Maurice-Please someone help me figure all this out

[mauricenme]

Hi I have a 10 1/2 year old min poodle named Maurice. Late dec. 2013 he developed a cough. I took him to a vet. They took an xray said his heart was normal, pushed on his throat said he had kennel cough even though he was vaccinated. Gave me doxycycline hyclate 100 mg. they didn't work. all it did was make him sick.

I took him to an emergency vet in orange county who looked at the xray and also said his heart was normal and gave me a weeks worth 50 mg of doxycycline but said I'd have to go to my vet for the second weeks worth. these didn't make him as sick but when I went to get the second weeks worth the vet didn't have the same pills. she again gave me doxycycline hyclate 100 mg. I gave the first pill and it made him sick so I quit giving those and went to vet number 3 who looked at the xray, also said his heart looked and did a blood panel which came back normal.

I got a copy and I noticed glucose said low and was out of range. so when I asked about it instead of telling me the real reason for the low reading he told me the blood used the sugar while it was on the way to the lab, which to me didn't make sense. I realized later the real reason, which makes perfect sense is that he did not bother to spin the blood sample. I was so focused on that one reading that I didn't pay much attention the the other results cause they were all normal. Stupid me again for not knowing about such a thing as normal low shame on him for not bringing it up but the t4 was normal low and a free t4 should have been suggested even though we were there for a cough. So off to vet number 4. This vet looked at the xray and said his heart looked normal also but he showed me on the xray where his trachea was slightly collapsed. And gave me cough suppressents. All those did was make him tired, didn't help his cough a bit. However the fact that he showed me something that the first 3 didn't made me trust him. I believed him when he said my dog would have that cough for the rest of his life and it only took 4 vets and 700.00 to get an answer. But turns out he may have been wrong. I wouldn't find that out till months later.

Then one day maurice decided to help himself to his bag of treats. He chewed a hole in the bag and had only a couple to go when I caught him . I looked for the plastic where the hole the size of a silver dollar in the bag used to be but never found any. He must have swallowed the pieces of plastic as he chewed through the bag. After that his energy level dropped to no energy at all and he started scrounging he even atell poo a couple times. Then he put on weight and it was may 2015, a little over a year since we went for bloodwork last so he was due. The vet I trusted was far away from where I was so I decided to pick one closer after all its just bloodwork. So we go to vet number 5. she did the geriatic panel and those results came back abnormal ALB was 4.0 g/dL range 2.7-3.9, ALKP 493 range 5-160, CHOL 407 mg/dL range 131-345, mchc 32.0 range 32.6-39.2, probnp 365 pmol/L range 0-900, a sentence below stating clinically significant heart disease is unlikely at this time. , and finally the t4 was now 0.5 ug/dL range 1.0-4.0. This vet recommended a thyroid panel and I agreed but when I told her I had to go pick up the rest of my money. she didn't want to wait. she put him on a liver supplement and .2 mg of thyroxine and handed me a piece of paper with a number for a free vet on it. I guess she thought i wouldnt be able to pay. Again stupid me shame on her because now we can't find out why his t4 was low unless we stop meds for a week which is a week wasted. I still didnt know that and trusted her but after 2 weeks he started panting real hard.

He had energy again but it was scattered energy something wasn t right so I call vet #5. He said it sounded like he was overdosing on thyroxine and to bring him in in the morning but wait 4 to 6 hours after giving him his pill. I did and I brought along both sets of bloodwork. I still didn't know that he needed to be off meds for a week in order to know whats really happening with his thyroid. So I asked about the thyroid panel. He chose the panel and for 250.00 I never dreamed he would rerun ALL the bloodwork i just paid 160.00 to run 2 weeks ago. With the addition of a free t4 by ed ng/dL and a free t4 pmol/L. He also did a urinalysis which came back normal. The blood came back the same as before with the exception of ALKP went down to 391 which is still high. ALB crossed the line back to normal and mchc went up to normal. the t4 and both free t4s were way high now so he said to only give one pill a day in the morning. by now I'm started to research things on my own and everything i read says to divide the dose in half ,morning and night. I asked, mentioned that and he said I was misinformed and if it were his dog he would do one in the morning. so I followed what he said and after a couple weeks maurice symptoms didn't change and that nagging feeling I had to stop the meds wait a week and get a full thyroid panel and go the distance to the vet I trusted.

so that's what I did and I went armed with my notebook full of questions and research and of course my opinion on what tests I wanted for piece of mind. And my research included every symptom including the cough. I got most of what I wanted and I don't understand how the pricing works on these panels but it seems to me that I'm being taken advantage of because this visit cost me 800.00 and I thought I knew what was included but apparantly I did not, because i specified the thyroid panel have the t4 free t4 by ed t3 free t3 by ed tsh tgaa and k value. T3 only because it when done with the other stuff would help to determine if he was primary hypothyroid or secondary to cushings or something else but that didn't happen. I got the t4 free t4 by ed tsh and tgaa no k value or t3 or free t3 the other bloodwork which I now had done 2 times in a month that were the same. I just wanted to add the alkp and the other values that were abnormal the first time which was CHOL, ALB, and MCHC but that also didn't happen. I now have 3 sets of the same bloodwork. also I demanded a ldds test because I read it was the most reliable for cushings. He said I was wasting my money. I said I don't care it's my money. I also asked that a bile acids test be done thinking about the plastic that may be in there someplace. But instead of a pre and post pandrial like i wanted i got a pre panpandrial random with a small d in front but the pre was normal but i do not know if the post was or not he didnt do the post. The other test came back as total t4 .05 range 1-4, free t4 by ed ng/dL 0.3 range 0.7-3.7, free t4 by ed pmol/L 3.9 range 9.0-47.4 tsh was 0.12 range .05-.42 ng/gL, tgaa 2.1 no range listed just %. No corrected tgaa which don't matter im not breeding. These results came in thursday but he didnt want to talk about them till the ldds came in which would be friday. so he said call him monday cause he's off friday even though he has a home office. so on Friday I called and had the lady email me the results which I took to another vet. I think I'm on vet 6 now. I no longer trusted this vet because when I asked about the abnormal results of the bloodwork that I already had, all he had to say is I'm not concerned about that. I just spent 800 dollars on these tests and all I hear is he's not concerned. if they didnt matter why did you run the whole panel, i only asked rhe abnormal ones be added to the thyroid panel. and he didn't even call to tell me when the first results came in. I had to call to find out.

The ldds test came back friday and i had to call again to remind them to email the results to me even though they said they would. The results are cortisol pre dex 2.6 baseline with the range being 1.0-6.0 ug/dL, cortisol 4 hour post dex 1.9 no range listed but ug/L, cortisol 8 hour post dex 1.7 with an a in front. And during that same week while we were waiting for results maurice was hit by a car. He did not appear to be hurt but I brought him in just in case. This is vet number 7 now. it was almost time for them to close and I almost walked out because the girl at the desk was very rude and she said it would cost 160 dollars for him to be seen 270 for 2 view on xray and 35 for them to look at the xray. I asked why so much after all this was during business hours she said because we're taking him in as emergency. I said never mind I'll go someplace else. all of a sudden the visit was dropped down to 70 dollars the 2 view xrays became 160. And still 35 dollars to look at them which really made them look money hungry to me but I did it.

And when I met the doctor I liked her immediately. she said everything looked fine and she even did a xray of his abdomen to be safe. but she said if I want a copy then I'd be charged and that showed me she cared she now has my trust. I told the vet who I have been dealing with when I went back for the scheduled ldds test and he didn't even care. he didn't ask if maurice was ok or what happened just ignored me. then while I was waiting for the 4 hour blood draw I got a phone call from the vet who did the xray after maurice was hit. She said she showed the xray to the radiologist and he saw something in his left lung she wanted to make sure my vet knew. I asked if she'd call and tell him because coming from a vet is better than me trying to remember everything she said.

so at the end of the day when I asked my vet if anyone called him about the xray and he said yes but he was busy he didn't take the call. I told him to call her back cause something was found. I found out he never called because I decided to take everything I had to this last vet cause she cared enough to take that 3rd xray that I didn't get charged for. I went in for a followup on the xray she took and a 2nd opinion on all my blood tests. Well she wanted to do another xray first to compare so I let her do that and it turned out that whatever it was was no longer there not only that but my explanation for his cough being from minor collapsed trachea was just blown out of the water his trachea looked normal in all those xrays and cushings is present because after she did the math.

I now could full in those ranges both were 1.3 but when I asked about the abnormal values on the rest of the blood that famous saying of I'm not concerned about that was my answer. Well I am concerned about that because now I have no explanation for his cough which is getting worse. she said she didn't want to treat cushings until it was severe. she didn't even mention trying to see what type he had. she just told me to keep giving the soloxine prescribed by the vet I no longer trusted. i asked him for a liver supplement but he said it wasnt necessary but i noticed his alp decreasing while he was taking it and increased when i ran out. so i asked her to give me some which she did. but I had to ask for it.

So after all these vets and 2500.00 dollars I still don't know if my baby has primary hypothyroidism or if it's secondary to cushings. his symptoms are still the same no energy and panting and that cough that he has mostly when he's excited. it's like he has something stuck in his throat. Hell give 2 hacks then a final cough like he got whatever it is out only nothing came out and now it's the exact same cough only more often and even at rest.

I read that it can be dangerous to treat a secondary hypothyroidism dog with thyroid supplement. you have to treat the primary condition first then the thyroid will fix itself if it's not too far gone. And no matter where I go it seems they rerun the same basic tests and everyone wants to do nothing but wait till he is on his death bed to treat sone thing that has not even been filly diagnosed..

I want answers I know there are things that can help slow down the illness but i don't know what they are. not knowing what he has doesnt make it eaier. and I can't find anywhere that will run the tests and be able to at least get the tests necessary to have a diagnosis. it's been almost 2 years. we live in my van. I'm on a disability ssi fixed income and I'm practically killing myself by going out and collecting enough cans and bottles to be able to pay for whatever is necessary without skimping on something. and that can only be done by someone willing to order the panels in a way to get it at the lowest cost possible instead of the highest and at least request a value we dont need be substituted for one we do its all the same blood sample. I was told the cortisol creatinine ratio alone costs 100.00 a urinalysis alone is 60.00 if i wanted to add that ratio it would be 60 dollars plus 130.00 to add it on. thats more that the test and I feel so helpless and so tasken advantage of because my dog is suffering and I'm running myself ragged to pay for his care and I'm being treated like I'm just appointment that they have to do to make money. I need a vet who cares about his patients and is willing to explain thing to me any answer my questions. if I ask the same question twice in different words it's cause I didn't understand the first time.

Thanks for taking the time to read this post.

[mytil]

Hi and welcome to both you and Maurice. I am so very sorry you have gone through so much just to get a simple, concise answer as to what is happening with your Maurice.

Is he eating normally? Is he acting lethargic?

A couple of questions about the coughing.
- is it a dry hack or a moist cough?
- Is Maurice up to date on his distemper vaccine?
- Has he been checked for roundworms and other internal parasites? (some larvae can creep up the throat to cause coughing with roundworms and of course heartworms can wreak havoc in the heart)

Is Maurice showing any other symptoms associated with Cushing's?
(pot belly, excessive urination, excessive drinking, muscle loss).

Sorry for all the questions.
Please keep us posted
Terry

[Squirt's Mom]

Hi and welcome to you and Maurice! :)

Are any of these vets an IMS? Or are they all GP vets? If Maurice has not seen an IMS, that is what my next step would be. They will be more expensive than a GP but they have a GREAT deal more training, education, and experience than a GP. For complex cases, an IMS is where to go. ;)

I don't see that an abdominal ultrasound has been done? Did I miss that?

Now, about the cough....let me share our story. I have a little blind dog (NON cushing baby) and when her eyeballs were removed they left a gland in one eye. It's the gland that makes our noses run when cry. So she has always gagged with mucous from that gland. Somewhere along the line her gag changed to a cough. I took her to see our vet (GP) who diagnosed her with CHF - his xray film showed her heart to be almost twice the normal size. I ask for a referral and the IMS ran an ECG along with other tests and found her heart to be perfectly normal BUT she had pneumonia and COPD. THAT was the source of her coughing, not her heart. The pneumonia has cleared and her coughing is much less on a daily bronchiodilator. I love our GP vet and trust him a great deal but I knew heart disease along with her other conditions was beyond the scope of a county GP vet and I wanted a specialist on her team. Thankfully, the IMS found the real problem and she is on the correct treatment now.

I have smoked most of my life - which is really long time! :p Trink's lung disease, if not directly caused by, was made worse by my smoking. If you smoke, be sure you never smoke around Maurice, never. They still inhale the chemicals from our clothing, bedding, carpets, drapes, etc. and if you have a licker, they lick them up from hard surfaces as well. So our babies ingest as much if not more chemicals from our cigarettes than we do. They have superb filters in their noses but after so many things to filter, - air pollution, cleaners, colognes, etc. - it finally becomes less and less effective and they inhale more and more that they should not. So if you smoke, have someone check out his lungs. ;)

I'll let others more versed in test results chime in on those. I'm glad you found us and look forward to learning more. I am very glad Maurice wasn't hurt worse when hit by the car!

Hugs,
Leslie and the gang

[mauricenme]

i don't know if im posting in the right place but no they are no ims. we have an appointment on Wednesday with an im in culver city.

[mytil]

Yes you are posting just fine. :)
How is Maurice doing now?

Keep us posted on what the vet discusses with you during your apt next week.

Terry

[Squirt's Mom]

IMS = Internal Medicine Specialist. Probably the same as as IM. ;) Let us know what you learn!

[molly muffin]

Wow you have been through so much just trying to find out what is wrong and causing the cough. I hope that the IM will have a definitive answer for you.

I totally understand about your concern. Just because they are t doesn't mean that you aren't. Holy cow.

Check. Heart. Lungs. Etc. Trachea again. Anything that might cause a cough like that.

Let I
Us know what the IM says

[mauricenme]

Last night when maurice was sleeping I was watching him breathe and his body was moving up and down real fast and hard and he couldn't get comfortable. Today we went to see the specialist but by then he was breathing fine. He said even though maurice failed the ldds test he doesn't have the signs of cushings and says his thyroid needs to be treated and none of it makes any sense because he didn't start with this panting and breathing hard until he started taking thyroxine . And now here we are again tonight and it's not even remotely warm but he's breathing hard again I scheduled an ultra sound and xrays and the acth stimulation test for the 2nd because I won't have the money till then. I don't qualify for care credit and I tried all the organization's but there is no help out there for me. I'm so scared maurice is going to die just because I can't come up with the money fast enough. Nobody is even sure he has cushings we know his thyroid is low but the medication isn't changing nothing but the blood levels and making one symptom stop and one that is worse start. Before he had no energy now he breathes hard I'm afraid he's gonna have a heart attack. I thought cushings caused coughing but the specialist said it don't and that is what all this started with was a cough that I've been trying to get diagnosed since 2013 and have spent almost 2000 trying and I am no closet now than I was then just broker. I don't know what to do. Why won't anybody give me a chance and take a down payment and let me make monthly payments

[molly muffin]

Did you take a look at outer financial aid section?

http://www.k9cushings.com/forum/showthread.php?t=212

No Cushing's doesn't cause coughing. I am thinking either heart lungs trachea still. Did the specialist investigate those?

[mauricenme]

Ok went to see the IM they took Maurice in the back and did nothing in front of me then the dr came in to talk with me. I ask where's Maurice and he said in a cage in back I want your full undivided attention. And he said everything looks normal. The LDDS shows cushings is present but Maurice's don't fit. And I do agree with that. We know his thyroid is low. But since he's been on soloxine the only change I noticed is he lost weight 3 lbs in a month and still loosing. And now he's always panting but mainly when it's humid and /or hot outside. Never when we are inside an air conditioned building. I still have all the same questions I had before I went in. He said the physical exam didn't show him nothing he basically was going by the records I had and I also gave him a summary of everything I noticed and the places we've been but either he didn't read it or it was irrelevant because I still have the same questions I had when we went in only now I'm 145 dollars broker. He asked me what problem do u want him to solve the cushings or cough. And for some stupid reason I thought coughing was a cushing symptom buy he said it was not. All I know is the cough came first but I want both checked out Maybe they are related maybe not. And things I never thought twice about before that I notice now I don't know if it's always been that way. Like I notice that when he pees his pee doesn't flow out it come out in spurts. Has he always peed that way? I don't know. I never paid attention to that detail before. But apparantly it's important because the dr asked. He also asked if there were any vomiting and there was for a minute but it hasn't happened in a long time and stupid me didn't write the date down. All I know is it was liquid foamy yellow stuff very little. Today he vomited only this time it was clear. Anyway on the 2nd we are going back to have an ultra sound xrays and acthe stim test done. That's gonna be 1000.00. I'm going to look at the financial aid page here but I doubt if I will qualify. That's where were at right now.

[mauricenme]

How do I post the lab results. They are all in my Gmail but how do I get then from there to here

[mauricenme]

I asked why the trachea in the last xray looked normal but the one from a year ago didn't and he said something about being dynamic he said one showed the trachea and one didn't but I saw both xrays and to me they looked identical except one show the trachea narrowed and the other one didnt.

[mauricenme]

He said something about it being dynamic but it didn't make sense and he said he didn't have time to explain it to me

[Squirt's Mom]

By "dynamic" the vet means the tracheal collapse is not constant but changes with inhalation and exhalation. Different areas of the trachea may collapse at differing times from other areas. So while a film might catch a collapse today, next week the film will catch the trachea opened. ;)

As for lab reports, we need to see only the abnormal values, too high or too low, on the labs that show things like ALP, BUN, CHOL, ect. You can enter those values like:

ALP 245 70-200 ug/dl (EXAMPLE)

From the LDDS, ACTH, and ultrasound we need to see all the numbers as well as the comments that come on the tests.

[mauricenme]

I just read that soloxine can cause panting. That is when I noticed the panting started. But if soloxine is the reason you'd think he'd pant no matter what the temperature is but he only pants when it's hot or / and humid

[mauricenme]

Ok here are the abnormal results -
albumin 4.0 range 2.7 - 3.9 g/dL,
AST 14 range 16 -55 U/L,
ALKP 740 range 5 - 160 U/L

I strongly believe in looking at the "gray scale" (values being in range but barely those are -
CHOL 328 range 131 - 345 mg/dL,
A/G ratio 1.4 range 0.7 - 1.5,
MCHC 33.0 range 32.6 - 39.2 g/dL

his platelet count is normal but on the low side-
181 range q43 - 448 K/uL and
BUN 9 range 9 - 31 mg/dL

when I look at all 4 times his blood was ran I noticed that BUN is decreasing a little more each time. Now for the ldds

[mauricenme]

Ldds
Cortisol - Pre Dex. 2.6. Range 1.0 - 6.0 ug/dL
Cortisol - 4 hr Post Dex. 1.9
Cortisol -8 hr Post Dex. a 1.7

a. Low -Dose Dexamethasone Diagnostic Intervals (Canine)
4 hours 8 hours. Interpretation
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
<1 <1. Normal
1.0 -1.5. 1.0 -1.5. Inconclusive
>1.5 and >50% >1.5 and >50% Consistent with hyperadren-
of baseline. of baseline. ocorticism Further testing
Required to differentiate
adrenal tumor from pituitary
dependant PDH
<1.5 or <50% >1.5 and >50% Consistent with pituitary
of baseline. of baseline dependant PDH
<1.5 or <50% >1.5 and <50% Consistent with pituitary
of baseline. of baseline. dependant PDH
>1.5 or >50% > 1.5 and <50% Consistent with pituitary
of baseline. of baseline. dependant PDH

[mauricenme]

Just curious as to why I am not allowed to post attachments and is that something that can change or will change later or never change

[labblab]

Just curious as to why I am not allowed to post attachments and is that something that can change or will change later or never change
I will try to stop by a little later on to comment on your test results. But I first wanted to quickly explain that it is a security feature that does not allow members to upload attachments other than images. It is unfortunate, but we have to protect the forum from malicious users who might try to inject malware of some sort onto the site.

In terms of reporting test results, I actually think it is more helpful for the rest of us when members do just what you have done -- post only any abnormal values in the body of a reply. This saves us from having to wade through a bunch of numbers that are not significant. But if there are occasions when you wish us to see a complete page or report, one option is to photograph or scan it, and then upload it as an image either in the body of a reply or as a photograph in your personal album.

Marianne

[lulusmom]

Hi and a belated welcome to you and Maurice.

My goodness you have gone above and beyond for Maurice so I applaud you. My heart breaks for you and given your circumstances, I want to try to help you minimize your expenses in any way I can. I used to be a regular here but my circumstances have changed so I am rarely here. I just popped in today to have a look-see and ended up reading your thread. Unfortunately, I don't have time to go into all my thoughts about Maurice's case right now but wanted to ask you to please tell me exactly what symptoms Maurice currently has? Please let me know which symptoms are intermittent and which ones are constant. If they are intermittent, have you noticed a pattern or anything out of the ordinary. For instance, I noticed you mentioned that Maurice only pants when it's hot or humid outside and never when he's in an air conditioned environment. That seems pretty apparent that the cause is most likely the heat.

I'd also like to know if you are giving Maurice his thyroid med an hour before he eats. This med needs to be given on an empty stomach for maximum absorption. Unfortunately most vets aren't aware of this and therefore don't provide proper dosing instructions to their clients. I will try to get back here later today or tomorrow to check for your responses and to post my comments.

Glynda

[mauricenme]

I must be stupid because I thought about doing that but couldn't figure out how

[mauricenme]

Sometimes I just feel like giving up because no matter what I do or where I go it feels like all I'm doing is spending money and everybody just keep wanting to repeat the same things over. I was reading someone's post and they were saying how their dog handled the ultra sound and how could they know that unless they were there. Everywhere I go I am left sitting in the waiting room and I don't get to see nothing I don't understand why I am not allowed to go back with my dog. This last specialist didn't even do the exam in front of me and I asked what his blood pressure was and the answer I got was 120. I thought blood pressure was a number over another number. I've been trying to find out what's wrong with my dog since Dec of 2013 and I had to find out about the ultra sound from this site none of the vets I been going to mentioned it and now to make matters worse I'm having second thoughts on this place I just don't know what to do anymore but sit here and cry

[mommyslittlegirl]

Hi,just want to say I am very sorry for all the things you are going through with your baby. My own toy poodle has a lot of problems. Tam and other vets can also not figure out why she has lots of weight loss and she looks like an untreated poodle even on Cushings medicine. But what I wanted to tell you is my poodles blood pressure is a 148. That is normal reading. She also has one number. And so I think your babys blood pressure is normal.

[labblab]

Hi and a belated welcome to you and Maurice.

My goodness you have gone above and beyond for Maurice so I applaud you. My heart breaks for you and given your circumstances, I want to try to help you minimize your expenses in any way I can. I used to be a regular here but my circumstances have changed so I am rarely here. I just popped in today to have a look-see and ended up reading your thread. Unfortunately, I don't have time to go into all my thoughts about Maurice's case right now but wanted to ask you to please tell me exactly what symptoms Maurice currently has? Please let me know which symptoms are intermittent and which ones are constant. If they are intermittent, have you noticed a pattern or anything out of the ordinary. For instance, I noticed you mentioned that Maurice only pants when it's hot or humid outside and never when he's in an air conditioned environment. That seems pretty apparent that the cause is most likely the heat.

I'd also like to know if you are giving Maurice his thyroid med an hour before he eats. This med needs to be given on an empty stomach for maximum absorption. Unfortunately most vets aren't aware of this and therefore don't provide proper dosing instructions to their clients. I will try to get back here later today or tomorrow to check for your responses and to post my comments.

Glynda
I just want to make sure you have the chance to see this reply that Glynda posted to you on the preceding page. Her reply went up just a minute before yours, so I'm not sure you even had a chance to see it. But she can be an enormous help to you, so I don't want you to miss out on reading what she wrote.

Also, you are not stupid at all -- or if you are, welcome to the club! I don't know how to scan stuff, either, or how to manipulate photos. But you've typed out the test results for us, and that's really all we need to know. So you've done just fine!!!!!

And another secret I'll share with you -- my dogs always get taken away for exams, too. I've certainly thought about asking to be present for everything, but then I think, "Oh, let them just go about their job." I really do have such respect and affection for my long-term vet, so that makes it easier to place the exam/procedure in his hands. But sometimes I think "I wonder what is going on back there," myself. :o

Marianne

[mauricenme]

I've been giving the pill an hour before he eats. The panting didn't start until he began taking the meds for his thyroid. The cough used to be when he was excited now it sometimes happens when he's at rest also. I know my dog and I know something isn't right. I think stress has alot to do with it. I stress over the that I am between a rock and a hard spot. We live in my van. I'm on ssi and for extra money we go out and recycle. We have been in this situation now for a few years and we're making the best of out situation. But since he got that cough it got harder and when he lost all his energy it got really hard because now that he's heat intolerant and cannot keep up anymore is taking away a good part of our recycling money away because it's summer it's hot and I can't leave him alone in the van and I can't take him with me and I don't have anyone that is able to help me. Sometimes hell just start breathing really hard I watch his body move up and down with every breath and it's hard and fast and irregular it's not all the time right now he's breathing normally but his nose runs and is warm sometimes his teeth need to be cleaned again. The last time I had them cleaned they pulled his 3 front top teeth without even asking me they just did it. I just can't seem to go to the right place

[mauricenme]

I've noticed his bun slowly decreasing each time his bloodwork is ran. It does not matter if hes eaten or on meds off meds it's slowly going down. Right now it's one number away from being low. We did a proBNP which came back normal but the note from the lab saying significant heart disease is unlikely at this time leaves me wondering if they see heart disease forming. And unlikely at this time is alot different than not present at all. Maybe I'm reading too much into things I don't know. They want to do xrays again and I don't understand how taking another xray of the same thing is going to show them anything that the 3 i already had done on 3 different days has not shown them.

[lulusmom]

Thank you for answering some of my questions. This may be the longest post I've ever posted and I've posted some doozies so make sure you have your beverage of choice and empty your bladder before you settle in to read this. Take it slow and try to digest everything so that you don't get overwhelmed. Write down questions as you go so you can remember them all and post them here later. There is always somebody around to answer them. Okay, if you are ready, you can find my comments in blue text within the body of some of your posts.


the t4 and both free t4s were way high now so he said to only give one pill a day in the morning. by now I'm started to research things on my own and everything i read says to divide the dose in half ,morning and night. I asked, mentioned that and he said I was misinformed and if it were his dog he would do one in the morning. so I followed what he said and after a couple weeks maurice symptoms didn't change and that nagging feeling I had to stop the meds wait a week and get a full thyroid panel and go the distance to the vet I trusted.

The half life of Thyroxine is no more than 12 hours so that’s why you give the med every twelve hours. If the results of the test were way high 4 to 6 hours after the morning dose, switching to one daily dosing is not really an appropriate way to reduce a dose. By the way what is way high? Can you post the number for us? A dog who is getting too much thyroxine will flip from hypo to hyperthyroidism and will start peeing buckets and drinking huge amount of water. These are classic symptoms of hyperthyroidism. Was Maurice drinking and peeing a lot after starting the thyroid meds?

I just wanted to add the alkp and the other values that were abnormal the first time which was CHOL, ALB, and MCHC but that also didn't happen. I now have 3 sets of the same bloodwork.

Unfortunately, you cannot pick and choose which blood enzymes to test. These are all part of a complete blood chemistry test. There is a cheaper mini blood chemistry but it only includes some liver enzymes and kidney values.

I demanded a ldds test because I read it was the most reliable for cushings. He said I was wasting my money. I said I don't care it's my money.

While the LDDS is probably the hallmark test used to diagnose cushing’s, it is also the most likely to yield a false positive result in the face of non adrenal illness or even severe stress. Since Maurice didn’t have the usual symptoms commonly associated with cushing’s he was not wrong in believing that it may not be cost effective to do an LDDS test. The goal of treatment is to remedy problematic symptoms which are usually a lot more problematic for the pet owner. A once housebroken dog who is soiling in the house and a dog constantly begging, whining and foraging for food can wear you down. If there are no symptoms, an experienced vet usually won’t recommend treatment, especially in a case like Maurice where there also no overt abnormal blood or urine values that are commonly seen in cushing’s. There have been some different trains of thought lately on starting early treatment in the absence of symptoms but I don’t think Maurice would qualify as a likely candidate.

I also asked that a bile acids test be done thinking about the plastic that may be in there someplace. But instead of a pre and post pandrial like i wanted i got a pre panpandrial random with a small d in front but the pre was normal but i do not know if the post was or not he didnt do the post.

Your vet probably didn’t feel it necessary to put Maurice through the entire bile acid test as his liver enzymes are not suggestive of liver disease. A cushing;s savvy vet knows that a good many dogs diagnosed with cushing’s will have increased pre and post prandial results and won’t recommend a bile acid test unless they suspect more than cushing’s is affecting liver function. If liver function was being impaired by something that is obstructing the bile duct, you would see more than a mild elevation in liver specific enzymes, ALT & GGT as well as elevated cholesterol. Maurice’s ALT, GGT and cholesterol are normal.

The ldds test came back friday and i had to call again to remind them to email the results to me even though they said they would. The results are cortisol pre dex 2.6 baseline with the range being 1.0-6.0 ug/dL, cortisol 4 hour post dex 1.9 no range listed but ug/L, cortisol 8 hour post dex 1.7 with an a in front.

Those LDDS test results are consistent with cushing’s but as I already mentioned, this test is prone to false positives so given that Maurice’s doesn’t really present as a cushingoid dog, both physically and clinically, I personally wouldn’t spend money on pursuing a cushing’s diagnosis at this point in time.


while I was waiting for the 4 hour blood draw I got a phone call from the vet who did the xray after maurice was hit. She said she showed the xray to the radiologist and he saw something in his left lung she wanted to make sure my vet knew.

Did you have the LDDS test done right after Maurice was hit by a car? If so, the stress alone could cause a false positive result.

so at the end of the day when I asked my vet if anyone called him about the xray and he said yes but he was busy he didn't take the call. I told him to call her back cause something was found. I found out he never called because I decided to take everything I had to this last vet cause she cared enough to take that 3rd xray that I didn't get charged for. I went in for a followup on the xray she took and a 2nd opinion on all my blood tests. Well she wanted to do another xray first to compare so I let her do that and it turned out that whatever it was was no longer there not only that but my explanation for his cough being from minor collapsed trachea was just blown out of the water his trachea looked normal in all those xrays and cushings is present because after she did the math.

At this point, the only thing I’d blow out of the water is a cushing’s diagnosis. One positive LDDS test for a dog with no symptoms and negligible abnormalities on bloodwork falls way short of supporting a cushing’s diagnosis. Setting the thyroid issue aside, I’m inclined to believe the Maurice does have a collapsing trachea. Panting, labored breathing and coughing are all very common symptoms associated with a collapsed trachea. It is almost impossible to tell the difference between a cough caused by a collapsing trachea and kennel cough. Both coughs sound like a honk. Coughing at rest isn’t unusual but it is easily triggered with excitement, eating, drinking, exercise and hot and humid weather. This could be why you observe Maurice coughing more on hot and humid days. One of my little dog had horrible coughing attacks when we had heavy smoke from brush fires in California so airborne irritants can trigger the cough as well. I have shared my life with and rescued many toy dogs over the years and I have dealt with many collapsing tracheas. Little dogs, especially toy breeds, are genetically predisposed and for what it’s worth, I never lost a baby due to collapsing trachea, however, it can be life threatening.. Symptoms of the condition can start at any age but in my experience, it’s more likely to rear its ugly head at middle age or older. Surgery is an option for those whose condition has become life threatening but it’s highly unlikely that dogs older than middle age would be a good candidate for surgery.

I now could full in those ranges both were 1.3 but when I asked about the abnormal values on the rest of the blood that famous saying of I'm not concerned about that was my answer. Well I am concerned about that because now I have no explanation for his cough which is getting worse. she said she didn't want to treat cushings until it was severe. she didn't even mention trying to see what type he had.

I’m glad the vet doesn’t want to treat for cushing’s because there is no way a cushing’s diagnosis should have been confirmed with such scant clinical evidence. As I mentioned earlier, if it were me, I wouldn’t spend any more on pursuing a cushing’s diagnosis nor would I spend any money trying to figure out what type of cushing’s Maurice has. It’s my layperson’s opinion that Maurice doesn’t have cushing’s. What you can do is talk to the vet, whichever one you are currently in contact with, and ask about putting Maurice on a bronchodilator . My last pup with this problem was put on aminophylline but it killed his appetite completely. This is a common side effect so ask the vet about Theophylline instead. It really helped my Jasper. He also had heart disease and I remember thinking I was going to lose him. His excitement to see me come home from work set him off on a coughing jag that I thought would never stop. Once we got him on Theophylline, he could walk and spin around circles as usual without coughing so much. I also raised his food and water bowls so you should try to do that for Maurice as well. If you go with Theophylline, it’s given every twelve hours on an empty stomach one hour before or two hours after a meal. Always have water available and always give the pill whole, never crush or cut it.

she just told me to keep giving the soloxine prescribed by the vet I no longer trusted. i asked him for a liver supplement but he said it wasnt necessary but i noticed his alp decreasing while he was taking it and increased when i ran out. so i asked her to give me some which she did. but I had to ask for it.

Dogs with untreated cushing’s don’t see drops in ALP. They see consistent increases so this is just one more piece of evidence that doesn’t support a cushing’s diagnosis. FYI, you can buy Milk Thistle, a great liver support supplement, over the counter. If buying human product, dosing is based on size, I’ve included a dosing chart below:

Dog's size Dose as % of adult human dose
5 lbs 10%
5-10 lbs 15%
11-20 lbs 20%
21-40 lbs 30%
41-70 lbs 50%
71-100 lbs 75%
100 lbs 100%


So after all these vets and 2500.00 dollars I still don't know if my baby has primary hypothyroidism or if it's secondary to cushings. his symptoms are still the same no energy and panting and that cough that he has mostly when he's excited. it's like he has something stuck in his throat. Hell give 2 hacks then a final cough like he got whatever it is out only nothing came out and now it's the exact same cough only more often and even at rest.

That sound like a collapsing trachea cough. It’s a honking cough with a final gack, like they are trying to cough up phlem. It could be very possible that Maurice has primary hypothyroidism and if he isn’t showing signs of hyperthyroidism, I’d keep him on the medication and continue to monitor. Dogs with primary disease usually have bad skin and often time the skin pigmentation turns completely black. The coat is dry, brittle and loss of coat is common on the flanks with normal coat on head, feet and legs. Low thyroid dogs can gain weight eating the same amount or even less. They become lethargic and don’t like to exercise. Does Maurice have problems with his skin or coat?

I read that it can be dangerous to treat a secondary hypothyroidism dog with thyroid supplement. you have to treat the primary condition first then the thyroid will fix itself if it's not too far gone.

It is rare that dog would die from over supplementing with thyroxine. As I mentioned before, if the thyroxine dose is too high, you’ll know it rather quickly by the marked increase in drinking and peeing. If Maurice’s low thyroid is due to an underlying condition that is transiently effecting his thyroid, you’ll need to figure out what underlying problem he has. It is quite common for dogs with cushing’s to have low T4 but based on all the information you’ve presented, I don’t think cushing’s is the problem. It could be that Maurice really does have primary hypothyroidism and will require thyroxine for the rest of his life. Hypothyroidism does causean increase in ALKP but elevations are usually more mild than cushing’s.


Ok here are the abnormal results -
albumin 4.0 range 2.7 - 3.9 g/dL,

Most vets would ignore this as increases in albumin doesn’t happen. If a dog is very sick with a fever or in shock , the concentration of blood can albumin appear high. Since that is not the case with Maurice, I suspect this minute elevation could have easily happen from an improper blood draw or even lipids (fat) in the blood, which is not uncommon in an unfasted specimen. Do the results mention a lipemic or hemolysis index with plus signs? If so, can you tell me exactly what it says?

AST 14 range 16 -55 U/L,

Was Maurice being treated for stomach problems with Flagyl (Metronidazole)? I ask because Maurice’s AST is low and this can be caused by Flagyl. Given that ALT and GGT liver enzymes are normal, I don’t think a vet would be concerned with this decrease.


ALKP 740 range 5 - 160 U/L

I strongly believe in looking at the “grayscale" (values being in range but barely those are -
CHOL 328 range 131 - 345 mg/dL,
A/G ratio 1.4 range 0.7 - 1.5,
MCHC 33.0 range 32.6 - 39.2 g/dL

Gray scale counts if there are other abnormalities driving the numbers and in my layperson’s opinion, there aren’t any so try not to drive yourself crazy. With the exception of the ALKP, everything looks great. Cushing’s isn’t the only disease that can raise ALKP. Stomach problems and even dental disease can cause increases in ALKP. If you are seeing this liver enzyme reduce with liver support, keep it up and monitor.

his platelet count is normal but on the low side-

181 range q43 - 448 K/uL and
BUN 9 range 9 - 31 mg/dL


I've noticed his bun s lowly decreasing each time his bloodwork is ran. Don't matter if hes eaten or on meds off meds it's slowing going down right now it's one number away from being low.

This miniscule decrease is definitely not anything that would raise any flags. Over hydration, iv fluids and any non-renal condition that makes a dog drink and pee too much (polyuria/polydipsia) can lower BUN. Problems in the gut that interferes with proper absorption of protein can also lower BUN but if that were the case, you would be seeing a lot more abnormalities in the blood chemistry and CBC.


We did a probnp that came back normal but the not from the lab saying significant heart ideas is unlikely at this time leaves me wondering if they see heart disease forming. And unlikely at this time is alot different than not present at all. Maybe I'm reading too much into things I don't know. They want to do xrays again and I don't understand how taking another xray of the same thing us going to show them anything that the 3 i already had done on 3 different days has not shown them.

A proBNP is a blood test that measures the severity of heart disease. I have two dogs that have had them done routinely to monitor the progression of their heart disease. The higher the number, the worse it is. I just received the results of one for my dog, Buster, and the results were much higher than the last test, which means his heart condition continues to deteriorate. Aside from the cough, I wasn’t quite sure why your vet ran this test in the absence of a heart murmur or arrhythmia. Soooo, I did a bit of research and discovered that they do this test sometimes in dogs that have symptoms common in heart disease and respiratory disease to differentiate between the two. In Maurice’s case, those overlapping symptoms would be coughing, panting, increased respiratory rate, lethargy and exercise intolerance. Many little dogs Maurice’s age have at least a low grade murmur so if there is no murmur heard at all and you have a normal proBNP result, I wouldn’t worry about Maurice’s heart.

At this point, I’m more worried about how your heart is doing after having to read this novel. You’ve been through so much and through so many vets who apparently didn’t take much time to explain things to you so I did my best to help you understand things a lot better. I hope I’ve helped and not confused you even more.

Glynda

[mauricenme]

Thank you for taking tI'm to explain. His pro bnp was 365 his after a week off thyroxine his total t4 was 0.5 range 1-4 ug/dL with an index of a in front. Free t4 by ed ng/dL 0.3 range 0.7-3.7 ng/dL free t4 by ed pmol/L 3.9 range 0.05 - 0.42 cTSH 0.12 range 0.05 - 0.42 tgaa 2.1

[mauricenme]

His albumin is high on all his blood panel and yes there is a lipemia index with c N then a hemolysis with b+++

[mauricenme]

I have not gotten the acth test yet or the ultra sound I was gonna get both those along with xrays on the 2nd but since my boyfriend changed his mind about splitting the cost with me I will only be able to do one of the 3. I've decided to do the ultra sound first. Is that a good choice the xrays have been done twice recently the ultra sound has never been done do you see any reason why the first and second set of xrays would need to be done over . He has tested negative for parasites and heartworm is roundworm a separate test the test was the Elisa but it's been a year since we did that test

[mauricenme]

I thank you for being patient with me through this. And I apologize for any complaining.

[mauricenme]

Is it possible his body is not converting t4 into t3 like it's supposed to. Because t3 is what gives them energy and he still has none

Can hypothyroidism cause a failed ldds

Maybe there is a tumor ion the thyroid gland that would cause a cough would a tumor be seen on an xray. No problems with his coat no hair loss the breathing problems didn't began until he got on thyroid medications. I notice the breathing when he's asleep so when we're at the vet it's not happening

[Squirt's Mom]

I have not gotten the acth test yet or the ultra sound I was gonna get both those along with xrays on the 2nd but since my boyfriend changed his mind about splitting the cost with me I will only be able to do one of the 3. I've decided to do the ultra sound first.

Not sure you read ALL of Glynda's reply but I agree with her about continuing to test for Cushing's - you are wasting your money and putting your baby thru stress unnecessarily if you continue testing for a disease nothing points to. ;) I would not do the ACTH but would have the ultrasound, or a CT scan, done if possible....looking at the heart, lungs, throat, and nasal passages in particular instead of the abdomen.

Just to restate my point - it does NOT appear that your baby has Cushing's so to continue testing for Cushing's is unfair to you and to your dog at this point in time. ;)

[mauricenme]

Glynda
I apologize for repeating myself - I don't mean to I am so overwhelmed with all of this and I feel really stupid. Alot of times I get stuck and ask questions that have already been answered. It's because of a learning disability that I've struggled with my whole life. I want you to know that you have been more helpful in the way you explained things than all the vets puts together and I thank you for that

[mauricenme]

I just wish I could find a vet who I am happy with and who I can trust. Maurice has been healthy his whole life we didn't even have a regular vet. I have nobody to blame but myself for that because I kept putting it off mainly because I didn't know how to tell who was good and who was not. Maybe I expect too much and I when I have a problem with how the visits go I don't know what to say so I say nothing. I just wish I had someone to come with me to the vet

[mauricenme]

I just watched a bunch of dogs coughs on u tube from kennel cough and from collapse trachea and if i had to pick out of which cough is like maurices cough the kennel cough describes how his cough sounds. The collpase trachea dog cough aint even close to how his sounds. It also never occured to me that maybe the person i got him from didnt properly vaccinate him by a vet. I keep thinking back and i remember him getting boosters from the pet store the do it yourself ones but he was not yet mine at that time. I know ive kept his shots up every year but what if all he ever had was boosters and never had that first actual shot i wish I could find a vet who I am happy with and who I can trust. Maurice has been healthy his whole life we didn't even have a regular vet. I have nobody to blame but myself for that because I kept putting

it off mainly because I didn't know how to tell who was good and who was not. Maybe I expect too much and I when I have a problem with how the visits go I don't know what to say so I say nothing. I just wish I had someone to come with me to the vet

[mauricenme]

Can anyone give me the name of an expierence internal medicine specialist in the la area. I don't know if I should stay with the one I went to or not. What questions should I ask before making an appointment. Is it unreasonable to want to meet the dr first instead of spending alot of money to find out i don't care for him. This last dr made me feel like I was a just another appointment. It seems like every visit with everyplace I go they say what they say I ask what I ask then they ask what I want to do and that's where I get tounge tied because I don't know. Maybe it's the way it's being worded like a fill in the blank question and I don't even know at that point what to say or ask. I know I want someone who really cares about my dogs well being and does not see him as just an object. I want whoever does this ultra sound to show me the ultra sound not just tell me.

[mauricenme]

We went to another specialist on sat and they did an ultra sound on his abdomen and found bilary sludge seeping into his liver. Everything look unremarkable except his liver and gall bladder. They gave me actigall to give once a day and more denamarin. They took him off the thyroid medication because they don't think his ctsh is high enough for his thyroid to be primary. They did another blood test with the gases on it. It was a venous source. His pH is higher than it should be 7.42 range 7.31 - 7.42. The other one is PO2 (ven) 50.0 range 24.0-48.0. She wants to do an acth stimulation test. The last time when he stopped the thyroid medication his heavy breathing and panting stopped but this time it didn't

[mauricenme]

Also his alt is moving up its still good at 95 U/L but it's higher than its ever been is PCV is 44% and T/S is 7.6 and BC <1% whatever that means and his sodium is 159.0 mmol/L range 144.0-160.0 mmol/L potassium 3.8 range 3.5-5.8 which would give him a na/k ratio of 41.8 with a range of 28-37.

[mauricenme]

Now his breathing hard and heavy happens all the time
Even when he's asleep it does come and go though but it's labored more than not

[Squirt's Mom]

I'm glad you got him to a specialist and they are taking some steps to find out what is going on with your sweet baby boy. If he is not truly hypothyroid but has been treated for it anyway, that alone would make him pant, make his heart rate higher, his body temp higher - a whole host of mal-functioning organs making him feel very bad. Do a bit of research on the thyroid gland and you will be astounded by what all this little gland controls.....and just how haywire the body can get when it is not working properly either naturally or due to external stimuli like thyroid meds that are actually needed. Hopefully he will start to breath a bit more normally without those on board.

You are doing a great job of keeping in touch but we have fallen down on our end of the bargain and have not been responding to you very often. I apologize and will do a better job of keeping an eye on Maurice's thread. I may not have anything of value to offer but I will do better and at least let you know we are reading even if we don't have any input.

Hugs,
Leslie and the gang

[mauricenme]

I'm scared that the gall bladder sludge isn't going to come out the medicine needs to be refrigerated and all I can do is keep it in a cup of ice that melts as fast as I fill it up.

[molly muffin]

What about one of those cold pack cooler, for like keeping a couple soda in? (not the big ones) and putting a bag of ice. That would keep it cooler than a cup would I think. I'm not sure, but a dollar store may have something that would work.

I don't know the answers either but sounds like the gall bladder may be affecting the liver (sludge seepage).

The panting is still worisome, but I hope that off the thyroid meds if he doesn't need them it would get better. (his heart and lungs looked okay on the ultrasound?)

I don't know, but maybe it is possible for them to titer test for his antibodies to kennel cough. Worth asking anyhow. My molly got kennel cough once, even though she was vaccinated and that was sooooo scary. I thought we'd lose her during it.

[mauricenme]

They took him off soloxine. The ultrasound of his abdomen revealed gallbladder sludge and bile seeping into his liver. They gave actigall. I got the one that don't have to be in the fridge. With pituitary cushings wouldn't both adrenal glands be somewhat enlarged? His are normal and kidneys spleen pancreas all excellent but she still wants to do an acth stimulation test. But I was thinking maybe the CiALP (cortisol infused alkaline phosphate might be better because that would tell us exactly what percentage of the ALP enzyme is being made by the adrenal glands.

[molly muffin]

yes usually with pituitary both adrenals are a bit enlarged. But we have had some that didn't have enlarged adrenal glands so it's not a given, just likely, as the adrenal glands would be producing excess cortisol (working over time)
It isn't a given, but it is expected.
Maybe it is gall bladder and liver that is causing the problems and not cushings though.

[molly muffin]

How are Maurice and you doing? Just checking in on you.

[mauricenme]

here are Maurices ATCH stim test

Cortisol - Pre ACTH 2.0 ug/dL
Cortisol - Post ACTH 20.4 ug/dL with a small a in front

the small a says
ACTH Reference Range:

Canine:
2-6 Pre-ACTH (resting) cortisol
6-18 Post -ATCH cortisol
18-22 Equivocal post-ATCH cortisol
>22 Post -ACTH cortisol consistent with hyperadrenocorticism
>2 Post -ACTH cortisol consistent with hyperadrenocorticism
1-5 Desired pre- and post- ATCH cortisol on lysoden therapy

ACTH response test is only clearly positive (>22) in 30% of dogs with hypoadrenocorticism (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs with HAC.* If the ACTH response test is normal and HAC is still suspected proceed with the ldds test
Dogs with iatrogenic cushings disease will have flatline response test results in the low end or normal reference range.

thyroid panel
Total T4 0.4 ref range 1-4ug/dL
Free T4 (ng/dL) <0.3 ref range 0.6-3.7 ng/dL
Free T4 (pmol/L <3.9 ref range 7.7 -47.6 pmol/L
cTSH 0.14 ramge 0.05-0.42 ng/dL

other abnormalities
CHOL 405 range 131-345
AST 11 range 16-55
ALP 835 range 5-160
Chloride 107 range 108-119

he is still on 1 ml of actigall for gallbladder sludge the recheck showed that is working
he threw up 4 times yesterday. they don't want to do anything about anything
else not even figure out whats going on with the low t4s I guess they want to wait till he is on his death bed. He hasn't been feeling good at all and his breathing is getting worse. he now breaths noisy all the time I'm not liking it

[molly muffin]

He definitely needs some thyroid medication, with that low across the board.

The AST being low is a concern, because the liver needs to be functioning well to do what it is suppose to do and the vets should definitely be looking at this.

I'm very sorry to hear that he is still struggling with breathing problems. Are is gums a good color?

[mauricenme]

Ok somehow I found this reply but today has been frustrating I went to see another vet that also does holistic medicine and she looked over all the blood work work and xrays and she is mainly worried about his liver. She gave me black Spanish fly supplement and said to give him 2 tablets twice a day till its gone. It's supposed to cleanse his liver but she told me to get nature's variety wet food lamb but in capital letters she wrote no flaxseed no sunflower oil and no sweet potato. I got what she said but when I read the ingredients I noticed 2 ingredients were flaxseed oil and ground flaxseed. She told me to get something that has an ingredient that she told me not to get. Now they r all closed and I gave to wait till morning to go and get her to explain. This is getting to be rediculous. The specialist said to give low protein but it's hard to know how much protein is even in there. you practically have to be a rocket scientist to understand the label. In one place it reads it's formulated to meet the nutritional levels established by AAFCO. But the same label says it's not recognized as an essential nutrient by AAFCO. How can AAFCO not recognize something that meets their standards. And crude protein is what? How can I know it's low protein when the ingredients also have protein you gotta be a rocket scientist and I am definitely not that. I just want to scream. If someone told me I would someday have this much stress over deciding what to feed my dog I would have told them they were insane. And the only vet that I could even get to tell me what to get sent me out to get something that contains an ingredient she said not to get. What is wrong with this picture. She may as well told me to go get an orange but make sure it don't contain vitamin c

[mauricenme]

Well maurice has failed 2 ldds tests, 1 acth stimulus came back inconclusive and 1 uccr was negative but borderline negatve. So they got him on thyroid meds for his low thyroid and ursidol for his gallbladder sludge. He's showing no symptoms of Cushings but I think he's getting a little bit of a belly on him. Eventually he will probably need a Stent for his collapsing trachea and his gallbladder removed. Other than that he is doing well.

[DoxieMama]

Wow, you have really been through a lot with Maurice. I just went back through and read all the history - what an ordeal!

I have to agree with the others, it sure does not seem like he has Cushing's. Just low thyroid, and maybe he is getting a little too much food and not enough exercise if he is getting a little bit of a belly. Me too. ;)

I am happy that he is doing well otherwise! That means you don't have to spend so much time or money at all the vets.

Thanks for checking in!

[molly muffin]

I am glad to hear that he is doing well. It sure hasn't been easy with his diagnosis and so much going on.

[mauricenme]

Yes but now I have to save up in case he needs his gallbladder removed. It's almost full of sludge and could rupture and if I don't have the 6000.00 for surgery he'll die. I got 800 saved so far

[mauricenme]

This is going to be long but this is where were at. We are now seein dr. Feldman at vca in west hollywood. Maurice is on levothyroxine for his thyroid, ursidol for his gallbladder sludge and denamarin. So far we have done 3 UCCRs. The cortisol levels have increased with each one. 2 months ago the Dr suggested givin supplements malatonin 2 times a day 3 MG and HMR ligand once a day 10 mg. The melatonin is cherry flavor but the Dr said it was fine. He said it would take 2 months to work. Right at the end of the 2 months Maurice began drinking way excessive. All the times when I thought his thirst increased it did butwhat I consider increased thirst is not noticed by most people. What I consider excessive thirst what most people call increased thirst but now he is drinking way more than he should and when he pees he can completely fill a urine sample cup and then some. He's peed the on the bed at least 5 times now and one time he didn't even bother to get up. I had to give him a bath and go to the laundry mat at midnight. His appetite for dog food has decreased he hasn't been eating his normal amount. He weighs 11 lbs. His dog food has been hills perscription low fat i/d dI gesture care. But he scrounges for people food and will pick up aNY thing he considers edible off the ground. Other than that no other symptoms.....yet. last night we stopped the supplements. Today we saw the Dr and did blood a blood test and urinalysis. Will have results tomorrow. If those dont reveal something else in 2 weeks when the supplements are out of his system and if his thirst is still excessive the Dr wants to send some blood to the university of tennessee for an adrenal panel. I couldn't find much informaton on what that test is going to reveal besides that it is used to find atypical Cushing but with atypical Cushing cortisol levels do not increase but the dr said it tells about the other hormones. I don't know what is going to reveal but he said it takes 2 weeks and it's 400.00. The latest ultra sound was done by a radiologist who said his liver was bright. I'm gonna call and get the written findings to see what else if anything. The dr. said nothing is wrong with his pancrease but on the last blood test the precision psl was high. Since sat. I've spent 950.00 between today and the radiologist on sat. In 2015 you all helped with 250.00 for the atch stim test. I was wondering if I am eligible for any help with this adrenal panel. I also would like to know what you all think about all this. Thanks

[Squirt's Mom]

Hi,

The UTK full adrenal panel looks at the cortisol as well as 5 intermediate, or sex, hormones. In Atypical Cushing's the cortisol is normal but two or more of the intermediates are elevated. These elevations can cause the same signs as typical Cushing's. The treatment for Atypical is a *combination* of melatonin and lignans from either spruce or flax. The melatonin used is plain ole melatonin - no flavors, no time released, no extended released, etc - just plain ole melatonin. This treatment takes at least 4 months to work. Why did you stop them? Here is a link that tells you the dose for both the melatonin and for the lignans. https://vetmed.tennessee.edu/vmc/dls/Endocrinology/Documents/Treatment%20Considerations.pdf

Has his blood glucose been checked lately? If not, I would have that done asap.

The $250 grant you were given for Maurice did not come from the forum here - it came from a fund called Tipper and Squirt Care for Cushing's Fund. Squirt was my baby but because I now have a second dog diagnosed with Cushing's I have stepped down to avoid any appearances of fraudulence, etc. If it has been a year since the first grant you were given you are eligible to apply again. Click on the "Apply" tab and follow the directions here - http://www.tipper-squirtcushingfund.org/

Hugs,
Leslie and the gang

[mauricenme]

But his uccr shows his cortisol levels rising. If they r rising how can it be atypical Cushing. What does the other hormones values give

[labblab]

Since Maurice has tested "negative" on multiple Cushing's diagnostic tests in the past, perhaps Dr. Feldman thinks that if you are going to repeat an ACTH test, it would be worth the extra money to have a full panel run this time. That way, even if Maurice's cortisol level still isn't high enough to actually meet the diagnostic cut-off for conventional Cushing's, you'd also have the chance to find out the status of any other elevated adrenal hormones. This information could tell you whether it makes sense to continue with the melatonin and lignans, and whether it might be a good idea to add yet another medication, such as a low dose of Lysodren, to try to ease Maurice's symptoms.

I'm assuming that Dr. Feldman realizes that testing and treatment costs are a hardship for you, so he must believe that the added cost of this expanded test will be of value. But you certainly can check with him again, in order to clarify in your own mind as to the value or necessity of this testing.

I just checked his credentials, and he appears to be a highly qualified clinician. Since he also trained at UC Davis, I wonder whether he may even be related to Dr. Edward Feldman, the renowned UC Davis Cushing's researcher. At any rate, if you have doubts as to what he's hoping to accomplish with this testing, I'd ask him to elaborate further for you.

Marianne

[Squirt's Mom]

The UC:CR cannot diangose Cushing's - it can simply say something is going on causing elevated cortisol. Elevated cortisol can occur for many reasons having nothing to do with Cushing's. When the UC:CR is abnormal that means further testing is needed to find out what is going on. If signs and blood work suggest Cushing's, then the ACTH is the next step, that or the LDDS. An abdominal ultrasound is also a very good test to have done as it would help point out any problems like a tumor that could cause the cortisol to rise.

[mauricenme]

He hasnt tested negative on the other tests he tested positive on 2 LDDS and one atch stimulus was inconclusive and his first uccr was negative but it was borderline negative bUT the latest uccr is positive. He had no symptoms before but now he has the thirst. We did a ua which shows an infection I'm waiting for a copy of the results and to hear back from Dr feldman

[mauricenme]

So gallbladder sludge is cleared up when Cushing is being treated or vice versa?

(Administrative note: I've moved this reply back to your original thread about Maurice. The member to whom you originally posted is no longer active on the forum.)

[Harley PoMMom]

According to one plublished study dogs with Cushing's were 29 times more likely to develop a gallbladder mucocele compared to those that didn't have Cushing's. Unfortunately I haven't found any data that says treating the Cushing's in a dog halts or resolves the production of the mucocele. :(

Lori

[mauricenme]

Got the blood results back ALT 123 (112-118) ALP 1800 (5-131) GGT 42 (1-12) PRECISION PSL 285 (24-140) CREA .4 (.5-1.6) the UA rods 51 - 100 HPF

[mauricenme]

Can someone find out if this adrenal panel frim the university of tenessee will be able to help confirm typical Cushing s

[Squirt's Mom]

The full adrenal panel from UTK will contain an ACTH. It covers the cortisol plus the five intermediate hormones involved in Atypical. So it can help with diagnosing both forms.

Would you mind editing your post with the test results to include the little letters along with normal ranges for each abnormal value. Thanks!

[mauricenme]

He has a bladder infection so we are going to do a culture to see what antibiotics to give

[Squirt's Mom]

That could go a long way in explaining his urination issues lately. I hope the meds work quickly and he is feeling better soon!

[molly muffin]

A bladder infection is better than some of the other options and can cause an increase in various lab results too. Whew.

[mauricenme]

When they order an adrenal panel from the university of Tennessee there are 2 of them
ONE is the adrenal panel combined dex/atch stim. and the other is adrenal atch stim. Is the combined dex just more informaton or completely different information

[labblab]

The combined panel is literally that: it reports results for both a LDDS test of cortisol samples, and also an ACTH stimulation test for the full panel of adrenal hormones including cortisol. I think the dog must be at the vet's all day so that first a baseline blood sample can be drawn, then subsequent samples are drawn as each of the two tests are completed one after the other. Since two different tests are being processed, the cost will be more expensive than either one alone.

Since you say that Maurice has already tested positive on two previous LDDS tests, I don't know that it's worth repeating that test yet one more time. The full adrenal ACTH, on the other hand, will give you info that was not previously available to you: Maurice's status on other adrenal hormones in addition to cortisol.

Marianne

[mauricenme]

I know this is in the wrong place but I cant find my original thread. Nothing happens when I click on search. My question is can a uti between 50,000 and 100,000 psuedoamonas species have an affect on the adrenal panel at atch stim? I am just beside myself because in jan of 2016 a urine mic found less than 5000 CFU/ML of pseudamonas. The Dr said he was 90 percent sure it was nothing bUT here we are over a year later with pseudamonas only now it's between 50,000 and 100,00 and he has crystals now not to mention if this can cause a false positive in the ldds and adrenal panel I'm screwed again because both tests were ran 2 days after the positive mic tests. I tell you I've about had it. Why does every vet I go to run these expensive tests when the results are going to be compromised. This infection was minor a year ago now he needs antibiotics for a month and the Dr wants to start treating Cushing before we even get the results back from tennessee. Am I overreacting here if so what am I missing

[Harley PoMMom]

I have taken the liberty and merged your latest post with your original thread so as to keep all of Maurice's history in one place. ;) I will also leave a visitor's message with a link to your thread on your user profile so it will be easier to find your thread.

Unfortunately any non-adrenal illness, even an UTI, can yield a false positive result on all tests for Cushing's, however, I'm not sure if an UTI will cause the other adrenal sex hormones to be elevated.

What type of treatment is the vet wanting to start? And what symptoms is Maurice displaying?

Lori

[mauricenme]

justthe increased thirst and urination but that can be from the uti

[Squirt's Mom]

I took the liberty of adding Maurice's name to the title of his thread. that way you can find it easier and search for it easier if it's been a while since you were here. ;)

[Harley PoMMom]

justthe increased thirst and urination but that can be from the uti

Yes, absolutely an UTI will cause increased urination and thirst. If this were me I would hold off any treatment for Cushing's until the antibiotics are all and an urine culture come backs clean....just my opinion. ;)

Lori

[mauricenme]

The vet said that since Cushings causes uti's we have to start treating it and we did at 5 mg capsules 11 days later we did acth stim and he upped the dose to 8 mg which requires using the compounding pharmacy. He has been on antibiotics since may 3Rd and 9 more pills to take. Yesterday we did another acth stim, a urine culture to see if uti is gone a t4 to see how the thyroid dosage needs adjusting. We also did a thorax/ abdominal xray. The dr. said he is happy with the cortisol level which confuses me because it's now low . T4 is still high and he wants to lower that. The culture is peNing and the xray is showing a possibe gallstone and in his stomach there's a piece of metal and a piece of plastic which he said isn't an emergency I do not agree because the metal is square and could be cutting his insides and if it tries to work its way out it could really do some damage so I'm really scared. I don't know how or why he even would swallow that or when he swallowed that but Im pretty sure the plastic has been there since Aug 29 2016. The metal really has me worried because yesterday's visit costed 913.00 dollars which left me brole till the 1st and that metal has to come out and if my vet can do it he will let me make payments but if I have to get referred someplace I'll need all the money up front. Tipper and squirt just helped me with my bill in april. But I need to find someplace to help me pay for the removal of this metal. Does anyone know where I can go for that? The acth results said sample 1 was 2.1 (range 1.0 - 5.0) sample 2 was 6.2 (range 8.0 - 17.0). Isn't that too low and if we don't adjust the dose will it go evendors lower? I think that maybe his uti is gone and that alone caused the cortisol to go down and the pills made it even lower. Any thoughts on that. Also since the cortisol got low he started loosing hair on his back legs. I think we should have waited till the uti was gone before treating Cushings but I'm so scared of not doing what my vet says cause what if I'm wrong but what if he's wrong. Maybe I am over reacting. How can a low cortisol be acceptable? Help

[labblab]

Hello again! I'm afraid I have only a moment to post right now, but I wanted to reassure you that Maurice's cortisol level is not too low for a Cushpup being treated with trilostane. The normal range you are citing is for a dog who does not have Cushing's. This is the post-ACTH range you need to refer to after beginning trilostane treatment:



< 1.45: Stop treatment. Re-start at a decreased dose

1.45 to 5.4: Continue on same dose

> 5.4 to 9.1: EITHER: Continue on current dose if clinical signs are well controlled; OR: Increase dose if clinical signs of hyperadrenocorticism are still evident

> 9.1: Increase initial dose

So you'll see that with a post-ACTH result of 6.2, your vet is correct that Maurice's cortisol level is within the desired therapeutic range so long as his Cushing's symptoms are well-controlled. If not, his cortisol should perhaps be even lower. One big question, though: Can you tell us for how he has been taking the 8 mg. daily dose?

Marianne

[Squirt's Mom]

Those ranges listed from the lab (sample one - range 1.0 - 5.0 and sample 2 - range 8.0 - 17.0) are for dogs who do NOT have Cushing's or who are NOT on treatment. The range for a dog being treated with Vetoryl (Trilostane) are as Marianne posted - from 1.45 ug/dl - 9.1 ug/dl. That last number, 9.1, is acceptable if and ONLY IF all signs are well controlled. If signs are still present with the higher post # then the cortisol needs to lowered a bit more.

[Squirt's Mom]

Also -

From our Helpful Resource section - https://www.k9cushings.com/forum/showthread.php?t=212

And from the Tipper and Squirt Care for Cushing's Fund website (under the Resources tab on the home page) - http://www.tipper-squirtcushingfund.org/other-sources-of-aid.html

[mauricenme]

But why does the lab say it's low? They have a range next to each sample and it says sample 1 samplease 2 it don't say pretty acth post acth.

[mauricenme]

Since may 18th

[mauricenme]

Why doesn't it say anything on the lab results about that. I don't understand. Why should the cortisol levels be brought down lower in a dog with Cushings? Won't it turn into Addison s at some point

[labblab]

The thing that makes this confusing is that the ACTH stimulation test has multiple purposes. It can be used as an initial diagnostic test to determine whether a dog has Cushing's or not. The norms you see listed on your form are the results for the ACTH when it is used strictly as a diagnostic.

The ACTH is also used to monitor cortisol levels for confirmed Cushing's dogs that are being treated with medications such as trilostane and Lysodren. When used for that purpose, the desired cortisol levels are different. Most labs now include all these different ranges on their report forms, so it's too bad that apparently your lab does not. It would make things easier for you to understand if they did.

But the point is that vets want to keep cortisol levels consistently lower for dogs who suffer from Cushing's. They do not want them to fall TOO low, because you're right, that would lead to Addison's. So that's why dogs need to be routinely monitored via bloodwork when they take these drugs. If the cortisol is too high, the drug dose is increased. If the cortisol is too low, the drug is decreased. Hope this makes better sense to you!

If you can download this form, take a look at the trilostane Treatment and Monitoring Chart on the second page. You'll see that post-ACTH cortisol levels up to around 9 are acceptable if symptoms are well-controlled. If not, the cortisol target should be lower: no more than 5-6.

http://www.dechra.us/Admin/Public/Download.aspx?file=Files%2FFiles%2FSupportMaterial Downloads%2Fus%2FUS-046-TEC.pdf

Marianne

[Squirt's Mom]

As long as he remains between 1.45 ug/dl and 9.1 ug/dl Maurice should be fine. Using the ranges given on the lab would cause the dog to suffer without need because the cortisol would NEVER be low enough to help. ;) The labs don't know what your dog is taking so all they have to go on are the ranges for a normal or untreated dog. The dog's history does not go to the lab....only the blood work. So the lab works off of information based on a healthy body, not a sick one or one on medication. It is up to the vet to educate themselves about the drugs they are giving our babies and to know how to interpret test results. Sadly, as is the case for Maurice, many vets don't' take the time to do this so it is up to US to learn and know when the vet is going off course...as Maurice's is.

So know you know more than Maurice's vet - you now know what the optimal range for Maurice, and any other dog on Vetoryl, should be - 1.45 ug/dl - 9.1 ug/dl (and yes, the little letters are crucial ;) ). You know his cortisol is NOT too low but is within the range for a pup on Trilo (Vetoryl).

Hugs,
Leslie and the gang

[Squirt's Mom]

I want to add that those numbers are only part of the picture for our babies. We also have to know the signs that indicate the cortisol is well controlled VS too high or too low. It is the combination of numbers PLUS signs that tell the whole picture.

For example - Maurice may be just fine with his numbers where they are but my dog may not feel well and may need to let their numbers rise a bit. The numbers where my dog is acting and feeling well may make Maurice start showing strong signs again. So we must know our babies and we must know the signs that indicate something is off and we must know the correct ranges for the drug our baby is using. Simple huh? :D In time it will be. Part of the reason this site exists is to educate and we will do all we can to help you learn. In no time you will be a pro! :)

Hugs,
Leslie and the gang

[mauricenme]

Trilostane is only working on paper. The drinking and peeing are getting worse and he's starting to loose his hair on his back legs but he's constantly licking them. No pot belly his appetite is normal what should I do. It's like I'm not even treating it. The only improvement is cortisol levels. Could Dr feldmsn be missing something? I thought trilostane was supposed to alleviate his symptoms. I may as well just move into the laundry mat cause I wash the blankets go to bed only to wake up in the morning to go back to the laundry mat. I want to go back to sleep. I don't want to go back to the laundry mat. I'm on the verge of tears. Why won't he just get off the bed when he has to go.

[Squirt's Mom]

There is a very real possibility the urination has nothing to do with the Cushing's. It could be an infection that has never been completely killed off. It could be a condition called Diabetes Insipidus - a rare form of diabetes that has nothing to do with blood sugar but rather with how the body processes water. He could be having some problem with the kidney(s) or bladder themselves, such as a tumor. I would want the vet to look at everything EXCEPT Cushing's to find out what is going on.

As for why he won't get off the bed...probably because he doesn't even know he is about to pee. It just happens. Loss of control is common in many conditions and diseases - in dogs as well as humans. AND in conditions and diseases that have nothing to do with Cushing's.

We tend, and our vets tend, to get tunnel vision when Cushing's is in play and think everything is connected to Cushing's somehow. That is simply not how it works. So at times we have to force ourselves, and our vets, to STOP looking at Cushing's to find the cause and look somewhere else. ;)

With Maurices' numbers good and his other signs controlled, this is enough to make me thing the problem lies somewhere other than Cushing's.

[mauricenme]

When you say his other signs are controlled are you referring to the high cortisol levels? Cause he hasn't got any other signs.

[molly muffin]

Trilostane will Normally alleviate cushing symptoms once cortisol is controlled but you might have to look outside of cushings for the cause of his symptoms. Thryoid, glucose etc, can change values and they have similiar symptoms to cushings.

[Squirt's Mom]

By "signs" I was referring to this comment you made -


The drinking and peeing are getting worse and he's starting to loose his hair on his back legs...

Excess drinking and peeing are signs of Cushing's BUT they are also signs of many other conditions. Hair loss is a sign of Cushing's BUT is also a sign of many other conditions. ;)

[mauricenme]

I am sorry it took me so long to update you on Maurice. So we are seeing a new IM vet. Dr Domenico Bianco and he is great. I wish I was able to find him sooner. OK The vet we were seeing was always so much in a rush and he made way too many mistakes. I tried to get Maurice an MRI last year before I was seeing Dr. Bianco and I talked to the lady in charge of finances at VCA west los angeles to see if they would let me make payments and they said no. The only signs of cushings Maurice had was the comedomes and wrinkled skin. Before that urinary tract was cleared up the previous vet ran an adrenal panel which I should have put my foot down and demand we wait but I didn't.

The results came back borderline positive. I felt the test was compromised because he had that UTI that went untreated for over a year due one of the mistakes the vet made. When the UTi cleared up so did his increased thirst and peeing. Also before the UTI cleared up that vet started him on trilostane. Maurice does not have increased hunger or thirst, never did (except thirst during the UTI), He had all his hair but one month after being on trilostane he started loosing his hair. First the 2 lower back legs, then the lower front, then his back, after that above his eyes and neck. The only place he really has any real hair is his ears and neck. Then he started to wobble when he walked. Then he started headpressing (which I soon learned that was his new way of saying he had to go to the bathroom.) He began pacing and circling and walking in between things that led no place and he would just stand there. Now he falls down all the time and most of the time he can't get up without help.


He began loosing weight. Now he 7.5 lbs. I wish I would never have given him trilostane. I really believe that trilostane is the reason his condition declined so rapidly. I read an abstract that said miotane has caused pituitary tumors to grow at a faster rate and possibly trilostane too but more research is needed. It also said every dog that has been diagnosed with a pituitary dependent cushings should have an MRI done.

He was off trilostane for quite a while but when I started seeing Dr. Bianco he wanted to try it again so we did for about 3 months but it didn't help so he said to stop giving it. Now Maurices alt levels are elevated and his colbalamin and TLI. His folate is normal. Dr. Bianco gave me some solution to put on his skin and the comedomes are almost gone. He only has a few now.

Dr. Bianco also made the MRI happen. He sent me to Dr. Oneill and asked him (they are friends) to let me make payments. I got 4 payments of 500.00 each (I still have 2 payments left) but he got the MRI and Maurice has a pituitary macroadenoma that is getting so large that it is pressing on his brain. That is what is causing him to wobble and fall down. There is only one way to treat it. The treatment has a good success rate with no side affects. He needs 3 treatments of stereotactic radiation. Its different than the radiation they do when you have cancer. This radiation is so precise it only hits the tumor and does not hurt any of the surrounding tissue.

After that some dogs never had to take trilostane again. The ones that did only needed a really low dose. With Maurice I'm not sure but I think that even though this tumor is on his pituitary his symptoms he has is not from cushings but from the tumor pressing on his brain. That could be why his results were always borderline. The problem now is paying for it. It cost 8300.00 dollars and they will not accept payments. And there are very few vets that have the skill and equipment to do it. Dr Bianco and Dr. Oneill referred me to Dr. Lyons at Veterinary Cancer Group.

Dr. Lyons said if Maurice doesn't get this treatment soon he will die. His neurological signs are worse during the day. At night there are more times than not he will start trotting down the sidewalk and not stumble at all. But he tires easily. He is off trilostane and is on 2.5 mg of predisone which seems to be helping. I found an organization that sets up fundraisers for pets and they set one up for Maurice but I'm not going to get my hopes up because 8300.00 is alot of money to raise in a short period of time. I don't have much social media expierence. I get on facebook only to see what people I know are talking about. I never write anything on my timeline and I only have a few friends. I need to find a way to get this link to the fundraiser out there where it can be seen by millions of people. Even if I can do that somehow it will still take a miracle to get that much money raised in time. So that is where we are at now. I put the URL (if that is what its called) below. If you can share it that would be great.

its https://freeanimaldoctor.org/campaigns/gentle-maurice/

How common is it to have trilostane make symptoms worse and have you ever heard of a dog with cushings that did not eat or drink excessively and have no potbelly?

what are your thoughts on the way this whole thing is going?

[Squirt's Mom]

Studies on Trilostane has proven to cause macro tumors to grow faster if IF the dog is prone to developing that type tumor. I am sure the same is true of Lysodren but I am not aware of studies along that line on Lysodren. The head pressing and circling were the early signs of that tumor. The wobbling and falling over are further signs that the tumor was present and growing. I am VERY glad you found a vet who is willing to work with you and pray the funds are raised in time for Maurice to get this radiation. As for the lack of signs, there are many other types of brain tumors that are not related to Cushing's so that may account for the lack of normal signs. Altho he has had so many other things going on prior to this I would expect his cortisol to be elevated at least a little bit. His current pics certainly LOOK like a cush pup, tho. You were spot on to question the testing done while he had an active UTI.

I will share your link on my FB page and the Tipper and Squirt Care for Cushing's Fund page. And please contact the fund to see if we can help in a small way. You will find our email at this link. Click on the "Apply" tab and follow the directions just as you did before. - http://www.tipper-squirtcushingfund.org/

Keeping you and your precious boy in my prayers!
Hugs,
Leslie

[Harley PoMMom]

I am so sorry that Maurice has a macro :( One thing I would ask if he could be started on prednisone as it may reduce the inflammation that the tumor is causing. On the forum we have seen this medication used with large pituitary tumors and it has helped. You both are in my thoughts and prayers.

[mauricenme]

i filled out the application to tipper and squirt but i need the email for them so i can send supporting documents. i have not heard back from them yet

[mauricenme]

i just want to update about maurice. he had his stereotactic radiation 3 treatments to shrink the pituitary tumor and his followup was yesterday. dr lyons says he sees improvement so thats good. he still has no hair and still cant stand up on his own but dr lyons says recovery is slow and physical therapy can help. but as usual he has to wait till i can find the money for the consultation. which will probably be 2 months cause i have to fix the van before the steering goes out.but at least i only have to come up with 300.

[Harley PoMMom]

Thanks so much for coming back to update us and I'm glad that Maurice is showing improvement. Hydrotherapy may help with strengthening the muscles in his legs, an option could be to start the hydrotherapy at home if you think your bathtub would hold enough water for Maurice to swim in, and they make life-flotation vests for dogs that have a handle attached for a person to hold on to while the dog is in the tub of water.

Lori