9 Year Old Maltese with Cushings

[Squirt's Mom]

I remember feeling much the same way when Squirt was first diagnosed! The more I read, the more confused and frustrated I became. My solution, and one that just happened to correspond with her vet's approach for the most part, was to have every test possible run. Her vet wanted the LDDS, HDDS and ultrasound; I asked for the ACTH and UTK panel, and a second ultrasound that ended up saving her life.

[KennyJ]

Which test did they run first on your pup?? That's a lot of testing.

[Squirt's Mom]

The first test to test for the Cushing's, was the LDDS.

The HDDS is rarely used these days; it's primary use is to help tell if the Cushing's is pituitary or adrenal based but the LDDS can also help with that and the ultrasound tells a great deal about which type, so the HDDS has fallen out of favor.

[KennyJ]

So I should most definitely go with a vet that wants to run a LSSD test as the first test? Can regular vets read an ultrasound correctly?

[doxiesrock912]

Kenny,
Daisy's regular vet ran the LDDS test but they sent us elsewhere for the ultrasound. Find an IMS specialist for that so that you're sure that its been properly read.

[StarDeb55]

Kenny, all Harley had done was the UTK panel, the panel will give you a cortisol result along with the 5 other associated adrenal hormones, & an ultrasound. When it comes to the ultrasound, you need to make sure that it is done on a high resolution scanner.

Debbie

[KennyJ]

So Debbie, no LSSD test??? But once you did that ACTH?? When Gracie was sedated to have her leg xrayed the vet played around with her stomach. He said he didn't notice her adrenal glands being abnormal but that it didn't mean they were not. The only other thing he mentioned was that it looked like her intestines were thickened.

[Squirt's Mom]

An xray is not an ultrasound and cannot see the same things. You want an ultrasound performed on a high resolution machine and the films read by either a qualified tech or the IMS. This is typically outside the range of a GP vet and most do not have the equipment for an US.

The UTK panel includes the ACTH. It is just expanded to look at the intermediate hormones, which can also come into play.

[StarDeb55]

No, neither of my boys ever had a low dose. The cortisol result from the UTK panel is the equivalent of an ACTH. After that, the only time Harley had ACTHs done were to monitor his meds.

Deb

[lulusmom]

Hi Kenny. I think the first thing you need to do, before committing to an LDDS or ACTH, is get a new blood chemistry done to see if there is any improvement in the liver values. It's possible that the ALKP has gone down and I'll be praying for that scenario.

[KennyJ]

Its funny you mentioned that because the vet that is treating Gracie for the laser therapy said the same exact thing. To test her liver enzymes again in about a month. Gracie has improved greatly on her injured leg and the cysts on her stomach and chest have decreased in size while some have disappeared. I can't explain how that happened but some of them were very noticeable. I didn't want to think I was going crazy so I had someone that felt the lumps previously and they too said the same thing. Maybe the DogTorX doesn't help with Cushings but I guess its possible it has some type of anti-inflammatory benefit. That's the only new thing I added to her treatments.

[Squirt's Mom]

Hi Kenny,

I wanted to make sure you understand something that has already been discussed concerning possible cush testing for Gracie.

The LDDS is more apt to return a false-positive when there are other conditions besides Cushing's present. This happened with my Squirt - her LDDS was positive beyond a doubt but they found a tumor on her spleen via ultrasound and once it was removed, her cortisol returned to normal, disproving the positive LDDS. She had a NON-ADRENAL condition that caused her cortisol to rise. These tests cannot determine why the cortisol is elevated, only that it is...and many, many, many things can cause cortisol to rise. There is no doubt in my mind whatsoever if you were to have an LDDS right now, it would be positive simply because you have been so stressed over Gracie. ;)

We already know Gracie has one non-adrenal condition - her leg - so in her case it is better to start with the ACTH because it is less likely to give a false-positive in the face of other conditions.

[KennyJ]

Gracie has always had a problem with biting her front legs and licking them like crazy. This has been going on for a long time. I just chalked it up as having allergies and kept trying to change her dog food. But here's the thing, all my Maltese end up looking like Gracie. Stocky built and constant licking and biting some place on their body. Gracie is really bad though about doing this.

[KennyJ]

You guys are smarter than the vets. :) Dr Poage at the Valley Animal Hospital and Dr Wadstrom said the tests would not be affected by the injured leg. I am going with what you guys say. My only problem is now finding a vet that I trust. All say they treat dogs with Cushings but not one of them said she could live her normal life expectancy. The only one that said that was the IMS doc at the vet school but since he won't treat her I am back to square one.

[Squirt's Mom]

Let me tell you a little secret. The reason the cush pups you see here outliving that 2-year crap is because of the wonderful, involved, educated parents they have....that would be us, including you. ;) We taught ourselves all we could about Cushing's and other conditions our babies face not because our vets didn't know enough but because we love our babies to distraction and are willing to go to great lengths for them.

But the vets don't often see parents like us. They see the parents that either can't or won't be involved in their pet's care. They don't take the time to learn about the disease their baby has, they don't watch them like we do, they don't know when something is off like we do, they simply do not have the connection to their babies that we do. That connection, that self-education, is the magic key to a long, healthy life with Cushing's. And we have that magic in spades here. ;)

[KennyJ]

I called Cave Spring a few minutes ago just to ask if they knew when my vet would return back to work. They still don't have any idea. I asked again which test would they run on Cushings, again they told me the ACTH test. So if they run this test and its positive and they want to start treatments do I go for it?

[StarDeb55]

Kenny, Leslie is absolutely correct about why we have a lot of pups in this group that blow that 2 year survival garbage away. I want to give you a shining example of how our pups are watched with almost literally a microscope.

Barkley had been in remission for about 15 months after his chemo for lymphoma. He had been doing really well, & life as they say was great. We were down to a monthly recheck with the oncologist & that's it. I knew that dog so very well, I knew something with him was off, but could not put my finger on it. It concerned me enough that I moved his recheck up with his oncologist. After giving him a very thorough exam, she comes in, telling me that, initially, she could not find anything, & was thinking I was a big worry wart, but she also knew how well I knew B so she kept checking. Lo & behold, she found one swollen lymph node in behind one knee that was only the size of a pea. She told me normally that she probably would have blown this off, but she didn't fortunately, as this was the first sign that Barkley had lost his remission. If I hadn't known B as well as I did, the lymphoma would have had a chance to take hold & get going, again.

Debbie

[KennyJ]

Ok finally my regular vet gave me a call. He is doing better but still not back full time. He wants me to bring a urine specimen to the clinic in the morning and start with that. Does this seem ok with you guys? He also said even at 16 ounces of water that is considered excessive drinking for a dog her size. That one confused me because I didn't think it was. I told him that was on the high end that she usually averages 12-14 ounces of water and he said even that was on the high end. I thought it was one ounce per lb but he used a different way of measuring it. I told him about all the different opinions from the vets and what Dr Leib from the vet school said about Gracie living out her normal life expectancy if treated for Cushings. He said this would be one time he would have to disagree with Dr Leib that the disease would most certainly cut some of her life short. He said unless the dog had a lot of the symptoms that went along with Cushings he didn't treat them all. But that without treatment most only live about year but could be longer. He's a great guy and he has always taken good care of Gracie but still not what I wanted to hear from him since he is Gracie's vet. But getting back to the urine test. Would you recommend that? And one more thing, he said he would most definitely do the ACTH first.

[StarDeb55]

Kenny, you're going to have to be a lot more specific than "urine test."
Are you talking about a urinalysis, urine culture, urine cortisol/creatinine ratio? You need to tell us which one the vet wants to do.

Debbie

[KennyJ]

Sorry urine creatine ratio test.

[StarDeb55]

The urine cortisol/creatinine ratio is a screening test for Cushing's. If it's negative, you're not dealing with Cushing's. Positive means that Cushing's is a possibility, further testing required. I guess you can start with the UCCR, but in Gracie's case I would almost bet that it will be elevated because of her leg issues.

Debbie

[KennyJ]

Thanks Debbie. Normally the first thing in the morning Gracie wants to drink water. This morning when we first got up she didn't touch it. After she ate and I gave her the chewy Glycoflex 111 and Omega 3 supplement she had her had in the bowl of water almost non stop. I have never seen her do that before. Usually she will take some laps of water and that's it. She was putting it away after she ate this morning. Very unusual. And as I stated in the post several spots up Dr Hairfield said the amount she was drinking was on the excessive side so I guess the one ounce per pound is not entirely true. Gracie weighs between 12.5-13.0 depending on what scale you weigh her on. She drinks on an average 12-14 ounces a day, her high being 16 ounces. That's probably going to change after today though because she really went after her water this morning after her meal and supplements.



Glyco-Flex III
Perna Canaliculus (GlycOmegaTM brand) 600 mg
Glucosamine HCl 1000 mg
Methylsulfonylmethane 1000 mg
Dimethylglycine HCl 100 mg
Manganese 10 mg
Vitamin C 30 mg
Vitamin E 50 IU
Grape Seed Extract 5 mg
Selenium 2 mcg
Glutathione 2 mg

Tablet Inactive Ingredients - brewers yeast, cellulose, silicon dioxide, smoke flavor, stearic acid

[Squirt's Mom]

Kenny, drinking a little extra water doesn't qualify for a cushing's sign. A cush pup will drink buckets and buckets of water - they have to. The Cushing's causes the kidneys to hyperfunction - makes them pee allllll the time - so they have to drink a whole bunch of water just to stay hydrated. The standard for measuring water intake is 1 oz per pound. This is NOT set in stone. A pup can drink more or less depending on many factors such as dry VS wet food, temps outside, and so on. So water intake will change from day to day and that doesn't mean there is an issue.

A cush pup will typically drink and drink and drink and drink.....day in and day out, 24/7. ;)

[KennyJ]

That's why I couldn't understand the formula that Dr Hairfied used. I told him what I had read and I didn't consider Gracie drinking excessively based on the 1 ounce per lb of body weight. However, his formula said she was drinking excessively. This morning I didn't think she was going to stop drinking. He was the one that suggested to do the urine/creatine cortisol test. But after ready what some of you guys have said that test would almost surely come back positive based on her leg. The vets seem to think her leg will not affect any of the test results and that she could be tested now. I did ask Dr Hairfield if he had treated many Cushing dogs and he said some they do not treat at all if the symptoms are not bothersome but he would treat with the new med Vetoryl should I decide to treat her. I told him that I would most definitely treat her. He said he has had mixed results but that he didn't agree with Dr Leib whom he knows very well and actually attended vet school where Dr Leib is an IMS about dogs being able to live out their life expectancy. He said that the disease even treated will shorten that. I let him know I didn't need to hear that that I wanted to think positive. And Dr Hairfield is one of the most positive people I have ever been around. I was to take a urine sample this morning but since Gracie had laser yesterday at 6 I decided against it. Without treatment he said he has seen dogs pass away within a year. Another thing I asked him was how much of this drug would Gracie take a day based on her size and how often and he said he wasn't sure he would have to read up on it. Is that a bad sign already?? Shouldn't a vet already know those things if they have used this drug before?


Sorry but I am full of questions this morning. Could I be giving Gracie too many supplements? Glycoflex 111, Nordic Omega 3 in liquid form, and I also include the DogTorX. Onlly recently did I add the first two.


http://www.nordicnaturals.com/petRet/nnpet_prodO3_2oz.php

[goldengirl88]

Kenny:
I don't think you are giving Gracie too many supplements. Tipper gets about 8 different ones. I think it is a lot better that we use the natural supplements, than pumping them full of drugs. Mostly everyone on here uses supplements. Blessings
Patti

[Trish]

We do not understand what your myriad of vets say either! But I do trust what the members here recommend to you even though you do not appear to.

Yes I do think you are giving Gracie too many supplements, you are giving her one that is egg membrane for its main ingredient for pete's sake, based on no scientific evidence whatsover. Give the dog an egg already if you think that is what is going to help her. Companies that produce these snake oils rub their hands together in glee when they see desparate people like us coming along that will do anything to help their dog. Kaching Kaching, lets sell these suckers an egg for $70, yeah that will work.

Supplements are not "natural" unless you can see it growing out of the ground, or walking around or swimming in the sea! In my opinion the only time it can be called natural is if you can go out to the garden, pick it then take it. Otherwise all these so call supplements are processed just like all the other pharmaceuticals out there and often without the quality control required for mainstream dugs. BUT they put a sticker on their bottle saying "natural" and we think ohhhh that must be safe and good for our baby. Lets buy it.... cos I read a story about some dog in Timbucktoo who was cured. Yeah right.

Humans and pets get most of these so called supplements in a normal diet and any excess we give them are just pee'ed right on out of their systems along with your money straight down the toilet. They don't need most of them and we buy them because of good marketing by the companies.

There are good studies out there for some of them, like fish oil, glucosamine/chondroitin or fibre supplements but there is no way I would give my dog something claiming to be egg blardy membrane based on the say so of some vet who has given it to a few dogs who also happens to be spruiking the product!!

Kenny, in the 50 odd pages of your thread you have been told many many times that Gracie is not drinking excessively please listen to the members here that seek to reassure you and stop going in circles distressing yourself.

You need a plan so here is mine!

1. Wait for her leg to heal, listen to one person, orthopaedic specialist to be precise and do exactly what they tell you
2. Once leg healed, get her tested as per recommendations of the good people here. After all she does not have many cushings symptoms so she may not even have it so there is no big rush to get that done. It is only 5 weeks since you started posting here and getting over her leg injury will take TIME
3. Stick with one vet and work with them to help them understand cushings disease. As you have found and also many on the forum have told you this too, vets are not all knowing especially with cushings treatment as it can be so tricky with so many different options. You need to stop obsessing and contacting all the vets in the country in the hope someone will have a miracle cure for cushings when you have not even got a diagnosis yet!
4. Enjoy your dog and keep her home as stress free as possible
5. Disable google on your computer :)

[KennyJ]

She pants a lot, elevated ALP of 3500, urinates in the house and does have a belly. It is true that she hasnt been tested yet but all signs sure point to Cushing's. I took all the supplements to the vet treating Gracie with laser and she didnt see anything that would harm her. She is also on Denamarin. And Gracies regular vet said her drinking was excessive based on the formula they use. Having said that I will only be giving her the Glyco Flex and Denamarin.

[Budsters Mom]

Hi Kenny,
Trish pretty much said it all! :DSome of us are living on borrowed time with our pups, so living out each day to the fullest is all we can do. It is not because they have Cushings. They may have a macro-tumor, which is a tumor that is growing or another terminal illness. Each day brings more challenges. Gracie's leg will heal. Yes, she has a high ALKP. That doesn't necessarily mean she has Cushings. There is no indication whatsoever that she is terminal. So rejoice in that thought!:) Gracie's likely to be with you for many years to come, so be thankful and cherish every moment!:)
Hugs,
Kathy

[KennyJ]

Thanks Kathy. I will try to take one day at a time. I wish I could get her from chewing and licking on her front leg.

[KennyJ]

Wow, I just found an IMS practicing at Companion Animal Clinic in Blacksburg.


Dr. Erin Herring completed her degree in Veterinary Medicine in 1996 from North Carolina State University. Following this, she came to Blacksburg and completed an internship and residency at the Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM), becoming an ACVIM diplomate in Internal Medicine in 2000. She worked at VMRCVM following this, and has been at Companion Animal Clinic since the spring of 2007.

She is married, and has three children and two cats. Her hobbies include teaching yoga, biking, and knitting.




http://companionanimalclinic.biz/clinic_staff.shtml

[molly muffin]

That is good Kenny, have you contacted this hospital previously?

Sharlene and Molly Muffin

[KennyJ]

Sharlene, yes I actually know one of the vets that works there. But it was about Gracie's leg and nothing else. He would have done surgery on Gracie's leg instead of the conservative management so I am glad I chose the Vet School on the leg.

[Jeanne]

My 12 1/2 yr old Pug-a-pooh has Cushings & Diabetes. In Harley Girls case the Vet suggested a very low protein diet and no meds unless absolutely necessary. Cushings means NO Meat, and he wants to keep her at 18 grams of protein a day or less. She eats high fiber soft dog food from the vet, and Morning Star veggie hot dogs or veggie chicken patties cut up on top of the dog food & she is doing good. Only veggie treats, but all protein has be counted ea day. I do cut up one tiny senior greenie for her special treat once in a while. I hope this works for your baby too.

[goldengirl88]

Jeanne:
I have never heard of no meat if a dog has Cushings, and protein restriction. Could you tell me what the reasoning is behind this approach? Sorry to hijack your thread Kenny. Thank you Blessings
Patti

[Squirt's Mom]

Hijack continues - :D

Jeanne, I'm not sure where you got that information but it is incorrect. Cushing's dogs need low fat diets, not no meat diets. Dogs are facultative carnivores and require meat for optimal nutrition. Rarely do health issues dictate a pup needs a vegetarian diet and Cushing's is NOT one of those issues.

Now, there may be other reasons your pup needs a vegetarian diet in your vet's mind, but if they are telling you it is because of Cushing's, they are sadly mistaken and leading you down a path that could lead to problems. So, I wanted everyone who reads this to understand - cush pups DO need meat in their diets.

[doxiesrock912]

Kenny,

please make an appointment to see the IMS with Gracie. They are much more knowleadgable than the GP vets, especially with Cushings.

Daisy's IMS said not to change her diet so I also disagree with the no meat restriction. There are nutrients that dogs need that come from meat. She eats Royal Canin Dachshund formula and hypoallergenic treats. Green beans are a favorite snack too.

As far as the supplements, it does sound like Gracie is getting an awful lot but I would ask the IMS which are necessary and truly helpful. Dachshunds are known for having issues and Daisy had luxating patella surgery so she's been getting Glucosamine Chondroitin with MSM for quite some time now for this reason and I have noticed a difference.

She was having stomach issues after starting Cushings meds, her symptoms were VERY obvious and she has all but one so there is no doubt that Daisy has Cushings, so she gets 1/2 packet of Fortiflora which has enzymes to help with digestion issues.

Now she is on Tylan powder for the diarrhea because we suspect IBD and the antibiotics weren't resolving the problem.

The difference is to find out which supplements are really helpful or just a waste of your money.
The vet who said that they don't think any will harm her was not giving you the answer that you need. In my opinion, that answer indicates a lack of knowledge where supplements are concerned.

It is well worth your time and money to see the IMS. Daisy saw 3 different vets before I found an IMS. She's two hours away, but well worth the trip and we are definitely on the right path now.

Good luck :)

[KennyJ]

I am only giving her the Glyoflex and Denamarin. Can someone please give me some help with Gracie biting her right front leg all the time? Either licking or biting and her skin is red from all the biting. This has been going on long before the injured leg.

[Squirt's Mom]

Behaviors like biting, licking, scratching, etc. can be very hard to pinpoint a definite cause for - even for vets. It could be allergies, pain, a nervous habit...any number of things. Has her vet ever checked it out?

Is this the same leg she is limping on?

[KennyJ]

No this is her front leg. She has been doing this forever. I mentioned this to tue vet on Friday that does the laser. No solution nor did she try to address the issue but I know this is driving Gracie crazy.

[doxiesrock912]

Kenny,

ask the IMS specialist if there are any tests that can help to determine why Gracie bites her leg. This habit can lead to infections and neither of you need that.

I know, another test - but if it helps to determine the cause its for the best.

[goldengirl88]

Kenny:
I agree that you need to make sure which supplements are helpful and skip the ones that are not. A no meat diet for a dog is ridiculous since they are carnivores. The reason I give Tipper supplements is they are to support her organ health and her heart. I was specifically told by the Cardiologist and Dr. to do this. The ones I give her have no known side effects, and have been proven to be helpful. All I can tell you is I have Lupus and have had some really bad blood results in the past. I got myself on certain supplements, and the next time I had a blood test the Dr. said my results were great. With that being said I do know certain ones are helpful from personal experience. I agree others are like wasting your money. I know you are trying to do all you can to help Gracie, as it can be scary when your baby is ill, and you love her like a child. I feel the same about Tipper, she is my world and I am not scared to admit it, it's just the plain truth. Tipper has a patella problem that bothers her at times also. She puts her mouth over her leg at the knee and bites in a motion going down her leg. I believe this is her attempt at putting her knee back in place. Is this what Gracie is doing, or is she just biting at her leg? I hope you can get Gracie's issues resolved, as the people on here do really know what they are talking about, and try their best to help. You are in the right place to get the help you need. Blessing
Patti

[KennyJ]

Hi Valerie, how is your little dog doing??

[KennyJ]

Patti, this is her front leg. The injured one is her right rear leg. The biting has been going on for some time now. I mentioned this to the vets previously and it was like going in one ear out the other. I have always thought it was allergies. When I took Gracie to the Holistic vet and mentioned her biting that leg she said the front left leg was related to the heart. I have no idea how she came to that conclusion. Update on finding an IMS locally. I just spoke with Companion Animal Clinic and Dr. Erin Herring is most definitely an IMS. I think she should be the one that does the tests for Cushings although I forgot to ask which test they use first. Is that something I should ask before I make my decision?



Dr. Erin Herring completed her degree in Veterinary Medicine in 1996 from North Carolina State University. Following this, she came to Blacksburg and completed an internship and residency at the Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM), becoming an ACVIM diplomate in Internal Medicine in 2000. She worked at VMRCVM following this, and has been at Companion Animal Clinic since the spring of 2007.

She is married, and has three children and two cats. Her hobbies include teaching yoga, biking, and knitting.

[goldengirl88]

Kenny:
I never heard that thing about the heart and the leg having something in common. I do know for a fact that Tipper never licked and bit her legs and feet until after she got Cushings. I have heard many others talk about licking behavior also. Tipper would lay there and lick the blankets on my bed until they were soaked in spots. Every once and a while she will start the licking. I think sometimes I have noticed it when she needed and adjustment in medication. I soaked Tipper's foot for a while in a Betadine solution when she kept chewing it. That seemed help as she stopped chewing, but Gracie will have a red leg and you have to watch they do not get I on anything as it does permanently stain things like carpeting. Blessings
Patti

[KennyJ]

If that's the case than she has had Cushings for a long time because the biting and licking has been going on for a while now.

[goldengirl88]

Kenny:
She may be biting and licking for a different reason though. Sometimes nervousness, anxiety, pain can all be precursors of licking and biting. Blessings
Patti

[Squirt's Mom]

There is probably a connection in TCM between the heart and front leg and that is what the Holistic vet is referring to. Chinese medicine is nothing like our Western medicine. They have looooong associated parts of the body with each other as well as seeing conditions as things like damp, hot, dry, cool instead of systems like respiratory, endocrine, and so on that are used in Western medicine. TCM is a whole new world! ;)

[KennyJ]

Just curious, when you noticed your dogs drinking excessive amounts of water did you actually measure the intake or just go by how much water disappeared from their bowl? Everything I see on water intake still suggests 1/2- 1 ounce of water per lb of your dog. Gracie on an average drinks 12-14 ounces of water and one day she drank 16 ounces. Depending on the scales she weighs anywhere from 12.5-12.8 lbs. Dr Hairfield said that was excessive drinking by the formula they use. I have to admit when I am there with her she is usually on my lap so she doesn't have access to water until I put her back in the doggie play pen.

[Squirt's Mom]

I have seen recommendations as 1 oz per pound per day, 1 cup per every 10 lbs per day, and a formula that takes into consideration the amount of food intake, whether it was wet or dry, and the body weight. All methods give a slightly different "recommendation" for a particular dog.

HOWEVER, in a cush pup there is no such thing as a "slight" variation. They literally drink buckets of water every day. They are constantly going to the water bowl and often stay there a long time drinking, catching their breath and drinking more. They will wake you up over and over and over during the night for a drink of water. They will empty their water bowl inside then go outside and spend the entire time licking dew or rain from the grass or searching for puddles to drink from. Cushing's causes EXCESSIVE drinking because it also causes excessive peeing. ;)

[KennyJ]

Thank you. So 16 ounces in a day for a almost 13 lb dog you would not consider excessive. And when she had the urine test for an infection the vet said she was right in the middle of it being diluted. Gracie only eats 1/2 cup of dry dog food a day along with some carrots. I do feed her quite a few carrots. The biting of the leg, panting, elevated ALP, and the ruptured ACL are still worrisome.


UPDATE: I didn't want to start another message but want you to know that I did speak with the IMS at Companion Animal Clinic. She said she may start with an ultrasound and then do the ACTH stim test. She is well aware of the injured leg but she did not think that would affect the test. I asked if her dogs did well after treatment and she said most of them do very well. I did ask about life expectancy and she said research showed that most dogs live another 3 years after being diagnosed but some are much older to begin with when they are diagnosed. So what do you guys think?? Is she the Dr I should go with since she is an IMS??? I assume she would be the one doing the ultrasound as well. I did notice some negative reviews about the clinic.

[Squirt's Mom]

I've shared all I can think of concerning the leg biting/licking - allergies, injury, pain, habit, neurotic behavior are what come to mind. Squirt is neurotic about licking her front paws when she is falling asleep and she's done it since she was a puppy. It is nothing more than a comforting behavior for her that once she starts, she can't seem to stop easily. Her eyes are closed, her breathing is that of one at sleep, but she's slowly licking that paw....unless I tell her "that's enough", then she stops. "Enough" is one of her learned commands, btw. ;)

No, I wouldn't be concerned about Gracie drinking 16 oz of water. But if I were you, I would put a bowl of water outside the puppy pen as well as inside so she has access when not in the pen. Nearly all biological systems need water to hydrate and ensure proper functioning of organs, therefore the system itself. Especially this time of year when it is so much warmer.

Panting is a dog's natural way of cooling its body so more panting than usual is to be expected as temps warm up. What is warm to you and what is warm to Gracie may be miles apart so you can't judge whether she feels hot by whether you do or not. Her body tells her when to pant to cool down. Panting is also a sign of pain, which would not be out of the question with her ACL and the unknown reason for the biting/licking of the front leg. Panting can also be caused by nausea, allergies, infection, chronic illness, medications (including supplements and herbs), irritation in the airway, poisoning, injury....to name a few. I had a Boston Terrier who got breast cancer that spread to her lungs and she would pant - pant so hard and so fast the couch or bed would shake. THAT level of panting is something that needs immediate attention if it doesn't stop very soon or is something that happens over and over.

Time is the magic key to the ACL - that and following the docs orders along with your TLC. She's doing some better?

Personally, the tests this IMS suggested are exactly what I would want to start with in Gracie's case and I would start with the ultrasound before the ACTH. In fact, if funds allowed, I would probably go ahead and get that out of the way now. They are expensive tests but they as one of our mods says - this test gives you the biggest bang for the buck. It will not only go a long way toward confirming or negating a Cushing's diagnosis, it lets them see many other organs to boot. This test saved my Squirt's life by finding a tumor on her spleen. I cannot recommend this one test highly enough. ;)

[Squirt's Mom]

Oh, and do start a new post instead of editing a prior one. We ain't too good at going backwards and we're apt to miss the edit! :p

[molly muffin]

Well, there are some good things there. In that, they have an IMS, she appears to have at least treated cushings. She has given a longer projection than the others and sounded more positive, while also acknowledging that diagnosis being discovered in older dogs, of course, would have less time than say a young dog. This at least sounds reasonable.

Nothing wrong with having an ultrasound to find out what is going on inside of Gracie. I had one on my molly and highly recommend them. Make sure it's a high res machine.

Sharlene and Molly Muffin

[KennyJ]

Thanks for such a quick response. She was very pleasant over the phone. Just wish I knew more about her. She worked at the vet school before taking a job with Companion. Of course some of the negative reviews of the clinic has me concerned as well.

[KennyJ]

This is what a friend of mine that works at the vet school had to say about Dr Herring and the negative reviews of Companion Animal Clinic. Not sure how to take what she said about Dr Herring.




Kenny-I have never had a personal pet to see her. However, I did work with her when she was here as a resident and I really thought a lot of her. She’s very knowledgeable but not so much that she is not beyond asking for a second opinion. I have heard positives and negatives regarding every vet and vet clinic in our area-including our clinic. Don’t focus on the negatives that you hear-focus on the positives. There is always another side to the story and people don’t always convey the whole story or the picture isn’t quite as clear-I have seen it countless times. Good luck-Sam

[labblab]

Kenny, I would take the comments about Dr. Herring as being positive. Your friend thought she is knowledgeable, but also willing to seek a second opinion re: anything about which she is uncertain. I think that is a very good thing in any doctor or vet. You want a person who is secure in what they do know, but who doesn't pretend to know things that they don't. Nobody can know everything about every disease, so it is great when a vet is aware of their own limits and is willing to ask for additional expert help when they need it.

Marianne

[KennyJ]

Gracie seemed to favor her leg a little this evening. Hope she didn't reinjure it. And it also looks like she had urine on her leg.

[molly muffin]

I agree with everything that Marianne said. It sounds very positive to me. The IMS is both knowledgable and willing to get a second opinion if she isn't sure. That is a good thing. The plan to start with the ultrasound is a good one and one I too would encourage you to pursue if it is affordable for you to do so.
Just keep Gracie off the leg. This takes time and even if she acts like she might be okay, it is very easy to rehurt it and have to start all over.

Sharlene and Molly Muffin

[KennyJ]

Another endorsement for Dr Herring.



Hey Kenny,
Of course I remember you, we have the love of Chinese food in common (use to see you there on occasion). I'm so sorry about your buddy. Dr. Herring is top of the line! She did her internship and residency with us. She is wonderful with regards to bedside manner and even better (if that is possible) as a veterinarian. I would not hesitate to take my furbabies to her. I remember Samatha saying you had come in, glad to hear the ACL issue is being handled with the conserative approach. Who would want to do surgery if there was a way to avoid it, eh? Hope this helps, and don't hesitate if I can do anything else...you're still kinda one of us you know. Take care, Lynn

[KennyJ]

Sharlene, she does look like she may have injured it again. Not sure. The vet doing the laser therapy told me to walk her for about 2 minutes and if that worked ok about 5 minutes. Not long walks of course. She's not limping like she did but she had been walking fine when I talk her out to use the bathroom. I pray she hasn't had a set back. I keep her in the play pen all day and she doesn't come out unless she is on my lap.

[molly muffin]

Might want to not do those 5 minute walks and keep it to about 2 for a bit longer. When do you see the laser therapist again? I'd take it easy, no point in rushing things.

The IMS is sounding real good. A nice bedside manner is crucial for us antsy furparents. :)

Sharlene and Molly Muffin

[labblab]

Kenny, I think the IMS is sounding real good, too. :)

I liked the things she told you during your conversation, and your friends' reports are both really positive to me.

Marianne

[doxiesrock912]

Kenny,
please get Gracie to Dr. Herring. Any doctor who is willing to ask questions of another is GREAT!!!! This means that she is still willing to learn and does not think that she knows everything.

That is the perfect doctor to have!!!!!

[KennyJ]

Thanks guys. The estimate they gave me for an ultrasound was around $150. The ACTH including the medication they use will will be around $150-180. I haven't been walking Gracie the 5 minutes and probably never reaches even the 2 minutes. I am very nervous about walking her. I do another laser this Saturday. I hate that she had urine on her. I feel so sorry for her.

[molly muffin]

Okay that is good, sounds like you are doing fine with the leg. Not sure when she would have hurt it again, but it's hard to keep dogs completely inactive. See how she does over the next week.
$150. for an ultrasound is a good price. Mine was much more.
Poor thing, I'm sure she felt bad to have urine on her too, but it's very hard for them to do normal potties with a hurt leg and having accidents.
It'll get better Kenny.

Sharlene and Molly Muffin

[KennyJ]

Looking ahead. What is most likely the dosage they will prescribe Gracie weighing 12.5-13.0 lbs. I believe she said it would probably be given twice a day. What do you use to give the capsules with?

[StarDeb55]

Kenny, every vet who has experience with vetoryl will probably have their own preferences about dosage. What you need to make sure of is that you understand Dechra dosage guidelines, so you can understand what the vet wants to do & why. If something you hear doesn't sound like the vet wants to follow suggested protocol, then as Gracie's advocate, you need to start asking questions.

I think you are jumping the gun asking about dosage guidelines right now. Gracie isn't even officially diagnosed yet, so let's not worry about things until you know for sure it's cushings. It's really important right now that you continue to read, & familiarize yourself with diagnostic testing protocols, along with the medication, so you can understand everything the vet wants to do. This link will give you tons of information about vetoryl.

http://www.k9cushings.com/forum/showthread.php?t=185

Debbie

[KennyJ]

At least please tell me I won't have to pay $85 for 30 capsules for the 30 mg?? Because according to the information you just gave me Gracie would have to get the 30mg. I knew it was expensive but I didn't know it would cost that much. Wow!!!

[Roxee's Dad]

Hi Kenny,
Like Debbie said, let's not get too far ahead of ourselves. ;):):)
The dosage recommendations on the data sheet are 1 to 3 mg per pound. Note that Dechra only makes 10, 30, 60, 120 and 180 mg doses.

The newest recommendations are to start at 1 mg per pound. You have choices of using the name brand Vetoryl (Trilostane) or the compounded version of Trilostane. In the compounded version, you can have doses made up to your vets specifications which If I were you, since Gracie is at about 13 lbs, I would start out at 13 mg.

If you go with the name brand, I would start out at the lower dose of 10 mg. Eventually I am sure Dechra will release the intermediate doses such as 15 mg 20 mg etc...

The compounded version that many of us get on line is much less expensive than the name brand.

A bit confusing?? Yeah, it can be LOL.... here is some more homework that discusses the name brand Dechra (Vetoryl / Trilostane) and the compounded version of Trilostane.
http://www.k9cushings.com/forum/showthread.php?t=185 (Post #2)

There will be a test in the morning ;)

[KennyJ]

John what if the vet recommends twice a day dosing?

[Roxee's Dad]

Ahhh... More homework. Check out the chart in this link.

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

Page 3 note "if clinical sign are not controlled for a full day, twice a day dosing may be indicated.

Test in the morning ;)

[labblab]

Kenny, John has done an outstanding job of helping clarify the dosing information. I just want to underscore the fact that Dechra's published dosing chart is outdated, so 30 mg. is a higher starting dose than would now generally be recommended for a dog of Gracie's weight. As John says, starting at a total daily dose of around 1 mg. per pound is becoming much more widely accepted. And if Gracie is dosed twice daily, you would give her half that daily total every 12 hours (you would not double the daily dose). For a wee one like Gracie, this means you must have her medication compounded since brandname Vetoryl comes in capsules no smaller than 10 mg.

Marianne

[goldengirl88]

Kenny:
I have found from personal experience that you need to start out on the lowest dose possible. My Tipper is sensitive to everything. She started out at 10mg of Vetoryl, and I truly believe that is why she had no problems with it.( I even went to the park next to the Vets office and stayed there for 3 hours in case of a reaction from the Vetoryl.) It gave her body time to adapt to it. She is now on 30mg. We went up in stages of 10mg, and she did wonderful with it. If we would have given her 30mg to start, I know what would have happened, so I am thankful for the guidance of Dechra, and the caution I decided to use. Hope Gracie does well. I am sure her leg will come along with a few more laser treatments. You are being very vigilant with her, so she is going to be fine. Blessings
Patti

[KennyJ]

Patti, after the initial testing with ACTH, do they decide at the end of the day what dosage to start her out on?? And since purchasing meds from the vets are so much more expensive than finding it online will I have the time to place an order online to get her started?? And do I copy all the info from Dechra and take that with me or should the IMS have that info already?? When you said they helped you, are you saying they actually called you to help you out??

[KennyJ]

Marianne, that was actually another question of mine. So I would have to wait until one of the pharmacies across the country had the time to do that before I started her on it?? So they would have to make a capsule that had 5mg per capsule if I did it twice a day??

[goldengirl88]

Kenny:
After all the testing is complete then they talk to you to see if you want to treat the dog, then they will recommend a dose. I am telling you no matter if God himself tells you to start at a high dose , don't do it for the sake of your dog err on the side of caution. This saved Tipper a lot of misery. An IMS is very educated and up on Cushings. They will discuss the dosage with you and if it is high, call Dechra first. These are very powerful drugs that you do not want to guess at. They have Vets there on staff to help you with problems. My country vet is clueless when it comes to Cushings, so I told him I wanted the lowest dose possible to start out, his partner disagreed and wanted to blast Tipper with 30mg right out of the gate, I said no way and am glad I did. Also I told him I wanted him to call Dechra so they could help him to manage my dog. It turned out that every time I have a question about Cushings he calls Dechra to double check with them, which is what I wanted. That way I have the advantage of 2 vets looking at a problem and finding a solution instead of one vet who barely knows anything. This is how I keep my Vet on the straight and narrow and eliminate mistakes. This also gives my vet a better understanding of this disease, enabling him to help others after Tipper. I get my Vetoryl from Lambert Vet Supply, they have a veterinary pharmacist for your help there also. I pay 54.00 for 30mg and no shipping if I get 2 boxes at a time. When first starting out, I got one box at a time because I was about broke, and if the dosage changes you are not stuck with 10mg boxes. Later when Tipper's dosage was pretty much figured out I went to 2 boxes. I can still use the 10mg, but have to give 3 pills. I keep them for an emergency back up. It takes 3-4 days to get the Vetoryl from Lambert and I am in Ohio. If you use Vetoryl ask for Nancy they give you a drug rep and that is who you purchase from. Believe me my Vet would rather cut his finger off than give you an RX as he is greedy and wants to charge almost double for what I can get it for. I just sat him down one day and told him he had to give me an Rx as I cannot afford what he sells the Vetoryl for. I told him I need the money to continue Tipper's health care with him. He did see my point and gave in. Nancy also will send your Vet an Rx request via fax for refills etc. so I don't have to beg him to do it. I actually showed my Vet the web site for Lambert as they are an approved veterinary pharmacy from the board of pharmacology, and that is not easy to do. He even called the vet pharmacist for me and checked them out. He told me some stories of people buying off the internet that did not end up well.There are few pharmacies with this approval, you will see a blue oval with the approval in it, only pharmacies that have this approval can display this. That means they get this drug straight from the manufacturer, and this is important for the safety of your dog. Do not buy from any fly by nite place. I do know that a lot on here use Diamondback and love them, but I have no personal experience with them. My honest opinion is that if I am using this powerful of a drug on my dog I want the real thing straight from the manufacturer. That is just me though, maybe you are comfortable with the compounding pharmacies. It is just a personal choice, so don't dwell on what I do. Make sure you write down all your questions to ask your IMS, as when you get there sometimes the emotion overrides your thinking. It will all turn out fine Kenny, as you are keeping a close watch on Gracie and that is what is necessary to keep her safe and doing well. God Bless You and Gracie
Patti

[labblab]

Hi again, Kenny.

Once a dog has been diagnosed with Cushing's, the initial dose is based solely upon weight alone. So Gracie would first have the ACTH and the ultrasound to confirm the diagnosis. If those tests are consistent with Cushing's, then you'd proceed on to treatment using that 1 mg. per pound formula.

As John has said, if your vet chooses to start with once daily dosing, you could begin with the 10 mg. capsule of brandname Vetoryl. If your vet prefers twice daily dosing, you would need to have a customized dose made up for Gracie by a compounding pharmacy. It only takes a few days to process and ship your order, though, so you needn't worry about any long delay at all.

Marianne

[KennyJ]

You guys are the greatest!!!! So in other words I would not be able to start medicating until I ordered the capsules online? It would be easier if I could simply do the once a day at 10mg instead of splitting it up. She suggested twice a day.

[labblab]

Some specialists do prefer twice daily dosing. This is because for most dogs, trilostane is processed out of the system after approx. 12 hours. So the thought is that a more consistent level of control may be achieved if a dog is given two doses a day rather than only one.

Having said that, though, the research is inconclusive as to whether or not the majority of dogs really do show greater improvement when dosed twice each day. It is certainly easier for the owner (and generally less expensive) to give only one dose a day. And as you will see from your reading, Dechra still recommends that dogs only shift to twice daily dosing if the single morning dose does not seem to be controlling symptoms effectively throughout the entire day.

So there really is no right or wrong answer to this, and you can certainly discuss your own preferences with the vet. She may be OK with letting you start out with a single morning dose. Then, depending upon how Gracie responds, you can alter the dosing as needed. You will be performing monitoring ACTH tests at specific times, and at that point, it will indeed be the actual numbers of the test results that determine any dosing changes (along with her symptom improvement, of course).

Marianne

[KennyJ]

Marianne, I called and the IMS at this clinic is off until Friday. I certainly do not want to get off on the wrong foot with this doctor but I would prefer the once daily dosage over the twice daily. I hope she will allow this if the test confirm Cushings which I believe will confirm the disease in Gracie. Another question, does anyone give their dog Glycoflex 111 to their dogs?

[Squirt's Mom]

Yes, I use the GlycoFlex III and am very pleased with it. ;)

[labblab]

I can't answer about the Glycoflex, but I am hoping that your vet will be open to working with you as you sort out the dose that is best for Gracie. She may not be aware of how tiny Gracie is, and that you'd be forced to get a custom dose in order to dose twice daily. Or, since Gracie's weight is between 10-20 pounds, she may be thinking she'd be OK with upping the dose to 10 mg. twice daily. If it were me, though, I'd rather start lower and work up. Really, the only thing you have to lose that way is money (:o), since you might end up needing extra ACTH monitoring tests in order to identify the perfect dose. If you stress to the vet that you are willing to shoulder extra monitoring tests, then I hope she'd be OK with letting you start out with a low single dose of brandname Vetoryl if that is your preference.

Marianne

[Squirt's Mom]

You do not have to use Trilostane (Vetoryl). Lysodren (Mitotane) is also an option. ;)

[labblab]

Just wanted to pop back to add that you may not even need/want to discuss dosing at all during a first conversation with the new IMS. As Glynda mentioned earlier, the very first thing the IMS may choose to do is just to repeat Gracie's basic labwork and proceed with an ultrasound. The ACTH itself may wait for another day, after the IMS has had a chance to review Gracie's records and physically examine her. So any actual drug/dosing discussion may end up on a back burner for the moment and only need to be addressed after you and the IMS have first had a chance to get to know one another and complete some initial testing.

There's that old saying, "Pick your battles wisely..." And "dosing" may not be a discussion that needs to be addressed at all right now.

Marianne

[labblab]

Me again...:o (I'm popping up here more often today than a prairie dog!)

But I just noticed Leslie's reply and wanted to add a comment. Normally, I recommend trilostane (Vetoryl) and mitotane (Lysodren) as equal treatment options to be considered. But in Gracie's case, I believe I would have more hesitation re: Lysodren due to the way in which it is initially dosed. With Lysodren, you go through an initial daily "loading" phase during which you vigilantly monitor food and water intake in order to determine when the dosing needs to shift away from daily dosing to weekly dosing. Since Gracie does not exhibit the excessive thirst or hunger that is generally characteristic of Cushpups, I think it would be harder to safely and accurately proceed through an initial Lysodren "loading" phase with her. With Vetoryl, you always dose daily, so you are not needing to judge a tiny decrease in appetite or thirst as carefully.

I must stress that this is just my personal opinion, however. And certainly you should feel free to discuss both drug options with the IMS if and when you reach a stage where Cushing's has been confirmed and treatment is forthcoming.

Marianne

[KennyJ]

Once again, thanks everyone for your input. The IMS is out of the office and will not return until Friday. I did ask the clinic to have her call me when she returns so we can set up an appointment. To help speed things up I took all of Gracie's lab work including her xrays and allowed the clinic to make copes for Dr Herring. The young lady at the clinic said if they split the dosage they do have a company they use to compound the medication. I believe she said they use Greenridge, does that sound familiar? Another fear I have is leaving Gracie alone once treatment starts while I am away at work.

[Roxee's Dad]

Hi Kenny :)

So as I look over your thread, I see you must be one of the best educated on canine cushings that has ever had a pup that hasn't been diagnosed yet :D and yes, that is a good thing :)

So ..... are you ready for that test yet?? ;)

First Question, let's have some fun.... What are the major symptoms of cushings?



I believe she said they use Greenridge, does that sound familiar?

Not familiar to me as I have used Diamondback Pharmacies, but I am sure their are many on line compounding pharmacies out there.


Another fear I have is leaving Gracie alone once treatment starts while I am away at work.

Many of us have had that fear, If that time comes, you may want to consider starting on a Thursday of a long weekend and maybe even taking a couple of days off. This is why many recommend the lower dose, less risk!

[Squirt's Mom]

IF it turns out that Gracie does have Cushing's, you will do just fine with treatment. Our babies typically give us signs that things are getting off kilter so we are usually aware long before things reach a crisis level that something is off. And you will have us by your side every step of the way.

This is where using your time wisely now is important. Learn the signs of Cushing's, the signs that mean the treatment is working, the signs that mean something is off, the signs that mean crisis and intervention is needed - learn about the disease and it's treatments now so you are armed if, IF, Gracie does have Cushing's.

[KennyJ]

Excessive drinking/eating, pot belly appearance, elevated ALP, thinning of the hair, lethargy, panting, muscle loss. I am positive I'm missing something. :)


Gracie's WBC and RBC were normal. She did have some absolute values that were slightly elevated. Glucose normal. Kidney function normal. I was reading what a couple of the vets noted about the size of her stomach and they said her liver could be enlarged.

[Roxee's Dad]

LOL... You covered that pretty darn well. What comes along with excessive thirst?

Question 2... What are the 2 most popular treatment options?

[KennyJ]

I knew I would forget something. Frequently urinating which could include accidents in the house. Vetoryl and Lysodren are the drugs used to treat Cushing symptoms.

[Roxee's Dad]

Good job !!!:D

Question 3 ... Name 2 of the diagnostic test used to diagnose cushings?

and what is a good 3rd option?

Ruh Roh, they are getting tougher LOL

[KennyJ]

ACTH, LSSD, and urine/creatine cortisol test. Ultrasound is also valuable. Speaking of that this IMS says she prefers the ACTH and would most likely do an ultrasound first.

[Roxee's Dad]

Ha ha ha... see!!! You know more than you thought... I was sure I would have you stumped on that Ultra sound... but remember, it has to be a high resolution Ultra Sound.



IMS says she prefers the ACTH and would most likely do an ultrasound first.

I think many of us would agree that vets have different preferences. I don't see anything wrong with an Ultrasound first, and many will probably agree. It's a great first step to see what is going on on the inside. The Ultrasound tech will be able to see all the vital organs and maybe spot something that wouldn't necessarily show up in the blood work. A possible cause for the high ALKP.

Edit to add: I think many here would forego the LDDS in favor of the High Resolution UltraSound

Remember Leslie's story about Squirt and finding that tumor on Squirt's spleen, that ultrasound probably saved Squirts life :)

Okay... You did great today :D You know more that you thought you did and you will be a great advocate for Gracie... now I have to go think of a tougher question.... maybe tomorrow. You might want to study that Dechra chart I posted the link too ;);)

Good job Kenny, that was fun :) Give that Gracie a gentle belly rub from me.

BTW It's an LDDS ( Low-Dose Dexamethasone Suppression) test.... but I knew what you meant. :D

[KennyJ]

I asked the clinic if it was a high resolution ultra sound but the young lady said she was unsure.



http://www.companionanimalclinic.biz/specialty_services.shtml

[Roxee's Dad]

Not many clinics have a high res ultra sound equipment. They usually call a mobile service and set up an appointment. They bring a big truck to the vet's parking lot with the equipment inside to do the ultrasound. If they do have one, that would certainly be a plus :)

[KennyJ]

Oh I bet they don't then. Not good. I was hoping since she was a IMS that they had the equipment.

[molly muffin]

Don't be too discouraged by that. They might and just the girl at the desk was unfamiliar with calling it that (high res).

My clinic and even the IMS didn't know what I meant when I asked if they had the High Res ultrasound equipment. She said, it's one of the best and shows everything clearly. Yes it was a high Res. So, your question might be, do you have one in house and does it show every little thing clearly? Mine even print out the ultrasounds on a DVD, so I can take it back to my regular vet. (course you won't need to worry about that since you'd be getting everything for cushings taken care of at the same office since they have an IMS on staff)

Sharlene and Molly Muffin

[frijole]

Kenny, None of us signed up to attend the University of Cushings - just happened. Beware you might become a vet at the end of the journey. :D

[KennyJ]

Gracie is biting her front left leg until its red. She will not stop. Any suggestions?

[Roxee's Dad]

Put a sock on it.

Are her nails too long?

[Budsters Mom]

Kenny,
There are a few things you can do to. You can get some bitter apple spray from the pet store, to try to deter her. I have found that rarely works unless they really are not all that interested in licking and chewing. If Gracie is really determined, that will not stop her. The next thing you could try is to wash and dry it really well, then put a baby sized sock on it. Then tape it up really good with medical tape so she can't get it off. Depending on where it is on her leg, of course. If that doesn't work, as a last resort you might have to cone her until it heals. Those nasty cones are known as e collars. They look uncomfortable and I'm sure that they are. They are now available in Soft blow up type. They look like a small inner tube. The collar will keep her from being able to get to her leg to chew it. You would leave the collar on whenever you are not able to be right with her to watch her. You take it off at meals, but she can drink water just fine with it on. She would have to wear until her leg healed. I always use the e collar as a last resort.
Hugs,
Kathy

[KennyJ]

John she is biting on the leg itself. Its red. My pants is wet from where she is on my lap.

[Roxee's Dad]

I would do as Kathy suggested. clean it, put a sock over it and wrap it up.

The more she licks it, the more agitated it gets. The more agitated.. the more she will lick it. If only they could tell us why :(

[KennyJ]

John, I have been studying the charts and almost ready for my next set of questions from you, but first I have a few questions and a concern. :)

1) Until I hear back from the IMS I am not sure what she will suggest to do first. She mentioned ultrasound and ACTH. So here's my question. Doesn't Gracie need to be sedated to do the ultrasound and if so how will they do the ACTH stim test? Will they do that first and then do the ultrasound?? Seems to be a lot on a little dog to do all that in one day.

2) If the ACTH comes back positive for Cushings won't I have to wait until the medication comes in before I start treatment? Especially if they have to use a compounded version of the meds. And I want to save money by purchasing it using one of the companies that have been suggested on here.

3) What if the IMS suggest twice a day therapy instead of the single dose in the morning? Should I tell her that I would feel comfortable with the single does to start out with or let her make that decision?

4) Do I make it clear that I want to start her on the 1mg dosage instead of the higher dosage that some Dr's try or let her make that decision? And if she does do the 1mg per pound I am guessing she would have to do the compounded version because Gracie weighs almost 13 lbs.

5) Depending on the day I start the therapy, if she tests postive, I will be in Charlottesville next Saturday and Gracie will be alone for most of the day. I am thinking it would be best to start near a weekend when I am home with her, correct??


Now my concern. I went back and read most of this thread and almost of all you say do not test until I get the leg under control because of false positives. Well I can tell you that Gracie's leg although better is far from being back to where it was. We are only only talking 3 weeks into conservative management and I can still see her favoring that leg at times. But most definitely an improvement. The vets do not seem concerned about a false positive coming from the leg injury, including this IMS. But in all honesty after reading your posts I am concerned about a false positive. If it was your dog what would you decide??

John, hopefully I will be ready for your next set of questions but as you can see I just asked quite a few myself. Again, thanks for all your help and to everyone here you have been great. :D

[goldengirl88]

Kenny:
I myself would definitely start on the weekend when you were home. I think if it were me knowing what I know now, I would let the IMS do all the talking. When finished then I would ask my questions etc. I have learned from experience that some of these Dr.'s have egos as big as a house, so if that happens to be the case they can get all over you if you don't sit there and listen to them first. Your case may be totally different, but I am telling you from mine and Tipper's experience. The IMS I got did not want you saying a word while she was talking, yours may be different, but they have so many patients and their time is limited so they want you to listen. Then I would go over all my concerns. you will probably have 2 appointments with the IMS as I am sure they will want to go over the lab results with you and that usually cannot be done in the same visit, unless you are at a hospital with a lab equipped to do that. Just be fore warned that it is usually more expensive to do it that way, as the hospital I took Tipper to said it was cheaper to send her blood work out. That does not mean the ultra sound results as they will be able to give you those right there if someone is available to read them. Good Luck to you and Gracie. Blessings
Patti

[KennyJ]

Patti, from what little I talked to her she seems to be an excellent communicator. But I still have my questions and my concerns about a false positive from the leg injury.

[Roxee's Dad]

Good morning Kenny Well it's morning here anyway and whoa aren't we full of questions today :D Okay, let's go through them and I may have to ask for help myself LOL



1) Until I hear back from the IMS I am not sure what she will suggest to do first. She mentioned ultrasound and ACTH. So here's my question. Doesn't Gracie need to be sedated to do the ultrasound and if so how will they do the ACTH stim test? Will they do that first and then do the ultrasound?? Seems to be a lot on a little dog to do all that in one day.


It really depends on the Ultrasound tech and Gracie. My Roxee would remain calm enough that she didn't need to be sedated. They may have to give Gracie a slight sedation if she doesn't cooperate. Others may also share their experience on this.



2) If the ACTH comes back positive for Cushings won't I have to wait until the medication comes in before I start treatment? Especially if they have to use a compounded version of the meds. And I want to save money by purchasing it using one of the companies that have been suggested on here.

Yes but it's only a few days in most cases, and quite possibly your vet if she works with a compounding pharmacy, may even get it quicker... but remember, it's not urgent as it is a very slow progressing disease / syndrome.



3) What if the IMS suggest twice a day therapy instead of the single dose in the morning? Should I tell her that I would feel comfortable with the single does to start out with or let her make that decision?

I think that is a decision you have to make based on the recommendations from Dechra.



4) Do I make it clear that I want to start her on the 1mg dosage instead of the higher dosage that some Dr's try or let her make that decision? And if she does do the 1mg per pound I am guessing she would have to do the compounded version because Gracie weighs almost 13 lbs.
I think Leslie gave you a great answer. Let the vet do all the testing, let the vet do all the talking while you are taking notes. Then when s/he is done discuss your concerns if you have any. She may very well Rx exactly 10 or 13 mg of Trilo. If s/he Rx's something like 30 mg, you may say you are more comfortable with the Dechra recommended starting dose of 1 mg per pound.



5) Depending on the day I start the therapy, if she tests postive, I will be in Charlottesville next Saturday and Gracie will be alone for most of the day. I am thinking it would be best to start near a weekend when I am home with her, correct??
I think you already know the answer to that question but yes, that is what I and most of us would do.



But in all honesty after reading your posts I am concerned about a false positive. If it was your dog what would you decide??


I think you already know the answer to this question too. We are not vets but and that's a big but, we have seen many dogs misdiagnosed the first time around. Once a non related adrenal issue was cleared up, the next cush test comes back as negative, meaning no cushings. When that happens, I guarantee you, we are here in the background doing a dance and pumping our fist. Yes we know we will probably lose that member who has become a friend.... but we are so happy that another dog doesn't have to suffer needless treatments. We stop worrying that the dog is getting proper care.

There is a post in the Everything Else section that Leslie bumped up, it always brings a tear to my eyes when I read it because it is so true.
It was written by a dear friend of ours.
http://www.k9cushings.com/forum/showthread.php?t=4928

[KennyJ]

John, I must say after reading that poem I lost it. Wow!!! And my greatest fear is treating Gracie if she doesn't have the disease. I mean all signs point to her having it especially the panting, elevated ALP, and possibly the thinning of the hair. But I will always have that doubt about the tests because of her leg issue.

[Roxee's Dad]

I think it is conditions like cushings, cancer, diabetes that make us realize we sometimes take our time with our pups for granted. When we find out that our pup has a condition that can shorten their time with us, we then come to the realization that every minute, every ball retrieved and every moment we observe them sleeping in comfort is a precious moment indeed. ;)

So are we ready for a few more questions?

1) What is the target normal range of the ACTH test result for a cush dog being treated with Trilostane?

2) How many days after starting Trilo treatment should a cush pup be rechecked via the ACTH Stim test?

3) What is the purpose of the ACTH test?

[KennyJ]

But John, Gracie will live to be an old lady, right?? :)

Ok now to the quiz. These are tough ones.

1) less than 1.45

2) 10-14 day

3) ACTH stim test is for the amount of cortisol a dog is producing.


I could be wrong on #1

[Roxee's Dad]

Ruh Roh....

Let's review question 1. What is the target normal range of the ACTH test result for a cush dog being treated with Trilostane?

According to the Dechra chart, page 2, what should you do if the ACTH stim result is < (less) than 1.45 ?

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

[KennyJ]

Stop Vetoryl capsules for 3-7 days and return to day 1 at lower dose.

[lulusmom]

Good job, Kenny!!!!

[KennyJ]

But I cheated on that one. :) So after the 10-14 day treatment not only will they do another ACTH but a complete CBC with chemistry profile too??

[Roxee's Dad]

Good !!

So what is the target therapeutic "range" we are looking for as a result of an ACTH stim test for a dog on trilostane?
(hint- page 3)

[Roxee's Dad]

LOL... there is no cheating... Cushings is always an open book test :D

[KennyJ]

1.45-5.4 Please tell me I am right. :)

[Roxee's Dad]

:D You are exactly right :D

[Budsters Mom]

Boy, does this bring back memories! ;)
Kathy

[Roxee's Dad]

LOL at Kathy... it is kind of fun and it helps refresh my memory too :-)

Ok Kenny, one last question for today.... well for now anyway.

What symptoms should you watch for that may indicate the cortisol is going too low?

Possibly meaning the Trilostane dosing may be too high.

[goldengirl88]

Hey Kenny:
What's white on four and you keep lovin her more???

[Simba's Mom]

Just checking in and wishing you and your furbaby a good day!!!

[KennyJ]

Still concerned about having her tested just yet. Was so saddened to see someone lose their little dog after only 8 months.

[Budsters Mom]

Kenny,
We are all scared. That's why we have each other. There is strength in numbers.:)
Kathy

[KennyJ]

Guess I wasnt expecting to see someone lose their little friend after being diagnosed 8 months ago.

[Roxee's Dad]

So.... How is Gracie doing today?

[KennyJ]

Her injured leg seems to be doing fairly well. But the panting is there. And it does look like her coat of hair is thinner. I would have never paid any attention to that if the vets hadn't mentioned it. Now I notice everything.

[Roxee's Dad]

yeah... we get like that, welcome to the cushings family ;):o

We also have an unofficial group called the Traveling Twitchers.... we twitch every time we notice something different, everytime our pup sneezes, coughs, trips, sits funny, sleeps, we learn to analyse poop :o and the list goes on...

[KennyJ]

Ok the IMS is supposed to call me today so I need your help. I am still concerned about having the tests for Cushings while her leg is still healing. She says it will not affect the ACTH stim test. Should I just let her do the ultrasound first. I know Gracie will most likely be sedated because she is just too hyper. I just dont want her to be put through too much in one day.

[Squirt's Mom]

I would have the ultrasound now if at all possible, Kenny. That is what I would do, others may do otherwise. ;)

[goldengirl88]

Kenny:
I would get as much done as possible because if they sedate it will help her not be so anxious about the testing either. The IMS is a good judge as to what Gracie can with stand. I think she will be fine. These dogs are more resilient than we think. I would get it done and then it will be off your mind, and you will know for sure if she has Cushings. God Bless You and sweet Gracie
Patti

[Squirt's Mom]

The ultrasound will not let you know for sure if Gracie has Cushing's or not - it will add an important piece to the puzzle and, in my mind, more importantly goes a long way in ruling out other possible issues that could cloud the picture by causing false positive - like Squirt's tumor. ;)

[Budsters Mom]

Kenny,
I agree with Leslie regarding an ultra-sound. It gives a clearer picture of what exactly you're dealing with. In Buddy's case, it showed that he has a profusely large liver, which envelopes all of his other organs. I have read some threads where our members have wished they had gotten an ultrasound sooner, because a tumor was later found. Also, an ultrasound is a noninvasive test, which is a good thing.:) Hugs,
Kathy

[StarDeb55]

Kenny, I'm going to chime in for the US, too. I'm another parent who found out about an abnormality that I had no idea it was there. When Harley had his US done to confirm his Cushing's diagnosis, they found evidence of a previous bile duct obstruction in his gall bladder. The way the IMS explained it was that it probably cleared on its own, & Harley never got really sick enough for me to think something was really out of whack. The US findings in the gall bladder became very important when somewhere around 8 months or so later, Harley started vomiting some very nasty looking bile colored material. He wasn't vomiting a lot, but the vet & I figured it was low cortisol, the vet had me put him on prednisone for several days. The vomiting continued 2-3x per day. I was touching base with my vet daily, & after day 2, I told the vet if Harley threw up any further, I'm bringing him in. Well, Harley spent the next 2 days at the vet's on IV fluids. The vet could not find anything really wrong on his bloodwork or an abdominal x-ray. He started reviewing everything & found the information about the gall bladder on the US, & pretty much figured that the little man had basically had another "gall bladder attack" After the IV fluid, along with meds to control vomiting, Harley came around, came home & was fine. Without that ultrasound, my GP vet or myself would have never have know about the gall bladder issue.

Debbie

[KennyJ]

Gracie is going Monday for her ultrasound. She can not have any food after 8 pm the night before the ultrasound. I do not believe she will be sedated. I made it clear that I did not want her in an area that she could do more damage to her leg. Starting to get nervous about what's coming up. After losing my father in 2011 Gracie has been my best friend. I miss the days when she met me at the door. I want those days back.

[Budsters Mom]

Buddy was not sedated when they did his ultrasound. They do many of these. I'm sure Gracie will be fine.:) Hugs,
Kathy

[KennyJ]

Gracie drank 14 ounces of water today but yet thats still considered excessive.

[doxiesrock912]

Daisy wasn't sedated either. She liked the "belly rub" so much that she fell asleep while they did the ultrasound!
The IMS and the tech came back with her laughing.

[Roxee's Dad]

Our Roxee wasn't sedated either.

Water consumption:
http://www.vcahospitals.com/main/news/pet-news/how-much-water-do-healthy-dogs-require/152

http://www.petmd.com/dog/nutrition/evr_dg_the_importance_of_water#.Uc5Zw_mThZ8

http://pets.webmd.com/dogs/my-dog-always-thirsty

http://dogcare.dailypuppy.com/much-water-should-dog-drink-day-3279.html

Pretty much all say 1 to 1 1/2 ounces per pound. believe me, you will know when Gracie is drinking excessive amounts of water. It will be double, triple what she is drinking now. Doesn't mean she does or does not have cushings but 15 ounces a day is normal. Summer she is in the air conditioning, which is dryer air, increases thirst.

[KennyJ]

Just got back from another laser therapy session. Dr Wilson said Gracie's leg was doing great. Walk her for about 3 minutes a day. I asked her again about Gracie's urine test. She said Gracie's was 1019. Does that make sense to anyone? Again she said it was right in the middle.

[Budsters Mom]

Hi Kenny,
I can't help you out with the urine tests, but I'm thrilled to hear that Gracie's leg is healing well! Great job dad! Hugs,
Kathy

[molly muffin]

Molly wasn't sedated for her ultrasound either and she's had a couple of them. (esophagus and tummy)

Gracie's urine is fine at a concentration of 1.019. I wouldn't worry about that.
Every vet is different as you have found, but I don't think that Gracie is over drinking water. You'd know it, take the amount of water that she is currently drinking, then double to triple that amount and then you are in full fledge cushings zone.

Sharlene and Molly Muffin

[KennyJ]

Sharlene the urine sample was also taken in the evening as well. Wouldn't that have made it more diluted than if it had been taken in the morning?

[Harley PoMMom]

When looking for USG one usually wants a first morning pee because that is when the urine will be most concentrated. If Gracie's urine sample was taken in the evening and is concentrated, that is a really good sign.

[KennyJ]

Yeah the only reason they took it in the evening was to check for infection. I didnt know the USG would be noted. She said it wasnt real low nor was it too high.So I just came out and asked her if she had a lab value for it and she said 1019. I am nervous they will find something during the ultrasound.

[Roxee's Dad]

We will be with you and Gracie in spirit :) Think positive thoughts !!

and don't forget to bring home a copy of the Ultra Sound results.

[KennyJ]

John will she have the results of the ultrasound the same day or does someone else have to read it?

[Roxee's Dad]

Ours were always the same day. The Ultrasound technician takes notes as s/he are doing the US. I would get a copy of the notes that they give the vet. Could be different at different vets and facilities.

[KennyJ]

Will she be able to see the adrenal glands? Besides the liver what else will she be looking at?

[Roxee's Dad]

Oh gosh, your testing my memory LOL ... Liver, both adrenals, intestines, pancreas, bladder, spleen, probably more that I don't quite remember :o:)

[KennyJ]

Glad you mentioned intestines. When I had the xray taken of Gracie's leg it showed part of her intestines. He mentioned that her intestines looked thick. And mentioned sometimes thickened intestines also happens when a dog has leukemia. That made absolutely no sense to me. I would think Gracie's CBC would have been more abnormal than they were.

[goldengirl88]

Kenny:
To answer your question about if you will see the adrenals and liver on the ultra sound. It depends on what your IMS told you she is looking at. They will not do say for instance all the organs, unless that is what she requested, and that is really expensive. Usually you are limited to the part of the body they told you they wanted to look at, and the other organs close by what they are looking at may be seen also. In other words when Tipper got hers done on her adrenals they also looked at the liver and pancreas to see if they were affected, only because I asked them to. It is like the difference between a full abdominal and half abdominal scan etc. Just make sure you and the IMS are on the same page as to what you and she want to know about from the ultra sound. Tipper and I will pray for you and Gracie, that she comes thru with flying colors. God Bless
Patti

[Squirt's Mom]

Squirt's ultrasounds saw her stomach, spleen, liver, kidneys, bladder, gall bladder, adrenal glands, intestines, lungs and heart. She had full body scans both times because I wanted to KNOW what was inside her - not just about the adrenals. If I had asked for a limited scan, that tumor may have been missed and she wouldn't be here today. ;) So let them look at all of her so you have peace of mind that everything inside has been looked at and reported on. This will also give you a sort of baseline for future US she may have - they can compare the first scan to later ones to see any changes.

[KennyJ]

The only thing I know for sure is that they warned me her stomach would be shaved. I pray they do not injure her leg and cause me to start all over.

[Squirt's Mom]

Yes, her belly will be shaved and it is possible she will be mildly sedated if it is needed to keep her still for the scan. Some pups lay out calm and fine, others are stressed and cannot be still enough so a mild sedative is given to help them relax. This is a very non-invasive test and typically low stress.

Remind them when she has the US about her leg, asking them to be especially aware and careful with it. ;)

[labblab]

Yes, Kenny, definitely stress to them that they have to be very, very careful with Gracie's leg when you take her in for the procedure. That is the one thing that worries me about the timing of the ultrasound, too -- you want to make sure they do not manipulate her body in any way that will cause reinjury to her leg now while it is still healing.

Marianne

[KennyJ]

Marianne thats what I fear. She has come a long way with her injured leg. Barely noticable now. Gracie is going crazy wanting to play. If she hadn't hurt her leg I would have never known her ALP was elevated. It does bother me that my regular vet never mentioned that Gracie looked like a dog with Cushings.

[KennyJ]

I need some encouragement. I am sooooooo stressed right now.

[Budsters Mom]

It will be okay Kenny. They literally do thousands of these! The calmer that you are able to be, the better Gracie will do because she feeds off of your energy. You have to be a nag like I sometimes have to be. The more you do it, the better you'll get at it.;) Tell everyone that you see that Gracie's leg is healing and make sure that they know about it. That's where the nagging comes in. :) Don't assume that somebody knows. Tell everybody anyway. Tracy will do great and you will make it too.;)
Hugs,
Kathy

[KennyJ]

I am worried about what they will find.

[Budsters Mom]

Oh sorry Kenny. I took your question in the wrong direction. I never worry about what they find in the scans, because it's always better to know what you're dealing with. ;)My Buddy has a profusely large liver extending over all of his organs. That explains why there's never much room in his tummy and it most always feels hard. I need to know these things in order to properly treat him. An ultrasound is the best bang for the buck that you can get. If they find nothing, you will feel a awesome sense of relief. It is so worth it!:)
Hugs,
Kathy

[Roxee's Dad]

One day at a time....

[doxiesrock912]

Kenny,
if they don't know about it, they can't treat it properly. That is what I tell myself to help when I'm worried. It's not about us, it's about what is best for our girls.

xo

[rathodh61]

I haven't any pet but I love all pets & always I am trying to care of them. Here are some important links which may help to you.
http://www.vetmed.wsu.edu/cliented/cushings.aspx
http://www.fda.gov/forconsumers/consumerupdates/ucm151209.htm
http://www.cesarsway.com/dog-care/senior-dog/senior-dog-and-cushings-disease
http://www.2ndchance.info/cushings.htm
http://www.canine-cushings.co.uk/
http://www.canine-cushings.co.uk/diagnosis.htm
http://pets.webmd.com/dogs/cushings-syndrome-dogs
http://www.petmd.com/dog/conditions/endocrine/c_dg_hyperadrenocorticism

MODERATOR NOTE: RATHODH61 - 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!

[goldengirl88]

Kenny:
I know this is scary for you, we are all here to support you in this. I pray for you and Gracie every nite. She is going to be ok, you will see. As far as knowing about things they could find on the scan. It can be daunting at times thinking about it, but as hard as it sounds, you then know how to formulate a plan of action. If you don't know what is going on, there is nothing you can do about it. We all know how much you love sweet Gracie, it is apparent every time you post. Keep as calm as you can, as Gracie can pick up on it when you are nervous, and you don't want to stress her out. I know all about your nerves getting the best of you, I have gone thru it many times with Tipper. I know I have to function and go on for her well being no matter how hard it is, I have to deal with it to save her life. That is what I keep telling myself, that she needs me now more than ever. So I know I will never let her down, and that gets me thru. I pray for you to get the strength to get you and Gracie thru this. It will be ok Kenny, just ask God to watch over Gracie and she will be fine. Blessings
Patti

[KennyJ]

Will she most likely have an enlarged liver?? What are they looking for when they look at the adrenal glands?

[KennyJ]

Thank you Patti. I needed that. I work for the Salem Red Sox baseball team and the EMT's tried their best to take me to the hospital. Chest pains and shortness of breath but I believe it's the stress over all this.

[molly muffin]

Hi Kenny,
Popping in to let you know that our thoughts and hopes will be right there with you for the ultrasound. It is definitely best to know, I think for Gracie and For you, so you can stop stressing so much.
Look how far you have come in such a short time.

Sharlene and Molly Muffin

[goldengirl88]

Kenny:
I feel terrible that this has taken you down. Stress can really do a number on you. I have Lupus and when I get really stressed with all this it flares up and I am a mess for weeks. Maybe you could ask your physician for a mild tranquilizer. I had to finally breakdown and ask my Dr. for one a few months back. I have only taken 2 out of the bottle, but it is nice to know I have them if needed. It seems Gracie is your friend, your little buddy, your everything. I am alone with no family and that is what Tipper is for me. I know it is not healthy to have a relationship with your dog like this, but I can't help it that's just how it turned out. This in not understandable to the average person, but nothing is more important in this world to me than my Tipper's life. I can sense you are on that level with Gracie. This is an awful disease and it robs us of so many things. Do you best to distress even if you have to get something for it. I am here for you, and would never fault you for your deep love of Gracie. I know first hand what this can do to you so take care. You are Gracie's only hope to make it through this so just remember that, and know she depends on you now more than ever. Blessings
Patti

[KennyJ]

How long does it take for the ultrasound?

[Roxee's Dad]

Somewhere around 30 to 45 minutes. Guess it will depend on what or how much you want scanned.

[KennyJ]

They were going to take her back around 12:00. And I don't think she discussed with me what she would scan. But she could have but I have been so stressed over this I probably didn't hear what she said.

[Roxee's Dad]

Don't forget to get a copy of the scan results. ;)

[Squirt's Mom]

We're right there with you, Kenny. Deep breaths and try to relax a bit. Like John said, remember to get a copy of the comments on the ultrasound so you have something to look at when we ask you a million questions! :D

It is a good idea to start now getting copies of all the test results - the actual results, not the invoice that says what they are charging you for. Most vets are happy to give you copies - just start a file at home for Gracie. That way if she ever needs to see a different vet, you walk in the door with all her info in hand.

Breath....breath....breath....Gracie needs you to be strong for her so you need to be sure to take time to care for yourself, too. Get out and do something fun for a bit, go for a walk in the woods, go to a movie with friends, play a game of B-Ball - something to let your mind take a break and refuel you a bit. We can't have you getting sick! ;)

[KennyJ]

Still waiting. I would have thought the exam would have been over by now.

[KennyJ]

Ok, here is what I know so far, the vet just called. Gracie has a nodule in her liver but she isn't concerned about that right now. She said she would do another ultrasound in about 6 weeks to see if has grown. But she says some dogs at her age get these. But there is a problem. Gracie has a gallbladder problem that is causing mucos feel?? I know that is not the correct spelling but I will have the full report once I pick her up this afternoon with the correct spelling. Gracie's adrenal glands are larger than they should be for a dog her size. Plump is how she put it. She wants to put Gracie on antibiotic, another kind of capsule, and continue the Denamarin. I asked if the gallbladder issue could cause the elevated ALP she said absolutely but that Cushings also causes this gall bladder problems in dogs. Her blood pressure was normal at 136. So here is her battle plan. 6 weeks of antibiotics for the gall bladder problem, the other med, and Denamarin. Do this for 6 weeks. After that she wants to retest her Chemistry profile for the liver enzymes. I did ask her if she thought Gracie had a pot belly and she said that Gracie did have thin skin on her belly but that she didn't really have a distended belly like some of the dogs with Cushings. She said she didn't really pay that much attention to Gracies's hair but that she would not have mentioned it in her report because she didn't think it looked patchy. So until I get the full report this is what I have. What do you guys think??

[Roxee's Dad]

Very glad you had the Ultra sound, Sounds like your vet has a good battle plan ;):):D Clear up any current issues and retest.

[KennyJ]

John, I was very impressed with her over the phone. And I know I did not correctly spell the mucus problem. Sound like the word "feel" but I am sure she said something else. And her adrenal glands being plump sounds like Cushings as well, don't you agree? But she said normally a dog with this type of gall bladder issue is somewhat sick and she said she didn't sense that in Gracie. And that she could hardly notice Gracie limping at all on the injured leg. I told her she should have seen her about 6 weeks ago. The one med has to be compounded because Gracie is so small. Can you put the capsule in a piece of cheese?? I have never given a dog a capsule.

[Roxee's Dad]

And her adrenal glands being plump sounds like Cushings as well, don't you agree?

Very well could be but the best plan of action is to clear up any current issues and move forward.

Want to mention I am impressed with all that you have learned so far.. Good Job Kenny :D

[molly muffin]

It might be and it might not be. Adrenal glands will become enlarged any time they are over producing the cortisol. Cortisol can be over produced due to anything else going in the body too, not Just cushings. A dog responds to an illness or an infection by usually producing cortisol. Gracie has both the leg tear and a gall bladder issue going on that the specialist wants to have cleared up and then see how her blood panels look. This is a good plan.
Clearing up the gall bladder issues could make her numbers start to go down and the adrenal glands to eventually return to normal with no cushings.
This is why you want to clear up anything else before jumping into a cushing diagnosis and treating for it.

I think you can put your stress to the back burner for awhile. Gracie appears to be in good hands with a good plan to go forward with.

Sharlene and Molly Muffin

[labblab]

Kenny, I'm betting the gallbladder issue is a "mucocele." These used to be considered rare, but as more and more dogs have ultrasounds performed for a variety of reasons, they are being discovered more frequently. So they actually may be much more common than once believed. Also, originally surgery was thought to be the best solution. But in recent years, I think that medication and monitoring is being used as an alternative treatment more often -- which sounds just like what your vet is proposing. I think we have at least one other member here whose dog has also been diagnosed with one, but I can't remember who off the top of my head...

I'm so glad this imaging was performed, and everything she is suggesting sounds very reasonable to me right now.

Marianne

[KennyJ]

Of all the doctors so far this one has impressed me the most. One more thing she mentioned although the adrenals appear larger they both appear to be the same size. I am sure that doesn't mean much. I was talking to her about the specific gravity being 1019 and she said they like to see at least 1025 as being normal. But I also told her that Gracie had the sample taken at 6:00 pm which means she had all day to drink water. She sounded like that was possible to make some difference. But overall I was very impressed with this vet. I may have a heart attack after seeing the invoice.

[Budsters Mom]

Way to go Kenny! You got through it and handled yourself so well!:D
Big hugs,
Kathy

[KennyJ]

Marianne, I bet you are right about the gall bladder issue. She did tell me when I start researching it not to get too excited about the rupturing. I guess she has me figured out already that I would be in panic mode. So Marianne, with this other member was the gall bladder issue caused by Cushings or something separate?

[KennyJ]

Ouch, she was right I would start doing my research.



Monitoring. Reexamine dogs undergoing medical therapy for mucoceles after four to six weeks. The recheck should include abdominal ultrasonography, a complete blood count, and a serum chemistry profile. In one report involving two dogs, alanine aminotransferase and alkaline phosphatase activities and total bilirubin concentrations remained elevated for weeks to months after ultrasonographic resolution of the mucocele.1 These persistent elevations are most likely associated with the extension of pathological processes from the gallbladder to the liver or from a concurrent hepatic or endocrine (e.g. hyperadrenocorticism, hypothyroidism, diabetes mellitus) condition.

Prognosis. The prognosis for patients treated medically appears to be variable. In one study, seven of 25 patients with mucoceles were treated with ursodiol and SAMe. Two died within two weeks, two were lost to follow-up, and three survived without complications for at least six months.12

In a recent case study, two clinically ill patients with mucoceles were successfully managed with medical therapy.1 One dog was treated with SAMe, omega-3 fatty acids, famotidine, ursodiol, and levothyroxine. The second dog received ursodiol, fenbendazole, and levothyroxine and was fed a hypoallergenic diet. Levothyroxine was used to treat hypothyroidism, and fenbendazole was used for prophylactic gastrointestinal parasite therapy. These patients showed complete ultrasonographic resolution of the mucocele after two and three months.1

Surgical intervention should be recommended in all dogs that fail to improve with medical therapy, including those with unresolved clinical signs, worsening laboratory findings, and progressing ultrasonographic abnormalities.

SUMMARY

Gallbladder mucoceles are being diagnosed with increasing frequency in dogs, but their true incidence remains uncertain. The underlying cause of this condition is still controversial, but there is a strong association with mucous gland hyperplasia within the gallbladder epithelium. While surgical management has been the historic treatment of choice, recent case-based evidence suggests that some patients may respond to medical management.

Rebecca Quinn, DVM
Audrey K. Cook, BVM&S, MRCVS, DACVIM, DECVIM-CA
Department of Small Animal Clinical Sciences
College of Veterinary Medicine and Biomedical Sciences
Texas A&M University
College Station, TX 77843

[labblab]

Darn, if only I could remember who the other member is...

But maybe it'll come back to me or they will even read our replies here. I'll try to do a word search on the site later on this afternoon, and maybe I can track them down. But I don't think you can ever know for certain what the cause is. Since it's another member here, that means his/her dog also has Cushing's. But I don't think you can know whether the Cushing's caused it.

Anyway, I'll check back later on if I can track him/her down.

[labblab]

Hey Kenny, I saw that study by Dr. Cook, too. She's an excellent researcher, but I just want to point out that the study is dated 2009. So there may be additional updates re: optimal medical treatment by now. And bear in mind that the dogs in this study undoubtedly presented as being "sick" in the first place. Unlike Gracie, who isn't showing any obvious symptoms.

[Squirt's Mom]

In a cush pup who has the pituitary form, PDH, both adrenal glands are typically enlarged. This is the form the majority (85%) of cush pups have. In adrenal based, ADH, we typically see one gland very large and the other gland either much smaller or even atrophied.

BUT as has been said, adrenal enlargement in and of itself is NOT a confirmation for Cushing's - they can become enlarged for a variety of reasons. ;)

All in all, sounds like a good report, Kenny! Nothing major found. Now take that deep breath and relax for just a bit. ;)

[KennyJ]

She gave me a copy of the ultrasound and they weren't exactly the same size. I just wish I hadn't looked up the gall bladder stuff. Found this interesting.


http://www.ncbi.nlm.nih.gov/pubmed/19954439

[molly muffin]

Can you post the ultrasound results Kenny? I think we'd be interested to see what exactly it says.

Sharlene and Molly Muffin

[KennyJ]

Sharlene, what would you like to know?? The written part I posted already. After researching the mucocele it seems like Cushings and this go hand in hand. Not sure I feel very comforting after reading this.

[molly muffin]

hmmm, I don't see where you posted what was typed up on the ultrasound report. I see the study by Dr. Cook and I see where you said what the vet mentioned over the phone.

Often the ultrasound report will give a more thorough written evaluation, such as what is the terminology about the adrenal glands and size. What is the terminology about the gall bladder, other organs such as liver. Sometimes it's all in the details, exactly what is what and we just like to see it. Did they look at the spleen? The pancreas?
I'm just anal for details that is all and a thorough written report just makes me feel better.

Sharlene and Molly Muffin

[KennyJ]

Sharlene, I have the ultrasound film out in the car with the size of the adrenal glands. She said they both were enlarged. The mucocele diagnosis from everything I have read can still be Cushings related. She said Gracie's skin was thin but she didn't see that much of a pot belly on Gracie. Her liver may be slightly enlarged but not that much that it covers much of her abdomen. When I left I was feeling pretty good but after doing my normal research I am concerned about Gracie having mucocele. She is treating this with medications including an antibiotic. She also found a nodule on Gracie's liver. She wants Gracie to have another ultrasound and another CBC and Chemistry profile after 6 weeks of treatment. If her live enzyme is still high she thinks she should have the Cushings test using the ACTH. Blood pressure was normal at 136.

[Roxee's Dad]

Hi Kenny,
Did the vet give you a set of notes or just the film. There should be some notes. Did the vet do the US herself or have a specialist come in?

[molly muffin]

I'm not speaking of the film itself but the written notes that John asked you about.
As an example, Molly's ultrasound read like this:


Liver: mildly enlarged, diffusely hyperechoic and margins rounded
gall bladder: moderate amount of echogenic debris present
stomach: moderate gas

It goes on to cover, left and right adrenal gland, kidneys, etc, etc. That is what I mean by often the notes can impart information that me being OCD about lab results, find to be helpful in actually Knowing what is going on, as opposed to just my own notes on what the vet tells me. It's all in the wording. ;)
I usually base the questions that I might want to ask or the things that I want to track from the written test results and notes rather than from anything I am specifically "told". I just find that to be a better way for me at least, to keep track of what specific questions I might want to ask going forward or keep track of.

I feel it is good to have a plan. Has this specialist treated many gall bladder mucocele?

Sharlene and Molly Muffin

[KennyJ]

Nothing was said about Kidney's although I do have a copy of the images. The only written notes were the ones I included in the above post. I did not ask her if she had treated mucocele in other animals before but I would think she had. The measurements of all the organs were included in the film and the only mention to me about the liver was what I also included in the above post. Once I get to my office I will look to see if I am missing anything. I am thinking Dr Herring did the ultrasound herself.

[Squirt's Mom]

When we had US done, I got a typed sheet that listed all the organs that were seen and a detailed description of each. It might say an organ is normal, and it might say one is enlarged and give measurements, and it may say one has such and such appearance, and so on. They are very detailed and specific for each organ seen. At the bottom of our sheets, each "abnormal" observation is discussed as to what the possible causes could be, what the possible treatments are, and perhaps the suggestion that the vet keep an eye on such and such scanning again after a certain time.

It may be that everything else they saw was normal and therefore there is no more information that what you were told - but I would want to know for sure exactly what was said about each organ seen. ;)

[KennyJ]

I looked and she listed what was abnormal and what she found. The size of her adrenal's was larger than normal and she went over that with the dimensions on the view graphs. She actually has the measurements on that and showed me what normal size would be. She also listed what they were treating Gracie for, mucocele and the dosage of the medications. After 6 weeks another ultrasound and more lab work. She may test for Cushings at that time. I was hoping the mucocele was a minor ailment that meds would clear up and hopefully that was causing the elevated ALP but after reading a lot on this last night it appears Cushing does have a tendency to have this go wrong with their gall bladder. Once again I was let down.

[KennyJ]

She prescribeed Ursodiol and clavamox along with the Denamarin. Anyone had any experiences with these medications?

[Squirt's Mom]

Ursodiol is used to help break up sludge and stones in the gall bladder - I haven't used this particular drug tho.

Clavamox is an antibiotic and I have used it often for a variety of reason with no ill effects.

Denamarin is a combination of SAMe and the active ingredient in Milk Thistle - silybum - and will help sooth the liver. I have used both SAMe and Milk Thistle, separately. There have been no issues with the SAMe at all; however Squirt is allergic to Milk Thistle tho no other dog I have used it on has had a problem with it.

[doxiesrock912]

Daisy is on Ursodiol. Her gall bladder was completely filled with sludge. The IMS doc indicated that this might be the beginning of a mucocele, but she could not tell from the xrays.

[KennyJ]

Valerie, the ultrasound showed the mucocele. Like I said in an earlier post I thought, ok this may be why Gracie has the elevated ALP and it not be Cushings. However, after reading about it says dogs with Cushings sometimes have mucocele. How long is your dog on this medication?? Mine will not arrive until later in the week because it had to be compounded. And why was clavamox prescribed as well?

[lulusmom]

Hi Kenny,

If you go back and read the Texas A & M study you referred to in a prior post, you will see that a good many dogs with mucoceles also have a bacterial infection. I suspect Clavamox, a broad spectrum antibiotic, was prescribed for that reason, even though the IMS can't be certain that Gracie has mucoceles. Actually, whenever a dog has abnormal liver enzymes, many vets automatically put them on an antiobiotic and then recheck values in 30 to 60 days. Sometimes they don't know what is going on but if there is an underlying infection somewhere , antibiotics will help. I'm not one for throwing antibiotics at a problem but I do understand that if a dog isn't overtly symptomatic, it's not always easy to figure out what is going on so an antibiotic trial makes sense.

The Texas A & M study also mentioned that it is difficult to tell the difference between sludge and mucoceles. I think sludge is definitely more common in cushdogs. My own little Lulu was on a treatment regimen that included Ursodiol.

[KennyJ]

On the ultrasound she showed me the spot that she called mucocele. It looks like it has tentacles or the way she described it kiwi appearance. Did Lulu handle the medication ok?? I have to wait for several days because Wedgewood has to make the capsule to fit Gracie's size. I hope I can wrap it in some cheese. This will be the first for me to give a capsule to a dog.

[goldengirl88]

Kenny:
My rescue cat takes ursodiol daily. It is to thin the viscosity flow thru his ducts. He has been on it for about 2 years now. He had gotten real sick, wouldn't eat, and his blood profile was not good. I urged my vet to consult with another vet as he did not know what to do after trying several things and they didn't work. He gets regular blood tests now. His health has been pretty good while on this. It is extremely expensive to buy from the vet. So I have gotten my vet to the point where he will match online prices. I was paying almost 175.00 for it now I pay 65.00 which is still bad, but he needs it. Thank God I rescued him, as someone else might not have wanted to spend this kind of money on him, or could not afford to and he would be dead. It really had his liver enzymes messed up for awhile. If he stops eating I immediately get suspect of his liver values rising. Hope all is well with you. God Bless you and Gracie.
Patti

[KennyJ]

Patti, the vet I took Gracie to uses Wedgewood and I got it including shipping for $55.

[goldengirl88]

Kenny:
Good for you, all this stuff is so expensive, you have to get it the cheapest way possible. Is that for 3 months supply of 120 capsules? What mg does she take? I hope it helps her like it did my cat. Blessings
Patti

[KennyJ]

Patti, no this was for two months. Gracie will be taking one a day. And its 55 mg capsules. How do you get your cat to take a capsule?

[KennyJ]

Has anyone ever had a dog that had extremely elevated ALKP and it came back to normal?? I was just curious. My regular vet said that he has never seen that happen. By the way I will probably switch over to the IMS as being my regular vet now. It means I have to bring Gracie about 40 minutes away from home but I feel better knowing she is a specialist.

[Roxee's Dad]

Actually Kenny... Yes :) Roxee's ALKP was very high and after treatment with Trilostane, and Milk Thistle her ALKP came down to high normal.

I don't know if it was the trilo or the Milk Thistle or a combination of both, but yes, it came way down to high normal range.

I kept pretty accurate records since she was a pup, every blood test, every Dr visit... I was, still am pretty OCD when it comes to my dogs :o and we could see when it started rising, then the cush test, then when it started coming back down. I had it all in excel and pretty much graphed it :o:) I had it in google docs, not sure if I could find it now.

[KennyJ]

Gracie is panting like crazy. She cant get comfortable. Its very cool in my house but when Gracie os lying on lap she pants more. She is lying beside me and not panting at all.

[doxiesrock912]

Cushingoid dogs have a really hard time regulating their body temps and they tend to run higher than dogs without Cushings.

It could be that your body heat is transferring to Gracie and she can't make the adjustment.

[KennyJ]

Valerie glad you brought that up. Gracie had normal blood pressure and body temp when taken during her ultrasound. Dont most Cush dogs have high blood pressure?

[goldengirl88]

Kenny:
I get Tipper's blood pressure checked every Wednesday. I was told by several Dr.'s that is the single most important thing to to check. It can really do a number on the kidneys if not kept in check. Yesterday Tipper's was dangerously high. The vet does not want to start her on Blood Pressure Meds yet , so he said to take her home let her calm down and rest in the cool. She had taken a walk and it was really humid. She had her ice pack harness on, but that walk may have done it. Dogs with Cushings are prone to high blood pressure according to my vet. When Gracie pants get a cool wash cloth and wipe her head etc. I do that a lot with Tipper if she seems hot or panting. God Bless
Patti

[KennyJ]

Wow Gracie drank a ton of water this morning. First time she has ever drank almost non stop. Could the clavamox make her drink more?

[Budsters Mom]

Kenny,
It helps to have a spray bottle of water handy when it heats up. Spraying Gracie's tummy and the bottom of her pays will help Gracie feel cooler. You can do this as often as necessary. XXXXXXX

[molly muffin]

Hi Kenny, yes sometimes clavamox can cause more water intake, causing more urination and at times, even incontinence. That is one of the possible side effects from what I just read.
I went to look after I read your post. This was mentioned by a vet as something she had noticed in her patients and once the antibiotic is used up then urine usually returns to normal.

Sharlene and Molly Muffin

[KennyJ]

Thanks Sharlene, I am just now seeing your post. For some reason it didn't come through using my email notifications. She is most definitely drinking more. The other medication, ursodiol, has not arrived in the mail yet. I am getting so frustrated. I was so hoping the mucocele was an easily treated disease of the gall bladder and that was the reason for the elevated ALP. But the more I read it's most common in dogs with Cushings. I might as well admit it and accept the fact that Gracie has Cushings. The 55 mg she prescribed for Gracie seems to be an extremely high dosage for a dog her size. All these meds. :(

[molly muffin]

There is nothing simple about anything with our precious dogs it seems.

Dogs with cushings can get mucocele and it's something that you would look for on ultrasounds. We have literally seen hundreds and hundreds of dogs with cushings come through here, I should actually say thousands. Very few have had a mucocele.

However, dogs without cushings Also get mucocele and it is not so simple as saying if they have a mucocele they have cushings.

Will the ALP come back to normal? Probably not normal, although never say never. It should however, once the leg is completely healed and the mucocele is taken care of, come down to something you can live with, without the worry.

Cushings is literally not as important as getting the mucocele cleared up. That and the leg are top of the list.

Sharlene and molly muffin

[KennyJ]

The IMS said she could barely notice Gracie's leg problem when she watched her walk. I must say that has improved so much. It's been tough and she still has accidents because she gets very hyper even in her play pen. But I am noticing more and more signs that point towards Cushings. I can't quit researching this disease and now I have another one to research. The combination of the two has left me emotionally exhausted. Then when someone loses their buddy on here it just really gets me down.

[Roxee's Dad]

Hi Kenny,
Your doing really well, keep positive and Gracie will sense your positive attitude.;)

Gracie's knee is improving, you made the choice to do an ultrasound and identified a situation before it became a problem... You are doing great for Gracie :)

[KennyJ]

John, shes drinking at least 16 ounces of water now. And part of that time she is on my lap and not near the water.

[Squirt's Mom]

Kenny, are you restricting her access to water? If so, stop and make sure she can get to water any time she wants. Restricting water is seldom a good idea and never a good idea with a pup who may have Cushing's.

Cush pups do not pee a lot because they drink a lot. It is just the opposite. They are going to pee a lot no matter how much or how little water they drink. So a cush pup will dehydrate pretty quickly if water is restricted. A cush pups drinks to excess in order to replace the fluids they are losing via urination.

So make sure Gracie always has access to as much water as she wants. ;)

[KennyJ]

Oh no I would never do that. I'm just saying when I am home with her she spends a lot of time on my lap and shes not near the water bowl. But she never wakes me up during the night wanting water. If she tries I am not aware.

[KennyJ]

The instructions for Ursodiol says it should be given with fatty food. I have been giving the clavamox with cheese. Can I do the same with Ursodiol?

[KennyJ]

Nice article on mucocele. Maltese happens to be one of the breeds that have an increased risk of this disease and of course Cushings is also mentioned. I am somewhat concerned about the dosage the IMS gave Gracie. 55 mg/day. That seems to be a lot more than is recommended in this article.

http://scvsh.com/_cme/Stegeman_Gall%20Bladder%20Mucocele%20in%20Dogs.pdf

[molly muffin]

I'm not familiar with how to give Ursodiol, but if it says with fatty food, then cheese would probably work.

You could ask the vet why the higher dose, but maybe she wants to kick it as fast as possible? I really don't know. How is Gracie doing over all?

sharlene and molly muffin

[KennyJ]

Sharlene she pants a lot but her leg is doing well. Still cant believe she has this mucocele. And I searched and searched but I still cant find where clavamox would make her drink more water. I just checked her bowl. I put 20 ounces of water in it everyday. Right now she has 6 ounces left.

[Roxee's Dad]

Kenny, Really.... 14 ounces of water is not excessive for Gracie. 1 to 1 1/2 ounces per pound is the the norm. When she gets up to 25 30 ounces, then I would start to call it excessive. :eek:

Panting could be pain, could be she is warm, could be cushings. It's really hard to say, sure wish they could talk to us and tell us what's going on.

[KennyJ]

But what if I left her in the play pen all night? I bet the water would be gone. She has since lost some weight. Probably around 12 lbs. Dr Hairfield said 14-16 ounces was considered excessive for her size.

[molly muffin]

I tried to find it again where the vet said that she did see that as a side effect even though it wasn't mentioned or listed as one.
I think it was on justanswer and the vet's name was Marsha something or other. I'm looking through my history trying to find it again. drat, I should have bookmarked it. grrr

sharlene and molly muffin

[KennyJ]

Gracie is lying here sound asleep no longer panting.

[molly muffin]

Awwww, I'm sure she is very sweet and it is heart warming to see her sleeping peacefully. She is such a cute little one.

Sharlene and molly muffin

[Squirt's Mom]

Dr Hairfield said 14-16 ounces was considered excessive for her size.

Once again, bluntly, Dr. Hairfield is wrong. ;)

[KennyJ]

I hate the fact that Gracie has all these things going on at the same time. I mean it's bad enough knowing she has a ruptured ACL but knowing she has a mucocele and strong possibility of Cushings is a little overwhelming.

[Roxee's Dad]

Welcome to the family, although it's a family we all wish we didn't have to be a part of, but at the same time we are glad we are.

Whenever you are feeling down, just revert back to the little story written by Beth....

http://www.k9cushings.com/forum/showthread.php?t=4928

It makes us realize that our family members have a special strength and bond because of our cush pups. They make us a special kind of strong. Strong in our love, strong in our emotions. We notice everything, the sneeze, the skipped step in a gait, an ounce or two of water, or a teaspoon of food left behind, a longer or shorter than usual nap, a new lump or skin irritation.

Welcome to the family....... The K9 Cushings family where we make each other stronger.

Give that little Gracie a Belly rub from her cush family :)

[KennyJ]

Thanks John. John, I know I am repeating myself quite a bit but I would like to ask this question again. Gracie's specific gravity was at 1019 which I considered normal but the IMS said they like it at least 1025. I told her the urine sample was taken later that evening. Wouldn't that have caused her urine to be more diluted than had it been taken first thing in the morning?

[molly muffin]

Yes it could have caused it to be more dilute usually. To get an accurate specific gravity, it should be the first urine of the morning.

Sharlene and Molly Muffin

[KennyJ]

That's what I was thinking as well Sharlene. Gracie is on clavamox, Ursodiol, Denamarin, and Glyco Flex 111. That's a lot of meds.

[KennyJ]

Her leg is so much better. Hard to believe anything is wrong with her.

[doxiesrock912]

That's great news Kenny! She may not need surgery after all.

[KennyJ]

Thank you. The mucocele has me concerned though.

[doxiesrock912]

Generally, that isn't something that needs immediate treatment. The vets will watch it. Daisy has had one since May.

[KennyJ]

Really? Can't they rupture? Do they think Cushings caused it?

[KennyJ]

How do you make yourself trust your vet?? I mean even with the IMS I am having trust issues. She too would use the ACTH and will most likely test Gracie when I take her back but yet most seem to recommend the LSSD test.

[frijole]

Kenny go back and read the thread - if I recall from what we have already said -most vets in the US with new patients would start with the ldds HOWEVER those that you told about Gracie's leg issues only one said ldds, the others all said acth. We all said acth. I don't know what more you want from vets or us for that matter. :confused::D:confused: If you've read about cushings you know that it is often misdiagnosed and as a result it is recommended that more than one test be done and/or an abdominal ultrasound. I believe it was discussed that the acth and an ultrasound were the next steps. Gracie's leg is getting better and I think this vet's opinion is a sound one. Perhaps you are afraid of having the test done - which I totally understand. Just remember - if it comes back as high cortisol you will be doing more tests so it is just a step in the whole process. Go read everyone else's thread on here and you will see you are not alone - I hope this helps. Kim

[KennyJ]

Kim, sorry for being such a pain and you are probably right. I am afraid of what the test results will be. Most likely Cushings. However, none of the vets said her leg would be an issue in testing her. It just happens to be the tests that the vets use. I asked if her leg issue would affect the results and they said no. Several said get the leg better because it was top priority while several said go ahead and test for Cushings. So I have gotten mixed signals. In 5 weeks I do another ultrasound to check the mucocele and more lab work. She noted on the report she may do the ACTH testing at that time, especially if her ALKP did not change.

[Roxee's Dad]

LOL... Kenny, your not a pain and we understand your frustration and confusion :(

It is so hard to have patience these days when almost everything else we do has instantaneous results. The waiting is very difficult. Then when you do have the test performed, it will be waiting for the results. ;)

As they say..hurry up... then wait, it doing it right is well worth it.

[KennyJ]

John, I think its a combination of differing opinions from the vets on their method of testing, the ruptured ACL, and now finding Gracie has a mucocele. It's a little overwhelming.