9 Year Old Maltese with Cushings

[KennyJ]

First I need to say I have not had my little dog tested but the physical exam and CBC with liver profile indicates Cushings. Her ALP was 3500, off the charts. That concerns me. I initially brought my dog in for an injured rear leg. The Vet noticed she had a pot belly appearance and immediately said she looked like she has Cushings. This is the same clinic I always go to and never has this ever been mentioned to me before. My question is has anyone ever tried alternative solutions over the traditional meds? And if so how did it work?

[frijole]

Hello! First off - non-traditional /holistic meds haven't worked or we would have all used them. :) Sorry. So skip reading up on miracle cures it'll save you some brain damage and cash too.

Don't jump to a cushing's diagnosis just yet. Yes cush dogs have high liver values but that could mean other issues as well as cushings. Does your dog have any symptoms? Excessive (as in buckets) water intake, frequent urination (as in gets you up in the middle of the night), inhales food (does not chew - lives to eat even though they just ate - like a walking vacuum cleaner sniffing for food at all times), hair loss, skin issues ?

This disease is so often misdiagnosed we don't even go there until we are sure multiple tests are done. So you had a blood panel done. If you don't have any of these symptoms I wouldn't waste a penny on cushings' tests at this time. You might have an ultrasound done to see if there is something going on with the organs.

Kim

[KennyJ]

Well she does pant a lot, drinks a lot of water but she never gets me up at night for the bathroom. She does have accidents urinating in the floor but I have always chalked that up because she is at the house at least 8 hours without a potty break. Another thing that concerns me is she has all these fatty tumors, cysts all over her stomach and chest. She has been to two Vets now and they both said she would test positive for Cushings. This second Vet practices Holistic and Chinese herbs as well as the traditional meds. The leg problem has not cleared up so this Vet used acupuncture on her. I am really torn on what to do. If I don't treat it I am sure that will shorten her life and she is only 9 years old.





Hello! First off - non-traditional /holistic meds haven't worked or we would have all used them. :) Sorry. So skip reading up on miracle cures it'll save you some brain damage and cash too.

Don't jump to a cushing's diagnosis just yet. Yes cush dogs have high liver values but that could mean other issues as well as cushings. Does your dog have any symptoms? Excessive (as in buckets) water intake, frequent urination (as in gets you up in the middle of the night), inhales food (does not chew - lives to eat even though they just ate - like a walking vacuum cleaner sniffing for food at all times), hair loss, skin issues ?

This disease is so often misdiagnosed we don't even go there until we are sure multiple tests are done. So you had a blood panel done. If you don't have any of these symptoms I wouldn't waste a penny on cushings' tests at this time. You might have an ultrasound done to see if there is something going on with the organs.

Kim

[KennyJ]

The more I read up on this disease the more confused I get. I read where some Vets say that Cushings will indeed shorten the life span of a dog, even with treatment and others saying that it doesn't affect the life span if you get it under control. So which is it?

[doxiesrock912]

Cushings affects a dog's immune system, it is fully treatable but not by holistic means. Many general vets are not familiar enough with the disease so please save yourself time and money and find an IMS (small animal internal specialist). That is advice that I wish that we had in the beginning :) Thankfully, Daisy is doing well so far.

In the beginning, it takes a little time to determine which medicine and the dosage are appropriate for your dog because every dog responds uniquely.
There is so much information on the internet, some older and less accurate than others.

This link http://www.2ndchance.info/cushings.htm provides easy to read information about Cushings
and there are many informational links in the "helpful resources for owner of Cushings dogs" section of this forum.

My dog, Daisy was recently diagnosed and the people here have provided an immense amount of support and knowledge.
Many dogs live full lives and die from something other than Cushings. The key is to treat it properly and monitor your dog as directed by the specialist.

An ultrasound in a really good idea in the beginning so that you have a baseline to go from for future monitoring,it helps to confirm which type of Cushings that your dog has, and if any other problems exist that need to be addressed.

Please obtain the test results from the vet and which tests were done. Feel free to post them along with the weight, name, and age of your dog because there are so many knowledgeable people on this website! They'll help you to interpret the results and answer any questions that you have.

Cushings is NOT a death sentence as they once first thought. It's more common than you realize.

[Harley PoMMom]

Dogs with Cushing's have excess cortisol running through their bodies. When left untreated this overabundance of cortisol can wreck havoc on their system including all organs and it suppresses the immune system leaving them vulnerable to infections.

Cushing’s is a treatable disease and with proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Love and hugs, Lori

[mytil]

Hi and welcome from me as well.

Testing is the most critical process when it comes to diagnosing Cushing's and before giving any medicine; including herbals. Many of its symptoms mimic others as well from diabetes, thyroid issues to even liver disease.

Take a look at this link to see more on testing....http://www.kateconnick.com/library/cushingsdisease.html.

Terry

[Squirt's Mom]

Hi Kenny and welcome to you and your baby girl! :)

All that reading will make your head spin, huh? :p How well I remember. A lot of what you can find out there is just plain wrong tho so don't get upset about something you run across until to talk to us, 'k? Like that life expectancy stuff - it's a myth, Kenny, just a myth. For one thing, most of that info is way out-dated. There have been improvements in understanding for both the vets and parents, new treatment approaches, better testing - AND, for another, they didn't take into consideration parents like us who will fight with all we have for our babies. ;) Vets are taught in school that Cushing's is incurable and that clients don't or won't comply so the pets suffer and die regardless. NOT TRUE! With the correct diagnosis and when proper treatment protocols are followed, cush pups can and do live out their expected life span and beyond. The majority of our babies here have passed from things completely unrelated to Cushing's and numerous pups have lived long, happy lives with treatment. ;) My own cush pup was 15 this Feb. So you just put that nonsense out of your mind right now and we will focus on getting to the bottom of what is going on with your baby then proceed from there.

As for alternative treatments - I come from a slightly different position than most here. The reason is that when we have had members who choose to treat holistically, they haven't continued the testing to see if the cortisol was actually be controlled with their methods and simply disappear; we never hear from them again. However, I have seen a few ACTHs from pups who were treated with herbs, diet, supplements that showed the cortisol within normal range. None of these pups were on the same things. BUT, the treatments used were a great deal more expensive than either of the traditional treatments of Lysodren (Mitotane) or Trilostane (Vetoryl) and it took a much longer time to find the right combinations and doses...and for the herbs to do their job. Herbs just take longer than pharmaceuticals for the most part. On the flip side, I have also seen dogs treated "holistically" who never improved and / or actually got much worse. Holistic approaches often require a great deal more time and effort on our part as well. An herb may need to be given 3, 4, 5 times a day so you need to be aware of time constraints. Some you may need to prepare so you will need to learn how to do that and have time to do what needs to be done - 3, 4, 5 times a day. ;) Adverse side effects are just as apt to happen with herbs as with pharmaceuticals - herbs are drugs in their own right and deserve the same respect. If a pup has something as common as allergies there will be numerous herbs that pup cannot use as a result so there are many factors to consider and watch for using alternative methods, too - they are not an "easy out" for either the pup or the parent. ;)

I put "holistically" in quotes because the use of herbs etc. does not mean the treatment is holistic. Holistic means "whole" - to treat the whole being internally as well as externally - physically, mentally, and spiritually. Every aspect of that beings existence is examined in depth and every area is treated as needed. That might mean a change in environment by not using any chemicals period, using only bottled water, changing the type bowls used for water, ect. Holistic approaches include many different types - TMC (Traditional Chinese Medicine), homeopathy, herbs, neutriceutical, Ayurveda just to name a few. Holistic isn't the stuff taken - holistic is the WHOLE of the being and more times that not, work in conjunction with traditional treatments like Lyso or Trilo. Rarely is optimal treatment achieved via herbs, etc. alone.

More food for thought! :D

For today, just breath and know you and your baby girl are in the best hands ever. Keep reading, keep asking questions and we will do our best to help you understand. None of us are vets but we do live with Cushing's on a daily basis and have much first-hand experience, knowledge, and unbeatable support to offer. You and your baby girl are no longer alone - we will be with you every step of the way.

Hugs,
Leslie and the gang

[KennyJ]

Thank you Lori.




Dogs with Cushing's have excess cortisol running through their bodies. When left untreated this overabundance of cortisol can wreck havoc on their system including all organs and it suppresses the immune system leaving them vulnerable to infections.

Cushing’s is a treatable disease and with proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Love and hugs, Lori

[KennyJ]

You guys are the best. Right now we are trying to tackle her rear leg problem. That is not getting any better. My Vet put her on anti-inflammatory meds but with no improvement. The Holistic Vet that also uses Chinese Herbs tried acupuncture on her yesterday. I still do not see any signs of improvement.




Hi Kenny and welcome to you and your baby girl! :)

All that reading will make your head spin, huh? :p How well I remember. A lot of what you can find out there is just plain wrong tho so don't get upset about something you run across until to talk to us, 'k? Like that life expectancy stuff - it's a myth, Kenny, just a myth. For one thing, most of that info is way out-dated. There have been improvements in understanding for both the vets and parents, new treatment approaches, better testing - AND, for another, they didn't take into consideration parents like us who will fight with all we have for our babies. ;) Vets are taught in school that Cushing's is incurable and that clients don't or won't comply so the pets suffer and die regardless. NOT TRUE! With the correct diagnosis and when proper treatment protocols are followed, cush pups can and do live out their expected life span and beyond. The majority of our babies here have passed from things completely unrelated to Cushing's and numerous pups have lived long, happy lives with treatment. ;) My own cush pup was 15 this Feb. So you just put that nonsense out of your mind right now and we will focus on getting to the bottom of what is going on with your baby then proceed from there.

As for alternative treatments - I come from a slightly different position than most here. The reason is that when we have had members who choose to treat holistically, they haven't continued the testing to see if the cortisol was actually be controlled with their methods and simply disappear; we never hear from them again. However, I have seen a few ACTHs from pups who were treated with herbs, diet, supplements that showed the cortisol within normal range. None of these pups were on the same things. BUT, the treatments used were a great deal more expensive than either of the traditional treatments of Lysodren (Mitotane) or Trilostane (Vetoryl) and it took a much longer time to find the right combinations and doses...and for the herbs to do their job. Herbs just take longer than pharmaceuticals for the most part. On the flip side, I have also seen dogs treated "holistically" who never improved and / or actually got much worse. Holistic approaches often require a great deal more time and effort on our part as well. An herb may need to be given 3, 4, 5 times a day so you need to be aware of time constraints. Some you may need to prepare so you will need to learn how to do that and have time to do what needs to be done - 3, 4, 5 times a day. ;) Adverse side effects are just as apt to happen with herbs as with pharmaceuticals - herbs are drugs in their own right and deserve the same respect. If a pup has something as common as allergies there will be numerous herbs that pup cannot use as a result so there are many factors to consider and watch for using alternative methods, too - they are not an "easy out" for either the pup or the parent. ;)

I put "holistically" in quotes because the use of herbs etc. does not mean the treatment is holistic. Holistic means "whole" - to treat the whole being internally as well as externally - physically, mentally, and spiritually. Every aspect of that beings existence is examined in depth and every area is treated as needed. That might mean a change in environment by not using any chemicals period, using only bottled water, changing the type bowls used for water, ect. Holistic approaches include many different types - TMC (Traditional Chinese Medicine), homeopathy, herbs, neutriceutical, Ayurveda just to name a few. Holistic isn't the stuff taken - holistic is the WHOLE of the being and more times that not, work in conjunction with traditional treatments like Lyso or Trilo. Rarely is optimal treatment achieved via herbs, etc. alone.

More food for thought! :D

For today, just breath and know you and your baby girl are in the best hands ever. Keep reading, keep asking questions and we will do our best to help you understand. None of us are vets but we do live with Cushing's on a daily basis and have much first-hand experience, knowledge, and unbeatable support to offer. You and your baby girl are no longer alone - we will be with you every step of the way.

Hugs,
Leslie and the gang

[Squirt's Mom]

Acupuncture can take a bit of time for the full effect so don't get discouraged just yet. Is your baby girl on any anti-inflammatory herbs, supplements, etc along with the med the doc gave? If not, you might talk to the Holistic vet about something like Devil's Claw. Cold pressed wild Salmon oil can help a great deal if it is joint related and has anti-inflammatory properties as well. My Squirt has two back legs that are pinned and screwed together and I use several things to help with the inflammation. She just started a product called Get Up and Go that is similar to Dog Gone Pain but has more herbs and more of the herbs I wanted her to have. I get it at Only Natural Pet online. I also use their salmon oil as it has the highest EPA and DHA that I have found - the Omegas that do the work.

Something that can help the liver a great deal is SAMe. I give a liquid form to Squirt since she no longer accepts pilling. Be sure to give it 2 hours either side of food for optimal absorption. Herbs that can help the liver are Milk Thistle, Schisandra, Artichoke to name a few. If the anti-inflammatory the vet gave you is an NSAID that will be very harsh on the liver and I would talk to him / her about something that wasn't in that class of med like Adequan, Dasiquin, etc.

[KennyJ]

Yes, the anti-inflammatory is rimadyl. I was thinking just like you. If her ALP is 3500 is that a medication she should be on. And so far it has not helped her. The herb that the other Vet gave me is Dispel Stasis in the Middle Palace. You can't really find that much info on it though. Does Milk Thistle help bring the ALP back down to normal range or am I just hoping? I guess it won't help if the Cushings is not under control.



Acupuncture can take a bit of time for the full effect so don't get discouraged just yet. Is your baby girl on any anti-inflammatory herbs, supplements, etc along with the med the doc gave? If not, you might talk to the Holistic vet about something like Devil's Claw. Cold pressed wild Salmon oil can help a great deal if it is joint related and has anti-inflammatory properties as well. My Squirt has two back legs that are pinned and screwed together and I use several things to help with the inflammation. She just started a product called Get Up and Go that is similar to Dog Gone Pain but has more herbs and more of the herbs I wanted her to have. I get it at Only Natural Pet online. I also use their salmon oil as it has the highest EPA and DHA that I have found - the Omegas that do the work.

Something that can help the liver a great deal is SAMe. I give a liquid form to Squirt since she no longer accepts pilling. Be sure to give it 2 hours either side of food for optimal absorption. Herbs that can help the liver are Milk Thistle, Schisandra, Artichoke to name a few. If the anti-inflammatory the vet gave you is an NSAID that will be very harsh on the liver and I would talk to him / her about something that wasn't in that class of med like Adequan, Dasiquin, etc.

[KennyJ]

Just found this on Devil's Claw. Not sure how accurate it is.

http://www.petforums.co.uk/dog-health-nutrition/85512-devils-claw-warning.html

[Squirt's Mom]

I would stop the Rimadyl - it can have some nasty side effects and will definitely be hard on the liver. And, yes, Milk Thistle can help lower the liver enzymes like ALP as can SAMe. In conjunction they can do wonders. However, we need to know why the values are elevated - is it Cushing's or is it something with the liver itself? So getting the testing done is the first step - full labs and an abdominal ultrasound would be a good start. If it turns out your girl does have Cushing's, sometimes those liver values come down with the cush treatment alone and sometimes the pup needs more help like the MT or SAMe or med from the vet. Don't you wish it was as simple as - if you see X, use ABC and all will be well? :p

[Squirt's Mom]

From your link -


...but people should be aware that just because something is a natural product, it doesnt mean it doesnt come with risks.

This is what I was trying to convey above - herbs are drugs in their own right and as such have their own set of side effects both positive and negative. "Natural" does NOT mean benign. ;) When using herbs you have to look at everything - interactions with other meds, herbs, supplements, foods, etc - just as we do when using chemical preparations (pharmaceuticals). Our pharmaceuticals are often made from plants but one single constituent of that plant has been extracted for use in the drug. When we use herbs, we are often using all the constituents in that plant. So while one constituent may help with inflammation another constituent in that same herb can cause diarrhea, another can cause excess peeing, another can help with vision, and another can cause elevated heart rate...all while addressing the inflammation. So it is seldom wise to simply start using herbs on our own - we need expert support from a Holistic vet...and a willingness to learn as much as we can about the herbs as about the conditions we are trying to treat. You have just begun a fascinating journey, Kenny. ;)

[KennyJ]

What about this product? Denamarin





From your link -



This is what I was trying to convey above - herbs are drugs in their own right and as such have their own set of side effects both positive and negative. "Natural" does NOT mean benign. ;) When using herbs you have to look at everything - interactions with other meds, herbs, supplements, foods, etc - just as we do when using chemical preparations (pharmaceuticals). Our pharmaceuticals are often made from plants but one single constituent of that plant has been extracted for use in the drug. When we use herbs, we are often using all the constituents in that plant. So while one constituent may help with inflammation another constituent in that same herb can cause diarrhea, another can cause excess peeing, another can help with vision, and another can cause elevated heart rate...all while addressing the inflammation. So it is seldom wise to simply start using herbs on our own - we need expert support from a Holistic vet...and a willingness to learn as much as we can about the herbs as about the conditions we are trying to treat. You have just begun a fascinating journey, Kenny. ;)

[Squirt's Mom]

Denamarin is a combination of SAMe and the active ingredient in Milk Thistle that helps the liver - silybin. It is a good product that is often very beneficial for our cush pups as well as others with liver issues. Certainly worth a shot!

http://www.drugs.com/vet/denamarin.html

[KennyJ]

Do I need to get this from a Vet or can I purchase it online?? Does it only come in pill form?? Getting Gracie to take pills can be a real pain sometimes.




Denamarin is a combination of SAMe and the active ingredient in Milk Thistle that helps the liver - silybin. It is a good product that is often very beneficial for our cush pups as well as others with liver issues. Certainly worth a shot!

http://www.drugs.com/vet/denamarin.html

[Harley PoMMom]

Denamarin can be purchased online without a rx. Many members, including myself, have used Milk Thistle instead and this product does come in a liquid form.

[Squirt's Mom]

Denamarin does not require a prescription as far as I know. However I'm not sure it comes in a liquid form - a google search may answer that. I can't pill Squirt so I have to use things that I can add to her food, which is home cooked so it is easy to mix med into it. You might try using a little Green Tripe or a good canned feed that she likes to give pills.

[KennyJ]

Found it in a chewable tablet for all sizes. Gives instructions on how to fit the size of the tablet for the weight of the dog. I just ordered 30 which equals 60 because I will cut it in half. I ordered this from PawsPlus for $39.99.




Denamarin does not require a prescription as far as I know. However I'm not sure it comes in a liquid form - a google search may answer that. I can't pill Squirt so I have to use things that I can add to her food, which is home cooked so it is easy to mix med into it. You might try using a little Green Tripe or a good canned feed that she likes to give pills.

[KennyJ]

I wanted to add. I took Gracie to see a Holistic Vet and just looked at their website again and noticed they have a Dr that is internal medicine. Isn't that the way I should go?? My other clinic does not have this type of doctor on board. Let me know what you think please.


http://roanokeanimalhospital.aahavet.org/web2/veterinarians.aspx

[Harley PoMMom]

From the bit of reading I did, this practise sounds really good and with Dr. Bridget Hickman specializing in Endocrinology, that's a huge plus!!

[Budsters Mom]

Welcome Kenny and Gracie,
I thought I'd drop in to say hello. We do that a lot around here!;)
You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help. It does appear that Gracie seems to be a poster girl for Cushings. Do not fret. Cushing's can be controlled and there is hope. :)Many of our members have been doing it for years!:)
So again welcome to you and Gracie,

Hugs,
Kathy and Buddy:cool:

[KennyJ]

You guys have been wonderful. So glad that I found this group. A little bit about me. I am a former Virginia Tech football player and most people think of me having a Pitt Bull, German Shepard, or some other large dog. But I simply love Maltese dogs. Gracie is my only child. So I will do whatever it takes to keep her with me as long as possible. I did call my regular clinic and asked if any of their Vets specialized in internal medicine and the receptionist said she did not believe so but that all of the Vets could take care of this problem. The depressing thing I heard from this office is the Vet that was taking care of Gracie this week said her dog had Cushings and died because of it after a year of treatment. I left the office in tears. Now don't get me wrong. This Vet is a wonderful person and I have seen other Vets online that said the same thing, that dogs with Cushings can NOT live their life expectancy because of this disease. That's when I found you guys. A big guy like me has been crying all week thinking I am about to lose my little buddy. I don't want to see that happen. I still need to do the ACTH Stim test but leaning more in the direction to the clinic I took her too yesterday because of the internal medicine doctor. Sorry for the rambling.





Welcome Kenny and Gracie,
I thought I'd drop in to say hello. We do that a lot around here!;)
You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. We will do all we can to help. It does appear that Gracie seems to be a poster girl for Cushings. Do not fret. Cushing's can be controlled and there is hope. :)Many of our members have been doing it for years!:)
So again welcome to you and Gracie,

Hugs,
Kathy and Buddy:cool:

[Harley PoMMom]

Usually a dog diagnosed with Cushing's is an elder one and most times these elder dogs go a long time before a diagnosis of Cushing's is finally arrived at and confirmed.

Many of these elder dogs with Cushing's, that are being treated, pass from a illness/disease unrelated to Cushing's.

We have many members whose dogs are/have been treated for this disease and have lived a long time with Cushing's.

[KennyJ]

Harley, is one drug safer than the other?? Also, do you agree that I should go to the Roanoke Animal Hospital that has an internal specialist on board? Or can any regular vet take care of this problem?? Gracie is only 9 so I am hoping that is to her advantage and Maltese typically live to be fairly old. And once the meds are regulated will the cost go down for the treatments?





Usually a dog diagnosed with Cushing's is an elder one and most times these elder dogs go a long time before a diagnosis of Cushing's is finally arrived at and confirmed.

Many of these elder dogs with Cushing's, that are being treated, pass from a illness/disease unrelated to Cushing's.

We have many members whose dogs are/have been treated for this disease and have lived a long time with Cushing's.

[mytil]

I sure am glad you found us! So you are a Hokiebird - well I am a Wahoo/Cavalier :D

I think the urban legend theme of dogs not lasting two years who are diagnosed with Cushing's is simply that - a legend. I have know dogs here who have been on treatment for well past two years - some 6 and 8 years. So please do not be discouraged. The key is treatment and being your dog's advocate and working with very experienced vets or IMS.

IMO I would set up an appt with the IMS if you are able. Yes the costs should go down once treatment starts. A good portion is the initial diagnostic testing. The costs after that are the meds and period testing to make the cortisol levels remain within the desired range.

Keep us posted
Terry

[KennyJ]

Thanks for the nice response. I hope it's not two years because I don't have any idea how long she has had this. My regular vet has never mentioned anything about her having a pot belly. Just that she was too heavy and cut back on the food. The same clinic just a different Dr was the one that said she looked like a prime candidate for Cushings with all thesymptoms. Never in my wildest dreams did I think I would hear that coming from my Vet. When her ALP came back 3500 that concerned me. By the way, I ordered the Cushex thinking I could beat this without the traditional meds. It hasn't arrived yet but I heard it was waste of money. I called the company this morning and they said they would refund my money once I send it back. However, the guy laughed when I told him that people said this does not work. He said it most definitely works.





I sure am glad you found us! So you are a Hokiebird - well I am a Wahoo/Cavalier :D

I think the urban legend theme of dogs not lasting two years who are diagnosed with Cushing's is simply that - a legend. I have know dogs here who have been on treatment for well past two years - some 6 and 8 years. So please do not be discouraged. The key is treatment and being your dog's advocate and working with very experienced vets or IMS.

IMO I would set up an appt with the IMS if you are able. Yes the costs should go down once treatment starts. A good portion is the initial diagnostic testing. The costs after that are the meds and period testing to make the cortisol levels remain within the desired range.

Keep us posted
Terry

[Squirt's Mom]

:D Oh, yes! Cushex works so very well...that is why our board and others exists! ;)

Cushex has changed its formula several times in the few years we've been around, none of which worked. One of our admins has contacted them for support of their claims other than the testimonials on their site - they can't provide any because there ain't none. The only ones to benefit from Cushex, Supraglan, and the like are those hawking the wares - not the pups. We have had members her who started with such products but realized they weren't controlling the cortisol, which is the enemy in Cushing's, which meant their dog wasn't getting better. Trust me - if these things actually had any hope of working, I would be one of the first to tell you so and be using them on my Squirt. ;)

[Budsters Mom]

Please believe me Kenny, If there was anything out out there other than the traditional drugs that bring down cortisol levels the angels would've found it. They have tried, and continue to try everything to no avail. None of us like the heavy duty meds! Every one of us would go the holistic route if there was one! Many of the angels here have years upon years of experience treating Cush dogs. They know tons more than your average vet. If you can afford the IMS, that definitely is the route to take. Many of the angels including myself, have vets that do not know the proper protocol for ACTH testing or Cushing Treatment. That is why I need to know MORE!!:). Many have spent lots of money on vets who did not know what they were doing, putting their precious fur babies in danger. Yes, By all means go to the IMS! I loved hearing about you and your precious Gracie. We all feel the exact same way about our fur babies as you do!

Hugs,
Kathy and Buddy:cool:

[KennyJ]

Is one drug safer than the other?






Please believe me Kenny, If there was anything out out there other than the traditional drugs that bring down cortisol levels the angels would've found it. They have tried, and continue to try everything to no avail. None of us like the heavy duty meds! Every one of us would go the holistic route if there was one! Many of the angels here have years upon years of experience treating Cush dogs. They know tons more than your average vet. If you can afford the IMS, that definitely is the route to take. Many of the angels including myself, have vets that do not know the proper protocol for ACTH testing or Cushing Treatment. That is why I need to know MORE!!:). Many have spent lots of money on vets who did not know what they were doing, putting their precious fur babies in danger. Yes, By all means go to the IMS! I loved hearing about you and your precious Gracie. We all feel the exact same way about our fur babies as you do!

Hugs,
Kathy and Buddy:cool:

[Budsters Mom]

Kenny,
I'm going to let our experts answer that question. They know tons more than I do about it. The drugs react differently. We have plenty of angels who know lots about both. I'm sure they will be popping in soon to answer your question.

Hugs,
Kathy and Buddy:cool:

[molly muffin]

Hello Kenny and Gracie and welcome to the forum. I think both drugs can work wonders for cushings and have done so. I would suggest speaking with your vet of choice as to which one they have the most experience and best results with.
You said that the vet clinic with the holistic vet has an IMS on staff also? And they treat with traditional and holistic medicines?
If so I would probably Lean in that direction, just so you can get everything at one place.
Awww Kenny, didn't the word go out? Love of animals comes in all shapes and sizes of both humans and the animals. We have guys here with big dogs and little dogs. I think you look into a face of an animal and it calls to your soul and that is that.
I think a liver support is a good option anytime you have elevated liver enzymes. Is the ALT elevated also? What about any high/lows. I wouldn't go with the NSAID they gave you but an alternate that isn't as harsh on the liver.
Again, welcome to the forum.
Sharlene and Molly Muffin

[Harley PoMMom]

Harley, is one drug safer than the other??

In my opinion, one drug is not "safer" than the other one. They do work differently. Lysodren/Mitotane mode of action is to erode a small portion of the adrenal gland so excess cortisol can not be produced. Lysodren/Mitotane does continue to "work" in a dog's system for 48 hours.

Trilostane/Vetoryl inhibits the production (the way it is made) of cortisol. Trilostane/Vetoryl has a short half-life so it is out of a dog's body in about 8 hours.


Also, do you agree that I should go to the Roanoke Animal Hospital that has an internal specialist on board? Or can any regular vet take care of this problem?? Gracie is only 9 so I am hoping that is to her advantage and Maltese typically live to be fairly old. And once the meds are regulated will the cost go down for the treatments?

If this were me, I would gravitate towards Roanoke and with Dr. Bridget Hickman, who specializes in Endocrinology.

[KennyJ]

Interesting take by this Vet. She has a 3 part series on Cushings.



Treatment Options

Most of the drugs currently available to treat Cushing’s disease have many undesirable side effects.

It’s extremely important that you discuss your concerns about the possible side effects of any drugs your veterinarian recommends for your pet. Do your own research as well and gauge your own comfort level with giving the medications to your animal.

In my practice, we don’t use most of the Cushing’s drugs because in my opinion, the side effects are usually worse than the symptoms of the disease itself.

In addition to side effects, Cushing’s medications are very expensive and require a great deal of monitoring of bloodwork to ensure the drugs are managed correctly.



http://healthypets.mercola.com/sites/healthypets/archive/2010/09/21/cushings-disease-caused-by-pet-stress.aspx






In my opinion, one drug is not "safer" than the other one. They do work differently. Lysodren/Mitotane mode of action is to erode a small portion of the adrenal gland so excess cortisol can not be produced. Lysodren/Mitotane does continue to "work" in a dog's system for 48 hours.

Trilostane/Vetoryl inhibits the production (the way it is made) of cortisol. Trilostane/Vetoryl has a short half-life so it is out of a dog's body in about 8 hours.



If this were me, I would gravitate towards Roanoke and with Dr. Bridget Hickman, who specializes in Endocrinology.

[Harley PoMMom]

Adverse effect are minimal if a vet follows the proper protocols for the drug they are prescribing. Almost anything has the potential for ill effects if consumed in overabundance.

[mytil]

I have just a sec and I do not want to dissuade you as you know your girl best, but, Cushing's is not a nice disease and it is very tough on the body and needs to be treated toughly. From my own experience and readings the holistic meds may treat or mask some of the symptoms, but they do not eliminate the root cause of Cushing's that causes immense levels of cortisol being produced and circulated through out the body continually even as the pup is on the holistic meds.

Yes, these meds need monitoring, and it seems the holistic meds do not - how can the cortisol levels be gauged if no periodic testing is done?

To get a second opinion I would contact the IMS Lori mentioned in Roanoke.

Have to scoot. Keep us posted
Terry

[Trish]

Well I feel sorry for her patients! Dr Becker's website is supported by a vitamin company so I am not surprised by her holistic approach, be careful what you read and stick to the websites by professionals in the endocrinology field as recommended by the experts here in the helpful resources section. :)

[Squirt's Mom]

Dr. Karen Becker - I'll let one of the others tackle this one and just say that her "think so's" are rather controversial. ;) For one thing, there is no known cause of conventional Cushing's - so exactly how does one go about preventing it?

One thing you can take to the bank - any time a vet says the traditional treatments are too harsh 1) they haven't had good luck with them probably because they refused to follow protocol in using them, 2) the dog was misdiagnosed (again the vet), 3) the vet is lazy or scared, or 4) the vet has their own program to tell you about.

Keep researching! You're doing good!

[KennyJ]

Harley, I was supposed to give Gracie the other half of her rimadyl this afternoon but decided against it because of her high liver enzymes. It is not helping her with the lameness, nor have I seen any improvement from yesterday's acupuncture. Not sure what my next step is for the injured leg. The holistic Vet wanted to get it squared away first. She is also part of the Roanoke Animal Hospital that has the IMS.

[molly muffin]

You said injured leg. What exactly happened to cause the injury?

Sharlene and Molly Muffin

[KennyJ]

You said injured leg. What exactly happened to cause the injury?

Sharlene and Molly Muffin

I am not sure. She did it during the day when I was not there.

[Harley PoMMom]

I believe the acupuncture may take a few sessions before improvement is seen. If my feeble memory serves me right :eek: I am sure we do have members that have their dogs receiving acupuncture, I can do a search later (right now I'm at work ;):eek:)

Love and hugs, Lori

[frijole]

I took my Annie in for acupuncture and it was a wonderful experience. That said not all vets are as experienced or as effective so the experience would of course vary... kind of like when you go to a massage therapist - some are just better at it than others.

She had an adrenal tumor that caused her to lose weight - alot of weight and she lost muscle mass and strength. She came out of those sessions like a new dog. She loved going to the vets. It made me a believer.

Give it a few sessions and look into your dog's eyes when you pick him/her up... that'll tell you if they like it and it's working or not. Kim

[lulusmom]

Hi and a big welcome to you and Gracie.

I love, love, love Maltese and have two boys, who are the light of my life. Neither have cushing's but do have other health issues. My cushdogs, both passed, were Pomeranians. Their cushing's was controlled for seven and five years respectively so don't believe that bunk about a two year survival rate.

Gracie's alkp elevations would be considered moderate to severe and I am wondering if you could let us know if there were any other abnormalities that we might be able to determine are consistent with cushing's. If you have copies of the the most recent bloodwork, please post the abnormal values, including the normal reference ranges. If you don't have the results, your vet should be happy to give you a copy.

Cushing's is one of the most difficult canine conditions to diagnose, especially when symptoms are mild or few. Based on what you've told us, it doesn't sound like Gracie has the usual overt symptoms we are used to seeing, such as drinking buckets and peeing lakes with lots of accidents in the house, as well as a huge appetite. Your description of Gracie's drinking and peeing habits doesn't quite paint the picture of a dog who is always at the water bowl and constantly peeing vast quantities of dilute urine. Your vet should have done a urinalysis to rule out a uti, check urine specific gravity, etc. Was this done? If so, can you please post the results? If not, I'd definitely have this done before launching into a cushing's diagnosis.

Is your girl spayed? Is she overweight and/or on a diet high in carbohydrates? I ask because I've read that there may be connection between these three things, the lipomas and high estrogen levels.

Dogs with cushing's are predisposed to cruciate ligament injuries so I am wondering if your vet determined the cause of your dog's lameness? Do you know how Gracie injured her leg? Did your vet do imaging and did he manipulate the hip and knee? Does Gracie looks like she has lost muscle mass and is weakened in her hind quarters?

Sorry for all the questions but the more history we have on Gracie, the better we can provide you with meaningful feedback and direct you to reference material that might be relevant.

Looking forward to hearing more about your precious Gracie.

Glynda

[KennyJ]

Thanks for your questions. The only other abnormal result from Gracie's lab work was a slightly higher than normal Cholesterol. I do not have the numbers but the Vet said her ALP was 3500. As far as her drinking she drinks a lot and she has a great appetite but I looked at her water bowl when I came home today and it looked like she barely touched her water. Yes, she does have accidents in the house but I figured it was because she is left alone for over 8 hours in the house without potty breaks while I am away at work. The fatty tumors or whatever they are all over her stomach and chest. When the first one showed up I took her to the Vet and he did a needle aspiration and was not concerned. Since then they have popped up everywhere.

I do not know how she hurt her leg. When I left the house that morning she was fine. I fix the chair where she can jump up and look out the window. Has never been a problem. She had gotten to the point that sometimes she had trouble climbing the stairs. I just chalked that up as her getting older. She was also having problems jumping up on the sofa like she used to. But again, every Maltese I have owned eventually got that way when they got older so I didn't think anything about it. I just had her to the Vet August 2012 for her yearly checkup and he never said anything about her pot belly appearance. Just told me to cut back on her food. She has never had a complete work up until this past Monday when I took her in for the injured leg. Even then I was the one that suggested having it done. So I do not have any other labs to compare this one to. I stopped the rimadyl after reading that it can damage the liver. She is still limping badly with no signs of improvement. I told the second vet that it looked like it was her hip that was injured. She agreed with the first vet that it was more like her knee. No xrays have been taken on either visit. I feed her Fromm whitefish dry kibble. Any advice would be greatly appreciated. I guess the next thing I need to do is have the ACTH stim test completed. The holistic vet wanted to treat her leg injury first.





Hi and a big welcome to you and Gracie.

I love, love, love Maltese and have two boys, who are the light of my life. Neither have cushing's but do have other health issues. My cushdogs, both passed, were Pomeranians. Their cushing's was controlled for seven and five years respectively so don't believe that bunk about a two year survival rate.

Gracie's alkp elevations would be considered moderate to severe and I am wondering if you could let us know if there were any other abnormalities that we might be able to determine are consistent with cushing's. If you have copies of the the most recent bloodwork, please post the abnormal values, including the normal reference ranges. If you don't have the results, your vet should be happy to give you a copy.

Cushing's is one of the most difficult canine conditions to diagnose, especially when symptoms are mild or few. Based on what you've told us, it doesn't sound like Gracie has the usual overt symptoms we are used to seeing, such as drinking buckets and peeing lakes with lots of accidents in the house, as well as a huge appetite. Your description of Gracie's drinking and peeing habits doesn't quite paint the picture of a dog who is always at the water bowl and constantly peeing vast quantities of dilute urine. Your vet should have done a urinalysis to rule out a uti, check urine specific gravity, etc. Was this done? If so, can you please post the results? If not, I'd definitely have this done before launching into a cushing's diagnosis.

Is your girl spayed? Is she overweight and/or on a diet high in carbohydrates? I ask because I've read that there may be connection between these three things, the lipomas and high estrogen levels.

Dogs with cushing's are predisposed to cruciate ligament injuries so I am wondering if your vet determined the cause of your dog's lameness? Do you know how Gracie injured her leg? Did your vet do imaging and did he manipulate the hip and knee? Does Gracie looks like she has lost muscle mass and is weakened in her hind quarters?

Sorry for all the questions but the more history we have on Gracie, the better we can provide you with meaningful feedback and direct you to reference material that might be relevant.

Looking forward to hearing more about your precious Gracie.

Glynda

[KennyJ]

I noticed that the one medication comes in capsule form. I haven't had her ACTH stim test completed yet but how on earth do you get a capsule down your dogs throat?

[Harley PoMMom]

We hide them!!! :D You can use cream cheese, peanut butter, low fat deli lunch meat, or pill pockets...here is a link about pill pockets: http://www.greenies.com/dogs.aspx

[KennyJ]

Oh so they can be given with food?? I thought the meds had to be on an empty stomach.





We hide them!!! :D You can use cream cheese, peanut butter, low fat deli lunch meat, or pill pockets...here is a link about pill pockets: http://www.greenies.com/dogs.aspx

[Harley PoMMom]

I thought you were referring to the Cushing's medications, which have to be given with food. :o Sorry, what medicines are you asking about?

[KennyJ]

yes, I was. Sorry I have been reading so much on this disease that my brain is fried. I just want Gracie to be better. I can't imagine being without her.




I thought you were referring to the Cushing's medications, which have to be given with food. :o Sorry, what medicines are you asking about?

[Harley PoMMom]

As one of our Moderators would say: "Time to put Cushing's in a drawer and close it for a bit" oh, and "breathe"!!!!!!

[mytil]

If it were me I would focus on the injured leg first and I would see about getting an x-ray performed. It could be anything from a sprain to a torn ligament.

Keep us posted
Terry

[KennyJ]

Other than cancer, Cushings, or liver disease is there anything else that could have caused such an elevated ALP in Gracie. I have been watching her water bowl since the Vets suspected her of having Cushings and quite honestly I do not see that much water disappearing from her bowl. At times it does seem she drinks a lot but overall there is not a large amount of water leaving her bowl. Yes, she is pot bellied that is for sure. And yes she has accidents on the carpet but when you are left alone for 8 hours or more in the house with no potty breaks I am not sure that's a sign of a disease or she simply couldn't hold it because of the long hours. I know I couldn't.

[KennyJ]

Harley, what happens if they actually eat the capsule instead of it being digested the way it was intended?

[molly muffin]

I would first off get an xray of the leg, knee and hip area. I also ask about an cruciate ligament injuries that Glynda mentioned.
Get the leg fixed first. The thing is that with any kind of trauma or other issue going on, the ACTH is very possibly going to give a false positive as they will produce cortisol in reaction to the pain, injury, etc. So while it is an excellent test, you don't want to do it when there is something else there and use it as your main reason to treat for cushings.

Sharlene and Molly Muffin

[Harley PoMMom]

Harley, what happens if they actually eat the capsule instead of it being digested the way it was intended?

If the dog doesn't swallow the hidden pill, most times the dog will spit it out intact.

Both Trilostane/Vetoryl and Lysodren/Mitotane can be purchased in a liquid form.

Almost anything can cause elevations in the ALP, so lets try to get Gracie's leg figured out first, ok? Remember deep breaths, breathe in then out, breathe in then out!!! ;)

[lulusmom]

Hi Kenny.

Can you please answer the questions below?



Is your girl spayed? Is she overweight and/or on a diet high in carbohydrates?

I agree that Gracie's leg pain needs to be addressed and the sooner the better. You mentioned that your vet wanted to address the leg issue first. That's great but I'm not sure how you effectively treat a problem if you haven't done appropriate testing to determine what you're treating. :confused::confused::confused: Prescribing a serious NSAID like Rimadyl to a dog suspected of having cushing's to alleviate pain and hopefully address inflammation wherever the pain is eminating is simply not right, at least in my layperson's opinion. If Gracie were my dog and I had the funds or credit, I would get her in to a specialty hospital, where most often there are board certified orthopedic surgeons and internal medicine specialists on staff. If you let us know which city and state you are in, somebody may be able to give you a name or two. You can also look for specialists at www.acvim.org.

With respect to the elevated ALKP, it would really help if you could get a copy of Gracie's blood tests and make sure that the only abnormalities are ALKP and cholesterol. It is possible that there are other abnormalities but because elevated ALKP and cholesterol are common findings in cushing's, they are the only abnormalities your vet mentioned to you. There is a condition called hyperestrinism which involves elevated estrogen, specifically estradiol. This is the only intermediate hormone which can be found in other areas outside the adrenal gland and fatty tissue is one of them. Severe elevations in ALKP and enlarged liver, contributing to pot belly appearance, is common. Symptoms can be much the same as pituitary or adrenal dependent cushing's and not all dogs display all symptoms. How is Gracie's skin and coat?

The goal of cushing's treatment is to resolve problematic symptoms, which are usually more problematic for the pet owner than the dog. Since Gracie doesn't really have many symptoms, I believe it is too soon to worry about Vetoryl or Lysodren. I would, however, definitely talk to the vet about putting Gracie on liver support like SAMe or milk thistle. Depending on the cause of the ALKP elevations, it may not help with reducing or normalizing ALKP but it will help the overall health of the liver.

Glynda

[KennyJ]

You guys are amazing. I agree with you on the anti-inflammatory meds and I quit giving her the meds yesterday. Gracie is over weight and that's the only thing my Vet up until Monday had ever said to me. I did ask about anything else being abnormal and those were the only two they said came back abnormal. I feel Gracie Fromm's dog food. One of the best dog foods out there. I live in Roanoke, VA and we have a Vet school at Virginia Tech. I contacted one of the doctors at the Vet school about the elevated ALP and he said one of the vets up there could look at her but said not sure if she needs to be up there right now. Whatever that means. Both of the Veterinarians that saw Gracie this week said she could continue the rimadyl. I chose to stop it on my own. I ordered Gracie the chewable pill that contains Milk Thistle and SamE combined. I am lost right now. Not sure which way to turn. The second Vet I saw happens to have a Vet that specializes in internal medicine. When they asked me if Gracie drank a lot of water I said yes. However, I am checking her water bowl daily since they suspected Cushings and I do not see the water level going down that much. So yes it does look like she is lapping it up when I am here but the water bowl suggests otherwise if that makes sense. Gracie was spayed at a very early age. No xrays were done on the leg which totally confuses me.





Hi Kenny.

Can you please answer the questions below?



I agree that Gracie's leg pain needs to be addressed and the sooner the better. You mentioned that your vet wanted to address the leg issue first. That's great but I'm not sure how you effectively treat a problem if you haven't done appropriate testing to determine what you're treating. :confused::confused::confused: Prescribing a serious NSAID like Rimadyl to a dog suspected of having cushing's to alleviate pain and hopefully address inflammation wherever the pain is eminating is simply not right, at least in my layperson's opinion. If Gracie were my dog and I had the funds or credit, I would get her in to a specialty hospital, where most often there are board certified orthopedic surgeons and internal medicine specialists on staff. If you let us know which city and state you are in, somebody may be able to give you a name or two. You can also look for specialists at www.acvim.org.

With respect to the elevated ALKP, it would really help if you could get a copy of Gracie's blood tests and make sure that the only abnormalities are ALKP and cholesterol. It is possible that there are other abnormalities but because elevated ALKP and cholesterol are common findings in cushing's, they are the only abnormalities your vet mentioned to you. There is a condition called hyperestrinism which involves elevated estrogen, specifically estradiol. This is the only intermediate hormone which can be found in other areas outside the adrenal gland and fatty tissue is one of them. Severe elevations in ALKP and enlarged liver, contributing to pot belly appearance, is common. Symptoms can be much the same as pituitary or adrenal dependent cushing's and not all dogs display all symptoms. How is Gracie's skin and coat?

The goal of cushing's treatment is to resolve problematic symptoms, which are usually more problematic for the pet owner than the dog. Since Gracie doesn't really have many symptoms, I believe it is too soon to worry about Vetoryl or Lysodren. I would, however, definitely talk to the vet about putting Gracie on liver support like SAMe or milk thistle. Depending on the cause of the ALKP elevations, it may not help with reducing or normalizing ALKP but it will help the overall health of the liver.

Glynda

[KennyJ]

I asked the Vet if Gracie's leg injury could have elevated her ALP and she said there is no way it would have elevated it. Not this particular liver enzyme. Like you I thought I had read any kind of trauma could elevate this enzyme. Both Vets said no. Again, I am so torn on what to do. I have already spent close to $600 this past week and I don't know anymore than I did before I took her to the two vets. Other than she is pot bellied, has numerous lumps all over stomach and chest and now has an injured leg.





I would first off get an xray of the leg, knee and hip area. I also ask about an cruciate ligament injuries that Glynda mentioned.
Get the leg fixed first. The thing is that with any kind of trauma or other issue going on, the ACTH is very possibly going to give a false positive as they will produce cortisol in reaction to the pain, injury, etc. So while it is an excellent test, you don't want to do it when there is something else there and use it as your main reason to treat for cushings.

Sharlene and Molly Muffin

[Squirt's Mom]

Originally Posted by lulusmom

Is your girl spayed?

Is she on a diet high in carbohydrates?

How is Gracie's skin and coat?

:D Ya missed a few.... :D

[KennyJ]

I went back and added that she was spayed at the earliest age permitted when she was a pup. Her hair in my opinion looks fine. Not that thin. Here are the ingredients of her dog food.



Flavor

Whitefish and Potato



Ingredients

Whitefish, Potato, Menhaden Fish Meal, Sweet Potato, Brown Rice, Pearled Barley, Oatmeal, White Rice, Herring Meal, Whole Dried Egg, Millet, Dried Tomato Pomace, Safflower Oil, Cheese, Flaxseed, Salmon Oil (preserved with mixed tocopherols), Carrots, Broccoli, Cauliflower, Apples, Lecithin, Chicken Cartilage, Potassium Chloride, Monosodium Phosphate, Calcium Sulfate, Cranberries, Blueberries, Salt, Monocalcium Phosphate, Chicory Root Extract, Alfalfa Sprouts, Yucca Schidigera Extract, Folic Acid, Parsley, Lactobacillus Acidophilus, Bifidobacterium Longum, Lactobacillus Plantarum, Enterococcous Faecium, Vitamin A, D3, E, B12 Supplements, Choline Bitartrate, Niacin, Pantothenic Acid, Ascorbic Acid, Riboflavin, Thiamine Mononitrate, Pyridoxine Hydrochloride, Biotin, Zinc Sulfate, Ferrous Sulfate, Manganous Sulfate, Copper Sulfate, Cobalt Carbonate, Calcium Iodate, Sorbic Acid, Iron Proteinate, Zinc Proteinate, Copper Proteinate, Manganese Proteinate, Sodium Selenite.



Guaranteed Analysis

Protein 23% Min

Fat 11% Min

Fiber 3.5% Max

Moisture 10% Max

Ash 6.5% Max

Omega 6 Fatty Acids 2.2% Min

Omega 3 Fatty Acids 0.3% Min

Lactobacillus Acidophilus 100,000,000 CFU/lb Min

Bifidobacterium Longum 100,000,000 CFU/lb Min

Lactobacillus Plantarum 100,000,000 CFU/lb Min

Enterococcous Faecium 100,000,000 CFU/lb Min

Calcium 1.0%

Phosphorus 0.85%

Sodium 0.4%

Potassium 0.6%

Magnesium 0.12%

Zinc 135 mg/kg

Iron 229 mg/kg

Manganese 70 mg/kg

Copper 11.0 mg/kg

Cobalt 0.4 mg/kg

Iodine 1.53 mg/kg

Selenium 0.47 mg/kg

Glucosamine 400 ppm

Chondroiten 40 ppm

Vitamin A 18,200 IU/kg

Vitamin D 1,300 IU/kg

Vitamin E 180 IU/kg

Vitamin K 1.52 mg/kg

Vitamin B12 0.10 mg/kg

Choline Chloride 2,320 mg/kg

Niacin 82 mg/kg

Pantothenic Acid 26 mg/kg

Ascorbic Acid (Vit C) 38 mg/kg

Riboflavin 7 mg/kg

Thiamine 8.7 mg/kg

Pyridoxine 4.2 mg/kg

Folic Acid 1.4 mg/kg

Biotin 0.3 mg/kg





:D Ya missed a few.... :D

[KennyJ]

I have been reading other posts in the forum and so far it looks like my little Gracie has the highest reading yet on the ALP. Her's was 3500 and so far I haven't seen any other dog with an elevation that high. I am scared to death.

[lucylovesdogs]

Sorry to trouble, but how did you start a new thread?

[Squirt's Mom]

Hi Lucy (Kenny - pardon the thread hijack for a sec),

You and your baby have a thread started on the Question and Discussion board. Check your email for a message from us to which you need to reply so your posts will no longer be delayed. Thanks!

[Budsters Mom]

Kenny,
Buddy,s ALP tested greater than 2000. His test only registers to 2000, so I have no idea how much higher it really is!!:(
3500 is really high, but it might not be the highest! What matters most is overall health. We look at the whole picture, not just high numbers. I know all of this is scary. We have all been there or are going through it now. Our experts are pros at getting to the nitty-gritty. Hang in there with us.;)

Hugs,
Kathy and Buddy:cool:

[molly muffin]

Hi Kenny,

No the leg problem wouldn't cause the ALKP to be high, but it would cause the cortisol to be high which is what you test if you do the ACTH test for cushings. That is why I am saying you don't want to do the cushing test (ACTH) while her leg is hurt.


ALKP, ALKALINE PHOSPHATASE - this enzyme is found in many different tissues within the body, primarily liver, bone, intestines, and kidneys. Increased ALP levels can be seen with liver disease and gallbladder disorders. In addition, drugs such as corticosteroids and phenobarbital can cause increased ALP levels. Very high ALP levels can be seen in dogs with adrenal gland disease as well.


However, you have to look at the big picture. My Molly's ALKP's started to go up when she first started getting crystals, which cause stones. The whole body can be affected by one thing. It's like a fine tuned machine that all works together. I think she (molly) is in the 800's now.

Because of Gracies ALKP being so high, it is worth finding out if this is cushings related,. I'm just not sure if the ACTH test would be accurate due to the cortisol being increased due to the leg problem. High cortisol causes cushings, that is usually caused by one of three things, adrenal tumor, pituitary tumor or having given steroids for a period of time (long). However, cortisol is also a response, if they get scared, excited, nervous, it can go up, if they have hurt, it would go up to try to help relieve the pain and that can mess with the cushing test.

I asked about the xray because when my molly was having problems jumping up and down, acting like she had hurt her leg, they did an xray. I knew from a previous xray that molly has one joint that isn't grooved right and that can cause her pain, even to pop out of socket, which has never happened, but it would be a possibility. That just seems that if you have an injury it would be one of the things that would be done to see what the injury is.

You're doing great Kenny. The greatest thing that we can have is knowledge and you are doing everything to gain that knowledge and be a great advocate for Gracie's care. So don't get discouraged, because you're doing fantastic.

Sharlene and Molly Muffin

[Squirt's Mom]

My Squirt was diagnosed with PDH, the pituitary form, based on five different tests - LDDS, HDDS, ACTH, UTK panel, and ultrasound. The second ultrasound they told me about a tumor on her spleen. Once the tumor was out, her cortisol returned to normal and remained that way for several years. It was the stress of the tumor causing elevations in the cortisol, not conventional Cushing's. If I had started treatment based on one or two tests without knowing about that tumor, she would more than likely not be here today due to it rupturing plus have been put on a powerful med she did not need at that time. So it is always prudent to rule out as many possible causes for elevations in cortisol before starting treatment.

[KennyJ]

Ok, what should I ask for next? An xray of the leg or an ultrasound of her stomach?? Or both?? I noticed both clinics say they can do an ultrasound but neither offered. I just simply do not understand why neither clinic offered to perform these. And I take Gracie for her annual checkup, why didn't the Vet ever perform lab work during her annual physical? Right now I am getting angry that this slipped under the radar when I always take her in for her checkups. Are all clinics experienced to perform all those tests?





My Squirt was diagnosed with PDH, the pituitary form, based on five different tests - LDDS, HDDS, ACTH, UTK panel, and ultrasound. The second ultrasound they told me about a tumor on her spleen. Once the tumor was out, her cortisol returned to normal and remained that way for several years. It was the stress of the tumor causing elevations in the cortisol, not conventional Cushing's. If I had started treatment based on one or two tests without knowing about that tumor, she would more than likely not be here today due to it rupturing plus have been put on a powerful med she did not need at that time. So it is always prudent to rule out as many possible causes for elevations in cortisol before starting treatment.

[KennyJ]

I am also wondering how long it will take for her leg to heal? It's been a week and she is still limping.






Hi Kenny,

No the leg problem wouldn't cause the ALKP to be high, but it would cause the cortisol to be high which is what you test if you do the ACTH test for cushings. That is why I am saying you don't want to do the cushing test (ACTH) while her leg is hurt.



However, you have to look at the big picture. My Molly's ALKP's started to go up when she first started getting crystals, which cause stones. The whole body can be affected by one thing. It's like a fine tuned machine that all works together. I think she (molly) is in the 800's now.

Because of Gracies ALKP being so high, it is worth finding out if this is cushings related,. I'm just not sure if the ACTH test would be accurate due to the cortisol being increased due to the leg problem. High cortisol causes cushings, that is usually caused by one of three things, adrenal tumor, pituitary tumor or having given steroids for a period of time (long). However, cortisol is also a response, if they get scared, excited, nervous, it can go up, if they have hurt, it would go up to try to help relieve the pain and that can mess with the cushing test.

I asked about the xray because when my molly was having problems jumping up and down, acting like she had hurt her leg, they did an xray. I knew from a previous xray that molly has one joint that isn't grooved right and that can cause her pain, even to pop out of socket, which has never happened, but it would be a possibility. That just seems that if you have an injury it would be one of the things that would be done to see what the injury is.

You're doing great Kenny. The greatest thing that we can have is knowledge and you are doing everything to gain that knowledge and be a great advocate for Gracie's care. So don't get discouraged, because you're doing fantastic.

Sharlene and Molly Muffin

[Harley PoMMom]

Is Gracie able to put any weight on her injured leg? Since improvement has not be seen with her leg an Xray, I believe, would be the next step.

[frijole]

I agree - focus on the leg! Make sure they look at the whole thing including the hip and spine just to make sure. Kim

[KennyJ]

She is able to put some weight on her leg, however, she is still limping noticeably. There are times it looks as if it's getting better. Does Cushings have anything to do with all the fatty tumors or cysts that are on Gracies' stomach and chest. Here it is almost 12:00 am and I am still looking at all this stuff. The more I look the more depressed I get. This forum is the only place I see encouraging words about this disease. And if I can't get the ACTH test done for Cushings because of the leg injury causing elevated cortisol this could take me forever. So very stressed right now.




Is Gracie able to put any weight on her injured leg? Since improvement has not be seen with her leg an Xray, I believe, would be the next step.

[Budsters Mom]

Please Kenny,
Take a few deep breaths and try to get some rest. You are a doing a wonderful job with Gracie. She is very lucky to have you. I know it is hard, but you need to take care of yourself so you can be strong for her. It is very easy to get depressed and overwhelmed, I've been there, most of us have. We gather strength, and hope from each other. That is how we get through very trying times. You are not alone in this. We will be with you every step of your journey. Now please, give Gracie a belly rub and leave it for tonight.

Sending you a great big hug,
Kathy and Buddy:cool:

[doxiesrock912]

Kenny, this is going to sound silly but make a long loop out of ladies stockings and loop it around Gracie when she walks so that you can help to support her. It might help the healing process and she'll still get exercise which is important.

[KennyJ]

Trying to visualize this but not sure I understand exactly what you mean.






Kenny, this is going to sound silly but make a long loop out of ladies stockings and loop it around Gracie when she walks so that you can help to support her. It might help the healing process and she'll still get exercise which is important.

[mytil]

Hi again,

VT has an amazing vet school, my own vet studied there. Anyway, I know it can be very over whelming - all of us have been through what you are going through.

Basically what doxiesrock912 is saying is to make a sling with pantyhose and loop it under her belly/hip to give support when she walks or goes up stairs.

I would get an xray. That way you know exactly what you are dealing with straight away regarding the leg and then if you are able an ultrasound to take a look at her liver and adrenal glands. I would get with VT and see about the pricing they have for this - it would be cheaper I bet.

Keep us posted
Terry

[Squirt's Mom]

You can use anything as a sling when needed to provide a bit of support. Take hose, towel, sheet, whatever and run it under Gracie's belly then you hold the two end in your hand(s) and lift a little bit so some of the weight is off her legs. This works well if the back legs need help but is a bit trickier to use for the front legs as the sling wants to slide back.

Now, Cushing's is a very slowly progressing condition taking years to do any real damage to organs. Most cush pups aren't diagnosed until they have already had the condition for several years and once treatment starts to work these pups turn around and become more of their old selves. Cushing's sounds absolutely horrible but once you understand what is happening and why and what can be done you start to understand this is not a death sentence - IF Gracie even has Cushing's. ;) We're kinda getting the cart before the horse. ;)

What you'll want to do for Gracie is call the vet first thing Monday morning and make an appt to get her leg checked out. You need to know if this is ligament damage, luxating patellas, something with the spine, ect....or simply an injury. If the ACL or Cruciate ligament has been damaged or the patellas are moving around, she may need surgery to correct that. And before you panic, yes cush pups can have surgery, can have anesthesia, and do just fine. Not that that fact has ever kept me from panicking but maybe you are not as bonkers as I am! :D So finding out what is wrong with the leg is the first step, 'k?

The fatty lumps and bumps could be what are called Lipomas - Squirt is covered in them now. She started with three on her chest and now has several. They are typically no problem at all unless they are in a place that can interfere with the gait, then they may need removed. Are any of her lumps close to the shoulder/leg that might be causing her pain when she walks? Could they be the source of her limp? Something else to ask the vet when you have her leg checked. ;)

When I first started reading about Cushing's I would read something that sounded awful...then realize the site was talking about human or equine Cushing's, not canine. It seems that canine Cushing's is bit gentler than in either of the other species and more easily controlled. But it is not easy to diagnose in any species. Cushing's is just a very quiet, sneaky, deceptive condition.

I think I cried for about 6 months after first hearing the word Cushing's and the more I read online the worse I felt. Nothing made sense - they might as well have been written in Greek. The few things I could understand scared the crap outta me. Our vet at the time, who was wonderful, was very conservative and did not rush to put Squirt on either Vetoryl or Lysodren - actually at that time (2008) she had never heard of Vetoryl because it wasn't approved in the US yet and was still in the early days in EU. I joined every canine Cushing's group I could find and started talking. They made me feel even worse - one lady actually told me I might as well put a bullet in Squirt's head as follow her vet's directions. :eek::(:mad: Our vet's directions, willingness to work as a team, and conservative approach saved Squirt's life and gave me time to learn how to help her. When I found this group these amazing folks took my hand and started talking calmly and knowledgeably to me, and gently led me along until I could once again breath and start to think a little bit. They saved my sanity - what little there was to save in the first place anyway! :p

I have some good links that I will give you but don't want you to look at them today. Today I want you to turn the computer off and spend the day with your sweet girl. Just enjoy the day with her and try not to worry about what might be. Gracie has no idea anything could be wrong - dogs don't think like we do, projecting and worrying but rather they live in this moment only. So for today, you live in each moment with Gracie, putting all this stuff out of your mind as best you can. Go to the park, go for a ride, curl up on the couch and watch movies with her in your lap - something fun and relaxing that you both enjoy. Just no flyball or Frisbee, etc. until you know what is going on with her leg. ;)

You're a good dad and Gracie is lucky to have you on her team. Don't forget that.
Hugs,
Leslie and the gang

The links -

Long Beach Animal Hospital*
http://www.lbah.com/canine/cushings.htm

Newman Veterinary*
http://www.newmanveterinary.com/CushingDiag.html

Cushing’s signs and pics*
http://www.newmanveterinary.com/CushSignFrame.html

Mar Vista Animal Medical Center*
http://www.marvistavet.com/html/cushing_s_disease.html

Kate Connick*
http://www.kateconnick.com/library/cushingsdisease.html
(This site, Kate Connick, is a tad bit out of date but she has a great list of common cush signs)

[frijole]

You've been given great advice - I just want to 2nd what has been said. Most of us had dogs with cushings for YEARS and we accidentally discovered it. There is no rush to treat or diagnose so don't lose a minute's sleep. Both my girls had those bumps on their tummies - one of them had cushings the other did not. Again unless one of them is impeding ability to walk they are not your priority or concern - the leg is the only focus right now. Kim

[KennyJ]

She can put pressure on that leg but still walks with a limp. Matter of fact she can even run with it but runs with a limp. When she squats to urinate she is always using the injured leg to plant herself. I find that very odd since that's the injured one. If the liver enzyme ALP had not been so high I might be less stressed. To look at Gracie you would never know anything was wrong. She is currently standing at the door going crazy over a squirrel. I just don't understad.





You've been given great advice - I just want to 2nd what has been said. Most of us had dogs with cushings for YEARS and we accidentally discovered it. There is no rush to treat or diagnose so don't lose a minute's sleep. Both my girls had those bumps on their tummies - one of them had cushings the other did not. Again unless one of them is impeding ability to walk they are not your priority or concern - the leg is the only focus right now. Kim

[molly muffin]

Molly never raises the leg that bothers her, even now, but always uses it to stance herself and raises the other one. I think it would hurt to try to raise that leg. So probably the same thing for Gracie.

It depends on what is causing the leg injury. It could take weeks. The last time Molly hurt hers she was off her normal self for awhile. Probably limped for just over a week, but another month before she wanted to really do any jumping up onto the couch. That was with nothing torn, just a pull from a missed jump up the stairs. I heard her yelp when it pulled as she was tearing up the staircase from the basement at 100mph.

That is good that Gracie feels good though and is barking at squirrels. Always a good sign when they have interest.

As for your question on the tests. Molly got blood tests done once a year, at her wellness check, or when I would take her in for something, like diarrhea. Then when she turned 8 or 9 I think they started to do the senior wellness check every year, which is a few added tests to catch things that can crop up once they start getting older and yes, all the vets can do them.

As for ultrasound, xray, as long as they have the equipment and someone to read the results they can do them. My vet's office has the xray and can do those, but for the ultrasound I had to go to the specialist.
I hope you and Gracie have a good day. Ii'd get an xray first if you don't notice any improvements, if you are seeing improvements, then you might not need to and it will heal)

Sharlene and Molly Muffin

[KennyJ]

Both places that I took Gracie have the equipment, including where Gracie has been going since she was a pup. Neither said anything about giving her an xray or ultrasound. The vet that I took her to for the injured leg said her dog had Cushings and died a year after she found out. Not very encouraging would you say?? She did say she could refer her to the Vet School at Virginia Tech but when I contacted my friend at the Vet School he said it didn't sound like maybe she needed it yet. This is why I am so confused. Elevated liver enzyme at 3500 and yet nothing is being done about it. That's not slightly high, that's out of the world high. I go between being angry and depressed over this. Not to start another post so I will ask in here. I need to get Gracie some more dog food and if you scroll up you can see I feed her Fromm Whitefish and Potato. Should I switch her to another brand?





Molly never raises the leg that bothers her, even now, but always uses it to stance herself and raises the other one. I think it would hurt to try to raise that leg. So probably the same thing for Gracie.

It depends on what is causing the leg injury. It could take weeks. The last time Molly hurt hers she was off her normal self for awhile. Probably limped for just over a week, but another month before she wanted to really do any jumping up onto the couch. That was with nothing torn, just a pull from a missed jump up the stairs. I heard her yelp when it pulled as she was tearing up the staircase from the basement at 100mph.

That is good that Gracie feels good though and is barking at squirrels. Always a good sign when they have interest.

As for your question on the tests. Molly got blood tests done once a year, at her wellness check, or when I would take her in for something, like diarrhea. Then when she turned 8 or 9 I think they started to do the senior wellness check every year, which is a few added tests to catch things that can crop up once they start getting older and yes, all the vets can do them.

As for ultrasound, xray, as long as they have the equipment and someone to read the results they can do them. My vet's office has the xray and can do those, but for the ultrasound I had to go to the specialist.
I hope you and Gracie have a good day. Ii'd get an xray first if you don't notice any improvements, if you are seeing improvements, then you might not need to and it will heal)

Sharlene and Molly Muffin

[Squirt's Mom]

No, I would not switch from Fromm. That is one of the very best feeds available and you just can't beat it. So unless there is a digestive issue for Gracie with what she is eating now, I wouldn't change a single thing. ;) If I could afford Fromm or Acana, that is what mine would be eating.

[Squirt's Mom]

Let me share something our IMS told me about Squirt's ALP. Hers is often off the charts - too high to register. It worries me no end but the IMS told me that the ALP value represents living cells and they can be elevated for any number of reasons that do not indicate a serious health issue. The other liver values - ALT, AST, GGT - represent dying liver cells and they do indicate a problem with the liver if there are consistent elevations in these values. But he told me not to worry about the ALP when it was the only one elevated....even when it's off the charts.

[doxiesrock912]

That's good to know!

[frijole]

The vet that had a dog die after one year of treating cushings is probably not the one I'd go to. I say this because if treated properly there is no reason whatsoever they can't lead a normal life unless something else is going on. Probably the reason that the vets at VA Tech said it was premature to visit them is that they are usually involved once there is a diagnosis because any vet should be able to determine if there is cushings. They also might not think your dog has cushings based on your conversation with them. I'm guessing they were trying to save you a trip and some money.

Let's say that your dog does have cushings' and the leg issue is as a result of it. The excess cortisol created by the cushing's is actually relieving your dog from pain. Once you start treating cushings that pain med called cortisol would be decreased and your dog would be in more pain. So what we are saying is simply get the leg checked out to see if it is something more than muscle waste caused from cushings. You should be able to get the answer to this rather quickly.

Once you do that you can focus on the next step. If the leg needs surgery you can have it done and treat the cushing's afterwards. If it does not then you can go down the cushing's path.

The cause of the high liver alk phos enzyme could be so many things. If you want to reduce it right away while you are checking out the leg I would purchase milk thistle at any drug store and pour some of the capsule with each meal into the food. My cush dog's alk phos got up to nearly 2000 and after giving milk thistle it went down to 800. Cush dogs alk phos never returns to normal so this was a great change and made me a believer in it. If you can find milk thistle with SamE that is even better.

One way to measure thirst level (above normal or not) is to measure water intake. Your dog should be drinking approx 1 oz of water for every lb of weight a day. Measure it and you'll soon know if it is excessive. Cush dogs drink buckets of it. They also scarf down food as in they do not chew before they swallow and they hardly breath.

Again - get the appt to have the leg checked out and then you can test for cushings. But I would find a local vet that has more experience. You don't have to go to a specialist if you have a vet with experience. Kim

[lulusmom]

She can put pressure on that leg but still walks with a limp. Matter of fact she can even run with it but runs with a limp. When she squats to urinate she is always using the injured leg to plant herself. I find that very odd since that's the injured one. If the liver enzyme ALP had not been so high I might be less stressed. To look at Gracie you would never know anything was wrong. She is currently standing at the door going crazy over a squirrel. I just don't understad.

Until you figure out what is wrong with Gracie's leg, I would try to keep use of that leg to a minimum until you find out what's wrong with it. If she has a cruciate ligament injury, crate rest and exercise restrictions are usually prescribed. I seem to recall that one of your vets mentioned that Gracie's leg injury would not cause the high elevations in ALK. I'm not sure how the vet would know that if s/he doesn't even know what the injury is but to prove that statement wrong, and I'm not saying this is what is going on with Gracie, but bone cancer (more prevalent in big breeds) can cause very high levels of ALKP. Symptoms can be much the same as cruciate ligament injuries and luxated patellas with first symptom being persistent lameness in one limb. A bit of research showed that dogs with osteosarcoma can have 10 to 30 fold increases in ALKP. Mammary tumors can also cause elevations in ALKP but since Gracie was spayed as a puppy, that risk was seriously reduced. It's probably unlikely that Gracie has cancer but I wanted to validate what Kim has told you by showing you that there are many causes for elevations in ALKP, as well as reasons why a dog goes lame. Your challenge, like many of us before you, is to find a vet who does more than throw antibiotics or NSAID's at a problem and hope it works. :(:mad::(

Glynda

[KennyJ]

Oh lord, I actually thought about bone cancer. I pray it's not that.




Until you figure out what is wrong with Gracie's leg, I would try to keep use of that leg to a minimum until you find out what's wrong with it. If she has a cruciate ligament injury, crate rest and exercise restrictions are usually prescribed. I seem to recall that one of your vets mentioned that Gracie's leg injury would not cause the high elevations in ALK. I'm not sure how the vet would know that if s/he doesn't even know what the injury is but to prove that statement wrong, and I'm not saying this is what is going on with Gracie, but bone cancer (more prevalent in big breeds) can cause very high levels of ALKP. Symptoms can be much the same as cruciate ligament injuries and luxated patellas with first symptom being persistent lameness in one limb. A bit of research showed that dogs with osteosarcoma can have 10 to 30 fold increases in ALKP. Mammary tumors can also cause elevations in ALKP but since Gracie was spayed as a puppy, that risk was seriously reduced. It's probably unlikely that Gracie has cancer but I wanted to validate what Kim has told you by showing you that there are many causes for elevations in ALKP, as well as reasons why a dog goes lame. Your challenge, like many of us before you, is to find a vet who does more than throw antibiotics or NSAID's at a problem and hope it works. :(:mad::(

Glynda

[KennyJ]

WOW!!!! You just made my day. I would send you flowers if I could. Neither Vet said that to me. Just the opposite. I think I will find Vet number 3 starting tomorrow. This time I will get some answers.





Let me share something our IMS told me about Squirt's ALP. Hers is often off the charts - too high to register. It worries me no end but the IMS told me that the ALP value represents living cells and they can be elevated for any number of reasons that do not indicate a serious health issue. The other liver values - ALT, AST, GGT - represent dying liver cells and they do indicate a problem with the liver if there are consistent elevations in these values. But he told me not to worry about the ALP when it was the only one elevated....even when it's off the charts.

[KennyJ]

I ordered the type that has Milk Thistle and SamE combined. I almost purchased a bottle while I was out today. It was in capsule form and I wasn't sure how much I would give a 13 lb dog.





The vet that had a dog die after one year of treating cushings is probably not the one I'd go to. I say this because if treated properly there is no reason whatsoever they can't lead a normal life unless something else is going on. Probably the reason that the vets at VA Tech said it was premature to visit them is that they are usually involved once there is a diagnosis because any vet should be able to determine if there is cushings. They also might not think your dog has cushings based on your conversation with them. I'm guessing they were trying to save you a trip and some money.

Let's say that your dog does have cushings' and the leg issue is as a result of it. The excess cortisol created by the cushing's is actually relieving your dog from pain. Once you start treating cushings that pain med called cortisol would be decreased and your dog would be in more pain. So what we are saying is simply get the leg checked out to see if it is something more than muscle waste caused from cushings. You should be able to get the answer to this rather quickly.

Once you do that you can focus on the next step. If the leg needs surgery you can have it done and treat the cushing's afterwards. If it does not then you can go down the cushing's path.

The cause of the high liver alk phos enzyme could be so many things. If you want to reduce it right away while you are checking out the leg I would purchase milk thistle at any drug store and pour some of the capsule with each meal into the food. My cush dog's alk phos got up to nearly 2000 and after giving milk thistle it went down to 800. Cush dogs alk phos never returns to normal so this was a great change and made me a believer in it. If you can find milk thistle with SamE that is even better.

One way to measure thirst level (above normal or not) is to measure water intake. Your dog should be drinking approx 1 oz of water for every lb of weight a day. Measure it and you'll soon know if it is excessive. Cush dogs drink buckets of it. They also scarf down food as in they do not chew before they swallow and they hardly breath.

Again - get the appt to have the leg checked out and then you can test for cushings. But I would find a local vet that has more experience. You don't have to go to a specialist if you have a vet with experience. Kim

[Harley PoMMom]

Here's a good place to start, from our Resource Thread, to learn more about milk thistle: Milk Thistle/Sam-e and more (for liver "support") (http://www.k9cushings.com/forum/showthread.php?t=192)

[KennyJ]

Wouldn't that be in a 24 hour period?? How can I measure that if she isn't drinking while she is sleeping?? I hope that wasn't a stupid question but I was going to try this tomorrow.






The vet that had a dog die after one year of treating cushings is probably not the one I'd go to. I say this because if treated properly there is no reason whatsoever they can't lead a normal life unless something else is going on. Probably the reason that the vets at VA Tech said it was premature to visit them is that they are usually involved once there is a diagnosis because any vet should be able to determine if there is cushings. They also might not think your dog has cushings based on your conversation with them. I'm guessing they were trying to save you a trip and some money.

Let's say that your dog does have cushings' and the leg issue is as a result of it. The excess cortisol created by the cushing's is actually relieving your dog from pain. Once you start treating cushings that pain med called cortisol would be decreased and your dog would be in more pain. So what we are saying is simply get the leg checked out to see if it is something more than muscle waste caused from cushings. You should be able to get the answer to this rather quickly.

Once you do that you can focus on the next step. If the leg needs surgery you can have it done and treat the cushing's afterwards. If it does not then you can go down the cushing's path.

The cause of the high liver alk phos enzyme could be so many things. If you want to reduce it right away while you are checking out the leg I would purchase milk thistle at any drug store and pour some of the capsule with each meal into the food. My cush dog's alk phos got up to nearly 2000 and after giving milk thistle it went down to 800. Cush dogs alk phos never returns to normal so this was a great change and made me a believer in it. If you can find milk thistle with SamE that is even better.

One way to measure thirst level (above normal or not) is to measure water intake. Your dog should be drinking approx 1 oz of water for every lb of weight a day. Measure it and you'll soon know if it is excessive. Cush dogs drink buckets of it. They also scarf down food as in they do not chew before they swallow and they hardly breath.

Again - get the appt to have the leg checked out and then you can test for cushings. But I would find a local vet that has more experience. You don't have to go to a specialist if you have a vet with experience. Kim

[Harley PoMMom]

Yes, in a 24 hour period you want to measure Gracie's water intake. See how much water her water bowl holds, then when the 24 hour period is up, measure what's left in her bowl.

And I want you to know that there is no such thing as a stupid question, ok? ;) Please ask anything you want and, hopefully, we will have an answer for you.

[KennyJ]

Ok heres what I was asking. Lets say I fill her bowl at 8 am how can I accurately measure at 24 hours if part of that time she will be asleep?






Yes, in a 24 hour period you want to measure Gracie's water intake. See how much water her water bowl holds, then when the 24 hour period is up, measure what's left in her bowl.

And I want you to know that there is no such thing as a stupid question, ok? ;) Please ask anything you want and, hopefully, we will have an answer for you.

[frijole]

Wouldn't that be in a 24 hour period?? How can I measure that if she isn't drinking while she is sleeping?? I hope that wasn't a stupid question but I was going to try this tomorrow.

:D:D:D:D:D:D

Alot of cush dogs are up all night drinking my friend! I meant it when I said buckets :) Since the norm is an oz per lb per day (which is 24 hrs) we measure it over that same period so we can see if it is above normal or not.

What I did to make it easy (I had 2 dogs) was I filled a bowl and marked the water level with tape. I calculated how much was drank for that timeframe and then I refilled it to the same spot and repeated for several days. It's real easy. Kim

[frijole]

Ok heres what I was asking. Lets say I fill her bowl at 8 am how can I accurately measure at 24 hours if part of that time she will be asleep?

If you fill it at 8 am 24 hrs later is 8 am. That will tell you how much she drank in that period. You fill it up again at 8 am and measure it at 8 am the next day. Got it?

The goal is to have a total for the entire day.

[KennyJ]

Yes, but she sleeps with me at night and never gets up to drink at night. So I guess I can fill it up at 8 am, measure it at 8 pm. And do the same thing for the next day?? She is sound asleep over by the door and hasn't touched her water bowl in probably 2 hours.





If you fill it at 8 am 24 hrs later is 8 am. That will tell you how much she drank in that period. You fill it up again at 8 am and measure it at 8 am the next day. Got it?

The goal is to have a total for the entire day.

[Budsters Mom]

If she doesn't drink any water at 8 PM to 8 AM, she is not drinking water excessively! Buddy used it down a full bowl, then in about 15 minutes be looking for more. He needed to have a water bowl in the bedroom and I would hear him drinking several times a night. THAT IS EXCESSIVE!!;)

Hugs,
Kathy and Buddy:cool:

[KennyJ]

I just measured out 13 ounces of water in her bowl. She weighs right at 13 lbs. The amount of water I see disappearing from her bowl when she is awake and active and the time she goes to bed is very close to that. So unless she is trying to wake me at night so I can let her down off the bed she is not drinking that much water. But she does have a pot belly and high ALP. If she plays with her stuffed animals she will drink more water.





If she doesn't drink any water at 8 PM to 8 AM, she is not drinking water excessively! Buddy used it down a full bowl, then in about 15 minutes be looking for more. He needed to have a water bowl in the bedroom and I would hear him drinking several times a night. THAT IS EXCESSIVE!!;)

Hugs,
Kathy and Buddy:cool:

[frijole]

Put more than 13 oz in it so you can see if she'll drink more than that. For example put in 20 oz. And if she doesn't leave your room at night you can measure it at 8 pm because it will be the same at 8 pm as it would be at 8 am. All good. I also believe she doesn't drink excessively - you'd know. But we can at least rule it out! :D

[KennyJ]

Sent you a private message. :)





Put more than 13 oz in it so you can see if she'll drink more than that. For example put in 20 oz. And if she doesn't leave your room at night you can measure it at 8 pm because it will be the same at 8 pm as it would be at 8 am. All good. I also believe she doesn't drink excessively - you'd know. But we can at least rule it out! :D

[Harley PoMMom]

I just now noticed Gracie as your avatar!! AWWWW, she is adorable!!!

[KennyJ]

She is my life!! I would be lost without her. I know someday I will have to let her go but I am just not ready yet.




I just now noticed Gracie as your avatar!! AWWWW, she is adorable!!!

[molly muffin]

Oh My Gosh! She is just soooo cute. How could one resist not constantly hugging on her. LOL

Sharlene and Molly Muffin

[Budsters Mom]

Gracie is adorable! :) None of us are ever ready to let our babies go! We feel exactly the same way about our fur babies. We will do all we can for you.

Hugs,
Kathy and Buddy:cool:

[KennyJ]

Thank you. I just wish her leg would get better. And those elevated liver enzymes would go away.





Oh My Gosh! She is just soooo cute. How could one resist not constantly hugging on her. LOL

Sharlene and Molly Muffin

[molly muffin]

I know Kenny. It just kills you inside when they hurt for any reason. They are little and we are the protectors of them (although I wouldn't tell them that because you know they think that protecting Us is Their job) :)

It's why I suggest the xray. When Molly hurt her leg, it was what we did and if she hurt it now, it is what I would do. I'd start giving the milk thistle/same 3 now (I give Molly Hepato Support, basically the same thing) and see what those liver numbers do. I'd get an ultrasound at some point to see how the, liver, adrenal, pancreas, spleen, etc all look. I'd also get copies of all test results and start my own file. That way no matter who you go to, you don't have to repeat tests and expense already done. Plus you'll have it for yourself and easy reference. This is something we encourage all members to do. Most of us have learned its the only way to be able to really see what is going on and what changes occur.

So if I was making a go forward plan, this would be it.

Sharlene and Molly Muffin

[KennyJ]

Thanks, not sure how long it will take to get the milk thistle/SamE combo delivered to me. Just placed the order the other day. Would I be crazy if I actually took her to yet another vet?





I know Kenny. It just kills you inside when they hurt for any reason. They are little and we are the protectors of them (although I wouldn't tell them that because you know they think that protecting Us is Their job) :)

It's why I suggest the xray. When Molly hurt her leg, it was what we did and if she hurt it now, it is what I would do. I'd start giving the milk thistle/same 3 now (I give Molly Hepato Support, basically the same thing) and see what those liver numbers do. I'd get an ultrasound at some point to see how the, liver, adrenal, pancreas, spleen, etc all look. I'd also get copies of all test results and start my own file. That way no matter who you go to, you don't have to repeat tests and expense already done. Plus you'll have it for yourself and easy reference. This is something we encourage all members to do. Most of us have learned its the only way to be able to really see what is going on and what changes occur.

So if I was making a go forward plan, this would be it.

Sharlene and Molly Muffin

[KennyJ]

Thank you. I just read Apollo's story and started sobbing like a baby. I am not supposed to cry like this.




Gracie is adorable! :) None of us are ever ready to let our babies go! We feel exactly the same way about our fur babies. We will do all we can for you.

Hugs,
Kathy and Buddy:cool:

[frijole]

:D We are all in love with our babies. Lots of members have been here a very long time so we've grown to love them all. Tears of happiness and sadness are common here so you fit right in. :D

[molly muffin]

Says who? :)

I don't know how many of us have sat at our desks, at our laptops, tablets, with tears running down our face, sometimes just sobbing, because we have lost one of our beloved furbabies and their parents are hurting so much. It is heart breaking.

I know, big tough football players don't cry over dogs. Well, that would be a myth. Empathy knows no size, no occupation, no sport and no gender. It's a gift and one that is sometimes a difficult one to carry, but it makes us all better humans to have it.

Around here we recommend investing in klenex. We go through a lot of it. :)

Sharlene and Molly Muffin

[doxiesrock912]

You're human, yes you are supposed to cry like this.
Animals love us unconditionally and anyone who can't form attachment to them has something missing.

[lulusmom]

Would I be crazy if I actually took her to yet another vet?

No, you would not be crazy. You need to find another vet who will tell you what is wrong with Gracie's leg. Her leg takes priority over worrying about her water intake. I had two cushdogs and I didn't have to measure their water to know that they were drinking too much. They were at the water bowl constantly and they wouldn't just take just a lap or two. They were guzzling water like they'd been in the desert for days.

If you let us know what city and state you are in, members may be able to give you the name of a good orthopedic vet in your area.

Glynda

[KennyJ]

Yeah, people think of us as hard hitting tough guys on the field and think that's the way we are off the field. At one time that may have been the case but age softens you up. I am a big softie and when it comes to animals, kids being abused and the elderly doesn't take much to get my tears to start flowing. By the way, not sure if any of you have ever heard of Morgan Harrington. She was the young lady that left the Metallica concert in Charlottesville, Va and was later found murdered. I have been helping the family keep her story in the media. If you google my name and Morgan Harrington you will see me doing all kinds of interviews. Plus getting her on Nancy Grace, AMW and a few other national shows. It's been a tough road for this family. Please keep them in your prayers.





Says who? :)

I don't know how many of us have sat at our desks, at our laptops, tablets, with tears running down our face, sometimes just sobbing, because we have lost one of our beloved furbabies and their parents are hurting so much. It is heart breaking.

I know, big tough football players don't cry over dogs. Well, that would be a myth. Empathy knows no size, no occupation, no sport and no gender. It's a gift and one that is sometimes a difficult one to carry, but it makes us all better humans to have it.

Around here we recommend investing in klenex. We go through a lot of it. :)

Sharlene and Molly Muffin

[KennyJ]

Roanoke, Va. I also work at Virginia Tech where we have a Vet school. I really don't want to take her there right now unless I have to. But if you can locate
a specialist in my city that would be excellent. Thinking about taking her to Vallery Animal Hospital in Roanoke.


http://www.valleyanimalhospital.com/




No, you would not be crazy. You need to find another vet who will tell you what is wrong with Gracie's leg. Her leg takes priority over worrying about her water intake. I had two cushdogs and I didn't have to measure their water to know that they were drinking too much. They were at the water bowl constantly and they wouldn't just take just a lap or two. They were guzzling water like they'd been in the desert for days.

If you let us know what city and state you are in, members may be able to give you the name of a good orthopedic vet in your area.

Glynda

[KennyJ]

I thought this was pretty special. I just finished mentioning Valley Animal Hospital and they just left me a message on Facebook. Her husband owns Valley Animal Hospital. If anyone would like to add me on Facebook my name is same as here. But I do a lot of work with Morgan Harrington so you may have to turn off you news feeds.



Valley Animal Hospital

Oops...I left the message on your page. Here's a copy...
Hi Kenny,
We were out of town today, and were going to call you tomorrow to find out more about your sweet little Gracie. We open at 7:30 tomorrow morning. I will text Debbie and let her know the situation, so ask for her when you call. I know how it is to feel helpless when your best friend is not feeling well....we will do our best to help her and her favorite human. 366-3433
Denise Poage

[doxiesrock912]

That's a wonderful message Kenny :)

By the way, I send you a LinkedIn invitation. If you read the message that goes with it, you'll know that it's from me here.

Good luck tomorrow!

[KennyJ]

Got it and thank you.





That's a wonderful message Kenny :)

By the way, I send you a LinkedIn invitation. If you read the message that goes with it, you'll know that it's from me here.

Good luck tomorrow!

[molly muffin]

Hi Kenny
okay First thing call back the vet that caled you yesterday and ask if they have an IMS on staff and if thy do xrays and ultresounds and get that leg takencare of. It could be a torn ligament or something that needs tobe treated.
Let us know how it goes Sharlene and molly muffin

[KennyJ]

Ok, finally an xray. Just what I thought. Torn ACL. He says with the possibility of Cushings that he thought Gracie needed surgery because Cushings slows down the healing process. I asked him about the two Vets that work for his clinic that have a special interest in Internal Medicine. He said none of them were specialist. So a little confused on that one. He also said something about Gracie's intestines showing up on the xray that looked like they were bulging. He really scared me about this but he did say that too could be because of Cushings. And he mentioned Leukemia. Turns out that some of Gracies White Blood Cells were lower than normal and that was also a sign of Cushings. When he performs the Cushings test he does not want to do the ACTH test like the other Vets. He wants to do the other one that takes all day. Is this test more conclusive? Again, I am looking at a lot of money that is going to come out this year on Gracie. Needless to say I am a nervous wreck. The healing of the ACL will take months of keeping her inactive. :confused:





Hi Kenny
okay First thing call back the vet that caled you yesterday and ask if they have an IMS on staff and if thy do xrays and ultresounds and get that leg takencare of. It could be a torn ligament or something that needs tobe treated.
Let us know how it goes Sharlene and molly muffin

[frijole]

He is talking about doing the low dose dex suppression test which is an 8 hr draw. It is prone to false positives when other things are going on and trust me the torn ACL would more then likely give you a false positive so I would NOT do that test at this time.


What is he suggesting you do to heal the torn ACL? Again the cushings in her system (if she even has it) would help treat it. I'm hoping some of our members that have been through this can chime in.

[KennyJ]

Ok, are you guys ready for this?? The owner of the Clinic that I have taken Gracie to since a pup called me this afternoon. He said first of all the price of repairing the ACL was too high, he would do it for half the price. Secondly, he said they do not normally repair the ACL of the smaller dogs. Confused. Very confused. And when I told him the type of test that Valley Animal Hospital wanted to run, the dex suppression test he said that is not their first choice. He wants me to bring a urine sample in from Gracie and then they would do a ACTH stim test. So again, by now I am so confused I am completely lost. Now here comes the biggie. When I told him I didn't think Gracie was drinking excessively he didn't think meds for Cushing would help her because it would be a different type of Cushings and it wouldn't help her. WHAT??????? What is he talking about?? Oh one more thing. All 3 of the other vets thinks Gracie has Cushings based on her physical appearance and her lab work. Dr Karras from Cave Spring Clinic said if she wasn't drinking excessively he wasn't sure she had it but that something serious was going on for her ALP being that high. I also found out that certain White Blood Cells were below normal, another indication of Cushings according to the Vet I saw this morning. So as you can see I am so confused right now I do not know which way to turn. So if Gracie has one particular type of Cushings based her not drinking a lot of water means the meds won't work??? That's exactly what this Vet told me. One more thing. The other 3 Vets said to address the leg injury first before the Cushings. Dr Karrass said if the dog has Cushings the healing process will be slower and it needed to be addressed first.


He is talking about doing the low dose dex suppression test which is an 8 hr draw. It is prone to false positives when other things are going on and trust me the torn ACL would more then likely give you a false positive so I would NOT do that test at this time.


What is he suggesting you do to heal the torn ACL? Again the cushings in her system (if she even has it) would help treat it. I'm hoping some of our members that have been through this can chime in.

[frijole]

Kenny,

Thank God you at least now know there is an ACL injury. Now to decide what to do about it.

I don't know how to be any more clear but please trust me that the world's most experienced vets in treating cushings all agree that YOU DO NOT TREAT IT IF THERE ARE NO SYMPTOMS. Gracie has no symptoms of cushings and so therefore you should just ignore it unless symptoms come up in the future.

The focus should not be on cushings at all - it should be on the leg. We have a moderator who is a med tech with over 20 years experience dealing with humans AND she has dealt with torn ACL in her lhasa apso dogs on at least TWO occasions. I just sent her a PM and asked her to take a look at your thread. Hopefully she'll log on tonight.

Again - I'd focus on the leg. How is Gracie doing?!!!

BTW great that you are involved in that missing persons' case.

Kim

[KennyJ]

I got a copy of Gracie's lab work and will post the ones that were either too high or too low. Reference range right beside it. Everything else was normal.

Platelet count 579 170-400

Monocytes 12 3-10%

Eosinophils 1 2-10%

Absolute Monocytes 1152 0-840

ALK Phosophates 3485 5-131

Cholesterol 360 92-324

[molly muffin]

Well this is a quandary. The good thing is to know what you are dealing with concerning the leg.

I found this site that talks about not having the surgery: http://www.tiggerpoz.com/index.html as an option.
The key seems to be severely restricting exercise for 8 weeks and see if there are improvements seen.

I do want to add since I saw that Kim Just posted at the same time I did. That treatment of the leg is most important. That has to be treated first in my opinion.

As for your cushings questions, and keep in mind this is not currently the main focus, the leg is.

I haven't heard of bulging intestines or lowered white cell count with cushings. That is not to say it isn't true, just that I haven't heard of it. Maybe some of the others have.

Is the one vet saying that he thinks this is an atypical type of cushings instead of adrenal or pituitary based?

Some vets prefer the ACTH and other vets prefer the LDDS (suppression). They do different things but with anything else going on, they can both register a false positive. Unless they are thinking of doing a panel for UTK, which is done with an ACTH then sent to University of Tenn, the only place who does this test to check levels of the intermediary hormones.

This is all made that much more difficult because none of these are actually Internal Medicine Specialist, only an "interest" in internal medicine. Specialist actually have much more specialized training for just these reasons than a regular GP vet.

I did end up gong to an internal specialist because my vet was ready to dose, when there was no increase in drinking, no increase in eating or any other symptoms than the pot belly.

As far as will the regular medicine work, it depends on if this is cushings and what is the cause of the cushings. For instance with atypical cushings, you don't treat the with two normal drugs and instead use melatonin and lignans, sometimes with lysodren and sometimes not. The cortisol is Not risen in atypical cushings.

Many of the others on here have much more experience so hopefully they will be around to weigh in soon.

Sharlene and Molly Muffin

[KennyJ]

I wish I could remember how much water I measured in Gracie's bowl because it only has a drop left in it. I was trying to gauge how much water she was drinking. Thank you for sending her a PM because right now I am so confused that I do not know which way to go with this. One of the Vets just called me and said they would NOT go the surgery route. Instead she knows a Vet that does physical therapy and laser. She even went as far to say that she would bet anything that the Vet School in my hometown would not recommend surgery. I believe I put 18 ounces of water in Gracie's bowl this morning and like I said there may be an ounce if that left in it. Gracie weighs only 13 lbs. Is that excessive drinking? 3 of the Vets say that they would bet anything she has Cushings with the lab work and other symptoms including her pot belly appearance. My concern is if she ends up not being diagnosed as Cushings then something else bad is going inside her. Look at her lab results and tell me what you think.





Kenny,

Thank God you at least now know there is an ACL injury. Now to decide what to do about it.

I don't know how to be any more clear but please trust me that the world's most experienced vets in treating cushings all agree that YOU DO NOT TREAT IT IF THERE ARE NO SYMPTOMS. Gracie has no symptoms of cushings and so therefore you should just ignore it unless symptoms come up in the future.

The focus should not be on cushings at all - it should be on the leg. We have a moderator who is a med tech with over 20 years experience dealing with humans AND she has dealt with torn ACL in her lhasa apso dogs on at least TWO occasions. I just sent her a PM and asked her to take a look at your thread. Hopefully she'll log on tonight.

Again - I'd focus on the leg. How is Gracie doing?!!!

BTW great that you are involved in that missing persons' case.

Kim

[frijole]

That is fantastic because Deb will be able to give you feedback on bloodwork given her background.

[KennyJ]

Again, thanks to everyone for trying to help. I am open to all suggestions. It looks like only the one WB Cell is low, the other two are slightly elevated. The one that really caused me the most confusion was Dr Karrass from Gracie's clinic. Saying treat the Cushings first and he too said unless she was drinking excessively didn't sound like Cushings. However, the vet this morning said not all Cushing dogs will have every symptom. And just because I didn't think she drinking excessively that she still could have it. If not she has something serious going on the inside of her. But I guess I am seeing that her water intake is more than her body weight and we are not even close to going to bed. So I am guessing at least 17 ounces of water. And part of that was spent at the Vet this morning.





Well this is a quandary. The good thing is to know what you are dealing with concerning the leg.

I found this site that talks about not having the surgery: http://www.tiggerpoz.com/index.html as an option.
The key seems to be severely restricting exercise for 8 weeks and see if there are improvements seen.

I do want to add since I saw that Kim Just posted at the same time I did. That treatment of the leg is most important. That has to be treated first in my opinion.

As for your cushings questions, and keep in mind this is not currently the main focus, the leg is.

I haven't heard of bulging intestines or lowered white cell count with cushings. That is not to say it isn't true, just that I haven't heard of it. Maybe some of the others have.

Is the one vet saying that he thinks this is an atypical type of cushings instead of adrenal or pituitary based?

Some vets prefer the ACTH and other vets prefer the LDDS (suppression). They do different things but with anything else going on, they can both register a false positive. Unless they are thinking of doing a panel for UTK, which is done with an ACTH then sent to University of Tenn, the only place who does this test to check levels of the intermediary hormones.

This is all made that much more difficult because none of these are actually Internal Medicine Specialist, only an "interest" in internal medicine. Specialist actually have much more specialized training for just these reasons than a regular GP vet.

I did end up gong to an internal specialist because my vet was ready to dose, when there was no increase in drinking, no increase in eating or any other symptoms than the pot belly.

As far as will the regular medicine work, it depends on if this is cushings and what is the cause of the cushings. For instance with atypical cushings, you don't treat the with two normal drugs and instead use melatonin and lignans, sometimes with lysodren and sometimes not. The cortisol is Not risen in atypical cushings.

Many of the others on here have much more experience so hopefully they will be around to weigh in soon.

Sharlene and Molly Muffin

[frijole]

:D The only thing you have said that was wrong with her is the leg.

Here are cushings symptoms:

hair loss/ doesn't grow back after shaved

skin issues/sores

excessive hunger as in does not breath when eating or chew food at all - simply inhales. spends every waking minute in search of food - sort of like a living vacuum cleaner.

excessive thirst as in drinks buckets - way over normal amounts not just a few extra ounces

has to go outside to potty non-stop and gets you up in the middle of the night to go outside to go potty

urinating in the house

-------------
See what I mean? Gracie only has a round puppy like a cush dog. I'd like to see a photo if you can post on in your album (profile)

I repeat the worlds best known specialists in the field all say - no symptoms no treat - even if it was cushings they say wait. So don't waste the money on testing something you aren't going to treat.

Focus on what you can fix and that is her leg!

[KennyJ]

I looked at her write up from the first doctor. She wrote that Gracie has sparse coat. I do not see that. Her tail hair is somewhat thinner maybe but her overall coat does not look thin nor does it fall out. It has been slower to grow back since her last grooming but overall her hair is pretty much the same. If not Cushings then I am even worried more. And if either test may result in a false positive because of the leg I don't know which way to turn.


Symptoms



No one patient displays all the signs or symptoms that are apparent in Cushing’s syndrome. One dog may have several of the symptoms, while another dog may also have several, but completely different ones than the other dog. A typical symptom is distention, or swelling of the abdomen. Yet on occasion, dogs will appear emaciated. There are many other physical and behavioral signs and symptoms which are listed below:

*an increase in drinking, excessive drinking (polydipsia)

*increased urination (polyuria)

The last two mentioned, increase in drinking and urinating, are the most common. About 85%.

*lack of appetite (anorexia)

*increased appetite

*increased defecation

*excessive hair loss (alopecia)

*constant or increased panting

*muscle weakness (especially in hind legs, but can be in front legs)

*a weaker heart

*pigmentation spots on skin (skin forms discolored areas, e.g. brownish or pink)

*thinning of the skin

*high blood pressure

*circling (or constant walking around as if in search of something)

*crusty skin

*hard skin lumps

*changes in normal behavior

*atrophy of the tongue

*sensitivity of the skin, or even painful skin

*symptoms of diabetes (e.g. sugar in urine)

*the head takes on the appearance of just being skull




:D The only thing you have said that was wrong with her is the leg.

Here are cushings symptoms:

hair loss/ doesn't grow back after shaved

skin issues/sores

excessive hunger as in does not breath when eating or chew food at all - simply inhales. spends every waking minute in search of food - sort of like a living vacuum cleaner.

excessive thirst as in drinks buckets - way over normal amounts not just a few extra ounces

has to go outside to potty non-stop and gets you up in the middle of the night to go outside to go potty

urinating in the house

-------------
See what I mean? Gracie only has a round puppy like a cush dog. I'd like to see a photo if you can post on in your album (profile)

I repeat the worlds best known specialists in the field all say - no symptoms no treat - even if it was cushings they say wait. So don't waste the money on testing something you aren't going to treat.

Focus on what you can fix and that is her leg!

[frijole]

Those are the symptoms but without a doubt the main two are appetite and thirst/urination (they go hand in hand). Some dogs only have the hunger.

[KennyJ]

There have been times that Gracie has left her food all day before eating it. But I have since cut her food intake back so maybe that's why she eats when I serve it now. As of 10:00 PM Gracie still has over 4 ounces of water in her water bowl. I believe I put 18 ounces in it this morning. So now I am also leaning that she is NOT drinking excessively.






Those are the symptoms but without a doubt the main two are appetite and thirst/urination (they go hand in hand). Some dogs only have the hunger.

[KennyJ]

I uploaded some photos of Gracie in my album. Got some shots of her stomach. The flash made it look like her hair was sparse but it doesn't look that bad in person. Although the first Vet did make a note of sparse hair. But the photos and what she looks like in person are totally different. Except the fat stomach.

[molly muffin]

Gracie's belly has that roundness to it. My molly has that same belly. It's one of the reasons along with high ALKP that my vet thought cushings (the look) but Molly has had that belly since she about 3 years old or so. We thought it was just too many treats (and it might still be) but my molly's liver is slightly enlarged too, which I didn't know until the ultrasound.

You have to try to take this one step at a time Kenny. I know that is very difficult when you are so worried.

Sharlene and Molly Muffin

[KennyJ]

So they still diagnosed her with Cushings with the test results being negative?? This is all so confusing. Did she have the excessive drinking? Because Gracie does not. I haven' gone to bed and there is still water in the bowl and I only put 18 ounces of water in it. And how are they treating her? I am physically and emotionally drained. Even the neighbor showed up at my door tonight and said they were worried about me. I thought that was very strange. That has never happened before.






Gracie's belly has that roundness to it. My molly has that same belly. It's one of the reasons along with high ALKP that my vet thought cushings (the look) but Molly has had that belly since she about 3 years old or so. We thought it was just too many treats (and it might still be) but my molly's liver is slightly enlarged too, which I didn't know until the ultrasound.

You have to try to take this one step at a time Kenny. I know that is very difficult when you are so worried.

Sharlene and Molly Muffin

[molly muffin]

It IS confusing and cushings is one of the hardest disease to diagnose.

My vet thought cushings when the ACTH test was positive and I even bought the vetoryl to begin treatment. I opted to see an internal medicine specialist before starting and we did the ultrasound and again, things look like cushings, except, she said not to start her on medication until an LDDS test was done. (this is the all day test) On that test she was negative, and suppressed fully for 8 hours. General consensus is not cushings at this time. I started her on a liver supplement and we are monitoring liver enzymes and full blood work every few months. I'd been through this the previous year also, when they diagnosed cushings and she suppressed on the LDDS test. That is just my story though and doesn't mean that it is the same for Gracie.

Molly does Not have excessive drinking (if anything is not enough sometimes), nor does she have excessive eating, she'll walk away from a bowl of food until she is ready to eat it, maybe hours later, maybe not at all. She does have the pot belly. That is all and maybe a bit of thinning of the coat (according to the vet, my groomer thinks otherwise) It is hard to treat cushings without symptoms. They think and I think that the ACTH was a false positive. That there is high cortisol levels, but Not because of cushings. She had a gastrointestinal issue either the month before or at the same time that the ACTH was taken, and was on antibiotics at that time because of this infection.

All this tells you is that it is tricky to diagnose and other things can cause false positives.
We're still waiting to see if our other member can take a look at the thread, as she has dealt with the ACL issue and is familiar with lab results.

Sharlene and Molly Muffin

[KennyJ]

So you are not medicating as it stands right now?? You are right. Gracie does not have the drinking nor does she have eating symptoms but has everything else. My concern has always been the way she can destroy toys. The ones that say can't be torn apart she can have apart in a matter of minutes with the squeaky toy out. She had also gotten to the point she couldn't jump up on the furniture and walk up the stairs. Like everyone just chalked it up as getting older. Here lately she sleeps more. Only want Vet wants to do surgery on her leg. The other two says dogs her size usually do not get the ACL surgery. So not only am I confused about Cushings and treatments I am also concerned the proper treatment for her leg. Why does it have to be so difficult? Looking forward hearing from the member regarding the lab work. This is my 3rd Maltese and to be honest all of them have developed the "Cushings" belly.



Platelet count 579 170-400

Monocytes 12 3-10%

Eosinophils 1 2-10%

Absolute Monocytes 1152 0-840

ALK Phosophates 3485 5-131

Cholesterol 360 92-324




It IS confusing and cushings is one of the hardest disease to diagnose.

My vet thought cushings when the ACTH test was positive and I even bought the vetoryl to begin treatment. I opted to see an internal medicine specialist before starting and we did the ultrasound and again, things look like cushings, except, she said not to start her on medication until an LDDS test was done. (this is the all day test) On that test she was negative, and suppressed fully for 8 hours. General consensus is not cushings at this time. I started her on a liver supplement and we are monitoring liver enzymes and full blood work every few months. I'd been through this the previous year also, when they diagnosed cushings and she suppressed on the LDDS test. That is just my story though and doesn't mean that it is the same for Gracie.

Molly does Not have excessive drinking (if anything is not enough sometimes), nor does she have excessive eating, she'll walk away from a bowl of food until she is ready to eat it, maybe hours later, maybe not at all. She does have the pot belly. That is all and maybe a bit of thinning of the coat (according to the vet, my groomer thinks otherwise) It is hard to treat cushings without symptoms. They think and I think that the ACTH was a false positive. That there is high cortisol levels, but Not because of cushings. She had a gastrointestinal issue either the month before or at the same time that the ACTH was taken, and was on antibiotics at that time because of this infection.

All this tells you is that it is tricky to diagnose and other things can cause false positives.
We're still waiting to see if our other member can take a look at the thread, as she has dealt with the ACL issue and is familiar with lab results.

Sharlene and Molly Muffin

[KennyJ]

Called my Vet School and they can see her at 1:00 next Tuesday with an orthopedic Dr?? What do you guys think? Said the visit itself would be $80.

[lulusmom]

I think that's an excellent choice! Do not miss that appointment. If you don't have a copy of the imaging that was done by the other vet, if you have time, go pick it up so you can take it with you. They can now send imaging via email so if you can't get there, you can call and ask them if they can email to the vet at VT.

Glynda

[KennyJ]

I have the xrays on a CD.




I think that's an excellent choice! Do not miss that appointment. If you don't have a copy of the imaging that was done by the other vet, if you have time, go pick it up so you can take it with you. They can now send imaging via email so if you can't get there, you can call and ask them if they can email to the vet at VT.

Glynda

[mytil]

Excellent job on getting that appointment.
Terry

[KennyJ]

Thanks!! Was still hoping the person that is excellent on reading lab work would come on the forum and tell me what she thinks about Gracie's abnormal lab work.




Excellent job on getting that appointment.
Terry

[lulusmom]

Hi Kenny.

I'm on the train and hate typing on my phome but will comment on Gracie's labwork when I get to work. I love my big puters and keyboards.

[KennyJ]

Thank you.




Hi Kenny.

I'm on the train and hate typing on my phome but will comment on Gracie's labwork when I get to work. I love my big puters and keyboards.

[thefireyredhead]

Hi, I just posted about my baby boy Zues who also has cushings. I will not write it out again, but I am going to try the holistic approach. I will be getting the items I need in the mail (next few days) and go from there. :O))

[lulusmom]

Hi Kenny,

I looked at Gracie's labwork and yes, most of those abnormalities can be attributed to cushing's; however, the cruciate ligament injury can also cause them. I've cut and pasted the normal causes which are included in the lab interpretations listed on Broadway Veterinary. You will see that Gracie's leg injury and/or stress of the injury could have caused some of these abnormalities. As I mentioned before, get the leg taken care of and then address any other concerns, including possible cushing's. You should redo bloodwork once the leg has healed.

Platelet count 579 170-400
Platelets are cells in the blood which are responsible for forming blood clots. Non-pathological reasons for the platelets to be elevated include recent excitement or exercise causing splenic contraction, severe dehydration, or it being secondary to a pet having no spleen or during late pregnancy. Pathologic reasons for the platelets to be elevated include iron deficiency anemia, drug induced (eg. Vincristine, glucocorticoids, epinephrine), chronic infection or inflammation (as with bronchitis), or with chronic hemorrhage. Primary bone marrow disease such as polycythemia or basophilic leukemia could also cause this finding.

My Maltese, Buster's, were elevated when he was diagnosed with oxalate bladder stones.

Monocytes 12 3-10%
This is a type of white blood cell. Minor elevations are most often seen as part of a normal stress response or secondary to corticosteroid medication. More significant elevations are most often seen with chronic inflammation or tissue destruction, like with an abscess, endocarditis, arthritis or an autoimmune disease.

Buster's monocytes were much higher than this when he had oxalate bladder stones.

Eosinophils 1 2-10%
Eosinophils are a type of white blood cell that is most often seen in association with allergic or parasitic diseases. A low eosinophil count is usually not of significance and most commonly occurs due to severe stress associated with illness or from the use of corticosteroid medication

Absolute Monocytes 1152 0-840
See Monocytes above

ALK Phosophates 3485 5-131
The Alkaline Phosphatase is profoundly elevated. This is a liver enzyme that is released when there is any type of inflammation in the liver tissues. The two most likely conditions to cause such a profound elevation are an obstruction of the bile flow from the liver (as with a gall bladder stone, pancreatitis, or tumor) or from a high level of systemic steroids (glucocorticoids), either from overdosing this medication or from a hormonal disorder called Cushing’s Disease.

What this doesn't say is that there is also an isoenzyme of ALK PH that is found in the bone so any bone or joint injury can cause high elevations in ALKP.

Cholesterol 360 92-324
This may be caused by a high fat diet or by sampling the blood shortly after eating. Mild elevations are rarely of significance.

Mild elevations are also common in cushing's.

[KennyJ]

I want you to be Gracie's doctor. :) I like your explanations much better. I asked all 3 Vets if Gracie's ALP could be that highly elevated because of her leg problem and all 3 said there was no way that was a possibility. All said it was most likely the Cushings causing her leg problems. Now, I just got off the phone with a Vet that wants to try physical therapy on Gracie before I go to the Vet School next week. She said wasn't sure if surgeons would give other options like the therapy she provides. She said she would be able to tell if Gracie needed surgery or not but that most research says for dogs with ACL/CCL tears only and under 20 lbs should have physical therapy before thinking about surgery. She also does laser therapy. Once again folks I am torn about what to do. All with the exception of one Vet says take care of the leg first. The other one said lets see if she has Cushings. But here's the thing. All the Vets say do the ACTH with the exception of the one that did they xrays. He wants to do the low suppression test. All this information has caused so much stress on me. All I want is my little dog to be well. And no matter how hard I try the Vets do not give me much to look forward to. If I do the surgery I am looking at $1800 and a long rehab period. Sometimes I just want to pick her up and just go off somewhere and pretend this is not happening.





Hi Kenny,

I looked at Gracie's labwork and yes, most of those abnormalities can be attributed to cushing's; however, the cruciate ligament injury can also cause them. I've cut and pasted the normal causes which are included in the lab interpretations listed on Broadway Veterinary. You will see that Gracie's leg injury and/or stress of the injury could have caused some of these abnormalities. As I mentioned before, get the leg taken care of and then address any other concerns, including possible cushing's. You should redo bloodwork once the leg has healed.

Platelet count 579 170-400
Platelets are cells in the blood which are responsible for forming blood clots. Non-pathological reasons for the platelets to be elevated include recent excitement or exercise causing splenic contraction, severe dehydration, or it being secondary to a pet having no spleen or during late pregnancy. Pathologic reasons for the platelets to be elevated include iron deficiency anemia, drug induced (eg. Vincristine, glucocorticoids, epinephrine), chronic infection or inflammation (as with bronchitis), or with chronic hemorrhage. Primary bone marrow disease such as polycythemia or basophilic leukemia could also cause this finding.

My Maltese, Buster's, were elevated when he was diagnosed with oxalate bladder stones.

Monocytes 12 3-10%
This is a type of white blood cell. Minor elevations are most often seen as part of a normal stress response or secondary to corticosteroid medication. More significant elevations are most often seen with chronic inflammation or tissue destruction, like with an abscess, endocarditis, arthritis or an autoimmune disease.

Buster's monocytes were much higher than this when he had oxalate bladder stones.

Eosinophils 1 2-10%
Eosinophils are a type of white blood cell that is most often seen in association with allergic or parasitic diseases. A low eosinophil count is usually not of significance and most commonly occurs due to severe stress associated with illness or from the use of corticosteroid medication

Absolute Monocytes 1152 0-840
See Monocytes above

ALK Phosophates 3485 5-131
The Alkaline Phosphatase is profoundly elevated. This is a liver enzyme that is released when there is any type of inflammation in the liver tissues. The two most likely conditions to cause such a profound elevation are an obstruction of the bile flow from the liver (as with a gall bladder stone, pancreatitis, or tumor) or from a high level of systemic steroids (glucocorticoids), either from overdosing this medication or from a hormonal disorder called Cushing’s Disease.

What this doesn't say is that there is also an isoenzyme of ALK PH that is found in the bone so any bone or joint injury can cause high elevations in ALKP.

Cholesterol 360 92-324
This may be caused by a high fat diet or by sampling the blood shortly after eating. Mild elevations are rarely of significance.

Mild elevations are also common in cushing's.

[lulusmom]

Kenny,

Gracie's leg injury is painful for her and that causes stess on the body. Two out of three of the diagnostic tests for cushing's are highly susceptible to false positive results in the face of severe stress or any illness or injury that is stressing the dog out. If it were my vet telling me to test for cushing's, I'd ask him point blank; "Can you guarantee me that my dog is not in any pain and if she is, can you guarantee me that the stress of that pain, along with the emotional stress of a vet visit, isn't enough stress to skew the low dose dex test or a UC:CR? If he tells you that he can make that guarantee, he's either a bold face liar or ignorant as hell about the specificity and sensitivity of these tests. Even if Gracie doesn't have cushing's, I would be surprised if the UC:CR or the Low Dose Dex tests came back normal.

Now I want to tell you a little story about my own Maltese, Buster, who has a story similar to Gracie's. I took him to the vet for a suspected UTI. He didn't have a UTI but had calcium oxalate bladder stones. Because these types of bladder stones are common in cushingoid dogs and because he was obese, with a pot belly, and had a thin coat, she was on a mission to prove he had cushing's. He did not have any symptoms associated with cushing's, no elevated alkp but he did have other blood abnormalities that we do see in cushing's but he was stressed out from the bladder stones. His coat was always thin and like his mom, he had a pot belly because he's fat. I finally caved in and allowed her to do a low dose dex test which was absolutely normal. I was angry because in my heart, I knew he didn't have cushing's and just wasted over $200 which I could have used for stim tests from my two cushdogs.

After his surgery, I took all of my dogs off of grain ladened kibble and put them on a commercially prepared raw food diet. Within three months, all lost weight, were more active and Buster not only didn't have a pot belly, he was slim and trim with a nice clean tuck. That was five years ago and he still looks great and recent bloodwork was perfect.

It's completely possible that Gracie has cushing's but because it progresses at a snail's pace, you have plenty of time to worry about testing her after you get her leg taken care of and Gracie has had a few months of liver support supplementation. At that point, you need to start from scratch and do new bloodwork.

After one of your vets told you that because Gracie wasn't drinking and peeing in excess, that he thought she had a another form of cushing's. I think I mentioned previously that there is a form of cushing's that is caused by excess estrogen, primarily estradiol. Dogs with elevated estradiol can have severe elevations in ALKP, don't always drink or pee too much but they do experience the same liver abnormalities, including a pot belly which is partially caused by an enlarged liver. The treatment for this condition is melatonin and lignans, both which are pretty darn benign. If you cannot stand the thought of doing nothing about possible cushing's, then go out to your local health food store and pick up 3mg melatonin and get her started on that twice a day. Make sure it is not fast acting and time released....just plain old melatonin. It's been a while since I talked about lignans so I need to refresh my memory on the right type, dosage and where you can find it. I used to order mine online from Vitacost. My little 4 lb Pomeranian was 3mg Melatonin for almost two years and while it didn't make her hair grow, she had no ill effects from it. This treatment can takes up to four months to notice any difference so just know that it's a crap shoot.

I'm sure I have given you too much information and that your head is spinning more than it already was. I hate to even have to keep talking about cushing's right now because to launch into full blown diagnostic tests right now is a really bad idea.

[Roxee's Dad]

Hi Kenny,
A belated welcome from me, You have been given great advice and I agree with it so I won't repeat what has been said.

Regarding the ACL tear or rupture in Gracie's leg. My Roxee had the surgery and it went well. After surgery for about 6 weeks is almost complete rest. no running, no jumping and only a very short walk to go potty. Never without a leash and much time spent on the couch or our lap to keep her from damaging the work of the surgeon.

My Rozee also had a torn ACL and mainly because of her age, we chose to do conservative management. We put Rozee in a doggie wheel chair for a little over 5 months and she was then able to walk and run again.

As many others have commented, the knee is very painful and does cause a rise in cortisol (a steroid type hormone) as a self medicating way to relieve the pain and try to heal itself.

Which ever method you choose, we need to be very carefull to keep her from running or jumping. It will tear again and the pain and healing will have to start all over again.

You are welcome to check out my album, I am sure there is a photo of Rozee in her wheelchair. If you are interested in the conservative management route, I would be happy to discuss in more detail.

[KennyJ]

Would you try the physical therapy over the surgery?? If Gracie's ALP wasn't so high I would probably be feeling much better. That's scary high.





Kenny,

Gracie's leg injury is painful for her and that causes stess on the body. Two out of three of the diagnostic tests for cushing's are highly susceptible to false positive results in the face of severe stress or any illness or injury that is stressing the dog out. If it were my vet telling me to test for cushing's, I'd ask him point blank; "Can you guarantee me that my dog is not in any pain and if she is, can you guarantee me that the stress of that pain, along with the emotional stress of a vet visit, isn't enough stress to skew the low dose dex test or a UC:CR? If he tells you that he can make that guarantee, he's either a bold face liar or ignorant as hell about the specificity and sensitivity of these tests. Even if Gracie doesn't have cushing's, I would be surprised if the UC:CR or the Low Dose Dex tests came back normal.

Now I want to tell you a little story about my own Maltese, Buster, who has a story similar to Gracie's. I took him to the vet for a suspected UTI. He didn't have a UTI but had calcium oxalate bladder stones. Because these types of bladder stones are common in cushingoid dogs and because he was obese, with a pot belly, and had a thin coat, she was on a mission to prove he had cushing's. He did not have any symptoms associated with cushing's, no elevated alkp but he did have other blood abnormalities that we do see in cushing's but he was stressed out from the bladder stones. His coat was always thin and like his mom, he had a pot belly because he's fat. I finally caved in and allowed her to do a low dose dex test which was absolutely normal. I was angry because in my heart, I knew he didn't have cushing's and just wasted over $200 which I could have used for stim tests from my two cushdogs.

After his surgery, I took all of my dogs off of grain ladened kibble and put them on a commercially prepared raw food diet. Within three months, all lost weight, were more active and Buster not only didn't have a pot belly, he was slim and trim with a nice clean tuck. That was five years ago and he still looks great and recent bloodwork was perfect.

It's completely possible that Gracie has cushing's but because it progresses at a snail's pace, you have plenty of time to worry about testing her after you get her leg taken care of and Gracie has had a few months of liver support supplementation. At that point, you need to start from scratch and do new bloodwork.

After one of your vets told you that because Gracie wasn't drinking and peeing in excess, that he thought she had a another form of cushing's. I think I mentioned previously that there is a form of cushing's that is caused by excess estrogen, primarily estradiol. Dogs with elevated estradiol can have severe elevations in ALKP, don't always drink or pee too much but they do experience the same liver abnormalities, including a pot belly which is partially caused by an enlarged liver. The treatment for this condition is melatonin and lignans, both which are pretty darn benign. If you cannot stand the thought of doing nothing about possible cushing's, then go out to your local health food store and pick up 3mg melatonin and get her started on that twice a day. Make sure it is not fast acting and time released....just plain old melatonin. It's been a while since I talked about lignans so I need to refresh my memory on the right type, dosage and where you can find it. I used to order mine online from Vitacost. My little 4 lb Pomeranian was 3mg Melatonin for almost two years and while it didn't make her hair grow, she had no ill effects from it. This treatment can takes up to four months to notice any difference so just know that it's a crap shoot.

I'm sure I have given you too much information and that your head is spinning more than it already was. I hate to even have to keep talking about cushing's right now because to launch into full blown diagnostic tests right now is a really bad idea.

[lulusmom]

Hi Kenny.

John, roxee's dad, has extensive experience with both the surgery and non-surgical treatment, both of which were very successful. Please pm him and perhaps you two can communicate directly. My cushdog had hip surgery so my experience is limited to my research. John can answer your questions and help you decide which avenue to take. I'm sure john will have questions of his own for you to determine the extent of Gracie's injury.

[KennyJ]

I just had someone tonight tell me I should euthanize Gracie. Not a vet just someone thinking they meant well. If I do surgery on the ACL and after that start testing and get her Cushings under control it's going to cost me a fortune. I will never get this paid off in my lifetime unless I win the lottery. I still have the appointment with the Vet that wants to do physical therapy instead of the surgery. A good friend of mine that happens to be a Vet said the surgery was the way to go. But he too warned me of the expense. Needless to say I am just lost right now. Not only do I have to deal with Cushings but the thought of her going under the knife for her little leg just devastates me. What would you guys do?? And when I ask what would you do, I am asking try the therapy or get the surgery.

[KennyJ]

What was the cost to fix her hip and how did she do?? How on earth can you give them pain meds if their liver enzymes are already off the charts?





Hi Kenny.

John, roxee's dad, has extensive experience with both the surgery and non-surgical treatment, both of which were very successful. Please pm him and perhaps you two can communicate directly. My cushdog had hip surgery so my experience is limited to my research. John can answer your questions and help you decide which avenue to take. I'm sure john will have questions of his own for you to determine the extent of Gracie's injury.

[doxiesrock912]

Kenny,
I would try the physical therapy if there is a possibility that it might help.
Surgery is tough to recover from especially if the Cushings is not under control at the time.

Try the PT first.

As for the person who mentioned euthanizing, they obviously don't know much about Cushings etc.

[lulusmom]

I took her to a specialty hospital and had a board certified surgeon do the procedure. It worked beautifully and as I recall, it was a few thousand dollars. It's been several years so I don't remember the exact amount. The vet did not put her on a NSAID. I think the name was torbutrol. It really made her loopy. John's girl, Roxee, had cushing's so hopefully, he'll let you know what pain meds his vet prescribed after surgery.

[KennyJ]

That's right, I keep thinking your dog had Cushings. Just wish Gracie's ALP wasn't so high.





I took her to a specialty hospital and had a board certified surgeon do the procedure. It worked beautifully and as I recall, it was a few thousand dollars. It's been several years so I don't remember the exact amount. The vet did not put her on a NSAID. I think the name was torbutrol. It really made her loopy. John's girl, Roxee, had cushing's so hopefully, he'll let you know what pain meds his vet prescribed after surgery.

[Roxee's Dad]

Hi Kenny,

Roxee was also on torbutrol for pain. One thing I wanted to mention. When Rozee hurt her knee, we did go to the vet and it was diagnosed as a sprain. She couldn't walk on it so she was hopping on 3 legs. The good knee was taking all the weight from the bad knee and that is when she ruptured her ACL. At that point she could not walk at all. :(

I mention this because you need to be aware if Gracie is only using 3 legs to get around, she could very possibly ruin her other knee.

As others mention, The knee damage should be taken care of before you even do any further testing for cushings. One other question, do you feed Gracie any type of chicken jerky treats? Or those dry sweet potato wrapped in chicken jerky? Many of the treats on the market contain ingredients that can cause ALP or ALK to rise. The FDA has recalled and also recommends against these chicken jerky treats.

[KennyJ]

No, I never feed her treats anymore other than carrots. She eats Fromm dog food which is a premium food. This is going to be so expensive. Thank God for credit cards. If I go the surgery route, can I fix up a small bed room instead of crating her?? She has never been in a crate all her life.







Hi Kenny,

Roxee was also on torbutrol for pain. One thing I wanted to mention. When Rozee hurt her knee, we did go to the vet and it was diagnosed as a sprain. She couldn't walk on it so she was hopping on 3 legs. The good knee was taking all the weight from the bad knee and that is when she ruptured her ACL. At that point she could not walk at all. :(

I mention this because you need to be aware if Gracie is only using 3 legs to get around, she could very possibly ruin her other knee.

As others mention, The knee damage should be taken care of before you even do any further testing for cushings. One other question, do you feed Gracie any type of chicken jerky treats? Or those dry sweet potato wrapped in chicken jerky? Many of the treats on the market contain ingredients that can cause ALP or ALK to rise. The FDA has recalled and also recommends against these chicken jerky treats.

[Roxee's Dad]

Either way you go, Gracie will have to be confined. The advantage of Surgery is that recovery time is about 6 weeks whereas the conservative management recovery / healing time is about 5 or 6 months.

Either way you go, she will have to be confined otherwise their is a risk of re-injury which would mean another surgery or for conservative management, you would have to start all over.

When we had to confine her, we used a play-n-pack playpen.

[molly muffin]

Oh I just wanted to jump in and mention Care Credit as a possibility. Many of our members have used it and continue to use it over the years.

http://www.carecredit.com/

Sharlene and Molly Muffin

[KennyJ]

If I take Gracie to see another Vet tomorrow about physical therapy, that's 4 vets total that will have seen her. Already the cost is getting up there and still I haven't gotten anything done. Right now my head is spinning. The vet tomorrow has already said she would charge me $150 for our first meeting. Can you tell I am lost?? Then worried about her being here at the house alone while I am at work. That concerns me after surgery should I go that route. She has never been in a crate so that would really stress her out. I know her. She is a very high stressed little dog as it is already.




Oh I just wanted to jump in and mention Care Credit as a possibility. Many of our members have used it and continue to use it over the years.

http://www.carecredit.com/

Sharlene and Molly Muffin

[doxiesrock912]

I forgot about Care Credit! My best friend has used it several times, and my father used another Care Credit to pay for his dentures.


Kenny, it's easy to apply online and get an answer quickly. It's basically a credit card used for a specific purpose.

[Roxee's Dad]

My wife (Pattee) or I always took Roxee to the office with us. That is why I purchased the Play-n-pack playpen, or I would set up a chair for her to sit in right next to me.

I hate to say it, but it's going to be tough love. You simply cannot let her have the run of the house, she doesn't know that she will hurt herself again. She will try to run and jump and the chance of re-injury is very high... and even more expensive.

When you see the therapist, ask how long the recovery will take, total cost and weigh that against the recovery time and cost of the surgery.

[KennyJ]

I know this probably does NOT mean anything at all because the Vets said not every dog would have all the symptoms of Cushings but I wanted to ask your opinion. I poured 20 ounces of water in Gracie's water bowl this morning. I just checked it and she still has 12 ounces of water left. Does this mean anything in your opinion? She drank 8 ounces of water. And she weighs 13 lbs.

[mytil]

Hi again,

I do not think she has thirst issues here Kenny. Daily water consumption usually 1 ounce per pound in a normal dog (a bit more in hotter weather) and it sounds like she is within this limit.

Terry

[KennyJ]

Thanks Terry. Has anyone ever had dog wirh Cushings that didn't drink a lot?


QUOTE=mytil;106358]Hi again,

I do not think she has thirst issues here Kenny. Daily water consumption usually 1 ounce per pound in a normal dog (a bit more in hotter weather) and it sounds like she is within this limit.

Terry[/QUOTE]

[labblab]

Hi Kenny, the vast majority of the Cushpups who join us here on our forum do drink and pee excessively. But that is not surprising to me, since those are troublesome symptoms that easily catch the attention of owners and end up prompting diagnostic testing. Dogs with classic Cushing's symptoms are usually diagnosed by their regular vets or by internal medicine specialists.

We now know, though, that a certain smaller percentage of Cushpups are diagnosed based on other, less "classic" abnormalities. An example are dogs diagnosed first by dermatologists. And for those dogs, instead of the more common problems of excessive hunger and thirst, the primary problems that prompted the consultation are skin and coat issues that are distinctive to Cushing's. So your vet/s is correct in saying that not all dogs with Cushing's will exhibit all the same symptoms.

As this relates to Gracie, I do agree with the others that decision-making regarding the treatment of her leg is your first priority. I do think it is better to hold off on the Cushing's testing until pain and inflammatory issues with her leg are resolved. I know it is hard to put your worry about the Cushing's on the back burner, because yes, it is possible that Gracie may have Cushing's even if she does not exhibit the classic symptoms of excessive hunger and thirst. But because she lacks the classic symptoms, the validity of all the testing becomes even more important. And until her leg has been dealt with, the testing will not be trustworthy.

Marianne

[KennyJ]

Thank you. The leg issue is another major decision. Do I try the Vet today that does physical therapy? Another $150 on top of the $700 I have already spent just to get second, third, and fourth opinions? Or do I just schedule the surgery?








Hi Kenny, the vast majority of the Cushpups who join us here on our forum do drink and pee excessively. But that is not surprising to me, since those are troublesome symptoms that easily catch the attention of owners and end up prompting diagnostic testing. Dogs with classic Cushing's symptoms are usually diagnosed by their regular vets or by internal medicine specialists.

We now know, though, that a certain smaller percentage of Cushpups are diagnosed based on other, less "classic" abnormalities. An example are dogs diagnosed first by dermatologists. And for those dogs, instead of the more common problems of excessive hunger and thirst, the primary problems that prompted the consultation are skin and coat issues that are distinctive to Cushing's. So your vet/s is correct in saying that not all dogs with Cushing's will exhibit all the same symptoms.

As this relates to Gracie, I do agree with the others that decision-making regarding the treatment of her leg is your first priority. I do think it is better to hold off on the Cushing's testing until pain and inflammatory issues with her leg are resolved. I know it is hard to put your worry about the Cushing's on the back burner, because yes, it is possible that Gracie may have Cushing's even if she does not exhibit the classic symptoms of excessive hunger and thirst. But because she lacks the classic symptoms, the validity of all the testing becomes even more important. And until her leg has been dealt with, the testing will not be trustworthy.

Marianne

[frijole]

Kenny we can't tell you what to do on that - you have to make that decision. I assume you and John have spoken via pm about the options - is there anything you learned that you can share to help us help you? Note this is why it's important to try to keep as much info as you can on this thread. When multiple people are responding and trying to help we don't have all the same info.

Kim

[KennyJ]

I discussed Gracie with a friend of mine that just happens to be a Vet but he's about an hour away. He also said she most likely needs surgery. Now that's without seeing her but based on what I told him he thinks she needs surgery. Having said that, I stayed with Gracie a while longer this morning before I went to work. She continues to look at the chair that she has always jumped upon to look out the window which makes me think during the day she is attempting to jump upon the chair. Not good. This may be the reason her limping hasn't gotten better. And it's possible it won't get any better without surgery. But John mentioned a play pen that I am interested in. I would like to try that instead of crating her. Gracie would be stressed out if I crated her.






Kenny we can't tell you what to do on that - you have to make that decision. I assume you and John have spoken via pm about the options - is there anything you learned that you can share to help us help you? Note this is why it's important to try to keep as much info as you can on this thread. When multiple people are responding and trying to help we don't have all the same info.

Kim

[Roxee's Dad]

Hi Kenny,

It is very obvious that you love and care fore little Gracie :)

Just in my humble opinion, given Gracie's age, and your circumstances of having to leave her home while you work, I would strongly consider the surgery mainly based on the healing / recovery time which will be much shorter than a conservative management approach. I am positive the surgeon will take all of Gracie's bloodwork into account before making the decision to perform the surgery. Roxee's ALP was also very high at the time.

You may want to try to schedule a few days off, vacation time or something if possible for the days right after surgery so you can be sure she doesn't lick or try to remove the bandages and sutures.

Either way, the surgeon will give you complete instructions on the healing and recovery time.

If you check my album, you will see Roxee with a green colored cast on her hind leg. This was the day after surgery and she is sleeping on the couch. Of course we never left her side to keep her from jumping off the couch.

Please let us know what you decide as soon as possible and please keep us updated... we do worry about our cush family :o:)

[KennyJ]

What kind of pain killers can you give a dog that has elevated ALP?





Hi Kenny,

It is very obvious that you love and care fore little Gracie :)

Just in my humble opinion, given Gracie's age, and your circumstances of having to leave her home while you work, I would strongly consider the surgery mainly based on the healing / recovery time which will be much shorter than a conservative management approach. I am positive the surgeon will take all of Gracie's bloodwork into account before making the decision to perform the surgery. Roxee's ALP was also very high at the time.

You may want to try to schedule a few days off, vacation time or something if possible for the days right after surgery so you can be sure she doesn't lick or try to remove the bandages and sutures.

Either way, the surgeon will give you complete instructions on the healing and recovery time.

If you check my album, you will see Roxee with a green colored cast on her hind leg. This was the day after surgery and she is sleeping on the couch. Of course we never left her side to keep her from jumping off the couch.

Please let us know what you decide as soon as possible and please keep us updated... we do worry about our cush family :o:)

[Roxee's Dad]

I think your vet or surgeon would be better qualified to recommend any type of pain medication. I would just make sure they realize the high ALP. I am also sure they will do an additional blood work up before surgery to check on blood chemistry of concern.

[apollo6]

Dear Kenny
I am posting your reply so that others can help you.
I live in Roanoke, Va. I have an appointment with an orthopedic surgeon at the Vet School but have since talked to another Vet that said she would like to look at Gracie about doing physical therapy on that injured leg first. I am so confused and lost right now. I realize I got a lot of Vets involved but I just want to make the correct choice before I have such an invasive surgery on such a little dog. If you know anyone in my area who they recommend please that would be great.


below is a link to specialists, you just type in the state or zip code.


http://www.acvim.org/PetOwners/FindaSpecialist.aspx
the fact your friend is a vet, maybe your friend could check into a good vet to help Gracie. Also he can give you input on doing the surgery. The play pen might be a good idea, or could you bring her to work in a crate/open cage? Or get a neighbor to check on her, or leave her in a confined area. I have my kitchen locked up with a gate, but my dog, Arial has a doggie door to go outside to a patio. Were there is a will ,there is a way. Try to take a little time to breath, and you will make the right decision.
Hugs Sonja, Angel Apollo and his little brother Arial.

Hugs Sonja and Angel Apollo

[KennyJ]

Thank you. I have been going like this non stop with Gracie. If I opt for the Vet School it will be a lot more expensive doing the surgery. My friend said he would do it for around $1500. The only place to find an internal medicine specialist would be the Vet School.





Dear Kenny
I am posting your reply so that others can help you.

below is a link to specialists, you just type in the state or zip code.


http://www.acvim.org/PetOwners/FindaSpecialist.aspx
the fact your friend is a vet, maybe your friend could check into a good vet to help Gracie. Also he can give you input on doing the surgery. The play pen might be a good idea, or could you bring her to work in a crate/open cage? Or get a neighbor to check on her, or leave her in a confined area. I have my kitchen locked up with a gate, but my dog, Arial has a doggie door to go outside to a patio. Were there is a will ,there is a way. Try to take a little time to breath, and you will make the right decision.
Hugs Sonja, Angel Apollo and his little brother Arial.

Hugs Sonja and Angel Apollo

[molly muffin]

They don't have an employee discount at the Vet School? Usually vet schools are cheaper than outside surgical options but that may not be true for your area.
Also, did you check into care credit? It might be a better option than credit card and you can get almost instant approval.
Sharlene and Molly Muffin

[KennyJ]

Back from Vet #4. She wants me to hold off on surgery and do physical therapy. Now even more confused.

[milosmom]

hello kenny !!! i was away for sometime and am so happy to be back here with all my furbaby parents !!! i have read up on your story with your litl one gracie and i can feel your anxiety and all that goes with this dreadful disease.as a massage therapist i would think maybe pt would be the way to go right now.we have to try all methods before going under a knife (my opinion)seems like surgery is totally up to you,you are the one that knows your baby best!i will be following your story in the meantime but i know its a bit late but i welcome you here to the most awesome forum ever !!! this place has helped me out before,during and after my milo and i am so sure i will stay here to support,love,cry,smile...whatever it takes ...patty(milo)meka xoxox

[StarDeb55]

Kenny, Kim asked me to stop in & discuss the ACL surgery with you. I have been through this 3 times with 2 dogs. I will explain how it ended up being 3 times with only 2 dogs.

My 1st cushpup, Barkley, ruptured an ACL while I was playing ball with him in the house. My regular vet put him on anti-inflammatories for about 3 weeks, along with crate rest. B really didn't improve much, so she sent us to a vet surgeon. This was a number of years ago where the main procedure for an ACL repair was to basically replace the ligament with the equivalent of fishing line. The surgery requires approximately 6- 8 weeks of crate rest to insure recovery. Crate rest also means that there can be no jumping, no playing, even potty breaks outside must be taken on a leash. B, also, had never been crated in his life, so I purchased what I believe is termed an "expen", set it up in my living room. It was about 6 ft. in diameter, so B at least had a little bit of room to move around without being cooped up in a crate. The only time he was allowed out was for meals, & to come to bed in my room. Everything was going great until about 7 weeks post-op, I let B out from the crate one evening for supper. He was simply following me to the kitchen, not running or doing any horsing around, I hear this yip, turnaround & he's limping on the repaired leg. B had to go back to surgery, & what had happened was this monofilament line had stretched so far out, the knee was no longer stable, & the repair had to be redone. The surgeon said that the line was so stretched it might as well have broken. B's ACL repair is actually what set us on the road to a Cushing's diagnosis. The surgeon calls me at work prior to going to the operating room, to tell me that B's alk phos is sky high, something like 1200 or higher. He wants to know if B had been on any allergy medicine, & I told him absolutely. He had horrible allergies, & had been taking various allergy meds from my regular vet for a long time. The surgeon said the meds were probably what caused the alk phos elevation, & took him to surgery. Now, when it comes to taking Gracie to surgery with an elevated alk phos or any other abnormal lab work, it's the surgeon's job to select the appropriate anesthetic that will not further compromise liver or kidney function. With this type of surgery, the pup will be on an IV which will help support liver & kidney function during the procedure.

My 2nd ACL experience was with my Lhasa, Chewy, about 18 months ago. Chew jumped off the bed one afternoon, I was laying down, heard him yip, jumped up to check on him, & he had come up lame after the jump. My GP vet set us to a vet surgeon, (not the same one as above), who reviewed everything including the x-rays. I told this surgeon up front about my previous experience with ACL surgery. He proceeded to explain to me that B's surgery was, now, considered to be "old school", had fallen out of favor, but he did say that he would still do this type of repair under certain circumstances. The preferred procedure for an ACL repair, now, is called TPLO for short. It is a fairly involved procedure, & I'll be honest, it's not cheap. You, also, want to make sure that you have a good vet surgeon who is more or less an orthopedic specialist, & has plenty of experience doing TPLO's Chewy came through the surgery just fine. This surgery will also require approximately 2 months of restricted activity as I have explained above. I can tell you that with both dogs I discussed trying conservative management, & I got the same answer both times, you can try, but eventually severe arthritis will probably settle in that injured knee which will inhibit the dog's mobility even further. Here's a link that should give more detailed information about TPLO surgery, & what to expect. I opted for surgery with both dogs as Barkley was only about 8 at the time of his injury, fairly active, & I wanted to make sure that he had a good shot at the best quality of life after his injury. Also, please don't let the pictures of the x-rays on the link freak you out, this is what has to be done for the repair to work, & it is the best shot as insuring a functional knee joint for the remainder of the pup's life.

If I can answer any more of you questions, feel free to ask.

http://www.vetsurgerycentral.com/tplo.htm

Debbie

[KennyJ]

I was told by the other Vets that the Vet School would want to do the TPLO surgery they performed on your second dog. The general practice Vets would perform the type your first dog got. I wish Gracie's ALKP was your dog's level. Hers was 3500. So here's my problem. Two Vets say physical therapy and two says surgery was the only way to go. This includes the Dr that sedated her and performed the xrays. The Vet that I took her to yesterday said let's do the PT for a month and then see. I have to admit, it's very difficult for me to to do the stretching twice a day. Confused is putting it mildly. I would do anything to make this all better for Gracie. I just hate thinking about surgery.






Kenny, Kim asked me to stop in & discuss the ACL surgery with you. I have been through this 3 times with 2 dogs. I will explain how it ended up being 3 times with only 2 dogs.

My 1st cushpup, Barkley, ruptured an ACL while I was playing ball with him in the house. My regular vet put him on anti-inflammatories for about 3 weeks, along with crate rest. B really didn't improve much, so she sent us to a vet surgeon. This was a number of years ago where the main procedure for an ACL repair was to basically replace the ligament with the equivalent of fishing line. The surgery requires approximately 6- 8 weeks of crate rest to insure recovery. Crate rest also means that there can be no jumping, no playing, even potty breaks outside must be taken on a leash. B, also, had never been crated in his life, so I purchased what I believe is termed an "expen", set it up in my living room. It was about 6 ft. in diameter, so B at least had a little bit of room to move around without being cooped up in a crate. The only time he was allowed out was for meals, & to come to bed in my room. Everything was going great until about 7 weeks post-op, I let B out from the crate one evening for supper. He was simply following me to the kitchen, not running or doing any horsing around, I hear this yip, turnaround & he's limping on the repaired leg. B had to go back to surgery, & what had happened was this monofilament line had stretched so far out, the knee was no longer stable, & the repair had to be redone. The surgeon said that the line was so stretched it might as well have broken. B's ACL repair is actually what set us on the road to a Cushing's diagnosis. The surgeon calls me at work prior to going to the operating room, to tell me that B's alk phos is sky high, something like 1200 or higher. He wants to know if B had been on any allergy medicine, & I told him absolutely. He had horrible allergies, & had been taking various allergy meds from my regular vet for a long time. The surgeon said the meds were probably what caused the alk phos elevation, & took him to surgery. Now, when it comes to taking Gracie to surgery with an elevated alk phos or any other abnormal lab work, it's the surgeon's job to select the appropriate anesthetic that will not further compromise liver or kidney function. With this type of surgery, the pup will be on an IV which will help support liver & kidney function during the procedure.

My 2nd ACL experience was with my Lhasa, Chewy, about 18 months ago. Chew jumped off the bed one afternoon, I was laying down, heard him yip, jumped up to check on him, & he had come up lame after the jump. My GP vet set us to a vet surgeon, (not the same one as above), who reviewed everything including the x-rays. I told this surgeon up front about my previous experience with ACL surgery. He proceeded to explain to me that B's surgery was, now, considered to be "old school", had fallen out of favor, but he did say that he would still do this type of repair under certain circumstances. The preferred procedure for an ACL repair, now, is called TPLO for short. It is a fairly involved procedure, & I'll be honest, it's not cheap. You, also, want to make sure that you have a good vet surgeon who is more or less an orthopedic specialist, & has plenty of experience doing TPLO's Chewy came through the surgery just fine. This surgery will also require approximately 2 months of restricted activity as I have explained above. I can tell you that with both dogs I discussed trying conservative management, & I got the same answer both times, you can try, but eventually severe arthritis will probably settle in that injured knee which will inhibit the dog's mobility even further. Here's a link that should give more detailed information about TPLO surgery, & what to expect. I opted for surgery with both dogs as Barkley was only about 8 at the time of his injury, fairly active, & I wanted to make sure that he had a good shot at the best quality of life after his injury. Also, please don't let the pictures of the x-rays on the link freak you out, this is what has to be done for the repair to work, & it is the best shot as insuring a functional knee joint for the remainder of the pup's life.

If I can answer any more of you questions, feel free to ask.

http://www.vetsurgerycentral.com/tplo.htm

Debbie

[StarDeb55]

Kenny, I need to let you know that I'm a lab tech with 30+ years experience, so reviewing lab values is what I do on a daily basis.

I need to tell you that any vet or MD is going to look at an elevated lab value when it's severely elevated, & view it from the point that it's severely elevated. They really don't care if it's 1200, 3500, or 6000 because clinically, for their patient, the specific number makes no difference. I am probably repeating what I believe John may have already mentioned, there are a huge number of reasons a pup's ALP may be elevated, & they're all not Cushing's related. I had to take both my ACL pups to a derm vet over the years, & at one point we both had a slight concern that the TPLO Lhasa might be developing Cushings. I will tell you exactly what the derm vet told me about elevated ALP in dogs. To quote him, " I think that you could sneeze sometimes in front of these guys, & it would elevate their ALP." His statement really just means that lots of things can elevate an ALP, some of them are not all that serious.

When it comes to PT. you might give it a try for a month. Re-evaluate how Gracie is doing, then make your decision about surgery. The surgeon who did the TPLO was very surprised that the injury had only been 4 days prior to the consult. He said that he usually is taking dogs to surgery for the repair, several weeks to a month or more after the initial injury. Ask the vets at the vet school if a delay of 4-6 weeks to try PT, would put the chance for success of the surgery in doubt. If they tell you no, then by all means give PT a try.

debbie

[KennyJ]

I can't tell everyone enough just how much their support means to me. If you didn't know Gracie had a bad limp you would never know anything was wrong with this little girl. Yes she is a big Maltese. I have only had one Maltese that was the perfect weight for a Maltese. That was the one I purchased for my mom and dad. The others have all looked just like Gracie. And I don't understand why my regular Vet has never said anything about her looking like a Cushing dog. This is not something that just happened over night. Gracie looked like that when I took her in for her last annual checkup in August 2012. But I have to tell you I am confused when it comes what to do with the ACL tear. Two Vets says she has to have surgery that it's a bad tear. The other two say try the therapy first. Of course I would rather her heal on her own but not sure that is going to be possible. This Vet wants to do therapy and laser therapy as well. The elevated ALP concerns me a great deal but Gracie happens to be a dog that gets very stressed very easily. I mean VERY stressed. I asked all the Vets if that could have contributed to an elevated ALP or if the injury itself could have caused it. One said maybe to a certain extent but not with those values, the other 3 said there is no way that her injury caused this.





Kenny, I need to let you know that I'm a lab tech with 30+ years experience, so reviewing lab values is what I do on a daily basis.

I need to tell you that any vet or MD is going to look at an elevated lab value when it's severely elevated, & view it from the point that it's severely elevated. They really don't care if it's 1200, 3500, or 6000 because clinically, for their patient, the specific number makes no difference. I am probably repeating what I believe John may have already mentioned, there are a huge number of reasons a pup's ALP may be elevated, & they're all not Cushing's related. I had to take both my ACL pups to a derm vet over the years, & at one point we both had a slight concern that the TPLO Lhasa might be developing Cushings. I will tell you exactly what the derm vet told me about elevated ALP in dogs. To quote him, " I think that you could sneeze sometimes in front of these guys, & it would elevate their ALP." His statement really just means that lots of things can elevate an ALP, some of them are not all that serious.

When it comes to PT. you might give it a try for a month. Re-evaluate how Gracie is doing, then make your decision about surgery. The surgeon who did the TPLO was very surprised that the injury had only been 4 days prior to the consult. He said that he usually is taking dogs to surgery for the repair, several weeks to a month or more after the initial injury. Ask the vets at the vet school if a delay of 4-6 weeks to try PT, would put the chance for success of the surgery in doubt. If they tell you no, then by all means give PT a try.

debbie

[molly muffin]

Which of these vets actually saw the xray of the tear? Was it the two that said it was a bad tear and that she needed surgery or did they all see it? I'm wondering if the xray specifically was a consideration for the recommendation.

Deb and John and everyone have given you excellent advice and they have both been through this. Deb was very specific was to what has to be done with each type of surgery and John was detailed about the therapy approach.
Rather than continuing to pour money into seeing different vets, at this point, you need to decide on a approach to try.
I think Deb's idea is a good one. Call the vet school, ask if it would hurt if the surgery was delayed for a month while you try therapy. No jumping or running around like a crazy thing though for Gracie till this is over.

Sharlene and molly muffin

[KennyJ]

The one Vet that actually took the xrays while Gracie was sedated said she most definitely needed surgery. The Vet I took Gracie to last night also viewed the xrays and gave that injured leg a good look said she believed she could get Gracie back with physical therapy and said if it was her she would cancel the visit to the Vet School. She agrees that Gracie's leg has a either a partial tear or complete tear but not sold on surgery just yet. Today will be the first time I actually left Gracie in a small bedroom with a gate. I have to admit it broke my heart. She owns that house. I tell everyone it's Gracie's house but she allows me to live there. I do have an appointment with the orthopedic Dr's at the Va Maryland Vet School on Wednesday here at Virginia Tech. Not sure if I should let them look at her or cancel it. I am going to be broke before I ever make a decision.






Which of these vets actually saw the xray of the tear? Was it the two that said it was a bad tear and that she needed surgery or did they all see it? I'm wondering if the xray specifically was a consideration for the recommendation.

Deb and John and everyone have given you excellent advice and they have both been through this. Deb was very specific was to what has to be done with each type of surgery and John was detailed about the therapy approach.
Rather than continuing to pour money into seeing different vets, at this point, you need to decide on a approach to try.
I think Deb's idea is a good one. Call the vet school, ask if it would hurt if the surgery was delayed for a month while you try therapy. No jumping or running around like a crazy thing though for Gracie till this is over.

Sharlene and molly muffin

[Trixie]

Hi Kenny,
I am so sorry for what you're going through with Gracie. I am no expert on Cushings or the acl problem. I began this whole thing with my dog's elevated liver number too. Before we did anything at all about testing for Cushings my vet prescribed Denamarin for the liver. We did a retest after 10 days on it and her liver number had dropped quite a bit.
Until you sort out what you are doing about the ACL issue perhaps you could ask the vet about trying the Denamarin since you feel so worried about her liver level. It's a supplement to aid the liver and pretty well tolerated by most dogs.
I know how one can be consumed with worry about all this..the dog's health and comfort, the expenses, all of it...it's so hard. Everyone here knows what you're going through. Hope that you can get it all worked out soon. At least Gracie sounds like she's holding up pretty well. I'm sure she didn't mind being gated too much...harder for you than her I bet!
Barbara

[KennyJ]

Thank you. I placed an order for Denamarin Chewable Tablets last week. Just waiting for them to arrive. I do know that lab work can change considerably because I had a Maltese a while back that had an elevated WBC of 65, 000. Took her to our Vet School and they still couldn't figure out what was going on. So even the best of Hospitals don't have all the answers. They wanted to diagnose her has having leukemia and gave me some chemo pills. I would not accept that. I placed her on COQ10 with Inistol twice a day and all her lab work came back to normal.




Hi Kenny,
I am so sorry for what you're going through with Gracie. I am no expert on Cushings or the acl problem. I began this whole thing with my dog's elevated liver number too. Before we did anything at all about testing for Cushings my vet prescribed Denamarin for the liver. We did a retest after 10 days on it and her liver number had dropped quite a bit.
Until you sort out what you are doing about the ACL issue perhaps you could ask the vet about trying the Denamarin since you feel so worried about her liver level. It's a supplement to aid the liver and pretty well tolerated by most dogs.
I know how one can be consumed with worry about all this..the dog's health and comfort, the expenses, all of it...it's so hard. Everyone here knows what you're going through. Hope that you can get it all worked out soon. At least Gracie sounds like she's holding up pretty well. I'm sure she didn't mind being gated too much...harder for you than her I bet!
Barbara

[Roxee's Dad]

Hi Kenny,
You have been given so much great advice and input, but I wanted to add one thing I forgot to mention a few days ago.

With all the vets you are taking Gracie to, They are ALL probably doing what is called a drawer test. This where they check the movement in the ACL (Cranial drawer motion)

Every-time a different vet that sees Gracie does that test.. their is a risk of re-injuring that knee and all the healing to date.

My Rozee has luxating patella's and even though she is healed, it's in her records and the vet's always want to perform that test to see how she is doing. I don't allow it. I already know she has luxating patella's, so I won't let a vet perform a Cranial drawer motion test anymore. the risk is too high to cause further injury.

I know this stuff is confusing and it is hard to make a decision, after you talk to the therapist and ask how long this will take and how long she will have to be confined.... then weigh that against the surgery option. Surgery is still the quickest recovery option so less time being cooped up.

We hate it, but sometimes it's tough love to get our pups better as soon as possible.

[Concernedmom]

Hi Kenny
I'm very sorry about the health problems you're having with Gracie. I too have a Maltese 13 yrs. old and has Cushings. We are Treating with Homeopathic remedies.
It sounds like you are really confused about Gracie's leg and whether or not she has cushings. I know there's a lot of information to take in especially on the cushings front but regarding her leg don't you think an orthopedic vet would be the most qualified to evaluate Gracie? I also had a dog with ACL. Tried physical therapy and acupucture but for mine surgery was the option. It is very painful for them before and after surgery. Will physical therapy work for Gracie who knows but you really should have an orthopedic doctor give that advice. I happen to love Vet Schools. Many doctors all in one place. I know you took your Gracie off of Rimadyl because you said it wasn't doing anything and because it isn't good for the liver. You're right it isn't good for the liver but it's also a pain medicine so I would talk to my doctor to get something else for her pain. I once had a dog in extreme pain from arthritis and it wasn't very nice. Here's a handout on how to tell if your dog is in pain.
https://www.aahanet.org/graphics/CustomContent/Dogs_in_Pain_Client_Handout.pdf

Please try not to worry about the cushings. You do need to take care of one thing at a time and everyone is correct the most important thing is her leg because if you don't fix it she will have awful arthritis in later years. The ALP levels seem to be driving you crazy but it's always clinical signs that the doctors look at not always the numbers on the blood work. If Gracie is eating, drinking, etc and happy then you shouldn't worry about the ALP. This is the same thing they told me about the cushing numbers. If the number isn't ideal it doesn't matter as long as clinically they are doing well. You are the only judge of how well Gracie feels or how poorly she feels.

You also mentioned she loves to jump in a chair. My boy loves to jump on our cedar chest so I wonder if you could build a small ramp for her to walk up to the chair. We have lots of small wood ramps around the house that my husband made for this purpose. He puts carpet on the top for traction. Works perfect.
I know how much you love Gracie you can tell by your posts. I wish you lots of luck and good health.

[KennyJ]

Wow, thank you for letting me know this. And now that you mentioned this I had Gracie in a small bedroom. When I came home she seemed to be doing better with her leg. Barely limped. Then I tried to do the physical therapy the Vet showed me and it looked like it caused her to limp more. And the Vet that did the xray he really put Gracies leg through some tough movement. When she was sedated he bent that leg even more. I was thinking the same thing when I was watching him. That couldn't have been good for her leg.




Hi Kenny,
You have been given so much great advice and input, but I wanted to add one thing I forgot to mention a few days ago.

With all the vets you are taking Gracie to, They are ALL probably doing what is called a drawer test. This where they check the movement in the ACL (Cranial drawer motion)

Every-time a different vet that sees Gracie does that test.. their is a risk of re-injuring that knee and all the healing to date.

My Rozee has luxating patella's and even though she is healed, it's in her records and the vet's always want to perform that test to see how she is doing. I don't allow it. I already know she has luxating patella's, so I won't let a vet perform a Cranial drawer motion test anymore. the risk is too high to cause further injury.

I know this stuff is confusing and it is hard to make a decision, after you talk to the therapist and ask how long this will take and how long she will have to be confined.... then weigh that against the surgery option. Surgery is still the quickest recovery option so less time being cooped up.

We hate it, but sometimes it's tough love to get our pups better as soon as possible.

[KennyJ]

Thank you. Gracie doesn't have the drinking problem that I see most of the people talking about. For the past 3 nights I have measured her water intake before we retire for the night. First night 12 ounces. Second Night 8 ounces. Third night 10 ounces. She weighs right at 13 lbs.





Hi Kenny
I'm very sorry about the health problems you're having with Gracie. I too have a Maltese 13 yrs. old and has Cushings. We are Treating with Homeopathic remedies.
It sounds like you are really confused about Gracie's leg and whether or not she has cushings. I know there's a lot of information to take in especially on the cushings front but regarding her leg don't you think an orthopedic vet would be the most qualified to evaluate Gracie? I also had a dog with ACL. Tried physical therapy and acupucture but for mine surgery was the option. It is very painful for them before and after surgery. Will physical therapy work for Gracie who knows but you really should have an orthopedic doctor give that advice. I happen to love Vet Schools. Many doctors all in one place. I know you took your Gracie off of Rimadyl because you said it wasn't doing anything and because it isn't good for the liver. You're right it isn't good for the liver but it's also a pain medicine so I would talk to my doctor to get something else for her pain. I once had a dog in extreme pain from arthritis and it wasn't very nice. Here's a handout on how to tell if your dog is in pain.
https://www.aahanet.org/graphics/CustomContent/Dogs_in_Pain_Client_Handout.pdf

Please try not to worry about the cushings. You do need to take care of one thing at a time and everyone is correct the most important thing is her leg because if you don't fix it she will have awful arthritis in later years. The ALP levels seem to be driving you crazy but it's always clinical signs that the doctors look at not always the numbers on the blood work. If Gracie is eating, drinking, etc and happy then you shouldn't worry about the ALP. This is the same thing they told me about the cushing numbers. If the number isn't ideal it doesn't matter as long as clinically they are doing well. You are the only judge of how well Gracie feels or how poorly she feels.

You also mentioned she loves to jump in a chair. My boy loves to jump on our cedar chest so I wonder if you could build a small ramp for her to walk up to the chair. We have lots of small wood ramps around the house that my husband made for this purpose. He puts carpet on the top for traction. Works perfect.
I know how much you love Gracie you can tell by your posts. I wish you lots of luck and good health.

[KennyJ]

Two symptoms I can most definitely rule out when it comes to Cushings. Drinking a lot and eating a lot. Gracie does not have those symptoms.

[StarDeb55]

Kenny, granted not all cushpups will have all symptoms. I can guarantee you that probably 85-90% of our pups will have the voracious appetite that we have talked to you about, along with drinking gallons of water, & peeing buckets. When I talk about voracious appetite, I like the description my GP vet has for a cushpup appetite, it's a "white shark appetite". They will eat anything & everything they can find, no matter what it is, & still look for more. My first boy, Barkley, would have literally eaten until he popped if I had let him. The appetite & excessive drinking are the 2 main ways to monitor how well either of the medications are working, so if Gracie has neither I would be very concerned about trying either medication with her at the present time. Not to repeat what you've been told already, Cushing's is a very graded disease with a very slow onset, it develops at a snail's pace, literally taking years to do any damage to the pup's internal organs.

I'm repeating the info right now about how slowly Cushing's develops because the primary concern with Gracie needs to be that knee. ACL ruptures are very painful for a pup, & if Gracie is already "3 legging" it because of the rupture, she is at high risk to blow her other knee out. The stress & pain from the injury will cause Gracie's cortisol to rise as a response, so it is absolutely useless at this time to attempt any Cushing's diagnostic testing on Gracie. It would be a huge waste of $$ that could be applied to taking care of her leg. I know all of these different vet opinions have you confused. It also sounds like you want to be careful with Gracie, so I'll repeat what I said earlier, contact the vet who wants to do the TPLO, ask if delaying the surgery for 4-6 weeks would lead to a poor outcome because of the delay. My understanding of treating an ACL with conservative management is that the ligament itself doesn't really heal, but what does happen is scar tissue forms in & around the ligament which will stabilize the knee. Tell him you want to give therapy a good chance to work, & if it doesn't you will reassess what needs to be done for Gracie's leg at that time.

There's one other thing I want to mention about the x-rays. X-rays can't show the tear in the ACL. What the vet is looking at is the change in the angle between the femur (thigh bone), & the tibia. The change in the angle is due to the ACL rupture. If I remember the explanation my Lhasa's surgeon gave me, the larger the angle between the 2 bones indicates the degree of the ACL tear.

Debbie

[KennyJ]

Actually the vets that I spoke with would do the lateral procedure. My guess the Vet School will want to to do the TPLO. And Gracie can actually use the leg but still limps.






Kenny, granted not all cushpups will have all symptoms. I can guarantee you that probably 85-90% of our pups will have the voracious appetite that we have talked to you about, along with drinking gallons of water, & peeing buckets. When I talk about voracious appetite, I like the description my GP vet has for a cushpup appetite, it's a "white shark appetite". They will eat anything & everything they can find, no matter what it is, & still look for more. My first boy, Barkley, would have literally eaten until he popped if I had let him. The appetite & excessive drinking are the 2 main ways to monitor how well either of the medications are working, so if Gracie has neither I would be very concerned about trying either medication with her at the present time. Not to repeat what you've been told already, Cushing's is a very graded disease with a very slow onset, it develops at a snail's pace, literally taking years to do any damage to the pup's internal organs.

I'm repeating the info right now about how slowly Cushing's develops because the primary concern with Gracie needs to be that knee. ACL ruptures are very painful for a pup, & if Gracie is already "3 legging" it because of the rupture, she is at high risk to blow her other knee out. The stress & pain from the injury will cause Gracie's cortisol to rise as a response, so it is absolutely useless at this time to attempt any Cushing's diagnostic testing on Gracie. It would be a huge waste of $$ that could be applied to taking care of her leg. I know all of these different vet opinions have you confused. It also sounds like you want to be careful with Gracie, so I'll repeat what I said earlier, contact the vet who wants to do the TPLO, ask if delaying the surgery for 4-6 weeks would lead to a poor outcome because of the delay. My understanding of treating an ACL with conservative management is that the ligament itself doesn't really heal, but what does happen is scar tissue forms in & around the ligament which will stabilize the knee. Tell him you want to give therapy a good chance to work, & if it doesn't you will reassess what needs to be done for Gracie's leg at that time.

There's one other thing I want to mention about the x-rays. X-rays can't show the tear in the ACL. What the vet is looking at is the change in the angle between the femur (thigh bone), & the tibia. The change in the angle is due to the ACL rupture. If I remember the explanation my Lhasa's surgeon gave me, the larger the angle between the 2 bones indicates the degree of the ACL tear.

Debbie

[voiletmay]

Just wanted to say hello.

My 9 year old maltese is also about to be diagnosed with cushings . He's only just gotten over having his spleen (and attached tumor) removed. The ultrasound he had for his spleen tumour showed that his adrenal glands were enlarged.

He wasn't showing symptoms of cushings then, but now is extremely hungry and thirsty all the time. He was having a cartophen injection today (for arthritis) and I mentioned it to the vet. We are getting the test next week. She wasn't sure if the 4 or 8 hour one would be done, so was going to ring the lab and get back to me.

Reading lots about cushings in dogs today, the treatment sounds pretty awful and expensive.

My dog also had lots of lumps all over his body and has had them all removed all the years. The big tumour on his spleen was his first big internal lump.

Just wanted to let you know, that yours isn't the only maltese going through this.

[KennyJ]

Thank you. One thing I have found out after owning 3 Maltese. They are tough little dogs. I can't believe the number of growths Gracie has all over stomach and chest area. None of the doctors seemed that concerned about them. The only thing they agreed on was get the leg fixed first. Now agreeing on how to do that is a different matter. 2 for and 2 against surgery. The 2 against says that research says for dogs under 30 lbs will heal with a torn ACL with rest and therapy. Not sure I agree with them but I think any of us would rather go with the less intrusive route if at all possible. However, I am not sure that will end up being Gracie's best option. She is putting weight on the injured leg but my part of performing the physical therapy concerns me that I may not be doing it correctly and I injure the leg even more. If I could get the liver enzyme to come down I would be happier. Still waiting on my combo of Milk Thistle and SamE to arrive so I can start her on that.





Just wanted to say hello.

My 9 year old maltese is also about to be diagnosed with cushings . He's only just gotten over having his spleen (and attached tumor) removed. The ultrasound he had for his spleen tumour showed that his adrenal glands were enlarged.

He wasn't showing symptoms of cushings then, but now is extremely hungry and thirsty all the time. He was having a cartophen injection today (for arthritis) and I mentioned it to the vet. We are getting the test next week. She wasn't sure if the 4 or 8 hour one would be done, so was going to ring the lab and get back to me.

Reading lots about cushings in dogs today, the treatment sounds pretty awful and expensive.

My dog also had lots of lumps all over his body and has had them all removed all the years. The big tumour on his spleen was his first big internal lump.

Just wanted to let you know, that yours isn't the only maltese going through this.

[KennyJ]

Question about Cushex drops. I know everyone says it's a scam and this product is not worth the money but I have another question. One of the ingredients has dandelion which is a diuretic. Wouldn't this cause your dog to urinate more than it already is?? And yes I was one of the suckers that ordered this a couple of weeks ago. Bottle is still unopened and I guess I will try and get a refund.

[lisamak]

Question about Cushex drops. I know everyone says it's a scam and this product is not worth the money but I have another question. One of the ingredients has dandelion which is a diuretic. Wouldn't this cause your dog to urinate more than it already is?? And yes I was one of the suckers that ordered this a couple of weeks ago. Bottle is still unopened and I guess I will try and get a refund.

IMHO the Cushex isn't a scam - its an herbal tonic that helps support Cushing's dogs. It isn't a cure-all (and the company is careful to state that it won't cure cushings).

Dandelion has a lot of properties...liver cleanser, diuretic, astringent...its most common use is in remedies/tonics for the urinary tract system - but has to be used carefully when treating dogs with recurring UTIs/crystals/stones.

From reading your posts it doesn't sound like you have a confirmed dx of Cushing's. So I'd focus on bringing the liver values down (with the sam-e and milk thistle) and working on the ACL issue. Putting too much into the mix all at once could leave you with results you don't want and may just complicate things (well, it would complicate me :) ).

Good luck!

[KennyJ]

Thank you Lisa. The last Vet I took Gracie to wants to try physical therapy first on the ACL. However, part of that falls on me to perform stretching on her legs. In all honesty I am afraid I am hurting her legs when I do this. She seems to limp more after I stretch her legs. Now another question. I have one small bedroom that has nothing but Gracie's toys in it. And believe me she has a lot of toys. I put a gate up so she couldn't have access to the hard wood floors only the carpeted bedroom. Will this help her heal or should she have something smaller? Crating her would cause her to be stressed because that is just the type of little dog she is. I thought about the play pens that you see babies in and set it up so she can look out the front door. I have milk thistle and SamE on the way but I am getting very impatient. I feel like I am wasting valuable time and money by prolonging the inevitable and that's surgery. Vet bills are already up to $1,000 and I haven't accomplished anything. Getting very discouraged. Now if I get the surgery that's probably another $2500 if I should allow the Vet School to do it.






IMHO the Cushex isn't a scam - its an herbal tonic that helps support Cushing's dogs. It isn't a cure-all (and the company is careful to state that it won't cure cushings).

Dandelion has a lot of properties...liver cleanser, diuretic, astringent...its most common use is in remedies/tonics for the urinary tract system - but has to be used carefully when treating dogs with recurring UTIs/crystals/stones.

From reading your posts it doesn't sound like you have a confirmed dx of Cushing's. So I'd focus on bringing the liver values down (with the sam-e and milk thistle) and working on the ACL issue. Putting too much into the mix all at once could leave you with results you don't want and may just complicate things (well, it would complicate me :) ).

Good luck!

[frijole]

You can purchase milk thistle and SamE at any drug store. That's what I did. So you don't have to wait - just saying.

[lisamak]

I think your idea of a play-pen (much cheaper than buying a crate or x-pen) is a good one...you do want to keep her movement as restricted as possible (I know a lot of dogs and even cats that have been through the ACL "mess"). Talk to your vet about the stretching and see if "warming her up" with a heating pad for a few minutes would make it easier.

My old man has some stiffness/arthritis issues and I do stretching and massage with him - he sleeps on my lap most of the day so I put a lightweight heating pad on him for a few minutes to warm/loosen things up then I do some massage and range of motion stuff (he's usually asleep through the whole thing).

I think trying to work on her now - either instead of or pre-surgery - is key. Just so you know, if she does have the surgery you're going to have to keep her even more restricted in her movements and you're going to have to do exercises/stretching/all that. So think of this as a test run - that might just work on its own.

~~Lisa and Vince

[KennyJ]

If I purchase the milk thistle and SamE at the drug store how much do I use for a 13 lb dog? Can you get the liquid Milk thistle at the drug store?






You can purchase milk thistle and SamE at any drug store. That's what I did. So you don't have to wait - just saying.

[frijole]

My dog weighed 17 lbs and I just took a capsule a day and poured 1/2 on her food in the am and another 1/2 at night.

[KennyJ]

I just purchased a bottle at a Vitamin store. Its in liquid form with a dropper. I put 4 or 5 drops on her food and she loved it. Still limping though. This Vet called the orthopedic surgeon at the Vet School and said she didn't see anything wrong trying physical therapy for 4-6 weeks to see it helped but Gracie still may need surgery. Gracie seems so heavy and she doesn't eat that much.





My dog weighed 17 lbs and I just took a capsule a day and poured 1/2 on her food in the am and another 1/2 at night.

[molly muffin]

Okay so you have a plan it sounds like. You'll try therapy for a month with the vet and then re-evaluate.
The limp is probably not going away until the leg has healed and we are talking quite a long time.
Just remember, no jumping or running at all. Minimal activity.

Sharlene and Molly Muffin

[KennyJ]

The jumping I have taken care of but the first thing she does when I put her down on the floor is run. Taking a long time is my concern. That means even longer to test for Cushings.





Okay so you have a plan it sounds like. You'll try therapy for a month with the vet and then re-evaluate.
The limp is probably not going away until the leg has healed and we are talking quite a long time.
Just remember, no jumping or running at all. Minimal activity.

Sharlene and Molly Muffin

[StarDeb55]

Kenny, Gracie can't run, no exceptions. If you have to put her on a leash to stop it, that's what has to be done. Any time she runs, jumps, her knee is sliding back/forth between the femur & tibia. That movement in the knee causes a lot of pain. The excess movement, more than likely, is undoing any good that Gracie might be getting from rest, & any stretching or massage that you are doing with her. You absolutely have to restrict her movement, no exceptions, if PT is going to work. If this means keeping her leash on her most of time, it has to be done. I know she will probably get very unhappy with her Dad, but you are doing what's best for her.

Sorry to be blunt, but we all want Gracie to have the best shot at healing on her own & avoiding surgery.

Debbie

[KennyJ]

I just got back from Gracie's laser therapy. Her limp is noticeably worse after the treatment. Is that normal?

[mytil]

She could be sore from the PT of which is more normal than not. I agree completely, she cannot run, jump, romp or climb stairs if she is to heal. I know she will give you those sad eyes, but it is so necessary! Dogs are masters at hiding pain so she will show you that she can run and romp and this gives the wrong message to owners.

And please follow exactly any after PT instructions given to you.

Another thing you may do is this when she is not confined to the pen. Set up in various parts of your house that you are in (kitchen, living room bedroom etc) places that a leash can be safely hooked to or tied to where she can be with you (while still on a leash), but not able to run around and place some soft blankets there so she can lay down. That way you do not have to keep holding a leash all the time and she may not feel "penned up." I call these leash stations.

Eons ago when my Mytilda had trouble I absolutely did everything I was instructed to do including not giving into her until she was completely healed; I even carried a 40 pound dog up and down the stairs. :) I had these "leash stations" all over the house. She healed ahead of schedule and never had a problem.

Terry

[KennyJ]

Actually the vet really didn't do much at all on the leg. Showed me another technique because I was afraid I was hurting her. But really didn't much PT at all. Just the laser.






She could be sore from the PT of which is more normal than not. I agree completely, she cannot run, jump, romp or climb stairs if she is to heal. I know she will give you those sad eyes, but it is so necessary! Dogs are masters at hiding pain so she will show you that she can run and romp and this gives the wrong message to owners.

And please follow exactly any after PT instructions given to you.

Another thing you may do is this when she is not confined to the pen. Set up in various parts of your house that you are in (kitchen, living room bedroom etc) places that a leash can be safely hooked to or tied to where she can be with you (while still on a leash), but not able to run around and place some soft blankets there so she can lay down. That way you do not have to keep holding a leash all the time and she may not feel "penned up." I call these leash stations.

Eons ago when my Mytilda had trouble I absolutely did everything I was instructed to do including not giving into her until she was completely healed; I even carried a 40 pound dog up and down the stairs. :) I had these "leash stations" all over the house. She healed ahead of schedule and never had a problem.

Terry

[KennyJ]

Terry, did you do surgery or did you do the conservative approach?





She could be sore from the PT of which is more normal than not. I agree completely, she cannot run, jump, romp or climb stairs if she is to heal. I know she will give you those sad eyes, but it is so necessary! Dogs are masters at hiding pain so she will show you that she can run and romp and this gives the wrong message to owners.

And please follow exactly any after PT instructions given to you.

Another thing you may do is this when she is not confined to the pen. Set up in various parts of your house that you are in (kitchen, living room bedroom etc) places that a leash can be safely hooked to or tied to where she can be with you (while still on a leash), but not able to run around and place some soft blankets there so she can lay down. That way you do not have to keep holding a leash all the time and she may not feel "penned up." I call these leash stations.

Eons ago when my Mytilda had trouble I absolutely did everything I was instructed to do including not giving into her until she was completely healed; I even carried a 40 pound dog up and down the stairs. :) I had these "leash stations" all over the house. She healed ahead of schedule and never had a problem.

Terry

[StarDeb55]

Kenny, I believe that Terry's pup did have surgery. She still had to do PT after surgery, so the instructions would have been pretty similar to what you have been told. Terry's suggestion of making "leash stations" around the house is a good one. When you say that Gracie "runs" when you put her down, is she actually running & 3 legging it while she runs. I'm asking because it would be almost impossible for a dog with a ruptured ACL to run. Not to repeat what John & I have already told you, but if she is trying to "3 leg" it while she runs, she is going to be at very high risk to blow out her other knee.

Debbie

[KennyJ]

At times it looks like she is pushing off the injured leg. Almost like nothing is injured. Then other times she skips.






Kenny, I believe that Terry's pup did have surgery. She still had to do PT after surgery, so the instructions would have been pretty similar to what you have been told. Terry's suggestion of making "leash stations" around the house is a good one. When you say that Gracie "runs" when you put her down, is she actually running & 3 legging it while she runs. I'm asking because it would be almost impossible for a dog with a ruptured ACL to run. Not to repeat what John & I have already told you, but if she is trying to "3 leg" it while she runs, she is going to be at very high risk to blow out her other knee.

Debbie

[Roxee's Dad]

Hi Kenny,
I strongly agree with the advice of the last few post. I have done both the surgery and the conservative management approach.

It's tough love, but it has to be done properly. Her knee is probably bone on bone. Dogs try not to show pain as pain is a sign of weakness, and in their world the strong survive. No running, no jumping.

Every minute new tissue is being built up, that tissue is very fragile until it scars up and becomes strong, one run, one mis step can destroy that tissue, and we are starting over again.

[KennyJ]

John should she be walking at all? For the most part she is lying down but is walking around the house.




Hi Kenny,
I strongly agree with the advice of the last few post. I have done both the surgery and the conservative management approach.

It's tough love, but it has to be done properly. Her knee is probably bone on bone. Dogs try not to show pain as pain is a sign of weakness, and in their world the strong survive. No running, no jumping.

Every minute new tissue is being built up, that tissue is very fragile until it scars up and becomes strong, one run, one mis step can destroy that tissue, and we are starting over again.

[Roxee's Dad]

Hey Kenny,
Is she walking on 3 legs or all 4?

By the way, You don't need to click the quote key to reply on this thread. It kind of makes it a bit messy and a long read for anybody that wants to catch up on your and Gracie's thread.

Just click on the post reply button just to the left and above the last post.

[StarDeb55]

Kenny, I'm going to relay a story to you about how our pups are past masters at hiding illness & pain. My 2nd cushpup, a 15 year old Shih Tzu, Harley, had really not been having trouble, but I noticed that it seemed that he was spending a long time at the water bowl. About this time, he had to go to the eye vet who asks me after his physical exam, "have you noticed the large mass on his upper jaw?" I'm like what Mass? I thought it might be an dental abscess, so I scheduled him for a dental at the regular vets ASAP. 2 days later, I wake up to a bed that is just covered with blood spray on the side where he sleeps. I rushed him into the vet that afternoon. To make a long story short, whatever that mass was, it was malignant, & had already spread to his lungs. There was nothing I could do, but release Harley from his pain. After Harley passed, the vet took a look in his mouth, that mass had eaten a hole in his upper palate. I'm sure that little boy was in terrible pain, & the only thing I noticed was that it seemed like it was taking him a long time to get a drink. This is to demonstrate that our pups are absolute masters at hiding pain, injury, & illness.

Debbie

[KennyJ]

Thanks John. Her injured leg is always on the ground when she walks but she still limps. Then then are times you can barely notice it. This is so stressful. I feel so helpless.

[Tina]

Hi Kenny,
I have been following along on your thread and just wanted to chime in with my experience with torn ACL's. My Angel Dakota tore both of her ACL's in her lifetime, thankfully not at the same time. The first happened at age 8, the second at age 12. She was a 75 lb Black Lab, so there was no option but surgery for each leg. The reason that I want to comment is to reiterate that Gracie must not run or jump AT ALL regardless of whether you decide on the surgery or conservative management. I just want to strongly reinforce what everyone else has said.

I live alone and there is no way that I could lift and carry a 75 lb dog in and out of the house. I managed to completely keep her from running or jumping and re injuring her legs during both post op and recovery periods. The leash stations are great ideas and I used them. I also tied a long leash around my waist so she couldn't go anywhere on her own. She was on a leash at all times. I had to work every day after her surgeries and she was crated while I was away. She absolutely hated the crate and was also highly anxious, but I could not risk her re injuring the leg that had been repaired, or God forbid, after the first repair, tear the ACL in the good leg. I was worried that would end up being the end for her if that happened since I could not carry her. So I had to bite the bullet. it was very difficult. I think it would be more manageable for you since Gracie is small and you can carry her in and out, etc.

I know this is so stressful, but I guess I just wanted to point out that there is an advantage for you since your dog is small, which ever approach you decide to take. Gracie is at very high risk to tear the other ACL if her activity is not restricted as Debbie and John have said. Not to mention the pain she is in when allowed to run. And there is also the risk of continued meniscus damage. Just my 2 cents from my experience.

Debbie, (((hugs))). I am so sorry to learn about Harley, you must have been just devastated. Yes, they are masters at hiding pain, always wanting to please.

Tina

[mytil]

Yes Kenny, I opted for surgery and yep Debbie is right, the PT you are doing is what I did to the letter. Just because I opted for surgery does not mean everyone has to - every dog, owner and situation are different. I am glad you are trying PT first to see if surgery may not be needed. The PT and inactivity are extremely important. I know as a football player you have had at some time PT - well you know how it feels and yes, it can be painful and uncomfortable; but you knew it was necessary and you had to be inactive, right?

I think you know inside what is really necessary and what to watch for - just relax and follow the instructions of inactivity and do not miss any PT appts. It will take a while and it will not heal in a week or even two. And to reiterate, dogs are great at hiding pain and just because she wants to run and be active, does not mean she is not in pain doing it; even if her tail is wagging.

Terry

[KennyJ]

I wanted to thank everyone again for all your support. I wish it was just one thing I had to be worried about when it comes to Gracie but the leg is causing me extra stress. I can't stand seeing her limp and possibly being in pain. Even if I choose to do the surgery the physical therapy part that I must do is going to be a challenge. I finally got my Denamarin today. Will start Gracie on those tomorrow.

[doxiesrock912]

Kenny, is will work out. You have options for Gracie. I know how much it hurt to see our furlets not feeling their best.
Please try to do something to ease your stress, remember that our pets can sense our feelings.

[molly muffin]

Hi Kenny. We are happy to help out by sharing our experiences. It's why we exist because cushings is so hard to diagnose, vets can and do get it wrong sometimes, protocols for medicine and dosing isn't always well known, and there are just so many factors that can go along with it.
I know it is all worrying, but really you have to make choices. The leg needs immediate attention. The denamarin will help with liver issues. You need to give that some time to work though. I retested after a couple months of giving daily.
We do what we can to give our furbabies, the best quality of life possible.

Sharlene and Molly Muffin

[KennyJ]

I need your advice. I have an appointment with an orthopedic surgeon at the Vet School on Wednesday. Should I cancel that and give the conservative approach more time or let them look at her leg? Shouldn't I notice some improvement by now on her leg??

[StarDeb55]

How long have you been doing PT exactly? Are you following the home care instructions to the letter? Have you made every effort to restrict Gracie's movements?

I think your questions would be more appropriate to ask the surgeon. You are simply going for a consult, not to authorize surgery. Keep in mind that it's a surgeon's job to cut, so you clearly explain that you really what to give conservative treatment every chance, but you need to know when you call a halt, & proceed to surgery.

Debbie

[KennyJ]

Deb, restricting her has been easier than the PT. I haven't done a very good job on her leg because she doesn't want me to to fool with it.

[StarDeb55]

I know it's hard, but it's a case of tough love. I would also ask the surgeon about post-op care, including how much you would have to work with Gracie doing therapy after surgery. I know with the TPLO Lhasa, I didn't have to really do anything, but make sure he was restricted. They told me that he would let me know when he felt comfortable walking on the leg, & that it would probably be about day 3 or 4. It was day 3. I guess my point is if you are having a hard time with you home care instructions now, chances are PT may not be successful. It might be the better option to just let them take Gracie to surgery. I felt immediate surgery was the best option for the Lhasa as I'm at work all day. He would be safely contained in an expen, & there would be minimal work for me to do with him at home after surgery. Please, please you need to run all of this by the surgeon. Tell the surgeon that you are having difficulty with your home care instructions because Gracie doesn't want you fooling with her leg. Just for your piece of mind, I would ask the surgeon how many of these procedures has he done, & how many has he done on small dogs. The last thing I would ask him is "If Gracie were you dog, would you give conservative management a good chance to work, or would you proceed to surgery?"

Debbie

[KennyJ]

Deb, since your dog has Cushings did it take long to heal because of that?

[Budsters Mom]

Sending big hugs to you and Gracie My gut feeling is that you should keep the appointment at the vet school. You are going only for a consultation. It is easier to make an informed decision when you have all of your bases covered. Please bear in mind that I know less about this than almost everyone else. My opinion is coming only from the heart, not from any knowledge that I have on the subject. Thankfully there are many angels on this site that know much more;) Hang in there Kenny,

Kathy and Buddy:cool:

[StarDeb55]

With Barkley, my 1st cushpup, I would have to say yes, because he had to go back to surgery, 7 weeks after the first procedure. I will also say that during the problems with his knee, we did not know he had Cushing's. It was abnormal pre-op labwork that put us on the road to a Cushing diagnosis about 4 months after the second surgery.

Debbie

[Roxee's Dad]

Hi Kenny, It's me again :)

Your question...

Shouldn't I notice some improvement by now on her leg??

Because we don't really know the extent of her injury, is the ligament torn or just stretched or completely ruptured?

If it is just a sprain or stretched, you might see improvement in a few days, if it is torn or ruptured, you are looking at "months" not "days" of recovery, especially with PT / conservative management. The quieter you keep her, the better it will heal, but just one slip up, one jump, just one time putting too much pressure on that knee and all the days up to date could be a waste and will have to start all over.

I strongly agree with Debbie, in your case because of your schedule and difficulty with PT. Surgery may be a better option for both you and Gracie. Recovery is weeks and not months.

[KennyJ]

Deb, would something like this be ideal for Gracie when I am at home?? When I am away during the day she is placed in a small bedroom but I like to have her with me when I am at home. Thought about purchasing a pet play pen to sit up in the living room so she could look outdoors. Unless you have another one you could recommend.


http://www.dog.com/item/midwest-pet-exercise-pen/110310/

[KennyJ]

John, I am starting to lean in that direction as well. Right now I have already spent over a $1,000 on the 4 different vets and I don't think I got my money's worth. I know the regular Vets will do a different type of procedure vs what the Vet School will do. Gracie will sometimes walk as if nothing was wrong and then will start limping badly again. They believe it is most definitely a torn ACL. The one Vet that is doing the laser and PT says she is not sure that it's a big tear, the Dr that did the xrays says he believes it is.

[Roxee's Dad]

When the knee is back in place, her walking will appear normal, the problem is that it's slipping out of the joint and at that moment, it is very painful and I am sure frightening for her. It is also further damaging the knee.

The problem is there is nothing keeping the knee joint together. It is just free floating. it will twist, float in and out and it's bone on bone. The cartilage between the bones that protects it from being bone on bone is probably already damaged and gone. Not through any fault of your own, it's just the nature of the injury.

[StarDeb55]

That pen is pretty much what I used with both dogs.

Debbie

[KennyJ]

Deb, will it scar hardwood floors. I would put rugs so Gracie wouldn't slip on the floors but was curious if it would damage the floors. How long did it take before your dogs were back to normal on their legs? One more thing. Will the Denamarin help lower her ALP levels at all?

[StarDeb55]

Concerning hardwood floors maybe, I can't say for sure. The surgeon who did the TPLO wanted 2 months of restrictions, no running, jumping, on a leash to go outside for potty breaks, etc. X-rays were taken at the 2 month mark to confirm the bone had healed, & all plates/screws were stable, after that we were back to normal.

For me, I could trust both boys to go outside to potty without a leash. All I had to do was walk out with them, when they were done, tell them that it's time to come in, & they would walk back in the house.

Debbie

[KennyJ]

Gracie loves kicking her back legs after she does number 2. She is still doing that. There is no way I can get her to stop it even with the injured leg. I stand right beside her and try to pick her up before she starts but can never catch her in time.

[Roxee's Dad]

You may want to try wrapping up a long towel. Then place the towel under her belly so both ends are up at your hand level. Use the towel as a handle / support when she goes out to potty. it will keep the weight off her hind legs and she won't be able to kick the grass as you can just ever so slightly pick up the towel a bit higher to keep her back paws off the ground.

She will hate it at first, but she will learn to get used to it.

[KennyJ]

Good idea John.

[KennyJ]

Really discouraged today.

[molly muffin]

Why discouraged Kenny?

Sharlene and Molly Muffin

[KennyJ]

Just overwhelmed with everything. Already spent over a $1000 and nothing to show for it. Its bad enough that she has a torn ACL and to think on top of that probably has Cushings. Although Gracie does not appear to be in pain is there anything I can give her that will not affect the liver?? I took her off the rimadyl after I found out her ALP was so elevated.

[StarDeb55]

Kenny, please don't take my comments wrong.

Sometimes indecision can eat you alive. You have taken Gracie to 3-4 vets seeking an informed opinion about what to do about her knee. I would still keep the appointment with surgeon. Once you talk to him, I sincerely think you have all the information you need to make the best decision that you can for Gracie. You know her better than any vet. You have already told us that she doesn't like you messing with her leg to do what needs to be done for home care for PT at the moment. That, along with the fact, that Gracie is alone while you are at work during the day needs to be taken into consideration. I feel that you just need to sit down review all of the information that you have been given, then move forward with a decision.

Let me tell you what happened to me when Barkley was diagnosed with lymphoma. Barkley was ill, I couldn't put my finger on the problem, so the trips to the vets started. We were shuffling between my regular vet, & his derm vet. One vet would do a bunch of lab work telling me one thing, the other vet would do something else, & tell me something completely different. The answers I was getting were really not telling me what the source of the problem was. I finally had to pitch a royal fit at the derm vet's office telling him, "I've spent a ton of $$ between you & the regular vet trying to figure out what is going on with this boy. He is literally dying in front of my eyes, & neither of you can give me an answer." At that point we were sent to an IMS, got an answer, & I had to make decisions to move forward with what needed to be done for Barkley.

Debbie

[Tina]

Hi Kenny,
I don't have time to go back through your entire thread with a fine tooth comb, but I have just scanned the whole thing and have a couple of thoughts/questions. First off, I am having trouble seeing why you think (or were told) that Gracie might have Cushing's. I don't see excessive drinking or peeing, or voracious appetite, which are the most common symptoms. Forgive me if I missed it, but I don't see any other troubling symptoms other than the elevated ALP and pot belly. I also didn't see where any diagnostic tests for Cushing's were performed, such as a LDDS or ACTH test. Again, please forgive me if I have missed this, I just quickly scanned all 25 pages of your thread.

I was wondering if any of the vets you have seen have done specific tests to rule out liver disease. Was a bile acid test done? This test examines the function of the liver specifically, as elevated enzymes can be caused by many things. I am just thinking that with the high ALP, Gracie's liver may be enlarged, and this alone can cause a pot belly appearance (rather than it being caused by Cushings). I know this from my own Jasper, his tummy was huge until the liver enlargement decreased. Now his tummy is almost back to normal. I know that during our journey to diagnose Cushing's, liver disease was one of the things my vet tested for and ruled out before we went down the Cushing's road. He also had an ALP that was off the charts.

I guess I am going through all of this because I feel that getting Gracie's leg taken care of is the priority here. I know that Cushing's is a concern of course, but we don't know that she has it at this point, do we? It is so hard to not worry about everything, I know, I am a master worrier. I agree with Debbie, once you talk to the surgeon I would think you have everything you need to make the absolute best decision for Gracie. You will feel better once you have made a decision and can make a plan to move forward.

Tina

[KennyJ]

Hi Tina. Gracie has not had any tests to confirm Cushings. However all 4 Vets said they believe she does based on her pot belly and elevated ALP. All also agreed her leg injury needs to come first. I have been putting 20 ounces of water in Gracie's water bowl and measuring it before we go to bed at night. The most she has drank is 15 ounces. One day she drank 8 and on another day 10 ounces. She weighs 13 lbs. Like you I am wondering if something else is going on. I started her on Denamarin a couple of days ago. Two vets say do not do surgery and 2 say do surgery. I tried to do the PT that they recommended but afraid I am hurting her.

[molly muffin]

Hi Kenny, my Molly has elevated ALP's and a pot belly, her ACTH was positive but the LDDS was negative for both 4 and 8 hour full suppression. She has now had that test numerous times as they said she might be pre-cushings, and it could switch over one day to where she is fully cushings or it could be something else, but they agree that she isn't cushings right now. So you can't go on ALP and pot belly alone.
Right now with the torn ACL, any test could show a false positive due to that injury, but you already know that.
Sharlene and Molly Muffin

[KennyJ]

How high was your dog's ALP Sharlene?? Do they even think they know why her's is elevated if it's not Cushings? I have often wondered if the torn ACL caused the elevated ALP and they all said no way. They said if any spike at all it would have been very minimal. Not this high.

[molly muffin]

Molly's ALP started to go up when she started to get crystals forming. It's now just over 1000. She is on the liver supplements and we'll see when we do the next ALP how that is.

Well, no I wouldn't expect it to go that high with the ACL, but it could be something else. Infections can cause them to spike pretty high, stones can cause them to go up, etc.

Sharlene and Molly Muffin

[molly muffin]

I take that back Kenny, I just rechecked her labs, and the ALP is now at 1229, so it's continued to rise.

Sharlene and Molly Muffin