What do you thiink?

[beaglesandbagels]

http://i63.tinypic.com/2jdl8ol.jpg

[Harley PoMMom]

These LDDS test results are indicative of the pituitary type of Cushing's. Could you tell us more about your furbaby? The more we know about your furbaby the better our feedback can be ok? So here goes some questions from me ;) Could you get copies of all tests that were done on your furbaby and post any abnormalities that are listed? With respect to the blood chemistry and complete blood count (CBC), you need only post the highs and lows and please include the normal reference ranges. Is your furbaby taking any other herbs/supplements/medications? Does your furbaby have any underlying illnesses? How much does your furbaby weigh? What symptoms is your furbaby displaying that led you or your vet to test for Cushing's?

We love details so any information you want to share would be great!!! Looking forward to hearing more about your furbaby.

Hugs, Lori

[beaglesandbagels]

A few years ago my beagle was diagnosed with hypothyroidism. I would bring up to my vet on occasion that I have read a lot about cushings and that I understand at times it is misdiagnosed as hypothyroidism being that there are similar symptoms. I gathered my facts from multiple websites throughout the years. I think one of the best websites with very detailed yet easy to understand information is from the Long Beach Animal Hospital. Their website address is http://www.lbah.com/word/canine/cushings-hyperadrenocorticism/

I will start with the fact that my dog is a neutered beagle. Beagles are on the very short list of canine prone to cushings. Neutered pets may be at a higher risk.

Symptoms:

Polydipsia (PU/PD)- excess drinking of water.
Pot bellied abdomen
Polyphagia- excess appetite
Pruritis (itchy skin) - constant, year round
Panting
Obesity
Straining to urinate
urinary tract infection
Weakness
Depression
Aggression
Lethargy

For me, two of the most telling symptoms are urinary tract infection and lameness due to a ruptured cruciate ligament

urinary tract infection - anytime a urinalysis has been done it comes back showing a UTI

lameness due to a ruptured cruciate ligament - both hind legs had torn ligaments. TTA surgeries on both were performed.

Bruising (hematoma) might be observed under the skin, or when a blood sample is obtained. A couple years ago she had a massive hematoma after blood sample drawn from jugular. Photos - https://flic.kr/s/aHsjxw9nxz

Skin infections and wounds that do not heal or recur after antibiotics are stopped. She is always scratching, chewing. Sometimes to the point of kicking herself in the face and/or making her feet bleed.

Here is her most recent cbc and urinalysis.

http://i68.tinypic.com/fxrw2e.jpg

http://i65.tinypic.com/2e54c46.jpg

By the way, my vet said there are no clinical signs of cushings and that he is puzzled by her HIGH levels in LDDS test. Thoughts on that?

Forgot to mention she is on 0.3 mg soloxine twice daily

[tank&kat]

Hi,

I am sorry to hear your girl is still having so many symptoms despite being treated for hypothyroidism. I have to say that those test results are indeed confusing. The blood chemistry panel looks great compared to what is usually seen in a cushingoid dog yet the LDDS results are the highest (baseline) numbers I have seen. I haven't been here long enough to assess a dog with these types of results so I will leave that to the more experienced people here.

I will say that your dog does have many of the symptoms in the list you provided associated with the disease. The other obvious abnormalities that suggest Cushing's are proteinuria, the multiple urinary tract infections and the skin infections resistant to antibiotics. Did the vet recommend any further diagnostic testing to rule out Cushing's? I am very curious to hear what other have to say.

I am not even sure what I would do if this was my dog. Maybe an abdominal ultrasound?? I hope you find the answers you are looking for.

~Kat

[labblab]

Hello and welcome from me, too. You'll see that I've merged your duplicate post into your original thread. This way, it is much easier for us to keep all comments and information about your dog consolidated in one spot.

I have to admit that your dog does present with some question marks, most of which you are already aware of. First of all, as Lori has already stated, the LDDS is indeed consistent with pituitary Cushing's. And yes, it's true, that the results are quite elevated. However, we have seen a few other animals with results that high, so they are not super surprising to me. Does your dog become stressed easily, and especially while at the vet? If so, stress alone may be a component of these higher results.

As Kat has already noted, of greater surprise to me is the total normalcy of the blood chemistry. Most Cushpups exhibit elevations of liver enzymes, and many also have elevated cholesterol and/or triglycerides. Turning to the cell counts and urinalysis, I'm not sure what to make of the listed abnormalities (I'm definitely not a hematology expert!), and this may be an area that might warrant greater analysis. How was your dog's urine sample obtained -- was it drawn by needle? If it was drawn by needle, perhaps that would explain the high number of red blood cells and occult blood that is noted. Of course, an active UTI could account for that, as well, I am guessing. But I am also seeing an extremely low platelet count (for which the lab notes a possible explanation, however) and also an elevated nucleated red blood count. Both of these abnormalities may signal something other than Cushing's -- perhaps not. However, for what it's worth, Cushpups often exhibit elevated platelet counts, rather than the reverse. To add to the confusion, you note a history of extreme bruising. This could be the result of Cushing's (it can cause thin skin and fragile blood vessels); or it could be the result of consistently low platelet counts caused by some other illness or syndrome.

Have you noticed any hair loss in your dog? You note constant itchiness, but honestly, that is less common in uncontrolled Cushpups because the high levels of cortisol can produce an anti-inflammatory effect similar to giving supplemental prednisone. What we see more often in Cushpups is the reverse: an "unmasking" of allergic and arthritic issues once cortisol levels are lowered by treating the Cushing's.

Since I know so little about blood interpretation, the abnormalities I've noted above may be insignificant. However, even though your girl exhibits several consistent overt symptoms, her overall lab profile does differ from the Cushing's norm. As a result, you might consider asking for a consultation with a specialized vet in order to get further input as far as the best steps forward, both in terms of diagnostics and treatment. What you'd be looking for is an "internal medicine specialist," and perhaps your regular vet already knows of such a specialist with whom he has consulted in the past. What is your own vet suggesting at this point?

Marianne

[beaglesandbagels]

Does your dog become stressed easily, and especially while at the vet? If so, stress alone may be a component of these higher results.

She does become stressed easily. Really though, it seems her stress comes from the day to day, hour to hour, minute to minute scratching, chewing, biting of self. She moves from one place to another all day long. Tries to get comfortable, that last a couple minutes, then she goes at it again, moves to somewhere else. Repeats throughout the day.

normalcy of the blood chemistry.

WBC are high
Neutrophils are high

How was your dog's urine sample obtained -- was it drawn by needle?

Yes

low platelet count

I don't remember if this came about when she was neutered or if it was a couple years later when she had a growth/mass removed. In house cbc performed right before surgery was going to begin and it showed low platelets. Surgery cancelled and scheduled for a couple weeks later. Vet diagnoses her with an autoimune disease. Cbc performed again right before surgery. Low platelets again. Now onto the part that makes me sound crazy. It is here when things started changing. That being the introduction to Prednisone. Prednisone temporarily brings platelet count up to a level that is acceptable for surgery. I would have to look at past bills/paper work to determine how much she would have had. To begin, she would have at least had 30 pills at 10mg. This is not the last time she would have had prednisone. After the growth was removed it came back. Surgery was performed again, prednisone taken in preperation of surgery.

September 2013 she had her first TTA surgery performed along with removing a tumor on her right side. More prednisone.

February 2014 she had her second TTA surgery performed. More prednisone.

October 2015 she had another tumor removed and a teeth cleaning. More prednisone. Azathioprine taken as well before each of those surgeries.

Temaril P prescribed a few times when I have brought her in because of really bad scratching and chewing making herself bleed.

The most recent new drug she has been on is Apoquel. I will say this, it does work as far as putting an end to her itching. The moment she is not on it, back to itching, bleeding, etc. Too expensive to be on everyday plus not much is known about long term use. She was on it for about 3 months. Stopped use two months ago.

Have you noticed any hair loss in your dog?

She does not seem to have hair loss right now. There are times however where she sheds quite a bit. Also, if she has been shaved for preparation for a surgery it will take at least 6 months for the hair to come back.

You note constant itchiness, but honestly, that is less common in uncontrolled Cushpups because the high levels of cortisol can produce an anti-inflammatory effect similar to giving supplemental prednisone.


So the following is not accurate?....

Some dogs have a history of pruritis (itchiness) if pyoderma is present.

What is your own vet suggesting at this point?

Vet has said he is almost positive she does not have cushings and that he is puzzled as to her high levels in the LDDS test. Would like her tested in 6 months unless we see symptoms worsen.

I believe and I have felt this for a very long time that she has Iatrogenic cushings. Then again, can prednisone or the affects of prednisone still be in her system. Like I said, she has had prednisone many times. The most recent being October 2015.

[labblab]

Thanks so much for supplying all this additional information. I'm sorry I don't have the time right now to answer you in greater detail, but even more so now, I'd want a referral to a specialist in order to sort out what's been going on. I am not at all convinced that your dog has Cushing's, either. Which autoimmune disorder was she originally diagnosed with? I have to agree that her history and medication response seems to be more consistent with a disease that was originally caused by her immune system being overactive instead of overly suppressed (which would be the case with uncontrolled Cushing's).

But the history of prednisone use definitely muddies the water, and may have introduced additional problems. As to whether or not there may be residual effects from long-term use, the proper test for that would be the ACTH stimulation test and not the LDDS. The ACTH more often misses making the Cushing's diagnosis in a dog that truly has the naturally occurring disease. However, it is less likely to return "false positives" in the face of other disorders, it is the gold standard for testing for Iatrogenic Cushing's, and it is also the test that is used to diagnose Addison's. So under these circumstances, I believe I'd request an ACTH stimulation test in order to further evaluate her adrenal function.

But overall, the history of consistently low platelets would be troubling to me, in addition to these other issues. It is true that the immunosuppression caused by uncontrolled Cushing's can cause recurrent infections, including skin infections that in turn may cause itchiness. But what you are describing sounds more like an inflammatory or allergic process that is instead caused by an overactive immune system. That would explain why immunosuppressants such as pred, azathioprine (Imuran), and Apoquel provide relief.

And once again, her blood chemistry panel (Superchem) is normal (unusual with Cushing's). It is her CBC (complete blood count) panel that shows the abnormalities in white cells and platelet count, with a low platelet count being inconsistent with Cushing's.

So, given the extensive history of prednisone use, I do believe I'd like to see the results of an ACTH stimulation test. But beyond that, I'd want a specialist who is familiar with endocrinological and autoimmune disorders to take a look at your girl to try and sort things out.

Marianne

[molly muffin]

I really can't add anything more specifically to what Marianne has already said, other than to encourage you to get a referral to an Internal Medicine Specialist.
I think that the hematology results themselves warrant this.
With cushings you normally see an effect on the liver when you have high cortisol levels for an extended period of time.
I'm not saying it can't be cushings but it doesn't present really as cushings off the bat, as far as the bloodwork goes. I'm like Marianne and thinking that something else is going on.

[beaglesandbagels]

Lori, Kat, and Marianne.....
Hi, how are you? Thank you for your replies. I should have said that sooner.

I am not at all convinced that your dog has Cushing's, either.

Are you saying that your not convinced she has the naturally occurring type of cushing's, but possibly the iatrogenic type?

Which autoimmune disorder was she originally diagnosed with?

Was never told. Time to ask though. More tests I imagine.

But the history of prednisone use definitely muddies the water, and may have introduced additional problems.

Indeed it has.

But overall, the history of consistently low platelets would be troubling to me, in addition to these other issues.

I am going to assume that the low platelets are related to the Autoimmune disease. Finding out which type of Autoimmune disease she has is probably key to everything here.

It is true that the immunosuppression caused by uncontrolled Cushing's can cause recurrent infections, including skin infections that in turn may cause itchiness. But what you are describing sounds more like an inflammatory or allergic process that is instead caused by an overactive immune system. That would explain why immunosuppressants such as pred, azathioprine (Imuran), and Apoquel provide relief.

Correct me if I'm wrong. Are you saying that a dog with true naturally occurring uncontrolled type of cushing's would not respond to pred, azathioprine (Imuran), and Apoquel as far as relief from itching, infections and what not?

And once again, her blood chemistry panel (Superchem) is normal (unusual with Cushing's). It is her CBC (complete blood count) panel that shows the abnormalities in white cells and platelet count, with a low platelet count being inconsistent with Cushing's.

"The CBC MIGHT show an increase in the number of red blood cells (RBC’s) and/or an increase in platelets"

Maybe a dog with an autoimmune disease which lowers the platelet count can still have cushing's or even more so iatrogenic cushing's.

So, given the extensive history of prednisone use, I do believe I'd like to see the results of an ACTH stimulation test. But beyond that, I'd want a specialist who is familiar with endocrinological and autoimmune disorders to take a look at your girl to try and sort things out.

Completely agree

[beaglesandbagels]

I would like to know who has had a dog with both Cushing's Disease and Cranial Cruciate Ligament Disease (torn ligament)

[Harley PoMMom]

Unfortunately Cushing's does predispose a dog to CCL (Cranial Cruciate Ligament) injuries. We have multiple members whose dogs had a CCL tear and have recovered either with either surgery, rehab and rest.

If you type in "cruciate ligament" in the search box a huge list will pop up, you can then search for cruciate ligament in any of the threads that are listed.

Hugs, Lori

[beaglesandbagels]

Lori, is it time for a new vet if they tell me that one has nothing to do with the other?

[Harley PoMMom]

With your girl having multiple health issues; autoimmune disorder, hypothyroidism, prior used of prednisone, if this were me I would feel more comfortable having an IMS, at least, take a look at her and her test results.

One question, has her thyroid levels been checked recently? Many of her symptoms can be attributed to a thyroid problem.

[labblab]

Hi again! Sorry it's taken me so long to return and respond to your questions about things I had written previously. But hopefully, better late than never! I've repeated some of your questions here, with my answers typed out in red.



Which autoimmune disorder was she originally diagnosed with?

Was never told. Time to ask though. More tests I imagine.

Have you had a chance yet to find out more re: the automimmune diagnosis? I really think that information is very important to discuss further.

But the history of prednisone use definitely muddies the water, and may have introduced additional problems.

Indeed it has.

But overall, the history of consistently low platelets would be troubling to me, in addition to these other issues.

I am going to assume that the low platelets are related to the Autoimmune disease. Finding out which type of Autoimmune disease she has is probably key to everything here.

It is true that the immunosuppression caused by uncontrolled Cushing's can cause recurrent infections, including skin infections that in turn may cause itchiness. But what you are describing sounds more like an inflammatory or allergic process that is instead caused by an overactive immune system. That would explain why immunosuppressants such as pred, azathioprine (Imuran), and Apoquel provide relief.

Correct me if I'm wrong. Are you saying that a dog with true naturally occurring uncontrolled type of cushing's would not respond to pred, azathioprine (Imuran), and Apoquel as far as relief from itching, infections and what not?

I do believe that dogs with Cushing's can also suffer from allergies. However, prior to Cushing's treatment, the highly elevated levels of circulating cortisol often blunt the need for meds such as supplemental prednisone or Imuran. In other words, the high cortisol often provides self-medication which keeps the allergies somewhat in check. What we've discovered here is that allergies are not a big problem for some Cushpups until after the cortisol has been lowered. It is at that point that some alternative form of immunosuppressive/anti-inflammatory medication is needed to replace the effect of the high cortisol. So it's not that prednisone or Imuran or Apoquel wouldn't provide relief -- it's instead that a dog with highly elevated cortisol often wouldn't need any additional relief -- the high cortisol would be medicating the allergic or inflammatory problem.

And once again, her blood chemistry panel (Superchem) is normal (unusual with Cushing's). It is her CBC (complete blood count) panel that shows the abnormalities in white cells and platelet count, with a low platelet count being inconsistent with Cushing's.

"The CBC MIGHT show an increase in the number of red blood cells (RBC’s) and/or an increase in platelets"

Maybe a dog with an autoimmune disease which lowers the platelet count can still have cushing's or even more so iatrogenic cushing's.

Yes, I'm guessing that an autoimmune disease may have an effect on platelets that is separate from any effect from Cushing's. However, dogs with Cushing's usually exhibit abnormalities on their blood chemistry panels that are totally absent here. There is usually always elevation of ALKP and sometimes ALT (liver markers), and often elevated cholesterol or triglycerides, for instance. Since your dog's chem panel is normal, that is very unusual for a Cushpup.

So, given the extensive history of prednisone use, I do believe I'd like to see the results of an ACTH stimulation test. But beyond that, I'd want a specialist who is familiar with endocrinological and autoimmune disorders to take a look at your girl to try and sort things out.

Completely agree.

Have you given any more thought yet to a consultation with a specialist? I still think it would be a really good idea!

[beaglesandbagels]

Have not found specialist yet. Her T4 was tested and is within the reference range.

Prednisone or Azathioprine never provided relief. They were prescribed to her in order to bring her platelets up in preparation to the numerous surgeries she has had. Apoquel did provide relief. Prednisone is the only steroid here.

[beaglesandbagels]

https://ibb.co/m5kFUQ

[Squirt's Mom]

Hi and welcome back to you and your girl,

I have merged your post about the labs you posted into the original thread. We like to keep all info about each dog in one thread. That way it is easier to look back thru the history if needed.

As for the lab work - to me it does not point to Cushing's. It DOES seem to indicate the thyroid is not under control; it is still low. There may also be an infection, virus, etc. in play as well as inflammation and many other possibilities. But I do not see Cushing's.

What are you seeing in your baby that tells you something is wrong / off with her? The more information you can give us the better. ;) Labs are valid for only a short time - that moment in which they were done. Things change from day to day, hour to hour so we need to also rely on what we observe. So please fill in the details if you can! Thanks!

[beaglesandbagels]

As far as lab work goes, I have read that the following are possible indications of cushings or the beginning of cushings. Scarlet fits all of those.

ALK Phosphate - HIGH
WBC - HIGH
Neutrophils - HIGH
Lymphocytes - LOW
Monocytes - HIGH

One month ago she had two seizures, three days apart. The first one was extremely mild, to the point where I didn't even think seizure. The second one was a very violent seizure lasting about 3 minutes.

She has an ongoing ear infection. Ears are cleaned daily and medication is applied daily. The next day her ears are layered in black crusty looking material. Process repeats...

She has had infections in the eye. Eye medication used. Comes back.
Allergic pododermatitis and viral papilloma. (My diagnosis)

https://ibb.co/bJRz8k
https://ibb.co/hc6MM5

When blood is drawn from her neck - https://ibb.co/f8uVEQ

Her LDDS - HIGH (results on a previous reply)

Her two CCL surgeries.

Basically all the symptoms I have listed before.

[Harley PoMMom]

As far as lab work goes, I have read that the following are possible indications of cushings or the beginning of cushings. Scarlet fits all of those.

ALK Phosphate - HIGH
WBC - HIGH
Neutrophils - HIGH
Lymphocytes - LOW
Monocytes - HIGH

These abnormalities in her blood work are commonly seen in dog's with Cushing's. Although a low platelet count, as noted on her recent blood work panel, is usually not found in dog's with Cushing's.

In your prior post you listed PU/PD as one of her symptoms but that she does have reoccurring UTI's. Has an urine culture and sensitivity test been performed to see exactly what bacteria is in the urine so that a proper antibiotic can be prescribed?


One month ago she had two seizures, three days apart. The first one was extremely mild, to the point where I didn't even think seizure. The second one was a very violent seizure lasting about 3 minutes.

What was the vet's response regarding the seizures?


She has an ongoing ear infection. Ears are cleaned daily and medication is applied daily. The next day her ears are layered in black crusty looking material. Process repeats...

Has a sample been obtained for a culture?



Her LDDS - HIGH (results on a previous reply)

Those LDDS results could be falsely high because of all that is going on with your sweet girl so an ACTH stimulation test could be a better option to perform for diagnosing Cushing's.

Lori

[beaglesandbagels]

No

No response to the seizures. Prescribed Phenobarbital for ten days.

No

I agree, though my vet wants to retest using LDDS.

Of course, she is back on prednisone, azathioprine, antibiotics all in preparation for another surgery to remove a growth in her mouth and growths on her eyelids. All which were surgically removed in May 2017. Due to her autoimune disease, her platelets are always extremely low and could bleed out during a surgery. Prednisone and azathioprine help bring levels back to normal. Even though I believe prednisone does damage after the usage of the drug. In the meantime she is like a normal dog almost. Walking around the yard, sniffing (beagle), interacting with the kitten, not being aggressive, not sleeping all day.

I have a theory about her seizures. She has been on a medication called Apoquel. She was on it for a couple months a year ago or so. It seemed to really help with the itching, chewing of skin. This time around it does not seem to work as well. She was prescribed fifteen 16mg pills. They were split in half totaling 30 days. We did not get it refilled immediately, so three days after not having apoquel she had a minor seizure. Two days later she had a pretty bad one. This is when the vet prescribed the Phenobarbital for ten days and while there also got another bottle of apoquel. After apoquel for another 30 days and not immediately getting it refilled, day four of not having apoquel she had another pretty bad seizure. So, even though this medication does not list seizures as side affects. I personally believe its possible. It's too much of a coincidence.

[labblab]

Hello again and welcome back, although I'm very sorry about these additional problems.

In trying to offer help to you, we are at the point now where we absolutely need to know exactly which autoimmune disorder your girl has been diagnosed with. Otherwise, we will be endlessly chasing down rabbit holes in terms of both symptoms and treatment. So until we find out that diagnosis, I believe our hands are tied.

In terms of the seizures, however, I do have a couple of comments. First, was the phenobarbital prescribed solely for ten days alone? If so, this seems strange to be. It is a medication that takes time to build up to a therapeutic level in the bloodstream -- typically at least a couple of weeks. So I am not understanding why a short course such as ten days would even be of any value. Also, just as a sidebar, once a dog has been treated for a period of time with phenobarbital, it cannot be stopped cold turkey or else seizures can be triggered simply by stopping the drug. Ten days probably isn't long enough to cause this problem, but I just want to mention that weaning off is necessary if a longer course of the med is ever prescribed.

Also, I find it interesting that your girl had the seizures after the Apoquel was discontinued and not while she was taking it. In that case, I wouldn't think the seizures were a side effect of the medication, but perhaps instead a reaction to the discontinuation of the medication. Since Apoquel is an immunosuppressant, we're back to needing to know the name of your girl's autoimmune disorder. Perhaps it's the case that Apoquel's immunosuppressive properties were somehow inhibiting the seizures during the time period that she was taking the drug.

Marianne

[beaglesandbagels]

autoimmune thrombocytopenia

[labblab]

Thank you so much for this info! I will plan to go and read up on this disorder as soon as I can. In the meantime, I'm still wondering about the phenobarbital -- are you still giving it, or was it only for those ten days?

Marianne

[Squirt's Mom]

autoimmune thrombocytopenia

Primary?

Secondary?

If secondary, what was the cause and has it been resolved?

[beaglesandbagels]

Scarlet had never had a seizure, at least not to my knowledge. Her first one was extremely minor. In fact I didn't even consider it to be a seizure until her second seizure two days later which was roughly three minutes long and just horrible to say the least. The following day she was prescribed the ten days of phenobarbital, and another 30 days of apoquel. Four days after apoquel ran out she had another very bad seizure. More phenobarbital was prescribed and is still currently on that medication.

As far as the autoimmune thrombocytopenia, the type was never discussed. However I am going to assume idiopathic, or primary because all her life anytime blood work has been done her platelets are extremely low.

[molly muffin]

That does sound like it is a genetic disposition, so primary.

Hopefully the phenobarbital will control seisure issues once it's in her system for awhile.

[labblab]

OK, I've finally made my way back again and now I have a few more thoughts to offer out. First, from your description, I'd agree that it sounds as though Scarlet probably suffers from the primary form of autoimmune thrombocytopenia. For the benefit of our other readers, here's a link to an article that helped me better understand the disorder:

https://www.cliniciansbrief.com/sites/default/files/attachments/CoC_Canine%20Primary%20(Idiopathic)%20Immune-Mediate%20Thrombocytopenia.pdf

With this additional information in hand, I'd encourage you even more strongly to seek the advice of an IMS before launching into additional Cushing's testing or treatment. Given the nature of Scarlet's disorder, and especially now with the onset of the seizures, I think you'd both benefit from having a specialist's input re: coordinating her medication and her general treatment. Since the low platelet count is life-threatening, that really does take the top priority with the necessity of her periodically taking the immunosuppressants including the prednisone. As you already know, the prednisone may be exaggerating underlying Cushing's symptoms. But the low platelets trump everything else. And even if she does have naturally occurring Cushing's, I honestly don't know whether treatment would be recommended in conjunction with her other necessary meds. And that's even before the phenobarbital gets factored in!

My non-Cushing's Lab girl successfully took phenobarb for six years to control seizures of an unknown origin. But I have to tell you that, especially during the first weeks of treatment, phenobarb can elicit symptoms that are identical to Cushing's: excessive thirst, urination & weight gain, lethargy, and hind-end clumsiness. So if those symptoms re-emerge for Scarlet right now, are they caused by prednisone, naturally-occurring Cushing's, or instead the phenobarbital?

Also, I do want to mention that seizures can be triggered by low thyroid levels, and according to this latest labwork, Scarlet's thyroid level is below normal range. A complication to phenobarbital treatment is that the drug skews subsequent thyroid test results. So from this point onward, if she remains on the phenobarb, it will really be helpful to have somebody on her case who is knowledgeable about thyroid issues and test interpretation.

So for all these reasons, I really think you'd be well-served to seek a consultation with a specialist, if that's possible. If not, I believe I'd focus my attention on the thrombocytopenia and the seizures right now as opposed to more Cushing's testing. If you still want to test for Cushing's, I'd recommend the ACTH stimulation test as opposed to another LDDS. Both those tests can return false positives in the face of other nonadrenal illnesses, but the ACTH is less likely to do so.

Whatever you decide, please do keep us updated, OK?
Marianne

[beaglesandbagels]

Is thrombocytopenia something that is supposed to be treated?

[beaglesandbagels]

What is wrong with her? What is wrong with my vet?

https://ibb.co/kZWVfb
https://ibb.co/ivoAfb
https://ibb.co/nmNgmG
https://ibb.co/eYZ5Dw
https://ibb.co/nDk1mG
https://ibb.co/hpWVfb

[molly muffin]

Oh poor baby. I looked up thrombocytopenia to see what I could find.
I don't know about treatment for immune type, it seems to be steroids, which would be in opposition to cushings, as it raises cortisol levels, but if that is the only option..... I don't know for sure what other types of options might be out there and is one reason that I would encourage you to try an Internal Medicine Specialist (small animal) As they might have more experience and know of various options for treatment.

https://www.vetinfo.com/thrombocytopenia-in-dogs.html

[labblab]

Are those photos all of the same thing -- which seems to be some sort of a bloody cyst on her paw? From one of the photos, it looked as though it was settling down a bit? If Scarlet's platelet count is low right now, she could probably bleed excessively from any small wound or even spontaneously experience bleeding from soft tissue areas.

From that Clinician's Brief article that I linked to earlier, it sounded as though most cases of the primary form of the disease can be managed as long as treatment extends for long enough -- I think it cites a typical time period lasting a full 4-6 months. During that time, the dog is treated with various immunosuppressants, including the prednisone and axathioprine that your vet has been using so far. The goal is to put a lid on the dog's immune system which is overactive and attacking blood cells in her own body. It looks as though prednisone is the standard first treatment followed by, or in conjunction with, other medications if needed. So it looks as though your vet has been using some of the recommended drugs, but perhaps just not for a consistently long time to get the disease fully under control? Or maybe in Scarlet's case, she just keeps relapsing? In that article, I see that spleen removal is mentioned as one possibility for dogs with recurrent issues.

So I don't know that your vet is doing anything wrong. But as complicated as things are for Scarlet, I really think it could help to consult with a specialist to make sure you're all on the right track and not missing something that could help. From reading that article, there may be additional immunosuppressant meds that could be tried in the event that her disease remains uncontrolled.

Marianne

[beaglesandbagels]

Are those photos all of the same thing -- which seems to be some sort of a bloody cyst on her paw? From one of the photos, it looked as though it was settling down a bit? If Scarlet's platelet count is low right now, she could probably bleed excessively from any small wound or even spontaneously experience bleeding from soft tissue areas.

From that Clinician's Brief article that I linked to earlier, it sounded as though most cases of the primary form of the disease can be managed as long as treatment extends for long enough -- I think it cites a typical time period lasting a full 4-6 months. During that time, the dog is treated with various immunosuppressants, including the prednisone and axathioprine that your vet has been using so far. The goal is to put a lid on the dog's immune system which is overactive and attacking blood cells in her own body. It looks as though prednisone is the standard first treatment followed by, or in conjunction with, other medications. So it looks as though your vet has been using some of the recommended drugs, but perhaps just not for a consistently long time to get the disease fully under control? Or maybe in Scarlet's case, she just keeps relapsing? In that article, I see that spleen removal is mentioned as one possibility for dogs with recurrent issues.

So I don't know that your vet is doing anything wrong. But as complicated as things are for Scarlet, I really think it could help to consult with a specialist to make sure you're all on the right track and not missing something that could help. From reading that article, there may be additional immunosuppressant meds that could be tried in the event that her disease remains uncontrolled.

Marianne

Marianne, only when she has to have a surgery does she have the prednisone and azathioprine. It usually takes about 30 - 45 days to bring her platelets to a level safe enough for surgery. After the surgery whatever prednisone is left she will take, and its usually not tapered because there may be just a few left. I bring up to him, well isn't it supposed to be tapered? No, Scarlet will be fine.

Even when she had her last surgery which was in May. I told him, how much of a different dog she is when on prednisone. Can't she be on a long-term low dose of it? When not on it, I hate saying this, but she is a dud.

[labblab]

Yes, it appears that the prednisone can be continued for a longer duration and perhaps SHOULD be continued for up to six months in Scarlet's case. Here's the treatment info from that article, and that's why I encourage you to consult with a specialist who may have more experience with this condition, as well as seizures and Cushing's.

https://www.cliniciansbrief.com/sites/default/files/attachments/CoC_Canine%20Primary%20(Idiopathic)%20Immune-Mediate%20Thrombocytopenia.pdf


• Prednisone (1–2.2 mg/kg q12h) is the
initial immunosuppressive therapy of choice for dogs with IMT; the majority of dogs will show a significantly increased platelet count within 7 days.

– Additional immunosuppressive medications are usually needed only if significant prednisone side effects are present.

• Azathioprine (2 mg/kg q24h, tapered to q48h a er 1 week) has been described as an immunosuppressive option, but studies are lacking.
– This medication can take more than
4 weeks to become effective.

• Cyclosporine (5–10 mg/kg divided q12h)
has been shown to be an effective immunosuppressive medication in dogs with IMT.

• Mycophenolate mofetil (10 mg/kg PO q12h) has been reported to have variable response rates as an immunosuppressive medication for canine IMT in small studies.
– This drug can be considered in refractory
cases.

• Leflunomide has shown efficacy in
anecdotal reports, but studies on this immunosuppressive medication for IMT are limited.

Melatonin (3 mg PO q12h) has been suggested anecdotally (based on clinical response in humans) to increase platelet counts in cases of IMT.

Human IV immunoglobulin (0.28–1.5 g/kg IV) has been shown to significantly reduce platelet recovery time and hospitalization when combined with prednisone given slowly over 4 to 12 hours.

• Human IVIG should be used with caution in patients with renal dysfunction.

• Patients should be monitored for volume overload and hypersensitivity reactions.

Splenectomy has shown variable response rates but can be considered in refractory cases.

FOLLOW-UP

Immunosuppressive medications are tapered slowly once the platelet count has normalized.

Prednisone is usually tapered first as many dogs will have significant side effects from this medication.

• If a second immunosuppressive medication is given, it is routinely tapered after the prednisone.

• Medication is generally reduced by about 25% every 3 to 4 weeks.

• Medications are usually tapered 1 medication at a time if multiple medications are given.

The minimum duration of treatment is usually 4 to 6 months.
The most common reason for treatment failure is an inadequate duration of therapy.

Patients should be evaluated via a manual platelet count 1, 3, and 6 months a er treatment has been discontinued and then every 6 to 12 months for life to monitor for disease relapse.
• A manual platelet count is usually performed before each medication adjustment.

[beaglesandbagels]

Thank you, Marianne.

[beaglesandbagels]

Scarlet, a.k.a. The Baby Beagle is ready for surgery on Thursday. This is blood work from a couple days ago.

https://www.scribd.com/document/361897391/LabReport-2017-18-10-03-13-59-removed-names

[Squirt's Mom]

Prayers rising for a successful operation and swift uneventful recovery! Please let us know how she is doing when you can and know we are with you!

Hugs,
Leslie

[molly muffin]

Crossing fingers, toes, paws, all thing for a safe and successful surgery and recovery. Keep us updated!!!

[beaglesandbagels]

This is the only website where I feel I am talking with genuine people. Everyone is too kind, thank you.

[molly muffin]

How is Scarlet? Anxiously awaiting update.

[beaglesandbagels]

I am disappointed in myself. I apologize for not responding sooner with an update on Scarlet's recovery from surgery. It seems since her surgery everything is going downhill. I have an Ultrasound I would like to share on here. Reason for the Ultrasound was because of a breathing problem that started a week or so after her surgery. The doctor still offers no reason for the breathing problem which is horrible. According to him the Ultrasound shows liver cancer and is terminal.

https://www.scribd.com/document/366599783/Scarlet-Ultrasound?secret_password=XdfqpvCo1sgXmlGlleJ7


https://youtu.be/GMYYA8G8e6I

[beaglesandbagels]

I tried sharing links to a couple of other videos, but for some reason, it kept combining the links into one.


https://photos.google.com/share/AF1QipPhymUs2Yk7uHm3FkXnPcLJHj3OMbhHBwjbwE-cTPCfnOvk5qZn0AOMmweEjVBIsw/photo/AF1QipM0R6vQ0Gz-gcAOql8Adc9sl2IP42RJG5GSdlOk?key=QnYzY05USlEyZDlYU 3d1QmpsUF84aTB5SUM5OHZB

[beaglesandbagels]

Also, after her surgery, she was prescribed medication for a staph infection in the right ear. It's called Amikacin Otis. The breathing problem started four days after being prescribed that drug. Within nine days of that drug, she had four seizures within a couple of hours. On day 12 she had over 50 seizures in a 12 hour period. At this point, I decided to stop the Amikacin, though my vet said it is impossible for it to be causing any of these problems. Dropped off at the vet in the morning. The vet said she had them all day long, had valium and then, of course, my car had to not start. Vet dropped her off (yes, nice gesture) prescribed some potassium pills to go along with the other seizure drug. He said her legs were a little weak. She had a few more seizures. She moved to another location in the house and was awake for longer than 24 hours. She did not move, eat, drink, pant, or go to the bathroom. She only drooled/foamed the whole time and tremored with head tics. When trying to move her, it felt like picking up a rag doll. She was temporarily paralyzed. She finally decided to get up and surprisingly got up and moved around very well. It was too unusual though. Turns out she went deaf and is no longer vocal in this 24 hours as well. I could only describe it as being a vestibular issue. Non stop roaming of the house and backyard, going to the bathroom wherever she felt like. Circling, stumbling, For a few days it looked like she was learning how to walk, eat and drink again. Over the years we have had nylabones but she only showed an interest in them as a puppy. All of a sudden she is all over them. At this point, it's now been a couple of days of not having that Amikacin. I worry about the staph infection, what if the doctor is right and the symptoms have nothing to do with the drug. He has to be right; he is a doctor. I start again on the drug, and within a couple of hours, the breathing starts again. Later in the day the odd roaming around and distressed. The doctor said its old age. She is an old girl, it's true. In fact, i made a mistake about her age. She is thirteen and four days old.

Back to her autoimmune problem, I now feel its secondary, and I believe it came from the distemper vac. Read the reasons when not to vaccinate. It fits exactly.

http://www.dogsnaturallymagazine.com/pet-vaccination-risks-and-benefits/

[beaglesandbagels]

x-rays

https://photos.app.goo.gl/zjP4prOWHJtl3K9f2

[Harley PoMMom]

OMGoodness, I am so sorry to hear that the ultrasound showed liver cancer. My prayers are with you both.



Also, after her surgery, she was prescribed medication for a staph infection in the right ear. It's called Amikacin Otis. The breathing problem started four days after being prescribed that drug. Within nine days of that drug, she had four seizures within a couple of hours. On day 12 she had over 50 seizures in a 12 hour period. At this point, I decided to stop the Amikacin, though my vet said it is impossible for it to be causing any of these problems.

Hmm, from a google search on side effects of Amikacin, hearing loss, difficulty with breathing, and seizures are listed, so I believe you are right in thinking that those symptoms could be from that medication. The best advice I can give you is to really consider seeing an IMS as they see many more complicated cases than a regular vet does.

Hugs, Lori

[beaglesandbagels]

Those are supposed to be side effects with the intervenous version of the drug and not the otic version. I have to question that, considering how visible these symptoms are.

[labblab]

Gosh, I too am so sorry to read about Scarlet’s newest problems. Sadly, I do believe it’s possible that the Amakacin may be responsible for her deafness. Even though it’s true that the IV form likely carries more hazards, we’ve found that even drops containing that class of antibiotics can sometimes produce hearing loss in vulnerable dogs. I do wonder whether the drops are responsible for some of her other problems, as well.

Upon reading the ultrasound report, though, I fear that the greatest issue is the apparent presence of a large mass or tumor in her abdomen. From the sound of the report, it’s possible that there are additional changes or growths in other organs including her liver. If so, associated organ damage could also be responsible for her seizures and other problems. Does your vet feel as though there is any value in trying to biopsy the mass, or is he pretty convinced as to the magnitude of the problem based on the imaging alone?

I am very sorry that the news about Scarlet is so worrisome. Please do keep us updated as far as any new information or changes.

Marianne