Punk, 13 yr Old beagle mix - Punk has crosssed The Bridge

[punksmom]

Hi,
I just wanted to say thanks to everyone on this board - reading your posts has given me so much comfort. Punk was diagnosed in the spring and was doing OK for a while on lignans and melatonin, however in the past month she started declining. Frequent accidents, lethargy, back leg weakness, scavenging (we live in NYC so she picks up some pretty horrendous stuff). She even started eating the kitty litter! We started trilostane (60mg, she's about 30lbs) 6 days ago and the first couple of days were rough - she seemed very depressed and a shell of her former happy self.

The last two days have been MUCH better, though her arthritis has made it almost impossible for her to climb stairs. We took her to the vet today for an Adequan injection and he taught us how to do that so I'm hoping we can get the arthritis back under control. The vet said it's typical for arthritis to show up in cush dogs after they start treatment so I'm choosing to hope that it's a sign that the trilo is doing its job. She'll go in for her bloodwork in a week so I will post results then.

Anyway, just wanted to share our progress and say thank you for being here - I really did spend a couple of days just tearfully reading everyone's stories and it helped to know that there are others fighting this and managing well, even when it sometimes seems so hard.

Cody

[Boriss McCall]

Hi Cody & Punk.. Welcome! Punk looks so cute in her picture. I bet she got to do a lot of fun food tasting from the city streets.:eek::p

Hopefully all that is getting better. I noticed the food part got better with my Boriss the first week. It was getting so old having his nose to the ground constantly looking for something to eat. He would go outside & eat the other dogs poop when he ran out of options.:eek:

Glad things are getting better for Punk. I just started my dog on the trilo pill 16 days ago. He is doing so much better. He still has off days & the symptoms haven't completely gone away yet. But, I have hope that they will.

Glad you found us!

[punksmom]

Thanks Amy, it helped me so much to hear how well Boriss was doing since he started his Trilo not that long before Punk did!

The streets here are littered with goodies - pizza crusts, chicken bones, pad thai, etc. Who are these people throwing their food out? Anyway, Punk always looks super sad when I'm pulling it out of her mouth. :) She was always a little bit of a scavenger but the cushings really made her more aggressive about it. Hoping that now I can get her to ignore most, if not all, of the street donuts once the meds do their thing.

[molly muffin]

Hi Punk and welcome to the group.

It's tough but it's doable, that is the message that I think all the threads convey in one way or another.

So, it sounds like originally Punk was Atypical but then has moved to Pituitary cushings? Or did you just try one thing first and then move to another when that wasn't working any longer?

What kind of numbers does Punk have now on the ACTH tests? Is everything else good with him on the blood panel? I know just tons of questions right. :) We're sort of like that around here. ACTH, LDDS, UCCR, ALP and ALT's are some of our most frequent acronyms. :)

So glad you found us, you'll have a really good support group here. Love Punks picture. ears back like he's flying in the wind.

Sharlene and Molly Muffin

[frijole]

Love the name Punk! Welcome to our gang. I just wanted to make sure you keep an eye out as 60 mgs for a 30 lb dog is a fairly high dose. There are different schools of thought on trilostane dosing but U C Davis and other schools that have researched it are recommending a lower dose now - 1 mg per lb to start. So that would be 1/2 of the dose you are on now. The trouble with walking can be caused by overdose so please keep us posted so we don't worry ok? :) Kim

[Steph n' Ella]

Welcome to you and Punk!

I put the kitty litter in a room or closet and use wire fencing used for gardens to keep doggie out...but kitty can easily fit through the gaps! I've never had a dog over to my house who didn't like eating cat turds...sooo gross!

http://www.amazon.com/Origin-Point-Folding-24-Inch-10-Feet/dp/B000HHO24Q/ref=pd_sim_sbs_lg_3

Ella and I are city folk...Baltimore...and we live very close to both Ravens and Oriole stadiums...national aquarium, etc.! The things tourists leave on the side walk are horrible! There's someone's pants outside on the way to the park right now. Ella keeps wanting to give them a good SNIF! Yuck!

[punksmom]

Sharon, She has atypical cushings and an enlarged adrenal, I'll dig up her original numbers from Univ of Tennessee panel and post. We did an ultrasound as well, which also shows that she's had only one working kidney, probably from birth! who knew? that made me nervous - no backup kidney - but it is functioning normally.

Kim, Thank you for the warning about the trilo dosing! Punk is due for her first panel in 1 week so we will know how she is doing then but I will definitely keep an eye out. The arthritis answer would be the least surprising since she had it before to a certain degree, is old, and now that she has to go out 5-6 times a day and we live on the third floor, it would make sense that she's achy. Her back legs seem both stiff and wobbly at the same time if that makes sense.

But on the positive side, her personality is coming back every minute. She's picking up toys to play, coming to me for petting - all of those things she had completely stopped doing!

Steph, the pants cracked me up! My friends who live in the suburbs can not believe that I go into regular battle with a guy on a bike who throws flavored croissants onto the ground, presumably to feed the rats? I yell at the pigeon feeders too. Sigh.
Don't worry, we put the kitty litter out of reach the first time I came home and had to brush clumping crap out of her teeth, call poison control, etc etc. It's like fort knox over there now.

[labblab]

Hi Cody,

Welcome from me, too. You mention that Punk was originally diagnosed with "Atypical" Cushing's and that the ultrasound revealed an enlarged adrenal gland. Just wanted to let you know that we have learned that the "Atypical" diagnosis is reserved for dogs with a normal cortisol level but with some/all elevated intermediate hormones. If you are treating with this hefty dose of trilostane, I am assuming that Punk now has elevated cortisol and has advanced to conventional Cushing's from Atypical? Virtually all dogs with elevated cortisol will also exhibit some elevation in intermediate hormones, as well. But with conventional Cushing's, the primary focus is on control of the cortisol.

You mention that Punk has only one functioning kidney, but I assume she has both adrenal glands? Was only one enlarged, however? If so, and if the other was shrunken, this would be an indicator that Punk likely suffers from the adrenal form of Cushing's (two equally enlarged adrenals point to the pituitary form). I mention this because surgery can offer a total cure for adrenal Cushing's. It is a major and expensive surgery and therefore not an option for every dog or family. But I just wanted to let you know it may be an option, depending on the form of Punk's disease. Any and all actual diagnostic test result numbers you can give us will be really helpful -- as would the actual written summary of the ultrasound report.

Once again, welcome!
Marianne

[Boriss McCall]

I have this image of you pulling street food out of Punk's mouth & it made me giggle. :)
I know those sad eyes from taking food away really well.. Poor things feel like they are starving.

His favorite thing to do was sneak off the bed at night to find anything that we might have forgot to throw away. I found his nose covered in yogurt all the time from cups my husband would leave on the table.:rolleyes:

I am so glad that symptom is going away in Boriss. I could hardly handle it. It made me feel so bad for him.

Now we just have to get the pee under control. I am just hoping I don't end up having to re-potty train him. He has been having accidents for about 6 months now before we realized he had cushing's.

I guess time will tell.. cushing's the wait & see game.:rolleyes:

[punksmom]

Thanks Marianne - I have a hard copy of the test somewhere but I'm going to get it emailed since I'm having trouble finding it now. I do remember that there was one adrenal way bigger than the other and cortisol was high but also she had high sex hormones, which may have been why the Dr. felt it was "atypical". Will have to pull the report for the details and I'll post it here.

I do remember he mentioned surgery as a possibility but did not recommend it at the time since then her cushings symptoms were pretty minimal and we were just treating with supplements. I'll ask again about it - it's hard since she is an older dog with 1 kidney, I'd feel worried about a major surgery for her. But something to think about and discuss again with the vet... Thank you!

[punksmom]

Hi friends - I got Punk's results from her original panel. This was in January actually (how time flies) and her cushings symptoms were pretty mild then. They only started to really increase in August.

Ultrasound:
Right kidney r/o small, non- recognizable c/w severe atrophy, end stage (prior infection) (1.9 cm)

Left Kidney r/o inflammation, enlarged (7.0cm), dilated pelvis c.w compensatory, interstitial nephritis +/- concurrent GN; pyelonephritis

Adrenal R/O bilateral asymmetrical enlargement (Left adrenal; .082cm, Right adrenal 2.2cm)

Labs:
Cortisol ng/ml
Baseline = 8.0 Normal Range = 2.1-58.8
Post ACTH = 64.7* Normal Range = 65-174

Androstenedione ng/ml
Baseline = .20 Normal rg = .05 - .57
Post ACTH = 1.86 Normal rg = 0.27 - 3.97

Estradiol pg/ml
Baseline = 71.0* Normal Rg= 30.8 - 69.9
Post ACTH = 66.1 Normal Rg = 27.9-69.2

Progesterone ng/ml
Baseline = .43 Normal rg= .08 - .77
Post ACTH = 11.4* Normal rg= .10-1.50

17 OH Progesterone ng/ml
Baseline = .24 Normal Rg .08-.77
Post ACTH =6.22* Normal Rg = .40-1.62

Aldosterone pg/ml
Baseline = 273.5* Normal Rg = 11-139.9
Post ACTH = 1717.0* Normal Rg = 72.9 - 398.5

* Above or below reference range

These results indicate presence of increased adrenal activity. Post-ACTH progestin concentrations and aldosterone are significantly elevated. Adrenal ultrasound may be a considration.

And then on the back, a number of treatment options including lignans/melatonin (which I started), and also lists lysodren, trilostane, ketoconazole.

I should also mention that she has a very enlarged vulva (and has had this for as long as I can remember). Vets have never seemed too concerned about it over the years though....

Woo - that was a lot of typing. She's on day 8 of the trilo and backsliding a little bit, still having trouble walking, trouble with stairs, and accidents. I'm going to move up her next blood test to Saturday so that we can check how the trilostane is working (or not) ASAP. Hanging in there!

[Squirt's Mom]

Hi Cody,

Please stop the Trilostane. If I am reading this right, her cortisol is BELOW normal already. Verify the post # is 64.7 with the normal low at 65.

Please do not give any more until one of the others can chime in.

Hugs,
Leslie and the gang

[labblab]

Cody, was the January ACTH the only stim test that Punk has had? Did your perform another ACTH prior to starting the trilostane? If not, I am also very concerned that she is being treated with trilostane (and a relatively high dose at that) with a cortisol level that was actually below normal. So yes, please do recheck those cortisol results!

If they are accurate, then Punk did indeed display "Atypical Cushing's" per UTK's definition: cortisol was not elevated, but certain other adrenal hormones were (e.g., progesterone and aldosterone). And unless you have evidence that her cortisol had increased during these past months, I too am very worried about using trilostane in her situation. From the utrasound report, it appears as though an adrenal tumor is a distinct possibility. And adrenal tumors can trigger various combinations of hormonal secretion without involving cortisol. For what it's worth, I believe that aldosterone can also be elevated in the face of certain kidney problems. So just to double-check: all of Punk's kidney lab values have always been normal? The ultrasound report on her one functional kidney sounds as though there have been issues with it in addition to the nonfunctional kidney...


Aldosterone levels can be increased in cases of adrenal hyperplasia or primary adrenal tumor, but aldosterone can also be increased in cases where the renin-angiotensin system is increased (e.g., renal and cardiac problems).

And one quick question in relation to her enlarged vulva: is anybody in your household using any type of topical hormone cream or treatment? With Punk's elevated baseline estradiol reading and very high post-ACTH progesterone reading, it is possible that she has been affected by exposure to topical hormones if any of her humans are using them. Scroll down to the bottom of this thread, and you will see related articles:

http://www.k9cushings.com/forum/showthread.php?t=198

Bottom line: please double-check that cortisol reading and also let us know if any subsequent testing was done prior to starting the trilostane.

Thanks!
Marianne

[molly muffin]

Yes, if cortisol goes below normal range, then you don't usually give medicine, as you don't want it to drop too low and send her into a crisis. I'm surprised that your vet didn't catch that.
See, posts from Leslie and Marianne as they both have a lot of experience with this medicine and cushings in particular.

hugs,
Sharlene

[punksmom]

Here was my vet's reply when I asked, but I'm going to call him first thing in the morning to discuss...

Her kidney values were tested recently and were normal.

Dr's Email::
***That is correct, the Trilostane doesn't seem to have the same direct effect on Estadiol that Lysodre has, in fact in cases can elevate it, however, it is a safer approach to treating adrenal disease altogether. There is a lot to learn about Atypical Cushing cases, and most of us are still experimenting with these meds in the sense that the effect is very variable. Here is my thought process, Punk had a significantly enlarged adrenal gland and poor architecture of the kidneys during that ultrasound at the beginning of the year, this issues a likely to have progressed over time, and I am concern of affecting her kidneys with Lysodren, so I believed trilostane to be a better/safer option specially, if we want to avoid repeating some of the previous test. There is a possibility that the large adrenal gland has a tumor, in which case the Trilostane is justified as a drug choice. If we were to try Lysodren instead of Trilostane, then I suggest that we repeat the cortisol test while on the Trilostane before doing a switch. If we were to switch her, then I'll suggest only the maintenance dose of Lysodren for her. Let me know how you feel about it, I am trying to be a practical as possible, but in reality the more we test and stay on top of the values, the easier it is to guide the therapy.


Call me as needed so we can discuss***

[punksmom]

Oh, and no hormone creams here. I read about that too but we don't have anything like that. She's had the enlarged vulva since right after she was spayed I think - so going on 12 years now. It got a little bigger in recent years but has always been fairly huge.

Thanks for all the input so far everyone!

[Squirt's Mom]

Please, Cody, can you verify the CORTISOL results you listed. If they are correct, your vet should have never started Punk on Trilo as his cortisol was too LOW at the time of that test. Can you verify those results and has Punk had another ACTH or adrenal panel since then? I am VERY worried about Punk taking any more Trilo until this is clear. Giving the Trilo is putting his life at risk if those were the last results and what you posted is correct.

Do not give any more Trilo, please.

Hugs,
Leslie and the gang

[Squirt's Mom]

Cortisol ng/ml
Baseline = 8.0 Normal Range = 2.1-58.8
Post ACTH = 64.7* Normal Range = 65-174

This is the value we are concerned about.

[labblab]

Cody, these are the issues I think are critical to discuss with your vet.

1) Not only was Punk's cortisol not elevated during the January testing, it was actually below normal. How can it be safe to administer a drug that lowers cortisol even further?

2) It is true that maintenance (lower) doses of Lysodren are sometimes recommended for dogs suffering from elevated intermediate hormones and NORMAL cortisol levels. However, Punk's cortisol level was sub-normal, and the current dose of trilostane is double that which is currently being recommended as an initial starting dose -- even for dogs with highly elevated cortisol levels. I truly doubt that a vet experienced in Cushing's treatment would give EITHER Lyosdren or trilostane to a dog who exhibits sub-normal levels of naturally-occuring cortisol.

3) The U.S. Product Insert for Vetoryl (brandname trilostane) contains specific warnings against using the drug in dogs suffering from impaired kidney or liver function. If your vet is concerned about Punk's kidney function, why does he feel that trilostane is a safer choice?

If Punk suffers from an adrenal tumor that is over-producing cortisol, then it is true that trilostane would be a preferred treatment option. However, we have no evidence that her cortisol was even within normal range at the time the trilostane was started.

Like Leslie, if Punk were my dog, I would not feel it was safe to continue the trilostane treatment under these circumstances. Depending upon Punk's behavior, I'd either opt for an immediate ACTH test, or I would stop the trilo, wait about a month, and then repeat the UTK panel in order to evaluate the current status of her naturally-occuring hormone levels.

Marianne

[frijole]

Hello! I am chiming in to agree with the others and I would cease with the trilostane. From your vet's email it appears they think it MIGHT be an adrenal tumor. Well you don't guess and you don't start a med like this - particularly given the fact that the cortisol was LOW.

My dog Annie was misdiagnosed as having cushings and she DID have an adrenal tumor but that tumor did NOT affect cortisol. If Punk has ever had all over body shaking or if the leg problems come and go, please let me know ok?

Kim

[punksmom]

Hi all - thanks I have stopped the trilo and will be talking with my vet about it at length tomorrow. Punk still seems fine but for the walking issues - but yes the leg problems come and go and she has had all-over shaking before (not recently but in the past- metacam was prescribed as it was thought to be from her arthritis. Seemed to work at the time).

The leg problem is weird now - it's not just stiffness, i can only describe it as drunk walking. It's a combined stiffness and weakness. This is different than what appeared to be just arthritis before when she would just have a little stiffness on the stairs. Now her legs are buckling more and she is stumbly so it feels like something else is going on...

That cortisol level is what's on the paper - i can't confirm its accuracy beyond the piece of paper I'm reading it from, but yes it is a point low and I remember the Dr. being surprised at the results and diagnosing atypical cushings likely caused by an adrenal tumor. Seems time to just stop the meds and start doing some more testing before proceeding.

Thank you all for the support

[frijole]

Since you confirmed leg issues are sporadic and you have seen trembling I would recommend when talking to your vet that you mention pheochromocytoma. It is a type of adrenal tumor. It is very rare. It emits adrenaline. It is not always active and therefore is not usually discovered until the dog has passed away. My dog Annie had one. Kim

[labblab]

Also, have Punk's basic blood chemistries been checked recently? I don't know a lot about elevated aldosterone, but I would think it could have a significant effect on potassium and sodium levels with potentially serious consequences, one of which could be the weakness you are seeing.

It's not clear to me whether Punk has had any additional labwork performed since the January ACTH. If not (and especially with the addition of trilostane), I am very fearful for her well-being. Given the possibility of a functional adrenal tumor, I'd encourage you to seek out a referral to a vet who is specialized in treating such disorders. Generally, this would be an Internal Medicine Specialist ("IMS"). Punk may be suffering from a rarer type of adrenal tumor (like the pheochromocytoma that Kim has mentioned), and an expert's input may be really important at this stage.

Here's a link that can help you locate sn IMS in your area:

http://www.k9cushings.com/forum/showthread.php?t=182

Marianne

[Squirt's Mom]

Mornin' Cody,

Thank you for letting us know about those results. How is Punk this morning? Did your vet by any chance give you prednisone? Did they by any slim chance tell you what to look for in case of a crash?

It is clear to me that your vet does not know very much at all, if any, about Cushing's. They endangered Punk's life by putting her on Trilostane and they owe you an apology for this at the very least.

With Punk's cortisol being BELOW normal, I would think Addison's would have been the first thing that should have entered their mind. Addison's is a disease that is the opposite of Cushing's in which the cortisol is too LOW. In naturally occurring Cushing's, the cortisol is always too HIGH. By giving Punk Trilostane, your vet was trying to further lower the cortisol that was already too low in Punk to start with. The ONLY time Trilostane is used is when the cortisol is too high. This was incredibly risky and professionally irresponsible in my book. That doesn't even include the kidney issue.

The UTK panel looks at two separate things - the cortisol and the intermediate hormones. If the cortisol is normal, the pup does NOT have true Cushing's. For determining the type of Cushing's, only the post numbers count.


Labs:
Cortisol ng/ml
Baseline = 8.0 Normal Range = 2.1-58.8
Post ACTH = 64.7* Normal Range = 65-174

This is clear as all get out that the cortisol is below normal which means Punk does not have naturally occurring Cushing's and Trilostane should have never been prescribed.



Androstenedione ng/ml
Baseline = .20 Normal rg = .05 - .57
Post ACTH = 1.86 Normal rg = 0.27 - 3.97

Estradiol pg/ml
Baseline = 71.0* Normal Rg= 30.8 - 69.9
Post ACTH = 66.1 Normal Rg = 27.9-69.2

Progesterone ng/ml
Baseline = .43 Normal rg= .08 - .77
Post ACTH = 11.4* Normal rg= .10-1.50

17 OH Progesterone ng/ml
Baseline = .24 Normal Rg .08-.77
Post ACTH =6.22* Normal Rg = .40-1.62

Aldosterone pg/ml
Baseline = 273.5* Normal Rg = 11-139.9
Post ACTH = 1717.0* Normal Rg = 72.9 - 398.5

These three bold post values mean that Punk is considered to be Atypical and the treatment is melatonin, lignans and possibly Lysodren...but NEVER Trilostane since the cortisol is not elevated.

The fact that her adrenal glands are asymmetrically enlarged means they need to be further checked out to see why this is the case - there may be a tumor present there that is NOT connected to Cushing's like a Pheochromocytoma - the type of tumor Kim's Annie had - or other causes for the difference in the sizes of the two glands. The lack of elevated cortisol says there is not a tumor on her adrenals causing true, or naturally occurring, Cushing's. However, there may be another type of tumor present.

The best thing you can do for Punk is get her to an IMS for a second opinion asap...and do not give any more Trilostane, please. If your vet insists he/she is right in their actions to date, you need to run, not walk, run to a new vet as fast as you can, honey. I hope they are willing to listen and learn, but if not, for Punk's sake, find a new vet asap.

It is possible that your vet knows something about Trilostane usage that we don't, of course. But we have a couple of Cushing's gurus here who eat, drink and breath canine Cushing's 24/7/365 and I truly think if there had been such a major shift in treatment protocol with Trilostane (Vetoryl), we would surely have heard of it.

Keep your chin up! We will get through this together. ;)
Hugs,
Leslie and the gang

[punksmom]

Hi - Thanks so much Leslie, Kim, and Marianne. It's hard to go from really trusting my vet to just not trusting him at all now. I have a friend who is a vet in LA and I will get her take as well along with all of your knowledge and advice.

Punk is getting blood work today and no more trilo. Here's hoping we figure it out soon. I'll look more into the pheochromosytoma - so sorry to hear about Annie's.

[frijole]

FYI I share Annie's story as an example of what can happen - an internal med specialist would have to rule it in or out obviously. My local vet would never have figured it out - too rare and frankly general vets can't be trained in everything.

That said - if cortisol was low it is strange they'd prescribe the trilo. Also fwiw in my opinion atypical cushings is a catchall - don't confuse it with regular cushings. Some dogs start out with atypical and turn cushinoid later. I am confident that Annie's sex hormones were elevated (the vulva, the hair loss) but that was a result of the tumor and not anything else. So I see atypical cushings as something that can be caused by something else going on. I did not waste money on the UTK panel because I was sure hers were elevated and I knew enough to go buy melatonin and lignans.

Hoping you find a specialist in your area or a teaching hospital that you can work with. Kim

[punksmom]

Thanks - My LA vet friend and my original vet both said that another ultrasound was in store to take a closer look at the adrenals AND that it would be good to take her to an internal med specialist. So that's sounds like my next step. Luckily she lives in NYC, so I'm told there are top specialists here.

Will keep you all updated as hopefully this can be a lesson to others with atypical and these types of rare problems. I feel so bad for my little girl but she is being a trooper!

[frijole]

They gave you sound advice of course. The imaging machine and those that read the film at specialists offices should provide you a better look at what is going on.

Here is where I would go if I were in NYC. This guys is one of the best in the world. Kim


http://www.animalendocrine.com/endocrine-clinic/endocrine-clinic/
http://www.drmarkepeterson.com/

[frijole]

I feel so bad for my little girl but she is being a trooper!
Your little girl is loved and it shows. Keep the positive vibes going and use us as a sounding board. You aren't alone on the journey.

[molly muffin]

I am so glad that you are on the road to discovering what is going on with Punk. I hope that the next ultrasound can give a more definitive answer.

You are an excellent mom to Punk. We'll all be anxiously awaiting further news.

Sharlene

[Squirt's Mom]

Hope she is feeling better today and that you find some answers with the specialist. How nice to have a tech friend! I would run a friend like that off bugging them with questions...for their own sanity, they would have to stop taking my calls and answering their door. ;)

Keep in touch and let us know what you learn....and I am sooo glad you have stopped the Trilo. The good thing about this drug is that it is so easy to stop and start. ;)

Hugs,
Leslie and the gang

[punksmom]

So, surprisingly (to me anyway), here were the results of yesterday's ACTH test:

Cortisol pre: 10.5 (Normal range - 1.0 - 5.0)
Cortisol post: 30.9 (Normal range - 8.0 - 17.0)

So the cortisol was actually high. Not sure if anything else was notable in the test, as I'm talking to my Dr. in an hour. He mentioned yesterday that she was also slightly anemic. Still walking funny but in better spirits and still eating like champ.

Thanks for the dr. reco Kim, I will look into it!

[molly muffin]

That is strange results compared to the other. Has Punk has an LDDS test also?
The reason I ask is that my molly had an ACTH, which was high, and the vet gave me Vetroyl to start and I didn't do it, opting instead for an ultrasound and then an LDDS test which showed she didn't have cushings and is able to suppress cortisol for the full 8 hours.
This is why I think they say cushings is so hard to diagnose. Anything and everything going on in their bodies, including stress can wanker the test results.

Let us know what the vet says.

hugs,
Sharlene

[punksmom]

Sharlene, Yes that's exactly what's up next, we'll do the ultrasound and the LDDS and then figure out next steps.

Leslie - I have been emailing my LA vet friend NONSTOP but I sent her a huge cookie basket :) She is in agreement with all the next steps so far - and just that it's tricky in general to diagnose so the more testing the better.

[frijole]

I'm not surprised by the acth test. Again, I'm sharing just in case. Annie had 2 false positives on the ldds test - they all were indicative of pituitary cushings. She had FIVE false positives on the acth test. I believe her body was creating cortisol as a result of her tumor and NOT from cushings. Note that the first number on the test (in your case 10+) is the resting cortisol. That number is usually between 1 and 2 unless a dog is stressed. Annie's were consistently between 10 and 20.

I just don't want you to waste money like I did (I spent many thousands and wasted a whole year trying to find answers). It could be something else but please make sure they at least are on the look out and consider a pheochromocytoma. (adrenal tumor)

Sending love and praying there is NO tumor that shows up. Kim

[Wolfgang]

Hello Punksmama,

I noted the kidney issues in the ultrasound report - i would be concerned. It is very odd your vet made no note of potential kidney infection. Did he did a UPC ( urine protein/creatinine ratio & a urine culture AND sensitivity ? ) My angel boy Wolfgang was taken by CRF ( not his PDH cushings ). If you do opt for that IM appt please, please discuss her kidneys with them in addition to the cushings/other possibilities. I'd also highly recommed you join K9Kidneys in the meantime. Am very sorry cannot offer you much in advice re : cushings. I learned an awful lesson by not changing vets sooner ( re : his CRF ) - listen to the people here ( & if you do join the kidney group listen to them too! :) )

Lots of hugs to Punk & hoping for some clarity of her condition.

[molly muffin]

Okay I have missed a few days, but what is going on with Punk? How are things? Hope all is well.

hugs,
Sharlene

[Squirt's Mom]

Yes, how is our girl doing? How are YOU doing? What did you learn from the vet? We would love an update when you get a chance! :)

Hugs,
Leslie and the gang

[punksmom]

Hi - Sorry to fall of the radar, I was just waiting to have something to report since Punk's ultrasound was today. Sadly, it appears that the adrenal mass looks to be a tumor (biopsy would be required to confirm, but it's larger than in Jan. and irregular). It also appears to have spread to the liver, as some small masses appear there. Her kidney and liver values are normal as late but she had high blood pressure, which we are treating. My vet suggested we consult an oncologist just to be safe, but doesn't recommend surgery given the placement of the mass and the apparent spreading. I'm not sure I can keep up with the board, it's starting to feel overwhelming, but I do really appreciate the support from all of you. Punk is doing pretty well considering all this but I imagine she will start to feel sick at some point as this progresses - my goal will just be to keep her comfortable and happy for as long as I can and hope that I can be strong enough to know when she's had it. Thanks again everyone

[molly muffin]

oh I am so sorry that appears that the mass has started to spread. I think you are right that keeping punk comfortable is the most important thing.

We are here for you if you need to talk about anything remember. Maybe just try to read only your thread and a only a limited amount of others. I know it can all be overwhelming.

hugs,
Sharlene

[frijole]

Hi - Sorry to fall of the radar, I was just waiting to have something to report since Punk's ultrasound was today. Sadly, it appears that the adrenal mass looks to be a tumor (biopsy would be required to confirm, but it's larger than in Jan. and irregular). It also appears to have spread to the liver, as some small masses appear there. Her kidney and liver values are normal as late but she had high blood pressure, which we are treating. My vet suggested we consult an oncologist just to be safe, but doesn't recommend surgery given the placement of the mass and the apparent spreading. I'm not sure I can keep up with the board, it's starting to feel overwhelming, but I do really appreciate the support from all of you. Punk is doing pretty well considering all this but I imagine she will start to feel sick at some point as this progresses - my goal will just be to keep her comfortable and happy for as long as I can and hope that I can be strong enough to know when she's had it. Thanks again everyone

Thanks for the update. I know you must be drained. What I was told by the head of animal science at K State Univ vet hospital is that if my dog (that had the adrenal tumor) has high blood pressure (she didn't while at their facility) then that would confirm that it is a pheochromocytoma.

While the news you got isn't the best - let me tell you it isn't the worst either. It took me over a year to figure out what you already have. My girl lived 2 years with the tumor (and who knows how long she had it before I even knew about it). She never lost her zest for life and she was a very happy girl. She never had cognitive issues. I had to let her go because of muscle wasting that led to the point where she could not get up on her own. Her legs simply gave out.

I used acupuncture and I am convinced it helped her a great deal. Anything you can do to keep her muscles toned - hydrotherapy etc. I would recommend.

There are so few people out there who have been thru this - please know I am here as a resource. I'll help in anyway I can. But please know that Punk's days aren't over and Punk can have many happy ones ahead. I have no doubts you will see to that!

Keep us posted and try not to let it overwhelm you. Sending strength, positive vibes, and love - Kim

[Squirt's Mom]

I am so sorry for this news and I know your heart is breaking. Take a look at your title here - "down but not out!" Even in the face of this news, that fact remains true. Cherish each day and fight right along side her as long as she can fight.

Please know we are here any time you need to talk, even if it is to scream for a while...we will listen and offer our shoulders for you to lean on.

Hugs and gentle belly rubs,
Leslie and the gang

[punksmom]

I'm tearfully reporting that Punk has passed away - her tumor started to wreak havoc on her 1 kidney and she went into renal failure. Will spare the gory details but it was blissfully fast in that she didn't have to suffer for long. She went to sleep with her head on my lap at home and it was very peaceful.

Thank you all again for the support and the love, I know that Punk felt it too!

[Boriss McCall]

Oh Cody.. I am so sorry. I know the pain you are feeling right now is overwhelming. Rest In Peace sweet Punk. :(

[Squirt's Mom]

Oh, Cody,

I am so sorry to hear this. I had so hoped you and Punk would have a bit more time together. My heart is broken with yours.

Punk was so lucky to have you for her mom and I know she is grateful for all you did for her. Today she is whole and well again, looking down on you with so much love in her heart. One day you will hold her in your arms again and cover her face with kisses.

Punk's name has been added to our In Loving Memory album for 2012 where she will always be remembered and honored as a member of our family here at k9c.

Our deepest sympathies,
Leslie, Squirt, Trinket, Brick, Tasha, and our Angels, Ruby and Crystal



I ONLY WANTED YOU

They say memories are golden
well maybe that is true
I never wanted memories,
I only wanted you.

A million times I needed you,
a million times I cried.
If love alone could have saved you
you never would have died.

In life I loved you dearly,
In death I love you still.
In my heart you hold a place
no one could ever fill.

If tears could build a stairway
and heartache make a lane,
I'd walk the path to heaven
and bring you back again.

Our family chain is broken,
and nothing seems the same.
But as God calls us one by one,
the chain will link again.

--- Anonymous ---

[lulusmom]

Cody, I am so terribly sorry for your loss but I'm so glad that your precious girl passed peacefully with her head on your lap. My thoughts and prayers are with you.

Godspeed sweet Punk.

Glynda

[Maya]

I'm so sorry to hear of your heart ache.... but, it's good to know that Punk didn't suffer and she passed quickly and peacefully. I can only hope the same for my poor old sick doggie:(
May God comfort you in this difficult time....
Hugs from Leah and Maya

[Harley PoMMom]

Dear Cody,

I am so sorry for your loss and you and your family are in my thoughts and prayers.

Godspeed sweet Punk

With Heartfelt Sympathy,
Lori

[labblab]

Dear Cody,

I, too, join in with deep sympathy for your loss. Your sweet girl will always be remembered and honored here, and we will always welcome you back with open arms should you wish to return and share more stories of your dear, brave Punk.

Marianne

[Nika'sMom]

I am so very sorry for your loss.I can see that your precious Punk was so very loved, and she knew it. I will keep you in my thoughts and prayers,

Lynda

[molly muffin]

I am so sorry that Punk has passed :(. I sure your lap is exactly where she wanted to be.

Hugs
Sharlene

[frijole]

Oh darn it this is so sad. I am glad Punk passed on your lap in the comfort of home. She was loved and in a wonderful place. I know it is so hard - may all those great memories of fun and healthy days sustain you as you heal. Punk, run free of pain in the sunshine and RIP dearest angel. Kim

[Roxee's Dad]

Dear Cody,
I am so very sorry for your loss... Rest in Peace sweet Punk, you are our newest and brightest star in the sky........

[scoora]

Cody,
So, so sorry to hear of your sweet Punk passing. My thoughts and prayers are with you.
Vicki

[goldengirl88]

Dear Cody:
I am saddened to hear of Punk's passing. May God bless you and give you strength in the days ahead. This is an awful disease, we need research to find a cure.

[mytil]

Oh, I am so very sad to read this. My heart is with you.
My deepest condolences
(((hugs)))
Terry