Is it possible to not medicate (Icy has passed)

[Wrighton]

Hi,
We have just received the results of the dexamethasone suppression test. Her prescore was 5.1 (1-6) ; Post 4 was 2.1( less than 1.5); Post 8 was 1.2 (less than 1.5). I really don't understand.
The whole thing started when she began to "leak" once in a while during daytime naps, never after night. She never had accidents when awake. The vet put her on one med that just did nothing. Her CBC was normal. The vet then tried DES. That stopped almost all leaking. The vet decided to do an ultrasound. She then sent us to an internal specialist. He determined that she was Cushings, had Hepetitus, wanted lepto testing, said she had a mucousele on her gallbladder that had sludge. After three test, they concluded she didn't have lepto (Elisha, PRC and MAT).
She is ten and full of energy with a beautiful shape and coat. She is a collie and therapy dog. To add to all this. She was chasing a deer from our year and tomorrow has surgery for a torn cruciate ligament.
I need help. I am so confused.
Thanks in advance.
Gail:confused:

[Harley PoMMom]

Hi Gail,

Welcome to you and your girl! I'm sorry for the circumstances that brought you here but glad you found us.

Those results you posted sure look like they came from a low-dose dexamethasone suppression (LDDS) test, that 1.5 value, is that the cut-off range that the lab listed? I assuming it is, and if so, those results do not support a diagnosis for Cushing's. When interpreting results from a LDDS test the 8 hour mark is looked at first, (which for your girl is 1.2) if that number is lower than the cut-off range for that lab (that 1.5) than the dog most likely does not have Cushing's.

What were the findings from the ultrasound? Is the urine leaking her only symptom? Dogs with Cushing's generally have a ravenous appetite, drink buckets of water and pee rivers, have skin and hair issues, and have a pot-bellied appearance. Are any of these symptoms present in your girl? Is she taking any other herbs/supplements/medications?

Once we have more information about your girl, we can all put our heads together and figure out what's going on with your sweet girl, ok? Hang in there!

Hugs, Lori

[Renee]

Urine leakage could be caused by a UTI or by bladder stones. Have these been ruled out?

[judymaggie]

Hi, Gail! Urine leaking is quite common among spayed female dogs, referred to as "sphincter incontinence". To me this is very different from having urinary accidents which is often a symptom of Cushing's. My first beagle, Maggie, had urinary incontinence. We first tried PPA which may have been the first medication your vet tried. When that didn't work, we tried PPA plus DES. She still wasn't 100% controlled. Then I tried "Leaks No More" which is a homeopathic remedy for urinary incontinence. It worked great! My vet was very impressed and now suggests it to other clients. One caution about the DES -- if your pup ever needs prednisone, the DES exaggerates the effects.

Curious about the hepatitis diagnosis - that is so rare these days for vaccinated dogs. Is that a definite diagnosis?

Will be thinking good thoughts for tomorrow's surgery -- do let us know how it goes.

What is your pup's name?

[Wrighton]

Our girl, Icy, is a beautifully coated blue Merle rough collie. She is 50 pounds, no belly, herds ducks, does therapy work, eats just as much as our other three. She does drink more than jami and Paige, but not buckets just a few more trips to the bowl. She is energetic and that energy cause a tear in her CCL for which she is having surgery tomorrow.
The " leaking" was drops when she got up from a nap, never overnight. She has never had an accident in the house. ( she doesn't know she leaks and that happens once or twice a week).
The ultrasound was done because the DES didn't totally stop the condition. The vet was worried when she saw a muceseal on the gallbladder. She sent us to a specialized hospital to an internist who did another ultrasound. He said that the gallbladder had to be watched. Our regular vet had started us on ursodiol. But then ... He said she had cushings, hepatitis, fatty liver, the gallbladder problem and told our regular vet to order lepto tests, a complete cushings panel. The CBC had been done and it was unremarkable. After three tests the vet said she didn't have lepto. For two weeks we scrubbed everything using Clorox. Tried to keep the dogs from sharing water bowls. We were told to check with our doctors. So, no lepto.
Then we got the results I shared from the cushings test. The first number I gave was her result and the one in parenthesis was the test standard or range of normal. As I read it, she started normal and ended that way. Only the 4 hour test was high.
Honest I have surgery tomorrow for her leg. That I understand. But, I have a perfectly lovely happy, healthy dog who according to the specialist has serious conditions including cushings. I read everything I could about lysodren and veteroyl, etc. I just am scared to death to give her these things and then judge her dosage by improved symptoms of which she had none already. By the way, no leaks in 28 days. Golly, they are only little.
I just don't understand how this snowball started going. She has currently been put on Marin , denamarin and ursodiol.
Thanks for any help you can give. I'm so upset.
Gail

[judymaggie]

Gail -- Icy sounds like a very special girl! From what you have shared I think you are a long way away from having to worry about giving her Lysodren or Vetoryl. Focus on her surgery and subsequent recovery!

I have done some reading about gallbladder mucoeles. Yes, it can be linked to Cushing's but it is also linked to other conditions, including hypothroidism. You said her CBC was normal but do you know if any thyroid tests were done?

A big hug to Icy -- will be thinking good thoughts for her tomorrow!

[Wrighton]

Her thyroid panel was normal. Her CBC was normal now between the Elisha, PCR, and MAT she doesn't have lepto. She did have a uninary tract infection in December. She received antibiotics and that cleared by the leaking didn't. Once she was on DES the leaking came once or twice a week and only a few drops. Now she hadn't had any for I believe 28 days.

Not sure when they want her to start cushing meds. I am just not convinced.

Gail:confused:

[molly muffin]

Hello and welcome from me too.

I wouldn't start cushing meds unless you are definite that she has cushings, and I would simply say, you want to concentrate on the surgery tomorrow, and then the gall bladder see if you can't get rid of that mucoeles and take it from there.
I'd want confirmation on the hepetitis diagnosis too. Why did they suspect that and what are they doing for it.
The marin is good for the liver, the urisidol is good for the gall bladder, so I wouldn't start any cushings meds yet. That is my personal opinion based on what you have told us.

Welcome to the forum

[Harley PoMMom]

Since Icy is not displaying the common clinical Cushing's symptoms and along with those negative LDDS test results, I would not pursue a diagnosis for Cushing's.

I'm including an excerpt from Dr. Bruyette on how to interpret a LDDS test. Dr. Bruyette is a renown internal medicine specialist, and considered an expert in canine Cushing's:
When interpreting LDDS test results, first evaluate the eight-hour postdexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

http://veterinarymedicine.dvm360.com/clinquiz-interpreting-low-dose-dexamethasone-suppression-test-results

As noted there is a slight chance of a false negative result with the LDDS test, however, since Icy has no Cushing's symptoms I would not seek treatment or have any tests performed for Cushing's.

Hugs, Lori

[Renee]

Agree 100% with Lori.

I also have to say that a bit of leakage, which is no longer occurring, would probably be on my list of 'wait and see' symptoms.

Rule out UTI (with a culture, not a UA), and rule out stones. If both those are clear, then I would watch and wait to see if anything further develops before jumping into more diagnostics.

[Wrighton]

I can't thank you enough for all your help. I never suspected so many things from an ultrasound. And then my little icy falls chasing the deer. Well, you are right. Tomorrow the leg. Then keeping her off it for eight weeks with minimal movement. That will be a trick. Icy is ten but she has only been here for four years. Her owner and my dogs' trainer died of brain cancer and she blessed us with icy and Mandi. Mandi died last year at fifteen, and icy is left with my two, Jami and Paige, all collies, all therapy dogs and all loves.

Thanks again. I hope it is alright that I will be back if any changes occur.

Blessings,
Gail

[molly muffin]

Oh we will definitely want to know how Icy is doing. :)
There is a saying, once you enter our doors, you are family and never alone on the journey whether it be cushings or not.

:)
So glad you were there to give Icy and Mandi a home when they needed it most.
I'm sure they are all a real fun bunch together. 3 collies. Just lovely.

[judymaggie]

Gail--definitely let us know how Icy's surgery goes. We are real worry warts! :D

[Wrighton]

Good Morning,
Icy came through the CCL surgery yesterday and we brought her home last night. She cried for an hour before I called the vet and he upped the pain meds.

As for the "Cushings", my vet and the specialist agree that the course of action for now should be melatonin 50 mg twice a day and flaxseed hulls with lignans 1 teaspoon full of powder once per day. I had determined with your help that Lysodren and Veteroyl were not for her with her lack of any clinical symptoms but leaking.

Has anyone tried these? I can't find the flaxseed hulls with lignane locally so I ordered some online.

Thanks so much for your concern and help.

Gail and Icy

[Squirt's Mom]

My pup was Atypical (normal cortisol with elevated intermediate or sex hormones); the treatment for Atypical is melatonin and lignans, either flax or spruce, most use flax. Several here tried the hulls, myself included, when they first came out but I didn't have as much luck controlling the hormones with them as I did with the capsule form of lignans. I purchased lignans from VitaCost and used their brand. ;) With the hulls, watch very carefully for digestive upset.

[labblab]

I know you have already placed your order, but for future reference, here's a factsheet from University of Tennessee at Knoxville that lists some additional internet sources along with basic info about lignans:

https://vetmed.tennessee.edu/vmc/dls/endocrinology/Documents/LIGNANS%20INFORMATION.pdf

Marianne

[judymaggie]

Gail--so glad that Icy did well with her surgery and is back home. Good to hear that your vet believes in pain control--there are still so many vets who do not.

My first beagle, Abbie, had atypical Cushing's. I, also, used lignans from Vitacost. My vet used a melatonin implant.

[Renee]

Good to hear that your vet believes in pain control--there are still so many vets who do not.



Gosh this is so true! I'll never understand why vets do major surgery, then think some rimadyl for 48 hours is enough pain control? :confused: I always get extra pain medication for my babies if they have surgery. They feel pain just like us!

[Harley PoMMom]

I am so glad to hear that Icy's surgery went well, now, on to a speedy and uneventful recovery.

Good Morning,

As for the "Cushings", my vet and the specialist agree that the course of action for now should be melatonin 50 mg twice a day and flaxseed hulls with lignans 1 teaspoon full of powder once per day.


That 50 mg dose twice a day sounds too high. The UTK has a treatment option sheet, which I will provide a link to, and the prescribed doses for Melatonin are:
Melatonin
Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the internet. Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs...

Regular melatonin is usually used rather than rapid release or extended release products.

Information from the treatment option sheet regarding the lignans:
Lignan.
Lignan has phytoestrogenic activity, and competes with estradiol for tissue estrogen receptors, with less biological effect. Lignan also inhibits aromatase enzyme (lowers estradiol). Available as FLAX HULL (SDG) lignan or HMR lignan. Suggested doses: SDG lignan; one milligram /lb B. Wt./ day. HMR lignan; 10-40 mg/day for small to large dogs

https://vetmed.tennessee.edu/vmc/dls/endocrinology/Documents/Treatment%20Info%2c%20Atypical%20Cushing%27s%2c%20 revised%20October%202014.pdf

Some dogs do get sleepy/dopey with the Melatonin so an adjustment to the dose may be needed.

Hugs, Lori

[molly muffin]

I used melatonin and flax seed for a bit with my dog, but it didn't bring the cortisol down and that was what we needed even though she didn't have the classic symptoms of cushings at that time. We moved on to trilostane, and measuring success with the acth testing.

So glad Icy did well with the surgery and hopefully won't need the pain meds for too long.

[Wrighton]

Good Morning,
Things are continuing to improve after the surgery. The first night was terrible, but gradually she whimpers and yelps less. She can get up, but getting down is another thing. Yesterday after she had gotten up to tend, it took her an hour and 35 minutes of turning and pacing before she could get down. However, she slept about four hours after midnight without crying under her breath. I went out and got melatonin but had to order the flaxseed hull with ligams because I couldn't find it around here. I decided to start the melatonin and I wonder if that improved her sleep, too. This morning she ate, tended, and drank then did about fifteen minutes of "how do I sit" and settled. We noticed that while she isn't using the right rear leg, she is touching it to the ground.
Here I was so worried (still am) about the Cushings, Hepititus, gallbladder musicale, possible lepto diagnosis of just a few days before the CCL tear. The cushing acth test came back the day she went through the snow mound after the deer. The lepto had finally been ruled out. What a week!
Gail

[Squirt's Mom]

I'm glad she managed to get some rest and is moving pretty good. That movement is important and will help her in many ways. She feels good enough to try and that is wonderful! What dose of melatonin did you end up using last nite? It probably did help her sleep. ;)

[Wrighton]

She had 5 m of melatonin. I hope the flaxseed hull with lignans comes soon. I just can't find it around here.
She has begun to use her foot a little, really just to balance.
I picked up meds , ursodiol, for her gallbladder, and fortunately the pharmacist told me to go online for a coupon. Originally it would have been $175 for one month, but with the coupon $75. Her total med bill is over $400.00 a month without the cushing's meds which are very reasonable.

[Squirt's Mom]

Did you see the info from Lori, Harley PoMMom on the correct dose for melatonin to treat the intermediate hormones?

To repeat -


That 50 mg dose twice a day sounds too high. The UTK has a treatment option sheet, which I will provide a link to, and the prescribed doses for Melatonin are:

Quote:
Melatonin
Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the internet. Typically, a dose of 3 mg is given q12hrs (BID) for dogs <30 lbs; a dose of 6 mg is given q12hrs (BID) for dogs > 30 lbs...End Quote

Regular melatonin is usually used rather than rapid release or extended release products.
Information from the treatment option sheet regarding the lignans:

Quote:
Lignan.
Lignan has phytoestrogenic activity, and competes with estradiol for tissue estrogen receptors, with less biological effect. Lignan also inhibits aromatase enzyme (lowers estradiol). Available as FLAX HULL (SDG) lignan or HMR lignan. Suggested doses: SDG lignan; one milligram /lb B. Wt./ day. HMR lignan; 10-40 mg/day for small to large dogs
https://vetmed.tennessee.edu/vmc/dls...ber%202014.pdf End Quote

I hope she is feeling better today!

[Squirt's Mom]

Oh and btw, UTK (University of Tennessee in Knoxville) is the seat of research for Atypical Cushing's and Dr. Jack Oliver (deceased) from there developed the treatment of melatonin and lignans for this form of Cushing's. So they are the world experts in this area. ;)

[Wrighton]

My vet and the specialist have agreed to try melatonin 5 mg two times a day and a teaspoon of the flaxseed hull with lignans for my 50.3 pound dog. Icy is pretty much asymptomatic, except an occasional leak. I just got the flaxseed hull with lignans today and it came with two scoops. They are both smaller than a teaspoon but it says an adults dose in the scoop once a day. Does anyone have any experience with these.

Are all flaxseed with lignans the same potency? This is scared to me. Thanks for any help.

Gail and Icy

[Harley PoMMom]

I have taken the liberty and merged your post regarding lignans into Icy's original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed.


From the UTK lignan sheet:
Currently, there are two types of lignans on the market: 1) Flax hull (SDG) lignans, derived from the hulls of flax seed; and lignan that is derived from the Norwegian Spruce tree (HMR lignan).

The major active ingredient of flax hull (SDG) lignan is secoisolariciresinol diglucoside (thus, SDG). SDG flax hull lignan is metabolized by intestinal bacteria to enterolactone (the major active mammalian lignan that is found in body tissues), and also enterodiol (also a mammalian lignan).

The active ingredient of HMR lignan is different from that of SDG flax hull lignan, and is 7-hydroxymatairesinol (thus, HMR). HMR lignan is extracted from the Norwegian Spruce tree, and yields high amounts of HMR lignan.

Adverse Effects.
SDG lignan, having fiber as a component, can cause increase in stool frequency (and occasionally diarrhea). HMR lignan contains very little (if any) fiber, so this side effect should not be seen with HMR lignan.

No adverse effects to the use of SDG flax hull lignan have been reported to our lab, based on suggested doses to use (one mg/lb of body weight daily). We only have limited feedback (at this time) on the use of HMR lignan. In human studies with HMR lignan, single doses of 1,200 mg did not have any side effects (www.hmrlignan.com). And in a chronic (13 week) study in rodents, 2,600 mg/kg of HMR lignan did not cause any toxic effects

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20120316-LIGNAN-Write-Up-Revision02.pdf

From UTK treatment option sheet:
Lignans are safe, so doses don’t have to be exact. Suggested doses: SDG lignan; one milligram/lb B. Wt./day. HMR lignan; 10-40 mg/day for small to large dogs.

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/TreatmentInfoAtypicalCushings201107.pdf

The amount of SDG or HMR is what is important, hope this helps ;)

[Wrighton]

Thanks. I just ordered the capsules of the HMR in case Icy has any negative reactions to the flaxseed. Okay so now Icy gets Marin, Denamarin for her fatty liver, Ursidiol for the sludge in her gallbladder melatonin, SDG for her "Cushings", and Dasaquin for her limbs. She has finished her antibiotics and pain meds for the torn CCL.

She starts physical therapy tomorrow.

Thanks and best to all.
Gail and Icy

[molly muffin]

Good luck with the therapy! Sounds like you have your supplement shelf well stocked. :) good job

[Squirt's Mom]

If you are trying to control the intermediate hormones with the lignans, you must use the combination of lignans and melatonin for them to have any effect. One or the other alone will not work on the intermediates. ;)

[Wrighton]

I just received the lignans. That's why I had only given the melatonin. By at the same time, The melatonin is given twice a day but the llignans only once. Do I divide the lignans? I just want to get all this right.

Thanks.

Gail

[Squirt's Mom]

ah, cool! The lignans are once a day, the melatonin twice. I gave Squirt the lignans in the AM and just the melatonin PM while she was on them. It started out that way because I wanted to be awake in case her digestive system reacted to the lignans - we were still able to share a bed at that point. ;):D

[Wrighton]

Thanks. She doesn't seem to have much of a reaction to either the melatonin or the lignans except she has more movements during the day but perfectly formed. I think that the melatonin might have helped her sleep peacefully in spite of the CCL surgery. She is now off pain meds.

Does anyone know if MDR1. Mutant/mutant dogs can use the cushings drugs should Icy need them?

Gail

[flynnandian]

your dog can be tested mdr1-normal, -carrier or -affected.
this can easily be done by sending a swab [cheek cells].
in europe [where i live] it costs + - euro 50 [65$].
trilostane [vetoryl] is not found in the "'dangerous"' list.

[Wrighton]

My dog is a MDR 1 mutant/mutant collie and therefore reacts to many drugs. Does anyone know if any cushings drugs or supplements must be avoided? The University of Washington vet school publishes a list, but drugs are added all the time and usually after investigation of a tragic use. I hoped someone might know.

Thanks.

Gail

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about contraindicated drugs for MDR 1 dogs into Icy’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[labblab]

Gail, I think probably your best bet in this regard is to contact the manufacturers directly re: any specific drug/supplement that you are considering using. They should have the most accurate and up-to-date research info re: contraindications to the use of their medications for any reason.

FWIW, in my many years on the forum, I have not heard of this being an issue with any the commonly used Cushing's treatment meds. But if I had a dog with this mutation, I would definitely check with the specific manufacturers.

Marianne

[labblab]

Hi Gail, just wanted to check back in with you because you had written a note elsewhere that looks as though you may have some testing questions? If so, please do feel free to go ahead here and ask about anything that is still puzzling you.

Marianne

[Wrighton]

Here are the results from U of T
Dexamethasone: Pre 5.1 (RefR esults1.0-1.6) ; Post 4 hour 2.1 (RR less than 1.5) and post 8 hour 1.2 (RR less than 1.5)

URINE?CPRTISOL/CREATINE
URINE CORTISOL 31.6
URINE CREATINE 90
URINE CORTISOL/CREAT Ratio 110
Comments:
< 34 Hyeradrenocorticism is highly unlikely and investigation of
other causes of the dog's climinal signs is recommended.

>or=34 HYdroadrenocorticism is possible; however a unrine sample collected from a stressed dog with nonadrenal illness can have an increased ratio.


Hope you can help.
Gail

[labblab]

Hi again, Gail. Sorry for the delay in getting back to you. The reults you've posted are for a diagnostic Cushing's blood test (LDDS or Low Dose Dexamethasone Suppression Test), and a diagnostic urine test (UCCR or Urine Cortisol Creatinine Ratio). The interesting (puzzling?) thing is that the two tests deliver opposite results. The LDDS blood test is negative for conventional Cushing's, although the urine test has a result that could be consistent with Cushing's. However, as the explanation for the urine test notes, factors or conditions other than Cushing's (like stress) can cause an elevated result on the UCCR. The same can be true for the LDDS, but since it was negative, I am thinking it carries greater weight in making conventional Cushing's seem much less likely. If you look back earlier in your thread, you will find links that explain exactly how to interpret a LDDS test.

Did you collect that urine sample at home to take in to the vet, or was the urine sample collected at the vet's office? It is generally recommended that the urine sample for this test be collected at home so that the dog is calm at the time the sample is taken. A high level of stress can definitely affect that test, as well as can other medical conditions. It is usually performed as a first, initial general screening test in order to see whether Cushing's even seems to be a possibility. If it is elevated, then you would move on to one of the more specific Cushing's diagnostic blood tests such as the LDDS, which you did -- and it turned out negative for elevated cortisol.

Was any other testing analyzed at U of T? Usually it is a different diagnostic blood test that is sent to them: a full adrenal panel subsequent to an ACTH stimulation test. This is the test that is used for analyzing all the hormones produced by the adrenal glands, including cortisol. When cortisol levels are normal on this test but other intermediate adrenal hormones are elevated, this is when a diagnosis of "Atypical Cushing's" may be made along with a treatment recommendation of lignans and melatonin. Since this is the treatment you are launching into, I would have assumed that this would have been the test that was performed at Tennessee. So are you sure no other testing was analyzed there? Earlier you did mention an ACTH test having been run...


The cushing acth test came back the day she went through the snow mound after the deer. The lepto had finally been ruled out. What a week!

So can you double-check all your test results for hormone levels taken both before and after injection of an ACTH stimulation agent? Cortisol will be one of the hormones, but there would also be several others listed, like estradiol and progesterone.

Marianne

[Wrighton]

I so appreciate your interpretation of the results. The day of the testing,We were told to bring a urine sample, but Icy in spite of three hours of walking in our yard (4:30-8:00 am) and a stop by the duck pond on the way (she is a duck herder so I thought they might inspire her) she wouldn't go. They somehow got the sample after we left her at her vet. She was trembling when we left her. I wanted to stay but they said no.
I know they did the dex test. They sent the samples to U of Tenn and the test cost about $ 260 . The results I copied were all I got when I asked for a copy of the tests. I had thought it was a form of the ATCH test.
My concern is exactly what you describe. How can the specialist and the vet say Cushings with those results? They did agree that she could start with lignans and melatonin and see if that works. She never had any clinical signs except leaking which stopped with DES.
I love this dog. We have only had her five years, but we took Icy and Mandi to join our two collies when her owner died of brain cancer. Their owner was a great friend and professional trainer.
I don't think the lignans and melatonin will hurt, but ....... What to do?
Thanks again. At least I feel less stupid. I couldn't make sense out of the results. This plus the CCL, the recent death of my husband, and now my youngest daughter's cancer surgery on Wednesday have me doubting everything.
Gail

[labblab]

Oh my gosh, Gail, you have so much on your plate right now! Your family here will be sending so many healing thoughts to your daughter. Please let us know how things go.

Given this additional info, I really encourage you to try to release some of your worry about Icy right now. I believe she is going to be just fine, and no, I do not think conventional Cushing's has been proven to be a problem for her. So that is a very good thing. :)

It absolutely sounds as though she was quite stressed at the time of the urine sample, so I think that result can now be disregarded. And honestly, I am betting that UTK did perform an ACTH analysis and your vet's office has neglected giving you the results. That is really the only thing that makes sense -- that is the only part that would correspond with the vets saying she has been diagnosed with a condition that may be helped by this treatment. If I were you, I would ask to speak directly to your vet again and specifically ask whether an ACTH test was analyzed at Tennessee. If so, you want the results. If not, why are they recommending this treatment?

But this can wait until after your daughter's surgery. You can just focus your attention on her for right now. Truly, I think Icy is going to be just fine, and you will soon get to the bottom of things.

Marianne

[Wrighton]

Thanks. I am just trying to do what I should do at a time when I can do little that is meaningful.
Again profound thanks.
Gail

[labblab]

Oh you are so welcome. Truly, in the absence of any remaining symptoms, I don't understand why your vets are pushing for any treatment at all. I really, really would press for a better explanation of the exact nature of the problem they are supposedly addressing.

[judymaggie]

Gail--sending prayers and good thoughts for your daughter!

[Squirt's Mom]

Darlin', your efforts and TLC are more meaningful than you are aware. You have figured out a great deal about Icy and that makes you stronger than you know right now but in time you will see. ;) Based on your attention and devotion to Icy, I know you gave your all plus to your hubby and are doing the same with your daughter. Don't forget about Gail, tho. Be good to her, too. She is a special lady who needs special treatment from time to time.

My thoughts and prayers are with you and your daughter facing this surgery Wed. that it will go extremely well and she will be at your side for the remainder of your days.
Hugs,
Leslie and the gang

[Harley PoMMom]

I am so sorry for the loss your husband and my heart goes out to you during this most difficult time. You and your daughter will be in my thoughts and prayers, and as Marianne has mentioned, your family here will be holding you both close to our hearts and sending positive energy your way.

Hugs, Lori

[molly muffin]

Sending my best wishes for your daughter and sincere condolences on the loss of your husband.

I know when things feel out of control, sometimes I try to focus on what I feel I can do too.

hugs

[Wrighton]

To all you were so kind,
Sarah is finally out of surgery and in the recovery room. Biopsies to identify the type and clarity of margins, sentinel lobes, etc. will take days. The first battle is over, and the war has begun.

Thank you.

Gail

[judymaggie]

So glad to hear that Sarah is over the first hurdle! Thank you for taking the time to ease our worries. Will continue to send prayers and good thoughts your way.

[molly muffin]

So glad to hear the first hurdle is past. Let us know how she is doing!
Hope you are doing well too Gail. It's nerve wrecking!

Hugs

[labblab]

Gail, thanks so much for updating us! I'll surely be hoping you can get some rest this evening.

Sending many healing thoughts to your daughter!
Marianne

[Wrighton]

You can't know how much your concern means. Sarah is our youngest, our third world woman, and she was her daddy's little girl. I know how much they miss each other. Her husband is the best.

Again. Thank you.

Gail and Icy

[Squirt's Mom]

I am so happy to hear this first phase is over and things went well. I hope that band that is so tightly wound around your chest was able to slip a notch or two looser. ;) Let us know when the path reports get in. Prayers and healing energies flying her way!

[Wrighton]

Today I found out that prescription discount programs ( just google the human med you need for your dog) and what a savings. I don't know why it works, but I printed out the coupons for ursidiol my Icy takes and while 30 tablets are $170+ at ShopRite without the coupon, I got 30 of the same tablets, same strength with the coupon at Walgreens for $36.34. The woman said lots of pet owners come and it is their pleasure. With all the meds, tests, and now physical and water therapy, this is a real blessing. Hope it can help someone with a fog taking a "human" drug.
Again, I don't know why it works in that there is no charge for the prescription programs or coupons, but it did work for us.
Gail

[labblab]

This is super helpful news, Gail! So was this coupon of Walgreen's one that was specific to ursidiol, or was it a general coupon that could be applied to discount other meds there, too?

Marianne

[Squirt's Mom]

Yes, please share the details about how you did this! Coupons for human drugs - what a wonder!

[Wrighton]

It is not just for ursidiol. It is for any human medication. I googled "ursidiol discout ". There were several discout drug programs. Then, I found one site that compared ursidol at different pharmacies with coupons. I found the cheapest was Walgreens at $34.36 compared to the $172.00 without a coupon. Once you get the coupon, you take it to the pharmacy and Voila! BIG savings. You can also get as many prescription discount program cards and the pharmacy will keep them on file and use the cheapest one for any human medicine for pets or people. The woman at Walgreens told me that lots of people check out the prescriptions they use and then use these in place of Medicare D.

I can't figure out how or why this works but it does. You can even use a coupon if you have insurance but your copay is greater than the cost with the coupon. Amazing!

Hope the above is clear. I'd be happy to try to clarify further if necessary.

Gail

[Wrighton]

I just learned my regular vet is leaving the practice and moving to one too far away. Is there a way to find a vet experienced with Cushings and secondly, a surgeon experienced and successful in performing gallbladder surgery? I am so confused. Does she even have Cushings? Seems fine on lignans and melatonin, but that is by observation because the ACTHtest isn't until May when after the test the next ultrasound will be done. Besides the lignans and melatonin, she now gets Marin, denamarin, ursidiol. I so wish my regular vet would be there to orchestrate this treatment.
I live in Hunterdon County, New Jersey.
Gail

[Squirt's Mom]

Hi Gail,

It really does throw us for a loop when a vet leaves, huh? Altho....there were a couple we dealt with that I was glad to see leave! :D

Check out this link - it should help you find any sort of vet you need in your area -

http://www.k9cushings.com/forum/showthread.php?t=182

[Squirt's Mom]

How is your daughter doing?

[Wrighton]

Thank you for asking. She is doing okay but has lots of swelling. The biopsies are not yet back. They said it takes at least nine days to get them and determine what is next.

I truly appreciate your concern.

Gail

[molly muffin]

Horrible waiting on results. None of us around here are very good waiting on test and biopsy reports. I mean, we do it, but we sure don't like it . LOL
Hope you get the results soon as the news is good.

[Wrighton]

I am the world's worst waiter!

I appreciate the list of canine internists. However, I find that not all doctors are equal to their education. I wonder if those on the list who have caring knowledgable doctors could share with those of us who are desperate, even in private mail.

I so wish my vet didn't move too far away to follow.

Gail

[Harley PoMMom]

I am the world's worst waiter!

I appreciate the list of canine internists. However, I find that not all doctors are equal to their education. I wonder if those on the list who have caring knowledgable doctors could share with those of us who are desperate, even in private mail.

I so wish my vet didn't move too far away to follow.

Gail

Some of our members have emailed Dr Bruyette, who is considered of the experts in canine Cushing's, and he did reply back to them. When I get time I'll see if I can find his email addy, or maybe someone who knows it will post it here.

[Wrighton]

Apparently mucoscele are common in Cushing pups. Anybody had any experience with one? If so, what treatment did you choose?

Gail

[Harley PoMMom]

This is gallbladder mucocele, right? If so, than yes it is commonly seen in dogs with Cushing's. Ursodiol is the medication generally given, and from what I have read it does help. I am including a link to a study where dogs with gallbladder mucoceles were treated successfully with urodiol along with other medications: http://www.medscape.com/medline/abstract/18518811

Hugs, Lori

[Wrighton]

I could not get into the link because I did not fit any of the criteria.

Icy is on ursidiol, Marin, and denamarin for the gallbladder and fatty liver. We didn't know she had any problem because the blood work showed everything to be normal. Only the ultrasound disclosed the Mucoscele and fatty liver. We have to go back in a few weeks. If it is not better or worse the recommendation will be surgery, I think. I want to go to the best place.

The survival odds for gallbladder surgery isn't great. I just came back from University of Pennsylvania Vet Hospital. It is about 1 3/4 hours away with hard driving in the city. However, they do laproscopic gallbladder surgery and the odds of success are greater, pain less, healing faster. I went to check it out.

I'm trying, but still so confused. No symptoms or LDD confirmation and they say she has Cushings. No symptoms and she might need gallbladder surgery.

Sarah's report is good and we sure are grateful. Still chemo and radiation to go but....

Gail

[molly muffin]

Very glad to hear that Sarah's report is good. Every good report can make such a huge difference. Every reason to look forward with positivity. :)

Do they not think that the ursidol will make a difference? It does take time for the medications alone to work. Did they say how long they thought it could wait? Is it a total blockage? That might make a difference.

[Squirt's Mom]

So glad the path report is good! YAY!

[Wrighton]

They found the mucoscele in Early February. My understanding is that a decision will be made after the stim test end of April and then the comparative ultrasound in early May. It would seem to me that if surgery is needed and only u of Penn does laproscopic I should have the ultra sound done there. Does that make sense?

I am giving the ursidiol in the morning at 4:30 am with breakfast along with melatonin, and Marin. Then no food until 2:00 pm when I give the denamarin. Dinner is 4:30 pm with melatonin and lignans.

I read in one place ursidiol should be given twice. My vet said once.

Gail

[molly muffin]

I am not sure about whether it is a once or twice a day dosage. Most sites say to dose according to vets recommendation, so it could be at their discretion. I found one site that said dogs should be dosed twice a day and cats once a day.

[Harley PoMMom]

Shoot, sorry about that link. Here is what the abstract said:
08Jun
Nonsurgical resolution of gallbladder mucocele in two dogs.

J. Am. Vet. Med. Assoc.
J Am Vet Med Assoc 2008 Jun;232(11):1688-93
Romanie Walter, Marilyn E Dunn, Marc-André d'Anjou, Manon Lécuyer

A gallbladder mucocele was diagnosed in 2 dogs. In both dogs, the mucocele resolved with medical treatment but without the need for surgical intervention.
A 12-year-old spayed female Miniature Schnauzer had a history of signs of gastrointestinal tract disease and high serum liver enzyme activities. Gallbladder mucocele and hypothyroidism were diagnosed. A 6-year-old neutered mixed-breed dog had chronic intermittent diarrhea and recurrent otitis; gallbladder mucocele and hypothyroidism were diagnosed.
The first dog was treated with S-adenosyl-methionine, omega-3 fatty acids, famotidine, ursodiol, and levothyroxine. Substantial improvement in the gastrointestinal tract condition and complete resolution of the gallbladder mucocele within 3 months were evident, but the dog was not available for further follow-up monitoring. The second dog was treated with fenbendazole, ursodiol, and levothyroxine and fed a hypoallergenic diet. One month after evaluation, abdominal ultrasonography revealed that the gallbladder mucocele was resolving, and treatment was continued. Ultrasonographic evaluation 2 and 4 months later revealed complete resolution of the mucocele.
Review of the clinical course of 2 dogs in which there was nonsurgical resolution of gallbladder mucocele revealed that surgery is not necessary in all dogs with gallbladder mucocele. Hypothyroidism may have resulted in delayed gallbladder emptying, and its role in the pathogenesis of gallbladder mucocele merits investigation. Despite this information, until further prospective trials with a control group and standardized treatments and follow-up monitoring can be performed, the authors recommend surgical intervention for treatment of dogs with gallbladder mucocele.
Affiliation
Department of Clinical Sciences, Faculté de Médecine Vétérinaire, Université de Montréal, CP 5000, St-Hyacinthe, QC J2S 7C6, Canada.

Hopefully this link will work: http://www.pubfacts.com/detail/18518811/Nonsurgical-resolution-of-gallbladder-mucocele-in-two-dogs

So glad to hear that Sarah's report was good, we are still keeping you both in our thoughts and prayers.

Hugs, Lori

[Wrighton]

I just TODAY got the report from the 2/3 exam and ultrasound at the specialist.
The blood work showed elevated enzymes called ALP& ALT.
The blood test called LDDST was normal. The urine test ( urine cortisol/creatine) test was positive for possible Cushings.

Physical exam findings:
1) Normal liver size., disproportionate liver love sizes, rounded liver lobe margins, hyperechoic hepatic parenchyma with portovasculature mineralization
2) moderate echogenic material - gall bladder
3) normal stomach, small intestine,spleen,kidney
4) moderate bilateral adrenomegaly, right adrenal -0.65cm-0.75
5) mildly thickened bladder wall

Conclusion: Hepatitus and cushings

Follow up needed.

I don't get it.

Gail

[molly muffin]

Because increased cortisol can cause the changes seen in the liver and one adrenal gland appears to be enlarged, they probably are thinking that she has adrenal cushings. The LDDS didn't support that though and normally if it is adrenal cushings, then an LDDS would show it definitely, in that she wouldn't suppress. Adrenal tumor would keep pushing out cortisol no matter what.

I would ask the vet about this but the LDDS might have been the follow up.

How is Icy actually doing? Still happy girl? No symptoms of cushings still?

I think that the meds for the gall bladder is number one right now.

[Wrighton]

Thanks.

Icy seems fine. As you may remember, she had surgery for her torn CCL 32 days ago. Her fur is growing back and her PT is going well. She is up to ten minute walks. She does well in the water treadmill. She has no pot belly, has had no accidents, but she still may drink a little more than Jami and Paige, but she always did. We are giving her the ursidiol, Marin, denamarin, melatonin, and flaxseed hull lignans. Her appetite is good as always. No skin lesions or blackening.

The follow up recommended is an adrenal panel. I think my regular vet thought the LDDST. So don't know what specialist wants. He also wants to do a liver biopsy. What does this have to do with Cushings?

I thought the LDDST determined if she had Cushings.

Now Hepatitus, Cushings and gallbladder and all with a happy, well dog.

Thanks for your help.

Gail

[Harley PoMMom]

I don't know why, either, that Hepatitus has now come into the picture. The U/S findings were a normal liver size, but with hyperechoic hepatic parenchyma, which means a fatty liver. I'm not so sure what portovasculature mineralization is. I think I would ask the vet about Icy's liver findings, and the reason the biopsy is needed.

Hugs, Lori

[molly muffin]

I probably wouldn't do a biopsy unless it was absolutely necessary.

[Wrighton]

I checked a little further
about the type biopsy he wants. I didn't know there were four types, He wants the ultrasound guided laproscopic. Here I am so concerned about the possible need to do gallbladder surgery for the mucoscele if the ursidiol doesn't hell that and he is proposing what sounds like surgery to me. Boy, I wish I never mention Icy's leaking!
Gail

[Wrighton]

It has been two months since the original work was sent to u of Tenn. The specialist wants a blood pressure, acth stim., liver enzymes, and untrasound. The doctor said she will call tomorrow with some results.

The specialist in requesting this further testing says Icy has typical AND atypical Cushings. This is.....I am so confused.

Guess will find out if the melatonin and flaxseed lignans is working.

Here's hoping. The Cushings, the mucoscele, and Hepatitus..... Who could believe this happy, spunky little dog could really have all these things?

Gail

[Squirt's Mom]

The specialist is wrong. A dog cannot have both Atypical and typical Cushing's. Here's why - Atypical means the cortisol is normal while typical means the cortisol is elevated. So it is impossible for the cortisol to be both normal and elevated.

What can happen and often does, is that a pup with true, or typical, Cushing's has elevated intermediate hormones ALONG with elevated cortisol. That doesn't matter. The key to differentiating between the two forms is the cortisol. If the cortisol is elevated, the pup is NOT Atypical even if all of the intermediates are elevated.

So your new specialist may not know as much as we would expect a specialist to know. I know that doesn't help you with deciding who to believe but being armed with facts will help you.

How is your daughter doing?

[Wrighton]

Thanks for asking. She is going to the medical oncologist next week to set up her chemo, then radiation. Other than some swelling and a little pain,she is grateful. Here's hoping.

I am still waiting for results from yesterday but don't think the ATCH stim test will be done. However, the liver enzymes, blood pressure and ultrasound might be. She said she'd call today.

The LDDST which you all said indicated unlikely Cushings ( first and last were within normal range only middle one was slightly raised). So now the specialist put her on melatonin and flaxseed hull with lignans, and we are at the two month time so he wanted the atch stim test. That's to see if cortisol is elevated, right?

I really want to know about the mucoscele which he says is common in Cushings dogs. That could kill her. Have any other of the dogs had one? If so what did they do, surgery or medicine.

I think he said that if cortisol is high it is Cushings. If the sex hormones are high it's atypical.....at least that's what I heard.

Oh do I wish my doctor hadn't left!

Gail

[Squirt's Mom]

Just keep in mind the cortisol is the key. If it is elevated, no matter what the levels of the other hormones. it is true/typical/conventional Cushing's. If the cortisol is normal but the other hormones are elevated then it is Atypical. The cortisol is the key. ;)

I'm glad things are going well for your baby girl and pray the upcoming treatments do the trick.

[Wrighton]

Just got a call with results. Her blood pressure was normal. Her liver enzymes were greatly improved with the alt only slightly beyond Norma but now the alto and gt were normal. Her atch stim was baseline 4.5 and two hours later 36.3. She was calling u of tenn to find out the one sent there in February which she didn't have although she had the record of doing the adrenal panel. She said it might not have been printed out.... Not sure.

Of great concern is that the mucoscele had not improved.

Not sure what happens now. I'm trying to find a good surgeon.

Gail

[Harley PoMMom]

I'm not familiar with ursodiol, did they say how long it would take to show improvement in the gallbladder? That is great news that her liver enzymes came down!!

I see you posted Icy's ACTH stim results and her post is high, but with everything going on with dear Icy, the mucocele, recovering from CCL surgery, those issues could contribute to that post elevation.


Thanks.
We are giving her the ursidiol, Marin, denamarin, melatonin, and flaxseed hull lignans.
Gail

I just now noticed that Icy is getting both marin and denamarin, I jusr want to make sure that you are aware that these need to be given 12 hours apart from each other.

Please do keep us updated. ;)

Hugs, Lori

[Wrighton]

Hi Lori,
No, I did not know about the Marin and denamarin. I understood denamarin had to be given on an empty stomach and marin with food. I will change it any way it should be. I give marin at 5:00 am with her food plus melatonin and ursidiol. At 2:00 pm I give her denamarin, and at 4:00 pm I give her her supper with melatonin and flaxseed hull with lignans.

My understanding of ursidiol is the only med with a chance of helping with a mucoscele, it's a human drug. Not sure but will try to find out about the length of time. I do know it only works in 26-42% of users. I so wanted to avoid surgery, but there is no change and my regular vet is very concerned. The internist said about four months till another ultrasound but my reg vet did one at my anxious request charging only $20 because she is worried,too.

Is the cortisol level very high? She was shaking all the way there because of her surgery there, but the pre stim level was low and her blood pressure was perfect. How long does it take for melatonin and lignans to work, if they do? The LDDST was normal, if that enters the picture.

I am sorry I am asking for so much help.

Gail

[Harley PoMMom]

Oh Gail,

We all have been where you are, and we do completely understand how confusing and frustrating this Cushing's can be, so you go on and ask all the questions you want, and please, no more apologies, ok? ;)

Icy did have a elevated post ACTH stim number, now a quick question, on the lab sheet that analyzed Icy's cortisol did they include their reference ranges for that ACTH stim test? On most labs, the cut-off post range is 20-22ug/dl, usually anything above that means that the dog's system is producing too much cortisol.

The melatonin and lignans will take months, say around 6 months, to show any improvement, and unfortunately, they do not usually have a lowering effect on cortisol.

Hugs, Lori

[Wrighton]

Should we then be considering switching to one of the others? We want her in the best possible shape with the surgery looming, or.... Our new regular vet is good but doesn't seem to understand Cushings and our specialist Internist wants to wait for surgery until May.

Maybe when he gets the most recent results he will change his mind.

Thanks for your support.

Gail

[Wrighton]

Finally they printed out the U of Tenn results. They had only printed out the LDDST and not the rest, I guess.
Test. Result. Range. Result (post). Range (post)

Cortisol. 2.7. <1.0-5.9. 30.4. 6.5-17.5
Androstenedione .45. .05-.57. 8.52. .27-3.97
Estradiol. 81.2. 30.8-69.9. 73.9. 27.9-69.2
Progesterone. <.20. <.20-.49. 3.2. <.2-1.50
17 OH progesterone. .09. .08-.77. 3.45. 0.40-1.62
Testosterone. <15. <15-32. <15. <15-45

What does it mean that before stim all are in normal range except estradiol?

Gail

[Squirt's Mom]

Yes, the pre numbers for all are normal except for estradiol. However, it is the post number that matters most. Based on these results, Ice is not Atypical but has true, or conventional, Cushing's because of this result -


Cortisol. 2.7. <1.0-5.9. 30.4. 6.5-17.5

The 30.4 tells us the cortisol is elevated and that negates Atypical. It can ONLY be Atypical if the cortisol is normal. It does not matter what the levels of the intermediates are if the cortisol is elevated. Nearly all dogs with elevated cortisol also have elevated intermediates. ;) The melatonin and lignans are not going to help the cortisol much at all, if any.

[Wrighton]

Is it pituitary or adrenal? What can tell? Her add all glands are not equal. The LDDST is negative.
Gail

[Harley PoMMom]

Hi Gail!

I've just reread your thread and typed my responses and questions below.


Hi,
We have just received the results of the dexamethasone suppression test. Her prescore was 5.1 (1-6) ; Post 4 was 2.1( less than 1.5); Post 8 was 1.2 (less than 1.5).


This LDDS (low-dose dexamethasone suppression) test was performed 2/3/15, correct?


Our girl, Icy, is a beautifully coated blue Merle rough collie. She is 50 pounds, no belly, herds ducks, does therapy work, eats just as much as our other three. She does drink more than jami and Paige, but not buckets just a few more trips to the bowl. She is energetic and that energy cause a tear in her CCL for which she is having surgery tomorrow.

Icy is still not showing any clinical symptoms of Cushing's, such as excessive drinking/urinating, ravenous appetite, pot bellied appearance, hair loss/skin problems, right?


She sent us to a specialized hospital to an internist who did another ultrasound. He said that the gallbladder had to be watched.


Now with this ultrasound, was it done in February by the specialist and was it after the other ultrasound that the vet did?



Icy came through the CCL surgery yesterday and we brought her home last night. She cried for an hour before I called the vet and he upped the pain meds.
Gail and Icy

On February 20th Icy had her CCL surgery, correct?


Here are the results from U of T
Dexamethasone: Pre 5.1 (RefR esults1.0-1.6) ; Post 4 hour 2.1 (RR less than 1.5) and post 8 hour 1.2 (RR less than 1.5)

URINE?CPRTISOL/CREATINE
URINE CORTISOL 31.6
URINE CREATINE 90
URINE CORTISOL/CREAT Ratio 110
Comments:
< 34 Hyeradrenocorticism is highly unlikely and investigation of
other causes of the dog's climinal signs is recommended.

>or=34 HYdroadrenocorticism is possible; however a unrine sample collected from a stressed dog with nonadrenal illness can have an increased ratio.
Gail

I so appreciate your interpretation of the results. The day of the testing,We were told to bring a urine sample, but Icy in spite of three hours of walking in our yard (4:30-8:00 am) and a stop by the duck pond on the way (she is a duck herder so I thought they might inspire her) she wouldn't go. They somehow got the sample after we left her at her vet. She was trembling when we left her. I wanted to stay but they said no.
Gail

Now, the UC:CR (urine cortisol-to-creatinine ratio) result was high, however Icy's urine sample was collected at the vet's office, right?


I just TODAY got the report from the 2/3 exam and ultrasound at the specialist.
The blood work showed elevated enzymes called ALP& ALT.
The blood test called LDDST was normal. The urine test ( urine cortisol/creatine) test was positive for possible Cushings.

Physical exam findings:
1) Normal liver size., disproportionate liver love sizes, rounded liver lobe margins, hyperechoic hepatic parenchyma with portovasculature mineralization
2) moderate echogenic material - gall bladder
3) normal stomach, small intestine,spleen,kidney
4) moderate bilateral adrenomegaly, right adrenal -0.65cm-0.75
5) mildly thickened bladder wall

Conclusion: Hepatitus and cushings
Gail

Was this ultrasound performed by the specialist?

From what I am reading here is that Icy's LDDS test was negative for Cushing's, and the UC:CR test was high BUT the urine sample was collected at the vet's office which would make it invalid. Now, on both ultrasounds the adrenal glands were not mentioned, so I am wondering if they were visualized or they appeared normal, could you ask the vet/specialist if her adrenal glands were seen?

And, yes that ACTH stimulation post number was elevated, however, our sweet Icy has had a lot going on, such as her CCL surgery on 2/20, and the mucocele may be making her a bit uncomfortable, so that post number could be high because of these non-adrenal issues. So, I'm still not convinced Icy has Cushing's, and if the adrenal glands were seen and they are of normal size, along with those negative LDDS test results, I would be comfortable saying that Icy does not have Cushing's.

I hope what I have typed does not add any undue stress or worry to you, I only want to help and I do not want to confuse you or cause any frustration.

Hugs, Lori

[Wrighton]

Hi,

Hi Gail! I copied and pasted here and answered your questions after each.

I've just reread your thread and typed my responses and questions below.

Quote:
Originally Posted by Wrighton View Post
We have just received the results of the dexamethasone suppression test. Her prescore was 5.1 (1-6) ; Post 4 was 2.1( less than 1.5); Post 8 was 1.2 (less than 1.5).

This LDDS (low-dose dexamethasone suppression) test was performed 2/3/15, correct? No, 1/29; 2/3/15 was the date of the results. The results are correctly listed.


Quote:
Originally Posted by Wrighton View Post
Our girl, Icy, is a beautifully coated blue Merle rough collie. She is 50 pounds, no belly, herds ducks, does therapy work, eats just as much as our other three. She does drink more than jami and Paige, but not buckets just a few more trips to the bowl. She is energetic and that energy cause a tear in her CCL for which she is having surgery tomorrow.

Icy is still not showing any clinical symptoms of Cushing's, such as excessive drinking/urinating, ravenous appetite, pot bellied appearance, hair loss/skin problems, right? As I said, she does drink more, but she always has. She holds her urine all night and has never had an accident. (She has "leaked" but DES stopped that)


Quote:
Originally Posted by Wrighton View Post
She sent us to a specialized hospital to an internist who did another ultrasound. He said that the gallbladder had to be watched.

Now with this ultrasound, was it done in February by the specialist and was it after the other ultrasound that the vet did? Yes, and the thirs was this week showing an unimproved mucoscele.
The Ultrasound by specialist was done on 2/3/2015.
Ultrasound Findings:
1) Normal liver size, disproportionate liver lobe sizes, rounded liver lobe margins, hyperechoic hepatic parenchyma with portovasculature mineralization.
2) Moderate echogenic material - gall bladder
3) Normal Stomach
4)Normal small intestine.
5) Normal spleen size/shape/structure
6) Normal kidney size/shape/structure
7) Moderate Bilateral adrenomegaly, right adrenal 0.65cm, Left 4.75
8) Mildly thickened bladder wall


Quote:
Originally Posted by Wrighton View Post
Icy came through the CCL surgery yesterday and we brought her home last night. She cried for an hour before I called the vet and he upped the pain meds.
Gail and Icy

On February 20th Icy had her CCL surgery, correct? Yes.



Quote:
Originally Posted by Wrighton View Post
Here are the results from U of T
Dexamethasone: Pre 5.1 (RefR esults1.0-1.6) ; Post 4 hour 2.1 (RR less than 1.5) and post 8 hour 1.2 (RR less than 1.5)

URINE?CPRTISOL/CREATINE
URINE CORTISOL 31.6
URINE CREATINE 90
URINE CORTISOL/CREAT Ratio 110
Comments:
< 34 Hyeradrenocorticism is highly unlikely and investigation of
other causes of the dog's climinal signs is recommended.

>or=34 HYdroadrenocorticism is possible; however a unrine sample collected from a stressed dog with nonadrenal illness can have an increased ratio.
Gail

Quote:
Originally Posted by Wrighton View Post
I so appreciate your interpretation of the results. The day of the testing,We were told to bring a urine sample, but Icy in spite of three hours of walking in our yard (4:30-8:00 am) and a stop by the duck pond on the way (she is a duck herder so I thought they might inspire her) she wouldn't go. They somehow got the sample after we left her at her vet. She was trembling when we left her. I wanted to stay but they said no.
Gail
She had not urinated since the night before

Now, the UC:CR (urine cortisol-to-creatinine ratio) result was high, however Icy's urine sample was collected at the vet's office, right?
Right, see above. They got the sample at about 11:99 am they said.



Quote:
Originally Posted by Wrighton View Post
I just TODAY got the report from the 2/3 exam and ultrasound at the specialist.
The blood work showed elevated enzymes called ALP& ALT.
The blood test called LDDST was normal. The urine test ( urine cortisol/creatine) test was positive for possible Cushings.

Physical exam findings:
1) Normal liver size., disproportionate liver love sizes, rounded liver lobe margins, hyperechoic hepatic parenchyma with portovasculature mineralization
2) moderate echogenic material - gall bladder
3) normal stomach, small intestine,spleen,kidney
4) moderate bilateral adrenomegaly, right adrenal -0.65cm-0.75
5) mildly thickened bladder wall

Conclusion: Hepatitus and cushings
Gail

Was this ultrasound performed by the specialist? yes


From what I am reading here is that Icy's LDDS test was negative for Cushing's, and the UC:CR test was high BUT the urine sample was collected at the vet's office which would make it invalid. Now, on both ultrasounds the adrenal glands were not mentioned, so I am wondering if they were visualized or they appeared normal, could you ask the vet/specialist if her adrenal glands were seen?
Yes, right was .65 cm and left .75 cm.


And, yes that ACTH stimulation post number was elevated, however, our sweet Icy has had a lot going on, such as her CCL surgery on 2/20, and the mucocele may be making her a bit uncomfortable, so that post number could be high because of these non-adrenal issues. So, I'm still not convinced Icy has Cushing's, and if the adrenal glands were seen and they are of normal size, along with those negative LDDS test results, I would be comfortable saying that Icy does not have Cushing's.

I hope what I have typed does not add any undue stress or worry to you, I only want to help and I do not want to confuse you or cause any frustration.

Your responses have kept me sane, sort of sane. With my husband's sudden death, daughter's cancer, and four things at once with Icy, I am near tears all the time.


Hugs, Lori

[Harley PoMMom]

Your responses have kept me sane, sort of sane. With my husband's sudden death, daughter's cancer, and four things at once with Icy, I am near tears all the time.

I think you are doing pretty darn good with everything that is going on, I believe I would be somewhat of a basketcase in your shoes.

Well, now, those bilateral enlarged adrenal glands do put a spin on things (how did I miss that info about the adrenal glands :eek::o) Icy sure is a puzzling case, so let me recap here:
Not indicative to Cushing's
negative LDDS test done 1/29/15
drinks more but always has but no other clinical Cushing's symptoms


Indicative to Cushing's
bilaterally enlarged adrenal glands
positive ACTH stimulation test results


I'm gonna have to ponder this a bit...

Hugs, Lori

[Wrighton]

Thanks. I feel strangely good it isn't too obvious. I've read articles and reread the results over and over and can make no sense. I've truly spent hours each day. Wish I could send you a picture so you could see her coat and shape.

Please put it aside and have a wonderful holiday. You certainly deserve it. You must have great satisfaction in the help you give.

Hugs,
Gail

[Harley PoMMom]

Hi Gail,

One important date I am missing is when that ACTH stim test was done, I believe it was included in the UTK adrenal panel right? But I can't seem to locate the correct date for the UTK adrenal panel. :o

[Wrighton]

Hi,
The date of the stim is 2/10/15 and from U of Tenn. Yes, this was the date of the adrenal panel.

Thanks so much. Would you believe? She was in the water tank which is part of the PT for her torn CCL and the door got stuck. Neither she nor the tech could get out. I tried to release it, but it wouldn't budge. The owner called someone and an hour later they were freed. Honestly.....

Gail

[Harley PoMMom]

OMGosh Gail! That would of freaked me out, for goodness sake, you just can't catch a break, can ya :eek::mad:

I have enlisted the help from the other staff members and hopefully they will be able to help you and I in figuring out our dear Icy's diagnosis . ;)

[Wrighton]

Lucky icy loves water......

Thanks so much.

Gail

[Squirt's Mom]

Oh I am so glad the tech was in there with her! How scary!

[Harley PoMMom]

Hi Gail,

Sorry it has taken me so long to get back to you, I had a cluster migraine episode which totally wiped me out.

After discussing Icy's situation with the other staff members, unfortunately we all are stumped as to whether she has Cushing's or not. With the diagnosis of Cushing's being questionable, we do believe that treatment for Cushing's should not be started. And if both the vet and specialist believe that the mucocele is an urgent issue than that should take priority right now. Is gallbladder surgery still being discussed?

Hugs, Lori

[Wrighton]

Unfortunately, the specialist has been away, and my new vet wants his consultation. She's very worried and very new. I've called twice this week after learning that the liver enzymes are improved but the mucoscele is unchanged. I don't want to wait until it ruptures. I don't know if I should just go somewhere else. I am giving her the melatonin and flaxseed hull lignans. Don't think they can hurt and until the doctors decide what is next or I decide by switching ...... She still shows no typical signs and her fur where shaved is growing quite well, not great. Well, I guess she still looks like a patchwork quilt between the shavings: two ultrasounds and CCL surgery.

Icy is walking very well. She goes to PT tomorrow. Hope she doesn't get stuck in the tub again!

Thanks.

Gail

[molly muffin]

When is the specialist back?

How is Icy doing? Goodness! What an adventure with the stuck tub door. Hope they get that fixed! LOL

[Wrighton]

I just came back from seeing the specialist today. The Cushings(?) remains unclear even to this twenty + year internist. Cortisol levels are still slightly higher than the norm. The LDDST was negative. The right adrenal gland is now slightly larger than it was two months ago, but the left is unchanged and not enlarged. The sg of the urine is now normal. Her drinking and eliminating are reduced. The mucuscele is unchanged. He says 30% of Cushings dogs develop them. Her liver is normal in size but the lobes are disproportionate. He calls it a fatty liver.

He said to continue the melatonin and lignans. He says that there has been improvement and it can take six months to fully take effect. He warned to use the brands recommended by U of Tenn. He said that he never treats a symptom free dog with lysodren or veteroyl.

While the mucuscele he says may never rupture, he says it could change quickly. He recommended removal ( everything I read does too) and at the same time a liver biopsy and a check of the adrenal gland/s. Surgery is scheduled for Tuesday. Her CBC. Is perfect with the ACT the only elevated score.

Please send her your prayers. As you may remember she had CCLsurgery only eight weeks ago. My daughter starts chemo next Friday. I feel frazzled, but trying to be faithful and sensible.
Gail

[Harley PoMMom]

Hi Gail,

Both Sarah and Icy are in my thoughts and prayers, sending positive energy too.

Looks like the diagnosis saga continues with our dear Icy, I believe what the specialist is recommending sounds like a good plan. I'm not sure if we've provided a link to the UTK lignans list so here it is: http://www.vet.utk.edu/diagnostic/endocrinology/pdf/20120316-LIGNAN-Write-Up-Revision02.pdf

You've got a lot on your plate, and I think you are doing an amazing job with everything that is going on.

Hugs, Lori

[Wrighton]

Thanks, Lori. I appreciate your help. I know that the melatonin and lignans are usually ineffective, but something has diminished Icy's drinking and eliminating. Funny thing is that she just loves the lignans and works on her bowl forever until it shines.

Don't any other dogs here have mucusceles? It seems strange. The specialist is getting stats together to publish and he showed us some of the backup data. Over 30% of mucusceles he finds are in Cushing pups.

Again thanks.

Gail

[Harley PoMMom]

Yes, I have seen this mentioned with other dogs that have Cushing's. One off the top of my head right now is Gracie, here's a link to that thread: http://www.k9cushings.com/forum/showthread.php?t=5290

Hugs, Lori

[molly muffin]

We've had other dogs that haven't necessarily developed mucusceles but are on medication for the amount of sludge in the gall bladder, which is what leads to mucusceles.

It like pancreatis is always one of the worries with cushing dogs it seems.

[Wrighton]

Just got the urine cortisol/ creatine test Is there any significance to the change in results?

1//2015. 4/15/2015
Cortisol. 31.6. 17.4
Creatinine 90. 52.3
Ratio. 110. 104

Both LDDST were negative.

Retesting was done before the surgery on Tuesday.

Thanks.

Gail

[Heartbroken2]

Hi Gail. I agree with above mend her leg & heal. How about a 2nd opinion Icy just not having the craziness of gallons of water & pee so much it's like a river. My butters also a service dog and only been on meds 2 1/2 wks. Major change I hope Icy heals up fast
Robyn & Butters

[Wrighton]

Her leg is better. She had that surgery eight weeks ago and has had PT each week.
This is the gallbladder surgery. Part of the reason the specialist keeps talking Cushings is the mucusceles. Apparently, clotting is affected too. I sure hope she can survive I've read apparently the three days post surgery are the days up to 49% die.
Honestly, this is far beyond me. All the tests show cortisol going down, not to where it should be , but down.
Meanwhile poor dog has to watch the others run and play in the yard but her leg stops that. She sits on the blocked deck and sends regards by a bark here and there.
For ten years she has herded, done therapy work and lived a happy healthy life with her three buddies.
Wish it were only one thing. If she has Cushings, I think we can handle it but Cushings, Hepatitus, mucuscele and torn CCL, I'm not sure. Hope she knows all the pain we are putting her through is because we love her, not that we are punishing her.
Gail

[Robert]

She knows. Prayers for her and hers. Cheers

[Harley PoMMom]

AWWW, Icy sure is gorgeous. I truly believe that our furbabies can feel how much we love them, and do somehow know that what we do is because we love them so much.

Regarding those UC:CR results, I wouldn't put much stock into those results, from what I've been reading vets believe a single sample of urine for the UC:CR does not accurately gauge urine cortisol levels and instead that a first morning pee should be obtained for 2 or 3 consecutive days and then pooled together. Also, even if the results are high on the UC:CR, this does not rule Cushing's in because other non-adrenal illnesses and even stress can cause those cortisol levels to rise.

A renowned endocrine specialist, Dr. Feldman, states that for an UC:CR test the urine should be collected over a 24-hour period as this is the protocol that is followed for humans. https://books.google.com/books?id=RwujBQAAQBAJ&pg=PA463&lpg=PA463&dq=high+Creatinine+level+in+an+UC:CR+test+in+a+dog&source=bl&ots=e_5aoLbdrY&sig=dWIOEjPQfmvUn93p_LSb8cv_SQ4&hl=en&sa=X&ei=REA0VeTOC8SlNuDSgKgM&ved=0CEEQ6AEwBQ#v=onepage&q=high%20Creatinine%20level%20in%20an%20UC%3ACR%20 test%20in%20a%20dog&f=false

I know Icy's surgery on Tuesday is approaching fast so I will be saying extra prayers for Icy and also for your daughter, Sarah.

Hugs, Lori

[Wrighton]

Thanks, Lori. She is walking with only a small limp. I'm considering trying to somehow label the leg so no one moves her in a way it would damage it during her stay. I am putting a big label on her collar to note she is mutant/mutant MDR1 which limits types of meds, some of which are anesthetics. Honestly, they should already be aware, but nothing has been logical so far. If there is anything I can do to help her, please let me know.
Sarah is starting chemo this week. She will get Six weeks, then radiation followed by a year of Herceptin.
I am so grateful for you all. Lori, you have been so supportive.
Warmly,
Gail

[Wrighton]

We are happy , we are thrilled. Icy came out of surgery fine. Her blood pressure and heart rate had stayed constant the whole time. They let us see her after two hours for five minutes and she was already standing albeit swaying. We talked with the surgeon who said her organs looked "pristine", except her gallbladder which he said when he opened it looked like solid black jello. He said it was a walking time bomb. She will be in intensive care until tomorrow morning or afternoon at least. They she will be in the regular areas until Friday when she might be able to come home.

Thanks for all your good thoughts.

Gail

[molly muffin]

Oh this is wonderful news!!!! Yay. So glad she came through like the trooper she is. Hopefully she will have a quick and easy recovery and be her old self in no time at all. It does sound like that gallbladder was a real doozy of a mess inside of her.
Keep us posted. Hopefully Sarah's chemo goes well this week and she too sails through with no problems.

[labblab]

Oh Gail, this is such terrific news! Thanks so much for taking the time to let us know. Tons of well wishes continuing to flow to sweet Icy girl!

Marianne

[Squirt's Mom]

Great news! So glad you got to see her for a minute, too. Praying all goes well with Sarah's treatments.

[judymaggie]

Excellent news! I'm sure Icy was thrilled to see you even if she was groggy. Sending prayers and good wishes to Sarah!

[Harley PoMMom]

Oh Gail,

I am thrilled!!! So, so happy our dear Icy's surgery was successful, and am glad the surgeon got that ucky gallbladder out...YAYAYA!!!! Sending healing thoughts and hoping that Icy has a speedy and uneventful recovery...please do keep us updated and give Icy some hugs and kisses from her Auntie Lori.

[Wrighton]

I went to visiting hours this morning at 10:30 AM. I waited and waited for Icy's nurse to come. When she came into the waiting room she had a clipboard and serious face. She said that the doctors had just finished rounds. They decided that icy was well enough to be released. I was amazed. I had been told it would be Thursday or Friday. The nurse said icy had eaten all her breakfast, had peed twice and had one bowel movement. Her CBC from the morning showed all results within the normal range. She was up and walking in her "room." Her blood pressure, pulse and temperature had remained perfect and constant since she entered. She put me In a conference room, gave me instructions, oral and written, gave me icy's meds, pain pills and a bottle of antibiotic, said she would get Icy and off she went. She got Icy and helped get in the car. And off we went. Amazing!

She just ate dinner, went out and peed and actually did a small bowel movement. Yeah! Thanks for your thoughts and prayers. I know they helped. I know I've required a lit but could you continue to remember Sarah as she starts treatment on Friday.

Hugs,
Gail

[molly muffin]

Of course we will be thinking of Sarah. :) There was never any doubt of that.

So glad to hear that Icy is doing so well on her recovery. That just couldn't be better news to hear after a surgery. Awesome!

Let us know how she continues to do!

[LtlBtyRam]

Of course we will remember Sarah. Glad to hear Icy has done so well and is home with you. It is so hard when they are away from us.

[Harley PoMMom]

I know I've required a lit but could you continue to remember Sarah as she starts treatment on Friday.

Hugs,
Gail

Oh Gail, do not ever feel like that, we are here to support you in any way we can, and we definitely will be keeping Sarah in our thoughts and prayers.

So happy to hear that Icy is doing so well, atta girl Icy!!

Hugs, Lori

[Squirt's Mom]

Oh Gail, what great news this morning on Icy! YAY! SO glad to wake up to see this! :)

As for "asking for a lot" - geez, woman, that is what family is for! To rejoice with each other in good times and to support each other in the not so good times. And we are family here at K9C. So of course your precious Sarah will be remembered in prayers, in thoughts and the myriad ways we may honor her as she faces this battle.

Hugs,
Leslie and the gang

[Wrighton]

Of course, icy was shaved along her whole underside once again, and today Sarah had her waist long hair given to Locks of Love as she prepares for tomorrow.

Life has ironies for sure.

Thanks for all the support and mostly the prayers.

Gail

[molly muffin]

Thinking of Sarah and Icy both today. Hope they are both doing okay.

hugs

[labblab]

Me too!!!

Marianne

[Budsters Mom]

Me three!!!

Kathy

[LtlBtyRam]

Adding my thoughts too!

[Squirt's Mom]

Hope Sarah is doing alright today. She has many new friends pulling for her, praying for her, lifting her up in hope and courage. You have your hands full with your baby girls; let us know how they both are when you can.

Hugs,
Leslie and the gang

[Wrighton]

Thanks for your continued support. Our Icy seems okay but we have a call in to the surgery center. There seems to be a "pocket" following her rib cage line, purple in color and perhaps containing blood. The incision is at least eight inches long. Hope we get a call back soon to explain this. She is eating, and she does walk around. Her operated on right rear leg seems much stiffer than it was. Guess that is to be expected. I just don't know

Sarah got home after eight last night after getting there at eight am. They were checking for an aneurysm. She was exhausted and went right up to sleep. Had to wait for details because the girls, of course, needed Jeff's attention. Poor Jeff. He is so good to everyone and now his mother's cancer has returned. She starts chemo on Monday.

Thanks again.

Gail

[Wrighton]

Icy has always loved her water, but since the surgery she has periods where she drinks bucketfuls. We never limit her water but the instructions for the antibiotic says not to limit it. That makes me wonder. Why would that be stated? Does that mean this increase in drinking is connected?

Then, yesterday we called the hospital because Icy had developed either bruises or pockets of blood over the bottom of the ribs. The surgical nurse said that was due to being Cushings. She said Cushings dogs bruise more. We should call or bring her in if any worse or if it leaked out. This morning the right side is absorbed or at least gone and there is less on the left than there was. Is that really because she might have
Cushings? Other than that she seems okay, except for the drinking excessively I mean.

Gail

[labblab]

Hi Gail,

I'm sure glad to hear those pockets are improving. As for the instruction to supply plenty of water...I think there can be multiple reasons for that: to avoid throat and stomach irritation, to make sure the antibiotic is absorbed efficiently, to keep the system well flushed so the drug is not accumulating in the liver or kidneys, etc. As to whether or not the antibiotic is increasing Icy's thirst, I don't know but I suppose it is possible. Increased thirst could definitely be caused if there is any steroidal component to any of her medications. And I suppose there is always the possibility that she might have developed a UTI while being boarded at the hospital. It seemed like my Cushpup always came home with a UTI after he had been kept at the vets for a few days. I always wondered whether it was from the stress of being there or whether maybe he was just not allowed to urinate frequently enough while being confined. :o

Anyway, I sure hope everything normalizes for Icy quickly!
Marianne

[Wrighton]

Icy's gallbladder surgery was one week ago today. We are so relieved to have that past us. The "blood pockets" above her ribs are much better. The one on the right is now just a healthy bruise and the left side has emptied mostly, still very purple but much less. She has been wanting to walk around on lead in the yard more and so her operated on leg is looser and there is less of a limp. Her water drinking is diminishing some, still more than before, but not like right after surgery. She goes to the hospital in a week and hopefully we will get a result from the liver biopsy as well as instructions of any changes needed for living without a gallbladder.

My daughter is not having any nausea following her first chemo. Her husband is wonderful and with his help and support, she is keeping up with their two young girls. I have become a meals on wheels for her family and her husband's mother's.

Thanks for all your support.

Gail

[Harley PoMMom]

Hi Gail,

Happy to read that Icy is doing so well!!! Do let us know what the vet says.

Also I am glad to hear that Sarah didn't have nausea with her initial chemo treatment. With my sister's chemo, if she doesn't keep herself hydrated she will get nauseated.

Keeping you all in my thoughts and prayers.

Hugs, Lori

[Wrighton]

Good morning,
I just got a message from our Internist that the liver biopsy showed a staph infection in the liver, enlarged cells and numerous nodules. The mucuscele was confirmed.

He is putting her on a three week regimen of antibiotics in addition to the antibiotics she is currently taking. We are to continue the Marin and Denamarin. Continue also the ursidiol, melatonin and the lignans.

Good news. Bad news. No idea.

Gail

[molly muffin]

Oh not what we wanted to hear. Hopefully they can knock this liver infection out with the antibiotics. How are they going to recheck to see if it is gone?

How is doing?

[Wrighton]

I am in tears. Icy was released because she was supposedly doing so well one week ago. The surgeon said her organs looked pristine. They discovered the staph infection through the liver biopsy at the time they removed the gallbladder which had no bacteria and called today when the biopsy was received. He said the amoxicillin 2 times a day would take care of the staph. I've read on the net everything I can find but little refers to staph of the liver. He didn't say how he would know the staph was gone. However, Icy's CBC at discharge was perfect, so I guess that wouldn't work. I sure am not going to put her through another biopsy to find out. The nodules didn't show on the ultrasound and weren't seen during surgery. Honestly, there is no end. Then there is the worry about the contagious nature of staph. Can that affect my daughter who is doing chemo?

I would so appreciate some answers. I am still digesting it all.

Gail

[labblab]

Awww Gail, I'm so sorry for all this new worry. Being the Queen of Fret myself, I'm gonna offer a suggestion, though. You have some very specific questions that I'll bet the Internist can answer quite easily. None of this may actually be as worrisome as you are fearing. Or if it is, at least you need some thorough answers. For sure, he should be able to tell you whether there is any danger of contagion to your daughter. It sounds as though you only got a message earlier. I'd encourage you to list out your questions and put a call back in, saying you need to speak to him personally. I really hope you can find out more info that will better clarify what you are really dealing with.

Marianne

[molly muffin]

I completely agree with Marianne. This requires either, a direct phone call with the specialist or a face to face discussion. You need to know what you should be worrying about what you shouldn't. For now, Icy is having a grand time and recovering from her surgery just fine.
So first, make that list of questions and then pronto, speak the specialist.

Google as I was just saying is both a blessing and a curse. It's great to learn and be able to have knowledgeable discussions but it can also scare the bejebees out of you.

Hang in there!
hugs

[Wrighton]

I did try, but only got the nurse. She knew only that the amoxicillin should be added to the zenaquin and all eight other things should be continued. The doctor is unavailable today, but he will try to call tomorrow.

I am frustrated. I have a Masters in Research and Writing but can't find the answers I need on the Internet. Lot of good that degree is. All I can find is canine staph relating to skin lesions and one entry that states it is unusual for it to be transmitted. Hope that's right. Until I can find out for sure I'll stay away from Sarah and the girls. I have a general vet friend. Maybe she can help.

I did find references that staph infection of the liver can be related to Cushings.

Thanks for trying to help.

Gail

[molly muffin]

I didn't find that one about staph infarction related to Cushing's. Do you have a link for it? I was trying to find something earlier but nothing definitive came up.

Try calling your vet friend and the internist tomorrow.

Hang in there.

[LtlBtyRam]

Positive thoughts and healing energy from us to you.

[Wrighton]

The Staphylococcus bacteria can live free in the environment, on the skin of a host as a parasite, and in the upper respiratory tract of animals. The bacteria can be transmitted easily from animal to animal and in some cases from animal to human. This infection can be found in any breed of dog, and at any age.

(I don't know how to copy address when using my iPad or I would have.)

I found the above quote. I tried to find the one that named Cushings, but had been so many places I haven't located it again, but will look. All focus on staph infections of skin as the one above. Some talk about respiratory, but only a few sites even mention liver. This is truly another nightmare. First, it was the lepto that took four weeks to finally decide it was the vaccination that gave positives, now staph. Not sure what to do next except keep Sarah away and her girls until I know for sure.

As always, Icy seems fine except urination and drinking is increased.

Thanks.

Gail

[labblab]

Hi Gail,

I sure hope you've heard back from the Internist and gotten the info you need!

As it turns out, I now know a bit more about staph infections of the skin that I had wanted to know! -- I'm home from taking my younger Lab girl in to be seen for skin lesions, and my vet thinks it is staph. What he has told me is that staph really is everywhere, all the time. If you cultured any of our skin, you'd undoubtedly find it present. However, it typically does not "blossom" into overt infection except for the young, elderly, or if something is amiss (skin trauma, allergies, immunocompromised state, etc.). Cushing's is definitely a disorder that can leave dogs more vulnerable to chronic skin infections of all sorts, including staph.

But these are staph infections of the skin that we're talking about. With Icy in mind, I asked him if he had ever heard of staph infections of the liver. He said no, that is not commonly the type of bacteria that would infect the liver, and frankly, he had never heard of it happening. So it is no surprise that you are not finding any related info on the internet! It also makes me wonder whether somehow the info left in the message was incomplete or confused. I really, really hope you will be able to talk directly to the vet ASAP in order to get your questions answered. We'll ALL be very interested in the answers!

Marianne

[Wrighton]

After a totally sleepless night, I got up and went the hours's drive to get a copy of the pathology report and to talk to the doctor. I wanted the report to give a copy to my daughter ' s doctor. Of course, I wanted it to share, too.

FROM THE REPORt:

The histopathogy results from the gallbladder was compatible with mucoscele.
The bacteria culture from the gallbladder yield no growth.
The bacterial culture from the liver revealed coagulate negative Staphylococcus. The histopathology from the liver revealed nodulars hyperplasia and cell swelling representing Cusging's disease.

Four sections from the submitted sample were examined. The lining of the gallbladder is columnar mucus secreting columnar epithelial cells that line thin papilliferous projections into the lumen. There is minimal multi floral lymphocytic infiltrate in the lamina prop ia. In one area the tunica muscular is hypertrophied. In one section there is a small amount of liver adherent. There is multi vesicular change of hepatocytes. The distended lumen contains mucin and insipissated bile. The vascular change in the hepatocytes is potentially reverse able. However, the APPLE remains elevated , consider testing for hyperadrenocortism


He says that the Staph is not contagious. Hope he is right.

Hope you understand this better than I do. Parts are clear, others very obscure.

Thanks for taking this roller coaster ride with me.

Gail

[labblab]

Alrighty then! So the liver really can contract staph infections. We knew Icy was one of a kind, but she is really pushing it here...:o

But did the vet not explain any of these things contained in the pathology report? How frustrating if you drove all that way only to be handed the paper without any explanation! Is he worried about this staph infection, for instance?

I do know that Cushpups often exhibit liver abnormalities, but the abnormalities do not necessarily translate into abnormal function. I have no idea what is meant by elevated "APPLE." But again, without more information, we don't know whether these changes are significantly worrisome or not. Since they are consistent with Cushing's, though, they are definitely another piece to fill into the diagnostic puzzle.

But aside from just reassuring you that the staph is not contagious, did the vet offer you any additional info at all?? If not, I am really annoyed at him on your behalf! :cool:

Marianne

[Wrighton]

I talked to him through the nurse who cared for Icy after her surgery. She was lovely the day of surgery coming out many times. She called her the "woman". Two hours post surgery icy was up and walking around her suite. Kim said she found her strong and determined.

I made a list as you suggested. First, infectious? Second, type of Staph. Third, how will I know it is cleared? What food should she be eating? Bottom line....

She took it back to the procedure room where he was working on an emergency.

First, no it is not infectious.
Second, it is coagulase negative Staph.
Third, he said when the exact strain is known, the exact med. can be given assuring the results.
Fourth, low protein and low fat. He gave a recipe for homemade and names of two prepared brands.
Bottom Line is that there is no cancer, and the Hepatitus caused by the staph is remedial. The liver enzymes will be checked in eight weeks. At that time if the ALT is elevated, we may need to do more. She is to continue with he course of zenadrin and amoxicillin, and long term: marin, denamarin, ursidiol, melatonin, lignans, and DES once a week.

Guess it is good news. Hope so.

Thanks.

Gail

[Harley PoMMom]

Found this definition for "APPLE."
Additionally, the acute patient physiologic and laboratory evaluation (APPLE) fast score was evaluated at admission. http://onlinelibrary.wiley.com/doi/10.1111/jvim.12474/full

My goodness Gail, I sure am sorry issues keep popping up, I am so hoping things start to turn around, you and Icy sure need to catch a break, ain't.

Hugs, Lori

[molly muffin]

Hi Gail, great to hear it isn't infectious. I am sure that is a load off your mind with your daughters chemo. Hopefully Icy will have good numbers on her next test.

Hope Sarah is still doing well with that. My sister didn't feel too nauseous till later in the treatment, I think around the time she lost her hair and she didn't feel bad every time.

[Wrighton]

Sarah was believed to have an aneurysm when they put in the port. Not sure while, but they have concluded after two MRi's that she does not. She is not eating and is now very tired. It is sad. Hope things get better for your sister.

Icy goes on Tuesday for stitch removal. Maybe then she can walk off lead in the backyard a little. Between the torn CCL and then the gallbladder, she hadn't been off lead since January. She seems happy and alert. She is drinking more than before the last surgery but that seems to be diminishing. Her hair is growing in but slowly from all the shaving for two ultrasounds and two surgeries. I feel like it's growing back will be a sign of improved health. In eight weeks the specialist wants another liver enzymes test.

Here's hoping.

Gail

[molly muffin]

My sister had chemo for breast cancer, for which she had a lumpectomy, and has now been cancer free for 7 years.

My mom had a masectomy for her breast cancer and had radiation treatment for both that and cancer of the saliva glands. So we've been through both in our family. Mom has sadly passed now, but not from any of the cancers she had, those she recovered from completely. I think the radiation treatments where harder than the chemo treatments.

I hope Sarah will get through this okay, it sure is scary. Loss of appetite is pretty normal, but she does have to try to keep getting nourishment, as she needs her strength. Have they given her any supplemental ideas, if she can't eat, can she keep down something like a nutrition drink maybe?

That is definitely a good sign that Icy's hair is growing back in. Remember it can take liver enzymes a while to bounce back. That she is happy and alert is excellent.

hugs

[Wrighton]

Sarah has Hers2 positive Breast cancer, not the kind one would choose. I carry one of the mutant Breast cancer genes, and I 've had numerous surgical biopsies and complete hysterectomy for ovarian cancer. My mom, grandmother and maternal aunt died of breast cancer. Funny thing is Sarah is one of our three adopted out of our six. My son and his wife, almost PhD bio chemists are working on a triple negative cancer drug with their company Merck. Life is strange.

Tomorrow Icy's stitches come out. I've read she'll feel much better after that. Maybe she can go off lead in our fenced yard for a little while as we watch for deer. She hasn't been off since January and the CCL fiasco. She is still drinking more than before surgery, but it seems to be lessening. I sure hope we can keep her on the melatonin and lignans, especially till we get her liver back in shape. Her recovery has been a really bright spot for me. Hope it continues. Do you think she should be put on one of the big guns with only her increased drinking? She obviously does have Cushings based on the pathology report. Do the big two slow the disease?

Thanks so much.

Gail

[Wrighton]

Staples out! Surgeon has released her. .... I am thrilled.

She is still drinking more than before the surgery. Normal?

Gail

[Harley PoMMom]

Hi Gail,

It's good to hear that Icy's stitches have come out....YYAA!! Is she taking any medication such as pain meds, antibiotics?

[Wrighton]

She has no pain meds and really doesn't seem to need the. She is finishing the zenadrin today which they gave her after surgery. She is still taking and will be for several weeks the amoxicillin for the staph infection of the liver they found on biopsy.

Do the antibiotics make her drink more? She is since surgery.

I got a call after returning home asking for my credit card number. They take the amount of their estimate when you come for surgery and they were returning $575 to the card because of Icy's "uncomplicated" recovery. I was shocked.

[Harley PoMMom]

She has no pain meds and really doesn't seem to need the. She is finishing the zenadrin today which they gave her after surgery. She is still taking and will be for several weeks the amoxicillin for the staph infection of the liver they found on biopsy.

Do the antibiotics make her drink more? She is since surgery.

Antibiotics usually do not cause an increase in drinking/urinating, but all dogs are different and can react differently to the same med. I googled zenadrin and can not find any information about it, did the vet tell you what this medication is and why Icy is taking it?


I got a call after returning home asking for my credit card number. They take the amount of their estimate when you come for surgery and they were returning $575 to the card because of Icy's "uncomplicated" recovery. I was shocked.

WOW!! That is great!

[molly muffin]

awww, so great to hear that Icy is doing so well. I bet she loves having those staples out too. I would. LOL

Wow! That is awesome that you actually got some money back. How cool is that!

[Wrighton]

She was given the zenadrin along with a pain med when they discharged her.

If the drinking increase isn't because of the antibiotics, I wonder if it could be the anxiety .....or the Cushings finally exhibiting a symptom. Don't know.

[molly muffin]

Just monitor her and see how she does for now and if once she is fully healed if the water consumption continues.

[Wrighton]

Icy is back to her usual exploring the backyard and is taking the stairs well, too (not the flight inside the house, just the outside ones). What a difference two weeks makes. Her leg is good, too.

Her coat is slowly growing back, four shaves is giving a challenge in that regard, but it is coming. Her water intake has slowed a little. Yesterday she was home with her buds and went seven hours with no accident, but she sure was glad I was back.

If we started one of the "big guns" because of the nodules in the liver and her having developed the mucoscele which the specialists say are cushing markers, and her torn CCL which is now repaired, will the meds not cure, but slow down the Cushings? I am wondering if my not wanting to go to them is letting Cushings advance more quickly than it would with it. The confusing test results, lack of normal signs ( no belly, hair loss, food craving. Personality change,etc.), and general well-being confuse me. All her symptoms are internal: mucuscele and liver changes. Do the meds slow the disease?

Happy Mother's Day!

Gail

[Harley PoMMom]

Hi Gail,

So happy to hear that Icy has rebounded quickly from her surgery and is doing well!!

And, yes, the medications for Cushing's that are given do halt the damage that the elevated cortisol can do. In Icy's case, though, since she does not display the commonly overt symptoms seen in dog's with Cushing's and with the negative LDDS test result I would not start treatment until those symptoms of Cushing's are observed and the tests for Cushing's do validate a diagnosis for Cushing's...now, that's just my 2 cents worth ;)

Hugs, Lori

[molly muffin]

I'd monitor and see how she does. You can start one of the meds at any point if you and the vet decide that there is definitely cushings in play, via retesting for cushings at some point in the future.

[Wrighton]

Thanks. I just don't want the disease to advance. We love our strong "woman" so much. She has done her part. I want to be sure to do mine.

Thanks.

Gail

[molly muffin]

Of course you don't and I understand that too. With the negative LDDS test, that makes it harder to say what is going on for sure, which is why I am thinking, give it a little break, let her totally recover from everything she's been through and then retest. See where you are at without the complications from the gall bladder, leg, etc. It might show a different picture.

[Wrighton]

Thanks for understanding. I have an appointment in six weeks to get a liver enzyme test. I'll share those results when I get them. I know that this confident little woman is reduced to a shaking collie every time we take her anywhere in the car because each time has been surgery, ultrasound, shots,bloodwork,etc. Since December four ultrasounds, two surgeries, hospitalization and all the PT sessions.

In spite of noticing only a little leaking during naps, she needed all this! I'm so afraid of missing the next emergency.

The doctor said if she seems good she can resume short sessions of her therapy work. She sure loves those visits. I'll see what two weeks brings.

Happy Mother's Day

Gail

[Wrighton]

Your advice was right on. Time has been good to icy. She is up and chasing her beloved bunnies, and best of all her drinking and peeing are now back to her normal. She drinks slightly more than the other two, but not too much more. Her fur is growing back slowly. She looks like she went to a beauty school and got the newest student. I do worry that she might get sunburn where they shaved so much for the gallbladder. Doctor said to continue the lignans and melatonin.

Sarah is in her fourth week of treatment. The first few weeks she was okay, but now she mostly rests. She is eating very little. She is slender always, but she is looking gaunt now. Her daughter's birthday is Sunday, and hopefully she will be able to enjoy it.

Warmly,
Gail and Icy

Thanks for all your help. It is four weeks ago that Icy had her gallbladder surgery and it will be four weeks until we get the next liver enzymes. Not sure how they will know if the staph infection of the liver is gone because it took the liver biopsy to find it.

[Harley PoMMom]

Glad to hear that Icy is doing so well!!

Chemo sure is hard on a person, my sister, Eva, has lost around 50lbs since she was diagnosed in October, doc told her he doesn't want her to lose anymore weight. Eva eats like a bird, so she started drinking those nutritional shakes, she really likes them.

Wishing your granddaughter a early Happy Birthday!! And sending healing and positive hugs your way, Lori

[Wrighton]

Lori,
Just got a book put out by the American Cancer Society, "what to eat" and another by Merck. They suggest recipes for all the phases of chemo treatment.

Sarah can't lose 50 pounds. She is normally 5 feet 2 inches and 102 pounds.

Best thoughts and prayers for your sister and you.

Gail

[molly muffin]

That is wonderful to hear that Icy is doing so well. Yay!!

I think the further you get into the chemo treatment the harder it is on the body. It still better today though than it was years ago, I think.

That sounds like a really good book and plan, diet along the stages of chemo. Wish Sarah all the best. Hope she enjoys the bday party.

[Wrighton]

Sarah grows more and more tired, has lost all her hair, and so far is able to eat most things.

Our icy has continued to improve her walking/running. She has co tuned to eat and poop as should be. Her drinking is back to her level pre December. Likewise, her urination is more than the other two, but as usual for her. Her fur is growing in but very slowly. Of course, four shavings for surgeries and ultrasounds can explain some of that. She is still on Marin, Denamarin, melatonin and legans.

On June 14 we have an appointment to have an enzyme test. What else should we get? For her "Cushings"? For her staph liver infection? Absent gallbladder? I'd like to avoid her having any additional trauma so want to get everything done together.

Thanks for all your help to Icy and so many others.

Gail and Icy, the dog with confusing tests

[Harley PoMMom]

Oh, sorry to hear that Sarah is having a rough time, that chemo sure does wear out my sister too. :(

Glad to hear that Icy is doing well!! The "enzyme test" is this a CBC/chemistry blood panel? If not, then I would recommend having that done along with an urinalysis. I wouldn't have any other test performed until the results of that blood panel are known...just my opinion.

Hugs, Lori

[Wrighton]

Last time the liver enzyme test was a blood test. So, I'll ask for a full CBC. Is there a test using the same blood draw that would reveal anything about Cushings?

The internist insists she has Cushings based on the ultrasounds , the torn CCL and the mucuscele She still remains slender with no pot belly, fur returning albeit slowly, moderate drinking and peeing. Able to hold urine eight hours easily. Her right rear leg is still weaker than the one she didn't injure, but.... She goes to PT for that. She pants after being outside in the eighties, but so do her two companions. I feel comfortable with the melatonin and Lignans which she licks the bowl until shiny. However, he had mentioned that after recovery from gallblatter, maybe to consider Lysodren.

Just want things as easy for her as possible.

Hope your sister is doing well. It is so tough.

Gail

[molly muffin]

Sorry to hear that Sarah is feeling so awful from the chemo. It left my sister exhausted too and she lost all her hair also. It does grow back after the chemo though and she gradually started feeling better too.

I agree with Lori. You still have to take things slowly and one day at a time. I'm not sure why they think definite cushings from the ultrasound. It didn't show an adrenal tumor or I don't recall you mentioning one and if something else was going on (and there was), gall bladder and liver infection, then she would produce excess cortisol in reaction to that and it would eventually cause the adrenals to be enlarged because they where producing excessive cortisol.

However, with those issues now being addressed, once they are completely healed, then that may no longer be the case and cushings might not be a factor at all. You can't tell for sure till everything else is cleared up, she is fully recovered and then if you want to do an LDDS test at THAT point and only at that point, you could.

I definitely wouldn't do it now and I wouldn't even consider starting medication like lysodren or vetroyl unless that point is reached and cushings confirmed.

I agree with Lori, baby steps here. Icy is doing good and still on the road to recovery.

hugs

[labblab]

Last time the liver enzyme test was a blood test. So, I'll ask for a full CBC. Is there a test using the same blood draw that would reveal anything about Cushings?
A blood chemistry panel and a CBC are two different panels, although many labs offer them linked together as part of a particular testing profile like a "Senior Profile" or a "Wellness Profile." Both panels can record abnormalities that are typical of Cushing's.

A chemistry panel is where you will find the liver enzymes, glucose level, kidney markers, pancreatic enzymes, basic thyroid, cholesterol, and chemical levels such as sodium, potassium, phosphorous, etc. Cushpups commonly exhibit elevations in certain liver enzymes and cholesterol along with lowered thyroid. A normal glucose level rules out diabetes.

The CBC offers complete blood counts of both red and white cells. Cushpups sometimes exhibit characteristic abnormalities in blood cell counts, too.

Taken alone, none of the lab abnormalities can confirm Cushing's. But in conjunction with more overt symptoms, if a dog exhibits a characteristic pattern of these blood abnormalities, it lends further fuel to the speculation that Cushing's is present as an underlying condition that is at the root of many/most of the problems.

Marianne

[Wrighton]

Thanks for being so patient with me. So I want a blood chemistry which includes liver enzymes and a CBC, sometimes calls a senior panel.

Would anything show that the liver staph infection has cleared?

The ultrasound showed no adrenal tumor, but one pituatary gland was larger than the other. The internist insisted it was pituitary Cushings. The last LDDS test did not prove Cushings.

Thanks so much.

Gail

[molly muffin]

Yes that is what you want. I assume that they want to see what any and all of her liver numbers will be on this test compared to the last test to see if they can tell if the liver infection is gone. From what I've read most dogs liver infections do clear up with the medication.

[Squirt's Mom]

How is Sarah doing?

FYI - dogs, and we, only have one pituitary gland and it is located in the skull. There are 2 adrenal glands, tho, and if the ultrasound shows both adrenal glands enlarged, that is indicative of pituitary based Cushing's or PDH - Pituitary Dependent Hyperadrenocorticism. In the adrenal based form, ADH, one adrenal gland will be much larger than the other and the smaller adrenal gland is often atrophied. So I would make sure I heard correctly about which way they saw the adrenal glands (they cannot see the pituitary on an abdominal ultrasound) so I knew whether we were dealing with pituitary or adrenal based Cushing's. That comment of one gland being larger is important. ;)


The ultrasound showed no adrenal tumor, but one pituatary gland was larger than the other.

[Wrighton]

Today I received the results of the hematology and chemistry for Icy. This is the one eight weeks post gallbladder surgery. I am very upset that the liver enzymes have not improved and some are worse.

The out of range results are:
MCV 53 ( 59-76)
MCHC 43.2 (32.6 - 39.2 g/dl)
Lipemia observed
ALT 170 (18-121)
ALP 493 ( 5-180)
GGT 19 ( 0-13)

The Internist's nurse said that the doctor said to add Marin (already taking it) and ursidiol ( which she took before surgery but he stopped after.)
I really don't understand what the above means. She said that's all the doctor said and did not explain the results. How bad is the liver? Is Cushings causring it?

Her drinking and peeing are now normal, and she shows no clinical signs of Cushings three months after starting melatonin and lignans.

I would appreciate any help in understanding and treating my girl.

Thanks,
Gail

[molly muffin]

Well Ursidiol is also used to treat liver problems, not just gall stones, so I think that is why he wants you back on that.

Maybe look into denamarin, which has both the sam-e and milk thistle as a support instead of just the marin. (sam-e)

So, how bad is her liver.... I don't think that can be answered specifically from these tests and the reason why I say that is because she was shown to have a liver infection, so there is bound to be some residual effects to the liver from that infection.

On the whole those the ALT, ALP, GGT are not so very elevated that it is dire. Most ALT results need to be 3 times the high normal before they look at treating any kind of liver disease. ALKP can be raised due to liver or a number of reason, high cortisol for instance due to the liver and gall bladder issues, can raise it. GGT can also be increase due to the infection or cortisol increase. So, again not so every bad. What you want to do now, is see if this is going to trend upwards or if they are going to eventually start to come down.

Not sure about the red blood cells, but since they too can be affected by infections and medications for the infections, I'd see if those don't come back into normal range too.

Cushings is still not on the radar. We're still about trying to recover from the liver and gall bladder. This is a long journey, and you say she acts just fine, her drinking and peeing are normal and so that is all good.

Remember too that the liver is a tough little organ, and it can regenerate, even when parts of it are removed, so considering how she is acting (like she is fine) then I think you are still doing good and on the right track.

How is Sarah?

[Wrighton]

Thanks so much for your so informed reply. I was so upset because the blood results were worse. I am thrilled when she boogies across the yard leading my three chasing a deer or other animal who decides to enter her yard. Yet from her demeanor I thought they would be down and improved. I still don't know how they can know the staph infection in the liver is cured when it took surgery to find it. Icy had very loose stools several days before the blood work, the stool tested negative but the reg vet put her on Metronidozole. One dose and it cleared up, but she was to take the med for seven days. Could that change the results? She was three days into the med. when her bloodwork was doing. on the other hand, her knee is very good after the CCL surgery, She runs , climbs stairs easily and has hardly any limp. She still goes for water therapy, but soon will stop. She can swim in the pool instead.

Sarah gets more and more tired. She goes to the radiation oncologist next week. Hope that goes well. She misses her dad. I am making chemo caps to share with others at Kessler. I can't do anything meaningful to beat down the cancer, but if it will make it one little bit more bearable, I'll keep sewing. My goal is ten a week for others.

My son , Timothy, a melanoma survivor, and just married three years told the family Sunday that he and Rebecca are expecting a baby on Thanksgiving. We will all be very grateful and really are already. We weren't sure what his treatments when he was twenty-three would mean to his having a child.

I feel so fractured.....everything is good/bad......

Thanks so much,
Gail

[Wrighton]

Sorry, but forgot to mention in last post that Icy has been on Marin, Denamarin and until the surgery Ursidiol. That along with melatonin and lignans. She takes DES every three days.

Sorry.

Gail

[molly muffin]

ahh, okay, so bases covered there.

[Wrighton]

Hi,
We started the ursidiol as directed by the Internist because Icy's liver enzyme levels had risen. Since we restarted the ursidiol, she is drinking a lot. In fact, almost twice as much as she had drunk. This is the fifth day back on ursidiol and the drinking in excess has continued. Is this normal?
My own vet who was going to call to explain the blood chemistry and liver enzyme results has still not called. On the other hand, the Internist's nurse has called about adding med and reminding me the the internist wants another test done in 30 days. I think I need a new vet!
Gail

[molly muffin]

I really don't know if ursidiol will increase water drinking or not. I couldn't find anything on it, and I don't know how different it would be for Icy with her gall bladder removed either.
These are questions that should definitely be pursued with the vet. Did he ever call you?

[Wrighton]

No, the vet never called. I still don't know what the red blood cell results mean, nor did she explain anything. My dilemma is that the internist is an hour more away, and so much more expensive for drawing blood, etc. moreover, the internist likes to work as a referral.

I don't understand anything. I feel so dumb. She was drinking normally until we restarted the ursidiol and now she is tanking. She has no gallbladder, but I am giving gallbladder medicine. She seems fine, but apparently is getting worse. The internist insists she has cushings, but she shows no signs (except now the water again). Etc,, etc, etc.

Sarah has been very sick. She is in her tenth week of chemo and very tired but not nauseous, now she had to go to hospital on Saturday because she vomited non-stop for two days. Dr. Says she has a sinus infection,,,,,,,??? Honestly, nothing makes sense.

I try to concentrate on my upcoming grandchild. As I said, we weren't sure TJ could father a child after his treatments for the melanoma when he was twenty-five.

However, Sarah and my Icy jump ahead in my thoughts because I think I should be able to help, but of course I really can't, but keep trying.

Thanks for checking about the ursidiol.

Gail

[Squirt's Mom]

Prayers rising for your sweet Sarah and Icy.
Hugs,
Leslie and the gang

[molly muffin]

Oh I'm sorry to hear that Sarah is feeling so awful. :( How long till she is done with the chemo treatments?

Well, it does seem that there must be some connection between Icy drinking more and starting the Urisodol again. If however, it will help the liver, then that is probably more important than her drinking more water.
I think again we are waiting for subsequent test results to see how she does, but gosh it is sure aggravating that the vet hasn't called to discuss these results with you. That would bother me too.

[Wrighton]

Sarah has two more weeks unless the tests they are to do indicate something else, but then she has five days a week radiation for ,I think, six weeks. They she has once a week shots for a year, if all goes well. Right now any movement brings on nausea but at least there are lulls now if she doesn't move

Icy had a great morning chasing bunnies who actually play with her and Jamison. I am very conscious that the added water may raise a possibility for bloat. So, chase time is limited and never after eating solids.

I thanks so much. Yes, liver health is the goal.

Gail

[labblab]

Hi Gail, I've been following all your posts but feel as though I have little to offer because I have no experience with ursodiol and little knowledge about it :o. One thought occurs to me, though. You might ask the internist if you could take a temporary break from the ursodiol for just a few days to see whether Icy's thirst normalizes again. If not, then the ursodiol is likely not the real culprit and it was instead coincidental that Icy started drinking more at that time. It is possible that the thirst is finally an emerging Cushing's symptom. But if she normalizes again when the ursodiol is stopped, then it's a good bet that the two are connected. Since I've not seen thirst listed as a side effect of ursodiol, either way, it would probably be good to let the internist know what is going on since it appears to be a significant change for Icy.

Marianne

[Wrighton]

What a great idea, but I talked through the nurse to the Internist who said that ursidiol requires lots of water to be effective. The dr said that the amount of drinking doesn't matter at this time. I checked the info that comes with the med and it says not to limit water.

Last night Sarah my daughter, went to the hospital because she needed stronger meds than could be given at home. Please remember her, her husband, and two young daughters.

Thanks.

Gail

[molly muffin]

How are Icy and Sarah doing?

How are you doing!?

[Wrighton]

Hi,
I just got home from having a liver enzyme test done as requested by the internist. Her results last time were remarkable.

This time all are unremarkable except the ALKP. 362 U/L ( 23-125)

The ALT was 95 UL. (10-125). But it also says " ALT: test results for the latest analyzer run have been multiplied by the dilution factor for a dilution of 1 in 4 total. 140 U/L

Does anyone have any idea about these?

Thanks.

BTW Sarah is home and this week may finish her chemo cycle ( two to go) if strong enough and then radiation will be begun.

Gail

[Wrighton]

Is it time for Cushing meds? Her liver enzyme scores are still high. She still appears fine, but I don't want to damage her internal organs? Are her scores cushings-like? Internist says wait for eight weeks and get another liver enzyme test.
Gail
( new results are in last message.)

[Harley PoMMom]

Is the increased drinking the only symptom she is displaying?

Dogs with Cushing's generally have a high elevation in the ALKP, I've seen many here with their ALKP in the 1000's, but all dogs are different.

I bet Sarah was glad to be home, that chemo is so rough on their system :( How is she feeling now?

Hugs, Lori

[Wrighton]

Icy is starting to play with Jami and his toys. She had stopped after her CCL. Yes, she still is drinking a lot. Is herALKP high enough to be damaging to her liver? Both the ALT and the ALKP are still up, but better.

Sarah had her last chemo today. Radiation is next and he reception every three weeks for at least a year. Thanks for caring.

Hugs to you,
Gail

[Harley PoMMom]

I agree with the Internist, waiting 8 weeks and doing another liver enzyme panel to check those levels is what I would do. It's been over 2 months since Icy's surgery, right? So when that 8 week liver enzyme check is done, Icy will, for sure, be all healed up, and if her numbers are still elevated, and her PU/PD is still increasing, I would probably revisit a Cushing's diagnosis.

I really don't think that Icy's ALP elevation is damaging her liver, but I am not a veterinarian, so I do suggest that you discuss this with Icy's vet, I would be very interested to hear their response. ;)

I bet Sarah is relieved that the chemo treatments are over, hopefully the radiation will go easier on her system. Sending you and Sarah huge and loving hugs, and will be keeping you all in my thoughts and prayers.

Hugs, Lori

[molly muffin]

I agree with Lori. And if still elevated the retest for Cushing's before starting any meds.

How is Sarah doing?

[Wrighton]

Which cushiness test would you have done if still elevated in eight weeks? Is there such a thing as mild cushiness? She is still getting melatonin and lignens. Plus Marin, defamation, ursidiol. How high is usual for Cushing pups? Tha ALT was. 95 (10-125), so that is okay, I think. The ALKP was 362 (10-125). Is that horrible?

Sarah goes to the radiation oncologist tomorrow. She is better then right after her hospital stay, but very tired. Her shingles are healing.

Thanks so much.

Gail

[Harley PoMMom]

If Icy is feeling back to normal, the LDDS test would be what I would recommend. And, yes, there is such a thing as a dog with early Cushing's, they may display some of the symptoms for Cushing's but the test results for Cushing's come back normal.

Dogs with Cushing's generally have a high elevation in the ALKP, I've seen many here with their ALKP in the 1000's, so no, I don't think Icy's ALKP value is that bad.

Hugs, Lori

[Wrighton]

Thanks, Lori. In that the ALKP went down 100 points I hoped we might be staving full blown cushings off. Maybe the lignens and melatonin are helping. Remember her last LDDS test came back not confirming cushings so maybe we can be lucky again.

Thanks so much.

Gail

[molly muffin]

Molly's alkp is over 1700 so yours is not bad at all. Alkp,can be elevated due to other things too so vets don't tend to worry about it as much unless you see other values going up like alt and ggt. (Liver specific)

[Wrighton]

Thanks Sharlene,
Every other value went down. The ALT was confusing because on the chart it was 95(12-125) but with this note: ALT test results for the latest analyzer run have been multiplies by the dilution factor of 1 to 4. 140 u/l
Everything else in the enzyme and blood panel were within average bounds.

So confusing.

Thanks.
gail

[molly muffin]

I'm not sure what that means exactly about the analyzer value. Weird.
But it is Very good that the other enzymes are all within range. I take that to mean that the liver infection is probably cleared up and that her liver is doing pretty good. ALKP can take much longer to come down than others and it may not come down. I still take this is pretty good results.

[Harley PoMMom]

The ALT was confusing because on the chart it was 95(12-125) but with this note: ALT test results for the latest analyzer run have been multiplies by the dilution factor of 1 to 4. 140 u/l
Everything else in the enzyme and blood panel were within average bounds.

So confusing.

Thanks.
gail

That is confusing, is the vet using a in-house VetTest Analyzer? I just did a google search and found this:
Plasma and Serum Dilutions
The VetTest analyzer supports plasma and serum dilutions in two circumstances:
When a test value is outside the linearity range of the VetTest analyzer •
When the sample contains interfering substances (e.g., medications) that cause a • nonlinear or invalid result

https://www.idexx.com/resource-library/smallanimal/vettest-operators-guide-en.pdf

Could you ask the vet about this and let us know what he says?...Thanks!

Hugs, Lori

[Wrighton]

I can try. I called My regular vet three times before she called back last time. The Internist calls back within an hour so I may ask him instead.


Not great news. The radiation oncologist wants tests and then my daughter to see the surgeon August 3 before any more decisions are made.

Be back and thanks.

Gail

[Wrighton]

Hi All,
Well we just had the liver enzyme test again. They are much the same as last time. All are well within normal range except the ALKP which was 406. (23-212). Haven't heard yet from the specialist. The regular vet seems unimpressed. Her GLU went down from 123 to 90. (70-143);bun went down from 16 to 14; Tp went down7.8 to 7.3. (5.2-8.2) ; ALB is 3.3 down from 3.6. (2.2-3.9); GLOB is 4 from 4.2 (2.5-4.5);ALT is 80 from 95 (10-125. The present test was done today compared to the previous done on 7/15/15.

Good? Bad? Keep with lignans and melatonin?

Thanks,

Gail

By the way, Sarah is receiving chemo still and two additional surgeries are being scheduled. Her spirits are up and down.

[molly muffin]

Hi Gail,

So those results are all within range except for the ALKP which is not always liver specific but still isn't too bad of a result.

Is her ALT and GGT also within range? As those are Very liver specific values.

Lignans and melatonine won't hurt her, so you could keep on with it and especially if any of her sex hormones, like aderstrone etc are out of range.

Sorry to hear Sarah has to have more surgeries :(

Hope you are doing well. It's a lot of worry on your shoulders too.

hugs,

[Wrighton]

Thanks for your response. Her ALT is now 80 and it was 95 in July (10-125). The CREA remained at 0.9 (0.5-1.8). The GLOB was 4.2 and is now 4 (2.5- 4.5). GLU is 99 down from 123 (70-143).

Not sure what GGT is. I think I gave you all the results now. The only thing HIgH was the ALKP which is 406 up from 362 (23-212).

She lost weight. 49 pounds to 47.6. I attribute that to the change to the low fat/ low protein food. I think I should have upped the amount. She eats whatever she is given as all three do. So I am upping her food.

So.... She is presently getting ursidiol, Marin, denamarin, melatonin, lignans. Not sure if the specialist will change that.

Thanks for your help.

Gail

[Squirt's Mom]

All in all not bad I'd say. :) I hope things are looking up for Sarah very soon. It would be hard to stay on an even keel with all she has going on...and you, too, Mom. ;)

[Wrighton]

Just got a call from the specialist after he reviewed the latest liver enzyme test. He was very happy. He said to continue all the meds including the lignans and melatonin. He said another liver enzyme test and adrenal panel should be done in six months.

I know that lignans and melatonin don't work for many, but could she be one of the few?

Gail

[Squirt's Mom]

Melatonin and lignans lowered Squirt's intermediate hormones. Her liver values went down then back up, then down then back up.... :D But they did work for her hormones.

[molly muffin]

The liver infection likely affected the values and now that is cleared up she is doing well. They do want to,keep,an eye on it which makes sense hence the next test in 6 months.

The infection and gallbladder would have also affected her cortisol causing it to raise. This all looks to be very good news right now. Cushing might never have been a factor. So staying on the right track seems like a good thing to do.

[labblab]

Yeah, until you have the repeat adrenal profile performed, it's impossible to know whether the melatonin and lignans are actually having a therapeutic effect or not. At this point, I don't think we even yet know whether the elevated liver enzymes are/were resulting from elevated adrenal hormone production, anyway, since Icy has had multiple issues going on these past months (gallbladder, liver infection, etc.).

So the melatonin/lignans may or may not be helping anything, but it definitely looks as though they are not hurting, given this across-the-board improvement in numbers. So if it ain't broke, don't fix it -- and I'd carry on with the same regimen myself. :)

Marianne

[gpgscott]

Hi Gail,

I think the problem with the lignin/melatonin treatment is with wide variance in the stuff available.

I think vitacost is a good source for the lignin as well as the melatonin.

In our case we tried a melatonin implant which did work well but I did not want to continue to subject Moria to it as she was easy to pill.

I also think you should stay away from flaxseed as it can cause digestive issues and you really don't get the goodies because it passes too fast.

There is a component in the lignin which is important and you need a processed lignan product to get it. For us it controlled the intermediate hormones which were causing her elevated liver numbers.

Best, Scott

[Wrighton]

We use the spruce tree lignan source and melatonin recommended by the University of Tennessee. The specialist felt the source was very important.

Thanks for all the feedback. She remains happy and healthy. Her CCL has healed and she is back to chasing deer and bunnies out of our yard.she drinks more than the other collies, her two buds, but she has no trouble holding her unwind at night or all day if we should be away. She eats normally. We have noticed that she has increased thirst and thus drinking if she is stressed in any way. Wonder why.

You all are great. This has been quite a journey.

Gail

[Wrighton]

Hi,
Well, icy is going today for another liver enzyme test. She seems to be drinking more and she had always drank a lot. Her fur has not grown back very well from her two surgeries last year, CCL and gall bladder. She has no pot belly or any other symptoms, but I am concerned about her water intake. She still takes the melatonin and lignans as well as Marin, Denamarin, ursidiol and Dasaquin. Hope things are not worse.

My daughter had a double mastectomy in Jan after six months of chemo. Unfortunately, after surgery, the surgeon told her she needed further surgery because they found more on the right side. So confused, radical and there is still more? Her young daughters are doing okay mostly due to her strength and her wonderful husband.

Here's hoping.

Regards,
Gail

[molly muffin]

Oh gosh Gail, I'm sorry to hear that they think another surgery is needed for your daughter. She has just been through so much, as have you. Rough on the family the last few years.

Oh poor Icy, I do hope she is okay. Does she seem to be feeling alright? Are they doing a full blood panel? Let us know what the results are.

sending you big hugs

[labblab]

Awww Gail, I'm really sorry, too. Your family has been through so much, it just isn't fair. I'm hoping that the testing goes well for Icy. I understand why you're worried about the water, but hopefully there's nothing truly amiss for her. As Sharlene says, we'll be very anxious to hear about both your girls.

Hugs from me, too!
Marianne

[Wrighton]

Hi,
Just did another liver enzyme test yesterday and when the specialist saw them he asked for a bilirubin test and ultrasound on Thursday. We are wondering how we will get through from 10 pm tonight til the ultrasound tomorrow at 11:00 am without food or water. This should be something; lots of banging bowls, etc.
The liver enzyme results out of range were the TP 8.3 ( 5.2-8.2) ; the alb 4.7 ( 2.2-3.9); alt 159 (10-125); the ALKP ( 23-212). This is the first time the TP and alb have ever been out of range. The bilirubin test results are not in as yet.
The 1 1/2 hour ride to the specialist should further stress her.
My daughter, Sarah, has her next surgery on May 13 to try and get the remaining cancer after the double mastectomy. Chemo has continued.
I'd appreciate any information about the above test results. The alb was off the scale it was so high. All I could find was that it indicates dehydration........ She still drinks A Lot! So confused.
Thanks to all and best regards.
Gail

[labblab]

Hi Gail, only time for a quick note, but I just want to clarify that Icy is not allowed to have any water at all for a full thirteen hours? I understand about the food, but I'm not understanding the reasoning (or safety) about going so long without even a bit of water unless she is going to undergo general anesthesia for the ultrasound. Even then, I think the restrictions have generally been eased somewhat, at least for humans, and the ban against water is often now for no longer than a few hours before a procedure. So are you sure about that part? For sure, the poor girl will be dehydrated. I would think it might even be hard to draw blood or start an IV after such a lengthy time without any fluid at all...:confused:

Marianne

[labblab]

Also, those elevated readings for total protein (TP) and albumin relate to blood proteins as opposed to liver enzymes. Low albumin can be related to liver dysfunction, but there can be other causes, as well. Low albumin is not good, but I'm not familiar with sinister causes for elevated albumin. As you say, dehydration can skew the reading. I also saw that anabolic steroids and some other drugs/hormones can cause elevated readings. I suspect the total protein level is elevated simply because of the high albumin component.

[Wrighton]

That's what they said no food or water. Last ultrasound they did not give her sedation. Honestly, wonder if I can get anyone who would know at the hospital.... I'm sure, however, that is what she said because I remarked it would be very hard for Icy.
Gail

[Wrighton]

The doctor raised her meds last time, but TP and alb were normal. Icy takes in morning meal Marin, melatonin, ursidiol, and dasaquin. At two, she gets denamarin. At supper she gets Marin,melatonin, lignans, and ursidiol.

Her thirst is still elevated. She pees many times a day, but not a lot. Her fur after her two operations has not grown in too well. Nothing else remarkable.

Gail

[labblab]

Maybe the water ban is somehow related to the bilirubin test instead of the ultrasound, if there's no sedation. Although maybe they don't want her bladder to have liquid in it during the ultrasound. I dunno. Certainly, you shouldn't disobey what you've been told to do. But maybe you can clarify the instruction with the vet's office first thing in the morning.

[Wrighton]

The bilirubin was done yesterday. I just didn't get the results yet. The hospital is open 24 hours, but the internal medicine department doesn't open until 8:00 am. Not sure the emergency staff would give the same answer as the internal med staff.

Golly.

Gail

[labblab]

I don't want to be creating worry for you needlessly, and as I say, you shouldn't disobey the orders you've been given. I'm just more familiar with human instructions, and being told to take nothing by mouth from midnight on, in preparation for morning procedures. Thirteen hours just seems like such a long time without water. If you've done this before, though, with no ill effect, then perhaps it's not really any big deal and maybe I'm probably just creating a question needlessly. If I've ended up worrying you about this, though, maybe the ER crew can contact the IMS who is taking call for the practice this evening. Otherwise, please just proceed in the manner you've been told.

[molly muffin]

i wonder if they are concerned about the liver infection coming back or something.

I really can't imagine no drinking, food I get but not the water withheld, but I don't really know. Molly's never had water withheld for an ultrasound.
I wouldn't want to go against the vet, but I think I would call and try to get some clarification for sure.

[Wrighton]

I just called the hospital, and the nurse checked with one of the vets who said that I had heard correctly, but if I was concerned, she could have small amounts of water but no food, but do not put out a water bowl.

I think we will feed all the dogs, three collies and a yorkie, their "breakfast" at 10:00 pm. With water. Then, wait an hour take them out for the last time today and remove the bowls while they are out.

After Icy leaves the back door in the morning to go, we'll put water down for the others and take a bowl and water for her for after the procedure. Sound okay?

Gail

[labblab]

Under the circumstances, that sounds good, Gail. I surely hope everything goes well today for sweet Icy! Do let us know, OK?

We'll surely be wishing Sarah well, too. She has been through so much already. Hopefully, this surgery and the chemo will usher in a lasting cure!!

Sending continuing hugs to you all,
Marianne

[Wrighton]

The dogs looked so confused when I gave them breakfast at 9:45 pm last night. It was not refused, however. Every few minutes they come over this morning and nudge me. I feel so sorry for them and anxious to give them their food and water. I never limit water, not ever. On the other hand, food......

Thank you for the good wishes for Sarah. Her husband has been a saint. He is always there for her and the girls. His mother, too, will have repeat colon/liver cancer surgery early in May. Lots of pressure on him. His dad just had successful prostate cancer surgery.

Here's hoping for our Icy. Let you know when we get home. Ultrasound is eleven, then we meet with the doctor, then and 1 1/2 ride home ( after Icy gets food and water).

Hope all enjoy a good day,

Gail

[Wrighton]

Just got home from the hospital after seeing our internist. He did an ultrasound and repeated the liver enzyme and bilirubin. As you might remember the albumin from our local vet was off the wall high and the TP was up, too. On the test done today, both are totally normal . The alt is two points high and the alp is two points high too, there is mineralization in the liver, but no growths. The bilirubin was totally normal as wa the albumin and TP. He concluded that the blood had hemolized at the local vet and he wanted to see her a sap because the extreme albumin and TP most usually means dehydration, but can also be a sign of cancer.

He was thrilled with both the ultrasound and with the blood work. He is also convinced that the U of Tenn protocol is keeping the cushings at bay.

We had hamburgers on the way home! Thanks for all your support.

Hugs,

Gail

[Harley PoMMom]

Oh Gail, that is such great news about your sweet girl, Icy!!!!!!!!

I am sorry to hear that Sarah has had to continue her fight with cancer, it's a nasty, nasty disease, keeping her in my thoughts and prayers.

Hugs, Lori

[molly muffin]

Yay!!! Great news about Icy. :) :) I have noticed that it isn't so uncommon for "in house" test results to reflect problems that don't show up on the big labs more accurate equipment. It makes sense, I suppose that if something is off in the vets office specimen to send then to specialist for more thorough check.

I do hope that Sarah will show progress in this fight soon. Poor girl has to be exhausted.

[labblab]

Gail has given me permission to post the sad news that Icy passed on July 13. She was nearly 16 years old, and had physically declined in recent weeks. She was a beloved family member and also so very dear to our K9C family here, as well. So I know you will all join me in honoring beautiful Icy, and in supporting Gail in her sadness over the loss of her precious girl.

Always in loving memory; forever in our hearts.
Marianne

[Joan2517]

Oh, Gail....I am so sorry to read of Icy's passing. My prayers are with you this morning.

[molly muffin]

Oh Gail. Big hugs. What a sad time for you and your family.
Dearest Icy. My sincerest condolences.

[DoxieMama]

I am so sorry to hear of your loss.

[Harley PoMMom]

Oh Gail,

I am so sorry for the loss of your beloved girl, Icy. I realize that there are no words to ease your pain but I do hope you will find some kind of comfort in knowing that we do understand the loss that you feel and we are here for you...always.

With Heartfelt Sympathy, Lori

[judymaggie]

Gail -- my heart goes out to you and your family on the passing of dear Icy.

[Squirt's Mom]

Dear Gail,

I was so saddened to read about our precious Icy. She was so much a part of your family and ours here at K9C - she will be missed by all.

You and she fought so hard for every good moment and when no more battles could be won, you gave her the greatest gift - freedom from a failing body. To be able to share that many years with a beloved dog is such a wonderful treasure and is a testament to the care Icy received. Cherish the memories you created thru those years and hold them tight....they will help you thru this time of the deepest grief and one day you will find yourself smiling instead of crying when they come to mind. I know she is watching over you now just as you watched over her for so long. And I firmly believe we will see our babies again, hold them again, kiss their darling faces again; and when that day comes, we will never be parted.

Our deepest sympathies,
Leslie, Trinket, Sophie, Fox and all our angels


A Special Gift

They're a very special gift, to be cherished and loved;
You're chosen for each other by God Himself above.
It's a match made in heaven so it can't be wrong;
You're tied together by a bond that's oh so strong.

All they'll ever ask from you is to be loved and fed,
And at night make sure they have fresh water and a bed.
In return, for so little, the rewards are so great!
You'll get a companion for life with some very special traits.

When you are lost and the end seems so far away
They'll walk by your side, they'll help you find your way.
When life gets you down they can put a smile on your face
As they run you in circles with their fast pace.

You'll share the good with the bad, you'll be happy and sad;
And through it all you have a friend, the best you ever had.
You're time together will be special and unique;
It will be as priceless to you as a rare antique.

Then, before you know it, the day will arrive
When suddenly your life takes a steep dive.
The furry friend who's been with you for all of these years
Has now passed on and left you in tears.

As you sit and wonder what did I do?
Why is this all happening to you?
Into each of our lives a little rain must fall,
And you must be strong to answer the call.

Your little one's spirit has flown home on the wings of a dove,
To a special place that awaits them in heaven above.
St. Francis will meet them; when they get home
He will take them to a meadow where they're free to roam.

There in the meadows, down by the pond,
Your furry friend will remember his loving bond.
He'll look into the water, then you appear;
He can see you're frightened, he can feel your fear.

Through the bond that still ties you from heaven above
He looks down upon you, he sends you his love.
Because you loved him and because you care
Whenever you need him, he'll always be there.

There, in the meadows, they patiently wait for the day
When you will celebrate your life together, each and every day.
Waiting for that day; when you come walking back home
When together for an eternity through the meadows you'll roam.

Author Unknown

[Joan2517]

What beautiful words....a lovely poem.

[Allison]

Gail, I'm sorry for your loss of Icy. Hugs.