My sweet little Ginger - Ginger has her angel wings [Archive] - Page 2 - Canine Cushing's Information and Support Forums

My sweet Ginger

11-22-2013, 10:36 PM

Usually when she's on prednisone she seems to finish her meals.
Although her appetite has gotten better since the restart of prednisone a few days ago she most of the times left a few kibble but she left a little more than the previous times this morning and she refused a piece of my toast so I was getting concerned about her.
At dinner time she did better than this morning tho still left a few kibbles. She's doing just about the same, still looking weak in her legs but not falling down like a few days ago. A little better but not much.
I didn't give her Lyso today. I've decided to give her one more day of break. Tomorrow will be 7days from last dose of Lysodren. I'm going to start her maintenance from tomorrow morning. By the time she sees the IMS on 12/2 she would've taken three doses of Lysodren.
I gave her 3.3 mg of Pepcid AC (called the vet about her dosage) 30 minutes before dinner time and hope it helps her if in fact she is having a stomach problem.
And yes, Kim, I'd like a copy of your summary, please. That will be a big help. Thanks as always.:)

I've always liked my vet, then again things were not so much complicated up until now, just the normal routine stuff, we've been so blessed with our babies's health so far. Sweet darlings.
I'm now having doubts in my mind about her as to how good of a doctor she really is while going through this painful experience.
We didn't have a consultation in a private room going over options, her possible prognosis, an explanation of this disease or what the results of all these tests mean in plain english up to that point, etc. All our communications were done either over the phone or near the front desk mostly me asking questions and not much information upfront, just quick and short instructions on dosing. She always just seemed way too busy. When I picked up Lysodren prior to the first loading I wasn't given a long, written instructions as to what to look for or what not to do etc. Just short warning signs typed on the tiny bottle of prednisone that was all. When I asked her an emergency contact number during the weekend in case Ginger gets sick during the first loading period, her response was there should be an on-call vet at another place.
I didn't get a daily calls from her on how Ginger was doing during the whole induction periods, full or minis, not a single call from her end.
I still do have a lot of questions for her but every time, I feel like I'm getting either the same answer or she wouldn't want to go into it. I'm discouraged to ask her any more questions now or do I really want to at this point.? At the beginning I didn't know about anything but now since I've been getting educated here I can point out the things that she didn't do appropriately as a responsible vet.
Sorry about this grumbling but I guess it's been building up inside of me. Thanks for letting me get this out of my chest. I wasn't having a good day today.:(

My sweet Ginger

11-22-2013, 10:37 PM

Wow, that was LONG, omg.:eek::eek::eek:

frijole

11-22-2013, 11:20 PM

:) Don't worry about it... I know it's hard when you've worked with a vet for a while. We don't mean to be unfair to them but we see soooooooo many cases where it's either the vet or the 'listener' not 'listening'. I know you are listening and learning. It seems to me like your vet is in a bustling clinic and simply doesn't take the time needed to explain. That's fine when they are dispensing antibiotics but when you are treating a disease like this and giving out lysodren you just can't mess around. I am really glad you found this board. That's how I landed here too - 8+ years ago!

I'll send you a pm re getting the example emailed to you.

You have to go with your gut on the lysodren. Personally I am nervous for you. I understand not wanting to have to load again. What bothers me is the weakness and wobbliness. I'm not sure I could do it. But I am going on your description and can't see Ginger.

Take care, Kim

molly muffin

11-23-2013, 01:09 AM

I don't know. The wobbles make me nervous. The not eating makes me nervous too. I just don't like the sound of that at all, but I don't know what the best thing is to do at this point.

I am wondering if the tumor on the spleen is affecting this more than we know.

Hang in there. Watch her like a hawk.
hugs,
Sharlene and Molly Muffin

My sweet Ginger

11-23-2013, 08:11 AM

Good morning?
As soon as Ginger was put back on prednisone on 11/18 after her ACTH which was after a few days of break from prenisone during her three days of 2nd mini loading, she's been a litte better with her meals (almost 1/4 cup of kibble & some kind of meat usual chicken or beef twice a day) though not finishing all of it. Everyday I've been giving prednisone after dinner because she started in the afternoon on the 18th.
Yesterday at dinner time she didn't get prednisone for two reasons :
1) Since she did ok with her dinner yesterday I wanted to see how she'd do without prednosone for the rest of the night and planning on giving one this morning.
2) I wanted to try to wean her off of prednisone this way by lengthening the intervals a little by little and was going to give her every other day until she's off totally as long as she does ok with it.
This morning inspite of no noticeable change in her demeanor (still weak in her legs) there was no barking at all while I was preparing for bf and she flatly refused her bf of GB & kibble. Tried to hand feed her and she refused that too. Finally she ate some of warm GB with no kibble and I was able to give her prednisone. That was about 6:15 this morning. This definitely seems to tell me maybe I shouldn't go forward with the maintenance. I'm just unsure of whether I should let the vet know of this fearing she will still insist to go ahead with her plan and start the maintenance. Please, help me in this, please. Thank you all. I know all of you guys are scratching your heads on this one. :confused::mad::eek:

labblab

11-23-2013, 08:34 AM

Oh Song, I am so sorry you are having such a tough time! But I do think you should discuss your worries/decisions with your vet, no matter what you choose to do. As Kim says, none of us here have actually seen Ginger and we are not vets, even if we *could* see her. I think it is important to keep your vet in the loop right now, even if it is to tell her that you've decided yourself to hold off on the Lysodren for the moment. If Ginger were to become acutely ill for any reason prior to the IMS visit, it will be important for your vet to know exactly what medication she's been taking and when.

FWIW, since Ginger seems to do better right now while taking the prednisone, I would probably just keep that routine in place until you see the specialist. As Glynda pointed out earlier, Ginger did not show any increase in her "post" ACTH stimulation. This may indicate that her system may now be dependent upon the supplemental prednisone and I do not know that it is safe for you to discontinue it at this time. I would definitely want the specialist's guidance in this regard, as to whether to stop and if so, how to safely taper.

Squirt's Mom

11-23-2013, 08:38 AM

I am quite concerned about starting the Lyso maintenance. Yes her cortisol may well start to rise again and yes she may have to go through another load BUT those things are not life-threatening while giving Lyso to a pup who isn't eating well and is showing signs of weakness for some unknown reason could be life-threatening. With the pred we really do not know what her cortisol is doing - I'm not convinced that last ACTH is showing cortisol and not pred and giving the Lyso could set up an very bad situation for Ginger and you.

I have been biting my tongue concerning the vet. Her comment that you stop the pred "when she says to" made me livid. How arrogant, uninformative, and insulting. :mad: As if you aren't capable of understanding her reasoning for continuing the pred. :mad: Blowing off your request for a contact number for her while Ginger was loading by saying someone else could do her job - ie, "don't bother me when I'm out of the office" - is irresponsible and tells me she doesn't really care what happens to Ginger. Cushing's is a disease that is best approached with a team mentality between the vets and the pet parent - your vet is NOT a team player. And now you are worried about asking her questions and fear her reaction for you seeking an IMS. She may be a good vet in other areas, but my gut tells me she is in over her head with Ginger and is using the pred as a sort of insurance should something go wrong - she can say she did all she could to prevent problems, to protect Ginger, should things not go well.

If Ginger were my baby, I would not give her any more Lyso until the IMS saw her. There are too many questions about what is going on with her; I would not feel good about giving her a very powerful drug that she may not need and that may make whatever is causing her lack of appetite to get worse, to the point she stops eating. I would also stop the pred and see how she did without it in her system - the continued use of this drug makes no sense whatsoever to me. If her appetite needs some help there are better choices than pred that don't have the side effects pred does. Pred is one of those miracle drugs when needed that come with horrible side effects - I've seen first hand the irreparable damage it does to the whole human system with long-term use. IF she won't eat without the pred on board, by all means continue using it until she sees the IMS and you can talk to them about it.

As good pet parents, which you certainly are, we have many obligations to our babies - but not a single one of those obligations belong to the vets, not ONE. We are not obligated to keep them happy; we are not obligated to follow their directions; we are not obligated to believe everything they tell us. Vets are simply a tool in our Cushing's toolbox. When that tool is defective or not able to do the job, we put that tool down and pick up another. You already hold another, more suitable to the job, tool in your hand - the IMS. ;)

Hugs,
Leslie and the gang

goldengirl88

11-23-2013, 09:03 AM

Song:
Everything Leslie says is true. It made me really angry how your vet treated you and reminded me of mine. I don't know where you live, but if there are other better qualified vets or and IMS that is where I would be headed. I know my vet does not care about Tipper, she is only a cash cow to him. He is the only decent vet around me though so I have to go there. I just basically use him and he follows my directions or I would not go to him. I need him for RX's etc. Inside it makes my blood boil when I see him, but I never let on for Tipper's sake. If there was a better vet around here I would be gone in seconds. He basically knows nothing about Cushings and I had to diagnose my own dog and pay him. He just really socks the fees to me which I really resent as I am the one researching everything. When he tells you he will look into something he never does. I don't believe anything her tells me in fact. I rely on myself, as he is ill equipped to make any decisions for my girl. I pray Ginger gets turned around and that you get some answers to this troubling situation. Blessings
Patti

My sweet Ginger

11-23-2013, 10:28 AM

Thank you everyone. There's no way I'm going to give Ginger Lysodren when her appetite is this much off and I'm continuing with prednisone every morning until we see the IMS. We have a 24 hr vet ER very close by if need be in fact that was where she used to go when she was young. The vet is not in the office on weekends so I won't be calling her until maybe Monday about my executive decision:eek: not to start the maintenance. I've known her as a caring vet all these years and we always have had an excellent relationship therefore it is that much more puzzling to me about her what seems to be a lack of care for Ginger so to speak.
Ginger is sleeping right now, looking peaceful but who knows what's going on inside her little body?
Kim, I got your PM and I really appreciate it as you know but I don't know why my emails have been being returned, all of them because I wanted you to look at Ginger with your own eyes. I guess we have to try again.:)

frijole

11-23-2013, 11:16 AM

:) I got 2 short videos - it's a bandwidth thing with videos. If you want to create utube videos and link them here it is pretty easy.

Re the tremors - looked like it was the leg as she slept/lay there and both my dogs did that. Don't think it was anything to worry about. Re the appetite I found it interesting that she stood by that bowl of food looking at it like she wanted to it but just couldn't. Could be upset tummy and could be lysodren. But I wouldn't chance it.

The prednisone should help revive the appetite. I'm glad you are going to consult with a specialist and agree with Marianne that you need to keep your current vet in the know and supportive until you have a replacement because if you get into an emergency situation they need to know what is going on. Very often IMS work hand in hand with vets. If your vet's ego won't allow that then the IMS can make recommendations of who you can work with.

Hang in there and again, you are doing everything right. Give Ginger a big hug from all of us. Kim

My sweet Ginger

11-23-2013, 11:41 AM

She also has head tremors too, I will try to get that and post it.

molly muffin

11-23-2013, 12:38 PM

I wonder if your vets reaction is because she hasn't been unlucky enough to ever have had a problem with lysodren before and doesn't really understand the dangers, or if she just felt at first that loading wouldn't be a big deal (due to her past experience with the drug) and now is just overwhelmed and baffled by Gingers reaction.
I'm so glad that Kim was able to see a couple of the vids as that can help for people to see what you are talking about. I was just going on the pictures and could tell a real difference.
Hang in there sweetie, you are doing everything that you should be doing and it can be so hard. We love it when things go smoothly and worry ourselves sick (literally) when it doesn't.

You really are doing good and taking care of Ginger. She is a darling by the way. I hate to see her not feeling well. I know you feel the same way x 1000.

hugs,
Sharlene and Molly Muffin

Wendy Tillotson

11-23-2013, 03:07 PM

Hi

About those prednisone pills. I get 1 mg tablets from Walmart :) They have a line in the middle and we cut them in half. I buy the Lysodren from Walmart as well. My vet was getting $8 a pill (which isn't too bad) but Walmart charges $5.50 (brand, not generic).

Have to save where you can as the testing is so expensive. This group helped on that. My vet was charging $400 a test until I brought her some info the admins here provided that said it would be done in a different manner. She looked into it and the test is now under $200. Phew. And my vet was thrilled as she was able to pass it along to all her Cushings clients.

goldengirl88

11-24-2013, 09:13 AM

Song:
Just checking in to see how Miss Ginger is doing today?? It is freezing and in the single digits here so the babies are inside for the day as it is not supposed to warm up. Tipper is already not liking the staying in part. We go to Pittsburgh at 5am so I am resting for the long ride tomorrow. Blessings
Patti

My sweet Ginger

11-24-2013, 11:14 AM

Good morning,
Ginger is doing about the same but didn't want to eat her bf this morning.:( Finished dinner last night so I don't know why her appetite is up and down. We will see a different IMS on Tues because Dec 2 seems to be too long of a wait going by her signs. Hope that IMS will give me some answers. Thanks, Song.

Wendy Tillotson

11-25-2013, 11:29 AM

We all seem to go through similar experiences and then all of a sudden, everything falls into place and your baby is in maintenance. So take heart - there is light at the end of the tunnel!

molly muffin

11-25-2013, 06:57 PM

Checking in on you and Ginger! How is she doing today?

yes, strange about her appetite being up and down like that.

hugs,
Sharlene and Molly Muffin

goldengirl88

11-26-2013, 08:56 AM

Song:
Hoping that Ginger is still doing well and that you all have a wonderful Thanksgiving knowing that she is there to celebrate with you. Blessings
Patti

My sweet Ginger

11-26-2013, 02:19 PM

Hi everyone,
Ginger did like 6 tests yesterday. :eek: Poor Ginger, she went through so much in the hospital. We both had a very rough day.

Superchem/Cbc Antech Sa020
Urinalysis W/Culture Antech M133
BP single measurement
Butorphanol Tartrate (10mg) per MI
Midazolam per ML Inj
Ultrasound (sedated)

She had a bad reaction to one of the drugs they used in her body. (I'm thinking the drug they used to sedate her) I just couldn't calm her down.
She was extremely restless and crying and whimpering, just wanted go outside and run around like a super bunny. I mean she ran and not hopped and that totally freaked me out. I couldn't even keep up with her, running around trying to catch her :eek:in the dark parking lot of the hospital.:eek::eek: I know what you all are thinking now but trust me it was not this old and cushy Ginger I brought in there with me when we first got there.
I stayed in (actually outside)the ER until she was seen by a Dr. after 9 and then was able to come home with her assurance that it will go away after 4-6 hours! I'd never experienced anything like that.
The ride back home was awful, too , she was still crying and whimpering and trying hard to go all over in the car and me trying to keep her on my lap the whole time (25miles) all by myself. I was forced to make a couple of emergency stops on the way which didn't help much. It was just so horrible, horrible. We left home @1PM and returned @10PM last night. Some time after we got home she was able to go to sleep (didn't want water or food) and she was back to her normal self this morning, slow, shaky and falling. Whatever they used on her yesterday I can't let that happen again.
I think the IMS tends to think it may be the low cortisol rather than a reaction to the drug so far going by her behavior before any tests were done but she thinks Ginger indeed have cushings and we talked about trilostane.
Hopefully she can come up with a better diagnosis after she reviews all the test results but I know how things can go now. I can only hope.:)

My sweet Ginger

11-26-2013, 02:36 PM

Forgot, she now is off Lysodren and on 1mg prednisone instead of 1.25mg and will try to taper off at some point.

frijole

11-26-2013, 02:46 PM

That was a long day! Do you have any test results to post yet? If not we want to see it all :) Get a full copy of the ultrasound so we can digest that as well.

Thanks,
Kim

My sweet Ginger

11-26-2013, 02:53 PM

Got it Kim. The preliminary US showed the normal size adrenal glands and splenic mass unchanged, final report pending and all others pending too.

frijole

11-26-2013, 05:21 PM

Interesting they said the adrenals are normal sized... could mean it is not cushings then. Could also mean early stages but keep an open mind on this. Kim

My sweet Ginger

11-26-2013, 05:54 PM

But the previous US showed they were mildly enlarged, tho, so if they are normal sized this time (it said the measurements have not been performed yet) what could that mean? Too much erosion? I hope not.
Her tremors seems pretty bad today but the IMS doesn't want to go back to 1.25mg yet. We are going back next Monday for a follow up.

goldengirl88

11-26-2013, 06:37 PM

Song:
I feel so bad that so much of Ginger's problems seem to remain a mystery. I am hopeful that somehow God willing this will get straightened out. I am not having any company for Thanksgiving, I have no living relatives, so it will be me and my girl, and the rest of the critters. It is snowing heavily here and I have to take Tipper in the morning for blood pressure. She will probably throw up when I put her in the car. She has had a car seat her whole life for in the car, and always loved it to look out the windows. She is extremely well behaved in the car, but now lays on pillows. I put a box on the front floor on the passenger side and it is as high as the seat. I put two queen pillows on top of the box and the seat and she has a huge area to lay on and be comfortable. Unfortunately she is too uncomfortable to sit in her car seat, she stares at it in the back seat now. I think from everything inside her moving around it hurts her to sit now. I seldom see her sit even in the house she lays. I am hoping that you and your baby have a wonderful Thanksgiving, and that Ginger shows some improvement in the coming weeks. Blessings
Patti

molly muffin

11-26-2013, 09:41 PM

I think the adrenal glands being mildly enlarged and now apparently normal size is just a result of her being on the lysodren. When the adrenals aren't working over time, they can go back to normal size.

Wow, not sure what they gave her, but it sure did get her revved up didn't it. I can't even imagine how horrible that day and drive back where. Gads!

It will be interesting to see the tests results. Hopefully you'll get to have a nice relaxed Thanksgiving.

Hugs,
Sharlene and Molly Muffin

goldengirl88

11-27-2013, 08:47 AM

Song:
Just wanting to see how Miss Ginger is today? We got more snow last nite and more to come tonite. If Tipper cannot walk she will be miserable today. Sometimes they do not plow the roads and you cannot walk on them then as the snow is too deep for the dogs. Are you cooking for Thanksgiving? Are you having family? I hope that you and Ginger have a good couple days together and that you can enjoy some of the holiday without stress. Blessings
Patti

My sweet Ginger

11-27-2013, 11:30 AM

Good morning,
Miss Ginger seems to be doing better toady than yesterday overall although she barely touched her breakfast I was able to hand feed her rice & chicken without the kibbles. She also took more than a few pieces of my toast with jelly on it (so far she seems to take something sweet) and just now a bit of rice & egg. She really got me worried yesterday tho. She was in a bad shape. The tremor just has gotten worse now but it wasn't that bad this morning like yesterday. I also noticed that she got her old looking nose back yesterday:) and it looks really good today. First I applied vitamin E for a week or so and not much change and then tried Bag Baum for a few days twice daily and wow! I just can't believe the difference in such a short time. The cracked part didn't even peeled off like the vet told me it will. It must have been hurting.
No results yet, I think I will get all of them next Mon when I see the IMS and I'm very curious as to what she will say. The way this journey has been turning out, I can't help thinking more tests will be required. Good thing I have a care credit now ($4500!:D:):p) and I have you guys to thank for. A big thanks to everyone.;) Trust me those tests weren't cheap and I thought we were going there just for a consultation on that day.:eek::eek:
Patti, my son who lives out of state is visiting us over Thanksgiving with his family and in the midst of everything going on with Ginger I'm really looking forward to see them all. It will be a nice change and give my brain a break.
So yes, I will be doing some cooking next few days and making my famous apple pies and the kale soup for everybody.:) That means I better get busy. Now that our children are all grown I don't cook that much anymore and I was never a good cook.:o Usually my husband cooks dinner whatever he wants and I'm just happy to eat what he makes.:p
I'm glad to hear that you are feeling better today.:) Patti, I have to tell you that where you live is clearly off my places to check list for our retirement which hopefully next year.:p:D Too cold and too much SNOW!:eek::eek::eek:

My sweet Ginger

11-27-2013, 07:03 PM

Hi, my Ginger needs help. She is constipated, nothing since 11/26 @2:30 AM and I'm getting concerned. I think the main reason is her food intake has not been adequate enough to produce a normal cycle last few days and I'm not sure if she drinks enough water these days. Also she started to take 1/4 tab of amlodipine besylate 2.5mg tablets for her high blood pressure starting yesterday. Is there any food that I can give her to help her before we have to use any medication if she doesn't go ? It's been three full days and she usually goes twice a day. Thank you for your help in advance. Song.

StarDeb55

11-27-2013, 07:14 PM

Hi, Song! I've not posted to you & Ginger previously but happened to see your post. You can use plain canned pumpkin. Make sure it's not the canned pumpkin pie filling as you don't want Ginger to have all of the spices in the pie filling. I would start with a small amount, no more than 1 tsp. Please be careful using it as you can push Ginger too far in the other direction, giving her diarrhea.

Debbie

molly muffin

11-27-2013, 07:46 PM

Happy Thanksgiving.

Hope you have some good poops tomorrow after the pumpkin. It can help with either diarrhea or constipation, but too much can also cause either.

Glad Deb saw your post.

hugs,
Sharlene and Molly Muffin

frijole

11-27-2013, 07:48 PM

She is right - it works for both ailments and 1 tsp would be the most for your little one. Its good for them too. I used to put it on top of the food and got my Annie to eat the food as a result. I had to use up a whole can and I'll never forget when I finally did and she got her food without the pumpkin she sniffed the food and looked up at me and her eyes clearly said "Where is my pumpkin mom?". LOL

Have a great holiday. Kim

My sweet Ginger

11-27-2013, 10:07 PM

Oops! I hope I didn't give her too much pumpkin. Right after I posted I looked it up online, went to store and got it. I read about the dosage which says 1 tsp for Ginger's weight but 1 tsp sounded too little so I was quite generous with my measurement.:eek:
Well, I took Ginger out and we just came back and wow, I didn't know pumpkin was a fast acting agent.:o She not only went poop but also ended like diarrhea.:o:mad: Now what? Give her more pumpkin for her diarrhea if she doesn't stop it? Oh, boy. I hope she stops.

frijole

11-27-2013, 10:54 PM

One of these days you will learn to listen to us :D:D:D:D:D:D

No more for now - maybe tomorrow but just a tsp. I gave it morning and pm meals. Fiber baby! :p

My sweet Ginger

11-27-2013, 11:44 PM

I certainly would have listened if I were a more patient person and waited around for the very first post.:o:);):p:rolleyes::D

molly muffin

11-28-2013, 12:03 AM

I think there is a song somewhere in this exchange. Rofl

Chuckles
Sharlene and Molly muffin.

frijole

11-28-2013, 12:12 AM

:D:o:):p;):rolleyes::eek::D:o:);):p:eek::rolleyes: :)

Sounds like something I would do.. don't sweat it she'll be fine. At least she pooped!

My sweet Ginger

11-28-2013, 08:14 AM

Happy Thanksgiving everyone!

Yup, I'm relieved she went last night (triple or quadruple portion:o:(;)) and no more since.:) She seems to be doing better in general yesterday and today so far. She still doesn't want to eat anything with kibble in it, she only ate rice and meat part and left all of the kibbles this morning.:o She has never been this finicky about food before Lysodren but at the moment I feel better seeing her a little more livelier and less tremors yesterday and today so yes, for that and a lot of other things in my life I'm indeed very thankful on this Thanksgiving morning.:)
Happy cooking and sharing. Song.

PS: Kim, you win the face painting (?) competition hands down! Look at all those cute faces. I love these faces.;)

goldengirl88

11-28-2013, 08:59 AM

Song:
It is such a blessing to hear that Ginger is doing better . I am sure you are breathing a sigh of relief for now. Enjoy your day with you family and your precious baby. Blessings and Happy Thanksgiving
Patti

frijole

11-28-2013, 10:13 AM

You are too funny. :D Enjoy the holiday and give Ginger whatever she wants to eat today. (except grapes, onions, chocolate!) Kim

Squirt's Mom

11-28-2013, 10:24 AM

I'm so glad Ginger is feeling less, welll, full today as we prepare to stuff ourselves beyond capacity - or I do anyway! :D

molly muffin

11-28-2013, 07:15 PM

Hhehehe, great news that Ginger is doing so much better and pooping too!
Enjoy the holidays!
happy thanksgiving
Sharlene and Molly Muffin

molly muffin

12-02-2013, 06:47 PM

How is Ginger doing? Poops all good? Eating okay?
How are you?

hugs,
Sharlene and Molly Muffin

frijole

12-02-2013, 08:45 PM

They went to the IMS today. No update yet but I emailed her asking her to check in with us worry warts. Positive vibes sent. Kim

molly muffin

12-02-2013, 09:10 PM

Vibing with ya Kim (I really don't think that is a word :D) Still sending out the good ones!

Sharlene and Molly Muffin

Squirt's Mom

12-03-2013, 07:57 AM

Thinking of you and sweet Ginger this morning hoping all is well.
Hugs,
Leslie and the gang

goldengirl88

12-03-2013, 09:16 AM

Song:
Hoping you and sweet Ginger are well today. It has been a rocky few days on here with the passing of some of our families babies. It is rather warm out today so Tipper has walked, and I am waiting to get her recipes form the nutritionist any time now. Blessings
patti

My sweet Ginger

12-03-2013, 09:47 AM

Good morning everyone,

I'm in such fog. The IMS summed it up as Ginger's test results were not very exciting. I feel like none of my questions was answered.

Diagnostics :
1 CBC : mild elevation in WBC (likely stress vs cushings disease)
2 Chemistry : elevated ALP and cholesterol, electrolytes normal
3 Urinalysis : dilute urine with protein
4 Urine culture : negative
5 Abdominal ultrasound : unchanged splenic nodule compared with previous ultrasound, normal sized adrenal glands, large liver nodule ( new)
6 Blood pressure recheck: 208 (down from 250 one wk ago)

She concluded her report by saying that Ginger's blood work and urinalysis are consistent with uncontrolled hyperadrenocorticism and despite lack of control on routine blood work, her ACTH stim test and the ultrasonographic appearance of the adrenal glands suggest that the cushings is under control (however interpretation of the ACTH stim test is hampered by concurrent prednisone therapy).
The nodule on her liver was new this time and she said the most conservative way'd be to recheck in three months to monitor for progression/change in appearance of the nodule.
After viewing the videos I sent her she recommends a consult with a neurologist.
About pheochromocytoma, thou the appearance of the adrenal glands makes a pheochromocytoma unlikely (no discrete mass), but they could run a urine metanephrine : creatinine ratio test to further investigate this possibility.

Diagnosis :
Hyperadrenocorticism (uncontrolled )
Small liver mass
Hypertension

Still all this doesn't give me any answer as to why Ginger was exhibiting the signs of low cortisol when it was not low while she was on treatment and she wasn't showing those signs prior to her Lysodren treatment except for being slow.
She's been on high BP med for a wk now (increased to 1.25mg (1/2 tab) tab from 1/4 tab) and starting today she is taking 0.5mg prednisone instead of 1mg for 2 weeks. I was overwhelmed about all these I forgot to ask her what her overall game plan was but I will do that when I see her next wk because I'm concerned about her still rising cortisol while she is on a Lysodren break (her last Lyso dose was on 11/16/13).
So I don't really know what all this means at the moment but at the moment I'm just relieved that Ginger seems to be doing better than last wk. She was so nervous the whole time yesterday as soon as we got in my car but no needles or anything as I promised to her.:)
Any thoughts would be appreciated as usual.;)

My sweet Ginger

12-03-2013, 09:54 AM

Oh boy! I'm definitely loosing it. I just posted on Woodydog about Ginger's visit to the IMS.:eek::o:mad::(
I will see if I can forward it back to mine.
Sorry everyone. Song.

My sweet Ginger

12-03-2013, 10:02 AM

:mad: :mad::mad:
It doesn't look good. Would someone do that for me please? Thank you so much and my excuse? Awwww, I couldn't fall a sleep from 12:30 to like 4 AM this morning.:(::D

Squirt's Mom

12-03-2013, 10:09 AM

Post moved, sweetie.

My sweet Ginger

12-03-2013, 10:21 AM

Thanks a bunch, Leslie. :):p

Squirt's Mom

12-03-2013, 10:39 AM

I'm no expert by a LONG shot, but all in all that looks pretty good to me! The one thing that would worry me is the new nodule on the liver and I would want that looked into asap. I hope others with more understanding of these labs will be along soon to talk with you but if I got this report I would feel pretty good. ;) Most of this can be explained by the uncontrolled cortisol.

My sweet Ginger

12-03-2013, 11:01 AM

I think I get that, Leslie. What I don't get is most of these were happening when her cortisol was supposed to be controlled. Am I missing something here?
What her IMS also said yesterday was that Ginger doesn't look like a cushy dog to her despite all the test results and seems to think there could be something else going on.?.?:confused: I will press more on that next wk.

frijole

12-03-2013, 08:52 PM

I'm shaking my head... my gut still suspects that she doesn't have cushings - she doesn't look like a cush dog, her adrenals are normal and after 'loading' she has signs of low cortisol despite being within range for a cush dog. Well if she isn't a cush dog then 2.9 is way low for a normal dog and would explain why she feels like crap and needs prednisone.

So then.. why is she peeing? Things to consider rule out and some might have already been done but I'm just throwing out 9 yrs worth of knowledge. :D Thyroid issues, diabetes insipidus or melitus, kidney problems, the growth on the tumor, there is a pheo that they didn't get on film.

The reason I throw out pheo again is because #1 your dog has high blood pressure and #2 I had an ultrasound done and they missed it and it was reported as a tumor on the liver. I went to another place and they got the pheo on film and there was no tumor on the liver. That and #3 I saw the video of Ginger shaking like Annie did as well as standing looking at food dish like Annie did and walking away. I don't think Annie went below 11 during loading - I remember her cortisol increased with an increase in dose and so we quit giving it and decided it was not cushings. But if I had continued to give it perhaps she too would have gone low and had the same issues you have.

I don't know but I throw out a few ideas. I really think you need to sit this vet down and talk. Kim

molly muffin

12-03-2013, 09:05 PM

Eh, don't worry about posting your post on Woody's thread. It's all moved now and good. We've all done it. I think it is very sweet of you and comforting to want to comment on Woody's thread. One of the joys of the forum is getting to know others and their pets and what is going on with them. Following journeys.
I've posted the wrong thing on the wrong thread and had to have it removed too. You aren't alone. I also have been known to get people and dog names wrong from thread to thread. It happens, there is a lot going on around this joint. :)

As for the labs. Overall I think they look good. I do have concerns that Ginger may not be cushings. We know from Leslies experience that a spleen mass (good that it hasn't grown!) can cause cortisol to rise. So can anything else going on, pheo or whatever, but my suspicion is the spleen could be causing it and if so, the yes, Ginger would react badly to cushing medication. Crash.
Just a thought.

So, write out your questions for the vet for next week and go from there. Right now, just her looking better and acting better is a Huge plus.

hugs,
Sharlene and Molly Muffin

My sweet Ginger

12-03-2013, 09:59 PM

Hmmm... Pheo, spleen mass, liver mass, etc. How to go about it?
The IMS said we could do this urine test to rule out Pheo and I'm thinking of doing that. I brought up the macro and she really didn't want to speculate on it and mentioned MRI (she prefers it over CT scan for either purposes) but I just don't see enough reasons putting Ginger through all that when that's not an option for her for more than one reason.
Yea, I really have to write down my questions for her. I will take your questions and will bring them to her too which will help me a lot for sure. Ginger sleeps a lot today and less active (?) and shakes more and I'm thinking maybe it's the lower dose of prednisone. I hope she adjusts to it soon if that's what's causing her this subtle changes.
Sharlene, you made me feel better. Thank you.;)

molly muffin

12-03-2013, 10:24 PM

hmmm, did she say anything further about this urine test that rules out a pheo?
Like what is it called and how is it done, etc? I think that would be super beneficial to others on the forum too. We might already have that information in the resource section and I am having a brain cramp (this too is known to happen) and if so, well, we'll have have it twice. :)

I don't know if I would go with the MRI, if you aren't planning on doing any kind of treatment for a macro, if that is indeed a possibility. I'd be inclined to rule out the pheo, ask her about the spleen mass raising the cortisol (it did for Squirt) and about the liver nodule (could that be causing cortisol to rise) Liver nodules by the way, yes you want to know, but they are also common on older dogs too. I think this was told to yet another of our members.

hugs,
Sharlene and Molly Muffin

My sweet Ginger

12-03-2013, 11:36 PM

This test is called a urine metanephrine : creatinine ratio test and she explained how it gets done but I guess not much about it was registering in my head. I will call and ask her how to do it, if I'm to bring Ginger's pee next Monday.
I'm definitely not considering doing an MRI for Ginger. I mentioned a CT scan just for the diagnostic purpose only and she still pushed for MRI for the obvious reasons.

My sweet Ginger

12-04-2013, 10:41 AM

Ok, I just talked to the IMS 's nurse and she said I need to collect two urine samples more than 1TBS each and the fresher the better but you can refrigerate it if need to. She even said I can collect the two on the same day but I will do one the night before and the other on the morning of her appt. and refrigerate the night sample. You will get result in a week and the cost is about $178.00. I don't expect I will get a lot clearer answer from this one test but hopefully this test will at least rule out Pheo if she doesn't have it.
Ginger is sleeping peacefully and at the moment I don't even see the tremor. She gets tremor pretty much all the time now and sometimes I also see minor head jerkings too at the same time when she trembles. When she sleeps, rests, while standing, sitting and usually it's her whole body it looks like.

goldengirl88

12-04-2013, 10:55 AM

Song:
I don't know about this test. I have heard from my IMS, and 2 vets that say this test is too iffy and has many false positives. You could then think she has a pheo and she may not. Just saying what I was told as I was going to do it to see if Tipper has one. If you read my post today to Glynda on my thread you will see what the IMS sent me about the questions I asked her about Tipper's possibility of a pheo. I think it may help you . I truly know what you mean about the tremors. Tipper's whole abdomen kind of contracts in and out. It scares me too, as it is not a natural thing during sleep. Tipper only does it when sleeping at nite. I wish I could be of more help, but a lot of these things have more questions than answers. Blessings
Patti

goldengirl88

12-05-2013, 11:01 AM

Song:
Hope you and Ginger are going to find out what is actually causing her symptoms. This disease is so horrible there are never any cut and dry answers it seems. All we want is time, and it seems so elusive. Hope sweet Ginger has a good day. Blessings
Patti

My sweet Ginger

12-05-2013, 11:49 AM

Hi, everyone,
I called the hospital and told them I'm postponing Ginger's urine test that was scheduled for next Mon. as I have some questions to ask to the IMS about this test. After reading the exchanges between beaglesmom and Trish, which were great articles on this urine test and a link on Pheo I now have a lot deeper questions for my IMS when I see her next Mon.. I think I was going Gong Ho about this test and the nurse who I talked clearly had a very limited info or knowledge about this test, too.
Although Ginger's ultrasound didn't show a mass on her adrenal glands she does have high blood pressure of over 250 before med and 1 wk after meds it was 208 this past Mon. and the IMS said even with her excitement being in the vet it shouldn't be over 190 and she also has tremors. I'm just trying to look for some answers that I can agree on towards her symptoms that match to where she is since her treatment because some of her symptoms started after the treatment started and I feel like her IMS is looking at those symptoms as ongoing and they are not. I hope I'm making a sense in my last sentence.:o
Gotta get going. Thank you all and have a wonderful day.:)

goldengirl88

12-05-2013, 12:09 PM

Song
Perfect sense to me. I would just step back from everything and analyze everything before moving on it. I feel so bad that you and sweet Ginger could possibly be facing this. My only qualms with the testing is they have a lot of false positives from medications the dog is on, to stress the dog is under. That can all influence the outcome. As you said though there are signs pointing in that direction. My only suggestion is if you decide to have this removed please find a surgeon that has done this procedure many times. In medicine it is called the Bermuda triangle for a reason, as there is a high mortality rate on this surgery. I would want someone with a known track record on this particular operation. The surgeon at the vet hospital in Pgh. thought she was qualified to do this operation as she is a cancer and soft tissue surgeon, but I never got to ask her how many of these particular operations she has done and the outcome. Would I be happy knowing the surgeon gave me the outcome, as I am not sure they would make themselves look bad by telling you how many dogs did not make it. I would have to have an independent source corroborate that. I truly wish you were not faced with these issues, I feel for you as I still do not fully know what is going on with my Tipper. Blessings
Patti

Squirt's Mom

12-05-2013, 12:31 PM

I think that's a good idea, Song. It will give you time to have a better understanding of not only the test but pheos as well. Letting the vets see Ginger in a state that is more like how she was before the Cushing's diagnosis and subsequent treatment is also a good idea - I'd probably do the same thing. At times the vets, as well as we, seem to get tunnel vision as soon as Cushing's is in our babies' charts - so much is automatically attributed to Cushing's when that isn't always the case. ;)

I hope you find some time during this to have some fun and relax with Ginger a bit. Cuddles with our babies are healing for us both. :)

Hugs,
Leslie and the gang

goldengirl88

12-07-2013, 09:47 AM

Ginger:
I am hoping and praying against all odds that sweet Ginger does not have a pheo. This disease is criminal and does such terrible things to our beloved babies that it is one of the worst things I have ever dealt with. I guess when you love you dog do deeply and they are the ones affected it just kills you inside. If I could take this on instead of my Tipper having it I gladly would do so in a nano second. I am praying all comes out well for you both. How is her skin looking lately? Blessings
Patti

goldengirl88

12-09-2013, 09:01 AM

Song:
Just checking in on sweet Ginger today. Hope she is still doing well. All we can do is take it one day at a time. Blessings
Patti

frijole

12-09-2013, 09:20 AM

Hi Song! Long time no see update. Hope you guys are doing ok. Hugs, Kim

My sweet Ginger

12-09-2013, 10:19 PM

Good evening, everyone,
We went in to see the IMS and BP check today. Nothing new to report except Ginger's BP was finally down.:) 150 the first time and 170 and then 190 as she was getting more stressed so they said they will go by the first number. I think she took today's visit better than last two times, calmer at times.
She still has an eating problem worse in the morning, really bad. The IMS described it as hyporexia rather than anorexia as she will eat certain flavored foods and she doesn't want to go near kibbles.:mad: She is mostly on meat and rice diet these days.:o We may have to find a nutritionist if she keeps this up.:eek:
Ginger is still off cushings drug as her IMS wouldn't want to treat the cushings until she gets better especially her appetite and we are trying to taper her off prednisone slowly. She is half way there and it worries me how further it will affect her already poor appetite in the end. It's interesting to see her come over for treats sitting and waiting with others but one sniff at certain food she would turn her head away and some she will take.:rolleyes: I really wonder what is causing this at this time in the game. She never, never had this problem before Lysodren treatment. Hope everyone had a good day today.

frijole

12-09-2013, 10:34 PM

Song, Thanks for the update! Glad Ginger is doing OK. My memory sometimes gets dogs confused but for some reason I was thinking that your IMS said he didn't think Ginger had cushings. Am I confused? :confused::):o:D Kim

PS I would hold off on lysodren too!

My sweet Ginger

12-09-2013, 10:45 PM

No, Kim. We all are confused.:confused: She is not sure of anything at this point. All the lab work points to cushings but her demeanor and symptoms don't match so we are left wondering and nowhere closer to finding what it is that she has than before IMS. She recommended to see a neurologist and a liver biopsy. I'm considering to have a consultation with the neurologist to see what he sees.

molly muffin

12-09-2013, 11:16 PM

That is probably one of the more aggravating things associated with cushings, when what they Think it is doesn't match up with what the tests say, then it is even more confusing and frustrating.

Strange that it all seems to have started, these neurological issues with the start of the lysodren, which immediately made her act like she was overdosed.

You're doing good though so hang in there.

hugs,
Sharlene and Molly Muffin

frijole

12-09-2013, 11:24 PM

Is she still urinating/excess thirst? Boy what a mystery. Have they ruled out diabetes insipidus? It is different than the diabetes we are most familiar with.

http://healthypets.mercola.com/sites/healthypets/archive/2012/12/24/diabetes-insipidus.aspx

We have seen dogs misdiagnosed with cushings before when they in fact had DI. Worth mentioning at least.

Kim

My sweet Ginger

12-09-2013, 11:48 PM

Thou she wears diapers she doesn't excessively drink or pee anymore, she just goes and DI I don't know. I will have read about it (thank you for the link) and ask her about it next time.

goldengirl88

12-10-2013, 08:59 AM

Song:
I am so sorry the Gingers situation continues to be a mystery. It is very hard to deal with something when you don't know what you're dealing with. I am hoping someone will come up with the answers you need. How is Ginger feeling today? God Bless You Both
Patti

goldengirl88

12-11-2013, 12:43 PM

Song:
Good questions you had for the Dr.'s I will be anxious to see what the answers are. Hope you and Ginger are safe and warm. We have 12 degree weather out here and real windy. Cuts right thru you . Tipper will not be walking in this. Blessings
Patti

My sweet Ginger

12-11-2013, 07:26 PM

labblab

12-11-2013, 09:25 PM

Song, I just want you to know that I definitely do not mind talking with you more about the problems my Barkis exhibited. I probably will not have the chance to write in greater detail until later this evening or sometime tomorrow, though. But I will definitely get back to you. My heart reaches out to you, because I will never forget how frantic I felt when he started acting so abnormally. It is sooooooooo hard to witness :o.

Sending you many hugs of comfort and support,
Marianne

molly muffin

12-11-2013, 10:21 PM

Sending you Big HUGS Song.
I wish I could take away all the fear and worry.
hugs,
Sharlene and molly muffin

Concernedmom

12-11-2013, 11:29 PM

Hi I haven't posted here before but when I read about the trouble Ginger is having I wanted to share Some of Buddy's problems as they sound similar. Instead of going through all of Buddy's background you can read my most recent posts about him if you'd like. Most recently he has had cluster seizures and was on phenobarbital at the hospital. Due to the side effects of the phenobarb we decided not to keep him on it. My regular vet suggested waiting 10 days and trying zonisamide instead and we did. The vet hospital and our vet both said they believe the pituitary tumor is growing which is causing seizures. I kept trying to find other reasons to prove different but at this point believe it to be true. From the time of stopping phenobarb and starting the zonisamide Buddy has had head tremors and loss of appetite and seems to be confused sometimes. Mornings are the worse time for him. He eats 3 x day but won't eat his 6 am kibble anymore and his 10 am feeding he now is turning away from. He has lost his sense of smell. He smells everything first and if it isn't what he's looking for ( whatever that may be) he turns his head at it. He doesn't take pleasure in the routine treat rituals we used to do. I think it all comes down to his appetite and this tumor. He shakes his body constantly. Rubs his face across the furniture or the bed all the time. I know dogs do this but he has started to do it more and more and I wonder if their head hurts or something. We have now stopped the zonisamide due to the loss of appetite and sleepiness and hope he will get some of his appetite back. He has hypothyroidism and CHF and is on lasix and thyroxine. Our vet says it is the neurological effects of the tumor and there isn't anything we can do for it except keep him comfortable and give him the food he wants to eat so that is what we are doing now. Yesterday he had a burst of energy and took off running came and stood in front of me and his head started to shake which made his body shake. Scarey. He is 13 1/2 Maltese. I pray Ginger gets better. Big hugs.

goldengirl88

12-12-2013, 08:45 AM

Song:
I know and completely understand your fear, and how scary this can be. I wish I could make it all go away for you. This has definitely been the scariest ride of my life. It is so hard that these babies cannot tell you what is wrong or what is bothering them. I think I doe a little each day this disease works on my baby. I pray for you and sweet Ginger every nite and wish I had the magic wand to make this disappear for you. Just pray on it, and ask God for mercy for Ginger. Blessings
Patti

My sweet Ginger

12-12-2013, 09:50 AM

Hi Buddy's mom,
I'm so sorry that you are going through this tough road with Buddy. Watching them deteriorate is too much for us parents because of our love for them who has showered us with their total devotion, loyalty and affection their whole life. I do feel it's my turn to love and care for her with all my heart and all I can do for her in her final years as painless as possible especially with what she is going through with this cruel disease.
It was interesting reading your post about Buddy's appetite changes during the day. I haven't read about it yet but have been intrigued by Ginger's fluctuations in her appetite each day. As you mentioned, Ginger has much harder time eating her breakfast than her dinner and in Ginger's case I thought it was the effect of prednisone wearing off by the time next morning comes around since she takes it between 6-7 AM every morning and now I know that may not be the case because Buddy is not on pred and he is the same way. This partial loss of appetite started soon after Ginger's treatment with Lysodren and it hasn't gotten any better even if she's been off Lysodren since 11/16, therefore it's still a mystery to me. She also tremors almost constantly at times more pronounced and I really don't know the difference a minor seizure and tremor or shake at this point as I've never experienced any of these before.
Ginger will be 14 on 12/23 and she is very frail to say the least and there's no way I'm going to put her through any grueling procedures even if it's for a diagnostic purpose. So no MRI for sure but I'm considering a CT scan if there is a way for her to make it without placing too much trauma on her only if her signs are strongly pointing to a Macro just to put an end to all these unnecessary manipulations and pain that've been done to her. I don't have a heart to put her through all the poking and sedation and side effects that come with procedures anymore.
We will see what the neurologist will say next wk and go from there but in my heart I think I will know the limit as to how far I will allow them to go. Thank you and I hope you and Your Buddy will have a better day today. Song.

Squirt's Mom

12-12-2013, 09:53 AM

Song, have you read the thread in Everything Else about Macros? A member started it for parents to post in so they could share what they saw in their babies and so others who come along behind have somethings to compare. You can find that thread here -

http://www.k9cushings.com/forum/showthread.php?t=3567

My sweet Ginger

12-12-2013, 10:56 AM

Yes, Leslie and that was where I saw a lot of similar symptoms I see in Ginger and made me think that a Macro might be what Ginger has.
I don't want to rush to a conclusion prematurely on my own yet until I talk to her Drs and will come up with the best possible treatment for her if indeed that is the diagnosis in the end. I'm truly hoping that is not the case but I have to prepare myself for the worst as there are no guaranties in life. Thank you, Leslie.

labblab

12-13-2013, 09:01 AM

Marianne, I read some of your posts about your Barkis and I'm sorry to bring him up now but I'd like to run some of the symptoms I see in Ginger these days and would like your opinion on them if you don't mind, painful it may be. From a few other posts from different people on their babies I saw some of the common symptoms that I see in Ginger.
1) Loss of appetite, in her case Hyporexia
2) Aimless walking in circles, to the left
3) The whole body shakes and between the shoulder blades and leg tremors while at rest, asleep or standing
4) The neck and head jerkings which only last for a few seconds each and the corners of her mouth being pulled back and she seems to opens her mouth wide a few times at a time it seem like
5) Loss of hearing
6) Dullness, lose of zest in life and always seems to be alone away from the others
7) Seems to want to eat but can't
8) Rapid breathing when usually tremor comes, not panting. Doesn't happen often but happens.
9) Gets stuck in corners
10) Goes pee and poo in the house if the timing is not right. We used to think she was going senile as she was getting old.

Most of these symptoms she had prior to Lysdren treatments and some came after like between the shoulder blades shakes, head jerkings, mouth opening and falling down ( this has gotten better these days).

Hi again, Song, and I am sorry it took me this long to get back with you. But I wanted to make sure I had enough time to think over my answer. I saw many of the same problems in my Barkis. The ones I did not see were the neck and head jerkings, and the rapid breathing (which, from what you have written, sounds different from panting). But as for the other problems, yes, they sound very familiar to what we went through with Barkis. I first noticed tremoring episodes prior to beginning Cushing's treatment. The other problems started about six months after starting trilostane, during which time he had really seemed to rebound from his Cushing's symptoms.

The hard part, though, is being certain as to what caused the neurological problems. Since we decided against an MRI or CT, we will never know for sure. We started Barkis on Vetoryl back in 2003 when it was first being introduced as a treatment. The dosing guidelines at that time were very different, and we were giving him a much bigger initial dose than is now being recommended. His monitoring ACTH tests and electrolyte checks were always fine, but I have always wondered whether the heavy dosing of the drug itself was responsible for some of his problems. We did temporarily discontinue it altogether before ending up reducing the dose, but that did not seem to help much with the neurological problems. Our internal medicine specialist strongly suspected a macro was the problem since all his general labwork was normal and a repeat ultrasound revealed no issues. But at that point in time, Barkis was doing so poorly that my husband and I decided that no matter WHAT the problem was, there did not seem to be an easy remedy and he had been through enough.

There are still moments when I wrestle a bit with the uncertainty as to what went wrong. But if I had it to do over, I believe we would still make the same decision. Barkis' quality of life had been steadily degenerating for quite some time, and the neurological decline was really the last blow. It came to a crisis point for us when he stopped eating and drinking entirely.

I am glad you are getting the neurological consultation, and I do understand why you are considering the CT scan. You know yourself best of all and if you think it may bring you some peace to know for certain, then by all means, opt for the diagnostic. One of the reasons we didn't is because our IMS told us that if we were to proceed with radiation treatment, the vet school would most likely prefer an MRI that they performed themselves (so from that, I am assuming a CT can confirm the diagnosis but an MRI may provide a more useful image for actual treatment). So we decided to just nix the imaging altogether. But once again, we were operating in crisis mode, and I wasn't able to think very clearly at all at that time. I hope you will be able to take the time you need to make decisions that will mark out a clear path for sweet little Ginger.

I will be so anxious to hear the outcome of your consultation. And truly, I do wish I could physically wrap my arms around you. I remember feeling as though my sweet boy was slipping away from me more and more with every day that passed. Finally, the day just came when we felt as though our greatest gift was to release him fully. I hope so much that there will be an alternative remedy for Ginger. But if not, I feel as though I do understand and I will continue to check in on you daily.

Sending many, many hugs of strength and comfort,
Marianne

frijole

12-13-2013, 09:25 AM

Song

My heart goes out to you as you search for answers as I remember that lost feeling so well. FWIW when I finally drove Annie to K State they did a cat scan and that is when they ruled out pituitary cushings and a macro and then did an MRI and discovered the pheo. So what you are considering totally makes sense.

You have done a fantastic job of researching the options and so know that you are doing everything right. Keep us posted and we will help in any way we can. Continued hugs, KIm

Squirt's Mom

12-13-2013, 10:08 AM

Ginger is very lucky to have you as her mom, Song. You are doing a fantastic job!

goldengirl88

12-13-2013, 10:40 AM

Song:
keep up the good work you are doing. You are a wonderful advocate for you precious Ginger and I am praying for some answers for you soon. I know what you are going through thinking all these things so please take care of yourself and know I am thinking and praying for the best for you both. Blessings
Patti

My sweet Ginger

12-13-2013, 11:38 AM

Marianne, please, no need for an apology as that would've been exactly what I'd have done and I knew that was what you were doing.;)
What I can only describe as head jerking, it happens often during the course of each day and they only last for a few seconds and if it happens while she was walking she'd stop and finish this and continue walking and I must say they are not dramatic but clearly noticeable.
She had all four leg tremors prior to Lysodren and very soon after she was losing her appetite which was good tho never huge especially for a cushy dog. She hasn't gotten her appetite back yet although she's been off Lysodren since 11/16/13. The between shoulders tremor came after Lysodren, too if my memory is correct along with falling down which means some of these signs showed up within a month of the start of the Lysodren treatment for cushings disease. From I what've been reading if it is a Macro the size of her tumor might be already too large even for a radiotherapy treatment at this point and all efforts and grueling and risky procedures she has to go through is for what, how much time would we buy her? She may not even make it out of the treatment because of the side effects of the radiation.
It was clear her IMS prefers an MRI over a CT scan but I truly think in our situation a CT would be sufficient enough if that does identify the tumor. Whether am I going to go for it or not, I don't have an answer yet. I have to think through a few things.
For now I will see what the neurologist will have to say, tho I'm not expecting any kind of a clear answer after one meeting with him. It hasn't been that way so far.;)
Thank you so much everyone for your kindness and support and a special thanks to Marianne for your painful but very valuable information regarding your sweet Barkis.

frijole

12-13-2013, 05:30 PM

Continued warm vibes sent your way!

I know you are thinking it is a macro but I have to share something that just hit me just in case it is not a macro...

you listed symptoms and the only ones Annie did not have were the ones re orientation/standing in corner

She too was started on lysodren despite not having cushings (pheo not cushings) and even though her cortisol did not go down as low as Ginger's it was AFTER the lysodren treatment that her appetite went away. Same exact thing - she is hungry and wants to eat but she walked away from it just like what i saw in your video. Just sharing in case it is of any value up the road.

Kim

goldengirl88

12-14-2013, 11:04 AM

Song:
Thinking of you and Ginger on this snowy morning and hoping you are both well. Stay safe and warm. Blessings
Patti

My sweet Ginger

12-16-2013, 02:37 PM

We are back from the Drs and just read about Woody. My goodness!
We are praying for Woody and Tracey. I hope he will be ok soon.

Just wanted to run today's visit with the neuro Dr. and the med he prescribed for Ginger's focal seizures (that's how he categorized her jerkings and not generalized seizures) with you guys. We came home with Levetiracetam 250mg tab and she's supposed to take 1/2 tab every 8 hrs:eek: and recheck in 10 days to see how they work. He said it has less side effects than others. Anyone has tried this? Please let me know what you think about drug.

We nixed the MRI option for multiple reasons and he seems to think CT scan for her now really doesn't have any point so we are going with this medicine and hope it works. For the reasons I don't quite remember now she is staying on prednisone at 0.5mg daily along with her BP med as is. She did the head jerking a few times in the examining room so the Dr. got a very good look at them.
I checked her seizure med online and they don't sound awfully scary and am hoping for no bad side effects.

goldengirl88

12-16-2013, 02:47 PM

Song:
Is the Dr. meaning all the tremors are focal seizures? I mean like the ones Tipper has at nite? Or is this just the head jerks? I am glad you went to the neurologist and got this figured out. I am also happy you got a medicine that does not seem to have bad side effects. Did he explain what focal seizures are exactly? I am glad you and Ginger are home safe and sound. I will keep my fingers crossed that this medicine works for her. Blessings
Patti

My sweet Ginger

12-16-2013, 03:40 PM

Hmmm. I remember asking him "You mean her whole body and leg shakes are focal seizures and not generalized one?" And he said "yes." I haven't seen Tipper's tremors so I can't say they are or not but what he saw on Ginger he said they are focal ones. He explained the difference of the two but I don't remember much and I'm not even sure if I understood it there as he was explaining them to me . If you tell me exactly what to ask I will do so next time we see him. I liked this Dr. today. I just gave her first dose and will monitor her if there's any change. I'm supposed to write her daily progress.

Squirt's Mom

12-16-2013, 03:53 PM

I think it's focal seizures they think Sophie has but hers are weird - they make her act feral as if she doesn't recognize anyone or anything. I can tell one is coming on by her behavior - she starts acting afraid, hiding, and running away when she sees me or anyone else. We aren't treating since she is now safe in a fenced area and they are not frequent.

molly muffin

12-16-2013, 06:12 PM

Hope this helps Ginger out.

It could be that they want her to stay on pred because they think it is the tumor (head) causing the seizures and pred can reduce inflammation. There are cases with macrotumors when they are being treated with vetroyl, that you will be on both, pred and vertroyl. I don't know if this is what they are thinking, but it is a possibility. If it helps here, then so much the better and you can always taper off with a vets guidance later if you want and this med is working well.

Hang in there. I really think you are doing awesome
hugs,
Sharlene and Molly muffin

My sweet Ginger

12-16-2013, 07:51 PM

Sharlene, I think he did mention that steroid helps inflammation in the brain tho he didn't come out and say he thinks it is the macro tumor causing the seizures. Things don't register in my brain as they should anymore. I will get a clearer explanation next time as to where he thinks the seizures are coming from. I feel like my brain might crash with all too much info I've been trying to program into it these days because it's just not used to doing that for way too long.:o
Ginger was supposed to go down to every other day starting next Mon with prednisone and now that plan is off for now. I'm kind of concerned about her cortisol creeping up because it's been 30 days since her last dose of Lysodren and her IMS is reluctant to do an ACTH yet as long as Ginger is on prednisone. It makes me wonder where her cortisol level might be now.
Although I still see little tremors once in a while she looks clearly better already. I just hope this drug doesn't bring any new symptoms as she is already on three different drugs, at 4 different times a day.:o
The new pills are quite large. I think I will have a tough time getting them down, they are too big to cover. I also got them in liquid form and syringes too in case I fail with tablets but they don't look any easier, either but as long as this drug works, that's all I care.;)

goldengirl88

12-16-2013, 08:13 PM

Song:
After seeing several different dogs having focal seizures, I can tell you this is what Tipper is having. Her symptoms were described to a t. That being said, I also read that these can be caused by a brain tumor, lesions on the brain, medication etc. So when it has been said that tremors are a side effect of Vetoryl, the tremors could in reality be focal seizures. Tipper never had these before taking Vetoryl. I am wanting you to ask the neurologist if he is familiar with this. Why did he decide against the MRI? Do you think Ginger's could be caused by any of the other things instead of a macro? Also I would like to know if Tipper is having a focal seizure, when I call her name and she wakes up if the seizure would stop, because that is what happens. My vet said he would look into it for me, but he will probably forget about it. I am praying that your sweet Ginger does not have a macro. Blessings
Patti

My sweet Ginger

12-16-2013, 10:41 PM

Patti, even though he answered yes to my question regarding body shake and leg tremor being focal seizures I will ask him again next time if he means the typical leg tremor can be also called a focal seizure which Ginger had before Lysodren. Her head jerkings started after Lysodren I believe. Without an MRI I don't think we will be able to find out exactly where Ginger's seizures come from. I think he told me a couple of other causes which can bring these focal seizures which I don't remember now other than macro and wants to try this drug if it will work for Ginger. He said Ginger may not be a good candidate because of her poor health and high BP and heart problem to go through the procedures of MRI and radiation therapy which we both agreed. About CT scan, I think the way he explained to me was that if it doesn't show a clear macro it really won't be very useful finding out possible other problems such as MRI.
I will write down the questions for him and I might even have him write down his answers as well so my brain won't lose them on the way home.:o
You could be right with Vetoryl being blamed for most of tremor happenings. Certainly I can't blame Vetoryl for Ginger's leg tremor.
Didn't you say Tipper's are only happening during nights? That's very different from Ginger's. Ginger's is all through out the day.

Squirt's Mom

12-17-2013, 09:52 AM

We think Sophie has focal seizures, too, but hers are altogether different - she does not shake, twitch, convulse, head shake, none of that. Her's is all behavioral. She becomes very frightened of everything and does not seem to recognize the forms or sounds of those who are familiar to her. I have always said they cause her to become feral. She would run away when she lived with my brother when these would happen and got hurt several times (they live in the country, no leash or fence laws) - once she was torn up very badly by either coyotes or large dogs. She was hit by a car. She runs so far and in such terror that she gets lost so when she does regain her mind and can't get back home. The last time I saw her posted on FB and brought her here to stay until they get a fence up - which ain't gonna happen. :p

She still has these spells but she is safe in the fence here. She runs through the house hiding, tail tucked, ears either flattened back or pricked way high (as high as a Pug can prick anyway! :D), eye bugged out, panting, on high alert - in obvious terror. They last anywhere from a few minutes to weeks. She will eat very little during these spells tho she does drink a great deal. It has gotten COLD in here at times this winter as I have to prop the door open then get out of sight so Soph will go out and potty then come back in when she can which might be right away or might a couple of hours while she dashes around the yard scared to pieces.

When the spells are over she sleeps more for a bit, depending on how long the spell lasted - the longer the spell, the more she sleeps. Then she's right back to her usual goofy self. I've opted not to put her on medication because she doesn't convulse and they aren't violent or frequent. So my job is to keep her safe when these spells happen.

My sweet Ginger

12-17-2013, 12:09 PM

Leslie, that's very interesting re Sophie. What I've read so far these focal or partial seizures only last for a few seconds or a couple of minutes but with Sophie they can last up to weeks? Wow!
Her behavioral change seems to fit in the description of being in fear of something they see or imagine so they just run blindly.
Poor little Sophie's been through quite a lot and it seems amazing she's survived through all those wild happenings.:eek::eek::eek:
I'm so glad she's finally found a place with you where she doesn't have to put herself in any kind of harm during those episodes.:)
It must be heart wrenching for you to watch her go through that. I just hope she gets them as few as possible.
Ginger is sleeping peacefully and just occasional shoulder or leg tremors or muscle twitches but much less of them overall since the med.;) Hope it continues with no bad side effects.

goldengirl88

12-17-2013, 12:57 PM

Song:
I have contacted my vet about suspecting this in Tipper. I was up all nite because Tipper had to pee so much from being given Sub Q Fluids. I took the opportunity to research focal seizures. Of the dozens of dog videos, article and vet writings I am convinced Tipper has this. It said that night time is usually when they do this. It involves a mess up of electrical transmission in the brain. I also read medications can cause this, one Dr. had also associated liver and gallbladder issues with it. Tipper does all of the things the dogs on the video do. I am convinced this is her problem. These are not tremors as explained by Dechra but focal seizures from all I read. Tipper will wake up form sleeping and look confused, she will then sit and smell the air, some dogs lick the air. This is one of the symptoms and also I have been talking for weeks about her eye twitching that is one also. They can start in one place and move to other and that is how Tippers started. I am wondering if somehow by controlling cortisol that it makes lesions on the brain, or has some cumulative effect as Tipper has been off it for 3 days and is still doing this at nite. This is a strong medication and I am just wondering since so many complain of tremors on here if this is the connection. Tipper never did this before taking Vetoryl. I also read that the focal ones at night can be helped with melatonin. I am going to ask Leslie if it would be safe for her to have one before bedtime. I would like to this out and see. I have faxed all I have found to my vet. Who better than a neurologist to know this?? Not too many people probably take their dog to a neurologist so this connection has probably never been made. Therefore it would not be reported to Dechra. All I know is Tipper has the symptoms and mimics the other dogs doing this. I am trying to get my vet to consult with someone and confirm this. I do not need a video of Tipper after I watched all these dogs. So if anyone wants to know what Tipper is doing go online as view the dogs that have this. I am so glad you put this information out there Song. Everything written on here is helpful to someone else in a way. I would have never started researching this if not for you, so thank you for the information. There may be many others on here with these symptoms who could maybe learn something from all this too. I am curious to know how Ginger is on the medication. I also researched it and you are right it has the fewest side effects of these drugs. I am curious to know what your Neurologist will say about all this. Please even print it out and show him . Do you remember me saying on here about holding Tipper legs and feeling like electrical impulses surging through her? That makes sense to me as these are electrical impulses from the brain. When I call her name and she wakes up so does the brain and this stops immediately. Please let me know what you think. I am asking for other opinions from other members. I hope Ginger is well. Blessings
Patti

My sweet Ginger

12-17-2013, 11:48 PM

Hi, Patti,
You are getting me excited about your 99% belief that you just might have found the answer you've been searching for weeks now.
I really hope that is the case and somehow you can also find the right treatment for Tiper's seizures so both of you can finally have long and uninterrupted nights of sleep. Hmmm, when was that?
I really feel like you are onto something.
Watching the videos I also saw a dog doing pretty much what Ginger does. I feel so bad for all these dogs. I wish it was easier to pinpoint what's causing these tremors or seizures so they can be treated promptly.
Ginger's shakes and tremors had subsided almost instantly once she took the med yesterday (she took her first dose @2pm) and I saw very little tremors all afternoon and evening. She took next dose @10pm. She was better tremor wise though they were there early this morning and her demeanor seemed the same as before. She took the med @7am (9hrs after last one) and by that time her tremors were back to close to normal size and remained pretty much through out today which by then clearly smaller. I will have to observe her closely to see how well this med works for her and I hope it does.
I will bring a copy of your post to Dr. Hammond when we see him next time and see what he says. We are going to try hard so Tiper can sleep peacefully and comfortably.:) Sweet dreams everyone.

goldengirl88

12-18-2013, 09:21 AM

Song:
Glad you got to see my post. Please read my one today as I tried an experiment with Tipper last nite. Please just remember that there were many causes for these and God willing maybe Ginger does not have a macro and it is caused by one of the other reasons. I am anxious to see what the neurologist says. Please ask him also about eh melatonin, maybe it can be combined with the current med she is on. I watched Tipper do this all thru the nite so it is just not when she goes to bed, it happens all nite long. Addy had a curious question too. If Tipper has hypothyroidism could this be causing it? I did not see it listed as one of the causes, but would say it is really possible as some have no known cause and are idiopathic. I hope you and Ginger are staying safe and warm and that her meds help her. It is supposed to be in the 40's Friday and all weekend Tipper will love that as she can walk then. Blessings
Patti

goldengirl88

12-23-2013, 09:11 AM

Song:
I am hoping that you and Ginger have a wonderful holiday together. God Bless you Both
Patti

molly muffin

12-23-2013, 02:58 PM

Happy Holidays Song and Ginger.

Thinking of you both
hugs,
Sharlene and Molly Muffin

My sweet Ginger

12-23-2013, 10:53 PM

Hi, everyone,
Today is Ginger's 14th birthday. It's been an emotional day for me on this special day for no other specific reason than just thinking about Ginger. It brings me tears so easily these days just by looking at her.:o

We just cut her cake and she liked the it. I will post a couple of pics from tonight.
She is doing just about the same since her seizure medicine, the seizures or tremors have subsided quite a bit but not completely gone especially towards the end of each 8hr mark it seems like they could be back almost same as before med at times. We are seeing her neurologist in a few days and I'm curious as to what he will say or do regarding her seizure medicine. For us three times a day is becoming an ordeal as she is getting suspicious of those foods that are wrapped with her pills inside as they are quite large. Her appetite is about the same and I don't even bother to give her kibble in the morning anymore. She gets it later in the day as she eats three times a day now because of her pills. It's starting to stressing me out each time but it's really nice to to see her looking calmer and more peaceful.

I didn't even get a tree this year, only a few little presents to give out, just couldn't get into the spirit this year.:o
Still I'd like to wish a very merry Christmas for those who celebrate Christmas and a happy and healthy new year to everyone and all of our fur babies. Xoxoxo Song

Renee

12-23-2013, 11:05 PM

Aww, Happy Birthday Ginger!

Roxee's Dad

12-23-2013, 11:19 PM

:):):) Happy Yappy Birthday to Sweet Ginger :):):)

frijole

12-23-2013, 11:39 PM

Happy Birthday Ginger! 14 years young. Hope mommy gave you a nice treat for your special day.

Song hang in there and have a peaceful holiday with your loved ones. Keep the faith and may 2014 bring you much happiness. Kim

Squirt's Mom

12-24-2013, 08:43 AM

Happy 14th Birthday, Ginger!

Birthdays can become just as sad as they are celebratory as our babies get older. That "bittersweet" feeling comes home to roost. Squirt will be 16 in Feb and while I am eternally grateful we have had most of those 16 years together, I also know each day is a gift to be cherished.

How lucky are we who get to spend so many years with our babies?! Yet it is more than luck. Our vet saw Squirt last month and as he was examining her, he made the comment - "this dog wouldn't be alive if not for you". Moms like us have a bit of magic...called love. We know our babies and we know when something isn't quite right with them and we do our best to address the things that come up so they have the best life possible. Yes, it's more than luck - it's the "power of love", a love that defies description but is easily seen.

So while I cry at times watching Squirt walking in obvious pain or see her lost standing in the middle of the yard, when I look into her eyes, I still see my Sweet Bebe in there like always. When she is feeling good and trying to play the games we have played all her life, those moments become gold to be scooped up and stashed away to sustain me during those times when she is not feeling so good.

You are a great mom, Song, and I wish you and Ginger many more birthdays together.

Hugs,
Leslie and the gang

molly muffin

12-24-2013, 09:05 AM

Happy Birthday Ginger!

14 years!

It is a milestone isn't it.

Leslie said it just right so I'm not even going to try to add onto that.
Wishing you Happy Holidays Song. I hope it isn't all sad for you this holiday season
hugs
Sharlene and Molly Muffin

My sweet Ginger

12-24-2013, 09:37 AM

Thank you everyone for all your sweet birthday wishes for Ginger.:)

Oh boy, you've got me started already,Leslie. You are so right. They can make you happy and sad at the same time.
Before I just thought she quit being a material girl being a senior dog when she stopped playing with toys and the other dogs.:rolleyes:
She still can tell me a lot with her beautiful and sweet eyes. Yea, I feel very lucky having her in my life.:)

A very special holiday wish for you, Leslie and your gang of three Squirt, Brick and Trinket.:) Song.

goldengirl88

12-24-2013, 10:40 AM

HAPPY BIRTHDAY GINGER AND TIPPER AND I WISH MANY MORE FOR YOU.
Song:
I know how you are feeling. I have no tree either. I wanted to tell you something I read about the seizures. When they have one, try to rub their ears in a circular motion as it helps them to come out of it sooner, because of the pressure points in the ear. I hope you can have some enjoyment for Christmas. Ginger will be your present as she is such a blessing to you. Blessings
Patti

doxiesrock912

12-24-2013, 03:15 PM

Merry Christmas Song!

goldengirl88

12-25-2013, 08:30 AM

Song:
Hoping your day with Ginger goes well today. Merry Christmas and God Bless you both.
Patti

molly muffin

12-25-2013, 06:17 PM

Merry Christmas Song and Ginger

hugs,
Sharlene and Molly Muffin

My sweet Ginger

12-27-2013, 05:53 PM

Hi,
We saw Dr. Hammond this morning and he switched Ginger's seizure medicine to Zonisamide 50mg, twice daily because 3 times a day proved to be very unpractical. He also increased her pred to 0.5mg twice daily from once daily.
He def. seems to believe it's a tumor that's causing these seizures in Ginger's brain and said she needs pred if that's the case. I'm to call back to him in 10 days with her progress.
Ginger's BP was 70:eek: and one of the internal med Drs is supposed to call me and let me know regarding her BP med (her IMS is on vac), probably lower her dosage I hope.

Patti, I asked him about tremors and seizures and he said they are not related so Ginger has two different things going on.
When I asked about Tipper's case he said he doesn't think trilostane causes seizures and didn't want to comment on that any further because he didn't see Tipper. I'm thinking maybe it's worth to see that neurologist who your vet recommended even just for a consultation.
The total cost of pills today was $64, not too bad - pred(30days), zonisamide (30days) and BP med (30 days).
I'm glad Tipper's leg's getting better. She probably needs little more time. I pray for you that you can get more sleep at night so you will be fresh the next morning for Tipper and yourself to enjoy.
Take care. Song.

Trish

12-27-2013, 06:08 PM

:eek: yikes that BP is low, that be making her feel yuck I would think, what medication does she take for her BP? I hope they do lower it or stop altogether for a while until rechecked.

Happy Belated Birthday xxxx

My sweet Ginger

12-27-2013, 06:41 PM

I thought that was too low myself considering she was at the vet where she gets totally stressed out every time . Yea, a dr. just called and stopped her BP med (Amlodipine ) for a week and recheck her BP and go from there.
I'm glad to have her BP checked today because it wasn't originally scheduled for a while.:eek:
Thank you for the bday wish, Trish.:)

Trish

12-27-2013, 06:59 PM

Yes, if you take any stress into account it could even be lower! :eek: Pleased they are giving it a break, be interesting to see if Ginger perks up more without it. I hope so :)

My Flynn is on Amlodipine, it seems to be doing the trick. We only check his monthly, sometimes he is a bit sluggish especially in the mornings and I wonder if it goes too low at times but always checks ok at the vets so we are reluctant to decrease it. He is on 1.25mg twice a day, plus Benzapril for his kidneys but that can have effect on BP too. A fine line sometimes getting everything in correct range :)

My sweet Ginger

12-27-2013, 07:44 PM

A very fine line indeed. :o

doxiesrock912

12-27-2013, 11:23 PM

Ginger will probably feel better once the blood pressure is up. Maybe she'll end up on a lower dose of bp meds?

goldengirl88

12-28-2013, 08:51 AM

Song:
well that was certainly unexpected with the bp so low. I would definitely keep my eyes on that. Has she been real tired and laying around a lot? I hope you get this resolved as maybe she will have to stay off the bp meds for a while. Did they give you any idea what would cause such a drop? Praying for you and sweet Ginger that all this gets straightened out soon. Blessings
Patti

My sweet Ginger

12-28-2013, 10:33 AM

Patti, I didn't even think of asking why Ginger's BP got so low because to me it was obvious enough that the dosage of her BP med was too high.
She started out with 0.625mg Amlodipine (1/4 tab) daily but her IMS doubled it to 1.25mg only after one week while her BP was still going down. I don't know how long it usually takes for this med to get regulated from the first dose was taken but I just think we should've waited for another week on a 1/4 tab.
It was hard to tell the difference in her demeanor regarding her BP being so low from her already very inactive daily routine. She mostly sleeps, no interactions with anybody. She just follows me around or rests or walks around aimlessly while she's awake. Believe it or not that is an improvement compared to pre Lysodren treatment when all she did was sleeping and looking incredibly dazed. I hope her BP will bounce back during this break.

molly muffin

12-28-2013, 01:13 PM

It seems that with Ginger, she has extreme reactions to medications. Lyso too much for her system and now the BP meds, too much. Her little body just may process medicines or be sensitive to them at a greater level, so any medication she needs might be at a lower level over all.
Just a thought I had.
Hopefully the BP will pop back up with this break and she'll be more herself going forward.

hugs,
Sharlene and molly muffin

My sweet Ginger

12-28-2013, 05:36 PM

Hi, has anyone tried zonisamide for focal seizures for your baby?
Ginger took her first dose 6AM this morning and she's been more lethargic and not as steady on her legs and by 3pm her tremors and seizures are pretty much back.:( It seems to me she does better on the previous medication so I called the hospital and no one is in the neurology. Wanted to tell them I'd like to go back to Levetiracetam as of now if that's ok since with Zonisamide she needs to wean off of it if she stays on it longer. I was told by a receptionist to give her another dose today as scheduled and talk to someone tomorrow but I will be an idiot to continue with another dose seeing her not doing well. At least with Levetiracetam I know she was tolerating it for 10 days. This leaves me with only one option and somehow someway I have to come up with 3 times a day schedule for I'm not moving onto another stronger and bigger side effects medication. A tech from the emergency dept. supposed to call me soon but regardless what they say I'm not giving her another capsule.

beaglemom3

12-28-2013, 06:14 PM

I hope Ginger feels better and the meds gets straightened out Hugs to sweet Ginger from me and Snuggles.

goldengirl88

12-28-2013, 06:22 PM

Song:
Thank you for asking the neurologist about Tipper. I appreciate it. I am hoping that Ginger's pressure is better and she is having a good day. Blessings
Patti

Trish

12-28-2013, 06:38 PM

Hi Song

Did they say it works immediately this new drug or does it take them a while to get used to it? I am wondering if her little body needs to normalise a bit from getting a new drug? Hope she perks up later x

molly muffin

12-28-2013, 06:51 PM

A couple people have used it on the forum. I think Buddy "concernedmom) was on it a bit, after the experience at the ER with him.

I just want to repeat what I mentioned before which is whatever a dosage they think should be, for Ginger might need to be less. I read on one thread that it can take a week to get to therapeutic levels normally, but not really sure if the would be true with Ginger.

hugs,
Sharlene and Molly Muffin

My sweet Ginger

12-28-2013, 07:46 PM

Well, a Dr. called and said she wasn't surprised to hear about Ginger's reaction and that it could take up to two weeks for the drug to be normalized. She also said it was ok to go back today so I gave her Levetiracetam with her dinner and we will stay on it. I just couldn't handle seeing her taking back steps when there seems to be another option available. I just have to make it happen no matter how inconvenient. Zonisamide was supposed to last for 12 hrs but the tremors and seizures already started to come back after about 9 hrs.
I will monitor her how she does on Levetiracetam because this drug doesn't completely stop her problems either and also seems to lose it's effectiveness after about 6 hrs but seems to keep her more alert.
Yesterday I asked her neurologist about the higher end of starting dose but he said in order to see an ideal range of improvements he wouldn't lower the dosage and I didn't really see any difference between the two drugs.

What's been on my mind after our appt. with her neurologist was that neither her IMS or neurologist is reluctant to do an ACTH because of her continuos use of prednisone by saying that you have to treat the bigger problem first and they can't treat both at the same time.:mad: But what about her rising cortisol? She's been off Lysodren since Nov. 16th.
I really don't know where this is taking us at this point. I just hope Ginger stays comfortable.

beaglemom3

12-28-2013, 08:20 PM

I hope Ginger stays comfortable too sweet girl I will praying it all sorts out well.

Concernedmom

12-28-2013, 11:26 PM

Hi Song
I've read a bit about your little Ginger and I'm so sorry she isn't feeling well. Sharlene is correct zonisamide is the seizure medicine my Buddy was on. He started after he was in the hospital on phenobarbital. He was on 25mg twice a day and after a a couple of doses he was sleeping a lot and wouldn't take his medicine. Then he wasn't interested in food. We kept him on it for 3 days and then I spoke to the vet who said to stop for a couple of days to see if he gets better. I think Buddy's system couldn't tolerate anymore drugs. My vet didn't think it was the medicine because none of the dogs she has treated have shown any of these side effects. (But that doesn't mean it can't happen). She told me she really thought it was neurological symptoms from the pituitary tumor growing. At the time we really thought it was the zonisamide and decided not to treat him for the seizures but looking back we know it was the tumor growing which gave him the seizures which gave him loss of appetite, sleeping all the time, head tremors once in awhile. He would feel good one day and eat some food and act like our Buddy then the next day he wouldn't want to eat and would sleep a lot. Our vet said she could have prescribed prednisone in the end but then the cushings would come back and it wouldn't stop the tumor from growing and it wouldn't make him want to eat food. That is what made our decision for us. He stopped eating. All of this happened so fast Dec 6 and we put him to rest on the 17th. So it was very difficult trying to make the right decisions everyday. You are taking such good care of Ginger and I know how hard it is to watch them go through this but you are doing all the right things for her. Hugs to the both of you

goldengirl88

12-29-2013, 08:31 AM

Song:
I am praying for you and Ginger. I am hoping this gets turned around. Blessings
Patti

Squirt's Mom

12-29-2013, 10:16 AM

Thinking of you and Ginger this morning. I hope this is one of those drugs that just takes some time to adjust to and she will be much better soon.

Hugs,
Leslie and the gang

Concernedmom

12-29-2013, 02:55 PM

Thinking of you and Ginger today. I hope she's doing better today and you're both enjoying a good day together.

My sweet Ginger

12-29-2013, 06:32 PM

Thank you Everybody. So yesterday I switched back to Levetiracetam and I see Ginger who I normally see these days, a little steadier in her legs. Her appetite seems a little off than usual although she still eats ok except for kibble and that could be from zonisamide. It was one of the side effects. She's what I'd describe as a candle in the wind these days, sooo frail that a little wind would easily knock her down but she's still hanging in there loving me in her own, sweet way.:)

Little Buddy's mom (I'm sorry I can't remember your name right now)
I want you to know that I really appreciate you sharing your sweet Buddy's story with me as your memories of him still must be too raw for you to talk about. I hope you are doing ok and also hope that it will get easier for you to think about him without so much crying as time goes by.
I went back to the start of Buddy's thread to read to see if there is anything I can take away from your and his long and courageous battle since Ginger and Buddy may share the same cause. I'm going to read the whole thread and then share my thoughts on it. Thank you again for keeping us in your prayer. Song.

goldengirl88

12-30-2013, 08:56 AM

Song:
I am praying for you both that these meds can get worked out right for sweet Ginger. You are doing an excellent job, so keep going!
Blessings
Patti

molly muffin

01-01-2014, 01:48 PM

Wishing you and Ginger and family the best in the new year.

hugs,
Sharlene and Molly Muffin

goldengirl88

01-04-2014, 08:53 AM

Hi Song:
I just wanted you to know I am thinking of you and sweet Ginger and hoping it is going well. I am hoping the New Year brings peace to all on this forum as we have all had a bumpy ride lately. Blessings
Patti

My sweet Ginger

01-04-2014, 11:55 AM

Happy and Healthy New Year!!

Could it be a new vet for Ginger for new year? We are seeing another IMS on Monday. BTW, we are still also seeing Dr. Nelson on the 14th.
I'm still going 'Hmmm...' about the phone calls I had on Thurs. with the head nurse at my vet's office. After a wk of break from Amlodipine Ginger was supposed to recheck her BP. Since the hospital is 30miles away and my vet's office is less than 2miles I called and wanted to bring her in yesterday. The nurse answered and said no problem and we were discussing Fri or Mon when she abruptly put me on hold for a few minutes, came back and said their BP machine broke:eek: so I have to go to the hospital since that's who checks her BP on a regular basis.:rolleyes: Asked how long it will take to fix it, she said at least 2 wks. Asked what if a patient needs it and she said 'We hardly ever use it, maybe twice year.':rolleyes: and then she again said since the hospital regularly checks her BP maybe you should go there from now on.:rolleyes:
After the calls I just can't shake off this feeling that I might've ticked the vet off by not listening to her and gone on to an IMS then she wouldn't display such unprofessional behavior, would she?
We were having a snow storm and I really didn't want to drive 30miles by myself with her so I called a local hospital and was told that they have to establish a Dr./patient relationship in order for Ginger to have her BP checked there.:mad: I thought if I was going to spend $100 just to check her BP with a regular vet there I might as well spend another $50 and see the IMS there for a second opinion.
I'd like to get this internist's opinion on treating both Cushings and seizures at the same time if that is possible as Ginger is being treated for seizures only for the time being and my worries getting bigger about her rising cortisol. It's been 6wks since she got off Lysodren and I can't have her symptoms go back to pre Lysodren. She is doing not that much better now but she is doing better. I'd like to keep this going before losing control over one problem while treating the other.
I really hope there's a way to treat both at the same time. We will see.

Ginger is doing pretty good these days, milder tremors and seizures, not collapsing so much, more alert, less sleep, a tiny bit of increase in appetite and drinking which I think is coming from an increased dose of prednisone. Although she still has some tremors and seizures it's still so nice to see her little body not shaking so much. It looks like Levetiracetam is working for her for now.

molly muffin

01-04-2014, 12:46 PM

Very glad to hear the Levetiracetam is working better for little Ginger.

Weird about the local vet, but it could be that it wasn't till mentioned about the BP machine that someone spoke up and said "oh that's not working". Who knows though if it is attitude or something else. I'd probably say, no I would rather have you check the BP when your machine is fixed and give me the read outs. ($50. is better than $100.) LOL

So, new year, new vet. Start making a list of everything to bring up to the IMS. You have copies of everything right to take with you to the new internist?

huggers,
Sharlene and Molly Muffin

frijole

01-04-2014, 01:21 PM

$100 to check BP is insane. Highway robbery.

If you go to a new specialist please write up your dog's whole story from the beginning with facts - dates - test results (the numbers not "normal" or "high"). Include EVERYTHING. Inbetween the tests and dosing info include what symptoms you saw afterward or at that time. This will help give the new person a leg up on the case as well as save you money on retesting everything.

Also provide them with videos of the current symptoms you are seeing if you can.

Glad she is feeling better! Kim

My sweet Ginger

01-04-2014, 02:12 PM

molly muffin

01-04-2014, 03:03 PM

Song!! Super big hugs, you're doing fabulous and all you can to get Ginger the best care possible.
This is not an easy task obviously. Ginger's body is like this small little environment that reacts to anything introduced to it in the extremes. That isn't easy.
I think you are doing an awesome job. I have high hopes that you'll find that really good balance for her.

hugs,
Sharlene and Molly muffin

frijole

01-04-2014, 03:58 PM

:) I learned from the pros here. I've already faxed Ginger's test results and daily log sheets from her journal, all of 26 pages.:eek:
I'm trying to send her a few video clips now.:mad: Not an easy task for me.:o but I will get it done.;)

Videos are too hard/large to send. If you can create a you tube account and just send the vet the link/s. That is what I had to do.

Of course you had a 26 page log. Poor vet :D

My sweet Ginger

01-04-2014, 04:32 PM

Well, Kim, I hope you are not thinking 'What have we created here?' are you?:D
The 26 pages was a trimmed down version from 37 as each page will cost me $1 :eek: at the mall where I work. I cringed but didn't have any better option because we were having an icy snow storm and I wanted to avoid driving if I could.:o
I might have to bribe my son to put clips on YouTube;) as that method works well here and there. Hmmm.. Then why do I still have to give him bailout money often enough, too?:rolleyes: Well, he is still in school and a very good kid.;)

frijole

01-04-2014, 06:05 PM

:):D:) Too funny re the bribes.. although I figured out how to open an account and it was easy... what's harder for me is remembering my name and password! ha

$1 a page? Yikes. Hope the sun comes out soon. We don't really have any snow yet. But the high on Monday is supposed to be in the negative numbers! :eek::eek::eek: I ran my errands today!

My sweet Ginger

01-04-2014, 06:29 PM

Sweet Sharlene,
I promised Ginger that she will get the best possible supportive treatments that are available out there for her when I opted out of extensive and expensive diagnostic procedures and treatments. I will do what I can to keep her away from unnecessary pain and discomfort the best I can and right now she seems just that, comfortable and not in any pain and I'd like to keep her that way as long as possible. I just want to be proactive so nothing gets too out of hand and if we don't address her cushings problem while treatable I'm afraid it will come back nastier and by then it might be too late to try anything. It seems almost impossible but I'm going to try to stay one step ahead of her ugly problems I can only hope.

My sweet Ginger

01-04-2014, 07:40 PM

I couldn't agree more with you Kim! Those log on IDs and passwords are such pain! I try to use the same one (at least the password) and that's not even easy sometimes.:mad:
Brrrrr... Negative numbers! Keep the snow and ice away.
When I was coming home from work this past Fri. during the icy snowstorm I counted total of 9 cars on the low embankment between east and westbound highways all bolted out from eastbound (westbound was already bumper to bumper), just stuck in the ditches, most of the drivers still sitting behind their wheel! Only a couple of cars or accidents were being aided by police when I drove by and I was only going one exit!! It was a rare sight I hadn't seen before.
Good thing you did your errands already. Stay home and get cozy at home I hope. I suppose you have to work, bundle up then.:(

My sweet Ginger

01-06-2014, 01:47 PM

Hi everyone,
We just came back from seeing our 2nd IMS and I'm glad we did.
I feel like I finally got some questions answered that's been hanging over my head. Firmly she said she believes the signs Ginger was showing during and after Lysodren treatment was Addison's disease from her cortisol plummeting from sky high down to 2.9 in such a short time from a clinical stand point and Ginger may even need prednisone for life.:eek: She said we have to treat Ginger by reading her and not just the test numbers only and that makes a lot of sense to me. She agrees with the neurologist that Ginger may have a macro tumor saying the tremors started before Lysodren treatment and also agrees opting out of extensive tests and procedures considering where she is and she wouldn't do tests after tests until she shows changes in her clinical signs. Ginger's BP readings were all between 235-250, so she's back on Amlodipine 1/4 tab daily.
She said Ginger looked pretty good and we need to keep her this way.
While I was there everything she said made so much sense to me that I may not have to drive 30 miles to see an IMS anymore. It's more expensive here but I think it will be well worth it. I really liked her and
I think it's a good idea to add a pair of fresh eyes to look at the whole situation from another angle.

molly muffin

01-06-2014, 03:15 PM

Excellent Song. Although sucks that it is more expensive, maybe having someone who seems to be in tune with what is happening with Ginger, will be cheaper over all as you won't have as many vet visits to contend with if they can just get her on a good treatment plan and keep her where she is.

I'm going to take this a positive experience for you and Ginger! :) :)

Hugs :)
Sharlene and Molly Muffin

My sweet Ginger

01-06-2014, 03:35 PM

Absolutely, Sharlene. ;)

Trish

01-07-2014, 05:45 AM

She does sound very sensible and I am glad you struck a good one! Eek that BP was high :eek:, glad Ginger is back on the Amlodipine. I too agree a fresh set of eyes can be very helpful. Sometimes we get so attached to our vets we do not want to believe they sometimes do not have the knowledge to care for our babies, so pleased you are happy with her. Is she going to do any blood tests to check where she is now, or leave it a bit longer? xx

doxiesrock912

01-07-2014, 05:53 AM

That's exactly what will happen Song. Fewer visits because she knows what she's doing.
Once we found our IMS, visits are starting to become less frequent.
I'm glad that she thinks that Ginger looks good :-)

goldengirl88

01-07-2014, 09:33 AM

Song:
You are too funny about the critters here. I am glad you found a Dr. you have confidence in. I am hoping you can get Ginger's blood pressure down. You are doing a wonderful job with her and I totally agree with you plan. These dogs are at the vets all the time and the stress from that alone has to be horrendous. I am trying to eliminate what is not absolutely necessary for Tipper also. She is past the point of being fed up with vets. Blessings
Patti

My sweet Ginger

01-07-2014, 09:55 AM

Good morning,

Now that I had some time to think about what our 2nd IMS said yesterday I've been going 'right, that's right...' reflecting Ginger's road on Lysodren.
Here's what I think happened to Ginger.
So far my 1st IMS hasn't been able to give me a clear answer why I was right not starting her with maintenance phase because she hasn't figured out why Ginger was still sick with a set of perfect looking ACTH numbers. Nonetheless, she agreed and said no more Lysodren for now and that was 6wks ago.
Although her latest stim #s were 2.9 there was no increase or decrease in those two #s which was very puzzling to me.
Dr. Goldman(our 2nd IMS) said that's because her adrenals are not producing cortisol anymore.:eek: and she doesn't know whether they will as time passes, we will have to wait and see through Ginger.
She didn't say it but I'm thinking the 2.9s were the residue from her constant use of prednisone even with a 24hr break, meaning her actual #s might be even lower than 1.0.:eek: and that gives me a chill on my back if this theory is correct.

After a heart wrenching and painful thought process in my little head
I was about to go with my vet and start her maintenance and none of you guys gave up on Ginger and still urged me to not to.
I've never been more sure than this morning that that was the right decision. I don't even want to think about what ifs. Like Leslie said my vet maybe a good Dr. but not in Ginger's case in more than one ways.
I think she was going with a cookie cutter treatment plan as far as treating Cushings disease and we all know so well how different an individual patient can be! All you guys rock!!:cool::D:cool::D
Trish, she doesn't think we need stim test now seeing Ginger's body still requires prednisone in order to function normally and said Ginger may even need prednisone for life depends. I'm interested to hear what Dr. Nelson (1st IMS) will say about Dr. Goldman's findings when I see her next wk and am so glad landing on Dr. Goldman. She said no one should care about anything else i.e. one's ego but Ginger's best interest and there were her personal email address and cell phone #:eek: on her business card!! I begged my vet for her # just for the loading weekend and she refused it!!:eek: I just think Dr. Goldman is one of the kind and am so glad to have discovered her.:)
Wish everyone a good day.

molly muffin

01-07-2014, 01:41 PM

Wow, Dr. Goldman sounds wonderful indeed!

hugs,
Sharlene and Molly Muffin

My sweet Ginger

01-08-2014, 09:14 AM

Good morning,
A question for anyone. Now that Ginger is possibly Addisonian's, would daily intake of prednisone be the best course of treatment for her or there are other options also? If she's Addisonian's, is it possible that her electrolytes would still be normal? I'm asking because her latest test showed they were normal. Thank you in advance. Song.

frijole

01-08-2014, 09:31 AM

Song,

Glad your visit went well. Can you tell us what your plans are for vet care moving forward? If I have it straight you have a regular vet (who wanted to go back on lysodren) and 2 IMS vets involved in the case.

Which ims are you planning on working with? Without a doubt you have no choice but to use prednisone for life if Ginger is Addisonian. Didn't the ims yesterday discuss treatment options and opinions with you? There is a delicate balance you must maintain and monitor with Addisons. There are other dogs here that have dealt with this so hopefully their owners can chime in.

I have no doubt in my mind that Ginger's case was beyond the abilities of your regular vet and that isn't all that uncommon. The question is are you going to continue to use that vet or strictly work with one of the IMS vets? I am hoping Tina can chime in (her dog went addisons).

I have to run to work but will check in later. Kim

doxiesrock912

01-08-2014, 09:45 AM

Song,
I wouldn't bother with the first IMS now that you've found Dr. Goldman. No need to start a war or make things more complicated, you're already confused it seems. Dr. Goldman is right on the mark and I would call her to confirm what you should do from this point on to be sure.

I agree with others that Ginger's regular vet is not knowledgeable enough but if you like them, you can use them for routine visits. We do this and make sure that they share information between both offices.

labblab

01-08-2014, 09:49 AM

Yup, I agree with Kim that if Ginger's adrenals never rejuvenate sufficiently, she'll always need supplementation with prednisone. It is possible that may be the only supplementation that she'll need, though, as long as her electrolytes remain in normal range. This would mean that her aldosterone level has not been affected in the same way as has her cortisol production, and yes, that can be the case.

Marianne

My sweet Ginger

01-08-2014, 10:29 AM

You got it right, Kim. We have a regular vet and two IMSs at the moment. A permanent treatment for Ginger was not discussed with the 2nd IMS because we still don't know whether her adrenals will start reproducing cortisol with time and we wanted to see what our 1st IMS thinks of all this once she gets the 2nd IMS's reports who we will see next Monday. On top of the fact that I felt like we were in tune so much with Dr. Goldman (2nd IMS ) and the inconvenience of driving 30miles alone with restless Ginger (she's not an easy rider and it gets dangerous at times:eek:) I think it's a no brainier for me to stay with Dr. Goldman who is only 4 miles away. I will be totally honest with Dr. Nelson and I have no doubt she will have any ego problem as she is such a sweet person, too.

I think it's clear on both our minds that my regular vet will no longer treat Ginger as far as cushings is concerned and that's only natural at this point. If I can go back to pre treatment, I wish I was given an option to choose between the two drugs with a through explanation in a private consult by my regular vet, then I'd have certainly chosen the low and slow option of trilostane for my Ginger but I got none of those and I hadn't found a bunch of wonderful people on here yet.:( Only a few days later I did.

My sweet Ginger

01-08-2014, 10:44 AM

Thank you Marranne, I wasn't sure that it was still possible.
I could've called and cancelled my appt. with Dr. Nelson but I wanted to hear what her take on this now and also want to thank her for her service so far in person as I could see she was trying hard to pinpoint Ginger's problems. So we will make another trip there.
Whether I'm staying with my regular vet or not I will decide it later.
I have very little doubt I bruised her ego.:( It's in their tone. If need to be, I will ask Dr. Goldman.

goldengirl88

01-08-2014, 12:08 PM

Song;
Thinking of you and Ginger. Praying you get things straightened out. Blessings
Patti

frijole

01-08-2014, 03:24 PM

Song, You are so nice. Remember this is about Ginger. I have no doubt your regular vet and the other IMS are nice people. Nice people make mistakes. What you need is someone - nice or not - that you are comfortable to treat Ginger. I think you found her.

I was asking about treatment because I wanted to make sure you are still giving the prednisone but that this new vet could make the determination if the dosage was correct and confirm electrolytes are ok etc.

FYI I am headed out of town for a few days but others here will take very good care of you. Kim

goldengirl88

01-09-2014, 09:56 AM

Song:
Just looking in on you and Ginger and hoping all is well with you both. Blessings
Patti

goldengirl88

01-12-2014, 09:41 AM

Song:
How have you and Miss Ginger been doing? Hope all is well and that you are having decent weather. Hope Ginger is still doing well at home getting love from her mom. Blessings
Patti

My sweet Ginger

01-13-2014, 10:58 AM

Good morning Patti and I hope you and Tipper had a better night last night. Thank you very much for checking in on us, Patti. I really do appreciate it especially when a lot is going on around you with Tipper and your neighbor.
Ginger is continuing with her improved state with calmer tremors and seizures, better alertness, steadier legs, somewhat improved appetite. She still sleeps a lot and her drinking seems to have increased a bit along with her peeing but I think she is clearly doing better now than during and after Lysodren treatment which makes me think Dr. Goldman's assessment is probably right on the mark. I'm thinking increased dose of prednisone is causing her drink and pee more.
I don't think I see any signs yet that indicate her adrenals are regenerating at the moment. It's been almost 2 months since her last dose of Lysodren and I think there is a chance she might turn out to be a true addisonian in the end and I don't know how I should feel about that if that's the case. Well, we are seeing Dr. Nelson tomorrow and now she should've read Dr. Goldman's report so I will see what she will say about it tomorrow.
Hope Tipper can have her walk today. The weather's been pretty warm the last couple of days here and what a difference that makes!
Spring can't come soon enough for me. Take care. Song.

Squirt's Mom

01-13-2014, 11:16 AM

It's good to see that our sweet Ginger is feeling a bit better. I hope the trend continues and gets even better as the days pass!

Hugs,
Leslie and the gang

goldengirl88

01-13-2014, 11:58 AM

Song:
It is so nice to hear that sweet Ginger is doing well. I wonder what happened to her with the Lyso. Maybe we will never know. I am just thankful you are having good quality time with her and that she is holding her own. I hope she continues on that way. Blessings
Patti

molly muffin

01-13-2014, 07:54 PM

Song, I am thrilled that Ginger seems to be doing better. If she turns out to be true Addisons, then that is something that can be dealt with too and I know you will be able to deal with whatever comes your and Gingers way, with the help of this new specialist. I'm so happy that you found her. It helps so much to have confidence in the one who holds the life of your most precious in their hands.

:) hugs,
Sharlene and Molly Muffin

My sweet Ginger

01-14-2014, 07:43 PM

Hi everyone,

We saw Dr. Nelson today and she didn't have nothing new to tell me or add that I didn't already know from Dr. Goldman. It was a Q&A basically. Ginger's BP was 112!:):):) So she is staying on 1/4 tab Amlodipine and recheck in 1 month. Also she will stay on prednisone and Levetiracetam as is. I hope she will continue to do good. I'm to make an appt. with Dr. Goldman in one month for her recheck. She gave us her blessing on us seeing Dr. Goldman because she understands why.;)

Sharlene, I totally agree about having confidence in a Dr. as long as it's not a misplaced done. One comes to my mind.

My sweet Ginger

01-14-2014, 07:45 PM

I meant 'misplaced one'. Sorry.

molly muffin

01-14-2014, 10:03 PM

Yes I know what you mean. It's just as bad to have confidence in a doctor that is doing things incorrectly and possibly putting lives at risk by doing so.

That is why it is so important to educate ones self, so you know the basics if they are on base or not.

I think you might be okay with your Dr. Goldman though :)

I hope Ginger continues to do well on the regime that she is on currently.

hugs,
Sharlene and Molly Muffin

doxiesrock912

01-14-2014, 10:23 PM

Good job Ginger! Keep up the good work girlie :)

Trish

01-17-2014, 06:08 PM

Hi Song

What a great BP! Awesome to read good news on Ginger's thread :D:D Love hearing how she is feeling so much better, I hope this month before her next checkup is full of happy days for you both xxxx

goldengirl88

01-17-2014, 06:12 PM

Song:
Good job to Ginger on her good bp. I know what you mean about this clan there is always something going on here, it really could be a reality show. I am so glad Ginger is doing better, it makes it easier to get some sleep, instead of constant worry. You are a great mom Song and you are doing a wonderful job!! Blessings
Patti

goldengirl88

01-22-2014, 11:14 AM

Song:
Just checking in this morning to see how things are going with Miss Ginger. Hope you are both doing well, and staying out of this freezing weather. Blessings to you both.
Patti

My sweet Ginger

01-26-2014, 10:14 AM

Hi friends,

Here are two assessments from both our IMSs and I'd be interested in your overall thoughts.

On 01/06/14 Dr. Goldman (the 2nd IMS) wrote after our first visit with her.

: History of hyperadrenocorticism - believed to be pituitary dependent based on US bilateral adrenomegaly- treated with Lysodren - recent cortisol levels considered within theraputic range but may be truly be more functionally addisonian since pre values were greater than 50 - her body could physiologically be addisonian as her appetite reduced post Lysodren Therapy and also appears to be positively responsive to prednisone therapy; historical tremors, focal seizure behavior prior to Lysodren therapy - cannot exclude separate disorder versus possible macroadenoma of the pituitary gland ; previous hex hypertension and then hypotension on Amlodipine - need to reassess today as Cushingoid patients and patients with heart disease can develop high blood pressure ; left sided systolic murmur - rule out mitral valve insufficiency versus other causes - would require CXR/echo for further evil.

On 01/14/14, Dr. Nelson wrote this after she talked to Dr. Goldman and mind you Addison's disease was never mentioned before this date.
Assessment and recommendations:
We discussed Ginger's improved signs on twice a day prednisone . While she does not have typical Addison's disease, she apparently has a need for low doses of steroids. We discussed the difference between typical and atypical Addison's disease. Speculated as to the cause of her need for a low dose of prednisone ; it is possible that the mitotane has destroyed the layer in the adrenal gland that makes cortisol and she is truly addisonian. It does not appear that she needs DOCP at this time as her electrolytes are normal. Recommended to consider watching her electrolytes closely. Relative adrenal insufficiency is a well known phenomenon in human ICU patients and is gaining more and more acceptance in veterinary circles. With this syndrome, non adrenal illness decreases the ability of the adrenal gland to adequately respond to stress and prednisone therapy is needed often for short durations. Animals in which we suspect this often have blunted ACTH Stim tests but are not addisonian (post - ACTH > 2 mg/dl).

My mind goes back to the beginning and playing "what ifs" game with me and it just makes me feel like crying for Ginger that she had to go through so much possibly unnecessarily. I have to get ready for work but will write some more later. Thank you all.

goldengirl88

01-26-2014, 12:17 PM

Song:
I think if you took a poll and asked how many played the what if game we would all be raising our hands. You have had an especially tough journey with sweet Ginger. Don't be hard on yourself as you were only doing what you thought was right at the time. We all learn new things on here every day. You are a good mom and Ginger is receiving excellent care. I hope she continues to do well and you enjoy her company for many years to come. Blessings
Patti

molly muffin

01-26-2014, 07:24 PM

Song, I am so glad that you found this new IMS, because I think things will be more accurate and hopefully easier on you and Ginger going forward.
The problem was always that her tests when she was on lysodren seems to say she shouldn't have any problems, but her symptoms all said that she was crashing (Addisons). Whether a crash only or going Addisons, wasn't ever really verified, but the need for prednisone and the continued need for prednison, could signify that she did go Addisons and that is why you will want to closely monitor to see what cortisol and electrolytes do going forward.

hugs,
Sharlene and Molly Muffin

Harley PoMMom

01-26-2014, 09:18 PM

What concerens me is that they are just speculating why Ginger needs supplemental doses of prednisone daily. An ACTH stimulation test, when done correctly, will show if a dog's adrenal glands are not producing enough cortisol. I see that ACTH tests have been done and Ginger's results are within the therapeutic ranges so I am wondering if the ACTH stimulation tests were performed correctly??

This Cushing's disease sure can be a roller coaster ride, ain't! :eek:

Hugs, Lori

molly muffin

01-26-2014, 09:26 PM

Lori,

I think the reason that Gingers ranges have all been within the correct range is because prednisone was being given with the lysodren from the beginning, so there was never a time that the ACTH was interpreting only what the adrenal glands were doing. It always had pred factored into it. :(

Sharlene and Molly Muffin

Harley PoMMom

01-26-2014, 09:30 PM

My sweet Ginger

01-26-2014, 10:36 PM

There are a few things I'd like to write about today for future parents who would be in a similar situation as ours so no one else will go through what we've gone through.

First, I wish I had come across this site before we started our first loading.:( ::mad: If I knew then what I know now I wouldn't have chosen Lysodren with Ginger's starting ACTH post number >50. I'd definitely have chosen the low and slow method, it was definitely way too much way too soon with Lyso.
Second is not to have a blind faith in your vet which I did unfortunately at first. Ask specific questions about their experience regarding your particular case to see if they've treated enough patients and not how long they've been in practice.
Third, find a vet who is willing to spend long enough time with you to listen to you and explain what it is and what their specific plans are to you upfront and then have you ask questions and not undermine what you are trying to say in a quiet room and not next to the receptionist's desk.
Forth,never, ever do Lysodren loading concurrently with prednisone. It will not only skew the ACTH stim test results but it will also skew the clinical signs so you will never be able to read your dogs signs accurately.
Fifth, if you get a blunted ACTH stim test numbers it could well mean your pup is functionally addisonian even if the numbers are >2.

Now the purpose my writing today is not to rehash what 'would've' or 'should've' in hind sight but to tell whomever what not to do so your precious pup won't unnecessarily have to suffer through in the hands of Gong ho style incompetent vets.

If my vet didn't instruct a concurrent prednisone therapy with Lysodren during our first loading I'd have seen Addison's signs much sooner and more clearer in Ginger therefore she wouldn't have to go through 2 more mini loadings which then destroyed her adrenals.
I kept telling her Ginger wasn't doing well and she kept telling me to keep giving her prednisone and still instructed me to go ahead with maintenance phase and that was when I decided not to listen to her anymore with all of your urging backing me up. Thank you so much from the bottom of my heart for that.
We are trying to get the right dose of prednisone for Ginger right now with Dr. Goldman (not seeing Dr. Nelson anymore). She is on 0.5mg pred in AM and 0.75mg in PM as she struggles more with her breakfast. I think I'm seeing a subtle change but not big enough.
She is scheduled to get some blood work done in 2 wks and BP recheck on this We'd. but I may want the blood work done Wed as I don't think she is doing well enough. It's been over 2 months since her last CBC and I'm curious where her electrolytes and other numbers are by now. Thank you.

doxiesrock912

01-26-2014, 10:48 PM

There's no reason why you can have Ginger tested for her electrolytes are right now since you're concerned.

Thank God for Dr. Goldman!

My sweet Ginger

01-26-2014, 10:54 PM

Ok, Lori and Sharlene, the reason Dr. Goldman wasn't in a hurry to do an ACTH is that after reading all my daily log of Ginger's demeanor and what meds were given during that time including prednisone and it was clear to her that Ginger was responding to prednisone like a clock work since Lysodren treatment started. There was no doubt in her mind what Ginger was going through and I couldn't agree more with her. We are going to do an ACTH and CBC soon to see where everything stands. Whether Ginger will switch to dex for a while to prepare for ACTH or not I don't know yet but it will get done soon.

molly muffin

01-26-2014, 11:16 PM

That makes perfect sense Song as to why she wouldn't want to do an ACTH test right now. Historically, the ACTH tests haven't shown what I think is a true evaluation of Ginger's situation due to the prednisone, exactly what Dr. Goldman was saying.

Thanks for posting that explanation Song. I Do hope it will help others, in fact I'm sure it will

hugs,
Sharlene and Molly Muffin

My sweet Ginger

01-26-2014, 11:34 PM

That's it Sharlene . She is saying that we don't need to do an ACTH now because we know it will be low going by her clinical signs but she does need prednisone every single day to survive. We will do an ACTH when we see the signs her cortisol might be rising tho we will do CBC to check everything else very soon.

goldengirl88

01-27-2014, 09:14 AM

Song:
I am so glad you got this IMS as things seem to be making more sense since she has come aboard. When you have confidence in your Dr. that means a lot when dealing with all this. Hoping Ginger continues to do well as it seems she is on the right track now. Blessings
Patti

My sweet Ginger

02-02-2014, 10:37 AM

I've been wondering about Ginger's behavior. I'm not sure about her focal seizures but her other cognitive problems might be coming from dementia. I thought they were from macro too but could be from dementia except for seizures. The circling, peeing in the house and I'm not talking about leakage here (she doesn't have UTI or GI), being stuck in corners, pacing or wandering around the house, spacing out, total decline in any activity, being alone. I will bring it up to her IMS this wk and may be we can bring some of her memories back with the help of medicine. More meds? Oh, boy.:(

molly muffin

02-02-2014, 02:15 PM

Hi Song, you might ask your vet about Novifit. One of our moderators (Leslie) has used it and another member is going to be speaking to their vet about using it for dementia.

hugs,
Sharlene and Molly Muffin

goldengirl88

02-03-2014, 09:24 AM

Song:
Just checking in on sweet Ginger today. I hope things are better for you both. Blessings
Patti

My sweet Ginger

02-04-2014, 01:28 PM

Hi,
Would anyone so kindly post the link where I can print how to divide the ACTH solution into multiple batches to lower the cost of doing the test, please? Been trying to locate it but couldn't even remember who's threads I saw them.:o I'd like to bring it to my IMS today as we are going to do Ginger's stim test soon. I'm sure the cost will be more expensive than the other two places we've been to.:( Thank you.:)

My sweet Ginger

02-04-2014, 01:35 PM

Oh, I've checked it in helpful resources for the owners and I didn't see it unless I missed it. Will check again.

My sweet Ginger

02-04-2014, 01:57 PM

Thank you everyone. I found it.:)

molly muffin

02-04-2014, 06:02 PM

Ugh, sorry none of us got back to you but glad you found it. Here is the basics of it:

There is more than one type of stimulating agent used for the acth stimulation test but the one used most often for it's proven accuracy is cortrosyn. Unfortunately, this little vial of liquid gold is what makes the acth stimulation test so costly. The manufacturers instructions call for using the entire vial, regardless of the size of the dog; however, it is now known that 5mcg/kg provides adequate stimulation to yield an accurate stimulated result. This means that if your dog weighs less than 55 lbs, your vet can do two acth stimulations test with one vial. The smaller the dog, the more tests you'll get out of one vial. For instance, a dog weighing 20 lbs is approximately 10 kg. That would mean there is enough cortrosyn in one vial to do five acth stimulation tests. If you don't know if your vet is aware of this valuable piece of information, you should definitely discuss it with him/her as it can save you a lot of money. I have included an excerpt below, which you can print out and give to your vet in case s/he has any questions about how to properly store the agent. This information can be found at www.wendyblount.net/etvma1/hac-3-13-07.ppt Be sure to check out the great powerpoint presentation for a lot of information about cushing's.

ACTH Stimulation Test Protocols for Dogs

Low Dose Cortrosyn ACTH Stimulation Test - Canine - to keep cost down and to stretch out your supply of Cortosyn, use a specific dose instead of 1 vial/dog.

Take pre ACTH blood sample, ideally after a 12 hour fast. Administer 5 mcg/kg Cortrosyn IV. Take post stimulation sample 1 hour after Cortrosyn.

Validation: A few papers have now shown that 5 mcg/kg IV is sufficient with a maximum of 250 mcg/dog (i.e., the whole vial).
Split any left over reconstituted Cortosyn into aliquots using plastic syringes. For a vial of 250 micrograms Cortosyn, split it into 5 aliquots of 50 micrograms each or 10 aliquots of 25 micrograms each, or any combination thereof. For about a 10 kg dog or so (probably average size of dog that we do many ACTH stims on), one of the 50 microgram syringes would work. For a 5 kg dog, a syringe of 25 micrograms would work. You can store the aliquots in a frost-free freezer for up to 6 months with no loss of activity as long as it is not thawed and re-frozen. Since no one knows the effect of thawing and refreezing, we don't advise using ACTH that has been thawed and refrozen.

Hugs,
Sharlene and Molly Muffin

goldengirl88

02-04-2014, 07:28 PM

Song:
I read an interesting article by Jean Dodds today stating that any dog having seizures should first have a thyroid panel done. I did not know if you discussed this with your Dr. I was curious about Tipper's as she has those episodes at note and thyroid problems can cause seizures. Hope Ginger is doing well. Blessings
Patti

My sweet Ginger

02-04-2014, 07:32 PM

Thank you Sharlene for your post. It still helps as what I found was the instruction only. ;)
I hope miss Molly is doing better today.:)

labblab

02-04-2014, 07:54 PM

Song, I'm so glad Sharlene was able to help you. Just so you'll have it, though, i'm thinking this may be the specific link you were looking for earlier (Dr. Mark Peterson's article, "How to Dilute and Store Cortrosyn for ACTH Stimulation Testing"):

http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html

Marianne

My sweet Ginger

02-04-2014, 08:00 PM

Thank you Patti and no, we haven't discussed this and both her neurologist and IMS tend to think her seizures are caused by the tumor. The seizure meds she is taking seem to be effective for now though not completely. Ginger did a complete blood panel today and I will get the results in a couple do days. She is still very hyporexic and gets very lethargic off and on so I'm very curious as to where things are in that little body of hers.

molly muffin

02-04-2014, 08:12 PM

That is the link I was looking for Marianne and didn't find. Thanks for posting it!!!

Molly is not having a great day. We'll hope for better tomorrow :)

hugs,
Sharlene and molly Muffin

addy

02-04-2014, 08:14 PM

Song I was just reading a link at work and hope I can find it again but it talks about when giving lysodren and prednisone, the combo often causes a blunt response on anACTh stim test.

I wasnt sure if that pertained to you and Ginger or not.

My sweet Ginger

02-04-2014, 08:17 PM

You are right Marianne, that's exactly what I got tho I didn't get a chance to talk to her about it today as she wants to wait for the results of the blood test first and then go from there. She really isn't in any hurry to do an ACTH test right now but she said we will do it in March and will let me know how we are going to do it regarding prednisone with the test and we are not adding any new things such as meds for dementia into the mix until we get the results. She doesn't want to do many tests or throw a lot of stuff in Ginger's tiny body unless they are necessary and I appreciate that.

My sweet Ginger

02-04-2014, 08:34 PM

Addy, I believe it did in Ginger's case. I do believe Ginger's true numbers for her last ACTH were lower than the 2.9 we got. Her numbers could well be in negative ranges if it wasn't for the prednisone circulating in her body. I hope we can find out what kind of damage was done to her body by Lysodren soon enough so we can appropriately treat her.:o
Addy and Sharlene, I hope Molly and Zoe both will have a better day tomorrow. Hugs.

My sweet Ginger

02-24-2014, 05:35 PM

Hi, everyone,
I can use an explanation from experts here because I don't quite know what to make of Ginger's latest ACTH results. Her last Lysodren dose was on 11/17/13 and this ACTH test was taken 02/20/14 and they are pre 3.8 & post 18.1 which are great I think. The reference ranges are pre: 2-6, post: 6-18, equivocal: 18-22, HAC: >22.
Still I'm scratching my head here because I haven't seen any change in her demeanor which would indicate her cortisol flow is normal. Her appetite is still quite off and she's very weak and has tremors and shakes her head noticeably even with anti seizure meds so she's been on pred for possible macro tumor and also to stimulate her poor appetite.
I knew the results may not be really accurate because of her concurrent use of pred and the main reason her IMS wanted to do the test was to see if her adrenals are stimulating at all or not. So I'm definitely glad that they are stimulating but could it be that the pre #of 3.8 coming from pred she'd been taking?
I'm curious to see what her IMS will say when I talk to her probably tomorrow. I'm just interested to see what the experts on here might say. I haven't seen hardly any change in her for the last 3 months so this stimulation of her adrenals is throwing me off. Her UPCR is 1.9

Harley PoMMom

02-24-2014, 05:57 PM

Is she peeing/drinking normally?

Her ACTH stim test does show that her adrenals are producing cortisol, which is absolutely a good thing!

Usually prednisone will perk up an appetite, but all dogs are different. Mirtazapine is supposed to stimulate a dog's appetite.

Hugs, Lori

My sweet Ginger

02-24-2014, 07:01 PM

Her peeing and drinking decreased during first loading but sometime after they increased again noticeably tho not quite to the level of pre loading and pretty much staying at the same level due to her pred to this date and her neurologist wants her to stay on it for her brain tumor. She's been taking Pepcid for a little over a wk now but it's not making any difference in her appetite. We wanted to see if she was having an upset stomach and it looks like she isn't.
But Lori, why isn't she feeling any better and still have the need for pred with what look like good numbers? Before her first loading she might have been sleeping a lot and still sleeps a lot but her appetite was perfect.

Harley PoMMom

02-24-2014, 07:51 PM

I used to give Harley Pepcid AC but eventually that started to make him nauseated, I switched to slippery elm bark (SEB) and it helped. Since the Pepcid seems to not help Ginger, I recommend trying SEB. I'm providing an excerpt and a link to info about SEB:
Herbalists attribute many wonderful healing properties to Slippery Elm: demulcent (soothing, mucilage-forming), emollient (soothing and protective for skin), nutritive (providing specific food nutrients), tonic (promoting healthy function of one or more body systems), and astringent (constricting, binding or drying effect). It can be used both internally and externally. Slippery Elm is one of the herbs used in the original formulation of “Essiac,” an herbal brew widely promoted as a cancer-fighter
Slippery Elm (http://www.littlebigcat.com/health/slippery-elm/)

Was it mentioned that the prednisone needs to be given with food? If given on an empty tummy, the prednisone will cause nausea.

Hugs, Lori

molly muffin

02-24-2014, 08:45 PM

Did the vet think the tumor on her spleen might be making her feel off?

I'm just throwing ideas out here. But a tumor on any organ I'd think might be enough to make them not feel good, depending on how it's affecting them.

hugs,
sharlene and molly muffin

My sweet Ginger

02-24-2014, 08:56 PM

Her IMS wanted me to try Pepcid in case her inappetence is from nausea or upset stomach. The fact that her appetite is still poor, that to me it's not her stomach causing it. I will mention SEB to her IMS.
I don't remember anybody telling me about pred with food but I always make sure she takes any kind of pills with food and that's the reason she eats 4times everyday.:eek: Still she lost 1lb when we weighed her last Thursday because she hasn't been eating as good recently.
Giving pills to her becoming more difficult and I'm pretty much running out of tricks to wrap her pills with food now that she is extremely picky. Other than that she seems comfortable and her breathing doesn't get faster these days like they sometimes were.
Thank you Lori.

My sweet Ginger

02-24-2014, 09:05 PM

No, Sharlene. No one has mentioned that. The tumor on her spleen didn't grow on the 2nd US and she will be due for another one soon to check on it. To me the only thing carrying her appetite these last few months is prednisone. Without it I'm not sure how much she would be able to eat.

Dawn Anderson

02-24-2014, 09:08 PM

Hiding the pill, lord know I tried everything, then after a while she would catch on. This has worked like a charm for a while. Ice Cream, I make a little ball & jam the pill in it and since its cold & sweet and slippery she swallows it down. Now Sweet Ginger is much much smaller then Buttercup and I do not know just how big her pills are it may not work, but give it a shot anyways, just remember to make sure the ice cream is real hard when you start handling it, by the time your done stuffing the pill in it, it will be soft & slippery and hopfully she likes ice cream as much as Butters, and she will be more then happy to take that little sweet treat off you hands.. Good luck, let us know if it works for ya

Dawn & Buttercup

molly muffin

02-24-2014, 09:18 PM

hmm, then it is not likely that it is the tumor if that is stable. Seems to all go back to that lysodren doesn't it. :(

Anything she likes a lot, stick in the pill in. Molly loves her wet dog food, so I use that now, she spit it out of wrapped in ham and bacon. Cream cheese maybe? I will say though that for us, the key is how much food is on the pill, if it is too much, she eats the food and spits out the pill. It has to just barely coat the pill, not too little or too much and have that next bite ready and almost at her mouth, so she has no time to think about anything else. They are pretty smart over all.

hugs,
Sharlene and molly muffin

My sweet Ginger

02-24-2014, 10:01 PM

My guess would be either the Lysodren or macro or who knows what.
Dawn, no one hardly eats ice cream in my house ( I like Pinkberry yogurt and I get it at work almost every time when I work:o. I work at the mall.) so I haven't tried it but tomorrow I will try it. Hope it works.
Sharlene, I read about your trick (have one in waiting) and since she isn't crazy about anything now she takes her time eating or chewing and then spitting them out or many times she just turns her nose away from them.:mad: Peanut butter out, cream cheese out, salami out, ham out:o I'm getting afraid of her meal times now anticipating upcoming ordeal.:o She takes anti seizure meds three times a day and they are 2-3 times bigger than pred pills. Try to make it as small as possible but not easy. But I also have liquid form of it in case pills don't work and I might have to switch it to this eventually. It's easier for me but for her I'm sure it tastes so yucky.:o

My sweet Ginger

02-24-2014, 10:03 PM

Oh, about wet dog food, she didn't even want to go near it. Not even a single lick. Totally hated it.

molly muffin

02-24-2014, 10:06 PM

Gravy?
Ginger is a toughie when it comes to pill obviously.

Sharlene and molly muffin

My sweet Ginger

02-24-2014, 10:10 PM

It makes me feel very sad because she never, never had an eating problem before all this.:(

molly muffin

02-24-2014, 10:24 PM

Poor baby and of course we worry like crazy when anything is off when them and not eating is one of the things that we would all be worrying about. It just isn't something we are use to seeing.
I wish we/the vets, anyone could figure out what is causing it. Does she get loose stools? Any throwing up? I was wondering about IBD? What does she eat for food usually? I'm wondering if maybe a change would help at all, a different protein maybe? Like fish, lamb, duck, anything?
What about those little can foods, like ceasar bistro, the ones that are cut up meat and veg, pasta in a gravy?
Hmmm, you know sometimes it is their sniffer that is off, not their tummy's or taste buds.
wow, I am throwing ideas left and right, so not sure if any of them are even relevant or would work but if even one does, that would be great.

hugs,
Sharlene and molly muffin

doxiesrock912

02-24-2014, 10:29 PM

Peanut butter with the pill inside maybe?
Daisy scarfs it all down.

I'm sorry that Ginger is a bit off. I hope that subsides.

My sweet Ginger

02-24-2014, 11:35 PM

:);) I just gave Ginger her night dose using very tasty mashed potato roughly mixed with diced chicken and coated the salami wrapped pill with the potato and she ate the whole thing. We will see how long this method will work. Maybe a day or two.

doxiesrock912

02-25-2014, 03:19 AM

What a process! I'm glad that she finally took it though.

Dawn Anderson

02-25-2014, 09:47 AM

Good job mom! AND WAY TO GO GINGER. Yeah. Keeping fingers crossed that this will work for quite a while:D

Dawn and Butters

goldengirl88

02-25-2014, 11:32 AM

Song:
You are doing a great job with sweet Ginger. Keep on moving forward as that is all wenCush moms can do. Blessings

My sweet Ginger

02-27-2014, 09:34 PM

Just an update on a Ginger.
So the ACTH stim test showed her adrenal glands are regenerating cortisol again. Yay! It was really a surprise to us especially when she was not showing hardly any clinical signs of improvements that I could see. We are still wondering where her inappetence is coming from. Nausea? Brain tumor? Or something else? Probably not a nausea because we tried Pepcid for over a wk and there was no improvement in her appetite.
Her IMS is tapering her off of prednisone now that she can produce her own cortisol but maybe not completely due to her possible inflammation in her brain. Both my husband and I think we see a little more spring in her walk last few days but all other symptoms are about the same ; hyporexia, tremor, walking in circle, staring into space, getting stuck in places, getting into tight spaces, overall weakness, sleeping a lot, no interaction with the other dogs.
Starting today she is getting 1/2 tab seizure med (same) & 0.5mg pred in the AM (same) and 1/4 tab Amlodipine 2.5mg (same) & 0.25mg pred (reduced from 0.75mg) in the PM and we are going to watch her and evaluate one week after.
While her latest blood test (2/5/14) still showed a few highs I still think they are tad better than the previous one that was done on 11/25/13.
ALT 129 (12-118), ALK 1562 (5-131), GGTP 167 (1-12), BUN/Creatinine ratio 50 (4-27), cholesterol 515 (92-324), triglycerides 465 (29-291), Platelet Count 638 (170-400). These are the highs and the low is Chloride 99 (102-120).
Her electrolytes are all good.
Her USG improved from 1.015 to 1.018 and no crystals in her urine this time.:)
Her UPCR is 1.9 (UP : 120.4 / UC : 64.0) which I have no clue how good or bad this is. I will welcome any input on this. Thank you.