Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

[molly muffin]

At vets now. They took Molly back for testing and to see docs. She will have 3 eye tests today too. I am heading for coffee and them waiting.

Appreciate everyone being with us today.

Hugs
Sharlene and Molly muffin

[labblab]

I'm grabbin' my cup and I'll head over some coffee, too. Thank goodness for our wings so we can speed back-and-forth between you and Molly and Earnie and Rosie all day! ;) :)

[My sweet Ginger]

I hope she will be a good sport having all the tests done today.
She needs them so that's all there is to it. You can shower her with love and treats later. Sending hugs for you now. Song.

[Jenny & Judi in MN]

I hope you get some answers!

[molly muffin]

I don't have any answers yet. I have some, but not enough. I had to leave her at the vet hospital for the afternoon due to high BP. This wasn't a planned stay, but more of we need to check her over a few hours time period situation.

I still don't know what the ultrasound has shown and I need to speak with the IMS about that and her sight.

What I can say now about her sight is that she has significant loss of sight. I'll be able to tell you more once I have the reports and have spoken with the IMS. She isn't totally blind (yet) and we'll try to save what we can and prevent further, but it's tricky at this point. There is retinal bleeding that we need to stop, probably due to high BP which wasn't a factor when she was checked in April. They think it might have started spiking in the June/July/August time period.

More later
hugs all
Sharlene and molly muffin

[Trish]

Not going anywhere until I hear whats what with Miss Molly! Hopefully we hear some good news soon Sharlene. I know you are super prepared for this visit and will be coming out of there with a plan to move forward. Our Molly has her No. 1 advocate by her side so she will be happy although I am picking a little miffed at having been left there all day!! It's for your own good Miss Muffin! xxxxxxxx

[Budsters Mom]

I'm waiting with you Trish!

Huge hugs Sharlene, thanks for not sitting on me!:p

[mcdavis]

Henry and I are also awaiting the outcome of the tests and hoping for good news. Lots of hugs for Molly and you.

[molly muffin]

okay, so ultrasound, nothing is significantly different from previous ultrasound.

However, the hypertension is a huge concern and is the main cause of the problem with her eyes and loss of sight. I spoke with the IMS and she says her gut instincts after reviewing all of mollys labs going back I don't know how long is that we might be dealing with kidney disease. Specifically, Systemic hypertension is a common occurance in chronic kidney disease. What she said maid her lean more towards that as possibility is that no matter what the UPC says, her urine protein has been consistently high. So, more labs drawn today, another urinalysis and UPC panel to be done. She said she wants to have their lab do these as a second opinion from the lab my GP vet used. She wants to see if the book work and urine work show anything different since previously when they were done and her eyes clear.
The hypertension appears to have begun in around July/August as before that her BP results were 140 range consistently while today, they were consistently 180 - 190. She said that is the most important thing to treat. We are starting Benazepril 2.5mg, prob moving up to 5mg and maybe adding in amlodipine if the BP doesn't come down on the Benazepril. She said for kidney disease though as the underlying problem she prefers the Benazepril as it helps with the protein.

Dratted timing as molly goes into boarding tomorrow, so they will be giving the BP med and then we'll recheck when I am back next week. This is recheck on the BP. IMS will call tomorrow with all results she gets back and any other tests that might need to be done as a result of those. They took extra blood today just for that reason.

I'm a tad bit overwhelmed at the moment with information. I asked if she felt cushings cortisol could be the underlying factor, she said, considering how long they have suspected cushings and her not showing cushings symptoms, that she doesn't think so. She thinks that in the 4 years we've been on this journey, symptoms Would have shown by now and that the cortisol in the last ACTH wouldn't have been lowered than it was in the 2012 test. That it wouldn't get better on it's own usually. (ever) Not saying it couldn't still be a factor but she thinks the kidneys are the main thing and that the numbers and symptoms are not consistent with either a pheo, or cushings causing the kidney problems. I can't remember what exactly she said we would see if it was high cortisol causing the kidney problems, everything has turned into a jumble in my brain.

Anyway, we are trying to preserve the sight she has as long as possible and the name of the supplement is Ocu-Glo R. We can't get back what is lost, but the eyesight is a result of the hypertension and the vet feels the hypertension comes from the kidneys. That is the summary I think.

Hopefully we'll be able to get this hypertension and the protein knocked down.

hugs
Sharlene and molly muffin

[Budsters Mom]

Sounds like you have a plan. So sorry to hear about Molly's eyesight.:o I know you are worried about boarding her and being gone, particularly when starting new meds. You have told us several times how wonderful the people are that take care of Molly when you're gone, so I'm sure it will all be fine. We worry. It's part of the program.:o

Of course you feel overwhelmed, there is so much information to process! You'll get it all figured out. You always do!:p

Right now, love on that little muffin. Sending tons of love to you both.

[Dixie'sMom]

It sounds like you and Molly had a long and difficult day. Hopefully, they can get the BP under control quickly and she won't suffer any more eye damage. I'm sure you will know more when all of her bloodwork gets back about her kidneys? It would be nice to take Cushing's off of the table. That one be one less worry for you. Try to get some rest, Sharlene. Big hugs for you and Molly tonite.

[doxiesrock912]

Oh Sharlene!
Hopefully they can stop this from progressing more!

[Trish]

I hope starting these new meds for Molly is going to sort out this BP and keep the eye situation under control. Yes we do love a good plan, your IMS is very thorough and I have fingers crossed for results tomorrow and a much better BP next week. She will be just fine boarding, who could not love our little Molly!! I am sure they will keeping a close eye on her starting the new meds, Flynny did not do anything funny starting the Benzapril so I am sure she will be just fine in her little holiday home!! xxxx

[labblab]

Oh, I know it must feel hard to leave Molly right now, but as Trish and Kathy say, she'll be in excellent hands. And this little break will give us all time to regroup and review the results and put our heads together!

Travel safely, Sharlene, and treasure this time with your sister. We'll all be right here ready to dive back in as soon as you're home again.

Many hugs,
Marianne

[Squirt's Mom]

aw sweetie, I can imagine how torn and sad your heart is right now. Leaving that sweet girl after learning so much you didn't want to hear. But as has been said, she is in the best place...the vets can watch her and monitor the new meds more closely. Try to take comfort in that, 'k?

Hugs,
Leslie and the gang

[mcdavis]

It's not surprising that you're feeling a bit overwhelmed, but I agree with the others that Molly will be fine with boarding - they obviously adore her, plus they will be able to closely monitor the new meds.
Hugs from Henry and me

[molly muffin]

They had better monitor her closely. :)

I'm looking at different vet options. Mine doesn't take BP and that won't work and I can't take off work to drive over to the Vet ER Hospital every week, so I'm looking for a vet who can do BP either in addition to my own vet, or I'll have to move completely. No matter what I think, Molly comes first and her needs when it comes to her health.

This will have to be looked into when I get back. We'll also be looking at transitioning to a kidney diet that contains SO for the stones, probably a wet food. There are a couple out there my IMS said, but I'm not pursuing till I get back.

Her UPC was 2.1 with protein in the urine, so diagnosis is "protein losing kidney disease" After conferring with the ophamologist, it is determined that this is primary cause of the hypertension. Dr. Richards (eye doc) said she hasn't seen cushings primary hypertension that causes BP high enough to cause retinal bleeds, but kidney disease does do that.

Prognosis is that in the end it will be up to molly's body as to how quickly the progression will be, but we're aiming for years together hopefully. So just have to get this controlled.

I'm out of here now until next week gang. I still hate leaving her, but the IMS said to tell them if they have Any concerns at all to call her.

hugs all and thank you
Sharlene and molly muffin

[addy]

Sharlene I am so sorry I missed all of this.

Big hugs and we will talk when you get back.

[molly muffin]

Well she is there and i must be the over protective momma. She has almost a suitcase full of stuff, it was a bag but pretty big. blanket - check, toys - check, dry food - check, dry food if she gets diarrhea - check, wet food morning - check, wet food night - check, medicine am, medicine pm -check, check. Call this number for us, call IMS here, order these tests, verify this, do that. Yea, I'm a pain in their butt I'm sure and I do Not care.

My vet is calling around to some other vets to see if they have BP machine to do molly's readings. So, hopefully she'll find someone if not i'll start calling and go when when I get back.

I'm a very nervous nelly this time leaving her. I never like it, but this time I was loath to do so.

well I haven't even started packing, and procrastination might not be my friend this time.

hugs all,
Sharlene and molly muffin

[doxiesrock912]

Sharlene, I would be a wreck too!!!!! Will you vet check on Molly while you're away?

[Harley PoMMom]

If your IMS can't find another vet with a BP machine you can purchase one online and have your IMS teach you on how to use it.

Here's a link to a couple I found: http://www.vmedtechnology.com/Vet-Dop.htm

http://www.petmap.com/

Oh Sharlene, I know how worried you will be about sweet Molly but I do hope you have a wonderful time visiting your sister.

Love and Hugs, Lori

[Dixie'sMom]

Have a great time on your trip Sharlene. I know your thoughts will be home with Miss Molly at times, but I hope you can "escape" some of the time and have some fun. It will all be here when you get back. <3

[Trish]

Have fun in the sun Sharlene, if I was your vet I would be listening and reading every word you put down for them!! Be good if the had doggy cam so you could keep an eye on her yourself! They know you and Molly well so with this new BP issue I am sure they will be taking extra special care of her. xxxx

[molly muffin]

I'm back :)

Molly visited the IMS today and her BP was 150. Whoo hooo. She was almost a constant 180 last week. So this is an improvement. We just need to keep her at that range now. 150 shouldn't cause retinal bleeds and that is important!! We want to save as much of her sight as possible.

They want her switched to a renal diet soon though. We ran a recheck of blood work today. We also are doing a couple other tests, but everything seems to be pointing to kidneys being the underlying problem.

I admit to being emotionally exhausted and half the time feeling brain dead these days. You can't help worrying about them.

I don't know what is going on with my vet lately, but something sure seems to be. No follow up calls in regards to after care, didn't run requested tests while Molly was boarding (the IMS drew blood for those tests today along with the other things she wanted to do) No follow up on the renal diet or finding a local vet near me that can do the BP tests.
This is really not like my GP vet at all, so I'm a bit concerned and it just adds to the stress. Now my IMS said she is going to email some contacts about what would be the best food for molly. She is thinking a vegetarian food, or novel protein with SO index, wet might work best.

My head hurts sometimes trying to keep everything between molly and hubby straight. His surgery is scheduled for mid November.

That's my update on the muffin. :)
hugs
Sharlene and molly muffin

[Woodydog]

Wtg on the BP constant 150 we,ll take that. So it's pointing towards the kidneys, hopefully a new Noval diet will help.

So sorry your feeling emotionally drained and brain dead no wonder you have had so much to consend with recently between molly and your hubs. So have a huge HUG from me you are doing a fantastic job with both Molly, your hubs and work. I think sometimes you get overwhelmed with everything as its always on your mind day and night but remember to take 5 mins for yourself and regroup your thoughts.

Can you raise the concerns you have with your vet, see what's been going on and if you iron the problems out.

We are all here for you to lean on gawd we,ve all leaned on you often enough so feel free to lean and vent on us. Have another Hug

[labblab]

Oh Sharlene, I'm so glad Molly's blood pressure is down! All fingers crossed that this is just the beginning of a really positive trend. :)

With so much worry on your plate, I feel like a heel bringing up the subject of cortisol yet again. I promise this will be "it" and I'll try to let it go from now on. But in view of Molly's issues with blood pressure and protein loss, in good conscience, I feel a need to talk about the cortisol one more time. Molly's cortisol has been highly elevated for a good while, and I know your IMS is puzzled as to the cause -- for good reason. But it seems as though she just keeps sweeping it under the carpet. Regardless of cause, elevated cortisol can contribute to both hypertension and protein loss. Unless the cortisol is addressed, I'm not sure how you are going to get a totally satisfactory handle on these problems.


ACTH (2 draws - this is due to the agent used by the vet) June 2012
Cor1 - Cortisol (base) 172 (30 - 300) 6.23 ug
Cor 21 - Cortisol (ACTH) - 1 hour 924 33.49 ug
Cor 22 - Cortisol (ACTH) - 2 hour 1014 36.75 ug


ACTH april 2014
Pre 29.5nmol range 2.1 - 58.8 1.06ug [corrected to 2.95 ug/dl]
1hr 283.1nmol range 65.0 - 174.6 10.26ug [corrected to 28.3 ug/dl]
2hr 345.6nmol range 65.0 - 174.6 12.52ug [corrected to 34.5 ug/dl

The normal reference range for this lab is 6.5 to 17.5 ug/dl. So since at least June of 2012, Molly's cortisol has been significantly elevated. I know your IMS commented on the fact that the cortisol had "gone down," but it seems to me that the difference between 36.75 and 34.5 could just be lab variation or normal daily variation. That does not seem like enough of a decrease to warrant believing that anything has significantly improved during these two years. I know there is a bit of the "chicken-and-the-egg" issue with all of this -- what came first, the high cortisol or the kidney issues? But with the recent onset of the hypertension and the lack of evidence of significant kidney dysfunction prior to 2012, it seems more likely to me that it was not her kidneys that caused Molly's elevated cortisol, but they are instead suffering as a result. At a minimum, the cortisol cannot be helping the problems that now exist. And so I can't help but wonder whether these new developments warrant more urgency in dealing with the dilemma of the cortisol.

In the absence of Cushing's symptoms, I do understand the reservations about aggressive treatment beyond the melatonin and lignans that you are trying now. But it just seems to me as though Molly's cortisol is the elephant in the room that your IMS chooses not to address. I would flat-out ask her: with a cortisol level that has remained so highly elevated for this long and given the known impact of steroids on hypertension and kidney function, do you think we can satisfactorily control these issues in the absence of significantly lowering the cortisol in some manner?

(And now I've said my piece, and you can whip me with a wet noodle, and I promise that I truly will not bring it up again...:o :o :o).

Marianne

[doxiesrock912]

Go Molly. Go Molly!!!!

Sharlene, I would absolutely bring up your concerns to your vet. In light of the grievous error that Daisy's vet made, PLEASE talk to them. Don't hold back.

I'm glad that your IMS in on top of things though.
I would like to know exactly what is causing her Cortiaol to be high so that it can be remedied.

Hood luck to hubby!

[molly muffin]

The IMS is suppose to call me today if the lab results come in. I have constantly mentioned the cortisol factor but they seem unwilling to go anywhere with it with her not having classic symptoms. I am thinking to ask to start her on low trilostane to see if it would help. This is all so scary. What do you think?

Hugs
Sharlene and Molly muffin.

[labblab]

After opening up my big mouth, I don't know whether trilo is the way to go or not. But I guess what I'd be hoping for, first, is for the IMS to engage in a genuine conversation as to the significance of the cortisol. It's true that up to now, Molly had not exhibited any outward symptoms. But suddenly she's got two big issues that, as far as I know, are genuinely impacted by elevated cortisol.

I think we've got a quote somewhere from one of the Cushing's gurus stating that in otherwise outwardly asymptomatic dogs who test positive for Cushing's, hypertension and/or significant proteinuria is a sufficient trigger to start treatment. I'll try to look that up again. However, I do realize that the negative LDDS results really muddy the diagnostic waters for Molly and make her case ever so much more confusing.

With that in mind, I wonder if your IMS would be willing to ask some colleagues what they would do in this situation. I do not have the training to know the right answer. But boy, I bet our Molly could generate a lot of conversation at an endocrinology convention!

Bottom line, if your IMS still thinks the risk of intervening with the cortisol outweighs the benefits, then she's the expert. But I'm hoping she'll address the issue straight-on so you'll truly know what it is she is thinking is best, and why. And if she's in doubt herself, I'm hoping she'll bounce the question off some other specialists.

Marianne

P.S. Here's the quote. It comes from Dr. Peterson's blog, and as it turns out, it is in response to a question asked by our own Glynda!:


I am not a proponent of treating dogs with asymtomatic Cushing's disease, unless they have secondary hypertension or proteinuria.

http://endocrinevet.blogspot.com/2011/02/diagnosing-hyperadrenocorticism.html

[molly muffin]

I know what you mean Marianne. We've discussed it every visit. When the retinal bleeds and hypertension where discovered both her and I brought it up to the eye specialist who said she had not seen retinal bleeds caused by cushings. So, she didn't think that was the problem causing the hypertension, but that protein loss, could and would cause retinal bleeds. That is why they chose to go with treatment of the kidney first.

It is very frustrating! I want to do whatever is best for her, but it is hard to pin it down and yes that LDDS is causing the confusion I think as it is consistently negative.

Argggggh
Sharlene and molly muffin

[labblab]

Well, the eye specialist's response is rather puzzling! No, Cushing's wouldn't directly cause the bleed. And yes, hypertension is associated with renal disease. But Cushing's is also a known cause of secondary hypertension which, in turn, can cause hypertensive retinopathy. Here's a "human" blurb, but I assume the same is true for dogs:


The arteriosclerotic changes of hypertensive retinopathy are caused by chronically elevated blood pressure, defined as systolic greater than 140 mmHg and diastolic greater than 90 mmHg[2]. Hypertension is usually essential and not secondary to another disease process. Essential hypertension is a polygenic disease with multiple modifiable environmental factors contributing to the disease. However, secondary hypertension can develop in the setting of pheochromocytoma, primary hyperaldosteronism, cushing’s syndrome, renal parenchymal disease, renal vascular disease, coarctation of the aorta, obstructive sleep apnea, hyperparathyroidism, and hyperthyroidism.
Probably nobody can separate out one single cause of Molly's issues. The kidneys, hypertension, and elevated cortisol may all be intertwined. But it seems odd to me that the eye specialist would totally dismiss Cushing's from the picture. I mean, that is basically ignoring the known impact of elevated steroids on blood pressure. :confused:

[labblab]

Here's another quote, this time from a veterinary paper on canine ocular disease:


Hypertension can be defined as systolic BP greater than 160mmHg. Hypertension is associated with renal disease, Cushing’s disease, pheochromocytoma, primary aldosteronism, hypothyroidism, and hyperthyroidism. Initial response to hypertension is constriction of retinal arterioles and with sustained high BP, occlusion and ischemic necrosis occurs of the blood vessel walls. This results in increased vascular permeability. Serous retinal exudates, hemorrhages, and edema occur due to the vascular permeability. In addition, tortuous retinal vessels and hyphema and vitreal hemorrhage can be seen. A blood pressure should be performed anytime there is bleeding in the eye. If the blood pressure can be controlled, then often retinal detachment and hemorrhage can be reversible and vision restored. Some permanent damage is likely..

http://c.ymcdn.com/sites/www.invma.org/resource/resmgr/imported/OCULAR%20MANIFESTATIONS%20OF%20SYSTEMIC%20DISEASE. pdf

I wonder if your IMS would even consider contacting Dr. Peterson and asking his opinion about Molly?

[labblab]

And I know this is probably overkill, but here's even a more comprehensive veterinary article, containing this summary statement:


Ocular complications often are not considered among
the primary manifestations of HAC in small animals.
However, there is actually an extensive list of possible
ophthalmic consequences to the excessive levels of corticosteroids
present in this disorder. Some possible findings
vary, depending on the specific circumstances of the case
and the location of the primary causative lesion in the
adrenal glands or the pituitary. Conversely, systemic
hypertension and its repercussions are common regardless
of the site of the primary lesion, as are metabolic changes
associated with hyperlipidemia and lipoproteinemia.

Hyperadrenocorticism
(HAC,Cushing’s disease)
• Systemic hypertension
— Retinal hemorrhage
— Retinal detachment
— Hyphema


Ocular Manifestations of Endocrine Disease (https://s3.amazonaws.com/assets.prod.vetlearn.com/mmah/06/ec1c82169848c884a899e6732dd4d5/filePV_29_12_733.pdf)

I am so sorry if I am overwhelming you with this stuff!!! But I know you're preparing to talk to the IMS and I'm just trying to arm you with as much info as possible. It makes it really hard since the eye specialist has already dismissed the cortisol as an issue. But I know you're wanting to do everything you can to preserve Molly's remaining eyesight. So I just don't want to overlook anything that is worth discussing further with your IMS while you have the opportunity to do so. :o

[molly muffin]

Well I sent a comment in to Dr. Peterson, referencing his response to Glynda. So lets see if he responds.

I hope my IMS will contact me today and I can ask her further about this. I don't know when Dr. Peterson will have a chance to respond, if he does.

Cross fingers.

I think there is enough evidence at this point that treatment with a low dose of trilostane should be considered. I'd want to start it once I return from Calgary, which will be Oct 13. I have another appt on Oc 16 with the IMS. I don't want to add anything new to the mix till then as I won't be around to monitor her and in addition to starting the benazepril.
We are currently not doing the lignams and melatonin, as I stopped those when this new situation occurred. I think I mentioned that on here, but it might have gotten loss in the muddle of the thread.

hugs
Sharlene and molly muffin

[labblab]

Bravo for writing to Dr. Peterson! :) Let's hope he responds!!

[Dixie'sMom]

I'd like to throw out a few things for consideration. If its helpful, please use it, if not just ignore it. Cushing's is new to me but I'm an old hat at eye disease. My eye doctor is the Professor and Chairman of the Retinal and Vitreous Disease Dept. at Duke University which is the 4th rated Ophthalmology clinic in the USA.

When my eye disease began, the first thing EVERYONE (1 opthalmologist, 1 retina specialist, and 1 neuro-ophthalmologist) thought was that I had a pituitary tumor because the back of my eyes at the retina was consistent with tumor. No tumor was identified on MRI and after many more tests, it was found that I had a very rare autoimmune disease that is destroying my retina. What am I saying here? If Molly has indeed had a micro pituitary tumor, there is the possibility that it has grown and that could be cause of the retinal bleeds. Pressure in the brain causes pressure on the back of the eyes where the retina and optic nerve reside.

As part of my treatment for severe inflammation in the vitrious fluid, chorid tissues and retina area of the eye, I was put on high doses of steroids by mouth and steroid injections in the eyeball. As a result of that, I developed cataracts and glaucoma. Even after the steroid shots and higher doses of steroids were discontinued, the glaucoma (eye pressure) and cataracts remain. Proof positive that high cortisol, natural or synthetic causes eye damage. I have also had to be put on blood pressure medicine because of the continued steroid use which has created the elevated BP

In thinking about the pituitary tumor possibility, maybe low dose Lysodren would make better sense since it actually shrinks the tumor. At least a short course of it may be more beneficial, and then you could always switch to Vetoryl.

I know you are worried sick about Molly and with the hubby's surgery coming up as well, you are probably about at the end of your rope. I'm praying for good answers for you and a good treatment plan so Miss Muffin can retain her sight and kidney function and live many more happy years. I know she brings you and the hubby so much joy. I also understand the "disconnect" with your regular GP vet. Mine did the same thing and as much as I love and respect him, I moved Dixie to someone else who has been very on top of things with regard to her Cushing's. You have a lot to think about, but I think if you will address 1 problem at a time and get 1 answer at a time, you will move thru your list of concerns and get to that place where you can sigh a breath of relief again. (((((SHARLENE)))))

[labblab]

Wow, Suzie, it sounds like you have had more than your share of eyeball adventures! :o

That is all really interesting information. If Sharlene were to start treatment, I've also thought about low-dose Lysodren for Molly, too, since UTK feels that treatment is safe for dogs who have even normal cortisol levels but elevations in other adrenal hormones (which Molly has, too, in addition to the elevated cortisol). Lysodren does not shrink a pituitary tumor, but a small percentage of adrenal tumors do physically respond to the drug, alongside the cells of the adrenal cortex. We do know that Molly has an adrenal nodule of some sort, so who knows, maybe the Lysodren would have an effect on it.

If there are issues of kidney function beyond proteinuria, that may be another reason why Lysodren might be a better choice, too. I'm not sure about that, though -- maybe some of our Lysodren experts will know more about Lysodren and kidney function.

Marianne

[molly muffin]

So, blood work is all good.

We will repeat the ACTH on Oct 16 and see where that stands. The 2012 ultrasound showed change in the kidney, so she said it is hard to know if the kidneys came first or the cortisol came first. I shared my concerns of the cortisol contributing to the kidney protein loss, which caused the hypertension, which caused the retinal bleeds. Since that was our first ACTH and LDDS has been negative since 2010, she doesn't think a repeat of an LDDS would do any good as Molly flatlines it every time. She said, depending on what that tells us, we can look at at 1mg/1kg dose of trilostane, but that she wouldn't do lysodren based on what she knows of molly's medical history. That we also don't want molly in any pain and that a bit higher cortisol would help that. In 2012, she had one kidney stone (it must have been on the report but I don't remember it being a factor in anything, I thought it was a bladder stone maybe?) small and unobstructed. Now she has two and they are unobstructed at this time too.

She doesn't think the cortisol is high enough to have caused the problems in mollys kidneys but thinks that the kidneys might have started the cortisol going up, although that isn't a definite, just us throwing ideas back and forth at each other. Either way, likely we will go with low trilostane and see how molly reacts to that and stop it if she appears to be in any pain from the kidneys, etc. She'll be calling me next week, once we get the lepo test results back and we hear back from the nutritionist on food options.

I'm so tired. My brain is a fog. :( The internet here at the house isn't the greatest for some reason today. Have a call in about that too. And I have to get ready to go to the funeral home for a visitation as my friends dad passed away.

We are hoping hope that molly's BP stays down and we can keep this controlled. Whatever it takes to do so, we'll do.

Wow, you have had a lot of experience with eye issues and steroids Suzie! I mentioned all of these things inclucing Dr. Peterson's thoughts to the IMS. She said these are all valid concerns and that we'll do our best to figure it out and get it all under control. She doesn't think there is a macro tumor involved, she said the clinical signs and neurological signs aren't there for that in molly.

so address the protein loss, doing that, get her on food, working on that, get the cortisol checked, doing that the 16th, start on trilostane (based on results of acth), BP, so far down, so working on that too.
All of these things should help us to keep molly, as she is at least currently for awhile. She plays, she walks, she loves her treats, even her medicine treats, so step by step.

hugs and thanks everyone
Sharlene and molly muffin

[Dixie'sMom]

Marianne, thanks for clearing up my mistakes about Lysodren. I'm showing my lack of Cushing's knowledge. ;) I'm glad you understood where I was going with that thought. Yes, my eye adventures have been quite amazing. Much, much more than I ever wanted to experience, but I'm not completely blind yet, so they are hanging in there. I actually have an apt. at Duke tomorrow. Yuk.

Sharlene, I'm glad you got to talk to the IMS and wrote Dr. Peterson. It will be interesting hear what he has to say and it sounds like you have a starting plan in place. Try to get some rest.

[addy]

Hi Sharlene, I am sorry you have so much on your plate. Hugs and love to you, hubby and sweet Molly. I have no words of wisdom, just our experience. Our ophthalmologist never saw evidence of high blood pressure in Zoe's eyes despite the IMS's claim she had high BP. Whenever he checked her BP it was not elevated. When the IMS would check it - it was higher. What the ophthalmologist did say was that with all of Zoe's eye issues, maintaining her cortisol at a lower level was important.

Zoe started out without the classic Cushings symptoms, even in her blood work. Dr. Peterson told me not all Cush pups will have the elevations we normally see. Her main problems were skin/coat issues. Dr.Peterson felt her cortisol was too high for a maintenance dose of Lysodren to work and that her IBD would not tolerate the higher Lysodren doses of a load. He opted for starting at a low dose of Trilostane.

I think if it were me, I would ask if a maintenance dose of Lysodren would hurt Molly and how and if her cortisol is not sky high, perhaps a maintenance dose would be enough to bring it down. Dr. Oliver did tell me he had dogs that did respond to a maintenance dose without a load.

Deciding when to start treatment and which treatment can be overwhelming. We all do the best we can and we listen to the experts and go with our gut.

So go with your gut, sweetie.

love you.

[Squirt's Mom]

My 2 cents worth - I would choose the Lyso maintenance over Trilo any day if that is the route I decided to go were Molly mine. I would probably go ahead and keep the melatonin and lignans treatment along with it as recommended by UTK. BUT you know I'm partial to Lyso. ;)

[Trish]

Jeepers, if that LDDS went up even a wee bit it would help clarify the course of action for Molly. Hopefully Dr Peterson will get back with some advice, or maybe even you could try Dr Bryette as some have had replies from him.

Sorry your local vet appears to have dropped the ball a little, that is surprising as she has always been so receptive. Hopefully that gets sorted out soon xxx

[molly muffin]

Dr. Peterson has responded:


Dr. Mark E. Peterson said...

If your vet has done the proper testing for Cushing's (ACTH Stimulation, LDDST, and urine cortisol:creatinine ratios) and it is positive, then I would start treatment. If the tests are normal, then the "complications of Cushing's" you are talking about are likely secondary to another problem.

The ALT and AP are not specific tests for Cushing's, and the finding of large adrenal glands could be due to nonadrenal illness (such as primary kidney disease).


Spoke with my vet today, who called me. I think she was just busy, but she has looked into food and ordered omega 3 for me, which I already received from the IMS, but I have now another bottle that I can pick up later.

My vet is not on board with treating for cushings as she doesn't think now that cushings is the main culprit or that the cortisol is constantly high, and her worry is that we could make her cortisol go to low.

Both IMS and vet have discarded lysodren as a choice, going with trilostane.
I think both the IMS and vet seem to think that the kidney disease is primary and the cortisol is secondary to that. I am not so sure, but don't know what the best option is. At the moment, I want to know what the cortisol is now and see if it has changed in either direction, up or down. Although I've been told that it might have gone higher in response to the advancement of kidney disease.

If she has cushings and constant high cortisol, I'd think we would want to bring it down a bit and the IMS does seem to be thinking that but wants the ACTH first, as do I.

This is so frustrating.
hugs
sharlene and molly muffin

[labblab]

Well, phooey on Dr. Peterson for missing the central issue: your vets have done the proper testing and the results are contradictory! Don't know whether it would be worth following up with another question to him, seeking that specific clarification: your dog has had significantly elevated ACTH tests two years apart, but two negative LDDS tests within that same timeframe. Of the two tests, the ACTH is supposed to be the most "specific" to Cushing's, so what gives??


My vet is not on board with treating for cushings as she doesn't think now that cushings is the main culprit or that the cortisol is constantly high, and her worry is that we could make her cortisol go to low.

I wonder what leads your vet to conclude that Molly's cortisol is not consistently high when she has had two significantly elevated ACTH tests fully two years apart? What evidence does she have of a normal cortisol? I worry a bit about her because I think I remember her making reference to Molly's basal cortisol as being normal as though that had diagnostic significance for Cushing's, which it does not. Plus, as is the case with maintenance Lysodren for "Atypical" cases, there are situations when trilostane is prescribed for dogs with even normal cortisol (including Alopecia X, I believe).

I also have been puzzling in my own mind about the notion that it is a kidney problem that has been elevating Molly's cortisol all along. I know it is written everywhere that other, nonadrenal illness can elevate cortisol, and Dr. Peterson mentions primary kidney disease as a possible cause of swollen adrenals as do your vets. But I've been trying to figure out exactly what the connection would be. In doing some searching, I came across this article relating to humans. And if anything, it seems as though the worry being investigated relates more to the reverse -- that human patients experiencing renal failure might need glucocorticoid supplementation. At any rate, here's the study's conclusion (one warning, though, this is an older 1998 study, so more recent research may be different):


It is surprising that neither changes of cortisol metabolism due to renal insufficiency, the effects of uremic toxins on the HPAaxis, nor the modalityof renal replacement therapy alters cortisol response to ACTH in patients with end-stage renal failure. Thus, in general, glucocorticoid replacement therapy in CRF patients does not appear to be necessary under everyday circumstances and only a minority of patients migh benefit from glucocorticoids in stressful situations, such as major surgery...

In summary, the low-dose ACTH [stimulation] test elicited a normal adrenal response in a well-selected group of patients with CRF [chronic renal failure] who were receiving hemodialysis or CAPD. This finding suggests that neither renal insufficiency itself nor the modality of renal replacement therapy has a major implication on adrenal function.

http://martinclodi.at/downloads/25-ref-----adrenal-function-in-patients-with-c.pdf

I sure am not trying to be Miss-Smarty-Pants, acting like I know more than Dr. Peterson and your vets (although I'm afraid that's exactly how I'm coming across! :o :o :o). And even though it may seem otherwise, I also don't know whether trilo is the right way to go. But I definitely think it's worth it to perform another ACTH to see where Molly stands now. If it is still high, then maybe your IMS would be willing to garner some additional opinions among her colleagues about Molly's very perplexing situation.

Just for the heck of it, would you mind if I sent Dr. Bruyette an email asking his thoughts about a situation like Molly's?

[molly muffin]

No my vet never mentioned a normal pre cortisol level. Thank god she wasn't of that mind. I don't know why she doesn't think the cortisol is consistently high but it has to do with not testing positive on the LDDS. It didn't make sense to me since they are two different test.
3 LDDS in last couple years. Two last year.
They are all worried that if it isn't cortisol that we will send her low but I think we have to try. Maybe we will know more after the next ACTH test? I hope anyhow.
She still doesn't have the appetite or drinking urinating of a Cush dog. Skin and hair fine. It is all the internal organs being affected in her case. :(. Which is bad.
I think we Have to try something but I am the only one advocating it. Now I have to check the urinalysis reports as my vet didn't think she had oxalate sones and I am sure that I had read she did. I want to add potassium citrate to any food we use and they think potassium could be a problem as it is an issue with renal function.
Some days they drive me nuts. No I don't mind if you email dr. B. I wish that Dr. P had addressed that the test were done and it is the contradiction between them that is the problem. No UC:CR has been done. I am thinking of that too.

Thanks Marianne

Addy you are such a sweetheart. I so remember Zoe eye problems. Cortisol. Bp. Proteinuria all are issues for the eyes.

Hugs
Sharlene and Molly muffin.

[labblab]

Well, I sent off an email this afternoon to Dr. Bruyette listing the specifics of Molly's original presentation (elevated ALKP and pot belly but no other external symptoms), her contradictory LDDS and ACTH testing history, and also included the same current summary you had written to Dr. Peterson, including continuing lack of outward symptoms. Within a half-hour (on a Saturday afternoon!), I already got a response back. Here it is:


Hi. It not uncommon to have discordance between the test results and given the whole picture I think the dog has PDH and I would treat. It may help with the blood pressure and proteinuria.


Dave
So another opinion to consider as we await the next ACTH test...

[Budsters Mom]

Yes, Dr. B is amazing with the speed of his replies. :p He responded to me right away too, but it wasn't the news I really wanted to validate.:o His recommendation is what was used to partner his vet with his consulting neurosurgeon. Someone who I couldn't afford to see on a regular basis because she was over the top expensive, but consulted daily for me anyway. This is a doctor who lectures all over the world in neurosurgery and still took the time to monitor Buddy for nothing. There are doctors out there who really care about our pups and are willing to help, even when they aren't getting paid. :p

I am so sorry that all of this is so darn complicated.Molly has been doing so well for so long without heavy duty Cushing's meds. I understand your reluctance to start on them.:o I'm not so sure I would want to do it either, particularly if you're not sure whether she needs them or not. :confused: I wish I could be of some help.

Big gentle hugs to you, hubby and out little diva,

[labblab]

Hi Sharlene, hoping that you and hubs and Molly are having a peaceful Sunday and that you can push all the worry in a drawer for now. You've got a very reasonable plan in place and in my book, just figuring out the plan is half the battle won! ;) :)

Sending lazy Sunday afternoon hugs your way,
Marianne

[molly muffin]

We are definitely being lazy. Just haven't been home much to do so as much as I'd like. Lol. All the errands from being away last weekend and then away next weekend too. All things we already had flights and plans for prior to this coming up with Molly. The high bp and sight thing.

Yes I think we will get the ACTH and if that is still high, then start trilostane at 1mg/1kg. Ratio. Which would be around 8mg so have to have it compounded.

Let's see what that is.

Thanks for checking in on us.
Hugs
Sharlene and Molly muffin.

[flynnandian]

i hope everything works out fine for you and molly.
when is molly's acth test?
luckily she is still feeling fine.
strong girl!

[Harley PoMMom]

I'm pretty sure that Calcium citrate can be used in place of potassium citrate.

Hugs to you and sweet Molly, Lori

[molly muffin]

Ahh ha! I was thinking there was another I'd read about. That is it! Thanks Lori.
I will mention to my vet
Hugs
Sharlene and Molly muffin

[Tina]

Hi Sharlene,

I haven't been around posting lately, but I've been following your posts about Molly very carefully. I am so sorry for everything that has been happening, I understand how frustrated you must feel. I keep meaning to chime in, and just haven't had a chance get my thoughts together to post. So happy to see all the information that Marianne, Lori and others have been providing.

I just have a quick minute now to post because it's the middle of the night and I need to get back to bed, but wanted to let you know about the food that you asked about on our thread.

The renal diet that Jasper was started on after being diagnosed with Protein Losing Nephropathy was Royal Canin Renal MP Modified. This is considered a moderate protein restricted diet rather than a low-protein diet. The other Royal Canin renal diet is called Renal LP Modified. That is the low-protein version and more protein restricted, the MP is what you want. Science Diet makes a renal diet also, I believe it's called K/D. We did try Jasper on that initially but he didn't like it and I had a lot of trouble getting him to eat it. Plus it was more protein restricted which I didn't like. After researching quite a bit, and with help from folks here, I asked my vet about the Royal Canin. Their prescription foods seem to have better ingredients than Hills, although none of them are wonderful as foods go. And I know there are others on the forum that will not recommend any of the prescription diets and feel very negatively about them. However, my vet insisted that Jasper needed to have that at the time, so that is what we went with.

He is no longer on the renal diet because his triglycerides got sky-high (he has hyperlipidemia also), so we now have to have him on a prescription low-fat diet. He is getting Royal Canin G.I. low-fat right now. Unfortunately, it was a trade-off for us. We had to get the triglycerides down, so I couldn't keep him on the moderately restricted protein diet for his kidneys. So far it hasn't seemed to affect the protein level in his urine significantly.

The other thing I wanted to make sure I mentioned right now is that in addition to the Benazepril, Molly needs to be taking fish oil daily. That is an extremely important component in treatment for PLN.

Sharlene, I will try to be back on the forum tomorrow night after I get home from work and post a little more. Again, I am so sorry with all that you and Molly are going through right now, and also about your hubby. I will try to help with whatever I can regarding the PLN, I have done a lot of reading on that.

Big hugs,
Tina and Jasper xo

[labblab]

Sharlene, I'm so glad Tina is having a chance to talk with you about the food options! Here's a link we all found helpful back when Jasper was first diagnosed with PLN:

http://dogaware.com/health/kidneyprescription.html

It's an article by Mary Strauss with a comparative chart of commercial renal foods and other helpful info. I confess that it is confusing to fairly compare the actual protein content among the foods on the chart, because there is a big difference between "as fed" and "dry matter" basis and "per 1000 calories," the latter number not being included in the chart and perhaps it is the most important comparison of all. But there is still a lot of helpful info there, and if you click on any food, you'll be taken directly to it's website.

For instance, here's the webpage for Royal Canin's moderately reduced protein foods. To show why I'm confused a bit about the comparisons, from their webpage it looks like the dry version has a bit higher protein while Mary's chart makes it appear that the wet version does. But either way, there is a lot of helpful info to look over.

http://web.archive.org/web/20101127054559/http://royalcanin.us/adx/aspx/adxGetMedia.aspx?DocID=134,293,12,1,Documents&MediaID=5967&Filename=Canine+Renal+MP+Modified.pdf

Marianne

[molly muffin]

That makes my head spin trying to sort out all that stuff. It looks like though that protein restriction can actually have adverse effects even. The key seems to be the low phosphorus in the food, not the protein. Interesting.
I definitely need to forward this one on to my IMS for her to review too.

Tina, that is one of the things that was mentioned, that every low protein, has a high fat content it seems, and that isn't good! So that causes me some concerns too, along with whether a low protein that is in fact too low, could cause protein malnourishment, especially in a dog caught early.

thanks Marianne!
hugs
Sharlene and molly muffin

[labblab]

Hey Sharlene, no, I don't think you are not looking for a low protein diet in Molly's situation but instead only mild/moderate protein restriction. But when a dog is persistantly leaking significant protein in the urine, you are looking at more than just phosphorous alone. The situation differs depending on the specific renal issues and abnormalities.


Remember that low protein is unnecessary and even harmful unless your dog is uremic, but low phosphorus is advisable. Moderate protein reduction may be required if your dog has proteinuria (significant protein in the urine).

Marianne

[labblab]

Here's a quote with a more extensive explanation that seems more relevant to Molly's situation. It comes from a really great IDEXX roundtable discussion on Proteinuria and Renal Disease.

https://www.idexx.com/pdf/en_us/smallanimal/education/proteinuria-round-table.pdf


Metzger: How about the nonclinical, non-azotemic animal with persistent proteinuria? If I have a senior patient with persistent proteinuria, should I initiate a renal diet?

Sanderson: Yes, there are some indications for renal diets in the nonazotemic proteinuric patient. If you have a choice between early-stage renal diets, which tend to have a little more protein, and advanced-stage diets, go with the early-stage diet in the beginning. The benefits are the omega-3 fatty acids and the protein itself. You want to keep up with what they’re losing, but you don’t want to give them so much that more and more protein is leaked into the kidneys and causes damage. Mild dietary protein restriction is warranted in those cases. Renal diets are indicated in both chronic renal failure and glomerular disease.

[molly muffin]

Moderate protein, got it.

Look at this:
These are commercial foods.
http://www.dogfoodadvisor.com/best-dog-foods/low-protein-dog-foods/

I compared the technical of Fromms Adult mature classic

http://frommfamily.com/products/classic/dog/dry/mature-adult/technical-analysis/

With renal mp

http://www.royalcanin.ca/index.php/Veterinary-Products/Canine-Nutrition/Veterinary-Therapeutic-Formulas/Renal-MP

looks about the same, except that Fromms, has lower fat content, while Renal MP has higher fat content, which can cause other problems.

Sharlene

[molly muffin]

Couldn't get the from a food. Grabbed the blue buffalo life protection senior and a can of natural balance vegetarian

Sharlene. Stop gap merhod

[labblab]

Sharlene, if I'm reading the analysis lists correctly, the Fromm's has significantly more protein than the Royal Canin.

Fromm's: 6.6 grams of protein per 100 kcal
Royal Canin: 3.9 grams of protein per 100 kcal (listed on the chart as 39 grams per 1000 kcal)

And the fat doesn't seem hugely different:

Fromm's: 3.5 grams of fat per 100 kcal
Royal Canin: 3.8 grams of fat per 100 kcal (listed on the chart as 38 grams per 1000 kcal)

But these charts are so darn confusing, so maybe I'm missing something...

Plus, I just looked at that DogFoodAdvisor list and I'm afraid they haven't made any effort to quantify or justify what they mean by "low protein." I mean, it just looks like they've arbitrarily picked as their criteria: "They must contain no more than 23% dry matter protein." From the article, I have no idea where they got that number or what they're basing it on. Plus, dry matter analysis isn't the most direct comparison, I don't think, because the actual amount of protein consumed will depend on how much food you'll actually feed your dog each day, and that varies depending on the calorie count comparison.

Plus, the article acknowledges that it made no attempt to analyse phosphorous.

I totally agree that it will be great if you can find a food with better ingredients than the the prescription diets. That's what I did with Peg when I hunted out a low-fat food for her. But unless I'm goofing up the anaysis, I think the prescription reduced protein foods are probably lower in protein content than most of the foods on this list.

Maybe Tina will have more experience with this.

[molly muffin]

ugh, you're right, I was reading them both as g/1000 kcal while the fromms is g/100 kcal

I couldn't get it anyhow. Picked up the blue buffalo as it was lower than the Fromms weight management I have been using to keep up with solid poops. The Protein in the Blue Buffalo is 18%, but doesn't give any analysis table that I can find online.

I might have just blow 20. bucks, but if so lesson learned and this should help at least till I can get the renal mp. (although see in my notes that the vet had recommended renal lp, but not sure I want Super low protein as you mentioned, it's keeping up with what is lost but still providing enough to keep her healthy. Such a balancing act this is!

thanks for the help Marianne!
hugs
Sharlene and molly muffin

[labblab]

Yeah, I definitely don't think you want to go as low as the Royal Canin LP. I think maybe Tina had to negotiate that one with her vet, too. :o

[labblab]

Just looked at the Blue Buffalo and yes, maybe it will pan out as at least mildly restricted protein which may be all the restriction Molly really needs tight now. The ingredients surely look better than the Rx foods!

[addy]

Not that I am anywhere up to par on this as Marianne and Tina but Zoe had a high protein diet and just replacing some of her turkey rewards with potato and decreasing her raw diet while increasing her Honest Kitchen Zeal helped the protein in her urine come down.

So just cutting back some of the protein a tad may be enough to do the trick, looking at Molly's total protein intake including any snacks. I don't think you need to go really low on the protein when looking at food.

Does Honest Kitchen Zeal not work? Marianne- I think you used it for a bit with Peg. It helped Zoe's IBD so maybe it would not bother Molly's poos.

Okay, off to cough some more:rolleyes::rolleyes::rolleyes::o I think I am getting more exercise from these coughing fits than from walking:D:D:D:D:D

[molly muffin]

I remember you saying that Zoe was on Honest Kitchen, but I haven't found it anywhere up here in Canada.

Yea I don't want to go too low, and she is on medication, so I want to move to less protein, not too high in fat, and see if that helps her.

This blue buffalo might help her and it is what we are going to try for the next little while, supplemented with a low protein can food, that I use to get her to eat at all and for pills. Her main treats right now are the liver and the joint treat. She gets some very small cranberry treats, or other fruit based. She will not eat blueberries. She just attacks them. I'm going to work on that. Same with green beans, she just turns up her nose and ignores them. grrrr

Oh Addy, do take care of yourself. It seems you have had this for way too long!

hugs
Sharlene and molly muffin

[molly muffin]

Ha! So just in case I went and checked Amazon.ca again, and sure enough, now they have Honest Kitchen food! It still has to be ordered in from the US it looks like. Very expensive. I'm going to look around some more. Which one did you feed Zoe? Looks like there are several forumlas. Do we know the protein and fat, phosphorus amounts?

hugs
Sharlene and molly muffin

[molly muffin]

hmm, it doesn't give much in the way of percentage per... it seems higher than the moderate protein diets, but you said it and the potatoes brought down zoes upc?

hugs,
Sharlene and molly muffin

[labblab]

No, I ended up not using the Honest Kitchen Zeal because it was just too expensive for a big girl like Peg :o. It did otherwise work for her in terms of being lowfat. But it is specifically marketed as a high protein food, and the specs seem to back that up. I don't know whether there is a different Honest Kitchen blend that would be more suitable for Molly, but on the face of it, I'm afraid Zeal is much higher in protein than your vet would want.

[addy]

I know it looks expensive but I have compared it to other quality canned foods and it really is not much more money when I compare the cost. I order a 10 pound box. It lasts about 6-8 weeks. Koko eats about 2/3 of a cup dry measure before I add water per day, divided between two meals. In the 10 pound box there is about 40 dry cups. He actually could eat 1/2 cup and be fine, he is a bit too heavy by a few pounds. 11-30 pounds can be fed 1/2 to 1 cup per day if average activity. It is human grade food, made in a human processing plant. My niece is a patent attorney and researched food for her dog which is how I first found Honest Kitchen.

I fed Zoe the Zeal which is the most expensive but that is fish and potato so has lower fat. I supplemented her raw turkey diet with the Zeal so she ate even less of it than Koko does but back then I increased the Zeal and cut back the raw as much as I could without it affecting her IBD. It was the only commercial food she ever could eat. After I increased the amount of Zeal Zoe ate and decreased her turkey treats, her UPC came down and stayed down. I had a long conversation with Zoe's GP about low protein diets. He felt the new thinking had changed on that and you did not want to go to a totally low protein diet. I also changed Zoe's probiotic and for the life of me cannot remember the name. I'll go back on her thread.

You can email Honest Kitchen or call them and they are very helpful and will tell you whatever you need to know and may even send free samples. They did for me. It may be that for Molly, it is not a good fit. But since it helped Zoe, I thought I would mention it.


P.S.
http://veterinarymedicine.dvm360.com/presentation-recap-probiotics-and-kidney-disease
Azodyl-not sure if it helps or is a placebo

[Junior's Mom]

I had a dog in the beginning stages of renal failure. I searched everywhere for a decent food. I finally settled on this one, because I found it to be the only semi decent food with low phosphorus. I also used an natural kidney supplement.
http://www.hillspet.com/sd-canine-natures-best-lamb-and-brown-rice-dinner-adult-small-bites-dry.pdf

[molly muffin]

Do you remember which kidney supplement you used? Did this food help keep the UPC down?

Thanks for the info.
I'm researching like crazy.

Hugs
Sharlene and Molly muffin

[spdd]

Sharlene, Honest Kitchen is sold at The Healthy Dog Store in Tottenham.
http://thehealthydogstore.ca/ not too far from here. Perhaps they could ship you some? If that fails let me know, I can possibly pick it up and mail it to you.

[molly muffin]

Thanks Judi. I will let you know if I go that route. At the moment I am going to go with a moderate protein and see if that makes a difference.
Baby steps.

Hugs
Sharlene and Molly muffin

[Budsters Mom]

Hi Sharlene,

I had a live chat with one of the representatives from the Honest Kitchen today. She was very helpful. She will be sending me some samples for Rosie to try. Rosie is a picky little thing with allergies. It has been difficult to find something she likes that she will actually eat. I want to try Honest Kitchen (Zeal Formula- fish base)at least as a topper. I pay three dollars a can for the wet food I stir in now.Their dehydrated formula isn't that much more expensive. Liz (their representative) asked where I found out about their food. When I mentioned this forum, she knew a whole lot about Cushings.

Their main offices are in San Diego, California with manufacturing plants in San Diego and Kentucky. Who would've thought that they process this food about a half an hour's drive from me. There is also a retail distributor(A mom-and-pop pet store)about five minutes from me that carries it.I thought that I would have to order it online, but it is available locally.

FYI....If you decide you want Molly to try it, they have retailers in Canada and will ship samples out to you free. I did a little digging for you while I had her online.:D

[molly muffin]

That sounds great Kathy, and thank you. I did have a discussion with my IMS and she wants a lower protein content than what she has now, so I won't be going with Honest Kitchen. Not low, but moderate like Marianne talked about.
Of course it was after I had bought the blue buffalo and my IMS said she won't recommend Blue any longer after the problems due to the problems previously with vit d toxicity, she thinks it's maybe not as good as it use to be.
There is a Rayne food along with the Royal MP that she is thinking of now for molly.

I'm heading out of town again, but when I get back, I'm working a spreadsheet of info that I can post and we can look at.

hugs all, have a good weekend
Sharlene and molly muffin

[doxiesrock912]

Sharlene, Daisy tried BB and ended up in the ER. It was bad and despite the veterinary reports, Blue Buffalo refused to compensate us at all.

[Budsters Mom]

I have had no trouble at all with Blue Buffalo Basics Salmon and Potato formula. It was one of the few limited ingredient feeds that Buddy was able to eat due to his allergies. Rosie is now eating it too with other things stirred in, of course. I changed her over to it after her turkey/puppy formula made her itch like crazy. She is doing well on it, but doesn't really like it much. That's why I am going to try honest kitchen as a topper/stir in. Rosie is an allergy baby too.

[molly muffin]

So, tomorrow is Molly's appt with the IMS. We'll be checking blood pressure, doing an ACTH test and making a decision on food.

I'll need to drop the Fromms weight management that I currently use for protein, so I need to introduce something else to account for that.

We need a dry food, and I'm currently thinking of going with the Royal Canine MP dry and then perhaps MP canned to top dress to get the pills down molly (omega 3 is huge and those eye pills aren't anything to sneeze at either). And we'll see how she does on these options.
I'm hoping her blood pressure has been holding steady.

She has been an energy magnet in the evenings this week. Running around and very playful. Every since Sunday when we came home from Calgary. I love to see her like that. Molly as everyone knows has tons of personality and other than when she is feeling bad or off in some way, she rules the house wit her antics and just in general molly behavior. That hasn't changed and I'm really happy about that.

So, cortisol, protein kidneys and eyes. Those are our issues. I know with the help of the gang here that we will get this figured out, one way or another. :)

I couldn't do it without you and really do want to say thank you. When I am freaking, you are there, when I'm confused, you are there, when I just need to let off steam, you are there and when I'm happy and things are going fine, we're all there together enjoying the good times while surviving the bad.
This is family. Thanks all

Sharlene and molly muffin

[Dixie'sMom]

Awww... what a sweet post. Big hug for you Sharlene. You are always there for me and Dixie and I just wish I knew more ways to help you with Molly. I'm so glad to hear she is feeling good and frisky! I know it does your heart good. :) Will this be trip #3 to the IMS this month? Geez. Bless your heart and pocketbook.

I'm hoping you get good reports tomorrow on Molly's bp, eyes, kidneys and cortisol. The food thing -- I don't envy you. I read a lot on Food Adviser but I end up just as confused as I was before I got there, so I just can't help you much. But I do wonder if plant-based protein would be different than meat protein with regard to kidney function? if so, there are lots of plant based protein powders at body building websites that could possibly supplement a low protein diet. But dogs eat meat, so I just don't know if that would work. See? Now I bet I have you confused too? LOL.

I'll be saying a prayer for you and your girlie tomorrow. Let us know as soon as you can how things go.

[labblab]

Good luck to you girls today!!!!!

[Squirt's Mom]

With you all the way, Sharlene!

[addy]

Thinking of you and Molly, Sharlene.

I'll check back later.

PAWS UP

[Harley PoMMom]

You and sweet Molly are in my thoughts and prayers, wishing you both the best of luck today.

Love and hugs, Lori

[Woodydog]

Right back at you, your here for all us too.

Paws up Molly

[Tina]

I'm here too Sharlene, thinking about you guys. All the best today. Paws up Molly!

Hugs from me, Jasper and Shelby xo

[Budsters Mom]

I'm here waiting with the others too!

[Budsters Mom]

Still not singing, "We Are Family" Sharlene. ;)I am quite partial to "Soft Puppy, Warm Puppy" though. That's a possibility. :D


I couldn't do it without you and really do want to say thank you. When I am freaking, you are there, when I'm confused, you are there, when I just need to let off steam, you are there and when I'm happy and things are going fine, we're all there together enjoying the good times while surviving the bad.
This is family. Thanks to all.

[molly muffin]

Well, they did an ACTH test today, so I had to leave her for two hours because as you know, here in Canada they draw at 1 hour after the injection and again at 2 hours after the injection.
They also did a UPC today (I think, it was on the agenda anyhow) and of course the Blood Pressure.

So, BP - not good. She was at 180 - 190 - 210. The medication is obviously not controlling the BP as we had hoped and as it seemed to be 2 weeks ago. I'm guessing that the UPC might be high too, causing the BP to go up. We'll know more once the labs are back.

I didn't get to speak to the IMS today after all, as instead she'll call me when the labs are back in. I had left mollys leash in the car, and gone up to the desk and said I wanted to pay before they brought molly out, but they didn't have the invoice yet. They were going to add that to the system as soon as the last blood draw was done. Anyway, the lab tech brings her out, tells me the BP readings, and said the IMS will call me when the labs are back, and they are hoping those come back tomorrow afternoon. I walked out without even paying, my mind was in turmoil, thinking crap, that means she has retinal bleeds again too and of course a million other things like what the heck, is the kidneys worse than we thought or what. (we were thinking we'd caught this very early)

Anyway, I drove home, then called them to give them my visa and apologize profusely for leaving without paying. They were fine of course, I mean I'm there pretty regularly. LOL They'll email the invoice and also mail me a copy with the visa slip. So, nice but man the bill was way more than I expected. This has been a rough month financially with Molly that is for sure. We'll have to go back again to I bet with the BP up there like it is. I really have to call my vet and get her to call the other vet and see if they will do BP readings for us. Then acclimate molly to that vet setting. I need to order the MP food, but am waiting till the results come back from todays draw. Hopefully they were able to get it. I didn't know it was on the agenda and let molly pee before I took her into the vets office.

I think today, I'm just very rattled with things and not my normal cool collected self at all. I feel like swearing and kicking something.

Thanks for hanging in with me gang
Sharlene and molly muffin

[labblab]

Well dang, I am so sorry about the blood pressure because I know that is a great worry to you. But maybe just the stress of being at the vet drove it higher than it is normally (my blood pressure always goes up at the doctor's office :o).

I sure hope you get the rest of the results tomorrow so you don't have to wonder and fret over the weekend. I will keep checking back, and am so glad to hear that Molly is otherwise her spunky diva self!

Marianne

[addy]

Sharlene, when did they take the blood pressure? Before or after the acth test?

With Zoe, the IMS would take it on the day of her acth test and it would be higher, the ophthalmologist knew how to calm Zoe down and the first reading would be high because they would force Zoe to lay on her side so then he would tell the techs to wait, he would stroke her head and then have techs measure with different legs and it would be lower. I remember someone on the forum said their dog freaked out as well when made to lay down on her side so her vet took Bp while pup was standing.

I think as well, Zoe always sensed my anxiety anticipating the acth test- she feed off me while at the eye doctor I was usually calmer because he had a good bedside manner.


just throwing stuff out there:o:o:o:o:o

[molly muffin]

Excellent point. I think the first was done before and the next two had to have been taken after the injection. The last one is pretty much discounted as molly was worked up. The first should have been better than it was though. Same guy took it the same way as the 150 last time. Molly knows him and seems to be fine with him. She is not fine when she has to stay there though like she did this time.

So I will mention this along with Zoe's history of BP testing to the IMS when she calls.

They seemed to think the results would be in tomorrow. So, cross fingers that they are right.

Molly having had the ACTH today, is a bundle of energy tonight. Even with the melatonin which I gave her because of the thunder and lightening. Good thing is the weather doesn't seem to be bothering her at all, but she is hungry for anything not in her dish (give me a treat, NOW) and is jumping and running all over the place. Lord help me if this is what constant cushings is like, I think I'd have a melt down at some point. LOL

I'm glad she seems to be doing okay though. Just have to survive the next couple days till this test wears off. She did this last time too. Man it was a long 2 days.

hugs
Sharlene and molly muffin

[Dixie'sMom]

What a frustrating day for you. Dang that blood pressure! I was really hoping that her medicine was giving her good control. I'm with you on having the regular GP do this. I couldn't imagine paying the IMS for the BP checks as often as you may have to have them to monitor things.

I'm so sorry Sharlene. I know this is so frustrating for you and you're worried sick about Molly. I'll be waiting with you to see what her blood work shows and hear what the IMS recommends. In the meantime, my best friend says Ice Cream is good for everything. Maybe you and Molly should just have a nice bowl of ice cream. Hugs and Love!

[My sweet Ginger]

Sharlene I'm so sorry about the BP readings but I hope you will get better results on other tests they did on Molly today.
Ginger gets very worked up at the vets especially when they take her away from me so I asked if they can take her BP in the examining rm with me sitting on the chair and holding her in my lap talking to her the whole time and the tech gets down on the floor and gets the readings from one of her rear legs. I don't know if this really helps calming her down but that's how we do it every time and I wouldn't do it any other way. Maybe you can try this way next time and see if that helps Molly stays calmer. I can also see Ginger gets more worked up as time passes so maybe it's better to get the BP out of the way early if possible. Many hugs to you and Molly. Song.

[Squirt's Mom]

I bet that BP was effected by having to stay there and would be lower if it had been done like usual. ;) And just wait til Molly jumps on your tummy while you're napping and starts barking her head off, "TREAT! TREAT! TREAT! NOOOOOWWW!" :D On a more serious note, it was Squirt's eyes that got to me when her cortisol went up; I will never forget that haunted, forlorn look.

Hang in there, sweetie. You're the best mom and I know Molly is in the best of hands.
Hugs,
Leslie and the gang

[Trish]

Tap tap tap, waiting for the phone to ring with our news.... so impatient!!! Go Molly!!!!!!!!

[Trish]

Well not my phone :D haha that came out wrong!! Waiting for the update though Sharlene, hope your nails are not bitten down!

[molly muffin]

So, first BP 170 we agree the next two which were 200 and 210 could have been due to the acth injection. However, will monitor and redo again next week, as we want to make sure she isn't spiking her BP.

ALT 163, down a tad
ALKP 1439, up around 100 points
UPC 2.1 so the same

ACTH
pre 74nmol
post 1hr 858nmol
post 2 hr over 1000nmol

This is taken from my notes, actually results will be emailed.

plan is to increase med for protein to 2.5 mg twice a day instead of once

start trilostane at 1mg/1kg ratio (based on U Davis protocol) using compounded 8mg. retest in 10 - 14 days. We'll be using a compound pharmacy in Guelph that they use all the time and have had good results with. (you know we went over that pretty thoroughly)

no change in food at this time, as we want to see what all this does and then if we need to change food, we'll look at a transition.

Let me know if any questions that we want to have answered! Or if you notice anything. I think she said everything else on the labs was good and in range. I'll verify of course.

Thanks everyone for hanging with me.

hugs
Sharlene and molly muffin

[Trish]

Nothing like a good plan, sounds like you have one right there. no better place to be starting meds than here with the support of all these smart ladies!! Pleased the BP to be rechecked too, don't want anything complicating that. Are they doing a few and averaging them to take into account normal variation? Hope you find someone closer to do that!! Bet Miss Molly will take this totally in her dainty little stride and hopefully we get some much better numbers soon!

[Dixie'sMom]

I agree -- it sounds like a good plan. I don't understand the numbers (nmol) other than the BP but I'm assuming the cortisol was high enough this time that all agreed that she should be on meds. I betcha a nickel that the trilo will help that bp come down also. Molly will do good on it and feel better.

I hope she has settled down some today and isn't still being a wild child from her ACTH yesterday. haha.

Hang in there Sharlene. You're getting there slowly but surely.

[molly muffin]

It's been a long road Suzie. We have been on this journey for over 4 years now. If not for the protein and bp we likely still wouldn't be doing dinner as she has never had the normal Cushing symptoms. Still doesn't even with the ACTH testing. She has food in her bowl still. Never finished yesterday either. Doesn't drink that much water. We have to encourage her even sometimes to drink. No accidents. Urine isn't dilute. In any other dog I'd say no way and they still don't know what the deal is with her cortisol levels. But we have to get it down so here we go. Another leg of the journey.

She is napping now after running around this evening. She doesn't want her food. Only her treats.

Got to run.
Hugs
Sharlene and Molly muffin

[Budsters Mom]

Okay Sharlene, you have two options for getting through the next 24 hours. Either you can take the batteries out of the little muffin or you can program her on a loop like a little electric train. That way she will run out her batteries on her own. LOL :D:D

I know, it's not really funny, but lightening the mood is always good.;) Our pups are bouncing off the walls after the Acth. Takes a while for it to wear off. Big hugs in the meantime.

[Dixie'sMom]

Sharlene, I know its been a long journey for you and a very confusing one. I've read quite a bit of Molly's story but at 261 pages my eyes just won't hold out to read it all. I have been following consistently since I joined the forum tho. The atypical cushings appears to be just sooo "atypical" that every single pup is showing different symptoms and there is not much consistency between cases. I'm not lucky that Dixie has Cushing's, but I am lucky she is a very typical case and has been so easy to manage so far. (Keeping my fingers crossed it stays that way. )

Molly is very, very lucky to have you and the Hubby to take care of her with your kindness and generosity and always going the extra mile to make sure she is getting the best of care. I have faith that this will all get sorted out soon and you and Molly can enjoy some peace.

[labblab]

Hey Sharlene, sounds like your plan is all in place! :)

Since Molly is already picky about eating, I understand why you might want to wait on the dietary change if for no other reason than just not altering too many variables right as you're starting out on the trilostane. It'll be interesting to see if there is any effect at all on her appetite. Who knows, maybe she'll be one of our very few contrary pups who gain a better appetite when the cortisol is lowered. I don't think you had joined the forum yet when one of our long-term members, Sue, was here treating her Zoe. But darned if Zoe didn't always stop eating when her cortisol started heading north!! It was the craziest thing, but Sue knew Zoe so well that she could always tell it was time for a cortisol check when she'd leave food in her bowl.

One other question occurs to me, and that is about fish oil. Tina had mentioned it earlier. I know it has been prescribed for Jasper, and most of the stuff I've been reading recommends it, as well, for treatment of protein loss. Here's a quote from that IDEXX roundtable discussion on proteinuria:


...we have antiproteinuric therapies that seem beneficial. These are interventions that can lower the magnitude of renal proteinuria. The most common are dietary protein restriction, dietary fish oil supplementation, and interventions that interfere with the renin-angiotensin- aldosterone system. In veterinary medicine, that latter group includes angiotensin- converting enzyme (ACE) inhibitors, such as benazepril or enalapril. In terms of reno-protection, the interventions that are supported by studies are ACE inhibitors and dietary fish oil supplementation. In dogs, for example, there is evidence that ACE inhibitors decrease proteinuria and renal lesion magnitude concurrently.10 In addition, a multicenter trial that Dr. Grauer led indicated that ACE inhibitors are antiproteinuric and potentially beneficial in spontaneous glomerular disease.11

Fish oil supplementation is also antiproteinuric and renoprotective in dogs,12 but there is no evidence yet of fish oil’s benefits in chronic kidney disease. Ongoing clinical trials in which Dr. Sanderson is involved are evaluating the potential benefits of long-term fish oil supplementation in dogs with spontaneous chronic kidney disease. There is reason for excitement.

https://www.idexx.com/pdf/en_us/smallanimal/education/proteinuria-round-table.pdf

So fish oil may be something else you want to discuss with your IMS if it has not already been mentioned.

[molly muffin]

They put her on omega supplement 3 weeks ago. I think that would have fish oil I. It. But I will check. It was first thing we added along with the vision supplement. The omegas can cause diarrhea too they said. Joy joy. We have had diarrhea all week off and on. Poor muffin. I will never be able to use poops as a determination for the trilostane or eating either. So that has always given me pause to think but we have to do something.

Oh gosh Susie that would be a long read indeed to try to go through all of this thread. Lol. I was trying to say how frustrating it has been for such a long time not knowing what to do for her. We have had a lot of really good times though and only a few real problems so far. Thank god. Text book cases are definitely easier I think to diagnose. It is always a roller coaster ride though that's for sure.
Molly isn't typical atypical either since she has the high cortisol too and normally you don't with atypical. She also has the high sex hormones though that is a sign of atypical but with low aldosterone which is often seen in adrenal tumors. Argh. See I over think this stuff too much sometimes I think. Lol. Drives one batty. Will need a straight jacket at some point I think. Rofl

Kathy you never fail to crack me up. Lol. I was considering the programming a loop and letting her go option. I think we are past the worse of it though and she is getting back to normal activity level.

Hugs
Sharlene and Molly muffin

[judymaggie]

Sharlene--I do want to go back and more of Molly's journey but the quote below really caught my eye. My Maggie (who was the reason for my joining this forum several years ago) was finally diagnosed by UTenn folks with atypical Cushing's with an overlay of "regular" Cushing's after testing showed the exact same pattern you describe below.


Molly isn't typical atypical either since she has the high cortisol too and normally you don't with atypical. She also has the high sex hormones though that is a sign of atypical but with low aldosterone

We treated Maggie with melatonin implants and lignan extracts. A maintenance dosage of Lysodren was also recommended but, at that point, Maggie was too ill to tolerate it.

I wish you all the best with Molly's care along this roller coaster!

[molly muffin]

Just checked and the very first thing in the Omega supplement is fish oil, so we're covered Marianne! Thank you for thinking of that.

Judy, it's so hard when they have a couple different things going on. My IMS opted not to go with the lysodren maintenance dose, as it is so tricky with molly not having the normal symptoms and with her low appetite and diarrhea, she (my IMS) said she wouldn't trust we'd be able to tell if the lysodren over did it and thinks we can manage the trilostane better. Hope she is right.

I hope Abbie is going to be an easier case to handle than Maggie. I'm following your journey too. :) A lot of twists and turns on this journey and darn if they don't throw a fork in the road in too every now and then just to keep us on our toes! :) :)

I do love the forum though. I just don't know how on earth I'd managed all of this without the people here. That straight jacket would have already been buckled up!!!!
My IMS said something yesterday that I thought was very nice, as we were chatting about results and working out a plan. She said, "it is so good to be able to talk to you as it is more of an exchange, than me just explaining, not that I mind explaining, but you already know all of this, so we can throw ideas back and forth and you understand what I am talking about, medications, dosages, risks, tests, protocols, etc." That was sweet. She had started to tell me about trilostane testing protocols, give in the morning, with food, test 4 - 6 hours later, test in 10 - 14 days and I swear I didn't say anything, was just letting her talk and then she stopped and said, I know you already know all of this. And I'm like, yea, I do, as I tell people the same thing all the time, but it's nice to know we are on the same page with it all too, as not all vets are. She started laughing and asked if she passed and I said, yep, you did, we'll be a good team. LOLOLOLOL

Hugs,
Sharlene and molly muffin

[Dixie'sMom]

I had remembered you saying that they added the Omega's to Molly during the last visit so I never mentioned it to you, but the Omega's are great for eye health so you are getting a two for one in giving her those. The retina docs recommend them highly for their eye patients and it sounds like great for kidney health. I'm glad your energizer muffin has wound down. Have a restful weekend! :)

[molly muffin]

It is interesting, the eye supplement, was engineered by vets, based a great deal upon studies of humans with retinal bleed and loss of focal point eyesight, add this in with the studies on dogs, and we are hoping that it will at least help give her some eye support.

Yep, she seems back to normal today, so the ACTH testing has worn off I think. Whew. :) It's cold and windy/damp here today so she isn't all that interested in going outside either. I'll probably have to convince her it is a good idea to go for her late afternoon and evening walks, as she isn't a fan of being wet and damp. (well really who is) When she ignores the rational, we really need to go outside so you can pee discussion, I just pick her up and out we go. A lot easier with a small dog, as impossible to pick up a big dog and do that. LOL

hugs
Sharlene and molly muffin

[Budsters Mom]

So glad that Molly is back to her normal Molly self.:p

I can just see that time to pee discussion. Lol :D Yes, it is so much easier to pick them up when they're small.

[apollo6]

Glad to hear Molly is doing better.
Sending love and hugs
Sonja,Apollo and little Ariel

[jas77450]

Glad Molly is better Sharlene.

[molly muffin]

Just a quick update. Molly's BP was rechecked today, it was 150. Yay.
I picked up the trilostane, she'll start this weekend and her recheck ATCH is Nov 6 at 1pm, based her getting her med at 8 - 8:30am.

hugs,
Sharlene and molly muffin

[Dixie'sMom]

YAY! thats great news on the BP. Go Molly!

[jas77450]

Good to hear!!!

[mcdavis]

Just catching up on Miss Molly. It sounds like you've had a worrying time but it's good to see that her BP is better.

[My sweet Ginger]

Yay! Brownie points for Molly for listening to mama.:)

[addy]

So glad the BP is down :):):):):):)

[molly muffin]

Thanks. I'm pretty happy about that too.
I actually am wondering if it wasn't all Falsly elevated, in that I'm not sure that first bp check last time was before the ACTH test now after speaking with the vet tech.

hugs
Sharlene and molly muffin

[Budsters Mom]

So glad the muffin'S BP is down, regardless of the cause. We'll take it!;)

[Squirt's Mom]

I'm with Kathy - glad to see this whatever the reason and hope this trend continues!

[labblab]

Good Mornin' Sharlene! ;)

Just read elsewhere that Molly started her trilo on Sunday and all is good. YAY!!! :) :)

All fingers and paws crossed that things continue to go well and that the medication will be a help to her.

[molly muffin]

Thanks Marianne. Yes Sunday we started 8mg daily given in the morning.
We based it on the UDavis 1mg/1kg ratio. I think with Molly we just watch and make sure she continues the same and go from there. See what the test shows at 2 weeks.

Hugs all

[Renee]

Hi Sharlene - I've been silent on your thread, but following along. Sure hope the girl continues doing well on the trilo. :)

[My sweet Ginger]

Yep, our fingers and paws are crossed for good results on trilo.

[addy]

Hope everything goes as planned, Sharlene. I'm sure it will be fine.:)

[Dixie'sMom]

I know it will be a relief for you to see that cortisol dropping in 2 weeks. Surely it will help her overall health. I'm glad shes tolerating the medicine. Have you changed her food yet and if so, how is she liking it?

[molly muffin]

No we didn't change her food at this point. The SO food has about the same protein/phosphorus as the moderate protein, so we opted to do one thing at a time and I felt the trilostane was the most important to get introduced.

Molly is her normal self and feeling pretty good overall if this afternoon is anything to go by. It's been rainy here this afternoon and rather than go to the door for her walkies, she was running all over the house, avoiding the door when I said, lets go walkies. Finally she ran for the door, leaping over a pair of shoes in her way and skidded to the door. Tail wagging when she got there. So if it has lowered the cortisol at all, she still feels okay and that is what I want. I'm not looking to go to low, with the way her back legs and back are, I think she'd be in pain if we did or at least feel those hurts more than she use to. I don't want that.

Thanks everyone for checking in on us.

hugs

[judymaggie]

Love the description of Molly -- she sounds very spunky! :D

[mcdavis]

I totally agree with only changing one thing at a time - that way you know if something is helping or causing problems.

With Hamish one of the vets was very eager to give him joint pills but I refused a couple of times when she had prescribed other pills because I was worried about interactions - when I got copies of his files you would think I was the worst puppy parent in history for refusing the joint pills :eek: (I did get them, just at a time when he wasn't taking anything else).

[doxiesrock912]

Yay Molly! We like spunky Sharlene!

[jas77450]

Go Molly!!!

[flynnandian]

good girl!

[molly muffin]

Hey Iris! Great to see you.

Hope that all is well with you and the gang.

Molly continues on, doing the same ole antics. She is a character. LOL

I on the other hand, am having a massive headache from that pupil dilation test they do on your eyes. I feel all cross eyed and wonky!

Do update your thread and let us know how you are doing!

hugs

[mcdavis]

Oh you poor thing Sharlene. I hope you feel better soon.
I think I've managed to avoid that so far but remember OH having it, and I had to drive him home - he said it wasn't pleasant (and I don't think he meant my driving :p ).

[Budsters Mom]

STOP!!!!! You need to rest your eyes, so go do it!!!! We will survive until your return tomorrow. Well, most of us anyway! :D;)

[molly muffin]

Eeek, it's hard to stop isn't it. LOL I should rest my eyes, but everything interesting happens when you aren't looking ya know!!!

Okay I'll stop. I took molly out for her last walk. Have a bit of an issue with the loose poops, but only at night, and this started before the trilostane, think it's the omega 3, as it was mentioned that it could and often does cause loose poops in dogs and she gets her's with the evening meal. She has so many other things in the morning, like eye, trilostane, and BP meds, that I wanted to space it out a bit.

Anyway, really will go close my eyes for a bit.

LOL MC, definitely not your driving. :) hahaha

hugs

[jas77450]

Hope you feel better!!!

[judymaggie]

Sharlene -- hope you are feeling better today! Because I have such a long-lasting effect from the dilation drops, my optometrist now only uses a third of the dose and he is still able to get a good view of everything. I also found inexpensive "cataract" glasses (the kind that fit over regular glasses and are almost black) so I am able to at least drive home after the exam.

Maybe you could try adding Forti-flora to Molly's dinner. It has worked very well with Abbie's liquid evening poops. I know I can't take omega-3 without having "issues" so expect you are right about the cause of Molly's problems.

[Trish]

Do they look like this?? :eek: :eek:

[molly muffin]

Yes Trish they look Exactly like that!

Good idea about the florifora, I have some on hand, will add. This morning I gave her the omega 3 in the AM and the eye vitamin in the evening. See if that makes a difference.

Headache is all gone, luckily that stuff does eventually wear off. Until then you are all kinds of wonky though.

Ready for trick or treaters here! Molly is on guard and the spider bowl is filled.

http://www.k9cushings.com/forum/album.php?albumid=518&pictureid=7186

hugs and shivers and giggles

[flynnandian]

we don't do halloween in the nl., but i hope you and molly have lots of fun!

[jas77450]

Happy your feeling better!!!

[doxiesrock912]

Sharlene, I see a retina specialist every year so I'm very familiar with those drops. His are even more potent. I've had to drive myself home from the last 2 appointments. Praying for a cloudy day when I go.

How cute Molly's bay window perch is. :-)

Bella barked at a few of the kids but after awhile she started whining in-between. I think that she was enjoying the sights once she saw the we were happy with the visitors.

Next year, I may consider putting her in a costume. We didn't get many kids and all was finished by 7:30pm. One man was crazy drunk walking his son around the neighborhood. I was NOT happy and was glad when he stumbled away from dad's house. The last thing we need is to be sued by a drunk man who fell. Ugh.

Sorry for the rant and I myself will have a few glasses of wine, BUT sloppy drunks do not impress me. Especially with my family history.

I am positive that the omega-3 is causing Molly's evening issues. Try a teaspoon of canned pumkpin when you give her the pill. Might bind her just enough..

[molly muffin]

I switched to giving her the omega 3 in the morning and that seems to have helped for now, she is back to firm poops.

hugs

[jas77450]

Go Molly:)

[doxiesrock912]

Good! Maybe having it with food helps instead of later in the day?

[molly muffin]

Took Molly for her ACTH test today. Results will be called and emailed to me tomorrow by IMS. Will see if this has had any effect on her cortisol. Doesn't act like anything is different.

Her BP was high again 214. Darn it.

[labblab]

Hi Sharlene, sorry about the dang blood pressure. But please don't be downhearted even if the cortisol is still pretty high. You have started out on a low dose, so there is plenty of room for an increase if that ultimately seems called for. I think it's really good that Molly hasn't had any adverse effects from the trilo -- that's one of the most important things right now, too. :)

[Budsters Mom]

Okay, A massage and meditation music prescribed for our little muffin. Got to get that dreaded blood pressure down. ;)

I'm so sorry Sharlene. :o At least she's acting like the little diva she is.:p

[molly muffin]

Just spoke with the IMS, and we are increasing molly's benazepril from 2.5mg x2 to 5mg am and 2.5mg pm. See if that makes any difference and we'll retest the UPC in a couple weeks.

Prior to doing any of the ACTH testing, they did the BP readings and she was consistently over 200, 220, etc, with 214 being an average.

So, I'll talk to them tomorrow once the ACTH comes back and we'll go from there but at those levels, she is definitely in a Not good zone.

We have to figure out Why the BP isn't staying down and if it is due to the protein in the kidneys, if it is due to cortisol or if it is due to the nodule on her adrenal glad perhaps being a pheo.

So many things to try and get a handle on.

I think molly and me are both going to need the massage and meditative music Kathy. I'm pretty sure my BP is spiking every time I hear that Molly's is up again.

hugs all, thanks for hanging in there with us on this journey




One worry is that the nodule is a pheo and her BP is spiking.

[judymaggie]

Thinking good thoughts for you and Molly! Sure hope the increased BP meds will do the trick.

[jas77450]

Hopefully the increased dosage will bring her BP down. Fingers crossed for Molly. Hang in there sweetie!!!

[addy]

I sure wish her blood pressure could be checked not on an ACTH test day:(:(:(:(:(:(:( but if they did readings there while you were away with a high average then it just could be so.

I sure hope her cortisol came down a bit.

Hang in there Sharlene.

[molly muffin]

I asked them specifically to do the BP before they started the ACTH and they said they did.

I was wondering if just the atmosphere there makes her BP go up. Today there were a few emergencies and a lot of dogs in there.

We will just keep plugging along. :)

hugs

[Trish]

It should not have affected it then if it was before ACTH, bah humbug on the high number, but was it just a one-off BP or a few and averaged, might pay to check their BP procedure. I sure wish your local vet could do it where Molly would be likely a bit calmer.

I am getting a bit more concerned about the pheo, as you are too. So with you there, when is the next scan due?? Wondering whether a CT might give a clearer picture of the nodule?? Another question to ask when you speak to IMS. Because that BP had come down last check, now bounced back up again. Stink.... will line up with you for the BP meds for us after this stressful week, thank god we have a place to come and vent and everyone understands. Hopefully we see some cortisol shift in the downwards direction with the results tomorrow. xxxxx

[My sweet Ginger]

Sharlene, I remember what Patti sometimes had to do to get Tipper's BP at the vets. She'd arrange one of the techs to come out to her car before they do anything else and get the numbers while she's holding Tipper. I know they can manage it because the BP machine is portable. We do it all the time to get Ginger's BP only we do it in the examining rm. Maybe you will get more accurate numbers doing this way. You know they are pretty accommodating, I'm sure they will do it for our Muffin but you have to ask. ;)

[molly muffin]

They do a series of BP, discard the first one as it is usually stress high and then average the others.

If my vet did BP's they probably would, but not sure this big vet hospital would or not, come out to car. Not even sure it would make a difference as molly starts shaking the moment she gets in the car to leave the house. She is fine when we leave anywhere to come home though.

Waiting on the IMS to call with the results of the ACTH.

hugs

[Trish]

Alrighty, that is a good protocol. But repeated x 3 over a few hours would be better. I remember when I first went down this BP line of testing, Vet did not want me there, I wanted to be there. He said owners can make it worse not better as pet is just stressed and wants them to take them home. But they settle more than we realise in a quiet room, our stress increases their stress etc etc. It is a hard one and I grumbled long and hard before letting him get on with it... but I am glad they are doing several recordings on Molly. Tell your local vet to get a darn BP machine as I am sure the money you have paid them for Molly over the years would probably equate to 100s of BP machines!!!

Waiting along with you Sharlene xxxx

[Dixie'sMom]

I read about Molly's vet visit and her BP last nite and all I could think of was "Good Golly Miss Molly!" I know you are frustrated at taking a step backward when she was doing so well the last BP check. I'm anxious to see what her ACTH results are. Something to me just doesn't sound right with the BP going from 140/150 last visit to over 200's this visit. I know anxiety plays a huge part, but dang. Is there a way you can discretely find out whether they use the same sized BP cuff each time or if they just grab one and test her. I know in humans the cuff size makes a huge difference. I, myself, after quite a bit of weigh gain on high dose steroids have to remind the nurses to use the large cuff or my BP is over the top and totally innaccurate with the smaller cuff. I know I'm grasping at straws but I want to see that little girl under good control, as I know you do. Or it may just not be the correct type of medicine for her. There are so many types and they all suppress the BP differently. Hopefully the higher dosage will give her good control.

Hang in there Sharlene. At least Molly is feeling good which is a huge blessing. I'm just sorry you are having to go thru this. I know your imagination runs wild with scary possibilities and that's no good for you or the hubby. She'll get there, it's just taking a little longer. Is the hubby's surgery coming up this month? Prayers coming your way honey!

[Bailey's Mom]

Hi Sharlene!

Well I've finally caught up with all that's been going on in Oct and so far in Nov. I ran into that cuff issue with the BP test, also. When I had my blood clot scare, I got a reading of 180+ and that was after having been stretched out in the waiting room for 3 hours, while we waited. I had it retaken this week and it's at 117. Stress is a mess.

What is the husband's surgery for? I didn't run into that in all of the pages I read. When is it and what is the recovery scenario? I hope it's nothing serious......although surgery is always serious.

I love hearing about Molly's antics. She and Bailey would have a ball together....if they got along, that is.:)

Light a bunch of candles, turn down the lights, fill the tub with hot water and bubbles, if you like, and have something to drink there for yourself, lie back and relax. Take your iPod with you. Nice relaxing music. It does wonders.

Love,
Sus

[molly muffin]

Okay, so we have the ACTH results back. She is coming down, although her pre was up a bit from last time. We talked about increasing but in the end decided that with lack of symptoms, other than BP and protein, we should continue slow and low and see if she continues to come down any further on the 8mg trilostane.
Recheck of ACTH in 3 weeks (Daniel has his surgery at 30 day mark so I can't do that and neither of us think she'll be too low on the same dose)

ACTH Oct 17, 2014

Pre 74 nmol 2.68ug
1hr 858 nmol 31.09ug
2hr 1024 nmol 37.11ug

ACTH Nov 07, 2014

Pre 102 nmol 3.69ug
1hr 582 nmol 21.09ug
2 hr 608 nmol 22.03ug

I think I did that right, dividing by 27.59 to get ug.

We will recheck her BP this thursday and see if the increase in dosage for that has helped.

We fully expect this week she'll be either at 150 or too low the way things seem to go with molly. 1 time she is way too high and the next at 150. I think they use the same cuff on her, the small - med dog cuff. We'll see how this one goes.

We need to get the cortisol down and the protein controlled and then see how that adrenal nodule is doing. We can't really determine pheo right now till we rule out the other possibilities. She isn't thinking pheo off the bat, with the cortisol being raised, but anything is possible and it's not unheard of.

Daniel is having a double hernia surgery and will be in the hospital for 4 days at least.

I've ordered thai food for dinner and plan to have a weekend with hubby, who has had a rough week himself so guess I'm spreading the TLC between him and molly right now.

When this is all over and his surgery is done, he's healed and molly is more stable. I'm going to need some serious Me time. LOL

We're hanging in there and dealing with things as they come up. Molly doesn't act a bit different, is still a little diva just doing her thing. She doesn't know there is a thing going on in her life and she seems to feel just fine.

thanks everyone for the well wishes.
Hugs!

[jas77450]

Glad to hear Molly is acting like she feels ok. You definatley have your hands full for now. Take care of yourself too!

[Budsters Mom]

(((((((hugs)))))))

[Squirt's Mom]

Sending healing white light to Daniel, praying all goes well and he is up and at 'em again very soon.

Hugs,
Leslie and the gang

[Trixie]

Hi Sharlene...so weird, I posted on your thread here late last night...I must have not clicked on the POST button hard enough as my post is not here!! :confused::confused::confused::confused:
Anyway...I have missed a lot of things going on with Molly. Happy to read she's acting like herself though...and not showing any signs that she's uncomfortable in any way.
Looks like really good progress on the decrease post number..looks like the Trilostane is doing a good job and not causing any issues for Molly. Hoping you notice a positive change in the BP number, though it is not easy to get a good reading and we never could with Trixie...just too nervous and hyper walking in the vets...
Between your husband..(hope all goes well there) and Molly you must be ready for your "me" time...hope your day comes soon!
I wonder what happened to my late night post!? :confused: I'm so puzzled!!
:) Barbara

[Bailey's Mom]

Hi Sharlene-
I'm sorry to hear Daniel is heading for a rough go. 4 days is a very long stay, these days.
I'm glad Molly is hanging in there.
You know-I think I posted on here yesterday and mine is not here either. That is weird.
Maybe you could take your "me" time in Florida???:cool:;):D
Susan

[labblab]

Hey Sharlene, I think you're on exactly the right track with the trilo (that's great the cortisol's coming down!:)), and I'll surely be thinking positive thoughts about the BP and most certainly for Daniel's surgery. What day does Poor Boy have to go in? :(

[molly muffin]

He goes in on the 18th. Surgery is on the 19th and 20th. (it's a double hernia so they do one side each day) He's doing it under a local instead of general anesthesia. I feel nauseous just thinking about it.

The hospital said today he will be in till Monday the 24th. So, it's a fairly long stay. 6 nights. Everyone says they have good results though with healing and want to make sure there are no complications going forward. He'll have mentors that are going through the same thing before he goes in and then he will mentor others until his release. Interesting eh. They are up on their feet 4 hours after surgery. My neighbors dad had his hernia surgery at the same hospital and said it's more like a 5 star resort, with their entire focus being on the patients well being and whole health recovery. This should be interesting.

Molly is still doing good. I have a couple things that have to be worked out in that I can't keep going to the IMS for the BP readings every week or other week. It's too far and I'm running out of vacation to take doing all these tests and being there all the time. My vet however, does not have a BP machine. *sigh*

I can find another vet, but none of the other vets do boarding and after some not so great experience with boarding her at other places, the vets is the only one I currently trust. My current vet though is the only one who does dog boarding and doggie day care when needed.
So, what to do about all this. Do I see if I just get a vet to do the BP readings and stick with my current vet which is what I'd like to do? Or do I have to switch because my vet doesn't have a BP machine and then what do I do about boarding.

I feel like I'm stuck in a hard place with no good solutions. I've been trying to figure this out since September, with no real answers.

I need to make sure my vet can do the ACTH and send to the lab that the IMS wants used also. IDEXX. She wants consistency with the testing since molly is not symptomatic and harder to determine what is happening without the tests being done in the same lab so we can see the drops or increases without any other factors (lab factors). I'm pretty sure that my vet can send to IDEXX lab, but need to verify. Also that she will order the trilostane compounded from same place my IMS orders it.

My head hurts just thinking about it.

hugs all
Sharlene and molly muffin

[judymaggie]

Sharlene--one thought re trying to find a solution to get Molly's BP tested. Since vets (and doctors, in general) seem to prefer conferring with each other, do you think your vet would be willing to locate a vet nearby who can do BP readings and ask him/her to work out the details (a professional courtesy would be ideal)?

Will be thinking good thoughts for your husband's surgeries--sounds like a great facility!

[doxiesrock912]

Sharlene,
Is there a mobile vet willing to come to your house to check Molly's BP? This would rule out the stress factor of being at the vet's office.

Double hernia under general. Wow! Hubby is brave!

Happy that Molly acts no different.

[jas77450]

Hope hubby is doing ok!!!:)
Just a thought, they have glucometers for animals to check Glucose...I wonder if you can buy BP machines and cuffs. When Cosmos BP shot up so high I got a BP cuff from the vet but the connection was different so it didn't work on my machine. Don't know if or where they sell them for pets but I will try to look if you want. or, maybe the vet can order it for you...you could do it at home and give her the results. Reaching here.

[Budsters Mom]

I am so sorry Sharlene. Your plate is overflowing!:o

Yes, your hubby is brave. OMG! I can't imagine repeating it the next day. It sounds like torture. It does sound like he's in really capable hands though. Sending prayers and healing energy your way.

Regarding little Miss Muffin... You mentioned that Molly was acting like her normal self and seemed happy. That is a true blessing. When it comes down to it, isn't that what we all want? FWIW... Focus on Daniel for now and try not to stress so much over Molly. :o Easier said than done. We all worry about you too!

What exactly is "Me time?" I don't think I know what that is? lol

[labblab]

I agree it would be ideal if you could take Molly's BP at home, either with your own cuff or a mobile vet. But the equipment may be pretty darn expensive for you to buy.

If those options aren't available, I really don't see how your regular vet could be miffed if you line up another vet to check BP, especially if you enlist your regular vet to help recommend somebody like Judy suggested. That way, your regular vet is participating in the process. ;)

I will say that this situation maybe should even prompt your GP to get a cuff. I must admit to being surprised to find out how many GPs don't seem to have them. Good grief, since they're doing surgical procedures on animals all the time, don't they ever need to check BPs just for safety's sake?? (Not singling out your own GP, just wondering about this is general :confused:).

[My sweet Ginger]

Marianne, you are so right. I didn't believe when one of my regular GP's techs told me that they only use BP machine once or twice a year and I know for fact that the vet does surgeries there, spaying and stuff. I just thought they didn't want to deal with Ginger anymore tho I still think that was the bottom line on their part.
I now believe that the tech might be telling me the truth when she said that which is kind of scary. Surgeries and they don't bother checking their patients BP? :eek:

http://www.bpmonitordepot.com/08a-versatile-digital-blood-pressure-monitor-with-pediatric-cuff-for-veterinary-use/

Sharlene, above is the link where Vicki purchased her BP machine for her Snuggles for a home use. I almost bought one if our IMS had Oked it but she was a little iffy about it and soon thereafter Ginger's BP got down under 200s so I thought no need for it any longer. I couldn't really understand her reason why she thought it may not work for Ginger then and I still don't but our Muffin is bigger than Ginger so this may just work for her. Just run it by your IMS and ask her what size cuffs you should order for Molly.
My IMS gave me the cuff size in inches. We all know when Vicki used it on Snuggs I think it was satisfactory in results. At least check it out and I hope it helps. Hugs, Song.

[Squirt's Mom]

I was gonna say pretty much what Marianne did. ;) I would stick with her usual vet that you both trust and just use someone else for the BP readings, having them send the reports to her usual vet. I hope there is someone close by who can do the readings?

Sending prayers and healing, strengthening energies to your hubby. Please keep us updated when you can, sweetie, but don't feel like you have to be here during all of this. Take the time away you may need to care for your family there. Don't let the site add to your pressure or stress, 'k? ;)

Hugs,
Leslie and the gang

[Trish]

Hubs is going to be fine, I think the trouble will be getting him out of that 5-star hospital and all the pampering to return home!!! It is going to be so good to get this over with and him feeling much better.

Pleased Molly is still acting the diva she is!! She is such a beauty that girl, just like her Mom!! :) xxx

[Harley PoMMom]

At Sampson's vet a vet tech does the BP readings, if a vet tech performs Molly's readings I would ask her/him if they would consider checking Molly's BP outside of the vet's office.

Hugs, Lori

[Jenny & Judi in MN]

I hope you can find a solution for the bp readings. Your vet should understand. And at least if your husband is in the hospital healing he can call nurses to come help him and you can hopefully get some rest.

hang in there

[molly muffin]

I'm not sure fear is a big factor. I saw her interaction today with the vet techs and her IMS and we got tail wags from her when she saw them. She even laid down in the waiting room and she doesn't lie down when she is stressing. I take her to small walled off area and she likes it there.

Anyway, so today, was Just suppose to be a BP check and pick up her trilostane. But her BP is still high even with the previous increase in benazepril, so they did a UPC and an electrolyte test. Her BUN was a big high and her calcium was a tad high too, so something else to keep an eye on. Her creatinine was good though, so yay for that. Expect her UPC will be high as it is when her BUN is higher it seems. So, once again we increased her benazepril to now 5mg morning and 5mg evening.
Depending on how the UPC is, if we'll try to introduce a BP drug or not. The IMS will call me tomorrow. She wasn't even suppose to see the specialist today and we saw her twice, but she didn't charge me for it and she also went through and checked to see what we could do to get the best price for the tests, looking at various bundles, etc. I thought that nice of her.

The journey continues, just need to get her stable on all the fronts.
Next week will be devoted solely to Daniel and his surgery recovery. Yes, he'll have nurses to take care of him. :)

We also have some issues now with Daniels mom's health. Hoping that will be okay too.

I'm pooped, anyone else? LOL I need a serious nap. Molly is sound a sleep in her window seat.

hugs

[addy]

If only we could nap at the window;););)

thinking of you

[judymaggie]

Wow, Sharlene -- you must be exhausted! Somewhere in between everyone else, you seriously do need to take care of yourself.

That's great that Molly is so relaxed with her doctors -- I think Abbie would prefer that I sedate her. I will have to look up "UPC" as I am not familiar with that test. I wonder if Molly would do better with a change in medication even if it is similar to the benazepril. I think that our pups sometimes build up a resistance to a med if they have been on it for a while.

[Dixie'sMom]

(((((SHARLENE)))))
Sending you a big hug today. I know this roller coaster is wearing you out. I'm glad Molly is feeling good. I smile everytime I see that perfectly precious little face on your avatar.
:p

[Squirt's Mom]

You just move Molly over and curl up in that window with her and rest yourself a bit, sweetie. You have a great deal going on right now so please remember Sharlene from time to time when you are handing out your special brand of TLC.

[flynnandian]

lots of strenght for next week for all of you.
but i am glad molly is feeling fine!

[labblab]

OK, the workday is almost at an end, so here's hoping you and Daniel and Molly can have a peaceful weekend in advance of the busy week ahead. Also surely hoping that there is nothing serious going on with his mom!

A glass of wine, a nice hot bath, some Cool jazz, and take-out dinner (or even better, delivered-in dinner!). Yep, that's your prescription, Sharlene. ;)

Sending you warm thoughts and big hugs.

[Mackenzie]

Hoping for the best for you on all fronts, Sharlene. I sure can imagine how exhausted you must be. At my place, because I've been stressed out lately, my dogs have had to put up with an excessive amount of hugs and kisses from me. Thankfully they are tolerant of me :) You should definitely put Molly to work on snuggle duty to help you all through this.

[jas77450]

Hope you got that nap:)

[Tina]

Sharlene,
Just getting caught up on you, Molly, and hubs. Wishing him all the best for his surgery and hospital stay, I know it will go perfectly well, but it is stressful nonetheless. Also hoping things are okay with your MIL.

As far as Molly, I sure am hoping that the increase in the Benazepril makes a difference with her BP. You know I'm kind of worried about you checking the UPC again so soon. How long ago was it checked last? I know my vet way back told me that checking it too frequently is often times cause for false alarm, because it takes time for the medication to work and for results to be seen. I know she isn't keen on checking it any more often than every three months or so, especially after any kind of change. But maybe your doc is doing that because of Molly's blood pressure? I just don't want you to have to worry unnecessarily about anything Sharlene, you have so much on your plate right now.

I hope you are able to get some rest and do a little relaxing this weekend. Thinking about you guys.

Big hugs,
Tina and Jasper xo

[molly muffin]

I think they are checking the UPC more frequently because of the blood pressure like you said and they want to get that down without BP meds if possible. The Bp is of course a concern because of the retinal bleeds. And now we have the ionized calcium which was a bit elevated but we all know that an elevation in ionized calcium is not a good sign.
I've done some reading and yea not great.
So on top of everything else my brother in law is now in the hospital after a fall. We are waiting on cat scan results of lower back and head. Hoping that comes back good. Nothing broken so that is good.
On that note hubby and I have decided we need a date night so off to the movies to see Interstellar.
Hugs all

[labblab]

Hopefully heading to one of those new fancy theaters where you can stretch out in a recliner seat and order a cocktail to go along with your popcorn and Junior Mints!!

[mcdavis]

Just catching up and sorry to hear you have so much on your plate at the moment. I hope you have a lovely evening at the movies, and that everything goes well with hubby's surgery next week.

I've not had any experience of vets taking BP, but have to say I'm surprised to hear that they don't all have BP monitors. It sounds like the best course of action is to keep your vet because she knows Molly's history, then go elsewhere for the BP readings.

[molly muffin]

yep, one of those fancy dancy theaters is exactly what we went to and the first thing I did was order a fancy drink with umbrella and puree and rum in it. Then was ready to settle in for the movie.

Looks like until I can get molly at least sort of stabilized I'll be going to the IMS. There are just too many variables currently to add anything else to the mix. It isn't going to be easy, as my ability to keep taking time of work ends with molly's next visit. I've been taking vacation time. Plus the expense is more at the IMS, but I don't know of any other option to get all this straightened out. So, for now, saving every penny possible for molly's appointments and hoping we can get this figured out.
As my husband said, this isn't sustainable to being paying out thousands every month.
Still nothing on my brother in law, so maybe they didn't do the cat scan today. I should hear something over night from my sister though. The 3 hour time difference means I'm often in bed when she emails.

Thanks for hanging in there with us gals.

hugs

[Budsters Mom]

Just wanted to drop in and surround you with love and healing energy. You most certainly have your hands full my dear.:o

Regarding Molly's bills...I can sympathize totally with your situation. I I was still paying off Buddy's vet bills long after he flew free. I managed without asking for any help, but it was difficult there for a while. The vets can pretty much charge whatever they want and we're stuck.

Please let Daniel know that he's family too. He has now been surrounded by a flock of busybody angels who will make sure he gets the best care possible. Sending tons of healing energy his way.

Of course, we are always here for you too Sharlene.:p

[doxiesrock912]

Hugs to all of you!!!!

[beaglemom3]

He goes in on the 18th. Surgery is on the 19th and 20th. (it's a double hernia so they do one side each day) He's doing it under a local instead of general anesthesia. I feel nauseous just thinking about it.

The hospital said today he will be in till Monday the 24th. So, it's a fairly long stay. 6 nights. Everyone says they have good results though with healing and want to make sure there are no complications going forward. He'll have mentors that are going through the same thing before he goes in and then he will mentor others until his release. Interesting eh. They are up on their feet 4 hours after surgery. My neighbors dad had his hernia surgery at the same hospital and said it's more like a 5 star resort, with their entire focus being on the patients well being and whole health recovery. This should be interesting.

Molly is still doing good. I have a couple things that have to be worked out in that I can't keep going to the IMS for the BP readings every week or other week. It's too far and I'm running out of vacation to take doing all these tests and being there all the time. My vet however, does not have a BP machine. *sigh*

I can find another vet, but none of the other vets do boarding and after some not so great experience with boarding her at other places, the vets is the only one I currently trust. My current vet though is the only one who does dog boarding and doggie day care when needed.
So, what to do about all this. Do I see if I just get a vet to do the BP readings and stick with my current vet which is what I'd like to do? Or do I have to switch because my vet doesn't have a BP machine and then what do I do about boarding.

I feel like I'm stuck in a hard place with no good solutions. I've been trying to figure this out since September, with no real answers.

I need to make sure my vet can do the ACTH and send to the lab that the IMS wants used also. IDEXX. She wants consistency with the testing since molly is not symptomatic and harder to determine what is happening without the tests being done in the same lab so we can see the drops or increases without any other factors (lab factors). I'm pretty sure that my vet can send to IDEXX lab, but need to verify. Also that she will order the trilostane compounded from same place my IMS orders it.

My head hurts just thinking about it.

hugs all
Sharlene and molly muffin

Hi Sharlene I am still catching up on your thread. My prayers for Daniel on his surgery so sorry he has to go through this.

I am not fully caught up with Molly yet but if you recall I bought a vet bp machine for Snuggles months ago due to his pheo, it works great and comes with 3 sized cuffs infant child and adult and it is a vet bp machine, so gives the HR BP and MAP. Most are very expensive but this one was reasonable about 100.00 or maybe less I don't recall exactly. If you are interested I can find where I purchased it, I don't recall atm..will be reading the rest of Mollys posts HUGS and prayers!

finished catching up and so so sorry to hear about Molly's eyesight, renal issues and high bp. You have so much to deal with. HUGS! I hope and prayer you get these issues resolved and stabilized. praying hard!

[beaglemom3]

this is thr bp monitor I bought and use for Snuggles

http://www.amazon.com/gp/product/B009FOHPFU/ref=oh_aui_search_detailpage?ie=UTF8&psc=1

[molly muffin]

I spoke too soon, that one doesn't ship to Canada. I'll look for one on amazon.ca. Sometimes I can find amazon.com that ships to canada but for a lot of things they won't ship outside the U.S. *sigh*

Song gave me a different link, but not sure if it will ship to Canada or not.

hugs

[Budsters Mom]

Hmmmmmm..... Doesn't your sister live in California? Maybe she'd order one to be shipped to her, then she could mail it to you.:confused:

[molly muffin]

Doesn't your sister live in California? Maybe she'd order one to be shipped to her, then she could mail it to you

Maybe. It's a thought.

[mcdavis]

Have you tried eBay as some sellers there will ship internationally. Argh - medical stuff seems particularly difficult to buy cross border.

[molly muffin]

Yep I looked on ebay, looks like the only ones that will ship here is from china. Of course.

Well I spoke too soon about my BIL. Turns out when the specialist reviewed xrays and cat scan, 2 vertebrae are broke, so he goes in to surgery tomorrow for repair and fusions. L2 and L3 are broke, so L1 and L4 will be fused.

Of course weather has turned crappy too, and we are expecting snow. I know I live in Canada, but frankly I am not a snow driver and the battery of course is kaput in the jeep that I would drive in the winter. So, not sure how this is going to work in regards to getting across toronto to the hospital. I've looked into subway/taxi combination and that would be doable. Hubby says he absolutely doesn't want to be worrying about me driving on hwy's to get over to him in bad weather. He'd rather facetime and know I am safe. He's a sweetheart. We'll see what I can manage.

In addition I have have been called in by my GP over an xray I had taken for my lower back bothering me, and he wants to send me to a specialist. I have to go see him Tuesday evening, since I said no way could I go earlier but he is leaving on vacation on Wed, so I have to get in this week.

Really, can I not go back to bed and wake up in maybe January or say spring even and everything just be fine with everyone?

I am going to either not have a lot of chance to be on the computer this week, or I'm going to have so much time I won't know what to do with it. LOL

hugs all

[mcdavis]

Sharlene,
I just heard about this service, for shipping from the US, from some other Brits. I've never used it myself so you might want to see if you can find reviews to see if they are reliable.
http://www.shipito.com/

[Budsters Mom]

((((((((((hugs))))))))))

[Budsters Mom]

OMG SHARLENE!! Enough already! Praying for you and your entire family. I think you need an exorcist to rid your family of these disasters. You are overdue for good news, or at least a break from the doom and gloom.

[molly muffin]

LOL Kathy. I know what you mean, I sort of feel the same way. This has to all get better soon, things do tend to get better after the bad stuff is out of the way.

If they don't better call the priest about that exorcism.

hugs and thanks for the smile

[beaglemom3]

wow Sharlene you are sure getting more than your fair share, so sorry!
I saw the ones on ebay too but searched for USA shipping. I did not realize you are in CA. I would be happy to order it and ship it to you if you would like.

[beaglemom3]

Sharlene I looked at the companies shipping polices
EastShore Shipping Policies

Where to ship:
We ship to almost anywhere as long as Amazon.com taking your order . However we do not ship to certain South American countries because local custom laws restriction on importing medical device.

seems like they do ship to CA

and its a different compamy but same model

http://www.amazon.com/CMS-08A-Professional-Pressure-Trending-Software/dp/B004V4G5IM/ref=sr_1_3?m=A2WWN8XZGXRZ1&s=merchant-items&ie=UTF8&qid=1416258083&sr=1-3
and cheaper! $78.95 & FREE SHIPPING

[Dixie'sMom]

Sharlene, I just wanted to tell you I'll be thinking of you and Daniel this week and the tough week ahead. Pop in when you get time and let us know how things are going. I hate you have to deal with nasty weather on top of everything else. Please stay safe! Hugs!

[Budsters Mom]

Vicki,

FYI...Sharlene lives in Canada. Her sister lives in CA.;)

[My sweet Ginger]

Poor Sharlene, I'm sending you tons of prayers and good luck as you do need both, a lot of them. :eek: driving in the snow for how many hours? I think I'm with your husband on this one if snow is in the play. I will also pray that this week goes by in a blink so everything will be done and over with when you open your eyes. Hugs, Song.

[beaglemom3]

hehe thanks but CA is Canada, at least that what I meant :)

[molly muffin]

It's both Canada and California. :)

Thanks Vicki. I might take you up on that. My vet is making some calls to other vets to see what the possibilities are here too.

I'll get back to you later after this week is over with. :)

Kathy you are such a sweetheart! I actually kind of love that you know where my sister lives. LOL Isn't that weird.

Thanks and hugs!

[Budsters Mom]

Okay, Duh, I'm bad. I probably should have known that.:o

It's not all that weird to me Sharlene, but I do work in Jr. High after all. I could definitely freak you out with weird!:D:D We get to know each other's families through association because we care about our family members here. AWWWW!:p

[molly muffin]

Just head from my sister. Is it spring yet?

It's too risky to surgery at any of the hospitals in their area it was decided, so an ambulance picked my brother in law up at 4pm today to take him to Stanford University Hospital. I think I forgot to mention that yesterday they found bleeding in the spinal chord and his ECG is abnormal, so risky to do surgery, but they have to stop the bleeding. Stanford does have a good reputation.

So, good news is snow didn't really stick to the roads today and hopefully there will be none till Wednesday, so it should be fine getting him to the hospital and then I won't go up if the roads are bad on Wed.

oh Kathy, I work with nerds, we can Do weird. LOL but only in a nerdy way. hahaha

You are right, we are all family here.

Vicki, just told hubs about your idea for the BP machine and that you are already using the model so we know it is good one. He thinks it's a good idea to get it and says thank you from both of us.

I'll PM you after this week over and done with and work out the details.

hugs

[Budsters Mom]

In junior high we do weird in a raging hormonal teenage kind of way. You don't want to go there. I don't either but I'm already there! Lol :D

[labblab]

Oh Sharlene, so hoping all goes well with your brother-in-law's surgery. And good luck to Daniel heading in today! What a load you are carrying this week. We are all there with you in spirit, don't ever forget that!

[Bailey's Mom]

Hi Sharlene-
I'm hangin' here as well, hoping all goes well for Daniel....and BIL. He really must have taken quite a tumble.

[mcdavis]

I'm really hoping that the surgeries for Daniel and BIL go well this week - I'll be thinking about them and you.
Take Care x

[Budsters Mom]

Sending healing energy to Daniel and your BIL. Stanford University has a great reputation. You BIL is in the best possible hands. Daniel has you watching out for him, so I'm sure he will breeze through. You may need a lullaby with a glass of wine later. Stay tuned. ;)

Big soothing hugs my friend,

[Squirt's Mom]

My goodness, I hope your BIL is ok. Let us know when you can and tell your sister your "other family" is praying for all.

Be careful today and the very best to Daniel. Waiting anxiously to hear back when you can, sweetie.

[beaglemom3]

Just head from my sister. Is it spring yet?

It's too risky to surgery at any of the hospitals in their area it was decided, so an ambulance picked my brother in law up at 4pm today to take him to Stanford University Hospital. I think I forgot to mention that yesterday they found bleeding in the spinal chord and his ECG is abnormal, so risky to do surgery, but they have to stop the bleeding. Stanford does have a good reputation.

So, good news is snow didn't really stick to the roads today and hopefully there will be none till Wednesday, so it should be fine getting him to the hospital and then I won't go up if the roads are bad on Wed.

oh Kathy, I work with nerds, we can Do weird. LOL but only in a nerdy way. hahaha

You are right, we are all family here.

Vicki, just told hubs about your idea for the BP machine and that you are already using the model so we know it is good one. He thinks it's a good idea to get it and says thank you from both of us.

I'll PM you after this week over and done with and work out the details.

hugs

Sharlene I sent you another link of the same model by a different company that ship to Canada and its cheaper by 30 USD! But I will be happy to ship t to you from the first company if that's what you prefer, its totally up to you

Prayers going up for you BIL!

[addy]

stopping by to say hello and let you know you and your family are in my thoughts.

[molly muffin]

Vicki, where did you send the other link at? No see it.

That sounds good if they ship direct to Canada.

Thanks for the well wishes everyone and hubby thanks you all too. He is in the hospital, checked in, first surgery tomorrow morning. He's first batter up. His second surgery will be Friday instead of Thursday, so a day in between. He's booked an hour long massage for both Thursday after dinner and Saturday.

He's already had a visitor from a good friend of ours who lives up there. He was thrilled.

I love facetime as it is good to see him when I talk to him, although it sort of through molly. She hasn't really got the hang of the whole idea of facetime yet. She kept looking towards the door or the dining room trying to find him instead of looking at the screen. It was kind of funny actually and I gave her a treat from him.

I haven't spoken to my sister yet tonight. Time difference and all but I will call her later and get the scoop on what is going on with my brother in law.

My bloody doctor, didn't remember by he had called me to come into the office to see him, and so went through everything he could think of, ordered some tests because it had been awhile (he is very much a preventive medicine doc which I do like) and we got that sorted out, chatted for a bit and off I came home. I'll run up and do my blood tests in the morning before snow comes if possible. hmm, make that a definite I need to get it out of the way, no time otherwise.

So that is it for now. So glad I took a couple days off work this week. It feels more relaxing to not have to think right now.

So far so good.

hugs all

[beaglemom3]

I psoted it on your thread
http://www.k9cushings.com/forum/showpost.php?p=165459&postcount=2707

[judymaggie]

Sharlene--just wanted you to know that I am sending up good vibes to Daniel and your brother-in-law!

[Dixie'sMom]

Oh thats so cute about Molly and the facetime! Leave it to the furbabies to bring us some smiles in times of great stress.

I'm glad you took some time off of work. You definitely don't need to have that worry right now. Still sending prayers your way!

[Bailey's Mom]

Thinking of you and yours...........
Hugs!!

[beaglemom3]

I have the Cms-08a which comes with
Adult, Pediatric or Infant mode, with 3 pediatric cuff ( child , infant and neonate cuff)

The one I showed you that ships from Chicago to Canada is same model as mine and comes with Adult, Pediatric or Infant mode, with 3 pediatric cuff ( child , infant and neonate cuff)

so you should be good with it

I use the infant size on Snugs the neonatal is too small for his leg
http://www.amazon.com/Professional-Pressure-Trending-Software-Pediatric/dp/B009FOHPFU/ref=sr_1_14?m=A2WWN8XZGXRZ1&s=merchant-items&ie=UTF8&qid=1416413092&sr=1-14

[doxiesrock912]

Hugs Sharlene, I know it's hard when you're not right there with him. Thank God for Facetime.

[Tina]

Sharlene,
Just wanted you to know I am thinking of you and your family. I hope everything is going well for Daniel today.

Hugs,
Tina

[Mackenzie]

Am thinking of you today and sending many positive, healing vibes for your hubby and BIL.
Cindy

[labblab]

Still thinking of you guys, and hoping for good news all the way around!

[beaglemom3]

Keep you all in my prayers hope all is going well and we hear good news.

[addy]

Just checking in - hope all is ok

[Budsters Mom]

Yo Sharlene!!!! Waiting alongside the others for positive news about Daniel and your BIL. xxxooo

[doxiesrock912]

Still here sweetie. Update when you can. Hugs.

[Budsters Mom]

Yo Sharleeeeeeeene!!! I see your light on.;)

[molly muffin]

Well Daniel had his first surgery but wasn't able to get up and walk when they wanted as he kept getting dizzy. I think around 7 he finally was able to get up in his room for a few minutes. I haven't heard from him since so maybe went back to sleep.

My BIL still hadn't had surgery. There are some complications as break in both front and back of spine. They were bringing in another surgeon to consult on that. When they do the surgery there will be both spinal team and neuro team in the operating theatre. So it's turned even more complicated. He is on a special watch ward neuro so a nurse with him at all times.

Hoping to hear more tonight or in the morning. If I don't hear then possible they did the surgery today.

Hugs all

[molly muffin]

Oh yea and got snow so I have been out shovelling this evening. I woke up at 5:30 this morning with house alarm beeping. Then the key fob on car wouldn't work and when I opened with the key the alarm on it went off. Finally got all alarms off. Whew. Of course it's a heck of a day.

Lol. Hugs

[Budsters Mom]

So relieved to hear from you Sharlene. What a long day you've had. :o Poor Daniel. I hope he is able to sleep off at that dizziness. I sure would not want to do a repeat performance. Continuing to send healing energy his way.

Your BIL's back sounds extremely serious. I'm glad that they are bringing in another surgeon to add to his team. More prayers and healing energy headed his way also.

Out shoveling snow huh? I've never had to do that.;)

How's it looking for that exorcist? You have a priest on call? lol

Try to get some rest sweetie and hug the little muffin for me. xxxooo

[jas77450]

thinking of you, hugs.

[molly muffin]

Surgery for BIL is scheduled for tomorrow. 12:30 pacific time. Expected to take 5 hours and then he will go to ICU. They have to try to go in from the side not the back.

Thanks everyone. Hugs.

[Dixie'sMom]

I am relieved to hear that Daniel's surgery went good. Now hopefully the BIL can get through tomorrow. I do not envy him at all. He has some very serious issues going on there but it sounds like they are taking a team approach so hopefully everything will go well. Hopefully Daniel will have a better day tomorrow. I'll keep praying for everyone.

Well that screaming alarm was just what your nerves needed, right? Between that and the snow, I would have just gone back to bed! haha! Thank goodness you are stronger than I am because the BIL, Daniel and little muffin would be in trouble if they just had me to help. Get some rest sweet lady... this awful week will be over soon.

[Squirt's Mom]

Glad Daniel got up and walked finally. That is crucial after surgery if the patient can manage. I hope today isn't too bad.

Please let us know about your BIL - this sounds quite serious and risky.

Prayers for all rising!

[judymaggie]

Good to hear that Daniel's first surgery is finished and that he is up and about. Sending prayers to your BIL that his surgery goes smoothly.

Wondering how Molly handled the alarm--Abbie would have been freaking out!

[mcdavis]

I'm pleased to hear the first surgery is over and Daniel was able to walk a little. I hope the second surgery and BILs both go well.

[molly muffin]

Daniel had a good of walking and he even did the stairs. Now he has dinner, then a massage, then bed and ready for early morning surgery. He is progressing nicely.

I won't hear anything for quite awhile about BIL. Will hear from probably one of the other family members as sister is at hospital.

Thanks everyone! HUGS

[spdd]

Hope you know your are in my thoughts. Take care of yourself too Sharlene.

[Budsters Mom]

So relieved to hear how well Daniel is doing. One down, one to go.;)

Hoping to hear an excellent report about your BIL too. ;)

How about your doctor's appt.? What's happening there:confused:

No more snow or alarms going off, okay? xxxxoooo

[molly muffin]

If you pray if that is your belief or just can send some really strong positive vibes our way, this would be a good time to do so.

Major complication with my BIL.

He is suspected to have a heart attack after receiving anesthesia. .. very serious. ..no back surgery. ..they are moving him to the cardiac cath lab...possibly cardiovascular surgery instead to open whatever artery is diseased.

We are waiting to hear from the doctors how bad it is. They just started the cardio procedure.

My nephews wife is with my sister at the hospital, thank god, I know it is my sisters mind, as it is in mine, that our mom had a massive heart attack in the hospital and didn't make it. We are all basically a wreck at the moment.
Had a bit of a panic attack and couldn't breath.

So, hang in there with us. I'll update as I know more.

My doctors appt, doctor didn't remember why he wanted me to come in, so ordered a bunch of yearly preventive med tests. :)