My Annie, 15 1/2 pheochromocytoma - Annie is now an angel running free [Archive] - Canine Cushing's Information and Support Forums

Squirt's Mom

07-14-2009, 03:36 PM

Hi Kim,

Bless your hearts. :( I know you are worried sick about your sweet Annie and all I can contribute is what I know about the teeth/heart connection...which ain't much!

Decaying teeth in a human's mouth, if left unattended, will cause a lot of pain and present the very real probability of a myriad of nasty consequences in the body...including heart problems. This holds true for pups, too. I'm NOT saying the heart murmur is a result of her teeth...they can be caused by several things, or can be idiopathic. But if Annie's canines are decaying, they could lead to other heart issues on top of the murmur.

I know you don't want to remove them, but our babies' canines are designed for defense and stabbing & holding prey (or treats!). Since our companion animals don't have to hunt for their food, that purpose for those teeth is greatly lessened. If a pup is in an environment in which they aren't required to defend themselves, then that purpose, too, is diminished. If her teeth don't improve with the bi-yearly dentals, then you might want to give this more thought. Just my 2 cents worth. :o

Here is a link I found that has some good info on the canine heart and the problems it can have, including murmurs.

http://www.dogaware.com/specific.html#heart

From there I found this link that has some info on murmurs:

http://www.vetgo.com/cardio/concepts/concindx.php#sect2

You're a great mom, Kim.... Annie knows you are going to take very good care of her just as we do.

Hugs,
Leslie and the girls

SasAndYunah

07-14-2009, 04:46 PM

Hi Kim,

I have to agree with Leslie about the canine teeth. Infected gums and teeth aren't just a problem of the mouth. The heart, kidneys, intestinal tract and even joints may become infected. The tartar and any infected areas of the mouth contain a multitude of bacteria that can "spread" to other parts of the body. I would strongly advise you to have them removed. Also because with each dental cleaning done (every 6 months) she will need an anti biotics treatment to prevent the bacteria entering the bloodstream and causing more problems. If you have the canines removed and try to keep the remaining teeth as clean as possible, that will also spare her the "constant" anti biotic treatments. Do note that if you decide to have her canines removed to make sure she will start anti biotics a couple of days before the dental surgery, this is really important.

About the heart murmur, did your vet mention wich grade it was? While heart murmurs can have several causes, in older dogs it is usually because of a leaking valve.
In the case of a heart murmur, an ultrasound is the most usefull. An ultrasound exam allows visualization of the heart valves, which allows accurate confirmation that the valve is the problem and the amount of reflux blood flow through the valve is measurable which is useful information. Furthermore, an ultrasound exam can help to rule out causes of heart murmurs in which the damage to the valves is due to a cause such as cancer or bacterial infection of the heart lining that would not show up using X-rays or ECG. Cardiomyopathy is usually identifiable on ultrasound exam as well and this is an important "rule-out" in many cases of heart failure. But for such an ultrasound you would need to see a cardiologist and probably need a refferal.

X-rays are more useful in helping to determine how serious the effect of the murmur is then in assessing the type of murmur. But a vet should have a pretty good idea of what kind of murmur is present based on the type of sound it makes and the location of the sound when listening to the heart. Especially in older dogs since most of them are valve failures. Often, using X-rays to determine when the heart is enlarging and when fluid accumulation in the lungs (pulmonary oedema) is beginning to occur is enough to make treatment decisions for the dog. In many ways it is not as accurate as an ultrasound exam but accurate enough to allow successful management of the heart problems associated with murmurs in many dogs.

Having had a miniature poodle with heart murmer (due to a leaking valve indeed) I first had the ultrasound done because it gives such valuable information and after that, managed his condition through x-rays if needed.

With medication, watching his weight and diet, and watching his excercise levels, he lived another 4.5 years and passed away at the age of 16 :)

Best of luck to you and Annie,

Saskia and Yunah :)

lulusmom

07-14-2009, 05:13 PM

Hi Kim,

I don't have a lot to add because Leslie and Saskia did an excellent job of presenting my case. :D If, as you say, Annie has always had dental problems, then you may want to rethink your decision. Depending on the severity of the heart murmur some vets won't do any type of surgery. If your vet thinks Annie can handle the dental procedure now, then I wouldn't wait as their is no guarantee that the heart condition won't worsen and surgery would be a much bigger risk at that point. So her tongue may fall out of her mouth without the support of canines? Mine does that all the time. :D:D:D

frijole

07-14-2009, 05:28 PM

You guys are great. I had to make a decision before I posted about the canine teeth because she was already there and bloodwork done. I promise to do it in 6 mos. Re the chest xray vs sonogram... I will talk to him when I pick her up. So there are different "grades"? Like high, medium, low or are there names? I am so ignorant... at work and can't read the links... just sneaking this out while I can. :D

There are no IMS physicians in my entire state. Yep. Closest is a 6 hour drive each way. There is a new program where K State docs drive to Omaha monthly or so but I'm not sure of their services. I'll figure it out. This one is my youngest. :(

Thanks guys.. I'll check in later. Kim

BestBuddy

07-14-2009, 06:00 PM

Hi Kim,

Like the others have said, bad teeth are better out than in. Buddy had to have one of his canines out and it was the best thing we did, no more pain and constant cleaning to try and save it. We left it too long and it had infected and gone through the gum to the nose so we then had to deal with an oral/nasal fistula. We battled trying to save the tooth for over twelve months and when we finally had it done it was amazing how quickly he bounced back even better than before.

Jenny

Harley PoMMom

07-14-2009, 06:04 PM

Hi Kim,

Heart murmurs are classified as follows: Grade I—the lowest intensity murmur that can be heard, typically detected only while auscultation is performed in a quiet room; Grade II—a faint murmur, easily audible, and restricted to a localized area; Grade III—a murmur immediately audible when auscultation begins; Grade IV—a loud murmur immediately heard at the beginning of auscultation but not accompanied by a thrill; Grade V—a very loud murmur with a palpable thrill, the loudest murmur that is still inaudible when the stethoscope is just removed from the chest wall; or Grade VI—an extremely loud murmur that can be heard when the stethoscope is just removed from the chest wall.

This came from:
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/11203.htm

Lori

mytil

07-14-2009, 06:04 PM

Hey Kim,

Sorry I am late in the game here but I am glad they will be taken out. And I am sorry to hear about the murmur :(

Big (((((hugs))))) to Annie
Keep us posted.
T.

StarDeb55

07-14-2009, 06:39 PM

Kim, Harley has had a grade 3 murmur for the past few years. It doesn't seem to be getting worse,. He has no symptoms such as coughing or lethargy, ( I sometimes wish he was a little more lethargic!:rolleyes:;)) It has not prevented him from having dentals done.

I won't add anything about the dental, & the problems that untreated periodontal disease can cause in the rest of the body as everyone else has pretty much covered it.

debbie

frijole

07-14-2009, 09:47 PM

Update....he graded it a 3 on a scale of 1 to 5. Slight enlargement. No fluids in the lungs. Does not feel we need to treat with medicine at this time.

He used a product called ProSeal on the canines to help seal them up. I appreciate your input on the canine removal.. I had already told him to keep them for now when I posted here. I knew I could have them removed in the future but I couldn't put them back and I had to get your advice first! :( We will do it next time. I feel so sorry for the little gal. She lost 16 teeth at the age of 7... Me thinks her parents wore dentures. ;)

Dang I left with photocopies but didn't end up with the T4 test copy. 2 pills a day. He said she should feel much better after a few days on this so she must have had a solid diagnosis.. dang can't believe I don't have that.

Blood panel was all normal except for ALP which was at 233 (normal is 0-140)... said that was most likely due to the teeth.

She came running to me and had a big grin on her face so I felt much better. She may be 14 but she is my youngest... I wasn't ready for it. None of us ever are, are we?

She ate Haley's fish oil tablet tonight as well as her own and I didn't scold her. :D Thanks all. What would I do without you? Big hugs of gratitude.

Carol G

07-14-2009, 10:09 PM

Kim,

McGill had a heart murmur as did Pippin, my Basset/Terrier mix before McGill.

I don't recall what grade McGill's was but awhile ago (3+ years?), the vet thought McGill's had gotten worse. He had an ultrasound and the murmur was not causing any problems (his heart was fine).

For both, the vet told me what to watch for (same as Debbie mentioned) but neither ever had a problem.

I'm happy Annie is home and doing well.

Carol, Atty Cat and always Winnie & McGill

MiniSchnauzerMom

07-15-2009, 08:08 AM

Kim,

I'm just catching up and sorry I missed this about Annie. Talk about coincidences, Munch was just diagnosed with a heart murmur too. Think a radiograph was done on him. Can't find my paperwork at the moment (could be because it's after 4 a.m. :eek: )

Anyway I, too, was told to bring him in right away if a cough developed and how important the dental is, especially in light of the murmur. Do you brush Annie's teeth? I do brush Munch's teeth, however, the dental specialist I consulted with who Munch is going to see gave me a lecture about the importance of home care and regular brushing (I have some improving to do). We'll have to line them up in the bathroom with us every morning!

Annie will be feeling perkier once she starts her thyroid meds. I watched my friend's dog basically transform after she was treated for hypothyroid. You'll probably need to have her thyroid rechecked to insure she's getting the right dose of meds and the blood needs to be drawn 4-5 hours post pill. If she's running around like a wild and crazy kinda schnauzer at midnight, that's a "hint" she needs her dose lowered. Munch takes the meds for his hyperlipidemia but his thyroid levels have always been normal. In the beginning he was getting too much and he was the "wild and crazy midnight schnauzer".

She came running to me and had a big grin on her face so I felt much better. She may be 14 but she is my youngest... I wasn't ready for it. None of us ever are, are we?No! You can say that again.

Hope you all are resting well. That's what I need to go do myself!

Louise

forscooter

07-15-2009, 01:08 PM

Hey Kim,

I wanted to throw in the little bit of experience I had with the heart murmur issue. Scooter had what they said was a Grade 4 murmur. His chest x-ray had shown a very enlarged heart at the time. I'll spare the other details. But, they did tell me the next steps would have been an ultrasound and EKG. He would have been treated with meds that would just require monitoring like blood work and periodic EKGs. Had things been better for him, this would have been the option/treatment plan. So, basically that is, what I think, you'll be wanting.......the u/s and EKG and then medication IF needed with periodic follow-up.

We're never ready for any of it....I agree. My thoughts and best wishes go out to you and Annie. Hopefully the thyroid will also help in this regard.

Hugs, Beth, Bailey and always Scoobie

MiniSchnauzerMom

07-15-2009, 03:14 PM

Hey Kim!

Now that I've had a few hours of sleep I was able to find my itemized bill. This is my experience w/Munch and Annie's may be entirely different.

The canine cardiologist performed both a radiograph and a cardiac ultrasound, no x-ray, no ekg. No enlarged heart and no meds required. Munch has a mitral valve issue. Neither the cardilogist or IMS were very concerned about the murmur....just the Mom! They both told me not to worry (ha!). Follow-up exams will take place every 6 months. As I said before I was advised about the cough and told the importance of the dental hygiene and upkeep of that at home.

Maybe there's a possibility of your vet consulting with a canine cardiologist via phone somewhere in another state?? If it were me, I'd probably be considering the removal of those bad teeth sooner than 6 months. Like I said, I was told the upkeep of the teeth was extremely important in light of the murmur.

Louise

Harley PoMMom

09-10-2009, 01:31 PM

Hi Kim,

How's Annie doing on her Thyroid meds? Did she have any tests done to see if the dose is right for her...I don't know anything about thyroid issues, sorry for the questions. Hope everything is going well for her.

Love and hugs.
Lori

frijole

09-10-2009, 03:44 PM

Annie is doing just fine. It really pepped her up and brought her back to normal. Haven't had her numbers rechecked yet. It is funny.. she is the younger of my 2 (at 13) and since Haley started slowing down and having a hard time hearing and seeing Annie has started helping guide her along and it is so sweet to see. She still sometimes throws her jealous fits but for the most part she is being a tremendous sister. Dogs are so smart.

Thanks for checking in.
Kim

Squirt's Mom

09-10-2009, 04:08 PM

Hi Kim,

Good news on Annie! :D Regardless of the numbers, tho I know they need to be checked, it sounds like the meds have really helped. When something is working, we moms and dads can tell just by the way they act and it is so heart-warming and up-lifting to see them returning.

Annie has started helping guide her along and it is so sweet to see.

Syra, a Shepherd, was my deaf and blind Dane's guide like Annie for Haley. They got so good together if you didn't know about her, you would think Dinah could see and hear normally. But they nearly killed each other the first week Dinah was home :eek: ...it was really great to see them work things out and become a team. :)

Hugs,
Leslie and the girls

Harley PoMMom

09-10-2009, 04:11 PM

So happy to see that Annie and Haley are both doing so well and it warms my heart too that Annie is so sensitive to her sisters needs. Our pups are so precious, they amaze me in so many ways.

Love and hugs.
Lori

MiniSchnauzerMom

09-10-2009, 06:43 PM

Kim,

Good to read that Annie and Haley are both doing well. Glad the thyroid meds have done the trick for Annie. I know I'm repeating myself here but I definitely suggest that Annie have her thyroid level checked again to make sure she's in the right range and that her meds don't need any adjusting, either up or down. You really won't know what's what until that's checked. Munch was feeling "mighty fine" on his thyroid meds and his level was almost double the high end :eek: :eek: and the meds had to be immediately lowered.

Louise

frijole

04-08-2010, 02:33 PM

Looks like I am going to have to change the thread title and move it to cushings... Did the LDDS test on her:

3.3 resting
.8 at 4 hrs
3.9 at 8 hrs

I am at work so haven't confirmed using the charts but the vet says it is pituitary.

Interesting he also called the pathologist at the lab and spoke to him. Said the guy is a board certified IMS. Lab guy said since she has no symptoms (water drinking) he would not treat yet. I told him I would schedule an ACTH to see where the cortisol levels are before deciding and reminded him that Haley NEVER had an issue with water drinking.

Annie's last blood panel was 30 days ago and her ALT levels are normal. Her ALK had gone to 438 from 220 in 6 months.

Her symptoms are ravenous appetite (I bet her thyroidism is a result of cushings), totally huge belly, licks her legs (not raw or saw but frequently), can't jump on sofa, and she has a heart murmur.

So I join the ranks of members with dualing cush dogs. Couldn't be in better company though it is exhausting to think of loading again. Hugs to all, Kim

zoesmom

04-08-2010, 02:44 PM

forscooter

04-08-2010, 02:53 PM

Sending big huge hugs Kim!!!!

I feel your pain, but as Sue said, it's a good thing for Annie that she has YOU to take care of her....but I understand the :eek: involved here too!

Lots of hugs and love, Beth

Harley PoMMom

04-08-2010, 03:09 PM

More hugs being sent your way, my friend. :eek::eek::) And like the others have said, she is so very lucky to have such a very experienced and cushy-savy parent that loves her. Oh...and us too!

Love and hugs,
Lori

bkdice

04-08-2010, 04:25 PM

I imagine the freak out factor is much less when you have a second (or third or fourth or.....) with cushings. Though, I also imagine it's still emotionally draining. Wish you and Annie the best for your journey. And you're right that you could not be in better company. :)

BestBuddy

04-08-2010, 07:16 PM

Kim,

Wow, so you are going for number 2 cush dog. It doesn't seem fair. Before Bud I hadn't heard of cushings and now there are so many out there and like you some with more than one.:eek: I feel sorry that you have to go through it ll again but for Annie I just feel luck because she really has the right person looking out for her.

Jenny

sunimist

04-08-2010, 10:46 PM

What a bummer Kim. Sorry to hear about Annie but know she has the perfect mom to pave the way for her. Also lots of aunties and uncles for love and support.

Prayers going up for our Annie girl and mom.

Lots of love and many hugs,

Shelba and Suni

frijole

04-08-2010, 10:58 PM

Thanks guys. :( Am trying to remember how to do an avatar. Also my scanner has been on the fritz and am trying to figure that out too... so hopefully I can find a nice shot of the 2 of them to put up.

PS... and to top it off my laptop where my photos are housed just wigged out on me. It won't reboot. I can't turn it off. LORD.

frijole

04-08-2010, 11:06 PM

Oh nooooo, Kim. Sorry to hear that. But at least you've got the experience under your belt now. Granted . . . . Not exactly the kind of experience any of us would have signed up for but good for Annie, anyway. A lab tech who's a BC IMS??? Wonder how that happens! You'd think he'd stick with the higher paying work. But maybe not??:confused: Sue
Sue, beats me. I wrote it down. He said the guy was a pathologist at the lab who was a bd certified IMS. To be honest my vet thought I was nuts for testing her. He wasn't concerned with the 440 alk phos but I kept pushing the symptoms. So I think he was a bit shocked and wanted an opinion on whether or not to recommend treating. Given that there are false positives on the ldds I feel the need to test the cortisol via acth test.

Poor gal made it onto the sofa after several sad attempts tonight. She is a "tall" skinny nimble schnauzer ... only a cush parent knows how sad this is.

lulusmom

04-08-2010, 11:15 PM

Sounds like you've got all the bases covered but then again, you know the drill. Welcome to the multi cushdog club.

Casey's Mom

04-08-2010, 11:19 PM

Hi Kim, poor you two cush pups!:confused::confused: If it were me I would be a lot less worried with number two because of the knowledge here and your own experience.

Hopefully Annie will be jumping back up on the couch in no time.

Love and hugs,

frijole

04-08-2010, 11:38 PM

Sounds like you've got all the bases covered but then again, you know the drill. Welcome to the multi cushdog club.

Is there a frequent buyers club for lysodren? Or some special status somewhere? :p:p:p:p:p

So who all here has or has had multiple cush dogs?

Glynda, Beth... trying to remember... I recall someone having 3 and that would make me suicidal. ha.

lulusmom

04-09-2010, 09:36 AM

Kim, I've never gotten a volume discount but that doesn't mean you can't find one if you take the time to call around.....and I'm serious. The one thing you should remember, especially if and when you load, is to ask your vet if he is familiar with using just 5mcg per kg for doing the acth stim. A lot of vets use the entire vial of cortrosyn, for which you pay dearly. With Annie's size, you should get several stims out of one vial.

My two are due for stims and I have found an IMS down the street from me. When I get back home, I'm going to interview the IMS and ask about a volume discount on stims....and I'm serious.

gpgscott

04-09-2010, 12:42 PM

Kim,

Sorry about Annie and the diagnosis.

The costs really are criminal, I can't believe either cortrosyn or Lysodren are really that costly to produce.

Wishing for a successful treatment.

Scott

Carol G

04-09-2010, 01:46 PM

Kim, I'm sorry to hear this but you have all the skills to handle this for sure.

On the IM lab tech, I remember years ago an IM that was at different clinics different days of the week also worked for a lab reviewing test results and offering treatment recommendations -- I think it was a way to make extra income part time.

On the stim tests, the specialty hospital where I took Winnie & McGill charged based on the weight of the dog/amount of cortrosyn used. So I paid a different amount for each. The stim tests there were cheaper than at my regular vet.

I think Glynda is right about asking for a discount. A guy I know hardly ever pays full price for anything. He always asks for discounts and nearly always gets them -- even at Macy's. You have the perfect lead in with two dogs needing the same testing.

I've had three cush pups but only two at once. Plus McGill was atypical and wasn't treated with lysodren so maybe that just counts as 1-3/4 or something.

Sorry about the computer problems -- so frustrating.

Carol

jrepac

04-09-2010, 02:16 PM

2 at the same time? Wow..what a bummer. But, you've got the experience. I've had 2 in succession, but many years apart, thankfully.

re: lyso pricing, like anything else, shop around. Walmart has pretty fair prices I think..The exact same prescription for selegiline cost me $118 at Walmart when Walgreen's wanted $272...and when I say "exact same", it was the very same generic manufacturer. Drug pricing is nuts out there!

Jeff

Franklin'sMum

04-12-2010, 09:18 PM

Hi Kim,

Sorry to hear about Annie's diagnosis :( But she is a very lucky girl. You have the skills and experience of Cushings with Haley. Sure, all pups are different, I get that, but you know Annie best and you're in a great position of not having to start learning about Cushings RIGHT NOW as you go 'coz you already have that knowledge :).

Wishing you the best of luck on your new journey with Annie.

PS- Maybe ask for something like pay for 5 prescriptions, get the 6th free or half price loyalty rewards type thing ;) just a thought.

Hugs,
Jane, Franklin and Bailey xxx
________
WASHINGTON MARIJUANA DISPENSARIES (http://washington.dispensaries.org/)

frijole

04-26-2010, 08:43 PM

I really wanted to hold off on this for two more weeks til I am thru with my busy season at work but this past week she started peeing in the house. Water consumption is NORMAL. Her pee is yellow. She also has lost strength in back legs. Jumped out my SUV (high seats) onto concrete garage floor and ALL FOUR LEGS GAVE OUT - FLAT LIKE A PANCAKE. :eek:

I want to confirm the ldds cushings diagnosis by doing an acth test tomorrow. I have some questions as her case is not the same as Haleys'.

1. If she has elevated cortisol on the ACTH to indicate cushings is the dx safe? I ask because she is able to concentrate her urine.

I worry that it might be her thyroid that isn't under control. Let me give you all I got history wise...

Jan 2009 her ALP was 233 (she had infection at time)

July 2009 due to her crazy appetite, lethargy and round belly I had her retested. They diagnosed her as hypothyroid & indicated a heart murmur. T4=0,7 ug/dl. The ALP data is not in my records dang it. Hemotology:

LYM is low 0.7 (1.2-5 is normal)
MPV (platelet) is high 10.2 (6.1-10.1 is normal)

Feb 2010 - dental cleaning did another blood panel and her ALP has increased to 433 (0-140 normal) ALT is 86 within range

Total Protein is High 7.6 (5.5-7.5 is normal)
LYM is low 0.9 (normal is 1.2-5)
MCHC (erythrocyte data) is high 39.3 (32-38 is normal)
PLT high 501 (200-500 normal)

April 5 2010 I took her in because she was so lethargic over the weekend I worried she was breathing still. I assumed he'd do a blood panel but he didn't since we had done one in Feb.

I collected 3 days worth of urine for the UC:CR... but I got a $24 "urinanalysis" that says the following:

color: yellow (I knew that! ha.... it was bright yellow fyi)
PH 7
Proteins +++ (not sure what this means)
SG 1030
WBCs rare
Bacteria (cannot read writing looks like Debrie Rare Bact)?

He also did a full exam and phoned to say she looked fine & give me the urine results. I asked if he had not done the UC:CR test and he said no and something about calling the lab to find out how cost prohibitive it is???? At that point there was no urine to test anyway so I instructed him to do the ldds test because of the signs.

Results: 3.3, 0.8, 3.9 = pituitary

His recommendation was to do nothing.

My concern is that she is concentrating her urine still, her appetite is usually like a cush dogs but there are times (comes and goes) where she won't eat at all. I used to think it was her teeth but this time she had just had them cleaned.

In the last week big changes with urination in the house. Stumbling up my patio steps and there are only 2. Most important is her total body trembling. This is not like Haley's hind leg tremors. It is her whole body - I can feel the bed shaking when I wake up in the am. It comes and goes.

She is still lethargic, her tummy looks ready to burst (she is normally skinny), she still licks her front legs off and on - but it isn't raw and I can't see sores.

I want to make sure she has cushings before giving her lysodren and find out if there is anything besides the acth test that i should have done. I will ask about a sonogram... I did that in the past too and I got a chest exray...I'm not sure they have a machine? Is this weird? The town is about 24,000 people and it is one of the largest clinics in town.. fyi...???..

I think this is the whole picture. Thank you!!! Kim

gpgscott

04-26-2010, 09:05 PM

Harley PoMMom

04-26-2010, 09:13 PM

Proteins +++ (not sure what this means)This means she is losing protein in her urine (Proteinuria) .

Poor Annie and poor you. :( I believe I would definitely get an ultrasound done if you can.

Harley licks his front legs sometimes and if he's on the bed he even licks the bed-comforter, this is a sign to me that he is uncomfortable, and I give him his tramadol.

Wishing you and Annie the best, Kim.

Love and hugs,
Lori

Nathalie

04-26-2010, 09:20 PM

Hi Kim,

I am sorry that your Annie is not doing well. :(
How much thyroid replacement is she taking and when did you last check thyroid function? What was the result(s)?

Nathalie

frijole

04-26-2010, 09:21 PM

Kim,

You have a positive LDDS, right?

And she is peeing in the house, and has not done so previously.

She is peeing because she has to, and if you are not leaving her for long periods of time the peeing is a concern.

I think the Dr. is suggesting no treatment based on her age.

Lignans, and melatonin can't hurt. And maybe a maint dose of Lysodren.

Scott
I wasn't clear - sorry. No he said it is cushings but because she didn't have any symptoms not to treat. At that time she wasn't peeing in the house. 14 is young Scott! ;)

Trust me, if the cortisol comes in high he will let me treat. My concern is not treating it - it is I want to be sure it is cushings.

frijole

04-26-2010, 09:23 PM

This means she is losing protein in her urine (Proteinuria) .

Poor Annie and poor you. :( I believe I would definitely get an ultrasound done if you can.

Harley licks his front legs sometimes and if he's on the bed he even licks the bed-comforter, this is a sign to me that he is uncomfortable, and I give him his tramadol.

Wishing you and Annie the best, Kim.

Love and hugs,
LoriThanks for that Lori! I remember now him mentioning that but saying it was not a significant amount and nothing to worry about.

frijole

04-26-2010, 09:31 PM

Hi Kim,

I am sorry that your Annie is not doing well. :(
How much thyroid replacement is she taking and when did you last check thyroid function? What was the result(s)?

Nathalie

Thanks for responding because you have a good handle on thyroids! :p She is taking one pill .2 mg Nutrived brand thyroxine in the morning and at night. He did the T4 when she was dx-ed. I had asked for a full thyroid panel but he did the "in house test" instead. No free T was done.

He thinks I am nuts for all the testing I do - he doesn't feel it is necessary to retest so long as the dog seems to feel OK. She did for a couple months but those symptoms returned along with the cushings like symptoms.

Thanks to you I now wait til 2 hrs post eating to give them both (yep both dogs) their Nutrived... no one mentioned it til I read your posts helping someone else.

If it is cushings I want to make sure the hypothyroidism isn't just because of that. I also want to make sure something else isn't causing the cushings like symptoms and a false positive on the ldds.

Maybe I am over worried but... that is just me. Love my girls. Kim

forscooter

04-26-2010, 09:48 PM

Hey Kim,

I am wondering if it isn't Cushing's directly at all. I mean I know she has the positive LDDS but I am wondering if the symptoms aren't that but pain...maybe from a UTI? With the bacteria in her urine and the WBCs, was she put on an antibiotic at that time?

I am asking bc Scoobie had some really bad UTIs....very painful. The shaking or trembling you see could be pain-related. The apparent weakness may be more pain, like cramping and "I can't stand up"? So would the lack of appetite. So would bloating. He always felt pretty yucky with bad UTIs and it seemed to affect everything.

So the first thought I had was does she have a full-blown UTI now...and if not, I think my next step would be the ultrasound if you can swing it bc maybe something is up with the GI tract?

Sending lots of love and prayers and hugs, Beth

Nathalie

04-26-2010, 10:09 PM

Thanks for responding because you have a good handle on thyroids! She is taking one pill .2 mg Nutrived brand thyroxine in the morning and at night. He did the T4 when she was dx-ed. I had asked for a full thyroid panel but he did the "in house test" instead. No free T was done.

That would be an appropriate starting dose for a 20-30 lbs dog.

He thinks I am nuts for all the testing I do - he doesn't feel it is necessary to retest so long as the dog seems to feel OK. She did for a couple months but those symptoms returned along with the cushings like symptoms.

The way I look at it, it is your money and some conditions don’t manifest itself symptomatically before major/irreversible damage has been done. Phillip’s vet suggested a couple of times to just wait until he becomes symptomatic again before testing – I don’t think so.

Thanks to you I now wait til 2 hrs post eating to give them both (yep both dogs) their Nutrived... no one mentioned it til I read your posts helping someone else.

That makes my day! I like to be of use.:)

If it is cushings I want to make sure the hypothyroidism isn't just because of that. I also want to make sure something else isn't causing the cushings like symptoms and a false positive on the ldds.

Here is how I look at it … 14 years is not geriatric by any means but if she is hypothyroid it makes her feel lousy and there is no harm done in supplementing at the correct dose regardless if it is due to cushings or true hypothyroidism. If you start treating for cushings you can always down the road revisit whether or not to take her off thyroxine.
Once taken off the thyroxine it will take 6-8 weeks for thyroid function to return to what it was before starting the supplementation, whether it was low or adequate.

You need to find out if 0.2 mg is an adequate dose by running a Free T4, 4-6 hours after pilling in am. The Free T4 is more specific as it will tell you how the body utilizes the thyroxine.

Maybe I am over worried but... that is just me. Love my girls. Kim

Just checked Phillips thyroid panel and just to give you an idea of the values we are looking for for a dog that is NOT on supplementation ..

Geriatric Optimal Levels
T4 1.20 – 3.00 mg/dL FT4 0.70 - 2.00 ng/dL
T3 40 – 70 ng/dL FT3 1.6 - 3.5 pg/mL

Best Wishes,
Nathalie

littleone1

04-26-2010, 10:42 PM

Hi Kim,

I wish I could give you some helpful advice.

I know that when Corky started having accidents in the house, it was a combination of 2 UTIs and Cushings. When his thyroid was on the low side, he had started shaking and trembling. I don't anything about the thyroid medication you're using, as Corky is on Soloxine.

I hope you will be able to find out what's going on very soon.

frijole

04-26-2010, 10:56 PM

Thanks Nat! I did notice on the computer printout with the T4 results it did at least say "Dog over 8 yrs" so they did some form of calculation. :p

Just checked Phillips thyroid panel and just to give you an idea of the values we are looking for for a dog that is NOT on supplementation ..

Geriatric Optimal Levels
T4 1.20 – 3.00 mg/dL FT4 0.70 - 2.00 ng/dL
T3 40 – 70 ng/dL FT3 1.6 - 3.5 pg/mL

Best Wishes,
Nathalie

frijole

04-26-2010, 10:59 PM

frijole

04-29-2010, 10:27 AM

Now I am really worried. ACTH results:

Pre 17.2
Post 30.9

What is up with that pre? I know she gets stressed but could this mean something else is going on? Thanks.

gpgscott

04-29-2010, 07:58 PM

Kim,

Wow, the stim numbers are strange high.

You said she has an extreme heart murmur. These are usually valves not operating properly. I wonder if this could be the cause of the elevated baseline cortisol.

Scott

frijole

04-29-2010, 08:14 PM

Well she is going to be a treat to load since she doesn't have excessive water intake and she sometimes leaves food and doesn't eat. Then she hordes it down later. I bought a bunch of canned food in hopes that she will inhale it more consistently.

Harley PoMMom

04-29-2010, 08:24 PM

Well she is going to be a treat to load since she doesn't have excessive water intake and she sometimes leads food and doesn't eat.Oh doesn't this sound like my boy!! They can't make it easy can they? :eek: Our poor pups. We are here for you, Kim!!!...Does this mean poop patrol?

Love and hugs,
Lori

Nathalie

04-29-2010, 09:07 PM

Just a thought ... to make Annie's appetite more reliable and discourage her from hoarding, how about feeding her just a bit less each meal to increase her appetite, starting a few days before you start loading.

Nathalie

frijole

05-01-2010, 07:29 PM

OK... let the games begin. Annie took her first lysodren just now. Seemed really weird to give it to them both. I gotta be real careful since Haley is on 2 x Annie's dosage.

We are starting Annie on 250 mgs since she is 15 lbs. Pretty sure she'll load faster than Haley. :D (it was a 4 month process)

Nathalie

05-04-2010, 07:07 PM

Hi Kim,

I was just wondering how you and Annie are making out so far?

Cheers,
Nathalie

frijole

05-05-2010, 12:56 AM

Sorry was out of town this evening and just got home. So far so good. No signs of loading yet. Thanks for asking! Hope all is well with you and Phillip. k

frijole

05-06-2010, 07:54 PM

The guessing game has begun. Tonight is 5 days into load at 36 mgs/kg and Annie just ate all the canned food and left about 1/2 of the kibble... this is something she has done in the past. I will skip the lysodren tonight and see what she does in the morning. Figures she'd do it tonight since getting in for an acth test on Saturday could be a challenge. Dang dog.

No other changes. Will check out the poop for sure! Love it! ha. ;)

Harley PoMMom

05-06-2010, 08:09 PM

Oh Kim,

So sorry...definitely let us know what the poop tells ya!

By the way, been meaning to tell ya, just love your new avatar, your girls are so precious!

Love and hugs,
Lori

frijole

05-06-2010, 08:13 PM

Thanks... I have had issues with my scanner and digital camera ever since I "removed" Norton antivirus a couple years ago so I just totally avoid anything to do with photos... I felt I owed it to Annie to have her represented here along with Haley so I took the extra time to get it done. ha. Thanks.

frijole

05-07-2010, 08:43 PM

Wish there was an at home test for cortisol. :p

Last night she didn't eat all food like she has since loading started. She left some and then within 30 mins ate the rest. She also was totally begging for my food. Poop fine.

This morning she gobbled everything like normal so I wanted to give her more lysodren but decided I'd rather commence it when I was home to watch her. So I didn't give her any this a.m.

So tonight she left food and still didn't finish it. (she has done this before. she eats the canned and leaves the kibble) Poop normal.

I'll call to set up a test but am sure they won't do it on a Saturday. That means they'd do it Monday which is 3 1/2 days since the last dose. Not good.

Thats the update.

MiniSchnauzerMom

05-07-2010, 09:37 PM

gpgscott

05-07-2010, 10:04 PM

Kim,

So, the little one is giving you fits eh!

If anyone can smell a loading, it is you.

Hope it is soon.

Scott

frijole

05-07-2010, 11:46 PM

Hope somehow they will run the test for you on Sat. but if not, better safe than sorry! Who knows...maybe Annie has decided she wants to compete with Haley for the record. :D

Your new avatar is just great and the girls look soooooo cute! Glad you managed to get the new pic.

Louise

Louise bite your tongue!!!!! Annie only went 5 days on loading so far. That would be a wonderful record for me. Haley went almost 75! That doesn't count the time off in between when we did the tests and waited for results... all told it took her 4 months to load.

That's part of why I am being so conservative.. I'm so used to high doses I gotta be careful. :o Yes, hopefully there will be someone to do a stim tomorrow... we shall see.

Nathalie

05-09-2010, 08:02 AM

Sorry Kim, just catching up ..

Hope this is 'it' and Annie is loaded.

Cheers,
Nathalie

Franklin'sMum

05-09-2010, 11:09 AM

Hi Kim,
Just wanted to wish you luck. Sending good thoughts your way.
Jane, Franklin and Bailey xxx
________
Blonde Girl Live (http://www.girlcamfriend.com/webcam/blonde-girls/)

Squirt's Mom

05-09-2010, 01:58 PM

Hey Kim,

Just a note to let you know I am with you in spirit. Hope Annie is loaded and ya'll are on your way to better days ahead!

Hugs,
Leslie and the girls - always

frijole

05-09-2010, 02:41 PM

Thanks all. I am suspecting that Annie is not loaded. I just came home from Mothers Day brunch and Annie was on the floor. She really struggled to get up and there was urination on the rug where she was laying. She was hopping on 3 legs to the door to go outside to the bathroom. She continued on 3 legs in the back yard. (I carried her down the steps) This was a leg weakness/pain thing and not a cortisol too low thing. She literally drags herself up off the floor to get up. That had gone away while using lysodren.

She hasn't had any since Thurs a.m. and I see the difference again. Thus I suspect she is not loaded or even close. I won't get lab results til Tues/Wed either so I might slip her a couple lysodren just so I don't lose progress... Poor thing.

Harley PoMMom

05-09-2010, 04:56 PM

Oh Kim,

Poor Annie :( Hoping she is feeling better soon.

And as Scott has aptly said "If anyone can smell a loading, it is you." So I'm sending you and Annie tons of well wishes, hugs, and hopefully soon she will be loaded.

Love and hugs,
Lori

littleone1

05-09-2010, 06:50 PM

You are really going through so much with your furbabies right now, Kim.

Sending positive thoughts and prayers that both Annie and Haley are soon back to their normal selves.

frijole

05-11-2010, 03:25 PM

As I suspected... not loaded... not even CLOSE. I don't know how I will monitor her since she doesn't drink more than a cup of water a day.

at diagnosis:
resting 17.2 and post 30.9

after 4 1/2 days loading:
resting 9.6 and post 24.6

Back to the lysodren and full time poop patrol.

acushdogsmom

05-11-2010, 07:27 PM

Well, the cortisol is coming down, at least. :) And you probably haven't lost any ground while holding back on the Lysodren because remember, the effect of the daily loading doses being given one day after the other is cumulative. It has already eroded away some of the adrenal cortex, as you can see by the numbers coming down, just not enough yet.

If my memory serves me correctly, the average time for loading any dog is about a week, so at the fairly conservative dose that she's on (I think it works out to about 36 mg/kg/day?) it may take a little while longer to get her fully loaded, but there's no reason at all to think that it will take anywhere near as long as it took to load Haley.

As for knowing when Annie may be loaded, hopefully she'll give you a nice clear sign and just refuse to eat breakfast one morning and then also refuse any other yummy favourite foods/treats that you can try to tempt her with. If she gives no sign at all of being loaded, maybe you should do another stim in about a week or so from now?

frijole

05-11-2010, 09:52 PM

frijole

05-17-2010, 12:04 AM

Annie just vomited her food all up. :( She is eating it again. I noticed there was lots of grass in it. I mowed today.

So I am thinking it isn't because she is loaded but her stomach is upset...guess she'll get some pepcid ac too. Doling out meds here is starting to get so complicated trying to remember who gets lysodren, what is in what pill pocket etc.

I'll watch the appetite before giving any more lysodren. She is on day 5 of the 2nd round. She was at 25 last acth.

gpgscott

05-17-2010, 09:46 AM

Wow the number is still way up there isn't it Kim.

Does sound like tummy upset with the part about eating grass until she vomits.

Continuing to think about you both.

Scott

frijole

05-23-2010, 01:23 PM

I failed to post on Friday that I took Annie in for a 9 day acth test (9 days after previous 5 days). I did it because I worry about lack of warning signs with her and wanted to see how much progress or lack thereof we have had.

To be honest her hunger seems to have increased this last week so I am not betting on her being loaded. I am thinking she is going to need to be increased to 3/4 of a pill which puts her at 50 mgs/kg.

Harley PoMMom

05-23-2010, 01:40 PM

Are you still giving Annie the Pepcid on a regular basis? If so, maybe this is why her food consumption has gone up...her tummy is settling down and she feels like eating more...Just a thought.

The stim test will show what's going on.

Hoping for good results with the stim.

Love and (((hugs)))
Lori

frijole

05-23-2010, 04:51 PM

frijole

05-23-2010, 04:55 PM

Oh lord... advice please. Annie is crying for Haley. At first she didn't seem affected...but she keeps going to all the doors. I let her outside and she just looks around and comes back in. When I leave and come back home/in she goes to the door to look for Haley. And then she makes the saddest crying sound.

I know to give her alot of attention. Any other advice? I got Annie when she was one - she had been abused. So she has always been a mommy's girl. My heart breaks for her. Thanks.

StarDeb55

05-23-2010, 05:04 PM

frijole

05-23-2010, 05:06 PM

Kim, the one thought that comes to mind is do you have one of Haley's toys or perhaps a blanket that would still have her scent. With Annie being able to smell Haley's scent, maybe that will provide her a little comfort.

Debbie

I will try that now. I left Haley's bed in its spot thinking maybe she'd hop in it but she hasn't. She used to all the time.

SasAndYunah

05-23-2010, 05:28 PM

Kim,

The best thing you can do for Annie is to keep the "old" routines that she and Haley shared, like perhaps dinnertime and walks. But at the same time to develop some new routines... Try to keep the routines as steady as you can, certainly at first.

So for example, if Annie and Haley ate dinner at 5 in the afternoon, keep feeding Annie at that same time...that's a routine she is used to. But on the other hand (for example) if you return home and the routine was to play some with both of them...change that into a new routine like going for a walk. By keeping "important" routines (times) the same, that will give Annie some security that certain things do continue. But by creating also some new routines, you will distract her and give her something else to focus on.

I hope I explained this clearly... If not, just whistle and I will try and do better.

Saskia and Yunah.

frijole

05-23-2010, 05:37 PM

Deb - I put Haley's blanket out and put a bunch of toys on it and she went right over to sniff and then laid down. Very touching.

Sas & Yunah - good advice on routine yet switch it up. I was thinking about how bonkers she is going to be tomorrow when she is alone in the house. Even though they were separated (Haley was in the sunroom while Annie roamed loose) she knew her buddie was right there. Maybe my neighbor buddy (11 yrs old) can take her out or over to his house for a bit to break it up.

When I moved from FL back to NE Annie got very sick - all nerves. So she likes things to stay somewhat the same. Whew.

SasAndYunah

05-23-2010, 06:05 PM

Forgot to mention a very important thing, especially after reading your reply... If Annie acts nervous/restless, don't go talk to her like "Ohhhh poor Annie, do you miss your buddie..?" Phrases like that are natyrally said with a tone of voice that will only "stimulate/encourage/reward" that behaviour. And we don't want that to happen. The best thing for Annie is to ignore that behaviour and instead try to distract her with a walk, a game of fetch or whatever else she would normally enjoy. When inviting a dog for something "fun" our voices are naturally more upbeat. Wether your neighbour 11-year old, can come tomorrow or not, don't make leaving a big deal. Annie will sense it so leave as you normally would (however difficult that might be, I understand that) If the 11 year old is coming, be aware that this could create a "new habbit" for Annie. In other words, she might come to connect this new situation of her being by herself, with visits from the 11 year old. In this situation, I would not start with "preventative meassures" beforehand. At least, not ones that would be hard to keep up... if Annie becomes dependant on them. You could try and leave a special toy (a kibble-cube for example) when you leave. This will give Annie something to do and to keep her occupied, so less time for being stressed. So if it were me, I would start by letting her stay alone (no visitors/company) because that is what you want her to be able to do...with the help perhaps of the beforementioned kibble-cube.

Will be thinking of both you and Annie tomorrow,

Saskia and Yunah.

frijole

05-23-2010, 06:19 PM

I failed to mention - the 11 yr old comes over every day after school to let them/her out. So was thinking if he came yet took her over to his yard or something might be a change. Got your message though.

Laughing at the kibble cube. I thought that sounded like such a great thing and bought them for both girls.. neither one ever touched them. Given their love for food it was surprising. Not sure if I still have them but I'll check.

Harley PoMMom

05-23-2010, 06:20 PM

Oh Kim,

Poor, sweet Annie...I am so thankful that Saskia is here to give you very good advice on how to comfort Annie. Will be keeping you both in my thoughts and prayers. Give Annie some gentle hugs from Harley and me.

Love and (((hugs)))
Lori

SasAndYunah

05-23-2010, 06:42 PM

Well, you could stuff a kong with some pate or something else and put it in the freezer. You can give her the frozen kong when you leave, that will keep her busy for a while as well :) And, by the way, dogs need to be taught how to play with/use the kibble-cube... So perhaps, if you still can find one, that could be a "new routine" for you and Annie...to play with the kibble cube together :)

Aha, so the 11 year old is already part of a very familiar routine for Annie....in that case, keep it up :) It will be higly positive for Annie that she sees that eventhough there was a huge change in her life, life still continues as it normally did. Not sure if the 11 year old had a routine with the girls but perhaps he can start a new routine with Annie. (11 year old shows up as normal = comforting/reassuring. But instead of doing what he always used to do with both girls, he now does something different with Annie = distracting Annie from the fact that eventhough the 11 year old shows up, there is a difference)

Best wishes and hugs,

Saskia and Yunah.

gpgscott

05-23-2010, 08:21 PM

Kim,

When we lost Moria recently I was very concerned about the others.

In our case it turns out the animals really don't seem to notice.

In fact they are less stressed. They have been looking for her I think but the household is doing well.

I hope it is the same with you and Annie.

Scott

frijole

05-24-2010, 07:55 PM

Annie continues to cry out for Haley and is extremely down. Last night I actually checked for a pulse as she looked dead the way she was laying on the bed. I hid my tears in Haley's blanket.

Meanwhile the vet called today and as I suspected - Annie isn't even CLOSE to loaded - 19!

So here is a summary:
4/28 17.2/30.9 at diagnosis
5 days at 250 mgs (35 mgs/kg) she stopped eating all her food
5/8 test 9.6/24.64

continued at same dose 250 mgs daily due to eating issues for 10 days

5/21 test 13/19 (he didn't give me exact nos.)

He wanted to know if I wanted to switch to trilo. I am betting he doesn't even know that you have a 30 day wash out. I told him I wanted to up her dose to 3/4 of a pill or 325 which will be at the 50 mgs/kg level first.

Please tell me if you think I am right or wrong on this. My thought is Annie loses total control over her legs when her levels are high and it is the scariest thing I have ever seen. Right now I don't want to put her thru any more misery than I have to.

Thoughts?

Oh and he informed me my little bro brought his schnauzer in for testing today and it has diabetes. (my mom's dog does too) I told him we were a regular annuity program for him. He didn't laugh. :confused:

Annie just chowed on her food. Going to check with the neighbor kid to ask how she was when he stopped in today.

StarDeb55

05-24-2010, 08:12 PM

zoesmom

05-24-2010, 08:25 PM

Wow, Kim. Those numbers ARE coming down slowly. Shades of sweet angel Haley, I guess. (Were they blood-related?) I wonder if the fact that's she's so obviously missing Haley will also have an impact on her cortisol levels. So . . . anyway, I'm thinking your plan makes sense. Really, kiddo, I'd say stick with what you know . . . and that be lysodren. You know all too well what you're doing and what to watch for . At the same time, I'm sure you're anxious for Annie to get some relief from that raging cortisol, and sooner rather than later. Hang in there. Saskia had some good suggestions for how to handle Annie's grieving. Wish there were some tricks for us on how to handle our own. :( Hugs. Sue

frijole

05-24-2010, 10:58 PM

Kim, right now, I agree that you need to stick with the lysodren, but just up the dose. Look at the positive, Annie has made progress as this is about a 35% drop in her cortisol. Right now, I don't think either of you need to take on any more stress by trying to switch to trilo, & watch Annie suffer through that 30 day washout, just my opinion.

By the way, what is it with Schnauzers & diabetes? Guess, I won't be getting one, just like I will never get a Golden Retriever as Barkley's oncologist told me that something like 75% of the dogs they treat for lymphoma are Goldens.

DebbieNo kidding! Alison suggested overbreeding and I have to also wonder about diet... companies pack all that crap to save money and I think it ends up hurting the animals. Yes, very prone to diabetes and cushings. I told my vet today I would never have another one - not financial issues just the stress of it.

frijole

05-24-2010, 11:04 PM

Sue, yes shades of Haley... what is the likelihood of having two dogs, UNRELATED that have cushings AND are hard to regulate? Sigh. I don't care. My focus is on making this gal feel great again and I will eat fire, walk on glass or chew out my vet if I have to to get there! :eek::D;):o

Took Miss Annie over to the neighbor, Matt to see how she was today and he said she was all smiles. I gave him a nice "tip" and a thank you note for being such a pal to Haley. He took Miss A for a walk and she liked that. She seemed much happier so I was major league relieved. She is snoozing now - I upped her lysodren dose.

Fingers crossed that she is adjusting to life without her soulmate. When the vet told me she was at 19 I just burst out crying at my desk. Of all people to "get it" that dogs are different - that'd be me but damn I was hoping to get a break.

Anyhooooo like I said... my mission right now is Operation make Annie better and happy. Hugs to all for your support. Kim

acushdogsmom

05-24-2010, 11:13 PM

Kim, I know it's frustrating, but it's quite likely that the low loading dose is what is making the loading take so long. I really think that upping the loading dose to 50 mg/kg/day will do the trick. Lysodren is what you know how to work with, and you certainly shouldn't be giving up on the Lysodren before even giving it at the dose most often recommended by Internal Med Specialists. (50 mg/kg/day)

And after you get her loaded, you might also want to consider maintaining her at 50 mg/kg/week, since she doesn't seem to be overly sensitive to the Lysodren and so that she doesn't backslide and lose the loading.

Hang in there.

Extra big (((hugs))) for you and Annie tonight. :)

frijole

05-24-2010, 11:22 PM

littleone1

05-24-2010, 11:47 PM

Hi Kim,

I wish I could offer some advice about the Lyso dosage, but since Corky is being treated with Trilo, I really don't know what's best about the Lyso dosage.

frijole

05-24-2010, 11:55 PM

Hi Kim,

I wish I could offer some advice about the Lyso dosage, but since Corky is being treated with Trilo, I really don't know what's best about the Lyso dosage.

You are so sweet. There are 2 schools of thought - depending on the specialist and the range is 25 to 50 mgs per kg of weight. I am a believer in starting HIGH with lysodren because it is just stressful to go thru this (my 2nd time). I went with the lower dose this time because my dog is hard to monitor because her hunger comes and goes. I felt it was safer... come to find out... I should have gone with my belief, which is what Cushymom said... is 50 mgs per kg.

So I am increasing her. I just wanted to make sure that I wasn't too quick with my decision based on my experience with my other dog Haley. I got the assurance I needed so don't fret at all.

Nathalie

05-25-2010, 08:08 AM

Kim, you have been around this for way longer then me but for what it is worth I think Alison is right on the money.

I totally understand your frustration.

Debbie wrote: “By the way, what is it with Schnauzers & diabetes? Guess, I won't be getting one, just like I will never get a Golden Retriever as Barkley's oncologist told me that something like 75% of the dogs they treat for lymphoma are Goldens.”

Kim wrote: “No kidding! Alison suggested overbreeding and I have to also wonder about diet... companies pack all that crap to save money and I think it ends up hurting the animals. Yes, very prone to diabetes and cushings. I told my vet today I would never have another one - not financial issues just the stress of it.”

I have had this conversation with one of my friends many times – why does it seem our dogs are getting sicker and sicker …. Cancer runs rampant, every other dog has skin issues or behavior issues, Immune system issues … this should make us examine very hard what we are doing with our dogs.

I believe ‘breeding’ certainly is a strong component and I could not agree more, Diet, none of us would thrive eating the same crappy commercial diet 365 days out of the year.
Add to that the accumulative effect of pesticides and vaccinations, well I am personally not surprised.:(

Every breed/mixes of these breeds has a list of ailments … perhaps the list only differs because poor diet, use of pesticides and vaccination manifest itself differently in different breeds …

Anyhow, Kim – I am keeping my fingers crossed that 50mg will do the trick.

Thinking of you,
Nathalie

frijole

05-25-2010, 02:37 PM

So I increased her dosage yesterday. She was at 19 remember? I gave her 1/2 pill pm. (vs 1/4).

I ceased giving her kibble and have gone 100% canned food as she usually eats it and more. WRONG. This morning she left a good 3 TBS of perfectly good canned food in her dish. :eek::confused:

I have no choice but to monitor poop because she obviously isn't going to help me with normal signs. She seemed down again this a.m. I assume that like me she is going thru ups and downs of losing Haley.

Hopefully our buddy Matt will get her smiling again when he visits her today to let her out.

frijole

05-28-2010, 10:59 PM

Just checking in re Annie. Tonight would be 4 days at the higher dose and she just looked at the food for a bit when I put it down. :eek: Then she ate about 1/2 of it. I dont believe she's loaded from a 19 in 3 1/2 days. But I held back the pill tonight and will see how she does tomorrow.

The only thing that might have had her out of sorts is my mom's dog Jessie is here for a couple days - arrived today. They get along fine but... who knows.

Like me she has her ups and downs days. At times she smiles again and then she looks like she lost her best friend. But she has improved since last weekend.

Meanwhile I gave my 2nd ever insulin shot tonight. Jessie is still breathing so I must have done it right. ;) I am NOT a needle person so this is new territory.

Harley PoMMom

05-28-2010, 11:08 PM

Hey, great job with the shots!!!

What about Annie's poop, how is that?

frijole

05-28-2010, 11:20 PM

I haven't seen any poops today. I know bad mom. I did watch though tonight... nothing yet. she's waiting for it to get dark and more of a challenge for me.

I took her last night to a "double header T Ball games" - 4 and 5 yr olds! (nephews) She had a smile on the whole time so that was cool.

Harley PoMMom

05-28-2010, 11:45 PM

frijole

05-28-2010, 11:47 PM

You a bad mom...NEVER!! You are a wonderful, loving and devoted mom. I too, soon, will be out at night with my stick and flash-light looking and prodding at Harley's poop! :eek:;):D My neighbors will think that I have gone bonkers! Oh well!

You will do fine. Hopefully it will go quickly for you. Going to take the girl out now and do my patrol thing. LOL

Roxee's Dad

05-28-2010, 11:53 PM

Hi Kim,
Just catching up on Annie. My goodness you do have your hands full. Keeping you both in my thoughts and prayers. I know you will do just fine.

lulusmom

05-29-2010, 01:45 AM

Kim, if Annie is giving you a sign that she's loaded, then she probably is. Unless a dog's been misdiagnosed, they all have a post much higher than 19 when they start and the average load at maximum dose is 5 to 7 days. So with a post of 19 and already having some level of erosion achieved at the lower dose, I don't think loading in 3 1/2 days at an increased dose is unreasonable at all. Just my two cents.

frijole

05-29-2010, 09:26 AM

Glynda - Before she even loaded this was my fear because she most days she enhales her food then she'll go thru a couple where she won't eat at all. I used to think it was her teeth or the kibble.. now I am not sure. She did this right after her last cleaning and I switched her to 100% canned for loading and she is still doing it.

Poop hard as a rock. She looked at her food and sniffed it this a.m. So I opened a different flavor since it was the 2nd half of the can (from last night) and it did spark a greater interest. She ate almost all of it.

I gave her 1/4 pill. (She's on 3/4 a day so I gave her the lower amt even tho last night she missed the 1/2 pill dose)

Squirt's Mom

05-29-2010, 12:50 PM

Hey Kim,

I cannot believe you even kid about being a bad mom! geez....you are one of the bestest moms around and we all know it...as does Annie.

I know you will do just fine with the load and that Annie will perking up in no time!

Hugs and love!
Leslie and the girls - always

frijole

05-30-2010, 12:00 PM

Update - acted normal except for the eating part yesterday. PM meal she did same thing - looked disinterested, sniffed. I brought out a bowl of a different flavor and left them both there so she could take her choice. She slowly ate almost a normal amount.

I witheld lysodren.

This morning (Sunday) not showing any interest in food. I have tried a couple times and she isn't interested. No lysodren. She'll be brought in Tuesday for testing. No vomit, no diarrhea, walking fine.

Just my luck to hit this on a holiday weekend dang it. Hope the tests are still valid by then. LOL Obviously would love for her to be loaded but she does this from time to time so I won't get my hopes up yet.

Happy Memorial Day all.

Nathalie

05-30-2010, 01:58 PM

Hope this is it! Keeping my fingers crossed.:)
Nathalie

acushdogsmom

05-30-2010, 02:02 PM

This morning (Sunday) not showing any interest in food. I have tried a couple times and she isn't interested. No lysodren. She'll be brought in Tuesday for testing. No vomit, no diarrhea, walking fine.

Just my luck to hit this on a holiday weekend dang it. Hope the tests are still valid by then.The effect of the daily loading doses of Lysodren is cumulative and you likely don't have the full effect of all the loading doses until two or three days after you stop the Lysodren, so testing on Tuesday would probably be even better than doing the test today. :)

Fingers crossed that the loading is now complete.

frijole

05-30-2010, 02:37 PM

The effect of the daily loading doses of Lysodren is cumulative and you likely don't have the full effect of all the loading doses until two or three days after you stop the Lysodren, so testing on Tuesday would probably be even better than doing the test today. :)

Fingers crossed that the loading is now complete. My concern is that she really hasn't had a full dose since Thursday. Oh well.. Thanks cushy! Its just so hard because she keeps going out to look for her friend Haley and I don't know how much of the eating strike is that vs lysodren. Guess I'll know more next week.

frijole

05-30-2010, 08:55 PM

She just ate her food from this a.m. She has gone outside no less than 30 times today only to look around for Haley. She doesn't go potty - just looks around. Sometimes thru the fence, sometimes on the horizon, sometimes she goes around poking under plants. She isn't playing - it is clear who she is looking for.

Anyone have any advice? I try to act like all is normal and ok. Is it just a matter of time or is there anything else I can do?

I went to a soccer game and dogs aren't allowed so I went to my mom's first and let her stay over there for a change of pace. She did have a smile on her face coming home.

I haven't moved Haley's things, her bed or anything because I didn't want to upset her world any more than necessary. I was going to do it slowly but have held off... for obvious reasons.

I hope Haley is looking down from above seeing how much her little sis loves her.

Nathalie

05-30-2010, 09:30 PM

Ohh, thats so sad.

I am just thingking out loud here but maybe Haley's things with her scent on it triggers Annie to look for her.
I have never been in a situation like this, but maybe removing Haley's bed etc. might be a good thing.
Does Annie have a dog friend that you could 'borrow' for daily visits ....

BestBuddy

05-30-2010, 11:41 PM

I really don't know how to help. Luke and Joey don't miss Phoebe at all because they played too rough and were kept away from her. That was making me sad that they didn't even know she was gone but I think that is better than being in your position.

Maybe it's just like us and time is the great healer.

Jenny

Roxee's Dad

05-31-2010, 12:39 AM

Hi Kim
When we lost Roxee, Rozee went around for over a week looking for Roxee and her favorite pee places. She eventually stopped. Roxee and Rozee were littermate sisters and it was heart breaking to watch. She now has LittleBit to keep her busy and to chase around. That's why I have mentioned before that LittleBit showing up when she did was a blessing.

frijole

06-01-2010, 09:08 AM

I wrote a long reply this weekend but I must have not hit send or something... anyway... the hunger strike continues. Am managing to get her to eat 1/2 normal amt. Yesterday she didn't eat a bite til 8pm. Nothing worked, treats, jerky, potato chip. Nothing this a.m. No lysodren since Sat a.m. No diarrhea or vomit.

Sunday was the first day I was home most of the day and she wanted out no less than 30 times to go look for Haley. :( I'm taking her for car rides, walks, over to my moms, anything to get the smile on her face. It helps a bit.

Am taking her in this morning for a stim test. I pray she is loaded. If she isn't I am not sure how I can get her there since she isn't eating.

littleone1

06-01-2010, 02:10 PM

Hi Kim,

Sending positive thoughts and prayers that Annie's test results are good.

I know you're doing everything you can possibly do to help Annie get through this. A trip to the pet store where she could pick out a new toy might help. Just a thought.

forscooter

06-01-2010, 02:37 PM

Kim,

The tears welled up in my eyes here at work (I am trying to maintain) when I read what you are going through. Bailey went through a horrible time after Scooter, was so lost. Was Annie or Haley the more dominant? I ask bc I did read that it is hardest on the dog who is the follower...bc they do feel lost. I also did a lot of reading, and like people, they need time. I was told to try and keep the routine as much as possible, give extra loving but not too much, and just giving them time. I wish I had more advice to offer, but I think like us, they just need to heal. It took Bailey 6 weeks, I was counting, before he even showed a remote likeness to himself...and then it took a while even after that.

So, I would say love her up as much as you need and can...and time will help heal her heart. As long as she has you, she will be OK.

As for the food, I ended up cooking all sorts of stuff for Bailey to get him to eat. I did spoil him in those first few months (OK, we we spoil them all the time!)...but I did extra-spoil him and I even sat next to him while he ate...that helped too.

I feel for you, Kim....and am keeping you close in heart!
Beth

Squirt's Mom

06-01-2010, 02:52 PM

Hi Kim,

It is heart-breaking to know Annie is having such a hard time; I know this makes things that much harder for you, too. :(

Beth said what my thoughts are...give her time, let her work through this in her own way, love her extra, talk to her about Haley, and the two of you can help heal each other.

When we lost Ruby, the other pups got to see her and say good-bye just before the burial. It seemed to help them understand she was going somewhere else. Of course, our pack hadn't been together nearly as long as Annie and Haley and I am sure that makes a big difference.

You are all in my thoughts and prayers, and if any sage insight comes to me in the wee hours of the morning ( or anytime ;) ), I will let you know asap.

Hugs,
Leslie and the girls - always

frijole

06-01-2010, 03:03 PM

Thanks. Annie wanted to be the alpha. I got her at the age of one - she had been abused. She would challenge Haley but Haley was clearly alpha.

Beth, I did quite a bit of reading this weekend and your summary is pretty much what I read. And yes - time heals all.

My challenge will be if she isn't loaded. How do you load a dog who won't eat? I can't let her symptoms come back as they came on fast and strong and she was falling all over the place.

Shes getting her acth this a.m. and my stepdad was going to pick her up so she isn't there all day. I bet her pre number is 155 this morning the way she was shaking. ;):D:( It just sucks that this happened when Annie was loading. I am praying to the lysodren gods for a load.

Harley PoMMom

06-01-2010, 05:05 PM

We are all here with you and Annie, praying also.

What about Nutri-Cal, do you think Annie would go for that?

Love and hugs,
Lori

acushdogsmom

06-01-2010, 05:10 PM

Hoping that she's loaded and hoping that she'll get her appetite back soon! Have you tried any homecooking at all? I have a good recipe for a ground chicken, egg and rice meatloaf that is pretty irresistable to dogs. :) I always keep some frozen slices of that in the freezer. It's pretty bland (so very unlikely to upset the dog's tummy) but also very tasty. I can send the recipe to you if you want, or have I sent it to you already?

Casey's Mom

06-01-2010, 05:18 PM

Good luck with your test results for Annie, am here praying for you. Poor little Annie, time will heal.

Love and hugs,

forscooter

06-01-2010, 08:48 PM

Kim,
I don't even want to put this out there, so I am whispering...but if Annie isn't loaded, and I do understand totally not wanting to lose ground, but given the circumstance, what if you just stopped loading for right now? Same as a dog who is sick, she is under some stress without Haley...and we're talking just a few weeks. Just to be on the safe side? I would try the home-cooking as well, I had to mix meats and chicken and all sorts of things in for Bailey to get him to eat, but if she still isn't eating well...and if she still isn't loaded, I think I would try and wait it out a bit...as much as I know it's frustrating after trying to load...it may take some of the stress off the two of you to allow for some healing. That's just my thoughts....
Lots of love to you both...and super hugs....Beth

frijole

06-01-2010, 08:57 PM

Thanks guys. She had her acth test today so we'll know soon. She didn't eat much again tonight. I cooked some rice and put it in the canned food and she chowed down. What a relief.

Beth - the reason why I don't want to stop giving lysodren is because her symptoms came on out of the clear blue with a vengeance and it cripples her. She is very "tall". Long skinny legs. I came home on Mothers Day and found her on the floor sitting on an area rug trying to get up. Both her back legs were off of the ground and she was trying to use her front legs to lift off and she couldn't. She had gone to the bathroom sitting there. :( So at the very least I would want to give her enough to keep her from getting to that point. Two weeks and she would probably be there (given the fact she was still at 19 last week)

But...we will worry about that tomorrow or the next day when we get the results. For now we celebrate eating food. This is a first for us. Hugs to all, Kim

sunimist

06-01-2010, 09:02 PM

Bless you Kim. Have you tried the old stinky crispy baked canned dog food?
Might hit an interesting taste bud there.

Still praying for you and sweet Annie.

frijole

06-01-2010, 09:05 PM

No - my dogs always chowed so I never had to cook for them. I will take any recipes you want to send me way. Hope I never have to use them but she might tire of rice. ;)

sunimist

06-01-2010, 09:36 PM

frijole

06-01-2010, 10:03 PM

:D
You could try slicing her favorite dog food and bake it on a cookie sheet. Something about the cooking brings out a strong flavor of some kind. I did it for Misty several times when she wouldn't eat. Just a thought.

:D I never would have thought of doing that. So simple. I could serve it with a side of rice too. ;) I'm going to try that tomorrow just to see the look on her face.

acushdogsmom

06-01-2010, 10:12 PM

You could try slicing her favorite dog food and bake it on a cookie sheet. Something about the cooking brings out a strong flavor of some kind. I did it for Misty several times when she wouldn't eat. Just a thought.It not only brings out the flavour, it apparently also brings out a strong, shall we say "aroma" :D - but I've seen them suggest doing this on the diabetes board and dogs just love it. :D

frijole

06-03-2010, 01:20 PM

Not good. Vet just called and she was pre 13 and 19 post.

That is the same reading as her last test. Vet wanted to switch and I told him about the washout and he said maybe that was the drug company playing it safe and I told him I couldn't ignore it.

We then talked about the appetite issue and Haley. That could be the reason for the appetite issues. BTW she acts like she wants to eat but then she doesn't. (even with the rice) I gave her tuna last night on kibble to get her to eat.

Guys I am worried she has a macro and I told the vet this. He is calling some specialist but I am inclined to either drive to K State (closest IMS) or to Omaha where they sometimes visit.

Please if you have any ideas why Annie is not suppressing let me know. I need to do something quickly. And I took the call in my boss's office and he saw me totally lose it.

littleone1

06-03-2010, 01:35 PM

I'm sorry to hear this Kim. I personally am glad that Corky is being treated with Trilo, even though his dosage has had to be increased twice. IMO, I'd rather be safe than sorry. I feel so much more at ease with him being on Trilo.

Have you tried meatloaf? When Corky got finicky about eating when his cortisol level came down, I had to give him meatloaf in order for him to take his Trilo.

My thoughts and prayers are with you and Annie. I hope she starts eating for you soon.

marie adams

06-03-2010, 01:42 PM

Hi Kim,

I hope all the best for you and Annie! Life likes to take us on an unusal ride sometimes.:( Keep up the great job you are doing for Annie and the rest of us!!:)

labblab

06-03-2010, 01:42 PM

Kim, I only have time for a couple quick thoughts. But I can't remember -- were you able to distinguish PDH vs. ADH with Annie's diagnostic testing? If not, maybe she's got an adrenal tumor that is not responding so well to the Lysodren??

Secondly, if you DID want to consider a switch to trilostane, I'd encourage you or your vet to call Dr. Allen at Dechra U.S.A. It might be the case that a full 30-day washout wouldn't be required, given the fact that Annie's stim results are still so high and she has remained symptomatic throughout. Here's Dechra's "Contact Us" webpage:

http://www.dechra-us.com/Default.aspx?ID=365

I surely do understand your worry about a macro, but maybe there's just something else going on that is interfering with the effectiveness of the Lysodren. For your own peace of mind, maybe a visit to an IMS might truly be a good idea...

Big (((hugs))),
Marianne

labblab

06-03-2010, 02:05 PM

Kim, I just looked at your thread title, and DUH!!!!!! :o ...
I see that Annie must have been diagnosed as being pituitary. So forget about that first thought of mine...

Marianne

frijole

06-03-2010, 02:19 PM

Marianne - her ldds was a strong pituitary dx. However - could it be both? If I go to KC or to Omaha to the IMS I want to know every possible thing to instruct them to do and look for. I am so upset that I cannot think clearly and that is why the appeal for input. I am not thinking rationally at all. Thanks

StarDeb55

06-03-2010, 02:42 PM

Kim, I do think it's possible for both types to occur simultaneously, but I would figure kind of rare. I don't remember, has Haley had a US done to take a look at the adrenals?

Debbie

labblab

06-03-2010, 02:47 PM

Debbie, you beat me to the punch. Kim, just on general principle, if an ultrasound hasn't been done -- that would be one of the first things I'd ask for, too.

And, FWIW, our IMS who treated Barkis had first become interested in trilostane because he was working with another dog that just could not be controlled effectively with Lysodren (not a common problem, but it was the case with that dog). The last that I heard, the dog DID respond favorably to the trilostane.

Marianne

frijole

06-03-2010, 02:51 PM

No ultrasound was done. Please refresh my memory... if they are both the same size that is indicative of pituitary but if not, adrenal? Sorry but I am beyond a blubbering idiot right now.

I have some major deadlines at work and I am not sure how I will be able to deliver right now. So I appreciate your help and I promise to pay you back in kind once I live thru this. This last month has just been a total nightmare. You are truly the best.

labblab

06-03-2010, 02:57 PM

If both adrenals are of normal size or both are enlarged -- either finding would be consistent with pituitary Cushing's. The key is the "both" part. If only ONE adrenal is enlarged or if a growth or mass is visualized, then the diagnosis would be ADH.

And Kim, you've more than earned a ton of payback for all the help you've given ALL of us around here!!!!!!!!!!

Marianne

zoesmom

06-03-2010, 03:01 PM

So is this right, Kim . . . you were loading at 35 mg/kg and then got some slight downward movement and so continued at that dose for a couple weeks and then got that first 13/19 reading. And then you upped it to the 50/mg/kg and nothing budged after about a week at the higher dose? Just wondering if the stress over the loss of Haley has counteracted any effect from that dose increase? How long have you been loading - total? I'm guessing it's still not anywhere close to how long Haley took??

Still, I understand why you are anxious for some sign of progress - either in numbers or symptoms. But remember, you are both in a rough spot right now and I can't help but think that is having an influence. She may be picking up on your state of mind as much as her own confusion over where Haley has gone. Just wondering (not being as well-versed in lysodren) if you could do something like the 3/4 pill one day and then every second or third day, give her a full pill. I know that full pill would be over the rec. 50 mg/kg, but maybe she just needs that extra-oooomph to get things rolling. If that's out of the qustion, then I guess trilostane might be the next best option. I agree with Marianne tho' - with her still hgh numbers and ongoing symptoms, she might not require the full 30-day washout. Sue

StarDeb55

06-03-2010, 03:02 PM

The other thing that can happen is the one that isn't enlarged, may actually be shrunken. Don't forget, a US has to be done on a high resolution imager.

Debbie

StarDeb55

06-03-2010, 03:03 PM

frijole

06-03-2010, 03:08 PM

So is this right, Kim . . . you were loading at 35 mg/kg and then got some slight downward movement and so continued at that dose for a couple weeks and then got that first 13/19 reading. And then you upped it to the 50/mg/kg and nothing budged after about a week at the higher dose? Just wondering if the stress over the loss of Haley has counteracted any effect from that dose increase? How long have you been loading - total? I'm guessing it's still not anywhere close to how long Haley took??

Still, I understand why you are anxious for some sign of progress - either in numbers or symptoms. But remember, you are both in a rough spot right now and I can't help but think that is having an influence. She may be picking up on your state of mind as much as her own con.usion over where Haley has gone. Just wondering (not being as well-versed in lysodren) if you could do something like the 3/4 pill one day and then every second or third day, give her a full pill. I know that full pill would be over the rec. 50 mg/kg, but maybe she just needs that extra-. oooomph to get things rolling. If that's out of the qustion, then I guess trilostane might be the next best option. I agree with Marianne tho' - with her still hgh numbers and ongoing symptoms, she might not require the full 30-day washout. Sue
Yes, you got it right re the numbers and timeline. The problem is the appetite. She quits eating. So I could give her lysodren so long as she eats but I have NO way of knowing if she has too much until it is too late.

Lets discuss trilo - i'll be honest, at first I wanted Haley to go on it but my vet didn't know it so I went with lysodren. I have seen enough dogs that went on it have to go to lysodren due to high hormones that I really didn't even consider it this time.

I would want to rule out potential Adrenal prior to considering trilo.

frijole

06-03-2010, 03:09 PM

The other thing that can happen is the one that isn't enlarged, may actually be shrunken. Don't forget, a US has to be done on a high resolution imager.

Debbie

yeah and what do you think the chances are that we have one in this town? not sure...but wouldn't bet on it. dang

frijole

06-03-2010, 03:14 PM

I think Sue has a good idea. You know a lot of us are on maintenance doses of >50 mg, even Angel Haley, if I remember. So maybe that little extra boost might get things moving in the right direction.

Debbie

Haley was on a dosage of over 100 mg so I'm not afraid of that at all. My only concern is that I couldn't give it to her on an empty stomach and so I couldn't stick to any sort of regime. I do think I need to give her something asap just to keep her at 19. It has been ONE WEEK since she had a full day's dose.

When I told my vet that Annie's cortisol went high she lost ability to get up, stand, go up stairs he said he is concerned there is something else going on. He didn't think that sounded like cushings. I argued that point but do you think I should have her looked at for something else?

I'll ask the hard question. How do you diagnose a macro? MRI? Be honest... are you fearing what I am fearing? I am terrified.

frijole

06-03-2010, 03:15 PM

Since I don't even know if the K State specialists are any good... do you think I could pay an IMS that one of you guys have used and trust to assist my doc? I am lost.

StarDeb55

06-03-2010, 03:30 PM

zoesmom

06-03-2010, 03:31 PM

I'll ask the hard question. How do you diagnose a macro? MRI? Be honest... are you fearing what I am fearing? I am terrified.

Yes, an mri (or a ct scan) is the usual method. Expensive. Was quoted over $1000 (I think it was $1200) for Zoe, at one time. Plus anaesthesia required. MRI is considered the better option, I believe. If it was a macro, then I assume you'd stick w/lyso, right?

Given the LDDS result, I'd be doubtful that she could have an adrenal, or even less of a chance for both. I can only recall one or two, at most, who've had that unfortunate diagnosis. But if it would put your mind to rest, then an u/s maybe first, to rule out adrenal, since it's cheaper. Isn't Nebraska close to U of Minn. Perhaps there's some place there, although we seldom get members from that area (wonder why???). But I guess it would depend on where you are in NE - I know it's a big, wide state and pretty spreaaaaad out. Sue

PS - if you got an mri and it showed a macro, would you put Annie thru radiation, or simply continue with lyso? In other words, is it going to change your approach, other than maybe upping the dose of lyso.

labblab

06-03-2010, 03:41 PM

Darn, I've got to leave for a meeting, so only have a moment more to post. I'll come back later, though. Just wanted to say that my recommendation for the ultrasound wasn't just to view the adrenals -- but also to see whether there are any other obvious internal organ issues that could account for Annie's lack of appetite/weakness.

I think I'd opt for an abdominal ultrasound before a head CT/MRI. But I'll think it over myself during the next couple of hours...

Marianne

P.S. Here's a link with info about diagnosing macros: http://www.k9cushings.com/forum/showthread.php?t=229

frijole

06-03-2010, 03:45 PM

Kim, I hate to present a worst case scenario, but I suppose if a macro was big enough to start causing neurological issues, mobility might be one of things that could be affected, but that's just a guess. You wouldn't need a MRI unless you might consider radiation. A CT should be able to tell you what's going on. Remember what happened with Mia, she had what appeared to be an ear infection, was losing her balance, couldn't stand, etc. Alison took her for a CT which showed another type of brain tumor, along with a good sized macro that would have started causing problems eventually. I don't want to scare the crap out of you, but I also believe in looking at the whole picture.

Debbie
I appreciate the info. I might have a ct done. I'd rather be scared and in the know so I can deal with it than to not know.

Annie's isn't tipsy with her legs - it is like they can't support her (lost muscle) That totally went away once her lysodren started kicking in. So even tho she's at 19 there has been improvement. Her total body shaking ended too.

So how do you dose a dog that doesn't eat? Just give what you can when you can? (to keep her around a 19 until she quits grieving if that is what it is?)

zoesmom

06-03-2010, 04:07 PM

Annie's isn't tipsy with her legs - it is like they can't support her (lost muscle) That totally went away once her lysodren started kicking in. So even tho she's at 19 there has been improvement. Her total body shaking ended too.

So how do you dose a dog that doesn't eat? Just give what you can when you can? (to keep her around a 19 until she quits grieving if that is what it is?)

That sounds like a reasonable plan - give it when you can get it into her, which would hopefully be something close to regular regime. But I don't think you'd want to stop completely, until she's past the grief since . . . first, we aren't positive that's playing into it, or second, how long it might last, if it is affecting her. Stopping would surely cause her to lose any ground gained and, at least, the legs and shaking have improved.

Has your vet ever consulted with a specialist for your dogs' care???? I don't see why he couldn't contact one of the big teaching vet schools . . . for free. (Texas A & M, UC Davis, a Big Ten school, any of the bigger vet schools, really.) And I'd also think that some IMS's would consult with your vet, without charging, if it's just a matter of asking a few questions about how to proceed next. But maybe not. :confused::confused::confused::confused: Can't hurt to ask. I'd be happy to contact Zoe's IMS in CA (a UC Davis grad with an excellent reputation, and see what she says about the consulting thing.) Sue

acushdogsmom

06-03-2010, 04:16 PM

Just a thought or two ...

It's really strange that the ACTH stim test numbers would be exactly the same as last time, especiallly after a dose increase.

Is it possible that your Vet is somehow looking at the previous stim test results instead of the current ones? Or that the Lab could have mixed up the results somehow?

Or is it possible that the stim agent (Cortrosyn or Synacthen or ACTHAR gel) that your vet is using is out of date (expired) or compromised in some other way - maybe it was not properly stored or came from a bad batch or something like that?

Or could the Lysodren itself be expired?

I also suppose that she could just be resistant to the effects of the Lysodren, but that's very rare.

If it was me, I'd be asking those questions, and if my Vet couldn't answer my questions for me, I'd want a referral to an Internal Med Specialist, asap. And it's been my experience that it's always better to actually bring the dog to be seen and examined by the Specialist if possible. Although if that's not possible, I guess a consult by phone, with all test results etc faxed to the Specialist for review, is better than not having any Specialist input at all.

P.S. I can't remember where I read this, so can't give any citation, but I think I remember reading somewhere that if a dog does not have Cushing's, that they would be resistant to the effects of the Lysodren. I can't remember why that would be, either - because you'd think that if Lysodren specifically targets and erodes away the adrenal cortex tissue, it shouldn't matter whether it's a normal adrenal cortex tissue or not - but maybe when the adrenals are enlarged, as in Pituitary Cushing's, the adrenal cortex tissue somehow becomes more sensitive to the effects of Lysodren? So if/when you do consult with a Specialist, can you maybe ask if that's true and if maybe that's why Annie is not responding as expected to the Lysodren? Maybe there's another explanation for her diagnostic ACTH and LDDS test results (ie something other than Cushing's going on)? After all, she never really had the ravenous appetite that is usually associated with Pituitary Cushing's, so maybe, just maybe, she really doesn't have Cushing's?

sunimist

06-03-2010, 04:30 PM

Cushy has some valid info. At one point Misty's stim was virtually the same for a couple tests and come to find out the Acthar Gel was bad. Did a stim with cortrosyn and got a true reading. That was years ago but the testing agents can be tainted or out of date sometimes as was shown in her case. Sorry I don't remember, but what testing agent does your vet use?

Harley PoMMom

06-03-2010, 04:49 PM

Hi Kim,

I am no expert on macro's but I would think if Annie would have one she would be experiencing some more signs like the circling, seizures and the staring off in space.

I think with Annie and like I am going to have with Harley, they just don't metabolize the Lysodren in the most efficient way because they aren't eating properly, and they are elders, so it is harder to get them loaded and maintained. Alison always points out how important it is to give your pup a standardized Lysodren meal and this is very important indeed, but when your pup is a very picky eater or when your pup does not want to eat at all this can be a very difficult task to accomplish. I say feed her what she will eat to get her through her grieving period.

Harley is dx'd PDH but he does have a nodule on his right adrenal gland that has grown. Dr Oliver has mentioned that it’s possible that I am dealing with both conditions (PDH and ADH).

I am so sorry you and Annie are going through so much...keeping you both in my thoughts and prayers.

Love and (((hugs)))
Lori

frijole

06-03-2010, 04:54 PM

I didn't notice as I am not at home and did not go back and read my posts... so this result was exactly the same pre and post? That could be it.

acushdogsmom

06-03-2010, 05:12 PM

Meanwhile the vet called today and as I suspected - Annie isn't even CLOSE to loaded - 19!

So here is a summary:
4/28 17.2/30.9 at diagnosis
5 days at 250 mgs (35 mgs/kg) she stopped eating all her food
5/8 test 9.6/24.64

continued at same dose 250 mgs daily due to eating issues for 10 days

5/21 test 13/19 (he didn't give me exact nos.)
Not good. Vet just called and she was pre 13 and 19 post.

That is the same reading as her last test.
I didn't notice as I am not at home and did not go back and read my posts... so this result was exactly the same pre and post? That could be it.Yes, although you did say (the first time you told us that the numbers were 13/19) that the Vet didn't give you the exact numbers, but you must have gotten those numbers from somewhere. You didn't just pull them out of nowhere. :)

BTW, if you aren't already, you should be asking the Vet to fax you a copy of every single lab report, so you can keep track of all of the exact numbers and have a file at home with all that kind of information in it.

frijole

06-03-2010, 05:54 PM

He gave me the wrong numbers but it doesn't help because they were 11.5 and 20.6!

I usually pick up the actual results at the next visit so I will have copies of everything. He just called and he consulted with that board certified guy at Idex. (remember that from last time?)

He said that he is concerned there is an adrenal tumor and recommends an ultrasound. He gave me a clinic in Omaha that has a high resolution machine to call for an appointment. He said the clinic that brings in the KState folks add a 20% surcharge to their bills and he didn't think they had the right ultrasound machine so that for this visit he thought just going to the other clinic would be a best next step. Thoughts?

Oh and they both said - no way to any more lysodren until she is eating better. He thinks it is due to grieving. I can buy that but a part of me is still wondering about the whole dx being wrong so hopefully the ultrasound will help there right?!?!?!

zoesmom

06-03-2010, 06:08 PM

AHA - I, too, was wondering why the #'s were exactly the same. Sounded very suspicious, but ya' never know. Glad you got that straightened out!

Well, Omaha doesn't sound tooooooo bad . . unless you're in the far western reaches of NE! But I think that's good advice. Go get the u/s, see what it shows and then proceed from there. I just hate that you might lose what little ground you've gained, by completely stopping the lysodren. And that she might regress with the legs and the shaking. They didn't suggest that you could give it on those occasions when she's eaten some food????

At this point, I guess that might not be a top priority. But I think you have a PLAN now. And I know that once I HAD A PLAN together, I always felt better.:rolleyes: Sue

frijole

06-03-2010, 06:17 PM

AlisonandMia

06-03-2010, 07:13 PM

I've just got a minute - and the computer is so sloooooow and I've only skimmed the page before this....but I wanted to comment on the MRI/CT versus US. I'd go for the abdominal US, especially in a mini-schnauzer. This is because we've seen heaps of mini-schnauzers with gall bladder problems (well known cause of fickle appetite, even with Cushing's) - but I cannot recall a single one with a macro! I guess a macro is a possibility but a cruddy gall-bladder is much, much more likely.

Of course with the long drive involved and scarcity of specialists you may decide you want to do the head imaging and an US on the same day.

You could also get your local vet to run a pancreatitis specific test.

Nathalie's Phillip seems to be a poor absorber of Lysodren and he's had pancreatic issues and we had wondered if that could affect the absorption of Lysodren via fat absorption problems - even though his poop was totally normal.

Gotta go now!

Alison

Harley PoMMom

06-03-2010, 07:35 PM

You could also get your local vet to run a pancreatitis specific test.

Nathalie's Phillip seems to be a poor absorber of Lysodren and he's had pancreatic issues and we had wondered if that could affect the absorption of Lysodren via fat absorption problems - even though his poop was totally normal.

Gotta go now!

Alison

Alison has made a really good point with the cPL/cPLI test. Pancreatitis is much more common in miniature schnauzers than in most other breeds. An ultrasound would probably show a problem with the pancreas but the cPL test does have a high Sensitivity and Specificity...both >95%

Lori

frijole

06-03-2010, 08:16 PM

I made the appt for Monday a.m. at 9 for the ultrasound. They have one doc that does them and she is in a conference all day and is going to come in just for the testing. She said to plan to leave her and go do something for a few hours as she'll be in and out but she'll give her the lookover.

I am assuming the ultrasound would catch gall bladder issues? About that pancreatitus test... is that something that every vet in american knows how to do? I ask because he didn't seem familiar with the Uc:cr. How long does it take? Wondering if I should have it done in Omaha? Wait til ultrasound is done first? Lord...

OK... lets talk appetite. Here is what happens. I come home and Annie seems starved. I have canned food from this a.m. left over (I tried a 3rd flavor) she ate about 1/8 of a can. I do a test. I give her that first which she runs over to the bowl, does a light lick and then walks away without eating it even though she is starving.

I then put down kibbles with tuna on top and she eats almost all of it. She no longer is interested in the rice/food mix either. So I am not seeing a rhyme or reason to her hunger. And this is not like anything she has ever done.

Her poops are fine. Note I did find urine in the living room just now so she went potty between 3 and 5:30. Scares me her symptoms might return.

Could a messed up gall bladder or pancreatitus result in false positives on both the ldds and the acth????!!!

littleone1

06-03-2010, 08:40 PM

Harley PoMMom

06-03-2010, 08:53 PM

I believe pancreatitis can create false positive results on all cushing's tests...and I did miss Harley's prior bouts of pancreatitis but he does have cushing's...the ultrasound did show his adrenal glands and that helped prove the cushing's.

I believe if the pancreatitis is flaring up in the dog and the cushing testing is done then that is when the false postives results are created. Once a pup has pancreatitis they usually always have it but it can be controlled, and when it is under control is when the pup should be tested. The cPL test, not the cPL snap test, will give a definite number of how severe the pancreatitis is. If a pup is in the lower range, like Harley is right now (303), then the likelihood of a false positive is minute. I hope this makes sense...

Not all vets have heard of the cPL test, so here is a link about it, also the test is sent out to The GI Lab at Texas A&M University to be analyzed.

New IDEXX Spec cPL® Test
http://www.idexx.co.uk/animalhealth/laboratory/speccpl/

The GI Lab at Texas A&M University
http://www.cvm.tamu.edu/gilab/

Hope this helps...keeping you both in my thoughts and prayers.

Love and hugs,
Lori

StarDeb55

06-03-2010, 09:04 PM

I am assuming the ultrasound would catch gall bladder issues?

Right you are, Kim. This is exactly how we found Harley's gall bladder problems including a dilated common bile duct which was on his US done to confirm his Cushing's.

Debbie

AlisonandMia

06-03-2010, 09:41 PM

frijole

06-03-2010, 09:58 PM

One thing I feel that might argue against the Cushing's tests being false positives is that on the LDDS she showed wonderful suppression at the 4 hour mark. You'd think that if it was a stress (physiological) related false + that there wouldn't be such marked suppression and the results would be much flatter. From what I recall (ha! ha!) borderline/false positives don't usually show a classic pituitary pattern.

And her post on the initial stim was pretty high (rather than just out of range) which again makes a false positive less likely too - though we have seen what were almost certainly false positives that were that high due to long-term chronic illness.

It looks like gall-bladder related poor appetite can and often does override the Cushing's appetite (Deb's Harley and others). Maybe she feels hungry (thanks to the Cushing's or even just because she is hungry) but as her digestive system gears up for food she starts to feel queasy?

I'm really hoping that this is minor gall-bladder issue that will respond to medical treatment. What is her ALT like?

Alison
Remember my vet didn't want to test for cushings said she was a very healthy dog. Her alk phos had gone to 433 but her alt was 86, clearly in the middle of normal (10-120)

Her pee is yellow and according to my vet, she is concentrating urine. That was at time of the diagnosis when he didn't do the uc:cr that I asked him to do. I can confirm as of 2 hrs ago her pee is yellow when you clean it up with a white paper towel. ;)

I am going to be sure to write out every question you guys have so I can hit this vet up on Monday. ha.

frijole

06-03-2010, 10:02 PM

Kim, is it possible Annie has a UTI? This could account for her having an accident in the house. A combination of Corky's Cushing's symptoms and his 2 UTI's were the reasons he started having accidents in the house.

I don't quite understand why she would have to stay for several hours for an U/S. The longest Corky had to stay there was about 45 minutes.

I'm hoping and praying that you will get a resolution to help Annie.

She hasn't been going outside to potty often but I suppose. Once she started on lysodren the frequent urination ended. I am concerned about today because I think her cortisol is already increasing and I'm not worried about pee.. I'm worried about having to see the look of distress on her face as she can't stand up. Shes too sad to have to deal with that right now again.

The vet is attending conferences and is going in especially for me. I am thinking she wants to do a physical exam and potentially other tests if needed? I gave her the whole story on the phone and told her to help me save my dog.

frijole

06-03-2010, 11:21 PM

Forgot to update you. My vet contacted Decra and they said - 30 days, no less. Just an fyi.

k9diabetes

06-04-2010, 01:24 AM

I believe that IDEXX can now run the pancreatitis test directly.

The other more specialized GI tests still have to go to TAM though I think.

Natalie

labblab

06-04-2010, 09:37 AM

Forgot to update you. My vet contacted Decra and they said - 30 days, no less. Just an fyi.
Thanks for passing on this info, Kim. It'll help us when we counsel other people about making a Lysodren/trilostane switch. And good luck with the ultrasound on Monday! I really do think that's the best "next step."

Hugs to you and Annie,
Marianne

frijole

06-04-2010, 07:58 PM

??!! Annie just vomited.

I came home just now and there is a note from the kid next door that Annie would not get up from the floor to go outside to go potty. This has never happened.

When I came in she was up and by the door acting happy and starved. I let her outside and she peed alot and pooped. I checked it and it is normal, no slime on it.

Tried to give her some canned food. She wanted it but didn't eat a bite. She then vomited. OK... description time

It looked like a cracked egg .. bright yellow liquid like a yolk - not orange at all. And this white thick stuff mixed in with it that looks like an egg yolk when you are cooking it. It was thick.

I suppose I should call my vet. Looking for thoughts. Sigh.

Harley PoMMom

06-04-2010, 08:07 PM

This to me sounds like Annie's stomache is very upset, Harley had 2 episodes of this vomiting, that's when we starting giving the Pepcid AC morning after Lysodren.

frijole

06-04-2010, 08:25 PM

She hasn't had lysodren for a week. She ate this morning kibble with tuna but that wasn't what she vomited.

Harley PoMMom

06-04-2010, 08:29 PM

It sounds like she's vomiting stomach acids, since it's white and yellow.

zoesmom

06-04-2010, 08:37 PM

Yeh, maybe bile??? Some dogs will vomit that on an empty stomach. Unless maybe she snuck out by herself and went to Denny's and had an egg or two!!!! It sounds like she's hungry and wants to eat . . . but then maybe the smell of food makes her queasy/sick.Wonder if several smaller meals/day would appeal to her. The neighbor kid would have to assist with that, I guess! And I'm thinkin' - there's still the possibility of pancreatitis. Otherwise . . . ????????? Sue

frijole

06-04-2010, 08:38 PM

I called the emergency no and got the doc on call (not mine). I don't know her at all. She knew a bit about what was going on from what he shared yesterday with his staff.

She told me to give her a pepcid ac and try feeding a little bit in an hour. If she vomits again put up food and water.

Annie has only had less than 1/4 water all day as I measured it.

The vet said something about unfortunately when you are dealing with cancer sometimes they eat and sometimes they don't and something about the back legs. I couldn't even reply. Then she said something about the ultrasound ... end of conversation.

frijole

06-04-2010, 08:39 PM

Yeh, maybe bile??? Some dogs will vomit that on an empty stomach. Unless maybe she snuck out by herself and went to Denny's and had an egg or two!!!! It sounds like she's hungry but then maybe the smell of food makes her queasy/sick. Maybe several smaller meals/day would appeal to her. And I'm thinkin' - there's still the possibility of pancreatitis. Otherwise . . . ????????? Sue

I got her to eat this a.m. Kibbles with tuna.

Rebelsmom

06-04-2010, 08:48 PM

So sorry you are going through this. Sounds like maybe the on call vet was not familiar with what's going on maybe? I hope you can get her to eat and keep it down.

Sending love and hugs your way.

Harley PoMMom

06-04-2010, 08:51 PM

zoesmom

06-04-2010, 08:52 PM

I'm guessing that whatever Annie ate this morning was long gone from her tummy by the time you came home. And that it's now close to dinner time in NE I was thinking maybe 3 smaller meals/day might help. That's what the vet suggested for my daughter's dog Guinness, who used to always vomit up bile when she got overly hungry. I wouldn't worry about what the vet said. Maybe she was just confusing what she heard - lor saying cancer when she meant cushings. Vets discuss things, off handedly, and the non-responsible vet doesn't always pay close attention.

The legs, to me, sound like just a resurgence of a cush symptom. Remember Annie's post was at 20+ something and then has not had pill for a week. I think you'll get some answers on Monday (with the u/s and are you planning on getting the cPL, too?) If Annie's cushings has been going on for awhile, that could have predisposed her to mild, chronic pancreatitis, and that too might account for some of her symptoms with eating. Sue

AlisonandMia

06-04-2010, 09:04 PM

I wouldn't worry about what the vet said. Maybe she was just confusing what she heard - like cushings with cancer. Vets discuss things, off handedly, and the non-responsible vet doesn't always pay close attention.

Cushing's = tumor, tumor = cancer! In some people's minds anyway - and even in the minds of people who actually know better, just the subconscious association. I wish some professionals would watch what they say, especially on Fridays and weekends! (Been a victim of horrific all-weekend stress because of something like this myself.):mad::mad::mad:

Alison

zoesmom

06-04-2010, 09:07 PM

Yeh, Alison. That's what I was trying to say. :rolleyes:

frijole

06-04-2010, 09:31 PM

FWIW...I really do think that the empty stomach is at play here...if you could get the pepcid in her then try something bland and hopefully she will eat that too. Later tonight before she goes to bed, try to get her eat something else, something small even if it's just one mouthful.

Were Annie's triglycerides and cholesterol ever checked?She had a full panel done every 6 mos when dental work was done because I was convinced for 2 yrs she had cushings due to appetite. I'm just seeing hematology data and chemistry data which includes: renal analytes, metabolic analytes and hepatic analytes.

And yes I am beyond upset with that doc. I dont even know what she looks like. There are 3 that practice there and the other gal is the one that saw Haley on that last day. Otherwise I always go to the male in the group. He is the principal.

frijole

06-04-2010, 09:31 PM

Cushing's = tumor, tumor = cancer! In some people's minds anyway - and even in the minds of people who actually know better, just the subconscious association. I wish some professionals would watch what they say, especially on Fridays and weekends! (Been a victim of horrific all-weekend stress because of something like this myself.):mad::mad::mad:

Alison

Trust me. I think I will be the next in this house to vomit. I am shaken and sick. And I wasn't real great before that. ;)

Harley PoMMom

06-04-2010, 10:12 PM

If this is pancreatitis, remember Harley's was found on his ultrasound. The ultrasound showed he had "prior bouts of pancreatitis." And he is doing fine, I didn't catch his pancreatitis early, heck I don't even know when he had his prior bouts of it...but he is doing great with his pancreatitis...303 was his last test result.

If Annie does have pancreatitis then she is probably is the early stages of pancreatitis. Does she wince or act like it hurts when you touch her tummy?

Casey's Mom

06-04-2010, 10:24 PM

My Desi the non cushings dog in the house is a Havanese and is often not hungry at mealtimes. When she goes a while without eating - sometimes almost 24 hours - she will vomit and because there is nothing in her stomach to vomit it sounds like Annies. She will also eat grass - then I try and feed her again with a little cooked turkey on top of her homemade and kibble and she is fine. It's almost like she has to think about it a while and go "okay food - now I will eat". She does this quite regularly and yes she is a healthy dog.

Just want to ease your mind a bit Kim. And if it is pancreatitis you have lots of members here who have dealt with it in the past to let you know about the symptoms.

I agree with Allison when the vet said cancer they think "pituitary tumour - cancer" try not to worry so much. We are here for you.

Love and hugs,

frijole

06-04-2010, 10:49 PM

I need to clarify that when I say "Annie is not eating" I really mean, my piggy cush dog who will eat anything at anytime is not always eating. I have managed to get her to eat about 1/2 of her normal daily consumption the last week and she has never gone for 24 hrs without eating.

What is freaking me out is that she seems starved yes just stares at food and then later she gorges. Example - this evening after refusing food and talking w/the vet I gave her a pepcid ac and waited an hour. I gave her 1/2 cup kibble with some rice and poured chicken broth over it.

I crossed my fingers and set it down. I actually had to put my hand on her and STOP her eating twice because she was dvouring it without breathing - like a cush dog.

So we have extremes. One day the rice works, the next it doesn't etc. I cannot find any correlations so I can't figure it out. And yes - the ultrasound should help.

Question - the ultrasound will give us a look at the adrenals and rule out or in adrenal. It would identify if this is a gall bladder issue.

How does it identify pancreatitus? Should I have this vet do that test you mentioned? Is it instant or sent away?

You mentioned UTI as another possibility - I don't suppose the ultrasound will help identify anything there huh? I am obvious clueless. :o

My plan is to give this vet a summary of symptoms, test results, and overview of behavior issues since Haley's passing. If you think of any other tests I should consider having done, let me know.

I have never noticed her tummy being sensitive or even growling during loading like is normal. No gas either. I DID notice even before the cushings dx that sometimes when I would go to pick her up from the floor or bed that she would yelp in pain if I grabbed her FRONT legs - almost like the "arm pit" area hurt? Thats the only thing I can think of.

Boy this thread is all over the map - you'd never know it was a cushings forum huh? Not a normal case at all. Hugs to all. Kim and Annie

AlisonandMia

06-04-2010, 11:01 PM

US is the preferred way of diagnosing gall-bladder problems. I gather the sludge and any thickenings are easily seen on US. An inflamed pancreas also usually shows up too - particularly if there is any scarring. The blood test is the usual way that pancreatitis is diagnosed but signs do show on US too.

I would guess (just guess mind you) that an US could look quite normal but there could still be a problem with pancreas and/or gall bladder.

It really isn't sounding like a macro though - sounds like something abdominal to me.

Alison

zoesmom

06-04-2010, 11:25 PM

Well, when Zoe had her u/s during the diagnostic process, they said her pancreas showed evidence of previous pancreatitis. If she had it, I was unaware of it. I think they can have chronic pancreatitis, which isn't so severe that it lands them in the hospital. And in many casaes, we owners probably miss that, just chalking it up to finickiness. Zoe was always a fickle eater, right up until and for awhile after starting on trilo. Eventually, her appetite improved but then sometimes, it would fall off again. I just assumed it was probably a mild flare-up with the pancreas which wasn't enough to make her full-on sick.

Later, like 2 years ago, she did have an acute and bad case of pancreatitis and there was no mistaking that one. But the more mild, 'subclinical' form, I would think could be easily missed or mistaken for something other. However, if that's been going on, it should show up as subtle changes in the pancreas. Kidneys - yes they should look at those, too, during the abdominal u/s. Don't thiink it will tell if there's an active uti, but it should detect changes from other chronic kidney coonditions. Sue

Harley PoMMom

06-04-2010, 11:43 PM

What is freaking me out is that she seems starved yes just stares at food and then later she gorges. Example - this evening after refusing food and talking w/the vet I gave her a pepcid ac and waited an hour. I gave her 1/2 cup kibble with some rice and poured chicken broth over it.

I crossed my fingers and set it down. I actually had to put my hand on her and STOP her eating twice because she was dvouring it without breathing - like a cush dog.

I am elated she is eating and I know this will be very hard to do but try not to let her eat alot at one time, I'm afraid she will fill-up so quickly and then maybe it will come back up again. I think giving her the Pepcid is a very good idea.

So we have extremes. One day the rice works, the next it doesn't etc. I cannot find any correlations so I can't figure it out. And yes - the ultrasound should help.

Question - the ultrasound will give us a look at the adrenals and rule out or in adrenal. It would identify if this is a gall bladder issue.

How does it identify pancreatitus? Should I have this vet do that test you mentioned? Is it instant or sent away?

In diseased states, the echogenicity of an organ can be altered, either more echogenic (hyperechoic) or less echogenic (hypoechoic) than usual. These observations can help the radiologist to categorize the type of disease process involved.

In Harley's second ultrasound report it states: The abdominal ultrasound showed a hyperechoic pancreas which could represent chronic inflammation or fibrosis.

The SNAP cPL Test uses the same biological reagents as the Spec cPL Test, but displays results in 10 minutes. The test result is displayed as a colored sample spot that must be compared to a reference spot. If the color intensity of the sample spot is lighter than the color intensity of the reference spot, then cPL concentration is normal. If the color intensity of the sample spot is equal to or darker than the reference spot, then cPL concentration is abnormal (either “elevated” or “consistent with pancreatitis.”)

http://www.idexx.co.uk/animalhealth/testkits/snapcpl/library/096905800m.pdf

The snap cPL does give you instant results but it only gives you a normal or abnormal response. They did say that the snap cPL has a 95% correlation to the reference laboratory Spec cPL Test, the most accurate test currently available for canine pancreatitis.

You mentioned UTI as another possibility - I don't suppose the ultrasound will help identify anything there huh? I am obvious clueless. :o

When Harley had his ultrasounds done I also had them do ultrasound guided cysto's to check for UTI's.

My plan is to give this vet a summary of symptoms, test results, and overview of behavior issues since Haley's passing. If you think of any other tests I should consider having done, let me know.

I have never noticed her tummy being sensitive or even growling during loading like is normal. No gas either. I DID notice even before the cushings dx that sometimes when I would go to pick her up from the floor or bed that she would yelp in pain if I grabbed her FRONT legs - almost like the "arm pit" area hurt? Thats the only thing I can think of.

Boy this thread is all over the map - you'd never know it was a cushings forum huh? Not a normal case at all. Hugs to all. Kim and Annie

Big hugs to you and Annie, my friend. Keeping you both in my thoughts and prayers.

frijole

06-04-2010, 11:53 PM

ultrasound guided cysto's ????

If you tell me what this is I can have her do that too right? :D:confused::D

Harley PoMMom

06-05-2010, 12:01 AM

Ultrasound guided Cystocentesis is a benign procedure that involves inserting a needle (usually guided by ultrasound) through the abdominal wall into the bladder to collect urine. Sometimes Cystocentesis (cysto) are not done with a ultrasound machine, but with Harley, well, he gets so tense so they use the ultrasound to locate his bladder.

BestBuddy

06-05-2010, 12:46 AM

Buddy was a champ at having cystos. He had many. It is important to have the badder full because it makes it nice and big (good target). Sometimes they were able to do Bud without the ultrasound because it was nice and large but other times if they were unsure they used the us to get an accurate target.

I'm not sure I would do the cysto without doing the quick urine catch test with a strip. If I got a positive on the strip then I would want the cysto to do the clean urine sample for culture and sensitivity testing.

I had a vial of multistix that cost about $40 for 100 and with all the UTI's Buddy had it was a much cheaper and quicker way at home to check.

Jenny

Harley PoMMom

06-05-2010, 05:58 PM

How are you and sweet Annie today?

Love and hugs,
Lori

frijole

06-05-2010, 06:36 PM

We are about the same. She only ate a few bites of her canned food this a.m. I gave her a pepcid ac an hour before trying. I had a hair appt so just left the food out..not much eaten.

Around noon I gave her a bit of rice with some kibble and chicken broth (I made it). She ate that up.

Just now a bit of chicken breast (no skin) cut into teeny pcs with a tiny bit of rice. She chowed on that.

She did the Haley search thing a ton last night and this a.m. but this afternoon shes just lounging which I will take.

I put together my list for the vet in Omaha. I was impressed - she had someone call to tell me that the construction/detour she had told me about is gone now so I can drive straight there... just showing she is courteous.

Need to attend to some chores but my heart isn't really in it... but I need to...

acushdogsmom

06-05-2010, 06:58 PM

Just another thought I'm having re: Annie's appetite seeming to come and go.

In addition to the grieving, which certainly could still be a factor, maybe the cortisol having come down from around 30 post-stim to around 20 post-stim could have something to do with the pickiness? Some dogs seem to get really picky - turning up their noses at foods they used to "love" - when the cortisol starts coming down. This isn't always because the cortisol is too low ... it can happen sometimes just when the cortisol is lower than it used to be. I think that sometimes the higher cortisol production prompts them to eat foods that they didn't really "love" so much - it was just the high cortisol making them eat almost anything and making it seem that they loved those foods.

And it's not unusual for a dog who is hungry to vomit up a little bile.

Anyway, just some things to consider.

I think that seeing this new Vet in Omaha on Monday, getting the ultrasound done and getting a fresh pair of eyes and ears on the case could be just what you and Annie need. Bring all the test results and your list of questions. Let her go over the Lab reports etc and do any other tests she thinks she should do in order to be able to confirm or refute Annie's Cushing's dx and anything else that she thinks might be going on. Maybe she'll see something or know something that your other local Vets haven't thought of yet or just haven't put together in a way that makes sense. Maybe she'll also agree to continue to consult with you and your Vets after she has seen Annie for herself. Maybe Annie is just a slow loader like Haley was?

Bring Annie in (to the appointment on Monday) fasted - i.e. no food from about 10 pm the night before - just in case there's a test that she wants to do that requires fasting, other than the ultrasound. Spec cPL blood sample, for example, is supposed to be taken on a fasted dog. My Vet used to always ask me to fast my dog before an ultrasound anyway.

Oh and one more thing. I do think that the pancreatitis blood test (Spec cPL) which was originally developed as the cPLI test by Dr. Jörg Steiner and Dr. David Williams in the Gastrointestinal Laboratory at Texas A&M University, can now be sent to any Idexx Lab for analysis. My friend's dog just recently had that blood test done (Spec cPL) at her GP Vet's and it was sent to their local IDEXX Lab here in Canada for analysis.

Here's some links that I found for my friend when her dog was being tested for pancreatitis:

Pancreatitis in Dogs and Cats (TAMU Gastrointestinal Lab website):
http://www.cvm.tamu.edu/gilab/research/Pancreatitis.shtml

Pancreatic Lipase Immunoreactivity Test info (Spec cPL) (TAMU Gastrointestinal Lab website):
http://www.cvm.tamu.edu/gilab/assays/cPLI.shtml

Spec cPL® Test (canine pancreas-specific lipase)(Idexx Labs USA website):
http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf

The Spec cPL® Test is a revolutionary test that allows you to quickly and confidently rule in or rule out pancreatitis in dogs.

(note that there are lots of links re: pancreatitis on the right hand side of the IDEXX Labs page at the link above)

Harley PoMMom

06-05-2010, 07:18 PM

You can get the cPLI or the cPL test, for Harley I get the cPLI test and it is sent to the TAMU Gastrointestinal Lab to be anaylaized. :)

I did just go look at Harley's report and it does say cPLI but I think with the cPLI they just call it that on the report!

IDEXX does do the spec cPL, and yes the pup needs a 12 hour fast.

Love and hugs,
Lori

frijole

06-05-2010, 07:20 PM

:D I truly truly don't know what I would do without all of you guys. Truly.

The vet did instruct me to fast her. When she asked how she could help me I told her to save my dog and do whatever she needed to starting with the ultrasound.

Going to be a rough trip since she is going to be in and out of some conference I have to go kill time and wait for her to call me back. I will be a wreck. Everyone I know in Omaha works. Dang. I'm bringing magazines. Won't be able to read a book.

Harley PoMMom

06-05-2010, 07:34 PM

I also took Harley's food and water with me so when he was finally finished he could eat because he was sooo hungry.

My boyfriend and I brought a lunch with us too, when we were in Philly for Harley's first visit with his IMS it was at least 6-7 hours.

frijole

06-05-2010, 07:52 PM

I read the links. I always thought pancreatitus was from vomit/diarrhea over time - had no idea it could exist without overt symptoms. Well.. those links led me to links on hyperlipidemia in schnauzers...

I'm going to quit reading til after Monday. :o

frijole

06-07-2010, 09:02 AM

Thanks to all for prepping me. I have food and water packed for Miss Annie. We head out to Omaha in less than an hour. We are accepting prayers. I am petrified but know we need to do this. Deep breaths. Hugs to all. Kim

Harley PoMMom

06-07-2010, 09:21 AM

Tons of prayers being sent your way, my friend, big hugs too. Safe travels and let us know anything as soon as possible...the best of luck to you and Annie.

Love and (((hugs)))
Lori

lulusmom

06-07-2010, 09:32 AM

Kim,

Safe travels, my friend. You've got prayers being said in Cali and big time positive thoughts being sent your way.

Franklin'sMum

06-07-2010, 09:39 AM

Hi Kim,

Just adding my thoughts and prayers for you and Annie from across the waves,

Jane, Franklin and Bailey xxx
________
Kitchen Measures (http://kitchenmeasures.com/)

ladysmom06

06-07-2010, 09:53 AM

Hi Kim,

Sending tons of prayers and positive thoughts for you and Annie. Have a safe trip. Hugs to the two of you.

Casey's Mom

06-07-2010, 09:55 AM

Safe trip Kim! Tons of good energy being sent your way . . .

Love and hugs,

Roxee's Dad

06-07-2010, 10:35 AM

Keeping you and Annie in my thoughts today.

AlisonandMia

06-07-2010, 10:47 AM

Thinking of you and Annie.

(((((Hugs))))))

Alison

labblab

06-07-2010, 11:28 AM

Me, too!!!!!!!!!!!!!!!!!!!!!!!!!!! Sending prayers and positives thoughts, that is. :)

(And, of course, if you end up with some time to kill -- you can always take a drive across the river and treat yourself to a few minutes spent in the most wonderful state of all...;) ;))

"Hawkeye" Marianne

marie adams

06-07-2010, 12:52 PM

Keep up good thoughts!! Take care!!!:)

sunimist

06-07-2010, 01:08 PM

Me too Kim! Lotsa prayers and hugs from me and Suni. Drive carefully and stay safe and I hope the wait passes quickly.

Waiting with you!

Love...Shelba

zoesmom

06-07-2010, 01:42 PM

Thinking of you and Annie today and anxious to hear what the Omaha vet has to say. Have a safe and productive trip. Sue

littleone1

06-07-2010, 02:52 PM

Keeping you both in my thoughts and prayers. Have a safe trip.

frijole

06-07-2010, 05:35 PM

I went to Omaha and they made me go to my vet for results! Its 1 hr 30 min drive! Had more tests done there and I don't know anything more than when I left my house this morning.

I am so upset and so confused. I am going to have a beer and will post after bit.

acushdogsmom

06-07-2010, 05:47 PM

I went to Omaha and they made me go to my vet for results! Its 1 hr 30 min drive! Had more tests done there and I don't know anything more than when I left my house this morning.That's probably because your own Vet referred you to the vet who did the ultrasound. They probably have a protocol to follow when another vet refers a patient there for u/s or anything else so that they don't inadvertently step on the referring vet's toes, so to speak. Your vet should be able to give you all of the results as soon as they get them from the vet in Omaha. Can you remember what other tests were done by the Vet in Omaha?

frijole

06-07-2010, 06:03 PM

That's probably because your own Vet referred you to the vet who did the ultrasound. They probably have a protocol to follow when another vet refers a patient there for u/s or anything else so that they don't inadvertently step on the referring vet's toes, so to speak. Your vet should be able to give you all of the results as soon as they get them from the vet in Omaha. Can you remember what other tests were done by the Vet in Omaha?

No - I got the results from my vet and I still have no idea what is going on - nor do they. More after I finish this beer.

frijole

06-07-2010, 07:03 PM

And it was only 1/2 of a beer left over from last night... I only had one in the house. Dang.

OK - first off - remember this vet is a regular vet and NOT an IMS. We have no IMS in this state. She has practiced for 35 yrs and is the only vet at the clinic that does ultrasounds.

We got there at 9 am and I had written up a brief summary with a timeline and test results and major events so I could give her the history. I reviewed it with her. I told her that my vet wanted to see if it was adrenal cushings but given the problems with eating I was concerned about pancreatitus, gall bladder or other issues. I told her that I authorized her to do whatever additional next steps/tests are needed in order to diagnose what is going on.

She said something about well 14 is old and you worry about other things as well... and on that note I left.

The clinic called me at almost noon to say I could pick Annie up. When I got there they gave me a bill that showed the ultrasound, a liver aspiration and cytology. There was an envelope that she said I should give to my vet for him to explain results...

So I drove off and found a spot to give Annie some food and water as well as read that report. The reason I was upset was because I spent the next few hours until I got to the vets thinking Annie had liver cancer.

Before I went into the vets I took notes from the ultrasound report so I could report:

liver - quite large homogenesis echofixture hyperchoic. very hyperchoic nodule deep in left liver loze (1 cm x .7 cm)

gall bladder - quite full thin wall no sludge. normal

kidneys - fairly normal. small calcification in left kidney

bladder - no masses or calcule seen

stomach - normal

small intestine - bowel loops seem quite prominent but measure within normal

pancreas - no changes seen

adrenal - left gland enlarged, unable to image right

lymph nodes - no enlargements no perifoneal effusion noted

FNA liver. quite alot of bile stasis. Hepatocytes seem quite normal.

------------------
So I drive back home and go directly to the vets office. I leave Annie in the car.

He says that there is no mass on the adrenals so that is good. That the liver biopsy was not cancerous. Even though she has cushings - the two of them discussed what each of them would do if it were their dog and both said they would not treat the cushings since there are no symptoms.

End of conversation.

I asked about the other adrenal and he said sometimes you just can't get a picture of it.

I asked about the appetite and pancreatitus. He said there was no previous sign of it but if I wanted to we could test. I said I wanted the Idex one (full) and he said the dog had to be fasted (which she was this am but I fed her at noon)... so I opted for this "in house" version of the quickie Idex test (they don't offer it) that measures one enzyme and is pretty indicative... he came back in red faced and said the machine isn't working and he'd have to send it out. Damn

Then he said to be honest we really very rarely do pancreatitus tests.

I brought up that Annie's legs were failing again - saw her fall yesterday going up 2 steps and he said it wasn't a cushings sign but rather addisons. I argued with him and said yes it is, muscle wasting blah blah. He seemed to be totally unaware of this. I was frustrated.

He then said, she is old Kim. I said 14 isn't old. ha. I reiterated that the leg issues happened very quickly along with urination in the house AFTER the ldds test and before the Acth test. Very quick and strong. Then after using lysodren both went away.

He keeps indicating that water consumption is the sign you look for w/cushings and I keep telling him Haley NEVER had it. EVER. Annie drank 1/2 cup water total each of the last 2 days and 1/4 cup the day before. That perked him up.

She acts starved but then stops and won't eat regular food. Only tuna and chicken will entice her to eat. But not alot. After she eats she lies on the floor and acts dead. He again told me she is old. I told him this has not been her and is not normal Annie.

He gave me metoclopramide 5 mg tablets cut in half and told me to give 2 to 4 daily to her to increase her appetite and get her stomach moving.

He gave me Metacam to give for arthritis.

I am not to use lysodren.

WTH do I do?

Buffaloe

06-07-2010, 07:20 PM

Kim,

May I suggest a Red Stripe? It is a Jamaican Lager. My good friend who owns some nice restaurants gave me my first one and now it's all my girlfriend and I will drink. It's good.

I don't have much to offer on Annie. It is great that she apparently does not have an adrenal tumor. Bottom line, I think Mom knows best. Annie is your dog. You know alot and I think you should proceed with Annie the way you think is best.

Ken

zoesmom

06-07-2010, 08:30 PM

Uh . . . that's crapola. There's just so much wrong with that picture you just gave us. Where to begin?

How about . . . your vet keeps saying the weak legs are signs of addisons'. Doesn't he remember Annie's last three ACTH tests!

What does a very hyperechoic nodule in the left liver lobe mean exactly??? He says not cancer, right?

With no changes in the pancreas on u/s, seems doubtful that pancreatitis is at work here.

Bowel loops ? seem quite prominent????? Could that be affecting her appetite, I wonder, even tho' within normal range. I have no idea.

Both said they would not treat their dogs if no symptoms, but Annie was having symptoms. Weak legs, urinating in the house (which is kinda odd, however, given her low intake of water). I forget - what were her liver enzymes like.

She did have the two positive cush tests - which so far don't look like they've been explained away by any other medical condition that might raise her cortisol.

If they only saw one adrenal, does that mean there is no chance of a tumor in the other, because . . . . it was what . . . too small to pick up on u/s . . . . or having to do with the way the organs lie? I'm curious as to the specific reason they can sometimes only see one? Maybe our adrenal people know that answer?

And the big puzzle - she acts hungry but then doesn't want to eat much. No explanation for that either, unless it IS simply the loss of Haley.

And then the metacam - in a dog with elevated cortisol - not a good idea, IMHO. How about adequan instead. Many here have reportedly done well with that.

Soooo many questions just left hangin' by both vets. I totally understand your anger and frustration. And wish I knew what to tell you. All I can think of is a UTK panel (but guess you'd have to wait awhile since she had lysodren recently.) And that may only help with some of your questions.

I guess if it were me, I'd wait and see if her appetite picks up on the one med he gave you. Maybe try to ride it out a little longer to get further past her missing Haley. And then do another ACTH (or get the UTK panel done), with an eye to restarting the lysodren or perhaps switching to trilo. Still, I know you don't want her to backslide with the symptoms she was having.

Has your vet ever offered to . . . or have you discussed with him . . . the possiblity of consulting with somebody like Dr. Bruyette - or one of the big teaching schools. I guess the only other procedure remaining would be a ct scan or mri but she hasn't really shown any neuro-type behavioural changes, right - other than her sadness over missing Haley.

Guess I'm just trying to run thru a mental list here - thinking out loud. Grasping for whatever. Wish I had something concrete instead. Sue

Harley PoMMom

06-07-2010, 10:23 PM

Hi Kim,

I was looking at Harley's ultrasound report and he has a hyperechoic nodule on one of his adrenal glands. I was told to just keep an eye on this for growth, it does not mean that this nodule is any type of cancer.

Also found this on the internet :p

In some animals the right adrenal gland is more difficult to find, since it is located deeper and more cranial than the left adrenal and therefore ribs and bowl gas can compromise visualisation.
http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2006&PID=15792&O=Generic

Just throwing some thoughts out here....what about a HDDS test? And another thing, in the beginning Harley did drink more water than usual but after his cortisol started climbing, well, his appetite and water consumption have lessened alot and he is a little pickier about what he eats...so in the beginning I really don't think Harley drank copious amounts of water like other cush-pups do but he definitely has cushing's. So I say you know your Annie best and your gut will tell you what the right thing is to do.

These decisions are buggers! :eek: We are here for you, my friend.

Love and hugs,
Lori

frijole

06-07-2010, 11:30 PM

Well the easiest advice to take is to go find a Red Stripe! LOL Thanks.

I think what upset me the most was I felt like they both gave up on my dog. I can understand their logic on holding off on lysodren while she isn't eating... but to ignore the fact she isn't eating?

At first I thought it was all about Haley but it is the way she runs for food, looks down at it and stares and just walks away that blows my mind. This is food she has always loved. Then when I get her the alternative she inhales it. I mean no breathing. I pick it up to make her breath and settle down before continuing.

I've tested her to see if I didn't give her an alternative and just left the other food out .. would she eat it... nope. I have left the house and let it sit for hours and she didn't eat it.

For now I am going to see if a bit of time helps heal this. Maybe with time I will come up with something else but right now... I am at a loss.

frijole

06-07-2010, 11:31 PM

Hi Kim,

I was looking at Harley's ultrasound report and he has a hyperechoic nodule on one of his adrenal glands. I was told to just keep an eye on this for growth, it does not mean that this nodule is any type of cancer.

Also found this on the internet :p

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2006&PID=15792&O=Generic

Just throwing some thoughts out here....what about a HDDS test? And another thing, in the beginning Harley did drink more water than usual but after his cortisol started climbing, well, his appetite and water consumption have lessened alot and he is a little pickier about what he eats...so in the beginning I really don't think Harley drank copious amounts of water like other cush-pups do but he definitely has cushing's. So I say you know your Annie best and your gut will tell you what the right thing is to do.

These decisions are buggers! :eek: We are here for you, my friend.

Love and hugs,
Lori

Thanks.. that article on the adrenal made me feel better.

frijole

06-07-2010, 11:35 PM

Sue - it was funny reading your post because my mind was going thru a similar check list. I didn't even give the metacam because I wanted to look it up first... I gave him the "hairy eye ball" when he recommended it - he said it was anti-steroidal. I'll research it later.... its weird because Haley used adequan and he never recommended metacam. Frankly he probably wanted me to get the heck out of there.

Rebelsmom

06-08-2010, 12:08 AM

Rebel just had a follow up u/s. On his first she said he has a hyperechoic growth on his liver. It was very small and she was not concerned about it. When she checked it again last Thursday she said it has actually gotten smaller. She also had a hard time seeing his left adrenal cause he was full of gas (which I can believe the dog can clear a room). That's all I can really offer for you since I'm not familiar with the other stuff. Thinking of you and sending love and hugs your way.

Melissa

zoesmom

06-08-2010, 12:24 AM

Ok, keep thinking about the Annie mystery. Scratch my previous thoughts on the UTK panel. I really don't think it's going to tell you anything that you don't already know, other than reconfirm the previous LDDS and ACTH tests, I guess. Probably the only way it would make sense is if you were considering switching to trilo.

Just browsed thru your thread again quickly and noted a few things . . . the liver enzymes, that Annie is hypothyroid and on medication, has a grade 3 heart murmur (no med?), never drinks much water but was having pee accidents, lost her appetite last couple weeks (& it used to be big), had vomiting episode or two a short time ago, and was supposed to have the uc:cr but just had a regular urinalysis instead.

So am wondering.....with her low thirst and yet the accidents, has another urinalysis been done? I know there was talk of doing a cysto on her in Omaha. Maybe that should be done, if it hasn't been, to make sure there's no uti. With as little as she drinks, the urinary accidents seem mighty strange (unless it's another sign she's missing Haley??)

When was the last time her thyroid levels were checked? I think you said she's on .2 mg dosage. Size isn't always the determining factor, as Zoe took everything from .2 to .8.

I noticed Alison felt that maybe a dog could still have pancreatits or gall bladder issues, even if no signs were visible on the u/s. So maybe the cPL would still be a good idea.

If there's any doubts at all about the LDDS and the ACTHs, returning false results, then I guess you could go back to square one and get a uc:cr. But that seems a little after the fact at this point, given all of her acth's combined.

Some of the things you wrote (about Annie) right after losing Haley also makes me think that grief really is a bigger factor in how Annie's been acting and feeling (and responding to the lysodren). And I think the only way for that NOT to be a factor is waiting it out - which I know is hard, but maybe it can't be avoided.

The thing that really puzzles me, tho', is the low drinking and yet having the accidents. Again, stress may be the logical explanation. Oh, and her USG was actually rather good. I think I saw 1.030? That doesn't exactly fit with cushings OR a uti. But didn't check the timing on that.

On the appetite, could it have fallen off simply because her cortisol was starting to head down. Maybe she was just getting ultra-picky because of that. Sounds like she'll still eat some things, just not others. Can't tell you how many times Zo pulled the picky-eater thing on me (last time was at Stacy the petsitters in Dec). She went on a hunger strike for almost a week. So Stacy - in desperation - went and bought a new food for her and she gobbled it right up. And also tried to gobble up the other dogs' foods too. But wanted no part of her own usual food. Here again, could there be a connection or reminder of Halely with the food issue???

Also odd . . . her AST (was that the one) isn't out of range and her ALK PH is only slightly high.

One last thing . . . and then I'll quit rambling. Has there been any follow-ups on her heart murmur? Don't know much about those and what it all means over the long-term. Just trying to cover all the bases.

Guess Annie's living up to our favorite adage of "not going by the book." Maybe you and she should sit down and have a little heart to heart, like Wendy posted about in Everything Else. Tell her that you are there for her, always, and that you both loved and are missing Haley but that you are both going to be fine, because you still have each other. And then say . . . how about let's have some food now (and a beer for mommy) :rolleyes::rolleyes: Sue

zoesmom

06-08-2010, 12:34 AM

Just saw your remark about the metacam. Zoe's IMS was always extremely concerned about using metacam in a cush pup. She didn't give it to us for a loooong time and finally, gave in and prescribed it for Zoe's failing legs, but she'd only let me give her half a pill once a day (would have to check what that dosage was, but I think it was at least 50% less than was norm for Zoe's size.) She was worried about intestinal bleeding, mostly. And Zoe's cushings was fairly well-controlled then (like a 5.- something post #)

And THEN, when I asked for some new pred to send w/Zo to the petsitters (you know . . as a precautionary only), she refused to give it. Said if Zoe was still on metacam, that the pred was even more dangerous and that she should not be given a pred for at least a week after taking her last metacam. Sue

lulusmom

06-08-2010, 12:38 AM

Hi Kim,

Metacam is a non-steroidal anti inflammatory (NSAID) that is prescribed for arthritis as well as for post surgical pain. It's a great drug for pain and my vet prescribed Metacam for Jojo's arthritis; however, his cushing's was well controlled at the time. NSAID's are not to be given with corticosteroids which means uncontrolled cushdogs are at much greater risk for side effects. This drug can be really rough on the stomach and the worst side effects are gastrointestinal toxity, intestinal perforations and renal toxicity. Unless your vet thinks that Annie has debilitating arthritis, I would be very wary of giving this drug to her and even then, I'd be concerned. Exactly why did he prescribe Metacam? Did he manipulate Annie and take xrays to determine if she has severe degenerative arthritis? I'm also not crazy about giving any drug that's tough on the stomach to a dog that's not eating normally.

P.S. By the way, it has been well over a year since I gave any Metacam to Jojo. I don't think his problem was ever arthritis...he had severe muscle wasting and psuedomyotonia. He's an old man but he regained his muscle mass and can run around and even stand on his hind legs. He still walks with a really stiff gait.

marie adams

06-08-2010, 02:03 AM

Hi Kim,

I so enjoyed the comments about the beer drinking--a good laugh!!:D:D My husband says it cures all ailments!!! Haha!!
They asked me if I wanted a drink of water at the vets today and I said it wasn't strong enough to cure the stress!!! He just chuckled...

I wish I had answers for you so I could help; I just don't know enough yet. I am still questioning if I tested Maddie too soon again and if I did how the heck will I figure this out--it seems like we all go through this trying to figure out what is going on even if you have been doing it for quite some time.

I hope the beer cleared up a few things!!!:D:D I do wish the answers were easier to come by for you at this time--my best to you!!

BestBuddy

06-08-2010, 04:51 AM

Metacam is a great drug but yes it is a nsaid. I take it for my arthritis but it is really hard on the liver. I take the human form called meloxicam and know that when I have taken it a lot over the month my bloods show a dramatic increase on my liver tests.

Phoebe took it occasionally and Nelson too but Buddy was not allowed because of the diabetes and also the cushings factor.

I suppose it is like a lot of drugs that you find the exact dosage that will help without causing any more problems.

I though it was also a big harsh on the stomach so I don't know how Annie would go with it. Does she act like she is in pain or just depressed?

Jenny

frijole

06-08-2010, 10:21 AM

Glynda - no he did not examine Annie's legs. While she was in his office she was running around like a pup. I told him it comes and goes and it came w/the urination (like a rush of cortisol production hit) in between the ldds and the acth tests. It went away with lysodren treatment as did the urination.

I think he threw it out there without thinking and being exhausted from my saying - So if you don't treat the cushings WTH would you do about the appetite and the legs? Thus the two drugs he threw out. I knew to check here before giving it to her.

Sue - her low water intake has just been since this past weekend. She never had anything greater than 1 1/2 cups a day and she is 14 - 15 lbs.

He thought based on the ultrasound that the bladder is not an issue. He is unfamiliar with the uc:cr test. I debated this with him a few weeks ago.

My plan was to do a full panel on her thyroid (Dodds) after her cushings was settled. He does some basic in house testing. For some reason he is not keen on sending things out. Yesterday when we were debating the pancreatitus testing he said the in house screenign is only $16 and I said "Doc I DO NOT CARE about the cost".

I am off to work - wishing all a great day. Thanks as always, Kim

frijole

06-08-2010, 02:57 PM

Doc called to say that he check two enzymes for pancreatitus on yesterday's test and both came back negative. (Not Idexx test - an in house one)

Harley PoMMom

06-08-2010, 03:26 PM

The snap cPL test, which is done in house, is to test the lipase levels. And the results would be normal or abnormal. Did he tell you specifically what pancreas test he did?

frijole

06-08-2010, 04:06 PM

The snap cPL test, which is done in house, is to test the lipase levels. And the results would be normal or abnormal. Did he tell you specifically what pancreas test he did?

he doesn't have access to the snap test but this is his inhouse version of the same. it measures lipase and amalypse (sp?) if i wrote it down right.

lulusmom

06-08-2010, 05:10 PM

I suspect that Kim is right and he only has the lipase and amylase values which is what you get on a standard blood chemistry.

Harley PoMMom

06-08-2010, 05:19 PM

The lipase and amylase levels can be normal on the chemistry tests in a dog with pancreatitis as my Harley has proven that...his were, but his cPLI was 464 (0-200) at that time.

lulusmom

06-08-2010, 05:38 PM

Kim, it seems that pancreatitis is becoming more and more prevalent on the forum so I've been doing a lot of reading about it. The one thing that stick in my mind is if you were to play a word association game with a knowledgable vet and you said pancreatitis, the vet would probably say "Miniature Schnauzer." They are the one breed that has shown up in just about every paper I read. I will echo Lori and tell you that just because the lipase and amylase are normal, doesn't mean that pancreatitis isn't brewing.

I could relate a lot of the stuff I've read lately but I ran across a terrific paper presented by IDEXX Laboratories called Diagnosing and Treating Pancreatitis, A Roundtable Discussion, which I heartily recommend that you read. They have a great paper on diagnosing liver disease as well. Even if Annie's problem isn't pancreatitis, you will have a much better understanding of the condition, which will come in handy for those times when Lori starts going off on the subject and you just sit there scratching your head. We've had so much exposure to pancreatitis lately that my head was getting raw from scratching it. I thought it wise to save the bit of hair I have left by continuing my education. :D

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/education/diagnosing-treating-pancreatitis-roundtable.pdf

frijole

06-08-2010, 10:33 PM

Wow Glynda, where do you find these articles? ha. I will print it at work tomorrow and read at lunch. I believe what you guys have told me...I am just tired and my brain is fried. I am no expert at pancreatitus but I have read enough posts here to know it is real and frequent, particularly in schnauzers. I'm just tired of arguing with and educating a vet.

Annie ate well today. She ate her chicken/rice in the a.m. like a cush dog. I left food out for the kid next door to place on the ground as a test. It was 1/2 of a normal helping of her kibble. Plain and nothing on it. I came home and it was all gone.

There was also pee in the living room. In all fairness - I didn't get home til 6:40 - more than an hour later than normal... her water intake today is less than 3/4 of a cup.

Anyway, I gave her a 3rd meal (more rice/chicken) and she inhaled it.

So - either that drug he prescribed (and the pepcid ac) worked wonders or her cortisol is rising...

Her last lysodren dose was on 5/29 in the a.m. So it has been 10 1/2 days.

acushdogsmom

06-08-2010, 10:57 PM

he doesn't have access to the snap test but this is his inhouse version of the same. it measures lipase and amalypse (sp?) if i wrote it down right.Okay, is it possible that your Vet doesn't know about the more accurate (and newer) way that many vets are now using to diagnose pancreatitis in dogs?

I gave you this link before, but here it is again ... maybe you can print it out for your Vet to see. It is written by Dr. Jörg M. Steiner from the Texas A&M Gastrointestinal Lab, one of the developers of the Spec cPL (also known as the Spec cPLI) test.

http://www.cvm.tamu.edu/gilab/research/Pancreatitis.shtml

Here are several quotes from that article:

Introduction:
Pancreatitis, an inflammatory condition of the exocrine pancreas, occurs frequently in both dogs and cats. While the true prevalence of pancreatitis in dogs and cats is unknown, recent studies would suggest that pancreatitis is a rather common and underdiagnosed condition in both dogs and cats. In a large retrospective study of necropsy findings 1.5% of 9,342 canine and 1.3% of 6,504 feline pancreata showed important pathological lesions. Pancreatitis can be difficult to diagnose. This may be due to the non-specific clinical signs commonly displayed by pancreatitis patients. However, there also has been a lack of diagnostic tests for pancreatitis that are both sensitive and specific for pancreatitis.

Clinical picture:
Clinical signs of dogs and cats with pancreatitis depend on the severity of the disease. Mild cases may remain subclinical while more severe cases may present with a wide variety of clinical signs. In a recent retrospective study of 70 dogs with fatal pancreatitis the following clinical signs were reported: anorexia in 91% of the cases, vomiting in 90%, weakness in 79%, abdominal pain in 58%, dehydration in 46%, and diarrhea in 33%. These findings are somewhat surprising as abdominal pain is the key clinical sign of pancreatitis in human patients. Thus, the question arises whether dogs with pancreatitis have abdominal pain less frequently than humans, or more likely, whether we fail to correctly identify abdominal pain. It goes on to say:

Serum lipase activity:
Serum lipase activity has been used for the diagnosis of human and canine pancreatitis for several decades. However, it has long been recognized that serum lipase activity is neither very sensitive nor very specific for pancreatitis in either species.

In summary, serum lipase activity is neither very sensitive nor very specific for diagnosing pancreatitis in dogs

Serum amylase activity:
The diagnostic utility of serum amylase activity for canine and feline pancreatitis is very similar to that of serum lipase activity. Some dogs with spontaneous pancreatitis have an elevated serum amylase activity, but others have serum amylase activities in the normal range.

Pancreatic lipase immunoreactivity (PLI):
Recently, assays for measurement of pancreatic lipase immunoreactivity in dogs and cats (cPLI and fPLI, respectively) have been developed and validated. As mentioned previously, many different cell types in the body synthesize and secrete lipases. In contrast to catalytic assays for the measurement of lipase activity, use of immunoassays does allow for the specific measurement of lipase originated from the exocrine pancreas.

The sensitivity of serum TLI concentration was below 35% and that of serum lipase activity was less than 55%. In contrast, the sensitivity for serum cPLI concentration for pancreatitis was above 80%.
In another study of cats with spontaneous pancreatitis serum fPLI concentration was more sensitive and more specific than serum fTLI concentration or abdominal ultrasonography.

These initial data would suggest that serum PLI concentration is highly sensitive and specific for the diagnosis of pancreatitis in dogs and cats.So the test that you need the vet to run, if you are trying to diagnose pancreatitis, is the Spec cPL test (also called Spec cPLI), not just serum amylase and lipase. Spec cPL is the current gold standard blood test for diagnosing canine (or feline) pancreatitis. To run a Spec cPL test, the vet used to have to send a fasted blood sample to the Texas A&M Lab to get a Spec cPL test run, but now, IDEXX Labs can run the Spec cPL test, too.

http://www.idexx.com/view/xhtml/en_us/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.jsf

The Spec cPL® Test is a revolutionary test that allows you to quickly and confidently rule in or rule out pancreatitis in dogs.

Originally developed as the cPLI test by Dr. Jörg Steiner and Dr. David Williams in the Gastrointestinal Laboratory at Texas A&M University, the Spec cPL Test offers:

Unprecedented accuracy—With more than 95% specificity and sensitivity (as compared to the cPLI assay), this test far outperforms other test methodologies, so you can treat confidently.

Fast results—Tests are run daily so you can move ahead quickly with treatment. The Vet just takes a blood sample from a dog who has been fasted and sends it out to an IDEXX Lab for analysis (requesting the Spec cPL test to be run). Your Vet can call any IDEXX Lab and ask about the Spec cPL test that can now be done to more accurately diagnose pancreatitis in dogs. They'll tell him (or her) that it is indeed the gold standard test to do now - much better than just measuring serum lipase and amylase.

P.S. There is also apparently a version of the cPL test that a Vet can do in-house with a so-called "Snap reader" apparatus, if they have it in their office, called a "Snap cPL". But as far as I know, it's not as good as running a Spec cPL that is sent out to IDEXX Labs to analyse.

http://www.idexx.com/view/xhtml/en_us/smallanimal/inhouse/snap/cpl.jsf

It's all a bit confusing, I know, but I hope this long post makes some sense to you. :)

frijole

06-08-2010, 11:49 PM

Cushy, I feel so bad that you wrote all that out with your bad hand! I actually did read what you had posted and took notes on it. I specifically requested this test. The problem was that I had given Annie food when leaving Omaha as she had fasted - I couldn't get it done yesterday. He offered the quick test and I asked if it was the snap test and he said that they dont offer that one as they do this instead... so I did it because I could get it done.

So - armed with your highlighting on how worthless his measurement is and the long article on treating dogs with panc. from Glynda I will do that test.

He did come right out and say that they hardly ever do tests for pancreatitus. HA - then read this article buddy... Sigh.

Again, thanks guys for everything. I am not feeling well. A bit dizzy. No doubt just stress and lack of sleep. A short while ago I sat Annie down with Haley's blanket, her dog collar and her ashes. We had a chat about Haley going bye bye but that it was OK because I am here for her. I don't know if it did any good but it was an attempt to give her some closure.

Hugs, Kim

BestBuddy

06-09-2010, 12:12 AM

Kim,

First of all you need to look after yourself, Annie depends on you. I like the thought of you talking to her about things, even if she doesn't understand the words I am sure she gets the feelings behind them.

I am glad she is eating but geez I don't know what else is going on. All I can do is tell you we are here for you.

Jenny

frijole

06-09-2010, 03:05 PM

I decided to test her this a.m. as she seemed real hungry. I dished out a normal 1/2 can of dogfood. She scarfed it all down.

Not sure why but I will take that.

acushdogsmom

06-09-2010, 03:10 PM

Maybe the metoclopramide (aka Reglan) is helping?

http://www.drsfostersmith.com/Rx_Info_Sheets/rx_metoclopramide.pdf

http://www.marvistavet.com/html/reglan.html

zoesmom

06-09-2010, 03:16 PM

frijole

06-09-2010, 03:18 PM

And maybe that little talk that you had with her, too!

Going back to the low thirst and the pee accidents, could it be that Annie's simply become incontinent, due to her age? I'm sure another med is not a thought you want to entertain right now, but maybe a trial run on proin (propalin/phenylpropanolamine) might help. Just another thought. Sue

She sleeps on a blanket on my bed that I could spot little stains which is how that usually starts... but I'm talking about a full "pee". :D I think she just couldn't hold it any longer last night - I was late coming home. And BTW it was very yellow too.

Harley PoMMom

06-09-2010, 03:27 PM

FWIW...I take Reglan for nausea, my migraines make me very sick in the stomach. The Reglan definitely takes the nausea away but it doesn't stimulate my appetite.

Just read the marvista article on Reglan...constipation, yep! OUCH!

zoesmom

06-09-2010, 05:01 PM

... but I'm talking about a full "pee". :D

In Zoe's case - incontinent from the time she was a puppy - there were many times when she'd just empty her bladder completely, rather than leave dribbles. Didn't matter if she'd just gone out to pee, even an hour or so earlier. She could come in, go into a deep sleep, then 'let go,' and wake up in a huge puddle. That was early on, before the proin. She ran the gamut actually. Sometimes, there'd be full puddles, other times just dribbles. Even after she was on the proin, whenever a uti would hit, she'd still do the dribbling.

... I think she just couldn't hold it any longer last night - I was late coming home. And BTW it was very yellow too.

That could be the explanation, too. Very yellow suggests pretty good concentration . . . which I guess you'd expect with her not drinking much. I think you posted that a recent USG was 1.030 - which is very respectable in a cush dog. That's why I thought simple incontinence might explain the accidents, at least, given the absence of excess thirst. Assuming last night was a fluke because of your late arrival, then she's only had that one other accident??? And, certainly, one accident could easily be explained by her being distraught over Haley.

So . . . . she doesn't have polydypsia and is concentrating her urine well, both things which run contrary to what we'd expect in a cush pup. Annie, you are indeed a mystery. :confused::confused::confused: Sue