Help! Is it Cushing's or Glomerulonephritis?

[Caseycase01]

My dog Casey, an almost 10 year old Rott has had protein in her urine an elevated ALP, and high sodium for like a year now. We have senior panels done every 6 mos, and almost to the day we had her current senior panel done, she started drinking gallons of water, and urinating a lot. She is also restless, and not much of an appetite. Her fur is thinning like above her front legs I guess the flank? and having a bit of muscle mass loss in hip area. Our former vet said it is probably glomerulonephritis but current vet thinks it is cushings. She has had an ACTH test which was normal, and has to go tomorrow for ldds test. If that one is negative also, then what? Has anybody else gone through the negative test dilemma? What about holistic treatment for either disease? Thanks.:confused:

[labblab]

Hello and welcome to you and Casey, although we're sorry for the worries that have brought you to us. For the most part, Casey's symptoms do indeed seem consistent with Cushing's with the exception of lack of appetite. Cushpups are more typically ravenous as opposed to the opposite. However, there are always exceptions and Casey may be one of them.

In considering her lack of appetite, though, does she have elevations in her bloodwork that would be associated with declining kidney function? The two significant levels in that regard would be creatinine (CR) and BUN. You've mentioned protein in her urine, and that can indeed be secondary to Cushing's, but I'm just wondering whether there is evidence of broader kidney dysfunction.

All in all, I do think it's wise to proceed to the LDDS, because the ACTH does "miss" making the Cushing's diagnosis in a fair number of dogs who truly have the disease. So we'll definitely be anxious to find out those test results, and then we'll be better armed to plan a treatment path going forward.

Once again, welcome to you both!
Marianne

[Caseycase01]

OK so the LDDS test was negative also, they had done a protein creatinine ratio which came back as 49.6!!! And Dr Wu freaked and wanted us to get a kidney biopsy done. I insisted on another test for ratio (no charge) and lo and behold it came back as 4.2. At this point I took her to an internal medicine doctor who did an ultrasound ANOTHER protein creatinine ratio (had been a week since the 4.2 result) and a blood pressure test. The ultrasound showed a mass on both adrenal glands, with the right one being larger with POSSIBLE involvement with the vena cava. Her protein had dropped to 1.3 and her blood pressure was a bit high where previously it had not been. We had to travel for 2 hours to get there and it was almost 100 degrees that day plus she is so sick of going to the doctor, so maybe that is why it was elevated. The doctor came in and said that basically we needed to just make her comfortable and put her down when the time came because the surgery was so involved and expensive. She could not tell me exactly what kind of tumors she has, whether or not malignant, or whether she DEFINITELY does or does not have Cushings! So really are at square one except the fact that we know she does have masses on adrenals. Her symptoms as we speak are some increased drinking and urinating, not as bad as a couple weeks ago, her appetite is back, and she is panting just a bit more than usual. And she has had some fur thinning on sides of neck. the only labs that have been abnormal were the protein, sodium, and ALP. So we are stumped and so is her regular vet quite frankly. He suggests wiping out her adrenals with lysodren and should take out tumors also and then treat her for addisons. This along with holistic therapies. Has anyone ever heard of doing this??? Thanks.

[labblab]

Welcome back again, although I'm very sorry about the worrisome news re: not just one, but two adrenal tumors. Given the normal ACTH and LDDS results, it sounds as though neither of the tumors are generating an excessive amount of cortisol. However, they may be resulting in overstimulation of certain other adrenal hormones and that may be the cause of the overt symptoms you are witnessing.

Personally, without further discussion and guidance from a specialized vet, I wouldn't feel at all comfortable with purposely trying to induce Addison's in your dog with Lysodren. It is true that Lysodren is a chemotherapy drug that actually erodes adrenal tissue, and in a few instances it can cause adrenal tumors to regress or "implode." But especially if your dog truly has tumors on both adrenal glands, this would be a very serious undertaking with no guarantee of success and many risks. I would want to talk with an expert before even considering such a treatment. Given the fact that the IMS who conducted the imaging didn't offer it as a treatment option makes me question it even more.

I see you are in Merced and you say you drove about 100 miles -- by any chance, did you go to the vet school at UC Davis? I am just wondering because an IMS at Davis would have knowledge about the full range of available treatment options in this situation. Either way, I'd encourage you to contact the IMS once again and ask for her opinion about Lysodren treatment. Please do keep us updated as you learn anything more, OK?

Marianne

[Harley PoMMom]

Has an UTI been ruled out as a possible reason for the increased drinking and urination?

[Caseycase01]

I had them do a urine C&S last week, due to history of struvite stones 3 + years ago. At the time, she had large stones and had passed a couple small ones, and 2 vets said surgery was the only option then a special diet. I researched it heavily and discovered that DL Methionine given daily would dissolve stones and keep urine ph'd correctly. I asked our former vet if she would be willing to prescribe some, she agreed, it dissolved every single stone, she takes it daily and has been stone and crystal free ever since. The recent ua C&S was clean.

[Caseycase01]

The IMS thinks that it is canine pheochromocytoma.

[labblab]

I wondered about pheos -- that would be consistent with the normal cortisol and episodic blood pressure spikes. Truly, as I said above, I'd contact the IMS and ask her about the idea of Lysodren treatment. We have had members here with pheos, but off-hand, I can't recall any that were treated with Lysodren as opposed to attempts at surgical removal. I would be very interested in the opinion of the IMS re: attempting full adrenal ablation with Lysodren.

Marianne

[Caseycase01]

OK I will. The outcome is very poor without the surgery isn't it? The IMS said it is between 6,000.00 and 7,000.00! We have spent almost 2400.00 just to find out what we know. It is not about the money however, it is about the risk of losing her on the table. We feel that the vet industry is a racket. I was charged 70.00 to get her blood pressure checked! It makes me wonder whether there is a treatment for this but that they would rather get the big money for surgery. So much of that goes on in human medicine. It is so sad.

[Budsters Mom]

It is about the $$$$ too, for many us us here. :o I totally understand.

Kathy

[molly muffin]

I think I would want to talk to a board certified surgeon when he comes to decisions about surgery and personally, your best bet for options might be U of Davis. We've had several members go there, so they might have further answers for you, cost estimates, or alternative routes to take.

The issue is going to be both adrenal glands having tumors. If they are growing into the vena cava or one of them is I should say, then it is life threatening unfortunately. I don't know if they can do anything with radiation to shrink the tumors on adrenal glands like they do with pituitary tumors or not.

I'm racking my brain trying to figure out what options there might be and if I think of something I'll pop in.

I'm going to also copy/paste a questionaire we use for dogs with adrenal tumors considering surgery:


This was put together by one of our members Trish whose dog Flynn under went an adrenalectomy for a pheo successfully.

Part I is for owners in the initial stages, when an adrenal tumour has been identified and they are considering if surgery is even an option for their dog.

Part II is for when surgery has been decided upon and what questions might help when they are discussing it with their surgeon.


Part I - Questions to ask when considering if surgery is an option for your dog’s adrenal tumour:
1. What type of tumour do you suspect, ?functional, ?non-functional, pheochromocytoma, benign, metastatic
2. Expected life span for my dog in a normal situation. If your dog is close to, at or past his expected lifespan for his breed is surgery going to be of any benefit?
3. Prognosis for my dog if we treated medically i.e. with Cushings medications. AND if we do not proceed with surgery how long do you think it would be before the tumour started adversely affecting his quality of life?
4. If he is miserable now, does the benefit of potentially risky surgery outweigh his current quality of life?
5. Are there any other health problems that could impact on a positive surgical outcome, for example: if your dog is overweight or has heart, BP, liver, kidney or lung conditions
6. Is there any sign of tumour spread – imaging should be done, including ultrasound and on advice of specialists either CT or MRI to check whether there is local invasion around the tumour, into blood vessels including vena cava or spread further away in the body to lungs etc
7. Surgeon recommendations – would he/she do it for their own dog?
8. Psychological impact for the owner: It is important to understand this is risky surgery, sadly current guidelines indicate 1:5 dogs do not make it, and some recommendations are not even that high. Can you accept it if your dogs dies during or in the postoperative recovery period surgery? This is where it is important to weigh up whether the benefit of your dog being fully cured is worth the risk of possibly losing him.
9. Financially – can you afford it? Find out estimate of costs.
10. Hopefully this will not happen, but if your dog collapses, e.g his heart stops either during his surgery or afterwards what emergency measures should be undertaken, do you want your dog to have CPR, how far are you (the owner) willing to go for your dog to be saved in such circumstances

Part II - Surgery has been recommended as treatment for your dogs adrenal tumour, here are a few suggestions on what questions you should ask your surgeon:
1. Are you board certified? How many operations of this type have you done? What complications have you experienced? What were the outcomes?
2. Please explain to me how you will do the surgery, which part would likely give you the most trouble? Will you be doing the actual surgery or a resident in a teaching situation? If so, is their close supervision?
3. Will there be a specialist anaesthetist available for the surgery?
4. If it hasn’t been done, do we need a CT/MRI scan to look at the tumour more closely to check for vena cava involvement or any other tumour spread?
5. What are the risks associated with this surgery, including
• Bleeding (including trauma to blood vessels or other organs during surgery)
• clots
• Blood pressure or heart problems such as arrhythmias
• pancreatitis
• pneumonia
• kidney failure
• infection
• wound problems
• bowel problems
• anaesthetic risks
• adrenal insufficiency or electrolyte abnormalities
• death (sorry but you have to ask that risk too)
6. If we proceed with surgery does my dog need preoperative treatment with Cushing’s meds, antihypertensive if high blood pressure is a problem – phenoxybenzamine recommended preoperatively for dogs with pheochromocytoma, anticoagulants or anything else?
7. How will you treat to prevent clots postoperatively?
8. What would you do if you found anything else during the surgery i.e. nodules in other organs e.g. spleen, opposite adrenal, liver, kidney. Would you remove them and what are the risks associated when doing additional abdominal surgery together with adrenalectomy
9. How long will it take and when will you contact me so I know all is OK, when can I visit after surgery?
10. How will the postoperative period go, how long would you anticipate he would need to stay in hospital? How will we manage pain?
11. What monitoring would be needed, e.g. heart monitoring, oxygen levels in the postoperative period
12. If your dog has an adrenocortical tumour affecting cortisol production will he need to be on steroids following surgery and for how long?
13. If there are problems when I take him home, who do I contact? Hopefully the surgical team until all is stable.

[Caseycase01]

Casey is being treated holistically and is doing very well. She had 2 more ultrasounds and the mass has grown just a tiny bit but has not been active. I guess there is now a blood test to dx pheo's, and our vet ordered the test "kit". Have been giving her chinese herbs and other things to try and dissolve tumor. She had a nodule on her spleen but that is completely gone now. Surgery, chemo and radiation will not be an option.

[molly muffin]

Keep us informed on how Casey is doing. I'm hoping that you'll have luck with the herbs enough to keep the tumor inactive at least. The risk is always the growth and spread of course, but I think that by keeping up wht the ultrasounds you should be able to at least know how that is going and what progress is being made.

big hugs, it's a rough road sometimes.

[Caseycase01]

I kept researching options and found a man doing research and had very good results with dissolving tumors with B17 (laetrile). So after consulting with Casey's vet, we started her on the protocol 2 1/2 months ago. She was doing GREAT! No episodes of tumor activity, great energy, appetite good, and then past couple of days she has had vomiting and diarrhea and no appetite. So taking her in to vet tomorrow. Anybody know what the course of events are as a pheo situation worsens?

[Squirt's Mom]

Having never heard of this alternative cancer treatment I did a bit of research. The most alarming thing I read was this -
The incidence of cyanide poisoning is much higher when laetrile is taken orally [21-23] because intestinal bacteria and some commonly eaten plants contain enzymes (beta-glucosidases) that activate the release of cyanide after laetrile has been ingested.[17,22] https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032851/

This study was based on use in humans but could translate to canines I would think. So not knowing how you are using this product, or which form, it is hard for me to offer any ideas about the signs Casey is now exhibiting. Can you contact this person where you got this idea and see what his experience is? As for "which form", from the same study -


Although the names laetrile, Laetrile, vitamin B-17, and amygdalin are often used interchangeably, they are not the same product. The chemical composition of U.S.-patented Laetrile (mandelonitrile-beta-glucuronide), a semisynthetic derivative of amygdalin, is different from the laetrile/amygdalin produced in Mexico (mandelonitrile beta-D-gentiobioside), which is made from crushed apricot pits.[15,16] Mandelonitrile, which contains a cyanide group, is a structural component of both products.[15] It has been proposed that released (hydrogen) cyanide is the active cancer-killing ingredient in laetrile, but two other breakdown products of amygdalin—prunasin (which is similar in structure to Laetrile) and benzaldehyde—may also be cancer cell inhibitors.[17-20]

I wish I had more to offer. But sincerely pray Casey recovers. Did you decide against the surgery completely?

Hugs
Leslie

[molly muffin]

How is casey doing? What did the vet say? Could it just be a bacterial stomach upset? Has the vomiting and diarrhea resolved?

[Caseycase01]

Cyanide poisoning does not occur because when the Laetrile enters a normal cell, nothing happens. It is only when it enters a cancerous cell is when it destroys the cells. And there has not been a officially documented case of cyanide poisoning from Amygdalin, (B17) Laetrile. Her vomiting and diarrhea were caused by a dog flu that was going around in our area. She has been doing very well, no flare ups at all until yesterday. She started drinking more water and has been restless, but seems to be getting better now. You need to remember that the government is not going to want people to know about Laetrile being successful in treating cancer. There is no money in it for them, period. It comes from Apricot seeds, so it cannot be patented. You need to look underground for true information.

http://www.oasisofhope.com/cancer-treatments-therapies/laetrile/