New here / Grant has passed

[Grants mom]

Hi my name is Teresa I am new my 10 year old malti poo Grant
began doing things not normal for him drinking lots of water, eating fast always hungry , licking the floors a lot, peeing a lot, and losing weight all but his belly I can feel his spine ribs and scull on his head , hair thinning and the worst going outside eating his poop , I thought it was all just him getting older I took him to the vet she did the blood work he had 4 high marks come back the ALT , GGT ,PLT and chol she has diagnosed him with cushings , I have been researching it trying to understand it ! I honestly can not financially afford all the medical for it and I'm not sure I would put him threw it the vet stated the medicine is harsh and treatment is expensive ! I plan on trying to care for him without the treatment from the vet I have him on a dry dog food that has no corn it has antioxidants and omega 3 in it also ! Has anyone else not done the vet treatment any advise on diet or anything else ? Is this a fast effecting disease on them !
Thank you in advance !
Teresa

[DoxieMama]

Hi Teresa,

Welcome to you and Grant, though I'm sorry for the reasons that brought you here.

First things first, Cushing's is not a fast progressing disease. You have some time to process things and make your decisions.

That said, is it possible for you to get copies of the tests that were done for Grant? We like to see the actual numbers of those results that are out of range, if you can post those along with the reference ranges so we can see just HOW high they are that can be helpful. In addition to the blood work, was any other more specific test done to diagnose him with Cushing's? Typically this is either an ACTH Stim test or an LDDS. If either of those are done, can you post the results of those (ACTH has 2 numbers, a pre and a post value... the LDDS has 3... post all of them if you can get copies).

I'm sure others will be along and will have their own questions for you, but let's start with those for now.

[Grants mom]

Thank you for replying to me I have his papers on blood work I hope I put them right I don't know really about this ! Alt 308U/L 10-125
GGT 52UL 0-11 CHOL 427mg/110-320 PLT 588K/uL 175-500 all these are typed in red ! She did mention a ACTH stim test not sure I will be able to do that ! I have another dog that tore her crucia in October so the vet bills have piled up on me ! I worry about grant now and I want to do what's best for him not me !

Thank you again wasn't sure someone would reply to me !
Teresa

[Harley PoMMom]

Hi Teresa,

Welcome to you and Grant from me as well! I sure am sorry that you and your precious boy are going through this and we are here to help in any way we can.

Increases in drinking, urinating, hunger, and skin issues are the symptoms routinely seen in dogs with Cushing's, and because of that ravenous appetite cushdogs are prone to weight gain. So Grant's weight loss is not common to Cushing's but on the forum a small number of our members have reported this happening to their dog.

I see from Grant's blood panel that the ALT and GGT (liver enzymes) are on the high side which is unusual in dog's with Cushing's. With cushdogs a very elevated ALP, another enzyme that is mostly produced in the the liver, is normally observed but according to your post Grant's ALP is not, that has me a bit concerned that his liver may not be functioning as well as it should be. Did the vet mention anything about his ALT and GGT being abnormally high?

Cushing's is a slow progressive disease however over time that superabundant supply of cortisol when left uncontrolled will cause systemic damage. We surely do understand and sympathize with you regarding the cost. The initial expense is during the diagnostic phase and when a dog becomes stabilized on treatment the cost does go down considerably. The medications used to treat Cushing's can be compounded and this does help with keeping the cost down. Those ACTH stim tests that are used for monitoring are expensive because of the stimulating agent. Cortrosyn is generally the stim agent used and if the dog is small in weight another cost savings would be for the vet to reconstitute the Cortrosyn. Dr Peterson, who is a renown canine Cushing's expert, states on his blog on how this can be done, here's an excerpt from his blog:
Cortrosyn is expensive. And once reconstituted, it has a limited shelf-life.

However, by following the protocol outlined below, you can easily dilute, aliquot and store Cortrosyn after reconstitution for up to 6 months. This makes each ACTH stimulation test much less expensive, because each vial of Cortrosyn can be used to perform as many as five ACTH stimulation tests. Full article can be found here: http://www.endocrinevet.info/2011/03/how-to-extend-your-supply-of-cortrosyn.html

One of the ways that helped me with the expense was applying for Care Credit. It's a revolving credit line that allows you to pay large bills same as cash for a year. This information and other financial resources can be found here: http://www.k9cushings.com/forum/showthread.php?t=212

I am sorry for the reasons that brought you here but so glad you found us and if you have any questions please do not hesitate to ask them.

Hugs, Lori

[Grants mom]

Yes thank you I have care credit I have nothing there used for the vet bills for grant ! The vet was not real clear to me on blood work she said she is 98 percent sure grant has cushings I don't know I paid for a resting cortisol test she said that tells them for sure if he has cushings ! I get results Monday ! His ALT is 308uL the reference interval is 10-125
His GGT is 52 u/L reference interval is 0-11 !
The weight loss could be from I put him on a better dog food in December no corn fillers etc he has lost 7 pounds ! I don't know ! I do know there is something not right with him lots of things going on
Thank you for the reply !

[Grants mom]

P.s according to articles I have read increased high liver enzymes is linked to cushings

[Squirt's Mom]

Hi and welcome to you and Grant!

I have one thing, a MAJOR thing, add - canine Cushing's CANNOT be diagnosed based on the labs you have presented. There is NO WAY your vet can be sure Grant has Cushing's without testing via the ACTH and/or the LDDS. An abdominal ultrasound is also a very very good test to have done. If funds are limited, I would do the ACTH and ultrasound personally. I beg you, do not start treatment on Grant for Cushing's based on these tests. If he has not had at least one of the tests I listed, please, for his sake, do not start giving him either one of these very powerful drugs - Vetoryl (Trilostane) or Lysodren (Mitotane). Lori has given you some very good info about the liver and that is what I would focus on if I were you. ;)

I'm glad you found us and look forward to learning more...but again, please don't start treatment based on the tests he has had so far. If these drugs are used improperly, they can both be fatal - hence my concern.

Hugs,
Leslie and the gang

[Grants mom]

I do not plan on starting anything with him right away ! I think dogs are like us we all have different signs of illness they do to ! We are at the vets mercy when illness does occur ! I may end up taking him to a different vet if needed again sorry to say I'm not wealthy so vet and medical expense is a issue I will try to apply to organizations for medical help all they can say is no ! I have had him over 10 years once again He is not him self at all

Thanks

[Squirt's Mom]

Hey Teresa,

Join the club! :D SOOO many of us here wonder from month to month if we are going to get to eat more than beans and potatoes since so much of our monthly income goes to our babies. I did everything I could think of with my first and am doing the same with my second...yeah, these little cush babies seem to find us over and over. :rolleyes:;):) We have some great info in our Helpful Resource section including a list of places that offer aid. Check them out and see if you can find something to help you and Grant...ya just never know!

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

[judymaggie]

Hi, Teresa -- welcome to you and Grant! You have received some excellent guidance already so really just wanted to say "hi". Like Lori, I am concerned about the liver tests that are elevated. You mentioned that you read that high liver enzymes can be related to Cushing's. That is true but, as Lori said, that is typically the alkaline phosphatase enzyme (often referred to as ALK or ALKP) and you did not mention that in your posts.

If you can get the funds together, I would recommend an ultrasound performed by an internist on high resolution equipment. As we often say here, this will give you a big bang for the bucks. Not only will the adrenal glands be evaluated (and one form of Cushing's would show two enlarged adrenal glands) but the status of the rest of the organs could be determined, in particular the liver based on the lab results.

All the testing is expensive but I strongly agree that the diagnosis of Cushing's for Grant is premature and it would take additional tests to definitively rule that in or out. Unfortunately, the resting cortisol that you already paid for will not do that. From what you have described as your vet's guidance, I am concerned that she is not familiar with the guidelines for diagnosing Cushing's and would be very uncomfortable with her prescribing and monitoring the medications used to treat Cushing's.

[Harley PoMMom]

Yes thank you I have care credit I have nothing there used for the vet bills for grant !

Yep, those vet bills are fast to accumulate when our furbaby has medical problems :( When my non-cush dog had to have surgery for a cancer tumor I called care credit and asked for an increase in my credit limit. The person I spoke with was very sympathetic to my situation and did grant me a hefty increase, so that may be an option to think about.

Regarding those liver enzymes, on the forum we see a significant increase in the ALP, like in the 1000's, with the GGT and ALT normal or minimally increased.

I'm not saying that because of those elevations in the ALT and GGT that Grant doesn't have Cushing's, I'm just more inclined to think that there is something else going on which is causing those elevations.

Hugs, Lori

Hugs, Lori

[Grants mom]

I thank you all for the replys ! Sounds like I wasted $125 for the resting cortisol test I asked the vet if the test was needed she said yes to confirm cushings the only tests that showed up high are the ones I posted here ! I will try to call another vet Monday to get some advise I'm in panick mode the unknown is frightening to me ! I can't get assistance with him until I know what's wrong with him once again we are at the vets mercy when our furry kids have medical issues ! Sorry to say some are just concerned about the money part not the pets health !

Thank you
Teresa

[Grants mom]

I will also call care credit about a increase ! My Lhasa apso had a complete crucia tear in her hind leg in October the knee cap was dislocated moving around , I took her to the first vet a orthopedic surgeon. He said it would be $2,500 for it she would never be right again without surgery ! I got a second opinion they put her on metacam daily told me the outcome would be good if I restricted her running jumping and she is young will be 5 March 19 I crated her when unsupervised I still do . I put her on a glucosamine supplement a good dog food and by Christmas she was and has been walking ,running, back to her self so sometimes again the vets try to take advantage for money !

[Grants mom]

I also have noticed grants belly is no longer pink it is turning grey and scaley

Thanks

[molly muffin]

Hello from me too. I'm with Judy and Lori on the liver enzymes issue. GGT and ALT are liver specific and while they can increase usually it is ALKP we see along with an increase a bit of the ALT. The GGT also being increased makes me think liver along with the weight loss. Maltese are from what I can tell on this forum where we see tons of dogs every year, prone to sludge of the gall bladder which can eventually cause a blockage to the liver. There is a medication for this but the best way to know for sure is with an ultrasound to look at the gall bladder and liver or there is also bile acid test.
I'd probably opt for the ultrasound if it is feasible at all.
A resting cortisol really won't tell you if it is cushings or not as it is the post number from a full ACTH that you look for in a cushing result. Your vet was probably trying to save money and thought cushings most likely and while I am not discounting cushings, I think that over all the liver and sludge issue needs to be ruled out first, based on what you are describing.

Diagnosis is always the most expensive portion it seems and then if cushings the follow up tests, but we aren't there yet

[rainiebo]

Hi and welcome to the site. You have come to the right place. I can't really add too much, but Squirts Mom, Molly Muffin, Judymaggie, Harley PomMom and the other faithful Administrators and senior members have been a God-send to me and my dog, Bobo. They know their "stuff" about Cushings. I can only add my experience here. A lot of the symptoms I was reporting to my vet over the years was ignored: heavy panting, ravenous appetite, drinking a lot of water, bloated stomach, collapsing, skin on belly turned black and increased liver enzymes. Bobo was suffering from undiagnosed Cushings symptoms and neuropathic pain for almost 4 years. It took a liver tumor to finally get him the help he needed. He's being treated by an internist and pain specialist and finally getting the help he needs. I agree - an ultrasound - though expensive is what Bobo needed to diagnose the liver tumor and rule out other problems. I am going back to work to pay for Bobo's medical bills. I feel like he's worth it.
Hang in there and keep coming back with your concerns.

[Grants mom]

Just a update on Grant I got the call today from vet Grant does have cushings ! He is going to be put to sleep March 13 all my resources for treatment are gone !

[labblab]

Teresa, I am so sorry to read this news. If we know that our companions are suffering and we've run out of treatment options, then I do believe that releasing them is an act of compassion. However, I am wanting and hoping to make sure you're truly at that place with Grant. If you do not have the ability to pay for any more testing at all and you believe he's suffering, then it may not even make any difference as to what is actually wrong with him. But in the absence of any new or additional testing, I truly don't believe any vet can yet know for certain that Grant has Cushing's, given some of the irregularities re: his lab results thus far. Has this new vet examined Grant or performed any more tests?

Please understand that I realize you will do what you feel is best for your boy. Our goal so far has been to help you sort through the information you have in hand, in order to see whether Grant's problems have a chance to be reversed or corrected. And should you wish to still move forward diagnostically, we stand ready to help you as much as we can. If that is not possible for you, then we are grateful for the chance to honor Grant's life and his brave battle. Please let us know if there is anything more we can do to help support you both.

Marianne

[Grants mom]

Thank you ! I am unable to afford anymore vet medical bills for Grant I have applied to every organization for help that has been no help ! I called credit card for credit increase a no also ! I have no means of any more medical expense for Grant ! His vet that did the resting cortisol test confirmed to me that the test did come back positive for cushings ! I will half to take her word and I will half to live with my decision again no money for further testing or treatment or another vets opinion !

Thank you

[DoxieMama]

Hi Teresa,

Did you call the second vet or was this call from your original vet, based on the resting cortisol test? Just curious if you got that second opinion.

I must admit, I'm surprised that Grant is scheduled to be put to sleep next week. I know that can't be an easy decision for you, especially after 10 years. If he's suffering and/or in pain, then I understand. My dog was diagnosed with Cushing's... and though I chose to start treatment, he did not stay on treatment for very long because of other issues. Instead, he got "liver support" supplements as well as home cooked meals for as long as he was doing well. When he stopped eating, and was having some trouble breathing, we had to make that same choice. :(

Again, I'm so sorry you're in this position with Grant. I do hope you'll allow us to support you both, and keep us informed as to how he's doing.

[DoxieMama]

Oh! I see we were typing at the same time. :o

[Grants mom]

Just another update I am not putting grant to sleep ! I was kinda pressed by the vet to do it ! I have called her and cancelled and grant or my other one Lucy will not go back there ! Grant is very aware and alert he is walking fine , going in and out to potty I keep him away from the poop or he eats it ! His main thing is low energy, drinking tons of water peeing a lot and never in the house he holds it while I am at work he licks the floor a lot gulps his food and barks wanting to eat I think the hunger has something to do with it ! He seems restless some at night pants off and on , his skin has thinned and hair , pot belly it's tuning grey and he isn't real loving to me anymore ,He passes gas a lot, licks his paw, and has been chewing on his back end ! I think benedryl might help with that ! I am going to try a all natural treatment for him it's called adrenal Harmony gold for dog cushings I have ordered it already they have suggested milk thistle also to go along with it I will seek out another vet to monitor his labs on this ! The reviews are very good ! I do not think grant is there yet to leave and I am not ready for him to ! We have been together threw a lot I am a 2 time breast cancer survivor and we lost my fiancé grants dad in 2011 he loved grant to the moon and back ! I would just like to ask any thoughts on a good meal plan for him ? I must add I do believe the test results. Are cushings but again we both are not there yet !
Thank you all !

[Squirt's Mom]

OH! what a relief for all of us, especially you and Grant! Yeah, any vet that is pressing to put down a pup who is still doing as well as Grant wouldn't touch my babies! I don't blame you for finding another one, not at all!

Adrenal Harmony won't do anything for the cortisol in a cush pup but the herbs can help with some of the signs. Just don't be fooled by the hype of the makers - it does not treat Cushing's, it simply masked some of the signs making it LOOK like it is working on the cortisol. ;) Milk Thistle, on the other hand, can do wonders for the liver and can bring those liver numbers down quite a bit in some dogs. It won't treat any liver diseases but it does a pretty good job of helping the liver work better.

There are some herbal formulas used to treat Cushing's...the problem with them is that no one I have seen using them continues to test the cortisal via the ACTH so they don't know if these herb are really working on the cortisol or simply working on the signs so it LOOKS like they are working. One of our member here has started using a TCM, Traditional Chinese Medicine, formula called Ophiogogon. Here is a link on that product from a vet in TENN who uses it -

http://franklintnvet.com/cushings-disease-in-dogs/

Rehmannia 11 or Rehmannia 14 are two others that have been used. I tried the 14 in conjunction with Lysodren in Squirt but she didn't care of it at all. Here is a link on Rehmannia - http://www.chinese-herbs.org/rehmannia/

Another one is Si Miao San. Gingko Biloba can help with some of the signs and is sometimes used with other forumlas. Here is a link from a holistic vet talking about her approach to Cushing's - https://pathwithpaws.com/blog/2011/06/25/managing-cushings-disease-in-dogs-holistically/

Do a search for holistic vets in your area and go talk to one. Be sure they have done a LOT of work with cush dogs before you go. They are typically more expensive than traditional vets and the herbs they recommend can be even more expensive that the traditional treatments....but not always so it's worth at least talking to one. ;) Dr. Susan G. Wynne is in GA I think and she would be one I would trust to recommend someone.

Above all else....we are here for you and Grant always.

Hugs,
Leslie and the gang

[DoxieMama]

Yay I'm glad you canceled that appointment! The only recommendations I've seen for diet are to make sure it has moderate protein. It sounds like Grant is often still hungry after eating - you can give him (no salt) green beans as a lower calorie way to "bulk up" his meals, or even as treats in between. That might help him with his hunger.

I hope the supplements help improve the symptoms for him. :)

[Grants mom]

Thank you I once again am limited on financial for grant maybe I'm grasping at straws but i will try this I am in Illinois Purdue university in Lafayette Indiana about a hour away from me does have a holistic vet school there and this product I am going to use they do also have it there it is worth a try to me ! I talked to them asked lots of questions before I ordered it according to them it does lower cortisol levels it doesn't just cover up the symptoms ! It's worth a try to me ! Our lives throw us curve balls finances change things change ! I have always heard if you can't afford vet bills don't get a dog well I have 2 and once again things in life changed for me we never know !
Thank you again !

[Grants mom]

Ps thank you for the green bean tip ! I also give him raw carrots and apple and I noticed he eats them slower he doesn't gulp them ! Must be the texture ! He has to chew

[labblab]

Teresa, this is great news that you're able to try a few more options! If you do end up going to Purdue, one last-ditch option you might talk over with them if Grant continues to decline is trying him on a very low dose of the Rx medication, trilostane. Our members here know it is very, very rare for me to suggest this medication in the absence of certain diagnostic and monitoring testing. But if Grant worsens to the point that you would consider putting him down again, a trial run of the trilostane might be worth the risk. Since I'm assuming Grant doesn't weigh a great deal, you could buy a compounded version of trilostane pretty economically (as opposed to the brandname version, Vetoryl). And as long as you started at a very low dose, you might see some benefit while trying to minimize the risk. As I say, just something to discuss with the folks at Purdue.

Marianne

[molly muffin]

Something you said, jumped out at me, Purdue University, holistic vet school, uses Adrenal Harmony and they said it does bring down the cortisol levels? Can you confirm that for me and have they done follow up ACTH testing on dogs to verify that the cortisol is coming down on it?

The reason that I ask is because we contacted the manufacturers of Adrenal Harmony and they said they hadn't done actual testing to verify, so we of course are very by the book and like to see testing to verify that something does what it says it does before we recommend anything on here. A university that has done follow up testing on Adrenal harmony and can verify those tests, is of definite interest. Have they published anything? I wasn't able to find anything just doing a google search but if there is something published we would love to read it.

Blueberries also as a snack. A good quality protein and moderate fat for a diet.

I'd also add the milk thistle and sam-e, buy from amazon as I think they might have cheapest prices.

[Grants mom]

Thank you squirts mom for the links I found the articles interesting I am going to try the vinegar and water for grants itchy skin and the recipe ! The can dog food she recommends I think I will skip that some reviews say it has caused gas I am dealing with that a lot now ! I ordered grants milk thistle in a caplet form 100mg I had to go with what I can afford now I need to figure out dosage I doubt I give him the whole thing he weighs 15 pounds ! Molly muffin I do not know proof of Purdue all I know we are all different I am trying to do what I can for grant the best way I can at least I feel a little better trying maybe this will help maybe it won't but I'm trying ! From my research there is no cure for cushings only treatment like cancer and I have been down that road ! I am just doing what my means allows me to do for him ! Not sure why these organizations even offer help with dogs I tried them all nothing !
Thank you !

[Squirt's Mom]

As a novice herbalist, I have issue with herbs in capsules. ;) One, several studies have proven that many of those makers put little to none of the herb in the capsules. GNC comes to mind as one company that was doing that...ie the capsule says Milk Thistle but it really doesn't have much if any MT. Since herbs and supplements aren't regulated, these companies can make any claims they wish...and the public pays the price. Another issues is just what you mentioned - the dosing. Herbs for are typically used based on weight so it is always best to use dried herbs from a reputable house OR prepared herbs, for animals that would be a glycerite tincture NOT alcohol. It is really easy to make teas or give dried herbs in feed. A great herb house is Mountain Rose Herbs. A 4 oz package of Milk Thistle would last a long time with Grant....and they may have a glycerite. I will look and let you know.

[Grants mom]

Thank you ! I have not received it yet ordered it from Amazon ! Maybe I can send it back ! I will check back in here I was not sure what to get ! Guess I should have asked for suggestions here !

Thank you
Squirts mom

[Squirt's Mom]

No, MRH does not have a glycerite but iHerb has one by Eclectic Institute. I am familiar with the name but don't really know anything about them. In a short, quick search I didn't find any recalls or problems mentioned with their MT glycerite. iHerb seems to have the lowest price, too. I DID find a write-up from one of the herbalist I follow and have deep respect for who says eating the seed provides the best result overall. So I would either get the glycerite or, more likely for me, the dried herb. Here are the links for both -

MRH whole seed - https://www.mountainroseherbs.com/products/milk-thistle-seed/profile

MRH powdered seed - https://www.mountainroseherbs.com/products/milk-thistle-seed-powder/profile

(NOTE: Powdered herbs have a shorter life than whole herbs)

iHerb - https://www.iherb.com/pr/eclectic-institute-milk-thistle-glycerite-alcohol-free-2-fl-oz-60-ml/18387

Some other herbs you might consider are Schisandra and Jerusalem Artichoke - both are good for the liver...and in the same forms.

[Grants mom]

I went to the vet this morning and asked for a copy of grants cortisol test results I wanted them lots of numbers one that stands out reads
As follows
Cortisol 10.0
Flag H
Normal range
Low2.0 high 6.0
About all I have figured so far of course the high liver enzymes are on there to !

[Harley PoMMom]

For that Cortisol 10.0, does it say that is for the post number?

[Grants mom]

No it does not say that down below it says cushings disease,IATR0GENIC
Then lots of numbers below that

Thank you

[Squirt's Mom]

Iatrogenic means that the Cushing's was caused by the use of steroids. Has Grant been on steroids OR have you or someone in your home been using a steroid cream? :confused:

[Grants mom]

He did get steroids a few times I do believe shots ! If I remember for allergys been long ago though ! He also blew out both back legs about 4 years ago maybe ! he had surgery on both legs one then when it healed he blew the other one out ! He was on a few meds for pain etc as for creams or anything no never me grant and Lucy are the only ones in the home no one else ! I noticed grant no longer gets in the recliner anymore to look out the window he used to I also have 2 stairs out back he has to use to go potty ! I have him and Lucy on a glucosamine supplement for joints in legs
Thank you

[Squirt's Mom]

Iatrogenic wouldn't happen with short term use of steroids. We see this with pups who take them long-term - like for allergies and other inflammatory issues. Use of steroids a while back should have no impact today. ;)

[Grants mom]

It breaks my heart grant passed away today !
August 26,2006- May 8, 2017

[Harley PoMMom]

Oh Teresa,

I am so sorry for the loss of your dear Grant and my heart goes out to you at this most painful time.

Please know that Grant will always be honored and remembered here amidst all our beloved pups who have passed on. After writing this reply, I will be adding his name to our memorial thread of honor and he will forever be a member of our family, and shall never be forgotten.

With Heartfelt Sympathy,
Lori

[Budsters Mom]

I am truly sorry for your loss.:o

Fly free Grant, fly free! No more meds. No more pain.

Hugs,
Kathy

[molly muffin]

My sincerest condolences to you and your family. :(

[Joan2517]

I'm so sorry for your loss, Teresa...hugs and comforting thoughts to you and your family.

[DoxieMama]

I am so sorry for your loss.