Sweet Kitana has passed - Push for Cushing's testing/thyroid testing or not?

[Greybeard]

Hi all :) I'm so happy to have found this forum. It's definitely the best site I've found on Cushing's (and I've looked at a lot). I'd love your opinions on how to proceed with my old gal. She turns 12 the end of this month but until recently (early spring) you would never have guessed her age- aside from some aches and pains after a good sprint.

I'll try to be as concise as possible but it's hard because I think she may have a few things going on and I'm gonna give you the whole story- Buckle up :) You can skip to the bottom if you just want the short version with list of symptoms and blood work.

Late winter/Early spring- She'd get up from napping every now and then with one particular hind leg tucked up. Would hop around a bit and after a few minutes it would be totally fine. No yelps of pain, no continued limp. I attributed this to a pins and needles sensation or arthritis since she would typically be sore after over exerting herself.

**I should note here also that it was about this time that I had just finished student teaching and had an opportunity to be more observant than usual. The leg thing would not have gone unnoticed but some of her subtle behavior changes may have.

We finished our basement over the winter and moved the tv down there. So, at this point we noticed she was also having trouble with the stairs. Still no yelping, but slipped enough that we just started carrying her up and down (she's around 42 pounds- lab/pit mix).

Soon after, early/mid spring- We notice she's leaking sometimes at night. Ok, she's old. However, she also started drinking like a fish. She'd down her bowl and then make a beeline for the toilet without pause. She's never been a toilet drinker. Then she started having accidents in the night. She's always been amazing at not going in the house and is seriously embarrassed when she's had accidents (like when she roots through the trash while we're out and something doesn't agree with her). We've never yelled at her because she's always hiding her face as soon as we walk in the door. Strangely though, if we don't notice her "let me out" stare-down, she whines at us. If it happens in the night she'll do that to wake us up. She wasn't doing that. She would just get up and go pee without a peep in the foyer right against the door :(

She also started not giving her one "Hey! I'm done out here" bark to ask to come back in the house. She'd just sit out there in front of the door waiting and sometimes give one scratch instead.

Also about this time, we notice she's putting on weight for the first time in her life. We've had strangers ask us if we feed her enough throughout her life. The vet has always said she's fine. She's just very lean and muscular, no fat.But she'd been, for a while I think, upping her normal begging. Couldn't open the fridge for anything without her right there waiting for something. Started asking to be let out for potty just for pretend so she could turn around and ask for a treat. Started going through S.O.'s office trash looking for goodies right in front of us with no shame and she's always waited until we're out of the house. So then, we eventually notice, hey, her back ends looking a little thick. But nothing I'd call overweight because she's always been thin.

Then, around same time, I notice she's doing this trembling thing only on intake of breath. Nobody has any ideas about this. She seemed more annoyed by it initially. Like she'd do it while trying to sleep and try to reposition herself, and then just say screw the nap. Vet initially thought pain on this (her spec-due to arthritis?) but tramadol has not made a difference nor has an NSAID and she'll eat while doing it so, if pain, she doesn't feel it can be that bad.

So, with the drinking, peeing, trembling, I brought her in. Figured they could look at her leg too.Vet ran urine/blood and said she had UTI. Did antibiotics. Said she was cleared up-all good they said... except she wasn't sure why she had some protein in her urine and liver was slightly elevated. Me- well what does that mean??? Because despite being in the clear, she was still drinking like a fish and still trembling occasionally throughout the day. Vet- well here's a slew of tests we could run if you want. Ok, S.O. and I will talk it over.

That night, he takes her for a walk. Comes back carrying her. Said she stumbled on nothing he could see, no yelp, and got up limping on that same darn leg she'd been tucking up. So he carried her back to the house.

Called the vet the next day. She suggested X-rays- they were on the list anyway. So they did two views of her abdomen/spine. No leg, no head. They had suspected slipped disc or some other spinal thing for the leg because of the preoci-whatever test when she didn't right that foot after they put her on her knuckles. Older, different vet went over the X-rays- I liked her much better, other one was a bit flippant, dismissive. She said X-rays didn't reveal anything amiss- no masses, no weird enlargements, no disc stuff- we'd have to do MRI to get real answers :( She took her time letting me explain that I didn't feel there'd been any improvement since antibiotics for UTI. She wasn't too concerned about liver enzymes (due to age) but mentioned possible recurrent UTI, possible hypothyroidism, possible cushing's- although neither seemed totally typical. Told us to watch her a few days and see what we thought.

During the back and forth at this vet's, they suggested switching her to Hill's food- started with W/D and she LOVED IT but it made her poop in the house A LOT (again not normal for her). Vet said it was all the fiber so switched her to K/D and she HATED it. Then they gave us G/D, she didn't like that either. Only wanted our food. Begged like crazy but wouldn't touch hers. Tried to switch her back on her old food but no go. She has been SUPER picky ever since. Always begging but will only like her own food for a few days before looking like she's offended by what's in her bowl and straight up turning her nose up at it and walking away. She'd rather starve than eat that. I tried home cooking for her and she loves the meat- BUT picking out the meat gives her the runs. And then she doesn't want to eat at all :(

The other vet was so dismissive-won't get into it- and the front desk was screwing up our bill repeatedly, so I decided to take her back to her reg vet who is further away but a friend of the family and I felt I could trust her to tell me what to do.

Told her old vet the story, told her that the other vet had thrown out hypothyroidism, Cushing's, mentioned liver enzymes. Told her I was concerned about the trembling, the peeing (not because of inconvenience like the other seemed to be stuck on but because this is NOT normal for my girl), the drinking. Was there an injury that was overlooked on the leg/foot? She'd gotten lazier. Was it the leg? She wasn't greeting me when I came home- hearing?? She didn't want to hang with me outside when I worked in the yard- just stood at the door the whole time :confused:

Her recommendation- we talked over surgeries and agreed whatever the MRI would show is just informational as we don't want to do that at her age and it's crazy expensive to do just for informational purposes. She agreed the leg was probably a spinal thing. Maybe, she said, she has some doggy dementia going on, or her hearing is going, and the spinal thing is causing pain in turn causing a lot of the symptoms.Suggested trying steroids and seeing how she responds. So we did.

Gave a shot of pred in the office and started pills the next day. After two days, she was getting around better and seemed to be more comfortable. Then June 13th (the third? day) we came home to red bloody poo. She said stop the steroids :( She WAS also taking pepcid with those. After about a week, week and a half, she seemed to be regressing a bit.

Took her on vacation for the 4th of July and she did nothing but sleep. At this point I was giving her the tramadol every 8 hrs (per the dr) especially worried that the trembling was evidence of pain (that's what everyone was telling me at the time). She didn't poo the whole time we were up there and she refused all food except people meat. She wasn't eating but she was BEGGING constantly so I gave her whatever she'd eat- burgers, couple hot dogs, some cheese, some snacks. Her eyes were bloodshot, she was a lazy lump, constipated (maybe my fault). Then she woke up one morning with one eye all rolled up (found out later it was her third eyelid) and wouldn't look at me or couldn't focus. She refused her pill and when my mom tried to open her mouth she cried like crazy and hid. My poor baby. Her heart beat and breathing were so undetectable that I thought she'd passed in the night when I checked on her (sleeping next to me). Took her home early and straight to the vet. We were gone three days.

July 7th- Vet suspected mouth/jaw pain but also couldn't get her to open to look (my girl howled like she was in the worst pain of her life). But vocal cords were working which I had started to question. Very warily, with lots of trepidation and letting me know she probably wouldn't recommend it to just anyone, she said we could try pred again to see if she'd open her mouth in a few days rather than put her under to get a look. I stupidly thought, maybe her appetite wasn't great back during the first pred try and I hadn't noticed. Maybe if I force her to eat better, she won't have problems this time. So, another shot, pills the next day, and immediate bloody poo. Never any vomiting. Vet had run blood again on the 7th and tests came back showing some anemia, some dehydration (despite heavy drinking) higher liver enzymes, lipase. Suggested maybe she had pancreatitis while on vacation or GI bleeding. Said could be brain lesion or mass somewhere, or combo of kidney/liver disease and really we just want to make her comfortable and love her up at this point.

I took her again on 10th. Vet had wanted to look in mouth and stool was still bloody. She opened silently and reluctantly and there were no obvious problems. However, she had projectile, clear, water poo with red chunks in the office. Vet gave subQ fluids, flagyl, pepcid, sulcrafate. Didn't even know if she'd take the pills after the vacation episode. She was in bad, bad, bad shape from vacation to this time. Looked bad. I started talking to S.O. about when "it's time". She's his first dog. His baby. He got her before we moved in together but I've been with her from day one and she's my baby too.

My girl is a TROOPER. Her and I had a serious talk after the vet visit that day. Call me crazy but I told her about what we needed to do for her to feel any better and also that if she was over this crap and was done, then that was ok too:( And that night my girl got up and ATE and she took ALL of her pills without complaint. And she got a little bit stronger each day. Meanwhile, I was researching and started to wonder about her liver+the tramadol dosage. Backed off to every 12 hours. She seemed more alert. Then reduced to half pill in the morning by the end of the week and whole pill at night. Her eyes weren't red anymore, she was eating better-still picky-she'd get up and walk around.

Except for the vacation episode and the second steroid round problems- she's always been a beggar, still drinking and peeing excessively, still interested in being around us and snuggling, car rides are her favorite. She has trouble doing things that require balance as it appears that she has serious muscle weakness in her back along with that one gimpy leg. She doesn't like to/has trouble getting up, but once going she's ok. She prefers cement to lumpy grass and only likes to sit up in the car when I drive because her dad takes crazy turns and she knows she'll fall over anyway. So I think she's still enjoying her life and has been stable since the last round of meds, and cutting back her tramadol.

2 weeks ago, I asked about NSAId since pred is not an option but there is still trembling. Another vet in the office (mine was out) ran blood again and gave trial of deramaxx.It made no difference and that's when the vet suggested maybe they're not from pain after all or just not that bad.

Now, we battle what she'll eat-still begs for our food-, and the diarrhea it sometimes causes. she's lost some weight because of this. Other than this, she is still stable-no worse, although maybe her muscle weakness is (still only same leg affected though). In fact, last blood draw, her reg vet called the next day and said her kidney levels were back to normal range, anemia had resolved...I think everything crazy from vacation was better but her liver enzymes were higher. From slight back in May, to 3&400 in early July to 4&500 2 weeks ago. Said maybe some due to steroids but still suspecting something going on with liver. I don't have those last results in front of me but I plan on getting them.

Also, new development: She has attempted to bark/cry a few times recently. She used to always bark at people and dogs in front of our house. She stopped. She did it twice recently and it sounded raspy. And she cried when S.O. picked her up poorly and that was raspy as well. :confused:
************************************************** ******
So symptoms altogether:
No barking/whining or when she does it is raspy.
Drinking and peeing excessively
Muscle weakness in back (she's not bothered by me pinching along her spine or leg)
Lame rear leg
Lethargic
Was ravenous unti we switched up her food with vet and then steroids and diarrhea episodes, and now only wants our food and is still always at the fridge. (will sniff her bowl and leave it, offended)
Liver enzymes, lipase elevated: May 16-ALP 171, ALT 210, BUN 26 (no ref given from first vet)
After bad episode July 7- ALP 350 (ref 23-212)
ALT 427 ( ref 10-125)
LIPA 2985 (200-1800)
NA 161 (144-160)
GGT 38 (0-7)
BUN 32 (7-27)
RBC, HCT,HGB, were a few points below the low cutoff each.
LYMand EOS were both borderline low-right at cutoff.

July 20th- I'll have to get most recent results but I remember no anemia, bun was normal, but ALT and ALP had both climbed about a hundred pts each. And I think Lipase was higher too.


***We don't think surgery and the recovery is a good idea due to her age and liver levels BUT if her symptoms were caused by something that pills or diet would help (if she'll do a decent diet) we would like to do that to give her her best life. Is it possible that one of her problems could be thyroid and/or Cushing's related like the first vet threw out there? We're not going with an MRI but a blood test(s) seems reasonable and fairly non-invasive.

I wonder if the tramadol dosage was just too much for her and that caused a lot of her issues on vacation? And I also wonder if she ever really had any problems with her mouth. She's always been a big baby and if she wasn't feeling well on vacation and the day we brought her back and to the vet, was she just crying like that as her way of saying "Don't freakin' mess with me right now!"? Because she's done it when we've tried to trim her nails. Baby. But she was in such bad shape that didn't occur to me then. Vet ok'd giving her whatever she'll eat but I struggle with trying to make sure she's getting proper nutrition. She liked FreshPet for a good run but I'm searching for something new now since she's turned her nose up at that too.

FWIW, she's always been easily nervous:shakes and pants heavily in the car even though she loves it, trembles and sheds like crazy for vet, groomers, when WE do her nails instead, in the bath, hates thunder and hard rain, and the vacuum (hates=trembles and hides).

So, there's my summer. What do y'all think? Sorry it wasn't concise at all. TIA!

[labblab]

Welcome to you and your girl, and thanks for such a comprehensive introduction to her issues! There are so many question marks involved with her that I apologize in advance because I am not going to be able to do justice to them all in the short time that I have available right now to reply. But here are a few initial thoughts off the top of my head.

Yes, it is possible that she suffers from Cushing's. The diagnostic challenge, however, is that there is no single definitive test for the disease and the two blood tests that are specific to Cushing's can be skewed in the presence of other nonadrenal illnesses. She may have multiple issues going on right now, and the challenge (as you are probably already aware :o) is unraveling them. In honesty, I believe the first test I would ask for right now is an abdominal ultrasound. Ultrasounds are typically much less expensive than MRIs, are not invasive, and are actually a favored imaging tool for viewing the status of the internal organs including the adrenal glands, liver, kidneys, pancreas and spleen. You get much more useful information than that gained via x-rays. The adrenal glands are not easy to see, so the ultrasound needs to be performed on high-resolution equipment and interpreted by a knowledgeable professional. This often requires referral to a specialty practice, but you can get a lot of bang for your buck and some obvious answers may be revealed to you that will provide a short-cut re: any further diagnostic/treatment decisions.

Definitely bear in mind that I am not a vet, but in the meantime, if she were mine and I did not have firm evidence that she was in significant pain, I would stop both the tramadol and any NSAIDS. The combo of NSAIDS and steroids (either given supplementally or in the face of naturally-occuring elevations caused by Cushing's) can be deadly. Catastrophic GI complications can result, and from what you have described, your girl has already suffered some pretty serious GI problems. And if she's really not in pain, then the tramadol may only be serving to dope her up and make her even more lethargic. If she becomes noticeably uncomfortable once off the painkillers, then at least you would have a reason to think that there is a benefit to outweigh the risk of resuming at least the tramadol. But while you are in the midst of uncertainty re: the status of her liver, kidneys, and cortisol level, I'd try really hard to stay away from any more NSAIDS.

One interesting side-bar comment about the trembling...over the years, we have had several members (including myself!) report that their Cushpups exhibited weird tremoring episodes that looked like shivering, but in the apparent absence of pain or cold. My own boy did that both before and for a time after Cushing's treatment was begun. Strangely, he did it most often when he was laying down or at rest -- he would have shivering episodes across his shoulderblades. I have no idea whether this is what is happening with your girl, but just thought I'd mention it as a curiosity. The episodes always bothered me more than they seemed to bother him, and they finally dropped away altogether after a few months of treatment.

So to summarize, I'd stop the painkillers for the moment and consider an abdominal ultrasound. Based on the results of the imaging (e.g., indications of pancreatitis, primary liver disease, obvious growths or masses, adrenal abnormalities that would be consistent with Cushing's, kidney abnormalities, etc.), you may have a better idea as to additional helpful laboratory diagnostics should you choose to pursue them. If there are no other obvious primary problems but you do see organ changes that are consistent with Cushing's, then that may be the time to go ahead with the Cushing's blood testing.

But given your girl's age, you may not decide to go any further if something sinister is identified. For instance, if she has an obvious tumor or serious abnormality, you may not press for other involved treatment options. So I do believe I would put my money into an ultrasound before I would spend it on Cushing's blood testing. As far as hypothyroidism, her general blood chemistry panels would likely have given a level for her T4. If that is within normal range, then you probably don't need to look a lot further into the thyroid right now.

Marianne

[Greybeard]

Thank you so much for your response and taking the time to read all that!!! Yes! Your description of the trembling sounds exactly like what my girl does. It is only ever her upper body- across her shoulder blades, and makes her head shake slightly sometimes. Her mid-section and lower body aren't involved at all. They've all insisted it must be pain and, you know, I was not convinced. But that first vet made me feel like that was stupid and insisted if nothing else she must have arthritis and I should give it to her everyday she said. You have no idea how much I googled those tremors looking for an answer. I did find several people asking the same question but NO ANSWERS.

She only took the deramaxx one day-one pill. I was extremely nervous about giving it to her and made sure to do it when I could be home with her all day. When her trembles went on as normal throughout the day I decided that was that, no more. And the steroids, I felt awful after that second round but wow- I never knew you could have such a bad reaction so fast. The first time we tried them she took them 3 days before diarrhea. The second time, it was the next morning. Both times, we took her off them as soon as that started.So yeah, definitely not going down that road again.

If I'm looking at her blood work right, there is nothing in any of it about her thyroid. Maybe I'm missing it though, I'm learning. No T4 stuff. The first vet said that was something they would sent to a lab out of the office.

I so appreciate your advice! I just happened to not give her the tramadol this morning as usual and she doesn't seem any worse off for it yet so I think I'll take your advice and wait it out. I am considering the ultrasound. I feel like last time she was in to see her reg vet on the 10th, she looked so bad she did figure that the end was near. But I really think the tramadol and then the steroids caused a lot of that.What do I know, though? :confused: But her vet did say she was encouraged by a lot of what she saw in that last blood work. However, I know there's that note in her chart about "quality of life" and keeping her comfortable and yes, we talked about that when she looked so bad, but she's not like that now. And I'd like to do as much as possible to make her life the best it can be without putting her through surgery. And the not knowing what's going on is killing me, especially when she seemed fine, just lazier just a few months ago.

So I am willing to do further testing (although I don't have endless funds but S.O. is willing to if I give him a good reason). I look forward to any further thoughts from you and anyone else :) Thank you!

[My sweet Ginger]

Welcome to you and your girl from me too.
Could those tremors look something like this?
This is my Ginger and this was happening for some time soon after her Lysodren treatment which she ended up going Addison's.
She also started having focal seizures (head jerkings) going on simultaneously. She was put on Keppra for seizures and we've been able to keep the focal seizures at an acceptable level. I haven't seen the between shoulder blade tremor for a very long time now and I honestly don't know what stopped it. One day it just went away as suddenly as the way it came.
I wish I had an answer for it but I don't. :o
Here's a video of that and I thought what you described happening to your girl sounded pretty similar to to this. You kind of have to look closely but it's there.
http://youtu.be/IHr0XG4a3Ic

Sharlene, I have to say that thought has crossed my mind too as Ginger's started while her cortisol was low. Also they never gave me any indication that they were caused by any type of pain.

[molly muffin]

Hi and welcome to the forum.

Marrianne is right, bang for the buck, ultrasound is the way to go I'd think.

Looks like the kidneys issue has cleared up but the lipase (pancrease) is still high and the liver is a concern, with the ALT raised and the GGT. Did the GGT come down or the ALT at all?

A couple good supplements for liver is a sam-e and milk thistle supplements. They have both of these for dogs, you can check amazon.com for some decent prices.

Tramadol often makes them loopy and steroids while good for some conditions, also is just like having excess cortisol in your body all the time, so not necessarily great.

I wonder if instead of excess, if low cortisol might be an issue, they are two sides of the same coin, and can have many of the same symptoms.

But I'd start with an ultrasound too if it where me. (my dog gets them every 6 months or so to keep an eye on her liver, adrenal, kidneys).

[Greybeard]

Welcome to you and your girl from me too.
Could those tremors look something like this?
This is my Ginger and this was happening for some time soon after her Lysodren treatment which she ended up going Addison's.
She also started having focal seizures (head jerkings) going on simultaneously. She was put on Keppra for seizures and we've been able to keep the focal seizures at an acceptable level. I haven't seen the between shoulder blade tremor for a very long time now and I honestly don't know what stopped it. One day it just went away as suddenly as the way it came.
I wish I had an answer for it but I don't. :o
Here's a video of that and I thought what you described happening to your girl sounded pretty similar to to this. You kind of have to look closely but it's there.
http://youtu.be/IHr0XG4a3Ic

Sharlene, I have to say that thought has crossed my mind too as Ginger's started while her cortisol was low. Also they never gave me any indication that they were caused by any type of pain.


That is EXACTLY what it looks like!!! Thank you! I searched youtube too but never came across this. Some of Kitana's (like the sword although spelled differently, but really named after the video game character :)) tremors are stronger than others but that is it! I had a video I showed the vet too but she hadn't a clue what it was.


Hmmmm, so now you've got me googling low cortisol and Addison's and I'm so confused. But yes, all of that sounds like it would fit Kitana too.

So I'm getting ahead of myself reading into the treatment of Addison's and noticed that it is prescribing steroids. Before the bloody diarrhea kicked in, the prednisone did seem to help quite a bit but I thought it was just helping whatever was going on in her back and making her feel overall better for it since that is why it was prescribed. Are those other types of steroids that are mentioned as part of treatment any better tolerated when a dog can't handle prednisone? Just curious.

Marianne and any other members here who have noticed the tremors in their dogs, was it also at a time when cortisol levels were lower?

I am going to pick up that last copy of blood work tomorrow and also talk to the S.O. and then the vet about an ultrasound.

Molly Muffin, thank you also :) I know the ALT was higher with the last blood work but will have to check the GGT tomorrow. And thanks for the supplement recommendations. I have seen those recommended on some sites and wondered about them...and also wondered why no vet has suggested anything like that. :(

Thank you all again! I feel so much less crazy and alone in this already :)

[labblab]

Wow, Song, thanks for posting that video of Ginger -- it is so interesting! For the most part, it looks very similar to my dog's tremoring, too. I don't remember that his was as closely linked to his respiration as it seemed to be for Ginger, but overall the appearance of the tremors across his shoulders looked very much the same. I first noticed the tremors right before he was diagnosed, when his cortisol was very, very high. They worsened when we started treatment and lowered his cortisol very rapidly. Then they kind of plateaued and finally stopped completely after a few months.

I'm also glad that Sharlene mentioned naturally-occuring Addison's because I often forget to even consider it, and it does indeed carry many of the same symptoms as you have found out from your reading. There are a few aspects of Kitana's bloodwork that don't necessarily fit Addison's, but there are a few that don't necessarily fit Cushing's, either. But one helpful consideration is that an ACTH stimulation blood test can be used to diagnose either condition. So even though I've suggested starting with an ultrasound, you could opt for (or include) an ACTH. If the results are high, there may be causes other than Cushing's and that would be the helpfulness of also doing an ultrasound. But if the results are low, I think that is pretty much definitive for Addison's.

If, by chance, Kitana does suffer from Addison's, there are other versions of steroid replacement that may carry less side effects than prednisone. But another key consideration is that that the daily doses of steroid that are used to replace lost cortisol are much lower than the doses given to treat acute inflammatory conditions. So even a low dose of prednisone might not affect her as negatively as the higher dose that she likely received before.

Marianne

[My sweet Ginger]

Yes, it only happened during inhalation mostly while she was sleeping or resting and it was often as she was sleeping or resting most of the day and I too thought it was very interesting.
Ginger already had leg tremor going on for a while prior to her Lysodren treatment but this shoulder blade tremors and head jerkings only started after the treatment. She still has occasional focal seizures and rather constant leg tremor but they've been much better controlled on Keppra. The shoulder blade tremors have been totally gone for a long time. Not a clue as to what started them or stop them but def something caused it and then something stopped it. :rolleyes:

[Greybeard]

Thanks again for the responses :) Good to know about the steroid treatment, and the ACTH test. So along with Addison's that would give an idea about Cushing's as well whether it's pituitary or adrenal?

I went and picked up the last labs and here they are:

July 20
ALT 525 (10-125)
ALKP 366 (23-212)
GGT 38 (0-7) exactly the same as on July 7th
LIPA 5872 (200-1800) :eek:
K 3.2 (3.5-5.8)
RBC 5.01 (5.5-8.50)

For the record, the kidney stuff was totally fine looking on the 20th even though that kept being mentioned as a possible problem at the vet's? On the 20th: BUN 14 (7-27)
GLU 103 (70-143)
CREA 0.9 (0.5-1.8)

Does any of this shed any more light on what's going on with her? And what the heck is going on with that LIPA?? I remember the vet saying on the phone that she wasn't sure how much of that is due to the steroid injection she got in the office on the 7th plus 1 and a half days of pills after that. Could it really increase that much due to the steroid? OR has my girl been having problems with her pancreas ever since the 7th when the LIPA was already elevated and then on the 20th it almost doubled again?? She's been so picky with her food and like I said we're battling diarrhea. I attributed it to switching up her food all of the time but now i don't know :confused: She did not say I needed to bring her in for anymore subQ fluids-only to try to watch the fatty foods (although since the 7th she had been eating Iam's Low Res canned for me very well).
Now I'm wondering what the heck her levels would be NOW.

[molly muffin]

Well since the lipase was elevated prior to the shot, I'd say that there is a bit of pancreatis perhaps going on and would explain the picky eating. You want bland food several small meals a day, like chicken and mushy rice.

The ALT and GGT being elevated indicate liver issues, have they done a bile acid test? Maybe an ultrasound would give you the most information.

Marianne, what do you think about the ACTH in light of these results? I'm thinking that it is going to be elevated with pancreas and liver issues already going on. If so not sure how trust worthy it would be, but it definitely would rule out any kind of Addison epidisode and we all know that cortisol high or low can cause all sorts of havoc on the body.

[labblab]

Yep, Sharlene, that's why I was originally suggesting that an ultrasound be done first, too, in order to see whether there are any other obvious issues that would account for (or contribute to) elevated cortisol. Right now, if the ACTH comes back high, we don't really know whether it's Cushing's or something else that is accounting for it. But if the cortisol comes back low and flat, then that would tell us something else entirely. If cortisol was high,though, I'd still proceed with an ultrasound anyway, in order to see what's going on internally.

The highly elevated lipase surely does raise questions about pancreatitis, so there is another classic chicken-or-egg issue. Cushpups are vulnerable to pancreatitis, so is Cushing's the underlying issue that is fueling some of these other problems, or are they primary problems in their own right (pancreatitis, liver disease).

I guess right now it's really a toss-up as to which test I'd do first...

Marianne

[Greybeard]

Thank you again for your replies :) You guys are amazing! And I so appreciate your time and thoughtfulness even though my baby has not been diagnosed yet.

The thing about the lipase is I don't have a reading on that before the first shot of prednisone. For some reason, that was not included with the rest of the values I picked up from that first vet. So I have the first LIPA number being after she had a shot, a few days of pills, and then her crazy lethargic, only eating fatty/salty people food, no poo to check episode on vacation. The day we came back is when the blood was drawn again giving me that LIPA value :( And the second was some time after round 2 (few days of pred) and more bloody diarrhea.

Same for the GGT. It was not in the first lab work before she ever had any prednisone. I have no idea how much that and her side effects from it actually affects the reading.

So I was all ready to go ahead and request the ultrasound but my vet suggested we do the urine cortisol check first. I caught a good long first morning pee today and dropped it off. The tech said I should have results by Monday at the latest. Maybe tomorrow if the lab isn't too backed up. I know it won't diagnose anything but it at least might give us an idea of where to go next, right? I did ask the vet about the ultrasound and she said it would probably be the next step along with one of the other hormone tests depending on this urine test.

She would've referred me for it if I had pushed. I don't think she's thinking Cushing's because she mentioned the usual pot-bellied appearance and hair loss that Kitana does not have, though she did mention atypical is possible. The first vet mentioned it as a possibility even though she wasn't the "typical" case. I don't think she's leaning Addison's either because her electrolytes are fine, though again could be atypical. I feel like there's SOMEthing going on with her hormones whether that's the cause for her liver/pancreas stuff or there's that on top of it :confused:

And if I'm being honest, I'm terrified after reading about these macro adenomas the last 2 days. Kitana started out ravenous and putting on weight for the first time in her life but has slowly lost her appetite. I'm struggling right now to get her to even eat people food. Maybe it's the pancreas/liver stuff, I don't know. But she's also got stuff going on I had thought (and been told) is probably doggy dementia. Her staring at walls has gotten worse at about the same rate as her appetite has gone downhill. She's gotten wobblier since her limp started although the other hind leg still seems strong. There's more. I want to hope it's maybe not eating right that's causing it but I'm really afraid for her. I so wanted to fix this. I'm going to hope for the best and try not to worry myself to death until those results come in. Kinda too late for that though :o In the meantime, I've got some high calorie Hill's A/D and slippery elm to try. She won't touch rice or chicken or pasta or potato right now. Thank you all again. I wouldn't even be this far without you all. As I've said, with her age, I think the vets (at least the first one) have just written her off. This other one is a friend of the family and I think she'll take it as far as I want to without letting me be ridiculous.

I almost forgot: The bile test has not been suggested by the vet at this time. I'm not sure if she thought we were not going to treat because of that earlier episode when we weren't given much hope or if it's because her other liver stuff looks ok as do gums, eyes, urine and poo (except from being diarrhea right now). If this other test reveals nothing, I guess I should ask about that too :) Thank you.

[molly muffin]

Well I am inclined to think that the first thing to do is get that pancreas taken care of and liver. The pancrease will affect the liver and loss of appetite and diarrhea and all can I think be laid at it's door. Sure you can do the cortisol urine test, it has the same problems that you already know, about if there is pancreatis, it is likely the cortisol will be elevated, the bodies natural means of combatting something going on in it. I dont think there is really any doubt that something is up with the pancrease at the moment.

So, lets concentrate on getting Kitana well enough to know what the test results are reflecting. What you are doing is good.

Now lets be honest, Macros scare the bejeebees out of everyone! In the grand scheme of things, they aren't all that common. To us, we see a lot more of them because we are a board, with world wide members, specializing specifically in cushings. It is the nature of the beast that we will see more.
If there is a macro though, it is going to grow as that is what it does. The symptoms most common with macros is neurological, knuckeling of the feet (paws turn under, front especially), getting stuck in corners, stuck anywhere really, very high cortisol levels if I remember correctly seem to be a part of it too. So, I don't think that is where Kitana is at though. At least you haven't mentioned that.

Right now. Pancrease! :) Get the pancrease better and I'm hoping the liver will be better, get both of those better and I'm hoping other things come right too, or at least get to a point where a test will be reliable.

[Greybeard]

Yes, ma'am :) Thank you. I will continue to work on the pancreas. When the vet calls today or Monday I'll ask about any follow up tests to that and the liver. Now I'm frustrated that that urine test might've been a waste. They know those enzymes have been high. It seemed like she thought it was high due to her possible pancreatitis 2 weeks prior (vacation) and no further follow up was recommended. Poo was fine at that time (the last blood test on the 20th) and appetite was picky but not like now. This morning, I am celebrating the first poo with any height to it in about ten days :happy dance: I got some low res canned food and the slippery elm in her yesterday. Also the other 2 supplements you suggested for her liver appear to also be good for GI/pancreas too so unless you know of any reason to hold off, id like to get those this weekend too. Although, I did read the milk thistle has the potential to cause diarrhea so maybe I'll hold off on that one?
So, I'm giving the slippery elm, the low res food (because she won't have anything to do with the bland diet) small meals more frequently, she's drinking plenty, and I'll add anything else you think I should :)

She does get stuck, especially at night, but I want to think that and the other weird habits she's developed recently are doggy dementia for now. As always, thank you!

[Squirt's Mom]

There is an excellent product called Novifit for doggy dementia. It does not require a prescription and worked MIRACLES for my old girl, Squirt, and is working for one of my fosters now. It does not work for every pup but those it does help it helps a great deal. Novifit is a stable SAMe product that can be given with food, unlike other SAMes and it is NOT the same as others. Squirt was already taking a SAMe that did nothing for her cognitive issues but when we started the Novifit within a week she was a great deal improved. It can be purchased many places and isn't expensive. So check it out - http://www.virbacvet.com/products/detail/novifit-novisame-tablets

[My sweet Ginger]

Can you tell me again how much Kitana weighs if I missed it?

[Greybeard]

Thanks, Squirt's Mom! So that one is supposed to support the liver the same way as the reg SAM-E?

Kitana weighed just about 43 lbs on the 20th but I'm guessing she's closer to 40 today. She's definitely lost weight and some of that looks to be muscles loss in her back. The vet had even commented on that back in May in the span of 2 weeks.

[Squirt's Mom]

I would assume so and according to the rep I talked with the difference is in how the molecules are "made" or whatever they do to molecules. The Novifit are stable molecules, the regular is not. Squirt's liver values fluctuated quite a bit so it was hard to say if it helped her liver or not - and she didn't get a lot of testing of any kind once she reached that stage. She had several things going on and was 15 yrs old so keeping her comfortable and happy was more important to me than knowing lab results. ;)

[Greybeard]

Thank you again! Ok, another question for you all. Vet just called with the urine cortisol creatinine ratio. She's not in the office and wants to recheck the math when she is in on Tuesday but wanted to let me know... She says they are telling her kitanas ratio is 527.... And normal is less then 34. She stressed again that other things can cause high numbers and we'll talk about ultrasound, lddr test, acth(atch?) on Tuesday after she looks at these results in person. In the meantime, is that kind of number even possible? If it's right it's SO high! Even if other things are responsible for the elevation, I just want to know if you've ever heard of such high numbers? Thanks all!

[molly muffin]

I've never used the urine creatinine urine test, but that sounds very high, however, if, there is any kind of pancreatis and liver or anything else, it wouldn't be surprising because you would expect the cortisol to be high.

I really, really think, that you need to get the pancrease taken care of Before pursuing any other cortisol test, it just is likely a waste of time without knowing what is really causing the high cortisol. Once you see the lipase is back within normal range at least, then would be better.

In the mean time supplements and small easy digestible meals is best.

[labblab]

I am thinking that today is when you'll have the chance to talk with your vet and reconfirm those test results. For what's it worth, I think 527 is extremely high and I cannot recall seeing UC:CR results that are that high. So I'll be curious to know whether that is really the accurate result.

I did want to tell you that there is a specific blood test for canine pancreatitis that is more accurate than looking at the lipase and amylase alone. It is called a spec cPL test, and perhaps would be of assessment value if pancreatitis is suspected and you really want a more definitive diagnosis. The test can be especially helpful in the reverse situation of yours -- when other pancreatic enzymes appear to be normal but the symptom profile matches pancreatitis. That's how acute pancreatitis was diagnosed in my own dog. Her lipase and amylase were normal, but she was acutely ill with vomiting and diarrhea. When we ran the spec cPL, we discovered that it was highly elevated and confirmed that her pancreas was indeed involved after all.

One of the diagnostic problems with Cushpups, though, is that if the underlying disease is uncontrolled, the dogs can remain vulnerable to a number of other chronic infections and ailments (such as pancreatitis). So you end up with the chicken-or-egg dilemma: for instance, will smoldering pancreatitis remain unresolved until the Cushing's is finally addressed? So even though Sharlene's point is well taken -- that other nonadrenal illnesses will also elevate cortisol and skew Cushing's test results -- sometimes there is no way to get the other illness fully resolved until the Cushing's has been identified and addressed. It can really be such a diagnostic dilemma.

But coming full circle, that's why I'm a fan of the abdominal ultrasound. In conjunction with lab abnormalities, sometimes that imaging can give you a clearer picture of internal abnormalities that make Cushing's seem more or less likely.

Marianne

[Greybeard]

Thanks all. I truly appreciate each and every bit of am advice I get from you all. I have not heard from the vet yet but I have my list of questions ready to go :) and yes I'm really confused and overwhelmed by the fact that any other issues Kitana may have will screw with testing for a lot of things.
I'm curious as to whether any of you have had dogs with laryngeal paralysis. I mentioned Kitana's virtual silence/raspy bark again last I talked to the vet. It came on about the same time as the drinking/peeing/constant begging but she thinks it's a separate issue. However, I've been reading that although it can occur spontaneously in older dogs, when its connected to other issues, it's usually Cushing's or hypothyroidism.
This is especially concerning to me since I've read that once breathing problems or aspiration occur, they're irreversible (or require surgery). And I find it really odd that it all started at the same time. Anyone else's dog have that particular problem on top of everything else?

Also, vet is calling it laryngeal paralysis- her only symptoms of that so far are the unusual silence funny/sad that this was her one and only annoying habit ever and now I long to hear her barking) or raspy bark when she does make noise. She also will often only stick the tip of her tongue out when panting instead if letting it all hang out. No coughing or choking though.
AND her paw pads are really red. It comes and goes. My grass has not been sprayed with anything and it's been weeks and lots of rain since my moms has (the only other place she's been). I was thinking it was perhaps her stepping on pee pads in the night but it is redder than ever this morning and no accidents last 2 nights. No itching or crusting. Just angry RED.

[Greybeard]

Well, vet called this afternoon and said those test results were correct. Something about a multiplier the lab uses. So her urine cortisol/creatinine test shows a very high ratio but she did say, as do you all, that other things can account for that.

She then said she called an IMS and talked through Kitana's case with her and both agreed it was a "strange" case. The specialist said Cushing's was a possibility but not everything was adding up. Said the possibility of infectious stuff came up as well as others. NOTHING I look at sounds like it fits her perfectly but I didn't think every animal will have every symptom of each disease. Vet is willing to do further testing if I wanted but thinks my money is better spent seeing a specialist, if only for the consult and ultrasound, and coming back to her for other tests if I choose.

She said not everything adds up as far as pancreatitis either and did mention that more specific test but thinks maybe ultrasound first. You all are so smart :) I mean that. I knew it before I ever posted just reading through the threads here and that's why I came to you all for help.

So looks like we're going for a specialist's opinion and the ultrasound. Question (another one): She first recommended a super high tech looking (with prices to match) hospital. We're probably smack between there and MSU Vet Hospital so I asked about them. She said either are great (that the other "reaches out more to referring vets) but MSU also has a neuro dept and the other does not. So now I'm not sure. Anybody have experience with MSU? Or is it usually better to go to a hospital with specialists vs. the college? I want the best for Kitana and I don't think prices are much different anyway.

[molly muffin]

So did you get an appointment for the ultrasound? When is it? Where did you decide to go?

We've had members go to both types of places. You will likely get great care at either place.

[Greybeard]

So did you get an appointment for the ultrasound? When is it? Where did you decide to go?

We've had members go to both types of places. You will likely get great care at either place.

Appt is first thing in the morning at MSU. Please think good thoughts for Kitana :)

[molly muffin]

Yes. Definitely good thoughts.

Good luck. Let us know what they say

[Greybeard]

I'm impatiently waiting for results of biopsy on liver nodules. They were supposed to be in last night but the vet called and said this morning instead. I'm supposed to get a phone call and an emailed copy of everything once those results are in but that was the only thing mentioned as a concern on the ultrasound. Chest X-ray was clear. Tick, tock...

[Greybeard]

I need help :confused:

The liver nodules showed no evidence of cancer...but doesn't mean it's not SOMEwhere. :( Those nodules were the only thing she mentioned via phone as a concern but there's a few other things here. I'll post results:
Abdominal Ultrasound:
Liver: Multiple hypoechoic lesions are seen throughout the otherwise bright liver parenchyma, some with ill-defined or well-defined hyperechoic centers, others with distal acoustic enhancement.
Gall bladder: Severe sludge.
Spleen: A single well-defined hyperechoic nodule is seen midbody, roughly 1.67 cm in diameter.
Left kidney: Moderate loss of corticomedullary definition, an anechoic cortical cystic lesion is present in the cranial pole.
Left adrenal gland: Mildly enlarged both poles, heterogenous medullae, 8.3/9.9 mm cranial and caudal poles respectively.
Right kidney: Moderate loss of corticomedullary definition.
Right adrenal gland: Upper limits of normal both poles, 7.6/8.4 mm cranial and caudal poles respectively.
Lymph nodes: No sonographic abnormalities, including region surrounding the main portal vein. Urinary bladder: No sonographic abnormalities.
Intestines: No sonographic abnormalities.
Stomach: No sonographic abnormalities.
Pancreas: Bright to surrounding mesentery, but small/normal in size.
One of the nodules with a hyperechoic center, and the hyperechoic splenic lesion were fine needle aspirated with no apparent immediate complications.
Diagnostic interpretation:
1. The target conformation hepatic nodules have been associated with malignancy (75%). Multiple hepatic cystic lesions may be unrelated and benign, or less likely metastatic lesions. Regenerative nodules are possible but also less likely, given the nodules' appearance.
2. Suspect adrenal hyperplasia with steroid hepatopathy. Other hepatic infiltration such as lymphoma is less likely given lack of lymphadenopathy.
3. Bilateral chronic renal changes, with left renal cortical degenerative cyst.

Fine Needle Aspirates:
Liver:

One smear from each of two samplings was moderately cellular. Besides blood, these smears consisted of clusters of hepatocytes, a portion of which were typical hepatocytes, and a moderate number of which contained moderate numbers of distinct lipid-like vacuoles, some of which were large and displaced the nucleus. Few hepatocytes had foamy cytoplasm. No atypical cell populations were present.
Interpretation:
There is a moderate degree of non-diffuse lipid vacuolation of hepatocytes; the cause of this fat accumulation is not apparent. There was no evidence of a malignancy or inflammation.
Spleen:
Microscopic Description
Eight smears from 2 samplings were examined. They all consisted mostly of blood, but there were a few splenic tissue particles in each sample. These particles contained a large amount of hemosiderin and were associated with low numbers of hematopoietic cells, mostly erythroid. There were also few mixed lymphoid cells. No atypical cell populations were present.
Interpretation:
Spleen was sampled but there was no definitive cytologic evidence of disease. Hemosiderin may be increased.
Blood Pressure: 160 mmHg

CBC:
LYM 0.4 [1.1-3.1]
Sodium 154 [143-149]
Iron 277 [61-226]
ALP 908 [13-107]
ALT 627 [14-102]
AST 66 [19-34]

No mention of any T levels and the GGT and Lipase are absent on this CBC also

[Greybeard]

IMS prescribed anti-nausea (just in case), appetite stimulant, and gabapentin because she did cry for the vet when she pinched her spine. She hasn't done it for me :(
Blood work was unremarkable except for liver enzymes being more elevated. So based on the way she was acting, weight loss, and lack of other ideas, she wants to say possible brain tumor. She circled in one direction in the exam room, I said she was getting stuck more the last week. I also stopped giving her the tramadol this week and noticed the pacing and confusion seeming worse.

She does not go in one direction at home. Since giving her the meds the last 2 days, she gets herself unstuck and isn't wandering aimlessly. And she's eating more.

Her last bout of diarrhea, which I think was caused by the foods she was eating due to her picky-ness, caused her to lose a lot of weight but she's been putting it back on the last week since I cleared it up on my own with no help from the vets. Had to find out about probiotics, pumpkin, and liver supplements all online. Don't know why I haven't been offered an appetite stimulant or a better pain med before. I've asked. Was given deramaxx but when that didn't work, that was it.

Nothing about ultrasound was mentioned via phone other than liver nodules. I google gallbladder sludge and it comes up as associated with 2 things: Cushing's and hypothyroidism. It can also cause inappetence. What about her adrenals being enlarged? Does that mean anything?

I asked early in the appt if either Cushings or hypothyroidism were possible and she said "possible". But it wasn't mentioned again. Neither were the other findings in the ultrasound. Also, when I got the paperwork from her first blood draw early this summer, it did show her T4 as being 0.5. No reference range was given. It was written in her chart, not as part of the lab printout. It's not in any of her other blood work. No ideas about her tremors either. They didn't even get a lot of the details right when I read through what the IMS wrote as her history.

I googled this appetite stimulant and it says it's prescribed as an anti-depressant in humans. It raises serotonin. I googled after I already noticed her seeming less confused. Whether that's the pain med or the appetite med, I don't know but I see improvement. I don't know what to do. She's been eating much better the last week. All on her own. Vet said she is going by body condition and I know she looks like crap right now with her weight/muscle loss but she didn't need to get to this point.:( I've had her in all summer. And even if we're just "making her comfortable" wouldn't better pain meds, liver supplements, appetite stimulants do that??? The IMS was really young. Not saying that is always bad but she has a superior we didn't get to see. I feel like maybe I should've gone to the other place. I feel let down. I feel like I let Kitana down. I was on top of this. I had her in right away. She looked fine in the beginning. They said just a UTI. My poor baby.

Oh, and also, they've been checking her eyes at every appt and I've mentioned how her left wouldn't focus after her shaking episode on vacation, and that she doesn't seem to always see treats and nobody mentioned to me until this last appt that she has minimal to ZERO vision in that eye!

[molly muffin]

Oh dear. :( Well, the good thing is that what was checked is negative for cancer. Liver/spleen. The adrenals can be enlarged due to cortisol of course, but if she is in pain, then that can cause the cortisol to raise naturally and of course prednisone, steroids can do that too.
That she is now doing better with becoming unstuck, eating more etc, makes me wonder if the pain wasn't causing the confusion. It can do that, you hurt so bad, it's just too hard to try and figure things out. So, possible.

I'd monitor her and see if she continues to do better. That she is eating is good as that will help her with recovery.

That she has loss eyesight in one eye, is something a dog ophalmologist might be able to help with. I have one for my dog, who has lost sight due to high blood pressure and it's good to stay on top of those things. We are doing Ocu-glo a dog eye supplement. Not sure if it is helping or not, but they think it has made the loss slower than it would have been.

Did they mention ursidol for the sludge? That is one thing that they often give if the sludge looks like there is enough to cause a blockage so maybe ask if it is needed.

You can always go to the other place and take these test results to them so they don't have to repeat test. They could however maybe give you their thoughts on the test results.

I am so sorry that this has been so hard. The complex and difficult the symptoms are the harder the diagnosis can be and sometimes you just have to keep trying till you find the right fit. I've had to do that and now I have an IMS I am comfortable with, but it is my second one too.

You're doing good and all you can and I am hopeful that things will continue to improve.

[Greybeard]

Thank you for your kind words and encouragement, Sharlene. Both vets (GP and IMS) called last night. She's losing enough protein in her urine to indicate kidney disease even though her kidney values are fine. They don't think it's what's causing any of this though. Just an underlying condition that happened to be found. I wasnt going to do the UPC test because online said then you do an ultrasound to determine damage and we already had that. I said this and asked knowing that, what would be the point? Vet said would be good idea because she could prescribe med that would stop protein/muscle loss. After the test she said she didn't think meds would benefit. Great, thanks. What will do her in, they say, is whatever else it is going on causing the muscle loss and dementia symptoms. Again, they guess brain tumor. Neither vet thinks there's really anything to be done at this point other than keep her comfortable. She was so strong just a few months ago. In June she was still rolling around in whatever stink she could find in the grass. I've been holding onto the hope I could fix her and that maybe that first vet was right with Cushings or hypothyroid. They don't think treating for low thyroid will help her even if she is HT. And I guess they think it doesn't matter if she has Cushings either. This has been tough beyond words to watch her decline so quickly. I guess the only blessing is that I've been off for the summer and been able to spend lots of time with her. I take her everywhere I go. Good Lord, I love this dog.

[Harley PoMMom]

Novifit is one that I have seen mentioned on the forum for canine cognitive dysfunction, and members have seen improvements in their dogs using this, maybe mention this to the vet and see what they have to say. NOVIFIT Tablets are an S-adenosylmethionine (SAMe) tosylate supplement.

Here's the conclusion from a study done with Novifit:
The current study investigated the effects of NOVIFIT tablets, a supplement containing NoviSAMe®, on laboratory measures of cognitive function in both aged dogs and cats. Overall, NOVIFIT tablets were ineffective at improving measures of short or long-term memory.

However, studies in both aged dogs and cats consistently revealed potential benefits of NOVIFIT tablets on executive function. Collectively, this supports the use of NOVIFIT tablets for cognitive health indications in aged companion animals

http://www.jarvm.com/articles/Vol10Iss1/Lobprise.pdf

Hugs, Lori

[Greybeard]

No medication has been recommended for the gallbladder sludge. She lost a lot of weight muscle this month with the diarrhea. It doesn't take much with her. She's always been a lean, mean, running machine :) Except the mean part. Not a mean bone in her body. She's always been all muscle. One of favorite things has always been to show off her skills while we cheer her on yelling, "Gooooo Kitana girl!!!" She could've been just about done but you yell that and she'd take it as a challenge and give you another show sprinting back and forth, back and forth :) Anyway, this muscle loss, rear end weakness thing kills me. It's been so fast. I just don't understand and I'm somebody that always needs an answer. She's been falling a lot more the last week. I think the gabapentin made it worse so I backed off that. I think the diarrhea this month also really set off the dementia she had setting in. I did start Novifit about a week-week plus 1/2 ago. It got much worse in a short amount of time. I don't know that that part bothers her but I think the falling does. SO used to call her the Barry Sanders of dogs she could duck and weave and spin mid-air like nobody's business. Until recently. Seriously, she's been in great shape for the longest time. She has a hard time standing in the back seat to enjoy car rides like she used to. Her appetite is pretty poor. Honestly, even though she's found something she's interested in, she's not eating enough of it on her own to sustain herself. Maybe the gallbladder issues? Maybe not. I've tried so many things. She loves to snuggle. Leans her whole body into me even when she's already lying down ( not just for the extra support). I don't know if that's enough though to make it fair to her to keep her around. How did you know when it was time to say goodbye?:( and now she's actually wagging her tail as best she can and the most she's done all summer watching he kids play at my moms. I don't know what to do.

[Jenny & Judi in MN]

my Jenny had a sludgy gallbladder. When we visited with her IMS regarding her cushings and diabetes he said we could give her ursidol or just try to keep her on lower fat food. He wasn't sure if the ursidol would work.

when I shared this with the diabetes forum. A woman who helped me a LOT said that ursidol gave her dog horrible bloody diarrhea that took a long time treating with flagyl to resolve. So she would NOT recommend it and would stick with lower fat.

That was all in spring 2012. Jenny lived for 2 1/2 years with her sludgy gallbladder. I did wind up feeding her fattier foods in the last year to get her to eat and she wound up with pancreatitis.

so sorry your girl is not feeling like herself. I made a list of 3 things my dog enjoyed. when it got to only 1 thing on the list still being able to do, and she was obviously in some pain, we made the call. It is so hard because they love us so much and they bear pain so well. big hugs to you and your girl. Judi

[mommyslittlegirl]

Hello,so sorry for all the issues you have with your girl. My baby has extreme muscle weakness and she has changed a lot from the happy ,spunky little girl she use to be. But Sometimes my baby will get a moment when her little tail wags also.. So we just continue to love them and when the time comes you will know. And she will tell you. Best to you and your girl.

[molly muffin]

I think the 3 things is a good idea. I mean it is about quality of life right. So, if they are still enjoying those things that make them happy and aren't in pain or suffering, then maybe it isn't time yet. At least it would help you to gauge how she is doing. In the end though, you know your baby the best and know how she is doing and how she is feeling.

hugs

[Greybeard]

Thank you all. Kitana has been taking the Novifit for 15 days now and I do think it has made a difference in her mental state. The little bit of confusion she had initially got SO much worse this last month. She'd never got stuck in corners or under chairs like this before. Lately, she's paying more attention to when her name is called and she does a much better job getting out of tight corners. She can stop her aimless wandering when I talk to her and will come to me. She couldn't do those things before. My mom's house has a step down by the back door that Kitana had forgotten was there (I piled it with pillows when we visited in case she missed) but now she'll walk to the edge and turn around :)
I'm just not sure about the vet's guess about a brain tumor. In her history, she wrote that she consistently lost weight over the summer which is not true. She was still 2 lbs over her normal weight before the diarrhea. This month has been hard on her but here she is bouncing back a little again. She wrote that she has had chronic diarrhea all summer. No. She had diarrhea for about 2 weeks early this month. Before that, she had two bouts that were 2 days each as a direct result of the prednisone.She wrote that her appetite has been bad all summer with no mention of how she'd gained 6 lbs when we first brought her in and was eating like crazy. She's always had a very steady weight before that. She wrote that she consistently circled to the right in the exam room. Maybe she did but she definitley does not at home. But her right is also her good eye side. And since I've been told about her minimal to ZIP vision in her other eye, I notice a lot of her behavior might be affected by that. I wonder also if some of the times that she really seems to TRY to get into a tight space is similar to what she's always done during a thunder storm, fireworks, the smoke alarm going off (sorry girl). She's a big 'fraidy cat and tight spaces make her feel safe.
She does not have seizures that I read are associated with brain tumors (unless that was one she had up north but nobody has called it that), and she does not do the head pressing. She has not thrown up in years. There was no mention of her not barking or raspy bark when she does and no mention of how she weirdly pants (with her tongue just barely poking out) which I think are kind of significant.
Judi, thank you so much for sharing what you know about ursidol. I had been wondering if I should ask about it but the last thing I want to do is upset Kitana's GI tract again. I was reading that that's another thing (gallbladder sludge) that can cause elevated liver enzymes, as well as the nodules being able to do that. So who knows if she has a primary liver condition. I'm a bit irritated that the vet talked me into doing the UPC being that we already had the ultrasound and Kitana's kidney values are completely normal. It was pointless. Is it normal when going to a vet school to only see the intern? I thought she was the IMS but when I looked her up later, I see that she just got her DVM this year and is an intern at the school's one year intern program. I was really hopeful that we were going to see someone who had seen a lot of stuff.
So, now that Kitana is less confused and less stumbly I'm back to thinking maybe she's got little more in her again. She could hardly walk without falling right over when we got her home and I think it was the sedation from the procedure and the gabapentin.
For now, she's skinny, she has considerable muscle loss, she has a poor appetite but she does eat, her back end is still very weak but she loves to love on us and she's come out of her fog a bit. And she does NOT cry for me when I pinch all over her spine to try and get a response like the vet does. I can't just not be doing it right. I swear I'm tougher than they are. She doesn't even flinch :(I don't know. I just wish she could talk for 5 min.
The ONLY thing that shows up in her bloodworm are those elevated liver enzymes and the protein in her urine- which I was reading can be accounted for by something that had nothing to do with her kidney function but I forget what.. I've read so much this summer.
Her thyroid levels have not been checked since her first visit in May when it showed her T4 as .5 with normal range being 1+. That's when she looked great and liver was only slightly raised (less than 50 pts). I keep asking about it but nobody wants to test further or do a trial treatment. I'm just so frustrated. Thanks for letting me vent.

About the barking and panting weirdness. Those started in the beginning when she didn't look sick. She does not have any of the other signs of laryngeal paralysis. I can count on one hand the amount of times she's barked this summer and when she has, it's a different voice. She used to bark all the time. It was seriously her one and only annoying habit. She used to let her tongue hang all out in the car and of course when outside in the heat but this summer she's done that maybe twice. When she pants, which is rare now, her tongue barely pokes out of her mouth.This is how she drinks her water too. It used to be big crazy long tongue slurps but now she just barely pokes that tongue out. The vets have nothing to say about this.

[molly muffin]

well you could definitely test her thyroid again, just say I want to schedule a thyroid test. It's up to you to do that.

It's a crap shoot sometimes with the vet schools as to who you see. Normally you can get a variety of specialist to see your furbaby.

I'd see how she continues to do on the novofit and if the improvements are sustained and how her quality of life ends up being.

[Greybeard]

My sweet girl is running at the bridge. I feel her around me now as she used to be and I know we did the right thing but it doesn't make it easier. On top of her poor appetite, in the last few days she's been really restless, back legs would hardly hold her up, and yesterday she wouldn't touch her water. She told me in her own way yesterday that she was ready and I knew it was the only thing left I could do to help her. She been the sweetest little love we could have ever asked for and we'll miss her always. We held her in our arms until her eyes closed and she took her last breath telling her how loved she was over and over. I love you forever my sweet, silly babygirl.

[mytil]

My deepest condolences!!!! She is pain free now and thankful for a wonderful family who shared their love so unconditionally with her.

Always remembering your sweet girl.
Terry

[judymaggie]

My heart goes out to you and your family during this difficult time. I know that Kitana was welcomed by all of our pups who crossed over to the bridge before her.

[mommyslittlegirl]

So very sorry for the loss of your sweet baby girl Kitana. She lives forever in your heart.

[Robert]

So sorry for your loss.

[My sweet Ginger]

I'm truly sorry for your loss of Kitana. I know it's hard to do right now but if nothing else, try to take some comfort in knowing that she is in peace now, free from all the pain and confusion that she was in before.
She is beautiful and will live forever just only in your heart now.
I'm so sorry. Many hugs, Song.

[molly muffin]

Oh no. :( I''m very sorry to hear this. I know she struggled so much and that your heart was breaking, is breaking even now.

My sincerest condolences to you and your family. We know how very hard this is.

hugs

[apollo6]

So sorry for the loss of your beautiful Kitana. She will always be a part of you,in your heart in your soul.
Sonja,Angel Apollo

[labblab]

I can only imagine how painful it was to wake up this morning (or get up this morning if sleep escaped you altogether...:o). The first morning after, the first day without your love beside you. It is so unspeakably hard. You did the right, loving thing. You released her spirit from her tired, sick body. But I am guessing you would do anything in your power today to have her back again for even just a few moments, at her best. I hope you may be able to close your eyes and picture her that way. Always in your mind's eye, always in your heart. Strong and brave and beautiful and loved. From now on, always at her best. And forever treasured.

Sending you many hugs on this first day with Spirit Kitana,
Marianne

[Jenny & Judi in MN]

I'm so sad to see this. big hugs

[Greybeard]

Thank you all so much. As much as I thought I knew it was the right thing, I can't help but question, what if this, what if that? Her breathing was really scary that last 24 hrs. And still I wonder... I just wanted her to rest. She wouldn't go to sleep. For the last few days she slept very little. Her eyes would stay open while she rested and she'd jump up in a hurry just needing to pace around-she'd only stop when one of us would lie down with her- and I did as much/often as I could. I had given her pain meds but I was scared they were't working. I had taken her in to the vet one last time Wednesday and wondered if the stress was doing it. She was always worse after a visit. It wasn't getting better though. And that breathing. This.Sucks. I just feel the weight of so many decisions on my shoulders.
Marianne- you are so right. Waking up (after sleeping late because of not being able to get/stay asleep) and not having her tippy-tapping around the bed wondering what was taking us so long was soooooo unbelievably hard. Not having her sitting right up on my back while I got ready for work this morning was just as awful. Not seeing the mess of many meals I'd make to try to get her to eat (and she wouldn't) all over the kitchen was tough too. Thank you so much for saying I did the right, loving thing. I needed/need to hear it. I know she wasn't going to get better. I know I took her in one last time knowing it was a last ditch effort anyway because things weren't good- but I keep forgetting and questioning.
Is this normal? This back and forth? She told me, I know she did and I still can't stop wondering..How long does it take to get it through your head? I've never had to make this decision.

[labblab]

Not only do I think the questioning is normal, I think it's inevitable. It's been over ten years now since my husband and I made the same decision for our Cushpup, and honestly, there are still times when I sink back into the questions and the self-doubt :o. But fortunately, those times come less often and leave more quickly now. I've come to believe and accept that even if I made mistakes, they were because I loved my boy and didn't want him to suffer unnecessarily. Possibly he could have lived longer, but really, to what end? Measured against the rest of his lifetime, a few more weeks or even months would probably have mattered only to us humans and not to him. The joy was gone from his life even if he physically could have carried on a bit longer.

It is so very hard to judge when the "right" time has come. In the absence of words, all we can do is trust our hearts and our instincts. I do believe that when the decision comes from a place of love, there really cannot be a "wrong" time, and a few days more or less at the end of a life well lived is really nothing more than the blink of an eye. What matters most is not the number of days spent together, but instead the love that has been, and will always be, shared.

Marianne