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View Full Version : New member - Princess Penny - 9-10 y/o American Eskimo - new diagnosis



EskiLvr
06-29-2011, 12:35 PM
Good morning.

First: thank you for all of the wonderful information I've already been able to learn from reading through these forums. It's been very helpful. We had a close family friend (Bandit the Beagle) who lived with Cushings for years, so we know that this is not the "worst" thing that Penny could have been dealt.

We've been owned by Princess Penny since December of 2010. We adopted her from our local humane society after they picked her up running the fields south of our metro area. She was a filthy matted mess, and they had to completely shave her while she was "under" for her spay in order to get all of mats off. She looked like a pathetic little mess when I met her, and she stole my heart. We'd just lost one of our Goldens to bloat, and we weren't expecting to adopt again so soon - but we couldn't say no to this poor girl.

We're thinking she was dumped (:eek:). The first night we had her home I gave her a bath - and her skin was extremely dry/flaky, just like when one of our Bridge Eskies was hypothyroid. She was also very lethargic, and her back leg was still bothering her. (She'd been at the Humane Society for close to a month - she developed kennel cough after her spay and had to be kept in isolation). Off we went for a T4 - and oh, yes, she was Hypothyroid. Our vet got her on Soloxine, and she responded pretty well to it (more energy, hair began to come back more quickly, etc). We've been managing it fairly closely, but we couldn't figure out why her hair wasn't completely coming back. She now has a *gorgeous* showdog-like coat, except for a good strip down the middle of her back (which is usually covered by her tail - natch). We've also found out that she's severely hearing impaired - which is fine with us, because we have a son who's completely deaf in one ear. They're a perfect match.

Because we weren't sure of her age, we had bloodwork done before dental work she was scheduled to have two weeks ago. Dr Matt (our wonderful, wonderful vet) was pretty happy with how happy and peppy she was, and our biggest concern was that out of our four dogs, she was the one who got hit the hardest by a Coccidia infection that our newest adoptee brought home with her. (ICK!) She's bounced back pretty well, but her tummy is still kinda touchy, and her teeth really need another cleaning... but that's been delayed.

Liver enzymes were high (ALKT in the 1600 range, with the other 2 key enzymes elevated but not as badly). She's had an increased appetite, wanted to drink more, and has taken to hanging out on our coolest surfaces (dark bathrooms, cold tile, even our shower stall) - but it's been *hot* here, so we didn't think anything of it. She's never had much strength in her back legs to jump on things (remember that gimpy leg from possibly being dumped from a moving car), and she's been having occasional accidents in the middle of the night. But she's got ENERGY!!! I have to take her on a mile (or longer) walk every night to wear her down, or she's up throwing a party until 2:30 or 3 - wanting to eat, drink, potty, and generally be merry. (I'm sure she's got a lampshade and adult beverages stashed to be brought out as soon as we try to go to sleep.) We've also noticed that the "gimpiness" from her leg has gotten much better - no more occasional "bunny hopping" on it like she did when she came home - like she's been taking Rimadyl for it.

Dr Matt ran a bile processing and LDDS test on her. I don't have her exact results with me - BP showed slightly elevated (mid-20s) pre-meal and 36.1 (IIRC) post - which shows her liver is irritated and sluggish, but not diseased. (We've been down the liver disease road before - these numbers were reassuring.) Her LDDS showed 4.1 pre-load, 2.0 at 4 hours, 2.1 at 8 hours.

So... the good news is that it looks like we caught this fairly early - and that her thyroid meds may have helped to "mask" what's really going on. We're starting on Lysodren this Saturday - Dr Matt is timing it so that the 5-7 day response window happens when he's not out of town, or we'd be starting sooner. She doesn't "act" like she's sick, so that's a good thing. We haven't had an ACTH yet because of her other test results - Dr Matt didn't want us to spend money to confirm what he (and we) were seeing both through test results and observations at home. He said we get to give him more money soon enough. :)

The Eskie rescue community has posted with some experiences with Cushings and Lysodren - and our friend Bandit was also a Lysodren dog. I know she'll be on just under half a pill 2x a day for the load, and our vet has a 3/4 page treatment plan waiting for me. I'm lucky - we've had some nasty things that we've brought to him over the years, and he really thinks situations through before he decides on a course of action - and our input is always not just welcome, but actively solicited.

Has anyone else had a dog get diagnosed when the numbers were this low? With her being a recent rescue, and under thyroid treatment to boot, it's been difficult to know what is and isn't "normal" for her.

Also - has anyone else had a recently diagnosed dog with a touchy tummy? She's getting (I kid you not) Vanilla Fat-Free Yogurt with chopped cucumbers and chopped baby carrots for breakfast, and then dinner is a mix of boiled chicken breast, rice (made with beef or chicken broth), chopped cukes, chopped carrots, and we may be adding some green beans soon. Was cheaper than continually feeding i/d, and it's keeping her from having to be on "anti-poop pills" constantly (or at least at a lower dose)... Vet thinks she has a touch of colitis as a leftover from her Coccadia encounter, and that the Cushings and associated liver issues aren't exactly helping. She, however, thinks her new diet is awesome (especially since it makes the the other three dogs jealous).

Thanks. Sorry for this being so long... she's a special girl, and we're trying to give her the care she deserves.

Kris
Mom to Eskies Princess Penny, Luke, and Holly - and Doofy Golden Retriever Murray

Harley PoMMom
06-29-2011, 04:18 PM
Hi Kris,

Welcome to you and Princess Penny! So sorry for the circumstances that brought you here but very happy you found us.

What a wonderful and loving thing you have done for Princess Penny by giving her a forever home...Bless you!

Non-adrenal illnesses and even stress can create false-positives on the LDDS test. With Princess Penny still having some tummy issues this could cause a false positive.

Stomach tenderness can be attributed to a variety of issues such as: pancreatitis, colitis, IBD and/or enlarged liver.

I believe getting just a post ATCH stim done could be beneficial. This could help to determine a starting point before Princess Penny begins her treatment plus it would help confirm the Cushing diagnosis.

Excessive drinking and urinating are also signs of diabetes, has this been ruled out?

Please know we will help you and Princess Penny in any way we can, so feel free to ask any questions you have.

Love and hugs,
Lori

EskiLvr
06-29-2011, 05:52 PM
Hi Kris,

Non-adrenal illnesses and even stress can create false-positives on the LDDS test. With Princess Penny still having some tummy issues this could cause a false positive.

Stomach tenderness can be attributed to a variety of issues such as: pancreatitis, colitis, IBD and/or enlarged liver.

I believe getting just a post ATCH stim done could be beneficial. This could help to determine a starting point before Princess Penny begins her treatment plus it would help confirm the Cushing diagnosis.

Excessive drinking and urinating are also signs of diabetes, has this been ruled out?

Love and hugs,
Lori

The good news is that she definitely isn't diabetic. Glucose numbers were obnoxiously normal. :D We were owned by an Eskie who was a Liver Failing-Diabetic-Epileptic-Blind boy - who we think died as a result of a pancreatic or spleen-based tumor (we didn't have a necropsy done) - so we've at least gone down a somewhat similar road in the past...

Dr Matt is thinking that the fact that her hip isn't bothering her *at all* (and that she can haul me on these long walks) is a huge symptom. The hair loss pattern is classic Cushings too - it was just being hidden by (a) her being shaved to start with and (b) her thyroid being out of whack. Oy.

So... we'll see what happens and take it from there. I know he's planning on being conservative. She's not puking, her tummy doesn't bother her at all in terms of it being touched - but she's definitely got a delicate system. Little stinker.

In the meantime... I'm left to wonder what antics she'll be pulling tonight. :-)

littleone1
06-29-2011, 05:58 PM
Hi Kris,

Corky and I also want to welcome you and Princess Penny.

You have found a wonderful group of very caring, supportive, and knowledgeable people.

I hope that you will be able to find out what is going on with Penny.
Terri

EskiLvr
07-01-2011, 10:29 AM
First off: I *love* the lab my vet uses. They print "owner-friendly" diagnostic data on the results to explain what everything means - it's rather reassuring as a pet Mom. :-)

Bile Acids test:

PreMeal - 28.8 (shld be 13 or less)
PostMeal - 36.9 (shld be 25 or less)

Increase expected after eating. The fact that her counts were well under 100 post-meal is a *good* thing. Liver is having issues - but could be much worse.

LDDS:

Baseline: 4.1 (Ref 1.0 - 5.0)
4 hours: 2.1 (Ref: 0.0 - 1.4)
8 hours: 2.0 (0.0 - 1.4)

Test results indicate PDH.

From her CBC:

ALT: 248 (Ref 12 - 118)
AlkPhos: 1474 (Ref 5-131)
GGT: 45 (Ref 1-12)

BUN: 19 (Ref 6-31)
Creatine: .6 (Ref 0.5-1.6)
BUN/Creatinine Ratio: 32 (Ref 4-27)
Calcium: 11.6 (Ref 8.9-11.4)
Glucose: 94 (Ref 70-138)

But... her T4 was in the normal range - 1.9 (ref 1.0 - 4.0) - that's the best it's ever been, so her Soloxine is doing its job.

Her WBC and Platelet counts are elevated - not huge amounts - but we'll have to watch that. Dr Matt thinks it could be attributed to a touch of colitis from the Coccadia infection.

Picked up her meds Wednesday. We start Lysodren Sunday so that I can keep an eye on her, and then the boys (my sons are 11 and, well, 13 on Sunday) will be on "Princess Patrol" while we're at work Tuesday. Hubby only works 10 minutes away if something were to happen. She's been on Primor and Amforol for the intestinal issues she's been having since Wednesday - and the poor girl is finally getting to sleep through the night, so I think they're helping. We have the Prednisone here, and I get to spend my afternoon cutting her Lysodren pills and shaving them down to get them to the dosage Dr Matt wants (just a hair under 1/2 a pill, 2x a day).

Off to monitor end-of-month processing (I really hate *waiting* for things)!

Kris
Mom to Princess Penny, Luke, Holly, and Murray

Harley PoMMom
07-01-2011, 10:44 AM
How much does Princess Penny weigh?

EskiLvr
07-01-2011, 11:22 AM
She's ranging between 18 to 20 pounds.

EskiLvr
07-05-2011, 12:09 PM
And all seems to be going well. She's going to be a much happier camper now that the fireworks are (hopefully) over. She's still eating and drinking quite a bit - but she hasn't had a "bad" reaction to the Lysodren, so I'm happy. We'll see if she loads quickly - she had a pretty quick reaction to starting on Soloxine, so we'll see...

EskiLvr
07-10-2011, 11:50 AM
And all seems to be going well. She's going to be a much happier camper now that the fireworks are (hopefully) over. She's still eating and drinking quite a bit - but she hasn't had a "bad" reaction to the Lysodren, so I'm happy. We'll see if she loads quickly - she had a pretty quick reaction to starting on Soloxine, so we'll see...

Penny's appetite finally started to go down Thursday night and our vet was able to get her in for the stim test Friday. Results came back yesterday while I was out running errands, so DH talked to the vet, which means I don't have actual numbers. First test was good, but the post-stim isn't where he wants it, so we're back on the loading dose until Wednesday when she has another stim scheduled. Aside from the insane heat and humidity we have right now, she's doing well - pretty peppy, still drinking more than usual (but so are all of our crew)... We'll just have to see how this all goes.

Do most dogs load on at the first try? Not worried - we're obviously at least making progress - just curious...

frijole
07-10-2011, 12:54 PM
Hello and greetings from me as well! Many of us had lots of acth tests before the dog finally loaded. Mine has the record for the longest but I won't tell you how long it took because you'd get depressed :p Average is 7 to 10 days so you hadn't gone a week yet. We've seen strange cases where they load in 2 days but normally is it longer and frankly smaller dogs take longer than larger ones for some reason.

Anyway... the first number on the test really doesn't tell us anything - it is the 2nd number which measures the cortisol. That is why its helpful to do this test beforehand so you can sort of gage how high she is and therefore how long it might take.

That said - you are aiming for a number between 1 and 5 (2nd no) on the acth test. Then you are loaded and strive to maintain it. In case it is helpful - here is a link to a sheet that I used when loading my dog. It is in our reference section.

Keep us posted. Any signs of too much stop the lysodren. I assume you have prednisone on hand at home in event of emergency. Once this is over it is a breeze! :D Kim

http://www.k9cushings.com/forum/showthread.php?t=181

EskiLvr
07-10-2011, 09:06 PM
Hello and greetings from me as well!... Many of us had lots of acth tests before the dog finally loaded. Mine has the record for the longest but I won't tell you how long it took because you'd get depressed :p Average is 7 to 10 days so you hadn't gone a week yet. We've seen strange cases where they load in 2 days but normally is it longer and frankly smaller dogs take longer than larger ones for some reason.


Thanks, Kim. I saw that you're in Nebraska - are you in the Central part of the state? We're in the Omaha suburbs - and lucky enough to have stumbled onto a vet who is a second-generation K-State vet. Even though he's only been practicing for just over 10 years, he worked alongside his dad since before he was a teenager - and he's gotten us through some weird and nasty stuff with other dogs in the past. :-)

Thanks for the feedback on the load times. With Penny only having been with us since December, and having been fairly ill to start with, we're still trying to figure out what her "normal" response to medication is. And, to top it all off, we're leaving the area on a vacation in 2 weeks - and while I have three different families lined up to make decisions for us while we're gone if necessary, I'm really hoping that we can get her onto maintenance before we're gone. (We've got our normal dog/housesitter coming to live here while we're out of town, so Penny won't be stressed out at all - she loves the girl who comes to spoil her and the rest of the crew).

Penny is definitely getting more energy - she was racing around the backyard even with all of the heat today. Our Golden was looking at her like she'd lost her mind. :-)

Kris

EskiLvr
07-10-2011, 09:09 PM
Keep us posted. Any signs of too much stop the lysodren. I assume you have prednisone on hand at home in event of emergency. Once this is over it is a breeze! :D Kim

http://www.k9cushings.com/forum/showthread.php?t=181

Gah!

Hit Return too quickly...

Yes - we have Pred on hand... Dr Matt got us well taken care of. And our pharmacist has given me the lead times he needs to order more Lyso for her if we need to get more in before we leave... I think we're good for now. :-)

Kris and the fur crew

frijole
07-10-2011, 09:13 PM
Kris, Great to have another Husker on the board! :D I am in Columbus. (I lived in W Omaha for many years though) I ended up having to take my dog to K State and I was so impressed with them. Glad you have a 'keeper' vet with experience. That is just what you need.

Meanwhile - if you need us, ask away. Kim

EskiLvr
07-10-2011, 09:38 PM
Kris, Great to have another Husker on the board! :D I am in Columbus. (I lived in W Omaha for many years though) I ended up having to take my dog to K State and I was so impressed with them. Glad you have a 'keeper' vet with experience. That is just what you need.

Meanwhile - if you need us, ask away. Kim

Well, I do live in Nebraska... but I'm a K-State Purple Person. :-) DH and his whole family attended KSU - he even has two cousins who are KSU Vet School grads. But my brother-in-law who teaches at K-State (agrieconomics - it makes my brain hurt) is a Nebraska native and huge Husker fan - so it balances us all out. :D

Columbus is a really nice town - we're up there quite a bit for Tae Kwon Do tournaments.

Did you know that there is a new specialist here in Omaha for endicronology? Don't know if that would help you out in the future or not...

Kris

frijole
07-10-2011, 09:47 PM
:D I told the vets at K State if they figured out what was wrong with my dog I'd buy her a purple scarf and I did. :D I found it astounding there were no IMS specialists in our entire state a year ago.

There is now a K State board certified eye vet in Omaha and I went there recently (same dog :() and she told me there is an endocrinologist... last I knew though they worked at a clinic that took everything and marked it way up to cover a part time K ST vet. Has that changed do you know? Just curious.

Kim

EskiLvr
07-10-2011, 10:19 PM
:D I told the vets at K State if they figured out what was wrong with my dog I'd buy her a purple scarf and I did. :D I found it astounding there were no IMS specialists in our entire state a year ago.

There is now a K State board certified eye vet in Omaha and I went there recently (same dog :() and she told me there is an endocrinologist... last I knew though they worked at a clinic that took everything and marked it way up to cover a part time K ST vet. Has that changed do you know? Just curious.

Kim

I'm not sure... but it wouldn't surprise me. The clinic is in the same facility that houses our local ER Vet Hospital, and they have KSU students come up and intern - and I was very impressed with the level of care we've gotten from them, if that's any help at all. We've had three different dogs end up there - and while there's a premium cost, the techs and vets truly did care about their patients, so that helped a bunch. They even did a courtesy phone consult at no charge for my epileptic-liver failing-diabetic-SARDS induced blind Eskie 10 years ago.

Will have to ask Dr Matt what he's heard about the new endo. And if you would ever want Dr Matt's name for anything, I can get you the specifics. He's got ultrasound and laser surgery equipment in his office - I feel like we stumbled onto a specialist without meaning to. :-)

Kris

EskiLvr
07-15-2011, 04:48 PM
Dr. Matt just called with Princess Penny's test results.

At Day 6, she'd been showing signs of loading. First ATCH results:

Pre: 3.0
Post: 5.9

Dr Matt had wanted her to be between 1 and 5 in both ranges since she'd just come off the Lysodren - so back on we went.

Day 10:

Pre: 1.1
Post: 2.2

Whoo hoo!!!

I'm doing a happy dance now.

We're now on 1/8 of a 500 mg pill, 4x a week for maintenance. Our "Pretty Pretty Princess" is definitely feeling peppier - taking the stairs two at a time in the morning, dragging me on 1.5 mile walks, and actually acting a bit like your typical Peskie Eskie. Her biggest grumble right now is the extreme heat and humidity outside - but none of the dogs are really appreciative, so she's in good company there.

Now to hope that her liver enzyme levels start dropping!

Back to work... have to earn the money to pay for the Princess' bills...

Kris:D