Just Diagnosed (10 y/o lemon Beagle) - Frida has passed

[FridasMom]

My 10 year old lemon Beagle, Frida was just diagnosed with Cushings. The past three weeks have been terrifying. I am so confused and scared and hoping to hear advice from others that are going through and have already been through this.
Most of her symptoms I started noticing about six months ago. Three weeks ago it seemed as if she had aged 80 years. After a stay in the ER, we had results.

Tumor on her left adrenal gland
Non-cancerous nodules on her liver
Slight amount of fluid in her right lung (we had X-rays done the day before which did not show this)
Small amount of bleeding in the area of the tumor
Cushings - her cortisol level after the ACTH Stim test was 46.9

She just started taking Trilostane. She has been better, and by that I mean not on her deathbed and in lots of pain. But she has been even more lethargic and nauseas and shaky than before the major episode. Her appetite is strange. She will seem really hungry and then spit out or stare at her food. We have been giving her several small meals throughout the day. Today she refused boiled chicken but ate the dry weight management dog food. I don't know what to do about her eating. She used to eat everything and anything! Before going into the ER, she was 27.6 lbs. Two days ago she was 25 lbs. I can see and feel that the muscle mass is disappearing.
Has anyone else had similar diagnosis? If so, what treatment and prognosis did you have? Any help or advice would be greatly appreciated.
Thanks,
Frida's Mom

[frijole]

Hold on while I approve your membership. YES I can relate! Kim

[frijole]

OK - first off deep breaths because you have found the absolute best place on the planet for help. And it is FREE! With treatment cush dogs can lead very normal lives. Key is to get you up to speed, make sure the diagnosis is accurate and drugs given are the right dosages oh and that your vet is up to speed. (sorry we see all sorts of things here so we need to be sure)

Tell us your dog's entire story from start to finish so we can get the big picture. Tell us every test that you can remember that was done to get to this point. What was ruled out and ruled in. Symptoms you name it. Not just cushings but everything.

The appetite could be a couple of things. It could be that the trilostane/vetoryl dose is a bit high and cortisol should be checked. Please tell us the dose and your dog's weight. Also tell us exactly how many doses you've given.

Secondly - when you mentioned weight loss and strange eating where it ranges from day to day you are describing my Annie. I've never seen anyone else here describe it to a T like you did. She had a very rare type of adrenal tumor called a pheochromocytoma. It took us a year to figure it out. (she was MISDIAGNOSED with cushings) Pheos are adrenal tumors but not cushings - they DO have cush symptoms. You can rule out a pheo if your dog does not have high blood pressure. (mine had episodes where breathing is frantic/total body shaking. ) She was starving but refused different types of food but would eat it the next day - it was like the flavor made her nauceous and she couldn't eat but COULD eat a different type of food that meal.

Anyway... tell us about your dog!!!!! Kim

[frijole]

MODERATOR NOTE: Your post has been manually approved so that members can start responding to you. Please check your email for a message from k9cushings. You will need to reply to that email so that your post go directly to the board and are not delayed waiting for approval. If you have already received and responded to the confirmatory email, please be patient. Your registration will be finalized shortly. Thanks and welcomE!

[mytil]

Hey,

Just wanted to welcome you and Frida to our site.

Kim has started you off, especially getting and posting the test results and how much Trilo you are giving and Frida's weight.

Has she had any vomiting episode or tried to vomit?

Here is a link that describes more about Trilo treatment http://www.k9cushings.com/forum/showthread.php?t=185

Terry

[SoggyDoggy]

The good news is you found the fountain of information! There are people here that have been dealing with Cushing's and various other related issues for a number of years, and they are the most supportive and helpful bunch of people I have EVER come across, HANDS DOWN! So whatever questions you have, be sure to ask them. The rest of us - many who are still very new and learning (like me) will be here to hold your hand give you a place to vent.

Anyway, one of the first things I learnt was to get a hold of copies of all of the tests that were run and the results. Where anything reads as unusual, or you don't understand it, post it up here for the wise ones to have a look at and help you out with. They will be able to guide you through what to expect, how to go about it and give you suggestions or questions to pose to your vet. Sometimes I think this seems scary just because we love our kids so much, but hey, whatever it takes right?

So I just wanted to say Welcome, you're not alone and take a deep breath.

[Simba's Mom]

Welcome, we are all here for you and your fur baby, I have learned no question is too big or too small, this site is awesome!

[FridasMom]

So, I had a huge long message typed and I accidentally hit the back button. :(
I will repost tomorrow. I would love to hear opinions.

[Harley PoMMom]

So, I had a huge long message typed and I accidentally hit the back button. :(
I will repost tomorrow. I would love to hear opinions.

After you hit/click the back arrow, just hit/click the forward arrow and your post should still be there...I just tried it and it worked.

[molly muffin]

Hello and welcome from me too!!!! *waving hand wildly in the air

or do what I do and use notepad for the big posts because who knows how long it'll take me to write it (a day!)

I think everybody has covered all the really pertinent stuff, so I'll just do the big smiles, give you a hug and tell you that you really Have found the gold mine of cushings information, opinions and support.

Sharlene and Molly Muffin

[FridasMom]

Hi all and thank you for the welcoming. I will try to give Frida's back story and diagnosis in as condensed version as possible.
About a year ago Frida was doing a lot of stretching. I thought that maybe it was gas and got slow feed bowls. That seemed to fix that problem. She was also getting all types of bumps and lumps. Some were squishy and movable, some hard, some looked like moles, and some looked like blackheads. The vet had told us this was normal in dogs as they age. Some have been removed and others were sampled (turned out to be a lipoma). She also seemed to be slowing down quite a bit. Not as interested in specific things anymore.
About 3-4 months ago she seemed to have a huge influx of the pimple and blackhead types. Then she started peeing in large volumes. Then there were accidents in the house.
We took her to the vet, and they felt like everything was fine. We couldn't do a urinalysis because I had mistakenly let her pee before the appointment. We were thinking stress because her schedule had been off due to visitors.
In December, the urinating seemed to get better but that may have been because we were going out on more walks.
Around the seventh of January, she had an accident on the bed (so not like Frida to do). We decided to take her back to the vet. On that visit, they were able to do a urinalysis and they also did a blood test. They found that she had a minor bladder infection and elevated levels of protein in her urine. Her blood work came back normal.
The next afternoon she was stretching a lot and not able to get really comfortable. As the day progressed she was noticeably in pain, sighing on each exhale, not wanting to jump up or down from things, and very lethargic. We decided to return to the vet. Before we went she vomited. It was all of the food she had for breakfast, hardly digested at all.
At the vet, we took an X-ray of her chest and stomach. They thought that what looked like her duodenum was a bit enlarged. They figured that it was spasming which in turn led to the pain and her throwing up. They gave us more meds and told us to feed her in small amounts throughout the day.
She seemed a little better the next day but she seemed to be walking gingerly and a little wobbly. By the time evening came she was in a lot more pain. She would not take any treats (also not like her) and she started acting like she needed to poop but she was standing on all fours. The she laid down and it looked like she was in labor. My husband and I rushed her to the 24 hour emergency vet. By the time we got there she could hardly keep her eyes open.
Intake Stats and Assessments:
Body Temp - 97.0
Cardiovascular/Pulses - 120/normal pulses
RR/Lungs - 24/Clear
Mucous Membranes - pale pink
Abdomen - abnormal; distended stomach and mild discomfort on palpitation
Neurological System - normal
Body Condition Score - 5/9
Lymph Nodes - abnormal; left submandibular feels enlarged
Dermatologic - abnormal; many small raised dermal masses
Laboratory Findings:
Alkp 234, ALT 127, Amyl 1474, Crea 1.4, GLu 147, Phos 1.6, K 2.6, manual plt ct 130000, Lymph .91%, lymph 8.7%, mono 5.5, RBC 4.68, HGB 10.6, HCT 29.76, MCHC 35.7, PCV 33%, TP 5.6, PT, PTT -wnl, auto agglutination;negative, CPL; abnormal
X-Ray Findings:
pleural effusion-right side
generalized loss of detail in abdomen
pylorus appears dilated
During her stay in the ER they noted that she had a heart murmur.
We opted to have an ultrasound done that took place the following day.
They found a "large tumor on the left adrenal gland with right adrenal not identifiable, multiple liver masses, as well as a trace peritoneal effusion." They also did blood work that day, "Blood work (ISTAT) at 1p 1/14 found mild hypokalemia (3.1) and persistent slightly progressive anemia (HCT 19%, PCV = 23%)."
They did a fine needle aspirate on one of the nodules on her liver which came back as benign.
Since she had clinically improved we were able to take her home. The next day we had the ACTH Stim test done. The post cortisol injection number was 46.9.
We started her on Trilostane. One 10mg capsule twice a day. She is about 27 lbs.
She was still lethargic and extremely shaky. She was being really weird about what food to eat. She would turn down chicken but wanted to eat the weight management dry food. I called the vet and we changed her dosage to two 10mg capsules once a day.
She has been a million times better. Less shakiness, more energy, and I can sleep for five hours without waking up to make sure she's ok.
I know that our next step is to do another ultrasound after 10-14 days of medicinal treatment. After that..........?

[frijole]

Those numbers don't scream cushings because the alkphos is so low. Do us a favor and put the range for normal beside each as not all labs are the same. THanks.


Alkp 234, ALT 127, Amyl 1474, Crea 1.4, GLu 147, Phos 1.6, K 2.6, manual plt ct 130000, Lymph .91%, lymph 8.7%, mono 5.5, RBC 4.68, HGB 10.6, HCT 29.76, MCHC 35.7, PCV 33%, TP 5.6, PT, PTT

For example:
alkp 234 (100-200)
alt 127 (50-75)

etc etc

We are concerned with anything on the labs that was high or low. Thank you! KIm

[NoonelovesmelikeNorman]

Welcome Frida'a Mom! You are in great hands and wealth of information on this site. I am too new to be of much help wth advice but pray and meditate and will do so for Frida and you!

Sharon and Norman

[FridasMom]

There were so many numbers so I only included those that were out of range.

1/13/13
Test Result Reference/Range
% Lymphs 8.7 12.0 – 30.0
% Monos 5.5 2.0 – 4.0
HCT 29.76% 37.00 – 55.00
HGB 10.6 12.0 – 18.0
MCHC 35.7 31.0 – 34.0
ALKP 234 20 – 150
ALT 127 10 – 118
AMYL 1474 200 – 1200
CREA 1.4 0.3 – 1.4
GLU 147 60 – 110
PHOS 1.6 2.9 – 6.6
Potassium 2.6 3.7 – 5.8

1/14/13
Test Result Reference/Range
HCT 19% 35 – 50
HGB 6.5 12 – 17
Potassium 3.1 3.4 – 4.9
PCV 23% 35 – 50
TP 5.2 5.4 – 8.2

1/14/13 (they took multiple tests this day)
Test Result Reference/Range
HCT 26% 35 – 50
HGB 8.8 12 – 17
Potassium 3.3 3.4 – 4.9
PCV 29% 35 - 50

1/15/13
Test Result Reference/Range
HCT 29% 35 – 50
HGB 9.9 12 – 17
Potassium 2.8 3.4 – 4.9

[frijole]

Wow - that's a lot of typing. Sorry but much easier for everyone to read and follow.

Cush dogs typically have very high alk phos as in 800-2000 range. Your dog's level could be caused by something else going on. There are so many things that are elevated/out of range that have nothing to do with cushing's that it causes me concern. Cushing's does not explain the numbers.

What have they ruled in and ruled out? For example the glucose is high. Did they rule out diabetes?

If you have the acth handy could you please read me the pre number (you gave us the post). It may or may not be meaningful.

Just so I'm clear what date did you start the trilostane and have you done an acth test since commencing? You mentioned doing another ultrasound 10 days after commencing trilostane. Am I to assume that was a typo and that you meant acth test? (this is the test you do to measure cortisol and see if the dose is working)

Thanks.
Kim

[frijole]

It's me again. :D

One of our mods is a med tech with over 20 yrs experience working with humans but she is a great help here. She gave me some feedback on your lab results and I wanted to pass them on. PLEASE know she is very good and I trust her judgement.


She feels there is a huge red flag on the hemoglobin & PCV (Hct) values and that your dog is severely anemic. You need to find out why??? The vet needs to be questioned about this.

Have you seen any sign of blood in the stool or a "coffee ground" appearance to the stool. Another thing to check is the gums. They should be nice & pink but if they are pale that is another sign of anemia.

Answers to this anemia needs to be put on the front burner. This is way more important than cushing's. Cushings can wait - there is NO rush to treat.

Please talk to your vet asap about this. Do not wait. She said she'd check in tomorrow a.m. to see if you have responded. Thanks so much!

Kim

[Harley PoMMom]

CPL; abnormal
I know that our next step is to do another ultrasound after 10-14 days of medicinal treatment. After that..........?

The abnormal findings on the cPL should be investigated further. An abnormal result means that pancreatitis is present and Frida should be on a very low fat diet, also, pancreatitis can be very painful so pain meds have to be rx'd.

[FridasMom]

I realize that I forgot to mention during the ultrasound they noticed a small amount of bleeding. They weren't 100% sure where that came from but they are thinking that it was from the tumor on the adrenal gland. Since her stay in the ER her anemia is gone and her gums are back to a normal color. We did the ACTH Stim on the 14th and received the results on the 16th. We started the Trilostane on the 17th. At the end of the month we were going to do another ultrasound (to make sure there wasn't anymore bleeding and to check on the growth of the tumor) and do another ACTH Stim. I do not have the paper with the first ACTH results. I wrote down the post number and I think the pre number was around 18. Frida's diet has been a low calorie, low fat, and high fiber. Diabetes was ruled out, since she has never shown any signs and her blood sugar levels have never been drastically high. The vets have told me that it is common for those levels to raise when they are nervous.
I also just got home after rushing Frida back to the ER. She had been doing really well the past couple of days. But, this evening we were getting off the elevator (coming in from our walk) and she started walking funny. She was falling on the ground and writhing in pain. The ER vets noticed that the painful leg was a bit cold and they could not get a pulse on it. They told me that they thought it might be a blood clot and the outlook is not good. She is staying the night in ICU, again, and will see a specialists in the morning. We are scheduled to do an ultrasound for a possible blood clot and the adrenal gland tumor tomorrow.
I don't know what to do. She was feeling and acting so much better and happier.

[Trish]

Oh no, poor Frida. Hopefully it is not a blood clot and just something else wrong with her leg. She will be getting excellent care in the ICU tonight then hopefully better news tomorrow after the scan. Thoughts are with you, hope you can get some rest tomorrow but I think you will be so worried. Sending lots of get well quick wishes for Frida and hugs for you
Trish xxxxxxxxxxxxx

[frijole]

Sending prayers. KIm

[Squirt's Mom]

Sending prayers and healing white light for Frida. Please let us hear from you when you can and know your family here is right by your side.

Hugs,
Leslie and the gang

[Boriss McCall]

Praying for you & Frida today. Hugs

[molly muffin]

Oh my gosh, my thoughts, prayers and best wishes are with you and Frida. I hope this all turns out well.

hugs,
Sharlene and Molly Muffin

[mytil]

Sending tons of positive thoughts to you both!

Terry

[Tina]

Sending love and prayers to you and Frida, and hoping she is doing ok.

Tina and Jasper

[milosmom]

all eyes on you and frita...sending you xoxox patty(milo)meka

[Squirt's Mom]

Still holding you both in my thoughts and prayers.
Hugs,
Leslie and the gang

[FridasMom]

Yesterday afternoon, Frida passed away. They did find a blood clot in her leg. I cannot describe the hurt I have for her. She was so happy to see me in ICU and she even ate lots of food. I think what makes this all so hard is that everything happened so quickly. I keep feeling as if there was more I could have done. She loved and trusted me unconditionally, more so than anyone else. I love you so much Frida monster!!!!

[Harley PoMMom]

I am so terribly sorry for your loss of sweet Frida and my heart goes out ot you. Please know we do understand the pain you are feeling and we are here for you.

I am sure Frida knows the depth of your love and that you did everything humanly possible. You and your family are in my thoughts and prayers.

With Heartfelt Sympathy,
Lori

[Squirt's Mom]

Oh, I am just so sorry to hear this. I know your heart is broken into pieces. You are a good mom, you did all you could to get her the help she needed when this crisis arose just as you have all along. I know that Frida does not feel you let her down in any way; she knows you did all you could for her and that you love her beyond all words.

Your sweet girl's name has been added to the In Loving Memory thread for 2013 where she will always be remembered by her family at K9C.
http://www.k9cushings.com/forum/showthread.php?t=4794

Please know we are here for you any time you wish to talk. We do understand, just as Lori said. Many of us have walked the same valley where you now walk and are more than willing to hold your hand, give you a soft shoulder to fall against.

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


A Simple Message From Your Pet
by Ken D. Conover

To have loved and then said farewell is better than to have never loved at all.
For all of the times that you stooped and touched my head, fed me my favorite treat and
returned the love that I so unconditionally gave to you. For the care that you gave to me
so unselfishly. For all of these things I am grateful and thankful. I ask that you grieve
not for the loss but rejoice in the fact that we lived, loved and touched each other's lives.
My life was fuller because you were there, not as owner, but as my friend. Today, I am
as I was in my youth. The grass is always green, butterflies flit among the flowers and
the sun shines gently down upon all of God's creatures. I can run, jump and play
and do all of the things that I did in my youth. There is no sickness, no aching joints
and no regrets and no aging. We await the arrival of our lifelong companions and know
that togetherness is forever. You live in our hearts as we do in yours. Companions such
as you are very rare and unique. Don't hold the love that you have within yourself.
Give it to another like me and then I will live forever. For love never really dies,
and you are loved and missed as surely as we are.

Your pet in heaven.

[Jenny & Judi in MN]

I am so so sorry. When it is this sudden it is just that much more heartbreaking because you weren't ready. Dogs give us so much love. that's why it hurts so much. I'm sorry

[Trish]

I am so very sorry to hear this about Frida, how awful for you to have to go through the sudden shock at the passing of your gorgeous girl. I am pleased you got to spend time with her and she sounds like she was so happy to have you by her side, so hold onto those moments. You couldn't have done anymore than you have, sometimes our babies have the misfortune to get these awful diseases and the best care in the world cannot save them so they slip away and we are the ones left grieving, so you rest assured you did all you could and unfortunately it was just her time as unfair as that is. I am so sorry. Lots of hugs being sent your way xxxxxxxxxx
Trish

[frijole]

Do not feel guilty for one second. You did what you needed to do. Obviously something was off and you had her at the ER multiple times. Know she is now free of any and all pain. I am glad you had some time with her and that she was happy and basking in your love. Keep that image in your heart as you heal. RIP dear angel Frida. Run free of pain. Kim

[Simba's Mom]

So sorry to hear about Frida, sending hugs your way......

[Boriss McCall]

I am so sorry you lost your sweet Frida. I know the pain is deep. :(

hugs..

[SoggyDoggy]

I'm so sorry you lost Frida, it's a horrible thing. Please be comforted that she loved you so much though and she knew you were trying to help her out in every way possible. She's now free to run and meet new friends but will still watch over you.

Sending Love and hugs you way.

[Tina]

I too am so sorry to read about Frida. I know that no words can bring you comfort right now, but know that you and your family are in my prayers.

Hugs,
Tina

[milosmom]

sending peace,love,hugs and kisses...cherish your memories..patty(milo)meka xoxox

[scoora]

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

[addy]

Fly free sweet Frida. I am so sorry you lost your girl. We are never ready to say good bye no matter what the circumstances.

I am so sorry.

[mytil]

Oh I am so very, very sorry Frida has passed. My heart is with you!! My deepest condolences and my (((hugs)))
Terry

[Bo's Mom]

RIP sweet Frida. Please know you are dearly missed by all who loved you but they will keep you close to them in their hearts.

[FridasMom]

I just keep thinking that there has to be a way of diagnosing any of these issues before they become terminal like this.

[molly muffin]

Oh no. I just got home and how very awful to find out that beautiful Freda has passed. My sincerest condolences.
I agree, there has to be or should be a way to diagnose this kind of thing so that it doesn't reach this stage, in this manner.

hugs,
Sharlene and Molly Muffin

[gummysmurf]

Just wanted to tell you that you and Frida are in my thoughts. She has such a sweet face in the picture. I can just tell that you two had a very special relationship, and that as much as you loved and cherished her, she adored you.

[Trish]

Awww I love her picture, she is beautiful. I wish they could have found it earlier too, so sad when you are so unprepared for something like that. More hugs for you
Trish xxxxxxxxxxxxxxxxxx

[FridasMom]

Thank you all. I'm still not able to come to grips with this. She was the best thing to ever happen to me.

[FridasMom]

Does anyone know what caused her to "throw" the blood clot in her leg? She seemed to be getting so much better and then all of a sudden she couldn't walk.

[frijole]

Hopefully someone can answer your question - I have no idea.

I just wanted to reach out and send you a huge cyber (((hug))). I lost my little one last February and I now have no dogs. I am still healing myself. I know the feeling of loss is painful. When you are strong enough I encourage you to walk down memory lane and get out the photos. Through tears you are bound to smile as you look back on the happy and healthy days. I still have the photos out for that reason.

Hang in there and know you are forever a part of this wonderful family of dog lovers. Kim

[mytil]

Oh I truly wish I knew for certain what caused this to happen. But I will say that deep vein thrombosis can be unpredictable from humans to dogs.

Kim said it best - you are now part of our family. We are all here for you.

My continued ((((hugs))))
Terry