My Annie, 15 1/2 pheochromocytoma - Annie is now an angel running free

[lulusmom]

Hi Kim,

I think I mentioned to you that due to Annie's age, her hind leg weakness could very well be an orthopedic issue. Saskia and Scott did a very good job of assessing the video and I would agree. The video showing her girth does show that her ribcage looks very large in comparison to her hindquarters which could be the result of muscle wasting....whether it's cushing's related, I don't know. It could be due to orthopedic issues like our little Otis. He had no muscle mass left in his hind quarters from severe luxated patellas. I hope that others will weigh in on whether or not they saw a pot belly...I did not. I know what Lulu's and Jojo's pot bellies looked like and unlike Annie, they had no abdominal tuck at all. The picture I've attached is what I saw in both of my dogs, though a bit smaller than this dog.

537

Annie has me befuddled. She's had multiple stims consistent with cushing's and now an LDDS that is definitely consistent with PDH and an ultrasound more consistent with ADH. I can't remember if you ever told me if the other adrenal was normal in size? If so, that would be more consistent with PDH and so are the stim tests, considering most dogs with ADH test normal on stims. Then again, the stims could have been false positives due to the Helicobactor and so could the LDDS, if the helicobactor has not completely resolved. I'm not familiar with this condition at all so I have no idea how difficult it might be to get under control. Your specialist doesn't think Annie has cushing's so I'm interested to see if the LDDS changes her mind.

Another oddity is that Annie's bloodwork is terrific and as I recall, the only abnormality was mildly elevated alk phos. How weird is it that a Mini Schnauzer, much less one with cushing's, doesn't have high cholesterol and triglycerides? With Annie's intestinal issues, the Alkp could be gut induced. Aside from what appears to be a thin coat in one of her videos, she doesn't look cushingoid to me. She had a recent ultrasound right? Most cushdogs take forever to regrow the hair where they were shaved? Has Annie regrown her hair? Her gorgeous eyes were so bright and clear that I was blown away by how incredible pretty she is, especially for her advanced years. She doesn't have that boney looking head my two dogs had nor the noticable pot belly. Is Annie PU/PD?

Sorry for responding to your questions with more questions but your girl is a real poser.

Glynda

P.S. Did Annie's shaking improve at all with the Tramadol and sweater? One last question. If it were determined that Annie's hind end weakness is due to orthopedic issues, which could effectively rule out one of Annie's few possible cushing's symptoms, would you opt to treat her with so few symptoms, even if your specialist confirms a diagnosis?

[littleone1]

I hope you hear something soon, Kim. It's so hard when we don't know what we can do to help our precious babies. Corky and I are keeping everything crossed that you will soon have an answer.

[frijole]

Thanks Glynda. I will answer your questions below...

Her stomach is much larger than her normal size (started 2 yrs ago when her appetite became cush like.. total pig, no breathing between bites etc) and her hind end has wasted away this spring as her leg strength went kapoot.

She has had 3 ultrasounds and yes one recently. The first one they only saw one adrenal. At K State they saw both and the one with the tumor was enlarged and the other was normal sized.

Helico is very hard to get rid of and I read that sometimes it never goes away and you have to treat again. But when I mention that the K State folks tell me they are very confident that we got that handled and I don' think they want to put her under for another endoscopy as it was over 2 hrs.

Yes her bloodwork has been good. The only time things were off was when she was 'loading' and her appetite caved. This is when I had a bunch of tests done. B12/Folate were high (probably helico); triglicerides were high (first and only time) ; and her alkphos went up to 450 (most of time it is only 250 or less). None of the other liver enzymes have ever been out of range.

I agree - with those kinds of blood results - how is it she has appetite and hind leg issues? I'll save my thoughts til the end.

You mentioned intestinal issues... even though she is not eating they (K State) ruled out anything gastro intestinal. She had rare rare rare inappetance prior to "loading" with lysodren. It got real bad when I ceased and has not gone away.

Her thirst went way down along with appetite from averaging 1 1/2 cups a day to 1/2 cup of water. However there were times thru all of this that she pees in the house. None of the vets believe me. I'd blame it on the kid that is supposed to let her out after school except for there have been occasions when she gets me up in the middle of the night to pee after drinking only 1/2 cup water a day.

Her water intake is now up to 1 cup a day. Her vulva is still enlarged and I have seen her licking it on occasion.

The shaking did not go away with the sweater and the meds. It was HOT in here so I say it was not from being cold. She is a very active dog despite her age... she really isn't frail... except when she has these episodes. I only gave her tramadol twice and I can't say I noticed any difference but I kept it low intentionally.

I tested her appetite to see if she was trying to pull one over on me... because she'll eat a food for two to three days and then refuse it. She usually will eat the 2nd or 3rd choice. Then when she gets the shakes she is more challenging and I resort to cooking rice, boiled eggs, chicken etc.

So I tested as Glynda suggested and only gave her kibble. She ate it without having to hand feed her etc for a few days and then this weekend when the shakes started she ceased eating it. Meanwhile she was dying for food - looking all over the place, going into the laundry room where I keep the food and looking at me etc. but she would NOT eat what I had out. This went on for 2 1/2 days. She finally ate this morning but not tonight.

Now let me describe her when she does eat. Normally when she caves in and eats it is late at night like close to 10 pm. She goes to the dish and just enhales it. No breathing, you can hear the snorting, the bowl is scooted and carried all over the place. She looks like she wants more so I go to get more of it (lord knows she needs the calories) and she never eats a single bite of what I bring. ????

To your question of whether I would treat cushings with so few signs assuming the legs are orthopedic... NO.

The vets at K State replied tonight and said they do not think it is cushings and they don't want to give her anything for the legs as they worry about the appetite.

This dog runs around like a young pup. Suddenly that leg gives and she really struggles to give up. I worry about her breaking her front legs trying to pull herself up. The video I captured doesn't begin to portray it... it is hard for me to have the camera on at all times so I miss the worse episodes.

Here is the email from the vet at K State:
I discussed Annie's LDDS test results with Dr. Harkin and went over the videos with him. He agrees that Annie's delay in rising, hind limb shaking, and missing a step with her back legs is most likely secondary to age-related problems (i.e. arthritic changes or degeneration of myelin). At this point, if she is doing relatively well at home, we would not want to add in any medication such as non-steroidal antiinflammatories or opioids that could affect her appetite.


As far as her LDDS test, it is suspicious for PDH except that her clinical signs don't fit, and there was nothing obvious on her CT. Some microadenomas could be below what we could detect with CT imaging. However, I would not want to treat her for Cushing's unless her signs fit the disease.


Please keep me updated on her condition or if anything changes.

--------------

I don't know what to do. I am fine with their decision that it is probably not cushings. I think something else, probably orthopedic has caused her cortisol levels to increase. I think that and the helico wigged out the tests I have done. I wonder if the lysodren affected her appetite like it can cush dogs or maybe she just hurts too bad to eat. I think the shaking is from pain. Kim

[Franklin'sMum]

Hey sweetie,
Just sending love your and Annie's way. Hope they figure something out to help her soon.
Jane, Franklin and Bailey xxx

[SasAndYunah]

Hi Kim,

I am kind of puzzled by the reaction of of K state:

"....most likely secondary to age-related problems (i.e. arthritic changes or degeneration of myelin). At this point, if she is doing relatively well at home, we would not want to add in any medication such as non-steroidal antiinflammatories or opioids that could affect her appetite."

I would expect, from my vet, whatever his/her discipline is, to tell me that yes, indeed they suspect that the hind leg(s) issue may be caused by something orthopedic (age related or not) and to take Annie to an orthopedic surgeon. Because, what K State is saying, about not wanting to add any medication that could affect her appetite, the reversed could be true as well. Namely, knowing what causes the hind leg problems, and then being able to treat that with the correct medication, might help alleviate pain or discomfort and in fact bring back her appetite and maybe even help stop the shivers.

I think that if you look at Annie's problems, hindleg issues and musclewasting in hindquarters, appetite coming and going, shivers...I think the "easiest" one of those symptoms to get a diagnosis for, is the hindleg/hindquarters issue. If the appetite and shivers are related to those problems, you can only find out if you go see an orthopedic surgeon and see what they can find out and how it could be treated possibly. And if it can be treated, you should then be able to tell if the other issues are related or not...

But to not advise you to look further into the orthopedic problems and therefore to not use drugs (not just any drugs, but specifically tailored to Annie's possible condition) in my opinion, is not good advice. They (and we) have no way of knowing what's going on in Annie's hindquarters, have no way of knowing she's in pain or not. So untill and unless they can be a 100% sure Annie's not in any pain, they should always advise you to seek further consultation.

At least, that's my opinion :)

Sas and Yunah :)

[frijole]

Sas, Thank you. And that is what I intend to do. Sure she might have some arthritis but the fact she can sometimes romp with ease up the steps and other times she falls really hard says it all to me.

The shakes ended yesterday and she ate real well.

This a.m. when she went out for her morning duty she fell real hard coming back up the steps. thank God I looked out when I did because she tried repeatedly to get up and kept falling. Sure enough the shakes came back and she did not eat this a.m.

I correspond by email with K State and sometimes it is hard to really know what is happening. I think K State would change their opinion if they had seen it this a.m. and if my camera would have been rolling.

[Carol G]

Hi Kim,

First, I'm so sorry that you and Annie are having such difficulties.

In thinking about the rear leg problems, I remembered that my Keeshond before Winnie would suddenly go lame in one of her hind legs (always the same one but don't recall which). It would happen and then a few days later she would be fine. I took her to the vet on numerous occasions for this but they could never find the cause. She would limp around but didn't seem to be in a terrible amount of pain (we didn't have stairs for her to try to navigate though). This girl also had cancer and went to UC Davis for radiation treatment. She experienced the leg problem while she was there and they couldn't diagnose it either but that was over 15 years ago.

I'm wondering if Annie isn't having something similar and the effort on the stairs is making the pain much worse. I really don't if this helps or not but I felt I should mention it.

I wish I could offer more help,

Carol

[gpgscott]

Kim, I know you remember Cheryl and Barney,

Remember the night Barn had to be taken to the hospital in extreme pain, it was all a pinched lumbar nerve if I remember right.

Annie's problem sure sounds more and more like a disk/nerve issue to me.

Scott

[AlisonandMia]

I believe drugs like Tramadol are not terrible effective with nerve-related pain - which could be why it hasn't helped. NSAIDS may help if controlling inflammation has some effect on the cause of the nerve pain - ie something swollen and inflamed pressing on a nerve - but otherwise they don't work particularly well with neurogenic pain. (Speaking from personal experience here!)

It seems the medications most likely to benefit are anticonvulsants. Neurontin (gabapentin) seems to be pretty widely used in both people and animals. http://en.wikipedia.org/wiki/Gabapentin

Sure sounds like the appetite problem could be related to pain.

Alison

[frijole]

Under adverse treactions I noticed that in studies in rats it increased adrenocarcinomatic activity....

I emailed K State and suggested I take Annie to a orthopedist but I would report back but not start any drug regime without consultation.

I didn't exactly ask for permission but I was hoping for a comment or reply... none so far. Going to go ahead and get it scheduled.

[littleone1]

Kim, I really wish I had some advice to give you. I'm hoping and praying that Annie's issues will be resolved soon. I know it's so difficult when we don't know what to do to help our precious babies. You are doing everything you can possibly do to help Annie.

(((HUGS))) for you and Annie.

[frijole]

Terri... don't sweat it. I'm going on 6 months of this. I don't expect replies to all my posts.... and certainly not answers when the docs can't figure it out. Its just nice to have a place to come to where people understand. My family doesn't even ask me about her any more. :(

Anyway... one day at a time. I'm giving her all I got. Would be nice to get a 'w' every now and then. Been a hard fought battle.

Hopefully I'll learn something soon. xoxo Kim

[Squirt's Mom]

Hi Kim,

Sending positive thoughts, white light, prayers, and love to you and Annie.

I hope the ortho doc can provide some answers at the very least. You are certainly doing your part to help her. Annie is so very lucky to have you by her side; she couldn't ask for a better mommy than you, darlin'!

Keep your chin up and remember you are both dearly loved!

Hugs,
Leslie and the girls :D - always

[MyRudy]

Gosh, Kim, still no resolution to Annie's problems?! My thoughts and prayers are with you both.

Donna and Rudy

[frijole]

The Dr did a quick physical exam and just called. I had emailed him the videos to watch and he felt that it might be heart related? He mentioned patella luxation as well as an arrythmia (sp) syndrome common in schnauzers. Thought she might actually be fainting?

I don't know that I agree with this but he felt it was a better next step than x-rays. I told him to do both.

He reviewed the notes I emailed him which were just a summary of the test results. He asked if I knew about atypical cushings. I laughed out loud at that one. Told him at this point I didn't want to do that test as I could start on melatonin without it. ;)

Gotta admit he was being thorough...

What do you guys think about the heart thing? I'll research at lunch but wanted to see if any of you had any experience.

As always xoxoxox Kim

[labblab]

The Dr did a quick physical exam and just called. I had emailed him the videos to watch and he felt that it might be heart related? He mentioned patella luxation as well as an arrythmia (sp) syndrome common in schnauzers. Thought she might actually be fainting?

I don't know that I agree with this but he felt it was a better next step than x-rays. I told him to do both.

Kim, is this the new orthopedist that you've taken Annie to see? It sounds as though he is suggesting a couple of tests? Can you tell us what they are?

Marianne

[frijole]

Kim, is this the new orthopedist that you've taken Annie to see? It sounds as though he is suggesting a couple of tests? Can you tell us what they are?

Marianne

Yes. The guy owns the clinic and he is NOT board certified (we have none in our state) He is a DVM but you can't see him unless you have an orthopedic issue. He can't be real busy in a town my size. I think he does alot of speaking and other things... anyway... I know they have the eqpt to do tests so figured wth.

So I was shocked when he said he was more worried about the heart than the legs. He had just given her a brief physical when he called. He was very personable - almost not like a vet ;) ...

They are doing an EKG to test the heart and XRays on the legs/hips

His wife is a DVM there as well but her main thing is acupuncture. She attended the Chi Institute in FL and took 180 yrs to get certified. He said 8 out of 156 got accredited.

He commended me on my medical knowledge and I told him flat out "my specialization is endocrinology" :D and not orthopedics nor matters of the heart... went to the school of hard knocks.

[labblab]

Gosh, you would have thought that the K-State crew would have identified any heart abnormality. But who knows? I know that with humans, heart arrhythmias (I can't spell it either so am clueless if that is right!) can definitely cause fainting episodes. But is he thinking that is what is happening when she is falling on the steps?

I'm sure you're doing the same thing, but I'll try to Google about any cardiac issue that's common to schnauzers...

Marianne

[labblab]

Hey Kim, this is not a very extensive summary, but it's something I've found about "Sick Sinus Sydrome" in miniature schnauzers:

http://www.upei.ca/cidd/Diseases/cardiovascular%20diseases/Sick%20sinus%20syndrome.htm

I'll keep looking for better summaries.

Marianne

[labblab]

OK, here's another article describing the syndrome in a bull terrier. Look at this interesting description!


Four months later, an episode of syncope lasting 45 s occurred after exercise. On being questioned, the owners recalled times when the dog had been seen shaking, was depressed, and was a little inappetent.

Here's the article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC339092/

[gpgscott]

Hey Kim,

I'm like Marianne that it seems odd if there is a heart issue that it is not already known.

I can say that I have had experience in smaller dogs with luxating patella and the dog almost always develops a habit of hyperextending the leg with the bad knee several times a day have you noticed her stretch or kick this leg back?

Scott

[lulusmom]

I've learned with my own dogs that if you think something is too weird to be true, it's usually true. :D Marianne did a great job of sleuthing and my immediate question was "what is the average age of onset". With a little Googling I discovered that it can be all ages; however, I found an interesting abstract of a study that suggests female Mini Schnauzers tend to be older when diagnosed.

http://onlinelibrary.wiley.com/doi/10.1046/j.1435-6935.2002.00052.x/abstract

By the way, Syncope is defined as a transient, self-limited loss of consciousness with an inability to maintain postural tone that is followed by spontaneous recovery. The term syncope excludes seizures, coma, shock, or other states of altered consciousness. :D

I'll be waiting on pins and needles to hear about the test results.

[frijole]

Geez you guys are good. Just spent about 30 mins on the phone. I will give you short version now.

he did ECG and sent it out to a bd certified heart guy (will get copy of report) who recommends she go on Benazepril. He thinks it is synchope!

She has mitral valve deficiency but no arrhythmia. I can't spell. ha.

Imaging - her hips, legs and pelvis look GREAT

She has spondolosis in the 4/5th lumbar but not near spinal cord. I'll write about that when I'm at home (at work now)

He also thinks she is atypical

I'll write his thoughts re treatment regime later... gotta get back to work. I love you guys.

[Squirt's Mom]

OMG! Some answers in the works!!! :D It's about dang time! Yipee! I hope the new med does the trick for her and she is feeling better in no time!

Great report on the hips, legs and pelvis! I bet the spondolosis explains her back posture. Look forward to hearing what the doc suggested.

I am so glad you got to see this doc. It sounds to me as if Annie may have found a hero. I certainly hope so for both your sakes!

Hugs,
Leslie and the girls :D - always

[frijole]

Hey Kim,

I'm like Marianne that it seems odd if there is a heart issue that it is not already known.

I can say that I have had experience in smaller dogs with luxating patella and the dog almost always develops a habit of hyperextending the leg with the bad knee several times a day have you noticed her stretch or kick this leg back?

Scott:D Annie is a tall skinny thing and is known for lying with her legs - all of them stretched out. At times she reminds me of a cat! :rolleyes: When she is shaking her legs are all curled up and bent at the 'knees' which is totally not normal for her. Can't say I have seen her kick a leg back. I have seen her leg spazz at night and the entire thing (back hind) lifts up in the air multiple times.. it wakes me up because you can hear the kicking sound. Doesn't last long but it is weird.

[frijole]

OK... first off K State checked her heart (not sure what tests) but they said it was a 4 out of 6. my 2nd trip on 8/10 they mentioned a left apical murmur grad 4/6 and bp of 140.

The ECG results were sent out of state to a vet consultant service:

Johnny D Hoskins, DVM, PhD, Diplomate ACVIM

His response: heart rate is 140-160 bpm. The ECG shows a normal sinus rhythm (so it excludes the schnauzer sinus syndrom). The QRS complexes are OK. No abnormal atrial or ventricular arrhythmias noted.

Based on clinical info provided my clinical diagnosis is existing mitral insufficiency. I would have this dog on benazepril 2.5 BID to help manage this dog's heart disease.

-----------

The vet here said the pills are tiny and for her weight she can go 2 1/2 to 5 mgs twice a day so he is recommending starting at 5 mgs since they are almost impossible to cut in two. I asked about side effects and he said it could cause gastro intestinal issues.

He also said that the inappetance could very well be caused by the heart problems. He believes the episodes are syncope. He said he thought that as soon as he watched the video.

--------------
As I mentioned, her hips, legs and pelvis looked great.

She has spondylosis at the 4th/5th vertebrae and it is probably what is causing her hunch back, weird walking and probably pain due to instability. He said the bones will form a bridge (new bone formation) and once that happens the pain will probably go away. Sorry I can't read my notes. ha ha
http://en.wikipedia.org/wiki/Spondylosis

He said some vets would start off recommending pain meds but he prefers to start with a plant extract called arnica montana. He would WAIT on this to see if the heart med alone does the trick and that way we aren't introducing multiple meds at one time. (no chit! :))
http://www.ehow.com/about_5480493_arnica-dogs.html

----------------
He said based on physical exam he really thinks she is atypical cushing's. He said if I didn't want to do the test he is OK with starting immediately on melaton (3 mgs) twice a day and lignans which he has on hand (don't know anything about the type etc)

He thinks her hair is very thin and metabolic. If you watch the video of Annie going up the steps you see her hair before her haircut. The groomer butchered her. She almost shaves it all off. Due to the legs and skirt being removed from tests she cut her extra short so it'd grow out evenly... so I am not sure I buy the thin hair thing. I haven't noticed a difference. I'll ask the groomer though.

---------------
In short - he thinks the biggest issue is the heart and was surprised it wasn't looked at earlier. He was even willing to just do heart tests after examining her and wait on the xrays. I wanted them done just so I would know.

I feel as if I should consult with K State and get their take on the benazepril.

Anyone have any thoughts??!!

[frijole]

OMG! Some answers in the works!!! :D It's about dang time! Yipee! I hope the new med does the trick for her and she is feeling better in no time!

Great report on the hips, legs and pelvis! I bet the spondolosis explains her back posture. Look forward to hearing what the doc suggested.

I am so glad you got to see this doc. It sounds to me as if Annie may have found a hero. I certainly hope so for both your sakes!

Hugs,
Leslie and the girls :D - always

You crack me up.

Given my luck with vets I am cautious and checking with you guys on anything I do. This clinic is a little 'different'. It was the one I went to when Haley was diagnosed with Cushings. There are 3 vets - the man/wife vet couple/owner and one other lady. the other lady is the one who diagnosed Haley with one test: ldds. she gave me recos for lysodren: 1/2 pill for 3 days then 1/2 pill per week. PERIOD. No acth done before or after. I asked about it, she got confused and said she'd have to talk to the specialist... when asked she told me it was someone at the lab. :rolleyes:

So I ran on to the next clinic (after finding you guys who set me straight). I only went to this clinic because they are the only ones that could do a BP test in town. Then I went because they could do the ldds. Then I went because he has more orthopedic skills than any vets I know.

I will say he is very different - informal, open to discussion and he didn't push the drugs on me.

[Harley PoMMom]

With Annie having normal blood pressure I would be just a little hesitate starting her out at 5mg BID...but that's just me probably being just a worry wart.

Harley's BP meds are small too and I had no problem cutting them when I had to, in fact I asked the Pharmacy to do it for me and they did.

Love and hugs,
Lori

[Squirt's Mom]

About the arnica montana...I use that myself often and it really does help with pain from strained muscles. It is also good to help heal after surgeries. When my shoulder/arm started acting up, a friend recommended it to me and I was amazed at how much it helped. I have continued to use it anytime needed.

I gave it to Squirt after her recent surgery and to Crys when she would over do. None of us have had any issues with it at all. I really hope you see some improvement with its use in Annie.

It comes in a topical form that is supposed to work just as well, in fact, this is the form most often recommended. But we all took it orally with no problems.

Hugs,
Leslie and the girls :D - always

PS. Here is a link to Drug Digest on arnica montana:

http://www.drugdigest.org/wps/portal/!ut/p/c1/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hjA3cDA3dnz1ADN09jA0 8LD18LH8cgoKihfjhIh1m8AQ7gaKDv55Gfm6pfkJ1XDgA3455Z/dl2/d1/L0lJSklLVUtVSklKSkpDZ3BSQ2dwUkEhIS9vSHd3QUFBWVFBQU VJSWdsRVU1QUFHTVlJU0pLMHJVbEdzYTBqQSEhL1lCcHhKRl9O N0R3NDEwLTRrc3V5cjBzbnl2dyEvNl8zMEcwMEdDSVUwRkkzME k4SE04TEFSMzBHMS83XzMwRzAwR0NJVTBGSTMwSThITThMQVIz MDgyL25vcm1hbC92aWV3L3NlYXJjaC9zdGVwL3NlYXJjaER2aA !!/?searchString=arnica+montana&x=8&y=2&select_category=3

[acushdogsmom]

The ECG results were sent out of state to a vet consultant service:

Johnny D Hoskins, DVM, PhD, Diplomate ACVIM

His response: heart rate is 140-160 bpm. The ECG shows a normal sinus rhythm (so it excludes the schnauzer sinus syndrom). The QRS complexes are OK. No abnormal atrial or ventricular arrhythmias noted.

Based on clinical info provided my clinical diagnosis is existing mitral insufficiency. I would have this dog on benazepril 2.5 BID to help manage this dog's heart disease.

-----------

The vet here said the pills are tiny and for her weight she can go 2 1/2 to 5 mgs twice a day so he is recommending starting at 5 mgs since they are almost impossible to cut in two. I asked about side effects and he said it could cause gastro intestinal issues.If Dr. Hoskins is recommending 2.5 mg BID (twice a day) then why isn't your Vet giving you 2.5 mg pills? They are available in 2.5 mg size, I'm sure.

http://www.petdrugs.com/dogs/product/Fortekor+(Known+as+Benazepril+in+the+U.S.)/1112/

(not recommending you buy via the site above, just posted it as proof that the 2.5 mg size is apparently available)

From the International Novartis site:

http://www.ah.novartis.com/products/en/fortekor_dog.shtml

Here's the product monograph with dosing chart etc from the Canadian Novartis site:

http://www.ah.novartis.ca/downloads/companion/fortekor_monograph_en.pdf

[frijole]

Cushy i wrote down 5 mg only size... I thought he said only size available. Maybe he meant all he had available? I also can't decipher whether he was saying to take 1 5 mg pill a day instead of 2 2.5 mg pills a day? I'd have to ask him.

He didn't have the pills made up for me because I told him I wanted to read up on them first to be comfortable. I know it could be days before I hear back from K State on their thoughts.

Went thru the archives and it seemed like every single case on this forum that came up when I searched for this drug was a dog that was atypical. Is that weird?

[Harley PoMMom]

Harley's first amlodipine rx dosage from the IMS was 2.5 mg BID. This was at the Univ. of Penn. and they filled the rx, pharmacist told me that since his bp med is a human med that 5mg is the lowest dose it comes in so they cut all the pills for me. :confused:

[labblab]

This is a side comment unrelated to the dosing question, but I just wanted to point out that Dr. Hoskins is the author of the article summarizing Dr. Feldman's 2007 presentation to which we always refer when we talk about the UC Davis protocol re: trilostane treatment. This is his article that we have posted in the first reply on the Trilostane FAQs thread. Quite a coincidence, huh??

Comparing therapies for canine hyperadrenocorticism (http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&pageID=1&sk=&date=)

BTW, here's the blurb about Dr. Hoskins at the end of the article:


Dr. Hoskins is owner of DocuTech Services. He is a diplomate of the American College of Veterinary Internal Medicine with specialities in small-animal pediatrics. He can be reached at (225) 955-3252, fax: (214) 242-2200 or e-mail: jdhoskins@mindspring.com

For what it's worth, I would definitely ask K-State for their feedback about this. I'm just curious if they also believe that Annie's behavioral symptomology would be explained by this diagnosis...

Marianne

[frijole]

While reading this article Marianne I heard this sad cry from outside my office. Annie was on her blanket shaking and making the saddest cries. Tried video but the camera scares her and she stops. Could it be the anethesia? She acted normal all night except going outside like 15 times. Most of the time she never left the landing... just stood there and turned around and came back in....

[labblab]

Gosh Kim, I don't know what would be setting her off. Poor little baby, and poor you!!!!! :( :(

Did they have to knock her out to take the x-rays?

Marianne

[frijole]

I forgot about the anethesia and fed her a normal amount of food tonight... I bet that is what is wrong. Damn. Long night ahead. She keeps crying and going outside... probably going to either vomit or the Big D.

[acushdogsmom]

Harley's first amlodipine rx dosage from the IMS was 2.5 mg BID. This was at the Univ. of Penn. and they filled the rx, pharmacist told me that since his bp med is a human med that 5mg is the lowest dose it comes in so they cut all the pills for me. :confused:Well, maybe in the States you can't get the Veterinary version of the drug? I don't know. :confused:

But if UPenn pharmacy was able to cut the 5 mg pills into halves for you, I'm sure that Kim can do it too - especially if she tries using a pill splitter (which can be bought pretty cheap at most pharmacies) and if Annie doesn't have high BP and Dr. Hoskins is Rxing 2.5 mg BID, then that's what I'd want to be giving (not 5 mg BID or even 5 mg once a day)

[frijole]

Gosh Kim, I don't know what would be setting her off. Poor little baby, and poor you!!!!! :( :(

Did they have to knock her out to take the x-rays?

Marianne

Yes. Not sure what they used. I'm sure I should have gone with a smaller amount of food.... I was just worried since she keeps fasting that she needed to eat ... I forgot all about it...:(

[lulusmom]

Dr. Hoskins is also the author of an excellent book entitled Geriatrics & Gerontology of the Dog and Cat. I have a copy and have used it a lot.

[Harley PoMMom]

But if UPenn pharmacy was able to cut the 5 mg pills into halves for you, I'm sure that Kim can do it too - especially if she tries using a pill splitter (which can be bought pretty cheap at most pharmacies) and if Annie doesn't have high BP and Dr. Hoskins is Rxing 2.5 mg BID, then that's what I'd want to be giving (not 5 mg BID or even 5 mg once a day)

I've had to cut his BP meds on occasions and used a pill cutter. The EZY Dose Safety Shield Tablet Cutter is the one that I found that did the best job: http://www.amazon.com/Safety-Shield-Tablet-Cutter-Colors/dp/B000BNZTM0

[frijole]

I've had to cut his BP meds on occasions and used a pill cutter. The EZY Dose Safety Shield Tablet Cutter is the one that I found that did the best job: http://www.amazon.com/Safety-Shield-Tablet-Cutter-Colors/dp/B000BNZTM0

:D You guys... I already have a pill cutter. This vet just said they were real tiny pills and hard as heck to cut. BTW that model does look nicer than the one I got so I might just have to pick one up. One can never have enough pill cutters right? :p

[zoesmom]

:D One can never have enough pill cutters right? :p

Right! :p

I'm glad to hear that maybe they're on to something with Annie. Here's hoping that the medicine is going to get the green light and that it helps. And yes, very interesting that the dogs with atypical are the same ones taking the drug. What a journey you two have been on. I hope it's about to be resolved. And that Annie doesn't puke or have the Big D tonight.:eek: Sue

[littleone1]

Hi Kim,

I hope they finally found our what is going on with Annie. It sounds very promising. I know it has been a rough journey for the both of you. I hope everything will soon improve for Annie.

(((HUGS)))

[SasAndYunah]

Hi Kim :)

Oh dear, oh dear... I can't really say I agree with that vet's opinion. At least not about the spondylosis part.

"She has spondylosis at the 4th/5th vertebrae and it is probably what is causing her hunch back, weird walking and probably pain due to instability. He said the bones will form a bridge (new bone formation) and once that happens the pain will probably go away."

It's true that the bonespurs will form bridges eventually and once that happens, the pain will get milder or even disappear. But untill that happens, spondylosis is very painful. And often, once spondylosis occurs in a certain place of the spine, it will also start in other places. So even when the current place of the spondylosis may form bridges there might be a new area with spondylosis, so the pain will continue (in another area.) The hind leg weakness, the "skinny butt", are all symptoms of spondylosis and a result of pain.

"He said some vets would start off recommending pain meds but he prefers to start with a plant extract called arnica montana. He would WAIT on this to see if the heart med alone does the trick and that way we aren't introducing multiple meds at one time. (no chit!)"

Again, I disagree with his opinion. I personally believe that treating the pain is very important combined with some new "rules" and therapies to prevent the spondylosis to advance quicker and to make the animal more comfortable. No more stairs, no more jumping on furniture, elevated foodbowl and bed, if possible swimming or else some massage techniques and moderate but consistent excercise. In my opinion this would take priority over the heartmurmur. A grade 4 is still considered moderate and should not affect Annie terribly (unless there are other heartabnormalities of course). Therapy for heartmurmurs in the mild and moderate ranges, are weigth control, not too much excercise and preventing stress. And pain, causes a lot of stress. So in my book, treating the spondylosis first, should be beneficial for Annie's heart as well..and not the other way around.

I hope you know I don't want to confuse you more but I can't simply sit here and tell you, "hooray, looks like they are on to something"...while I wholeheartedly disagree :) But also, it's just what it is, my humble opinion ;)

Sas and Yunah :)

[frijole]

Sas - appreciate your honesty and it gives me more to chew on. I sent this vets reco to K State but haven't heard back.

Wish I knew all the answers. Anyway - I will keep you posted on what I decide to do.

Those two steps are the only ones in my house so that helps. I need to google elevated bed to see if hers qualifies. She usually prefers the carpet next to it though.

She has slept alot last 2 days since the testing and this am she ate well again. She vomited a bit of food (not bile) around noon. Unusual so I will blame that on the anethesia unless it happens again. It wasn't much but she hasn't vomited much during this ordeal so it stood out.

Thanks to everyone for listening to me...long 6 mos and you are family for sure. Kim

[Dollydog]

It's been a couple of days now since you posted anything....so just checking....know you're online, checking on Leslie and Squirt! Hope Annie is eating and feeling comfortable ;)
Jo-Ann

[frijole]

Was really hoping to get some direction from K State before starting the heart meds and to get their feedback re the pain meds for the bone spurs as well.

Got an email today:
I had our cardiology resident take a look at Annie's videos as well so you could get another opinion. We do not think that Annie is having syncopal episodes based on what we see (she does not appear to lose consciousness). It would be possible for her to have weakness related to intermittent arrhythmias, but since her ECG was normal and we have never heard an arrhythmia, she would most likely have to have a Holter monitor placed (which would continuously record her ECG) to check for this. Please let me know if you have any additional questions or concerns.

---------

So - couple of questions -

1. Would it hurt to start her on the heart meds with a grade 4 murmur? Note she does have wheezing and sneezing episodes... and 2 days after her last anethesia I was concerned there was coughing (sort of... hard to describe but I chalked it up to the tubes)

2. Guess I should ask their opinion of giving her meds for the bone spurs... though I am sure that in spite of the 'non cushings diagnosis' they really dont want her on the meds just to be safe

She ate good for a few days. Yesterday not so well and she was restless last night... we both got up at midnight for a while and she ate a whole cup of kibble which she hasn't touched in weeks. So this a.m. she didn't eat anything.

I try to put glucosamine in her food but it is so hard to know if she'll eat it that half the time it is a waste of the powder.

I bought liquid fish oil which she refuses to eat anything that has this on it.

I purchased her an elevated orthopedic bed and a really cool car seat today at work. I am buying an elevated foodbowl and a ramp for those steps off of Amazon. Oh and that pill cutter. ha.

Have been giving her massages at night which she seems to like. She won't sit on my lap at all any more so its the only cuddles I get.

[Carol G]

Hi Kim,

I don't have any answers for you but I was wondering if you might talk this over with the vet in Lincoln (I think it was Lincoln) that you thought was good. I really don't know, but I was just thinking she (he?) might have some input for you.

I wish I could offer more besides moral support.

Carol

[frijole]

I have had a hard time communicating with the Lincoln vet as she doesn't use/give out email. Being out of town it has made it challenging.

I took everything all you have said into consideration and I am moving forward with treating my dog's heart and her bone spurs. Thanks to the cushings angel that made me quit thinking about medical jargon long enough to use common sense and think of my gal's every day comfort.

I think I will also try accupuncture but will wait a few weeks for that. In the meantime - all her new special orthopedic stuff is on order and should be here in a week.

xoxo to you all.... Kim

[littleone1]

Kim, you need to do what you feel is best for Annie. You know her better than anyone else. The Corkster and I are keeping everything crossed that Annie will soon be back to her normal self.

Hang in there my friend. You are doing everything you can possibly do, and you're doing great at it.

We're sending extra love and super big hugs.

[gpgscott]

Sounds like a good plan Kim, make her as comfortable as possible. I really wish I could say more.

Scott

[labblab]

Hi Kim,

Sorry to be late in responding to your question. But one concern that I would have about the heart med is the fact that you said that GI distress is listed as a possible side effect (although that's a common side effect of just about any med...:o). I'm just worried, though, that more digestive issues are the last thing that you need right now. So if her cardiac status isn't a pressing problem, I'd lay off the heart med if it seems as though it's upsetting her stomach at all. Although I guess that would also be hard to judge, what with her intermittant inappetance anyway. It might be worth emailing K-State back with the specific question as to whether or not THEY think you should give the heart med.

Marianne

[frijole]

Marianne - I did email K State re meds for both pain and the heart. No response yet.

This is the challenge when there are so many cooks in the kitchen and no head chef - except for me. Only I have seen the leg issues although they happen frequently enough.

The vet in Lincoln was shocked at her heart murmur during our first visit - called it a 6. She said you could hear the beat loudly thru the lungs. K State 3 days later called it a 4. Latest vet is concerned.

K State hasn't wanted any meds due to concern for cushings and/or appetite issues. So I held off. But keep in mind we still don't know what is causing inappetance. She isn't vomiting. She just sometimes is picky - very. I think she doesn't eat when she is in pain myself.

Re the heart - Annie has had sniffling, sneezing, smacking that K State couldn't explain upon exam. She got her teeth cleaned... no change. 2 days after her anethesia for xrays she was hacking. She didn't hack the night of or the next day.

The last 2 days her breathing is a bit labored and she snores very loudly when sleeping - noise coming from the nose.

I gotta protect the heart. If it gives she won't be eating anyway. So while I understand your concern I don't know what else to do.

[SasAndYunah]

Hi Kim,

I was so happy to read about the massages, and Annie liking them :) It's nice to have some interaction that is positive and relaxing for both of you :) Just a time to enjoy each other without worrying or watching Annie like a hawk... Massages can be so healing in many ways...and for both parties. I use it a lot and am crazy about them and what it gives Yunah and myself :D

Hoping wholeheartedly, you can figure things out with Annie...

Our best,

Saskia and Yunah :)

[Squirt's Mom]

Hey Kim,

Keeping an eye on ya'll and hoping for the best each day. You are an exceptional mom and I know you will do what is best for Annie under any circumstance.

Hugs,
Leslie and the girls :D - always

[frijole]

If Dr. Hoskins is recommending 2.5 mg BID (twice a day) then why isn't your Vet giving you 2.5 mg pills? They are available in 2.5 mg size, I'm sure.

http://www.petdrugs.com/dogs/product/Fortekor+(Known+as+Benazepril+in+the+U.S.)/1112/

(not recommending you buy via the site above, just posted it as proof that the 2.5 mg size is apparently available)

From the International Novartis site:

http://www.ah.novartis.com/products/en/fortekor_dog.shtml

Here's the product monograph with dosing chart etc from the Canadian Novartis site:

http://www.ah.novartis.ca/downloads/companion/fortekor_monograph_en.pdf

Cushy - the supplier of vet meds in our area just filed bankruptcy! They supplied companies in a large area of the midwest. Mostly vets. That is why he can't get the 2.5 mg. The gal in the office told me that.... he worded it differently in an email to me below.

In an email I told him that I would get started on 5 mg but wanted to start at 2.5 and if I found cutting the pills cumbersome I'd just buy them online.

:eek: Look at his response:

Apparently 2.5mg Benazepril is manufactured by Novartis for sale overseas but is not sold in the US. That brings up a potential problem between us that I would like to head off if possible. In response to 800 Pet Med type veterinary pharmacies we adopted a policy years ago whereby we charge a script fee or records review fee when we write or call in prescriptions to outside pharmacies. We could have a long discussion about our reasoning if you like. Hopefully it will not be a problem between us. We have dealt some with Canadian pharmacies and will follow up to see if they have the 2.5 size.

Am I reading too much into this? I don't ever remember anyone being charged a fee if they didn't buy drugs from their vet. Is this common practice?

Having spent thousands and thousand this year and having a dog that is a damn 'annuity program' for a vet that gets my business I think it is wrong to expect I spend 3 x the amount on drugs I can buy elsewhere...

What say you guys?

[littleone1]

I've never been charged a fee for getting Corky's meds elsewhere. Even when Corky was originally diagnosed with Cushings, my vet told me to shop around as I would be able to get them cheaper than what I would have to pay to get them from him. Corky's Torbutrol is half the price at Diamondback than what I paid at his specialist's. She told me that if I needed it refilled just let her know and she would call it in. There was no extra charge for doing this.

[Harley PoMMom]

Harley's GP has never charged me to phone in a rx to a pharmacy. She is even the one who found the Tylosin at Diamondback and she didn't charge me anything for her time or any extra for the rx as she called many pharmacies looking for the Tylosin.

[BestBuddy]

My "local" vet charges for scripts not written in a consultation. The price is $10 and most of the time it is still better to pay this and fill my them myself at a pharmacy.

It really annoyed me the first time but I am used to it now, I have no loyalty to this vet but because they are 2 minutes up the road I need to stay on good terms.

I do try to have a list of scripts I want written when I take a dog in so that there is no fee.

Jenny

[StarDeb55]

Kim, my GP will charge for the script, if you want to use an internet pharmacy. Neither my GP or any of the specialists I use have a problem with me getting meds through Diamondback & are more than happy to call in scripts.

Debbie

[lulusmom]

Kim, none of my gp vets nor the IMS charges to call in my prescriptions to Diamondback. As a matter of fact our last gp vet used them a lot. They are a reputable veterinary pharmacy located in Scottsdale. They do have a website but they are not an internet (ecommerce) company. My own doctor doesn't charge a fee for a script so why should a vet? I guess you could sit down and have that long discussion if you really want to understand their rationale but I mean really, how long does it take to tell somebody that they are cutting into the net profits. :(

[Franklin'sMum]

Hi Kim,

My own doctor doesn't charge a fee for a script so why should a vet?I guess you could sit down and have that long discussion if you really want to understand their rationale but I mean really, how long does it take to tell somebody that they are cutting into the net profits. :(

I hear ya sister! And they don't seem to understand that loyalty is a two way street. :mad: Previous gp vet wouldn't even write a script, at all, but my human doc will charge $5 if there's no consult

Jane, Franklin and Bailey xxx

[MyRudy]

Oh gosh, Kim, just catching up on poor little Annie's never ending ordeal........I can't believe the vet wants to charge you for calling in a script, that is unconscionable to me considering all you have been through already!

Hoping that you and Annie both get some relief soon.

Rudy and Donna

[gpgscott]

I just saw this also Kim.

I think it is outrageous. First the Dr. has zero liability, a dog is property and it is impossible to bring a legal action against a vet so that cannot possibly be the rationale.

I think the problem is most vets have traditionally been one stop shops. Emergency, regular office visits, hospitalization, pharmacy... and with the advent of better educated patients and availability of alternate sources the pharmacy revenue stream is drying up and the vet is attempting to plug the leak. If the meds were even close in cost it would be an entirely different issue in my view but as we all know the cost difference can be huge. I support my vet when I can but I cannot pay several times the market rate for a product just because it requires a prescription. And it is the Dr.s obligation to prescribe in the process of diagnosing and treating, so under what logic does the Dr. impose an additional charge.

In a word, outrageous.

Scott

[Carol G]

I've never been charged for a script and the vet where I worked for a number of years never charged for them (even though it clearly did not make him happy to write them).

But what is even worse is that you asking for the script for treatment considerations (splitting the pill) and not to save money. So, he is really saying that you should compromise Annie's treatment or pay him more just to keep his "business plan" in place.

Completely disgusting.

Carol

[Harley PoMMom]

FWIW, Harley has just been put on 2.5 mg of Benazepril SID and they do only come in 5 mg in the States. I have had to split them in half, this has been no problem with that pill splitter that I gave you that link to. :)

Love and hugs,
Lori

[sunimist]

WOW! I never paid for scripts. As a matter of fact, when I asked for different meds from different pharms, my vet would make the long distance call for me at no charge!

[frijole]

Hi guys.. long time no update so thought I should document it here and let you know what is up.

As I mentioned in the Duralactin thread - we've been doing that for a month now and it does seem to offer her pain relief and her legs are better though not normal.. still weak.

I have been giving her 3 mgs melatonin am and pm. She sleeps well. ha.

Her appetite remains a challenge... actually she's hungry but refusing food still. There are times when I just cook her a hamburger to get her to eat something. Salmon patties. But at times she will even refuse those. No rhyme or reason seen.

Now on to the NEW SYMPTOM: hair loss?!

Crap. I told you the new local vet (that charges for rx) thinks she is atypical. I do not have a feel yet for this guys knowledge level of anything yet fyi. But he commented 2 mos ago that her hair was abnormally thin. Well she had just had a haircut and if you remember from the video you could see every spot on her skin thru her hair. I just thought the groomer messed up and shaved her too close.

Just had another grooming... Her hair is still growing but it is markedly thinner. It also seems duller on her hind parts. The groomer cut her much longer and she is starting to look like a schnauzer again.. itty bitty skirt.

I also noticed a few months ago that she has NO EYELASHES. Not uppers or lowers. None. I have racked my brain to remember if she ever had any.. am I bad or what? She surely did but I don't know when they went away if she did.

Only other things that she does is :

1. she licks her legs (has since early in the year) Not raw, no redness or hairloss there... just sometmes licks them.. I assumed pain.
2. she scratches the carpet. she always did this but not it is alot. Its like she is digging a hole! I just had the carpet cleaned and no change after that.
3. she sneezes (this has been going on since earlier in the year and K State checked her out and said no sinus issues etc)
4. she licks her fem parts still and it is still enlarged. I'm going to check AGAIN for a UTI this week.

Obviously atypical could be at play or allergies?

Just an update in case anyone has any thoughts. And no I don't use hormone creams. :D;) Kim

[frijole]

Oh I knew I was forgetting something... Annie is a WHITE schnauzer and they have some traits of albinos - very white skin. At times - usually when not eating or legs bad her skin is very bright pink. Sometimes she feels warm but not always.

:confused:

[littleone1]

It's always something with our furbabies. Corky sneezes at certain times of the year because of his allergies.

I hope Annie will start eating better. I'm glad her legs are doing better. I'm really hoping that you will be able to get to the bottom of Annie's issues and be able to get them resolved.

Take care.

[StarDeb55]

Kim, I read your post at work. A lot of the symptoms you are reporting sound an awful lot like allergies are in play. Chewy is almost constantly licking paws, legs belly, anywhere else he can get at. His belly is usually pale pink to outright red. He has never really gotten any better with his thinning hair & the bald spot on top of his butt. This is after a year on allergy injections which are every 2 weeks. He, also, gets a Zyrtec, & a "Efacap", which I think is a fatty acid supplement, daily. I will say that the allergy injections have done the trick with the ear infections. He hasn't had one in over a year. Now, when it comes to hair loss, my derm vet says it's kind of unusual with allergies, but not impossible. Dr. Lewis, the derm vet, is one of the few medical people that I trust implicitly. I'm not sure about what other meds Annie is taking at the moment, but you can try some human OTC antihistamines. Chewy weight about 20 lbs. & gets the Zyrtec daily. When we first started working him up, he was getting 2 adult Benadryl per day. You can give up to a max of 3 for a pup of his weight. Dogs do not respond to all antihistamines equally, so the derm vet's rule of thumb is you try one for 2-3 weeks, no improvement, move on to the next one. I'm not sure I can find the antihistamine list I was given, but if I do I will let you know.

As usual, talk to the vet before you try anything. Also, if you want to get an idea about how good Dr. Lewis is, check his bio/info at dermatologyforanimals.com. By the way, they do have a clinic in Lincoln.

Debbie

[addy]

Hi Kim,

My Zoe has thinning hair, really pink skin, rubs herself on the wall, has reverse sneezing, sneezing, she snores, she chews her paws and licks her front legs and licks just about everything. Her cortisol is high but 4 out of 5 of her intermediate hormones are also very high, especially her estradiol.

Our IMS mentioned allergies briefly but she thinks most of this is from her hormones. So far melatonin and lignans have not done anything but we were only on them for 2 months and now have colitis flare and had to stop the lignans while we are on metronidazole. The lignans work with the bacteria in their stomach and the antibiotic can alter that bacteria so the lignans can work differently. It was making her colitis worse.

Not sure if any of this helps you but alot of what you described sounds like my pup. Zoe's back legs remin me of the video you did of Annie's legs.

Addy

[frijole]

Thanks Deb and Addy -

Annie currently takes the heart meds and the duralactin and melatonin - that is it. As I type she is licking her legs and then her urethra. Now she is digging at the carpet... :o:D:confused::p;)

PS Deb, yes let me know if you get that list. Amazing that there is a link from your dermatologist to NE. Yeah!

[StarDeb55]

Kim, Derm Clinic for Animals has something like 8 clinics in the western US. I knew there was one in NE, but just couldn't remember where, so I looked it up. I see I still screwed up, it's Omaha, not Lincoln. I think I posted the wrong link, too, try dermvet.com.

Debbie

[frijole]

I took Annie in today for her first round of acupuncture. They had a very nice room furnished like a living room - comfortable with music like you'd hear in a spa. I sat on a sofa to hold/restrain her and she was on a table with a rug on it in front of me - the vet on the other side. Very relaxing... except to Annie. :D

She can be hyper and she was shaking and panting like I had never seen her pant before. We tried soothing her but she just shook like a leaf for most of the hour. I finally got her to lie down the last 10 minutes. She will have 3 treatments the first week and then weekly or so after that assuming it works.

It got cold here this week so she started shivering and I've had her in a cute little fleece top. On the way home she wasn't shivering any more. I fed her and she ate her food with no fight other than I had to feed her by hand. :rolleyes:

She seems more comfortable tonight. No shaking, very calm, not as 'tight'. Fingers crossed. Oh, forgot to share I dropped off some dry cleaning this am and the owner noticed Annie in her carseat and brought out her dog. She told me that her dog is old and was having allergy and arthritis issues and she started acupuncture and is doing great.. I saw the dog and she looked very healthy. That made me feel great - same vet "Dr Ann". Will keep you posted on this new journey. Kim

[foxandhound]

What is the chest Xray for specifically with the murmur?

[BestBuddy]

I had acupuncture done on my old horse and she wasn't that keen on it the first time either but I did notice that same night she seemed to be walking much more easily and didn't have that cranky look in her eye.

The second time she was much more relaxed about it and I do think it helped.

It would be similar to using a tens machine (I have just upgraded mine) and I love it. The machine just sends an electrical pulse where the pads are placed into the muscle so very similar to the needle but much easier to do yourself.

I don't think the tens would work that well on a dog because the pads have to stick to the skin and dogs are just so hairy.

Hopefully Annie will begin to enjoy her sessions.

Jenny

[Squirt's Mom]

Hi Kim,

Oh, I so hope the acupuncture helps Annie! It sounds like she was better right away! YEAH!

Hugs,
Leslie and the girls :D- always

[sunimist]

Hi Kim,

I am so glad little Annie seems to be responding to the acpuncture treatments. Keeping positive thoughts and sending up many prayers for the sweet girl.

(((HUGS)))

Shelba and Suni~~

[frijole]

Treatment no. 2 was yesterday... another 'experience'. :D This room is so comfy, like home and the music is calming with birds chirping and my gal just shakes like the room is -30 degrees. Yet she has a smile on her face. Jittery she is. This time she was all about watching the vet put the needles in and she winced/moved each time. We got them all in and the vet left us to 'relax'. :rolleyes:

About 2 mins into it I was holding Annie's neck area and she decided to shake as if wet... and all but 2 of the needles flew out. :eek: Poor Dr Ann. She had a dog under anethesia that her helper was watching so she took Annie to the back so that her helper could hold her and told me to run errands. LOL

Anyway... the Dr Jim, the guy who did the xrays, ECG etc on her saw her and said he couldn't believe how much better she looked. I agree. I attribute it to the Duralatin and stress relief from acupuncture. Her hind legs still fail at times but this week I went to my aunts house and she was running in and out of the house trying to keep up with their dog and she wasn't hesitating on the step to get inside. Last few visits she tripped going up a single step every time. Better energy.

And knock on wood the last few days she is eating well. Could be a fluke because there are cycles like this. But we'll see.

I have to tell you about this new food I found by Merrick. At least it is new to Petco. It is their 5 star entrees series and they all have names. She ate "Grandmas Pot Pie" 2 days ago. I fed her regular canned yesterday so she didn't get too spoiled and she ate it!!!

I got one called "Thanksgiving Day Dinner"! It has turkey, sweet potatoes, carrots, green beans and granny smith apples in it. Hope she likes it.

[addy]

I got one called "Thanksgiving Day Dinner"! It has turkey, sweet potatoes, carrots, green beans and granny smith apples in it. Hope she likes it.

How could she not love it? So much love, Kim, There is so much love in your sentence:)

Happy Thanksgiving,
Addy

[Roxee's Dad]

Hi Kim,

Great news, :) sounds like the therapy is working. :):D:):D

[StarDeb55]

Oh, yes, I'm very familiar with Merrick canned, probably helped to keep them in business with my picky eater. I used to look at those cans, read the ingredients, & shake my head, muttering "that blasted little dog is eating better than his human".

Debbie

[littleone1]

I'm glad Annie's doing better. I hope she continues to do well.

[gpgscott]

Hi Kim,

Glad the acupuncture is showing some results. Vandy tried it a number of years ago with upper respiratory issues and it helped her.

The food sounds way good:D

Scott

[frijole]

OMG I just had to post because I am so freaked in a good way. :D

Just came back from Annie's 3rd acupuncture appt. I now leave her as she is too jittery with me there. She smiled in her car seat the whole way home and was hungry so I fed her. I gave her 3/4 can (she normally has to be hand fed 1/2 can but never finishes it) She started scarfing it down - this wasn't even the Merrick stuff - regular Solid Gold. She couldn't eat it fast enough. I haven't seen this hunger since the first of the year.

Her eyes are bright and lively again, she is walking around the house and not just lying around. Her hind legs still give every now and then but by God her quality of life is turned around. THANK YOU THANK YOU THANK YOU!

I think the combo of duralactin and acupuncture has given her the pain relief she needed. I feel like doing a cartwheel.... but that could be dangerous. :rolleyes:

[littleone1]

This is such great news. :D It is so good to hear that Annie is doing so much better. I'm glad that her treatment is really helping.

[Harley PoMMom]

It warms my heart so much to hear this great news about Annie! Give your precious girl some gentle hugs and kisses from Harley and me and tell her what a sweet and good girl she is!!

Love and (((hugs)))
Lori

[frijole]

The vet must have done something to trigger appetite today. Seriously. She ate that food so fast. I had chicken and she was begging for it so of course I obliged.

[Carol G]

That is wonderful news Kim!

Congratulations to you -- you hung in there and didn't give up.

Carol

[Squirt's Mom]

Oh, Kim! I just had to come back tonite and tell you how ECSTATIC I am to read this post!! :D:D:D YIPPEE!! I would join in the cartwheels but will refrain for the same reasons as you!

Big happy hugs!
Leslie and the girls - always

[Roxee's Dad]

Great news Kim :D:D:D...doing a happy dance :D:D:D since a cartwheel is really out of the question. :o:) So glad that Annie is feeling much better.....Must be great to see your Annie so happy after all you both have been through.....:D:D

ETA .... a yipee and a yahoo !!!!

[SachiMom]

Kim,
Usually I am at a loss for words because of a very sad event..... but now I can't find the words to express the happiness and joy I feel for you and Annie. It is more than wonderful. It is superbulous. :D :D :D
Seeing her eating and smiling makes everything worthwhile. I hope she continues to improve. You've given her a new lease on life. Enjoy.
:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D:D :D:D:D:D:D:D:D
Luv & Hugs ~ Mary Ann

[Franklin'sMum]

Kim,

Happy happy joy joy!!! :D:D:D It thrills me to the bone to hear such good news :D:D! Love the schnauzer smile :) and the prancing and dancing around :) (oops, that's me ;))
Bigs (((hugs))) for such a happy day! :)

Jane, Franklin and Bailey xxx

[Dollydog]

What awesome news Kim....I'm so glad for both of you! :D :D :D :D What a great Thanksgiving you must have had!! :)

[addy]

This is so exciting, I am crying tears of joy that sweet little Annie had such a good day.:)

She has such a good Mommy!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Hugs and Smiles,
Addy, Zoe and Koko

[apollo6]

Dear Kim
So happy to hear about Annie. A wonderful Thanksgiving day blessing to hear about.
Apollo just started the Durclain ? on the 24th. He has been doing accupuncture for years for his spinal problems. Also read it is good for dealing with cushing's disease. I will keep you posted on Apollo's progress with the Durclain.
Hugs Sonja and Apollo.

[k9diabetes]

Hey Kim,

Are you doing acupuncture only or are you trying some herbal remedies from the acupuncturist also?

Natalie

[frijole]

Hey Kim,

Are you doing acupuncture only or are you trying some herbal remedies from the acupuncturist also?

Natalie
The vet IS doing the acupuncture - she is certified from Chi Inst. I am giving her homeopathic drops for anxiety - just started those. They had me try arnica montana for pain but it did not work at all. Unrelated to this vet - Kansas State recommended a product called Duralactin (I created a thread about this in Everything Else forum). It is a natural alternative to steroidal anti inflammatories. So far it HAS given her relief. I am really impressed with it. Google it and read the reviews. All very good.

[gpgscott]

Grrreat news Kim!

Scott

[k9diabetes]

I saw the Duralactin thread and am keeping that on the list of potential things to use.

We have started acupuncture on Jack and are debating whether to go with a Chinese herbal mixture... I'm a pretty serious skeptic on the herbals... and the vet who is doing the acupuncture (she does only Eastern medicine now but is a veterinarian) has never used them on a dog who is also taking Prozac so she was going to do some research. I think we might try just acupuncture for now as he's already on Metacam and then talk more about the Chinese herbs.

Natalie

[frijole]

Hi all... I will post more details later but wanted to let you know I took Annie in for a dental this morning and they called due to the CBC results. Specifically they are concerned at the ALT reading which was 218 and high end of normal is 118. Her ALP was at least twice what it was last time at 1600+.

They wanted to do a complete "liver function test" but when they went to do it the "rotor broke"... I don't know what that means.. but it was the only one in stock so I will have this all redone next week because she has a much needed acupuncture appt for Friday.

She has other things elevated but they weren't concerned... I will post it all tonight.. . As always I will seek your advice regarding what to do, ask, etc. I love you guys.

He also said they might put her on denamarin.

Kim

[lulusmom]

Hi Kim,

If Annie's teeth were pretty bad, that can elevate liver enzymes but not sure to the extent you've posted, particularly the ALKP. If it were me, I'd definitely get Annie on liver support.

Check out this site for information about what your vet was referring to when he said the rotor was broken.

http://www.abaxis.com/pdf/Mammalian%20Liver%20Profile.pdf

[StarDeb55]

"rotor broke", Kim my best guess is that their in office analyzer that they run their chem panels on took a powder.

Debbie

[frijole]

"rotor broke", Kim my best guess is that their in office analyzer that they run their chem panels on took a powder.

Debbie:D Huh? :D Whatever it is, it was there last rotor and they need to bring one in ...

[frijole]

OK... here is what was elevated. Note that I don't think these items were elevated previously..ever... only alk phos and her triglicerides were high once but then normal.

Alk pho and ALT much higher than ever.

ALB 4.5 (2.5-4.4)
ALP 1634 (150 high range)
ALT 218 (10-118)
BUN 29 (7-25)
K+ 6 (3.7-5.8)

Note creatine was normal at 0.5 (.3 -1.4)

OK guys you all know that K State says it isn't cushings, that she does have an adrenal tumor that could be a pheochromocytoma. Her issues are hair loss (I'm using melatonin), serious hind leg issue (lack of muscle mass - using duralactin), and her appetite comes and goes... lately its been bad but we tried to go 2 weeks without acupuncture as it really seems to help both legs and appetite.

Please shoot it straight so I can prepare for doing the full liver panel on next Tuesday. Again... I love you guys so much. Kim

[SachiMom]

Kim,
I can't help you with lab test analysis, but know that you and sweet Annie are never far from my thoughts.
Sending Luv & Hugs
~Mary Ann

[frijole]

Thanks Mary Ann... she is really not wanting to eat... thank God for Cushy's turkey/rice dog casserole recipe.. I make it up and freeze it for emergencies.

Hoping Deb has a minute to look over the numbers. Kim

[lulusmom]

Hey Kim, I'm no lab tech but those numbers look like something you'd see for a cushdog. I'm not sure about the slight elevation in potassium but hopefully, Deb can tell us. I don't think you see the same bloodwork common with an adrenal tumor with a pheochromocytoma. Are they certain what they were looking at was a pheo?

[frijole]

Hey Kim, I'm no lab tech but those numbers look like something you'd see for a cushdog. I'm not sure about the slight elevation in potassium but hopefully, Deb can tell us. I don't think you see the same bloodwork common with an adrenal tumor with a pheochromocytoma. Are they certain what they were looking at was a pheo?
No - they said if her BP was elevated they could confirm the dx though. Their thought were based on ultrasounds and images taken of it from different angles.

Meanwhile Annie's urine is YELLOW - she lays on the carpet (never tile or wood floor) near the space heater. So I have a hard time thinking cushing's. Wonder if it is thyroid? She was dx-ed hypothyroid years ago and put on thyroxine. The vet at KState took her off those meds when they told me she didn't have cushing's.

She only had the free T (I believe) done. Never a full test.

[StarDeb55]

Kim, I have about 5 seconds as I have company starting yesterday thru Sunday. The potassium is such a slight increase that I don't think it's much to be concerned about. If the sample was even slightly hemolyzed, that would explain it. I agree with the liver function numbers looking like Cushing's. When it comes to BUN, dehydration might explain it. Also, a high protein dog food. Chew had an elevated BUN with a normal creatinine on the labs done before his dental. The BUN/Creat ratio was elevated which concerned me. I talked to my vet & he said that heart problems might cause it, not necessarily kidney. He did say that it might possibly be a warning for a pre-renal issue.

Debbie

[frijole]

Deb - thanks. I trust you more than my vets and I mean that! I have tried every vet in town and this is the only one with the equipment I need and I cannot drive out of town every week to go to a vet. So I need all the support I can get to help 'direct' them.

Interesting that you are concerned about the creatine ratio because the only thing they focused on was the liver and said they weren't concerned about anything else. :confused:

When I picked Annie up today from acupuncture they informed me they did the liver function test. They told me it would tell me specifically what was wrong... Here are the results:

Vetscan Mammalian Liver Profile

ALP 1899 (20-150 u/l)
ALT 261 (10-118 u/l)
GGT 15 (0-7) u/l
BA 30 (0-25 umol/l)
TBIL 0.8 (0.1-0.6 mg/dl)
ALB 3.9 (2.5-4.4 g/dl)
BUN 47 (7-25 mg/dl)
CHOL 376 (125-270 mg/dl)
QC OK
Hem 3+ Lip 3+ ICT 0

The vet just said that these liver enzymes are too high to even think about doing a dental and we want her on demaril for 2 mos before even testing again to see if she can do a dental.

They think she has atypical cushings. I tend to disagree with this because every single acth test that Annie had - even the ones that did NOT indicate cushings she had elevated cortisol at the BASELINE. My understanding is if there is elevated cortisol it is not atypical cushings.

I told this vet that I was having deja vu of exactly a year ago when we went down the road of $8000 worth of tests and no diagnosis. She mentioned maybe doing an ultrasound to look at the adrenal tumor and I suggested that maybe we should first have K State send the images they took and reports last year and they SPEAK and discuss the case. She was very open to doing this.

I feel so bad because I still can't trust a vet. I am running a business - I can't leave every week to go to K State like last year... My mind is spinning... she won't eat anything except for cushy's ground turkey/rice casserole (I sneak in the drugs, and Solid Gold seameal w/vitamins). She's even passing on treats.

Down to 14.3 lbs. She looked so sad this a.m. but after the acupuncture she came out with a smile as usual... at least she likes the place!

[StarDeb55]

Kim, can you post a creatinine, even if it's normal? Gotta have it to calculate the ratio.

Debbie

[frijole]

Kim, can you post a creatinine, even if it's normal? Gotta have it to calculate the ratio.

Debbie
There was no creatine reading on this. I typed everything that was measured. :( I did post it from 2 days ago - different test but...

[StarDeb55]

Ok, so I calculated the ratio using the earlier labs. The BUN/creat ratio by my math is 58, someone may want to double check this as it's late & I'm tired. Going by the normal range that was posted on Chewy's lab for the ratio is 4-27. It goes without saying that there's a problem here. Now, the question is whether or not this is really a renal issue or something else. Chew's was only elevated a tick at 31. I talked to the vet about him & he said it might be a pre-renal failure issue, but it may also be due to his grade 3 heart murmur. With Annie's result so much higher, I think you are going to have to start asking some serious questions, & if you can't get satisfactory answers, it may require a trip to K State. Serious renal or cardiac problems would have to be moved to the top of the list, but I don't have to tell you this. Wish I could be a little more optimistic.

Debbie

[lulusmom]

Hi Kim,

I've had dogs with primary liver disease and kidney disease and while it's been some time ago, I don't think their liver profiles looked like Annie's. My dogs had major organ failure and a lot more abnormalities which makes Annie's results look fabulous. One abnormality you that is classic in primary liver and kidney disease is low albumin levels and Annie's are high normal. I have no idea what QC is but none of the other results made me cringe when I looked at them. In my not so professional opinion, I believe any of these abnormalities could be from hypothyroidism, typical cushing's, atypical cushing's or any number of intestinal issues, which Annie most definitely has or has had in the past.

What medication is Annie on at the moment and is she on liver support?

[StarDeb55]

I have no idea what QC is

If this was mentioned in relation to lab results, it probably means quality control. I don't remember reading this, so if someone could re-post the quote that has this or the post number, I can determine if it is quality control.

Debbie

[lulusmom]

Deb, QC was the next to last value on the results:

ALP 1899 (20-150 u/l)
ALT 261 (10-118 u/l)
GGT 15 (0-7) u/l
BA 30 (0-25 umol/l)
TBIL 0.8 (0.1-0.6 mg/dl)
ALB 3.9 (2.5-4.4 g/dl)
BUN 47 (7-25 mg/dl)
CHOL 376 (125-270 mg/dl)
QC OK
Hem 3+ Lip 3+ ICT 0

Deb, can you also comment on the Hem 3+ and Lip 3+. Could either of those things have any impact the other values?

[Squirt's Mom]

Dear sweet Kim,

Can't help with any of the values posted but do have much love and many hugs along with belly rubs and ear scritches for you and Annie.

Keep up the good work! Annie is such a lucky girl to have you for her mom.
Hugs,
Leslie and the gang

[StarDeb55]

Yes, that is quality control. Here's the best explanation I've found about lipemia/hemolysis. The only thing I will add to it is that at 3+, I'm sure some of these values were affected.


Hemolysis can interfere with lab results due to several processes.

1. Leakage of analytes from lysed erythrocytes may cause a false increase in the amount of analyte measured in serum if the analyte is normally present in a greater amount inside the RBC than in plasma. This can occur when measuring the levels of potassium, creatine kinase (CK), and alanine amino transferase (ALT).
2. If the analyte is normally present in greater amounts in plasma than in the erythrocytes, the analyte will be diluted by the lysing of the RBCs, causing a false decrease. Sodium and chloride can both be increased.
3. Color interference (tinting the serum pink or red) can cause false increases when using a spectrophotometer. Hemoglobin, bilirubin and protein are a few of the analytes affected by hemolysis.
4. Sometimes erythrocyte constituents can react with analytes, causing a false decrease. This can occur when testing for carbon dioxide, thyroxin and insulin.
5. Hemolysis can cause increased turbidity when using the refractometer to determine blood protein levels.

Lipemia is another interference that can adversely affect test results. Hemolysis is enhanced by lipemia, which increases erythrocyte fragility. Lipids present in a specimen scatter light and can cause either an increase or decrease in values, depending upon the analytes being evaluated. Because electrolytes are in the aqueous phase of blood, lipids may dilute their concentration. Lipemia can be minimized by fasting an animal prior to blood collection, by ultracentrifuging the sample (100,00g) or using polymers to precipitate the lipids out of the sample.

Debbie

[lulusmom]

Well that could explain some of the milder elevations, huh?

[frijole]

Hi Kim,


What medication is Annie on at the moment and is she on liver support?

OK here goes:

Benazepril 5 mg - 1/2 tablet twice daily (heart - for about 2 mos)

Oxstrin nutritional antioxidant tablet 1/2 once a day (vitamins for about 2 mos)

3 mgs of melatonin twice a day (4-5 mos at this dose, longer at lower dose for hair loss/nerves)

Duralactin tablet 1/2 a pill twice a day (since the fall for hind legs)

Denamarin 225 mgs once a day (liver - started last night)

My challenge is the last week her appetite is horrendous. She is refusing everything except for my home made ground turkey/rice. She refuses treats, pill pockets and foods she loves - even canned chicken, salmon...

I ran out of the ground turkey and substituted 93% lean ground beef, drained this week... I am wondering if that effected her cholesterol? Certainly she has had more protein than anything else because I am lucky to get her to eat anything.

Last night she shocked me and ate kibble (I leave it out in hopes she'll eat more!) Last night her breathing scared me but today she seems fine. She did get me up in the night to go outside a few times this week and last. Her water intake is LESS than 1 1/2 cups a day. The vet was not concerned with this.

I have noticed that we have "episodes" for lack of a better word - since last spring when this all started. She quits eating, her legs get worse, her skin is reddish, there are times when her breathing is rapid. That is why I always suspect that adrenal tumor might be doing its thing. But what the heck do I know?

I was gone all day (my 6 yr old nephew took first place in the state wrestling championship) and she was excited to see me, gave me kisses, went potty and just took a treat.

--------
Deb thanks for explaining the comments at the end... once again the levels might not be accurate... sigh.

I emailed the vet at K State with an update. I would feel better if they were involved in discussions since they have the history. I'm just not sure what to have them do next. I don't think I want to give the liver pill and wait.

Thank you.
Kim

[Harley PoMMom]

Benazepril can cause the BUN, creatinine, and the potassium levels to increase.

Hoping Annie eats more for you and is feeling better.

Love and hugs,
Lori

[frijole]

Benazepril can cause the BUN, creatinine, and the potassium levels to increase.

Hoping Annie eats more for you and is feeling better.

Love and hugs,
Lori
How do you know all this stuff? :D Thank you. The vet gave me a can of Hill's A/D critical care dog food when I told her my concern about getting yet another pill down her with her food issues. She said sick dogs love it and it won't hurt her cholesterol and to just try it. Last night she sniffed it and walked away. I tried it tonight and she ate a bite so I tucked the denamarin in it and she ate it. I was relieved... I then hand fed her and though it is a small can she ate all but two bites. Just grateful for any dog food that she eats.

[littleone1]

Hi Kim,

I don't have any advice to offer, but you and Annie are in my thoughts and prayers.

[lulusmom]

Benazapril can also cause loss of appetite but I believe Annie has been on this medication for a while now so I think that side effect would have been recognized a lot earlier. I can't see where any of the other meds would cause a problem. Just a note, some dogs will have gastrointestinal issues with Duralactin because of the milk product in it. Again, Annie has been taking this for awhile.

[StarDeb55]

Kim, my vet told me the same thing about that specific type of Hill's when I was having a really bad time with Harley at one point, I think it was during that gall bladder attack. Harley would not touch the stuff under any circumstances.

Debbie

[Squirt's Mom]

Mornin' Kim,

My frazzled brain remembered something....I'm not sure what is in Cushy's recipe (one I would like to have BTW ;) ) but if it isn't stinky enough, Annie may have lost interest simply because her appetite isn't being stimulated via smell. You might try adding some stinkies to it like Parmesan cheese, green tripe, or some fish like salmon or tuna that has a strong fish smell. As our babies age, they start to lose their sense of smell along with other senses and they sometimes need a bit of help getting that olfactory stimulation. Dogs ain't too picky about the presentation of their meals but the smell and taste are very important to them and part of the digestive process. Just like us, when they smell something good, juices start flowing and the desire to taste increases.

So if there are some things that she likes, or might like, give 'em a try to see if that will stimulate her appetite. New things might pique her interest more than something she is used to.

Hugs,
Leslie and the gang

[frijole]

Heh Les... I wasn't clear - that recipe is all she WILL eat. She turns down tripe, salmon, chicken, fish, beef, bison, duck dog foods.

Since early last year she will eat a food (example first half of a can) and then when I go to give her the second half she refuses it. So I just alternate. I only used cushy's recipe for emergencies when I have four dishes sitting out and she will not eat anything. I let them all sit out and wait until the next feeding trying to get her to eat the regular dog food.

This past week my strategy has not worked so she's had a lot of home cooked food.

My challenge is that she has a lot of meds and I have to fight to get her to eat one little pill pocket... so I have to crush alot of it and mix it in the food. This has worked fine until this past week. There was no change in the meds at that time.

She lost a lb in the last 2 weeks and at 14.3 lbs now she can't be losing weight.

------------
But my concern is more about getting meds into her than the food part.

That and determining what is up... and the fear continued lack of success at figuring it out.

[Squirt's Mom]

Oh, I didn't catch that she wouldn't eat anything. :( I'm sure you have tried Nutrical?

Crys got funky about having meds in her food and treats but would take them in peanut butter. I could crush or pour the meds and mix them in PB and then she would take it - but nothing else. She ate fine just not if meds were in there. She got really gun shy about it, too, checking her food before eating any of it.

There are mechanical approaches to getting food in, but that would be very difficult for me to contemplate emotionally, much less do. :(

Bless your heart....and Annie's, too.

Hugs,
Leslie and the gang

[frijole]

Oh, I didn't catch that she wouldn't eat anything. :( I'm sure you have tried Nutrical?


Hugs,
Leslie and the gang

Yep. She doesn't like anything sweet any more. Nutrical, peanutbutter, etc. When its real bad I spread it on her gums as best I can to get calories into her. She fights it real hard.

[addy]

Just wanted you to know we are thinking of you and Annie and sending hugs across cyberspace to you both.

I had an email from Dr. Oliver and wondered about a comment he made regarding Zoe. He said something about lysodren and "monitor it like you would regular Cushings". I'll go find the quote but it made me wonder because, I, like you, thought that if the cortisol was elevated it was regular Cushings. Maybe he misspoke.

Hugs,
Addy

Found the quote refering to "True Cushings" Not sure what he meant though.



>>>You can give the melatonin, lignan and maintenance Lysodren, and if you don’t see improvement within 3 months, then you can consider a loading dose of Lysodren at that time. Monitor the cortisol levels in either case, like you would for a true Cushing’s case treated with a loading dose of Lysodren. When cortisol gets down to around 50 ng/ml (5 ug/dL), the intermediates as well as cortisol will be controlled. Estradiol is sometimes an exception to this.

[Cushpup]

Heh Les... I wasn't clear - that recipe is all she WILL eat. She turns down tripe, salmon, chicken, fish, beef, bison, duck dog foods.

Since early last year she will eat a food (example first half of a can) and then when I go to give her the second half she refuses it. So I just alternate. I only used cushy's recipe for emergencies when I have four dishes sitting out and she will not eat anything. I let them all sit out and wait until the next feeding trying to get her to eat the regular dog food.

This past week my strategy has not worked so she's had a lot of home cooked food.

My challenge is that she has a lot of meds and I have to fight to get her to eat one little pill pocket... so I have to crush alot of it and mix it in the food. This has worked fine until this past week. There was no change in the meds at that time.

She lost a lb in the last 2 weeks and at 14.3 lbs now she can't be losing weight.

------------
But my concern is more about getting meds into her than the food part.

That and determining what is up... and the fear continued lack of success at figuring it out.

I realize that many symptoms overlap with different diagnosis, but your Annie's appetite and bloodwork sure look a lot like my Munchkin's:
Feb 2 bloodwork:
ALT 254
ALKPhos 864
GGTP 15 (normal 1-12)
Calcuim 13.1
Potassium 5.6 (normal 3.6-5.5)

CBC= normal.

I noticed that in addition to Annie's Liver enzymes, her BILIRUBIN is slightly elevated. Any chance of Annie having a problem with the BILIARY Tubes and/or GALLBLADDER? A GOOD ultrasound Radiologist with a high resolution machine should be able to give you an answer.

With the liver enzymes and Bilirubin elevated, I would STRONGLY suspect a blockage or inflammation of some sort in the area of the GB and Liver. The Liver, GB, Pancreas and Small Bowel are all connected via TUBES. The digestion, hence the appetite is affected if one is inflamed or blocked.

Unlike in people, the GB is something that the vets don't pay much attention to, especially when a dog has Cushings. They blame everything on Cushings, Pancreatitis or IBD. The Adrenals are responsible for FAT distribution, so it would reason that the GB which helps digest the fats can be affected, and go out of whack. Dogs can have GB attacks, just like people.
Gallbladder is one of those forgotten organs, yet it IS involved in the digestion causing inappetance with possible vomitting and some stool softening.

The way you're describing Annie's appetite sounds different than a typical loss of appetite. That's what was different about my dog, too. Mine would start eating something then change her mind. Sometimes she seemed interested but would turn her head. Wouldn't eat kibble then one day ate it well. I was pulling my hair in frustration. Their was no rhyme or reason to her appetite, or lack of it. She lost weight, too. Unfortunately the Radiologist misdiagnosed the GB on my dog. When we opened her up we saw everything.

BTW- Checking her thyorid (T4, TSH, Free T4)is a good idea, too. I would check the PTH, also.

[frijole]

OK guys... weekend is almost up and I want to prepare for a discussion with my vet. Following are my thoughts and questions from everyone's posts:

1. I need to get tests and films from K State in hands of current vets and have them discuss what is going on and what was previously found/ruled out and why. This is to help guide my local vets and eliminate tests that will just waste time.

2. Ultrasound to look at heart, kidney, liver, gall bladder, adrenals
-Has the previously discovered adrenal tumor grown?
-What are the changes since July when previous ultrasound was done?

3. Thyroid panel. I want to be very specific with them regarding what tests to do because every single time at my previous vet I asked for a FULL thyroid panel I got a T4 and that was it. Do they even do TSH any more? They are probably hooked up to a particular lab (don't know who) Is there a benefit of requesting testing go to Dodds? How does that work?

???

I went back and read Cushpup's entire story and their stories are very similar. (appetite, adrenal tumor, cushings or not) I am hesitant to have another acth test done because I know her pre will be elevated... I know she has cortisol in her system but I am not convinced anymore it is cushings. K State did a catscan and ruled out PDH. Later the acth sent to Michigan State came back 'normal' for cushings but again the base reading was HIGH. Her body is fighting something.

Kim

[lulusmom]

Hi Kim,

I think you've done a great job of summarizing your talking points and to do list. To answer your question about the thyroid panel, I firmly believe that you can't do any better than Dr. Dodds. She is to thyroid serum levels what Dr. Oliver is to adrenal steroids so that should tell you something. Dr. Dodds' interpretation of the test results will be a lot different than any gp vet, unless they've been tutored by her.

Hang in there, girlfriend, and promise me that you won't do anything rash like rob a bank to pay for all the tests. Been there, done that...not robbing the bank part though. :D:o:D

((((Comforting Hugs)))))

P.S. Sorry but forgot to give you a link to Hemopet, Dr. Dodds website. You'll here her speak about thyroid issues for cats and dogs and you'll find how to request a thyroid panel there. http://www.hemopet.org/services.htmlG.

[StarDeb55]

Kim, I had forgotten about gall bladder issues. Harley had a dilated common bile duct which was found on his diagnostic ultrasound for his Cushing's. The IMS said that it probably had a blockage at one point in time, but he probably never got sick enough for me to think he needed to go to the vet. I know you remember well Harley's very picky dining habits, so it was hard for me to tell if he was actually sick or not. There was a period of time though, that he would eat ok, but about 6-8 hours later, he would vomit this horrible looking bile colored stuff, then he would seem to be ok. Both the vet & I are thinking, "Oops, his cortisol has dropped a little low, will give him a pred." This went on for 3 days even with the pred, & the morning of the 3rd day, I told the vet that if he gets sick, again, today, he's all yours. He ended up at the vets on IV fluid over night. I really thought it was pancreatitis, but after all the labs came back normal, an x-ray of his belly did show anything remarkable, the vet went back through his records, saw the "gallbladder" issues on the ultrasound report, & figured that is what the problem is. If I remember, the little guy got put on something to help clear gallbladder sludge, (which he did have), & something else, probably liver support. Those 2 things seemed to solve the problem.

Debbie

[k9diabetes]

Hi Kim,

You definitely can get a full thyroid screening panel. We talked about doing it with Jack after he abruptly came back with a low thyroid level on the regular blood panel and a Free T4 with ED. Fortunately for him, his thyroid level bounced back up and we believe the temporary low was related to gabapentin that he was taking.

I've seen a couple of other dogs with gall bladder issues. It is very frustrating because there really doesn't seem to be much attention paid to it or much to be done for it. In the case of one of these dogs who I heard a fair amount about, she goes through periods of feeling really crappy and then periods of doing better. I don't think her appetite issues are as severe as Annie's. Last I heard, this person had just kind of gotten used to her going through these periods where she's not as well since the vet didn't offer her much other than a really risky surgery.

My cat Gus, who has IBD and now some far more serious problems, eats much the way Annie does. I can only guess that he associates a particular food with his feeling crummy so doesn't want to eat it again. He will turn his nose up at things for weeks and then start eating them again and we cycle through that.

Chris would do the same thing his last year. Eat one food for a couple of days and then flat refuse it. We'd switch to something else and he would eat a meal or two or three and then refuse it.

It seems like it is a common reaction to many kinds of stomach upset or other sources of not feeling well.

I'm glad you've generally been able to find something she will eat. My cat is on pure junk food now - Friskies kibble, which he is thrilled to have so far - while the high quality stuff rots in the cupboard. He's at the point where he gets whatever he wants as he doesn't have much time left with us.

Natalie

[Cushpup]

OK guys... weekend is almost up and I want to prepare for a discussion with my vet. Following are my thoughts and questions from everyone's posts:

1. I need to get tests and films from K State in hands of current vets and have them discuss what is going on and what was previously found/ruled out and why. This is to help guide my local vets and eliminate tests that will just waste time.

2. Ultrasound to look at heart, kidney, liver, gall bladder, adrenals
-Has the previously discovered adrenal tumor grown?
-What are the changes since July when previous ultrasound was done?

3. Thyroid panel. I want to be very specific with them regarding what tests to do because every single time at my previous vet I asked for a FULL thyroid panel I got a T4 and that was it. Do they even do TSH any more? They are probably hooked up to a particular lab (don't know who) Is there a benefit of requesting testing go to Dodds? How does that work?

???

I went back and read Cushpup's entire story and their stories are very similar. (appetite, adrenal tumor, cushings or not) I am hesitant to have another acth test done because I know her pre will be elevated... I know she has cortisol in her system but I am not convinced anymore it is cushings. K State did a catscan and ruled out PDH. Later the acth sent to Michigan State came back 'normal' for cushings but again the base reading was HIGH. Her body is fighting something.

Kim

Kim,

Hang in there.

Let me throw some things out:

Duralactin has anti inflammatory properties, so it should help keep the swelling in the GB area down, so hopefully the GB is still working.
Cortisone also keeps the swelling down.

I know there is Actigall to help the GB work better.

Milk Thistle helps the Liver work better.

When my Vet orders a full Thyroid panel, it has the T4, tsh, and Free T 4. This gives a better picture if they truly have low thyroid.
Having a low thyroid should not cause inappetance.

I had a couple of pets with hypothyroid, and thrust me, they loved to eat. They gained weight. If there is a tumor growing in the Parathyroid you could see some inappetance, thirst, urination....but you would probably see an elevation in Calcium in the regular chemistry profile.

It looks like you have to spell out what you want done on Annie, so my suggestion is that when you get the US done they should take a close look at the entire abdomen. When you tell them about the GB, please tell them to image the entire BILIARY SYSTEM( that's all the TUBES, GB and Liver).... If the tubes are inflamed, clogged or there is something growing in them, Annie can be in a lot of pain. I know this from people medicine ;)

Good luck and keep us posted.
M

[gpgscott]

Watching and waiting Kim and praying for you both.

Scott

[frijole]

Lord... I just read thru Annie's entire medical file over the last 12 mos. What a saga.

The only notes I have on the gallbladder were on the FIRST ultrasound which was done May/June last year. They said GB full with thin wall and no sludge.

Less than a month later I went to K State and they have done ultrasounds on two occasions. Their notes do not mention GB but I have the abbreviated notes that they give to owners vs vets.

I think that K State thought that the helicobacter was the cause of the inappetance and after treating it - that would go away. We have stuck with as many homeopathic medicines as possible because alot of the meds cause inappetance.

[frijole]

Thanks M. - I wrote it down. :p

Kim

[frijole]

Taking her to vet this morning. Last night her breathing scared the crap out of me. Very very fast while sleeping and through mouth.. could hear it over the TV. This am more normal but I think she needs to be with the vets. :( Pray for my girl please. Kim

[Squirt's Mom]

With you all the way, Kim....right by your side, prayers and healing white light flowing for Annie and her oh so special mom.

Hugs,
Leslie and the gang

[labblab]

Oh Kim, I'm so sorry I didn't see your post until right now. I'm holding Annie in my thoughts and prayers.

Marianne

[lulusmom]

Kim, I am with you in spirit and I am praying for Annie.

[addy]

saying prayers for Annie, Kim.

Love,
Addy

[Harley PoMMom]

You and sweet Annie are in my thoughts and prayers.

Love and big hugs,
Lori

[Roxee's Dad]

I'm here as well and sending good thoughts and prayers for you and Annie.

[littleone1]

You and Annie are in my thoughts and prayers.

[madison's mommy]

Thinking of you and Annie with caring thoughts... Sharon

[frijole]

Well we are both home after a long day. Think I told you she was much calmer this a.m. She has had episodes of breathing heavy and fast before and I attribute them to that adrenal tumor. But this was much worse. So I bring Annie into the clinic and she looks 'normal' and I tell them about the episode and that I could not live with myself if I hadn't brought her in for testing.

They started with BP reading. K State said they could not classify her adrenal tumor as a pheochromocytoma unless her BP was high. Frankly I think it does go high but only on weekends and late at night. :p Today she was 210/91 with 188/100 being normal. Annie is very jittery by nature and they were not at all worried about that reading because she had a strap on her leg, people trying to calm her down etc so they felt it was ok.

Her heart sounds regular and only a very subtle murmur. Her lungs were clear. They use a stethoscope that has magnification to enhance the sound and it was fine.

Her coloring was good.

They did a chest xray to look at the heart and there is a spot near the aorta they were worried about. They said they just couldn't tell. They have high end equipment but they farm out most diagnostics. They are sending this out to a board certified radiologist for review.

I pushed them to do an ultrasound. The male vet was concerned that her hair wouldn't grow back on her belly. :D They have grown attached to her since she is there weekly... but I said I wanted to see if that adrenal tumor had grown, the complete gall bladder, and obviously heart and liver. They sent this out to the same guy.

I won't have results for a couple days. Annie did fine, got groomed also and came home and I got her to eat all her food and take her pills. I hand fed her but she ate.

She is rummaging around the house looking for more food so that is good. Thanks to all for your kind thoughts.. Annie sends hugs. Kim

[frijole]

P.S. The grad student that was hands on with Annie at K State emailed me back and she is in India for two weeks! I think she is on vacation. She gave me the no. to call and I did - they have already faxed info to the vets and are sending a CD of all the images. K State has just been wonderful to work with.

[Casey's Mom]

Kim - I hope you can find some answers for Annie. You have been through so much trying to get to the bottom of her problems. I hope you both can sleep well tonight.

Love and many hugs,

[lulusmom]

So Annie is feeling much better and eating this evening after spending a good deal of time at the vet's office today? Hmmm? Maybe she was just Jonesing for the vet and got her fix. :o Seriously, I'll be looking forward to more test results.

G.

[frijole]

So Annie is feeling much better and eating this evening after spending a good deal of time at the vet's office today? Hmmm? Maybe she was just Jonesing for the vet and got her fix. :o Seriously, I'll be looking forward to more test results.

G.Pretty much these ups and downs have been my last 12 mos... just this last one was so much worse. I wonder what her cbc would look like if given today.

[littleone1]

How is Annie doing this morning? I hope you both had a good night.

[frijole]

How is Annie doing this morning? I hope you both had a good night.Back to normal which isn't normal but you know... Still glad I did the tests because those numbers aren't good. Thanks.

[Squirt's Mom]

Mornin' Kim,

I am so glad that Annie is home! It sounds like they did a thorough job - with a bit of coaxing by Mom. ;)

When you said you couldn't live with yourself if you hadn't taken Annie in to be checked out - I understand so well how that feels, from all sides. When Squirt got bronchitis this last year, I was terrified at what they might discover but her breathing was not typical of Cushing's and I knew something else was going on. We have to know, to do all we can for them yet the whole time we are scared, oh so scared, of what the tests will show.

Kim, you are a top notch Mom and Annie could be in no better hands than yours. You are never alone; so many folks are right by your side day and night. You and Annie are surrounded by all the hope, strength, and love we can send. A prayer is always rising for ya'll.

Many hugs,
Leslie and the gang

[sunimist]

Kim, keeping you and sweet little Annie in my daily thoughts and prayers.
((((HUGS))))
Shelba

[BestBuddy]

Hi Kim,

I haven't posted to you for a while but I just want you to know I am thinking of you and Annie. I am hoping for good things and following along. I have no great insights on what is going on so all I can do is let you know I am here with thoughts and prayers.

Jen

[frijole]

Got the report back from Dr Rendano who is not only a board certified radiologist - he also is an oncology radiologist. Here's a link to his bio - he is out of NY. http://www.evetdiagnostics.com/%28S%28bfjxhjyjl1jmgoymeqfrxl55%29%29/DrVicRendano.aspx

Obviously they sent the xray and ultrasound to this guy because they were concerned and wanted to rule out cancer. Well they did. :)

They said they sent tons of film from chest and abdomen because they wanted to make sure nothing was missed. They gave him a brief description of her history and described her breathing attack the other night.

I'll go ahead and type it all out so I don't skip something important that one of you smart people might like to have me question.

No masses or free fluid are seen in the thorax
No evidence of heart failure or lung consolidation
Contour of the diaphragm is normal
There is mild hyperinflation of the trachea
There is mild bronchointerstitial thickening
There is no evidence of lung infarction
There is generalized osteoporosis
There are changes involving the spine that are consistent with metabolic, degenerative and inflammatory processes; I do not appreciate unequivical evidence of neoplasia or discopondylitis in these images.

There is paucity of adipose tissue with marginal abdominal definition.
The spleen is prominent
The stomach is distended with gas

The pet has a mass lesion involving the left adrenal tissue.
There is distortion of the adjacent vessels
No masses are seen in the adjacent kidney.

He then said the left adrenal gland is abnormal and gave them instructions on how to compare the data between the two ultrasounds (K State's and theirs)

Relative to the dramatic dyspnea (breathing attack) I do not see a lesion in the lungs to cause this finding; thus it is most likely associated with pain, metabolic disease or upper airway disease.
Assure the larynx is normal. You could consult with an internist.

He then offered to discuss the case with them and said their imaging was very good and professional.

-------------
Interesting he did not comment on the liver or the gall bladder.

They (local vets) do not feel it is an airway issue. They think it was caused by a cortisol storm from the adrenal gland.

Meanwhile Annie has been eating normally.

[littleone1]

It sounds like you got some good news, Kim. There's alot I don't understand. Hopefully, Annie won't have anymore problems.

[Casey's Mom]

A cortisol storm - wow that makes sense. Interesting stuff Kim thanks for posting. You are amazing - you keep on going trying to get to the bottom of all of her mysteries and in the process teaching all of us.

Love and hugs,

[Squirt's Mom]

Hi Kim,

What I understand from this is that Annie does not have cancer. :D:cool::cool::D It also sounds as if her heart and lungs are in good shape for her age. :cool::cool:

It does sound like her adrenals are at the root of her problems but not that Cushing's is the cause of the adrenal problem. The adrenals, and/or the pheno I assume, could be causing her cortisol and aldosterone levels to be out of whack leading to the signs you are seeing, as well as other hormones but still not sure that would constitute a form of Cushing's. I tried to find some info on "cortisol storms" online but didn't have any luck; what I did find always tied cortisol to a thyroid storm. ???? All part of the endocrine system but that is about all I can figure out. :o:rolleyes:

Do you have any idea what could have been causing her pain the nite she had the bad breathing attack? Are these phenos painful?

All in all, it looks like a pretty good report to one as ignorant as me considering all the signs she has been displaying for so long. How do you feel about it?

Hugs,
Leslie and the gang

[StarDeb55]

Kim, with generalized osteoporosis, could some of what you're seeing with Annie be pain related? Is there any chance she has a pathological fracture somewhere from the osteo? My mother had osteo & suffered from several pathologic fractures in her lumbar spine which we did not even know about for a very long period of time until either an MRI or x-ray was done because of another problem.

Debbie

[frijole]

Kim, with generalized osteoporosis, could some of what you're seeing with Annie be pain related? Is there any chance she has a pathological fracture somewhere from the osteo? My mother had osteo & suffered from several pathologic fractures in her lumbar spine which we did not even know about for a very long period of time until either an MRI or x-ray was done because of another problem.

Debbie
I'm not sure Deb - good point. They did extensive xrays on her spine and legs just a few months ago.

What are your thoughts on the comments about the stomach being distended by gas? Annie has NO flatulence. Her stomach IS huge (like a cush dog or one with enflamed liver etc) Could something be going on with her stomach that is causing pain? That would also explain the eating issues.

I'll check the xrays tonight... I have copies. ha

[lulusmom]

Hi Kim,

Dr. Rendano has some pretty impressive credentials and he is well published. I hope you feel pretty good about having him involved. He's pretty much ruled out any internal abnormalities in the thorax, trachea, lungs and diaphragm that would have caused the symptoms you noticed a few evening ago. This leads me to believe that the pheochromocytoma is the culprit. I don't buy into the cortisol storm because pheo's don't secrete cortisol. I believe the majority of pheos are nonfunctional but they can "episodically" secrete catecholamines, the true fight or flight hormone. Catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline) and dopamine and if a pheo dumps out enough catecholamines, it has a huge impact on blood pressure and the heart.

Think back to the worst time of your life when you were scared or traumatized beyond belief. Did you become short of breath and shakey. I know I have and when horrible things happen those fight or flight hormones kick into high gear and your body is at saturation point. I don't think Annie was responding to anything frightening or traumatizing but I do think her body was responding to a sudden and excessive amount of catecholamines that were dumped by the pheo. I am speculating that it is much more likely that a catecholamine storm took place that night and by the time you got Annie to the vet the next day, her body had cleared the hormones and blood pressure, aldosterone and everything else had normalized again. Because of the episodic nature of pheo secretions, monitoring blood pressure or anything else is iffy. In the morning it could be high and normal by the afternoon. So there you have it again, my two cents worth.

Glynda

[frijole]

Glynda - thank you for forcing me to read up on pheochromocytomas once again... it has been a while. K State said they could not confirm this diagnosis without a high blood pressure reading. The trouble is the episodes occur at night or on weekends and by the time I get her in she is normal.

I think you are right and for some strange reason I thought they emitted cortisol.... my bad. Anyway... I read all kinds of studies and this has to be it. And it isn't just the episodes of breathing - it explains the hind leg weakness, the inappetance, occasional peeing in the house despite normal water intake and the swollen belly. I did read that often dogs with pheos also have cushings or diabetes (about 33% of the time).

The only treatment I saw for a pheo is surgical removal. Given her age and the fact that a "successful" outcome can result in months to a year of life I don't see it as being worth it. My odds are better not treating... I am searching for anything I can find on alternative treatments or ways to give her relief.

I guess we stick with the weekly acupuncture. Open to other ideas. Thanks Glynda for hitting me upside the head.. sometimes I need this. I am now sure she has a pheo.

And after all this time I still can't tell you whether she also has cushing's. I can only say that the lysodren didn't work (remember how her cortisol went UP after we increased the dose?), she doesn't have the water drinking thing, her urine is concentrated and she seeks out warm spots and carpeting and avoids tile and cold spaces. But I can't explain why her baseline readings on 2 ldds and 4 or 5 acth tests were all so high.

Sigh. I can live with not knowing I guess. I'll focus on continuing to make her as comfy as possible.

[lulusmom]

Kim, some things can't be explained and some things are just beyond our ability to control. I know first hand how difficult it is to deal with the frustration and the aching heartbreak of not being able to do more. I don't want you to feel either of those things because you've done everything humanly possible to make sure Annie is taken care of and has a good quality of life. I am unsure about a lot of things but one thing I am sure of and that is that Annie has a great life with you and she knows that she is loved. FWIW, I think your decision to make your sweet girl as comfortable as possible and enjoy her to the fullest every day is the right answer.

Hugs,
G.

[AlisonandMia]

Just a few disconnected thoughts:

I see they say her stomach is distended with gas (not intestines). That sounds a bit like a mild degree of bloat (?????). Maybe some sort of pain (anywhere in her body), nausea or even anxiety is causing her to swallow air? (Some people do this when in pain or stressed - my niece is one such person and it can make her quite bloated and uncomfortable and set up a vicious cycle if she doesn't make a conscious effort to stop it.)

It is possible that the tumor isn't active at all. These happen and are called "incidentalomas". Quite common in humans I believe. You can also get mixed steroid-producing/pheos.

What about UTK adrenal panel? Could the tumor be producing progesterone or something rather than a particularly large amount cortisol. If it is a steroid-hormone producing tumor then it looks like would be one of those adrenal tumors resistant to Lysodren. Now I think about it you'd expect that maybe a mixed tumor (steroid-producing/pheo) could quite possibly be resistant to Lysodren.

Another thought - could a large amount of sex hormones (from adrenal tumor) cause something like morning sickness at times, I wonder? (I have seen a pregnant dog who definitely had morning sickness - so it can affect dogs!)

Did they give any idea as to what could have caused the osteoporosis? In humans high cortisol/corticosteroid meds just about always cause osteoporosis and yet we never see it as being an issue with Cushing's dogs. Is it because it doesn't happen or because it doesn't often cause problems? Do dogs normally tend to get osteoporosis in old age? (They certainly don't have osteoporosis problems as a result of spaying/neutering however.)

Alison

[Cushpup]

Kim,
I'm so glad that Annie is eating!

You're the best mommy, and I'm sure Annie knows it.

The Radiologist sounds impressive. Based on the report you've posted, my concern is that he can only read what is in front of him, however thorough, it may not be the entire picture. I'm seeing that you still do not have an answer. Am I right?
This reading is only the Xray.

Do you have the full US report? This is what we need for the GB.

The Gallbladder, with the Biliary system does NOT show up on a regular radiograph. US is THEE tool for that. My gp Vet and I saw the golfball-like density near the stomach and thought it was a mass in the small intestine, because of her symptoms and because usually the Gb does not show up like that. It was a fluke and it was soooo diseased that the bile was stuck in the GB making it appear WHITE/SOLID on the Xray.Sometimes the Radiologist can see that the Liver is enlarged because it pushes all the other organs lower so you can make out an outline of the Liver being larger than it should be. The Gb cannot be visualized on a typical front to back film (VD), because the Liver is so thick that it overlapse the GB. Mine showed up on the sideview only.

I hope I answered your above question why the Radiologist said NOTHING about the GB on the regular Xray.

Random thoughts:
-sure, if the dog is in pain the appetite can come and go. I had an old 18 yo with a bad back and arthritis, so in her las year she wasn't as perky as before and she wouldn't eat some of her AM meals...but it was different than my last one with the GB problem.
-when they get old their immune system is compromised, Cushings, or not. But all this depends on the dog.
-If dogs live long enough and they get Xrays, you will see osteoporosis,degeneration, and arthritis of the bones. Dogs that have too much cortisone pumped through their body seem to get it more because while SOME cortisone now and then is good because it keeps the inflammation down (in arthritis), too much of cortisone damages the entire body, and it seems to "suck"(strips) the bone part out of the bones. There is a balance when the cortisone should be used to keep the inflammation down and/or do other damage.

In people, Drs are afraid of steroids because while it builds muscle mass, and you look healthy, it can strip the bones, and can multiply cancers(if you have a small area with abnormal cells, and you're taking steroids they multiply like crazy, hence Cancer grows) among other things. Steriods mask many things. Once you remove the steriods, you fall apart. Steroids pumping through your body give you a fake well-being. Does that make sense?

Have you checked her thyroid?

M

[SasAndYunah]

Hi Kim,

I am still not convinced that Annie's symptoms aren't caused by her osteoporosis. It's clearly present, it's generalized (not one localized spot) and very painfull (it can cause several microscopic fractures). It causes about every symptom you describe in Annie, including elevated cortisol levels (baseline) due to the pain (= stress) But it can also cause very painfull ribs that can have her "gasp" for air wich could explain the breathing episodes and the air in her stomach.

I still would like to ask you to try another painkiller, one that's "heavier" for just a few days. If it doesn't change things, you know it's not the pain from the osteoporosis and no real harm is done. If it does change things, you know the pain plays a major factor in Annie's issues.

Sorry to bother you again with this :)

Sas and Yunah :)

[frijole]

M. The radiologist reviewed images taken both by xray and by ultrasound. I have it on my list to have the vets contact him for comments on the gallbladder.

Sas I will bring this up again. Every vet has told me they want to stay away from pain meds out of fear it will make things worse. (NSAID/potential cushings/inappetance).

In case anyone wants to read up on what a pheo is and the symptoms following is a link. I read repeatedly that it is difficult for most vets to diagnose due to the intermittent symptoms that are seemingly unrelated and the most never get the diagnosis until dogs have passed.

https://secure.vlsstore.com/Media/PublicationsArticle/PV_23_09_807.pdf

[SasAndYunah]

Kim,

I surely understand that. You don't want to give them if it's not absolutely needed. But in my opinion, a trial period of a few days, will tell you a lot. If it doesn't change anything, you can stop after 4 or 5 days. But it will rule out/or in, the painfactor...and I think that would be important to know. And since the osteoporosis is the only thing that has been absolutely, clearly diagnosed, it would be strange not to start there, in ruling other possibilities out or in. But that's my opinion of course :) But I surely appreciate you not going crazy over me and my thoughts ;)

Hugs,

Sas and Yunah :)

[frijole]

I am hoping that we have figured out what has been going on with Annie. It's like a mystery novel - the clues are all there, you just have to have enough pieces and eventually you can put them together.

For those of you who are new - please don't try to read my whole thread as you will go bonkers. In short, Annie was diagnosed with cushing's disease a year ago. Lysodren did not bring her cortisol down. All of a sudden she had bouts of inappetance. Her original vet literally gave up on her/us and said "She is old". I tried other vets. I went to the closest IMS which is Kansas State Univ. They said - no it isn't cushing's (they did ultrasound and cat scan) They found an adrenal tumor.

They couldn't explain the inappetance. They did an endoscopy and found thousands of lesions (blood/pus filled) lined her throat/esophagus all the way down into her stomach where they found bleeding ulcers. They did find the helicobacter virus which is quite common and usually sits dormant. It can cause stomach ulcers but the endoscopy guy said he'd never seen anything like the lesions lining her entire esophagus. They treated the helico with antibiotics and assured me the helico was gone.

However - her appetite stayed the same and over the year she has lost weight, muscle mass in her hind legs, her cortisol levels are high, and we have these little episodes where she breaths heavy. Last Sunday's was the worst. That is what led me to do the testing again.

What stood out to me from the report was the comment that her stomach was distended from gas. From the beginning I have felt her tummy gurgling in the lower abdomen but there hasn't been flatulence so I had no idea she had this gas thing going on.

When Glynda corrected me the other night and said she didn't experience a cortisol storm from the pheo it got me back to researching pheochromocytomas. K State suspected that is what she has but because her blood pressure was normal they could not dx it. I guarantee you that on Sunday night when I saw her in distress that her BP level was not normal.

I share this theory because I know I'm not the only person out there that might be struggling with diagnosing - as we always say here "cushing's is tough to diagnose and other diseases mimic it".

OK so back to the pieces of the puzzle... remember those puss & blood filled lesions and the gentleman that did the endoscopy had never seen anything like it. It was assumed that they were from the helicobacter.

With the help of google and our dear friend Glynda and crappy weather today... we did a bunch of research and we think that Annie's pheo is secreting epinephrine that results in high serum gastrin levels that perhaps caused the esophageal lesions.

It could also explain the gas seen on imaging this week , as well as the inappetance and abdominal pain. There is an undeniable connection to gas ulcerations and lesions.

We found this snippet in the article linked below:
In 1955,Zollinger and Ellison described,in man, a syndrome of marked gastric acid hypersecretion,upper gastrointestinal tract ulceration, and non-beta islet cell tumors. It was later demonstrated that the tumors consisted of gastrin-secreting cells that liberated large quantities of gastrin into the circulation resulting in hypersecretion of gastric acid. Gastrointestinal ulceration was commonly reported. Proximal duodenal ulceration occurred in five of seven animals,while gastric and jejunal ulceration occurred only once. Esophagitis was present in five animals and ulcers were present in the esophagus of two animals.

Entire article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1680629/pdf/canvetj00570-0034.pdf

I wish I could post photos of her lesions - they looked absolutely painful. I suspect they never went away. The pain from these bleeding ulcers and the gas in the tummy would certainly cause her to not eat and her body would produce cortisol in an effort to fight this off.

The fact that the tumor is sometimes dormant would explain the good days and the bad days are when it is shooting out epinephrine resulting in the gas.

I read that Pepcid can help treat these ulcers so I went ahead and gave her some today. The only cure for a pheo is surgical removal and the survival rates are not good. We've already lived with this for a year so I am content to forge forward and treat for wellness and continue to give my dear, sweet little thing every last ounce of comfort I can find.

We could be wrong on all of this but boy oh boy the pieces sure fit. I emailed the head of the small animal sciences department at K State today with the theory. (He was the lead on her case) I'll let you know what he says. I hope this helps someone else some day. Its been a long journey - but worth it. Thanks to everyone for your thoughts and ideas. Glynda thanks for helping me with the terminology. You should have been a vet!

[Squirt's Mom]

Hi Kim,

The assessment you and Glynda have come up with makes a great deal of sense. I look forward to hearing what the doc at K State thinks of it and hopefully he will have a good approach that will help Annie feel better.

If Annie likes it, and is not lactose intolerant, you might want to consider giving her some plain, unflavored, low-fat, organic yogurt to help counter the Pepcid's effect on bacteria in the gut. ;)

I sympathize with Annie. Those acids can do a number on tissue. :(

Yeah, I think Glynda missed her calling! ;)

Hugs,
Leslie and the gang

[frijole]

Hi Kim,



If Annie likes it, and is not lactose intolerant, you might want to consider giving her some plain, unflavored, low-fat, organic yogurt to help counter the Pepcid's effect on bacteria in the gut. ;)


Hugs,
Leslie and the gang

Leslie... Annie won't eat any dairy products (even cheese!) or anything sweet. Her taste buds have changed - no peanutbutter or anything fattening. :(

[frijole]

Dear friends - sorry I have not updated Annie's story in some time. We have continued the battle of the pheo tumor and her days are still mostly good and her vet recently told me she thinks her life quality is good.

That said, I am in a real battle to keep weight on my poor girl. She was always between 17 and 18 lbs. but a year ago when diagnosed she was at 14.5 lbs. She is a very tall schnauzer so she is really thin. We have maintained that weight until recently.

Right before I went on a vacation at the end of May she weighed in at 12.5 lbs. The vets got her up to 12.9 lbs when I picked her up after a week away.

Glynda gave me a recipe for Satin Balls which is chalked full of calories and good things and she was chowing on those but she's had more episodes and today she weighed in at 11.7 lbs.

I spent some time reading on a forum for human beings with pheo's and weight loss is common because the body is in 'overdrive' when the tumor is active and emitting adrenaline. Also after episodes they have headaches, dizziness, and are just completely spent. Oh... and heartburn is a real issue. Lately I can't even get meds down her (Pepcid AC, melatonin, HBP med) without forcing them and she is fighting me.

This a.m. she ate a full meal for the first time in TWO days. Dog food too! This evening I got her to eat a bit of chicken breast.

I'm open to any and all ideas! They just can't include anything sweet or dairy because I've tried it all and its not going to work. Pretty much meat and carbs is what has worked and it is always sporadic.

I learned that these tumors are very very rare both in humans and in dogs. That is why so little is known. Normally discovered upon death. So I guess I add to this story in the hopes that some day someone googles and can learn from my dear Annie's story. Its been a long journey but worth every single minute of life I can squeeze out of her. She isn't in physical pain other than her weak legs and those come and go with the episodes.

So my focus is on getting some meat on her. She continues to love her weekly acupuncture appointments and the staff spoils her rotten.

Kim

[StarDeb55]

Kim, what about NutriCal paste? I don't know if this has been mentioned previously. You know what a battle I had keeping Harley's weight up because of his picky eating habits. I got to the point where I kept a tube available at all times. I would add a tablespoonful to all of his meals to get extra calories in him. If he wouldn't eat at all, I could usually get him to lick the Nutrical paste off my fingers or off the end of a spoon. You can buy it a places like Petco & PetsMart. If I remember, I think the paste is beef flavored, so sweet wouldn't be an issue.

Debbie

[frijole]

Kim, what about NutriCal paste? I don't know if this has been mentioned previously. You know what a battle I had keeping Harley's weight up because of his picky eating habits. I got to the point where I kept a tube available at all times. I would add a tablespoonful to all of his meals to get extra calories in him. If he wouldn't eat at all, I could usually get him to lick the Nutrical paste off my fingers or off the end of a spoon. You can buy it a places like Petco & PetsMart. If I remember, I think the paste is beef flavored, so sweet wouldn't be an issue.

DebbieThanks Deb. Its beef flavored but sweet ... I have a tube if you want me to mail it to you. :p;) Sometimes when it is really bad I will force it onto her gums but she is really fighting me. I had forgotten your battles with eating... it really is a helpless feeling isn't it? As a mom of a cushdog it is just hard to relate.... talk about extremes.

[BestBuddy]

It is just so darn frustrating when you struggle to get them to eat. I had these problems with Phoebe and I found a secret weapon or at least it worked for her.
Sardines! It gave her stinky fish breath but I could put sardines mixed with other food and she usually ate it.

Jen

[StarDeb55]

OMG, please don't! :D:p I finally have 2 dogs who love their food, gobble it right up, then beg me to share my food with them. I never realized it was sweet. Now that I think it about, it would have to be sweet to be high calorie as I'm sure it is loaded with dextrose & other things like it. I wonder if they make anything else for dogs along the lines of Nutrical, but not sweet?

Debbie

[frijole]

It is just so darn frustrating when you struggle to get them to eat. I had these problems with Phoebe and I found a secret weapon or at least it worked for her.
Sardines! It gave her stinky fish breath but I could put sardines mixed with other food and she usually ate it.

Jen

Lord.. I could try it... the ultimate sign of a mother's love? ha. I have a can of TRIPE that she is refusing to eat in the frig. Want me to send that on over? :D Tripe stinks but sardines have to be worse. Lord. Do I have to look at the little things or do they come without the scales? :eek:

[Harley PoMMom]

I would recommend trying slippery elm to soothe her tummy.

[frijole]

I would recommend trying slippery elm to soothe her tummy.

I know nothing about it. Does it help heart burn? Is it liquid? Taste? I'll have to google it. Thanks.

[Harley PoMMom]

Slippery elm coats the stomach and helps to diminish the accumulation of acid in the stomach (which is a big problem in dogs that are not eating regularly)that can result in nausea and ulcers.

Slippery Elm Bark is a good treatment for ulcers, gastritis, colitis, and other inflammatory bowel problems. Its mucilage content coats, soothes and lubricates the mucus membranes lining the digestive tract. It is high in fiber, and so helps normalize intestinal action, relieving both diarrhea and constipation. It may also help alleviate nausea and vomiting in pups suffering from non-GI illnesses.

SEB contains many nutrients (carbs, protein, fat, ascorbic acid, beta-carotene, calcium, and trace minerals) that can be beneficial for recuperating pets and it may stay down when other foods are not tolerated. However, it is somewhat high in magnesium.

The SEB is usually available at any Whole Food Store or health food store (in capsule form or bulk powder form).

Here is a link about it:http://www.littlebigcat.com/health/slippery-elm/

Sending huge loving hugs, Lori

[BestBuddy]

The sardines come cooked in the can and don't smell too bad when opened but after eaten that fishy breath (dog or human) could wilt flowers.;)

Thanks for the offer for the tripe but NO.

Jenny

[addy]

Hi Kim,

I don't have any suggestions but want you to know I am sending hugs and prayers you find something Annie will like to eat. You can make a paste out of the Slippery Elm if you want. I have the directions in one of my books. If you need it let me know. I so want to try if for Zoe when I can.

Love,
Addy

[frijole]

Thanks all .... Lori I finally read up on the slippery elm and it seems like a real possibility... I am convinced the tumor/adrenaline emitted creates gas and probably the ulcers all along her esophagus. And this is why we have eating issues. Anyway... I looked and can't buy locally at health food store... so ordered from amazon just now. Will let you know.

Since it has a sweet taste and she doesn't do sweet... I thought I'd mix with beef broth? Thoughts? :D Hope she'll eat it!

[Harley PoMMom]

I think adding the SEB to beef broth is a great idea! I do hope that Annie will like it and that it helps.

Love and hugs,
Lori

[frijole]

I adopted Annie when she was around a year old. Her original mom was dying of cancer and her 20 yr old son was supposed to take care of Annie. She was starved, abused, and stayed in a kennel 24 hrs a day so she peed in her bed when I got her!

So I don't have her exact birthday. I elected to celebrate it every 4th of July because she was such a 'firecracker' bundle of energy when I got her. So.................

HAPPY 15TH BIRTHDAY TO MY DEAR SWEET ANNIE!!!!!

I have been experimenting with the Slippery Elm and so far I can only get her to eat it when mixed with steak :D, rice with some sort of meat... but so be it... I have mixed it the last 3 meals and she is eating it.

She has no meat on her anywhere anymore. :( Not even her shoulders. I pray this helps her with the heartburn and I can add at least a pound of weight back on her.

So for her birthday... she gets to eat whatever she wants... so long as it has Slippery Elm in it. Too bad she doesn't eat anything sweet anymore... would love to give her some ice cream and cake to pack on some calories. ;):D

[littleone1]

Happy 15th Birthday Annie! I hope you have a wonderful day.

[Squirt's Mom]

Happy 15th Birthday, Annie! We hope you get something you really, really like to eat today and enjoy it to the fullest!


Hugs and belly rubs,
Leslie, Squirt, Trinket, and Brick

[Roxee's Dad]

:D:D:D Happy Birthday Annie :D:D:D

[Harley PoMMom]

Happy Birthday, sweet Annie!!!

[addy]

Happy Birthday to YOU, :D:D:D:D:D:D

Happy Birthday Sweet Annie


Happy Birthday to YOU:D:D:D:D:D:D

[Rene]

Happy Belated Birthday Dear Sweet Annie...you are a very lucky girl. :)

Rene & Snoop

[lulusmom]

I am ashamed of myself for missing Miss Annie's birthday. :o

:D:D:D:D Happy Belated Birthday, Miss Annie!!! :D:D:D:D

I hope mom made it a very special day for you and that you enjoyed every minute of it.

Hugs,
Auntie Glynda

[frijole]

Thanks guys. I have been able to get her to take the slippery elm when I can get her to eat. That is still a challenge at times. I posted photos and you can clearly see how dreadfully thin she now is. No matter where I pet her I can only feel bones. :( Yet tonight she was running thru the house like a pup. Damn tumor.

[addy]

Hi Kim,

I wanted to stop by and ask if you ever tried Seacure with Annie? It helps with malnutrition and putting weight on and also can stimulate a dog to be interested in her food. I saw something on line today about it which made me think of Annie.:):)

Was hoping it might help if you had not already tried it.

Love,
Addy

[frijole]

Hi Kim,

I wanted to stop by and ask if you ever tried Seacure with Annie? It helps with malnutrition and putting weight on and also can stimulate a dog to be interested in her food. I saw something on line today about it which made me think of Annie.:):)

Was hoping it might help if you had not already tried it.

Love,
AddyLord another item for me to google and research! :D;):confused::eek::D I will look it up right now... Thank you so much for thinking of us. Hugs

[frijole]

OK... I got the slippery elm and started it over the weekend. By gosh I'm afraid to post anything positive and jinx us but I think it is doing some good. :D

Here's the deal... I mixed it up and a day or so later she had the 'spurts' which is some regular poop along with some diarrhea. I made that word up. :D It was in my living room carpet.

So I added some pumpkin to the meal. The recipe (tee hee) is a bit of meat of some sort (chicken breast or lean ground beef - just a bit to get her interested in eating, white rice, some slippery elm mixed with water and beef or chicken boullion, a tsp or so of pumpkin, and some kibble that has been sitting there waiting for her to eat. She gobbled it up.

I did this for like the last 4 days and she is eating it all the first try without me having to prod her. And each day I added a bit more kibble to the point where she is eating more than 1/2 cup of kibble each meal along with about 1/3 cup of rice and the meat... so its a full plate of food. She's eating this morning and night.

Lord I hope I didn't jinx us by reporting good news for a change. The only thing is that a couple nights this week I have been up all night letting her out... I finally sealed her off in the patio room so I can sleep and one a.m. there was nothing but this am there were little turd pieces... lets call them 'turdettes' :p fully formed and not runny at all.

Her back legs are so weak as you can see in her recent photos that pooping is difficult so she poops little pieces sometimes. I'm guessing she just didn't finish her 'job' prior to going to bed... but I can live with this so long as she is eating.

Whew... Thanks for bringing up the slippery elm.. I'm thinking it is helping her with the gas and ulcers caused by the pheochromocytoma. :)

[Harley PoMMom]

Such fantastic news that our Annie is eating more!!! Please give sweet Annie some gentle hugs from me.

Love and hugs,
Lori

[Rene]

Hi Kim,

Im glad Annie is eating and having good poopies! Congratulations!


No matter where I pet her I can only feel bones. :( Yet tonight she was running thru the house like a pup. Damn tumor.

When you made reference to the "tumor" I assume you were refering to Annie being so thin and not "running thru the house like a pup". However, in case you weren't can the tumor cause bouts of euphoria? Snoop has been depressed over her recent eye surgery but she experienced a few hours of what you described Annie was doing then she crashed.

Love,
Rene & Snoop

[frijole]

Rene, Yes I was referring to every negative experience over the last 16 mos. That said, since this tumor emits adrenaline, yes it could cause moments of euphoria. Afterwards she is spent. There are times though when she is just her normal Annie and those are the moments I cherish. She'll run around with a big smile on her face and be playful. Kim

[Squirt's Mom]

Hey Kim,

I am so glad to hear that Annie is eating, pooping, and acting better! :D It did my old heart good to read this so I can only imagine how it makes you feel to see it. I hope the trend continues!

I have been very pleased with SEB in my own world, both for my babies and myself. Don't you love the smell when you mix it?! :cool: It smells so clean and earthy to me.

Many hugs and gently belly rubs,
Leslie and the gang

[Rene]

Thank You Kim,

That really helps! That does explain it better...an "adrenaline" rush. I was just very worried it was some kind of stroke. You are so helpful. I will not be so worried now and just "roll" with it.

My best to Annie!

Rene & Snoopie

[frijole]

Annie had her acupuncture today so she's a happy camper. Her vet has really grown attached to her since she sees her at least once a week. I've had so many headaches and heartaches over the last year and a half I thought I'd share something really sweet that the vet said about her.

The vet said "I have never seen a dog with such a strong will to live."

Ya know... I'd never thought about it but it is surprising she is still with me and that can be the only explanation. Yes she has her down days but even though her body is skeletal, she still has a huge heart and yes, she wants to live. Her hind legs often fail her completely but she acts like a pup and pulls herself up without hesitating. She truly is fighting the side effect of this tumor. While it is hard for me to watch... Annie is a happy dog. I'm really glad the vet said that because I never thought about it... and it gives me great relief.

[jmac]

Kim,

What a nice thing to hear from your vet. It sure helps to know she is happy and wants to keep on fighting. I'm sure it brings peace to you to know how happy you have made Annie. Thanks for sharing a sweet story. Glad to hear she is feeling good today, too!

Julie & Hannah

[MBK]

Kim -

You take such wonderful care of Annie that of course she has a strong will to live! ;) I am sure she appreciates all you continue to do for her. It is truly amazing that these little ones enjoy life as best they can and never waste time feeling sorry for themselves. I hope her appetite continues and you can get a bit of weight on her.

[Rene]

Kim,

Our little wonders seem to know where their place is in this terrible disease. I often tell myself I must forget what I know is really going on with Snoops health and just simply follow her lead and enjoy that she is here!

Love to you both!

Rene & Snoopie

[Squirt's Mom]

Dear Kim,

It is amazing how much our babies can sometimes take and keep on going. Of course, moms like you play a big role in that ability! ;) Not to mention the love the two of you share.

Hugs,
Leslie and the gang

[SachiMom]

Annie is a happy dog.
This warms my heart and makes my day.
Kim, I don't get by as often, but I think of you two every day and keep you both in my prayers.
You both are special girls.
Luv & Hugs ~ Mary Ann

[lulusmom]

I've kinda grown attached to Annie too. :-)

[frijole]

Thanks guys. :) I posted a few photos of Annie in her album taken before she got ill so you could see what she looked like before the tumor. I took these photos into the vet so she could see them too since she just met Annie about 9 mos ago. Her eyes and her heart are the same. :D

[Roxee's Dad]

The strong will comes from the strong LOVE !!:)

We all Love you Annie :) and you too Kim :)

[frijole]

OK....I am now officially going on record and nominating myself as the President of the Slippery Elm Bark fan club. :D

For one year and 4 months... that would be 485 days... 970 feedings Annie refused to eat. She wanted to eat but didn't. With the help of many of you I came to believe that she has gas, heartburn and ulcers caused by the pheochromocytoma. Twice daily Pepcid AC didn't seem to make a difference.

I bought the Slippery Elm July 17th. For the last two weeks Annie has eaten whatever I gave her the first time. Sometimes I feed her with a spoon but she is eating AND she is eating normal amounts. In fact, the last few days she has eaten close to a full can of dog food in one sitting... a record.

I believe it was Lori who suggested I give Slippery Elm Bark a try... and after trying everything on the market I was suspect... I googled it and read remarkable things about it even from vets. I gave it a try and knock on wood.... THANK YOU LORI! Kim

[Rene]

That is terriffic Kim!!!!

You go little Annie girl! That has brought a BIG SMILE to my face. Snoop is getting good pets for her.

:D:D:D:D:D:D:D
Rene & Snoop

[Harley PoMMom]

Kim, I am so happy to hear that sweet Annie is eating better!!!! Go Annie!!!!

Sending huge loving hugs for you both, Lori

[Squirt's Mom]

That SEB is good stuff! Lori directed us to it as well and it has done wonders for us, too. I am so glad you are seeing such good results with Annie! :D

Hugs,
Leslie and the gang

[jmac]

Kim,
That is so great to hear! What wonderful news! I bet Annie is happy about it too. Congrats!

Julie & Hannah

[marie adams]

YAY Kim!!!

I am so happy Annie is eating now!!!:) That takes one of the worries off your plate.

I hope you are doing good yourself!!:)

Have a great week!!

[mytil]

Kim,

I am so very happy to read this.

T. xxx and big smoochies to Annie.

[frijole]

Time for an Annie update :) Interesting we have had fewer of the episodes where I can clearly see that the tumor is active so her eating is better - but we fight to keep the weight on... she got down to under 11 lbs but we have her back up to 12.8!

Her back legs are really bad (weak) but it is neurological and the symptoms come and go. She refuses to even stand up when I put her in the Eddies wheels. She can still walk and run... most of the time.

Anyway.. in April she had an ulcerated cornea which we treated. It would go away but every time we stopped the antibiotics the ''divet'' would reappear. So we stayed the course.... and I'd try to wean her off etc. My vet said that lack of tear production can cause the divets as well so we have been using thick 'tears' for a while...

The other night her eye really scared me so I took her to the vet this a.m. and we agreed that it is time to go back to the specialist in Omaha tomorrow a.m. She said that it appears that the ulcer is undermining the cornea.

I know NOTHING about these things so ... if anyone has any advice or questions I should ask.... let me know... we head out first thing in the a.m. for the appt. We'll keep you posted.

I am sure that the adrenal tumor which results in high blood pressure and blood rushing to the brain is what is causing the eye issue.

She never appears in pain - is still a happy little thing... her eye is just weepy. She sends her best to all her buddies here :) Kim

[jmac]

My Hannah has had TONS of eye issues and they began well before Cushing's. She has a tendency to rub her face across the carpet (as well as anywhere else she can find) to rub her eyes. We have been to a specialist in the Twin Cities (I loved him and an office visit is cheaper than the regular vet after the initial appt. I LOVE that!) and he did several tests. We found out her eyes do not close completely, so therefore, they are always a little dry. I put the artificial tears in daily, (he recommends I use gel, actually; I buy GenTeal). When she gets a scratch we use antibiotic drops instead of gel because she doesn't want me to be near her eye when it hurts. I'm glad to hear Annie doesn't seem to be in pain. I wish I had some better advice for you, but Hannah has not had a problem healing, luckily. I do have plenty of experience with scratches and ulcers though; I'm sure she's done it at least 25 times in the 8 years I've had her. I hope you'll get some answers to help it heal. They say it is really incredibly painful-like having a charlie horse in your eye. Hannah holds her eye closed most of the time when this happens, so I know it hurts. Good luck tomorrow, and keep me posted!

Julie & Hannah

[lulusmom]

Hi Kim,

I'm not sure if you remember but I had a little long hair chi rescue who had severe ulcerations in both eyes. I had to take her to a specialist who performed a procedure where they numb the eyes and basically debride the eyeballs of the dead cells. This stimulates new cells. I doubt that Annie is that bad but if she has ulcerations and dry eye, she probably needs to be on daily cyclosporin drops. My friend adopted Lola and she just went for her six month check up today. She's doing well but will probably always have to have cyclosporin drops and triple antibiotic with Dexamethasone applied twice daily. It was a long haul getting her eyes under control and the eye vet said they look great. She looks like she has cataracts but it's actually scar tissue. She sees fine but does have a bit of trouble in dim lighting.

I hate optimune because it's in a little expensive tube and it's hard to control. Once you squeeze the tube, it keeps coming out so it doesn't last long, especially if your reflexes are slow like mine. :D If the eye vet gives you optimune and you need to refill it, ask for a prescription and get compounded cyclosporin from Diamondback Drugs. They suspend it in an oil and it lasts a really long time and it is much cheaper. If you need the triple antibiotic, with or without Dexamethasone or Hydrocortizone, let me know and I'll tell you where to get it cheaper too.

[jmac]

Just to add onto what Glynda said- we also used cyclosporin for a while. He thought she improved quite a bit and said it was okay to go back to the artificial tears for now. When she was on antibiotics, I put it in 4 times per day when possible and that really seemed to help.
Julie & Hannah

[BestBuddy]

Buddy had a a corneal ulcer in each eye (different times) and they were called as indolent-slow healing. He had grids scratched over his cornea in the clinic (only a little eye drop of anaesthetic) and one healed fine but the other would heal superficially but as soon as the antibiotics stopped it would come out again. He had that one scratched deeper (grid keratomy sp??) in surgery and had the third eyelid sewn closed for 3 weeks. Several different types of drops too.

I believe that ulcers can take months to heal and only if they heal all the way through not just on the surface so maybe Annie needs a bit more attention from the specialist to fix the problem.

I do believe that because of the weakened immunes of our pups that it all can take a lot longer than normal. Joey, young and healthy had an ulcer earlier this year and it took about 6 weeks to completely heal with just drops.

Jen

[frijole]

OK... we made it home OK and Annie was a trooper as always.

I'm glad I went because her corneal ulcer has progressed to what is called a Stromal ulcer. I'll quote the write up from the vet:

Annie has developed a bacterially infected ulcer or defect on the surface of her eye. A stromal ulcer occurs when the surface cells of the eyes are lost. Once this happens bacteria can gain access to the corneal collagen. Bacteria uses this collagen as a food source and begin to digest a hole in the cornea. This can eventually lead to rupture of the eye and even loss of the eye. :(

To treat the problem we need to eliminate the bacteria. If more thant 50% of the depth of the cornea has been lost, surgical repair of the corneal defect may be require to prevent the loss of the eye. If Less than 50% of the corneal thickness has been lost we can eliminate the infection we can avoid surgical repair.

Annie's is approximately 50% depth.

They put her on a more aggressive antibiotic, Ofloxacin

She is to have those drops, saline drops AND Optixcare lubricating drops 3 to 4 times a day.

I am to watch for increased cloudiness, holding the eye closed most of the time, increased discharge, vomiting, diarrhea or loss of appetite (oh no) and am to call right away if any of these occur.

I feel like crap because she was so chipper coming home and ate her dinner like she was starved and then I gave her the drops... She literally went to her blanket (in a dark corner) and has not moved since.

I just went over to check on her and put a warm wash cloth on her eye and cleaned the discharge. She did not even move. She did not open her eye. I then took her and gave her another drop of the antibiotic and I had to lift her eyelid open to even put the drops in.

Can Cush angels pray for eye issues? My heart bleeds for her knowing just a few hours ago she was a happy little thing (albeit with an infected eye)

Thanks guys.
Kim

[jmac]

Oh, Kim....I am so sorry to hear that! I will definitely say prayers for you and Annie. Like I said, my vets have told me it is incredibly painful, so she must definitely be feeling the pain now. Did they give her something for pain? Hannah got Atropine drops that I was to use a few times per day until the pain improved.

I'm sure it must be so hard knowing how happy she seemed earlier today, but hopefully this is what she needs to ultimately make her feel better. It is just so hard to see them sad or in pain.

I will definitely keep you both in my thoughts. I can so relate to the eye issues. I'm sending positive vibes your way!

Julie & Hannah

[jmac]

One more thing... did the holding the eye closed just start AFTER the drops? That seems a little weird. Is that what you are supposed to watch for? Or is it just because she is getting some good meds in there now? Good luck to you!
Julie & Hannah

[StarDeb55]

Kim, I didn't post last night as I was waiting for what the eye vet had to say. I don't know if you remember but Harley suffered basically the exact same thing. He had a corneal ulcer that we couldn't get to heal up. At least my GP threw in the towel soon enough that by the time we got to the eye vet, Harley was very close to having a stromal ulcer. With aggressive treatment, we finally got everything under control, but I'm telling you for about a 4-6 weeks, I felt like I was spending my free time medicating his eye. It wasn't easy because the little demon dog absolutely hated having his eye treated. Trying to get drops in that eye one afternoon was how he flipped himself off the kitchen counter & fell to the floor, because he was fighting me so hard. You can get this under control, but it's going to be a long road.

Deb

[frijole]

One more thing... did the holding the eye closed just start AFTER the drops? That seems a little weird. Is that what you are supposed to watch for? Or is it just because she is getting some good meds in there now? Good luck to you!
Julie & Hannah

No - no pain meds. I was wondering about giving her a baby aspirin... but didn't want to upset any apple carts... I dunno!

[frijole]

Kim, I didn't post last night as I was waiting for what the eye vet had to say. I don't know if you remember but Harley suffered basically the exact same thing. He had a corneal ulcer that we couldn't get to heal up. At least my GP threw in the towel soon enough that by the time we got to the eye vet, Harley was very close to having a stromal ulcer. With aggressive treatment, we finally got everything under control, but I'm telling you for about a 4-6 weeks, I felt like I was spending my free time medicating his eye. It wasn't easy because the little demon dog absolutely hated having his eye treated. Trying to get drops in that eye one afternoon was how he flipped himself off the kitchen counter & fell to the floor, because he was fighting me so hard. You can get this under control, but it's going to be a long road.

Deb
I remember now! How frequently did you give the meds? My instructions are 3-4 times a day (all 3 drops given 5 to 10 mins apart)... I read online some vets are saying every 30 mins to an hour!! Freaked me out.

Julie - you asked if the eyes closed started after the drugs and YES it was tonight after I gave the drugs. Its the saline that kills her. It is so red (the eye) but that means its healing so I can deal with that. The eye looks like a grape at times (with dents and irregular shape)

Deb... please give me any tips you might have... and thanks!!!

[jmac]

I would ask about Atropine; I have been told to use it every time Hannah has had anything more than a small scratch. I don't know if it is different because of how deep the ulcer is, but I would think that would be all the more reason to get some pain meds. It's worth asking for sure. I would think they would want to give her something.

Julie

[frijole]

I would ask about Atropine; I have been told to use it every time Hannah has had anything more than a small scratch. I don't know if it is different because of how deep the ulcer is, but I would think that would be all the more reason to get some pain meds. It's worth asking for sure. I would think they would want to give her something.

Julie

I googled it and side effects can include fast pulse and irregular heart beat .... with her tumor emitting adrenaline and causing high blood pressure... I can't chance that. Dang - sounded good til I read that.

[jmac]

Darn! I would think there would be something else she could take though...see what your vet says.

[frijole]

Darn! I would think there would be something else she could take though...see what your vet says.

She goes to the vet for acupuncture tomorrow... I will have them call the vet in Omaha (eye specialist) and see what they say. I might give her an aspirin tonight though.

[StarDeb55]

Kim, she wanted a minimum of 3-4x daily. If I could get them in more frequently, great. I told her that with my funky schedule, the only time that more than 3x daily was going to happen was my days off. Yes, a minimum of 5 minutes between meds. I really don't have tips exactly. The only thing I did after Harley took that header was I moved him to the top of my washer. The dryer was on one side of him, a wall on the other, & I was standing in front of him, so it would have been a neat little trick, if he managed to fall, again. The one thing that did help was I kept a bag of treats on the shelf above the washer. I would put him on the washer, shake the treat bag, give him one. He was then basically as good as gold, let me get the meds done, then he got more treats. Keep in mind that this was the little demon dog, so even though I said, "as good as gold", there was still a certain amount of complaining. I, also, think he finally realized that what I was doing for his eye made it feel better. Hopefully, Annie will begin to realize that Mom is bugging her for a reason, & when her eye starts feeling better, she will know that you are helping.

Debbie

[StarDeb55]

Kim, I was posting at the same time. I know how you hate tramadol, I do, too, but what about 1/4 tab of tramadol or less if you can cut the pill smaller. I just remembered something else, when Chewy tore up his knee, & had the bad reaction to tramadol, I told the surgeon about this as he normally uses tramadol to control post-op pain, & sends it home. He told me that there was an alternative to tramadol that was less likely to cause a reaction like tram does. Unfortunately, I do not remember what the drug was. I do think Annie does need some type of pain meds for awhile as my eye vet told me that this is very painful/uncomfortable, & a pup can be quite miserable.

Debbie

[frijole]

Kim, I was posting at the same time. I know how you hate tramadol, I do, too, but what about 1/4 tab of tramadol or less if you can cut the pill smaller. I just remembered something else, when Chewy tore up his knee, & had the bad reaction to tramadol, I told the surgeon about this as he normally uses tramadol to control post-op pain, & sends it home. He told me that there was an alternative to tramadol that was less likely to cause a reaction like tram does. Unfortunately, I do not remember what the drug was. I do think Annie does need some type of pain meds for awhile as my eye vet told me that this is very painful/uncomfortable, & a pup can be quite miserable.

Debbie

I'll ask the vet about it tomorrow and let her talk to the vet in Omaha (eye doc). Meanwhile I'm giving her an aspirin right now. I figured if I give her a round of drops in the a.m., another over lunch, one at dinner and one at bedtime I can get in 4.

My biggest challenge is remember to give all 3 and waiting the 5-10 mins... my memory isn't all that :)

To top it all off we are expecting snow this weekend which has been my greatest fear. I did buy some Pooch Pads (arrived today) so if she has to go potty in the house cuz it's awful.. so be it.

[frijole]

I FORGOT TO TELL YOU!!!

When we were waiting to pay our bill a guy came in with a bulldog on a leash and the bulldog went after Annie biting her front leg! Luckily he yanked the dog back so it was brief. Annie didn't even yelp. I grabbed her and hugged her and it didn't appear to break the skin. He was dying of embarrassment and said his dog has issues because it was bit when it was a puppy... the other people in the waiting area and I were shocked by it all.

Annie... she didnt' appear fazed at all. Whew.

[Rene]

Kim,

I looked it up from Snoops records. It was the Atropine. It works for the pain as it slightly dlilates and paralyses the eyes to restrict movement that is causing the pain.

Is it possible the vet used it today to give Annie relief and that is why she is closing her eye and avoiding light...because she is slightly dialated?

If not and she does need pain relief for the long road...I know you said you did not want to try it because of the BP and other issues but ask the specialist how often he sees those issues with it before you cross it off the list.

Also, there was a realativly new drop that was being touted that repairs corneal ulcers that was written up in the med journals. When I asked about it to Snoops eye specalist she said she had not used it but Snoop would not have been a candidate for it anyways because surgery was a must for her. I will try to find the name of it.

Prayers and hugs,
Rene & Angel Snoopie

[Rene]

Found it. Not sure if it will be of help until the infection is cleared up though. Hopefully the eye specalist will have more info on it.

http://www.virbacvet.com/Products/Dermatology/WoundCare/REMENDCornealRepairDrops.aspx

http://www.virbacvet.com/Libraries/PDFs/VIRC-10939_Detailer-Sell_Sheet_prt.sflb.ashx

http://www.virbacvet.com/Libraries/PDFs/VIRC11256_Remend_Technical_Monograph_v2.sflb.ashx

More Prayers For Annie...& Kim.

[Harley PoMMom]

I FORGOT TO TELL YOU!!!

When we were waiting to pay our bill a guy came in with a bulldog on a leash and the bulldog went after Annie biting her front leg! Luckily he yanked the dog back so it was brief. Annie didn't even yelp. I grabbed her and hugged her and it didn't appear to break the skin. He was dying of embarrassment and said his dog has issues because it was bit when it was a puppy... the other people in the waiting area and I were shocked by it all.

Annie... she didnt' appear fazed at all. Whew.

Oh Kim,

That's awful that the man put you and Annie in that situation, since he knew his dog had issues he should of made sure that a situation like that would not of happened.

Keeping you both in my thoughts and prayers and sending huge, loving hugs, Lori

[frijole]

Found it. Not sure if it will be of help until the infection is cleared up though. Hopefully the eye specalist will have more info on it.

http://www.virbacvet.com/Products/Dermatology/WoundCare/REMENDCornealRepairDrops.aspx

http://www.virbacvet.com/Libraries/PDFs/VIRC-10939_Detailer-Sell_Sheet_prt.sflb.ashx

http://www.virbacvet.com/Libraries/PDFs/VIRC11256_Remend_Technical_Monograph_v2.sflb.ashx

More Prayers For Annie...& Kim.

Thanks... so this is for use with regular ulcers.. as in after we get her thru the crisis?

[Rene]

Snoops eye specialist was not familar with it. If you read the first link it specifies it is for accute non infected injuries. However, if you read the third link...detailed information...it mentions other conditions...including immune related corneal conditions. Hopefully you can get clairification.

[Squirt's Mom]

Hi Kim,

SO glad that bulldog didn't harm Annie! :eek: And that guy should feel badly about it. geez...how scary that had to be!

I wish I could help with the eye situation but I don't have any experience with trying to save the eyeball. But I know you will do everything you can possibly do to make this as stress-free as you can for Annie yet clear up the eye. I CAN send lots of hugs and well-wishes!

Love ya,
Leslie and the gang

[frijole]

She is better today. I was so happy to see those wide eyes both open this morning. The drops definitely cause the pain.

She went to the vets for her weekly acupuncture and they spoiled her with a medicated bath. It is so hard for me to bath her as she can't stand in the tub and I have to hold her with one hand and only have one hand to shampoo and scrub and rinse... hard to get her face and hard to reach areas.. so they treat me to these baths at least once a week... they love her :D

The specialist in Omaha does not work Fridays so my vet has a call into her. She is OK with me giving Annie tramadol but we decided there are a lot of good reasons to try baby aspirin first since it can benefit the heart and prevent strokes... so I am going that route and testing it first.

I am taking her in to the vets twice next week so they can help me keep an eye on the ulcer. We all know Annie is not a good candidate for surgery so monitoring is critical.

Thanks for the advice and the prayers. Annie sends her love back at ya.

[jmac]

Kim-
I'm so glad to hear your little sweetie's eye is doing a little better today...and glad she got a nice bath, too! I'll definitely keep you both in my thoughts and prayers. Hope that little eye gets better!

Julie & Hannah