New To Forum - Keesh has crossed over

[frijole]

Has Keesh's not eating issue just started out of the blue or has this been a concurrent problem? If this just started I am wondering if something is going on in Keesh's mouth such as a bad tooth. Maybe trying baby food or putting the food in a food processor/blender and making like a puree would help???

No Lori... you'd have to read thru the thread but the short version is there seems to be a correlation between when Keesh has trilostane and his eating. We doubted the dx but the tests keep showing cushings. the acth shows not addisons... frustrating. Kim

[Roxee's Dad]

With out going back through the thread, has any dental or mouth issues been ruled out?

[spdd]

His mouth was checked twice... the teeth are ok, but he's showing gingivitis. I got told to give him dental sticks, but he has never liked them.

He doesn't like mushy food, it's all texture with him believe it or not. If I put a tsp of gravy in his dish, he's fine with that, but anything more and he'll walk away. I've tried cottage cheese and that doesn't work, small bites but something with substinance is all he'll eat. I even shredded some roast beef.. that wasn't working, but give him small pieces 2 seconds later and that works.

Thanks for the wake up call Patti.... I should be ashamed of myself.

[Trixie]

How about some raw chopped beef/hamburger? Is that too mushy for him? Dogs seem to really like raw meat...if it's good quality and not too fatty he shouldn't hurt him, if he would eat it. A little peanut butter smeared on some chicken? I know it's fatty, but a tiny bit of bacon chopped up on top of something else...turkey or chicken? How could he turn down bacon?? If he goes for the bacon he might eat what's under it??

Poor Keesh...I wonder what's bringing his appetite down like that.
Don't feel bad...you're losing patience because you want him to eat and be healthy! It's hard to deal with all this. Hoping there's a turn around for Keesh and that he will soon indulge in a meal!!

Barbara

[Roxee's Dad]

Hmmm.. with all medical issues ruled out, I like Leslie's idea. It looks like Keesh is out to be more stubborn than you... LOL

I have one that will eat anything, she snatches anything that might smell like food, then decide to spit it out or not, and another that has to have her menu changed every day, sometimes 2 or 3 times a day.

[Trish]

Do not feel ashamed of yourself, you are entitled to your feelings as we all are and this is meant to be a safe place to express them. Keesh is as important as any other dog that gets talked about here, living or who has passed. Please do not feel bad about that and do not stop talking about him. Hope this food issue sorts itself out. **BIG HUGS**

[goldengirl88]

Yes please don't feel bad or ashamed of yourself. We all express feelings on here freely and you need to be able to do that too. I was just wanting you to see Keesh's side of it, that's all. Dogs seem to like the meat cooked on a grill. Do you have a grill you could use to make him something? Sounds stupid, but does he like fish? My dogs will eat cooked fish on occasion, especially salmon. It is easy to break up in small bits. Poor Keesh I wish he could talk and tell you what is wrong. Cheer up you are doing a good job trying to solve this mystery. I have a lot of mystery solving with Tipper too, and it does wear you down. Blessings
Patti

[spdd]

How about some raw chopped beef/hamburger? Is that too mushy for him? Dogs seem to really like raw meat...if it's good quality and not too fatty he shouldn't hurt him, if he would eat it. A little peanut butter smeared on some chicken? I know it's fatty, but a tiny bit of bacon chopped up on top of something else...turkey or chicken? How could he turn down bacon?? If he goes for the bacon he might eat what's under it??

Poor Keesh...I wonder what's bringing his appetite down like that.
Don't feel bad...you're losing patience because you want him to eat and be healthy! It's hard to deal with all this. Hoping there's a turn around for Keesh and that he will soon indulge in a meal!!


Barbara

I have tried the hamburger, he used to love it... it's a no go now. Peanut butter is out of the question, because when little someone put peanut butter on the roof of his mouth and he won't go near it now. I cooked up some bacon the other day, didn't want it, turkey or chicken is a staple around here and it was just this morning he turned down the chicken. He liked hamburger on the grill, but he won't eat that either.
He is wandering around here now it's 5:00 p.m. and I think he's looking for something to eat, so I'll try again, and if this works then his Trilostane will have to be moved to evening, which could be a bummer for testing. Maybe he just wants to go back to eating at night only, which was before I started giving him 2 small meals a day instead of one big one... we'll see.. Thanks again everyone, you are all fabulous. I'll let you know tomorrow how this is going.

[Budsters Mom]

Sending you an Keesh big hugs!:) I know it's also hard, but you're doing a great job! Come on Keesh, eat for your mama!:D xxxxx

[Harley PoMMom]

His mouth was checked twice... the teeth are ok, but he's showing gingivitis. I got told to give him dental sticks, but he has never liked them.

He doesn't like mushy food, it's all texture with him believe it or not. If I put a tsp of gravy in his dish, he's fine with that, but anything more and he'll walk away. I've tried cottage cheese and that doesn't work, small bites but something with substinance is all he'll eat. I even shredded some roast beef.. that wasn't working, but give him small pieces 2 seconds later and that works.

Thanks for the wake up call Patti.... I should be ashamed of myself.

I really want to reiterate what Trish has said, in no way should you feel ashamed. I truly do understand how frustrating it can be when your furbaby does not want to eat. You are doing everything one could possibly do to get Keesh to eat, please do not be so hard on yourself, and remember we are here for YOU and Keesh.

Sending huge and loving hugs to you both, Lori

[Squirt's Mom]

Sweetheart, you vent any time you feel the need. All too often we find the "real-life" world is indifferent, cold, unable to understand our connection to our babies. But that connection is very real and very much alive...and everyone here knows that connection on an intimate level....everyone here understands. We know what it is like to become so frustrated you want to stomp your feet and throw plates around the kitchen screaming your head off the whole time...and trust me, if I thought that would help, I would be a pro at that by now. If I didn't have a safe place to come where I could comfortably say, "I'm at my wits end with _____", much worse than flying plates might occur. ;) We are mere humans and as such we reach the end of our rope at times and need to holler for help, to explain how we got there dangling by a thread.

Squirt and my other babies regularly shame me with their approach to life in spite of the many obstacles they face while I whine about a hang nail. I was shamed to the core recently because I gave up on Squirt...but she never gave up and showed me just how wrong I was to do so. My babies daily teach me life lessons I need to learn...Keesh will teach you what you need to learn as well.

Never, ever feel ashamed for sharing your fears, frustrations, or anger - we are your family and we can take it, understanding how you feel and loving you the whole time just as we love Keesh.

[goldengirl88]

Anxious to see how Keesh is doing today. Wondering if he ate any food yesterday. I had an advantage when Tipper started on the twice a day dosing, as she has eaten 3 small mini meals of years so it was not hard to transition into with the Vetoryl. Maybe Keesh is just so used to eating that one meal a day that it is so hard to make him eat at other times. I have been thinking of what might tempt him, and it is so hard when they won't try anything. Would he eat fish? How about some cooked egg? Tuna? I am thinking the smell may grab him, and get him to try it. I guess putting the food down for 30 minutes and taking it away did not work? Did you try the baby food? Hope today brings a better day for you both as I know what it is to struggle with all this, it is not easy. Blessings
Patti

[spdd]

So I got Keesh to eat a little supper last night and breakfast this a.m. Seems he's taken a liking to rollover now, so that is in his kibble.

Got his Tramadol down but I've so far tried cheese, bologna, and rollover, and he's spit his Trilostane out every time. If it isn't one thing it's another.... first time I've had such difficulty getting a pill down his throat. Later today it's mouth held open and putting it in the back of his throat. Sure wish they knew how we are trying to help them.

Excessive thirst did come back within 24 hrs of no Trilostane yesterday, so I have to get this into him.

Patti.. if I put fish down for him.. he'd roll in it. Anything new no matter what it is to eat, he spits it out, pushes it around the floor, rolls in it then will decide to eat it. I really have to watch him outside at times - LOL - if he's rolling it could be anything. I should re-phrase that, he can't roll anymore but he will bulldoze with the side of his face. I've caught him doing it in seagull poop. He also will bulldoze against furniture if his face is wet from food or anything else. Funny how a dog wants to be so clean after a meal, yet will roll in almost anything else.

[addy]

Well, then I guess my thoughts about Stella and Chewy or Honest Kitchen dog food wont be a go. I have yet to meet a dog that wont eat either one but maybe Keesh would be the first. Honest Kitchen used to send free samples, you mix it with water and you could just put a little mixed onto his kibble as it is pricey. Stella and Chewy you can just crumble over his kibble, you dont have to hydrate it.

Of course you get frustrated, care giving is really stressful, we have all been there, so you can always come here to vent, we get it.:):)

[spdd]

I can't find a Canadian distributor of Stella & Chewy but there is a store not too far from here that carries Honest Kitchen. What do I have to lose? I'll check it out. Thanks

[goldengirl88]

Tipper bulldozes too so I know that routine all to well, and can she make a mess of whatever she is bulldozing. I am at least glad you got food into him. Do you have anyone to help you hold him down and put the pill down the throat? It is so hard when your dog won't take the pills. I used to just take them and shove them down Tipper, but it got really hard to hold her as she is really strong. She takes them in chicken now, and I have to hold my hand under her chin and make her swallow and not let her spit it out. You have to be a multi talented person to get all this stuff done with these dogs as they are too smart. It keeps looking like rain off and on here, so I guess Tipper will bolt for the closet soon. Blessings
Patti

[addy]

ask for free samples- they should have some, I hope:):):):)

[Jan W.]

I just read most of what is going on with your dog and my prayers are with you. I thought I was going through a lot and my story is nothing compared to yours. But then again mine is just starting and I don't have a diagnosis yet. I have concerns about giving honest kitchen and stella and chewies - I'm pretty sure Stella and Chewies is raw (some frozen and some freeze dried), as I feed my dogs this food frequently. Honest kitchen I think has different levels and does have some raw (freeze dried) I am having problems with my dog right now having diarrhea which just came about in the last 4 days. We will send a stool sample tomorrow when her LDDS test is done. If our dogs have cushings disease would bacteria be a concern here. I feed my dogs raw all the time and have for some time. I think this is from something she ate out in the cow pasture or my compost pile, but none-the-less, with a declined immune system is this a problem?
Freezing kills parasites but not some bacteria which they can get from whatever they eat whether raw or not. Not that familiar with freeze dried as extremely expensive. Is there any on this list that feeds raw with Cushings? Jan W.

[addy]

Honest kitchen I think has different levels and does have some raw (freeze dried

I dont believe this statement is totally accurate. You can find more information here about their dehydrated food and yes it is very pricey which is why I suggested mixing some in with Keesh's kibble.

http://www.thehonestkitchen.com/the-benefits/why-choose-dehydrated-pet-food


I'll come over to your thread, Jan.

[goldengirl88]

Yes this is a concern. As Cushings dogs have immune problems until the Cushings is controlled, and then still have it sometimes. The vet at Dechra told me this. I don't even get my Tipper any shots anymore, and bacterial infections etc. are a real concern because of this. That is why these dogs are prone to ear, urinary tract infections etc. I don't know too much of the raw feeding as I never did it, and would be very scared to do it with Cushings. Blessings
Patti

[goldengirl88]

I forgot to ask how Keesh is today? Did I mention to you that it may take up to 5 treatments before Keesh sees relief on the laser treatments? It has to have a build up to begin with. Has he eaten anything in the last day? How does he seem energy wise? When is his next apt? Blessings
Patti

[spdd]

Hmmmm. I've never given Keesh raw food (meat) . For some strange reason when he was young I didn't want him to get the remotest taste of blood. I also wanted to make sure any bacteria was destroyed. Remember I didn't start him on people food, his vet did after his operation with chicken and hamburger for 2 solid weeks . Needless to say with such a stubborn dog, even though he is a wimp I've just had to continue it on and off, but mostly on.

After a major struggle yesterday, he got his Trilostane and got it into him today, however he's wise now to all my tricks including my advice with tempting him with the next treat morsel close to his mouth. One capsule broke when he spit it out and even though the powder wasn't on the cheese, he could smell it had been and would NOT touch it.
Today it was a marathon to get his Tramadol into him. Sometimes I laugh at his antics, other times I get frustrated. Gotta take the good with the bad.

His eating was ok.. he's still not too hungry, but I've stopped his nightime meal so he'll be hungrier in the morning. I'd like to see him eat more and he certainly looks like he's lost a little weight.

Laser therapy tomorrow and Thursday, which will by his 3rd and 4th treatment. I've paid for 5 with a 6th one free. ACTH sometime this week and am calling about hydrotherapy and cost tomorrow when they re-open after holidays. I really want to go swimming with "mah boy." He would jump into my friends pool without coaxing and swim the length, but I made sure I was always there. Easy steps to get out of pool helped.

Hope everyone had a good weekend.

Keep up the good work with your pups. Today is the start of a brand new week with all the ups and downs we face but take one day at a time - a lesson I've had to teach myself.

[goldengirl88]

That is a wonderful idea taking Keesh to hydrotherapy. We don't have any around here, so I made Tipper a homemade job. My next door neighbor sews, so she made Tipper a harness with leg holes that I can hold her up in the tub and let her swim in the water. I have to make the water really deep and she makes one heck of a mess. I am glad Keesh is getting his ACTH soon. Tipper gets hers Wednesday and I stay there with her to make sure everything goes like it is supposed to. She hates these tests but her ALk Phos was up the last time and I am worried about it. We won't get the results until Friday, and I hate that waiting. I am trying to decide if I am going to get an ultra sound again. This will be her third one. Blessings
Patti

[spdd]

Patti... you have one great neighbour. I don't have a tub big enough to suspend Keesh, and no lakes near by either.

So we both have our dogs with ACTH this week, sure hope for both our sakes it's a fairly good report.

Keesh only had the one ultrasound, and I'm not going to do it again. He's so big and they took off so much hair, he resembles something of a lion head right now. That's not the reason, I'm just not going to do it.

Good luck this week... I'll be checking in.

[addy]

FYI- Honest Kitchen is not raw meat food, humans taste test every batch:):).

It is minimally processed whole food which is as close to home cooking as I could get.

[molly muffin]

Hi checking in on your and Keesh. Hopefully the once a day meals will encourage him to chow down more. Tricky about getting the meds in. Might have to use one of those pill popper syringes that kind of shoot it down the throat. I've had to use that with Molly a few times.
How is Keesh getting around now? Hopefully better.

hugs,
Sharlene and Molly muffin

[spdd]

HELP NEEDED !! Don't want to alarm anybody, but I found out today that the vet I am taking Keesh to now has never done an ACTH test before. He had in front of me a printout from a book on how to do it. Now that's just scary.

So here are my questions for you.
1. Does he fast prior to the test?
2. I assume he has his Trilostane prior to testing but when is the best time for him to actually have it after meds?
3. How often should a sample be taken during the test?
There are two types of meds they can give him, one is a gel which said they only need to test once and another looks like it has to be compounded by the vet and 2 samples need to be taken.

Man... I cannot believe after all the years this guy has been in practice, I find out he doesn't even know how to test. I've pretty much alienated vet 1 and, vet 3 and the college isn't an option.

Can you please give me strict guidelines as to what "mah boy" needs to be tested correctly. I have checked around and some say fast, others say not... I'm confused.

Keesh is doing ok, I got the pill popper which I'll try tomorrow but his appetite isn't great. I also got liquid Tramadol and we'll see if I have better luck with that.

[goldengirl88]

Oh My God you poor thing!!! First is there any where else you can get this test? Please call around, this is nothing to fool around with, with a vet that has never done this before, especially in Keesh's present state. You need to give them a meal and give the Vetoryl. Do not fast the dog or the results will not be right and her can get overdosed from it according to Dr. Peterson who cautioned me on this. This is a very bad situation and I feel so sorry for you. Not matter what avenue you try you get blocked. This is terrible, I wish I could help you somehow. If you call around for a vet, ask if they have performed this test before going there, and ask if they have treated Cushings so you don't go from the frying pan into the fire. The test should be done before 6 hours after the Vetoryl. I get Tipper's done between 4-6 hours after the Vetoryl. Please let me know what happens I am worried for you both. Blessings
Patti

[Squirt's Mom]

The best bet is for your vet to call Dechra and ask for guidance. It isn't the end of the world that he isn't up on doing the ACTH but with Trilo things have to be done a certain way or the test is invalid so the manufacturer is the one for him to talk to - not reading a book. ;)

Our vet didn't do them often either and doesn't stock the stim agents...but he has done just fine with us and with others he is now seeing. ;)

[spdd]

I don't think Dechra will help my vet due again to FDA regulations. Their subsiduary in Quebec, will not give any direction at all either to me or the vet other then the standard printed documents.

Not only am I worried about this test being done right, he asked me for the billing amount of the previous vet so he'd know what to charge and...... how is he going to interpret the findings correctly?

I am depending on you guys here to help me with that.

Patti... the only alternative I have was with vet # 3 and he never has worked with Trilostane, he give all his cushs dogs Lysodren, which of course Keesh isn't on, so he would be in the dark as well I would think in regard to dose adjustments if needed.

Current vet is adamant that Trilostane cannot be compounded, but I know it can... so I'll be on my own trying to get the pharmacies up here to get me what I want.

[labblab]

Here are two articles that may help guide you and your vet. If you ask your vet specifically as to the names of the two choices of testing stimulant, hopefully these articles can make some sense of things. I find it scary and startling that he is asking you to make that decision, though, rather than consulting himself with a specialist or the lab that will be performing the analysis...:eek: :(

http://endocrinevet.blogspot.com/2011/03/whats-best-protocol-for-acth.html

http://endocrinevet.blogspot.com/2011/03/what-acth-preparations-should-be-used.html

I find it hard to believe that this vet has ever treated a Cushpup before if he has never performed an ACTH. So how will he know how to regulate trilo dosing, either? Maybe the Lyso vet is your better bet if he at least knows how to conduct the testing properly. It would seem as though he'd be 1-1 rather than 0-2...:o

Marianne

[frijole]

Holy crap. I may live in a small town but your vets up there scare me to death. I invite you and Keesh to move in with me. Shaking my head... Kim

[spdd]

I am going with my gut feeling here. Going to look for vet # 5 ( sheesh, can't believe it) to see if they are experienced in both giving and correctly reading ACTH.

He is overdue- been on current dose now for 2 1/2 weeks.

His first hydrotherapy session is tomorrow and I can't wait to have some fun in the pool with him.

[spdd]

Holy crap. I may live in a small town but your vets up there scare me to death. I invite you and Keesh to move in with me. Shaking my head... Kim

That made me laugh- I needed that. If Keesh had his shots up to date and I could cross the border, we'd be there in a flash. I'm not giving him any injections at this point. We have enough problems right now. Great offer though... thanks.

[goldengirl88]

Great, I knew you would do the right thing! I am happy you are on the hunt for yet another vet. Maybe #5 will be the lucky one. I would just ask many questions up front as possible before making an appointment so you don't get another dud. What a time you are having . It's bad enough to have a sick dog, but then to have to go thru all this too?? I sure hope things turn the corner soon for you and Keesh. Blessings
Patti

[Trixie]

So is vet number 5 is someone new all together??
Just wondering--Vet (#4), who never ran an acth, was he open to learning exactly what to do from sources you would provide...like Dr. Mark Peterson for instance. I mean if he was doing the test to the exact specifications maybe it's better than someone who thinks he knows how to do it but really doesn't.

Well, you'll be able to check out everything prior to Keesh going to Vet #5....make sure you have it done the way you know it should be. I would also check out which lab the vet will send the test to and make sure they are experienced as well.
Hope Keesh has good numbers once you get the test done! :)

Barbara

[molly muffin]

Holy Crapola!!!

Okay Orangeville is not the sticks, sheezzz.. I mean, country yes, but hello.. probably be fine if you had a horse (they get cushings too btw, but it's a bit different than dogs)
Look, you definitely need to find someone who had done an ACTH test before.
My vet uses compounded for the test, which requires two draws instead of the normal one that is seen in the states. If he wants to use the gel then that requires one draw and I think is more expensive but heck, he sure wouldn't know.
They need to do a draw (pre) and then they need to inject and then draw an hour later. (if compounded then they would do another draw after that) Then this has to be sent to the lab, the lab will write out the results, but gosh you don't want the wrong amount injected or anything.
No fasting for ACTH test, you feed a bit with the medicine and then 4 hours later you do the first pre draw.
Look Toronto has vets that at least know how to do ACTH testing if you get stuck.
I'm totally stunned!
Sharlene and Molly Muffin

[goldengirl88]

I was hoping to log on and find an update on Keesh's situation. I hope you question the heck out of vet#5 before going there. Heaven knows you don't need any more disappointment. You really need someone who has done this before and treated Cushings. You are at the point where you need to get something done, and by a qualified vet. If they would do the test wrong, inject too much or too little, this could skew the test results, which could result in your dog being ever, or underdosed. I am sorry, but for this I would want someone who 100% has done this before and has experience with treating this disease. If you take less than that you will be wasting time, money, and sacrificing the quality care Keesh needs. How has he been eating? This is such a fiasco, my heart goes out to you. Please just take your time, and find a quality vet to do this as you have been let down too many times now. If you are in the mind set that any vet is better than what you had, this is not good. There has to be a qualified vet out there someone near you, so just don't take anyone please. I thought my vet was bad! Wow what a ride you have been taken on. Good luck, keep at it and it will work out for you. Praying you find someone for Keesh soon. Blessings
Patti

[spdd]

There is not going to be vet # 5. They want to examine him before an ACTH test, which I know is a good idea, but he just had an exam with vet 4 (now I'm getting confused which one) and that was $85.00 last week, plus just got his Tramadol re-prescribed. I can't do it. Today it's $65.00 for his first hydro therapy. The possible vet #5 is an hour from here, so I'd have to return again for the test.
I am going to thoroughly check out what method the vet is using for the ACTH test, just pray if he has to compound it, he does it exactly right and with any luck the lab will be ok and I can take the findings from there. My huge concern is that his dose is right and it's a gamble I know if this test isn't done properly.
I will instruct him to put the times down, actually I will probably be there anyway, and if it isn't done right, he can do it again for free at another time.
Otherwise Keesh is doing well, he ate a big breakfast, because I stopped the evening feeds. He took his Trilo this morning like a champ, now I have to get the liquid Tramadol into him before our swim. I'll try to post pics later today of his swim time.

[Squirt's Mom]

I forget you're in Canada and that Dechra won't help you as a result. Sorry.

Could the lab your vet uses perhaps help him? I guess I don't see this as a huge deal because our vet didn't know much about the disease or testing when we started with him but has done a great job by Squirt. But I knew that going in and chose him in spite of his admitted lack of experience and knowledge.

Let us know how it goes and what you learn. I don't blame you - I wouldn't go after vet #5 either at this point.

Hugs,
Leslie and the gang

[Budsters Mom]

Maybe combine all four vets together and you might end up with a decent one!;):o You have certainly been having a tough time of it! Thinking of you and Keesh, hugs

[Trixie]

I don't think this is all bad as long as vet#4 is ready to learn how to do everything correctly. Maybe an open mind..(as long as it's a smart one) will be helpful.
Maybe besides the info you bring him he could consult with another knowledgeable vet or the lab. You may want to contact the lab yourself just to be sure both sides know what they're doing.
The vet could start with the links Marianne gave from Dr. Peterson's site. I wonder if he could call/email Dr. Peterson?
It's worth a try maybe.
Anyway great news that Keesh is doing well and had a good breakfast...and now off for swimming. Sounds like a good day for Keesh. :)

Barbara

[spdd]

Keesh's pictures are posted during hydro therapy. I don't know if he feels better, but I sure do. Does wonders for my bad shoulder.

Will let you know tomorrow what is going on with ACTH test and he has another laser therapy in the morning.

[molly muffin]

Oh gosh, just look at you and Keesh enjoying some therapy time. Those eyes sure are expressive. :)
I sure wish that we could get this appetite thing figured out. *sigh* Patience, patience. Boy who ever came up with That concept.... enough said.

Can't wait to hear the next chapter in the ACTH testing. Looking at the map, could look in Brampton, straight down the hwy if you can't find anyone experienced around you. (I'm trying to think of who, what, where)

hang in there. That water therapy sounds pretty darn good. Hope it and the laser helps.
hugs,
Sharlene and Molly Muffin

[spdd]

We have had a fairly good few days other then the appetite thing which I also think I may have worked out. It hasn't been long enough with this once a day feeding to really know.
I went out last nite for a couple of hours, came home to a lake in the kitchen, and I've never seen him drink as much water in one shot during this whole process.
I was worried sick, however he seems to have stabilized this morning. Nothing changed re his Trilo, but yesterday I tried to re-fill his Tramadol. He has none right now.
Vet 4, was away, a substitue vet was there. I called them twice and they called me back twice incuding one call from substitute doctor.
Go to pharmacy to get pills and they can't fill it. Some screw up with the prescription, so we are now on day 2 without Tramadol and all this after he worked so hard yesterday in therapy. Some tenderness is to be expected but the poor little guy needs his Tramadol
I have to admit that the outside frustration is almost sending me over the edge. I am taking him for laser today and going to walk in there with real attitude. What do you want to bet they aren't prepared today for the ACTH.... nothing at this point would surprise me, and if they aren't you will hear me all the way to California. I've had it.

Sharlene... I never even thought of Brampton.. I grew up there. It's worth a shot and I just heard there is a good one in Bolton too.

Update re Tramadol and this is a vent:::: phoned pharmacy to see if Keesh's Tramadol is ready, he really needs it. Turns out yesterday's vet didn't spell it right, didn't mark it as a controlled substance and didn't tell the pharmacy it had to be capsule form, and didn't put her licence number on the script. What am I dealing with ?????? So pharmacy now tells me they don't carry capsule form and it had to be special ordered. Dog is suffering here and all this because I wanted to save some money from paying the vet fee for this pill.

He is having his ACTH today, and vet seems confident he knows what he's doing even though I had to tell him "No" he doesn't come back in two hours, it is 4 hours after pill.

Update 2 ACTH test done and vet is going to consult with IMS specialist re the results. I was super glad to hear that. Finally got Keesh some Tramadol... it was all wrong when I got there, so he doesn't have a capsule anymore, it's a pill. Will update tomorrow when I get the results.

[spdd]

Ups & downs for sure. Last post I mentioned peeing a lake, well that has continued since Wednesday nite. His thirst has increased and yesterday extreme weakness in the back end, but I chalk that up to the hydrotherapy, I hope.
This morning he won't eat, certainly won't take anything out of my hand anymore (guess he figures there are pills in whatever I offer), within 1 1/2 hrs of going outside, he peed in the house again. I took him for a walk and he wasn't overly excited about it but his poop was normal . Came home and drank a bucketful again.
He did have a rough day yesterday with 3 trips to the vet and back. I have tried pumpkin with him yesterday too... no luck and wouldn't eat cottage cheese either.
It seems that all his symptoms have come back just prior to ACTH yesterday. He has dropped over 2 1/2 pounds as well.
Last nite and today he has me worried more then usual. Hopefully as the day progresses he will do better.
I can't figure out with symptoms back why he won't eat, flies in the face of Cushings does it not?

[goldengirl88]

Ok did I miss something? What happened about the ACTH? Who is the current vet? I did however see the pictures of you with your precious baby at hydrotherapy. How cute is he? That is wonderful that you got to go there with him. I am however concerned about the weight loss. Is he taking the trilostane ok? How and what has he been eating? I was hoping to log on and get some ACTH results on him. The panting etc. must be because he is going to need his dose adjusted?? I am worn out form yesterday, and so is Tipper 3 times to the vets this week is a lot. Blessings
Patti

[spdd]

Patti.. I'll get the ACTH results later today, but this peeing is awful. He is even leaking now where he lies. Current vet is # 4.
He is taking his Trilostane everyday... don't know if it needs to be increased or he has a UTI.
He has been eating kibble with all sorts of different people food. I offer him one thing and he won't eat it, so have to change it up to something else.
I know about being worn out with vet visits... I need a couple of days break from all of this. Yesterday he went for laser at 9:30 - back at 12:00 for ACTH then back at 2:00 - dropped him off then back for his meds at store.
Today however... I actually vacuumed - LOL - but the hair loss not only filled the vacuum, he's really starting to get scraggly in the last few days.

[goldengirl88]

When they did the ACTH did you take a urine sample in? I think you may have to get that checked as they are prone to urinary tract infections. I put Tipper on the Renal Essentials from Vetri Science after her first one, we have no had any since then. Maybe he needs some supportive supplement for his bladder etc? Blessings
Patti

[spdd]

Keesh's ACTH test results yesterday

ALT 212 - S/B 12-116 units U/L down from 246
ALK 132 - S/B 5-131 units U/L down from 155

Bilibrubin 5.2 S/B 0.0-5.1 units umol/L up from 1.7
BUN 11.8 S/B 2.1-11.1 units mmol/L

Glucose 2.4 S/B 3.9-7.7 units mmol/L down from 4.7

His blood count both red and white are normal so no UTI

Everything else is within range. Vet said to ride it out re the peeing. He is referring to a IMS and then getting the vet college in on this too.

Told to keep the Trilo at what it is for now. This is going to be one heck of a weekend with the peeing.

[Squirt's Mom]

uhhhh...hate to tell you this, but none of that is an ACTH. Did you miss those results when posting or is the vet telling you those are ACTH results?

[spdd]

What should I be posting? I only posted the abnormal findings.

It says test requested " cortisol - 2 samples (ACTH) on the sheet he faxed me... maybe I didn't post what I should have???

[Roxee's Dad]

It says test requested " cortisol - 2 samples (ACTH) on the sheet he faxed me... maybe I didn't post what I should have???

Is there anything that says draw 1 or Sample 1 and Draw 2 or Sample 2 ?

Was Keesh at the vet for a few hours?

[frijole]

You posted items from a blood panel test not an acth test.

It should say acth test pre = 1.5 post (1 or 2 hrs) = 8.9 for example. There are two numbers. They usually show the hours/time that the pre and post draws were done as well. Kim

[spdd]

Here is what is at the bottom of the sheet

Cortisol 2 samples (ACTH)
Tube Labeled 0H
Tube Labeled 2H
Corstisol Sample 1 ACTH Results 54 Reference Range 28-124 nmol/L
Cortisol Sample 2 ACTH Results 46 - no reference range shown nmol/L

Keesh went in at 12:00 - 4 hrs after pill and took him back again at 2:00 for another blood sample

There is no times showing but I was right there, but I don't see any pre draw number at all.

[Roxee's Dad]

Yes these are the results of the ACTH :)


Corstisol Sample 1 ACTH Results 54 Reference Range 28-124 nmol/L
Cortisol Sample 2 ACTH Results 46 - no reference range shown nmol/L

54 = 2.0 ug/dl
46 = 1.7 ug/dl

[spdd]

Thanks John... you're a saint.. so are these good? And if they are why are all his symptoms back? Vet said his red and white blood cells are fine, so no infection.

[frijole]

If anything those results are on the LOW side of a good report and with that you shouldn't be seeing the pools/lakes of urine. Something is not right. Either that test was not done properly or there is something besides cushings going on with Keesh. Has anyone looked at kidney disease? God I wish we could bring you to our vets. This is frustrating for us, I can't imagine how it must make you feel. I am totally stumped. Kim

[frijole]

Looking at the other items you posted from the regular blood work and the alk phos is basically normal which is not what happens in cushings dogs and the ALT is elevated. Normally with cush dogs the alk is way way way high and the ALT is normal to slightly elevated. I have to go back to work (darn it) but hopefully others will have some fresh thoughts. Kim

[spdd]

All I can say is " OH GEEEEZZZZ!!"

[Roxee's Dad]

This is frustrating I am sure... I know it is for us. I just copied my summary up to July 16th and added yesterday's test results to make it easier for others to review Keesh's history here.


6 / 29 - Keesh - 13-1/2 Y.O. (LAB?)
65 pounds and is on 58mg dose once daily of Trilostane

Signs -Thirst and peeing.
He had a small amount of infection in his urine - No meds for infection. Urine also diluted.

June 13
LDDS results Prior to any cush meds.

Cortisol 0 hours - 395
Cortisol (4 hr Dex) - 72
Cortisol (8 hr Dex) - 134

6/29 - On Trilo for 10 days with no change

7/5 -
-collapsed and for most of the day had extreme difficulty getting up. Vet upped dose of Trilo by 10 mg.
-Prescribed Tramadol and said to start him back up on low dose Metacam
-ACTH test, extreme thirst, no appetite.
-Vet recommended to continue Trilo but Trilo was stopped by guardian.

Baseline was 149 (5.4mg) (15 - 120)
-1 hour after - 188 (6.8mg)
-2 hours after- 200 (7.2mg)
-ALP is 155 down from 183 taken on May 24th
-ALT is 246 up from 145 taken May 24th.
-Urea is 11.6 and should be 3.0-10.0
-ACTH test was after giving him Trilostane between 6:30 and 7:00 a.m. He had - 68 mg / brought him to vet shortly before 1:00 p.m.
(Note at least 6 hours between dosing and ACTH test maybe more)
-Potassium 5.3 ( 3.9-5.7)
-Sodium 147 ( 143-155)

7/7
Keesh is eating, walking well and able to navigate stairs.
-evening - no appetite, less drinking, less urination.

7/9
No Trilo

7/12 ish
-Restarted Trilo at increased dose of 68mg
-Keesh has improved

Ontario Veterinary College on Tuesday July 16th

-Taken off Metacam
-back on Tramadol but reduce it from 100 mg to 75 mg
UltraSound:
-enlarged liver with rounded edges
-no liver disease
-adrenal glands are normal
-results are consistent with cushings
-definitely pituitary cushings
-Awaiting Urine analysis

Follow up ACTH on 8/2


Aug 8th
ACTH Results
Sample 1 - 54 nmol/L = 2.0 ug/dl
Sample 2 - 46 nmol/L = 1.7 ug/dl

ALT 212 - S/B 12-116 units U/L down from 246
ALK 132 - S/B 5-131 units U/L down from 155

Bilibrubin 5.2 S/B 0.0-5.1 units umol/L up from 1.7
BUN 11.8 S/B 2.1-11.1 units mmol/L

Glucose 2.4 S/B 3.9-7.7 units mmol/L down from 4.7

His blood count both red and white are normal so no UTI

Everything else is within range. Vet said to ride it out re the peeing. He is referring to a IMS and then getting the vet college in on this too.

Told to keep the Trilo at what it is for now. This is going to be one heck of a weekend with the peeing.
__________________

[Junior's Mom]

If it were me, I would be getting a urine culture and stopping the trilostane. You poor thing, dealing with so much, and no good vets around. I sure hope Keesh is better over the weekend.

[frijole]

I think we should locate all ACTH tests done to date an insert the results into that nice write up that John did. THAT should tell us something. Kim

[molly muffin]

I was reading your results and telling my vet about it as I was reading. She too said, something here does not sound right. She said she couldn't say anything else though since she hadn't seen Keesh and didn't know what was really going on.

I think it is harder since Guelph basically agreed that it Was cushings, which means you are trying to figure something out, when the experts have already agreed that it is something else. (I think the Guelph people would need to be more involved) My vet said and I agree, that the IMS that we saw at Mississauga/Oakville is very good. Not sure if you want to pursue that or wait to see what specialist your vet is going to be conferring with.

What a tough ride you are on.
hugs,
Sharlene and Molly Muffin

[spdd]

Considering it's the weekend, is everybody in agreement that I should stop the Trilostane? What do I have to lose? He has all his symptoms back anyway!!

He ate like there was no tomorrow tonight, and the only reason why I fed him was because he's lost over 2 1/2 pounds.

Can't wait to see what tomorrow brings. Sorry for being sarcastic here, but I really am concerned. Possibly persuing the wrong disease for 3 months now, and doing more damage then good.

[Squirt's Mom]

Honey you have every reason to be frustrated and sarcastic. Keesh's case is not simple and you are doing all you can to help him. If it were me, I would stop the Trilo for now just in the hopes he would eat better. ;)

[frijole]

That's what I would do. Sending you huge hugs and some for dear Keesh too. And I send Keesh a juicy hamburger as well. xoxo Kim

[molly muffin]

I think the whole thing with Keesh is super frustrating. I'd be climbing the walls by now. You are doing excellent that you haven't pulled out your hair yet in fact. I'm sort of back to the scenerio of what if this is Not cushing and in fact something else. How about DI? Diabetes Insipidus as we are discussing on Woody's thread? Glucose could be normal.
I think that is something to ask about. I don't know if I would do the deprivation test though, instead, just give the med and if it helps you know. If not, stop it.
http://www.petmd.com/dog/conditions/endocrine/c_dg_diabetes_insipidus#.UgWhoG22V8E

We have been here before, a few weeks ago. Which makes me wonder even more. *sigh*

hugs,
Sharlene and Molly Muffin

[spdd]

I measured Keesh's drinking yesterday. He's 62.3 pounds and drank 2.5 quarts of water which is 80 ounces- that's high . No accidents last night thankfully, so we will see how today goes.

I am going to check with vet re DI... that's very interesting. Thank you for that info. That's why I'm here cause you guys really do rock !!

[goldengirl88]

Read about your poor Keesh. I am so sorry you are having so much trouble getting him to a better state. So he ate really good? I had though about diabetes before when you said he lost weight, but don't know all that much about it so I kept quiet. Could be a possibility though. I hope you have a good weekend and that Keesh eats well. I would skip the trilostane for now too. Blessings
Patti

[spdd]

So the weekend has come and gone and no change in Keesh. Still peeing and drinking, appetite increase up until today as he only ate a little this morning. I kept the Trilostane going and not really sure why other then I'm really confused. I think I am going to stop it completely when his pills are gone in about 5 days.
Expert letter came back and she is in agreement with hyperadrenocorticism. No suggestions whatsoever other then get another urine sample but she reviewed his history thinking the Trilostane was supposedly working. I told the vet before he referred to her his symptoms were back, so probably her recommendations are useless. Turns out she's a clinical pathologist not an IMS.
Obviously the 65 mg of Trilostane isn't working anymore, so do I just give up or try to figure out a proper dose for him and split it during the day.
The vet is leaving it up to me.
It all boils down to thousands of dollars spent and I am exactly where I was when this started or I should say Keesh is, funds are exhausted and now being left on my own to figure out his dosage. P O'd doesn't even come close to how I feel about all this.

[goldengirl88]

I can feel your frustration, we have all been there! I think if Keesh were mine and I was experiencing all the problems you had I would go for the proper dose of 1mg per pound. I forgot how much Keesh weighs. If there is a drastic difference between what he is taking and the proper dose I would do it in increments not do a big jump as you are asking for trouble there. Have you located a person that can do a correct ACTH test and urine? That is what I would do, if no one is able to help you with your dog than you have to wing it I guess, or do nothing, and you know the consequences of nothing. I don't see any other options you haven't explored. I know it is terrible exhausting your funds, but if you intend on keeping him on the drug you need to do the proper amount and he will need an ACTH test later and urine. I simply don't know what else to say. If you cannot get any help that is all that is left to do, unless you are willing to travel and find someone else?? I know you are in a terrible situation, but we do have certain factors known to us. Firstly he does have a confirmed Cushings diagnosis. Secondly the dosage he is on cannot be controlling his cortisol if he is showing clinical signs that it is not. Third you have no vet to help you. So with all these known factors a Dr. would more than likely opt to get him on the proper dosage. All you are missing is a Dr. guiding you, so do you think you can handle that without one? God I hate this disease!! Let us know what you are going to do. He made it this far it would be a shame not to continue his treatment. Blessings
Patti

[spdd]

Keesh is now dribbling his pee when resting, which was the first sign I ever had of this supposed Cushings. Patti, he was 65 lbs and he is taking 65 mg of Trilostane. How much of a bump up should I do?

I phoned the vet and asked if an antibiotic can be taken when on Trilostane. If he can take it, I'm going to try it and see if this poor pup has had an infection all along or at the very least has one now. I'm not waiting until tomorrow for the urine test which will take another day to get the results. Remember all 3 urine samples came back with bacteria and there was an excuse about why these 3 samples could have been contaminated.

The next thing will be DI as I have had this nagging feeling all along he doesn't have Cushings..... probably in denial maybe?

[goldengirl88]

I think that is what an excellent idea since you seem to be dealing with incompetent Dr.'s. I would get an antibiotic shot that lasts ofr a few weeks. It gets into him right away, and then you can see if this is the problem. I hate for you to have to go about things backwards, but there is little choice. I would do that before raising the Trilostane. Maybe he needs to be on the name brand Vetoryl??So you know the exact dose he is getting. That is a thought. If they saw bacteria in his urine I don't understand why they did not treat him??? This is all so confusing. Blessings
Patti

[lulusmom]

I am so sorry that you hit a road block with Dechra. It's simply not right that non U.S. residents don't have the consumer support we do here. For what it's worth, I have written to Dechra U.K. to see if they could give me contact information for our non U.S. resident members who don't have the benefit of the valuable resources they offer in their Dechra U.S. subsidiary. I have no idea if they will respond but if they do, I'll let everybody know.

Just wanted to let everybody know that Dechra never responded to my inquiry.

[spdd]

Glynda you tried and I really appreciate it. When you have incompetent vets and manufacturers that can't help their customers, I pretty much feel I'm going this completely alone, other then the ones here that have been helpful.

[Budsters Mom]

So sorry that you are having such a touch time getting the answers you seek. Hugs to you and a belly rub for Keesh. Xxx

[lulusmom]

Don't you think it's rather curious that every time you continue the Trilostane, Keesh's peeing and drinking increases and he loses his appetite? This has been the pattern since the very beginning, yet nobody has tried to figure out why this is happening to poor Keesh. As a matter of fact the level and accuracy of testing done since starting treatment has been abysmal at best. You and your vets have been flying by the seat of your pants in treating Keesh and that's just plan dangerous. Studies show that some dogs simply can't tolerate Trilostane, some dogs are overdosed on minute amounts of the drug and some dogs are misdiagnosed. Unless you know that Keesh's cortisol is too high and that none of these other possibilities are at play, there is no way in heck you should even be thinking about bumping up the dose. I sure don't know what the problem is but there is a problem and Keesh is bearing the brundt of it.

Keesh's story is not unique. We've had at least a few members with dogs who despite the lack of major symptoms, were diagnosed with cushing's and ultimately treated with Trilostane. I distinctly remember Louise, Munchie's mom, repeatedly telling her vet that Trilostane was responsible for Munchie's symptoms. He started peeing and drinking a lot more and acting like he could barely move. It turned out he was misdiagnosed, or at least his mom was convinced he was. Treatment was discontinued and his symptoms went away. At least one gp vet and two specialists thought Munch had cushing's but in the two or three years I knew him, he never developed any symptoms. Cushing's did not take his life, cancer did. Louise hasn't been on the forum for quite a while but I'm hoping that she might share her experience with you.

Another thing that crossed my mind is that in some of the studies done by Dechra, a small number of dogs on Trilostane developed hypercalcemia (excess calcium in the blood) which was listed as a rare side effect of the drug. Symptoms of hypercalcemia are increased urination, increased thirst, lack of appetite, lethargy and hypertension. Does any of that sound familiar? If Keesh really is a Keeshond mix, that happens to be the only breed of dog that is genetically predisposed to hypercalcemia caused by primary hyperparathyroidism. Granted that most dogs with primary hyperparathyroidism have very enlarged glands but I'm not sure dogs with secondary hyperparathyroidism have enlarged glands. Do you recall any of the vets checking the glands in his neck? You may want to feel around Keesh's neck for swollen glands yourself. I check one of my dogs routinely for swollen lymph glands as he has had chronic nasal inflammation that has now become critical, requiring exploratory surgery.

Loss of appetite is not a symptom of high cortisol, it is the opposite and to continue dosing a dog who isn't eating well is wrong and to increase the current dose without knowing where his cortisol levels are, is even worse. I know I've said this before but I'm saying it a bit differently again.....if Keesh were my dog, he would be off of Trilsotane so fast it would make your head spin.

Glynda

[goldengirl88]

After reading Glynda's post it made a lot of sense to me, and she is a wonderful source of information. She has a lot of experience with these issues. I do feel all this wasting of time and these incompetent vets have really gotten you in a bad place. I did not realize Keesh's symptoms got worse every time you put him on the trilostane, or I would never suggest upping the dose. It makes a lot of sense what Glynda is saying that maybe he cannot tolerate the drug. So in light of all the new info I say you need to drive him somewhere they have a competent vet or IMS. I know you exhausted your money on all this, but I think you have to go back to square one and get this resolved once and for all. I know you love Keesh and you are trying, you just haven't gotten much cooperation. Could you call Dechra in the US and ask them the contact person and email for the UK? They may be able to help sort this out. I worried about all the wasted time and money. I don't want to log on here and see something has happened to Keesh. Please try to contact the UK and see if they can offer some assistance. Is there no where else that you can go to maybe in another city or town? I know you are frustrated and broke from all this. Is there a family member or someone who could help you financially until you get Keesh straightened out? I think it is imperative to follow Glynda she is very wise. Please let us know what you decide to do. I am praying for you both to get this resolved. Blessings
Patti

[frijole]

I'm glad Glynda came and posted. I have said repeatedly I don't think this is cushings and to stop the trilostane. And then a new vet enters the picture and he's back on the trilostane with the same results. Well you know what they say about doing the same thing over and over... Please take the last 5 pills and throw them away.

Kim

[molly muffin]

I'm with Glynda, who has so much experience through all the years as do our other admins, having seen so many different variables, if it were me, I'd also stop the Trilostane, get an antibiotic for the possible UTI and some floriflora (for digestion) and then I'd see where that takes you.
If say they are right and it is cushings, stopping trilostane doesn't hurt them, and can be restarted if needed, but I wouldn't even go down that road at this point.
All these urine test showing bacteria and no one treating it is beyond my comprehension.

Glynda, my vet was astounded that Dechra talks to the owners themselves in the states. (I brought that subject up last Friday) She said here, they give the vet the case number and the IMS or any other doctor working on the case itself and the owners never talk to them. Count yourselves Very lucky to have that avenue for help and information, it seems that here we have nothing.

Hang in there!
hugs,
Sharlene and Molly Muffin

[doxiesrock912]

I had a similar problem with Daisy before she was diagnosed. The general vet assumed that she became incontinent following being spayed as this can happen with some dogs.

The IMS put her on Baytril for an underlying systemic infection and now she's on Tylan powder. The specialist said that these infections are difficult to detect.
Daisy no longer has accidents of any kind.

[goldengirl88]

Hoping Keesh is doing well this morning. Did you stop the trilostane? What are you planning to do now? Have you gotten the antibiotic for the infection? I am so worried about you and Keesh. I am praying for you both to get this resolved. Blessings
Patti

[spdd]

Hi... I have stopped the Trilostane and only giving him Tramadol. I took a mid flow urine sample and it is going in today to be tested for an infection.

Sharlene has emailed me and I'm going to talk to her as she is not too far away, possibly get in to see her vet. It's a long way away, but her vet is the one that didn't seem to think things were right when Sharlene mentioned Keesh.

Keesh is ok... appetite is normal, still peeing and drinking lots but had a long walk this morning. I will let you know what my next move is and thanks so much for asking.

All this info you are giving me Glynda, if I can get into Sharlene's vet, I will mention it. Thank you for all this great information.

[goldengirl88]

My God I am so happy for you and Keesh that Sharlene has taken you under her wing, and you can go to her vet. This is the smartest thing you could do to help your baby. I am so excited for you as you have been jerked around by all these other vets. I feel this will be the decision that saves your Keesh from any other problems and puts him in a good place. I am so happy Tipper and I will do the happy dance for you! Yahooooooooo! Let us know as you progress. Blessings
Patti

[spdd]

Thanks Patti... I am putting the clinical pathologists test in my pictures. Hopefully it is large enough or people can enlarge it to read it.

[molly muffin]

When do you get the results back on the urine test?

I sent you a PM. Not sure if it is best to go is to my vet or my specialist. I know my vet will see you that isn't the issue, the issue is that she might send you to the IMS anyway and if that is the case, then if your vet can you refer you to the IMS, then you'd save the dollars of a vet visit too. I gave you that information too. You just would have to say that you want a referral to this specialist, who deals with cushings.
So you took Keesh of the Trilostane and his appetite came back?

we'll get this figured out.
hugs,
Sharlene and Molly Muffin

[spdd]

Results from urine test come back tomorrow. I'll contact you then.

Keesh is off the Trilostane and he's eating well. Not greedy or overly hungry just back to his regular two meals a day.

Water consumption is down slightly a little bit today, peeing just the same though. Instead of 2 1/2 quarts he's down to 2 quarts.

[goldengirl88]

Hoping for good results for Keesh on the urine test, or at least identifying the bacteria so you can treat it. Hope all worked out with Sharlene and that you have a plan for Keesh's treatment with her vet. Praying for you Both
Patti

[spdd]

Hey Patti. Sharlene has been a complete godsend literally. She is working with me and going way above and beyond.

I sure hope you get things sorted out and you can stop the worrying about your beloved babies. I haven't stopped worrying in weeks now, some days I'm worse then others, and even at night I get so upset I sit up on the side of the bed and actually get angry at what is going on. I know how you feel really, Keesh is all I have right now too.

I'll be glad for you when tomorrow is over and you know where you are at. It's the unknown that can really do a number on us.

I hope you have a good day today.

Keesh & Judi

[goldengirl88]

Thank God for Sharlene she is your miracle to help Keesh. I am so excited that she is helping you get Keesh taken care of. It means a lot to get help when nothing you have tried is working and your vets work against you. This is truly a blessing for you both and I am so happy. Blessings
Patti

[spdd]

Urine is back, absolutely nothing in his urine other then being diluted. No crystals, bacteria, protein, glucose etc.

[goldengirl88]

I guess that is kind of a shocker?? Everyone was suspecting an infection I guess. Well it is one less thing to worry about, and it does not require any money so that is a good thing. Hope Keesh does well and hangs in there until you can see Sharlene's vet. have a good day with the baby. Blessings
Patti

[Junior's Mom]

Did they do a culture on the urine? With it being so dilute, infections can not always be seen without a culture.

[spdd]

I'll be ok... I just re-read the test. It was a cortisol/creatinine ratio with his results reading 40. I gave him a mid stream sample.

He didn't give me any advice at all and when I asked about DI or hypercalcemia all he said was I'd have to see an IMS. Then he got busy with something else.

I don't know if this means anything but the ratio is determined by converting cortisol and creatinine values to molar units (nmole/L) and then performing the calculation. Urine cortisol/creatinine ratio = cortisol x 27.6/creatinine x 0.0866 - if this is any use to anybody.

They did a culture at OVC, that's the one where they said they grow 100's of cultures and 2 came back with infection, however it was so minute that's when they said they thought it was their equipment.

[molly muffin]

I know that Guelph did a complete culture on Keesh's urine. 24 hours wouldn't have been enough to have done a grow culture, they need 72hours for that.

We are working on a plan for Keesh, he is just so darn hard to get a reading on. His LDDS was consistent for cushings, if we go back in the thread, John and Kim and others discuss the values. His ACTH was a bit towards the low side in my opinion, and just didn't give much variance at all.

He'll do okay on trilostane if he has been off it for say a few days, then goes back on. Peeing/drinking will normalize, however, eventually he'll Not eat at all again and eventually have a bad episode and we start all over again.

To give an over view, we have had 5 vets in the mix so far and the University Vet Hospital at Guelph.

All have agreed that he is symptomatic for cushings, but I don't know if they are shall we say, feeding off each other or what. Adrenal glands are normal, and liver is only mildly enlarged. Everything else appeared to be normal from what was said on here, but I would love to get my beady eyes on a copy of the ultrasound report. (hint, hint :) )

I think DI maybe should be ruled out? A bit concerned that the glucose went low on the last test compared to month before too. I don't know though if a complete wash out of trilostane is needed and then try the drops for DI or what.

Anyone have any thoughts on that possibility?

Nothing like brain storming the forum gang :)

hugs,
Sharlene and Molly Muffin

[spdd]

I know that Guelph did a complete culture on Keesh's urine. 24 hours wouldn't have been enough to have done a grow culture, they need 72hours for that.

We are working on a plan for Keesh, he is just so darn hard to get a reading on. His LDDS was consistent for cushings, if we go back in the thread, John and Kim and others discuss the values. His ACTH was a bit towards the low side in my opinion, and just didn't give much variance at all.

He'll do okay on trilostane if he has been off it for say a few days, then goes back on. Peeing/drinking will normalize, however, eventually he'll Not eat at all again and eventually have a bad episode and we start all over again.

To give an over view, we have had 5 vets in the mix so far and the University Vet Hospital at Guelph.

All have agreed that he is symptomatic for cushings, but I don't know if they are shall we say, feeding off each other or what. Adrenal glands are normal, and liver is only mildly enlarged. Everything else appeared to be normal from what was said on here, but I would love to get my beady eyes on a copy of the ultrasound report. (hint, hint :) )

I think DI maybe should be ruled out? A bit concerned that the glucose went low on the last test compared to month before too. I don't know though if a complete wash out of trilostane is needed and then try the drops for DI or what.

Anyone have any thoughts on that possibility?

Nothing like brain storming the forum gang :)

hugs,
Sharlene and Molly Muffin

Working on getting OVC ultrasound results now. Vet has to approve everything and he's busy right now. He'll call me back.

[molly muffin]

Just to clarify in case it got lost in the conversation.

UC:CR 40 Lab normal is 13

Sharlene and Molly Muffin

[spdd]

Appt set for IMS with Sharlene's specialist on August 28th. I was hoping the referral from my vet would be made and they'd call me to set up time, but NOPE my vet got on the phone and made arrangements then passed off these instructions. I don't know if they are his, as he doesn't know anything about these tests and looks up my case always in a text book or if they are the IMS.

So the instructions are no water 2 hrs before visit and 12 hr fast. I only want a test for Diabetes Insipidus and hypercalcemia before or if we have to restart Trilostane.

Does anybody know if the above criteria is standard for these tests?

[goldengirl88]

Hi:
I can't comment on those tests as I never had them. You are smart for checking the facts this time as you want no slip ups. Imagine your vet doing that. I would tell the person you see on the 28th that he really doesn't know anything and has to look it up, so they do not listen to him. You want to start off new and get these tests and a fresh look at things, not drag the old crap along where no one knew what they were doing. I am so excited for you and Keesh, this is the break you have been needing. I am truly glad it was made possible by another members caring also. This is one big family. I know you will be on pins and needles until the 28th, but thank God it is not that far away. It seems to me we sailed right thru August! I am hoping and praying for the best for you both. Blessings
Patti

[molly muffin]

Marking down 28 Aug in my calendar. It took me a couple weeks to get in with my appointment too.
I think with this IMS, you can just give her the whole story and she'll do a complete evaluation. She isn't cheap but I think she is pretty good and a very good people/dog person.

I have never had either test done, so I don't know the protocols for doing them. Maybe one of the others will know, if not we'll start looking it up. :) Take a copy of the clinical pathologist report with you and the test results, just in case something hasn't been faxed, although I know they want everything faxed to them. And tell her about the reaction when he is on the trilostane. eat, not eat, pee, not peeing, it's a rollercoaster that you and Keesh need to get off of.

hugs,
Sharlene and Molly Muffin

[goldengirl88]

Just checking in on how Keesh is doing this morning? Tipper was restless last nite and another stomach ache this morning. I can't wait until the 28 and Keesh gets some help, this will take a lot of worry off of you too. Is he still going to hi laser treatments? Blessings
Patti

[frijole]

I join the club of those excited for your Aug 28th appt. I had a similar roller coaster with my Annie a few years ago. She was misdiagnosed with cushing's and I went through like 4 vets here in Nebraska before I elected to go to the closest IMS which was a 5 hr drive each way.

I didn't want them to have to start from scratch so I typed up a document in chronological order from the first test to the last. It had dates, test names, test results and then what drugs were being taken and the dosages and symptoms. That way it was enough for them to see what was going on without having to retest every single thing.

They were very grateful for the write up. The entire staff read it at their morning meeting prior to deciding what they would do with Annie. The good news is you can use your thread here to refresh your memory along with your test results at home to do the same thing.

Go get 'em Mom. We're with you the whole trip. Shout out to Sharlene for helping you. Praying you will get answers. Kim

[Budsters Mom]

We'll all be waiting for the 28th to arrive. So glad that Sharlene's vet is going to see Keesh.:) Answers are finally on the way, YAY!! Xxxx

[Harley PoMMom]

So the instructions are no water 2 hrs before visit and 12 hr fast. I only want a test for Diabetes Insipidus and hypercalcemia before or if we have to restart Trilostane.

Does anybody know if the above criteria is standard for these tests?

There are two ways to test a dog for the Diabetes Insipidus. The first is called a water deprivation test, when a dog is suspected of having Cushing's depriving water can be very harmful. The second way to test is to simply treat for it with desmopressin, (DDAVP).

When a dog shows consistent (2 or 3 blood test) high levels of calcium this is know as hypercalcemia. Once hypercalcemia is diagnosed a measurement of the active form of calcium called ionized calcium needs to done (more blood-work).

So glad that Sharlene is able to help you with finding such an excellent IMS, and looking forward to hearing what she has to say...best of luck with the appt. ;)

Love and hugs, Lori

[goldengirl88]

Just checking in to see how Keesh is this morning. Is he still eating good? How is the peeing? Hope you are both having a good weekend. Blessings
Patti

[spdd]

Patti - Keesh is doing well. He's up and down with his appetite but in general sooner or later the food gets eaten. I think he's like me, just not hungry in the mornings. He's also a stubborn little guy and will hold out until there's something in his food he likes, and it certainly better be a variety from meal to meal. Peeing & drinking continues more then it should be, but he had a long walk this morning before it got hot.Keesh's last laser treatment was on Friday. He's not much better but he's not worse either. When I get him sorted out, I'm going to go to hydrotherapy. It helped me if not him, so it's worth it and cheaper then physiotherapy.

Lori - thanks for that information. It helps a lot. I wouldn't put Keesh through the water deprivation test. Sharlene is actually going to meet me at the IMS which is wonderful, so another fabulous reason this forum "ROCKS."

Kim- great idea, thankyou. This will be vet 5 and the 2nd IMS- however the first one was still doing his residency at the vet college. I do have his teacher's name though and going to look her up to see her credentials. At the college they just looked at the previous tests from his 1st vet and did an ultrasound, no blood work and the urine test was tainted.

Kathy - thank you for the encouragement, I sure hope there are solid answers, no matter what they are and if it is Cushings for sure, then I should be able to get the proper dosage (compounded or not) from the IMS.

Sharlene- what can I say. You are an absolute doll in my books and Keesh and I can't thank you enough.

[goldengirl88]

You not only get to help Keesh, but get to meet Sharlene. I am jealous, as she has talked me thru many a bad time. There are truly wonderful people on here. I am so glad for you, I am praying all will be resolved for you and Keesh. That hydrotherapy sounds great, wish I had some around here. Blessings
Patti

[Harley PoMMom]

Sharlene- what can I say. You are an absolute doll in my books and Keesh and I can't thank you enough.

Yes, she most definitely is.

[Budsters Mom]

Yes I second that, Sharlene is definitely a sweetheart!:p

[lulusmom]

And I third it. You rock, Sharlene!

[goldengirl88]

Just checking in to give you and Keesh a big hug, and hope that you both are doing well. Today is the 20th so it won't be long before you and Keesh get some answers. The members on here really go that xtra mile to help each other which is great. We need a first name for you so we can address our post to you!! I feel like an idiot sending you posts without your name on. Blessings
Patti

[spdd]

Patti Guess I should put a signature on here permanently. I have signed a couple of times.
Really glad to hear Tipper is doing a bit better, and almost unheard of they will give another test for free, way to go.
Keesh is unchanged, still peeing and drinking, but no other signs. Loves his walks and still navigates the stairs.
If I can get this peeing under control, I'll take him back for hydrotherapy. They said it didn't matter if he pees there, but I'd sooner wait.
I need to get a new prescription for his Tramadol, I was splitting it, but I noticed it's not quite strong enough. 100 mg in the morning is too much and 50 isn't enough. He still won't take a pill at all from me, which is humorous, so still getting someone else to do it.
I have a large wedding to do this weekend and will be gone Friday afternoon and evening, back home then gone from 7:30 in the a.m. on Saturday till around 11 at night. This weekend is going to be interesting to see how he makes out.

Judi & Keesh

[Squirt's Mom]

Judi, I am wondering if that would work with Squirt. One of our neighbors has helped with things in the past so I may ask her to come over and see if Squirt will accept human food from her. It would be soooo fitting if she does - little huzzy! :D

[spdd]

Leslie, it might work so far it's great for me but not sure how long it's going to take before Keesh catches on. I have been his only food and treat provider up till now - LOL - he hangs around when I'm getting his meal ready, but anything from my hand he turns away. I've even tried holding my hand open so he can choose treats not laced with a pill, no dice.

[doxiesrock912]

Judi,
try Pill Pockets. They're made by the same people who make "greenies".

[spdd]

Valerie.. he won't take them. Anything new he has to throw on the ground and roll in it. Maybe he'll eat it then and maybe he won't. No matter what it is, if it's new, it's on the floor. I tried pill pockets, he doesn't like any of the flavors.
He can't roll anymore so he bulldozes it.

[molly muffin]

Yea, the pill pockets didn't work for me either. Molly would eat the pocket and spit out the pill.
Brat.
I'm smearing the pill now in her wet food and giving it to her by hand, which is exactly what Keesh Won't do.
Stubborn isn't he. LOL

hugs,
Sharlene and Molly Muffin

[spdd]

They can re-write the dictionary for stubborn... it is now spelled... Keesh.

Today is a great day for "mah boy." He actually played with a tennis ball today and is very happy. That of course in turn makes me happy.

Peeing and drinking up a storm, and even stole a sock today. Of course there is also the trek up the stairs to the office and a hard stare at me looking for an early supper. Couldn't ask for more right now.

[goldengirl88]

Judi:
I tried the pill pockets with Tipper and they were kind of greasy and smelly and she was repulsed by them! I had to throw them out. I know how hard it is trying to get them to eat pills etc. You always have to be on the look out for new tricks. Blessings
Patti

[Trixie]

Trixie didn't love the pill pockets either. She'll eat cheese anytime so we mold something like havarti or port salut (Trixie has extravagant taste ;) haha and we keep a lot of cheese) around the pill and that does it because she doesn't even try and chew cheese..just gulps it down. She'll take the dog food smeared pill too.
Keesh won't even take his pill in cheese? Does he nose out the pill from anything? He is a stubborn boy and pretty smart too if he's figured out there's a pill inside anything that's special!! How about something with a lot of aroma...like maybe some liverwurst? Or maybe raw chopped meat? How could he turn those down? :p

Barbara

[doxiesrock912]

Wow! I have it made with Daisy! For the most part, she eats the pills right from my hand.

[molly muffin]

Valerie, We are all jealous! :D

LOL Sharlene and Molly Muffin

[Budsters Mom]

I am thrilled that Keesh is playing! That is always great news!:) xxxx

[doxiesrock912]

Daisy came down with kennel cough less than a month of coming home with us. She learned early on that if I was giving her something with my hands that it had to be beneficial to her somehow:) Since then, it's stuck!

I give her treats with my hands so that she also associates things that taste good too. The Urisidol does not taste good and I've had to put it in her mouth the past two days.

[spdd]

Being picky is one thing, but I made an error in judgement and from then on Keesh won't come near me for treats of any kind. I bought the liquid Tramadol, just touched a drop to his lips and the reaction was extreme to say the least. That clinched it for him. Nothing from Mommy from now on in. Before that it was touch and go whether he'd take something from me, but he is completely finished with that. If I have a treat, I now have to put it in his dish, then he'll eat it. I've tried regular liver treats, his favourite rollover and nope, he just walks the other way. Usually he gets excited if I say "Look what Mommy's got!!" - he couldn't care less anymore. I did get a refund though for the liquid Tramadol.

[Squirt's Mom]

I can totally empathize with you on this! NOTHING works for Squirt anymore...but I am gonna get my neighbor to try to give her something just to see if she will take it. Squirt has gotten so mistrustful of treats she won't even eat human food treats I put in her bowl! If it don't crunch and come out of the crinkly bag, she ain't messing with it! :p

[Roxee's Dad]

I have had to resort to dissolving in water and use a syringe to get meds into some pups mouths. Of course I remove the needle from the syringe. :)

Rozee will fight me to the death if I try to pill her. :mad:

[spdd]

John, you gave me a laugh with that comment. I've been fighting with my cell phone provider Koodo all day, so that made me feel better.

[Roxee's Dad]

Sometimes we need a good laugh.... Rozee gives me one all the time, and Oh how can I forget Addy's Chicken walks LOL. Every time I see that, I just start laughing out loud. :D

[goldengirl88]

Judi:
Thank you for your continued support of my Tipper. Blessings
Patti

[spdd]

You're more then welcome Patti. I think it should be a given in my opinion that if you receive support for our own pups on here we should at least reciprocate and support others. I have tried and I certainly know the others on here that have been support angels.

Good luck today, again, I'll be praying and thinking about you.

Huge hugs to Tipper.

[molly muffin]

Hey Judi,
How is Keesh doing? Not long now till next Wed. :)
Have a great wedding this weekend. Hope Keesh does okay while you are away.
hugs,
Sharlene and Molly Muffin

[spdd]

Hey Sharlene.... I was going to post early this a.m. on your thread when I read this one.
Keesh is good, but I'll need some TLC myself after this weekend for sure. These types of weddings just do me in for a day afterwards.
How is your sweet Molly? If we could find a dogsitter on Wednesday, I'd treat you to lunch. Know of any dog friendly restaurants?

[goldengirl88]

Judi:
Hope you have a great wedding. Hope Keesh is as excited as all of us are on the forum to finally get some help. God Bless you both, I can hardly wait until Wednesday. Blessings
Patti

[molly muffin]

Okay I am back from the wedding. Exhausted, brain semi functional I think. :)
Just want to let you know that I'm set on my end for Wed but I think that we should touch base on Tuesday, either day or evening, and go over what we want to accomplish at the IMS appointment and a run down of Keesh's history with Trilostane, if that is okay with you.
Nope, I don't know of a pet friendly restaurant in the area over there. Drat! Always can do a drive through and find a park though if you want. I'll do a quick google maps on tuesday and see what's in the area.
Hope you are in recovery mode from your wedding this weekend. How did Keesh do over the weekend with you away so much?
hugs,
Sharlene and Molly Muffin

[spdd]

Hi.... I am not quite recovered from the wedding even today, sore all over, but that's to be expected when running around like a banshee for over 12 hours .
Sharlene, I will call you Tuesday at the number I have if that's ok with you during the day.
Keesh did ok on the weekend, only 2 house accidents but I blame that on the caregiver. When I'm around there isn't any. Still drinking and peeing a lot but no huge appetite, he leaves food in his bowl, and just as fussy as ever as to what he wants to eat.
He hasn't had Trilostane now for a long time, and I haven't seen any improvement or worsening since off it.
From now on I'll call him "mystery dog" and hopefully that will end on Wednesday.

The fasting for 12 hours prior to Wednesday isn't going to make me popular with him at all, and I'm not right now anyway ( still won't take anything from my hand) plus no water 2 hours before appt. Sure wish I knew why this criteria is needed. Maybe I'll call IMS office today to find out.

[goldengirl88]

Hi Judi:
It certainly sounds like you were real busy with that wedding. I know how hard it is to fast these dogs as Tipper has had to do it more times than I care to remember. She always has to have a shot to calm her stomach down as she goes into gastritis etc. right away from nothing in her tummy, and that is painful. You can hear the loud noises she makes. I am praying for you and Keesh for Wednesday. I am hoping for a good resolution. Keesh probably missed you and is glad you are home with him now. Blessings
Patti

[molly muffin]

Here at specialist with Keesh and Judi

Sharlene

[Trixie]

can't wait to hear the word on Keesh! So great that you have helped out Sharlene. :)

Barbara

[Squirt's Mom]

Anxiously awaiting word! Bless you, Sharlene! One of our many Angels we are Blessed to have here!

[goldengirl88]

Judi:
God Bless you and Keesh, I am there with you in spirit. I know it will be ok. Blessings
Patti

[molly muffin]

We are currently waiting after having lunch. Keesh has been off trilostane for 2 weeks and they are doing an ACTH to check levels currently. Checking calcium specific to rule out hypercalcimium. Also checking urine. Do not think diabetes insepitis since urine concentrate is usually way more dilute than even seen with cushings. Below 1.008 and Keesh is not. They will make sure Keesh is ok now on cortisol levels and start ruling out these other things. Judi will be collecting urine samples to verify that it doesn't go into that very low dilute levels too. So. Really full from lots of food. Judi and Keesh are both quite adorable.

Hugs
Sharlene

[spdd]

There is no news as of today. I am home and Keesh is about to have his first Tramadol of the day and his supper.

Specialist will call tomorrow with results of tests she ran, but right now everything is fairly stable. I'll be back to check on everybody later tonight or first thing in the a.m.

Sharlene... thanks again for meeting me and being there. Keesh really is more friendly then what he appeared, he was just soooooo stressed, which I know you understand. If you had come to the house he would have run and brought you his favourite stuffed toy as a present.

BTW - I beat the traffic and went up 410.

[goldengirl88]

Judi:
Thank God you are both home safe. Will be eagerly awaiting the results tomorrow. Just take a rest now and let Keesh relax. You were so lucky to have Sharlene on your team. Blessings
Patti

[Budsters Mom]

I am glad that's it's over and you're back home. Try to get some rest, although that's easier said than done. Fingers, toes and paws crossed that the test results are great!

I have a great idea Sharlene...... What don't you jet set all over the globe and escort us to all of our appointments. You could bring the Diva to entertain us all! LOL:D

[spdd]

Sounds like a great idea. I'd like to meet the Diva too.

I have a bit of ADD today, can someone please give me the link to the FB group? Sharlene told me twice and I still can't find it.

Sharlene wasn't allowed to come home after our appt. - LOL - seems some cement was going down and she had to wait till it dried to get into the house. Last I knew she was out shopping!!!! That was 3 hours ago .

[molly muffin]

LOL Judi!

Facebook page link: https://www.facebook.com/groups/89435412886/

ask to join the group, and someone will pop in and okay you.

Had a lovely time shopping, thank you! :) I didn't even leave that end of town till probably around 4:30. Then went and picked up the extra lamp, and just as I was finishing up, I got the call that everything was dry enough for me to get into the house. So that was good timing. Then I had to work till around 7:30 tonight. Busy busy

LOL wouldn't that be fun to jet around meet everyone! I'd love it. :)

Keesh is another one of our furbabies with no definite answers. There are things that do point towards cushings, and things that are not consistent with cushings. They did seem to think that the earlier problem with collapsing and not eating could have been due to low cortisol. Due to his problems with rear end weakness, he can just have a sit down very suddenly, and it be hard to get back up, if at all. It happened today and he hasn't been on trilostane, so I think that is a problem that is not necessarily associated with trilostane and low cortisol specifically, but that lower cortisol might not be a good option for him too because of it. The specialist thought that the not eating was a cause of concern when on the trilostane that might outweigh the advantages of taking it.

I can tell you something definite though. Keesh is a beauty and his eyes are bright and he is very much engaged in his surroundings, even if he didn't care for them. That his early vet, who one assumes would know him, would have just gone straight to putting him to sleep, rather than trying to figure out what was wrong, really irritates me.

I think that this specialist is a straight shooter and very conservative with treatment starting out. She doesn't start at the high end of dosages, she starts low. She is okay with compounding if needed and said they have a pharmacy that they have had very good luck with as far as consistency, which she mentioned can be an issue sometimes.

I think that she'll give her best evaluation, which I tend to trust, as I am using her for my molly too, and I think she'll be honest and do her best for Keesh and for Judi.

Hugs all, great day I think, progress hopefully is being made

Sharlene and Molly Muffin

[goldengirl88]

Judi:
Tipper and I are hoping for some good results for Keesh today. We are praying for you both. God Bless you and Keesh
Patti

[Trixie]

Hi Judi,
Sounds like you are closer to some answers now and a treatment plan that will help Keesh. So glad you and Sharlene got to meet! Wouldn't it be so nice for all of us to have a knowledgeable companion at vet visits...boy could I use that myself!! I always forget a question here and there even when I write them down! It's always unnerving at the vet because the dog gets so stressed and then your mind just races--well at least mine does!
So glad there's a vet you can feel good about after all those others!! Hope Keesh is feeling well and having a stress free day today! :)

Barbara

[spdd]

It's 2:00 p.m. and I've heard nothing yet.

Keesh is not having a good day. He has been sleeping all day and peeing rivers in his sleep. Don't like that at all. I'm hoping he is just worn out from yesterday and things settle down tomorrow. Will post as soon as I hear from yesterdays IMS.

[doxiesrock912]

Awww, poor Keesh!
I hope that you hear something soon!

[spdd]

Called the IMS, there will be no results today. They said they are crazy, busy and results won't be in until sometime tonight. They will call me tomorrow..... I'm so freakin frustrated !!!!!

[molly muffin]

Oh Judi, so very sorry that the results didn't come in today. :( :(
He is peeing in sleep?

Do let Beth know that when she/they call. Has he ever done that before?

hugs,
Sharlene and molly muffin

[spdd]

He's done it the odd time, but today the poor guy was a mess. I don't know if he's compensating for doing without yesterday, or he's getting worse. I think tomorrow will tell the story. He just wasn't himself at all today. He was so wet that when I let him out and then he came in, I could see the drips on the stairs and floor, that's when I realized how wet he actually was.
He tried to clean himself off and was going to clean up the floor too where he was laying. I caught him and used doggy wipes on him to get him clean, then cleaned the floor. He did it twice.

This may be a real fun night .... NOT !!!

[goldengirl88]

Judi:
The waiting is what gets to you, but just know this you are going to get them at last, even if they are a little late. Is Keesh peeing in his sleep? Poor baby, I hope they call you as soon as they get these results, even tonite. praying for you and Keesh. Blessings
Patti

[spdd]

IMS left a message last nite and all she said was things look stable for Keesh, whatever that means entirely.

She can't talk to me until sometime this afternoon, which irks me a little cause it's the long weekend and if Trilostane is needed, I can't get it until some time next week.

Over 48 hours now and still no answers.

[addy]

I'm sorry you have to wait, sometimes the IMS vets make us wait for what to us is an eternity. If you dont hear by early afternoon could you call and tell them you are concerned with the long weekend coming up?

I think it is all in the way you phrase it that possibly gets their attention. Sympathy usually gets you farther than demanding.;)

[spdd]

I haven't demanded yet.. but come 5:00 o'clock that may change.

Posted some new pics on recycling 101 - thought Letti would enjoy it as new puppies can do just about anything.

[molly muffin]

Hi Judi, how is Keesh doing today? Are you giving him the tramadol now and is that helping with the rear leg weakness? I hope it is.

Hoping you hear something soon!
hugs,
Sharlene and Molly Muffin

[spdd]

Keesh is back to normal today... I think it was just too much for him on Wednesday. He's bright, alert, no weakness and peeing, drinking has decreased a bit. I really think he was making up for everything he didn't get when at IMS office.

As soon as I hear, I'll post immediately. Probably depending on results will need some guidance. I think too that maybe a low dose twice a day would be a serious consideration. We'll see what the results are first.

[molly muffin]

Oh geez, slapping my forehead here, but he had an ACTH test on Wed. After that, there is usually an increase in water consumption, peeing and most other symptoms. That usually lasts from 24 - 48 hours and then they are back to normal. I am sorry as I completely forgot about that aspect of the testing!! My bad :(

Glad to hear that he is doing well today.

hugs,
Sharlene and Molly Muffin

[spdd]

Good to know. I either didn't know or had forgotten.

[goldengirl88]

Judi:
I am going to keep checking in on Keesh as I am anxious for you to get some answers. Gheez, don't they know we are all waiting like mother hens to dive into this information!! I hate waiting on anything, I think it is one of my weakest points, I want stuff yesterday. Blessings

[spdd]

Well it's after 2:00 and I called them. IMS didn't answer their page, but I told them nicely, if I need meds, it is the long weekend and I might have difficulty if it gets too late. I am NOT driving 1 1/2 hours tomorrow to get medication, but I might have to.

So.. nothing from them yet.

[doxiesrock912]

Judi,
hopefully they'll respond soon!

[spdd]

Well here is what I have and won't have copies of the reports until next week.
Good news is he is fairly normal and nothing is extreme.

There are no loasting effects of the Trilostane he previously received.

0 hr- 82 ref is 15-120 nmol/L
1 hr - 417- don't have reference
2 hr - 464 - don't have reference

She said she is wary and uncomfortable and really doesn't know if it's cushings. Options are
1. wait and see if he develops more symptoms
2. start on low dose Trilostane twice a day at 25 mg each dose
3. Get him on Phenylpropanolamine or other name PPA to help the muscle with his urine.
She suggested a kidney test called iohexal clearance. One is done there and another at Guelph Vet College ( $500-800) each test
His specific gravity is 10 10, calcium is normal high and kidneys are normal.

There is another test DDAVP trial http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/601621 that she suggested however cushings dog would show cushings.

So..... I am thinking of trying the Trilostane at 25 mg and get another ACTH test done where the IMS is. They have to ship the Trilostane to me. She said with Keesh and his history it could take literally months before there is any improvement. She agrees that he is much better off the Trilostane and if I do start it and see that he is not doing well, then I will remove it entirely from his daily routine. I have no choice.

I sure wish there was an absolute diagnosis.. in the long run it is still trial and error.

No meds until next week, so no uninterrupted sleep for the long weekend. Hope everybody has a good one.

[frijole]

I'm going to be blunt because I love you and Keesh. I think the reason why this vet said she isn't sure if it's cushing's is because you have been treating a dog for cushing's that doesn't have cushing's for a long time and she's trying not to slam another vet. Just a guess.

The 2nd number when translated into US terms is 16.57 which is not indicative of cushings. In other words the cortisol levels are normal.

I would not give trilostane ever again. End of story. I'd start to focus on what is really going on. This vet needs to help you figure this out. My two cents. Kim

[Squirt's Mom]

I'm with Kim. You and the vet see that he is better without the Trilo and based on the current post number, I would not restart the Trilo now, no way.

I also want to let you know that the drug the vet is talking about for the urinary muscles is Proin - the drug that caused many problems for Squirt culminating in a seizure. It nearly killed her. :( Do your research before agreeing to try this. ;)

[Trixie]

How frustrating for you Judi. I am happy to hear that Keesh is having such a good day though and that yesterday's problems can be chalked up to residual symptoms from his stim test as well as the all day vet visit and the stress that can cause.
I hope he remains feeling well without the drinking and peeing issues!! So sorry that you've had such trouble getting answers about Keesh. It's certainly not bad news that it's probably not Cushings...but I know you would like to know what exactly is wrong.
Hoping you and Keesh have a good weekend.

Barbara

[goldengirl88]

Judi:
Wow what are they thinking?- probably about their weekend off. I empathize with you as I know my vet has done this to me too many times. It is frustrating, and I know you want to get his medicine. I am praying you receive a phone call soon, or I may have to call them, as I can't stand it either!!!! Blessings
Patti

[Roxee's Dad]

I went back to the early pages in your thread and the only signs are thirst and excessive urination PU/PD. Glynda read the test results and sees no consistency with cushings.

The teeth chattering is something my Shepard used to do whenever he smelled a female dog... Vet explained it as his way of working up her scent in his saliva (This was back in the 70's) So Keesh just might be a little excited when he can sense the girls :)

Based on the early post, and latest comment from the new vet, I agree and I would not start any Trilo.

What are his issues lately? Let's try to break down what is going on by telling us any symptoms that are troubling you or Keesh. Kind of like "Let's start over"

In the beginning...

-2 outward signs of Cushings, which is thirst and peeing.
- I suspect pituitary as he used to have seizures. Nothing major, just head down and some chattering
-He was tested for diabetes and it was ruled out.
-He had a small amount of infection in his urine,
-Glynda
Also the latest bloodwork is not consistent with cushing's and for that matter, neither was the first blood chemistry.
- There has been absolutely no improvement since starting Trilostane 13 days ago.
-He has had a history of small siezures, nothing drastic just some teeth chattering, which has been almost non existent for weeks now. He never got spaced out when having them, was fully coherent. Another thing that would set his seizures off was smelling another dogs scent

[molly muffin]

I can throw in that at the specialist yesterday, she didn't think that the amount of water Keesh was drinking was too much. It came in at just under 2 Liters, and she said, she thought up to 2.5 liters would be fine for him, his size. Judi can say whether it goes over that amount regularly or not. It seems to be a bladder issue maybe, muscle weakness of the bladder is what she mentioned, that happens sometimes as dogs get older. (just like it does in people) I think that is why she mentioned the Proin, which I said, we've heard had some bad side effects. She admitted that it is possible that some dogs would be affected negatively. Her words were that any drug can have bad side effects but it won't be for all dogs. So, not sure what to make of that in light of Squirts problems with Proin. Is there something else that would help Keesh with bladder weakness if that is what it is?

What are your thoughts Judi?

hugs,
Sharlene and Molly Muffin

[spdd]

Ok.. now that I have I think my head on straight, I'll answer the issues.

Keesh's only symptoms to date since the beginning are peeing and thirst. His first symptom was dribbling while asleep and then the lakes later downstairs in the middle of the night.

He does not do well on Trilostane, loses appetite and of course we had that scare re the crash. No improvement on 3 different doses (58 mg then up to 68 mg then down to 65 mg) other then a relief from peeing and drinking for about a total of 4 days.

His urine is clear as of Wednesday, no infection or anything else .

Adrenals are normal, enlarged liver with rounded edges but no concern according to vet college. That could be from his Metacam he was on.

His coat isn't as nice as it was, but I'm going to chalk that up to old age. His hair is growing in nicely from where they shaved him for blood samples and his belly is looking good after being shaved for the ultrasound.

Today and tonight he has been bright, alert, lots of peeing & drinking, poop is normal and he actually whipped his treat ball at me to fill after supper which he hasn't done in weeks

If this is bladder weakness, I am going to scream, seriously. One reason for joy, the other because of the thousands of dollars wasted and bad information.

The vet in town called and has the prescription from the IMS to be filled for Trilostane, however I told him I wasn't going to do anything about it for now. He does carry the Proin if I need or want it.

Sharlene when she ran that long name passed me of PPA, I asked her about any side effects, and she said it was a safe drug. I didn't relate it to the Proin name.

If I can find a safe drug for incontinence, I'll try that first and if it doesn't work for him, then hell I'll take it, cause this excursion I'm on with him has me so worked up I will probably need it myself anyway.

John.. good to know about the teeth chattering. He does it on walks occasionally, but he also will do it at home. At first I was told it was excitement, but when he's doing nothing it happens too. Laying down or standing up it can happen. He had two at the IMS - one in the waiting room, and one outside but the outside was he was in the peeing area.

When I get my copy of the IMS report I will post everything that is not known already. She said she was going to include her synopsis with the report and fax it to me.

Hope everyone has a safe, healthy and happy long weekend. Think just maybe I'll spoil myself and make a pina colada tomorrow " FOR BREAKFAST.":D

[frijole]

Do it! Sounds like a yummy breakfast. Hang in there.

FWIW I had my Haley on Proin for about 2 years and she was fine. I would now search for alteranatives first but if I had to I'd give it a try. Kim

[Roxee's Dad]

A pina colada sounds good, I may consider a mimosa myself... after all, it is a holiday weekend :)

All medications have possible side effects... Watching some of these drug commercials with the announcer whispering someo f the possible side effects... "may cause heart attack, raise blood pressure, in rare occasions may cause death" etc... it makes one wonder.

I agree with Kim and I would try it but watch carefully. We know he doesn't do well on trilo, he doesn't really have cush symptoms. So I would definitely not give him any more trilo. Seems to do more harm than good on Keesh.

Enjoy your Pina Colada, I will join you with a Mimosa :)

[molly muffin]

I know what you mean Judi, I said Proin and spelled it to her and she didn't equate it to what she was talking about either, so I'm not sure if it is the same or not. I've never had to use it for any of my animals, so can't really say anything about it, or what it is. Just what Leslie and Kim have experienced. One good and one not so good.

It is horrible if it turns out to be a bladder issue, but if that is all it is, then it will be much cheaper to treat and yea, dang the vet who suggested cushings and then all the expensive testing.

One of the things that is always suspect is if you are told it is cushings and put them on the medicine and there is no change at all in symptoms. It is also, dangerous, as you are lowering the cortisol, when they don't need the cortisol lowered and it can cause exactly what happened with Keesh, which was a terrible crash. So, that is very concerning and it is one of the red alerts that I think caused many on the forum to say "whoa, what is going on here". I'm glad that Beth said she wasn't sure based upon her evaluation.

Pina Colada! Go for it!
hugs,
Sharlene and Molly Muffin

[molly muffin]

Okay, if it is pina coladas and mimosas (which I love!), I'm going for a Sangria or a martini.
hmmmm

Sharlene

[Roxee's Dad]

I just had a little brain uhmm... gas let's call it :p

You mentioned his fur was not so great, I do remember in some of my research, I ran across an article that mentions a possibility of one of the other hormones that may cause not only fur problems but weakness in the urethral sphincter. If that is the case, I guess it could be considered a type of Atypical cushings.

I have to see if I can go find it, mentions some treatments as an alternative to Proin.

May give you some insight... or ideas.

http://www.vetinfo.com/dincont.html#b

[spdd]

Going to research any and all drugs for incontinence but still need something for his thirst. It may be in range according to the IMS but it's far more then he's ever consumed before all this started.

[goldengirl88]

Great idea John, you may have happened onto something there. It makes a lot of sense with the symptoms Keesh has had. Am I to understand Judi that the IMS never called you yet? Oh my that is too bad. I hope you both have a wonderful weekend, and I am sorry that you did not get to go on holiday. Blessings
Patti

[frijole]

I wouldn't really worry about the thirst. Your vet said the drinking is normal volume and I would bet that the drinking is because of the urination. The kidneys are working overtime/peeing for some reason and when that happens a dog gets dehydrated and so they drink. So don't worry about 'fixing' that. Kim

[molly muffin]

Hi Judi Which option did the specialist recommend for Keesh? I saw theoption but wasn't sure if there was a recommendation of one over the other. hugs sharlene

[spdd]

Kim - thanks for that, hopefully then if I can get a proper med for peeing then the thirst will subside.

Sharlene - The IMS didn't recommend any option. She was sitting on the fence. Her words exactly were "wary and uncomfortable" and possibly "wait and see until he shows more symptoms."
She also said with the 2nd option fi it was cushings but we should proceed in a cautious manner if using Trilostane twice a day at 25 mg per pill - so there really is no definitive diagnosis which she agreed.

Patti.. I did get the results from the IMS- doesn't look like cushings, but I won't have all the test results until next week. Look back a couple of my posts as I put what the IMS said on it yesterday afternoon.

[goldengirl88]

Judi:
How did I miss that posting??? Oh well I am not in my right frame of mind the last couple weeks. I am sorry you have no concrete diagnosis, I know how frustrating that is to deal with. I think you are on the right track though, as will soon be able to narrow the possibilities down. Poor Keesh, my heart goes out to him. This has to be frustrating for him too. I say get your Pina Colada and work on that!! Try to have a good weekend, as any weekend with Tipper is a good weekend for me. Blessings
Patti

[addy]

Judi I am sorry everything is still a bit blurred for you and Keesh but I do think without a definite diagnosis and the fact Keesh has not done well on the drug, why go there again right now?

I'm thinking a chocolate drink might be better, or an ice cream drink, does anyone remember oh shoot, were they called Gold Cadillacs?

Gosh, I used to love ice cream drinks. I am probably dating myself. Of course I might be fun to date:p:p:p:p:p

Okay, and I am sober, scary.:rolleyes::rolleyes::rolleyes:

[Simba's Mom]

Oh goodness, hope you get it all figured out with your furbaby, hugs

[molly muffin]

I'd have a date with you Addy. Love those ice cream drinks. I have had one in years and rather forgot all about them. Got to love the internet.

http://www.yummly.com/recipes/ice-cream-liquor-drinks

Perfect for a long weekend! :)

Hope Keesh is having a good day Judi. :) Think of it like this, if Keesh's cortisol is in a normal range and he is still having accidents and having to go out more frequently than normal, then it wouldn't be high cortisol causing it. If the kidneys are good, then it isn't a kidney problem causing it. So just have to figure out if it is a weak bladder, from getting older, or is it something else, and what is the best way to treat.

Hang in there!
Sharlene and Molly Muffin

[spdd]

As an old bartender from a way back, it's a Golden Cadillac. It is creme de cocao, galiano and cream, shook over ice and poured into a martini glass. I used to make them by the pitcher full. Never made them with ice cream though.

Keesh is the same, drinking and peeing, and feeling in general pretty good I think. I've looked for alternatives to proin and can't find anything, but I need to research further.

Sharlene, love the link. Think I'll try each recipe daily -:D

[goldengirl88]

Judi:
I know what it feels like not to have things figured out. I really am hoping that Keesh does not have Cushings and that it is a bladder issue. This disease is so horrible that if it is a bladder problem, I think he is better off. There has to be something besides that proin, I will try to research it and see if I can come up with anything. I would not want to use the proin after Leslie's experience using it on Squirt. I am sure once everyone reads your posts they will be looking too. Hope you and Keesh are enjoying the weekend off and that he is doing well this morning. Blessings
Patti

[molly muffin]

Leslie might have some ideas for natural herbal alternatives. She is using herbs with Squirt and of course she has studied so many of the herbal remedies and what different herbs do that she is my "go to" for all things herbal on here. :)

I wonder if it is long term use of proin that can cause problems or if even a short stint can be dangerous if the dog reacts badly. My thought being that if it isn't dangerous to use for short term, then trying it to find out if that is the problem would be beneficial, while trying to find an alternative medicine. I just don't know enough about it to say one way or another though. :(
I looked and found some stuff that you can buy, like incontinence control pills, etc, but since I don't know what ingredients I'm looking for, not sure what would work and what wouldn't.

I agree, that site looked really yummy.

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

This is something I've been working on with Squirt. When she was taking the Lyso, there were many herbs I wasn't comfortable giving her but now that she is off that, we have more options. I had been using dry Stinging Nettle leaf in her feed 3X a day and it did help. But as the diarrhea started I had to stop it as it can work as a laxative. There is a blog entry I plan to locate written by Cat Lane on this subject that gives more ideas for managing incontinence herbally. I'll let you know what it says, or give you the link.

[goldengirl88]

Judi:
I would never tell some one not to do something , but when I read the horror stories on Proin, I would never ever use it. Many of the dogs had strokes, it said it is absolutely toxic to the brain, many dogs died after the first dosage. I read and read and this is what I was able to uncover. I would run it past Leslie first though. Homeopet Leaks No More. It had good things said about it from a number of people who used it on their pet. It helps by strengthening the affected muscles. The ingredients are:
Plantago Major, Gelsemium, Sempervirens, Causticum, Canthares, and Alumina. It is supposed to be all natural ingredients. Saw another Pet Naturals Bladder Support For Dogs. Maybe you could look into them as the Proin had bad things said about it everywhere. I could not find one good thing about it. It used to be given to women until they started having strokes. Please reconsider even trying this. I would consult Leslie as I said she is our resident herbalogist. Blessings
Patti

[Squirt's Mom]

I would consult Leslie as I said she is our resident herbalogist.

Oh me, what a kind thing to say....however, I will never be able to claim the title "Herbalist". There simply isn't enough lifetime left to learn enough to ever claim that distinction. I'm just a simple old woman who happens to think there is much Nature has to offer that we so often overlook and am fascinated with herbs. I'm always happy to share what I learn, links, and contacts to real herbalists anytime. Thank you, tho - that makes me feel good. :)

[LtlBtyRam]

I had trouble deciphering what this really was, but a friend from Facebook, who lives in Canada too. Has had a ton of problems with her dog. I don't know about the thirst & peeing issues, but I know she has a lot of back end issues with her pup.

Her pup has Myelitis. Again info non this is not nearly as easy to come by and she doesn't even understand it extremely well. I do know it seems to be the same kind of roller coaster thing we deal with regarding Cushing's.

Totally in over my head here as you all have more experience than I do, and this may be a long shot.

Angela

[Squirt's Mom]

Ok...we don't know what's causing Keesh's urinary issues so that makes it difficult to know what herbs may help...and which may harm. But I've been spending some time today and tonite looking into herbs that are used for a variety of urinary issues in dogs. I would think if stones or crystals were the issue, that would have shown up by now so I didn't pay much attention to those. Here is a list of herbs used for canine incontinence -

corn silk, raspberry leaf, couch grass, uva ursi, agrimoy, marshmallow, plantain, ginkgo biloba, mullein, dandelion, parsley, alfalfa, astragalus, horsetail, saw palmetto, Oregon grape, hawthorn, stinging nettle, St. John's Wort, oatstraw, skullcap, milky oats, passionflower, and goldenseal

Not by any means a comprehensive list. ;) These are typically combined into a tonic based on the cause of the incontinence. Here is a formulas for incontinence from Herbs for Pets by Gregory L. Tilford and Mary L. Wulff –

Tonic formula for urinary incontinence:

1 part oatstraw
1 part plantain
1 part corn silk
1 part stinging nettle root or saw palmetto
1 part horsetail

Starting dose = 1 tsp (5ml) for every 20 lbs of body weight 2X a day


Just in case - by "part" that means any measure you wish to use but maintain that measure. ie if you use 1 tsp of Oatstraw, that 1 tsp = 1 part, so you would use 1 tsp for each of the other herbs (1 part each).

I also found another tonic formulated by Tilford and Wulff for Mountain Rose Herbs called, creatively :p, Tinkle Tonic. (You'll have to scroll down the page a little bit to find it) -

http://www.mountainroseherbs.com/animal/animal.php

I have a great deal of respect for Tilford and Wulff as real animal herbalists ;) and trust MRH products.

As you research these herbs, you will find that some of them, like Dandelion, have diuretic actions - meaning they increase urination. However, that isn't always a bad thing in incontinence depending on the cause of the problem. By increasing urine output, that can help empty the bladder as well as remove toxins that may be exacerbating the problem. We want to use diuretics that have a MILD effect, tho. Stinging Nettle has been shown to increase urine output during the day yet decrease output during the night, thus reducing night-time leaking. You will see that some have anti-bacterial actions like the Oregon Grape or Echinacea. Also watch for laxative actions as they may cause loose stools or diarrhea. I know several folk who use Oregon Grape with no issues but Squirt and I both reacted to it with diarrhea. Some are called nervines and have sedative properties if the incontinence seems to be stress or anxiety related.

As you learn what each of these herbs can do, the benefits they each may have for Keesh (as well as things that would take them out of consideration for him), you can try them one at a time or combine them in the 1 part to 1 part formulation. I like to keep things as simple as possible when I start working on a problem. That way I have a better idea if she has a problem what is likely causing it. So I wouldn't start with more than 2.

I've added Plantain and Echinacea to Squirt's tea this week and no problems so far. I plan to add Goldenrod, Marshmallow root, and Mullien leaf over the next few weeks. For now, I'm having to work with the herbs I already have on hand but intend to add to my "pharmacy" soon to include the corn silk, horsetail and couch grass (or those are the ones I'm leaning toward for Squirt today anyway! ;)).

I'll be happy to offer what limited help I can anytime. We will learn this together and find a way to have dry rear ends...and carpets and beds and tiles and porches and cars and blankets and couches! :D

[Squirt's Mom]

I also wanted to mention that I was reading a site that was trying to make a connection between allergies and incontinence - in this article, specifically seasonal allergies. I had never heard of such and was basically blowing it off as some trendy new fad. THEN I was having a discussion on the FB Animal Herbalism page and one of the members told me her vet had prescribed "a Sudafed-like" product for her dogs incontinence so she got Sudafed - and it WORKED! She said she gave it to him for a while and when it looked like the leaking was under control, she stopped the daily dose and only gives it when he has a dribble. So this has set my poor old mind off on a real journey back in time - does Squirt have an allergy that is playing a role not only in the diarrhea but also the incontinence? The incontinence came first...could that have been an early sign of allergies? Her eosinophils were elevated for the first time when she had the seizure but we put that off to the Proin - she's allergic to the chemical in it. That value did go down after stopping the Proin but not into normal range last check.

I know some music can cause head-banging but I've found that dogs can cause the same phenomenon! :p:D:p

[spdd]

Wow Leslie, you're too much. I mean that in a kind way. What a lot of work you've done to help with Keesh's problem. It is appreciated so much.

[goldengirl88]

Hi Judi;
Hoping Monday finds you and Keesh doing well. Leslie has some great ideas with the herbs for Keesh. I always go the natural method if possible, I try to stay away from all the drugs if I can. I think Keesh may benefit from a more natural approach since he had such a bad time on the trilostane. Blessings
Patti

[spdd]

Thanks Patti.... no stores open today, so I can't get anything for him. Funny thing today he isn't eating at all so he hasn't even had his Tramadol. He's happy enough though and no poop issues, so whatever it is... I haven't a clue.

[Tina]

Hi Judi,
Gosh, now Keesh isn't eating again? I hope he ended up eating something today, that is so worrisome. I read back a bit in your thread and may have missed it, but has a UTI been ruled out? And are his kidney values ok? I am just asking because Jasper's increased drinking and peeing never really resolved, and he has ended up with some kidney issues, mainly proteinuria. And he was just treated for a UTI and I noticed his drinking increased even more then.

I was so happy to read that Sharlene went to the specialist with you and Keesh. She is an absolute doll. I am going to see if she will come to Nebraska to go with me when Jasper has to have his fractured teeth removed. I will be a basket case then for sure. She seems to travel a lot, you never know! ;) :p

Thank you for your kind words and support on our thread. Jasper seems a bit better now, so hope I can get him back on his regular food soon. And I hope you get things figured out soon for Keesh.

Hugs,
Tina and Jasper xo

[goldengirl88]

Judi:
Just checking in to see how Keesh is this morning. Hope all is going well and I hope he is eating again. Blessings
Patti

[spdd]

As far as I know his kidneys are good. I'll have to check back and see what if anything was written about them, but nobody ever mentioned anything to me. Only bad comment was his liver was enlarged. Urine is good.

Keesh finally ate this morning and got his Tramadol. He did so well yesterday, I'm even wondering if I'll cut back on that and give it to him every other day. My van windows in the back only come down 2/3rds of the way and he was able to put his front paws on the door and look out the window with all his weight on his back legs... all this without Tramadol or food yesterday.

He was bribed this morning however by a little grated cheese in his food. That got him eating.

I have to do some reading on herbal medication and then head out today to see what our local health food store may have. There are a couple in town, so hope I can find things.

I won't be on the forum much this week, got 3 appts. with brides and all the other routine things that go on not to mention a party to possibly crash. ( just kidding Sharlene)

Everyone have a great week...

[spdd]

I have got to have the most confusing dog "evah"

Test is back and here is what it reads. You already know the readings but the normals are here too.

Cortisol 0 hr - 82..... Normal 15-120 nmol/L
Cortisol 1 hr - 417... Normal 220-550 nmol/L
Cortisol 2 hr - 464... Normal 220-550 nmol/L

Specific gravity 1.010
ph - 7.0

Blood, bilirubin urine, glucose, ketones, protein all are marked negative. No bacteria seen, RBC none seen, WBC 0-3/HPF and no crystals.

All tests were performed with 12 hour fasting ( actually more like 18) and no water for a little over 4 hours if that makes a difference?

So... I have gone out and bought Leak No More, herbal meds and will try that.

Sharlene, I have the full synopsis from Dr. Hanselman if you want to see it.

[goldengirl88]

Judi:
I am sure hoping the Leaks No More helps Keesh. You are like me you are willing to do whatever it takes to help your baby. You and Keesh have been through a lot. Hopefully this will do the trick. Blessings
Patti

[spdd]

Wouldn't you know it.. I'm telling you this dog!!!!!

He has slowed down today with his water drinking. As you know he's a real smarty when it comes to meds, so rather then squirt this in his mouth, cause then he'd never come near me ever, I dropped 3 drops in his water. ( He needs 10 drops a day total).

It's been over 2 1/2 hours and he hasn't touched a drop. Too much !!

[goldengirl88]

Judi:
Keesh isn't going to let you pull any fast ones on him! He didn't get to that age by being dumb!! He is one smart cookie. I wonder if you put another water bowl in the room if he would go to that one?? Blessings
Patti

[molly muffin]

That Keesh!! He does like to baffle a person. I hope he is having a big grin inside somewhere from ear to ear.
See, those cortisol results are absolutely perfectly normal. A beautiful ACTH test in fact.
I hope these drops help with the incontinence.

Sounds like you have a busy week coming up. No need to crash the party, you are entirely welcome to come. :)

If you do want to drop in and meet a bunch of new people, let me know and I'll give you my address and the details privately.

I'm off to figure out what to do for dinner. I'm still in cooking mode till Wednesday night, after which it is left overs and clear the fridge out of anything and everything to make room for the caterers stuff.

Hugs,
Sharlene and Molly Muffin

[spdd]

Only kidding about crashing the party. I hope it's everything you want it to be and a great memory for you.

Keesh picked up on his drinking in the afternoon and I was able to get almost his complete 10 drops into him by evening. He doesn't seem to mind the taste if there is any, but it says on the insert that there is an alcohol smell to it, so let it dissipate for 10 minutes before adding it to their food or water. Best scenario is to put inside their lip, but that would pretty much destroy any interaction between him and me if I did that.

So my next question is, we know there can be false positives on tests due to stress that could lead to a cushing diagnosis, but can there be good readings like his last ACTH and still have cushings?

[goldengirl88]

Judi:
I am glad you were able to get the drops into Keesh and I am hoping this starts to help him in a few days. I know we want everything to work immediately, but somehow it does not. I hate waiting for anything. Well I must go and put the cat in his carrier. Blessings
Patti

[molly muffin]

Well, I wasn't kidding, you are definitely invited Judi. :)

Okay, so does it say how long it might take to see some symptoms decrease?
I know I suck at patience myself. Grossly over rated.

hugs,
Sharlene and Molly Muffin

[Roxee's Dad]

Hi Judi,


So my next question is, we know there can be false positives on tests due to stress that could lead to a cushing diagnosis, but can there be good readings like his last ACTH and still have cushings?

Since Keesh's only real problem is the urination, I don't think I would pursue any further Cushings diagnosis until he shows the typical symptoms. One thing to keep in the back of your mind is Atypical cushings. His Cortisol levels could remain normal but the other Intermediate/Sex Hormones could be out of whack.

But if he is fine except for the leaky urination issue, I would just keep that on the back burner.

[spdd]

I have read that a lot of people have noticed a change within two days. No change for Keesh yet, but we are just starting out on day 3.

I also noticed the dosing can be increased. I read it as 10 drops for his weight and thought that was the daily dose. It's not. It can be increased. It's a tiny bottle, and costs around $16.00 so with his dosage being altered, I'd probably go through 2 bottles a week.

I am going to increase his dosage today and see if there are any changes. I've also read some people have waited 3 weeks to see a change. With "mah boy" it will probably be at least a 3 week wait.

John.. I've been reading about atypical cushings. I can't seem to find what I'm looking for. Do you know what tests I should be running for that if they are different then LDDS and ACTH?

[goldengirl88]

Judi:
Are you getting it directly into his mouth now, or still in the water bowl? I was thinking if it's the water bowl maybe he is not getting enough of it. I sure hope he shows some signs of getting better before 3 weeks, but he has been a hard case all along. Is there some where online you can buy it cheaper? Sometimes these things just take a while, so I am hopeful for Keesh's sake and yours that it helps. Blessings
Patti

[Harley PoMMom]

John.. I've been reading about atypical cushings. I can't seem to find what I'm looking for. Do you know what tests I should be running for that if they are different then LDDS and ACTH?

Information regarding Atypical Cushing's can be found in our Resource Thread here: Congenital adrenal hyperplasia-like syndrome/ Hyperestrinism/ "atypical Cushing's" (http://www.k9cushings.com/forum/showthread.php?t=198)

Information from our Resource Thread about Atypical Testing: CLINICAL ENDOCRINOLOGY SERVICE (http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info_07.pdf) (see #3 on the above document link for the explanation of the UTenn Lab adrenal function tests, and specifically, #3g for an explanation of the ACTH stimulation test plus a full adrenal "panel", which includes cortisol and other adrenal hormones) ;)

Please feel free to print anything out and if you have any questions, do ask. ;)

Love and hugs, Lori

[spdd]

Thanks so much Lori. I wonder what that test will cost and wonder if it's worth doing?

Keesh is having tummy troubles, not eating but grazing and eating the grass. Seems he eats one day then nothing the next, but his poops are normal.

Sharlene, I've increased his dose today, but water drinking is down a bit too.

[frijole]

If you go to the link provided you should be able to find the University's website and the pricing is all available for you to see. I'd guess $200 or so.

[Roxee's Dad]

On that link I posted a few pages back is a question and answer forum about incontinence in our canine family. She (The vet) does mention hormone imbalance quite frequently, among other issues that could cause leakage.

Did Keesh have an Ultrasound? and was the bladder checked for any crystals or stones?

[spdd]

Keesh did have an ultrasound and all is good except a slightly enlarged liver. Adrenals were normal.

No crystals or stones were detected which they checked for a couple of weeks ago.

[molly muffin]

If you wanted to pursue the atypical, then I'd give Beth or your vet a call and see if they will send off to the U of Tennessee, as that is the only place that does that test. It's up to you, but hormones could be a culprit, it's just hard to tell, and the cortisol does remain normal.

Treatment for atypical is flax seed and melatonin. Neither of these should hurt him. You get them at the health food store usually. I think there is two kinds of flax, so you might want to check with Leslie on that.

hugs,
Sharlene and Molly Muffin

[spdd]

This dog can rip apart a 1" thick piece of old cheddar cheese and find a pill. I can just see me trying to give him flax seed.

I'll look into it though. Thanks

[goldengirl88]

Hi Judi;
Just checking in on Keesh this morning. How is everything going? Noticing any difference in him yet? Maybe it will take a while. It is nice and cool here today for Tipper. We have storms coming Saturday, I am so sick of storms!!. Blessings
Patti

[spdd]

Hi Patti. Keesh is just about the same. I was hoping if the peeing was reduced so the drinking would be too. He seems to drink more during the night.

Leslie wrote on FB that the ACTH test is invalid if the dog hasn't eaten however she was referring to a dog taking Trilostane and food absorbing the pill . Keesh had been off Trilostane for 2 weeks and had been fasted for about 17-18 hours before his last test that came back normal... so is his test invalid?

[goldengirl88]

Judi:
The reason they do not fast the dogs before an ACTH test is it can make the cortisol seem higher than it really is when the test comes back, therefore the dog could be overdosed with Trilostane. Remember you must have some type of meal with some fat before the test so that the Trilostane is absorbed and gives a true reading of the cortisol number. Because Keesh had no trilostane the number would be unaffected by the fast. That is how Dr. Peterson explained it to me. Tipper had another restless nite. We are scheduled for Monday for the ACTH again. God I hate doing that to her. I hope that stuff starts working on Keesh soon. Maybe he does not have Cushings. Maybe that is why every time he started on the Trilostane he would get sick. Blessings

[Squirt's Mom]

Hi Judi,

Yes, when the ACTH is given to monitor the effectiveness of the Trilostane (Vetoryl), it must be taken with food and the ACTH done within 4 hours of that dose.

However, when we are looking to see if Cushing's is a possibility, food isn't an issues because no meds are on board to be absorbed. During a diagnostic ACTH (as opposed to a monitoring ACTH - same test, different purposes) we are wanting to see how much cortisol is actually present without meds. Then with the monitoring ACTHs we want to see how much cortisol is present WITH the meds.

What Keesh had done recently was more of a diagnostic ACTH to see how much cortisol his body is over-producing, if any, not to see how well the Trilo was controlling the cortisol. ;)

Hope this helps!
Hugs,
Leslie and the gang

[spdd]

Perfect thanks !!

[spdd]

Next question !! Should I send Keesh for another ACTH test in about a week? That would then be 3 weeks between tests. Because he is so unpredictable, and this is the first test that came back normal, I'm wondering if I should check again. All symptoms still the same right now. "Leaks No More" so far has made no difference.

[Squirt's Mom]

If it were me I would consider two things right now....and I know the IMS said he couldn't have DI based on the specific gravity, BUT we have heard of vets being wrong once or twice in the past ;):p -

1) I would consider asking to try the eye drops for DI anyway. I would NOT let them do the water deprivation test but just start treatment and see if that helps. You would need a prescription for this treatment.

2) I would consider doing the UTK panel and checking his intermediate hormones...ie, looking into Atypical. You could also simply start treatment for this as well, bearing in mind it can take around 4 months for it to work. The treatment is quite benign compared to Lyso or Trilo. We can help you with dosage if you want to try this - no prescription required (in the US anyway). Just remember, if you do start treatment without testing, you will not have a baseline on the hormones to compare to later.

Based on the testing done and his signs that don't quite fit, I think I'd do my best to forget about cortisol as the culprit and focus on other possibilities. Easier said than done. :(

Hugs,
Leslie and the gang

[spdd]

Thanks Leslie.. I think I'll phone the IMS tomorrow and inquire about the UTK panel, and possibly another urine test for specific gravity. He had held his urine for quite awhile before they got the sample, don't know if that makes a difference in the result, but he's peeing up a storm still.

These tests have got to stop soon. I'm going on a cruise in November and need my money.:o

[goldengirl88]

Judi:
I am so sorry that Keesh is not showing any improvement. I really don't know what to suggest now, I am out of ideas. maybe some other will come along and have something. I feel bad for you both as you have gone the xtra mile and beyond for help. I am still praying for you both that you get to the bottom of this and Keesh gets help. Looks like rain here, my poor Tipper can't hardly take any more storms. Blessings
Patti

[labblab]

Hi Judi,

Just wanted to make sure you know that the UTK panel is merely an ACTH that is sent to their lab for analysis, and they measure all the other intermediate hormones in addition to cortisol. So you will get the baseline and stimulated readings for all the hormones instead of cortisol alone. The cost of analysis that you saw on UTK's website will be in addition to what your vet charges for administering the stimulating agent and drawing the blood. But in terms of procedure, nothing will be different for Keesh than is the case for the ACTHs that he has had performed previously.

Marianne

[spdd]

Is this university the only place it can be done? The shipping alone will be a fortune from Canada.

My vet has no idea about Cushings, never mind Atypical, so I'd have to take him quite a distance to even get the test done.

[molly muffin]

Hi Judi,

I just want to remind you that the IMS spoke of collecting urine samples and having them checked for specific gravity to see if it remained constant or not. Not sure if she wanted mornings or different times of the day, this could be done by your vet and was in relation to the Diabetes Insipdus question.
I think that the gist she seemed to be thinking is that if it never dropped much and below 1.008 then that DI could be ruled out completely.

You could talk to her maybe about that option further, when exactly she wanted from (time of day) and start that with your vet. The cost of specific gravity urinalysis shouldn't be that much.

We're doing good here today. Wish you could have made it over. I am thinking of a nap though soon as didn't get to bed till after 3am and was awake at 8am.

hugs,
Sharlene and Molly Muffin

[Roxee's Dad]

Hi Judi,

They have instructions for your vet on the UTK website.

http://www.vet.utk.edu/diagnostic/endocrinology/submissionguidelines.php


Shipping instructions from outside the USA

http://www.vet.utk.edu/diagnostic/endocrinology/contact.php

[goldengirl88]

Judi:
Just wanting to see how Keesh is today. Hope all is going well. Any change yet with the peeing? What do you think your next move will be? We are really liking the cooler weather it is much easier on Tipper. Blessings
Patti

[Squirt's Mom]

To answer your question - as far as I know, UTK is the only place in the world that does testing for Atypical. In the foggy recesses of my memory, there was another university that started doing them but I'm not sure that is accurate. :o

[spdd]

I just got off the phone with Oakville Emergency Animal Hospital where Sharlene and I took Keesh.

I am under the impression, however I could be wrong that they actually are familiar with the University of Tennessee protocol and they test and evaluate right there.

We are going back on Wednesday this week to see if this is Atypical or not.

Glad everyone has their poop under control or at least on their way.. Keesh's is now looking pretty bad.

[Trixie]

Judi--Oh no.. Keesh is on the bad poop list too? :eek: These dogs sure keep us all worrying don't they?
So sorry Keesh is still drinking and peeing so much. Who ever thought that water drinking would create such anxiety! I still tense up when Trixie goes for the water dish. We are definitely way better but it's still more drinking than it was before this all started.
She goes in for water first thing after waking which she never, ever did before Cushings. She is drinking a lot less, so I won't complain.

I hope that you can get some answers about Keesh soon..it must be quite frustrating after everything you have already done to still not really know what's going on. Just hope Keesh is doing okay for the most part. Maybe some sticky white rice for the poops...that seems to help quite a bit with Trixie. A pepcid a/c can help too but I know Keesh doesn't like getting those pills. :rolleyes:

Barbara

[goldengirl88]

Judi:
I am so sorry to hear Keesh is on the bad pooh list. I know this is driving you crazy and you have to get it figured out. I am praying for some resolve to the problems. I hope some how this all gets sorted out and that you have a firm diagnosis on Keesh. It is so hard going thru what you two have been thru. I am praying that whatever this is it can be managed successfully. I can feel how frustrating this must be for you two. It is just a shame this has to happen in our babies senior years, as it is hard on them no doubt. I am praying to God for Mercy for Keesh. Blessings
Patti

[Squirt's Mom]

That would be great, Judi, if they can run that test locally! If it turns out this is what they were telling you, please share the info with us so we can pass it on to others as an option other than UTK. ;)

[addy]

Sorry to hear we have another rider jumped on the poo bandwagon.
Did you read the paper Glynda posted By Ellen Behrend on Atypical? I just started reading it.

If you don't have a copy, I'll go find it for you. For some reason I though you did:o My mind is off in space I think:confused::confused:

[spdd]

Ok !! (slap) - I was wrong. I phoned back and the confusion was that I was speaking to a technician, not a doctor. They DO NOT do the analysis there, they send it to the Guelph College and they in turn send it to Tennessee.

So the IMS will call my local vet later this week, he will do the draw, and then wherever it goes from there I assume is to the college and down to Tennessee. Saves me lots of driving. I'm sure the local vet will do it right when instructed properly. It's the language barrier that scares me.

Addy I can't find the Atypical article Glynda posted, and I googled it with no luck. If you can find it, that would be great.

I am sure Keesh's poop problems are because of his eating habits. I have monitored for the last week and he is one day eating well, the other day nothing. It's like he only needs to eat every other day. I also notice the days he doesn't eat, he doesn't drink as much either. Seems food triggers his thirst, and he drinks buckets after he eats. Sometimes ( not often) he'll drink a feast, then he just isn't hungry.

[lulusmom]

Hi Judy,

Here's the post in which I included the URL to Dr. Behrend's paper on Atypical Cushing's.

http://k9cushings.com/forum/showpost.php?p=120549&postcount=7

Glynda

[goldengirl88]

Hi Judi:
Please send us some more cool Canadian air. Today is already breath taking, hot, and humid. Are you going to have Keesh tested for the Atypical? If you can get the test done I think that is your best bet. Hope you both are doing well, and that Keesh is eating and not peeing so much. I wish there was a crystal ball we could all go to for answers! Blessings
Patti

[molly muffin]

Patti, sorry to say but the air up here right now is horridly hot and humid. Think we're getting it from you guys. LOL Friday though, we're switching to a northern wind and some of it should blow down your way. Yay!!

Hope Keesh is doing good Judi. Still no signs of the incontinence meds helping?

hugs,
sharlene and molly muffin

[goldengirl88]

Judi:
Sorry to hear you are having it hot and humid there to. I did see the weather Sharlene and it did say a big drop and cool air by the weekend here. Thank goodness. Just checking in on Keesh to see how things have been going?? Blessings
Patti

[spdd]

Hi.. been busy the last few days. Keesh has no change in peeing and drinking. He's up and down like a yo yo. Same with food. One day on, one day off.

We had another hydrotherapy session yesterday, he loved it. I think he's sooner have it just as Mommy and me rather then the therapist there in the water and him having to wear a life jacket. The jacket is in case he gets a weak back end but he hates it.

I was hoping to hear from either vet about the blood work to go to Univ. of Tennessee, but so far nothing and the day is almost gone.

I will call tomorrow if I hear nothing.

[Trixie]

Awww...Keesh still up and down on the roller coaster. I feel for you Judi...all you want is for him to be better and to know what's going on. I surely hope you get some answers soon. When you feel like this I bet it seems like the vets are in slow motion!!
Hope that your phone rings soon with some feedback on the blood work. In the meantime at least Keesh gets to have a little hydrotherapy and enjoy it!
Hope he is doing okay...I'm sure things will get figured out soon!!

Barbara

[goldengirl88]

Judi:
Hope we both hear something soon, I cannot take this waiting!!!

[spdd]

I'm not going to hear anything today now. It's too late. Will call in the a.m. and find out what is going on.

Keesh's poo is getting worse. TMI maybe, but it's puddles for sure and not a good colour.

Could be from excitement swimming yesterday, or because today he isn't eating... just too much water. Sometimes I just throw my hands in the air in complete frustration.

Have a great evening everyone. Sorry you haven't heard anything Patti. I guess patience is a protocol with our pups. Who really needs that!!