Harley 14y/o Pom-PDH-Lysodren switched to Vetoryl (Harley has passed) [Archive] - Canine Cushing's Information and Support Forums

Harley PoMMom

04-16-2009, 05:37 PM

Hi everyone!! Glad to see alot of you have made it here, I was so worried that I had lost you's just when Harley and I found such loving and supporting friends.:):) So, Harley's U/S showed and Confirmed: Gallbladder wall hyperplasia, right adrenal nodule (7.3 mm at caudal pole), left adrenal gland normal in size ( high end of normal range), small splenic nodule, and an enlarged liver. Also confirmed: Hyperadrenocorticism ( suspect pituitary-dependent). His blood pressure was elevated at 180 mmHg. They collected a sterile sample of urine to test for a urinary tract infection. They performed an endogenous ACTH level to see if this will help to determine which type of Cushings he has and I also requested they run a full adrenal panel through the Tennessee lab. Someone will call me with the results (endogenous ACTH, UTI, full adrenal panel) next week, then finally we can start Harley on meds. Dr. O'Neill (Univ. of Penn. woman IMS) is leaning towards trilostane for treatment and I am just not sure, what do you all think? His NEW vet back here in York, which I had a consult with on Monday said he's not real keen on treating Cush pups with trilo, but he would do whatever I wanted to do and he really was interested to hear what Univ. of Penn. diagnosed and what they wanted to treat Harley with. Dr. O'Neill did tell me to take Harley off the raw food diet, so now I'm feeding him Innova senior.

Lori and Harley

lulusmom

04-17-2009, 02:52 AM

Hi Lori.

I am glad to see that you made your way here too.

Can you tell us why your vet suspects that Harley has pituitary dependent cushing's. Just asking because from everything I've seen, the ultrasound findings don't clearly indicate PDH. My memory is bad and without the benefit of your thread on cc.net, I can't remember if perhaps Harley had an LDDS test that was consistent with PDH. In any event, the endogenous acth should give your vet a good indication as what you are dealing with.

I'm glad to hear that you are going to request a UTK adrenal panel. This is so important for anyone that is contemplating treating their dog with Trilostane. This test takes quite a bit longer to get results so I wouldn't expect them for about 10 days.

I think you need to get a confirmed diagnosis before you decide on an appropriate treatment. Surgery is usually the first option for an adrenal tumor; however, if treatment is chosen over surgery, then Lysodren would be a better choice of treatment. Trilostane is very effective in reducing cortisol; however, it is known to always elevate one or more of the intermediate sex hormones with long term use. This is particularly problematic for dog that already has sex hormone elevation(s). This is the reason why the UTK adrenal panel is so important before making your final decision.

My dogs are thriving and healthier than ever since switching them to a commercially prepared raw diet so I am curious as to why Dr. O'Neill had you change Harley's diet??

Glynda

Harley PoMMom

04-17-2009, 09:21 AM

Hi Glynda,
Harley's LDDS test results, taken 3/30/2009, were:
Suppression, 4samples
vet cortisol......................5.9................. ..............1-6...(resting)..uG/DL
Time 1:...........................10AM

vet cortisol......................9.5................. ..............uG/DL
.............................................Canin e...
.......................................POST DEX:..<1.0
.......................................POST ACTH:.5.0-18.0
Time 2:...........................2PM

vet cortisol.......................11.4............... ..............uG/DL
Time 3:............................4PM

vet cortisol.......................12.1............... ...............uG/DL
Time 4.............................6PM

I thought these numbers were pointing to adrenal cushings, but since the U/S did not differentiate between pituitary or adrenal, they are running the adrenal panel thru UTK lab. I was considering a CT scan on Harley's brain to see if we could find a pituitary tumor, do you know if anyone has had any luck with that? I asked down at Univ. of Penn. they didn't seem too hopeful that they would find a tumor.

As far as the raw food diet, I was making Harley's food at home, not getting the commercially prepared raw diet, like BARF, what do you feed your furbabies? If you don't mind me asking?

Thanks alot for replying back to me.....Harley and Lori

lulusmom

04-17-2009, 09:45 AM

Hi Lori,

Thanks for posting those LDDS results again. I now remember looking at them and thinking "adrenal tumor". The ultrasound results are more indicative of an adrenal tumor as well. The UTK panel does not differentiate between PDH and an adrenal tumor but the endogenous acth does so I'm glad that your vet will be doing one.

My dogs eat Primal organic, hormone and antibiotic free chicken. I buy the frozen nougats. You thaw out what you need in the refrigerator and serve it up.

Glynda

Squirt's Mom

04-17-2009, 05:08 PM

Hi Lori,

So glad you to see you and Harley made it here!

I'm not well versed on the LDDS, but from the ultrasound does sound more like ADH to me. Usually with PDH, both adrenal are enlarged and relatively close in size. The one adrenal being so much larger in Harley's U/S, makes me wonder if he doesn't have an adrenal tumor. That could be good news, tho! Adrenal tumors are the only form that offers a cure, in the US currently anyway. Will be looking forward to the andogenous ACTH results along with you and everyone else!

Sounds like the folks and U Penn are some fine docs! I'm glad you have a source like that so close!

Hugs,
Leslie and the girls

Wylie's Mom

04-17-2009, 06:51 PM

Hi Lori,

FWIW - I feed my cushpup Primal chicken also. I used to give him kibble and after reading an article on Raw Green Tripe, I added some of it in his diet. I've been trying for years to get Wylie's coat softer - it's always been dry. I tried supplementing with olive oil, Foster's & Smith 3V caps, fish oil...nothing worked. After a couple weeks of supplementing with some tripe, his coat started to get softer. He then was diagnosed with Cushing's and now has an IMS vet. In December I decided to get rid of the kibble and switch him to raw. The IMS did not like that idea and sent me several articles, basically being worried about bacteria with a dog having a compromised immune system. I was torn because she has a valid point, but I had seen for myself what a little raw can do (improved coat in Wylie's case) and what I've read of kibble also worried me. In the end, I decided to go with the raw.

Alison (Alison & Mia) had posted an article or link to an article about somone going to a veterinarian conference and commented on the "bacteria hysteria" that was present. For me, it helped put things in perspective.

-Susy

Harley PoMMom

04-17-2009, 07:28 PM

Hi Susy,
"The IMS did not like that idea and sent me several articles, basically being worried about bacteria with a dog having a compromised immune system." That's what the IMS said to me too, so you know me, all worried, have to switch food for Harley so he doesn't get sicker. UGH. This so hard sometimes, trying to do the right thing for your furbaby. Harley loved the home-cooked meals, so I compromised and give him alittle cooked lean meat and some raw vegs w/ his innova, he wolfs it down in seconds. Do you think that is ok?

Harley and Lori

Wylie's Mom

04-17-2009, 08:15 PM

A raw (uncooked) diet is different from a cooked meal. A properly handled & cooked meal shouldn't raise as much of a bacterial concern to your vet, IMO. I primarily give my pup Primal or Nature's Variety (Raw), about 70%; and some cooked Chicken & rice, about 20%; the rest is a mix of commercial treats and frozen veggies/fruit and a little kibble for his toy. I think it's apparent that my Wylie likes the cooked Chicken & rice the best, the way he violently eats it. Sorry, I can't really give you an opinion - I don't think I know enough about dog diets - plus, I don't really know how I feel about kibble anymore. I gave Wylie kibble for about nine years - I only give him a little now because I can't put raw or cooked food in his buster cube!

-Susy

Buffaloe

04-17-2009, 10:04 PM

Hi Lori,

I think I mentioned before, Harley sure is a cool looking dog. If Shiloh ever ran into him, I know she would just love him...she'd flirt with him like a school-girl.

Shiloh had a very large adrenal tumor, a very successful adrenalectomy in 2006 and is doing great today at 14. Most certainly, if Harley has an adrenal tumor it is very much on the small side. At 7.3 millimeters, that is about 1/8 the size of Shiloh's tumor and much smaller than most we have seen here. That is very good news! The results of the LDDS test indicate that it could be an adrenal tumor. What the chances are based on the LDDS test, I don't have a clue. Hopefully, the endog. ACTH test will give you more certainty. The adrenal panel is also a great idea. Most dogs with adrenal tumors secrete an excess of one or more of the intermediate hormones. If Harley has any elevated intermediate hormones, I think Lysodren would be a better choice than Trilostane.

I'm sure no expert on diet but I discuss it with my vet quite a bit and Shiloh is an awfully healthy dog at 14 1/2. For her kibble, I've always fed her Solid Gold Hundenflocken. I just buy the very best canned food I can find and give her about 1/4 can/day. I buy those cooked chickens at Costco and give her the white meat along with some organic brown rice and some brocolli, green beans, carrots, etc. I feel real good about giving her the chicken, organic rice and veggies and she loves it. Her only supplements are glucosomine and fish oil, every day.

You sure are going the extra mile with all of Harley's testing. I hope and pray it all pays off beautifully. All the best to you and Harley and Shi sends your cool boy kisses.

Ken

Barney's Mom

04-18-2009, 02:30 AM

Hi Lori,
I just wanted to say hello and welcome!
I see that we are neighbors! I just moved to York, PA six months ago. I have a border collie who has pituitary cushing's and is on Lysodren. I moved from MD and we were seeing an IMS there, but have just been seeing a regular vet here. It is nice to know that U of Penn is an option if needed.
Nice to see someone so close!

Cheryl

Harley PoMMom

04-18-2009, 10:30 AM

Barney's Mom

04-18-2009, 08:44 PM

Hi Cheryl,
It is comforting to know that you and your border collie (would his/her name be Barney?) live so close to Harley and I. What vet are you seeing down here? The Univ. of Penn.that Harley went to was in Philly (Matthew J. Ryan Veterinary Hospital), although I was told there is a Univ. of Penn. located in MD.

Yes, he is Barney :)
I live in west York and we were in the process of looking for a vet up here in York when my other dog Beth got in a scrap with my sister in law's dog and ripped her eyelid. We took her to Dover animal hospital and she was stitched up by "Dr. Rick" (that's what we call him, and his last name escapes me at the moment) He has been absolutely awesome and I was very lucky to find him.
Barney has been seeing him ever since he developed a corneal ulcer that is very slow in healing. He is coming due for a stim test, and if all is well and stable, I would like to have Dr. Rick continue to treat him for cushings as well.
He did have a stim test there a few months ago but the Dr and I don't see eye to eye on his treatment (his stim has been slowly trending upward and the other doc didn't want to tweak his meds or miniload him again since technically he was within normal limits, I will be astounded if he is still normal and not high, although he remains asymptomatic. but lol that's a whole other story)

What vet do you see here?
I am glad that Harley saw a specialist for diagnosis. The vet my dog used to see originally diagnosed Barney with adrenal cushings due to a poor quality ultrasound and was going to treat him with much higher doses of Lysodren to supress the adrenal tumor. All his other tests were positive for cushings but inconclusive for the type of cushings. The IMS found he had pituitary cushings and I shudder to think of what would have happened had we begun therapy on high doses. (he loaded on a bird dose)

Cheryl

Harley PoMMom

04-18-2009, 10:12 PM

Hi Cheryl,
I live in Strinestown, it's a little town about 10 miles north of York.
How is Beth doing with her eyelid? What breed is Beth? When I was searching for a new vet for Harley (long story about his old vet :mad:), Dover Area Animal Hospital is one I called also, they told me Dr. Anne Parker was their vet that was up on Cush dogs and I was going to go there but the Sunday before we were to go to Univ. of Penn., (which was on Tuesday 14), I noticed Harley was overdue for his rabies shot, so Monday morning I got up early and starting calling vets that I talked to before and asked them if they could get Harley in for his shot and the only one that would schedule me in on that day was Shiloh Vet. Hospital in Manchester, boy were they a life saver:eek: I believe I am going to call John Ingold Vet. hospital, located at 2200 west market street b/c he has a 24 hour emergency service of his own, in which HE is on call for, just to have him for a back-up for Harley.

Let me know how you make out with Barney, and I will pray his limits will be normal. How did your IMS find out Barney had pituitary cushings? Harley's diagnosis is still up in the air as to adrenal or pituitary :eek::confused: The IMS at U of Penn thinks pituitary, but I'm not so sure.

Take care........Harley and Lori

Barney's Mom

04-18-2009, 10:54 PM

Beth's eye has completely healed. Dr. Rick did an amazing job at stitching her up. Her eye was ripped back at the outer corner completely through. I can't even see the spot if I look for it. Beth is a pound puppy whose pappers say she is a german shepherd mutt. The vet doesn't think she is a shepherd. I've looked online at dog pics of black and tan kelpies that could be her twin. So who knows ;)

I have heard wonderful things about Anne Parker at Dover.

Barney was hard to diagnose. One ultrasound showed that one of his adrenal glands were enlarged. His stim as well as his endogenous ACTH came back inconclusive. He had a horrible painful episode in which we didn't know where the pain was coming from at the time (it turned out to be a herniated disc) and during his work up they did two more ultrasounds as well as an MRI that got much clearer images of the adrenal glands. Bilateral enlargement indicated pituitary cushings.

I like the idea of having a vet on call that you are familiar with. My best friend takes her dog to Dr. Ingold! She loves him but snuggles doesn't have any health problems, so I guess she hasn't really seen him in action.
(what a small world eh?)

I was looking at Harleys ultrasound and it does show both glands enlarged. Doesn't one gland usually atrophy in the case of an adrenal tumor? (its been awhile since Barney's diagnosis, forgotten alot of the specifics)

Harley PoMMom

04-22-2009, 11:49 AM

Hi all,
Dr. O'neill (Univ. of Penn.) called me on Sunday to tell me that Harley's adrenal panel bloodwork, somehow, got messed up, so today Harley is at his vet getting the panel redone again to be sent to UTK. Dr. Oneill did say that he does not have UTI (good news), but his Endogenous ACTH results are not back yet.
So, if you all would please keep fingers, paws crossed that Harley's bloodwork panel gets done right today and we receive the results soon (I know around 2 weeks), I'd appreciate it!!
Harley and Lori

Kwiggles

04-22-2009, 02:47 PM

Hello Lori,

I wanted to stop by and say hi to you and your handsome Harley. My dog Joe is in a similar boat as your Harley- he is positive for Cushings but despite extensive testing we haven't been able to definitively distinguish if it is adrenal or pituitary.

An abdominal ultrasound done on Joe at Cornell Vet Hospital about 4 weeks ago was able to clearly visualize the left adrenal and it appeared normal but slightly enlarged. The right adrenal could not be fully visualized or measured because it was obscured by a loop of bowel.

Not sure what your vet will recommend for Harley, but my vet's advice was to go ahead and put Joe on Lysodren to give him some relief from his symptoms, and at the same time continue to try to get a good visualization of the adrenals, by CAT scan, MRI or re-check ultrasound. So we just completed Lysodren loading on Sunday and I'm awaiting results of his ACTH stim test done yesterday AM.

I wanted also to tell you that I asked the ultrasonographer (her name was Dr Yaeger) about the guideline that 'when there is a tumor on one adrenal gland, the opposite adrenal is atrophied.' She responded that she has found that to be often not the case- that even with a tumor on one adrenal, the other may be normal size or even enlarged. Just thought I'd pass that along for what its worth.

Wishing you success in pinning down Harley's diagnosis and hoping you will get good results on his bloodwork.
Karen & Joe

Harley PoMMom

04-22-2009, 03:45 PM

Hi Karen and Joe,

'when there is a tumor on one adrenal gland, the opposite adrenal is atrophied.' She responded that she has found that to be often not the case- that even with a tumor on one adrenal, the other may be normal size or even enlarged. Just thought I'd pass that along for what its worth.
Hey thanks for the info, will keep that in mind, all info. is welcomed.
This waiting and wondering is awful :confused::eek:but what are you going to do:confused: When I picked Harley up at the vets office he was all smiles, he shows his teeth when he is happy, so I know they are good to him. They said they were just finishing the test (Spinning ??, freezing ??) and were getting the info. to send to UTK. Glad they know what they're doing :) as I sure don't feel like I do :confused: They took his blood out of his neck this time b/c they read in the info. pack that I gave to them from the UTK that if the blood samples are grossly hemolyzed they have to be repeated in a week, they said sometimes it's better to take the blood from the dogs neck than the leg, they did say why and I should have written it down, I will when I see them next week.
Poor Harley:eek: he has his neck, belly, right front leg and right rear leg all shaven, he doesn't know what to make of this bare skin :confused::eek:
We'll be watching for Joe's test results and crossing all of fingers and paws for good luck and believe me w/ 2 dogs and 2 cats that's alot of paws crossed!!:)
Talk to you soon, Take care,
Harley and Lori

Harley PoMMom

04-24-2009, 09:49 AM

A Doctor from Univ of Penn. called me yesterday with Harley's Endogenous ACTH results, he said the number's were high and indictive to pituitary cushing.:(:confused::eek:
I also heard from Harley's vet that they sent his adrenal panel out to UTK along with all his results/records related to his cushings. Now the waiting game :eek::eek::eek: I will post the details when I receive them for sure, b/c I know that I am going to need ALOT of advice.:eek::confused::(

Harley and Lori

Barney's Mom

04-24-2009, 01:29 PM

Dontcha just hate the waiting game?????????
It seems all my test results are due Friday and are never on time, so I am stuck the entire weekend wondering. Hopefully it goes quick for you!
ps...I passed the Shiloh Veterinary Hospital today and thought of you, haha!
Ironically, me and Barney were coming home from the vets.

Cheryl

Harley PoMMom

04-30-2009, 08:39 AM

Can anyone tell me what these endogenous results mean?

..............4/15/2009 11:09:00.........Reference Range.......Units
Endogenous ACTH.............41.1 (H).......(6.7-25.6)..........pmol/L
Aldosterone, Baseline.........197..............(14-957)...........pmol/L
Aldosterone 1h post ACTH...443.............(197-2103)........pmol/L

Any info would be appreciated,
Thanks,Harley and Lori

Barney's Mom

04-30-2009, 05:13 PM

Hi Lori,
Unfortunately, about the only one I can decipher is the endogenous ACTH, which you already know is high and would indicate PDH.
I am sure some of our members more experienced with a full adrenal panel can help you with your other numbers will be along this evening.

Cheryl

Harley PoMMom

04-30-2009, 06:14 PM

These other numbers were with the endogenous results, I haven't got the adrenal panel results back yet, still anxiously waiting :eek::confused: I was just wondering if these results should be emailed to Dr. Oliver (UTK).

Harley and Lori

Buffaloe

04-30-2009, 06:28 PM

Hi Lori,

I personally think the endogenous ACTH test is probably the best of the blood tests to differentiate between pituitary/adrenal cushing's. We never had that one done on Shiloh and I don't know how to interperet the numbers. But, they said it indicated PDH. I would think that is a positive because pituitary tumors are much easier to treat with medication than adrenal.

I also think it is really good that Harley's aldosterone is within the normal range. Shiloh's aldosterone was significantly elevated and she had the big adrenal tumor. All of her other intermediate hormones were within the normal range. I'm just saying, Harley having normal levels of aldosterone is a heck of a lot better than if they were elevated.

It sounds like your vet treats Harley very well. I know my vet and his assistants treat Shi really well because she gives my vet kisses...and Shi is pretty darn stingy with her kisses.

Lori, we were typing at the same time...if it were me I'd wait until I had all of the results from Tennessee before contacting Dr. Oliver. Hopefully in just a few more days.

Ken

Harley PoMMom

04-30-2009, 06:58 PM

Ken and Cheryl, you are both right, from what I am reading the high number for the endogenous ACTH test does indicate pituitary cushings for Harley :( I'm on pins and needles until the full adrenal panel results from Dr. Oliver gets back.:eek: Then I don't know what will be worse-- this waiting game-- or the treatment phase-- will I do it right:confused::confused::eek::eek:I'll be a mess:eek::eek: Hopefully, you'll all be here to help me thru it:p

Harley and Lori

Barney's Mom

04-30-2009, 10:43 PM

The waiting game is WAY worse than the treatments. ;) I still hate the waiting game. (waiting on stim test results now, lol)
We are right here with you! Hoping you get your panel back soon.
It's been over a year since Barney's diagnosis, and every single test he had came back consistent with cushings' but we couldn't differentiate the kind of cushings until his ultrasounds.
Sounds to me like Harley is PDH, and you are awaiting information to rule out that he is atypical also?

If this is solely PDH, have you given any thought to treatment?

Ps.....it was chilly today :)

Harley PoMMom

05-01-2009, 08:37 AM

Cheryl, Yes I am waiting to make sure Harley is not atypical also.

As far as treatment, I was hoping Dr Oliver would suggest something, if not, then I'll probably go with Lysodren, or what Harley's vet and I feel most comfortable giving to him. I really like Harley's new vet, and Harley does too.
When I get the adrenal panel results back, I will post them and hopefully I will get advice here as well. I DO NOT WANT TO MAKE THE WRONG CHOICE for Harley, so I am asking everyone and anyone to help me when this time arrives. It seems Harley's LDDS test was indictive to adrenal cushings and now his endogenous test points to pituitary, so WHAT DO YOU DO???:confused::eek: Harley's U/S really showed nothing but a small nodule on one of his adrenal glands and enlarged liver, so this tells me nothing.:eek::confused:
I've read trilo. is for both adrenal and pituitary cushings, but one can only treat a cushpup w/trilo as long as the cushpup is not atypical.
So, if I never really can pinpoint Harley's cushings, how can I really treat him properly? :confused::(

Harley and Lori

Harley PoMMom

05-06-2009, 08:26 PM

Here's Harley's results from the UTK.

.......................................result..... ..Normal.....RESULT(post.....Normal
....................................(baseline).... RANGE**.....ACTH)...........Range**
CORTISOL ng/ml.................61.6*....2.0-56.5.........129.8..........70.6-151.2
ANDROSTENEDIONE ng/ml.....0.43*...0.05-0.36.......1.67............0.24-2.90
ESTRADIOL pg/ml...............129.4*..23.1-65.1.......132.2*.........23.3-69.4
PROGESTERONE ng/ml.........0.66*....0.03-0.17.......1.15............0.22-1.45
17 OH PROGESTERONE ng/ml.0.30*...0.08-0.22........0.91...........0.25-2.63
ALDOSTERONE pg/ml ***......32.5.....11-139.9.........81.9...........72.9-398.5

(*Above or below reference range.)
(**Mean normal range values for neutered male dogs (N=37)),
(*** Normal range values for male and female dogs (N=72, baseline, N=23 post-ACTH).)

These results indicate presence of increased adrenal activity.(Mild)
Comments: Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens.:confused::eek: For elevated estadiol, some veternarians consider items 2 or 3 and 4 of attached sheet. Various treatment option considerations are attached. More estradiol information is on our website under Treatment Considerations.

I understand giving Harley Melatonin (regular, NOT rapid release) but for the flaxseed oil with lignans, the website they direct you to is confusing me-www.FLAXHULLS.COM, THIS WEBSITE is now selling pressed flaxhulls that they say are just for Atypical canine cushing's and the dosage is the same. I'm not so sure, does anyone know about this????

Any comments, advice, anything is appreciated on Harley's results, treatment, just talk to me please:eek::confused:

Harley and Lori

AlisonandMia

05-06-2009, 08:33 PM

I understand giving Harley Melatonin (regular, NOT rapid release) but for the flaxseed oil with lignans, the website they direct you to is confusing me-www.FLAXHULLS.COM, THIS WEBSITE is now selling pressed flaxhulls that they say are just for Atypical canine cushing's and the dosage is the same. I'm not so sure, does anyone know about this????

I personally don't know a lot about this (the whole flaxseed oil/hulls etc issue) - but don't worry others do! On the old board (cc.net) there was a lot of discussion about this so there is a quite a bit of knowledge here on the subject. Someone should be along with some useful input for you soon.:)

Alison

Buffaloe

05-07-2009, 12:54 AM

Hi Lori,

I can't help you with the flaxseed, etc. at all, we never dealt with atypical cushing's.

I've heard that Dr. Oliver may be on vacation but should return in a few days. Alison has all of his contact information, particularly his e-mail address. In my opinion, when you communicate with him, you should ask him if the U.T. test results give any indication that Harley may have an adrenal tumor. We had similar testing done and after going back and forth with Dr. O a couple of times, he eventually told me he thought Shiloh had a primary adrenal tumor....based on the test results. I'm just saying, I think it would be worth asking him about it in light of Harley's LDDST results and his ultrasound. Harley's post ACTH cortisol level was in the normal range which is often seen with adrenal tumors. That may also be common with atypical cushing's, I don't know. I'm strictly a layman but Dr. Oliver is THE expert. I think you should pick his brain a little when you get the chance...get all the information from him that you can. He is the best!

I think someone will be by soon to help you with the atypical treatment. I hope I didn't confuse you or worry you needlessly. I think after you converse with Dr. O everything (diagnosis, treatment) will be crystal clear.

Ken

Squirt's Mom

05-07-2009, 03:21 PM

Hi Lori,

I know how hard it is to relax when the diagnostic phase seems to go on and on, but I was like you and wanted to know all I could about Squirt's hormone functions that could effect treatment choices.

The most important thing on her results and treatment options was the suggestion from Dr O to have an ultrasound done. She had already had one four months earlier but I took his advise and had a second one. This is when I was told about a tumor on her spleen. To make a long story short, once the surgery was over and she had completely recovered, her cortisol level came back the lowest its been since 3/08 when she was diagnosed. Her signs are gone, she is doing very well tho she has not been tested again. Without his suggestion, that tumor would probably have ruptured, which is life-threatening. When I saw the comment about the nodule on Harley's adrenal, my antennae went up. Did the docs make any comment about that? I can't help but wonder if it could be the source of the hyper-adrenal activity. :confused:

I have included a portion of the treatment sheet from UTK showing the numbers Dr O listed and put the dosing info in bold. Many have not seen this sheet so don't really know what we are talking about when we mention it. :o

Anyway....the FSO (Flax Seed Oil) w/ Lignans was the standard approach at 1000 mg until the purified lignans in a capsule came on the scene. The purified lignans have a consistent dose of 40 mg/cap. Many dogs cannot handle the amount of oil in the FSO's so the caps helped them. Now, there are the crushed hulls. They serve the same purpose as the FSO w/lignans and the capsules. I use the purified lignans so I can't offer any first hand experience with the hulls, but it seems like Glynda was looking into it for her little ones. And on the old site, one, or more perhaps, of our members had opted to use them with apparent good results. It's is my opinion that if Dr O approves, then they have to be alright. ;)

The post numbers all look good to me except for the estradiol, which makes me wonder about that nodule again. I'm not sure what the pre numbers indicate but there are those here who do! :D

What Dr O is saying here, "Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens." is that the hormone estradiol can be produced (synthesized) in areas of the body other than the adrenal glands (where the other intermediate/sex hormones are produced) such as fat (Adipose cells/tissue). This is why Lysodren may not be effective on estradiol; Lyso works on the adrenal cortex only so since estradiol may be coming from fat tissue, the combination of melatonin and lignans are used as they will be effective outside the adrenal glands. Estradiol is one of the more difficult hormones to get control of because of this, but the bright side is that treatment for Atypical is much easier than for true Cushing's. ;)

You will do just fine with all this, Lori, I know you will. And we will be here with you all the way.

Hugs,
Leslie and the girls

Treatment Option Considerations Steroid Profiles in the Diagnosis of Atypical Cushing’s Disease Clinical Endocrinology Service/College of Veterinary Medicine/University of Tennessee

"2) Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a total dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a total dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs. Regular melatonin is usually used rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity (effective for ferret adrenal disease), and it inhibits aromatase enzyme (decreases androstenedione and testosterone conversion into estradiol) and 21-hydroxylase enzyme (effectively lowers cortisol level). Monitor treatment effectiveness by improvement in clinical signs, biochemistries or by repeat of steroid profile.

3) Melatonin Implants. Available for dogs and ferrets. (WWW.MELATEK.NET). Sizes are 8, 12 and 18 mg for <25, 25-50 and >50 lb dogs, respectively. Effects last 3-4 months.

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

4) Flaxseed oil (FSO) with lignans. The lignans in FSO have phytoestrogenic activity, and may compete with estradiol for tissue estrogen receptors with less biological effect. Lignans also inhibit aromatase enzyme (lowers estradiol) and 3-beta HSD enzyme (lowers cortisol). The oil may have low level of lignan, so a flax hull product may be preferable. E.g., WWW.FLAXHULLS.COM (standardized product with high content of lignan). Give SID on food: 1/2 tsp for dogs <30 lbs; 1 tsp for dogs >30 lbs. Also, WWW.VITACOST.COM/NSIFLAXSEEDLIGNANS. Standardized, lower concentration lignan product (40 mg capsules). Give SID: 1 capsule for dogs <30 lbs; 2 capsules for dogs > 30 lbs."

Harley PoMMom

05-07-2009, 05:41 PM

Oh Darn,:( just when I thought we might be on the road to treatment.
I pulled out Harley's papers from the Univ. of Penn. and there in my face is:

Confirmed: Right adrenal nodule(7.3mm at caudal pole), could be consistent with hyperplasia or an EARLY ADRENAL TUMOR.

Confirmed: Small splenic nodule.
Univ. of Penn. says to do another U/S in 6 months to see if the nodules have grown.

I called Harley's vet and left a message to see if we should have another U/S done now.

OMG, I never gave those nodules a thought bc when I asked Dr O'Neill(Univ. of Penn) about the nodule on Harley's adrenal gland, she said it was so small it PROBABLY had no effect on his cortisol levels.:mad:, so, thank you, thank you so much for bringing this to my attention Leslie and Ken. I really don't know what I would do without all your help and support.

Leslie, special thank you for deciphering for me about the elevated estradiol and peripheral tissues :) Was all jibberish to me :eek::confused: until you put into cushpup mom terms :D

Well, the ole boy nudgin me to go out, so I'll check back later.
Again, Thank you so much for the information.

Harley and Lori

Barney's Mom

05-07-2009, 06:10 PM

Not sure what to make of that Lori.
Honestly I don't think they do either. It is small that they aren't sure if it is a tumor, or hyperplasia, which is an overgrowth in the number of cells in that area.
I am still in the camp of I don't know what to think with Harley.

Also, if it is an adrenal tumor, they sometimes still treat with meds before surgery. So I guess a whole lot will be learned from your doc looking at the whole clinical picture, the lab results in conjunction with the US findings.

OMGosh, you have got to be going nuts at this point!

Cheryl

ETA:
Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens.

My knowledge here is strictly in humans, estradiol is an estrogen, the most prevalent form of estrogen in the human body. Fatty tissue can synthesize estrogen. That's why obesity is a risk factor or breast cancer, the increased amount of circulating estrogen.

Cheryl

Harley PoMMom

05-08-2009, 05:09 PM

I have, probably, a stupid question :o

"When using Melatonin, Typically, a total dose of 3 mg is given (BID) for dogs < 30 lbs."

Total dose, does that mean 3 mg twice a day or does it mean 1.5 mg twice a day??:confused::confused:

I should be getting this, yous are probably reading this and thinking "did this girl fall down and hit her head and can't think straight." :):confused::eek:
Well, I didn't fall down, but I sure can't seem to think straight right now.

Harley and Lori

Squirt's Mom

05-08-2009, 06:15 PM

Hey Lori, :D

No such thing as stupid questions!

BID means twice a day, every 12 hours, so that means you give 3mg 2X/day for a pup under 30 lbs.

I tried that fell-down-and-hurt-my-head thing once, no one believed me. :p

Hugs,
Leslie and the girls

Harley PoMMom

05-08-2009, 07:09 PM

Bless you Leslie,

I tried that fell-down-and-hurt-my-head thing once, no one believed me.

You know just what to say to make a person laugh when they feel like just screaming, bawling, tearing their hair out, etc... you get the picture~that's me right now!!:p :eek::confused::p

Harley and Lori

Truffa's Mom

05-09-2009, 04:06 AM

Hi Lori and Harley, I've seen you've been following us successfully to here.

My Truffa is an atypical cushings pup. I am not as versed on the tests and all about atypical, you would think, but no. I always ask for help here, is like mi mind doesn't want to understand. When we received the diagnosis we were sent home with the Melatonin prescription and the medicine for the high blood pressure. My vets never recommended the lignans or all the other options that Dr. Oliver suggests for atypicals.

So I asked on this forum, and after a lot of research on my part I decided to use The Mega Omega Organic Sprouted Flax High Lignans (http://www.health4allproducts.com/faq.htm), in part because Leslie bought all the inventory of the Flax Oil capsules that they were using on CC.net (kidding but true ;)) and because after reviewing several options I thought that this product was very interesting. Both my dogs take it now and they love it. I am buying it at http://www.tandjnaturals.com/ and I am very happy with it. We will have to do another UTK panel and for sure another Ultrasound and blood pressure to really be sure. But without knowing the numbers, I would say that she is doing better.

I know that raw food is the best, but I took a "middle option", in part because I am not sure if cancer is present so I am avoiding grains and things that can put a strain on her immune system. Ahhh and she lost her teeth, so I am giving her Thrive (dehydrated food that I mix with low sodium chicken broth and water) and also Core from Wellness (grain free kibble) mixed with the chicken broth. So far We all love the food here. I don't think most vets are aware of all the good diets that are listed beyond their commercial shelves.

Please say hello to adorable Harley and keep smiling.

Marcela & the Choco Labs

Harley PoMMom

05-09-2009, 10:17 PM

Hi Marcela & the Choco Labs,

Marcela and Truffa, what very unique and beatiful names. Thanks for the info and the links, I did check them out and found them very interesting.

When are you having the next UTK panel done? I am very anxious, as you are too, to see them numbers and I am glad to hear she is doing better.

Harley's vet said that she can do the Melatonin implant in Harley, if I choose to have it done, I'm not sure, do you know of anyone that has a furbaby with one? I didn't talk to her about the implant at all, so I don't anything about it and she is on vacation this week.

I love your avatar, Truffa sure is a sweatheart, I once owned a black lab named Blue. He loved to catch his frisbee.

Harley thanks you for keeping his Mom sane, well nearly :D

Take care, Harley and Lori

MiniSchnauzerMom

05-09-2009, 11:00 PM

Harley's vet said that she can do the Melatonin implant in Harley, if I choose to have it done, I'm not sure, do you know of anyone that has a furbaby with one? I didn't talk to her about the implant at all, so I don't anything about it and she is on vacation this week.

Scott's (gpgscott) Moria and also Steph's (corgipallie) Pallie have both had the melatonin implant.

Louise

Harley PoMMom

05-09-2009, 11:04 PM

Thanks Louise,

Do you know if they have had any luck with it?

Harley and Lori

MiniSchnauzerMom

05-09-2009, 11:26 PM

I know that Pallie has had more than one implant and I do believe the melatonin is doing its job. I'm not sure at this point if Moria currently has the implant or is taking the melatonin orally but as far as I know, Moria is doing well also.

Louise

Harley PoMMom

05-09-2009, 11:35 PM

Oh Louise, that's great news to hear, cushpups doing well.

From the little bit I've been reading or should I say comprehending:confused:, they have to replace the implants every so often, like every 4 months.

Just don't know if I would want Harley to go through that stress all the time, or maybe it's not that bad.:confused: Have to find out more :eek::rolleyes::)

Harley and Lori

StarDeb55

05-09-2009, 11:56 PM

Lori, Scott was using an implant on Moria, but he has said in the past that there is no definite way to determine when the life of the implant is running out. Mostly because of that, he has switched Moria to oral melatonin. He has also said that the implant did have a tendency to leave a pretty nasty looking scab. My Harley who is both Pit & Atypical has been using oral melatonin since diagnosis, along with the Flax Essence capsules.

Debbie

Harley PoMMom

05-10-2009, 01:37 AM

Debbie,

Do you get your Melatonin online or from where? How does one tell if you are getting the "pure" thing? I purchased Harley's at the 'Vitamin Shoppe' here in York, Pa. and am hoping they are of the right quality.

Harley and Lori

StarDeb55

05-10-2009, 07:43 AM

I just buy it at Target or wherever, making sure that I don't get the extended release version.

Debbie

Harley PoMMom

05-10-2009, 09:32 AM

Hello to all,

Just wanted to wish everyone a "HAPPY MOTHER'S DAY."

Squirt's Mom

05-10-2009, 11:51 AM

Thank you, Lori,

Happy Mother's Day to you as well.

Hugs,
Leslie and the girls

MiniSchnauzerMom

05-10-2009, 02:33 PM

Hello to all,

Just wanted to wish everyone a "HAPPY MOTHER'S DAY."

.....and a very "Happy Mother's Day" to you and all the other Moms from me also!!

Louise

gpgscott

05-11-2009, 05:27 PM

Hi Lori,

So you have a complicated diagnosis going on and you may or may not have an adrenal tumor.

Concerning the melatonin implant, Stephanie (corgipalliesmom) still does it, I do not.

As has been mentioned there is no concensus concerning the effective life of the implant, and the needle is large and can cause bleeding and scabbing.

I like the oral. It is cheap, you see it go down, and in our case combined with the lignans and other support (purified lignans, lecithen, milk thistle) it is effective.

I have not studied your entire thread and so some of these comments might not apply to your case.

I can't see a downside to trying the oral melatonin first.

As has been mentioned the most commonly prescribed dose we see is 3mg twice daily and you do not use the timed release product.

Best to you and Harley.

Scott

Harley PoMMom

05-11-2009, 05:57 PM

Hi Scott,

Thanks so much for posting to me, your opinion on the implant was very much appreciated and helpful. :)

the needle is large and can cause bleeding and scabbing.
:eek: Harley does not like needles, so this was valuable information, and I don't want to put him thru undue stress if I don't have to.

So, the oral Melatonin and the pressed flax hulls will be what he is on.:D

Thank you again Scott,

Harley PoMMom

05-12-2009, 01:56 PM

Hi To All,

I sent DR. Oliver a e-mail concerning Harley and his diagnosis and treatment, I would like to share it with you all and get your opinions/advice/whatever:)

The cortisol levels are fairly normal, although baseline is slightly
high. So, this would be called Atypical Cushing's syndrome (cortisol
essentially normal, but sex hormones are increased).
>>>The Estradiol levels are very elevated and probably causing rhe most
problems. Other intermediate hormone levels are also increased at
baseline. by DR. Oliver of Harley's Full Adrenal Panel.

But does Harley have pituitary cushings as well as Atypical? So will I
be treating Harley with something more powerful later? (Pituitary
cushings noted below by his endogenous test)

The hormone levels above support what is called Atypical Cushing's, and
it is due to a pituitary-dependent condition based on the endogenous ACTH
test result. Atypical Cushing's can be caused by eithe pituitary-dependent
disease or adrenal-dependent disease; in this case, pituitary-dependent. answer by Dr. Oliver

I'm sorry for all the questions, and I hope you can answer them for
me. Should I be running more test? Another ultra-sound? His Ultra-
sound did show a 7.3 mm nodule on his right adrenal gland, (U/S done
4/14/2009 @ University of Pennsylvania Vet. Hospital).

The nodule is probably not an issue at this point. The endogenous ACTH
level indicates the problem is with the pituitary (probably a small tumor
in the anterior lobe of the pituitary) that is releasing excess ACTH, and
this is stimulating the adrenals to produce excessive adrenal steroids.

>>>Treatment in this case can be melatonin and the flax hull product, and a
maintenance dose of Lysodren can also be added to give greater coverage
(treatment effect). I can discuss this with your veterinarian if it would
be helpful.

>>>Hope that helps. Regards, Jack.

StarDeb55

05-12-2009, 03:29 PM

Lori, Dr. O isn't saying that Harley has Pit Cushing's, too. What he is saying is that the source of the Atypical is coming from a lesion in the Pit gland which is causing the adrenals to pump out the excess intermediate hormones. To have Pit Cushing's, the cortisol must elevated. Harley's cortisol is basically normal. (You always look at the post value which is the most important). Atypical can be either adrenal or pit-based, just like regular Cushing's.

What do the vets say about monitoring the nodule on the adrenal gland? Have they said to do a US after a certain period of time to see if there are any changes in that nodule? If they haven't said anything, I would ask.

Debbie

Harley PoMMom

05-12-2009, 03:38 PM

Debbie,
Thanks for your post.

Harley's vet want to do another U/S in 6 months to see if the nodule has grown.

Harley PoMMom

05-21-2009, 08:49 AM

Hi Everyone,

Glad to be home, can't post long, I am at work :( Will post later

AlisonandMia

05-21-2009, 09:01 AM

Hi Lori,

As you can see I've merged the new thread you started here today with the "imported" thread from K9Diabetes. Looked like basically it worked well. Yours is the first thread to be merged with the imported K9Diabetes thread, BTW.:)

Alison

Harley PoMMom

05-21-2009, 11:54 AM

Hi Alison,

You guys are angels. The thread is perfect. Thank you, Thank you very, very much. :D:D:D

Harley PoMMom

05-29-2009, 02:14 PM

Hi Everyone,

Dr. Owens (Harley’s vet) talked to Dr. Oliver about Harley, just making sure we are doing everything we should be doing for his atypical cushings bc this is their first case of an atypical pup.

Anyways, one question he asked her was if I was using any cream or lotion that had Estrogen in it. He said bc Harley’s estradiol levels were so elevated that if I were using anything that had estrogen in it Harley’s skin would absorb it and it would cause his estradiol levels to rise.

Although I do not use anything with estrogen in it, I thought this was worth mentioning.

Take care, Lori and Harley

gpgscott

05-29-2009, 04:24 PM

Hi Lori,

Sounds like it is going well, you have your Dr. and now also Dr. O actively involved.

Best to you both.

Scott

StarDeb55

05-29-2009, 04:41 PM

Lori, you may want to take a look at the comments my derm vet has made concerning estrogen levels on the following thread that I started in the "Everything Else" section.

http://www.k9cushings.com/forum/showthread.php?t=540

Debbie

Harley PoMMom

05-29-2009, 05:03 PM

Hi Scott,

Although none of Harley’s cush-symptom’s have subsided, he is still a happy, soon to be 13 y/o boy.

Dr. O says to give this at least two months to see results (symptoms) and to retest his estradiol only in two months (in July).

Then in another four months (around Nov.) do another ultrasound to see if that nodule has grown and then do another full adrenal panel.

Dr. O also told Dr. Owens to send Harley’s test (estradiol) to UTK bc all labs have different reference ranges and ways of doing the tests.

I believe I will have another CBC done too since his ALP, ALT, and cholesterol was high.

Best to You and Moria too,

Lori and Harley

Harley PoMMom

05-29-2009, 05:26 PM

Debbie,

I did read that, and I thought OMGosh that sounds similar to Harley.

Harley has always had dry, flaky skin, and twice he got that bald spot on the base of his tail. Poor thing, it got beet red, took him to the vet and the vet put him on prednisone for a week and it cleared right up :(

When we were at the U Of Penn. I mentioned his skin condition to the IMS, she didn't think it was a big deal :mad::( but I do, never knew what to do about it tho.:(:mad::(

Hopefully now that Harley is on the Melatonin and lignans his skin condition will get better. :confused::)

Good Luck with dear Chewy and them allergies/estrogen and I hope your sweet Harley soon finds something he loves to eat.

Take care, Lori and Harley

forscooter

05-29-2009, 10:50 PM

Hey Lori,

Not sure if this would help or not but thought I'd throw it out there. Scooter had awful skin...one thing that helped was giving a bath and then using Aveeno Oatmeal Bath soak. I would rinse him with it for about 15 minutes and then not rinse...just towel dry. It helped to soothe things until the skin would clear on its own.

Hugs to you and Harley! Beth, Bailey and always Scooter

Wylie's Mom

06-25-2009, 05:36 PM

Hi Lori,

I saw your post on Asia's thread:

... The only problem I see with using the pressed hulls is when I mix them into his food, sometimes, when Harley is done with his food I see some of them left behind, (they kinda look like ground pepper). I guess I need to mix them into his food better.

I haven't used the pressed hulls, but if they're like pepper, I can imagine how they might stick to the bowl and be so small that it wouldn't be worth the effort for Harley to lick them all off. I don't know if you're still preparing home cooked meals for him, but maybe whatever it is, you can make little meatballs with them with centers full of the hulls? - just a thought;).

-Susy

Harley PoMMom

06-25-2009, 05:52 PM

Hi Lori,

I saw your post on Asia's thread:

I haven't used the pressed hulls, but if they're like pepper, I can imagine how they might stick to the bowl and be so small that it wouldn't be worth the effort for Harley to lick them all off. I don't know if you're still preparing home cooked meals for him, but maybe whatever it is, you can make little meatballs with them with centers full of the hulls? - just a thought;).

-Susy

That is a really good idea, he would love the meatballs. Thank you so much, Susy.

Harley PoMMom

06-29-2009, 06:13 PM

Hi Everyone,

We are seeing some very good changes in Harley this past week. His pee is YELLOW!!! :):):) He has more spunk, wants to play with his frisbee and when I MAKE him come back inside he wants to toss around one of his many toys!!! :D My sister noticed the change in him too. The sparkle is back in his eyes again, he's almost like his "ole self", before cushings.

I guess we'll know for sure when the tests are done on the 16th of July, but I believe he's feeling better for sure.

So we're going to our happy, feeling good, yellow pee dance, not sure how it's done, but we'll make it up as we go!! :eek::D

Hugs to all.
Lori and Harley.

gpgscott

06-29-2009, 06:42 PM

Hi Lori,

That is wonderful news especially the yellow part:D

As far as the dance, I think most any step that avoids the puddle would be appropriate;)

Scott

lulusmom

06-29-2009, 06:56 PM

YAY, YELLOW PEE RULES!!!!! Congratulations. Doesn't it do your heart good to see your baby acting like his old self again. I do remember that feeling with both Lulu and Jojo.

After two years of Jojo drinking and peeing buckets and failed attempts to remedy it with desmopressin drops, I gotta tell you that if my boy peed yellow, I would not only dance in the puddle, I'd roll around in it. Eeeeewwww!

G.

Harley PoMMom

06-29-2009, 08:33 PM

Oh Glynda you are so right, Yellow Pee Rules!!

I am so thankful that when I first came to the forum that you shared your story with me about Lulu and Jojo. It gave me the courage to speak up to Harley's former vet and I am forever grateful for you for that bc I don't even want to think about the negative consequences that Harley might have suffered in the hands of his former vet.

These positive results are because of all of you, your awesome wisdom and knowledge of cushing that you lovingly share with members. You guys are so wonderful, and I thank all of you from the bottom of my heart.

Hugs to all of you.
Lori and Harley.

lulusmom

06-29-2009, 10:01 PM

Lori, the positive results you are seeing in Harley are because you have become a wonderful and educated advocate for him. All any of us did was share our experience and try to arm you with knowledge. The decision to take an active role and have an informed say in Harley Treatment was yours and yours alone. Like we always say, you are your furbaby's only voice so make it heard. You made your voice heard loud and clear and for what it's worth, I am very proud of you. Harley is a lucky boy to have a kick butt mom like you for a mom. :D:D:D

Glynda

P.S. I've noticed that you have done a fair amount of your own sharing and supporting. You have learned a heck of lot since we first met and there is no doubt in my mind that you have already helped a good number of members. Good for you!!!

BestBuddy

06-29-2009, 11:28 PM

Gotta love yellow pee.:D
I still wouldn't be dancing through it let alone rolling in it.:eek:

Jenny

Barney's Mom

07-24-2009, 11:08 AM

Gotta love yellow pee.:D
I still wouldn't be dancing through it let alone rolling in it.:eek:

Jenny

slacker! :D

Barney's Mom

07-24-2009, 11:09 AM

Lori, I had to go back to June to find Harley's thread! It is time for updates!

Harley PoMMom

07-24-2009, 05:29 PM

Hi Cheryl,

Thanks for checking in on us. :D

I had Harley in on the 20th for his tests...estradiol, geriatric senior profile and an urinalysis. I am waiting for the estradiol results. :eek: You all know the waiting game. :( When I get the estradiol results, I'll post everything...and then once again...if everyone would kindly help me figure things out.

Harley is still doing great, still playing frisbee and with his toys.

Hugs to all.
Lori

ladysmom06

07-24-2009, 05:37 PM

Hi Lori,

Harley is still doing great, still playing frisbee and with his toys.

Great News!!!!!! :):):):) Hugs to the two of you.

Wylie's Mom

07-24-2009, 05:57 PM

Hi Lori,

We're waiting with ya! Glad Harley is doing so well!

That dratted estradiol... I hope the Hulls did wonders (beyond the yellow pee:p).

-Susy

Barney's Mom

07-26-2009, 04:49 PM

Hi Lori,

We're waiting with ya! Glad Harley is doing so well!

That dratted estradiol... I hope the Hulls did wonders (beyond the yellow pee:p).

-Susy

What she said!

labblab

07-26-2009, 05:15 PM

Truffa's Mom

07-28-2009, 02:11 PM

Just checking :D on you guys. Meanwhile enjoying the frisbee play and the yellow dance

Barney's Mom

07-31-2009, 12:30 PM

hey Lori, any news yet?
The yellow pee continues?
Hope all is well with you guys.

Cheryl

Harley PoMMom

07-31-2009, 12:52 PM

Thanks so much for checking in on us.

I called my vet at 9 am and she said she heard nothing from UTK, so I just got off the phone with the lab from UTK and they are now just finishing up Harley's test. So... hopefully I will know soon. UGH this waiting. :eek::eek:

Love and hugs.
Lori

Squirt's Mom

07-31-2009, 02:05 PM

Hi Sweetie,

Good to know the sample is being worked on and results will soon be in your hands! I was just before telling you to ask your vet to check their freezer....;):p:D

Patience is one factor that is not deemed a "requirement" when we start this Cushing's journey, but I think it should be as much as we sit around WAITING. Man! The things we learn with Cushing's ....whether we want to or not! :rolleyes::p

Hugs,
Leslie and the girls

Coolidge

07-31-2009, 02:22 PM

I'm sure you will update as soon as you know. Thinking of you and Harley....

And, there is nothing as loverly as yellow pee.

Harley PoMMom

07-31-2009, 07:03 PM

Dear Lori,

I've just now gone back to re-read your entire thread, and I am so ashamed that there is not one single word of welcome or support from me before this!! :o My feeble excuse is that you have largely been dealing with Atypical issues, and I am not as knowledgeable about those as I would wish to be.

Please do not feel ashamed, you guys are so busy, I know administrators and the moderators can't get to everyone individually. Your welcome and support now means the world to me.

But please know that I have been following your journey, and I am so grateful for all of the wonderful support and information that you have been offering to all of our members. Thank you so much!!!!

Awww, heck, thanks...I am just trying to contribute what I can, yous have helped me and Harley so much and my gratitiude is unmeasurable...but thank you for the compliment Marianne.

I'm so pleased to know that, "outwardly," Harley is still doing great. :) And I'll surely be hoping that his "inward" test results will also be good ones! ;)

Thank you again, and my very best wishes to both you and Harley!
Marianne

Now for the "inward" test results.

Harley's last estradiol test done 5/1/09 result...132.2 pg/mL.
Harley's estradiol test 7/29/09 result...116.4 pg/mL..(N.R 23.1-65.1).
His ALT done 3/16/09...208 U/L.
His ALT done 7/22/09...188 U/L...(12-118 U/L).
His cholesterol is 557...(92-324 mg/dl).
His Bun/Creatinine Ratio..31...(4-27).
His Urea Nitrogen...28..(6-25 mg/dl).

SPECIFIC GRAVITY...1.006 (LOW)..(1.015-1.050).
PROTEIN...2+ (H)..(NEG).
PH...8.0 (H)..(5.5-7.0).
MICROALBUMIN...>30...(<2.5).

From UTK for elevated estradiol:
Comments: Consider items 1 through 4 on the treatment option sheet attached.

1) U/S and or Endogenous ACTH.
2) Melatonin.
3) Melatonin Implants.
4) Lignans.

So there we stand, altho it's only been 2 months on treatment, Harley started the melatonin and flaxhulls 5/16/09, I think it's good, could be better, but his low USG, High protein in his urine, high B/C Ratio and Urea nitrogen scare me. I'm thinking of having him tested for DI, not with the water deprivation test tho. I'm wondering if his kidney's are taking a whack too. We still need to do the U/S on his adrenal gland for that nodule, am trying to get that scheduled in for next week or the following at Univ. of Penn.

So any comments, opinions, suggestions, questions, anything you want to say is more than welcomed...please.

Hugs from Harley and Lori

Wylie's Mom

07-31-2009, 07:58 PM

gpgscott

07-31-2009, 08:15 PM

Hi Lori,

I am most concered with the high urinary pH. This can lead to UTI, the urine needs to be of a much lower pH to my understanding. I would be asking about an acidifier (dl methionine is one)

You have reasonable reduction in liver enzymes. The melatonin/lignans do not work fast, it took nearly a year to get Moria's value's into high normal range.

The kidey issue's I think are one of advancing age and you should be considering diet. I don't know any other way to address renal function.

Just my thoughts.

Thanks for posting the results and hoping to hear from others soon.

Scott

Squirt's Mom

07-31-2009, 08:32 PM

Hi Lori,

Harley has had some reduction in his estradiol and ALT, and I am always grateful for any drop in the estradiol...tho "normal" would be nice, huh? Harley is already on the hulls, isn't he? Compared to Squirt's estradiol levels, Harley's seems to be responding better than hers to treatment. So for nearly 3 mos. on treatment, I say not bad! In the next few months you may see that level come on down so more.

IMHO, that first recommendation for an ultrasound is one not to be taken lightly so I am glad to know you are already working on that! If I had let that slide thinking the Atypical was more important to focus on, Squirt may not have made it to today. ;) Very proud of you!

The kidney values are concerning to me as well, tho I don't know a lot about that. I'm sure Debbie will be able to tell you more there. :cool: Based on what Pallie has been through, that BUN/creatinine ratio scares me tho, as does the urea nitrogen level. Getting this checked out asap is a great move on your part!

You are working on these things so that is about all you can do now except WAIT! :rolleyes:

Hugs,
Leslie and the girls

Harley PoMMom

07-31-2009, 08:45 PM

Darn it, I wish I could make some insightful comment or suggestion for you, but I just don't know enough... I agree with your thinking of looking into DI & the kidneys, but that's as far as my knowledge on the two subjects go.

Sorry:(,
Susy

Oh Susy,

Thanks so much for looking at my post, your thoughts and prayers are much needed too, and I know you are sending them. :D

Hi Lori,

I am most concered with the high urinary pH. This can lead to UTI, the urine needs to be of a much lower pH to my understanding. I would be asking about an acidifier (dl methionine is one)

I will ask my vet about an acidifier, thank you Scott.

You have reasonable reduction in liver enzymes. The melatonin/lignans do not work fast, it took nearly a year to get Moria's value's into high normal range.

Yes, I am pleased with the ALT, however the ALP went from 416 to 1289, but I figured that would rise significantly, so I am not that worried about the ALP, just the ALT.

The kidey issue's I think are one of advancing age and you should be considering diet. I don't know any other way to address renal function.

I am addressing his diet but not for kidney disease, at least I thought I was doing a better job, looks like I am going to have to do a even better, better job and like you said a diet for renal function. :o

Just my thoughts.

Thank you very much for your thoughts, they are very much appreciated.

Thanks for posting the results and hoping to hear from others soon.

Scott

Hugs to you both.
Lori

MiniSchnauzerMom

07-31-2009, 10:41 PM

Hi Lori,

Haven't posted to Harley's thread for a bit. Just read it again to refresh my memory. Some good that did! :( I'm an Atypical dummy and my dealings with kidney values all pertain to my "abnormal is normal" Munchie. I can offer my support and prayers for Harley though!

I do have one question for you. Back in April Harley had elevated blood pressure. Has his blood pressure been rechecked or was he put on any bp meds? If it was just the white coat effect that caused the increase it wouldn't be a big deal. However, consistently elevated bp with no treatment can have a negative impact on the kidneys. Just thought I'd ask.

Sending scritchies for Harley...scritch, scritch!

Louise

forscooter

07-31-2009, 10:44 PM

Lori,

I don't have much to add unfortunately, but I am also wondering about starting a med for the kidneys to avoid further damage? Bailey is in the very early chronic renal stages and was put on enalapril which helped bring those numbers back into range....

just concerned about the high ratio....

Lots of hugs! Beth, Bailey and always Scoobie

corgipallie

07-31-2009, 10:53 PM

High protein in his urine, high B/C Ratio and Urea nitrogen scare me.

Hi Lori!
Did you get the creatinine tested as well as the BUN? Harley's BUN is a little high, but only by 3 points. The creatinine is more of an indication of kidney function. And did you get a full urinanalysis? Measuring blood cells? Casts? Bacteria possibilities?

Protein in his urine can mean the kidneys are not processing as well as they should but it doesn't necessarily mean renal failure. It just means the kidneys are allowing more protein to escape. Pallie's protein loss has been high for 2 years. It was just recently she had that acute kidney failure attack, which was directly related to repeated and repeated UTIs.

With that protein loss and a little high BUN, if you didn't get a full urinanalysis (one sent to a lab, not done in house), I would think about asking your vet about that. A UTI (including kidney infection) can definitely cause these values to be elevated.

If an infection is ruled out, then maybe you could be looking at the early stages of renal failure, in which Harley can start some medications to help improve his kidney function as well as a diet more suited to protect his kidneys.

I'm also curious about blood pressure if you've had it checked. High blood pressure can be from the atypical cushings or kidney problems (or a number of things). Pallie takes an ACE inhibitor called Benazepril which is used to control her blood pressure and it also dilates the blood vessels in the kidneys to allow the right stuff to filter through without losing the stuff that's not supposed to go through (glomerular function -- I think that is the right word. Glom____ something)

Keeping the atypical cushings under control is essential too because if that's not maintained, then the kidneys and UTIs will be more vulnerable.

Hoping for the best.

Steph and Pallie

Harley PoMMom

07-31-2009, 11:06 PM

Yep, Harley's vet and I will be doing alot of talking come Monday, she hasn't even seen his estradiol results yet.

Louise...thanks so much for reminding me about his BP, yes I did have that rechecked when he had his bloodwork done on 7/22, they gave me a piece of paper with some heart-beat lines on it (it's a copy and I can barely read it) with numbers, Harley's vet never went over it with me. :mad::eek: I just now, took it out and put it in my Harley notebook that I keep in my pocketbook for when I talk to Harley's vet on Monday, the notebook has all my questions in it that I want to ask her.

Love and hugs.
Lori and Harley

Harley PoMMom

07-31-2009, 11:40 PM

Hi Lori!
Did you get the creatinine tested as well as the BUN? Harley's BUN is a little high, but only by 3 points. The creatinine is more of an indication of kidney function. And did you get a full urinanalysis? Measuring blood cells? Casts? Bacteria possibilities?

Protein in his urine can mean the kidneys are not processing as well as they should but it doesn't necessarily mean renal failure. It just means the kidneys are allowing more protein to escape. Pallie's protein loss has been high for 2 years. It was just recently she had that acute kidney failure attack, which was directly related to repeated and repeated UTIs.

With that protein loss and a little high BUN, if you didn't get a full urinanalysis (one sent to a lab, not done in house), I would think about asking your vet about that. A UTI (including kidney infection) can definitely cause these values to be elevated.

If an infection is ruled out, then maybe you could be looking at the early stages of renal failure, in which Harley can start some medications to help improve his kidney function as well as a diet more suited to protect his kidneys.

I'm also curious about blood pressure if you've had it checked. High blood pressure can be from the atypical cushings or kidney problems (or a number of things). Pallie takes an ACE inhibitor called Benazepril which is used to control her blood pressure and it also dilates the blood vessels in the kidneys to allow the right stuff to filter through without losing the stuff that's not supposed to go through (glomerular function -- I think that is the right word. Glom____ something)

Keeping the atypical cushings under control is essential too because if that's not maintained, then the kidneys and UTIs will be more vulnerable.

Hoping for the best.

Steph and Pallie

Thanks for all that information Steph, I did get all that done, so what do yous think? What's in () is the reference ranges. Sorry I put it all up there, the good, the bad and the ugly. :):eek::D Love you guys. Lori

Harley's Creatinine from 7/22/09... 0.9 ( 0.5-1.6 mg/dl ).

Harley's Urinalysis from Antech Diagnostics 7/22 /09.
PH........8.0 (H).. (5.5-7.0).
SPECIFIC GRAVITy..1.006 (LOW)..(1.015-1.050).
APPEARANCE.....CLEAR....(CLEAR).
COLOR...YELLOW.
PROTEIN......2+ (H)...(NEG).
Urine protein verified with 3% sulfosalicylic acid.
GLUCOSE....NEGATIVE...(NEG).
KETONE...NEGATIVE..(NEG).
BILIRUBIN...NEGATIVE...(NEG TO 1+).
BLOOD...NEGATIVE...(NEG).
WBC...0-3...(0-3).
RBC...0-3...(0-3).
BACTERIA...NONE...(NONE).
EPITHERIA...RARE...(NONE-FEW).
RENAL EPITHELIA CELLS...NONE...(NONE-RARE).
TRANSITIONAL EPITHELIA CELLS...NONE...(NONE-RARE).
TRIPLE PHOSPATE CRYSTALS...NONE.
AMORPHOUS PHOSPATES...NONE.
CALCIUM PHOSPATE CRYSTALS...NONE.
CALCIUM CARBONATE CRYSTALS...NONE.
AMMONIUM BURATE CRYSTALS...NONE.
AMORPHOUS URATE...NONE.
CALCIUM OXIATE CRYSTALS...NONE.
URIC ACID CRYSTALS...NONE.
MUCOUS...NONE...(NONE-2+).
HYALINE CASTS...NONE SEEN...(0-3).
GRANULAR CASTS...NONE SEEN.
RBC CASTS...NONE SEEN.
WAXY CASTS...NONE SEEN.
WBC CASTS...NONE SEEN.
BUDDING YEAST...NONE...(NONE).
OVA FAT BODY... NONE...(NONE).

URINE MICROALBUMIN.

................... RESULTS. REFERENCE RANGES.
MICROALBUMIN. >30....... (<2.5)

Thank you guys, you are the best. Love yas! :D

corgipallie

07-31-2009, 11:59 PM

That urine looks beautiful! And your Creatinine is normal!!

So right now you're just looking at a little protein loss, a high pH (which can be a breeding ground for a UTI at some point) and a little high BUN (which can be related to water intake).

Kidneys seem to be functioning fine based on the creatinine and no infection based on those results.

If Harley is dehydrated or just not drinking enough, that could definitely affect that BUN. But it's not a bad result in my opinion. As I said, creatinine is a much better indication of kidney function

I honestly don't know if the BUN is affected by the pH or the protein loss or even the dilute urine. That may be something to ask you vet. You may want to ask him if there is something you can do or a food you can switch to in order to get the pH down.
Clear urine is good. Cloudy generally indicates a UTI (white blood cells floating around in there).

So the questions are:
Is Harley dehydrated? Or not drinking enough?
Why is the USG a little low? Could be cushings related or because of that protein loss/glom___ function?
pH? Does that need to come down?

Those are the questions I would be asking my vet in light of the results of the urinanalysis and the BUN results.

I am really unsure how the Atypical really plays into this --- but my suspicion is that the kidneys are having some issues with the glom___ function (aka protein loss) but overall they're functioning ok. They may be working harder though, and the more protein is lost, the more they are vulnerable to chronic kidney disease at some point. That's exactly what Pallie has been going through the last 2 years and why she was put on Benazepril 2 years ago. It helps those gloms. Rest assured that right now Harley is not in renal failure. Yet at the same time, you'll want to stay conscious of that creatinine and BUN in further tests since that protein number is an early indication. FYI, Pallie's protein was rarely 2+. It was usually 3+ and it varies between 2+ and 3+ depending on the test date.

In your next urinanalysis, you may want to add a Urine/Protein Creatine ratio (a different reading than blood work). The protein 2+ is just a dipstick reading. The UPC will give a better idea of really how much protein is slipping through.

Of course I'm not a vet and this is just my experience. Pallie's lab work goes to Antech too so I'm glad the results were easy and familiar for me to read. :)

And you know it takes about 3 months for the melatonin and lignans to affect the hormones so it's possible once the cushings is maintained, the protein issues could go down. And just FYI on the flax hulls -- if they are working for you, great!!! I put Pallie on them but after about 2 weeks went back to the lignan capsules. I think she was OD'ing on fiber and was having some GI issues. The hulls are 50% fiber and with everything else going on with her, I don't think her GI could handle that much fiber. If you see some GI issues with Harley, it could very well be the hulls. I learned that the hard way so I'm just passing that along.

corgipallie

08-01-2009, 12:17 AM

I just found this. Good info, although human-related and not doggie specific.:
http://kidney.niddk.nih.gov/kudiseases/pubs/glomerular/

Harley PoMMom

08-01-2009, 12:26 AM

Thank you so much Steph, I thought Harley was for sure having bad kidneys. You have definitely put my mind at ease, thank you, thank you.

Harley does not drink alot of water, and I have brought that to the attention of his vet many times, I guess on Monday I will force this issue with her. I think he pees more than he drinks. :( That's why I thought about the DI. He does have a dry, crusty nose too...hmmm.
Those questions you posted I will ask Harley's vet and thanks again.

Thanks so much for taking the time and reading my post and posting back to me, I know you have alot going on right now with sweet Pallie, it really means alot to me, you're a wonderful person Steph.

Hugs.
Lori

corgipallie

08-01-2009, 12:37 AM

The big question is: How is Harley feeling and behaving?
As my vet says related to cushings, numbers are numbers, but behavior can tell more sometimes. Pallie's hormones have been elevated for a while, but she's has always acted great (up until the recent UTIs, kidney and arthritis issues) and that's how we responded accordingly to treating the hormone elevations.

I'm glad you're going to your vet on Monday so you can get the blood and urine results professionally interpreted.

Harley PoMMom

08-01-2009, 07:12 AM

Hi Lori,

Harley has had some reduction in his estradiol and ALT, and I am always grateful for any drop in the estradiol...tho "normal" would be nice, huh? Do are pups know the word "normal," nor do they follow any of the "norms"!!

Harley is already on the hulls, isn't he? He's been on the hulls since 5/16/09.

Compared to Squirt's estradiol levels, Harley's seems to be responding better than hers to treatment. So for nearly 3 mos. on treatment, I say not bad! In the next few months you may see that level come on down so more. I hope we both see our pups levels coming down.

IMHO, that first recommendation for an ultrasound is one not to be taken lightly so I am glad to know you are already working on that! If I had let that slide thinking the Atypical was more important to focus on, Squirt may not have made it to today. ;) Very proud of you! Thank you Leslie, your opinions and recommendations mean alot.

The kidney values are concerning to me as well, tho I don't know a lot about that. I'm sure Debbie will be able to tell you more there. :cool: Based on what Pallie has been through, that BUN/creatinine ratio scares me tho, as does the urea nitrogen level. Getting this checked out asap is a great move on your part!

I got alot of feedback about this, and Steph (Pallie's Mom) was kind enough to look at Harley's numbers and said IHO altho he is not in kidney disease yet, I do need to take some action before this happens.

You are working on these things so that is about all you can do now except WAIT! :rolleyes: UGH..."patience you dunz", I keep telling myself! I know Harley's treatment is working, and it is going to take time, a long time for it to bring that estradiol level down to a more normal level, so I have to be patient and watchful of him and start adjusting his diet for his kidneys.

Hugs,
Leslie and the girls

Lori,

I don't have much to add unfortunately, but I am also wondering about starting a med for the kidneys to avoid further damage? Bailey is in the very early chronic renal stages and was put on enalapril which helped bring those numbers back into range....

I remember you were having some trouble with Bailey and you mentioned Steph and Leslie helped you out, was this it, his kidney's?
Sorry, I didn't mean to pry, none of my business...I am glad it brought his numbers back into range.

just concerned about the high ratio....Me too.

Lots of hugs! Beth, Bailey and always Scoobie

Thanks so much for caring enough to look at Harley's numbers and replying, it means the world to me, just please keep us in your thoughts and prayers.
Love and Hugs to you both.
Lori and Harley

Roxee's Dad

08-01-2009, 10:12 AM

Squirt's Mom

08-01-2009, 11:09 AM

Hi Lori,

I am so glad that Steph was able to talk with you and ease your mind about Harley's kidney values (and mine, too!). She's a sweetie!

Enjoy the weekend!

Hugs to you and belly rubs to Harley,
Leslie and the girls

Harley PoMMom

08-01-2009, 02:16 PM

Hi Lori,
I just wanted to drop by and let you know that although I haven't posted to you, I have been following Harley's story and do hope you get some positive answers from your vet Monday.

Don't know how positive those answers will be, but I will be definitely getting some answers. :(:)

Keeping you and Harley in my thoughts and prayers today.

We very much appreciate you keeping us in your thoughts and prayers.

Love and hugs.
Lori

Gabrielle

08-01-2009, 02:21 PM

I don't know a lot about what the numbers mean, but just want you to know I'm keeping Harley in my thoughts and prayers.

Lots of love and hugs,

Gabrielle and Charlie Brown

Harley PoMMom

08-01-2009, 02:33 PM

Gabrielle,

I'm keeping Harley in my thoughts and prayers.
Thank you so much Gabrielle, that means the world to me, your Charlie is in my thoughts and prayers too.

Love and hugs.
Lori

Dollydog

08-02-2009, 11:13 AM

Lori,
Here's hoping that you get some answers that set your mind at ease about Harley. Waiting is so difficult...
Jo-Ann & Lady :)

Harley PoMMom

08-02-2009, 02:15 PM

Hi Jo-Ann,

I also hope that I get some answers...don't know if the answers I get will be putting me at ease...but they will be answers. :eek::) The waiting is the pits...you would think we would be "pros" at waiting (NOT), I'm just a "beginner" at this and already this waiting for "test results, talking to the vet, getting appts. made, answers, etc...ugh," I don't know how you all that have been at this for years have done it and still have any sanity, hair, nails, nerves, etc...left. But I guess you get up the next day and forge on. :) and be thankful for that day with your furbaby.

Love and hugs.
Lori and Harley

Barney's Mom

08-02-2009, 05:40 PM

Hey Lori!
I don't think Harley's numbers look bad either. Barney has protein in his urine, and the IMS told me that it could be caused by the cushing's or it could be his blood pressure. He is so worked up when he goes to the vet, that it is really hard to get an accurate reading on him. It doesn't necessarily mean he has renal disease. We put him on Pepcid Ac, Benazepril, and fish oil to protect his kidneys.

I hate the waiting game over the weekend too! ;)
Ps..... I am off until Wednesday! Veggies are calling.........

Cheryl

Harley PoMMom

08-02-2009, 08:00 PM

Hi Cheryl,

Thanks so much for the info on the Pepcid Ac, Benazepril, and fish oil to protect his kidneys, I will ask his vet about that too.

Ps..... I am off until Wednesday! Veggies are calling......... Darn, my layoff doen't start until the 10th of August. :( and then I don't go back until the 24th, if it's convenient for you, maybe we can do the veggie thing in between those days??

Love and hugs.
Lori and Harley

MiniSchnauzerMom

08-03-2009, 02:07 AM

Hi Lori,

Just wanted to wish you good luck and answers when you're discussing all your Harley questions with the vet tomorrow.

Lots of Hugs,
Louise

Harley PoMMom

08-03-2009, 09:38 AM

Hi Louise,

Thanks for the good luck wishes, I will need them, the appt. with Harley's vet is at 3:30pm, and his ultrasound is scheduled for August 18th at 11am at the Univ. of Penn. So...all I need is answers. :confused::eek::)

You guys are the best, thanks so much for all your support, comments, opinions, ideas, suggestions, and being there for Harley and me. I hope you all realize how comforting it is to come here and know you are going to get sound advice and hand-holding at the same time.

Love and tons of hugs to you all.
Lori and Harley

Coolidge

08-03-2009, 09:58 AM

Good luck Harley!

Will be thinking of you both today.... Paws crossed that you have lots of answers!!!!

Harley PoMMom

08-03-2009, 10:43 AM

Hi Becky,

Thanks so much, and we need to get some answers for sweet, beautiful Coolidge too. Ugh, our furbabies, I wish they could tell us what is wrong with them...it just breaks your heart when you know your furbaby is not feeling up to "par."

Love and hugs.
Lori and Harley

Wylie's Mom

08-03-2009, 10:45 AM

labblab

08-03-2009, 01:07 PM

Tons of positive thoughts heading your way from our house, too!!

Marianne (forever Barkis' mom and Peg's and Luna's mom)

Wylie's Mom

08-03-2009, 02:08 PM

I found an Antech comment on the web for MA > 30. The comment on Wylie's sheet is exactly the same except the first line of his says "The MA is greater than 2.5 mg/dl and less than 30 mg/dl, indicating microalbuminuria."

The MA is greater than 30 mg/dl indicating overt albuminuria. A P:C ratio suggested to quantify the proteinuria.

Microalbuminuria (MA) usually indicates compromise of the glomerular barrier and is a significant finding when it is persistent (2 or more positive results obtained 2 or more weeks apart). Persistent MA, in the majority of pets, is due to renal injury secondary to other systemic disease or primary renal disease. Systemic diseases associated with persistent MA include inflammatory disease, chronic infections, metabolic disease (e.g. hypertension, Cushing's Syndrome, diabetes mellitus, hyperthyroidism) and neoplasia. False positive results may occur with pyuria and gross hematuria.
Suggestions for evaluating patients with microalbuminuria:
1. Check for and treat underlying diseases indicated above.
2. Recheck MA in 2-4 weeks
3. In the absence of underlying disease, monitor for progression of MA and development of renal failure

Harley PoMMom

08-03-2009, 03:20 PM

Hi Lori,

FWIW- in June 2007 Wylie had blood & urine work done with his former vet (he was showing signs of Cushing's /Atypical but they told me they didn't think he had Cushing's - later, when I got all test results to give to the new vet, I found that they missed several indications that he had cushing's - not saying Harley has cushing's, but there are some similarities and my former vet didn't make any comment to these findings):
pH - 8.0 H
SG - 1.012 L
Protein - 1+ H
Microalbumin 17.2 H

Do you have the Antech comments for the high Microalbumin? I have one for 2.5 - 30... I can post it for you, but Harley's is >30.

Good luck on your vet visit today, and yes, you have my thoughts & prayers;).

-Susy

Thanks so much Susy, I printed out the Antech comment you found to take along with me to the vet appt.

When I had Harley at the Univ. of Penn. before, they did a endogenous test on him, it was high...it seems they believe he has Pituitary cushings as well as his high estradiol hormone, but with that nodule on his adrenal gland...who knows. The info you provided, it very informative tho, I do believe Harley is a true cushings pup, just don't know if it's PDH or ADH...:(

Love and hugs.
Lori and Harley

4Mikeydog

08-03-2009, 05:08 PM

Hi Lori,

I haven't been around for awhile due to some personal business and I just read your thread...
We are sending positive healing prayers and wishes for sweet Harley. We hope you get some answers today.
Hang in there!

Dorothy and Mikey

Squirt's Mom

08-03-2009, 05:58 PM

Hi Lori,

Just checking in on you and Harley on this day of vet questioning. :p I hope you leave with some answers and some direction for Harley.

Hugs,
Leslie and the girls

Harley PoMMom

08-03-2009, 08:44 PM

Hi Everyone,

I had a nice conversation with Harley's vet, her name is Dr. Dena Owings. Our game plan is:

1) to get his BP checked and if it is indeed high then to get this under control. Appt. set up for 8/12. I thought this was done at his last appt., but it wasn't, I forgot until today when I asked her about it and then I remembered Dr. Owings telling me since she was running so behind schedule that day and Harley was so stressed out, that we should have his BP done at a later time.

2) along with the BP check on 8/12, he is getting an Urine/Protein Creatine ration test done, need to really find out how much protein is slipping thru.

3) Amylase and Lipase test done for his pancreas on 8/12. His tummy makes these gurgle sounds, and his U/S did say that he had prior bouts of pancreatitis, altho he doesn't throw up or have diarrhea, his tummy is alittle sensitive to the touch. This tummy sensitivity could be alot of things, but I want to know what his numbers are.

4) The dehydration issues and (DI) I will be taking up with Dr. O'neill, Dr.Owings doesn't feel qualified enough in this field and felt that Dr. O'neill and the Univ. of Penn is. So until then his diet is getting changed, which we talked about, white rice boiled in lots of water then mixed with boiled ground turkey then mixed with his Innova dog food, for now, when I get all his test results back and know exactly what we have to deal with, I will have a special diet made for him.

5) Oh, that white piece of paper with the heart lines on it, that I thought was his BP, was his EKG, DUH me, it turns out his heart is excellent according to the EKG and Dr. Owings. YAAA!!

6) U/S and urine culture at the Univ. of Penn 8/18, I think I might have an endogenous test ran too, don't know yet, his last one at Penn was 41.1pmol/L (High),(RR~6.7-25.0).

7) After all this then we need to get his teeth cleaned, his got some teeth that need cleaned bad...none are infected or anything I had her check, they just need cleaned.

So that's the "game plan" for now, if you all see anything I should be adding, please, please let me know. Again let me thank all of you from the bottom of my heart for all of your suggestion, comments and opinions, without them and you all I would be lost.

Love and hugs to my K9cushings family.
Lori and Harley

Barney's Mom

08-03-2009, 09:19 PM

Sounds like a good plan! The urine protein/creatinine ratio (UPC) is a good test to run. If the urine is dilute, as Harley's is, it's hard to get a handle on exactly how much protein is being lost in the urine. This would be much more accurate.
Not a bad idea to get the amylase/lipase run either.
Accurate BP's are so hard to get on a stressed out dog in a vets office. The IMS told me that even though they can be inaccurate, if you have more than one systolic blood pressure reading over 180, you should treat.

Sounds like things went well, and I am glad Harley's EKG is good :)

Cheryl

corgipallie

08-03-2009, 09:50 PM

Good to hear your visit went well and you got much needed info. UPC definitely. Glad you'll get that done!

His tummy makes these gurgle sounds, and his U/S did say that he had prior bouts of pancreatitis, altho he doesn't throw up or have diarrhea, his tummy is alittle sensitive to the touch. This tummy sensitivity could be alot of things, but I want to know what his numbers are.

Again, you may want to play around with his dosage of flax hulls. The tummy noises were exactly what Pallie had, which I concluded and my vet agreed was an overdose of fiber or her sensitive tummy not being able to handle that much fiber (the flax hulls are 50% fiber). Maybe cut a little flax hulls out and see if his tummy stops making noises while you wait to test the lipase/amalyse. If it does help, maybe talk to your vet or email Dr. Oliver on whether a lower dose would be ok or if you should switch to capsule lignans.

Truffa's Mom

08-03-2009, 10:11 PM

Sounds like a good plan to me too.

LOL with the confusion between the EKG & the BP. Sometimes I wonder if it would be a good idea that we the mothers, specially, would be put on a low dose of Anipryl at the same time our pups are diagnosed with Cushings.

Well everything seems to be quite on a good path, the amylase/lipase test is a good idea.

We will keep watching over you and Harley.

Wylie's Mom

08-04-2009, 06:39 PM

I agree with the others... good plan:). When you originally mentioned DI, I thought you meant Diabetes Insipidus:p... but now that I think about it, you probably had already ruled that out;).

Regarding dehydration issues, I do still measure Wylie's water intake (I don't bother taking into account moisture in his food)... if it looks like he's not drinking enough, I give him water spiked with dilute chicken broth.

BTW...did you read that Whole Dog Journal about Doggie teeth?

-Susy

MiniSchnauzerMom

08-05-2009, 06:29 PM

Hi Lori,

You've got it together, gal! Sounds like you had a very successful talk with Harley's vet and have everything covered.

After all this then we need to get his teeth cleaned, his got some teeth that need cleaned bad...none are infected or anything I had her check, they just need cleaned.

After Munch's current dental issues and the fact that inspection from the outside showed nothing wrong but the radiographs showed a whole different story - well, I'll never quite feel the same about someone just looking at his teeth. :(

Regarding the bp - different vets or different specialists all seem to have their own ideas/techniques. This is what they do w/Munch who was originally misdiagnosed and has an extreme case of the white coat problem. Maybe your doc would consider using this technique w/Harley? They use one of those bp machines that periodically inflates, records, deflates and then automatically takes another reading. Currently he is taken into a room and a tech holds him for awhile. They allow calm down time and several measurements are taken. On other occasions he sat in a room w/me and this was done. Mind, you - it has been determined that Munch has excellent bp. His doc discovered that if she remains in the room he is extremely stressed and his bp elevates but when she would leave all his readings were normal. When she'd walk back into the room his bp would spike to 200. :eek:

Good luck with all the testing and follow-up. I'm glad you're having all this checked out for Harley.....you're a good Mommy!!!

Hugs,
Louise

Harley PoMMom

08-05-2009, 08:41 PM

I agree with the others... good plan:). When you originally mentioned DI, I thought you meant Diabetes Insipidus:p... but now that I think about it, you probably had already ruled that out;).

Actually Susy, Diabetes Insipidus is what I was referring to, I just looked at my list and seen that I had dehydration issues and then the (DI) with no commas between them...DUH me...sorry for the confusion.

Regarding dehydration issues, I do still measure Wylie's water intake (I don't bother taking into account moisture in his food)... if it looks like he's not drinking enough, I give him water spiked with dilute chicken broth.

It would be hard for me to measure Harley's water intake bc I have another Pom. too, I don't know how to do it with 2 dogs. :confused:

BTW...did you read that Whole Dog Journal about Doggie teeth?

I didn't get to read that article yet...but I will...and thank you for posting that link for us.
-Susy

Hi Lori,

You've got it together, gal! Sounds like you had a very successful talk with Harley's vet and have everything covered.

Thanks Louise, I hope so.

After Munch's current dental issues and the fact that inspection from the outside showed nothing wrong but the radiographs showed a whole different story - well, I'll never quite feel the same about someone just looking at his teeth. :(

I was thinking the same thing, I'm going to have to find Harley a dental specialist...we're praying that you'll be hearing some good news soon regarding Munch.

Regarding the bp - different vets or different specialists all seem to have their own ideas/techniques. This is what they do w/Munch who was originally misdiagnosed and has an extreme case of the white coat problem. Maybe your doc would consider using this technique w/Harley? They use one of those bp machines that periodically inflates, records, deflates and then automatically takes another reading. Currently he is taken into a room and a tech holds him for awhile. They allow calm down time and several measurements are taken. On other occasions he sat in a room w/me and this was done. Mind, you - it has been determined that Munch has excellent bp. His doc discovered that if she remains in the room he is extremely stressed and his bp elevates but when she would leave all his readings were normal. When she'd walk back into the room his bp would spike to 200. :eek:

Thank you for that excellent advice, that is what Harley's vet said too, when Harley' bp was taken at U.P. he was already in a truck for 2 hours, had an U/S and endogenous test done, no food and was there for 5 hours, I think he was pretty stressed, so his bp of 180 wasn't that bad, so this time will be a whole lot different...exactly the way you said you do it with Munch and I hope and pray it's normal but if it's not then we will deal with it and get him on some meds.

Good luck with all the testing and follow-up. I'm glad you're having all this checked out for Harley.....you're a good Mommy!!!

Thanks Louise we need all the luck we can get, and like I said before our prayers and positive thoughts are with you and Munchie.

Hugs,
Louise

Love and hugs to you both.
Lori and Harley

Roxee's Dad

08-15-2009, 11:53 PM

Hi Lori,
I think the ultrasound is comming up very soon? Just wanted to wish you and Harley good luck. We'll be thinking about both of you.

BTW - did you get any of the results back from the test on Weds?

Harley PoMMom

08-16-2009, 12:30 AM

Hi John,

Yep, Tuesday the 18th we go to the Univ. of Penn. And thank you for keeping us in your thoughts and for the good luck, I do believe we will need it.

Harley's BP averaged out to be 195 :( and his urine protein/creatinine ratio test results were 2.5 :( normal range is </= 0.5 It will probably be another week until I get the results back for the amylase/lipase test.

Since we are going to the Univ. of Penn on the 18th, I will take up these issues (BP, UPC), with his IMS there and she can confer with Harley's regular GP here.

I am really worried, but I hope we are catching his kidney issues early enough and if we can get his BP under control hopefully that will help too.

All thoughts and prayers are very much appreciated.

Love and hugs.
Lori and Harley

MiniSchnauzerMom

08-16-2009, 03:33 AM

All thoughts and prayers are very much appreciated.

Lori,

More prayers for your Harley coming from me!

Louise

Squirt's Mom

08-16-2009, 11:07 AM

Hi Lori,

You and Harley have my prayers and well-wishes, too.

Hugs,
Leslie and the girls

frijole

08-16-2009, 01:06 PM

Lori, Add me to the list of those sending prayers and positive vibes your way. Hang in there and do keep us posted. Hugs to Harley. Kim

gpgscott

08-16-2009, 03:43 PM

Hi Lori,

Make sure you count me on the list of well-wishers.

Hoping for good news.

Scott

Barney's Mom

08-16-2009, 10:36 PM

Same here Lori, lots of good thoughts and prayers coming from us too!
Hugs,
Barney and Cheryl

lulusmom

08-17-2009, 05:34 PM

Hi Lori,

I am trying to catch up with everybody as I've been without a computer for a few days....so sorry for the late post. I am sending positive thoughts your ways and lots of prayers for you and your sweet Harley.

Glynda

Wylie's Mom

08-17-2009, 05:37 PM

Good thoughts & prayers from me, too!

-Susy

corgipallie

08-18-2009, 12:14 AM

Harley's BP averaged out to be 195 and his urine protein/creatinine ratio test results were 2.5 normal range is 0.5-1. It will probably be another week until I get the results back for the amylase/lipase test.

It is difficult to know how much that blood pressure level is due to being at the vet with a strange thing around his leg, or his actual blood pressure, but most vets will want to treat anything above 130. Pallie took benzapril, but there are several medications that can help Harley out.

That UPC ratio is high but not terribly bad. You knew from the other tests that he was losing protein. 2.5 is high, but not crazy high. Pallie's usually was in the 5.0-6.0 range. Pallie's benezapril was used to treat the kidneys and the blood pressure. The protein loss is a sign of kidney impairment, so this is just something to monitor and try to keep them as healthy as possible for as long as you can. The good news is the actual function, based on your last blood test, was perfect.

Good luck with the ultrasound and your visit to the university.
Steph and Pallie forever

Harley PoMMom

08-18-2009, 12:37 AM

I would like to thank everyone for their well wishes and prayers, it truly does mean so much to me.

And Steph...your post touched me so...reaching out to comfort me when it should be I doing that for you...thank you, Steph, you are such a loving and beautiful friend.

Love and hugs.
Lori and Harley

Barney's Mom

08-18-2009, 04:27 PM

How did it go today?

Squirt's Mom

08-18-2009, 04:29 PM

Waiting with Cheryl to hear what you learned today, Lori!

Hugs,
Leslie and the girls

MiniSchnauzerMom

08-18-2009, 04:37 PM

Add me to the waiting list with Cheryl and Leslie!!!! :D

Louise

gpgscott

08-18-2009, 05:36 PM

Whatssup!, Lori holdin out on us?:D

ventilate

08-18-2009, 09:01 PM

Lori;
I am waiting with the rest. I just wanted to add that the hypertension can be caused from the kidneys. If there is renal artery stenosis the blood flow is impaired to the kidneys, the kidneys dont like this and sent out hormones that cause the peripheral arteries to constrict, tighter arteries, harder to pump through, needs more pressure to get it through. thus the hypertension. I believe any kidney disease chronic or acute can also cause these hormones to be released. So it may be one of those chicken or egg, as hytension can cause kidney damage. Am anxious to hear what the specialist says. the ultrasound should tell some.
hoping all went well
Sharon

Harley PoMMom

08-18-2009, 10:09 PM

Hi to my dearest friends :)

We just got home at 6:45pm, they had an emergency u/s before us...poor Harley, Thank God I remembered to take some of his food along, he was starving when he was done at 4pm. Our appt was at 11am, he didn't have anything to eat after 9pm the night before. :eek: I never did find out about the emergency u/s case, we asked but they couldn't tell us anything, I respect that.

Well according to Dr. O'neill we need to address the following:

1) Harley's high BP, which was a surprisingly 160 there, still high, so he is on Amlodipine 2.5mg 1/2 tablet BID. He will be taken next week and the following week (reg. GP) to have his BP checked to see if this is helping and if it is; another UPC will be run to see if it has come down also.

2) Comparing his U/S's from 4/14 & today concerning the adrenals, the nodule on the right one has grown larger...7.3mm to 8.0mm and now both are enlarged, where on the 4/14 u/s only the right one was enlarged.

3) His pancreatitis: the u/s showed no change in his pancreas even tho his PLI was elevated at 528 (0-200ug/L), since he is not throwing up nor having diarrhea she believes changing his diet to a low-fat diet will help him. She did give me Tramadol for him bc sometimes he does seem very uncomfortable.

4) She does not think he has diabetes insipidus, 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.

5) An endogenous test and an urine culture were done, results pending.

6) More than likely this endogenous test will come back high as well, his last one was 41.1 (6.7-25.0pmol/L), his IMS and I have discussed Lysodren for Harley. Since the u/s showed both adrenals enlarged now and if/when his endogenous is high then more than likely Harley is PDH and this can be causing alot of his organ trouble also...right? especially since it's not controlled? Maybe that's why his other #'s starting going up, I'm thinking his high BUN, maybe even his high BP and UPC?? Anyways, this is what she is leading me to think about his kidney's, she saying since his creatinine is within normal range that his kidneys are ok...for now, but bc his BP is high and his cortisol isn't controlled that we need to act soon.

So sorry this was a book my wonderful friends and I've probably missed something.:eek: So...any comments, opinions, suggestions, advice...anything at all...Love you all.

Love and hugs.
Lori and Harley

Barney's Mom

08-19-2009, 06:11 AM

So we all wait, and I think we all went to bed at the same time!
Wow, she certainly was thorough! Glad Harley is started on the amlopidine. May be that will be all that is needed to stop the kidneys from spilling protein in the urine. I'd have to read up on the PLI again, but I believe that it is specific to lipase secreted by the pancreas only, and not other organs, so if it is high, it would be indicative of pancreatitis. I know you and Harley are doing the flax seed hulls, which are high in fiber. Some vets say hi fiber for pancreatitis, and some say low fiber, so who knows! Hoping that if the endogenous comes back high again in light of the new ultrasound findings, that Harley does start on Lysodren. We'll get the blender ready and have a loading party!
Poor Harley, I bet he was starved! Poor mom too! That's a long way from home! Looking forward to the endogenous results.
Cheryl

corgipallie

08-19-2009, 10:07 AM

I'm sorry his adrenal glands are enlarged. But I'm glad his pancreas is ok and no diabetes. I hope the blood pressure medicine works great!
I hope he's doing ok this morning.
I still have to take care of my peeps, as is Pallie from above.

Hi to my dearest friends :)

We just got home at 6:45pm, they had an emergency u/s before us...poor Harley, Thank God I remembered to take some of his food along, he was starving when he was done at 4pm. Our appt was at 11am, he didn't have anything to eat after 9pm the night before. :eek: I never did find out about the emergency u/s case, we asked but they couldn't tell us anything, I respect that.

Well according to Dr. O'neill we need to address the following:

1) Harley's high BP, which was a surprisingly 160 there, still high, so he is on Amlodipine 2.5mg 1/2 tablet BID. He will be taken next week and the following week (reg. GP) to have his BP checked to see if this is helping and if it is; another UPC will be run to see if it has come down also.

2) Comparing his U/S's from 4/14 & today concerning the adrenals, the nodule on the right one has grown larger...7.3mm to 8.0mm and now both are enlarged, where on the 4/14 u/s only the right one was enlarged.

3) His pancreatitis: the u/s showed no change in his pancreas even tho his PLI was elevated at 528 (0-200ug/L), since he is not throwing up nor having diarrhea she believes changing his diet to a low-fat diet will help him. She did give me Tramadol for him bc sometimes he does seem very uncomfortable.

4) She does not think he has diabetes insipidus, 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.

5) An endogenous test and an urine culture were done, results pending.

6) More than likely this endogenous test will come back high as well, his last one was 41.1 (6.7-25.0pmol/L), his IMS and I have discussed Lysodren for Harley. Since the u/s showed both adrenals enlarged now and if/when his endogenous is high then more than likely Harley is PDH and this can be causing alot of his organ trouble also...right? especially since it's not controlled? Maybe that's why his other #'s starting going up, I'm thinking his high BUN, maybe even his high BP and UPC?? Anyways, this is what she is leading me to think about his kidney's, she saying since his creatinine is within normal range that his kidneys are ok...for now, but bc his BP is high and his cortisol isn't controlled that we need to act soon.

So sorry this was a book my wonderful friends and I've probably missed something.:eek: So...any comments, opinions, suggestions, advice...anything at all...Love you all.

Love and hugs.
Lori and Harley

Squirt's Mom

08-19-2009, 10:22 AM

2.) Comparing his U/S's from 4/14 & today concerning the adrenals, the nodule on the right one has grown larger...7.3mm to 8.0mm and now both are enlarged, where on the 4/14 u/s only the right one was enlarged.

Hi Lori,

I cannot tell you how glad I was to read your report last nite even tho I didn't respond then. :o I had gotten really worried about you and Harley so was very happy to see you post! :D

It's really early for me plus the crud remains but in reading the above I have some questions/thoughts/concerns. Has it ever been said that Harley had ADH? (too lazy to look back :p:o ) The "nodule" makes me think ADH, especially since it has grown. It is possible that Harley could have both ADH and PDH, tho that is uncommon. Another possibility is that the adrenals have enlarged because of the uncontrolled hormone production, both cortisol and the ones associated with Atypical. The endogenous ACTH should shed some light on this for us.

IMHO, with all that Harley is experiencing with the kidneys, BP, growing adrenals, and pancreatitis, it is time for the Lyso to be added to his melatonin and lignans. Of course, the pending test results will be your guide in this. Don't be afraid...we will be with you as always. You are such a wonderful mom, this won't be a problem for you at all!

BTW, don't get carried away with lowering Harley's fat in his diet like I did with Squirt. :eek: They need fatty acids in the diet for the body to function properly...but I tried to remove ALL fat! Bad mama! :eek: Find a good holistic nutritionist or nutritional consultant who will take all facets of Harley and his life into consideration in making a diet for him. (BTW - Holistic is a way of looking at the whole dog; ie environment, age, breed, health issues, body mass, life style, personality, energy level, etc. VS only what the lab reports and studies say.)

Hang in there, honey!
Hugs,
Leslie and the girls

Harley PoMMom

08-19-2009, 12:12 PM

Wow, she certainly was thorough! Glad Harley is started on the amlopidine. May be that will be all that is needed to stop the kidneys from spilling protein in the urine.

She said if the amlopidine does not lower his BP then we will try benezapril, especially if his UPC is still elevated.

I'd have to read up on the PLI again, but I believe that it is specific to lipase secreted by the pancreas only, and not other organs, so if it is high, it would be indicative of pancreatitis.

You are correct, and she kept asking me, "Harley does not throw up? Harley does not have diarrhea?" And Harley is not throwing up and does not have diarrhea, I guess bc of his PLI being 528, she thought he would be having symptoms.

I know you and Harley are doing the flax seed hulls, which are high in fiber. Some vets say hi fiber for pancreatitis, and some say low fiber, so who knows!

She says low-fat, moderate fiber...so I guess she's a happy medium. :)

Hoping that if the endogenous comes back high again in light of the new ultrasound findings, that Harley does start on Lysodren. We'll get the blender ready and have a loading party! :eek:

Poor Harley, I bet he was starved! Poor mom too! That's a long way from home! Looking forward to the endogenous results.
Cheryl

I'm sorry his adrenal glands are enlarged. But I'm glad his pancreas is ok and no diabetes. I hope the blood pressure medicine works great!
I hope he's doing ok this morning.

Thanks for asking Steph, Harley's doing as well as can be expected after having all them tests + 2 rectal exams. One from the resident internist and the other from his IMS. :eek:

I still have to take care of my peeps, as is Pallie from above.

Hi Lori,

I cannot tell you how glad I was to read your report last nite even tho I didn't respond then. :o I had gotten really worried about you and Harley so was very happy to see you post! :D

It's really early for me plus the crud remains but in reading the above I have some questions/thoughts/concerns. Has it ever been said that Harley had ADH? (too lazy to look back :p:o ) The "nodule" makes me think ADH, especially since it has grown. It is possible that Harley could have both ADH and PDH, tho that is uncommon.

Leslie this is such a question that I've been asking myself and others, Cheryl and I talked about it, Dr. O and I hit lightly on it. From his UTK panel from 5/1/09...all baselines were elevated EXCEPT Aldosterone...his post, ONLY his estradiol was elevated. This is where I get confused, Dr. O called Harley Atypical with that adrenal panel but was he just hyperstrinism? His cortisol was, at baseline ~ 61.6 (2.0-56.5) and at post 129.8 (70.6-151.2).

Another possibility is that the adrenals have enlarged because of the uncontrolled hormone production, both cortisol and the ones associated with Atypical. The endogenous ACTH should shed some light on this for us.

I plan on getting another full adrenal done before starting Lysodren, I need to find out if I have to stop his melatonin and hulls treatment for this.

IMHO, with all that Harley is experiencing with the kidneys, BP, growing adrenals, and pancreatitis, it is time for the Lyso to be added to his melatonin and lignans. Of course, the pending test results will be your guide in this. Don't be afraid...we will be with you as always. You are such a wonderful mom, this won't be a problem for you at all!

BTW, don't get carried away with lowering Harley's fat in his diet like I did with Squirt. :eek: They need fatty acids in the diet for the body to function properly...but I tried to remove ALL fat! Bad mama! :eek: Find a good holistic nutritionist or nutritional consultant who will take all facets of Harley and his life into consideration in making a diet for him. (BTW - Holistic is a way of looking at the whole dog; ie environment, age, breed, health issues, body mass, life style, personality, energy level, etc. VS only what the lab reports and studies say.)

I am going to get a diet made for him, probably by Monica Segal. What do you think of her?

Hang in there, honey!
Hugs,
Leslie and the girls

Thanks so much for your valuable input...couldn't and wouldn't think of doing this without your help and advice.

Love and hugs.
Lori and Harley

4Mikeydog

08-19-2009, 12:24 PM

Hi Lori,

It sounds like you have a thorough approach and a good strategy in place. I'm so sorry you and Harley are going through all of this.
Hopefully some of the changes you make will resolve these developments. Hang in there, you are doing a fantastic job!

Dorothy and Mikey

Squirt's Mom

08-19-2009, 01:45 PM

Lori, I think Monica would be excellent. She's very knowledgeable and sweet, and she cares a great deal about her clients. Harley will be in good hands with her. :)

I'm a bit confused, too, about where Hyperestrinisim falls...is it a condition unto itself, or is it considered part of being Atypical. Since Dr O classified him as Atypical, then either the Hyperestrinism is considered part of Atypical, or the elevated baselines, or the combination caused him to make this diagnosis....that makes sense, right? :o

What got my attention was the term "nodule" and that it had grown. If I understand Ken right, adrenal tumors can cause the other hormones to be released/produced that are associated with Atypical. If this "nodule" is a tumor, then that could be the source of the estradiol, and certainly would cause his cortisol to rise. Hopefully, those who know more will be along to explain and/or correct! :o:):o But, at the moment, I am more inclined to think this "nodule" is the culprit VS Harley having both ADH and PDH.

When the results come in, then we will all understand more, surely :rolleyes:;) , and getting the UTK panel repeated will tell us even more. For right now, you have a good start on getting him feeling better, a good plan in place, and lots of love-n-support.

Hugs,
Leslie and the girls

PS. I think I will add "must love puzzles" to the growing list of things a cush parent needs to have in order to deal with this condition. :p

Harley PoMMom

08-19-2009, 02:59 PM

Hi Leslie,

I know, trying to figure out if he is PDH, ADH, or both is driving me nuts...but as long as I am treating him with Lysodren then the worry will be with mainly with the load, ain't, cause if that "nodule" is a tumor than he may take more to load? or may just longer to load? Oh boy!

Well anyways, posted below is part of my confusion. :confused::eek::) The letter sent to Dr. O was after his UTK panel ~ 5/1/09, Dr. O responses are in red.

Hi To All,

I sent DR. Oliver a e-mail concerning Harley and his diagnosis and treatment.

The cortisol levels are fairly normal, although baseline is slightly
high. So, this would be called Atypical Cushing's syndrome (cortisol
essentially normal, but sex hormones are increased).
The Estradiol levels are very elevated and probably causing the most
problems. Other intermediate hormone levels are also increased at
baseline. by DR. Oliver of Harley's Full Adrenal Panel.

But does Harley have pituitary cushings as well as Atypical? So will I
be treating Harley with something more powerful later? (Pituitary
cushings noted below by his endogenous test)

The hormone levels above support what is called Atypical Cushing's, and it is due to a pituitary-dependent condition based on the endogenous ACTH test result. Atypical Cushing's can be caused by either pituitary-dependent disease or adrenal-dependent disease; in this case, pituitary-dependent. answer by Dr. Oliver

I'm sorry for all the questions, and I hope you can answer them for
me. Should I be running more test? Another ultra-sound? His Ultra-
sound did show a 7.3 mm nodule on his right adrenal gland, (U/S done
4/14/2009 @ University of Pennsylvania Vet. Hospital).

The nodule is probably not an issue at this point. The endogenous ACTH level indicates the problem is with the pituitary (probably a small tumor in the anterior lobe of the pituitary) that is releasing excess ACTH, and this is stimulating the adrenals to produce excessive adrenal steroids.
Treatment in this case can be melatonin and the flax hull product, and a maintenance dose of Lysodren can also be added to give greater coverage (treatment effect). I can discuss this with your veterinarian if it would be helpful.
Hope that helps. Regards, Jack.

Not sure what to make of that Lori.
Honestly I don't think they do either. It is small that they aren't sure if it is a tumor, or hyperplasia, which is an overgrowth in the number of cells in that area.
I am still in the camp of I don't know what to think with Harley.

Also, if it is an adrenal tumor, they sometimes still treat with meds before surgery. So I guess a whole lot will be learned from your doc looking at the whole clinical picture, the lab results in conjunction with the US findings.

OMGosh, you have got to be going nuts at this point!

Cheryl

ETA:
Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens.

My knowledge here is strictly in humans, estradiol is an estrogen, the most prevalent form of estrogen in the human body. Fatty tissue can synthesize estrogen. That's why obesity is a risk factor or breast cancer, the increased amount of circulating estrogen.

Cheryl

Here lies my confusion, if this nodule is a hormone secreting tumor, then why is only Harley's estradiol hormone elevated at post. One would think that almost all or at least a few other of his intermediates would be elevated as well.

Elevated estradiol may be coming from the adrenal glands or may be coming from peripheral tissues such as adipose which can synthesize estrogens. (Thanks Cheryl for putting that in laymen's terms for me :) in your post) Fatty tissue can synthesize estrogen. Well, Harley has gained 3 lbs...IMS scolded me for that.

Dr. O says nodule is probably not an issue at that point. The endogenous ACTH level indicates the problem is with the pituitary (probably a small tumor in the anterior lobe of the pituitary) that is releasing excess ACTH, and this is stimulating the adrenals to produce excessive adrenal steroids. But I am wondering what he would think now that the nodule has grown from 7.3mm to 8.0 mm in just 4 months....hmmm...might have to email him and ask him.

So I guess my big question is does it matter which type he has, PDH or ADH or both, bc I will be treating him with Lysodren. Does it matter bc of the dose that he will have to initially take for me to try to load him? bc if this a adrenal tumor than he needs more? UGH...I'm confused....HELP :eek::D

Love and hugs.
Lori

PS...Thanks Leslie for your opinion on Monica, I really feel alot better now, since you have a high opinion of her, for her to formulate a diet for Harley.

Wylie's Mom

08-19-2009, 06:03 PM

Hi Lori,
Sorry, I don’t really have any answers for you… there is one thing that I was wondering about, and it’s really a question for Dr. O (so if you do email him, can you ask:o?)…

Harley’s first UTK Estradiol results:
Pre: 129.4 (23.1-65.1)
Post: 132.2 (23.3-69.4)

It seems that stimulating the adrenals in Harley’s case (like many of the pups here) doesn’t increase the estradiol that much, so does this indicate that most of the estradiol is probably coming from outside of the adrenals:rolleyes:?

So I guess my big question is does it matter which type he has, PDH or ADH or both, bc I will be treating him with Lysodren. Does it matter bc of the dose that he will have to initially take for me to try to load him? bc if this a adrenal tumor than he needs more?

So, because of the recent U/S findings and expectations on the endogenous test results, you’re thinking of Lyso for controlling cortisol, right? And if so, based on a post stim of 12.98ug/dL (UTK- 129.8 ng/ml) 3 months ago, do you/they think Harley would be in the very early stages, or even pre-Cushing’s (if there is such a thing:confused:)? My gut feeling/assumption on adding Lyso would be that it doesn’t terribly matter much whether he’s PDH or ADH in addition… you do want a good guess (protocol range) as to what dose to start with and it would be nice to have a general idea of how long of a loading phase to expect; but really, other than that, to me, it’s kinda like trial and error anyway until you find the right dose and frequency that works particularly for Harley. It maybe that the vets wouldn't even think a load would be necessary if you are finding this early in the game. But either way, whether you start with a load or maintenance dose, if it's PDH or PDH & ADH, you will still be monitoring for "the signs" and still be doing the same tests. But that’s just my gut feeling on the matter, based on my experience with Wylie (still on-going trial & error:mad:). I would be interested to see what others think:rolleyes:.

-Susy

Buffaloe

08-19-2009, 11:49 PM

Hi Lori,

Poor Harley, they really put him through the ringer yesterday. I'm glad you brought some of his food along. These dogs are go with the flow so well, he's probably already forgotten all about it.

If the nodule on Harley's right gland could possibly be classified as an adrenal tumor, it is teensy-weensie. It is not growing very fast. I think the fact that they're both enlarged would point toward a pituitary tumor. Yes, the LDDST indicated it could be adrenal based but the endog. ACTH indicated pituitary. I'd put much more credence in the endogenous ACTH test than the LDDST to distinguish between the two types. Dr. Oliver thinks it's a small pituitary tumor. My money says it's pituitary but I wouldn't bet my house on it...Shiloh loves her house and yard.

It seems like adrenal tumors secrete all different combinations of intermediate hormones. Some just produce excess aldosterone (Shiloh's), some just increased estradol, some any combination of 2,3,4 or even all 5 of the sex hormones. Not that it matters but Shiloh's big ole adrenal tumor produced very excessive amounts of aldosterone and 3 of the other intermediate hormones were a touch high.

You have done a huge amount of testing for Harley. I honestly don't think it matters much, if at all, whether the source is pituitary, adrenal or both. His cortisol is basically in the normal range so I don't think you will need a large amount of Lysodren to bring it down. I'm thinking you might just start with a maintenance dose or else a fairly conservative loading dose. I'd be real surprised if Harley needs a large amount of Lysodren. It sounds like the flax hulls and melatonin are working fairly well, right? Throw in a little Lysodren and Harley's gonna feel like a puppy again.

Shiloh says she still wants to meet up with him. ;);)

Ken

MiniSchnauzerMom

08-20-2009, 02:05 AM

Hi Lori,

Have no words of wisdom for you just a warm "hi" and hope you and Harley were able to "chill" today! :D Those all day vet visit/tests can be pretty wearing on the Mom as well as the pup.

Sounds like you are on the ball and have the new, revised plan in place. Hope the amlopidine will take care of the elevated bp and protein in the urine.

Wishing you and Harley well!!!

Louise

Harley PoMMom

08-20-2009, 08:53 PM

Hi Everyone,

Louise: Harley had to have a bath today, from the 2 rectal exams his poor butt was alittle icky, and he hasn't been to the groomer since Feb. He's really good with taking a bath, just stands there in my job sink and lets me wash him...he's a good boy. :)

He seems to doing well on the amlopidine, no side effects, I realize it is a low dose, but one never knows how a pup will react, he goes next Tues. (25th) to get his BP checked.

Ken: I was so happy and comforted to see your post. Your advice is always informative, your knowledge of the adrenals is invaluable, and your kind support is very much appreciated.

Harley thinks Shiloh is such a pretty girl, and he would love to meet up with her. ;)

Susy: I got your answer back from Dr. O.

A friend and moderator of a cushings forum that I belong to, Susy, asked me to ask you this question about Harley, and she said and I agree, that it seems to apply to many of our cushpups at the forum. "It seems that stimulating the adrenals in Harley’s case doesn’t increase the estradiol that much, so does this indicate that most of the estradiol is probably coming from outside of the adrenals? He had a baseline of 129.4 and a post of 132.2."

>>>Estradiol is definitely not affected by ACTH or Dexamethasone, so you almost always see similar baseline and stim results in our canine adrenal panel. In fact, the baseline tends to be higher than the stim values in most cases. In Harley’s case, they are virtually identical. The estradiol can definitely be secreted by adrenal tissues and primary adrenal tumors, but also is formed in other places, like fat cells, hair follicles and the liver. If other hormones are increased on our panel, then it’s likely that the estradiol is being secreted by the adrenals.

Hair follicles?? did not know that, FWIW, I thought this was a very good question Susy, and I believe Dr. O gave a very good answer too.

This is the rest of the email I sent to Dr. Oliver concerning Harley.

Hi Lori,

There are some questions I was wondering if you could clarify for me concerning my 12 y/o dog, Harley.

He was diagnosed Atypical from your adrenal panel # EN 09-3017 with his; cortisol...baseline ~ 61.6, post ~ 129.8, androstenedione...baseline ~ .43, post ~ 1.67, estradiol...baseline ~ 129.4, post ~ 132.2, progesterone...baseline ~ .66, post ~ 1.15, 17 OH progest...baseline ~ .30, post ~ .91, aldosterone...baseline ~ 32.5, post ~ 61.9.

He's had an endogenous ACTH (4/15/09) results ~ 41.1 (R.R. 6.7-25.0 pmol/L), and another done on 8/18/09 with results pending.

>>>This would support a pituitary-dependent condition. If the second test gives similar resuts, then it is very unlikely that you are dealing with a primary adrenal tumor.

From his 2 ultasounds it has shown that a nodule on his right adrenal gland has grown from 7.3mm to 8.0mm in 4 months, and now both adrenals are enlarged, where before only the right one was.

>>>This is a very minimal growth in the nodule, and probably in the range of where you would get similar results if the gland were measured multiple times.

What I am trying to figure out is, does Harley have PDH or ADH or both, plus being Atypical?

>>>It looks like PDH from the endogenous ACTH result. You’ll need to see if the second test gives you a similar result. It’s possible to have both PDH and ADH, but it’s much less common. And the endogenous ACTH level should be low if a primary adrenal tumor were present. But a primary adrenal tumor would probably not suppress a pituitary adenoma, that would continue to secrete increased ACTH. So, it’s possible that you are dealing with both conditions.

A friend and moderator of a cushings forum that I belong to, Susy, asked me to ask you this question about Harley, and she said and I agree, that it seems to apply to many of our cushpups at the forum. "It seems that stimulating the adrenals in Harley’s case doesn’t increase the estradiol that much, so does this indicate that most of the estradiol is probably coming from outside of the adrenals? He had a baseline of 129.4 and a post of 132.2."

>>>Estradiol is definitely not affected by ACTH or Dexamethasone, so you almost always see similar baseline and stim results in our canine adrenal panel. In fact, the baseline tends to be higher than the stim values in most cases. In Harley’s case, they are virtually identical. The estradiol can definitely be secreted by adrenal tissues and primary adrenal tumors, but also is formed in other places, like fat cells, hair follicles and the liver. If other hormones are increased on our panel, then it’s likely that the estradiol is being secreted by the adrenals.

I have decided to use Lysodren, have not started it on him, I want to run a full adrenal panel first, do I need to stop his melatonin and flax hulls prior to running the full adrenal panel?

>>>You could do that for maybe a week to 10 days if you wanted to. Or, you may want to see how effective the melatonin and flax hull product has been since the last panel. If no response has occurred, then you could add in a maintenance Lysodren dose, or go to the traditional Lysodren treatment that requires and induction phase with higher levels of Lysodren.

>>I hope this has been helpful. Regards, Jack.

So since Harley's last estradiol test did come down from 132.2 to 116.4, I believe just a maintenance dose of Lysodren will be ok, I guess the results of the UTK panel will decide that too. What do you guys think?

Love and hugs.
Lori and Harley

Barney's Mom

08-20-2009, 09:10 PM

wow.......no ideas on how to proceed! I never heard of just a maintenance dose of Lysodren with no loading, but he is the the expert. Harley is complicated. What could it hurt? So would he still be considered atypical and PDH, or just PDH? I didn't realize that hair follicles secreted estradiol either. That was an excellent explanation by Dr. O.
I am so confused!
Hope you are holding up well :)
Cheryl

Buffaloe

08-21-2009, 12:13 AM

Lori,

I think you need to wait until you get the results of the full adrenal panel to decide which way to go with the Lysodren. You will know alot more when you see exactly where his cortisol and intermediate hormones are at this time.

Because his cortisol is not significantly elevated, I think you will want to proceed pretty cautiously with the Lysodren. Either a conservative loading dose (30 mg/kg ??) or just a maintenance dose. I believe the goal is to lower the elevated intermediate hormones to the level you want them before lowering the cortisol toooo much.

Ken

Harley PoMMom

08-21-2009, 12:44 AM

Lori,

I think you need to wait until you get the results of the full adrenal panel to decide which way to go with the Lysodren. You will know alot more when you see exactly where his cortisol and intermediate hormones are at this time.

Yes, you are absolutely correct...Thank God you caught my goof...I will go change that...thank you...but after playing back my tape recorder of our visit (can you believe I actually did this), one comment from Harley's IMS concerns me regarding another STIM, she said his pancreatitis will skew any ACTH STIM results...hmmm. So when I get the UTK panel done, will those cortisol results be skewed?

Because his cortisol is not significantly elevated, I think you will want to proceed pretty cautiously with the Lysodren. Either a conservative loading dose (30 mg/kg ??) or just a maintenance dose. I believe the goal is to lower the elevated intermediate hormones as much as possible without lowering the cortisol too much.

Ken

Ken, You are the best. :D

Love and hugs.
Lori and Harley

Buffaloe

08-21-2009, 11:20 AM

Hi Lori,

I never saw any "goof" you made. I did see a goof I made and corrected it last night...I think the goal is to get the intermediate hormones right where you want them, not lowered as much as possible as I first typed last night. I think you have some good "wiggle room" to lower the cortisol a moderate amount while lowering the intermediate hormones to the level you want them.

Did you say you are having another full adrenal panel done on Harley? I have no idea if pancreatitis would skew the results of the adrenal panel. I just think it is such a valuable test.

You are going way, way, way beyone the call of duty with Harley. He is a very lucky boy to have you as his Mom. Shi sends kisses.

Ken

Harley PoMMom

08-21-2009, 02:26 PM

I bet Dr. O. is going to put a block on my emails, I send him so many. :eek: :p :) :(

I fired off another one at 10 am and got an answer at 1 pm. :D Here it is:

Dear Dr. Oliver:

I did have Harley's estradiol hormone rechecked on 7/29/09 Case # 09-5412, his results did show a decline...from 132.2 to 116.4, but I still want to introduce the maintenance dose of Lysodren because of his high endogenous number. What do you think a proper maintenance dose for Harley would be, he weighs 10.3 kg or 22.7 lbs.

>>>It often takes time for the estradiol level to decline to normal, so the decrease is good. Veterinarians often begin maintenance Lysodren at 25 mg/kg, given once per week. It can be given 2 to 3 times a week if the initial response is less than desirable. But, talk this over with your veterinarian.

I want to run a full adrenal panel before introducing the Lysodren, his IMS made the comment that his pancreatitis, although he has no active symptoms, but he had a PLI test recently and his results were 528 (0-200ug/L), will skew any ACTH STIM results. So when I get the full adrenal panel done, will all these results be skewed?

>>>If you haven’t done the adrenal panel yet, it would be good to get the pancreatitis issue under control first, just to be sure the test results aren’t affected by a non-adrenal illness such as pancreatitis.

>>Regards, Jack.

So altho Harley is not showing any symptoms of pancreatitis but being his PLI is so elevated, this could skew the results of another UTK panel...I know the UTK panel is a very valuable tool, but not if it's numbers are skewed and I don't believe I can wait any longer to treat his high cortisol, I realize Harley's cortisol numbers aren't as high as some cushpups, but I think I have to look at the whole picture with him. His UTK Cortisol ACTH results of pre. 6.0 and post of 13.0 are high, but not significantly high, but his endogenous ACTH of 41.1 is significantly high, and still waiting for the results of the other endog. tests, which probably will be the same or even higher. :(

So altho I hate, hate to skip the UTK panel, I don't believe I have a choice here...What do my very knowledgeable, kind and supportive friends think?

Love and hugs.
Lori and Harley

gpgscott

08-21-2009, 04:54 PM

Lori,

If I am reading this all right you do not have extreme symptoms and already some decline in the estradiol. Which is good.

And Dr. Oliver would like to rely on a full panel which is not skewed by other conditions.

This sounds like wisdom to me, and although I know you want an answer YESTERDAY!, it still sounds like wisdom.

And it is not not uncommon for a maint only dose of Lysodren with Atypical Cushing's and you and Harley avoid the loading:D

Hang in there.

Scott

Buffaloe

08-21-2009, 07:32 PM

How great a guy is Dr. Oliver!!! You can't put a price tag on his information.

In light of what Dr. O said, I think you probably should skip the adrenal panel until the pancreatitis issue is settled. As he said, you should talk over a maintenance dose of Lysodren with your vet. I agree with everything Scott said.

You will make the right choice with regards to a maintenance dose of Lysodren. Mom knows best. You have tons of information and you understand this stuff real well. Talk it over with your vet and do whatever you feel will be best for Harley.

Ken

Wylie's Mom

08-21-2009, 07:58 PM

Hi Lori,

Thank you for posting Dr. O's responses.

>>>Estradiol is definitely not affected by ACTH or Dexamethasone, so you almost always see similar baseline and stim results in our canine adrenal panel.

Interesting, didn’t know that… I can’t recall many of the pre & post estradiols posted on this site, but I do recall that being the case for Harley, Finnegan & Wylie.

The estradiol can definitely be secreted by adrenal tissues and primary adrenal tumors, but also is formed in other places, like fat cells, hair follicles and the liver. If other hormones are increased on our panel, then it’s likely that the estradiol is being secreted by the adrenals.

Didn’t know about the hair follicles & liver either!!!

I took another look at Harley’s UTK results (page 3) – all the hormones, except Aldosterone were above range for the pre-stim, but only the Estradiol was above for the post… so I wonder if he was talking about the pre levels or the post levels or either of them.

You did read the Pancreatitis section in Dogaware.com, right? I've posted the link on so many threads I just can't remember if I did it on yours... but, you're on the forum so much that I'm sure you've read it:p:D;), but here's a link just in case:
http://dogaware.com/wdjpancreatitis.html

-Susy

Harley PoMMom

08-25-2009, 07:29 PM

Hello my dear friends,

Harley had his BP checked today and it averaged out at 153 :) I think the Amlodipine is working. His crusty and dry nose is all healed up too, now I never would of thought that had anything to do with his high BP. He gets his BP checked again next Tuesday and hopefully if it still under control, then he'll have another UPC done, and then I guess he will start his maintenance dose of Lysodren.

I still have to talk to his GP about this, she was on vac. last week. I haven't received his endogenous results yet, probably won't get the results until Friday.

Susy: I sure did read that article, but unlike Cheryl I can't recite it word for word, so I printed it out. :) Thanks so much for it.

So we are "Hangin in there." :D

Love and hugs.
Lori and Harley

Roxee's Dad

08-25-2009, 07:35 PM

Hi Lori,
Glad BP and dry nose are looking better. Hope it continues. :):D:)

Squirt's Mom

08-25-2009, 07:37 PM

Hey Lori!

Good news on the BP!!!! :D I know that was exciting to hear! YIPEE!

Let us know what your vet thinks about starting the Lyso now and of course we want the results when they come in...nosy folks that we are. :p

Keep on hanging! :D
Hugs,
Leslie and the girls

Barney's Mom

08-25-2009, 07:43 PM

Susy: I sure did read that article, but unlike Cheryl I can't recite it word for word, so I printed it out. :) Thanks so much for it.

Lori and Harley

I wish I never would have said that :o
Great news on the BP and I woudn't have thunk it either.
Hugs
Cheryl

Wylie's Mom

08-25-2009, 07:57 PM

I wish I never would have said that :o

That's okay Cheryl... we won't make you prove it;):p. There are times that I've read something so many times that I think I know it like the back of my hand, but then a couple months later, I need to read the dang thing again:mad:... I need more ROM!... and Lori, you printed it... I've even printed some of that stuff over and over again 'cause I have no idea where I left the other copies:p.

And I'm happy about Harley's BP:D:p:D, wonder what the vet says about Lyso.

-Susy

MiniSchnauzerMom

08-26-2009, 03:05 AM

Lori,

Great news about the improvement in Harley's bp. Glad the Amlodipine is doing its job!

Louise

Harley PoMMom

08-26-2009, 07:51 PM

Hi Everyone,

Dr. Owings, Harley’s GP called me last night…it was around 9pm, anyways, she wanted to touch base with us, she felt if his BP is the same next week then we will do the UPC. I’m pretty confident that his protein loss has dropped; I no longer see what looks like a “foamy” residue after he is done peeing.

I discussed with her about starting Harley on the maintenance dose of Lysodren, and she agreed that this is the right path to take. We’re still not sure on a dosage; she wants to confer with Dr. Oliver so she can take in consideration the effect of all his intermediate hormones, as everyone is well aware of Lysodren lowers progesterone, androstenedione and 17 OH Progresterone, and on Harley’s UTK panel from 5/1/09 none of these were elevated at the post, in fact his 17 OH at post is .91 (.25-2.63); and his Progest. at post 1.15 (.22-1.45); his Androst. at post 1.67 (.24-2.90). Even his cortisol at post is 13 ug/dl, so I’m thinking Dr. Oliver’s suggestion in his email to me of 25 mg/kg given once a week would be a good start.

Dr.O’Neill (Harley’s IMS) called me today with his endogenous results…60.5 (6.7-25.0), :( so that went up from 41.1, but she said he’s urine culture came back negative, so no UTI. :) I also talked to her about the maintenance dose of Lysodren, at first she thought Harley should be loaded, but when I asked her to explain to me why Harley’s UTK cortisol ACTH are not that elevated and his endogenous ACTH are, she can’t, she doesn’t understand that either. So right now she is agreeing with Dr. Owings and me too, better safe than sorry.

So a summary, get his BP checked next Tuesday, if still under control…UPC test done and hopefully Dr. Owings has talked to Dr. Oliver and we have a plan for Harley for a dosage of Lysodren. And then we will need lots of good luck and well wishes from our fabulous friends here at K9cushings…and probably Harley’s mommy is going to need a lot of support, even tho it’s just a maintenance dose, she’s scared as you know what. :eek:

Love and hugs.
Lori and Harley

Squirt's Mom

08-26-2009, 08:47 PM

Hi Lori,

Drat that estradiol! I had so hoped Harley's had gone down. :( And he has been on the hulls all along....hummmmm. What melatonin are you using? I have begun to wonder about it, too...if there isn't some better form of melatonin out there that may work better for our pups. Since they work together it seems to me it would be best to have the best quality of both...but what is that??? Dang estradiol!

If you decide to go on the Lyso maintenance, you will do just fine, honey! I understand your fear, but I also know you are one great mom and will do all in your power to see that Harley has no problems whatsoever. I have full faith in you! And I know Harley does as well.

Hugs,
Leslie and the girls

Harley PoMMom

08-26-2009, 09:06 PM

Leslie,

Harley's estradiol did go down...from 132.2 to 116.4, it's his endogenous that had gone up. ;) So I think the hulls are working for the estradiol, I need the Lysodren for the endogenous to go down.

Love and hugs.
Lori

gpgscott

08-26-2009, 09:10 PM

Hi Lori,

They are all a part of this story called Cushing's. Harley will write his chapter and we will be here for you both as he does it.

Best to you and Harley.

Scott

Harley PoMMom

08-26-2009, 09:27 PM

Leslie,

I did ask Harley's GP about the Melatonin, and she said what I was getting was fine. I get mine at "The Vitamin Shoppe." I know some say to give Melatonin on an empty stomache/or 2hr after a meal and some say it doesn't matter. I emailed Dr. Oliver with that question and he said it doesn't matter. The only thing Harley's GP asked me is to be sure that it's a capsule, why...I don't know.

Love and hugs.
Lori

forscooter

08-27-2009, 08:32 PM

Lori,

I understand your fear of the Lysodren...I was terrfied each and every time I used it...which was a lot. Hated loading...talk about anxiety!!!

BUT....let me tell you it is a wonderful medicine! It saved both my boys for so much longer and improved the quality of their lives more than I can describe. When Scoobie was diagnosed, or should I say right before, he was a complete mess. He would literally pee while he was walking. He was miserable. Bailey wasn't so hot either but not quite as symptomatic as Scoot. Scooter had so many issues we were dealing with at once, allergies and IBD and all sorts of "stuff". If it wasn't for the Lysodren, I would never have had those last 18 months. And it was his heart in the end not the Lysodren.

I know all the things we read and hear are scary. But the important thing is to be armed with the info...and G forbid something goes screwy, you will already know what to do. And things happen over time, not usually all at once, so you will be there to intervene.

It will be OK....we know the fear.....but we also know the glory...and there will be glory! ( I almost said Lori after that and then realized I made a little poem!)....but I think you will be so pleased to see the results....and we will always be watching over you....I am going to try to be better about being here too...

Love and hugs, Beth and the boys

Barney's Mom

08-27-2009, 10:30 PM

Wow, sounds like Lysodren is right around the corner. One of the things that gave me the most comfort when I loaded Barn was when Alison told someone that our message board had never lost a dog during loading. And you prob won't be loading :) just a maintenance dose. You are so in tune with Harley and you know exactly what to look for. As far as water intake with both dogs drinking out of the same bowl, I had the same situation. I just measured the amount of water they both drank every day before I started the lysodren. Suprisingly even with two dogs drinking out of the same bowl the intake remained fairly the same.

Can't wait to hear more.
Cheryl

Harley PoMMom

09-02-2009, 07:03 PM

Hello My Dear Friends,

Well, we have great news, Harley's BP averaged out at 140 on Tuesday 9/2. :D:D:D Also his UPC results came back at 0.6 with the R.R. (< /= 0.5), down from 2.3. :D:D:D

So next Wednesday, 9/9, he goes in for an ACTH test, I want to see where his numbers are, I realize they might be skewed bc of his pancreatitis but I don't think they will that bad bc he has no symptoms of pancreatitis, and from there, hopefully we all can figure out what maintenance dose of Lysodren my boy should take.

Love and hugs.
Lori and Harley

gpgscott

09-02-2009, 07:18 PM

Hi Lori,

Very good news about the BP, I just saw the note about the melatonin having to be in capsules, I have never had it in capsules, only in compressed tabs. I do know it is important that it is not extended, or rapid release.

Also very glad to hear that there are no symptoms of gastric issues and that could mean the pancreatitus is not a big issue for Harley.

So, now on to treatment with a modest dose of Lysodren most likely.

Hugs and best wishes.

Scott

frijole

09-02-2009, 08:09 PM

yeah! great news. hugs,kim

Roxee's Dad

09-02-2009, 08:13 PM

Hi Lori,
Well that is great news.:D Wow this has been a long and complicated diagnostic for you and Harley. You have to be commended for sticking with it.:D:D:D:D

Great job girl. Harley is such a lucky boy to have you on his side.:)

Squirt's Mom

09-02-2009, 09:14 PM

Hi Lori,

This is good news! Now on to bigger and better times for you both! Bigger as is facing the Lyso, better as in seeing work for Harley! :D

You will do just fine, I know it! You're a wonderful mom!
Hugs,
Leslie and the girls

MiniSchnauzerMom

09-02-2009, 10:49 PM

Hi Lori,

Well, we have great news, Harley's BP averaged out at 140 on Tuesday 9/2. Also his UPC results came back at 0.6 with the R.R. (< /= 0.5), down from 2.3.

Wonderful, wonderful.....fantastic news!!! Hope everything goes smoothly with the ACTH next week. I'll be curious to see Harley's numbers.

Hugs,
Louise....(slurps from Munch!:D )

4Mikeydog

09-03-2009, 10:08 AM

Hi Lori,

We are so happy for both of you :):):) This is Great News :D:D:D
You will do fine with the Lysodren when the time comes. You are attentive and well informed. Harley is lucky to have you for a mom:)
Hang in there and good luck with the ACTH next week!

best wishes,
Dorothy and Mikey

labblab

09-03-2009, 10:53 AM

Lori, I'm so glad to hear your good news about Harley's BP. And just like everybody else has said, I'm betting you two won't have any problems at all with the maintenance Lysodren. And hopefully that will fill in the final puzzle piece in terms of Harley's treatment!

Continuing best wishes,
Marianne

Barney's Mom

09-03-2009, 04:12 PM

Lori that is absolutely fantastic news, especially the protein in the urine, absolutely the best you could hope for!

Harley PoMMom

09-09-2009, 05:31 PM

Hi Everyone,

Harley went today to get his stim done, we should get the results by Friday, and then we can get an idea on a maintenance dose of Lysodren to give him.

Before we left the vets office they wanted to weigh him, they have a floor scale in the waiting area, I was taking his harness off of him and the vet-tech was kneeling behind him and before I could say anything to the vet-tech, she placed her hands on Harley’s hind quarters, I could see in Harleys eyes and read his mind, “You’re not going to give ME another rectal exam.” :eek:

Harley’s lip snarled up and as fast as I could I placed my hand in front of his mouth, he caught ahold of my pinky finger, as soon as he felt it was mine, he left go and looked up at me with such sad eyes…no puncture wounds, no blood was shed…I feel horrible that he is terrified like this…I cried the whole way home. :(

Love and hugs.
Lori

Squirt's Mom

09-09-2009, 05:55 PM

Hi Lori,

I can so relate to that feeling...a while back we had to take Goldie in because she had diarrhea and vomiting. While trying to get her and put the harness on, she tore my hands up! She didn't do it out of anything other than fear and it just broke my heart, first that she has reason to fear so deeply and second that I had been the cause of bringing that fear back to the forefront of her little mind. :( I went to the vet bawling and squalling my eyes out.

So often we have to do things for our babies that frighten them. We know it is for their ultimate good, but they don't understand that at all. Squirt has never forgotten her leg surgery or the pain that came from it and the look in her eyes when we have to go the vet is just so sad.

I am glad you weren't hurt AND that he didn't get the tech! :eek: I bet she minds where she puts her hands from now on! :p

Hugs,
Leslie and the girls

forscooter

09-09-2009, 07:44 PM

Lori,

I feel your pain...it hurts me every time I have to take Bailey in...hence my hesitance to do so....but I try to remember that it is for something positive and as much as we want to explain to them, we can't. I was so afraid you got a bite and so relieved that you didn't. Sometimes, I get so frustrated bc as much as I explain to the staff...he WILL bite you, NO muzzle, NO you CANNOT take him in the back without me, GET the doctor, he knows....they still sometimes will make fast moves, bring in the muzzle, try to grab the leash out of my hands.....sigh....and then I want to scream at them do you not think I know my own dog??? Any sudden moves like was made today is just not good practice...and I am so sorry he got so scared!!!:( Even with the best dog, coming up and grabbing them from where they can't see is not a good idea.

Give Harley lots of kissies and for you, I send you one blender of margaritas!!!
Beth, Bailey, and always Scoobie

gpgscott

09-09-2009, 07:52 PM

Oh Lori,

Poor little boy, almost caught nipping momma:eek:

It must be so confusing for them.

You are such a good parent. Awaiting results with the others.

Scott

Barney's Mom

09-10-2009, 10:35 AM

I don't know who I feel worse for, you or Harley. :( Rectal thermometers bring out the worst in Barney, you would think there would be a better way to get their temps. I wonder if we took a rectal temp before the vet visit if they would accept the results? It would be nice to have a pleasant vet visit. It is so hard to see them in distress. :( Glad you still have your pinky, you would look a bit strange holding a margarita glass with out one ;)

Big hugs and I am so sorry that you had a lousy day.

Cheryl

Harley PoMMom

09-10-2009, 09:34 PM

Well Dr Owings just called me and told me Harley's stim results... his pre was 3.2 and his post was 12...hmmm...not your average cushings dog.

That pre of 3.2 has got me worried...I just don't get it, how can he have a endogenous ACTH of over 60 and have a stim like this???

She would like to try 125mg of Lysodren 2x week, I said positively not, especially with that pre of 3.2 and I reminded her that his pancreatitis could of even made that stim higher than what it even is, I said maybe 60mg 2x week...but I still don't know...I really could use some advice here...any thoughts anyone?

HELP!!

Love and hugs.
Lori and Harley

Barney's Mom

09-10-2009, 10:18 PM

The tests are measuring two different things.
As you know, ACTH stimulates the production and release of cortisol.
In the stim test the a baseline cortisol level is obtained, then the ACTH is given and then after a specified period of time another cortisol level obtained. So this test is measuring cortisol levels.

The endogenous ACTH test is actually measuring the ACTH (adrenocorticotropic hormone ) levels, not the cortisol levels.

Hope this is what you are asking.

Hugs
Cheryl

Harley PoMMom

09-10-2009, 10:35 PM

Ok, thanks for straighting me out on that Cheryl...I think we went thru that before...I just forgot.

So what do you think about 60mg 2x week for my boy...too much?

gpgscott

09-10-2009, 10:52 PM

Lori,

You have a strange one here.

12 is not an extreme number for a post in cases of Cushing's that are not based mainly on cortisol overproduction.

As Cheryl has posted the endogenous number is the stimulating hormone, not cortisol. The fact that this number is high leads me to believe the Harley continues to be under some sort of stress internally. I wonder if he is a sick euthryoid pup?

If this was me, I would stay with the current treatment unless symptoms became an issue.

Scott

Barney's Mom

09-10-2009, 10:57 PM

Ok, thanks for straighting me out on that Cheryl...I think we went thru that before...I just forgot.

So what do you think about 60mg 2x week for my boy...too much?

I am scared to even venture a guess. He isn't loading, so I guess in theory since you aren't eroding the adrenal gland ahead of time the dose could be higher, but I would be very afraid to start that high.

I would think 60mg a week would be a much safer bet. You will have to ask Alison how to cut those pills in to such tiny portions. She was the expert, cutting Mia's pills into FIVE even pieces, can you imagine? I believe 62.5mg would be 1/8 of a pill :p The good news is Harley would be an incredibly cheap date!

I just got Barney's filled at the CVS in Dover. I paid 137.00 for 20 pills. I am sure there are much cheaper pharmacies out there, but I didn't want to wait.

Cheryl

Harley PoMMom

09-10-2009, 11:11 PM

I wonder if he is a sick euthryoid pup?His T4 was low 0.6 (1.0-4.0), do you think I should pursue this?

Barney's Mom

09-11-2009, 12:00 AM

Lori, we need our experts to chime in here:
I had to look up the normals for ACTH stim test results for a dog that is not being treated with lysodren or Trilostane for cushings. The following came from the Dechra US Vetoryl brochure:

http://www.dechra-us.com/File/vetoryl_diagnostic_brochure.pdf

• In normal dogs, pre-ACTH cortisol concentrations are usually between 0.5 μg/dL and 6 μg/dL (14 and 165 nmol/L) and post-ACTH concentrations between 17 μg/dL and 22 μg/dL (470 and 606 nmol/L).*

• Regardless of the pre-ACTH cortisol value, a diagnosis of HAC can be confirmed by a post-ACTH concentration of more than 22 μg/dL (600 nmol/L) in a dog with compatible clinical signs.*

• Highly specific but poorly sensitive test.
• High confidence in positive result but false negatives can occur.
• If the result is negative but clinical signs and routine tests continue to suggest HAC then further testing should be considered.
With a post stim of 12 I am completely stumped. I know that an ACTH stim shouldn't be used to diagnose cushings, but I am wondering if you should start Lysodren with a post stim of 12?

Hoping someone chimes in soon, and I am praying that you get a more clear cut decision regarding treatment VERY soon, you poor baby, I skimmed back through Harley's thread and the diagnosis stage has gone on since April. This is much too long to be in limbo, for you and Harley.
I would ask the vet why they would start Lysodren with a post stim of 12.

Cheryl

MiniSchnauzerMom

09-11-2009, 02:15 AM

Sorry, no "expert" here...just me! :D

(Post from Harlely's thread 8/26/09) I discussed with her about starting Harley on the maintenance dose of Lysodren, and she agreed that this is the right path to take. We’re still not sure on a dosage; she wants to confer with Dr. Oliver so she can take in consideration the effect of all his intermediate hormones, as everyone is well aware of Lysodren lowers progesterone, androstenedione and 17 OH Progresterone, and on Harley’s UTK panel from 5/1/09 none of these were elevated at the post, in fact his 17 OH at post is .91 (.25-2.63); and his Progest. at post 1.15 (.22-1.45); his Androst. at post 1.67 (.24-2.90). Even his cortisol at post is 13 ug/dl, so I’m thinking Dr. Oliver’s suggestion in his email to me of 25 mg/kg given once a week would be a good start.

(Post w/Dr. Oliver's response) I did have Harley's estradiol hormone rechecked on 7/29/09 Case # 09-5412, his results did show a decline...from 132.2 to 116.4, but I still want to introduce the maintenance dose of Lysodren because of his high endogenous number. What do you think a proper maintenance dose for Harley would be, he weighs 10.3 kg or 22.7 lbs.

>>>It often takes time for the estradiol level to decline to normal, so the decrease is good. Veterinarians often begin maintenance Lysodren at 25 mg/kg, given once per week. It can be given 2 to 3 times a week if the initial response is less than desirable. But, talk this over with your veterinarian.

:confused: :confused: Based on these two posts from Harley's thread I'm a bit confused as to why the hurry to start Lysodren especially since Harley's cortisol falls in the normal range (IDEXX Labs Normal = Pre ACTH 2-6 ug/dl Post ACTH 6-18 ug/dl) and his last results on 7/29 showed a decline of Harley's estradiol.

Is the 125 mg. 2x a week of Lysodren the amount your vet determined after her conversation w/Dr. O. It sure isn't what he said in his email to you but perhaps something different transpired in his conversation w/your vet.

I would certainly be asking your vet questions about the Lysodren maintenance dose amount and the low T-4.

Louise

Harley PoMMom

09-11-2009, 10:38 AM

The twice a day Lysodren dosage was my idea bc of his pancreas issues, I didn't want all that Lysodren going in him at one time and maybe causing a flare-up.

The more I think about this, and his numbers..ugh..still :confused:...I did ask his GP and his IMS about his low T4 they both think it's cushings related, euthyroid sick syndrome, that once I start the Lysodren that T4 number will return to normal range. :confused:

Do yous think I should run more tests on Harley? maybe a HDDS test? Rerun his LDDS test bc his former GP never really performed this accurately in the first place to dx'd him.

Now here is another thing...when Harley had his first UPC done they also did an UC:CR, by accident, and I did not get charged for this test, the results of that:

Cortisol (urine) 3.6 (LOW) (RR 5-55 ug/dl).
Creatinine (urine) 35.2 (LOW) (RR 100-500 mg/dl).
Cortisol/Creatinine (urine) Ratio 32 (HIGH) ~ urine~ Cortisol/Creatinine ratio = > 13 : consistent with but not diagnostic for Cushing's syndrome. Patients with an elevated ratio should be further evaluated for this disorder using the ACTH stimulation or low-dose dexamethasone suppression test.

So what do yous think I sould do? Here's a run down of his symptoms: Hair-loss on the trunk and he has a rat tail now and when they shave him the hair is not growing back, his appetite is ravenous, pot-belly, peeing and drinking is above normal but not that bad, weakness in his hind legs, but he will be 13 y/o....while I'm typing these and reading them, it sounds more like thyroid sypmtoms...oh...ugh...these two diseases can mimic each other.

I just have no idea......................help :(

Love and hugs.
Lori and Harley

StarDeb55

09-11-2009, 10:44 AM

Lori, the one thing I can tell you is you need to run a free T4 to confirm the low thyroid value. If it is only sick euthyroid, the free T4 will come back normal, & no treatment is required.

Debbie

Squirt's Mom

09-11-2009, 12:59 PM

Hi Lori,

It looks to me as if cortisol is not Harley's problem with the ACTH results he has just received. So, it could be his thyroid, the estradiol, or another mimicking condition, but more likely one of those two. If it is the estradiol, the Lyso may or may not help depending on where the production is coming from as you know. But, like you, I would want to start with the lowest possible dose when/if we did start the Lyso. If it were me, I would look into the thyroid first...JMHO.

His ACTH doesn't even indicate he is under any stress either pre or post...it is perfectly in the middle. :confused: However, based on Squirt's experience, that sounds really good to me! :D If, like her, there was something else wrong, I would expect to see elevations in one or both of those numbers.

Since his ACTH is perfect, if it were me, I would table the Lyso for now, take a deep breath, and look elsewhere...starting with Dr. Dodds.

I am sure you are about ready to pull your hair out but don't despair. There is an answer and with your love and diligence continuing as always, you will find it. Harley couldn't be in better hands than yours.

Hugs,
Leslie and the girls

lulusmom

09-11-2009, 08:16 PM

Hi Lori,

I just got caught up on your thread and have made a few comments below. I hope they are of some help to you.

I discussed with her about starting Harley on the maintenance dose of Lysodren, and she agreed that this is the right path to take. We’re still not sure on a dosage; she wants to confer with Dr. Oliver so she can take in consideration the effect of all his intermediate hormones, as everyone is well aware of Lysodren lowers progesterone, androstenedione and 17 OH Progresterone, and on Harley’s UTK panel from 5/1/09 none of these were elevated at the post, in fact his 17 OH at post is .91 (.25-2.63); and his Progest. at post 1.15 (.22-1.45); his Androst. at post 1.67 (.24-2.90). Even his cortisol at post is 13 ug/dl, so I’m thinking Dr. Oliver’s suggestion in his email to me of 25 mg/kg given once a week would be a good start.

Dr.O’Neill (Harley’s IMS) called me today with his endogenous results…60.5 (6.7-25.0), :( so that went up from 41.1, but she said he’s urine culture came back negative, so no UTI. :) I also talked to her about the maintenance dose of Lysodren, at first she thought Harley should be loaded, but when I asked her to explain to me why Harley’s UTK cortisol ACTH are not that elevated and his endogenous ACTH are, she can’t, she doesn’t understand that either. So right now she is agreeing with Dr. Owings and me too, better safe than sorry.

When Lulu started treatment with Lysodren, her IM knew that she had a few elevated intermediates and the others were normal. I don’t believe there is a danger in loading dogs with normal intermediate and certainly not with maintenance dosing.

Cheryl has address the difference between the endogenous acth test and the acth stim test in a subsequent post but I would like to expand a bit. The acth stimulation test measures the plasma cortisol concentrations in ug/dl whereas the endogenous acth test measures the plasma acth concentrations in pg/ml. The resting or basal cortisol reference range is 1 to 6 ug/dl so Harley is perfectly normal with no indication of major stress at the time of the stim test. I believe the reference range for the endogenous acth test is 13 to 46 pg/ml so Harley’s results of 60 are indicative of a dog with pituitary based adrenal imbalance as opposed to adrenal based. I assume that your vet was trying to make this determination; otherwise, I’m not sure why she would do this test.

I am glad that your vet understands that Dr. O is following proper protocol when recommending that a Lysodren maintenance be given versus loading for a dog with normal cortisol levels.

She would like to try 125mg of Lysodren 2x week, I said positively not, especially with that pre of 3.2 and I reminded her that his pancreatitis could of even made that stim higher than what it even is, I said maybe 60mg 2x week...but I still don't know...I really could use some advice here...any thoughts anyone?

HELP!!

Love and hugs.
Lori and Harley

If you are contemplating starting a Lysodren maintenance dose based on the endogenous acth test, then don’t because it is the acth stimulation test results for all adrenal hormones that should guide you in making that decision. If Harley is still symptomatic because the melatonin and lignans have not yet reduced the intermediates sufficiently then you can either 1) give these two meds more time or 2) you can start a maintenance dose. Since Dr. Oliver recommended 25mg/kg, a maintenance dose of 250mg per week would be appropriate for Harley, who weighs 10.3 kg.

The more I think about this, and his numbers..ugh..still :confused:...I did ask his GP and his IMS about his low T4 they both think it's cushings related, euthyroid sick syndrome, that once I start the Lysodren that T4 number will return to normal range. :confused:

I tend to agree with your gp and IM. I think that once you get Harley's intermediates down to a normal level, that T4 will return to normal. If your curiosity is overwhelming you, then as Debbie mentioned, you can ask your vet to run a free T4 assay. If this value is low, it is more likely that you are dealing with primary hypothyroidism and treatment should be considered.

Do yous think I should run more tests on Harley? maybe a HDDS test? Rerun his LDDS test bc his former GP never really performed this accurately in the first place to dx'd him.

I believe that the UTK panel as well as the endogenous acth test has established that Harley has pituitary based atypical cushing’s so in your shoes, I wouldn’t pursue any more diagnostics. FYI, the endogenous acth test was consistent with pituitary as opposed to adrenal so the HDDS test (differentiation test) is not necessary.

Now here is another thing...when Harley had his first UPC done they also did an UC:CR, by accident, and I did not get charged for this test, the results of that:

Cortisol (urine) 3.6 (LOW) (RR 5-55 ug/dl).
Creatinine (urine) 35.2 (LOW) (RR 100-500 mg/dl).
Cortisol/Creatinine (urine) Ratio 32 (HIGH) ~ urine~ Cortisol/Creatinine ratio = > 13 : consistent with but not diagnostic for Cushing's syndrome. Patients with an elevated ratio should be further evaluated for this disorder using the ACTH stimulation or low-dose dexamethasone suppression test.

Just remember that the UC:CR can be abnormal (high) in dogs that are strictly atypical so this does not mean that Harley has elevated cortisol.

So what do yous think I sould do? Here's a run down of his symptoms: Hair-loss on the trunk and he has a rat tail now and when they shave him the hair is not growing back, his appetite is ravenous, pot-belly, peeing and drinking is above normal but not that bad, weakness in his hind legs, but he will be 13 y/o....while I'm typing these and reading them, it sounds more like thyroid sypmtoms...oh...ugh...these two diseases can mimic each other.

I just have no idea......................help :(

As I mentioned previously, you can rule out primary hypothyroidism with a free t4 assay and if normal, then you can rule in sick euthyroid in which case I personally would consider adding the Lysodren maintenance dose to Harley’s treatment regimen.

You, my dear, have done a fabulous job of dotting all the i's and crossing all the t's. You are a terrific advocate for Harley and he is quite the lucky guy.

Glynda

Harley PoMMom

09-14-2009, 02:02 PM

Hello To My Dear Friends,

I want to thank all of you for your words of advice, support, your thoughts and opinions about my boy Harley...he seems to be a bugger to figure out. I did also...of course :)...email Dr. Oliver and I would like to share that with you all.

Dear Dr. Oliver:

Since one of your Specialty Areas is Endocrinology, I was hoping I could get your opinion on my boy Harley, I have written many emails to you and you have so graciously responded back to me.

Harley's had 2 endogenous ACTH tests ~4/16/09 41.1(RR 6.7-25.0), 8/12/09 62.5 (RR 6.7-25.0)
>>>These would seemingly rule out any chance of a primary adrenal tumor being present.

Harley's had the UTK panel Case # EN 09-3017 done 5/01/09
...............................result......... ..Normal.....RESULT(post.....Normal
............................(baseline)....... RANGE**.....ACTH)...........Range**
CORTISOL ng/ml......61.6*........2.0-56.5..........129.8.........70.6-151.2
ANDROST ng/ml.....0.43*..........0.050............36..1.67... ....0.24-2.90
ESTRADIOL pg/ml...129.4*.......23.1-65.1.......132.2*.........23.3-69.4
PROGES ng/m.........0.66*..........0.03-0.17.......1.15............0.22-1.45
17 OH PROG ng/ml..0.30*.........0.08-0.22........0.91..........0.25-2.63
ALDOST pg/ml ***..32.5..........11-139.9.........81.9..........72.9-398.5
>>>The estradiol levels are very elevated, and probably the main problem in this case.

Harley had his estradiol rechecked case # 09-5412 7/29/09 results showed ~116.4 which is a decline in his estradiol.
>>>But still very elevated.

His bloodwork is showing that his ALT is coming down too, from 208 to 188 (RR 12-118), but his T4 is low 0.6 (1.0-4.0)
>>>The decrease in ALT is good, but not a tremendous drop at this point. Your veterinarian should council on whether or not replacement treatment with T4 is needed. I wouldn’t expect the elevated estradiol to cause this low of a level in T4.

Harley's ACTH which was done 9/9/2009 results were pre~3.2ug/dl and post~12ug/dl cortisol falls in the normal range (IDEXX Labs Normal = Pre ACTH 2-6 ug/dl Post ACTH 6-18 ug/dl), this is with the treatment of melatonin and flax hulls lignans only.
>>>No problem here. Levels are normal.

Currently he is on melatonin 3mg BID and flax hulls lignans 1/2 tsp SID - this treatment of melatonin and flax hulls lignans he started 5/16/09, he has high blood pressure so he takes 1.25mg amlodipine BID, denamarin in the am and marin in the pm for his liver. I was going to start a maintenance dose of Lysodren but after his very low ACTH stim I don't think that is wise, I want your opinion on that...Please.
>>>I would say that the ACTH stim is normal, in terms of the cortisol levels. The increased estradiol is the main problem. Increased estradiol can cause high blood pressure, so getting this down should help with the increased B.P. Lysodren often fails to have any effect at all on estradiol level, so I don’t think I’d use Lysodren at this time.

Do you think there is something else going on with Harley internally that is causing the high endogenous ACTH tests.
>>>I wouldn’t consider them high, and I don’t think other things are going on. Just the high estradiol.

..maybe his gall bladder or spleen or thryoid...they do show up as not normal on his ultrasounds, his last ultrasound showed his gall bladder as early mucocele, mucosal hyperplasia and his spleen as hyperplasia/neoplasia and with a 5mm nodule near the caudoventral extremity.
Any opinions or advice you would have for me and my boy would be greatly appreciated.
>>>Again, I think you’re mainly dealing with a very high estradiol level, and things should improve when the estradiol is back to normal.
>>>Hope this is helpful. Regards, Jack.

I believe the Lysodren will be put on hold, at least for now, and I will ask Harley's GP to run a FreeT4 to see if his thyroid is not functioning properly. Even if this comes back that his thyroid is ok, I'm still keeping him on just the melatonin and flax hulls...and I hope and pray that I am doing the right thing.

Please keep Harley in your thoughts and prayers...bc Harley's mommy is scared that she is missing something but doesn't know what it is. :(

You, my friends are the best.

Love and hugs.
Lori and Harley

Barney's Mom

09-14-2009, 06:44 PM

I posted a few minutes ago and now I can't find my post! I must not have hit submit!

I am so glad that Dr Oliver emailed you back and that you aren't starting the Lysodren. I am also glad you are pursuing the low t4. The endogenous ACTH has quite an overlap for normal dogs and dogs with PDH.

I did find this reference: http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2552&Category=411

Plasma endogenous ACTH concentration

Stringent and meticulous sample handling is crucial since ACTH activity in the plasma will reduce rapidly resulting in falsely low values and incorrect interpretation. The endogenous ACTH assay used must be validated for use in dogs.

Measurement of basal endogenous ACTH concentrations is of no value in the diagnosis of hyperadrenocorticism because of the episodic secretion of ACTH in the normal dog and the overlapping values with those dogs with hyperadrenocorticism.

Interpretation-Endogenous ACTH concentrations in normal dogs range from 13 to 46 pg/ml. Dogs with adrenal tumours have very low endogenous ACTH concentrations (< 5 pg/ml) whereas cases with pituitary-dependant hyperadrenocorticism tend to have high-normal to high concentrations (> 28 pg/ml) (Gould et al., 2001).

I believe the numbers vary from lab to lab, in Barney's case the labs overlap area was from 15 to 45 pg/ml. Dr Oliver's response to you regarding the endogenous ACTH, and the reference I found really makes me wonder if the value of this test is in ruling out an adrenal tumor, and now I am wondering if it has any value in the diagnosis of PDH?

gpgscott

09-14-2009, 08:08 PM

Lori,

Moria improved a lot after begining thyroid supplementation.

She has never had an elevation of anything but estradiol.

scott

Harley PoMMom

09-14-2009, 08:18 PM

Thanks for that link, Cheryl...very interesting...I did read it before, I think, :) but it seems like nothing wants to stay in MY feeble brain. :eek: It seems like I have to read something umteenth times to get it to stick in my head.

When Glynda posted:
If you are contemplating starting a Lysodren maintenance dose based on the endogenous acth test, then don’t because it is the acth stimulation test results for all adrenal hormones that should guide you in making that decision. ...plus with all the other postings from my loving K9Cushings friends...This made me really think...then I received the email from Dr. Oliver and that sealed the deal about not using the Lysodren. I really do think this is the right decision as of right now.

So please wish us luck...and please keep Harley in your prayers.

Love and hugs.
Lori and Harley

nelliesmom

09-14-2009, 10:08 PM

Lori,

I just read most of your thread and I feel like my head may explode!!!You should never question yourself on whether you have done all there is to be done. I don't think your baby could have a more thorough mom! I hope all Harley needs is a little thyroid replacement. It's amazing how one little bit of hormone can cause such havoc in a tiny body.

Best of luck to you & Harley. You will be in my prayers!

Mary

MiniSchnauzerMom

09-15-2009, 03:35 PM

This made me really think...then I received the email from Dr. Oliver and that sealed the deal about not using the Lysodren. I really do think this is the right decision as of right now.

So please wish us luck...and please keep Harley in your prayers.

Love and hugs.
Lori and Harley

Hi Lori,

I am so glad you contacted Dr. O again and think you've made a good decision in not starting the Lysodren, especially after what Dr. O has said regarding Harley's case. I also think you are wise in pursuing the thyroid issue since Dr. O has stated. "I wouldn’t expect the elevated estradiol to cause this low of a level in T4." You have my appreciation and thanks for contacting Dr. O....I always get an opportunity to learn something every time I read one of his replies.

Lori, both you and Harley do and will remain in my prayers. You have been very thorough regarding Harley so please don't second guess yourself. Give Harley some extra "scritches" from me. :D

Louise

Harley PoMMom

09-25-2009, 07:59 PM

Hello My Dear Friends,

I got Harley's Free T4 (Equilibrium Dialysis) results back today...normal ~ 12 (8-40 pmol/L), I talked to Dr. Owings and in 3 months we will run a UTK full adrenal panel, CBC and Chemistry blood work unless his symptoms are to change, then we will test sooner. Another ultrasound will be scheduled sometime in Jan.

So the plan is to keep Harley on his current treatment of melatonin and the flaxhulls with lignans...and alot of praying. He really seems to be doing fine, we still go out everyday and play frisbee and in the evening he likes me to toss around one of his toys. So I believe my boy who has cushings, pancreatitis, hyperestrinism, high BP, and soon will be 13 y/o is doing pretty darn good...I think his mommy should start enjoying her time with him and stop obsessing so much. :eek::rolleyes::p

I hope everyone has a wonderful weekend and give your furbabies extra scritches from Harley and me.

Love and hugs.
Lori and Harley.

gpgscott

09-25-2009, 08:11 PM

Lori,

You have been such a breath of new air to us all.

Thanks for the update, and I think the treament protocol is right for Harley.

My very best to you both.

Scott

forscooter

09-25-2009, 09:33 PM

Lori,

I think his mommy should start enjoying her time with him and stop obsessing so much.

You are a wonderful mommy and a great friend to everyone here....let me second your motion!!! You have to enjoy the time you have while you have it....I was reminded of that with Scoobie and part of what I have been busy doing since then...I want every minute I can get! So go enjoy your boy!!!!!:D:D:D

I have the alcohol covered for tonight!:D

Love and hugs right back, Beth and the rest of them

frijole

09-25-2009, 09:45 PM

Big cheers from our house to yours. You should be so very proud of all you have done... Harley is a lucky dog. And we are lucky to have you here. Good job!! Kim and girls

Barney's Mom

09-26-2009, 03:03 AM

Glad to hear the good news, and that sounds like a great plan. I think I could take a lesson ;)
Cheryl

Casey's Mom

09-26-2009, 10:42 AM

Lori good news about Harley, I think the obsessing thing is so correct. We need to enjoy them and I am guilty about obsessing as much as the next person. Good advice . . . Have fun and enjoy your boy.

Wylie's Mom

09-28-2009, 06:58 PM

Hi Lori,

I'm glad to see Harley's FT4 by dialysis was in the normal range;):D.

-Susy

Squirt's Mom

09-29-2009, 12:23 PM

Hi Lori,

When you figure out how to stop twitching over all this stuff, pass it on! :p My twitcher stays on 'ready' at all times! :rolleyes::D Squirt had a day at my brother's last week when she just wasn't acting quite right and I went into panic mode...:eek:....in ARK, away from Dr C, Squirt's not right, OMG no one here knows her history, OMG! :eek::eek: Come to find out she was just mad cuz she wanted to stay outside in this wonderful country atmosphere. Once she was let out, she was just fine, took off after a squirrel, and acting like herself immediately! :rolleyes: We had a long talk that afternoon about making mommy nuttier than necessary. :p;):D

I am so glad that Harley's tests were good and there is one less thing you have to worry about. You are such a wonderful mom, and you and Harley both deserve a break.

Big hugs,
Leslie and the girls

Barney's Mom

09-29-2009, 12:42 PM

I agree with the rest, when you discover the secret, pass it on! I watch Barney like there's no tommorow. The dog can't even lick his lips without me saying, OMG he's nauseous. John says the reason he's acting funny is because I stress him out. :o

Great advice Lori, I am really going to try.

Cheryl

hfurlotte

10-04-2009, 03:43 PM

Glad to hear all is good on your end with Harley:D:D........I am guilty too:eek: but that is what makes us good mommy's :)

Puppy kisses from Zoe Claire

Heather

Barney's Mom

10-04-2009, 09:15 PM

Just wanted to tell ya that I love the pictures you put up of Harley in the gallery. He's very photogenic ;-)

Harley PoMMom

10-04-2009, 09:58 PM

Thanks Cheryl :)

On his birthday I decided to take him to Petsmart so he could "pick out" his toys. So we are at the toys and I am taking the toys one by one, squeaking them, and putting them down by his face to see if he wants it. No to this one...no to that one...etc...I'm thinking OMGosh he's either so picky or so not focused, and then suddenly I bump that little blue dog toy on the floor and he swipes it up in his mouth and I'm thinking...:eek::eek: IT just hit the FLOOR and YOU put IT in your MOUTH. But he looked so happy and proud (and I'm trying not to be so obsessing about everything) and he carried that little blue dog toy all around that store...darn I wish I'd taken my camera.

Love and hugs.
Lori

Barney's Mom

10-04-2009, 10:41 PM

Dollydog

10-05-2009, 09:10 AM

Lori, that sounds like an awesome time at the pet store!! And enjoying your time with Harley is a great idea....sounds like he's doing wonderful and enjoying his life. He IS a very photogenic dog....so is Bear!
Jo-Ann & my Dollydog angel :)

gpgscott

10-05-2009, 11:29 AM

Hi Lori,

Sounds like it was a fun trip. Petsmart is where I find the best toys also.

Scott

Barney's Mom

10-26-2009, 09:30 AM

Happy Birthday Lori!!!!!!

lulusmom

10-26-2009, 09:56 AM

Happy Birthday Lori.

In case I haven't told you lately, it is a real pleasure to have you as part of our family. You are an awesome mom, a great source of comfort and knowledge to many and a terrific, supportive friend. Thank you for all that you do.

Glynda

lucygoo

10-26-2009, 12:11 PM

Happy Birthday, Lori!!!:)

And I second what Glynda said!

Gina and Lucy

Dollydog

10-26-2009, 12:16 PM

HAPPY BIRTHDAY LORI! :D :D :D

And ditto to all that Glynda said!
Jo-Ann

labblab

10-26-2009, 12:35 PM

And double ditto to all that Glynda said...:p :p :p :p :p :p

Marianne

Wylie's Mom

10-26-2009, 06:09 PM

:p:D:p Happy Birthday, Lori!!! :p:D:p

Put me on the "Ditto what Glynda said" list:D:D;)!

-Susy

Harley PoMMom

10-26-2009, 07:26 PM

To All My Dear Friends,

Even tho I worked 10 hours today, (need the $$, but who doesn't...huh), I had a wonderful day...my boyfriend sent me flowers at work, many of my friends and family called to wish me a happy birthday, and my very dear, loving, kind, and special friends here have posted happy birthday messages for me...I feel so very blessed.

I want to thank you all for everything you have done for Harley and I, if it weren't for all of you so lovingly sharing your knowledge, experiences and support, I know Harley would not be doing as well as he is and I would be a basket-case. :eek: You all are the greatest birthday present I have ever received...Thank you so, so much.

Love and ((((hugs))))
Lori

corgipallie

10-26-2009, 10:21 PM

Sorry to be a little late on the wishes. HAPPY BIRTHDAY LORI!

Franklin'sMum

10-27-2009, 05:01 AM

Hi Lori
HAPPY BIRTHDAY!!!!! :) :)
Jane and Franklin
________
CHILD PRILOSEC (http://www.classactionsettlements.org/lawsuit/prilosec/)

Truffa's Mom

10-28-2009, 12:54 AM

Happy HAppy HAPpy HAPPy HAPPY
BIRTHDAY
:) :D :p ;) :) :D :p ;)
You are an AWSOME PERSON & Ditto
Ditto, Ditto Ditto what everyone said

Especial Choco hugs from this house to you, a little late but still full of love flavor and vanilla care.

Casey's Mom

10-29-2009, 10:22 PM

Lori, Happy Happy Belated Birthday to you. Sorry its late! I'm glad that you had a good day. I especially wanted to thank you for being so kind and generous with all of your good wishes and thoughtful words of encouragement to me and everyone else on this site. You make the world a better place :):):):)

Harley PoMMom

10-29-2009, 11:49 PM

Dear Marcela,

Thanks so much for the birthday wishes and when they are full of love flavor and vanilla care...awww so sweet. And by the way...WHERE have you been? I have been missing hearing about your beautiful self and your precious choco Truffa and Nina.

Dear Ellen,

Thank you too for the birthday wishes, they are greatly appreciated. Your very thoughtful compliments are very touching, and I see you have been reaching out to others and giving them your support and reassurance as well...Ellen, you're such a wonderful person, so you see, You make the world a better place too!! And I feel so blessed to know you.

Love and hugs.
Lori

mypuppy

10-30-2009, 08:18 AM

Hi Lori, Im so sorry. I didn't realize it was your birthday. Happy belated. I hope it was a nice one. I'm sure Harley made it the more complete,,, he is adorable btw. Best birthday wishes, hugs and lots of luve to a very sweet person....xo Jeanette.

To All My Dear Friends,

Even tho I worked 10 hours today, (need the $$, but who doesn't...huh), I had a wonderful day...my boyfriend sent me flowers at work, many of my friends and family called to wish me a happy birthday, and my very dear, loving, kind, and special friends here have posted happy birthday messages for me...I feel so very blessed.

I want to thank you all for everything you have done for Harley and I, if it weren't for all of you so lovingly sharing your knowledge, experiences and support, I know Harley would not be doing as well as he is and I would be a basket-case. :eek: You all are the greatest birthday present I have ever received...Thank you so, so much.

Love and ((((hugs))))
Lori

mypuppy

10-30-2009, 08:22 AM

Hey Marcela, I can't help but mention I love your signature at the end of your posts. It is so true. My Princess, chocolate lab btw, has brought so much love into my life and my family's, and they really become a part of who we are, deep down in our hearts and souls....

Regards, Jeanette
chocolab lover (and all animals too-lol)

Happy HAppy HAPpy HAPPy HAPPY
BIRTHDAY
:) :D :p ;) :) :D :p ;)
You are an AWSOME PERSON & Ditto
Ditto, Ditto Ditto what everyone said

Especial Choco hugs from this house to you, a little late but still full of love flavor and vanilla care.

Franklin'sMum

11-01-2009, 07:21 PM

Wow, Lori,
You and Harley really have been through the wringer! :eek:
You are such a wonderful mummy (and lovely person) :D
Hugs from me and big sloppy kisses from my baby boy
Jane and Franklin xx
________
Wellbutrin settlement info (http://www.classactionsettlements.org/lawsuit/wellbutrin/)

Harley PoMMom

11-01-2009, 08:40 PM

Hi Jane,

Awww, Jane, how sweet of you to say so. You are such a wonderful and loving person and I am so happy Franklin has you as his mommy.

Yes, my boy Harley and this cushings journey has made me lose a few hairs and them hairs have been replaced by gray ones. But all those hairs and even all the tears that I have cried are worth it because Harley is worth it, I love my boy so very much. I know I've written this in my post before, but it bares repeating Jane, I would not of been able to make this journey without these amazing people here, they definitely helped me save my boy's life.

Love and (((hugs)))
Lori and Harley

littleone1

11-02-2009, 09:50 PM

Hi Lori,

Please let me know if you got my message. For some reason, when I send a message, it's not showing up as a sent message.

Franklin'sMum

11-03-2009, 12:11 AM

[QUOTE=Harley PoMMom;18068]
Hi Lori and Harley,

[Yes, my boy Harley and this cushings journey has made me lose a few hairs and them hairs have been replaced by gray ones. But all those hairs and even all the tears that I have cried are worth it because Harley is worth it, I love my boy so very much. I know I've written this in my post before, but it bares repeating Jane, I would not of been able to make this journey without these amazing people here, they definitely helped me save my boy's life.]

They are truly amazing people, I completely agree with you Lori. The info and advice and hand-holding I have gotten in my short time here is ASTOUNDING!

Remarkable, wonderful people.
Our best wishes to you all
Jane and Franklin xx
________
WENDIE 99 (http://www.lovelywendie99.com/)

Coolidge

11-05-2009, 03:45 PM

Happy Belated Birthday Lori!

You are absolutely correct. The support from the people on this site is beyond words. Truly family.

Give Harley a hug from Tyler and me.

littleone1

11-05-2009, 05:52 PM

Hi Lori,

Congrats on becoming a Moderator. This is well deserved.

Harley PoMMom

11-05-2009, 10:46 PM

Hi Lori,

Congrats on becoming a Moderator. This is well deserved.

Awww...Thank you so much Terri. :)

Love and hugs.
Lori

Harley PoMMom

11-05-2009, 10:49 PM

Happy Belated Birthday Lori!

You are absolutely correct. The support from the people on this site is beyond words. Truly family.

Give Harley a hug from Tyler and me.

Becky,

It is sooo good to see a post from you...makes my heart so happy.

How's Tyler doing with his girlfriends?

Love and (((hugs)))
Lori

Franklin'sMum

11-05-2009, 11:55 PM

Hi Lori,
Yes indeed, congrats on becoming a moderator! :) That's great.
With Love,
Jane and Franklin xx
________
Big Dick Movies (http://www.fucktube.com/categories/9/big-dick/videos/1)

Dollydog

11-06-2009, 12:04 AM

Congratulations from me too!!! But this doesn't surprise me as you are perfect moderator material!!
Jo-Ann & my Dollydog angel :)

John II

11-06-2009, 04:41 PM

Hey Lori,

Congratulations on becoming a Moderator!
:):):):):):):):):D:D:D:D:D:D:):):):):):):):)

Squirt's Mom

11-06-2009, 04:48 PM

Hi Lori!

What great news to come home and see! :) Couldn't have made a better choice IMHO! Glad to have you on the team and I know you will be a great asset to us all...just as you have been for so long.

Hugs,
Leslie

Franklin'sMum

11-15-2009, 08:27 AM

Hi Lori,

How are you and the handsome Harley these days? We hope you're doing well.

Jane and Franklin xx
________
Rhode Island Medical Marijuana Dispensaries (http://rhodeisland.dispensaries.org/)

Harley PoMMom

11-15-2009, 04:05 PM

Hi Jane,

Thanks so much for checking in on us, you are such a wonderful and caring person.

We are doing great...Harley is still playing with his frisbee and his toys, and barking orders at Alex our cat! He is adjusting very well to his new diet...very nice formed poops :eek: yes, I have been on poop partrol! I guess next week I will call his GP and make the appts for his tests that are due. :(:eek: Oh boy...where is that money tree??

It was starting to get cooler here in York, PA. but today it is really warm out and I had to turn my A/C back on, it actually got hot in my house. :eek: :confused: This is November and it is supposed to be cold in York, PA...oh well, I guess I shouldn't complain the A/C is cheaper to run than the furnace. :)

Love and hugs.
Lori and Harley

Franklin'sMum

11-24-2009, 01:03 AM

Hi Lori,

How are you and Harley doing? Has Harley had the tests that you mentioned? I do hope everything is well with you all, and that Harley is still "barking orders to Alex"!

Cuddles to all your babies (Harley, Bear and Alex.) and a big hug to you, Lori.

Jane and Franklin xx
________
No2 vaporizers (http://no2vaporizers.com)

Harley PoMMom

11-24-2009, 03:20 AM

Hi Jane,

Ahhh, thanks for checking in on us...Harley had all his tests done on 11/18. It will probably be another 10 days or more, bc of our Thanksgiving Holiday, that I get back the results for the UTK full adrenal panel.

I do have the results back from his Geriatric Senior Profile, cPLI, UPC, and I had his blood pressure checked too.

It seems his blood pressure meds are not controlling his high blood pressure :mad::(:eek: I noticed this 2 weeks ago, or thought I did bc his nose started getting dry and cracked again. At the pharmacy when I went to pick up his rx for his BP pills they were different, instead of being little blue pills these were little white pills. I asked the pharmacist about it and she said that they were the same thing just a different generic brand,(he takes amlodipine). I called his vet and she said the same thing...now I wonder. I mean I believe they are BP pills but I don't believe all generic pills are equal.

Well since his BP was 185 :eek::eek::eek: the UPC came back at 2.6(</=0.5) His last UPC done 9/2 was 0.6 when his BP was 140.

But on a brighter note his cPLI came down from 528 to 464; ALP was 1289, it now is 761 (5-131); cholesterol was 557, it is now 383 (92-324); but his ALT took a turn upward :mad: was 188, it is now 272 (12-118.) So I'm fearing the worse about his estradiol level, that has probably gone up too. :(

Looks like I'm going to have to research liver issues with the estradiol/estrogen connection. I have some but not indepth like I have the pancreatitis. I guess Dr O will be getting e-mails from me again. :eek::eek:

Well that's all I have for now, when the UTK results come back I'll post them as soon as I get them. :)

Love and hugs.
Lori and Harley