Zanya - 13.5yo Shiba Inu, newly diagnosed

[ShibaMom]

Hello everyone!

I've read a few threads (and have cried!), and am so relieved to have found such an incredible community of support! (warning: this ended up being REALLY long!)

My Shiba Inu, Zanya, was diagnosed with Cushing's last week. It's been a long journey, and I wish I proceeded with the ACTH Stim test earlier.

Anyhow, she's 13 1/2, 18.3 pounds, and in overall pretty good health. She's always had some skin allergies that wax and wane, but then about a year or so ago, suddenly she began chewing far worse, and in more areas. We tried a shot of cortisone (ugh), though it didn't seem to make a difference. Fortunately, our vet is conservative about giving cortisone, so wouldn't give more when it didn't seem to do much. Zanya's been on hydroxyzine (antihistamine) for quite some time. I don't think it's done a lot, but I've figured it may be helping some, so I didn't want to deprive her of that.
We've used DermaCool spray on areas when she gets hotspots or her chewing gets particularly bad, as well as Neopredef powder.
At times we'll use the e-collar, when her chewing gets real bad, to keep her from completely destroying her skin and paws.

Zanya was dx hypothyroid a couple years ago (she's on L-Thyroxine, 0.1mg bid), and also has had a low urine specific gravity for some time. Her kidney values have always been fine, though. That's what first caused the vet to suggest that we may want to run an ACTH stim test after seeing how some others things went.
Zanya had also begun drinking a lot more water, although wasn't asking to go out more frequently, until recently.
As a precaution, due to the low specific gravity, Zanya has been on the Royal Canin LP (low protein) Modified dry food for a while. I'll gather dates for various things from her records and come back and give a list.

One odd thing I noticed over the past year or so, is that Zanya has actually grown MORE hair on her belly, which was pretty sparse previously. Go figure on that one. I'd also noted darkened patches of skin on her belly, which I had asked the vet about as I was afraid of skin cancer. She told me that's not common in dogs, and I shouldn't be worrying about skin cancer.

Zanya had also developed the habit of pawing at our legs often. She wouldn't necessarily want to go out, but would just want SOMETHING. Usually we can't quite figure out what. If you're sitting on the couch, or floor, she'll climb on top of you. She'll paw and paw (her nails are kept reasonably trimmed, though there not quite as short as I'd like them to be). It's brutal on bare calves!!! Very frustrating, since we don't know what she wants or needs - we try just about everything. Clearly, she's uncomfortable at these times.

A few months ago, Zanya started waking us up at night sometimes, to go out. She'd paw at the door and do her shiba bark and scream until let out. Sometimes twice in a night. She had a few UTI's last year (first early in the year, where we could se blood (poor baby!!!), and then several late summer/fall and finally there were no bacteria in her urine, but she still appears to be bothered. That's eased up, fortunately, as has the waking during the night.
However, she definitely acts stressed out. She pants a lot (thought she was in pain, but does it even with Tramadol), perhaps left over from breaking her tail (real fluke!) last Spring, or something else (skin, UTI, etc).

My daughter got a puppy last March, who developed major separation anxiety after being spayed in December. It's been pretty rough, and when she gets anxious, I noticed that Zanya was getting WAY anxious... chewing even more at her paws (which she does ALL the time), as well as pawing/clawing to get OUT.

My other daughter sent me a picture at work 2 weeks ago, showing how Zanya had been freaking out, clawing at the door, and there was blood on the doorframe and wall. Yikes! She hurt the skin around the based of one dew claw from the pawing/clawing. This was what really made us say ok, she's really stressed, over the top, it's time to test.

She'd been seeing one of the other vets for most of these things in the past 6 months, and although I brought up Cushing's as a possibility, he felt it could more likely be an auto-immune disease, and suggested we run an ANA test to rule out Lupus or other things, also since it was a cheaper test to run first.

Also, Zanya had a dental done back in October or so, with her top left 4th premolar cracked. It wasn't clear on visual examination (and it's NOT easy to look at her teeth!) before the dental, but from the smell of her breath, it was clear there was a likely infection. Again for that, we thought the panting and pawing was due to pain. It very may well have been partially, but clearly not only. They extracted it, and it was healing ok at first, but then infection came back. she's on antibiotics again, for the second time post-surgery.

Ah yes, also, I had noticed she seemed stockier, even though she hadn't gained weight. I don't know if it falls under the "pot-bellied" description, though seems to maybe more in the past few weeks? It's hard to tell.

Wow, this was really long-winded. If you're still with me, THANK YOU!

Some of Zanya's values:
Urine specific gravity - 1.013

IDEXX ACTH Stim test:
pre-cosytrin: 5.6 mcg/dl Ref: Normal 2-6 mcg/dl
post-cosytrin: 22.9 mcg/dl Ref: Equivocal 18-22 mcg/dl, definite > 22. (I don't recall the exact for negative, but obviously less than 18.)

I'm probably missing something, but I can always add.

Oh, vet's plan is to start with 1mg/kg of trilostane once per day, and re-check at a week. He said we'll do the UCCR test (to collect first morning's urine), and we'll repeat the IDEXX ACTH stim test 2-3 hours after she takes her trilostane. It looks like this follows the UC Davis protocol, as quoted from a link that I found under the Helpful Resources section.
I asked what compounding pharmacy they use, and office staff called back and said it's from a hospital. I'll find out more.

PS - Zanya also has a Thundershirt, which at times does seem to help with her anxiety. At times. Not always!

I'm SO looking forward to my baby being relieved of this stress from the high cortisol levels, and from needing to drink and pee so much, etc, since it's obviously a bother for her. It's heartbreaking, having her suffer with all of these different symptoms. The relief, knowing we may be able to change that, is palpable!

Thanks all!!!
Samantha

[addy]

Hi and Welcome,
I'm so sorry I have not had a chance to read thoroughly your post. Others will be along soon and I promise to be back as well.

I did not want you to feel lonely or left out. I'm a bit late for work, again sorry this is so short but everyone will be along soon.

Glad you found your way here.

[Harley PoMMom]

Hi Samantha,

Welcome to you and Zanya, oh what a pretty name for such a beautiful girl!

I have only a moment to post, but do have a few questions, have the vets ever done a skin scraping or biopsy on Zanya?

Also, since Zanya already had the ACTH stim test the UC:CR would be pretty useless right now, instead I would have a Low Dose Dexamethasone Suppression (LDDS) test performed, it is the gold standard test used to diagnose canine Cushing's and it has the capability to differentiate between the pituitary or adrenal type of Cushing's.

I will be back later to share more of my thoughts ;)

Hugs, Lori

[ShibaMom]

Thanks ladies!

No worries about only having a moment for a quick hi, I wrote a novel :/

I adopted Zanya when she was 3. She was a showdog, who was surrendered back to the breeder, from whom I got her. Her name came with her, but I do love it. People often think I'm saying Lasagna, lol. It's short for Zakazanya (last part of her full name).

I also adopted her 1/2 brother, Chip (Chip-n-Dale Dancer), a year later. He's 14, and a Black and Tan Shiba. He has his own issues going on, a variety of neurological and vision stuff, we'll see how he does.

Back to Zanya... I believe the vet is planning for the UCCR based on the UC Davis guidelines, which state,
"The goal of therapy is an owner who is completely pleased with the response. As aids in achieving this goal, both urine and blood tests are indicated. The urine should be checked, at a minimum, for specific gravity, glucose and urine cortisol-to-creatinine ratio (UCCR). An ACTH stimulation test should be started at the time the dog is seen, again about two to three hours after trilostane administration."

The reasoning given is, "If the serum-cortisol concentration is within that goal and the UCCR is abnormal, the medication should be given BID. If the serum-cortisol concentration is too high, the trilostane dose should be increased. But if the serum-cortisol concentration is too low, the dose should be decreased."

Would there be value in doing the LDDS after the first week of trilostane administration, or should it be done beforehand?
While she's not FAR over the 22 mcg/dl, is there a compelling reason to question if she has Cushing's?

With regards to skin scraping, I think we did that a few years ago.

Ironically, last night while nearing the end of my post, Zanya starting barking out of the blue (while lying on the couch), her insistent bark. I let her out and she peed, and then about 10 minutes after posting, she started up again. Of course - any time you say they haven't done something for a bit, they do it. Gotta love Murphy!!!

Thanks!
Samantha

[Harley PoMMom]

Hi Samantha, I'm back!!, I inserted my replies in blue test below.


Hello everyone!

I've read a few threads (and have cried!), and am so relieved to have found such an incredible community of support! (warning: this ended up being REALLY long!)

You did a good job with all those details, our feedback can be more meaningful when we know a lot about a dog's history.



I'd also noted darkened patches of skin on her belly, which I had asked the vet about as I was afraid of skin cancer. She told me that's not common in dogs, and I shouldn't be worrying about skin cancer.

Shiba Inu is part of the nordic breeds, these nordic breeds are prone to a condition known as Black Skin Disease (Alopecia X). Here's a link with info on this: http://www.marvistavet.com/html/body_alopecia_x.html


A few months ago, Zanya started waking us up at night sometimes, to go out. She'd paw at the door and do her shiba bark and scream until let out. Sometimes twice in a night. She had a few UTI's last year (first early in the year, where we could se blood (poor baby!!!), and then several late summer/fall and finally there were no bacteria in her urine, but she still appears to be bothered. That's eased up, fortunately, as has the waking during the night.
However, she definitely acts stressed out. She pants a lot (thought she was in pain, but does it even with Tramadol), perhaps left over from breaking her tail (real fluke!) last Spring, or something else (skin, UTI, etc).

When dogs have diluted urine a regular urinalysis may not be sensitive enough to pick up any bacteria, an urine culture and sensitivity test is done so the exact bacteris is known and the appropriate antibiotic can be given


IDEXX ACTH Stim test:
pre-cosytrin: 5.6 mcg/dl Ref: Normal 2-6 mcg/dl
post-cosytrin: 22.9 mcg/dl Ref: Equivocal 18-22 mcg/dl, definite > 22. (I don't recall the exact for negative, but obviously less than 18.)

Was Zanya being treated for the infection when this test was performed?



Oh, vet's plan is to start with 1mg/kg of trilostane once per day, and re-check at a week. He said we'll do the UCCR test (to collect first morning's urine), and we'll repeat the IDEXX ACTH stim test 2-3 hours after she takes her trilostane. It looks like this follows the UC Davis protocol, as quoted from a link that I found under the Helpful Resources section.

The UC:CR test is used to initially diagnose Cushing's, it can rule Cushing's out but not diagnose it. Since you have already had an ACTH stimulation test done I would not bother having the UC:CR, I would instead invest that money into having an ultrasound done.

Those ultrasounds are expensive, however, any abnormalities with the internal organs may be seen. With my boy, Harley, his first ultrasound showed that he had prior bouts of pancreatitis. Harley never displayed symptoms of pancreatitis and a spec cPL test later confirmed the ultrasound findings. Our motto here is you get a lot of bang for your buck with an ultrasound. However not ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it.

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I asked what compounding pharmacy they use, and office staff called back and said it's from a hospital. I'll find out more.

Many of our members do have their dog's medications compounded, Diamondback is one I've seen used: http://www.diamondbackdrugs.com/



I'm SO looking forward to my baby being relieved of this stress from the high cortisol levels, and from needing to drink and pee so much, etc, since it's obviously a bother for her. It's heartbreaking, having her suffer with all of these different symptoms. The relief, knowing we may be able to change that, is palpable!


The medications used for Cushing's do not cure the disease they are given to help abate the symptoms, however, in some cush dogs even with treatment the PU/PD may not resolve, which is called renal medullary washout. This means that all the stuff (solute) the kidneys need to concentrate their urine has been washed out for a very long time so the kidneys will take some time to recover.

Please do not hesitate to ask all the questions you want and remember we are here for you and Zanya. ;)

Hugs, Lori

[Harley PoMMom]

Back to Zanya... I believe the vet is planning for the UCCR based on the UC Davis guidelines, which state,
"The goal of therapy is an owner who is completely pleased with the response. As aids in achieving this goal, both urine and blood tests are indicated. The urine should be checked, at a minimum, for specific gravity, glucose and urine cortisol-to-creatinine ratio (UCCR). An ACTH stimulation test should be started at the time the dog is seen, again about two to three hours after trilostane administration."

The reasoning given is, "If the serum-cortisol concentration is within that goal and the UCCR is abnormal, the medication should be given BID. If the serum-cortisol concentration is too high, the trilostane dose should be increased. But if the serum-cortisol concentration is too low, the dose should be decreased."

This excerpt is from Dr Peterson's blog, Dr Peterson is a renown canine Cushing's expert and also a contributor to Dechra's continuing education site:


Monitoring & the goals of therapy
We must use a combination of the dog's clinical response and the results of ACTH stimulation testing to monitor dogs on trilostane treatment. In this paper (13), Feldman had three goals of therapy, which included the following:

a post-ACTH serum cortisol concentration ≤ 5.5 μg/dl (3-4 hours after the morning dose)
a urine specific gravity > 1.020
owner satisfaction in dog’s improvement.

Of these 3 goals, I agree completely with the last one — the owner's evaluation of the clinical response is key. As far as the urine specific gravity goes, I would agree that most dogs will be able to concentrate their urine to greater than 1.020 once the polyuria resolves. However, if the urine specific gravity is less than 1.020, I would certainly not raise the dose if the owner reported a good clinical response and serum cortisol concentrations were lowered to within the desired range. http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html


Would there be value in doing the LDDS after the first week of trilostane administration, or should it be done beforehand?
While she's not FAR over the 22 mcg/dl, is there a compelling reason to question if she has Cushing's?

The LDDS test needs to be done before any treatment is started.

Hugs, Lori

[addy]

I came back as promised and I am pleased to see Lori has already done a very thorough job answering your questions and giving her thoughts.

You have been in good, capable hands.

So I will just say hi and I wanted you to know I did not forget about you:)

[ShibaMom]

Hi Lori,

Thanks for your responses!
It seems that the system quoted them in reverse post order, but I'm sure it will be fine....


This excerpt is from Dr Peterson's blog, Dr Peterson is a renown canine Cushing's expert and also a contributor to Dechra's continuing education site:

http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html

The LDDS test needs to be done before any treatment is started.

Hugs, Lori

Thank you, I did see about Dr Peterson and his and Dechra's information, and that it differs from UC Davis.
I saw information in some threads where it was mentioned that it's best to go with the therapy that the vet is most familiar and comfortable with. Is it common to ask for a different protocol? I know this is different than the trilostane vs. mitotane difference, but ... just wondering?

I kind of like the lower starting dose of the UC Davis method...
The vet is also doing a full urinalysis at the recheck, so do you think it matters so much?

I guess one of my questions still, is if there's some reason you'd doubt that she has Cushing's? Just seeking more clarification and answers, thanks! :)


Hi Samantha, I'm back!!, I inserted my replies in blue test below.

Thanks :) I'm very appreciative!



Shiba Inu is part of the nordic breeds, these nordic breeds are prone to a condition known as Black Skin Disease (Alopecia X). Here's a link with info on this: http://www.marvistavet.com/html/body_alopecia_x.html


Zanya doesn't have hair loss like that, in fact, she's gotten more hair on her belly than she used to have! I'll have to search for some more pictures of this to be able to better evaluate.



When dogs have diluted urine a regular urinalysis may not be sensitive enough to pick up any bacteria, an urine culture and sensitivity test is done so the exact bacteris is known and the appropriate antibiotic can be given

A culture was sent out. Zero bacterial growth.



Was Zanya being treated for the infection when this test was performed?

Not for the possible UTI, but for the oral infection, yes. She was on Clindamycin (150mg BID) for one week prior, although had not been on Rimadyl or another NSAID.
I didn't think antibiotics could affect the results of the ACTH stim test ... can they?



The UC:CR test is used to initially diagnose Cushing's, it can rule Cushing's out but not diagnose it. Since you have already had an ACTH stimulation test done I would not bother having the UC:CR, I would instead invest that money into having an ultrasound done.

Those ultrasounds are expensive, however, any abnormalities with the internal organs may be seen. With my boy, Harley, his first ultrasound showed that he had prior bouts of pancreatitis. Harley never displayed symptoms of pancreatitis and a spec cPL test later confirmed the ultrasound findings. Our motto here is you get a lot of bang for your buck with an ultrasound. However not ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it.

So the UCCR is planned since that protocol includes it. I could ask about postponing the UC:CR until a future testing date. The vet did suggest we do an ultrasound, although knows I'm seriously strapped financially due to the significant amount of care that all 3 of our dogs have required this year. I'll summarize that separately.
She did have an x-ray recently, to check for any stones, can any other information that could be pertinent to Cushing's be derived from that?



Many of our members do have their dog's medications compounded, Diamondback is one I've seen used: http://www.diamondbackdrugs.com/

I had offered the comment about asking that since someone had mentioned to find out in another thread ;-)



The medications used for Cushing's do not cure the disease they are given to help abate the symptoms, however, in some cush dogs even with treatment the PU/PD may not resolve, which is called renal medullary washout. This means that all the stuff (solute) the kidneys need to concentrate their urine has been washed out for a very long time so the kidneys will take some time to recover.

Right, I understand that it doesn't cure Cushing's, but can (although not always, and not all) relieve some symptoms and improve quality of life. I appreciate you letting me know about renal medullary washout. Good to know!



Please do not hesitate to ask all the questions you want and remember we are here for you and Zanya. ;)

Hugs, Lori

I really appreciate it. I'm going to let the Peterson/Dechra protocol vs UC Davis bounce around my head some. Maybe I'll call in the morning and ask why they use one over the other. I'd venture to guess that it's because he likes that particular medical reference which lists the UC Davis one, but I could request we follow the other.

Very torn now about the LDDS and Ultrasound. Knowing the trilostane should be in tomorrow or Friday, and the LDDS has to be conducted prior to treatment commencing, there's certainly a time pressure on me!

Rawr!

I've added 2 more photos into our album.

Thanks much!
Hugs back,
Samantha
and
Zanya - Shiba Inu 13.5yo
Chip - Shiba Inu 14yo
Kappa - Shepherd mix 11mo (my grandpuppy - daughter got her a couple of days before moving out, then moved back. Oy!)
Tux and Gingus - Black w/ white DSH cats, about 7yo
Weasley - White and orange cat, almost 3yo

Needless to say, it's a busy house (zoo)!

[Harley PoMMom]

Thank you, I did see about Dr Peterson and his and Dechra's information, and that it differs from UC Davis.
I saw information in some threads where it was mentioned that it's best to go with the therapy that the vet is most familiar and comfortable with. Is it common to ask for a different protocol? I know this is different than the trilostane vs. mitotane difference, but ... just wondering?

I believe that Dechra's starting dose of 1mg per pound and UC Davis initial dose of 1mg per kg are both good protocols to follow, start low and go slow is our motto here! The important thing is that YOU are comfortable with Zanya's treatment.


I kind of like the lower starting dose of the UC Davis method...
The vet is also doing a full urinalysis at the recheck, so do you think it matters so much?

I really don't think an urinalysis is needed at the recheck, Dechra recommends that the electrolytes be checked along with the ACTH stim test. Another thing, Dechra (manufacturer of brandname Vetoryl) recommends that the first monitoring ACTH test be performed 10-14 days after treatment has begun. Dechra also recommends leaving the dose unchanged for the remainder of thirty days of treatment. This is because cortisol levels tend to continue to drift downward during those first weeks, and therefore dosage increases are not recommended until the true effect of the initial dose is known.



I guess one of my questions still, is if there's some reason you'd doubt that she has Cushing's? Just seeking more clarification and answers, thanks! :)

Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed.


A culture was sent out. Zero bacterial growth.

Happy to hear that, Great job!!


Not for the possible UTI, but for the oral infection, yes. She was on Clindamycin (150mg BID) for one week prior, although had not been on Rimadyl or another NSAID.
I didn't think antibiotics could affect the results of the ACTH stim test ... can they?

Antibiotics no, but stress and any kind of illness can have an effect on all test results for Cushing's


So the UCCR is planned since that protocol includes it. I could ask about postponing the UC:CR until a future testing date. The vet did suggest we do an ultrasound, although knows I'm seriously strapped financially due to the significant amount of care that all 3 of our dogs have required this year. I'll summarize that separately.
She did have an x-ray recently, to check for any stones, can any other information that could be pertinent to Cushing's be derived from that?

Like I mentioned before, I think having an UC:CR done now or at the recheck is not needed.

This excerpt is from Dr Audrey Cook, who is a distinguished veterinary endocrinologist, a faculty member at Texas A & M, and also a consultant to Dechra.


An early study found that the urine cortisol:creatinine ratio (UCCR) before administering trilostane could be an indication of duration of action, but 2 later studies yielded conflicting results...

Further research is needed to determine whether UCCR will prove useful as a monitoring tool.
http://www.dechra-us.com/Files/dechraUSA/downloads/Case%20Studies/Clinicians%20Brief-trilostane.pdf

An xray really isn't useful as a diagnostic tool for cushing's. An abdominal ultrasound is valuable.


Very torn now about the LDDS and Ultrasound. Knowing the trilostane should be in tomorrow or Friday, and the LDDS has to be conducted prior to treatment commencing, there's certainly a time pressure on me!

If this were me, I would probably have an ultrasound done.

Hugs, Lori

[ShibaMom]

Hi Lori!

Thanks for your reply, I read it this morning, but haven't had time to respond. This is just a quick post to say I uploaded a few skin pics to another album... The one without caption is between two over her front digits where she keeps chewing tons. The lighting definitely somewhat reduces the red of it, but to give an idea. Also a spot she's currently chewing (put cone on last night!) and then an example of a darkened skin area. No hair loss there though. Like I said, she acquired fur on her belly! (Where she never had any before, or minimal, her whole life).

More later :) Thanks again! Samantha

[ShibaMom]

I believe that Dechra's starting dose of 1mg per pound and UC Davis initial dose of 1mg per kg are both good protocols to follow, start low and go slow is our motto here! The important thing is that YOU are comfortable with Zanya's treatment.

Yes, that's definitely what I've picked up, if nothing else - low and slow!!! :-)


I really don't think an urinalysis is needed at the recheck, Dechra recommends that the electrolytes be checked along with the ACTH stim test. Another thing, Dechra (manufacturer of brandname Vetoryl) recommends that the first monitoring ACTH test be performed 10-14 days after treatment has begun. Dechra also recommends leaving the dose unchanged for the remainder of thirty days of treatment. This is because cortisol levels tend to continue to drift downward during those first weeks, and therefore dosage increases are not recommended until the true effect of the initial dose is known.

I spoke with the owner and head vet of our clinic tonight, and she agreed about the UC:Cr test not being necessary, and agreed to use the money all toward an ultrasound, instead of just doing LDDS.

When I was comparing some of the differences between the Dechra and UC Davis protocols, and brought up the testing, she said she much prefers the first test to be at 7 days, to be sure the values aren't dropping too quickly. Agree with not changing dose at that time.



Cushing's is one of the most difficult canine diseases to diagnose, which makes it one of the most misdiagnosed.

I'd expect a high rate of false-negative misdiagnoses, but is there also a high rate of false-positive diagnoses?



Antibiotics no, but stress and any kind of illness can have an effect on all test results for Cushing's

Ah, right - so actually, since she was on it for 7 days at that point, and her mouth was starting to feel better, I'd think it would be a more accurate result than it would have a week prior.



This excerpt is from Dr Audrey Cook, who is a distinguished veterinary endocrinologist, a faculty member at Texas A & M, and also a consultant to Dechra.

http://www.dechra-us.com/Files/dechraUSA/downloads/Case%20Studies/Clinicians%20Brief-trilostane.pdf


Thanks! I'll take a look. This weekend, when I have some more time, I'll also look for more papers by these professionals, as well as other studies. I'm always interested in seeing source information (which, of course, is well-cited on these sites).



An xray really isn't useful as a diagnostic tool for cushing's. An abdominal ultrasound is valuable.

If this were me, I would probably have an ultrasound done.

Hugs, Lori

I didn't think it was, but figured it was worth asking :)
I scheduled the ultrasound for next week. I also asked the vet if she preferred one of the two places I knew do the ultrasound, if one of them was better, based on her experience with them. She said definitely always the place I was leaning toward, so I was glad I asked and had that confirmed.

Thanks again for your help and guidance. I also do really like the particular vet at our clinic that we're working with for Zanya's Cushing's, but I did ask the head honcho to please follow along and see how Zanya's doing. The other vet had been consulting with others as well, which they regularly do, so that's good. I really like how he takes the time to explain things carefully - like with Chip, explaining which nerve pathways are responsible for different eye stuff, and how doing this or that can rule this or that out, etc. Drawing pictures, too :)

And now, once again, off to bed late than I should!!

TGI(almost)F!
Samantha

PS - Hugs! (I'm a hugger, too)

PPS - I asked about getting Zanya's records, for putting a timeline of things together, and she said they can email it all to me tomorrow. SWEET!

[Harley PoMMom]

Yes, that's definitely what I've picked up, if nothing else - low and slow!!! :-)

I am happy and relieved to hear that you do agree with the "low and slow" method, we do see less adverse side effects when a dog is started on that "low and slow" protocol. Has the vet mentioned what dose of Trilostane she is going to prescribe for Zanya!


I spoke with the owner and head vet of our clinic tonight, and she agreed about the UC:Cr test not being necessary, and agreed to use the money all toward an ultrasound, instead of just doing LDDS.

When I was comparing some of the differences between the Dechra and UC Davis protocols, and brought up the testing, she said she much prefers the first test to be at 7 days, to be sure the values aren't dropping too quickly. Agree with not changing dose at that time.

I'm glad Zanya's vet is on board regarding in not performing the UC:CR test.

Having an ACTH stimulation test done at the 7 day mark is a bit early, so don't be surprised if Zanya's cortisol hasn't dropped too much.


I'd expect a high rate of false-negative misdiagnoses, but is there also a high rate of false-positive diagnoses?

The ACTH stimulation is more apt to give a false negative result, and if a dog is actually suffering from a disease other than Cushing's the LDDS test is more likely to give a false positive response.



Thanks! I'll take a look. This weekend, when I have some more time, I'll also look for more papers by these professionals, as well as other studies. I'm always interested in seeing source information (which, of course, is well-cited on these sites).

One of the most important things that pet parents can do for their furbaby's is to educate themselves on Cushing's, so kudos to you for wanting to do that!

We have a wealth of information regarding Cushing's in our Resource thread, which does include articles written by some of the most renown veterinarians that specialize in endocrinology such as David Bruyette, Mark Peterson, and Edward Feldman. Here's a link to our Resource thread: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)



I scheduled the ultrasound for next week. I also asked the vet if she preferred one of the two places I knew do the ultrasound, if one of them was better, based on her experience with them. She said definitely always the place I was leaning toward, so I was glad I asked and had that confirmed.

Ultrasounds can be such a useful diagnostic tool. Zanya sure is a lucky girl to have such an amazing mom that is so involved in her health care.


Thanks again for your help and guidance. I also do really like the particular vet at our clinic that we're working with for Zanya's Cushing's, but I did ask the head honcho to please follow along and see how Zanya's doing. The other vet had been consulting with others as well, which they regularly do, so that's good. I really like how he takes the time to explain things carefully - like with Chip, explaining which nerve pathways are responsible for different eye stuff, and how doing this or that can rule this or that out, etc. Drawing pictures, too :)

It is a bonus when the vet is knowledgeable about Cushing's, but what I think is most important is having a vet that is willing to work with you as a team, and it does sound like you do have a vet like that.

You are doing such a wonderful job at being Zanya's voice and advocate!

Hugs, Lori

[ShibaMom]

I am happy and relieved to hear that you do agree with the "low and slow" method, we do see less adverse side effects when a dog is started on that "low and slow" protocol. Has the vet mentioned what dose of Trilostane she is going to prescribe for Zanya!

I just picked up Zanya's meds - yay!! He prescribed 10mg once a day. (She's 18.3 lbs (which is, ironically, 8.3kg - easy to remember!))(okay, I'm a geek)



Having an ACTH stimulation test done at the 7 day mark is a bit early, so don't be surprised if Zanya's cortisol hasn't dropped too much.

Since I'm starting it tomorrow, I'll request we re-test on the following Monday, at day 10, unless we observe something concerning that prompts us to test earlier. We'll see what they say.



One of the most important things that pet parents can do for their furbaby's is to educate themselves on Cushing's, so kudos to you for wanting to do that!

We have a wealth of information regarding Cushing's in our Resource thread, which does include articles written by some of the most renown veterinarians that specialize in endocrinology such as David Bruyette, Mark Peterson, and Edward Feldman. Here's a link to our Resource thread: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)


Thanks! I've always been the sort to research lots with regard to medical issues - human or furbaby. You really have to be empowered and an advocate for yourself. I went through some major hip surgery in 2013, it was quite the ordeal. Still re-building!



Ultrasounds can be such a useful diagnostic tool. Zanya sure is a lucky girl to have such an amazing mom that is so involved in her health care.

It is a bonus when the vet is knowledgeable about Cushing's, but what I think is most important is having a vet that is willing to work with you as a team, and it does sound like you do have a vet like that.

You are doing such a wonderful job at being Zanya's voice and advocate!

You're so sweet! I'm thankful that I'm able to do the ultrasound. It'll be tight, but I'll manage. As I mentioned, I'm happy with our vet practice. They've always been wonderful, flexible, and incredibly compassionate.

It looks like this is the med she has:
http://www.wedgewoodpetrx.com/items/trilostane-gourmeds-chewable-tablets.html
I was going to post a picture, but I was able to find it via a google image search. :)
Just did a search through the forums, and it looks like some others have gotten it from there as well. I'll definitely be asking my vet about a prescription, so I can order from them directly, as the price mentioned by someone else is definitely lower than what I just paid through my vet.
I'm guessing it's since they have their own markup, plus, they got it from some hospital, so that's marked up as well no doubt.
It was $97.10 for (30) 10mg tablets. That's not going to cut it!!

Here's hoping for a calm, quiet weekend...
(especially since Chip got into dog treats my daughter had in her room. Had liqui-poop in the bathroom and living room, and threw up several times. Thank goodness for hardwood floors!!!)

Cheers,
Samantha

[Harley PoMMom]

That is an excellent starting dose, Zanya's vet does sound like a keeper!!

I'm not too fond of the Wedgewood pharmacy, on the FDA site it shows that problems with Wedgewood inspections go back several years. If you are interested in seeing this for yourself, you can go to the FDA website and type Wedgewood pharmacy in their search engine: http://www.fda.gov/

Many of our members use Diamondback to get their dog's medications compounded. And, yes, Diamondback has had some problems with the FDA inspections, however on the FDA site when I did a search for Diamondback they have 7 citations listed on only 1 page, where Wedgewood has 53 which took up 6 pages.

Although a lot of vets do prescribe to Wedgewood, I would be very hesitant to use them but I am such a huge worry wart! :eek:

Hugs, Lori

[ShibaMom]

Thanks Lori :)

I'll discuss the pharmacy choice with my vet, and about getting an rx to order from diamondback myself. I looked at some of the documents (eek).

Zanya took her first dose (10mg) of trilostane this morning, and so far, so good.

She's driving me nuts with the scooting, though. (Not a new development.) She's been doing it more the past couple of weeks. She even had her anal glads expressed (for the first time) a few weeks ago, so I doubt they're full. (They were moderately full at the time.)

I can't tell if she's scooting for her rear or her vulva. When she had her UTI's, she'd be scooting. Perhaps her vulva is irritated in general (just caught her licking her vulva, so I'm guessing that's more likely). I wonder if there's something topical that can be prescribed (or OTC), I think I saw someone mention something in an older thread.

I'm looking forward to Zanya's ultrasound on Wednesday. I hope they're able to confirm pituitary, and don't find anything of concern. (Or, more accurately, that there isn't anything of concern to be found!)

Hope everyone's having a good weekend. We had nice 40F temps earlier, which was delightful.

Cheers,
Samantha

Dogs: Zanya, Chip and Kappa
Cats: Tux, Gingus and Weasley

[judymaggie]

Samantha: The best thing I have ever used for an irritated vulva is Dr. Smith's Diaper Ointment. I have seen good results after just one application. I expect other similar ointments are just as good but the Dr. Smith's isn't greasy and is readily absorbed.

[ShibaMom]

Thanks Judy! I'll look right in to that. Surely it can't be pleasant for her as it is!!!

Much appreciated,
Samantha

[ShibaMom]

2nd dose and all's well.
Zanya had woken us at 5am, screaming to go out. (she'll normally let us sleep until whenever. 10, 11, etc., except when she has her flares, as I suppose you could call them. She had been out at midnight.)

Let her out. Then out again before breakfast/meds, she peed. Then right after eating, out again and peed, then a few steps forward and tried to pee (nothing came out). Then a few more feet, and try again.
Water intake still aplenty. I'm sure it's just part of her normal on and off stuff.

Sometimes she's hesitant to eat in the morning... usually it's when her tummy's upset. I hand fed her a few pieces and then she ate all her food, and when I was trimming her nails I heard her tummy rumbling, so I'm sure that's why she hesitated. Sometimes you can't get her to eat at all. Othertimes, she scarfs it down.
She's definitely read for her dinner now! (Heavens forbid that it's 19 minutes past dinnertime!!)

Cheers,
Samantha

[judymaggie]

Samantha -- glad meds are going well. Are you giving Zanya pepcid AC before she eats? If not, it might help settle her stomach. I give it to Abbie about 20 minutes before she eats.

[ShibaMom]

No, I'm not. When her stomach gets particularly bad we'll give it, but haven't had to lately. Is trilostane irritating to the stomach?

[judymaggie]

I haven't read all the trilostane articles but both Lysodren and trilostane are powerful drugs so I would think they both can cause stomach upset. Since you are dosing in the morning and Zanya is hesitant to eat in the morning, you might want to consider giving the pepcid on a regular basis to help ensure she gets her med on a full stomach.

[ShibaMom]

Thanks Judy. She's not always hesitant to eat int he morning, that's only when her tummy is upset. I'll see how she does and if it seems to continue, then will get her pepcid again. She ate her dinner just fine. I'm going to put a note on our whiteboard to remind me about it :)

Thanks!
Samantha

[Harley PoMMom]

Let her out. Then out again before breakfast/meds, she peed. Then right after eating, out again and peed, then a few steps forward and tried to pee (nothing came out). Then a few more feet, and try again.
Water intake still aplenty. I'm sure it's just part of her normal on and off stuff.


This really sounds like a UTI, cush dogs are prone to UTI's. Also, dogs with Cushing's usually have diluted urine which makes it difficult for a regular urinalysis to pick up the bacteria that is causing the UTI so a urine culture and sensitivity test is needed. The urine culture and sensitivity test will be able to show exactly what the bacteria is and then the correct antibiotic can be prescribed.

Trilostane is known to cause gastric upset, and I agree with Judy's advice about giving Zanya Pepcid AC. The generic version (famotidine) will work just as well & costs much less, and it should be given 20-30 minutes before the Trilostane dose.

Hugs, Lori

[ShibaMom]

Zanya does have dilute urine (specific gravity of 1.013).

2 regular UA's picked up bacteria (the second one showed only a wee bit, compared to the first one), then after last course of a different antibiotic when she was still showing symptoms just like today, we took the urine culture and sent it out for the sensitivity test on 12/17/14, and it came back negative (no growth 12/18 and no growth 12/19, final report).

She's had those sorts of times since then, as well. On and off.

I was SO positive that she had a UTI still when we sent the urine off for the sensitivity test, but there was nada.
Doesn't mean she couldn't have one again, but now it makes me doubt my judgment on that, since last time I was wrong.

I guess we could start with a regular UA on Wednesday when we go for the Ultrasound if symptoms continue, since they picked up the infections previously.
(Unless she shows worsening symptoms before then, then of course I'd take her in.)

At times like these, it is SO frustrating that they can't communicate with us more effectively!!!!!

Thanks re the gastric upset. I do usually get the generic for that, so on board with you there!

PS - I will call the vet tomorrow, though, to see what he thinks about it.

Have a good night!
Samantha

[ShibaMom]

Just a quick check-in. I left a message for the vet this morning, but he didn't call back until I was sitting at Disney on ice: Frozen, and couldn't answer, and he was leaving for the night.
He did feel I should bring her in for a urine test to check for infection, so I will take her tomorrow.

She's doing well otherwise, tolerating the trilostane well it seems. Fingers crossed!

Thanks for your care and support, hope everyone's doing well!

Regards,
Samantha

[ShibaMom]

It figures, that the ONE time I hesitate to take her in, is when it's good I took her.

Zanya was confirmed to have a UTI.
UA out-of-range values:
LEUK trace
PROTEIN trace
BACTERIA 1+ rods
WBC 3-6/HPF
RBC 15-20/HPF
DEBRIS 3+
EPS 3+ transitional, occasional squamous
SPECIFIC GRAVITY 1.023 (highest it's been in a long time, though still way below normal)

Vet said we'll watch real closely, since with the bacteria being rod type, could be pseudomonas. If doesn't clear up with this round of Clindamycin, we'll send out a culture.

The transitional and occasional squamous epithelial cells concern him a little bit, saying they could (but aren't necessarily) indicative of something more, so faxed those results over to the specialty center for her ultrasound tomorrow, so they can make sure to look extra closely at her kidneys, bladder, etc, as well. (Not that they wouldn't, but ... )
(Her last UA didn't have any listed, but the one prior had 3-5 listed. hm)

My poor baby!

Hopefully, once we (hopefully!) get her Cushing's controlled, she'll be free of all these UTIs!

We also had a chat about his Cushing's treatment and testing approach, I'll write more later, but it was very productive, and I'm glad I brought some things up.

Cheers,
Samantha

[Harley PoMMom]

Those dratted UTI's can be difficult to get rid of :mad: And our cush dogs are prone to them :(

I'm curious, what reference ranges does the lab list for the urine specific gravity? I thought 1.015-1.050 were the RR.

I believe minor numbers of squamous and transitional epithelial cells are generally a common finding in urine.

With an UTI more transitional epithelial cells are shed in urine.

The ones that are worrisome are renal tubular epithelial cells, when these are seen it points to a problem with the kidneys.

[ShibaMom]

PoMMom,

Yeah, these UTI's are frustrating!!

My apologies - they did the UA in-house, and didn't list reference ranges. Vet said he prefers to see the values between 1.035 - 1.045.

Hopefully the Clavamox will be able to clear this up, and that it's not pseudomonas. Also, that the trans epithelial cells are just transient, and not an indicator of some other issue.

Here's hoping for the best possible news from the Ultrasound tomorrow, whatever that may be. (PDH and nothing else??)

BTW: The protocol the vet is following is from Plumb's Veterinary Drug Reference, which apparently uses the UC Davis protocol.
He said if I'd prefer something else, he'd be happy for me to continue Zanya's care with one of the other vets who may be ok with that, but this is the protocol he's most familiar with and used, and seen how patients react, etc., and he wouldn't feel comfortable deviating from that.

There was more to it, but it was a good conversation, and he didn't feel threatened or put off by my questioning things at all, and thinks it's awful when vets won't listen. He did ask me to share some articles I've read.

Oh, I did also mention about the FDA activity with Wedgewood, and he wasn't aware of that and will be looking at it. I mentioned Diamondback as an alternative, which he said he'd heard of, and will look at more.
(It was funny, at first I said BlackDiamond, and he paused, thinking, then said, "I haven't heard of BlackDiamond... and if I haven't heard of it, that's probably not a good thing." Then I corrected myself, and he said ok, I've heard of that! LOL)

Thanks!
Samantha

[ShibaMom]

PS - Zanya's also on (and been on for about 2 weeks) Proviable-DC, a probiotic since she's been on all these antibiotics.

[ShibaMom]

Ok, so good news - it looks like Zanya has PDH.
Her ultrasound was good. They said one adrenal gland was slightly larger than normal, but the other was normal. No growths. Everything else looks good.

Only other thing was in the kidneys, the calyces which are normally about 1mm in diameter, are 2mm in diameter. She said it could be due to all the urine she was holding for the ultrasound, or from the UTIs, but said she couldn't 100% rule out any kidney disease because of that, but she thought they looked good.

No sign of tumors on adrenals or any other organs that she could see. Yay!

I got the still images sent to me, but I'll get the report tomorrow to get the exact verbiage of everything.

I'm very pleased, needless to say! It also took almost no time at all (too bad you don't get a discount for that!). Zanya was perfect, and let them put her on her back, and just stayed still for shaving and the imaging. She was a perfect patient :) Proud of my little girl.

Cheers,
Samantha

[Harley PoMMom]

AWWW, dear Zanya is such a good girl! Glad to read that ultrasound found no major abnormalities ~~whew, huh!

[ShibaMom]

Whew, indeed! Thanks much :)

Here's the report... I was off a little, but mostly on.

ABDOMINAL ULTRASOUND:
The left adrenal gland is mildly enlarged (caudal pole 7.8mm thick) and the right is at the upper limits of normal in size (6.3mm). Both renal pelves are minimally dilated (~2mm) and the kidneys otherwise appear normal. No abnormalities are seen in the liver, gall bladder, spleen, urinary bladder, gastrointestinal tract, or pancreas. There is no evidence of lymphadenopathy or peritoneal effusion.

IMPRESSIONS:
The mild left adrenomegaly likely represents hypeplasia and is consistent with the history of hyperadrenocorticism. The minimal pyelectasia is likely secondary to urinary bladder distention, although the possibility of pyelonephritis cannot be excluded.

The main vet I'm working with was out by the time we were done, and off today, but I believe he's in tomorrow, and we'll be seeing him on Saturday for her first post-trilostane ACTH stim. Crossing fingers everything looks good!

Zanya did barge into my daughters room late last night (after midnight), yelling to be let out, but she does have a UTI, so can't say anything with regard to that about her Cushing's symptoms.

How are you doing?

Cheers,
Samantha

[Harley PoMMom]

That is one good ultrasound report, and no anomalies are seen in most internal organs...YAAAA!!

Zanya's bilaterally enlarged adrenal glands are indicative to a dog with the pituitary type of Cushing's, so this would be typical and thankfully no tumors or masses were found, another YYAA!!

Wishing you and Zanya the best of luck with her first monitoring ACTH stim test on Saturday, all fingers and toes in my house are crossed. ;)


How are you doing?

Thanks so much for asking, I'm doing fine just a bit cold, the temps in York, PA are hovering in the 20's (degrees) here...brrr! We've also been getting some snow but no huge accumulations, I just hate shoveling :eek::D

Hugs, Lori

[ShibaMom]

I agree about the report! Thanks :)

I totally forgot about the UC:Cr urine catch first thing (he REALLY wanted do to this at this point), so we had to defer until Monday. Grrr. I woke up earlier than I would on a Saturday to make sure she got her med at the usual time.
Now I have to tomorrow, too... ugh - lol. Oh the joys!

Ick, I'm not fond of the 20's. Are you going to be hit with this new snowstorm? They keep upping the forecast for us. First it was saying 3-5", then after several iterations it's now at 10-14". Looking at the radar, I think it's safe to say we'll get at least a few inches. It's a decent size storm!
Looks like much of PA is included...though looks like your area is on the lower end of predictions? Enough to shovel, though, I'm guessing... Ick.

Zanya's finished 4.5 days on the Clavimox, and I'm not sure about abating of symptoms yet. Will be watching her closely, I sure hope it ISN'T pseudomonas!

It seems to be a rough cortisol day, though (I'm guessing?), as she was doing her intense bark at me this morning and afternoon and clawing and wanting to be on top of me (like standing on my chest). Also panting heavily and chewing all over. If I blocked where she was chewing, she'd just start chewing somewhere else, which leads me to believe it's stress-chewing and not allergy-chewing. Who knows, though.

Or else, her barking and panting is from the UTI, and the chewing is from lower cortisol unmasking her allergies again. Who knows, but I think it's the former (stress/Cushing's) primarily, especially only 7 days in on 10mgs (she's 18.9lbs, she's gained a bit).

Cheers,
Samantha

[Harley PoMMom]

Oh poor Zanya, wonder why she licking so much, wish they could talk to us, ain't!! My Harley started licking the lower part of one his front legs, I think it was the left, any how, the vet thought it was from anxiety so he gave me something to put on it that had a bitter taste. Well it wasn't anxiety at all, it turns out that he had the beginnings of arthritis, Harley was a frisbee junkie :eek::D he just loved to catch his frisbee, so I think that was why the arthritis started.

I had to google pseudomona, didn't know what that was, and I sure hope sweet Zanya doesn't have it neither.

My sister told me about that snow coming to PA, she said she heard that we could get 8" :mad::mad: Doesn't that snow know that I hate shoveling :D Luckily I drive a truck that has 4 wheel drive, so I usually do not shovel my 100 foot driveway, just drive right on that snow covered driveway!

Hugs, Lori

[ShibaMom]

Oh boy, I have no idea how I'm going to manage to catch Zanya's urine with this snowstorm! I may just take her straight in to the vet before letting her out or feeding or giving meds, and let them take care of it all.

It will partially depend, I guess, on if the snow has stopped falling, for one thing. Wouldn't want snow falling in to it and skewing the results.

Awww, poor Harley, that must have been rough! My grandpup (Kappa) is becoming a "disc dog" and loves it. Then again, she loves anything that can be thrown and she can catch. She'll play with herself for ages - run a bit, toss the ball, and then grab it, repeat ad nauseum! This weather doesn't even bother her, either. She'd keep playing in the backyard until she became a pupcicle if we'd let her!

Poor Zanya and Chip with this much snow, although Zanya's shorter than Chip... I should have put her thundershirt on before letting them out, since her belly's bare from the shaving, it had to be quite cold when she was out going #2. She has to walk back and forth a bit, and it always takes her a while to go. Fortunately, Kappa and Chip made some tracks she was able to then improve, but you could see she was like, "Save me!"

Thank goodness our driveway is short, though it's packed with our cars, so it's kind of a pain in the rear to clear. Yeah, 100 feet? No thanks!!! :-)

Good luck with the snow!

Hugs,
Samantha

[molly muffin]

Molly is a stress licker. I didn't really know it was stress related until I had given her some melatonin at night and for the first time in years she didn't spend 20 minutes cleaning her paws just to be able to go to sleep or sucking her tail. She's done both of these activities since she as a baby. When on the melatonin she cleaned her paws in 5 minutes and no tail sucking, off to sleep and snoring herself silly.

So, maybe that is a possibility you could try and see if it helps?

So glad the report was good.

[ShibaMom]

Thanks Molly, I'll keep that in mind if things don't settle down when her dose is good.

Results from Monday's tests aren't in yet. Vet was surprised, as usually they turnaround ACTH stim tests in a day. Maybe the delivery was delayed due to the storm. It showed in process, though, so should have results tomorrow.

She was at 22.9 post-stim (but pre-treatment). She's on 10mg/day. I had a dream yesterday that her post was 15.x. Hopefully it's better than that, although not too low, since it will likely continue to drop. Yesterday was day 9.
Definitely no signs of crashing, and no adverse affects.

Vet feels her case is on the milder end, and he really expects her to respond very well to treatment.

Whew! Here's crossing fingers (again/still)
Cheers,
samantha

[ShibaMom]

Aggggh I'm about to slam the desk, just posted twice, but didn't go through as it says the page has been reloaded since I logged in, and to refresh the page.

VERY short version - Zanya's numbers are better, I'm very pleased. Will continue on current (initial) dose of 10mg (she's 18.9lb, was 18.3 at dosing). Conservative. Vet said could go to twice a day since she still has symptoms, but I prefer to let it keep going without a change for a bit and then revisit, based on what I've learned here.
Will keep eye out for any crashing or increasing Cush symptoms. Test was taken on morning 9 of treatment.

UCCR: 22 <34 = "normal" (shortened version of description)

Test Result Reference Range
PRE-ACTH 2.0 ug/dL 2-6 ug/dL
POST-ACTH 9.8 ug/dL 6-18 ug/dL
18-22 ug/dL = equivocal
>22 = hyperadrenocorticism

UTI doing better, though not gone. UA numbers much better, will continue Clavamox until 30 days of treatment, and re-test prior to completion, and go from there.

Edit: Her specific gravity was back lower from last week, at 1.010 today. (was 1.023 on the 27th). We'll continue keeping an eye.

More later, thanks for your support!

[ShibaMom]

In other news, devastating event this morning... one of our 7 yr old cats died suddenly, and unexpectedly. My older daughter found him. Since young, and we have other cats (and dogs), decided to do necropsy to make sure it wasn't something environmental, ingested, etc, that could pose a risk to others. We knew it was probably his heart, but wanted to be sure. He's never had any health issues.

Results show he had cardiomyopathy, with left side thickening, and right side thinning. Couldn't have really done anything. It would have been quick, fortunately, so he didn't suffer - thank goodness. He was literally lying 1 foot outside my bedroom door. If he had been meowing at all, if not both of us, then at least my boyfriend/partner would have awoken, as he's a very light sleeper.

We're all shocked and terribly saddened at this loss. Incredibly shocked.
Gingus was a sweetheart, and okay, a pain in the rear at times, but wouldn't trade him for anything. My daughter whose cat he was, has her pup Kappa, who was very mopey tonight. We did let them all sniff him, and could tell they understood he wasn't ok.

He's actually the cat in the picture with Zanya, in her profile. They'd nuzzle each other, it was so cute. In earlier days, Zanya did NOT reciprocate (nor appreciate!) his advances...lol. He'd literally throw himself at her feet, and flip onto his back, belly up. What a character he was. We're so going to miss him. This part of having pets totally sucks.

So, my eyes are puffy from lots of crying today. So much for getting to bed (which I said in the very first post that didn't go, either. ugh.)

Thanks all, needed to share.

[labblab]

Oh Samantha, I am so sorry to hear this news about your kitty! What a sad shock for you all. I am especially sorry you had such a hard time posting at a time when you had so much information to share. :o

I don't know whether these tips would have helped at all as far as not losing your replies, but here's a link that might give you some suggestions:

http://www.k9cushings.com/forum/showthread.php?t=1329

Again, I am so sorry for your loss.
Marianne

[Squirt's Mom]

Oh, Samantha, I am so sorry to hear about your sweet Gingus boy. :( I know your heart is broken. But I hope you can find some measure of peace knowing he didn't suffer but had a swift Journey from this life. I am sure he flew on wings lifted by the love your family gave him and he will carry that love with him always.

Hugs,
Leslie and the gang

[molly muffin]

So sorry to hear of the loss of Gingus. I guess the blessing is that it would have been quick with no suffering. It is so hard on our poor hearts though to lose them.

Rip Gingus

Hugs

[Harley PoMMom]

Oh Samantha,

I am so sorry to hear that Gingus has passed, and my heart goes out to you and your family.




Test Result Reference Range
PRE-ACTH 2.0 ug/dL 2-6 ug/dL
POST-ACTH 9.8 ug/dL 6-18 ug/dL
18-22 ug/dL = equivocal
>22 = hyperadrenocorticism


Those reference ranges listed are for dog that is NOT being treated for Cushing's. The therapeutic ranges for Vetoryl/Trilostane are 1.45 ug/dl - 5.5 ug/dl and the post can be as high as 9.1 ug/dl if symptoms are controlled.

I think Zanya's ACTH stim numbers are pretty good, and in a short time period there was a significant drop with her post.

Hugs, Lori

[ShibaMom]

Thank you all for your kind thoughts on the passing of Gingus, they mean a lot to me. Today was rough, and I cried as I left the house and on the way to work and as I was going in to work. Oy vei. My older daughter (the one who found him) printed some pics overnight, putting one on the calendar, under the feeding/med chart for everyone, and also a photo paper pic she put on my other daughter's door, to have. Very sweet of her. (They're 22 and 19)


As for Zanya, Iwas copying the reference ranges, forgetting that they didn't matter to include, since it's the post-treatment. I knew up to 9.1 is considered ok, if symptoms are controlled, though less than that is ideal. That's why I opted not to add the second daily dose, since she's only just a bit above that, and it's early yet. Definitely don't want to risk her going hypo. She still has symptoms, though do see improvements, but taking it low and slow.

Thanks for pointing that out, though, Lori, especially for others who may read this who are new! Reading others' threads from their first post through current has been so informative!

Thanks for the posting tips too, Marianne :)

I think I need to go veg in front of the TV and try not to think too much.
Also taking Chip to the vet on Saturday, as he developed polydipsia and polyuria pretty suddenly about 2 months ago. He's 14, and also developed a cataract in his right eye causing near total vision loss in that eye. That was noticed before the pd/pu, but in the past 6 months probably. It, too, seemed pretty sudden.

Oh how these babies keep our hearts full and our wallets lean! LOL

Cheers,
Samantha
Zanya, Chip, Kappa, Tux, Weasley, and Gingus (over the rainbow bridge)

[ShibaMom]

Every night when I'd come home, Zanya and Chip would bark like crazy in greeting. Chip stopped when he started losing his hearing, and Zanya a little ways back. She's lost some hearing, but not a significant amount.

Tonight, when I got home from work, Zanya barked, and was all spazzed out, wanting to play. She hasn't done this in quite a while! She's so much peppier again! It brought tears to my eyes :)
I'm sure her levels have continued to go down since Monday. I'm so happy about this! It helps ease a little of the sadness of missing Gingus, just a little bit.

I just had to share, as I was so excited to see this!

Take care,
Samantha

[molly muffin]

Yay! We celebrate those little things that mean so much, each and every time just like it's Christmas morning. Believe me when I say we All understand and have a smile to go right along with yours.
Does the heart good doesn't it. Especially when it's currently a broken heart for little Gingus.

big hugs, smile big

[Harley PoMMom]

I am so glad you shared this with us, we love to hear good news,,,YYAA!!! Zanya, you go girl!!! :D

[ShibaMom]

Thanks ladies, I know you TRULY understand :-)

[ShibaMom]

Zanya was panting a fair bit today, but it's hard to tell if it's because she was having a bad cortisol day, or because she has more energy and has been zipping around more?
I also noticed tonight that she's been sleeping on the couch a lot more again - so jumping up on it. She used to a lot, then for the past while (3-6 months?? not sure) she only had been very occasionally. Also, when she would jump up, she'd sort of do "false starts" and step back and do that a number of times. Also even for the one step up into the house from the garage.

I'd seen her up there these past days, but the significance didn't hit me until tonight! She's been up there so much more!


As far as Chip, his exam yesterday went very well, and he definitely doesn't have diabetes - whew!! His values were quite good on the UA.
We'll have the bloodwork results tomorrow, I'm eager to see those.

The vet said he's in great shape for his age, and is very pleased. He has a mature cataract in his "good" eye, so some diminished vision, but it's not very dense, so that's why he can still see decently well.
His heart murmur hasn't gotten any worse, it's not that bad, so that's always a relief. He has an interesting arrhythmia, that goes along with his breathing (not new). I forget which way it is, but one direction of breathing (in/out), it slows down, and the other direction (out/in), it beats rapidly.

I hope it's ok to share all this about him in here as well?

Here's hoping for a much better week this week!!!

Best,
Samantha
and Zanya, Chip, Tux, Weasley and Angel Gingus

[Dixie'sMom]

Well I just got caught up on your thread and was so sad to hear about Gingus. Cats bring such a unique spirit to the party and when they leave our lives, they are always missed. I know you and your family will miss him very much.

It sounds like Zanya is doing well and even back to jumping! yay! She's feeling better. :D :D and that's always great news!

As far as Chip goes, what an interesting murmur. Thank goodness it doesn't really cause him any problems and doesn't get worse. It probably never will get worse if it hasn't by now, so thats good news too. I'll be waiting along with you to see what his labs have to offer up.

You are doing a great job with all of your babies. Hugs and keep up the good work. :)

[Harley PoMMom]

It is just so wonderful to hear that Zanya is doing well with her treatment!!!




As far as Chip, his exam yesterday went very well, and he definitely doesn't have diabetes - whew!! His values were quite good on the UA.
We'll have the bloodwork results tomorrow, I'm eager to see those.


I hope it's ok to share all this about him in here as well?

Here's hoping for a much better week this week!!!

Best,
Samantha
and Zanya, Chip, Tux, Weasley and Angel Gingus

Of course it is ok if you post about Chip, however, you can also start a new thread for Chip in our "Everything Else" Forum, so people like me won't get confused with which information belongs to what furbaby, and trust me, it doesn't take too much for me to get scattered brain!!! :eek::eek::D

[Crystal&Zoe]

I'm so sorry to hear about Gingus. Prayers for comfort and peace as you acclimate to losing him.

But I'm very happy to hear Zanya's results are so good and doing so well!

[ShibaMom]

Thanks Molly. I haven't tried that, actually, thanks! I'm sure Chip would love it. He's usually pretty indiscriminate when it comes to anything edible, though seems to get tired of whatever his food is after some time (it's only happened twice though, I think?).
Is there a certain brand you like? I'm sure the local, family-owned store we like to frequent has something good.

With Zanya, I'm thinking of maybe moving up her next ACTH stim, and seeing about upping her dose a little. I feel pretty sure it hasn't dropped much, and that she needs more. The past couple of days she's been panting more, and acting more needy again. She's still jumping up on the couch and those other things, but can tell she's feeling "off." I hate to see her feeling that way. She's a pretty sensitive girl.

I'm definitely relieved that we've gotten this far to date, though! :) Thanks!

Cheers,
Samantha

[molly muffin]

I buy a local canadian brand organic. I just give her a bit. But might be a good mix in for chip.
I just upped Molly to 11 mg. she came down steady for over a month then levelled off. We are now at 11 mg once a day. She acts different at different times of the day I have noticed. Maybe watch and see if there is a pattern.

[Squirt's Mom]

You can slice the canned tripe then bake the slices for a crispier treat. But before you do this the first time, get some of those swimmers nose clips for the humans in the house to use while they are baking. :p I've done this with several canned food and it always works.....and always stinks real good so the babies know what's up. :D

[ShibaMom]

Hi ladies!

Ok, I'm going to go do Chip's thread now. It's been a crazy week!
He doesn't have any protein in his urine (unless I'm completely losing my mind. I'm going to grab his results so I can post in his thread).

I'm waiting for a call back regarding Zanya. I know she's only 21 days in, but since her post value was 9.8, and she still has symptoms (the panting and the being very needy, in the particular way that seemingly developed with the Cushing's), I want to ask what she'd think about doing a retest now and maybe upping Zanya from 10mg to 15mg. (She's 18.9lbs). I know 10mg twice a day could be helpful, too, but I know it would be really hard for us to be consistent on timing. [it was the first vet that started her on 10mg, which I was totally fine with starting low, though he's no longer there]

What do you all think? Should I wait until the 30-day mark, or would this approach be reasonable?

Thanks,
Samantha

[ShibaMom]

Spoke with vet - she said she feels we should leave her dose as is right now, and do the 30 day recheck, especially since her pre-Cortrosyn cortisol was 2.0, and her post, at 9.8, isn't that much above normal, *AND* because Zanya's drinking is reduced. She said also since panting and neediness aren't necessarily Cushing's symptoms, but first and foremost the reduction in drinking as a significant measure.

So, we'll see what happens.

Cheers,
Samantha

[molly muffin]

I would not increase either until after the 30 day time frame. Molly's cortisol dropped for like 40 days then levelled off and now we have increased a bit but you want to see where you level off at. May not need an increase at all you never know

[ShibaMom]

Yeah, I know... I guess I just feel impatient. I hate seeing her uncomfortable.
I'll be patient. Thanks :)

[molly muffin]

How is Zanya doing? Notice any decrease in some of those symptoms yet?

hugs

[ShibaMom]

Hi Sharlene,

Thanks for asking, Zanya's doing ok. She definitely gets all panty when she's stressed, though I guess she seems much better overall. Not sure she's right where she needs to be, but probably not far off. It's hard to track her drinking, but it definitely is less than it had been, urinating, as well. Ideal? Not positive. It's very hard to tell with 3 dogs and 2 cats!

Thanks for asking :)
Tomorrow we'll take her pee for an in-house UA to see if her infection is gone (she's on day 28 of treatment this time).

Poor baby gets stressed so easily. We left my grandpup in her room with door closed while we ran to grab dinner, and she wasn't happy about being cooped up... was crying and howling, and Zanya got so stressed she wedged herself behind one of the couches. I've never seen her do that before... she was panting hard.

I think we'll be doing her ACTH stim in another week.

How are you?

Regards,
Samantha

[molly muffin]

We are good here. Still dealing with protein in the urine though. It's a slow process getting things figured out and medication right for one thing then something else goes out of whack and upsets the apple cart so to speak and back to figuring things out again. Nutso!

Oh poor thing. I am sure the pup howling stressed her out. I know it would Molly too. I am sure she was just trying to escape the noise. No telling what that pup was saying in doggie language.

I do hope that she is over the infection.

Oh yea it's hard to know how much they are drinking when there is more than one animal drinking in the house and you have a whole crew.

Have a good night

[ShibaMom]

Glad to hear, other than the protein in the urine - ugh!
Sounds like you've really had your hands full with Molly! Oy!!

I laughed at "No telling what that up was saying in doggie language." lol. Kappa's usually pretty chill, though she had developed major separation anxiety after being spayed ~ 10.5 months old in December. We've gotten her to a pretty good point now when my daughter goes to work, but Kappa was cooped up a lot today (her Mommy slept in way late, though I let her out a couple of times), so I guess she was just NOT in the mood to be shut in her room.
It's so ironic, though, since most of the time when at home, and her door is open, she's in her room, in her crate. Sometimes I bring her out and shut her door so that she can't just be hidden away. She's very social, but with Chip being a grumpy old man right now, and very snarky, I think she finds it easier to just hide out.

Anyhow, crossing fingers that she's over the infection, as well. I think she actually may be! Definitely seems much better than 2 weeks ago.

Thanks for all the well wishes :)

Cheers,
Samantha, Zanya and the crew

[ShibaMom]

Ok, so here are her UA results from today. I'm pasting the last test results with UTI approx 28 days ago first, and new to the right of them.

UA out-of-range values:
LEUK trace

PROTEIN trace

NEW: + (just a plus sign, going to validate what that means)
BACTERIA 1+ rods

NEW: 1+ cocci
WBC 3-6/HPF

NEW: rare
RBC 15-20/HPF

NEW: rare
DEBRIS 3+

NEW: amorphous
EPS 3+ transitional, occasional squamous

NEW: transitional 1-2, squamous 1-2

Not abnormal, but for the record:
SPECIFIC GRAVITY 1.023

SAME
PH: 7.5 (this time)

[molly muffin]

Okay so sounds like she still has an infection. Did the vet say anything about more antibiotics and did they culture so they know exactly which anitibiotics to give her? I don't remember but does she have an ecolli infection? They really are very hard to get rid of an being on antibiotics steadily for over a month and even finding the right one to get rid of it can be hard, none of that is unusual with ecolli.

hugs, hang in there!

[ShibaMom]

Well, I'm not sure now - as vet had said it was "normal" to see some bacteria (like +1) from a free catch.
I have a call in to her, as I only spoke with a tech thus far today.
They didn't culture this time.

We'll see what she says. Anyone else have any feedback?

Thanks,
Samantha

[Harley PoMMom]

Cocci and amorphous, didn't know what they were so I googled :)

Seems the "cocci" in cocci bacteria describes the shape of the bacteria (which is round). Cocci bacteria can be good or bad, yes, there are several. :eek: found this info here: http://www.brighthub.com/science/medical/articles/114333.aspx

The Amorphous, well there are Amorphous phospates and there are Amorphous urates. Amorphous phospates are commonly seen in alkaline uriine, which Zanya's urine is (7.5); Amorphous urates are seen in acidic.

Also:
Small amorphous crystals can be confused with bacterial cocci in some cases, but can be distinguished by Gram-staining http://www.med.illinois.edu/depts_programs/sciences/clinical/internal_med/residency/edmod/mod1/crystals.htm

So, hmmm, if this were me, I think I would need the vet's opinion on all of this. Wish I could of been of more help, sorry. I am very interested in what you and vet decide, if you don't mind sharing.

[molly muffin]

It could be crystals which could cause blood to show up if they cause irritation to the lining. The bacteria along with the blood made me think the infection wasn't completely gone but crystals could do it too.

[ShibaMom]

Of course I'll share! Thanks ladies.
I'm familiar with cocci, mostly curious if others have had their vets say for a free catch, having some bacteria is ok/normal.
The vet didn't get to call back, which is unusual, but I'm confident I'll hear from her tomorrow. I'll let you know what I find out!

Regards,
Samantha

[Harley PoMMom]

Getting a free-catch urine sample from a female dog can be challenging, and sometimes some kind of substance from around her woohoo hair will fall into the sample cup, so yes, I have been told that this may happen (bacteria). I have had all boys so getting that free catch sample was pretty easy.

[molly muffin]

Did you hear from the vet today?

[ShibaMom]

Yes, I spoke with the vet this afternoon.
She said as I thought she would, that it's just fine with that, and that even showing "rare" RBCs and WBCs is ok - in fact, 1-5 is acceptable, she says.

And yes, like Lori said, it's because with the free catch, any bacteria, debris, etc, that can be on the outside as well as in the vaginal canal, can contaminate the catch. Also anything on the hairs can fall off.

Fortunately, Zanya's pretty easy to get a catch on. Yesterday, though, was more challenging than usual, as me crunching on the snow/ice behind her kept making her not want to go...lol. But yes, very easy for anything to fall off the fur.

So, hopefully all is well! We're going to wait another 2 weeks after the 30-day mark (which we hit 2 days ago) as far as Zanya's ACTH stim. Vet's ok with that since she seems to be doing pretty well, and definitely doesn't show any signs of crashing. She knows it's been a very challenging time for us financially due to vet bills over the past 6 months (at her place, and 2 emergency vet clinics!), so since all signs point green, she's ok extending it, for which I'm thankful.

Zanya definitely gets all panty and "needy" when stressed out. Poor girl hasn't been too thrilled today, as last night, a friend of my daughters' came back into town and has to stay with us for around a week or so -- with her Australian Cattle pup (prob around 12-14 months old). Oy vei!

She's a pretty good girl (Lucy, aka Lulu), but Kappa and Lucy play hard, and a lot, which I guess stressed my little ol' lady out a bit.

Hope you're all doing well, and thanks for checking up on us :)
Samantha

[ShibaMom]

PS - The office staff apparently hadn't written down the note for the vet to call me, and mentioned it just before she was leaving. They had 3 emergencies come in shortly before closing, and she forgot to call me when she got home. She felt terrible, but called me today on her day off, very apologetic.
I assured her not to worry, that had it been urgent, I'd have made sure to say so!

[molly muffin]

Awww thT was nice of her to call on her day off just because she didn't get a chance to otherwise.

Okay so that makes sense.

I wasnt thinking of the rbc and WBC being just an off thing. I know we have had some bacteria from free catch as Molly isn't the easiest to get just was worried a bit because she had an infection previously. But if that is all cleared up and not the same type. Whoop hoo very good news indeed.

My Molly can get stressed with pups in the house. She gets miss grumpy and wills snap at them eventually if they won't leave her alone. Old diva is what I tells her she is acting like. Not that she cares. Her house her rules in her mind. Lol.

Things will calm down eventually and Zanya will be less stressed.

So very good news on for you today. Yay. :). We will take as many good news days as we can get. Nice she is doing so well too on her meds.

[ShibaMom]

Thanks Sharlene :)
(Late response, sorry...)

Zanya just got back from her ACTH stim... hopefully we'll get results tomorrow, hate to wait until Monday!

[molly muffin]

Molly always gets what I call the ACTH buzz after her test. About 48 hours of bouncing off the walls and driving the household nutso.

LOL

hugs

[ShibaMom]

I recall seeing that, Sharlene. Zanya doesn't seem to get that. Perhaps she's not quite as sensitive?

Just got her results, but with a caveat. Zanya's pre-treatment ACTH stim and her test at 9 days were done by the first vet, who did it differently. He did the pre-Cortrosyn between 2-3 hours after med, and then the post-Cortrosyn an hour after that (or was it 2? have to check my notes).

The main vet, who's been caring for Zanya since first vet's departure, follows the 4-6 hours.
I fed Zanya at 7:57, she had Vetoryl at 8:05 and they did pre-draw at 1:30pm and post-draw at 2:40.
pre: 9.4
post:11.9
(I'll grab the ref ranges later from an earlier post.)
These are higher than her last test, but, was also done at very different times.
I was trying to tell the vet about the timings when scheduling the test, but it was a madhouse there, and I don't think she really registered what I was saying. I don't think she realized the other vet did it SO differently.

So, she's going to go thru the records and gather the times of dosing, pre's and post's for each of the 3 times, and have them together, for easy comparison. Then she's going to research as far as how the timings would affect results.

She said with those results she didn't think it was time to adjust up yet, as she could continue to drop, even though the numbers went up.
She said she'll re-evaluate that after she does the research and such.

Advice/experience with this?

I love my vet, she's wonderful... but it definitely is a bit frustrating.
When the other vet was no longer there, she had suggested I may prefer to work with one of the other vets who are fulltime (she owns the clinic, and is PT and trying to head to retirement, so not always there), but I really preferred her.
I wonder if I should maybe take her to an IMS for subsequent treatment. We'll see what happens.

Thanks,
Samantha

[molly muffin]

I think the different times would make a difference it makes sense that it would be higher if the first draw is at 5 1/2 vs 3 hours starting time. Some vets like to do the 3 hours as it gives the lower value now. Use to they all did the 4 - 6 hour testing. My specialist still does that and molly's tests are all done at about the same as your vet did this time.

Molly dropped for 30 days and then we had to raise her medication at that point.

It sounds like the only problem was in the difference in timing, so it's not as easy to make a determination for comparison. However, it does sound like once they get that on tract that they are fine with her treatment.

Do you have other concerns?

[ShibaMom]

Ah, I think I misunderstood your last sentence. Gotit. No, it's probably ok otherwise. :)

[molly muffin]

Oh yes the clarity of typed conversations. Lol.

But if you would feel better with a specialist then it could be worth it.
We do it all. Specialist. Gp. Blood pressure vet. It gets crazy sometimes.