Coolidge...(has passed and is now at peace)

[Coolidge]

Hi all. Took me a while to find this, and I was panicking.

Coolidge is now showing all signs of her Cushings. It's been since the middle of October since she was loaded, and only one dose of Lysodren on Jan 1st.

She is scheduled for her ACTH test next week. Everyone mentioned doing the Uof Tenn adrenal panel. Just noticed there are several adrenal panels for dogs. Which one am I to tell the vet to have done?

Appt is for this Weds. Need answers prior to then.

Thanks again for all your help.

Becky and Coolidge (Possible DX 2008)

[frijole]

Hi Becky and welcome.

Could you start from the beginning. Was the dog diagnosed or not in Oct? I'm not sure about your comment about lysodren. Normally dogs load and then they take the drug weekly. You are saying the last pill was in January? That would be why the symptoms are coming back.

Do you know if your vet has much experience with cushings? You shouldn't have to tell him what tests to do. Can you get records from Oct and see what tests he already did? That would help. Also the results (numbers) on the tests.

Tell us more about your Coolidge - age, type, weight, symptoms. This will help us help you.

Thanks
Kim

[StarDeb55]

Becky, you want the full adrenal panel which is explained at letter "G" on the follow link.

http://www.vet.utk.edu/diagnostic/endocrinology/general.php

Debbie

[Coolidge]

So long of a story, sorry. She was diagnosed in Sept 2008, but had other issues that could have skewed things. Lepto, UTI's., etc. This all happened after her loading in October. She loaded relatively fast, and wound up almost Addisonian. Really, really low numbers.

My vet wanted her to have an ACTH test at the end of Dec, which she had and showed it was coming back. So she had me begin maintenance. Jan 1st was her first and last maintenance pill. She became very lethargic. In mid Jan, I took her to UW-Madison's vet school, they did an ultrasound of her adrenals, both were of normal size. They told me to hold off treating her until she really showed signs. Which she is.

Everyone on the old caninecushings.net recommended that when this time came, to have my vet send the bloodwork to UTN for their adrenal panel.
The time has come and there is a variety (listed below). Please tell me which one????

Adrenal Function
Cortisol-ACTH Stim Dog, Cat Serum Adrenal Function $30.00
Cortisol-Dex Supp/ACTH Stim Dog, Horse Serum Adrenal Function $35.00
Cortisol-Low Dose Dex Supp Dog Serum Adrenal Function $35.00
Cortisol-High Dose Dex Supp Dog Serum Adrenal Function $35.00
Cortisol-Dex Supp/TRH Stim Test) Horse Serum Adrenal Function $35.00
Cortisol-(Overnight Dex Supp) Horse Serum Adrenal Function $30.00
Adrenal Panel (ACTH Stim) Dog, Cat Serum Adrenal Function $135.00
Adrenal Panel (Combined Dex Supp / ACTH Stim) Dog Serum Adrenal Function $155.00
Adrenal Panel Ferret Serum Adrenal Function $65.00
Adrenal Panel Rabbit Serum Adrenal Function $65.00
17 Hydroxyprogesterone (ACTH Stim required) Dog Serum Adrenal Function $30.00
Aldosterone baseline Dog, Cat Serum Adrenal Function $15.00
Aldosterone
(ACTH Stim required) Dog Serum Adrenal Function $30.00

[Coolidge]

Thank you Debbie!

[ventilate]

Do you have the results of the stim tests and of the test you had done to confirm cushings, it could be possible as your vet said that the results could have been skewed due to all that was going on at the time. That could explain why your dog had the reaction it did to the one dose of lysodren, may be your dog does not have cushings. Did the UW Madisons confirm that your dog had cushings? or just do the ultrasound. What signs and symptoms does your dog show?
I am sure someone that knows about the UT panel will be along shortly to tell you which test, that can also confirm cushings. The UT panel is useful when people want to treat with trilostain as that drug is know to increase the other sex hormones in the dog and if there is any possibility that your dog could have atypical cushings it is very helpful to know what the baseline hormones were before starting the trilo. IMO it would would be agood idea to have the UT Panel anyway even with treating with lysodren that does not elevate the sex hormones but you get more bang for your buck you still get the confirmation of a cushings diagnosis and the added bonus of being sure your dog is not atpyical:D
Hope this helps some
Sharon

[Coolidge]

If she does in fact have cushings (which I assume this full panel will tell me definitively), and we load her, do we have to do another full panel after loading? Or can I have my vet just send off the results of the ACTH followup to her normal lab?

Any insight greatly appreciated. Coolidge is now up all hours drinking and peeing.

[frijole]

You just said, "if she does have cushings" and I am pretty sure in earlier comments you said you loaded with lysodren... have you been thinking the dog was misdiagnosed originally? Are you wanting to test the adrenal hormones to see if she has atypical cushings? If so the treatment might be handled with flax, melatonin and lignons which are certainly cheaper than chemo drugs.

I do not know if you do the same panel for monitoring progress. I am sure someone with knowledge on atypical cushings will join in the discussion. I'm glad that you are having this test done. Good luck! Kim

[StarDeb55]

Becky, you really just need a regular stim test to monitor your Coolidge while on lysodren. I e-mailed Dr. Oliver about how necessary it is to repeat a full panel, & how frequently, several months ago. His response was maybe in a year as the lyso will control all other associated sex hormones except for estradiol, if Coolidge should happen to have an elevated estradiol. Estradiol is difficult to control because it is also produced in non-adrenal tissue, such as adipose (fat) tissue, the gonads, & a couple of other places. This is where the use of melatonin & lignans comes into the picture, to help control the estradiol. Harley had everything elevated on his full panel at diagnosis a year ago. I have yet to have a full panel repeated, especially after what Dr. O wrote. I may have the estradiol rechecked at Harley's next stim which is due in early July.

Hope this helps.

Debbie

PS- I know it's a real pain, but with the loss of the old cc.net, would it be possible for you to re-post Coolidge's test results? We will be moving to a new "home" within the next week or two which is great news. Even better news, anything that has been posted in our temporary home can be transferred over to the new site, so none of us will have to repost.

[lulusmom]

Hi Becky.

I am sure glad that you found us. I remember Coolidge and I also remember fearing that he had been misdiagnosed. As luck would have it, I found a cached page from your thread which had one of my posts on it which will update the other members. I'll see if I can find some more information that might help too.


I've just reread your thread and I've decided that I haven't changed my opinion since the last time I posted to you. I still wonder about the accuracy of a cushing's diagnosis based solely on the results of a questionable LDDS. With the Leptospirosis being diagnosed shortly after, I would certainly question if the whether the LDDS results were false positive. It is also highly unlikely that a cushdog's liver enzymes would return to normal after a regimen of antibiotics. I was hoping that the ultrasound would at least support the LDDs but adrenals are normal.

Both of my cushdogs were switched to Trilostane which I truly regret. Had I done a full adrenal panel prior to starting treatment, I would have known that my little Lulu also had atypical cushing's in additional to pituitary dependent cushing's. We switched back to Lysodren in the last few months. I waited until both were totally symptomatic and then did an acth stim test to make certain that their post stim numbers were at least 22 or 23 before loading them with Lysodren.

If I were in your shoes, I would be highly suspicious of the original diagnosis and would want a lot more evidence than one questionable LDDS. Based on my own experience with switching meds twice under the guidance of a phenomenal internal medicine specialist, I sincerely think you should wait until full blown symptoms return and then have your vet request a full adrenal panel from the University of Tennessee. It is known that Trilostane always elevates one or more of the adrenal intermediate/sex hormones and if a dog has atypical cushing's, Trilostane is not an appropriate treatment as it will makes matters worse and some symptoms will never resolve. I know this first hand because Lulu is atypical and after two years on Trilostane her intermediates were off the charts. Because of this, a lot of us members feel that a full adrenal panel should be done for every dog prior to initiating treatment with Trilostane.

I think that everybody else has already given you this same information in one form or another but I thought it was worth a repeat.

Glynda

[lulusmom]

Here is the contents of page 7 of your thread. My post was the only one on page 8. Sorry but that is all I could find.


01-23-2009, 05:37 PM
Coolidge
Member Join Date: Jan 2009
Location: Franksville, WI
Posts: 36
Images: 1

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Results of the urine test are in. The bacteria is e-coli.

Anyone here know how a dog can contract that????

I realize it's not Cushings related, but this is a knowledgeable board.

Thanks for any answers!!!

Coolidge
View Public Profile
Find all posts by Coolidge
View Gallery Uploads

01-23-2009, 05:41 PM
stardeb55
Senior Member Join Date: Apr 2008
Location: Chandler,AZ
Posts: 1,324
Images: 5

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

E. coli is a gram negative rod, & it's probably the most common bacteria associated with UTI's in both people & dogs. There's really no specific explanation as to how a pup may contract it as it is usually part of the normal gut flora. You just need to make sure that the "bug" is sensitive to any antibiotic that is administered.

Debbie

stardeb55
View Public Profile
Find all posts by stardeb55
View Gallery Uploads

01-23-2009, 06:02 PM
Coolidge
Member Join Date: Jan 2009
Location: Franksville, WI
Posts: 36
Images: 1

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

They had her on the doxycycline for a month for the lepto. That was followed by two weeks of amoxicillin. Since neither of them knocked it out they have told me that I have to give Coolidge a new drug, followed a week later by another cystocentises to see if it's working, and if it is, another three weeks of drugs. if not, yet another drug...repeat in a week.

My concern is this, we have well water. If the well water has the e-coli in it, and Coolidge has been drinking this, what is the point of giving her the meds?
With Cushings weakening the immune system, she would continually be getting the UTI (which come to think of it, she has...)


Perhaps I should have the well water tested first and then treat it and her.

Thanks!

Coolidge
View Public Profile
Find all posts by Coolidge
View Gallery Uploads

01-23-2009, 06:07 PM
stardeb55
Senior Member Join Date: Apr 2008
Location: Chandler,AZ
Posts: 1,324
Images: 5

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

I'm in total agreement about the well water. I think you definitely need to get that checked out as a possible source. Also, all they have to do is a sensitivity where they check a number of antibiotics against the bacteria was found i the urine & pick one of the antibiotics that the urine is sensitive to. This switching drugs back & forth sounds a little silly to me, if they just do the sensitivity. This might be worthwhile to ask the vet.

Debbie

stardeb55
View Public Profile
Find all posts by stardeb55
View Gallery Uploads

01-23-2009, 06:14 PM
AlisonandMia
Moderator Join Date: Nov 2007
Location: Brisbane, Australia
Posts: 2,984
Images: 16

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

No it won't be the well water. If that water did contain E.coli it would likely be causing GI problems - which would probably be more likely to be affecting you rather than Coolidge - dogs generally handle these things better than humans.

E. coli infections of the urinary tract have almost always ascended from the outside - probably caused by contamination by bowel bacteria that has got into the urethra so the drinking water will not be an issue. E.coli (various strains) are part of normal mammalian gut flora but will cause a problem if they get into the usually-sterile urinary tract - particularly if there is any immune suppression. Females are more prone to this problem than males although it can and does happen quite frequently in males, particularly in dogs.

If this current round of antibiotics doesn't clear the infection I would think the best thing to do is to have the cysto done and get a culture and sensitivity done on the sample - which means they grow any organisms present and test to see what antibiotics they are killed by. This would be vastly preferable (and probably cheaper) than on-going trial and error.

Alison

If you do have E.coli in your well water that means you have some fecal contamination of the water either from human or animal waste.

Here's a link to some info on e. coli: http://en.wikipedia.org/wiki/Escherichia_coli - there is section on UTI's.

--------------------------------------------------------------------------------
Last edited by AlisonandMia; 01-23-2009 at 09:47 PM.

AlisonandMia
View Public Profile
Find all posts by AlisonandMia
View Gallery Uploads

01-23-2009, 06:58 PM
maggiebeagle
Senior Member Join Date: Jan 2007
Location: LaPorte, Texas
Posts: 271

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Some of us have found that giving our pups cranberry pills or juice helps prevent a reoccurence of UTI's. Research has shown that it helps prevent the attachment of the bacteria to the wall of the bladder. Maggie has been UTI free for two years while taking cranberry pills.
Some of us have speculated also thatg with the more dilute urine our cushpups have, the antibiotic doesn't reach the proper therapuetic levels in the urine and takes longer to do its work. I agree with Debbie, your vet should have susceptibility data on the E. coli and should be able to pick one that will work.
Virginia and Maggie

maggiebeagle
View Public Profile
Find all posts by maggiebeagle

01-26-2009, 08:19 AM
Coolidge
Member Join Date: Jan 2009
Location: Franksville, WI
Posts: 36
Images: 1

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Thanks for your help. We will get to the bottom of this glitch in Coolidge's treatment. Speaking of..

The vet school was covering as many bases as they could. They treated Coolidge for parasites as well. Some powder substance that I gave her for three days. Other than the difficulty of adding powder to dry food (didn't want to give her wet food because that would really give her diarrhea).

Still awaiting the lab reports for the IBD and Pancreatitis.

ps. My backyard abuts a corn/soy field. I live 1/4 mile away from the biggest landfill in SE Wisconsin. The odds of something being in the well water are pretty good. Whether or not it is the source, who knows. Better safe than sorry.

Coolidge
View Public Profile
Find all posts by Coolidge
View Gallery Uploads

01-26-2009, 09:02 AM
gpgscott
Forum Administrator Join Date: Feb 2007
Location: SC
Posts: 3,995
Images: 19

Re: Coolidge - 9yo GSD/Newfie

--------------------------------------------------------------------------------

Quote:
Originally Posted by Coolidge
ps. My backyard abuts a corn/soy field. I live 1/4 mile away from the biggest landfill in SE Wisconsin. The odds of something being in the well water are pretty good. Whether or not it is the source, who knows. Better safe than sorry.

Unrelated to Cushing's this comment is disconcerting, I bet if you contact your local EPA office you may find that this landfill would be responsible for periodic testing of your water.

Scott

[Coolidge]

I'll try to get together a short synopsis of test results starting with her "original" diagnosis.

I have it at work, will post from there. THanks again!


Just to clarify, the specialist/internist didn't run the tests in the normal course of treatment, and what I learned from this board, I didn't have any controlled test results to show a before and after. Just an after. The ACTH test was only done after Coolidge was loaded. There wasn't one done before. And she didn't prescribe any prednisone for Coolidge, and after loading Coolidge had very very low numbers, and THEN she prescribed the prednisone. So in reality, we had no idea what Coolidges numbers were at before she was loaded. And since she loaded in a relatively short time, there was a question of whether or not Coolidge did have Cushings. It peeved me that we trust those with the knowledge and put our furkids into their hands.

I'm just trying to dot my i's and cross my t's now. Follow procedure and what people on this board recommend from experience. (That's why I panicked in not being able to find you all).

[Coolidge]

Found the note I wrote to you all in January, hope this sheds light on my questioning her diagnosis.

9/2/2008, Took Coolidge into vet due to her increased appetite, drinking, urination.

9/5/2008, results come back from vet bloodwork. Elevated ALP. (results not included here, trying to locate). Vet states that she believes the Coolidge has Cushings, and that I should take her to a specialist to confirm. She also states at that time that if it is Adrenal gland Cushings, not to do surgery; and that if pituitary, not to do the lysodren.

9/8/2008, take her to see an internal medicine specialist. This specialist’s area of interest is Addisons. I figure she’s had experience with Cushings animals. Coolidge, it turns out, would be the 2nd Cushings patient at the clinic.

Vet does palpitations, ultrasound, and LDDST. Reading the notes, liver is normal reading (NR). However, ultrasound shows adrenals as bilaterally plump. Please note the size differences between these.

9/13/08, horrible diarrhea for three days. We wake up to piles of yellow bile throwup everywhere. Coolidge is very lethargic. I even was considering putting her to sleep that morning, especially with the possibility of Cushings. I figured if this was any indication of what she was to be going through, I didn’t want to put her through it.

We take her to the emergency vet hospital. They tell us that the diarrhea and vomiting isn’t a symptom of Cushings. And that we should run bloodwork, which we do. Their notes on the other hand say they recommended hospitalization and we refused, which they never did, or we would have agreed to it. (Hindsight, they never tested for lepto at this point.)

It is at this visit that we find out the results of the ultrasound and LDDST. The Emergency Vet says the results show Coolidge has Adrenal Cushings. He then says that it’s always good to have a second opinion, and the 2nd vet says “no, Coolidge has pituitary cushings”. They then call the specialist who ran the tests and she says, “I don’t think Coolidge has Cushings at all.”

LDDST (9/09/08)

Cortisol Sample 1 4.9
Cortisol Sample 2 3.0 (High)
Cortisol Sample 3 1.6 (High)

ULTRASOUND (9/9/08)

Adrenal Glands –L: 4.57 x 1.17cm; R: 3.09 x 0.89cm
Interpretation: Adrenal Glands are bilaterally plump.


We took the meds for Coolidge and took her and her football size lump of SubQ fluids home.

10/1/08, Took Coolidge back to specialist due to diarrhea again. (She wrote in the records that it was for recheck). She is now drinking 3 gallons of water a day, needing to go outside every 30 minutes. Her appetite is increasing. Specialist does not mention doing an ACTH Stim test at this point.

10/9/08, Have our other dog into emergency vet due to rock eating incident. Specialist asks if I have put Coolidge on lysodren yet. Told her that I was hesitant in doing so due to the fact she really didn’t strike me as being certain Coolidge has Cushings. She says that Coolidge does have Cushings and that I really should start the meds. I ask her for prednisone, she says that at the low dose she is giving Coolidge, prednisone is not necessary. (Hindsight, the dosage Coolidge was on was by no means a low dose 750 mg/bid).

10/13/08, we begin the loading phase for Coolidge. Was told to look for decreased water consumption and decreased appetite. Neither occurred during loading phase.

10/17/08. Coolidge begins having soft stools again.

10/18/08, Coolidge is acting a little strange, almost lethargic. I call the vet, she is not there. Receptionist relays to the vet that I am stopping giving Coolidge her pills. Vet relays through receptionist that I should continue.

10/19/08, Gave Coolidge her morning dose of Lysodren. She spent the afternoon with diarrhea and vomiting. Took her off loading and scheduled an appt.

10/20/08, Coolidge has her ACTH Stim test. As a precaution, specialist now gives me the prednisone with instructions to give Coolidge 2 tablets the next day and until further notice or that I see that she is having any signs of distress.

10/21/08, I call the vet for results. They aren’t in. Vet will call when in. Vet calls at 8:30 that night to tell me that Coolidge’s numbers are now low and to continue giving Coolidge the prednisone if she looks like she’s having problems. I tell her that she appears to be doing fine and that I would be giving Coolidge 1 tablet the next morning and that would be it. (Total Pred: 3 tablets.)

ACTH Results

Cortisol Serial 2 (ACTH)
Sample 1 0.9 (low)
Sample 2 0.6 (low)


11/4/08, Coolidge has been having difficulty walking the past few days. This along with horrible diarrhea again. She also is very lethargic. Specialist thinks she may have lepto and wants to test for it. She takes a blood sample. Forgets to take urine sample. I have to go in again later that week and drop off the urine sample. Gives me meds to give Coolidge just in case it’s lepto.

11/06/08, Coolidge log indicates that her thirst and appetite is starting to decrease. Hindsight? She’s been on the doxycycline for lepto for two days.

Super Chem Blood Test Done
ALK Phosphatase is high at 732 IU/L
Glucose is low at 51 mg/dl

It’s at this time that the urine tests show she has tested positive for five of the seven serovars of lepto.

Her urinalysis shows low specific gravity (1.006) and high pH (8.5)

11/12/08. After daily calls and messages left at the AEC, I finally get a call from the specialist. Coolidge does have a mild case of Lepto. She doesn’t tell me that it’s contagious, that I should be taking special precautions with our other animals. Nothing.
On the other hand, Coolidges water intake is now down to 14 cups a day and her appetite was back to normal a few days earlier!!! Yippee…

11/20/08, It’s been a month since Coolidge was loaded, I called and asked for another ACTH Stim test. Her appetite has started to increase. Stim test done.

ACTH Results

Cortisol Serial 2 (ACTH)
Sample 1 56 nmol/L
Sample 2 73 nmol/L (low) (220-550 is norm)

Fed up, I change vets.

[Buffaloe]

Hi Becky,

We had a very long and difficult diagnosis with my dog. Finally, my primary gp vet did a great thing which directly led to our confirmed diagnosis. He contacted the lab at U. of Tennessee and explained everything we had previously done and asked what test(s) they recommended. They recommended the following test which we had performed:

Adrenal Panel (Combined Dex Supp / ACTH Stim) Dog Serum Adrenal Function $155.00

It is a combination LDDS/ACTH stim test and includes a full adrenal panel. After we got the written results, we contacted Dr. Oliver and at that point he succinctly told us he believed Shiloh had a primary adrenal tumor. I'm just saying, either you or your vet could contact the people at U.T. and see what test(s) they prefer given your situation.

I sure don't know what is going on with Coolidge. I'd say his left adrenal gland is pretty darn plump and is quite a bit larger than his right.

What kind of dog is he and how much does he weigh? I sure do wish you and Coolidge all the best.

Ken

[Coolidge]

Coolidge is a German Shepherd/Newfie Mix, who at the beginning of all of this weighed 100+ pounds. She is now at 84 and holding.

Her weight loss was another issue in January. Which is one of the main reasons we went to UW Madison. She lost nearly 5 pounds immediately after the ACTH test at the end of Dec. And continued to lose until shortly after the UW visit. I'm working on getting the results of the other tests since January.

Her adrenal glands (at least as of the middle of January) were of normal size. And yes, I did question the bilaterally plump (which to me meant they were both plump and of equal plumpness). One was quite larger than the other. Perhaps this is what got the one vet to say she had Adrenal Cushings.

I'll ask my vet about checking with them before tomorrow.

Thanks for the help!

[Squirt's Mom]

Hi Becky,

I gotta tell you....reading Coolidge's history is just scary. You seem to have had quite a farce of vets going on here, contradicting each other, giving poor advise, failing to communicate with you, not seeing Coolidge as an individual... How sad. :( You and Coolidge have payed for it, too, in more than one way. :( If it were me, and were possible, I would be looking for some fresh eyes to look at her. Give all her signs, changes, etc but with no mention of a previous diagnosis or testing. It seems sometimes docs, both human and animal, get locked onto an idea and develop tunnel vision. I think you are on the mark to question her initial diagnosis! :cool::cool:

Since we don't have all the info from the other site, can you refresh my memory on how long it's been since she was tested for hypothyroidism and diabetes (DM and DI)? The signs you mention can indicate Cushing's but they are also connected with some other conditions such as those above. The weight loss is not usually seen with Cushing's, more often seen with diabetes, tho some cush pups do present with this sign. How long has it been since she had what Dr C calls a SuperChem - a full blood workup? You said "Her adrenal glands (at least as of the middle of January) were of normal size"; I am understanding by this that she had another U/S since the one listed 9/08 and that the adrenals had returned to normal size. Is this correct? If so, it makes sense to me that, with all she had going on when first diagnosed with the iffy LDDS, the adrenals could have been larger due to the extra work they were having to do in dealing with the physiological stress Coolidge was under at the time. (But that is my logic only, no medical backing. ;) ) The IMS who wrote the adrenals were "bilaterally enlarged" in 9/08 sounds like the one Squirt first saw who didn't think it necessary to let anyone know she had a tumor on her spleen. Got their heads somewhere else rather than on our babies or they just don't care! :mad:

Have you had your water checked? Having lived in a house where the water supply was contaminated, take some advice if you decide to do that...get samples from someplace like the outside faucet, someplace drinking pipe isn't used and no filtering process should be going on. There may be no difference between a sample from a source like that and the kitchen faucet but, then again, there could be. There was for me. BUT, like Alison said, the humans were the ones sick, not the dogs. So if you and your family don't have any issues then the water may not be the problem. I don't know enough about bacterias to know if some may target animals and not humans from the same source.

Keep your chin up, Becky. You are doing a great job in trying to find out what is wrong with Coolidge. :) Your perseverance not only in getting to a correct diagnosis but in trying to learn all you can, is admirable.

Hugs,
Leslie and the girls

[Buffaloe]

Hi Becky,

What a great mix, german shepherd and newfie! I'm sure she is one heck of a dog.

As I understand it, you had two ultrasounds, one in November and another at UW in January. Both said the adrenal glands were pretty much normal in size. That should rule out an adrenal tumor. I think the reason the emergency vet thought she had an adrenal tumor was because of the size of her Lt. adrenal gland (4.57 cm x 1.17 cm) on her November ultrasound. Unfortunately, this can be tricky stuff.

If it was me, I'd call the lab at U.T. and explain things to them (hopefully, in an organized fashion :eek:) and ask what test they recommend. I would think that they might be able to tell more from the combination LDDS/ACTH with the adrenal panel than just the ACTH with the adrenal panel. Of course, I'm not sure but the U.T. people could tell you. I can tell you this...the written results we got after the combination test were very complicated. I contacted Dr. Oliver myself and he was great and told me that based on the test results, he thought Shi had an adrenal tumor.

I'm sorry you are having such a tough time figuring out exactly what is ailing Coolidge. I went through a similar scenario for two months and it consumed my life, all the while Shi was getting worse and worse. I hope you can find the right veterinary professional to help you. I felt like a couple of the vets I took Shiloh to just looked at me as some surfer dude off the street with an older, sick dog who wasn't going to live very long anyway. Finally, my primary gp vet came through. But, I seriously stepped on some toes and I had to follow up on things myself to get all of the information.

Hang in there Becky, hang real tough and do what you gotta do to take care of Coolidge. I'm confident it is something treatable and she can be a happy, healthy girl for many years to come. From my experience, working with the lab at U.T. and Dr. Oliver is a big cut above.

Ken

[AlisonandMia]

I've just put up one of the threads regarding "Atypical Cushing's" - it includes links info on the the testing (near the bottom):

http://www.k9diabetes.com/forum/showthread.php?t=845

Alison

[Coolidge]

Help. Coolidge is supposed to be fasted before the test. Does this mean water as well? She can't go long without it! Answer needed, as the fast goes into effect shortly.

[StarDeb55]

Water is fine.

Debbie

[Coolidge]

I know I sound like a nut case. Just want to make certain I have everything in order so there is no chance for skewing the tests.

I just remembered that the last ACTH test done at the end of Dec required fasting as well. (I'm pleading senior moment.):o (None of the other ACTH tests were done with fasting.)

I just want an answer. I'm hoping this test will explain everything. The most expensive part of this is the shipping. Go figure.

I will keep everyone informed of the results of the tests.

Thank you everyone! I'd be lost without this board.

[Roxee's Dad]

Hi Becky,
Wow, what an epic you and Coolidge have been thru. I have nothing to add except good thoughts and prayers that you and Coolidge finally get a proper diagnosis and poor Coolidge gets a well deserved break.

Were all keeping our fingers and paws crossed.

John (Roxee's Dad)

[Squirt's Mom]

Hi Becky,

You are doing just fine! Nut cases are always welcomed as I need all the company I can get! :p

I am sure UTK will be able to help Coolidge get the right diagnosis if this is Cushing's. That is one fine bunch of folks at UTK! Especially Dr O and his staff.

Squirt has had to fast for one of her ACTHs but not the others. I'm not sure what the difference is as to why they fast sometimes and not others. Seems like others have experienced this as well.

Like Ken said, hang real tough! We are hanging with you and are here anytime you need us.

Hugs,
Leslie and the girls

[Coolidge]

Well, it's been a week since they sent the samples to UT. I called my vet out of concern that no results have been forthcoming.

They called UT and they said they were "in the works". I'm glad I had this done, but I now know that they aren't the people I'd send any more samples to after her next loading phase. With Coolidge's low counts last time, we wouldn't have the luxury of waiting a week to put her on steroids.

Hopefully will hear back from them tomorrow or Monday. This waiting sorta, well, sucks - for both Coolidge and I. She's getting slower and her head hangs low. Would be nice to see her back at her perky self.

Thanks for all your support!

[StarDeb55]

I thought one of us had mentioned that it take 10-14 days to get UTK panel results back. How they handle their testing is they go through their freezers every Monday, collect up all sample received from the previous week, & start running panels on Monday. You are exactly right, this is why you don't send your routine stims to UTK. Routine stims need to be done by one of your regular vets so you get them back in a timely manner for med monitoring purposes. I'm contemplating having a repeat panel run on Harley at his next stim in July, but I will clearly indicate to my vet the stim is to be done locally, the remainder of the panel is to go to UTK. I also intend to make sure that UTK does not run a cortisol as I'm not going to pay twice for the same test.

Debbie

PS-Being a lab tech, I can understand why UTK has to batch their panels in this manner. I'm sure that the necessary supplies/reagents to do this testing are hideously expensive, so the more tests they run at once, the less the expense, & the less you have to pay as the owner. I shudder to think what a panel would cost, if they were being run one at at time.

[Coolidge]

The results are in. Just got a call from my vet. Cortisol levels were normal before and after.

However, the Hydroxyprogesterone and Progesteronewere elevated. My vet spoke with Dr. Oliver, who stated that Coolidge does in fact have ATYPICAL CUSHINGS.

He recommended a treatment of Flaxseed and if that didn't work, melatonin.

Now to research the atypical cushings.

I will post test results after I receive them. Thanks again for all your help!

[StarDeb55]

A couple of things. FSO & melatonin are usually used together. I can think of no one in this group who has an Atypical pup that is not using both of them, & that includes my Harley. This is per the treatment recommendation sheet from UTK. There should be one of these recommendation sheets that came with Coolidge's results. It would be a good idea if you could get a copy.

When it comes to the FSO, most of us are using some type of product that is purified lignans. Lignans are the active ingredient that works. The purified lignans allow you to make sure that you are giving a consistent, standardized dose, where the FSO is hit & miss about dosing. Also, a lot of Cushpups have liver issues, & adding the extra oil to their diet is not ideal. You might take a look a vitacost.com as I know they have a purified lignan. Several members are also using crushed flaxhulls from flaxhulls.com, but I'm not sure about the dosing on this product.

Debbie

[lulusmom]

Hi Becky,

I am so glad that you finally have a correct diagnosis. YAY!!!! Sorry for getting excited about your baby having Atypical Cushing's but I am pretty jazzed that it looks like he never had typical cushing's. That would certainly explain the apparent sensitivity to Lysodren. Having said that, I want to make it perfectly clear that not all dogs with normal cortisol are sensitive to the drug. The dogs involved in the original studies of the drug (then called o.p.-ddd) in the early 1940's were very healthy with normal adrenal activity. Many proved to be resistant to o.p.-ddd as they received very large doses of the drug for up to a year with no ill effects.

Please make sure that your vet gives you a copy of the treatment recommendations sheet that usually is attached to the panel results. I don't recall any other member advising that recommended treatment was solely flaxseed. Most of us atypical parents were given appropriate dosing for both melatonin and flaxseed oil with lignans. Since fso has a negligible amount of lignans, a lot of us have opted to leave the fso behind and go with purified lignans or the pressed flax hull lignans. Website links for the two latter products can be found on the utk website.

We'll be waiting to see the actual results of the panel and will be anxious to see how Coolidge responds to his new treatment. Just keep in mind that, often times, treatment with melotonin and/or lignans can take up to 3 to 4 months to see improvements so patience really is a virtue with atypical cushing's. :D

Glynda

P.S. I see that Debbie posted way ahead of me so sorry for the duplication. I'm at work and it really ticks me off when work gets in the way of my posts. :D

[Wylie's Mom]

Atypical...That's great news!:D

Did you get a copy of the actual results? I agree with Debbie - just using one of the two doesn't make sense - get the actual treatment recommendations that UTK provided. They will list treatment option numbers and those numbers correspond to this list (on their website):

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing's.pdf

-Susy

[Coolidge]

Well, my vet is snail mailing the results to me. I guess I could call and have them faxed to me.

She was pretty specific about what Dr. Oliver said. He wanted to start on the Flaxseed (powdered, not oil) and if that didn't cut back on Coolidges problems, to go to the Melatonin. He said that the last item to try was the Trilostane and only at maintenance doses (no loading). He agreed with the UW Vet school that Coolidge was hypersensitive to the lysodren and should be switched in that event.

However, I need your assistance in understanding Atypical Cushings. All I know is that instead of having excess cortisol (steroids) which left unchecked could lead to liver/kidney/heart problems; she has excess sex hormones. The first thing I thought of was, well, what kind of problem is that? ;) But obviously there must be some ill effect from that as well. Can anyone share their insight with me?

The following link was interesting, but didn't tell me what I needed to know, at least in lay terms.


http://veterinarynews.dvm360.com/dvm/Veterinary+news/Newer-tests-shed-light-on-causes-treatment-of-adre/ArticleStandard/Article/detail/485128

[StarDeb55]

Excess production of the associated hormones, usually estradiol, progesterone, & 17-OH can cause the same sorts of liver damage that the excess cortisol will do. I almost sure that skin & coat issues are a common problem, too.

I'm not doubting your vet's word, but I think there may be a misinterpretation of what Dr. Oliver has said, this is why it's important to get a copy of that treatment recommendation sheet. The following link is the treatment recommendation straight from the UTK website, it might be good to review. I would also suggest you take a look at the enclosed link for Dr. O's article on steroid profiles.

http://www.vet.utk.edu/diagnostic/endocrinology/treatment.php

Hope this helps.

Debbie

[Coolidge]

What I would give for a webpage that listed the complications of atypical cushings. Something that people can understand.

So basically she is in the same boat she was before, other than a final diagnosis.

I will still have to watch her closely, liver and other organs can still be affected.

I will have them fax me a copy tomorrow.

In the meantime, thank you thank you thank you. The expertise on this board is unsurpassed.

[gpgscott]

Sorry I have not posted to you earlier, it has been a crazy period.

Yes, get the treatment recommendation.

It will most likely be melatonin and lignans.

It is not a profound treatment like Lydosren or Trilo and that is because these other hormones although profound in their effect over time are not as immediately affected.

My Moria has been on melatonin and lignans now for almost 2 years. She is 15 years old. She is responding well to the treatment.

Scott

[Coolidge]

Results are in:

Cortisol:
Baseline: 24.2 ng/ml (Normal 2.1-58.8)
Post Acth: 83.1 ng/ml (Normal 65-174.6)
Androstendedione:
Baseline: 0.03 ng/ml (Normal 0.05-0.57)
Post Acth: 0.80 ng/ml (Normal 0.27-3.97)
Estradiol:
Baseline: 63.4 pg/ml (30.8-69.9)
Post Acth: 54.2 pg/ml (27.9-69.2)
Progesterone:
Baseline: 0.13 ng/ml (0.03-0.49)
Post Acth: 1.60 ng/ml (0.10-1.50)
17 OH Progesterone:
Baseline: 0.11 ng/ml (0.08-0.77)
Post Acth: 2.22 ng/ml (0.40-1.62)
Aldosterone***
Baseline: 76.1 pg/ml (11-139.9)
Post Acth: 141.4 pg/ml (72.9-398.5)

*** Normal range values for male and female dogs (N=72 baseline, N-23 post ACTH)

Dr. Oliver's Comments: Most hormone levels are normal, but both progestin's are modestly increased at stim. Consider items 2 or 3 or 5 on the treatment option sheet attached.

Feel free to comment. Thanks. (Am I the only one who thinks these "abnormal" findings are extremely mild, and that Cushing's really isn't the cause for her problems?")

Please note that I just realized his recommendation is different from what my vet told me he said. Have asked for clarification.

[StarDeb55]

Could you post exactly what items 2,3,5 are? Yes, the elevations are mild compared to some that I've seen. The standard treatment of melatonin + lignans is pretty mild, so it might be the best thing to try. If it doesn't help, at least, it can't hurt.

Debbie

[AlisonandMia]

This is the UTK's treatment recommendation sheet: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing%27s.pdf

Alison

[Coolidge]

The treatment, according to Dr. Oliver would be:

2) Melatonin or
3) Melatonin implants or
5) Lysodren maintenance dose

I'm thinking (and waiting for it to be confirmed) that my vet pointed out that Coolidge is very sensitive to lysodren. So he probably recommended at that point to switch it to flaxseed or melatonin or Trilostane. However, reading up on the trilostane, we really don't want to go there because its not recommended for dogs with the higher progesterones. So I think the flaxseed and melatonin will be our course of action.

So she's mildly atypical cushings. Seeing what she is going through and being mild, I don't envy what you are all going through. Coolidge is experiencing a hiccup in her road of life. Others are experiencing tidal waves.
You all are tremendous in your love for your furkids.

ps. I'm having the vet check all of Coolidges records to find out if Coolidge was ever specifically tested for Diabetes.

[Coolidge]

I've probably asked this before, but what does one do with extra lysodren that they aren't going to use?

I have 15-20 500mg pills I halved for Coolidge. Before it expires, I'd like to find a home for it.

[Wylie's Mom]

Regarding the Lysodren - I would donate them to an animal rescue or shelter if they could use it or see if your vet could donate them to a client.

I'm thinking that the flaxseed lignans are not necessary... I believe it is primarily for the patients that have increased estradiol levels. But see what the others think about this or double check with Dr. O.

-Susy

[Wylie's Mom]

Becky,

I was trying to get more background information on Coolidge... here's the first page of your cc.net thread:

http://74.125.95.132/search?q=cache:ylfNyYI9fOIJ:www.caninecushings.net/forums/showthread.php%3Fp%3D88310+%22coolidge%22+site:www .caninecushings.net&cd=20&hl=en&ct=clnk&gl=us

You had posted on 01/02/2009:
"Results of the ACTH stim test following the loading phase was 0.9 and 0.6 ug/dl. (That was the 20th of October)...Latest are Sample 1 (5.5 ug/dl) and Sample 2 (8.8 ug/dl)."

This is from your first post on this thread:

It's been since the middle of October since she was loaded, and only one dose of Lysodren on Jan 1st.

I'm confused - I just want to make sure - please confirm that we are sure Coolidge does not have regular Cushing's? The "within range" cortisol levels on the UTK panel are not due to the Lysodren?

-Susy

[AlisonandMia]

I'm thinking (and waiting for it to be confirmed) that my vet pointed out that Coolidge is very sensitive to lysodren. So he probably recommended at that point to switch it to flaxseed or melatonin or Trilostane. However, reading up on the trilostane, we really don't want to go there because its not recommended for dogs with the higher progesterones. So I think the flaxseed and melatonin will be our course of action.

If Coolidge is indeed particularly sensitive to Lysodren this does not mean that she can never take it - it could simply mean that she is best served by a much-lower-than-usual dose. Occasionally an individual dog does seem to be inordinately sensitive to Lysodren (or Trilostane for that matter) and in those cases unusually low doses are used - which is actually a good thing rather than a problem. If nothing else it saves money.

I believe that Trilo can lower progesterone but that it raises 17 OH Progesterone so would probably cause problems on that front. It also lowers cortisol and if her cortisol levels are so nice and normal then Trilostane could very well result in a low-cortisol situation much as you saw with the Lysodren overload.

When just a maintenance dosing of Lysodren (no loading) is used in Atypical Cushing's the aim is to give a dose that is sufficient to just gently damp down the adrenal overactivity but not to actively erode adrenal tissue which is what the aim is with a dog with Cushing's where the cortisol is elevated. When this is done a low-end maintenance dose is usually trialled at first, particularly with a larger dog. I believe Dr. O usually advocates 25mg/kg per week to start with and for a dog that could be sensitive to Lysodren starting considerably lower would probably be the way to go. Your vet could consult with Dr. O should it look like Lysodren treatment is in the offing and he could advise based on Coolidge's history and your concerns.

It is possible that Coolidge went very low after just one dose of Lysodren simply because she did not actually have elevated cortisol to begin with. Larger dogs often need a smaller mg/kg dose than do smaller dogs and will often load very fast on the regular 50mg/kg so that may have been a factor too.

I do share Susy's thought that the normal (very normal) cortisol levels on the UTK panel may be because the adrenals have not yet regenerated fully after the Lysodren overload. If that is the case then the production of other hormones may still be lower than it was pre-treatment too. How long adrenals take to regenerate is a real how-long-is-a-piece-of-string thing so time will tell if this is the case. Fingers crossed that what you have now is indeed a true picture though.

Alison

[Coolidge]

She underwent lysodren loading in Oct of 2008. She wound up with very, very low numbers on the ACTH test immediately following the loading.

Another followup ACTH test at the end of November showed the numbers till low.

Another followup ACTH test (Coolidges thirst had increased two fold) was done at the end of Dec. Numbers were rising, (don't have them but will get them), so my new vet thought we should begin maintenance. Gave her one pill on new year's day. Period. She immediately became very lethargic.

Mid Jan she had an ultrasound done at UW Madison Vet School. Adrenals were normal. (She was taken there because she had lost over 20 pounds between Oct and Jan 1st.)

While there, they discovered Coolidge had a UTI. Took three different antibiotics to get rid of it. Thirst decreased.

Never had a ACTH stim test done before Coolidge was loaded because the "specialist" said it wasn't necessary. She was basing her decision off of the Creatine Test and the LDDST. So I had no ACTH preloading numbers to reference.

So, it's now the middle of May. It's been over 4-1/2 months total since her last lysodren tablet. Can lysodren stay in the system that long?

added:

Crap. Can a dog have both atypical and pituitary based cushings at the same time? Just when I thought we had "the final answer"?
If things aren't bad, what is causing her symptoms? She was tested for Diabetes at the end of December.

All I know is this. I have spent $3000 on tests that have given me absolutely no answers.

[StarDeb55]

Lyso normally peaks about 48 hours after the dose is given. Frankly, I don't think there's any way that Coolidge would even still have a trace amount of lysodren iin her system after this extended period of time, even if she is highly sensitive.

Debbie

[Wylie's Mom]

Crap. Can a dog have both atypical and pituitary based cushings at the same time? Just when I thought we had "the final answer"?

Yes, it's possible (my pup is one of them:p). I'm not a vet, but given the recent UTK panel & given how little Lysodren was used & how long it's been since Coolidge had any of it... I would think he does not have regular Cushing's...just a non-vet's opinion;).

-Susy

[StarDeb55]

Yes, Harley is another Atypical + Pit Cushing's. I'm in total agreement with Susy that I, too, think that the problem for Coolidge from the beginning was Atypical, not Pit Cushing's, thus the bad reaction to the Lyso.

Debbie

[Squirt's Mom]

Hi Becky,

Another PDH/Atypical parent here. :)

Based on Coolidge's reaction to the Lyso and the UTK panel, I think you are dealing with Atypical only! YEAH! If I were you, I would not let the vet use any Lyso for now. Try the melatonin and lignans first for a good while, then if it seems the signs are not controlled, check the cortisol again. But I feel you may have just lucked out and Coolidge is simply Atypical! :D Just another "non vet" opinion! ;)

Hugs,
Leslie and the girls

[Wylie's Mom]

I think it's still questionable whether the flaxseed lignans are necessary... he doesn't have elevated estradiol levels - I'm not absolutely positive, but I thought the lignans were more for controlling the estradiol levels:confused:.

-Susy

[StarDeb55]

Susy, I believe you are 100% correct about the purpose of the lignans.

Debbie

[Harley PoMMom]

On the Treatment Option Considerations Paper I got back for Harley it has under option # 3:

Note: Melatonin and flaxseed oil with lignans are used together when estradiol is increased.

I seen from older sheets that it used to say may be used together, so, I guess Dr. Oliver changed it?

[Coolidge]

Just thought I would post the results of the ACTH stim test done at the end of December, when my new vet said I should start Coolidge on maintenance.
Of course one test lab does it in ng/ml and this one did it in ug/dl. (Math has never been a strong suit).

December Results:

Pre-ACTH: 5.5 ug/dl (norm: 2-6)
Post- 8.8 ug/dl (norm: 6-18)

However, I noticed that the notes in the reference range (from Idexx) says 1-5 is the desired pre and post cortisol on lysodren therapy (which I assume means that's the numbers you want to keep it at during maintenance.

Perhaps that one pill put her over again.

The endocrinology report on her thyroid (done also at the end of Dec) has everything in the normal range except for:

Free Thyroxine (FT4) 7 pmol/l (8-26 norm)
Free Triidothyronine (FT3) 1.5 pmol/l (4.5-12 norm)
T4: 2% (Norm 0-20%)
T3: 3% (Norm 0-10%)

The thryrogobulin antibody results were:
<20% Negative
20-35% inconclusive
>35% positive


The endo guy at Michigan State said "The free fractions are borderline to low, but total fractions look good. TSH is not elevated and the specific TgAA is negative. Hence, not real indication of primary thyroid disease."

I don't know about all of you, but I'm getting pretty tired of "we will treat it as if" and "not real indication". It's like it's purely a guessing game at the expense of our animals. One would think this guy on this test would have said, hmmm, that FT3 number is really low, I wonder what is causing that... and do a Dr. House on Coolidge. Where is Dr. House when you need him?

Coolidge's panting, drinking, hunger, and urination is getting worse by the day. Her cough is getting huskier and more frequent.

I'd like to think that one day we will have this all resolved. And a final determination made. I'd like to think it's just Atypical, and we do the melatonin routine. I will keep the lysodren just in case we do need to go there. But I will tell Hope Safehouse, a rescue in our area, that I have pills in the event a pup needs some. I will be able to share.

[StarDeb55]

In theory, with a post of 8.8, on dose of lyso should not have caused an Addisonian crisis. I still think the real problem is that Coolidge never had PDH to begin with, & that's why there have been so many problems with the lyso.

Debbie

[Coolidge]

Just an update. The vet wanted Coolidge on the flaxhulls only for 8 weeks. That being done, I can honestly say that they haven't improved her at all. Still drinking in excess of 22 cups of water a day. Waking me up 2-3 times a night to go outside. :(. Next treatment is the melatonin. Giving that one month and yet another ACTH panel.

Thanks for all the support you have given me in the past. I wish I could say that all is improving. Hopefully that time will come. Please, let that time come.

[Squirt's Mom]

Hi Becky,

It's really good to hear from you and Coolidge again! :)

Dr O just switched Squirt to the hulls but it hasn't been long enough to be able to see any changes. Her estradiol and progesterones were down from Dec but not enough so we're hoping the hulls will improve those levels. Her cortisol is normal again for the second test in a row! So her initial diagnosis of PHD is "highly questionable" now.

I hope you will see some positive changes in Coolidge after adding the melatonin to the lignans. Melatonin has properties that can help lower cortisol as well as the intermediate/sex hormones involved in Atypical. I'm actually surprised the combo hasn't been recommended before now, but I have been surprised quite often here lately. :o And remember it may take several months to see any improvement with the Atypical treatments. From Squirt's first UTK panel in Dec 08 to the one last month, her levels had improved, but not enough. Patience is truly a virtue when dealing with Atypical....unfortunately, not a trait strongly present in my make-up. :rolleyes::p:o

How has Coolidge been acting and feeling since we last heard from you? Any new developments in her world? Has the cough gone away? Any sign of Dr. House yet? ;)

Keep in touch!
Hugs,
Leslie and the girls

[StarDeb55]

8 weeks is cutting the timeframe for the flaxhulls to work a little short. The recommendation sheet says normally 3-4 months. One question, is there some reason you aren't using the flaxhulls with melatonin together? The great majority of us who have Atypical pups use both together.

Debbie

[Coolidge]

I'm following what my vet and Dr. Oliver talked about in their conversation. I asked the same thing. Vet was adamant that Dr. Oliver said to try the flaxseed hulls first and then go to the melatonin.
BUT NOT BOTH TOGETHER.

I'm at a total loss. I'm not the expert here. Supposedly those two are. So what do I do, tell them I want Coolidge on Melatonin? No matter what?

Help appreciated...

Leslie: Coolidge's estradiol count was normal. Progesterons were a little high. So that's why they weren't doing the melatonin. Yesterday's water count: 30 cups. Three times out last night. Here we go again. And yes, she still has the cough/choking thing going on. Especially after drinking.

[Squirt's Mom]

Hi Becky,

Good thing Coolidge isn't dealing with elevated estradiol. Of the intermediate/sex hormones involved in Atypical, this one is the hardest to control and usually calls for the combination of the two treatments. As most of us Atypical moms and dads deal with estradiol, that is why we typically see both used together.

Coolidge isn't the only one here on an unusual treatment protocol for Atypical. Asia, a greyhound, was started on just the melatonin first and is just now adding the lignans. But greyhounds have a different make-up so must be approached a bit differently; Dr O knew that so designed her treatment for her unique needs. If Dr O said not to use them together for Coolidge, there must be a logical reason. I trust him completely when it comes to Atypical. :) Who would understand the nuances of this condition better than the premier researcher in the the field? ;) If it were me, I would follow his directions above anyone else. No matter how "odd". :p

I am unhappy to hear that her cough is still around. :( Any time one of mine cough, my first thought is, "OH NO! heart problems!" Of course, I'm a twitcher and a worry wart who always thinks the worst right off the bat. :o:rolleyes: Have they given you any idea of what the problem is? (If you have said so previously, forgive me for asking again...I didn't see anything in looking back. :o)

The Lepto...can it come back or is it gone once the treatments have been effective? What about a UTI again?

Has she had an UTK panel done since last year? Nov.? Dec.? seems like was the last one from my reading just now. If not, it might be a good idea to re-do it and see where her levels are now. It may be that she just needs an increase of the hulls before trying the melatonin. I just hate the thought of her ever having to go on Trilo! :eek: So, I'm just grabbing ideas as they float by. :p

I know you are frustrated to the max right now but just hang in there. It may take some extra time for Coolidge with all the problems she had at the beginning, but I do believe the correct dose(s) will be found and that you will get to see your old sweet girl once again.

Hugs,
Leslie and the girls

[Harley PoMMom]

Hi Becky,

I'm confused, which doesn't take much :) but, when was this panel done? And if was done recently I wonder why Dr. O changed his mind about the treatment.


Results are in:

Cortisol:
Baseline: 24.2 ng/ml (Normal 2.1-58.8)
Post Acth: 83.1 ng/ml (Normal 65-174.6)
Androstendedione:
Baseline: 0.03 ng/ml (Normal 0.05-0.57)
Post Acth: 0.80 ng/ml (Normal 0.27-3.97)
Estradiol:
Baseline: 63.4 pg/ml (30.8-69.9)
Post Acth: 54.2 pg/ml (27.9-69.2)
Progesterone:
Baseline: 0.13 ng/ml (0.03-0.49)
Post Acth: 1.60 ng/ml (0.10-1.50)
17 OH Progesterone:
Baseline: 0.11 ng/ml (0.08-0.77)
Post Acth: 2.22 ng/ml (0.40-1.62)
Aldosterone***
Baseline: 76.1 pg/ml (11-139.9)
Post Acth: 141.4 pg/ml (72.9-398.5)

*** Normal range values for male and female dogs (N=72 baseline, N-23 post ACTH)

Dr. Oliver's Comments: Most hormone levels are normal, but both progestin's are modestly increased at stim. Consider items 2 or 3 or 5 on the treatment option sheet attached.
Feel free to comment. Thanks. (Am I the only one who thinks these "abnormal" findings are extremely mild, and that Cushing's really isn't the cause for her problems?")

Please note that I just realized his recommendation is different from what my vet told me he said. Have asked for clarification.

#2 is Melatonin
#3 is Melatonin Implants
#5 is Maintenance dose of Lysodren ~ which from what I've read Coolidge probably does not need.

Lori

[Squirt's Mom]

Hey Lori,

My understanding is that because of Coolidge's apparent sensitivity to Lyso they chose to go with just the lignans first.

Hugs,
Leslie and the girls

[Coolidge]

Yes, Coolidge is highly sensitive to lysodren.

But I'm now in a quandry. If I'm supposed to give the lignans MONTHS to work, and her water intake over the weekend increased to 34 cups on Sat and 38 on Sunday (temps in the high 70's), how much longer do I give it to say "it just isn't working"?

Her test from UTK was done just a couple months ago (exact date escapes me right now).

The well water is being tested this week (finally). She goes back a week from tomorrow for an xray of her chest (had a spot on the rib cage that my vet wants to keep an eye on) - which could be the cause for the cough, who knows. Vet didn't think so at the time.

So, I will have her run a full workup on a urine sample. See if there is anything funky going on there.

Explanation for the differing opinion of Dr. Oliver. Leslie is correct. My vet clarified with Dr. Oliver that Coolidge was originally loaded in a relatively short amount of time, nearly went addisonian on the original loading, and had a lethargic reaction to just one lysodren tablet when she was to begin maintenance. (So I stopped giving it to her). With that additional knowledge, Dr. Oliver switched his suggestion.


The only thing NOT happening with her is the increased appetite.
Normal as normal can be. So we have excessive panting, urination, and water intake. Can't wait until it gets hot here. Not.

[Harley PoMMom]

Hi Becky,

Just a thought here, I see from the UTK panel that Coolidge's Aldosterone level was normal, but maybe now it could be on the low side from the lysodren, and now the lignans.

The Aldosterone is what balances electrolytes in the body, if Coolidge's electrolytes are unbalanced, maybe she's alittle dehydrated and that's why she's drinking so much.

Hopefully the others will comment on this, but I think I would get her electrolytes checked.

Best of luck to you and Coolidge.
Lori

[Coolidge]

Latest blood test showed an Alkaline Phosphatase count of 813.

Her urine was very dilute... 1.003

Vet says that she's pretty sure her cushings is back... but wants me to remain on the melatonin for four weeks and then run some liver tests. And if that is clear, we begin a maintenance level of lysodren.

Getting me up three-four times a night now.

However... and I'm confused here. I was looking at her bloodwork that was done a month after her loading phase (Nov 2008). Her Alkaline Phosphatase count was 789 or something like that. One would think that the count would have dropped because she nearly went addisonian on us. This leads me to believe that her count will always be high because it's due to something else.

Can someone explain this?:o Much appreciated.

[frijole]

Hi! I will answer as a mom to a dog with pituitary cushings. The AlkP level may never go back to normal, in fact probably won't. This is the case with PDH dogs. I do not know if this is true with atypical pups.

My dog has been treated with lysodren for 3 yrs and the best her alkp has ever been is 780. She's happy and symptoms are under control so I don't worry about it.

Kim

[Harley PoMMom]

Hi Becky,

My Harley's ALP is high, alot higher than his previous one, but really that's not the one I worry about, the one I keep my eye on is his ALT, the ALT is liver specific, what is Coolidge's ALT?

ALP isoenzymes are found in a variety of tissues including intestine, liver, bone, placenta, kidney and leukocytes.

ALP could be high bc kidney's are working harder (you said she's getting up alot in the middle of the night and her urine is very diluted), and the liver is working harder bc of the cushings and this cushings is just rough on the internal organs. But 813 isn't the highest I've seen, ok.

Remember we are always here for you.

I hope I made things alittle clearer for you.

Hugs. Lori

[Coolidge]

Just gotta learn to go with the flow... not get stressed out over something that might not even be there and not to dwell on what is there. Just take it one day at a time and love every minute of it. Grasshopper is learning.

Thanks.

[Wylie's Mom]

Hi Becky,

I'm just getting caught up... I still don't understand why the flax hulls... her estradiol and cortisol weren't out of range. If it was added for increased cortisol levels (in lieu of Lyso because of sensitivity), were her cortisol levels checked again after the UTK panel? I don't think one can assume her cortisol levels are increasing based on the high Alk. Phos and dilute urine... I think these can be caused by other things.

-Susy

[AlisonandMia]

My understanding with elevated liver enzymes (especially ALP) and Cushing's is that they are result of the liver working hard to metabolize the extra load of steroid hormones. When a dog develops Cushing's its liver enzymes probably rise slowly as the disease develops and you expect a similar delay in their returning to normal once the cortisol is lowered. How long this takes is a very individual thing and, as Kim says, some dogs' liver enzymes never return to normal. This is very likely why Coolidge's enzymes still showed pretty much the same elevation after she went into an addisonian state - they simply hadn't had time to return to normal. Also I was reading yesterday that dogs with naturally occurring Addison's also very often have elevated liver enzymes when diagnosed, so it looks like being in an Addisonian state may also be related to an increase in liver enzymes. Here's a link to that info: http://www.dogaware.com/specific.html#addisons

The other thing is that there are so many other things that can cause elevated ALP (dental problems are a common cause) - and some dogs apparently just have somewhat elevated ALP for no discernible reason, especially as they age.

Elevated ALP always look alarming as they can be so many times the normal level and we associate any lab result that is so apparently beyond normal range as being a sign of severe illness. I remember how worried I was when Mia's ALP came back in the 400's in the months before she was actually diagnosed with Cushing's - I now realize that the 400's is not actually particularly high although at the time it seemed truly alarming because it was so much out of normal range to my eyes. Since then I've seen them in the 1000's and even the 10's of 1000's! Her ALP went a fair bit higher than that (and her ALT was elevated too) by the time she was diagnosed but returned to normal after 18 months of treatment. She did take Milk Thistle and I remember saying to the vet that either it worked really well or she never needed it!

Alison

[Coolidge]

Can't see the forest for the trees... That's how I feel about vets (and myself) right about now...

Coolidge has two teeth that are broken off in back. Vet said that we shouldn't do anything until she shows signs of infection in those areas. Which she hasn't. I check weekly, the vet does a thorough exam each time I bring Coolidge in, which is frequently.

That being said, I know that although painful at the start, when I have a toothache I love to suck on ice. It cools down my mouth. Perhaps all the water Coolidge is drinking has to do with the teeth issue.

The last time Coolidge was put under was when she was fixed as a puppy. She is now 9-1/2. Are there any issues to putting a dog under to have her teeth pulled at her age?

I'm thinking that having this issue fixed rather than ignoring it until a major problem arises (perhaps it already has, alas) would give a clean slate to things. Maybe, the stress factor of stress fractures innocently raised coolidges cortisol levels in October. Remember, the specialist said at first "I don't think Coolidge has Cushings at all" and then said to treat her as IF she had Cushings. That started this whole process.

Thanks for your pointing this out! I've sent an email to my vet. Should hear back from her this morning.

[StarDeb55]

Having a dental done to pull those teeth shouldn't be a problem. Harley is 14 years old, & has a dental done yearly with no problems from the anesthesia.

Debbie

[Nathalie]

Hi Becky,

I have worked in the dental field man years and here are my thoughts on Coolidge’s tooth issue … You may already know all this.

If only part of the tooth broke off without exposing the pulp (nerve) I would not worry too much about it unless your dog shows visible discomfort chewing.
If the tooth broke off right at the gum line then it is pretty much a given that the pulp is exposed which can cause bacteria to travel down the root canal causing an infection at the root of the tooth.
If the never is exposed it can be quite painful eating and drinking. You might be able to see if the nerve is exposed by simply looking at the top surface – the root canal area is a more darker color then the enamel (outer layer).

To check for infection before it becomes apparent by inflammation or a little fistula (pus filled blister on gum root area) you can do a couple of tests:

1. Lightly tab a healthy tooth with fork (handle part or similar) and see how the dog reacts to give you something to compare his reaction compared to the broken tooth. Now lightly tab the broken tooth on inside/outside and top. If your dog reacts way stronger to the tabbing of the broken tooth you most likely have infection going on which can lead to an abscess at the tip of the roots.

2. Take a small piece of ice and wrap half of it with some gauze or tissue paper so you have something to hold on to. Touch a healthy tooth for a couple of seconds and note your dogs response. Now do the same thing with the broken tooth. If you are getting a strong response there is most likely an infection going on.

There is also the possibility that the tooth’s nerve has already died in which case you may not get a different response when doing the ice cube test.
If there is not much of a response to the ice cube but a definite pain response to the tabbing the tooth is dead but infection is happening at the root.

Nathalie

[Wylie's Mom]

Hi Becky,


Can't see the forest for the trees...
You and your vet are not alone;)! I still, and I think forever will, struggle to see & understand the whole picture…

About the teeth, Wylie was 11-1/2 last December when I took him to a Vet Dentist. They required that we run CBC w/ electrolytes & differentials and T4 tests before the appointment. I went ahead and had the blood chemistries done too – his Alk Phos was 949 at the time. They used this info to determine whether or not he was fit to go under/have surgery. This dentist has worked on many senior animals and used anesthesia (or a combination) that did not keep him under for too long… propofol was it or one of them. He ended up having a molar extracted. I think he may have gotten an antibiotic afterwards and he got a couple Tramadol pills for pain. He had to have soft food for 2 weeks and he did just fine. I would just make sure you get a dentist that has alot of experience with senior dogs and be sure they know of all of Coolidge's issues.

Here is an article on dog teeth that you can access for free if you join this free “library” - it’s what inspired me to get Wylie to a dentist:

“Improve your dental acuity: what do you know about your dog's teeth? Probably not enough!” The Whole Dog Journal
http://www.accessmylibrary.com/coms2/browse_JJ_W163

I still don’t understand why Coolidge is getting the Flax Hulls… could you please answer the question I posted yesterday:confused:?

-Susy

[Wylie's Mom]

Thanks for sharing that information, Nathalie... Wylie's dentist told me about the tapping, but not the ice... and he didn't explain what the reactions meant as thoroughly as you did:).

-Susy

[Coolidge]

Susy: Re: Flaxhulls...

I want to say your guess is as good as mine regarding the flaxhulls. When my vet got the recommendation from Dr. Oliver, she contacted him regarding doing both. Dr. Oliver was not privy to Coolidge's health records prior to seeing the Adrenal Panel results. So at the end of the conversation, Dr. Oliver told her to give the flaxhulls first - see what it does, and then give the melatonin. Which is totally against anything in his literature. Which gets me even more frustrated when trying to explain this to you all. Coolidge is so OUT OF THE NORM for just about everything (test results and treatments for) that I have no idea which way is up any longer.

She may have Pituitary Cushings, she may not. The slightly elevated progesterones may indicate Atypical Cushings, again it may not.

All I know is that I have a dog that pants continuously and has a drinking problem. :o

And, with the drinking problem, a lot of visits to the great outdoors in the middle of the night. :(

Oh, and has been shedding hair continuously all summer. (There is no issue with that according to the vet, her skin is fine... The odd thing is that the hair on the base of her tail is getting thicker and thicker. She looks weird, but I'm told it's not a problem. Can only go with what I'm told.)

ps. The vet said early on after discovering the tooth issue that she would prefer to get Coolidge's other health issues under control prior to doing surgery. So what you said makes sense. That she is worried about the effect of Coolidges health under anesthesia.

[Harley PoMMom]

Hi Becky,

I did some researching on the flaxhulls cause I was wondering too why they were recommended and this is what I found:

As a hormone, 17OHP also interacts with the progesterone receptor. It is derived from progesterone via 17-hydroxylase, a P450c17 enzyme, or from 17-hydroxypregnenolone via 3β-hydroxysteroid dehydrogenase/Δ5-4 isomerase.

This found at:http://en.wikipedia.org/wiki/17-Hydroxyprogesterone


Now on the "STEROID PROFILES IN THE DIAGNOSIS OF CANINE ADRENAL DISORDERS," by Jack W. Oliver, DVM, Ph.D it says: Phytoestrogens (isoflavones, lignans, genistein) are known to inhibit 3-beta hydroxysteroid dehydrogenase.

Hope this helps.
Love and hugs.
Lori

[Wylie's Mom]

Hi Becky,

I see where Lori is getting to, but I would have thought that Dr. O would "get to the point" and actually state that it would, or might reduce Progesterone & 17 OH Progesterone... but maybe he thinks it might and just isn't positive yet:confused:. Another thing, sure those two levels are above the range, but I don't know enough to know at what point they are considered needing treatment:rolleyes:.

I'm just curious, Becky - How much does Coolidge weight and how much was that one dose of Lysodren that you gave her?

-Susy

[Harley PoMMom]

Hi Becky,

I think Susy is right with her suggestion about Dr. O not really being positive.

The wikipedia site sometimes is not a very reliable site, if I were you I would email him and ask him.

Love and hugs.
Lori

[Gabrielle]

Becky,

Charlie Brown is 14 1/2 and he just had his gall bladder and left adrenal gland removed and he experienced no problems at all with the anesthesia. I think Coolidge will be fine having his dental problems treated.

Hugs,

Gabrielle and Charlie Brown

[Coolidge]

Coolidge weighs 84 pounds. Her maintenance dose (the single one) was one 500mg tablet.

I didn't think it strange, as her loading phase had her at 1500 mg a day. (I don't know if you all recall, but I was told that was a low dose for loading and therefore no need for prednisone, and it turned out it wasn't really a low dose.) I guess that is beside the point.

Poor Coolidge, I feel so badly for her. She looks miserable all the time. And I have no solace and comfort for her.

[AllisonJ]

Hi Becky,

I just read your thread and I'm so sorry that Coolidge isn't feeling good, even after all you've done!

I wanted to touch on a couple of things that might be of help to your little girl. The first is her coughing. My Emma had the same issue and originally we thought it was bronchitis, but it turned out to be Larangeal Paralysis (LP), which is when one of the 2 little flaps in the trachea becomes paralyzed and won't open. Because of this, she pants incessently and coughs/hacks/dry heaves, literally sounds like she's going to hack up a lung. It also causes her to aspirate water when she drinks. This could be the reason for her coughing issues. Has your vet considered it? There is a surgery that can be done which involves pinning back the paralyzed flap, but I was told it's not foolproof and sometimes comes undone. So for $3000, I decided against it. For whatever reason, it's quite common in larger dogs. As long as I keep Emma cooler (she stays in the A/C and has her own oscillating fan that I keep near her at night and when she's home alone), she does OK, but will always breathe heavier and hack occasionally. The only word of caution is, don't let her sleep on a bed with a bolster around it, or anything that could kink her neck. Emma has had 3 incidences in which she stopped breathing and nearly suffocated. I don't mean to scare you, but I don't want you or Coolidge to go through what we did!

The other thing I wanted to touch on was, has your vet considered that she may have gone Addisonian due to the Lyso? Emma also had an extreme sensitivity to the Lyso and even at underdosing her, she had a reaction that sent her Potassium levels crashing down. She spent 2 days in the emergency room getting a Potassium drip, then her levels spiked and we couldn't get them down, so more time in the ER with a saline drip. After she was stabilized we put her on Prednisone b/c my vet figured she went Addisonian, at least temporarily - that was in March. And lo and behold, she's doing great. She is definitely a Cush pup as she has a HUGE adrenal tumor (found through scans and an ultrasound) and was confirmed along with all the other testing, but I decided not to do surgery for fear of losing her. Coolidge may do a little better if she gets 5mg or less of Prednisone each day - something to ask your vet. Emma's water drinking went back to normal and she pees normally too - she was drinking 230oz of H2O a day and getting me up every 20 minutes at night to pee. She also hasn't had a bladder infection since, when she used to have at least one a month.

I certainly wouldn't say that Coolidge is the same case as Emma, but it wouldn't hurt to check into these things. Also, I noticed that you live in Franklin - I live in New Berlin and have a great vet. She has gone the extra mile with Emma through this whole ordeal and I'm sure she would be happy to consult with your vet on any issue. She has dealt with other Cush cases and might be able to help with Coolidge. If you'd like her info, I'd be happy to give it to you, just send me an e-mail through this site.

And, if you need anything, I'm only a hop, skip and jump away, so just ask! :D

Good luck and big hugs!
~Allison, Emma & forever Tucker

[Harley PoMMom]

Hi Becky,

It's just me checking in on you and Coolidge, we haven't heard from you for a long while...starting to get worried about ya. :( :) Hope everything is fine.

Love and hugs.
Lori

[Coolidge]

Well, the melatonin and flaxseed hulls didn't work. Her drinking has increased in leaps and bounds, now goes through 5+ gallons of water a day. Her appetite is also increasing.

As I stated before, I arranged for the well to be tested. When I called for results, they claimed they "misplaced" the samples. So they will be coming back early next week.

Her water intake has increased a lot during the past two weeks, which coincidently is right around the same time she began to show symptoms of Cushings last year, which has led to this roller coaster ride. I asked the vet if she'd be willing to put Coolidge on the same meds she was put on for the lepto. (It was a month after her loading and two days into the lepto meds when her water consumption starting going down. Coincidence? maybe.) She said anything was worth a try. So she starts on the meds tonite.

And I will give it a week of meds, and then back to the ACTH test and probably re-loading.

Coolidge emptied her bladder in the house for the first time yesterday. :( So, things aren't going well. Up every 45 minutes to let her outside.

[Squirt's Mom]

Hi Becky,

Goodness, you and Coolidge have really been through the ringer with this stuff! Has she been on the computer talking to Glynda's Jojo? Jojo is an expert at NOT following the rules of Cushing's and has been know to secretly share his ideas with others here before. So keep Coolidge away from the computer and don't let her have any snail mail either! That Jojo is sneaky! :p

How long has it been since she had an ultrasound? I may be repeating myself but here goes anyway. ;) When Squirt was first diagnosed as having PDH, her cortisol levels ranged from borderline to significantly high, but her signs were mild and Anipryl controlled them nicely for quite some time. A second U/S showed a tumor on her spleen which was removed along with part of the spleen itself. Since then, her cortisol has been in the normal range and her signs stopped until recently; the panting and seeking a cool spot to lay has shown up but the weather could be causing that as could her elevated estradiol and progesterones.

My point here is the splenic tumor appears to be the cause behind her cortisol levels being elevated. Dr. Peterson talks about non-adrenal illnesses that can cause false positive results in Cushing's tests....Squirt seems to fall into this category at the moment. With all the trouble Coolidge has had, it might be a good idea to have her looked via an U/S or cat scan...even if she has had one done already. Sometimes a second look will provide better or more info. It certainly did for Squirty! Her tumor was on the U/S done 4 months earlier but the IMS that did the first one didn't feel the need to note it or mention it. :mad: So an U/S might be something you want to consider. Just a thought.

Hope things get better for sweet Coolidge and you!
Hugs,
Leslie and the girls

[Harley PoMMom]

Becky,

OMGosh, so sorry Coolidge's symptoms haven't improved and they lost your water sample. I don't trust my water either, I have city water, so I buy Harley distilled water to drink.

I hope the meds work, something has to...you both need to catch a break here, IMO, it was just too much a coincidence that when Coolidge was put on the meds for the lepto her cush-like symptoms decreased.

Please keep us updated.

Love and hugs.
Lori

[Squirt's Mom]

Hi again...

Here is the link to Dr. Peterson's article on Cushing's:

http://www.k9cushings.com/forum/showthread.php?t=216

Hope you find it helpful!

[Harley PoMMom]

Hi Becky,

Just checking in on you and Coolidge...hoping the meds are doing the trick. :)

Love and hugs.
Lori

[Coolidge]

Can anyone give me a crash course on diabetes insipidus? How much the meds cost :eek:(heard they were atrociously expensive) per month. How much improvement can be seen. Etc.

We are looking at this being a culprit right now. The meds had a little effect (95% consumption now). For the first time in months Coolidge actually walked away from her supper without eating it all.
So the vet is thinking the drinking and eating aren't related to the Cushings at all, even though Coolidge has it.

We are going to run the DDAVP drug trial to see if she responds to treatment.

Any tips/help appreciated, as always...

[Roxee's Dad]

Hi Becky,
You may want to zip (click over at K9diabetes)

http://www.k9diabetes.com/forum/index.php

It's really a great forum. Plenty of info and help just like here with cushings. I am sure they can help you over there. Natalie is also an admin there.

Please do keep us updated.

[acushdogsmom]

Can anyone give me a crash course on diabetes insipidus? We are going to run the DDAVP drug trial to see if she responds to treatment.

Any tips/help appreciated, as always...Here is a link I happen to have bookmarked :)

http://www.indulgedfurries.com/petdiabetes/diabetes_insipidus.htm

[StarDeb55]

You might want to PM Sharon (Ventilate), I believe one, if not both of her Giant Schnauzers have DI.

Debbie

[Coolidge]

I would love to pm but have only responded to pms to me. How do I go about PM'g someone :confused:.

Are there instructions somewhere? Took me forever and a day to figure out how to add Coolidge's photo.:o

[Harley PoMMom]

Becky,

Up at the top of our page it reads "Community" click on that and then click on the "members list," the alphabet will show...click on the letter "V" then click on "Ventilate", this will take you to Sharon's profile's page, under her name you will see "send message" click on that, then click on "send a private message..."

Hope this helps.

Love and hugs.
Lori

[gpgscott]

Becky,

Just click on the user who you wish to message and you will get options.

If you need more help just ask, there are lot's of people here who can answer.

Scott

[acushdogsmom]

I would love to pm but have only responded to pms to me. How do I go about PM'g someone :confused:.

Are there instructions somewhere? Took me forever and a day to figure out how to add Coolidge's photo.:oThere are sveral ways to PM somebody. No time to explain in detail about all the ways you can do it but here are two ways to send a PM to Sharon (ventilate) in particular.

Go to her user profile page here:
http://www.k9cushings.com/forum/member.php?u=71

Look under her username there and you'll see "send message". Click there and you'll be given a choice to either "post a visitor message for ventilate" or "send a private message to ventilate".

Click on "send a private message to ventilate" and a PM box will automatically pop up with the name ventilate in the "recipient" field.

Type out your PM to her and hit "submit message".

Another way to do it is to go to your "UserCp" and look on the left hand side of Your Control Panel page. Under "private messages" you'll see the option to "Send new message". Click there and when the text box pops up, enter the recipient's name ... in this case, ventilate ... in the recipient field. Make sure to spell the recipient's name correctly.

Hope this helps.

[Coolidge]

After discussion with my vet, we have opted not to have Coolidge tested for Diabetes Insipidus. Too costly for the tests (to figure out which of the two she may have or not have as the case may be.) We are running out of money to figure out what is going on with Coolidge.

In addition to the Cushings, she has developed hip problems. We discussed putting her on small maintenance doses of lysodren as she has proven slightly intolerant of lysodren. But right now I'm mainly concerned with her being in pain. Which she is in big time. She began rimadyl yesterday (which I have been told causes seizures, so we will be switching to a different med today).

So, that being said, I should bow out of this forum gracefully. And tell you all how much I have appreciated your insight, love, and concern for Coolidge. We will check in from time to time to see how everyone is doing.

May your furkids be blessed.

[Roxee's Dad]

Hi Becky,
We know you love Coolidge and are doing everything you can. You are family so please stay with us. We are here for you if for nothing else but to listen and help you through this. Please stay with us.

[Harley PoMMom]

Hi Becky,

Please don't bow out, like John has said you are family, we love you and Coolidge.

We know you are doing everything you can think of for Coolidge, there is no doubt of your love and devotion for her.

Re: the diabetitis insipidis; I thought Harley might of had this too, when we had his appt. at the Univ. of Penn last month (8/18) I brought this to the attention to his IMS. She did a couple simple tests as follows:

"She pulled down the bottom lid of his eye and it filled with tears and then checked his gums by pressing against them and seeing how long it took for the color to come back, I realize these aren't the "standard tests" but Harley passed both of these simple tests with ease. His IMS said since he passed these simple tests she believed he did not have diabetitis insipidis."

The color of Coolidge's gums should come back within a couple seconds.

Remember Becky, we are always here for you...always.

Love and hugs.
Lori

[Squirt's Mom]

Hi Becky,

No bowing out, gracefully or otherwise! :( As John and Lori have said, you and Coolidge are family, and you belong here regardless. We may not have the answers, but we do have gentle arms and strong shoulders, and are here for you anytime, for any reason.

I have no doubt that you have and will continue to do your very best for Coolidge. That is evident in every post you have made, in every word you have spoken about your sweet baby.

I hope you can find a good pain management program for her now. You might ask about Adeqan injections as they have helped several here with arthritis and they won't be as hard on her digestive system as some of the pills can be.

Please stay, we would worry about you and Coolidge. Besides, Lori and I would be apt to come looking for you! :eek::p;)

Hugs,
Leslie and the girls

[Coolidge]

Coolidge update...

She has severe arthritis in her left hip, a huge bone spur on the ball of her right hip bone and is on pain meds and rimadyl for that.

She began her maintenance dose of lysodren today. 1-1/2 tablets twice a week. Vet is reluctant to reload her due to her sensitivity to lysodren. However, she says if Coolidge tolerates the maintenance doses, we can gradually increase it until she shows the signs.

I'd like to thank everyone for their support. And I will keep you up to date and will be asking questions yet again.

Hugs to all your furkids!

[Harley PoMMom]

Hi Becky,

I am so happy to see your post and I am hoping the dosage of Lysodren will help Coolidge.

Bone spur...ouch...I have those on the heels of my feet and have to wear orthotics in my shoes, have to have them custom made. Poor Coolidge, is there anything they can do about the bone spur?

Thanks so much for the update and will be looking forward to more from you.

Love and hugs.
Lori

[Wylie's Mom]

Hi Becky,

Here is a (very lengthy) link reagarding supplements & meds & other options for arthritis & pain:
http://www.dogaware.com/arthritis.html

Regarding the Lyso... I think I've missed something - I thought Coolidge's cortisol levels were (finally) determined to be normal... Is the maintenance dose of Lyso being giving for the (somewhat mild?) elevations in Progesterone & 17 OH Progest? Anyway, if so, and given Coolidge's sensitivity, I give Wylie a little bit (10mg) of Pepcid AC before he gets his Lysodren dose with dinner. (I get the generic Walmart brand, 60 tablets of 20 mg that I split - Wylie is 78lbs) This might help Coolidge in tolerating the Lyso. Also, you might consider giving the same amount of Lyso per week (1500mg/wk?), but in smaller doses that are spread out, like maybe 500mg 3x/wk.

I was wondering if you ever got in tough with Sharon regarding DI... hear is some of what she wrote on her thread about the DDAVP drops:

...He is not quite as bad as Nike, with her if I am a hour late with her ddavp, she starts to drink a gallon again, right away....
...I started Nike off with I think 3 but now are down to 1 BID, Kenai is on 1 BID as well, started him off on 2. I am sure they are still some dilute but it is not symptomatic, they drink normal or close to it on the 1 drop and that stuff is expensive so we will stick to 1 drop as long as it keeps working for us. It didnt take very long to see it working especially with the 2 or 3 drops 2 times per day....


She did find a way to save some $$$ on the drops:


I wanted to mention to all about what I found out about Walgreens. I have been paying $120.00 for Nike and Kenais eye drops. I called Walgreens and they have the perscription plan. You pay 25$ to sign up and $10.00 per addition of others family members, they allow dogs as other family members. So I paid $45 to sign us all up. They charge me $60.00 for the dDAVp drops so I have gotten one perscription and have already saved money even with the price of the membership.

It tires me thinking of what you & Coolidge are going through - 5 gallons of water! Plus, all that you've already gone through - has cushing's... PDH... no, ADH...no, not cushing's, but atypical...:confused::confused:. We are always her for you... please stay with us.

-Susy

Also, you can get a quote for comparison at diamondback drugs http://www.diamondbackdrugs.com/ - this is where I get Wylie's Mitotane (Lysodren). I just looked at their cataloge - it looks like they list DDAVP as Desmopressin.

[Coolidge]

I have to be honest and state that I have gotten to the point where I need to address Coolidge's comfort, rather than continually subject her to test after test after test, only to find out that she has...nothing.

That and I no longer have the money to continually test her. I've spent nearly $6000 on her since this all began. It's been a nightmare from her side as well as mine.:(

So, I opted to go with the recommendation of my vet and Dr. Oliver. THat if the flaxseed and melatonin don't work, to go with the lysodren. I've run out of options here.

She is now confined to the kitchen area as she now has a tendancy to pee everywhere. Her water intake is astronomical and I found out why. She has a bladder the size of Texas. This showed up in her xrays (to rule out anything on her kidneys, liver, etc.). It was short of stunning.:eek:

The interesting thing is that after one dose she isn't panting like she has been over the past month. That's a good thing. And she wiggled her tail continually while outside peeing eight times.:)

I have decided one thing though... When her time on earth has ended, she will be shipped off to a vet school so they can figure out what she had, compare it to what her primary complaints were and hopefully, stress HOPEFULLY, this will save someone else from going through what we did. (Please note that I have not given up on her, this is a waaaaay in the future thing.)

[MiniSchnauzerMom]

I have to be honest and state that I have gotten to the point where I need to address Coolidge's comfort, rather than continually subject her to test after test after test, only to find out that she has...nothing.

I hear you, Becky, and I certainly agree with you about addressing Coolidge's comfort rather than continuing to put her through a multitude of tests. Others may not share my opinion but I've been in the very same place with my Munchie and finally had to say "whoa....that's enough!"

I'm glad the one dose of Lysodren has helped with the panting and Coolidge must feel somewhat better to be wiggling her tail - even if it was while she was peeing 8 times! :D Hang in there, Becky. You and Coolige deserve a break!

Louise

[Wylie's Mom]

Hi Becky,

I’m sorry, I didn’t mean to suggest more testing… you had mentioned earlier that you were thinking of doing a “DDAVP drug trial to see if she responds to treatment”. This drug alone is pricey, I didn’t realize the testing would still be required.

I’m glad to hear about the tail wiggles – that’s always nice to see.

Now that Coolidge is confined to the kitchen, do you find that she tends to pee in a certain area of the kitchen? If you think it may help, you might consider getting washable/reusable incontinence bedpads - Glynda (Lulu’s mom) had told me about them. Wylie lives on the 1st & 2nd floor, and he will willingly pee anywhere in the basement… I ended up blocking access to the room downstairs except for a 4’ x 4’ area at the bottom of the steps. That area is kept covered in piddle pads (been doing this for about 7 years). When I run low on piddle pads, I’m going to get the bedpads. I don’t know about the quality, but this site looks to have a good deal: http://www.allegromedical.com/incontinence-c525/grayson-reusable-bedpads-p193256.html. The pads might help to keep the pee puddles from spreading out and may help to cut down on pee tracks:rolleyes:.

Please keep us updated on how she’s doing.

-Susy

[Coolidge]

I misspoke, We aren't doing a testing. We are just putting her on the desmo stuff. If it works, we will be thrilled. And will search out a place that will compound the stuff at a cheaper cost. Someone gave me a link for the compounding and I will hope that it is still around the 1/2 price range.

I'm just worried about Coolidge. If she isn't peeing, she is laying on the floor not moving. She is on her 2nd dose of lysodren along with the tramadol. So, I can't tell if she's lethargic, because she is from the pain pills. She is averaging 5 cups of water every 45 minutes.
When I get home from work her water dish is empty and she drinks 4 bowls (16 cups) in less than a minute. She gets frantic if I don't continually refill the bowl.

Pee pads wouldn't work. We thought they might, but when she pees, its a continuous stream for over 1 minute (and she still has enough to repeat it 5 steps later). It's a lake, not a puddle. Sadly.

It appears it is now a waiting game to see what comes next. I've tried just about everything in my power and am running low on options. I just don't want my coobcake suffering.

[Buffaloe]

Hi Becky,

Back in 2006, we had a relatively long and difficult diagnosis with Shiloh. At one point we tried the DDAVP drops, to see if she might have diabetes insipidus. I tried the drops in her eyes for several days and it didn't make any difference. She was still drinking 5.5 quarts of water a day, etc. The drops are pricy but I noticed ventilate posted some information about a program with Walgreens that might be helpful for you. With Shiloh, shortly after the trial with the DDAVP drops we figured out she had an adrenal tumor, had surgery and everything worked out very well.

I know this whole thing must be extremely difficult and frustrating for you. Poor Coolidge sure is drinking alot of water. Let's hope the water consumption lessens significantly with the drops. All the best to you and Coolidge.

Ken

[Harley PoMMom]

Hi Becky,

Oh sweety, you poor dear...so much going on here and poor Coolidge too.


We are just putting her on the desmo stuff.I am so happy you are trying this, and I am praying this works.

I don't want to alarm you but if Coolidge does has DI she must have access to water at all times, dogs with DI are very prone to dehydration bc of the peeing.


I've tried just about everything in my power and am running low on options. Yes, Becky you certainly have tried everything humanly possible, you are a wonderful mom and everyone can see that you love Coolidge very, very much...hang in there, I know it is tough but I am praying my @$$ off that positive changes will happen soon.

Love and many hugs.
Lori

[ventilate]

Becky;
Good luck with the DDAVP (Desmopressin) I started Nike out with 2 drops AM and PM I think maybe even 3, sorry it has been a long time, but I was able to decrease it after it had started to work. I looked into compounding it at 2 pharms here in Asheville and it was going to be way more expensive for me since they would have to order the ADH and that is very expensive. With the perscription card from Walgreens I pay $60 some dollars for 5 ccs and that lasts Nike about 6 weeks or so, at 2 drops per day. Every place else it was about 120 or more. I bought a medicine bottle with an eye dropper. some eye droppers will fit the bottle of the ddavp, I now use that. I tried using the OTC peoples eye drop bottle but I would waste to much. this works best for me.
I hope the ddavp works. I know how it is to have lakes. Nike is 90+ lbs so not a tiny thing. If it works it will be a wonderful thing. it was for us, both with Kenai and Nike. As well I am sure it makes them a lot more comfortable, cant imagine drinking that much and always having to pee can be comfortable for them either.
I sent you a PM all about DI, did you get it?
Let us know how it works.
Sharon, Nike and Kenai

[Wylie's Mom]

Hi Becky,

Sounds strange to say this, but I hope it is DI & I hope the drops work. You & Coolidge certainly do deserve a break.

Sending hopeful thoughts your wayhttp://www.runemasterstudios.com/graemlins/images/pray.gif,

Susy

[Coolidge]

Nine years ago this past May, we made the long trek to Rochester NY to pick up our new “bundle of joy”, Coolidge. (Her foster mom was a woman I met on a cat chat board shortly after I lost my beloved cat Charlie. She remembered that I loved big dogs and was fostering a dog she thought I would love. She sent me a photo and the rest was history.) It was on the return trip that we were enlightened to Coolidge’s peculiarities, including motion sickness. She would be the first dog in history to run in the opposite direction when the magic words “go for a ride in the car” were uttered.

She gave us much joy and laughter over the past nine years. Her habit of sucking on a stuffed animal until she fell asleep always brought a smile to my face, and always will. Her waiting for me to sing “Truly, scrumptious, that chewie’s truly scrumptious” before chomping away on her rawhide. Her chasing our escaped cat all over the neighborhood and back into HER outside dog run/kennel. How smart of her! (We rewarded her by enclosing our entire back yard in chain link fence.) Her diving into a friend’s pool to rescue us because she thought we were drowning – the newfie in her I guess, and our having to rescue her instead.


Today, with great sadness, we said goodbye to her. She is no longer in pain, no longer staggering, no longer thirsting. She is at peace for the first time in a very long time.

So I will end my post with the last words that Coolidge heard from me…


“Goodnight, sleep tight, God watch over you tonight.

See you in the Heaven’s light, Angels watch over you.”



May you and all your beloved furkids be blessed.

[Roxee's Dad]

Dear Becky,
I am so very sorry for your loss of beautiful sweet Coolidge.


“Goodnight, sleep tight, God watch over you tonight.

See you in the Heaven’s light, Angels watch over you.”

I know Coolidge is now the angel that will be watching over you until you meet again. I'm sure that our many cush pups that have gone before have greeted and welcomed her.

[MiniSchnauzerMom]

Becky,

My heart sank when I started reading your post. I am sorry for your loss and that your Coolidge is no longer with you.

Peace sweet Coolidge.

With deepest sympathy,
Louise

[sarahbera1]

Becky,
I am so sorry to hear of Coolidge's passing. I understand your feeling of loss as I had to say goodbye to my sweet Darla a week ago today. We now know that they are at peace and no longer in pain.
With sympathy,
Sarah Rascal and Darla in spirit

[frijole]

Deepest sympathy. I can tell you totally know that you did what was best for dear Coolidge. What wonderful final words. Got me all choked up. Pls take care and do keep us posted on how you are doing. RIP sweet Coolidge. We'll see you on the other side. Kim

[Dollydog]

Becky,
My Lady was waiting for Coolidge....like Bonnie said about Chrissy and Lady....now Coolidge can compare notes with them. They are all at peace and having a great time playing together.
Please take good care of yourself at this time and come back to let us know how you're doing.
Jo-Ann & my Dollydog angel

[sunimist]

Dear Becky,

Though I haven't posted in your thread, I have followed it daily and you are truly a remarkable and loving mom. Precious Coolidge knew how much you loved her. I am so very sorry she had to leave you and I know how heartbroken you are. My Misty was also there to help her cross over and greet her with some angel kisses.
Please know you are in my thoughts and prayers, as is sweet Coolidge. Rest in Peace beautiful girl.

Shelba and Suni

[Casey's Mom]

What a beautiful tribute to your Coolidge, she is now at peace. Hugs and love to you and your family,

[Squirt's Mom]

Dear Becky,

It is with great sadness that I read of Coolidge's passing. You and she have fought for so long and so hard to find an answer that would bring her some relief. As you said, she is no longer fighting now against a body out of control, but is once again as she was always meant to be - happy and healthy and strong.

Our deepest sympathies,
Leslie, Squirt, Ruby, Goldie and Crystal

[Carol G]

I am so sorry. My thoughts are with you.

Carol

[maggiebeagle]

So sorry to hear of your loss. I'll keep you in my prayers. Coolidge sounds like she was a real character. I'm glad you have so many happy times to remember.
Virginia

[corgipallie]

My heart is aching with you. I'm so sorry to hear about Coolidge's passing. May he run free in heaven.

[Harley PoMMom]

Dearest Becky,

Oh Becky...I am so, so sorry for the loss of your beloved Coolidge.
I realize mere words cannot ease the pain you are feeling right now, but know we understand your pain, we love you and we are here for you...always.

Someone posted that when you release your furbaby from their pain you take that pain and put it on yourself. Oh Sweety, that is exactly what you did for Coolidge and it was the most loving gesture of all.

Becky, I do hope and pray you come back and let us know how you are doing.

Peace Sweet Coolidge

With Heartfelt Sympathy,
Lori

[BestBuddy]

Becky.
You post brought smiles and tears. I am sorry Coolige has gone but your heart will always have those memories.
Jenny

[chelsealucy]

I am so very sorry to read you have lost your Coolidge run free little one you are at peace now.

[nikkismom]

I was so sorry to read of your loss of sweet Coolidge. Nikki has been gone three weeks, and I miss her every day, but like you, I'm glad she is at peace. You were a wonderful mom. Sharon

[Wylie's Mom]

Dear Becky,

I'm so sorry you had to say goodbye to your dear Coolidge... we know how much she meant to you. Thank you for sharing your fond memories of her. She is now happily romping running around with all her new friends.

((((Hugs))))
-Susy

[Coolidge]

Thank you all for your kind words, they are truly appreciated.

Coolidge has some great company at the bridge, I know she has lots of new friends.

[forscooter]

Dear Becky,

I am so very sorry to read of Coolidge's passing...I wish you peace.

I hope the memories you have will bring you comfort....

Hugs, Beth, Bailey and always Scooter

[Coolidge]

I don't know if anyone is getting responses to my private messages. My sent folder doesn't indicate they have been sent. I can only hope that they have reached their destinations.

Thanks.

[gpgscott]

Becky,

I am sorry that I did not hear of your loss of Coolidge until this morning.

Mine will all get special attention tonight in his memory.

Blessings to you and your family.

Scott

[Barney's Mom]

“Goodnight, sleep tight, God watch over you tonight.

See you in the Heaven’s light, Angels watch over you.”



That is just beautiful Becky. I am so sorry for your loss of sweet Coolidge. I am sure that Coolidge is watching over you too.

Cheryl

[ChristyA]

Becky,
I am so sorry for your loss. Coolidge was fortunate to have you and you were to have Coolidge. It brought a smile to my face to read your rememberances of Coolidge.

God Bless,
Christy

[Dollydog]

Hi Becky,
I just noticed that the little box that says to save my messages to the sent folder did not have the check mark in it. Maybe yours is not checked off either. Not sure how that happened but I've put the check mark back in the little box.
Take care,
Jo-Ann & my Dollydog angel

PS: Have just checked and the check mark won't stay in the box like it used to. It automatically becomes "unchecked" when I leave the private messages page so I have to check it each time I want to save a sent message.

[John II]

Hi Becky,

I am so sorry to hear about Coolidge.
My thoughts are with you.

[k9diabetes]

I just met, and then lost, Coolidge today... I'm so sorry for your loss. You wrote a wonderful tribute to her that conveyed beautifully how much you loved her. Bless you for providing her with such a loving forever home and Godspeed to her,

Natalie

[muskyhusky]

I'm so sorry for your loss, he is always and forever in your heart, you have my deepest sympathies.
Lynne, Shadow & Cooper

[ladysmom06]

Becky,

I am so very sorry for your loss of Coolidge. My thoughts and prayers are with you.