New here and need help

[Bk1]

Hello everyone,
I am so glad to have found you guys. I have read through several posts and I am hopeful that you guys can advise me what to do for my precious baby Chewy. Chewy is a male, neutered, cockapoo who will be 11 in November. Chewy weighs 23 pounds. Chewy is very special to me and I want to do what is best for him. He is my best friend. He has been there for me through my heart failure, my heart transplant and recovery. He has been there through my sons 5 cardiac arrests, my horrible car accident where I broke my back after recovering from my heart transplant. I spend more time with Chewy then I do with my husband or my kids! He has taken care of me and now it's my time to take care of him.

Over the past 3 years, Chewys blood work has steadily worsened. The most recent blood work done in August 2016 shows: Alk Phosphatase 1347. Triglycerid of 392. Everything else is in the normal range. If you need to know any other number, I have the lab results.

What is interesting is that when I took Chewy to the vet in August of 2016, my vet mentioned doing some kind of liver enzyme test. Then during that same conversation, changed it to a low dose dex test. I also have a 10 year old chocolate lab. At Chewys visit in August, I had gotten him groomed, gotten his shots, gotten both dogs a years supply of their heart worm meds, done the blood work panel on Chewy - my bill was over 500 dollars and I decided not to do any further testing until my credit card cycled.

About a week after this august vet visit, I noticed Chewy had this "fatty" area on his right side, near his armpit area - It felt like a squishy gold fish was in there. I told a friend of mine about it - she had several dogs with medical problems and she advised me to take Chewy to her vet. I took Chewy there Friday. I took the lab work
I had done in August too. He said he thought the thing on Chewys side was a fatty tumor. He took a sample of fluid from it and came back and said that he hoped it would just have fat droplets in it, but under the microscope he could see cells. He started feeling of it and said he thought he could remove it. Then he listened to Chewys heart. He said Chewy has a 5 out of 6 heart murmur! I don't remember if my vet listened to his heart in august. I have taken Chewy to my vet since he was a puppy and he had several ear infections this year where I took him to my vet. It was never mentioned that Chewy had a heart murmur.

After finding the heart murmur, my friends vet said we need to put the tumor on the back burner. He recommended that we do the ACTH test, which I did yesterday. He said he needs to know if Chewy has cushings - that it would help determine what we do from there. I am afraid to call about the results.

Chewy is super hungry all the time. He has never barked at us for food, but started barking at us for food last year. He is thirsty and drinks a lot of water. I am home with Chewy all day and Chewy sleeps in the bed with us. We live in the country and I am outside a lot and Chewy is always with me . He has never had an accident in the house and he does not wake me up in the night to go outside to pee. He does frequently wake me up at night to get a drink of water. I don't like him jumping off the bed, so he knows to wait for me. I feel it if he moves and if wants down, he just sits on the edge of the bed and I let him down. Chewy gets groomed every 4 weeks. His coat is beautiful, shiny and full and grows quickly. His skin is healthy. His back legs are not skinny and are covered in healthy fur too. He has no weakness. He sometimes pants. He has no trouble sleeping. He has tons of energy and runs all over the place in the yard, chasing birds, bugs, etc.
I'm completely shocked he has such a bad heart condition.

I know my friends vet will advise me to treat Chewy with The Vectryl drug if he has cushings. I'm supposed to call him this afternoon for the results.

I'm broken hearted. I cannot stand the though of Chewy suffering. What is most important to me is his quality of life. If the Vectryl will help him, I will give it to him. If the cushings has no effect on his heart, should I treat him? Since he does not have bad symptoms, should I treat him. Or is the fact that he has cushings bad and the treatment will help, even though he doesn't seem sick to us? I really do not know what to do.

Is there a natural alternative to help him. My son wants to give him Doggie supplements from Dr. Mercola. Doggie krill oil, co q 10, and the other supplements that humans take for heart failure/ heart health.

I know I dont have the official diagnosis, but I feel certain that Chewy has cushings based on the high liver enzymes and his hunger and thirst.

Thank you guys for listening to my story. I can't express how special Chewy is to our family. I love this dog.
Barbara

[Harley PoMMom]

Hi Barbara,

Welcome to you and Chewy! OMGoodness you have been through a lot and I hope that after all those surgeries you are doing much better.

Is/has Chewy been taking any other medications? What tests has the vet mentioned performing for his heart murmur?

Cushing's is a slow progressing disease so you do have time to make sure that the diagnosis for Cushing's is what Chewy has. Chewy does exhibit some of the symptoms of Cushing's, increased hunger, drinking, urination, and dog's with Cushing's generally have a very high ALP (liver enzyme). However, elevations in the triglycerides can cause liver enzyme levels to be increased so that ALP (alkaline phosphatase) could be increased due to that. Once you get the results from that ACTH stimulation test could you post them for us, it may help us to get a better picture of what is going on.

The goal of treatment is to control the troublesome symptoms (things like excessive thirst, urination, hunger, panting) and since the damage of untreated Cushing's usually occurs over time, my own opinion is that I don't worry so much about the "silent" damage in a dog who is already elderly and my primary concern for a senior dog is immediate quality of life. So if the overt symptoms are making the senior dog uncomfortable, I would treat. Otherwise, I probably wouldn't. Another reason that makes it difficult in deciding to treat is that it's not pleasant for any dog to go through the trauma of multiple vet visits and the many monitoring tests that are required for treatment and for a senior dog it can be worse. Also, if a dog is already suffering from arthritis, treatment for Cushing's may cause more discomfort as that elevated cortisol does have anti-inflammatory properties. I don't tell us this to discourage you from treating your precious boy, only you know Chewy best and I have no doubt that you will choose the right path for your sweet boy.

Hugs, Lori

[DoxieMama]

Hi Barbara, welcome to you and Chewy! Wow what a lot you've been through! I hope you and your son are doing well now.

If Chewy does indeed have Cushing's, as Lori said, it is a slow progressing disease and you have time to decide whether or not to treat. Let's see what those ACTH results are and we'll take it one step at a time, with you. :)

Shana

[Bk1]

I got chewys acth results today. It was negative for cushings. He said this test shows cushings 80 percent of the time. He wants me to start 225 mg denamarin and do labs in 30 days. I assume he means the basic test that shows the liver enzymes.
We still have the mass on his side that the vet thinks is cancer. With chewys 5 grade heart murmur, he said he would be afraid to put chewy under anesthesia to take the mass out. The mass feels squishy and reminds me of a gold fish the way it feels.
My son wants to give chewy some kind of doggie heart supplements and the vet was ok with this.
Do you guys think we are out of the woods on cushings? Chews only symptoms are ravenous appetite and he drinks a ton of water. No accidents ever in the house and he is not restless at all. Tons of energy and happy.

[Harley PoMMom]

As the vet mentioned there is a small percentage of dogs with Cushing's that do have a negative ACTH stimulation result. The other test used to diagnose Cushing's is the low-dose dexamethasone suppression (LDDS) and is considered the "gold standard" test for Cushing's, however, any non-adrenal illness can create a false positive result so with Chewy's other health issues I would not recommend having that test performed. And in my opinion before initiating any treatment for Cushing's a confirmed diagnosis is critical, so I do agree with the vet that the focus should be placed on those lab abnormalities. Did the vet mention anything about the triglycerides being high?

Hugs, Lori

[Bk1]

Lori, The vet did mention that sometimes the ACTH test doesn't show cushings when there is cushings. I mentioned the high triglicerids Chewys are 392 with the range being 29-291. The Alk phosphate is very high 1347 with a range of 5-131. All other numbers on this super chem test were in the normal range except these 2.
When I mentioned the high tryglicerides, my vet said he was not concerned about that. Maybe it is because we have other issues?
Any ideals why alk phosphate is so high? Could it be the tumor? His Alk numbers have gone up steadily the last 3 years we have been monitoring it. The tumor literally was the size it is now when I noticed it in August. It was just there one day. I have never been told the Chewy has a heart murmur. He didn't have one, then suddenly had a 5 level murmur when I took him to the new vet last week.

Is it your opinion that you should not give anesthesia to a dog with a class 5 murmur? I wish we could remove the fatty feeling mass on his side. It just feels like something squishy right under the skin - it is kind of big - a few inches long and about 3/4 of an inch wide.

Thank you for your help

[Harley PoMMom]

Is it your opinion that you should not give anesthesia to a dog with a class 5 murmur?

I really don't know the answer to that question, my Bear had a heart murmur, grade 3 I think, and than was diagnosed with a malignant peripheral nerve sheath tumor on his front elbow. Because of the murmur his IMS wanted Bear to see a cardiologist to be cleared for surgery, so I believe that a heart murmur at any grade level has to be taken in consideration with any type of surgery.

Hugs, Lori

[lulusmom]

Hi and a belated welcome to you and Chewy.

After reading your physical description of Chewy, I believe the acth stimulation test is probably accurate and not a false negative. It just doesn't sound as though he presents as a cushingoid dog. Was Chewy fasted for the blood labs? If not, the increase in triglycerides could have been caused by a recent meal but regardless, your vet is most likely not concerned because such a mild increase is not concerning. If it were over 500, that would be a concerning problem. What is very strange is that ALKP and triglycerides are the only abnormalities in a dog with a grade 5 heart murmur, which on a scale from 1 to 6, is quite serious. My last two heart dogs had grade 5 heart murmurs and were on multiple medications for congestive heart failure. I've been a senior dog rescuer for decades so I've dealt with a lot of heart murmurs over the years and what I've learned is that small grade heart murmurs are rather subjective. One vet may not hear one at all and another will heart a 2 or 3 grade murmur. But when you get to grade 5 and 6 murmurs, those are very loud, very concerning and not much disparity in grade assignment from vet to vet. I can tell you without a doubt that a dog with a grade 5 murmur that is directly related to a major defect in the heart structure is at much greater risk for complications of anesthesia and most certainly hearth failure. Has your vet done any xrays to check for the usual abnormalities found in cushing's as well as to check the size of the heart and any fluid buildup in the abdomen. Was an echocardiogram done yet? Some of the symptoms of CHF and cushing's can overlap, such as panting, exercise intolerance and even a pot belly due to accumulation of fluids. Is Chewy coughing or experiencing rapid and difficulty in breathing? Aside from the increase in ALKP and persistent UTI's, what other factors prompted your vet to test for cushing's. Is Chewy on any heart meds or any other medication?

Based on the information you have provided thus far, I personally believe continued testing for cushing's at this point would be misguided. I would definitely want to know what is going on with his heart. Can you please go back through your blood chemistry and tell me if the creatine kinase is normal? Lab abbreviation for this is CPK or CK. This is a muscle enzyme and as the heart is one big muscle, dogs with serious heart issues almost always have increased CPK or CK.

With respect to the mass on Chewy's side, it sounds like a fatty tumor (lipoma) but your vet should be able to tell you whether it is a fatty tumor by manipulating the mass and verifying via a fine needle aspirate. Has your vet done this yet? Lipomas are rarely removed unless the growth interferes with mobility. Removal is even more unlikely in a dog with severe cardiac issues.

I look forward to hearing more about your precious Chewy.

Glynda