, I had to explain about the check, fish it out of the donation vase and re-write another! Then, I won the door prize - a CD called "Coping with the Loss of a Pet". I couldn't get out ther fast enough! :p
I think I told you my vet ordered a compounded 200 mg mitotane to start Ali one. It hasn't come in, yet. I think part of me is kind of relieved about that, because I am dreading starting anything!
Oh, I can totally relate to your post. When I first heard the news of Zoe, I cried for days on end. All of that anticipatory grief just wipes a person out. So then I started putting Cushings in the drawer:)
It really works!!!!! Open a drawer or your glove box in the car and say out loud, very sternly "Cushings, get in the drawer and don't come out!!!" and close the drawer and then try to step back from it and do something you would normally enjoy. Sometimes I had to do this 10 times a day:eek::eek::D:D:D
We are all here for you and Ali. The loading will be fine. Positive thoughts;);)
Love,
Addy
I don't think I can put it out of my mind right now, because there is too much of it in my face. Ali has a shaved bare belly and leg, plus she is having symptoms. So, as long as I am around her (which I want to be!), I see Cushing's and I am very much reminded of it. :(
Both of us might feel better if we could just get on with her treatment but, I am still waiting for the compounded Lysodren/mitotane...just called her vet and they are supposed to check with him and get back to me. It should have been ordered on Tuesday. Hope it didn't slip through the cracks! Anyone know about how long it usually takes to get a compounded version?
lulusmom
05-06-2011, 02:16 PM
I came across this quote from Dr. Mark E. Peterson:
“In dogs with Cushing's disease, you must use a daily loading protocol in order to adequately destroy enough of the hyperplasic adrenal cortex. It's quite unlikely that starting with a weekly maintenance dosage of mitotane would do much at all to lower the high serum cortisol concentrations in your dog.
But you don't necessarily have to use the standard loading dose for mitotane of 50 mg/kg per day. You could try a lower daily dosage of 20-25 mg/kg (with food) to evaluate the effect. “
I just got off the phone with Ali's vet. Between his research and mine, we agreed that this "Low dose mitotane loading" sounded like a reasonable treatment compromise (I REALLY hope so). Alivia weighs 18 pounds and he is going to start her on 200 mg per day. Has ANYONE had any experience with this?
I'm just plain terrified of starting ANY treatment.
When Dr. Peterson commented on the feasibility of a lower daily loading dose, I don’t believe he was talking about dogs with adrenal tumors. Adrenal tumors are much more difficult to treat with mitotane because they are highly resistant to the drug and usually require much higher doses. My concern is that with such a low loading dose, you are going to be in for a very, very long loading period and when you do eventually achieve loading, it is going to be very difficult to determine an accurate maintenance dose. I realize that you and your vet want to take a very conservative approach because of Alivia’s history but I thought you should know what you may be in for. Most vets start dogs with adrenal tumors on no less than 50mg/kg and it is not uncommon to have to increase the dose some times to as high as 75mg/kg to 100mg/kg to achieve loading. These are huge doses which is why Pepcid is definitely a necessity.
Since her Cushing's is not pituitary, if the mitotane successfully lowers her cortisol levels, can it be stopped after awhile? I hate the idea of giving her something so strong for an extended period.
Once a dog is on mitotane, it is for life. The loading dose is the roughest phase and once you get loaded, maintenance is not bad. I have two cushdogs, both are much smaller than Alivia (4.5lb and 6lb) and they loaded at the full 50mg/kg. They have been maintained for over two years on a maintenance dose of 60mg three times a week. For me, it’s part of my routine to dig the cream cheese out of the reefer and stick a capsule in it on Monday, Wednesday and Friday. I should be so good about taking my own meds.
Anyone know about how long it usually takes to get a compounded version?
If I ordered my Mitotane or any other veterinary drug on Tuesday, I have it no later than Thursday. I use Diamondback Drugs in AZ.
Glynda
There was a mix up with the mitotane order. It was actually ready in one day. I thought it was going to my vet's but he called it into a pharmacy I had never heard of - probably 15 miles away. They left a message for me to "call to schedule a delivery", but never said a name or who it was for or anything. Thinking it was a wrong number I never called them back. Anyway, they are supposed to deliver it to me in the next hour or so. But, I am right back to square one and pretty sure I am not going to use it at all. I don't think I can load a dog who has a fluctuating appetite to start with. She hasn't had anything to eat all day and just walked away after eating half her food (something I know she likes, too).
I am just as confused as I was the day she was diagnosed (19 days ago). I am now re-thinking Trilostane and a bottle of wine. The wine would be for me, of course. :rolleyes:
Glynda, refresh my memory, do your dogs have adrenal tumors?
Pour me a glass while you are at it, is there room on the couch?;)
Arrggggggg!!!!!! It is always so darn confusing. Did Dr. Oliver suggest a maintenance dose to you knowing Ali's adrenal tumor and history? Just curious. Maybe I am remembering wrong but if he did then how would that work?
Okay, maybe pour us each TWO glasses:rolleyes::rolleyes:
Love ya,
Addy
Lysodren was delivered 10 minutes ago. Alivia just finished the rest of her food, after an hour and half break. I don't think I can do it.
Addy, thanks for reminding me of what Dr. Oliver said (in red):
Attached are the results of the adrenal panel testing done at your facility. My dog, Alivia, is a 13 year old, 18 pound, female, spayed Jack Russell Terrier. She had IMHA when she was 7 years old. She has recovered from that but has some residuals and still takes Amlodipine for high blood pressure and compounded aspirin to help prevent any clotting issues. Ali has been exhibiting typical Cushing’s symptoms off and on for about 2 years (fur not growing, panting, thirst, hunger, laying in cool spaces, skin infection), I did mention these things to her internist, dermatologist and regular vet but she was not tested for Cushing until recently. I am really confused as to the best treatment option for her. I have ruled out surgery because of her age and health; I am terrified she would not survive it and I don’t want to put her through the trauma. Her regular vet has recommended Trilostane because he believes it will be easier on her, with less chance of negative side effects.>>>We usually don’t recommend trilostane where sex hormones are increased. Trilostane increases androstenedione and estradiol levels in particular, and these dogs often come back with clinical signs of Cushing’s after they have been on treatment for awhile. Then you have to switch to another drug; usually Lysodren.
I am pretty scared of Lysodren because the drug seems so harsh and because Alivia’s appetite varies - she can be ravenous, have a normal appetite and occasionally has no appetite for a day. I am not sure how I would ever get a proper loading dose and wouldn’t want to cause her more harm than good.
>>>You can use melatonin, lignan and “maintenance” Lysodren (without the loading dose). This treatment is often used for these cases with good results.
Current medications and supplements: Amlodipine, compounded aspirin, The Missing Link Canine Food Supplement, Flax Hulls (SDG) Lignans, Melatonin 3 mg BID (the Flax Hulls and melatonin are recent additions as I didn’t think it could hurt, but I can stop them if you recommend that).[/COLOR[COLOR="Red"]]>>>They can be continued.
>>>Your choices seem to be surgery (expensive and fairly critical surgery); careful follow-up needed in the immediate post-surgery time period. Otherwise, the melatonin, lignan and maintenance Lysodren could be tried. If the tumor is a carcinoma, it can develop rapidly and cause problems for you.
I have 200 mg capsules of Lysodren, just delivered....should I or shouldn't I. :eek: I am pouring the wine now!!!! Addy, I'll pour you one, too, but if you don't show up soon I'll have to drink it for you!
Girl, I am here but I don't know what to tell you.:D
I wish I could get into my email at work but I can't. I am trying to remember if I told Dr. Peterson that Zoe had Pituitary or I just said Cushings. I am so sorry I can't get at my emails for you.:(:(
I'll go look to see if I sent a copy to my other email account.
Glynda, Marianne, Lori, Leslie, please help us out here!!!!!!
I know I have read not to give mitotane to a dog that does not have a good appetite. Not sure how far to take that comment.:confused:
I'll be back.
Found it!!!!! I did tell Dr. Peterson Zoe had Pituitary Cushings. I guess the thing that bothers me is right back at Dr. Oliver thinking a maintenance dose could work so if that could work could a low dose load work?
You don't have to give it tonight unless you need to start on a Friday for the ACTH test to come out on the right day? Is it a timing thing with your vet?
My other question would be to Glynda- did your pups have other health issues when you loaded?
Who here has loaded a dog with concurrent health issues?
Hang in there and save me some of that wine:cool:
Love ya,
Addy
I think the appetite fluctuation, and health issues, was the reason Dr. Oliver recommended a maintenance dose instead of a full loading dose. Dr. Oliver is aware Ali has an adrenal tumor. Glynda posted here earlier today and she thought the low dose loading would not help with an adrenal tumor.
A maintennance dose would be much LESS than the low dose loading of 200 mg per day, right?
I wanted to start her on a Friday, so that I could be home with her for the first three days of dosing. But, I think Ali is making the decision for me that tonight is not the night to start. She seems to be constipated - she tried to go for at least 5 minutes when I came home from work and was not successful. That's not a normal thing for her - lignans, maybe? Her appetite was off - she paused for 1 1/2 hours before finishing her dinner. She is not panting like she has been and she hasn't drank any water since I've been home (2 1/2 hours). She seems very tired. If I had been "loading" her I would probably be calling the vet for Prednisone right now. I would LOVE to think she is going into a remission phase, something she has seemed to do in the past.
Hey Mary Beth,
I don't want to leave you but I have to run out with hubby. I am hoping others will come along to comment while I am gone.
I'll check in with you later. If you are in doubt, don't give the drug. Delaying treatment for a week won't mean anything. I have read over and over that treating Cushings is not an emergency.
Love ya,
Addy
littleone1
05-06-2011, 07:44 PM
Hi Mary Beth ,
I can definitely relate to how you feel right now. When Corky was first diagnosed with cushings, he was going to be treated with Lysodren, which I actually still have. Because he was on antibiotics for two UTI's, his treatment had to be delayed. His clinical signs then went into remission for seven months. His IMS is the one that put him on Trilostane, as she felt it would be easier on Corky because of everything else he had going on. I was actually relieved.
There are successes with both Lyso and Trilo. I hope you get to a point where you are comfortable with whichever treatment you decide on.
I know we do worry and wonder if we're doing the right thing.
I'll join you and Addy for a glass of wine. :D
StarDeb55
05-06-2011, 08:13 PM
Mary Beth, I can answer a couple of your questions. A maintenance dose is the same as a loading dose except the frequency you give it. 200 mg for loading would be give daily, split into an AM & PM dose. Maintenance dosing splits the 200 mg into several doses over a week's time. For instance, 100 mg twice per week, or 50, 100, 50 given 3 days per week.
Neither of Glynda's pups have adrenal tumors, they both are PDH. I have zero experience with adrenal tumors except the information I have read on the forum, along with my own personal research. Everything I've seen concurs with what Glynda posted to you earlier that adrenal tumors can be very resistant to lysodren & require a much higher loading dose. I can sympathize with the appetite issue as my Harley was an extremely picky eater, & loading him was an absolute nightmare because of it. I had to depend on both appetite & water consumption to make my best educated guess about loading. When it comes to trilo raising the associated hormones, it usually does, but even the experts are not sure how significant this is. I will tell you this that all dogs who have an elevated cortisol will most have definitely have one or more of the associated hormones elevated as cortisol is used as one of the building blocks to make these other hormones.
For what it's worth, if I were in your position, I think I would be asking the vet about adrenal tumors being resistant to lyso, requiring higher than the normal loading dose, & how much of a help would doing only maintenance dosing be.
I'm not sure if this has helped, but keep us posted.
Debbie
Addy, Terri and Debbie....I am thinking a bottle of wine is not going to be enough. :confused:
I think not. Break out the Scotch!!!!!
The problem is each dog is different and then if the dog has other health issues going on it really is a pickle.
Corky has elevated hormones and Terri is using Triolstane with no ill effects caused by higher intermediates.
I am going to take you back to the vet you so trust and love that helped Ali. His contact said use Trilostane. Then Dr. Oliver confused you with his maintenance dose. I have come to the conclusion that the University Tenn full adrenal panel should only be used when a dog has symptoms but standard tests are normal or if a dog continues to show symptoms even though cortisol is controlled.
What was your first gut reaction? You have another week. You don't have to start tonight. Go back and reread about adrenal tumors and Trilostane. Ask Terri questions. She has done alot of research.
Then decide and remember, you can always do a wash out and try the other drug.
Pour me a scotch!!!!!! no ice!!!!!
Hugs and Love,
Addy
It seems like the more I read the more I go in circles.
Addy, not sure I understand your point...Alivia did have many symptoms and her LDDS test was completely normal, but the ultrasound wasn't. That is why her IMS did the U of Tenn full panel. On that, everything is elevated, except Estradiol.
Initially, I thought I'd go with Alivia's regular vet's reccomendation of Trilostane. Which was also what his friend said. Then we both read more and learned it could elevate the other levels and there is the possiblity that those elevated levels can cause damage. I'm afraid of masking symptoms, while damage may continue. I also read that with Trilostane there is a risk of DEATH. That really scared me, since Ali tends to have unusual reactions to things.
Wish I liked scotch.....
Alivia did have many symptoms and her LDDS test was completely normal, but the ultrasound wasn't. That is why her IMS did the U of Tenn full panel. On that, everything is elevated, except Estradiol.
Sorry, I forgot that part. So then it makes sense to me now. So many of the vets seem to be doing the UTK panel for different reasons, mine included:(
I know exactly what you mean about the more you read, the more worried and stressed you feel. I hope I did not confuse you more:o
All medication has risks. I look at my Advair asthma drug that I must take . It can cause asthma related death and all kinds of bad things according to the label. I take the lowest dose and only when I really need it for the shortest time possible, like when I get sick with the flu or a cold or bronchitis.
Trilostane and Lysorden are both serious drugs, we can't escape that fact. None of us have any way of knowing in advance how our dogs will react to either drug. All we can do is hedge our bets, so to speak.
When I spoke with Dr. Oliver about Zoe (who does not have an adreanl tumor) he thought a maintenance dose could be tried for 3 months and then she could try loading if the maintenance dose did not work. Her cortisol is high. Dr. Oliver is telling you a maintenance dose could be tried with Alivia. I don't know what the down side is to trying that for Zoe or Alivia. I do know that quie a few people including my internist tell me miantnenace does not work. Yet Dr. Oliver sees it work in some cases so it is like a Merry Go Round that you can't get off:eek::eek:
For my Zoe, I cannot try trilostane because my IMS does not use it.
I have no other IMS choices in this city and I need my internist for Zoe's colitis. If I had an internist for Zoe that used Trilostane, I would start Zoe on a low dose and if that did not work, I would switch to Lysodren. I am not telling you to use Trilostane, I am just telling you the conclusions I reached for my dog because I have been in the exact same boat you are.:confused::confused::confused: But Zoe has different isssues than Ali to some degree.
I am just babbling now and I hope I don't confuse you even further:eek::eek: I'm just babbling all the thoughts in my head.
I don't like scotch either:p:p
Love,
Addy
lulusmom
05-07-2011, 09:27 AM
Hi Mary Beth,
I have some thoughts but can you remind me what cushing's symptoms you are seeing at the moment? I may not be able to give my thoughts until later today but I will get back here.
Glynda
Thanks, Addy. I think I am back to square one and leaning towards the Trilostane, which was Alivia's regular vet's first opinion...
Glynda,
Alivia has most of the typical cushing's symptoms. Her fur grows EXTREMELY slow - almost not at all. She has the Cushing's pot belly and redistribution of body mass. The skin on her belly seems very thin and her belly looks bloated. She sometimes pants. She seems listless and very clingy. She has always liked being near me, but it is now seems excessive - she will follow me everywhere, even from my bed to the bathroom IN my bedroom. She stopped sleeping under blankets like she always did; and now lays on the hardwood floor or in strange places. She has hind leg weakness, too, and sometimes has a hard time going up steps. She has increased thirst and appetite...usually. But, that can fluctuate a lot! Sometimes her appetite is ravenous, sometimes normal and sometimes none. That is what scares me the most about loading Lysodren. When Ali was treated with high doses of Prenisone years ago for the IMHA, she did not do well on it. So, if she were accidentally overloaded with Lysodren, I think it would be catastrophic for her.
In my lay opinion, I think Alivia's tumor causes her hormone levels to fluctuate. If she could be tested every day, my guess is they would be high sometimes, low sometimes and normal sometimes. Looking back, she has had symptoms off and on for a long time. But, she will go long periods with either very mild or no symptoms. Her dental surgery on 2/14 seemed to trigger symptoms and this time they do not seem to be subsiding.
And, as an aside. Alivia and my healthy 11 year old JRT, Maxwell, who normally get along just fine, now seem to grumble and growl at each other a lot. Like maybe Max senses her weakness and Ali is trying to assert herself more to hide it?
Enough? Thanks for your help.
Another question....any down side to starting Ali on a little Milk Thistle?
Bad news. Alivia is in the hospital. She wasn't herself all weekend and was very lethargic yesterday. During the night she was panting heavily and shaking and in obvious discomfort. I gave her some pain medication left over from her recent dental surgery and she slept for a little while. When she got up, she was having a hard time walking and you could tell she was in extreme pain. It was awful. She peed on the floor right in front of me because she knew she couldn't walk to go out. She has NEVER done that.
I picked her up to carry her to the car and she yelped in pain. The slightest touch made her yelp. Took her to the emergency hospital. Her temp was 104.2, they gave her a morphine type pain medication so that they could take x-rays of her chest and abdomen. Nothing appeared majorly abnormal in the x-rays. She has an enlarged liver and some degenerative arthritis in her spine and rear legs, but she is 13+, and she said unless there was a pinched nerve - nothing to explain the pain, which the vet characterized as "severe, at least a 7 on a 1 to 10 scale". They couldn't visualize the adrenal gland but said there was no evidence that it had spread. She saw no tumors anywhere and said everything was where it was expected to be. I asked if it could be pancreatitis and she said possibly, but that she doesn't have some of the classic symptoms (vomiting). They kept her so that they could keep the pain down and were going to do blood testing. By luck, her IMS was coming in to do an ultrasound on another dog, so they are going to have her review everything and probably do another ultrasound. Then they will call me. I am hoping that I can bring her home later today, but I am really scared. Please keep her in your thoughts.
Harley PoMMom
05-08-2011, 02:30 PM
Many prayers are being said and sent your way, I am so sorry that Aivia is having these issues.
My boy, Harley, had pancreatitis but never showed the classic symptoms. The test which is the best to diagnose pancreatitis is a Spec PL test. Here is a link to information about this test: http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf?SSOTOKEN=0
Keeping you both in my thoughts and prayers.
Love and many hugs,
Lori
Squirt's Mom
05-08-2011, 02:32 PM
Hi Mary Beth,
I am so sorry to hear about Alivia's problems. :( I hope your IMS can find what is causing her such pain and have a plan to give her some relief asap. Nothing quite so bad as your baby hurting and them not being able to tell you where or why. Keep in touch and let us know what you learn, ok?
About the milk thistle - most pups handle it just fine but be sure to run it by your vet before you start using it. Milk thistle works best in a cyclic pattern as in giving it for 3 months in the spring and fall, and off of it for 3 months in the summer and winter. Basically, give it for 3 months then don't for the next 3, then back on it. Squirt took it for some time but I didn't know about cycling it and she took in daily all that time. She started throwing it back up - the capsule would be dissolved but the herb came back up still in the capsule form! :eek: I tried a liquid form after she had a break from it but it still made her sick and I haven't tried it again since. Like I said, tho, most dogs do just fine with it!
Hugs,
Leslie and the gang
littleone1
05-08-2011, 05:10 PM
Hi Mary Beth,
I am so sorry that Alivia is ill. I'm sending positive thoughts and healing prayers that the root of the pain will be found, and that it is nothing serious.
Lori, Leslie and Terri -
Thanks for your messages. I strongly suspect pancreatitis, but, I have not heard anything, yet. I have a feeling she will not be coming home tonight. It breaks my heart but, she is probably better off there so they can manage her pain and give her fluids. She had two abcessed molars, with "infection to the bone" and never showed a sign of pain. This pain must have been horrific for her, because it was very evident. :( I hope she never has that much pain again.
It's a good thing I didn't start the Lysodren on Friday. I just knew she wasn't herself.
Thanks for keeping her in your thoughts. I'll let you know when I hear more. Give your pups an extra hug from me tonight.
Oh Mary Beth, I just logged on and saw your post and am so sad to hear this news. I am saying all the prayers I can the Alivia will pull through this and come home tomorrow.
Please keep us updated.
Love,
Addy
Harley PoMMom
05-08-2011, 09:09 PM
Pancreatitis is a very serious disease but it is manageable. Please let me know if you need information about pancreatitis as I have a lot of bookmarks on this disease. :eek::)
Keeping you both in my thoughts and prayers. Sending big loving hugs too...Lori
Thanks for the messages everyone. Alivia spent the day in the hospital and came home tonight. While she was there she saw the ER Vet and her IMS. She had chest and abdominal x-rays, blood work, BP check and a CPL Snap Test. They said she does not have pancreatitis. They both think it is "spinal pain" from some arthritic changes in her spine, but no neurologic deficits. :confused: They gave her an injection of Hydromorphone while she was there and she was released on Methocarbamol and Tramadol and instructions for limited activity and no steps at all for 6-8 weeks.
I am having a very hard time with that diagnosis. To me it doesn't explain why she had a fever of 104.9 when I took her in (I think I incorrectly posted it as 104.2 earlier). When the vet called, I was so relieved that they thought she was well enough to go home that I didn't think to ask about this specifically and I didn't talk to the vet when I picked Ali up. I did call back to ask, but the vet had gone and the tech had no explaination, other than to say her fever came down while she was there. She has not eaten anything since about 5:00 PM Saturday and that was with coaxing.
She is still in a lot of pain. She can barely walk and cannot seem to get comfortable. I am sitting up with her and seriously considering taking her back to the hospital or to the other specialty hospital for a second opinion. To me this does not seem like back pain. Too severe and too quickly. I am also very concerned about some of the changes in her blood work in just two weeks. The most dramatic:
On 3/24
Alk Phosphatase 205 (5-131) U/L
Amylase 1393 (290-1125) U/L
Today 5/8
Alk Phosphatase 693 (23-212) U/L
Amylase 2813 (500-1500) U/L
Her ultrasound 2 weeks ago showed a gall stone. She has an enlarged liver so I am wondering if this might be a bile blockage issue.
She is sleeping off and on. When she wakes up she is in obvious pain. I'm sleeping on the floor with her tonight because I don't want to hurt her carrying her up the steps (she yelped when I lifted her into the car from the vet's).
Oh, they said not to start Trilostane or Lysodren for now, but milk thistle would be okay. She was just sleeping, yelped and sat up. I'm taking her to the other hospital...
labblab
05-09-2011, 07:15 AM
Dear Mary Beth,
I am so sorry to hear about Alivia's pain! It must be so difficult for you to watch her suffering. I have not had the chance to write to you before, but I have been following your journey and I am hoping for the best possible result for your little girl. I regret that I have no words of wisdom to offer. But if it is feasible for you to get a second opinion from a reputable specialty clinic, I believe I would opt for that if I were in your situation. Because I agree with you, it surely does sound as if there is something else going on aside from the diagnosis that you have been given. We have had at least one other dog here who suffered from misdiagnosed and untreated gall bladder issues, so I am thinking that you may very well have hit the nail on the head. But whatever your course of action, please know that I am thinking of you both and hoping so much that sweet Alivia soon gets some relief.
Sending many hugs and healing thoughts,
Marianne
Thank you, Marianne. I do appreciate the kind words. I almost took her to the other specialty hosptial last night for another opinion. I laid on the floor with her all night. Just about the time I was sure I was going to take her, she'd start resting a bit more comfortably and then I didn't want to disturb her. The tramadol she is supposed to get every 8 hours seems to only take the edge off of her pain for about 2. She is not much better this morning, so I am taking her for another opinion. Actually, this will be a third opinion since she saw two vets yesterday.
I agree, I would go get another opinion and ask them why that would cause fever. It always helps me to write down all my questions and trains of thought including any possible health issues not discussed previously.
I hope you get some answers today, Mary Beth. I know hard hard it is to feel helpless when they are so sick. You can table both Cushing drugs for now. You could not start until she is better.
Sending prayers and hugs for you and sweet Alivia.
Love,
Addy
Squirt's Mom
05-09-2011, 08:57 AM
Mornin' Mary Beth,
You are very wise to seek another opinion. While I know how painful spine problems can be for humans and that fever can result from trauma causing pain, I would want a better explanation of her condition. I, too, think the gall bladder should be considered in this situation. ;) Methocarbamol is a skeletal muscle relaxer so that tells me the vets she saw do think this is related to her skeletal system in some manner. That doesn't, however, mean they are right nor does that mean there couldn't be something else in addition to the spine so getting that second opinion in the face of her continuing pain and discomfort is a smart move IMHO.
Please let us know how things are going. We are keeping your all in our thoughts and prayers, and sending healing white light and strength to Alivia.
Hugs,
Leslie and the gang
I took Alivia to her regular vet this morning - the one that has treated her for YEARS and who I trust completely. Just got back. He felt up and down her spine and she did nothing. He touched her belly lightly in two places and she yelped and snapped. He has done everything to her over the years and she has never had that reaction. Her fever is 104. He agrees with me and doesn't think it is "spine pain". He has an internist he works with, who goes to various vets to do ultrasounds, as needed. So he will come in ultrasound Ali later this afternoon. Since I am only a block away, he gave Ali a pain injection and I brought her home. They will call when the ultrasound doctor gets there and I'll run her back over. Even with the injection she is still in a lot of pain. I feel so bad for her. :(
Squirt's Mom
05-09-2011, 12:03 PM
We are hanging in there with you, sweetie. Please let us know what the U/S shows and what they plan to do to help her. Know we are here any time you need to talk, even if it is just to vent. Most of us have been in scary situations like this ourselves and understand how you must be feeling. Just know we are here, ok?
Hugs,
Leslie and the gang
labblab
05-09-2011, 12:03 PM
I am so glad that you're getting more input about Alivia! I'll be checking back all through the afternoon to see how things are going.
Continuing healing hugs to you both,
Marianne
Thanks, guys! I appreciate you hanging in here with us. I just posted a couple pictures of my baby not feeling well. One from at her IMS office yesterday and three of her just a few minutes ago. She is so sick that there were cats meowing and all the usual commotion at a busy vet's office on a Monday morning and she never lifted her head. The pain injection has helped her to sleep a minute here and there, but she is still in pain. :(
littleone1
05-09-2011, 12:47 PM
Hi Mary Beth,
I am so sorry that Alivia is experiencing so much pain. I'm glad you were able to take her to your vet this morning. I hope you will get an answer as to what is causing the pain and that your vet will be able to start a treatment for it today.
I'll also be waiting to hear what you find out.
WOW! I e-mailed Dechra (Vetoryl manufacturer) Friday evening and asked questions about Trilostane. Dr. Tim Allen from Dchra just called me and he had reviewed all of Alivia's information. I sent him ALL of her test results! :cool: He offered some suggestions on what her current issue might be - pancreatitis or pyelonephritis (kidney infection). He thought the repeat ultrasound was a good idea and doesn't think I should rule out surgery just yet, but thinks Trilostane is a good altrnative option. Now here is where the small world part comes in. I told him I was waiting for the ultrasound doctor to get to my vet's office and he asked if it was Chip Meyer - it is!!! He knows him and said he is one of the best he knows and that Alivia is in very good hands! That makes me feel so much better. I already knew Ali's regular vet was the best, so I shouldn't be surprised that he has good people around him!
labblab
05-09-2011, 01:13 PM
Double WOW!! Talk about a small world, indeed! What reassuring news about Dr. Meyer. And Dr. Allen is sooo nice. He has been really helpful to any number of us here. I've got to run some errands now, but I'll keep checking back afterwards.
Marianne
I am here too Mary Beth and am relived to hear Alivia is in your trusted doctor's hands. It can sometimes be a small world; it always amazes me. Now you can have confidence in the ultra sound.:) I am so glad you spoke to Dr. Tim.
We are all praying for Ali to find some pain relief and that they can now get to the bottom of things. Please keep us posted as we all get very close and protective of you all. When you and your pup hurt, we hurt too. I can only imagine how worried you are. Stay strong. You are doing everything you can for her and she knows that.
We are here for you, you know that.
Love,
Addy
Thanks, Marianne and Addy. It is a help to have you guys around throughout this.
Ali's pain injection must have kicked in and/or she is just totally exhausted and she is sleeping (peacefully!) beside me. :) We are waiting to hear when we can go for her ultrasound, but knew it wouldn't be until afternoon sometime.
I cannot believe Dr. Allen knows the doctor that will do Ali's ultrasound!! I feel so much more comfortable! Dr. Meyer is also the internist my vet consulted with initially. I have not had 100% confidence in the first ultrasound done by her IMS - partly because they did not provide the results at the same time as they sent me the other test results. Then when I finally got them, there were 2 dates on the report, neither of which were dates she was at the IMS. I could understand one might be the date of dictation, but two incorrect dates? And, also, partly because the IMS never mentioned a gall stone that showed in the u/s or the changes to her liver. This will give me peace of mind that this doctor is good at this and Ali's regular vet will be right there watching it, too!
One thing I am learning is that my first instincts have so far proven to be the best. I need to sometimes quit second guessing them. :p
Harley PoMMom
05-09-2011, 01:38 PM
I'm glad to hear that Ali is sleeping peacefully. I do hope that the u/s will show what is causing her this pain.
Please keep us posted and wishing you both the best.
Love and huge hugs,
Lori
Squirt's Mom
05-09-2011, 01:43 PM
Well, my newly repaired laptop is acting up again and my post just went off into the wild blue yonder....along with two documents I was working on! :eek::mad:
It is great that Dr. Peterson knows the one who will be doing the U/S on Alivia. That would be reassuring to me as well! :)
One of our mantras around here is, "Listen to your gut - you know your baby better than anyone." You are doing a GREAT job of this so keep up the good work! Stay in touch....
Hugs,
Leslie and the gang
lulusmom
05-09-2011, 04:18 PM
Hi Mary Beth.
I was going to post a follow up to my prior post but things have changed since I was here last so those thoughts are on the back burner for now. Just know that I'm thinking of you both and will be staying tuned for your updates.
Glynda
P.S. Dr. Allen is great and oh my, it is a small world. I'm glad that he could bring you some comfort because you deserve some relief. Hang in there, kiddo.
Hi, everyone.
Alivia had another ultrasound by Dr. Meyers, at her regular vet's office this afternoon. As I suspected all along, she has pancreatitis. From there we went directly to the hospital and she's been admitted for a minimum of 3 days, but they say it could be longer. They also say it is "life threatening", which of course is terrifying. And, it makes me so angry because if I hadn't pushed the issue, she could have died and she should have been at least 36 hours further into the treatment by now! Fortunately Ali had the good sense not eat anything for 2 days and only drank a minimal amount of water or things could have been even worse.
Because of the inflammation, Dr. Meyers was not able to visualize the adrenal glands as clearly as he would have liked to but he said there is no evidence that anything has spread and it appears to be an right adrenal adenoma, but "cannot rule out atypical nodular hyper plasia since LDDS did reveal suppression" and she has a normal left adrenal gland. Because he believes the Cushing's contributed to this and she will be suceptible to other effects, he thinks surgery should not be ruled out. :eek: Also, he states, "Cannot rule-out concurrent or inciting cholangitis secondary to bile clumping." A "goopy gall bladder" was how he stated it. Dr. Myers and my vet were awesome!!! They let me stay with Alivia for the entire ultrasound (in fact Dr. Meyers suggested it!) and he was even showing me things and explaining what he was looking at. The gave Ali another pain injection prior to the u/s to make it as comfortable as they could. For the awful pain she was in, she was amazing! I rubbed her little head and held her paw and she stayed perfectly still for the whole procedure. She stared at me with her beautiful dark eyes and I think she was calmer because they allowed me to stay with her. I already miss her terribly. :( I am so tired from all this.
Unfortuantely, Alivia is not ou of the woods yet, so please continue sending the possitive thoughts and prayers this way. Thank you all!
Harley PoMMom
05-09-2011, 07:59 PM
I am so sorry. Pancreatitis is a dreadful disease but manageable. Did they do a spec PL test? If so, what was her number?
I truly understand you missing Alivia but right now she is where she needs to be, getting the proper care for her illness.
I will definitely be keeping you and Ali in my thoughts and prayers.
Sending big loving hugs, Lori
labblab
05-09-2011, 08:12 PM
Oh Mary Beth, you must be so exhausted and drained! Thank goodness for the care that Alivia received today, and for the care that she will be receiving at the hospital. You can count on a boatload of prayers and well wishes from my house.
Thank you so much for taking the time to update us this evening, and please let us know as soon as you hear more tomorrow.
Marianne
Harley PoMMom
05-09-2011, 08:19 PM
I also wanted to tell you...Great job for getting another opinion on Ali. Always trust your gut!
Love and hugs,
Lori
littleone1
05-09-2011, 08:34 PM
Mary Beth, I know you miss Alivia right now, but I am so glad that you now know what is causing her pain, and that something is being done to help her.
You are both in my thoughts and prayers that Alivia has a speedy recovery. Try to get some rest.
Oh Mary Beth, you must be so drained. What an ordeal for you and Alivia. I will be saying numerous prayers for your little girl. She is in good hands so we are thankful for that.
Try to get some sleep as Terri suggested, if you can. You will need your strength for Ali. I am so glad they let you stay with her for her test.
Did they allow you to leave something of yours for her with your smell on it while she is in the hospital?
Thinking of you and hoping for the best news and that she improves now that she has the right care.
Love,
Addy
Squirt's Mom
05-10-2011, 09:50 AM
Hi Mary Beth,
I am so proud of you for keeping after the docs until they found what was causing Alivia such pain. You are a great mom!
Squirt had an acute pancreatic attack following a surgery and it was soooo scary! She had to go back to the hospital just one day after coming home and stayed for about an additional four days with the pancreatitis. I called to check on her so often the hospital finally told me they would call me at set times of the day to report on her. :o:p
Ali is where she needs to be right now so they can get the inflammation under control and give the organ a chance to rest and recover. She knew that food and water would just make her worse so she wisely listened to her body....just as her mom wisely listened to her.
We are with you both in spirit, sending prayers and healing white light. Get some rest yourself today - you have to take care of you so you can take care of Alivia when she gets back home. Know we are here any time you need us.
Keep your chin up!
Hugs,
Leslie and the gang
Hi Mary Beth,
Checking in to see if we have any news. I hope you got some rest.
Let us know as soon as you can.
Love,
Addy
Thanks for the concern, everyone.
I just got off the phone with Alivia's IMS. They increased her pain meds this morning to keep her more comfortable. Which concerns me as I can't help but think how uncomfortable was she throughout the night and up until that point??? She is going to start giving her plasma because she said that usually helps with the inflammation and will do a repeat ultrasound later. Before I had a chance to ask, she asked if I wanted to come see her later....OF COURSE I DO!!!!! I hope the fact that she asked me that was not a bad thing. :confused: After the run around Sunday, I am a bit shell shocked and skeptical....not to mention TERRIFIED. When the words "life threatening" are spoken as you are leaving your baby, well, it's a horrible thing.
Addy, I carried Ali in and out of the vet's on her bed because I found I could carry her "taco style" (as my vet's tech called it!) and she kind of partially stood in her bed, which prevented me from having to put any pressure on her belly picking her up. Transporting her like that saved her from a lot of additional pain. The hospital actually allowed her to keep her bed with her and even carried her back in it! I was surprised but happy about that. She also had a towel that her regular vet given her. Speaking of him, he was so concerned about Ali getting to the hospital and under care as soon as possible yesterday, that he told me to just go and we would worry about his bill later (it included an ultrasound so it will not be small). I told you he was the best. How many vets let you leave with your dog without paying?!
So, after work I will stop home to take care of Maxwell (my little healthy guy!) and then go out to visit my sweet Alivia Rose. I'll post another update later this evening.
As an aside, this is turning into the week from hell. Had to take off yesterday, then on my way to work today I got a flat tire and had to wait FOUR hours for a tow truck to come change it!
I do appreciate all the positive thoughts so please keep them coming!
labblab
05-10-2011, 04:30 PM
Mary Beth, I'm sending every positive thought that my brain can muster!! I've been hoping all day for an update, but knew that you'd have your hands full. With all that you've got going on, thank you so much for taking the time to check in with us.
Please give Maxwell a big hug for us, and tell little Alivia Rose that her k9cushing's family is sending her much love and strength.
And here's a giant hug for you, too!
Marianne
littleone1
05-10-2011, 05:18 PM
Hi Mary Beth,
I'm continuing to send positive thoughts and healing prayers that Alivia will soon feel so much better and be able to go home with you.
Hi Mary Beth,
I understand what you are going through with Alivia Rose and wish I could wait with you. Pancreatitis is terrifying and you know it when you see it....hunched back...hair stands straight out...and that look in their eyes...good for you for staying on them!
Snoopie had cronic Pancreatitis too. When she had it her LIPA (Lipase) count would sometimes shoot up over 3000. Her HGB (hemoglobin) would also go up to the mid 20's. Sometimes the AMYL will go up too, but not hers.
But, when her gall bladder went bad her LIPA, AMYL and HGB were all NORMAL. Her ALKP was off the chart, RBC,WBC, NEU, GLOB, ALKP, TBIL & CHOL were all high. Her MCV, EOS and Cl were low.
Have them recheck both the MRI's and have a second look at her gall bladder...just in case. As you may know this was the root of Snoopie's last attack and hers had to be removed along with her spleen. It saved her life.
I know you said her AMYL was normal but was was her LIPA (Lipase) count?
We will get you through this.
Love,
Rene & Snoop
StarDeb55
05-10-2011, 08:44 PM
Even though I haven't posted to you yet since Alivia's setback, I most definitely have been following. I so sorry to hear that your little girl is so very ill, but I want to give you a huge pat on the back for for sticking to your guns with the vets that there was something very wrong. I will be looking forward to your updates.
Debbie
Harley PoMMom
05-10-2011, 09:12 PM
Tons of prayers being said and sent.
Love and hugs,
Lori
I visited with Ali tonight at the hospital and it was very upsetting. I had hoped that she would be feeling a little better, but despite them having upped her pain medication she was still in obvious pain. She also seemed to be mad at me and would not look at me. :( I am so angry that she suffered an extra 36 hours before the proper treatment was started. She is still critical.
Rene, Her IMS did say there was "clumping" in her gall bladder and she isn't sure it is just pancreatitis. I will definitely question her more about it tomorrow morning.
There are a lot of abnormalities in her blood and even a lot of changes from Sunday. I'll post the abnormal values:
Total Protein 4.7 (5.0-7.4) g/dl
Albumin 1.8 (2.7-4.4) g/dl
Albumin/Globulin Ration 0.6 (0.8-2.0) Ratio
AST (SGOT) 108 (15-66) U/L
ALK Phosphatase 628 (5-131) U/L
Calcium 7.9 (8.9-11.4) mg/dl
Cholesterol 349 (92-324) mg/dl
Amylase 1785 (290-1125) U/L
RBC 3.93 (4.8-9.3) 10^6/uL
Hemoglobin 8.9 (12.1-20.3) g/dL
Hematocrit 25.0 (36-60) %
Platelet Count 75 (170-400) 10^3/uL
(Giant platelets may indicate active thrombopoiesis)
Neutrophils 90 (60-77) %
Lymphocytes 4 (12-30) %
Eosinophils 0 (2-10) %
Absolute Lymphocytes 460 (690-4500)
* Clots are detected in the sample; CBC results may be affected.
That's a lot of abnormal values! The IMS never mentioned the clotting stuff and I just read that. Now I am really scared. They probably can't give her any blood thinners in case she has to have surgery - although they has not been suggested, yet. I am going to go now because I need to send this info to her regular vet. I want to make sure he has it and also get any thoughts he may have.
Thanks again for all the thoughts and please continue the prayers. Alivia desperately needs them!
Thank you Mary Beth for taking the time to keep us posted. We are all praying and pulling for you and your little Ali. She is not mad at you and loves you very much. She is just dealing with a lot right now, as you are. You have done the right thing all along and none of us have a crystal ball. You are a great mom and Ali is very lucky.
We all love you,
Rene & Snoopie
StarDeb55
05-11-2011, 06:38 AM
* Clots are detected in the sample; CBC results may be affected.
Mary Beth, the first thing a clotted sample or partially clotted sample will affect is the platelet count. Was a platelet estimate noted on the report? If it says normal or says anything about plt. clumping, this is nothing to become terribly alarmed about, IMO. The sample is a bad draw.
Debbie
Good morning, Debbie,
The only thing in the report about platelets is:
"Platelet Count 75 (170-400) 10^3/uL
(Giant platelets may indicate active thrombopoiesis)"
I don't know what to do right now. Leave her where she is? Take her to the other area specialty hospital for additional opinions? There are more internists there.
There just hasn't been any improvement and I am beside myself.
Help!
I just got off the phone with Dr. Peterson's office and he is willing to do a phone consultation with me and/or Ali's IMS or regular vet. My problem is I am not sure Cushing's is her most pressing issue right now, although iit is contributing for certain. I am spending a fortune, going into debt, and that would be okay if I can save her life. I just want to spend the money where I can get the most benefit for her...whatever that may be. I am wondering now if I should transfer her to the larger specialty hospital in the area where there are multiple internists and multiple surgeons...or keep her with her IMS who is familiar with her history???? :confused:
Please chime in....anyone.
Oh Mary Beth I don't know what to say not being there. The other hospital, can your doctor consult with them? Does it have anything to do with the vets who misdiagnosed her a few days ago? Which facility are they with? Either one?
Your vet has not steered you wrong ever. Could you do phone consult see what he thinks after phone consult?
ASK YOUR VET SHOULD YOU TRANSFER HER?
Stay calm, you need your wits about you. Breathe, breathe, slow down, slow down. Call Dr. Peterson back, ask him his thought on transferring her. I think he should do the phone consult and then ask his opinion about transferring her. He can't work with the new hospital?
Love,
Addy
Where Ali is currently admitted is a hospital that actually consists of two facilities - regular vets and emergency services are on one side and then specialty services on the other side. So, it was the emergency side and the vet that was on duty at the time that dropped the ball and released her in such a critical state. Her IMS is on the other side and she is admitted there under her care. I was very hesitant to take her back there at all, because although they are separate, they are affiliated and I am not sure to what extent. The problem is that Ali has such a long complicated history and her regular vet felt that it might not be the best time to start care with someone brand new.
The other area specialty hospital is larger and has more doctors in all fields. Ali had her dental surgery there and was treated by a dermatologist there as well and I really like the facility and everyone I have dealt with there. They also have many surgeons, one of which Dr. Meyers (the ultrasound vet) recommended as the best in the ares to do the adrenalectomy when, or if, we get to that point.
Too many decisions and I don't know where to begin.
Squirt's Mom
05-11-2011, 09:52 AM
Hi Mary Beth,
First of all, don't get too upset that you didn't see much improvement last nite. Once the pancreas is inflamed it can take some time for it to recover. When Squirt had her acute attack, the IMS and surgeon both told me that the pancreas is a very, very touchy, persnickety organ and once it is upset, it can take a long time for it to settle back down. Squirt's pancreas reacted so badly because it was touched during her surgery removing the tumor on the spleen. She was four days in the hospital getting over that attack and needed a few more days even after she came home on a special diet and feeding schedule.
As for moving her....unless there are obvious signs she is not getting the treatment or care she needs where she is, I wouldn't. The fluids, meds and rest are critical to her recovery and I would fear that moving her to another hospital would undo the healing that has begun. I think I would contact the GP vet Ali uses and ask him to check on her care at the hospital then let him be my guide on whether to move her now or not. Just my 2 cents worth! ;)
I know so well how upsetting it is to see your baby so very sick and to feel like you aren't doing enough to help her. It is incredibly difficult not to let our emotions lead our decisions at times like this. But you are doing a great job as Mom to Alivia - even tho you don't feel like it right now, you ARE! If you hadn't been so persistent and so in tune with Ali in the first place, she would not be getting the care she so badly needs today. You are doing a fabulous job!
Having Dr. Peterson consult would be wonderful but I agree with you in that the time for that is not right just now. He could, of course, look over and discuss the tests to date but testing right now with the pancreatitis would be useless. I would certainly let him know his services will be appreciated and let the other vets involved with Ali's care know you want Dr. Peterson involved. It is great that a doc as renowned as Dr. Peterson would take the time to help Ali! :cool:
Keep your chin up, honey! You really are doing great with all of this. We are here anytime you need to scream. :p
Hugs,
Leslie and the gang
Harley PoMMom
05-11-2011, 09:59 AM
The only test that I know of that will confirm pancreatitis is a spec PL test.
The last spec PL test that was done on Harley showed his number to be over 1000. Harley was in some pain but then when I started him on Tramadol every 8 hours the discomfort abated.
When a dog does have a severe attack of pancreatitis, there can be a lot of pain but usually with-holding food for 48 hours to rest the pancreas and with strong pain medicine the pain does subside.
If Ali is still experiencing a lot of pain than I believe there is something else attributing to this but I would want the pancreatitis to be confirmed with a spec PL test. They should, I think, be looking around her gall bladder for an obstruction or to see if the gall bladder is bad.
These are just my thoughts. Keeping you in my thoughts and prayers.
Love and hugs,
Lori
Leslie - Very good and reasonable advice. You are right. I want to see immediate results and I feel like I am not doing enough. I feel like I am being selfish allowing her to suffer, if I can't do anything to help her. But, my heart is not ready to admit it's time to let go, yet, and no one has told me that it was. Her current IMS has a very good reputation throughout Pittsburgh. Dr. Peterson's office had e-mailed me and said he'd prefer to examine Alivia. I replied to them this morning from home that there was no way I could do that as she is critically ill in the hospital. They called me about an hour later, as soon as I got in to work this morning. They were very nice and said he was willing to do whatever I wanted, talk to me, talk to her vets. Review her records and write a report. I said I really appreciated that and I would get back to them after discussing the best way to proceed with her vets.
Lori - As of last night, she was still in MAJOR pain. I have not yet talked to her IMS this morning. If she doesn't call very soon, I am going to call her. I was told the SnapCPL test done yesterday confirmed pancreatitis, but her IMS is not sure that is all that is going on. The ultrasound on Monday showed no bile blockage (and she is not at all jaundiced), but there is "clumping" in her gall bladder and possibly a stone (seen in one ultrasound, but not in the second). The IMS was going to do another ultrasound. She actually said she would keep an eye on things with u/s and would not charge for them.
Thanks again for the posts. I need you guys to keep me sane right now and keep me from doing anything crazy....like picking Alivia up and driving her to NY to see Dr. Peterson when that might not be what she needs most right now! :confused:
Harley PoMMom
05-11-2011, 10:51 AM
The SnapCPL will only show a “normal” or “abnormal” result for pancreatic lipase levels. The spec PL gives one a number with the reference ranges of the spec PL being 0-200.
This is just my logic; if the spec PL shows that Ali's pancreatic lipase levels are 300 then the possibilities of this severe pain coming from pancreatitis, to me, would be unlikely.
So, Lori, in your opinion if the Spec PL is 300 or less, the pain is coming from something more...correct? Just want ot be certain I am understanding you. I will ask the IMS if this test can be done today.
I talked to Alivia's IMS. She thinks Alivia is a bit "perkier" today and said she is anxious for me to see her to see what I think. She said she was sitting on the floor and Ali crawled up into her lap because she didn't want to go with one of the girls who had given her injections! That certainly sounds like an improvement from last night. I REALLY hope so. I am going to leave work early to visit with Ali and her doctor said we will discuss where things are then, too. Removing her gall bladder has not been ruled out, but she feels we are not ready for that decision, yet, due to the pancreatic inflammation.
Okay, I have it now. You were talking about THE Dr. Peterson, I thought your vet's name was also Dr. Peterson.:confused:
I'm with Leslie about not moving her unless you feel she is not getting proper care and if your trusted vet is affiliated with the current hospital he can still oversee her care. If he thinks she is better off where she is and he has access to her, well, that seems like a big important deal even if the emergency vet dropped the ball the other day.
See what happens today and she how your gut feels when you see her.
Gosh, I know this is so hard for you, Mary Beth, and rightfully so.
Hey, I have to say I am really impressed you called THE Dr. Peterson for a consultation. :) Great minds think alike as I was thinking of doing the exact same thing!!!!!:cool: Sweetie you have really got it together, much more so than you think. I am really proud of you.
Alivia is one fortunate dog to have you.:)
I have every part of my body crossed for Ali at the moment. I am a human pretzel!!!!!!! I'll go ask my coworker to say a prayer for her too. Whenever she says a prayer for Zoe, she gets better.:)
Love,
Addy
littleone1
05-11-2011, 02:02 PM
You and Alivia are in my thoughts and prayers, Mary Beth.
Even a slight improvment shows a step in the right direction. We all have to take baby steps at times. I know we want our fur babies to improve right away, but sometimes it is a slow process.
You are a doing a wonderful job of taking care of Alivia, and making sure that she has the best care possible.
Addy - Of course, I called THE Dr. Peterson....actually I emailed him and they called me! I would have found a way to contact the Queen of England if I thought she would be of any help! ;) (Beautiful wedding, by the way!) Back when Alivia had IMHA, we had no specialists in Pittsburgh at all. She was in critical condition so I did a lot of fast research about where the most knowledgeable specialists were and in less than 24 hours we were on a road trip to Ohio State University, 4 hours away. Thank goodness it was ONLY 4 hours away, because I was prepared to take her wherever I had to! She was in intensive care there a few times and we made numerous trips. Ali's regular vet worked very closely with them and Alivia surprised them all and pulled through. My daughter would jokingly say I'd never drive her to Ohio if she were sick; that I'd just tell her to get over it! Fortuantely, I never had to! :) So, Ali's regular vet is well aware of the lengths I will go to. I won't lose Ali without a fight. On Monday, the ultrasound doctor was looking through my folder of Alivia's test results and saw the e-mails from Dr. Peterson, Dr. Oliver and Dr. Allen. He said he felt humbled because the most well known people in the country were participating in her care. Whatever it takes!
Terri - Thanks! You are right....baby steps forward are a good thing. She's a tough little one! I am hoping to see some improvement when I see her in about an hour or so. I hope she isn't still mad at me. She really would not even look at me yesterday. I can't even bribe her with treats. :(
You guys are such a tremendous help. I feel like I have been monopolizing all of your time with my posts, and I am sorry for that. But, please know I appreciate everyone of your comments.
My Dear Mary Beth,
We have all been in crisis with our little ones. Do not apologize. We are glued to our computers and to your side...feel us.
Love,
Rene & Snoopie
Help!
I am spending a fortune, going into debt, and that would be okay if I can save her life. I just want to spend the money where I can get the most benefit for her...whatever that may be. :confused:
Please chime in....anyone.
I had to share something my very wise husband said to me when I was making the desicion to let Snoop go or give her an expensive surgery to save her life.
My husband would never spend that kind of money on his horse, dog, cat or even himself for that matter so when he sat me down and said this to me I cried. He knows I how I feel about my Snoop.
"If you spent this money on her and it saved her life, she will most likely live out her life and be around another four years. If you do the math that is only a couple dollars a day spent for your happiness. That's money well spent in my book."
I love my husband.
Rene & Snoopie
labblab
05-11-2011, 08:42 PM
Dear Mary Beth,
I have only a moment to post tonight, but I want you to know that I am still holding your sweet Alivia in my thoughts. I've had to be away today, so could not check back in until now. But I'm so hoping that you will see improvement in her during your visit this evening.
Continuing hugs,
Marianne
Me Again, checking in for news, to see if you are back from seeing Ali.
Sending love,
Addy
Rene - You do have a very wise (and kind) husband and you are so lucky to have him. From what I know about you, he is also lucky to have you!
Addy, Marianne and all - Thanks for checking in. Sorry I didn't post any updates last night. My internet was out for awhile and then I was too emotionally drained to post.
I visited with Ali for over two hours yesterday. She still wasn't sure she wanted to look at me, but she did snuggle up and lay with me. She even slept soundly at times. She is still painful, but there seemed to have been a big improvement in that. She was gingerly walking a little and knew where the door out was and she really wanted to use it. While I was there her IMS did another u/s. She said the fluid in her abdomen had resolved but her pancreas looked "about the same". There is no evidence of gall bladder blockage. She said Ali's results are not typical of pancreatitis and there seems to be more going on. Because of the clotting issue in her blood work yesterday, it was repeated. The really upsetting news is that there are indications her IMHA is reoccurring as she is becoming more anemic. That was a very hard battle to fight when Alivia was 6 years old and otherwise very healthy. I don't know if her little body could do it again. :( She will have a COOMBS test and some other things today. My heart is so heavy. How do you know when you are helping or when it is time to let go? Alivia really wanted to come home last night and it is so hard to leave her, not knowing what the final outcome of all this will be. If these are to be her last days, what a horrible way to spend them. How do you know if you are helping or being selfish?
I am so sorry to hear there might be something else going on. I understand why your heart is so heavy and mine is heavy with yours.
Sometimes it seems very bleak. In the morning light it may seem different. I feel more information is needed to determine the possible final outcome. Quality of life, odds of overcoming present illness, so many things come in to play before you can determine are you being selfish.
I, myself, play the odds so to speak. Is there a reasonable chance for recovery?
Don't go there yet, sweetie. You need to find out what else may be going on and if it is treatable.
I am praying this mornings light will bring more insight for you.
You have been strong for so long. I know your tired. See what today brings.
So much love being sent your way and for Alivia.
Addy
labblab
05-12-2011, 10:32 AM
I cannot add to what Addy has said so beautifully. I am so hopeful that you will receive some news today that will make your decisions clearer, no matter what they may turn out to be. Please know we will stay here to talk over anything that you may find out.
Sending strength to you and comfort to Alivia,
Marianne
Squirt's Mom
05-12-2011, 11:01 AM
Hi Mary Beth,
Oh, I hope the IMHA is NOT rearing it head again! Do let us know what the tests today show when you can. I know you are overwhelmed with everything that has happened and now this new possibility just makes things even worse so don't feel as if you HAVE to check in with us.....just know we are anxious with you and here anytime you need us.
It would be so nice if there were a set of rules or guidelines that were clear-cut; "if you see A, B, and C in your pup, then it is time." But that just wouldn't work across the canine board. Each pup is different, each parent is different so it becomes a question of what we believe is enough for our baby - since we are the ones who know our babies best of all. It is even more difficult when a pup is as sick as Ali has been. It is difficult to see how much fight they have left in them through all the aspects of the current situation - are they giving up, or do the drugs making them seem listless? have they lost their appetite because they are just too tired to care or is it because of the illness and treatments? is that look in their eye "goodbye" or is it depression from being in a cage away from those they love?
I do think talking to the docs involved will help you decide the path to take. That her pancreas is still inflamed isn't surprising to me - Squirt's still was when she came home after four days in the hospital. It really does take time for that organ to recover. It wouldn't be surprising to learn that the surrounding organs are also inflamed as a result of the enzymes, etc. the pancreas has been releasing willy-nilly but they will recover faster than the pancreas. So right now Ali feels like total CRAP just from the pancreatic attack.
Find out what the test results are today, what the docs feel about her chances of recovery and ability to fight another problem IF one is actually present - then you will have more info to use in making any decisions on her behalf. Talk with Ali; she will also help guide you because you can hear her when no one else can.
There is one thing I want to hear and take to heart - no matter what you decide, it will not be wrong. Your decisions will be based on your abiding love for Alivia and a decision made from a love like that cannot be wrong.
We will be with you every step of the way regardless of the choices you make - an amazing mom like you deserves no less. And I have no doubt whatsoever that Ali knows you will do the right thing for her always - just as you have from day one, and that you love her dearly. She carries that knowledge with her deep in her soul and it will never waver.
My thoughts and prayers are with you both.
Hugs,
Leslie and the gang
littleone1
05-12-2011, 11:17 AM
Mary Beth,
I don't have anything to add to what the others have so beautifully said. I am continuing to send positive thoughts and healing prayers.
Mary Beth,
I can't add much to the lovely words written here. But, I keep going back to Alivia Rose's avaitar of her on the bridge, what you said about it and those eyes communicating with you. Perhaps she is not looking at you right now because she is not willing to give up the fight and is not yet looking to you help her to the bridge.
Her eyes will let you know.
With love,
Rene
Harley PoMMom
05-12-2011, 12:41 PM
So, Lori, in your opinion if the Spec PL is 300 or less, the pain is coming from something more...correct? Just want ot be certain I am understanding you. I will ask the IMS if this test can be done today.
I am so sorry that Ali is continuing to have pain and not feeling like herself. I also apologize for getting back to you so late.
According to this chart from IDEXX laboratories about the spec PL test:
≤200 μg/L= Serum Spec cPL concentration is in the normal range. Investigate for hepatic, renal, gastrointestinal or other disease.
201–399 μg/L= Serum Spec cPL concentration is questionable. The patient may have pancreatitis, and serum Spec cPL concentration should be re‑evaluated.
≥400 μg/L= Serum Spec cPL concentration is consistent with pancreatitis.
http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/reference-laboratories/spec-cpl-clues-for-diagnosing-pancreatitis.pdf
Keeping you both in my thoughts and prayers.
With much love and huge hugs,
Lori
Hello dear friends!
Today the news is a bit more hopeful. Alivia seems to be doing a little better. She seems like her pain is decreasing and her beautiful dark eyes are getting brighter - she is even starting to look at me with them! :o Her platelet count today was ADEQUATE, so that was an improvement, but she still had large platelets, which means the bone marrow is producing them in response to bleeding or red blood cell destruction (as in IMHA). That is not good, but I asked her IMS if it could be because of the severe internal inflammation she had and she said it was possible. Too soon to tell for certain, so I am going to try to keep positive. The fact that her platelet count is higher today is a good sign.
While I was visiting her, they wanted me to try to get her to eat a tiny bit of bland food for her first time since Saturday. She licked it once, but wouldn't eat any of it. I'm actually not really surprised as Ali will never eat anything in a vet's office (or a pet store for that matter) even if it is a treat that she likes. I took her outside tonight for a few minutes. She still walks gingerly and slowly and seems very tired, but I guess that's to be expected. Like people, I know she is not resting well in the hospital. When I visit with her, she will snuggle up and fall asleep and has even snored a couple times! She only does that when she is completely exhausted.
Now for the best news, if things continue on the same path...ALIVIA WILL COME HOME TOMORROW! :D I think she will make a much faster recovery when she can rest in her own bed in surroundings where she feels safe and comfortable. I will be able to keep a close eye on her over the weekend, too. I KNOW I'll rest better!!
All the positive thoughts seem to be working!
I do so hope tomorrow night will find Alivia at home snuggled in bed with you.
Keeping positive thoughts and sending good energy for that to happen.
Love,
Addy
littleone1
05-12-2011, 09:28 PM
I'm so glad that Alivia is doing better. I'm continuing to send positive thoughts and healing prayers.
That would be wonderful if she could come home tomorrow.
I am so anxious for her to be home and resting comfortably! I just posted some hospital pictures....
Hooray Mary Beth! She looks great! Finally some good news and real hope. Cuddle up with Maxwell and savor the little wins.
Sleep well...you deserve it.
Rene & Snoop
Squirt's Mom
05-13-2011, 10:10 AM
Mornin' Mary Beth,
I was so anxious to see the report on Ali this morning and am so happy it is good! :):cool: Even baby steps forward are cause for celebration! :D
I hope she is home today with her loving mom!
Hugs,
Leslie and the gang
labblab
05-13-2011, 07:37 PM
Oh Mary Beth, I just saw your new photo of sweet Alivia safely back home again!!!!!!!!!!!!!!!!!!!!!!!! Thank goodness!! I hope you'll have a good report for us, just as soon as you are able to post one.
Tons of "welcome home" hugs!!! :) :) :)
Marianne
Hello, everyone!!!
Good news to report.....ALIVIA IS HOME!!!! She is sound asleep on the couch right now (I posted a picture). Her IMS said she would be tired and that she hadn't slept soundly all week. She mentioned that Ali is very sensitive (personality-wise). She is, but I am curious now about how she noticed that! I'll have to ask, next visit. She was released with antibiotics, pepcid and a bag of IV fluid that I have to administer, if needed. She wouldn't eat or drink at the vet's so they wanted me to have the fluids, just in case. She came in the house and went directly to her water dish, so that was good, but she hasn't wanted to eat, yet.
Her IMS said that her latest blood tests were pretty good and the hematocrit was coming up. In the excitement of picking her up, getting instructions on her medications and paying the large bill, I forgot to ask for copies of her test results, so I will have to call them on Monday.
They said her belly is still somewhat tender...I've been very careful about not finding that out - she's had enough pain! She's still very tired and weak, but there is a big improvement even in the last 24 hours. I think being home will help her progress.
Woo hoo! She just got up and ate a couple bites of food and took her medicine in 2 pill pockets! :) She is panting a lot when she walks, though. I hope that's just because she hasn't walked much in 6 days.
Last Sunday I worried if she would ever be home again, so I am VERY happy!!! All of your positive thoughts worked!!! THANK YOU!! :D
littleone1
05-13-2011, 08:43 PM
This is such wonderful news, Mary Beth. I am so glad that Alivia is home, and that she has shown such an improvement. I hope she continues to improve, which she probably will, as she is home with you.
Bless both of you. You've both had a rough time. I know Alivia has to be so happy to be home.
This news just made my whole day:):)
Mary Beth, I am so happy Ali is home with you and is improving.
I will continue to says prayers for her recovery.
Love,
Addy
Mary Beth,
The picture of Alivia Rose's homecoming made me bawl. Isn't it just the best when you get them back home after a such trying time. I'm so happy for you.
Sleep Well,
Rene & Snoopie
You guys have been the best! Thanks for helping me and Alivia through this.
Just wanted to give a quick report on her first night home. She is drinking water in normal amounts and she is eating a small amount. I didn't want to give her too much too soon since she hadn't eaten at all for almost a week. So, we are easing her system in gradually. Glad that the IV fluids will most likely not be necessary!
She slept soundly! Barely moved. :) My backyard is fenced, so that is where my two go to "go", but they have to go down a flight of stairs from the deck. I thought it would be easier for Ali to go out to the front yard since there are only a couple steps. Normally she loves the front porch/yard, since it means I'll be outside with her or we are going for a walk or car trip. She is absolutely refusing to go out the front door! I think she must be terrified that she will go back to the hospital. Poor baby! :(
I am just so relieved to have her home and to see the improvement in her each day. This episode definitely put the Trilostane/Lysodren decision on hold for awhile, anyway.
Have a great weekend everyone! Give your sweet pups a hug and belly rub from Alivia and me!
Mary Beth I am so glad you both had a good night and Alivia continues to improve. Baby steps are fine steps to take. She was very sick.
I would put the trilostane on the back burner for now. Little Alivia needs to regain her strength.
Keep us posted.
Love,
Addy
Squirt's Mom
05-14-2011, 08:45 AM
Hi Mary Beth,
What good news! Ali is home!!! :D:D AND she's eating and drinking on her own! :D:D
Did the clinic show you how to pick Ali up so her tender belly isn't bothered as much? You may already know! But just in case......slip one arm under her forearms and one arm behind the knees; lift by first moving the arm behind the knees forward so that she sorta sits on that arm the immediately lift her off the ground, gently, using both arms. Don't wad her up when you get her off the ground but hold her to you keeping pressure off the belly and keeping the spine straight.
She may be very hesitant to go up or down steps for a day or so as she is quite tender so carrying her up and down will help. Don't be surprised if she doesn't really need to go to the bathroom right off - she hasn't had much input for output. ;)
You are right - being home usually does wonders for the healing process! Being with her loving mom is the bestest medicine of all! Keep up the good work!
Prayers and healing white light continue flying your way!
Hugs,
Leslie and the gang
littleone1
05-14-2011, 01:21 PM
I am so glad that Alivia is doing so much better. I'm sure you feel very relieved. I'm hoping that she continues to do well. Enjoy the rest of your weekend.
Hi, everyone.
Alivia continues to slowly improve. She seems to be panting a lot and sometimes her rear legs still seem weak, though. Her appetite and thirst seem normal - not Cushing's normal, just normal. I made her a dinner of boiled beef liver with some rice and cottage cheese, yesterday, and she picked all the liver out first! Then ate a bit of the rice and cottage cheese but left some in the bowl (which, Maxwell happily finished)! I am happy that I have not had to use the IV fluids!! Most importantly, she does not seem to be in any pain! :) She is still sleepy but her body has been through a lot, so I think that is to be expected. If she continues doing as well as she is doing I'll try to take her on some very short walks to try to slowly build up her stamina.
Hope you all are enjoying the aweekend. It is another rainy one in Pittsburgh!!!
Hurrah For Alivia
I am so very, very happy to hear of Alivia's continued improvement.
:D:D:D:D:D:D
Cause for celebration- I hearby declare today to be
ALIVIA DAY
Happy Alivia Day sweet puppy with the most beautiful eyes!!!!!
Love,
Addy
Thanks, Addy!
I am always up for an "Alivia Day"! Wish it could be tomorrow instead AND that I could have a day off work because of it! :) Oh well! I am certainly not going to complain. I really feel lucky that Alivia pulled through another serious crisis. She's a spunky little thing! :D Now, to get her strength up enough to deal with the Cushing's issue....
littleone1
05-15-2011, 07:30 PM
This is great news. I am so glad that Alivia is doing so well.
Mary Beth,
It is wonderful to hear Ali is improving...what a trooper! Not surprising though from what you have said about the little wonder!!!
When Snoop had her bouts of pancreatitis it was helpful to go very slowly and give her digestive track a chance to heal. Essentially it had been digesting itself. So the very bland diet of the white rice and a little cottage cheese for protien was a good idea. I would add extra water to the white rice, when cooking it, to make sure she was getting the extra fluids and cook it extra long to aid digestion. Also, I found that the Lucern brand of cottage cheese had a low soduim version.
Ask your vet about L-Glutamine amino acid supplment. It is suppose to aid digesive health by repairing damaged digestive tissues. It also is suppose to rebuild and repair muscles, blood proteins and help with the rear end weakness in our cush pups. So far it has seemed to help Snoop with both her pancreatitis bouts and rear end weakness.
Give Ali a hug for us,
Rene & Snoopie
Hi Mary Beth,
Stopping by to say if you have to go to work today, try not to worry too much. I hope the day flys by and you come home to Alivia and Maxwell and everything is positive.
I am glad everything is improving.
Hugs,
Addy
Hi, Terri, Rene, Addy, Leslie and all!
Happy Monday! Yes, I had to come to work today. :( Ali is doing really good, though. She seems to be coninuing to get stronger. When I was getting ready for work this morning, she actually crawled UNDER the blankets and went back to sleep. That is what she always did pre-Cushing's. When her Cushing's symptoms were really noticeable, she stopped going under the blankets. She isn't panting and she lets me pet her belly (gently, of course), without any indication of discomfort. I am still keeping her diet on the bland side for awhile and she is still taking antibiotics and pepcid. So far, so good. She seems happy to be home and I think getting back to the regular "routine" will do her good. My two are both little fuddy, duddies and like everything to be the same.
I just realized Ali came home from the hospital on Friday the 13th and she is 13 years old. I hope 13 continues to be lucky for her!!!
Hope everyone has a great week!
Harley PoMMom
05-16-2011, 10:02 AM
That Ali is feeling more like herself is really wonderful, wonderful news!! Continuing to keep you both in my thoughts and prayers and sending huge loving hugs, Lori
Squirt's Mom
05-16-2011, 11:54 AM
Wonderful news, Mary Beth! :D So glad Ali is steadily returning to herself.
So.....Fri. the 13th will be Ali Day from now on? :p
Hope you have a good day back at work!
Hugs,
Leslie and the gang
labblab
05-16-2011, 12:42 PM
I, too, am thrilled to hear that Ali continues to improve!!!!!!!!!!!!!!
What a great way to start out our week! ;) :p :)
Marianne
littleone1
05-16-2011, 01:44 PM
This is really great news. I hope 13 does continue to be a lucky number for you and Ali.
Hi Mary Beth and Ali,
Just checking in on you, after your days work. Hoping you came home to a happy Ali, that she welcomed you home and you are snuggling in for a good nights rest.
Rene & Snoopie
Happy Tuesday!!!!
I hope you and Alivia had a good night. Thinking of you.
Love,
Addy
Leslie, Lori, Marianne, Terri, Rene, Addy and EVERYONE!
Alivia update: Ali continues to do well. She is amazing me again! She continues to get stronger evey day. Even her Cushing's symptoms seem to have subsided, somewhat! No panting and her appetite and thirst seem NORMAL!!! I am even having to keep her from going up and down the steps too much. When she does overdo it, she starts to get a little week in her back legs. Rene, thanks for the tip about the supplement. I'll ask about it.
Leslie, every day is Alivia Day to me! :D
Ali is a little stinky right now, which is very unusual for her. I think it is from being crated so long in the hospital. She HATES baths, so I have been being easy on her and letting her recover before subjecting her to that. It's been chilly and rainy here, too. I feel so fortunate with her recovery that I am taking everything slow and cautiously! :p
Alivia sends much love to everyone!!! There was so much positive energy coming her way that she had no choice but to get better!
Squirt's Mom
05-17-2011, 09:15 AM
:D:D:D Yeah! Another good report for Alivia! :D:D:D
Great way to start the day!
Keep up the good work!
Hugs,
Leslie and the gang
Hi, all.
My updates are uneventfully boring and I am SO happy about that! Alivia continues to do well - getting better every day! :D
I spoke to the Office Manager of the emergency hospital yesterday. The place that kept Ali all day on Mother's Day to supposedly do an ultrasound, but ended up doing nothing for her the entire day. They released her that evening saying it was spine pain, but did not explain why she had a fever of 104.9. I even asked about pancreatitis because it was obvious the pain was in her abdomen, but they said it wasn't that. Well, I think I figured out why they didn't do the ultrasound. Ali had one a few weeks before and I just found out their policy is repeat ultrasounds less than 30 days apart are not charged. So, because there was no money to be made, they chose not to do it!! As a result, Ali suffered an additional 36 hours, her condition got worse and she could have died! I paid over $600 to them that day, then the next day had to pay Ali's regular vet for an emergency visit and another vet for an ultrasound (would have been no charge at the emergency hospital if they would have done it!) and then was billed another $500+ by the emergency hospital to finally admit her Monday evening so she could be transferred into the care of her IMS the next day!! Plus, I had to take a day off work Monday to get medical care for Ali. I already paid the bill for the first day (which incuded unnecessary medications), but I refused to pay their bill for the next day. The Office Manger listened and said she had to talk to the ER vet and she would get back to me. Oh, and on Sunday, when I picked Ali up and they said it was "spine pain" the vet was "too busy to talk to me", even though I had just paid over $600 and there was not a single person in the waiting room.
I don't have a problem paying for care for Ali when she actually gets care, but that whole day was a fiasco! What really breaks my heart is Alivia suffered a full day and a half longer than she should have. I don't think I should have to pay the second bill. I think they should refund the first bill, too, or at least part of it, but that probably won't happen. So, we'll see.
I agree with you 100%. You should not have to pay ANY bill for their substandard care.
You go girl!!!!!
Love,
Addy
P.S. We love uneventful;)
Hi, Addy!!!
How are you?
Now that we are at "uneventful" , I can fight the vet bill mess. :mad: The people that know about the whole thing agree with you that I should not have to pay any of it. I can't think of anything they could say to justify what happened. I am just so thankful that Ali was able to pull through it despite the delay!
Love from us both!
Mary Beth and Alivia (getting stronger every day!)
Mary Beth,
I'm so sorry you are having such a frustrating time with the bills and the fall out. You both have been through a lot in the last couple weeks. You did so much for Ali, while trying to work, balancing it all and eventually it just took over. You did a great job bringing Ali home!
This time should be for healing, for both you and Ali.
It is what it is. Enjoy your girl.
Love,
Rene & Snoop
I am very thankful that the end result for Alivia turned out well. She was and is my first priority. The 6 days of treatment cost well over $4,000 and I would gladly pay that to get Ali whatever care she needs. What I am angry about is the $635 I paid for a hospital emergency visit where instead of doing what they told me they would do, they put Ali in a crate for a full day and basically did nothing to help her. Their lack of treatment caused her to suffer an extra 36 hours and if I had listened to them she would have died. It breaks my heart to know she spent the day in a crate, scared and in extreme pain for no good reason and no one was doing their job to help her. If they would have told me that was what they were going to do, I would have immediately taken her elsewhere. That is the only day I have a problem with paying for. Our dogs are so vulnerable in situations like that. We are their voice to make sure they get proper care and I do feel I need to speak up for how she was mistreated. Maybe, by me complaining, they will be a bit more thorough when another dog comes through their doors in pain.
Okay, that was my soapbox speech. ;) Ali continues to improve and her Cushing's symptoms also seem to have lessened! (Holding my breath and keeping my fingers and toes crossed!) She is no longer panting and is back to sleeping under blankets and drinking and eating like normal. She still doesn't have her full strength back, but she is getting stronger every day! :D:D:D
Squirt's Mom
05-19-2011, 09:32 AM
Hi Mary Beth,
We just LOVE uneventful! :D:D
I know so well the anger you feel at the way Ali was handled. When Squirt had her first ultrasound, a tumor showed up on her spleen - plainly! But the IMS who did the test didn't feel the need to make any note of it - not in her charts, not to the staff, not to me. When she had the second ultrasound, the IMS who did this one told me about it and showed me the first film that clearly showed the tumor then - FOUR MONTHS PRIOR!!! :mad::mad::mad::mad::mad::mad::mad: Luckily, the first IMS had left the hospital by then or I would still be in jail! If I had seen her the day I learned of her neglect, there is no telling what my reaction would have been because I was LIVID....and am still very angry at her for putting my baby's life in danger. :mad::mad::mad::mad:
You are absolutely correct - we are their advocates and when we are misled it is our babies that pay - through no fault of their own nor ours.
SIC 'EM, honey! :D
Hugs,
Leslie and the gang
Harley PoMMom
05-19-2011, 09:47 AM
Hi Mary Beth,
Here is a link to the AVMA State Legislative Resource page for PA.:http://www.avma.org/advocacy/state/resources/pa.asp
I totally agree with you about the care and not paying that hospital emergency visit. I don't know if it would help you to write to someone on that list about this.
So happy to hear that Ali is continuing to improve.
Love and hugs,
Lori
Leslie,
That is AWFUL!! If something is not in a report, you would have absolutely no way of knowing it was missed. When Ali had the ultrasound at her regular vet's office they allowed me to be with her. The ultrasound vet was pointing out organs to me, but to be honest, I couldn't tell what any of it was! :mad:
I was doing some research on cortisol levels and pancreatitis and came across a question you had asked a long time ago on Askvet (I think it was called)!
Lori,
Thank you so much for the link. I will wait until the office manger gets back to me, but if they are not willing to drop the bill, that site will be very helpful!
Good morining Mary Beth,
I understand your frustration and I don't let folks take advantage. When I have come across this type of abuse I have taken advantage of the dispute services offered by my credit card service, that is of course if you paid by credit card. They suspend the charge in question until the dispute is settled. They require the vendor to explain the charges in full to your satisfaction before the payment is made. I don't know if yours offers it but I have found it most helpful and it is pain free. They do all the work and it is complimentary.
Enjoy every minute,
Rene & Snoop
MyLittleMan
05-19-2011, 11:39 PM
First, let me say that I am so glad Alivia is doing better!
I've been a little preoccupied lately with my JRT, Jack, and his Cushing's, high blood pressure, bladder stones, etc. So I haven't had time to read up one anyone else's struggles until tonight when I read your thread.
I read your story from beginning to today's post, and my heart went out to you and your Alivia. We don't have the same health issues but I am a JRT mommy like yourself and fiercely protective of my little fella and his health as you are of yours. I think you've done a fantastic job to date!
I don't have any anything to offer but my best wishes for continued success and a "3 cheers" for JRT fortitude. They really do fight the good fight. You just can't keep 'em down! Hip hip Hooray!!!!!!
Kindest and best regards,
Kim and Jack
Hi, Kim.
So happy to "meet" you and Jack! I am so glad you posted here and thank you for reading my very long string!! I am a dog lover in general, but certainly have a soft spot for Jack Russells! Fortunately, I had not read anything at all about the breed to scare me off prior to falling in love with Alivia when she was 7 weeks old. I took her home when she was 8 weeks old and she has had my heart ever since. Both of my JRTs have always had high energy outside, but they are sweet, snuggly couch potatoes when we are at home. So smart, sensitive and intuitive. I am SURE you agree! :D
Sorry I missed welcoming you when you first started posting here, but as you know, I was in the midst of dealing with a medical crisis. Alivia continues to improve and I am thrilled about that. I just read your string and am so sorry to hear about everything Jack has been through. Their issues may not be the same but there are some similarities. Alivia has high blood pressure. She takes Amlodopine for that. I was interested to read that Jack has a bald spot on the tip of his tail, as Ali does, too! It has been there for awhile, but in the past several months it seems to bit more noticeable. I don't think there are any lumps, but I will check it out more closely today. Ali's fur barely grows. Her belly was shaved for an ultrasound about 7 weeks ago and she still only has peach fuzz. With the recently hospitalization, she's had three legs shaved. She will always be gorgeous to me, though!
I checked out Jack's pictures! What a handsome guy! His coloring over his ear is very similar to Alivia's. Oh, one of Ali's littermates was named Jack. :) Jack is very lucky to have you and I understand your feelings of doing whatever it takes to give him the best care possible. Some people do not get that; but, I think EVERYONE here does. I look forward to keeping up with Jack and wish you both well!
Hi Mary Beth,
Give that sweet Alivia hugs and kisses from me and Zoe and tell her we are very proud of her progress and what a trooper she is.
Such a good girl!!!!:D:D:D
I hope you have a stress free weekend, you deserve it.
Love,
Addy
Hi, Addy -
Alivia continues to do well. We finally have a nice day here so she was out in the yard with me most of the day. She seemed to be enjoying the fresh air and sunshine. She came in, had her dinner and is now napping soundly! :)
I hope you and Zoe are enjoying your weekend! Hugs to you both!!!
littleone1
05-22-2011, 12:35 PM
Hi Mary Beth,
I am so glad to see that Alivia is continuing to improve and is doing so well.
Thanks, Terri.
Even better, Alivia currently has no Cushing's symptoms! I am starting to doubt that she actually has a right adrenal "tumor". According to Dr. Peterson, with an adrenal tumor, they cannot suppress for the LDDS. Alivia clearly did. The second ultrasound she had done by a vet who specializes in u/s, showed the left adrenal gland of normal size (not atrophied) and the right one was larger but there was not a clear tumor. I left the report at work, but he said something to the effect that is could be an area of hyperplasia. Things have never been clear cut when it comes to Ali! :p
She sees her IMS for follow up on Wednesday, so we will see if she can expalin any of this!
Horray for Ali...Rene & Snoop!
Thanks, Rene.
She has a follow up with IMS tomorrow, so fingers crossed things continue to go well!
I'm crossing mine too, Mary Beth!!!:D:D:D
Hugs,
Addy
Hello,
My Maisie was diagnosed with Cushing's disease in the fall of 2009 following a tooth being pulled.....surgery. The diagnosis was directly after the surgery and we always felt it was somehow linked. My baby passed away 3 weeks ago. I am so devastated. Words cannot describe the loss and my sadness.
I read that your dog Alivia was diagnosed after two teeth being pulled. I wonder if the stress of the surgery brought on the Cushing's. Maisie was on Trilostane. Whether the tumor grew on her pituitary from a micro adenoma to a macro adenoma or else a new brain tumor grew they could not tell me. She was so weak from the disease from having it almost 2 years I opted out of an MRI. The doctors said it would have told them what they already knew anyway.
Where did you hear that Trilostane can make tumors grow faster? Could you please let me know your resource for that information?
I am so sorry for your Avilia.
take care,
jani
Squirt's Mom
05-26-2011, 09:20 AM
Hi Jani,
I just wanted to let you know that I have copied your post here to a new thread of your own. In this way, the members can discuss the questions you asked here and you will be able to keep up with all the info in one place.
You will find your thread at this link in the Questions and Discussions (same section as this):
http://www.k9cushings.com/forum/showthread.php?t=3385
I am glad you found us and hope we are able to help answer some of your questions and ease the pain of your loss.
Hugs,
Leslie and the gang
Hi Mary Beth,
Stopping by to thank you for your support and to see how Alivia is doing. It was a hard day for me yesterday, hearing someone else say how high Zoe's coritosl is. I started doubting myself. I think it scared me because I was worried I waited too long. Not about starting treatment but that I did not start it soon enough.
You will like Dr. Peterson. He is really nice. Carol in his office is very nice too.
Happy Memorial Day:D
Hugs,
Addy
Hi, Jani.
I just wanted to welcome you and thank you for your post here, but I will respond in more detail on your new string.
Hi Addy -
Glad you are feeling better about things today. What is Zoe's cortisol level? Just curious as to what it is in relation to Alivia's. Carol is who I spoke to at Dr. Peterson's office and she was very nice!
Hi, everyone!
Just finally getting to posting an Alivia Update. She had a re-check last night with the IMS (the first since her 5 day hospitalization for pancreatitis). Her abdomen was not swollen and she had no pain! Her color was good; temperature normal. Her weight had dropped from 18 lbs. to 16 lbs. since she was not able to eat or drink for 7 days. It is now up to 17.5. They did complete blood work with a chemistry panel so I am waiting for those results. So far, so good.
Surprisingly, her Cushing's symptoms seem milder. I asked about whether I should consider starting treatment and got this response, "She has Cushing's because of the adrenal tumor. Surgery would cure that. Since you don't want the surgery, if her symptoms aren't bothering you, there's no reason to start treatment. Lysodren can create its own problems." First of all, Alivia's symptoms NEVER "bothered" ME, other than me worrying about HER health. It seems with this doctor it is surgery or nothing and I don't agree with that for multiple reasons: 1) Alivia is 13+ and has had other health issues, 2) The adrenal "tumor" is not clearly diagnosed and I am not 100% convinced that is what it is, and 3) Whatever is there is on her right adrenal, making surgery even more risky. On the other hand, I never want her to suffer through another bout of pancreatitis and if that takes medication, I'll have to get over it.
Why do I doubt the original diagnosis? It will make this post super long and I apologize in advance, but I would like some opinions on the "Assessment" in the ultrasound report prepared by an independent vet, specializing in ultrasound.
"Assessment: Continue to detect adrenal asymmetry with suspected nodule in cranial pole of the right adrenal gland. Normal appearance to left adrenal gland and caudal aspect of right adrenal gland suspicious for autonomous nodular function (adrenal adenoma). Cannot rule out atypical nodular hyperplasia since LDDS did reveal suppression. Recent onset of abdominal discomfort and fever suspicious for flare-up of pancreatitis. Cannot rule out concurrent or inciting cholangitis secondary to bile clumping. Visualization of “meaty” pancreas, hyperechoic peripancreatic fat, and trace of regional effusion all support inflammatory disease (pancreatitis/cholangitis). Hyperadrenalcorticism likely contributing to predisposition for pancreatitis.”
His recommendations were for the immediate hospitalization and treatment of the pancreatitis and then when she was recovered to “…continue endocrine work up with plasma ACTH level. Presence of potential complications associated with hyperadrenocorticism (pancreatitis, cholangitis) suggests that HAC should be managed more aggressively with Mitotane(rather than trilostane)if suspect macronodular PDH, or Lysodren/adrenalectomy if suspect adrenal adenoma.”
So, as usual, nothing is ever clear cut with my Alivia. I think the next step is to get her ACTH level tested then get all her records together for the consultation with Dr. Peterson I had planned on before the pancreatitis crisis. I don't want her to ever have to suffer through another attack of pancreatitis.
Sorry for the extra long post, but I wanted to hear if any of you had any thoughts on the ultrasound report, Also, I should mention that there is a bit of discrepancy between this u/s report done by a vet who specializes in u/s and Ali's regular IMS who simply said, "I don't see what he's seeing". :confused:
marie adams
05-26-2011, 06:56 PM
Oh Mary Beth,
I wish there was a clear cut answer out there and why do these vets seem to differ so much....I never had an ultrasound done on Maddie because she had Cushings no doubt about it and I just wanted her to get comfortable again. The lyso did help and she had no side effects so I was grateful. I just wish we could have seen the cancer coming, but that was a surprise and then it went so fast.
You are doing a great job and I think talking with Dr. Peterson like Addy did will help you figure it out. You will make the right decision for Alivia!!!:)
Things really are so much more confusing when the vets are in such disagreement. I had actually talked with Dr. Peterson's office about the consultation a few weeks ago and then the pancreatic crisis occurred, so it was postponed. I do think that is my next step. Although, since Ali seems to be doing so well, I think I will give us a bit of a break! This recent hospitalization took a lot out of both of us!
I forgot to post that I just added Milk Thistle to Alivia's routine. I found an alcohol-free Milk Thistle extract on The Vitamin Shoppe's website for only $9.99 and got her IMS's blessing on it. She calculated the dosage for me and gave me syringes to measure it more accurately, since Ali's dosage is pretty small. Ali's doctors are all for using human grade products as much as possible because they are better regulated.
It is confusing when things are not clear cut. I do know Dr. Peterson has written that a serious illness can also enlarge the adrenal glands.
That blog was one of things that spurred me on about Zoe and rethinking the lysodren and wanting to talk to him. Not that I doubted Zoe's diagnosis. It was just that all her tests were not conducted in a optimal way which left me uncomfortable to some degree. Her cortisol was too high to doubt it.
She was post 32ug in June 2010 and after her illness at the end of the year she was post 44ug:eek::eek: Dr. Oliver did say her illness could have contributed to some of that but the number was way too high to contribute all of it to a concurrent illness.
All her UTK tests are marked :Significant adrenal activity yet she started with just hair/coat problems and looked like a hypothyroid dog not a Cushing dog when we started this journey. The hind leg weakness came on fast. The appetite got huge the last few months and she also started drinking more water though not buckets, she does not drink more than normal but more than she did which is alot for her.
I waited for stronger symptoms and wanted to give her time to get strong, she had been so sick. I had hoped to change her food but I ran out of time:) we only made it to 2 teaspoons:(
I don't think there is a right or wrong answer, Mary Beth. My husband made me promise, when all this started, not to look back and blame myself. The decisions I make are the best I can do and whatever the outcome, I did the best I could.
You will do the best you can for Ali, you always have. Go with your gut and don't look back.
When I started this journey, Zoe's colitis bothered me more than her Cushings. We have tried to fix that as best we could. Now we work on the Cushings. I could have fixed the colitis better but I ran out of time.
Love,
Addy
Addy - You have a very wise and kind husband.
The GOOD news: I missed a call from Alivia's IMS yesterday to tell me the results of her most recent blood tests. (Actually she called my home number when I am at work all day even though they have my direct dial work number, which always annoys me) Anyway, her message was, "Nice results!..." Her Amylase is about 300 above normal - she wasn't concerned. Her Lipase was normal. And, "there was a slight change in one of the liver enzymes". She didn't specify which, but said she wasn't concerned and that Alivia needed nothing further than to come back in 6 months for routine twice a year exam.
The CONCERNING news: Why does it seem like good news is short lived? Went to bed feeling really good that Ali was improving...only to be up worrying about her most of the night. She was panting almost continuously and very restless - the way the pancreatitis started. :( She allowed me to pet her belly, which you couldn't do during her pancreatitis flare up. It was much warmer in my house than it has been but my other JRT, Maxwell, was not effected at all. I gave her a pain pill in a pill pocket, which she readily accepted (and looked for more). When she had pancreatitis she refused EVERYTHING. She fell asleep soon after and seemed more comfortable. I had given her a different canned food for dinner and the fat content was a bit higher. I wonder if that bothered her a bit.
Always something!
Harley PoMMom
05-27-2011, 10:17 AM
Lipase and Amylase can be normal even when a dog is suffering from pancreatitis. One time with Harley I had the Lipase and Amylase checked along with a Spec PL test and his Lipase and Amylase were both in the normal ranges but the Spec PL test results were 464 (0-200).
The pancreas is such a fickle organ and it can take a while for it to heal. Also, pancreatitis can elevate the liver enzyme levels and it may take some time for those liver enzymes to come down.
Keeping you both in my thoughts and prayers.
Love and hugs,
Lori
Lori - Any dietary tips or other suggestions to keep Alivia from having another full fledged episode?
Just had her most recent blood results faxed to me and there have been many improvements. The only things outside the normal range are:
ALK Phosphatase 341 (5-131 U/L) 2 weeks ago this was 628 and then 2 days later went up to 665! :)
GGTP 15 (1-12 U/L) Was <5 2 weeks ago-I'm not familiar with this one? :confused:
Phosphorus 6.6 (2.5-6.0 mg/dL) 2 weeks ago was 5.5
Amylase 1474 (290-1125 U/L) 2 weeks ago was 1785!
WBC 16.9 (4.0-15.5 10^3/uL) was 11.5
Platelet Count 652 (170-400 10^3/uL) was 75!
Absolute Neutrophils 11999 (2060-10600 10^9/L) was 10350
A lot of other values have improved into normal range! :D Overall these are really good results for Alivia, especially considering what she's just been through. Her IMS was quite pleased. I think I need to be more vigilant with her diet.
labblab
05-27-2011, 12:08 PM
"Assessment: Continue to detect adrenal asymmetry with suspected nodule in cranial pole of the right adrenal gland. Normal appearance to left adrenal gland and caudal aspect of right adrenal gland suspicious for autonomous nodular function (adrenal adenoma). Cannot rule out atypical nodular hyperplasia since LDDS did reveal suppression. Recent onset of abdominal discomfort and fever suspicious for flare-up of pancreatitis. Cannot rule out concurrent or inciting cholangitis secondary to bile clumping. Visualization of “meaty” pancreas, hyperechoic peripancreatic fat, and trace of regional effusion all support inflammatory disease (pancreatitis/cholangitis). Hyperadrenalcorticism likely contributing to predisposition for pancreatitis.”
His recommendations were for the immediate hospitalization and treatment of the pancreatitis and then when she was recovered to “…continue endocrine work up with plasma ACTH level. Presence of potential complications associated with hyperadrenocorticism (pancreatitis, cholangitis) suggests that HAC should be managed more aggressively with Mitotane(rather than trilostane)if suspect macronodular PDH, or Lysodren/adrenalectomy if suspect adrenal adenoma.”
Hi Mary Beth,
First off, I am so sorry that you had another uneasy night. And I surely understand your continuing uncertainty over which path to choose regarding Ali's diagnostics and treatment. I know you had asked earlier for thoughts about her ultrasound results and the related recommendations. It took me a while to be able to look them over (and think them over), but here's the little bit I can offer.
First of all, this may be what you had already planned, but I do believe the ultrasound specialist is recommending that Ali have an "Endogenous (Plasma) ACTH" performed as opposed to an ACTH stimulation test. I did not have the chance to completely read through your entire thread, but I do believe that she has already exhibited elevated cortisol per the ACTH stimulation component of the UTK adrenal panel. The Endogenous ACTH is an entirely different test, is somewhat challenging to accurately perform, but can aid in differentiating between pituitary and adrenal Cushing's. And right now, that still seems to be the question for the ultrasound specialist: trying to confirm whether or not that adrenal abnormality is actually an adrenal adenoma.
Even though Ali's 8-hour LDDS result was not consistent with a Cushing's diagnosis, it does not definitively rule out the possibility of PDH because up to 10% of dogs with PDH will score within the normal reference range. However, the fact that she exhibited suppression at both the 4 and 8-hour marks would seemingly rule out ADH: dogs with ADH typically never exhibit cortisol suppression on this test. But then, we have the ultrasound imaging which does demonstrate an abnormality of some sort limited to the right adrenal gland. So how to resolve the inconsistencies? I do believe that is why the "Plasma ACTH" is being recommended -- to further aid in differentiating whether Ali may be suffering from PDH or ADH. Because that information, in turn, may affect your treatment of choice: both the type of medication and the aggressiveness of treatment. And I definitely do "get it" that both he and you are wanting to move forward with Cushing's treatment if it is warranted and if it will stave off future pancreatitis attacks.
But there is some additional confusion from the standpoint that now Ali's behavioral Cushing's symptoms seem to be improving, but during the same time period that she has suffered from this life-threatening attack of pancreatitis. Even if you wanted to also perform a repeat screening ACTH stimulation test at this time, I don't know whether it might show residual elevation simply as a result of Ali's pancreatitis.
The bottom line is, I think these are all really good questions to discuss with Dr. Peterson. I am also thinking that you may not want to invest any more money in additional testing until you have had the chance to talk with him. Ali's situation is truly complicated, and I think it may be really helpful to have his feedback before moving forward. I know you will pay any price to keep her healthy and happy. But perhaps he'll be able to help you prioritize and focus on what the very best "next steps" will be.
Marianne
Dear Marianne -
Thank you, thank you , THANK YOU! For the time you spent on that wonderful analysis and well thought out explanation! You just clarified a lot of confusion for me and validated my feeling that the cause of her Cushing's is not so clear cut! I have been saying her symptoms have come and gone to various degrees for YEARS! Maybe there is some other explantion - a congential defect in her adrenal gland perhaps that casues fluctuations in the hormones? Alivia has never been a clear cut case with ANYTHING. When she had IMHA - the vet at Ohio State University actually said she did things that they couldn't explain and that were not even medically possible (or so they thought!). She had u/s way back then - I think I will try to get those reports. It would be interesting to see if there were any comments on her adrenal glands.
The doctor that did this u/s ONLY does ultrasound and has an extremely good reputation. The vet that works for the Trilostane manufacturer, Dr. Allen, even told me he knows this guy and that he was very good. Yet, her IMS basically dismissed this report by saying she didn't see what he saw and that Ali has an adrenal tumor and could be cured with surgery! She did not mention the LDDS supression and I did not specifically ask her to explain that, though.
I "talked" to Ali's regular vet last night by email. He agrees that the best way to proceed is a consultation with Dr. Peterson and that he will be happy to oversee her care and do whatever is best for Alivia. I appreciate him so much. He has already saved Ali's life multiple times.
Your post really put the inconsitencies of Ali's test results together in a much easier to understand way. It's also immensely reassuring that I am not going crazy (at least not about this) and not the only one that saw all these things that didn't add up!
Thank you so MUCH!!!! I can't even begin to tell you how much the support from ALL of you here has meant to me and Alivia. Happy Memorial Day weekend to you!
littleone1
05-27-2011, 01:20 PM
Hi Mary Beth,
I hope you have a good conference with Dr. Peterson and will be able to get some positive answers.
I hope you also have a good Memorial Day weekend.
Thanks, Addy! Same to you! About the good weekend, I mean! I REALLY need a long weekend right about now. My patience is shot! On days like this I think a bottle of ChocoVine in my desk drawer would be a good thing! :rolleyes:
I think this roller coaster ride of stress and worry is catching up to me.
Cindy Thoman
05-27-2011, 02:17 PM
Mary Beth, I have been following your thread and just want to let you know I am sending lots of positive thoughts your way. I hope you can get off the roller coaster for awhile and have a relaxing weekend.. Try to let go of some of the stress and just enjoy your time with Alivia.
xoxo,
Cindy, Alex and Bear
Thanks, Terri....I am sooo looking forward to the long weekend! I hope you have an awesome one, as well.
Thanks for the message , Cindy. I appreciate it! I just checked out your pictures - so sweet!!!
My goal for the weekend is for it to be COMPLETELY uneventful. I'd like to spend some time outside and take some quiet walks with Alivia and Maxwell. I am keeping my fingers crossed that Ali has the same plan! :p
A safe and happy Memorial Day weekend to all of you, my dear friends!
Harley PoMMom
05-27-2011, 04:10 PM
Lori - Any dietary tips or other suggestions to keep Alivia from having another full fledged episode?
Just had her most recent blood results faxed to me and there have been many improvements. The only things outside the normal range are:
ALK Phosphatase 341 (5-131 U/L) 2 weeks ago this was 628 and then 2 days later went up to 665! :)
GGTP 15 (1-12 U/L) Was <5 2 weeks ago-I'm not familiar with this one? :confused:
Phosphorus 6.6 (2.5-6.0 mg/dL) 2 weeks ago was 5.5
Amylase 1474 (290-1125 U/L) 2 weeks ago was 1785!
WBC 16.9 (4.0-15.5 10^3/uL) was 11.5
Platelet Count 652 (170-400 10^3/uL) was 75!
Absolute Neutrophils 11999 (2060-10600 10^9/L) was 10350
A lot of other values have improved into normal range! :D Overall these are really good results for Alivia, especially considering what she's just been through. Her IMS was quite pleased. I think I need to be more vigilant with her diet.
Hi Mary Beth,
GGTP is an enzyme associated with the liver. With her Phosphorus elevated I would really keep a watch on this and maybe ask your vet about adding a Phosphorus binder. Elevated Phosphorus levels can lead to a host of other problems especially inappetence.
With Harley and his pancreatitis I would feed him small meals throughout the day (3-4 meals). I made sure that when his pancreatitis was causing him discomfort that he got a pain pill to relieve the pain. I fed him proteins like skinless, boneless chicken breast, eggs and/or fish. I added carbs like rice, potatoes, noodles and/or barley. His diet was formulated for his pancreatitis/cushing's.
Hope this helps and if I can help in any way, please do not hesitate to ask.
Love and hugs,
Lori
Thanks, Lori.
I was on the right track. I had just bought a bunch of boneless, skinless chicken breasts and am cooking them in the pressure cooker right now. Got the rice ready, too. I figured I would cook them all in advance and use my Foodsaver to pack them into serving size portions. I wouldn't have thought of the eggs, though! I'll scramble some and add them to the chicken and rice for some variety.
I have Tramadol for Ali and a prescription for more. I will definitely give it to her if I think she is in pain. I think it is cruel for people to NOT treat a dog for pain!
Thanks for the info on the GGTP. I will have to read up on it and also on the phosporus levels.
I appreciate your help!
Dear Mary Beth,
I am here if you need anything. I'll be around all weekend if you need to talk. I'll check in on you and Alivia.
It sounds like you are going to be cooking up a storm:D:D Pour yourself a glass of Chocovin and have at it:D:D:D
It would be like a cooking for dogs pilot TV show. Can you picture it? Mary Beth in an apron with puppies on it, drinking a glass of Chocovin and her two pups in the kitchen watching Mom as she explains the recipe for dog food chicken and rice:D:D:D
It would be a hit:D:D:D:D
Love ya,
Addy
I probably could do a cooking for dogs show! I must have 10 dog cookbooks. I've been making Ali and Max treats for years, and friends' dogs, too. Alivia gets excited when she sees the rolling pin because it means I am making them treats. She will sit in the kitchen and wait for them! I try to not give them much wheat so I even started grinding my own rice and oat flour to use in their treats. I always think how fun it would be to open a dog bakery. But, since I am single and have an expensive little dog to support, I certainly can't give up my day job! ;)
I might as well cook their main course, too! I don't even cook for me! The thing is Max will want what Ali is having so I will have to cook for him, too, to avoid any grumbling. I'm thinking I might as well make enough that we can all eat the same thing! :D Would I be eating dog food or would my dogs be eating people food?? :cool:
Addy, I don't think it is a good idea for me to mix lack of sleep, a hot stove and ChocoVine! All kinds of things could go wrong with that combination! :rolleyes: As of now I have no plans for the weekend and I am really happy about that! I am truly hoping to be home ALL weekend, so I'll check in here every so often. I just hope Alivia read the memo that we are going to have a calm, UNEVENTFUL weekend!
Squirt's Mom
05-28-2011, 10:14 AM
Hi Mary Beth,
If I was closer, we could make that dog food/treat thing happen together! :D I spend at least 3 days a week cooking my babies menus and love every minute of it. My three also stand right under my feet the whole time as they know Mom is a klutz and will drop things from time to time. :p
Squirt and Trinket eat nothing but home cooked while Brick eats a combination of kibble and fresh food. In time, he will more than likely go to home cooked, too. For now, we are still figuring out what he likes and what he doesn't. Sweet potatoes are right up there at the top of the list for him! :D He didn't care for salmon BUT when I mixed it with sweet potatoes, that made it much better. :p He loves the cod, SP and quinoa mix that Trink eats...which has done wonders for her colitis.
I hope Ali enjoys her meals!
Hugs,
Leslie and the gang
Hi, Leslie,
I've been making treats for years, but last night I experimented with a "main course". I cooked about 8 boneless, skinless, chicken breasts in a pressure cooker, then chopped them up and mixed it with about 2 cups of cooked brown rice; scrambled 8 eggs mixed with non-fat dry milk, water and ground flaxseed meal and added that to the chicken. Then I steamed baby carrots and chopped apples and blended them in my Vitamix, along with one can of drained green beans, about a cup of fresh kale and 2 Tbs. of honey (fresh kale is full of nutrients, but can be a bit bitter) and some of the chicken broth with the fat skimmed off. It was the consistency of thick, dark green gravy; then mixed this into the chicken/egg/rice mixture. There was enough to thoroughly coat everything.
It came out a "lovely" lime green color (:rolleyes:) but both my dogs LOVED it!! Alivia can be very picky and I can never get her to eat any kind of veggie by itself, but apparrently I disguised them pretty well! This made enough for both my dogs to eat for a week, so I packaged it up in serving size portions and sealed them with my Foodsaver. I tried to get a variety of nutrients into this: protein, calcium, fruit, veggies, antioxidants, flax, fiber, etc.
I had checked to make sure every ingredient was not only "dog safe", but had a beneficial nutritional value (even the honey in small amounts). Next time, I'd probably use fresh or frozen green beans, but I didn't have any. Anyway, since this is my first attempt, any suggestions?
Squirt's Mom
05-28-2011, 12:18 PM
Hi again, :p
You are right on the mark about the canned stuff. They can contain things that are not particularly good for our babies - like onion and garlic for seasoning not to mention the salt content. Fresh or frozen is always best!
Kale is from the Brassica family of veggies which can cause problems with the thyroid. So if you have a baby who already had issues with the thyroid, this family is best avoided. When I first started cooking for Squirt, I went to a Holistic vet who specialized in canine nutrition. She made up a diet for Squirt that gave me options of what to use - a list of meat, veggies and fruits - but no measured quantities of the ingredients. The list included kale, broccoli, cauliflower, and cabbage. After she was on this diet for a bit, I had labs run and she came back as hypothyroid. When I took her off that diet, her values returned to normal. So I know from experience that these veggies can cause problems. Use them sparingly.
I don't use any processed ingredients in the menus I fix - everything is fresh/frozen. Mostly fresh. I will spend days cooking squash and sweet potatoes, then measure out the amount for a weeks worth of food and freeze the portions. Cooking as much ahead as I can and freezing helps when it comes time to make the food - not as much has to be cooked all at once. And I use several ingredients in Squirt's menu - turkey, beef liver, sardines, sweet potatoes, butternut or acorn squash, brown rice, quinoa, green beans, low fat organic yogurt, and lentils (I think that's all! :p) When I cook Trink's cod and Squirt's liver, the whole camper stinks! :D
Rice needs to be well cooked - to the consistency of wallpaper paste - to aid in digestion and absorption. That was easy for me since that is way I like to eat my rice! ;) Loose grains make me gag. :o
White meat has less fats than the dark meat, and fats are something you want to watch with our cush pups - pancreatitis, as you well know. Cook skinless poultry, boiled or baked. Squirt gets the white turkey meat and Brick gets the dark so it works out well to cook a whole turkey breast for us. Before Brick came along, I ended up using the dark meat for our meals.
You are doing a good job and I know you will learn more and more as you progress. Canine nutrition is a passion of mine these days; I love my studies and especially love to see my babies eat with such obvious pleasure when I know they are getting really good food.
Keep up the good work!
Hugs,
Leslie and the gang
lulusmom
05-28-2011, 01:00 PM
Hi Mary Beth,
I must say that you are an adventurer in the kitchen. I never would have come up with such a concoction. If I had half the energy you have, I might try to duplicate that recipe but without the milk. I think all of my crew would love it.
I've discovered over the years that most of my dogs have been very dairy intolerant. When I was growing up, we had a miniature poodle who slurped down ice cream cones in record time and it didn't phase him one bit. I tried that in later years with a few of my furbutts and the fallout was pretty awful. I'm lactose intolerant and my dogs were even more intolerant and experienced much worse side effects than I ever did. I ended up at the vet's office so between the bill and the vet telling me no ice cream or milk for my dogs was enough to keep them lactose free. Thank goodness the cream cheese I wrap around Lulu and Jojo's mitotane doesn't bother them.
Leslie - Thanks for the tips. The green beans I used were low sodium and unseasoned, plus I rinsed them. Still not optimal, I know. Next time I will use fresh or frozen. Alivia has never had any thyroid issues, so she should be okay with kale in moderation. I make my own yogurt and sometimes give them a bit of that as a treat. Love quinoa, so maybe next batch I will try that! Right now, on the heals of the pancreatitis attack, my primary concern is to keep it low fat.
Glynda - You could easily leave out the milk. I actually wanted to use almond milk (which is soy and lactose free and just all around good for people), but wasn't sure if that was okay for dogs. I'll have to research that unless Leslie or someone else here knows. And, I WISH I had energy! I was recently diagnosed with RA, so between work, taking care of a house and everything else, I am usually pretty exhausted! Plus, stress seams to really take a toll on me so Alivia's recent crisis took a lot out of me. But on the positive side, Alivia seems to be doing well! It's a holiday weekend and for a change it is NOT raining in Pittsburgh!!!
Squirt's Mom
05-28-2011, 04:57 PM
Hi Mary Beth,
I am not familiar with almond milk so I did a bit of research....and found conflicting info. :rolleyes: I did find this response from a vet on Just.answer Dog Veterinary:
Question - Can I give my dog almond milk?
Answer - Hi there, I am Dr Christelle and I would like to answer your question. :)
Almonds are known to be toxic to dogs - the kernel inside the pit is toxic. It can cause vomiting, diarrhea, abdominal pains, seizures, lethargy and coma. The toxin is related to cyanide.
It all depends on how the milk is produced, and if any of the kernel gets incorporated into it. I would stay away from feeding my dog almond milk just as a safety precaution - I would guess that they would have to ingest quite a bit for it to be toxic and it all depends on how it was manufactured (I don't know anything about the standards or procedures for human consumption, but humans and dogs are very different regarding poisons). I would not take that chance though.
- JustAnswer http://www.justanswer.com/dog-health/47ekn-give-dog-almond-milk.html#ixzz1NgNi6eR2
Another site made a distinction between bitter almonds and the almonds that are sold for food in the US, saying that it was the bitter almonds that contain cyanide, not the ones we can purchase in this country (USA).
I will pose the question to my nutrition group and see if I get a better answer. If I do, I will pass it on asap.
Hugs,
Leslie and the gang
Dang, Im a gettin' mighty hungry with all this talk of food!!!!!!
Forget the dogs, how about cooking for ME???????:D:D:D:D
Mary Beth, I don't know how you do it. I work full time, have an elderly mom to watch out for, the house, the yard, the dogs, two grandchildren and I am exhausted most of the time. I don't know how you keep up.:) You go girl!!!!!!!!:D:D:D:D:D:D
I hope Alivia is resting, is pain free and enjoying Mom's wonderful food. I'm telling you, a cooking show for dogs!!!! It would be a hit!!!!;););)
Love,
Addy
Leslie - Thanks for checking on the almond milk. I did a very quick search, too, with similar results. I hate when people post answers to questions on the internet when they really have no clue what they are talking about!! Seems like there was a lot of that when it came to almond milk! I won't chance it until I know. It's not all that important since my dogs have never had a problem with dairy products. I am curious now, though.
Addy - We have much in common! I work full time, have a house and yard to care for, 2 dogs and two beautiful grandkids, too! My elderly father passed away in October. :( Trust me....I am exhausted most of the time, too! Believe me, I have lowered my standards on a lot of things! I used to be a neat freak, but apparently I have gotten over that! :o
We had an "episode" early today. Ali and Max were in the backyard. I heard a lot of birds squaking and Ali barked the bark she does when she is telling on Maxwell. Max had caught a baby bird that had just left its nest. Needless to say, the tiny little thing did not make it. Max was quite proud of himself and really wanted to bring it inside. I finally convinced him to drop it and was left with having to get it off the deck....:eek:
Alivia LOVED her homemade food this evening and seems to be doing well today. I still am terrified that she could relapse with the pancreatitis...so, I feel like I am on eggshells watching her every move. I gave her a bath today and her fur seeems to be getting thicker! I think it is even starting to grow on her belly and shaved legs!! I wish I could have some type of gauge installed on her that would tell me hour by hour what her cortisol level was!! Wouldn't that be helpful for all of us?!
Hope everyone is having a good weekend!
Harley PoMMom
05-28-2011, 08:27 PM
I still am terrified that she could relapse with the pancreatitis...so, I feel like I am on eggshells watching her every move.
I remember how nervous and panicky I was when Harley was dx'd with pancreatitis especially because he never showed any symptoms of that illness.
Every 3 months from his initial dx of pancreatitis I would have a Spec PL test done. I did this for almost a year and then seeing his Lipase numbers dropping I only did the Spec PL test when I thought Harley might be having problems with his pancreas.
You're doing a great job!
Love and hugs,
Lori
Lori -
I can understand why you would have the tests done. With Ali it was very evident there was something wrong. I had never seen her in so much pain and I never want to see that again. It was awful. It came on so suddenly. It really scares me to think it could happen again. She seems to be doing well, so hopefully with time I'll be able to relax some....at least that is what I am hoping!
Thanks for the kind words.
Squirt's Mom
05-29-2011, 09:47 AM
RE: Almond Milk....so far, the consensus is to use goat's milk as a substitute. Will pass on more as I get it! :)
Hugs,
Leslie and the gang
Squirt's Mom
05-29-2011, 11:04 AM
Got this via email just now -
http://www.ehow.com/facts_5595045_nutritional-information-almond-milk.html
Harley PoMMom
05-29-2011, 02:24 PM
Hi Mary Beth,
I am sorry if it seems that I am pushing you to get the Spec PL test done on Ali. This is not true at all and if I have made you feel uncomfortable in any way, I truly apologize.
I am hoping, with this post, that I can clarify my reason as to why I had Spec PL testing done.
Harley's pancreatitis was first seen via an ultrasound. To confirm the severity of his condition I had a Spec PL test done. I also had other Spec PL tests done to verify that what I was doing did not further antagonize his pancreatitis, especially since Harley did not display any symptoms.
The first Spec PL test results were in the 500's and later on we were able to get that number down to 303. The Spec PL test is a diagnostic tool for pancreatitis but it can be used to monitor pancreatitis as well, much like how an ACTH stim test is performed to analyze how well the Cushing medicines are working.
Wishing you and Ali the best.
Love and hugs,
Lori
Leslie - Who knew info on Almond milk would be so difficult to find?! Goat's milk?! I see that is listed as an ingredient in some store bought treats I recently got them. Personally, I will just stick to good old cow's milk in limited quantities!
Lori - No worries. Nothing to apologize for! I did ask her IMS about that test and she didn't think it would tell anything we didn't already know at this point. But, may have it done at some point. Glad you told me about it so that I now know it is available.
Hope everyone is enjoying the holiday weekend!!!
Spent the weekend worrying an watching BOTH my dogs. Maxwell, my JRT who will be 11 years old in August, suddenly stopped eating completely. He killed a baby bird Saturday morning (but did not eat it); ate dinner fine on Saturday and that was the last he's eaten. Sunday around noon, he drank some water and threw up a little clear liquid. I never saw him drink any water after that. He had no interest in anything and was very lethargic - not at all himself. He is usually happy go lucky and full of energy. Max has never been sick a single time in his entire life, nor has he ever refused a meal or a treat. He didn't seem to be in any pain, but I started imagining cancer and all kinds of awful stuff. Took off work to take him to the vet's and, of course, he perked up there! He had a slight fever, 102.7, but nothing else obvious. The vet said it could just be a bug and gave him an antibiotic for 5 days, and I am to call him if he's not better in a couple days. He is still refusing food - I couldn't get him to take a pill pocket - and is back to sleeping.
These dogs are really going to age me!
Alivia still seems pretty good...I think. Her cushing's symptoms still seem pretty mild. She was very clingy this weekend, which concerned me because that's how she was right before the pancreatitis. She doesn't have the stamina to be running around chasing me from room to room and upstairs and down, so as a result, I spent a lot of time not doing much of anything. She does not seem to be in any pain, but there is just something about her...she just doesn't look happy anymore. :( Sometimes I feel like I am holding my breath waiting for the next crisis.
I sorry Mary Beth that you are the roller coaster again!!!! It just doesn't seem to end sometimes. Snoop got ahold of a rotten rabbit the week before last and gobbled down a good portion of it when she saw me coming. I kid and call her a "reverse muchausen by proxy pup"!
Sometimes, I think they want to get sick for all the attention. I spent the next few days waiting for the other "shoe to drop". Thankfully, it didn't...just really bad gas for a couple days!
Good thoughts coming your way for some relief and good times with Ali and Maxwell!
Rene & Snoopie
We all seem to be on a merry go round lately. A friend always used to say "you know dogs, always something":D:D
I hope Maxwell starts feeling better soon. Sometimes they just know to fast themselves.
I'm thinking we should have a case of Chocovine at work, not just a bottle:rolleyes::rolleyes:
Hugs,
Addy
Hi Mary Beth,
Here is the info you asked about. I posted on my thread but did not know if you saw it. I am also puting the dry matter comparison. The guaranteed analysis on link is as for as served and makes it hard to compare.
Steve's Real Food Beef
Protein 48.62
Fat 26.79
Carbs 23.00
Steve's Real Food Chicken
Protein 54.50
Fat 30.87
Carbs 23.00
http://stevesrealfood.com/rawmeat-products/raw-meet-dog-food/beef-diet/
It seems Snoop and I are taking our turn on the roller coaster today! She ate a squirrel's intestines with fresh poision in them. Will post all the drama on my thread!
Love,
Rene & Snoopie
Now that I know my Maxwell is fine, and after reading Rene's hysterical Snoop story, I can now kind of laugh at what happened to us. There was a birds nest built on top of one the posts under my deck. Of course my dogs found it first and were sniffing it through the floor boards. I put a carpet on the floor over it so they would not traumatize mama bird and I delayed cleaning the deck so as not to disturb the nest. Saturday morning I let the dogs out and there were so many birds squaking that it reminded me of that old Hitchcock movie, "The Birds". Then Alivia barked her, "I'm telling on Max" bark and I suddenly remembered the... BIRD'S NEST! Ran out to find Max with a baby bird in his mouth, running up the deck steps towards me, probably trying to make a break from all the birds threatening to attack him! I'm screaming, "Drop it!" and he's completely ignoring me (and, Rene, he is NOT deaf!). So, I start trying to pry his mouth open and the poor baby bird is still moving but obviously injured. In my mind I'm thinking I am going to have to somehow humanely put the poor thing out its suffering. Max is holding on tightly, intent on bringing it in the house and also eliminating my worry of having to humanely euthanize the bird. So, I shut the gate at the top of the steps to keep him on the deck to save the two other baby birds frantically hopping around the yard terrified. Max is still refusing to give up his prize, so I grab the broom and point it at him and shake it. This scares Max and he drops the baby and runs for the door. I got Max when he was 8 weeks old and for all of his 10+ years he has been absolutely terrified of brooms and I have always tried unsuccessfully to reassure him there was nothing to be afraid of...well, so much for the past 10 years! I am sure he now thinks he has been right all along and there is a really good reason to fear the broom!
It was less than a day later that he stopped eating and became ill. I still think he caught something from the bird. He's doing fine now. The poor baby bird probably hadn't been out of the nest for more than a few minutes when it met Maxwell. Not a very successful inaugaral flight. :( My sweet Alivia watched the whole commotion and throughout it all, never tried to hurt either of the two other babies. The dead bird clean up was a process in itself - consisting of multiple plastic bags, wads of tissue paper and an oven mitt...don't ask.
It must have been the week for critters!!!!! After all the stories, I'm putting Zoe in a bubble until Saturday:cool::cool:
She wanted to take a walk tonight and I said "Girl, no way!!! You went this morning and I am not taking any chances that that Cushings nose of yours will find some geese poop or mouse parts or who knows what":D:D
Thank goodness Maxwell is fine now. They sure keep us on our toes.
But they are dogs, that is what dogs do, eat stuff:p:p eat stuff we freak about :rolleyes::rolleyes::rolleyes:
TGIF,Mary Beth!!!!!!!!!!!!
OHHH to funny U Guys!!!! Im crying again. MBK.....Ms. Broom Killer!!!!
I think I should mass produce Snoops bonnet for our cush pups!
Addy - Wise choice! Avoid the temptation of critters (and disgusting parts of things) this week, especially! You don't need anything more added to the mix!
Rene - I probably looked almost as funny as you did. Especially trying to pry Max's jaws off of the still alive baby bird. Max will probably have evil broom nightmares now and I will have to try to find a doggy psychologist to add to our list of specialists! :eek: I saw Snoop's bonnet - so cute! I'm not sure I could get one of those on Max though, but he needs it much more than my cush pup!
Here's hoping for an UNEVENTFUL weekend!!! (Has anyone actually tried Chocovine, yet?) :)
marie adams
06-04-2011, 11:31 PM
Mary Beth,
Good story--Maxwell being afraid of brooms. Miss Ella seems to be not afraid of anything so far which is amazing. The first time she saw the broom she barked at it, but now won't leave it alone.:p
The things we have to do for our buddies the dogs--haha!!:D
Have a great rest of the weekend!!
Sad day. My best friend has Alivia's sister/littermate, Patches. She's had a couple seizures recently and seemed to have many personality changes. They hadn't been able to determine the cause. She died in his arms around 2:00 a.m. on the way to an emergency hospital. Patches had seemingly always been healthier than Ali. He's devastated and I feel so sad for him. RIP sweet Patches.
Harley PoMMom
06-05-2011, 10:28 AM
Oh Mary Beth,
I am so sorry to hear this. Please extend my condolences to your best friend. Sending huge and loving hugs to you all.
Godspeed sweet Patches.
With Heartfelt Sympathy,
Lori
Oh Mary Beth, I am so sorry as well.
Such sad news to hear. Your friend must be so devasted.
Saying prayers for all of you. I am so sorry to hear about Patches.
Fly free dear Patches.
Love,
Addy
Thanks Addy and Lori.
It hits way too close to home. We saw them for the first time together and we picked them up to bring them home together. You could always tell they were sisters because they had a lot of similar qualities. Both of them are calmer and more gentler than the typical Jack Russell; just very sweet. They were each our first dogs and we fell head over heels for them. Neither of us expected Patches would go first. Just goes to show, you never know.
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