Ginger-16 yo Poochon (Bichon Poodle mix) [Archive] - Canine Cushing's Information and Support Forums

LtlBtyRam

05-20-2020, 02:52 AM

Hi all,
I know I haven't been around since I lost my girl a little over 4 years ago. It looks like we are headed down this path again. I am beside myself at what to do. She is 16 years old and we have been having skin problems for a couple of years we have tried a lot to get it under control. Each step has helped but not quite hit the mark. I know skin problems are a part of Cushings. We fought it for about 3 1/2 years with my girl before she passed. We just don't know what to do with Ginger. She is harder to medicate than Shasta was. I will post a second post with tests I have right now. Really would like experiences and more information on Lysodren protocol. Thanks everyone.

Here are her overall particulars
Ginger is 16 years old
as the title says she is a Poochon (Bichon Frise & Poodle mix) she doesn't like being called a Bichipoo her ears drop backwards but keeps them forward with Poochon
She is almost 14 pounds
She takes 500 mg Quercitin daily
2 drops of CBD oil
Back on Gabapentin 100 mg daily

We had her on Apoquel but took her off (after being on it we noticed more growths than she had before. mostly wart like)
She is on Darwin's Pet food which is raw but has directions for lightly cooking it which we do
She has started to refuse her food with the meds and we are really struggling with that

LtlBtyRam

05-20-2020, 03:03 AM

Patient Info: Hospital: Name: Ginger Species:Dog Hawks Prairie Veterinary Hospital Record No: 32988 Breed: Poodle, Miniature 8919 Martin Way East Owner: Livermore, Ann Age: 16Y Lacey, WA 98516 Doctor: Kim Martin, DVM Sex: S
Accession No. Doctor Owner Patient Name POBC52006567 Kim Martin, DVM Livermore, Ann Ginger
Test Results Adult ReferenceRange L H Normal
Superchem Date given: 02-08-19 T8:49a
Total Protein 7.1 5.0-7.4 g/dL
Albumin 4.1 2.7-4.4 g/dL
Globulin 3.0 1.6-3.6 g/dL
A/G Ratio 1.4 0.8-2.0
AST (SGOT) 31 15-66 IU/L
ALT (SGPT) 109 12-118 IU/L
Alk Phosphatase 649 5-131 IU/L HIGH
GGT 12 1-12 IU/L
Total Bilirubin 0.1 0.1-0.3 mg/dL
BUN 49 6-31 mg/dL HIGH
Creatinine 1.2 0.5-1.6 mg/dL
BUN/Creatinine Ratio 41 4-27 HIGH
Phosphorus 4.5 2.5-6.0 mg/dL
Glucose 87 70-138 mg/dL
Calcium 10.6 8.9-11.4 mg/dL
Magnesium 2.5 1.5-2.5 mEq/L
Sodium 145 139-154 mEq/L
Potassium 4.8 3.6-5.5 mEq/L
NA/K Ratio 30 27-38
Chloride 108 102-120 mEq/L
Cholesterol 428 92-324 mg/dL HIGH
Triglyceride 827 29-291 mg/dL HIGH
Amylase 696 290-1125 IU/L
PrecisionPSL 144 24-140 U/L HIGH
In dogs with appropriate clinical signs, this mildly elevated PrecisionPSL result is equivocal for a diagnosis of pancreatitis. In dogs without clinical signs of pancreatitis, a mild PrescisionPSL elevation is an insignificant finding.
CPK 102 59-895 IU/L
Comment(s)
Page: 2
Accession No. Doctor Owner Patient Name POBC52006567 Kim Martin, DVM Livermore, Ann Ginger
Test Results Adult ReferenceRange L H Normal
Hemolysis 3+, , Lipemia 2+ No significant interference.
Complete Blood Count Date given: 02-08-19 T8:49a
WBC 8.6 4.0-15.5 10^3/mL
RBC 7.0 4.8-9.3 10^6/mL
HGB 16.5 12.1-20.3 g/dL
HCT 48 36-60 %
MCV 68 58-79 fL
MCH 23.7 19-28 pg
MCHC 35 30-38 g/dL
Platelet Count 662 170-400 10^3/mL HIGH
Platelet Estimate Increased
Neutrophils 68 60-77 %
Bands 0 0-3 %
Lymphocytes 25 12-30 %
Monocytes 5 3-10 %
Eosinophils 2 2-10 %
Basophils 0 0-1 %
Absolute Neutrophils 5848 2060-10600 /mL
Absolute Lymphocytes 2150 690-4500 /mL
Absolute Monocytes 430 0-840 /mL
Absolute Eosinophils 172 0-1200 /mL
Absolute Basophils 0 0-150 /mL
T4 Date given: 02-08-19 T8:49a
T4 <0.5 0.8-3.5 mg/dL
Result Verified The Total T4 result is less than 1.0 mcg/dl. A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism.Please contact Customer Service for this additional testing.
Urinalysis-Complete Date given: 02-08-19 T8:49a
OTHER
Page: 3
Accession No. Doctor Owner Patient Name POBC52006567 Kim Martin, DVM Livermore, Ann Ginger
Test Results Adult ReferenceRange L H Normal
Testing which requires urine has been requested on this patient; however, no urine was received. Please submit a urine sample, WITHIN 30 DAYS, on a new test request form including this reference number and order unit code 3004 so we may complete the testing.Please call Customer Service with any questions.
Cortisol Serial 3 DEX Date given: 02-08-19 T8:49a
Time 1 7
Time 2 Post1
Time 3 Post2
CORTISOL SAMPLE 1 7.4 1.0-5.0 mg/dL HIGH
CORTISOL SAMPLE 2 DEX 0.7 0.0-1.4 mg/dL
CORTISOL SAMPLE 3 DEX 0.6 0.0-1.4 mg/dL
INTERPRETATION OF THE DEXAMETHASONE SUPPRESSION TESTS: * Low-dose dexamethasone suppression test: Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex. Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs post-dex. ... If the 8hr post dex. cortisol level is greater than 1.4 ug/dl, the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor: 1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is consistent with PDH. 2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH. (Samples taken at 2 or 6hrs are interpreted the same way as a 4hr sample) ... If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings. ... NOTE: Approx. 5% of dogs with PDH have normal results. False positives may occur with stress/nonadrenal illness. . ************************************************** ********** High-dose dexamethasone suppression test: Use this test after hyperadrenocorticism has been diagnosed. PDH or AT: Cortisol level suppressed by less than 50% 8hrs post-dex. PDH ONLY: Cortisol level suppressed by > 50% 8hrs post-dex.

LtlBtyRam

05-20-2020, 03:05 AM

LtlBtyRam

05-20-2020, 03:10 AM

Canine - Bichon Frise X
Id:
Female Spayed
Owner:
Breed:
379649
Name Livermore, Ann 'Ginger'
Age:
Livermore, Ann 'Ginger'
Gender:
16 years
Patient
Report Date: Tuesday, May 19, 2020
Phone: 253.474.0791 Email: ellie.nuth@bluepearlvet.com 5608 S Durango Street , Tacoma, WA Ellie Nuth DVM, DACVR BPVP WA TACOMA
Requesting doctor direct contact information if the radiologist needs to contact you: Mountain View Vet Hosp
History (2000 max character count) : Cushing's screening
Exam Type: Abdomen
Patient Clinical History
Findings: Abdominal study. The liver was overall moderately enlarged with blunted caudoventral lobar margins, exhibited a smooth capsular surface, diffusely hyperechoic background parenchyma, and contained a few scattered small rounded well-defined hyperechoic nodules up to 0.83 centimeter in diameter. The gallbladder had normal wall thickness and contained a small amount of mobile settling echogenic content. No intrahepatic or common bile duct distention was identified. No hepatic lymphadenopathy was identified. There were a few well-defined strongly hyperechoic rounded nodules present along the mesenteric border of the spleen. Both kidneys exhibit slightly speckled hyperechoic cortices (more echogenic than splenic parenchyma), a few small (0.3 centimeters) thin-walled through transmitting cortical cysts, adequate corticomedullary definition, a large amount of pinpoint speckled medullary mineralization, and mild pyelectasia measuring 0.22 centimeters in the transverse plane on the left and 0.14 centimeter in the right. Both adrenal glands were moderately enlarged for this patient's size with rounded polar margins, more prominent on the left. The left adrenal gland measured 0.70 cm in ventral dorsal thickness caudally and 0.91 centimeters cranially. The right adrenal gland measured 0.58 centimeters in thickness caudally. In the caudal aspect of the bladder, arising from the dorsal trigone wall there was a moderately broad-based medium echogenic nodule which measured 0.54 cm ventral dorsal x 0.48 cm craniocaudal x 0.82 cm mediolateral. No significant amount of vascularity able to be detected in this structure via color Doppler interrogation, but this had limited effectiveness due to motion artifact. Unable to evaluate the rest of the caudal urinary bladder and proximal urethra caudal to this site due to shadowing from the pelvic canal. Remainder of the urinary bladder walls were uniform and exhibited appropriate thickness for bladder size (somewhat small). The pancreas was unremarkable. There was a normal moderate amount of gas in the stomach and small intestines, and gas with semisolid feces in the colon. The walls of the gastrointestinal tract were normal in thickness and had normal distinct layering throughout. No gastrointestinal obstructive pattern or abnormal luminal content, masses/ulcers or other focal GI lesions identified. No abdominal masses, lymphadenopathy, nor free effusion identified.
Assessment:
1. Bilateral adrenomegaly is supportive of clinical suspicion of pituitary dependent Cushing's disease causing adrenal hyperplasia.
2. Diffuse hyperechoic hepatomegaly with few small hyperechoic nodules is most suspicious for nodular regeneration/hyperplasia and steroid or other vacuolar hepatopathy (presumably secondary to Cushing's but additional consideration may be given to other reactive hepatopathy or chronic primary hepatopathy such as chronic toxic insult or hepatitis with hyperplasia). No concerning for neoplasia at this time.
3. Hyperechoic splenic nodules most consistent with incidental myelolipomas.
4. Bilateral nephrocalcinosis/medullary mineralization and mild degenerative change. Small left renal cortical cyst. Mild bilateral renal pyelectasia likely secondary to physiologic diuresis and PU/PD.
5. Singular caudodorsally located urinary bladder trigone mural nodule has characteristics most concerning for early/emerging neoplasia,

Report of Imaging Findings
Referring Practice Tacoma Washington BPVP WA TACOMA
Tuesday, May 19, 2020 US (Ultrasound) Imaging Details
Report created through Asteris Keystone Teleconsultation Page 1 of 6
less likely inflammatory polyp or benign change.

Recommendations: ‡ Adrenal function testing for Cushing;s disease is indicated. ‡ Continue to monitor renal function. ‡ Consider additional testing to workup urinary bladder mural nodule including traumatic catheterization or genetic screening for neoplastic markers (BRAF test). __________________________________________________ _______________________________ Thank you for this referral. I welcome any feedback or follow-up on this case. If you have any questions or would like to discuss this case, please don't hesitate to contact me at ellie.nuth@bluepearlvet.com or (253)474-0791.

I can provide ultrasound images if it would help.

Squirt's Mom

05-20-2020, 09:41 AM

Welcome back Kim!

Welcome, but I am sorry you have need to be here again. We never want to start this journey again but these dogs just seem to know who they can count on for the best care.

Ginger is absolutely adorable! Had I been asked, I would have said she was a Pom/Pom mix! I would have never guess Bichon and Poodle. What a lovely mix! I have to say I laughed at loud at this comment - "...she doesn't like being called a Bichipoo her ears drop backwards but keeps them forward with Poochon". :D:D:D I think I would be on the same wave link tho I have been called a name similar to "Bichipoo". In fact, I am going to try to remember that one for future use. :D:o

While some of her lab results are seen with Cushing's the number aren't what we usually see with the liver enzymes. ALP is often in the 1000's. Ginger's is mildly elevated in comparison. Something to keep in mind - in some studies with humans, CBD oil has caused changes in liver enzymes, even liver damage. This product is not regulated so unless we make our own OR purchase from an individual we trust we can never be sure exactly what is in the oil. Just food for thought. What concerns me most are the kidneys. The PHOS, CPK, and BUN elevations along with the finding on the ultrasound would cause me to want to focus on the kidneys first and foremost to rule out any thing with them that could skew the Cushing's tests. A tumor on any other organ can cause the cortisol to rise naturally and skew the tests to return a false-positive. So in your shoes I wouldn't waste money on tests for Cushing's just yet but rather have an indepth check of the kidneys. Remember - Cushing's is a very slowly progressing condition so there is rarely need to rush into treatment. We want to be as sure as we possibly can that our baby does indeed have Cushing's and not something that could cause elevated cortisol like a tumor or other illness before we start these powerful treatments.

As for Lysodren, it is my personal drug of choice for treating Cushing's. Lyso is given in two phases - the load, or induction, phase in which the drug is given twice a day until signs are seen that the load has been achieved. Then an ACTH is give to be sure the cortisol is in the desired range. If the numbers come back indicating the load has been achieved then the maintenance phase begins. During this phase the Lyso is given 2-4 times a week usually a the same dose used for the load, just spread out over a week VS daily. The typical dose is 50mg/kg/daily divided AM and PM for the load then the same formula divided into 2-4 doses over a week. So if she loaded on 250mg/day then in maintenance she would take 250mg/week - 125mg/twice a week, 62.5mg/4x a week, etc. Since Lyso only comes in 500mg tablets to get doses that aren't easily divided a compounded form can be used. (If you do need to compound we direct you to some reliable pharmacies for this). Here is a link from the Helpful Resource section on Lysodren tips:

https://www.k9cushings.com/forum/showthread.php?181-Lysodren-loading-Instructions-and-related-tips

Again, welcome back! I am sure others will be along soon to chat with you as well.
Hugs,
Leslie

LtlBtyRam

05-21-2020, 01:56 AM

My profile pic is from my pup who passed away 4 years ago. She was all Pom. I started an album of Ginger (the link is below).

Ginger has been stumping us for a few years. She was licking herself raw. First it was only her paws then her legs then pretty much all over. We have tried so much to alleviate this. Each attempt has gotten some results but nothing seemed to completely work. So we have just kept on troubleshooting. About a year ago we started seeing scavenging which made us think she needed to be tested, so we had the bloodwork done with a Low dose Dex test which came back negative. We were like great. Last year we also had a raging yeast problem. We finally got that under control. Then she started the licking behavior again. We had been using Apoquel off and on when the licking was the worst. The licking got worse again Sept/Oct. She otherwise seemed fine. We decided to stick with the Apoquel since it seemed to work, although we didn't really want to. Then in January it seemed the yeast came back in a bad way. We went to a different vet. This vet has been touted as being one who pioneered alternative vet practices. He is the one who had us change food and suggested the CBD. We got it from him and our closer holistic vet also said the same brand, so I am pretty confident it is a reliable product. Thanks for the heads up it can cause liver problems in humans. We went with the CBD because we wanted to get her off Gabapentin. Which we did take her off of for several months. After making these changes the bloodwork had some different results. I don't know how much liver values can change which is one of the most dramatic changes. She has also had problems with tooth reabsorption. She is also presenting with more of the classic Cushing's symptoms. Pot-Belly, increased thirst, scavenging behavior, and hair thinning on the trunk, and hind quarter weakness. She only has 9 teeth left due to being pulled or reabsorbed. She also has white dog shaking syndrome. (sorry for the wall of text, my thoughts are a bit random at the moment and I don't seem to be able to organize them)

Thank you for pointing out the kidney issues Leslie. We are waiting to hear from her primary Western vet about either traumatic catherization or Braf testing. Do you have any other suggestions as to what to do to check into possible kidney issues. I had also forgotten until you mentioned it about other things causing false positives (in her case the bladder nodule).

On to more positive fun things here are some pics of her.
https://www.k9cushings.com/forum/album.php?albumid=1282

Thanks again,
Angela

Remy’s Mom

05-21-2020, 02:19 AM

HI, not really an expert on Cushings but I do have a toy poodle diagnosed March 2019 with Transitional Cell Carcinoma. Given Ginger’s age, etc. I would have your vet order a Cadet BRAF Mutation test kit from Sentinel Biomedical. You collect urine over a day or two, put it in their container and Fedex it to them in the envelope they include. Results come back in a couple of days. It is very accurate, almost never a false positive and it’s much easier on these senior dogs than a traumatic catherization. I read about the test online. My vet hadn’t heard of it but he ordered the kit and it was simple to do and noninvasive. We were fortunate to catch Angel’s TCC early. And, also it isn’t in the trigone area. She has been on chemotherapy now since April 2019 and you never know she had cancer. We were very fortunate. Having some other issues lately but unrelated to the cancer. (Just got her home from hospital after bout of gastroenteritis) I had just had Angel in for a lipoma removal and we really didn’t want to put her through another procedure with anesthetic at her age. Her urinalysis had come back with elevated proteins and suspicious transitional cells. At that point we couldn’t see more than just a little thickening in the bladder wall On ultrasound which might have been inflammation however the suspicious transitional cells and protein got us #1 checking and treating her blood pressure which was elevated and #2 we found out early on that she did have bladder cancer. Or if there is an oncology or Internal Med. practice they might have the test kits. Maybe down the road they might feel a catherization is necessary but we have not had to do one and the BRAF test was totally noninvasive. Best of luck with Ginger, Claire

LtlBtyRam

05-21-2020, 02:33 AM

Thanks for the info on the Braf test Claire. I don't know if we would opt for chemotherapy. Ginger seems very sensitive to almost everything. We just had an ultrasound done and there was a nodule in her bladder which is what is prompting further testing about it.

For a while I was thinking Ginger might have atypical Cushing's. Now I'm not so sure. Now I don't feel like I know anything about any of it. I am at such a loss as to what to do next.
Angela

Squirt's Mom

05-21-2020, 09:20 AM

Hi ANGELA, I don't know where I got "Kim" from! :o My apologies. Aged minds do weird things is all I can think of! That aged mind thing also applies to the profile pic.....I used to foster for Small Paws, a Bichon rescue, and had several Bichon/Poodle mixes so I know full well what they look like. :rolleyes: And Ginger is adorable!

As for other testing, the test Clair mentioned is one and the SDMA is another. The SDMA is a fairly new test and is done only by the IDEXX lab. This test tells us much sooner if the kidney function is impaired. Before this test we had to rely on CREA, BUN and other kidney values on the labs but by the time they were showing abnormal the organs has lost something like 75% of function. Not all vets are aware of the SDMA test yet so don't be surprised if Ginger's vet doesn't. The catheterization testing mentioned on the US is another. Based on the comments on the US they too are considering TCC a possibility.

The continuing allergy signs aren't typically seen in an untreated cush pup. The elevated cortisol in Cushing's usually acts as a sort of treatment just as a steroidal medication like prednisone for allergies would act. It is when the cortisol is lowered back to more normal levels with treatment that we see inflammatory conditions like allergies and arthritis come into play. Prior to treatment the cortisol was controlling those conditions. But the signs you mention are certainly associated with Cushing's.

Just fyi - here is the product insert for Apoquel that talks about side effects like certain skin issues and neoplasia that might apply to Ginger:
https://www.zoetisus.com/products/dogs/apoquel/downloads/final_apoquel_pi_030116.pdf

As for the Shaker Syndrome, treatment for this condition is often prednisone so I would think the elevated cortisol found in untreated Cushing's would also be sort of "treating" this condition and that it would worsen if the cortisol were lowered. But I could be wrong. Like I said, the signs you are seeing are associated with Cushing's. But those signs are shared with so many other conditions too. I would still be focusing on the kidneys first then go from there in your shoes.

Hugs,
Leslie

Remy’s Mom

05-21-2020, 10:14 AM

Hello Angela,
Of course you have to do what you feel is best for your baby. I did see some similarities in our girls though. Angel is 15 as best we can determine. She has an abnormal liver, missing the left lobe and she reacts in very strange ways to many drugs and medications. Galliprant and Apoquel, both which are not supposed to effect the liver and kidneys so much sent her liver enzymes to the moon. We have to be very very careful because we never know how she will handle a new drug. Sometimes the liver enzymes go sky high but there are no actual clinical symptoms. There have also been issues with the bile duct/gall bladder. Her kidneys are definitely aging but still sneak into the ‘normal’ range. She handled chemo well which is another story. Right now since the gastroenteritis we are giving her a drug holiday where she’s off pretty much everything for a couple of days including blood pressure meds. I actually saw a number of similarities in Ginger’s ultrasound and Angel’s.

The reason I would recommend the BRAF is so you know what to expect if it is TCC. It is often found in the trigone area of the bladder and it can result in a serious emergency if the ureters or urethra become blocked and urine cannot pass. IF it turned out to be TCC at least you have an idea as to how it might skew her other test results and if it is something you would want to explore treating. It’s not a terribly expensive test and completely noninvasive. I just had to take a little dish and collect some urine until I had the necessary amount to send. I decided to try and treat it since at that point since we caught it early.

Because so many drugs are metabolized or work thru the liver it can be very tricky managing these dogs and never knowing how they will react to a seemingly innocuous drug. One eye drop of neopolydex per day was enough to keep her liver enzymes elevated. Steroids will send them upwards. So she is definitely complicated as we must always consider how a drug of choice might affect her. Overall Angel has done well and we manage things as they come up but she is an old gal and treatment becomes more complicated. She is also a very picky eater which doesn’t help matters.

I’m sure you will get lots of support in the Cushings department. I feel more experienced in kidney failure, liver, TCC and heart failure issues. I do have a Bichon who was recently diagnosed with Cushings and had a little poodle some years ago who underwent adrenalectomy. And I sure understand the stress and emotional ups and downs of loving our babies so much and wanting to do the best for them. Thankfully there is wonderful support and information here!!
Best,
Claire

labblab

05-21-2020, 11:46 AM

Hello Angela! I want to welcome you back, too, although I’m sorry for the problems that have brought you to us. The other ladies have already given you some great information, and the one additional thought that I might add relates to additional thyroid testing. I see that Ginger’s T4 reading was low on both blood panels:

T4 Date given: 02-08-19 T8:49a
T4 <0.5 0.8-3.5 mg/dL
Result Verified The Total T4 result is less than 1.0 mcg/dl. A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism.Please contact Customer Service for this additional testing.

T4 Date given: 03-17-20 T8:31a
T4 0.8 0.8-3.5 mg/dL
The Total T4 result is less than 1.0 mcg/dl. A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism.Please contact Customer Service for this additional testing.

Since the result was consistently low on both panels a year apart, I’m wondering whether your vet has discussed proceeding with a more complete thyroid analysis. This would only involve another blood sample, and since skin issues have been some of Ginger’s primary presenting problems, I’d think it would be very helpful to see whether or not she suffers from thyroid dysfunction. Hypothyroidism itself doesn’t usually cause skin irritation/itching, but it can leave a dog more vulnerable to recurrent skin infections which can indeed cause those problems. Low thyroid can also cause elevated cholesterol levels.

Since Ginger has already tested negative on the LDDS, I do agree that I’d probably want to pursue some of these other questionable areas before proceeding again with Cushing’s testing. At her age, the main goal of Cushing’s treatment would be immediate symptom relief. So if some of her problems are instead being caused by other conditions, that’s all the more reason to investigate them more thoroughly beforehand. Please do keep us updated, OK?

Marianne

labblab

05-21-2020, 01:04 PM

BTW, your new photos of Ginger are sooooooooooooo sweet! :):D;)

LtlBtyRam

05-22-2020, 11:58 PM

Thank you. I will try and get a picture of her in the next few days. Most of the ones I put in are after grooming, which we don't have done anymore and try to do ourselves. Operative word. Try.

Off note, does anyone know of a way to trim the hair between paw pads which is low/no risk of hurting them. We are struggling with this.

LtlBtyRam

05-23-2020, 12:06 AM

Here is our latest.

So we spoke to the vet. I asked about Thyroid issues, she said Cushing's would alter the Thyroid levels so there wasn't really a point in further testing. I brought up the tumor giving a false positive on a Low Dose Dex test. She said if her Cortisol levels were high due to the tumor something about the suppression part still being viable. I didn't really understand. We were also told we could get a free catch urine sample and have it sent out for a better "spinning" to get more detailed results, this was going to be about $100 the BRAF test was going to be about $500.

This was all about 8 pm West Coast US time. Right now we have opted for the free catch urine cytology. I hope everyone is doing ok.

One other question. Does anyone here put any faith in the AAHA accreditation?

labblab

05-23-2020, 09:15 AM

So we spoke to the vet. I asked about Thyroid issues, she said Cushing's would alter the Thyroid levels so there wasn't really a point in further testing.
I’m seriously not happy with that answer. Your vet is absolutely correct that low thyroid readings can be secondary to Cushing’s. If that’s the case, effective treatment of the Cushing’s can result in spontaneous normalization of the thyroid level as well. However, it’s possible for a dog to suffer from *both* Cushing’s and also primary hypothyroidism in its own right. If that’s the situation, the dog requires thyroid supplementation in addition to Cushing’s treatment. And that’s the whole purpose of the more complete thyroid testing in this situation — to see if it seems more likely as to whether the low T4 is secondary to some other condition (like Cushing’s), or whether it appears to be a problem that needs to be addressed independently.

The Michigan State University Veterinary Endocrinology Lab is nationally known for its thyroid expertise, and here’s a link to its page that answers a number of related testing questions. Blood samples from anywhere can be sent to MSU for their lab analysis and clinical interpretation. At my request, my vet has sent samples there for two of my dogs when we suspected thyroid problems. But even a lab like IDEXX will offer a more comprehensive thyroid panel upon request, too. As you’ll see, measuring the TSH level in addition to specialized measurement of the T4 level aids in determining whether low thyroid readings are likely primary, or instead probably secondary to some other underlying condition like Cushing’s.

https://cvm.msu.edu/vdl/laboratory-sections/endocrinology/thyroid-function-in-dogs

You’ve already generated a lot of expense with Ginger’s diagnostics, with more to come. So perhaps your vet is trying to prioritize the spending that she thinks is most important. I am not a vet, of course, but my personal opinion is that an advanced thyroid profile could be of real value. Depending on the result, you could receive added evidence that Cushing’s is present and also affecting Ginger’s thyroid level. But on the other hand, if thyroid supplementation seems warranted due to genuinely low thyroid function, I can promise you that it’s far less expensive and involved to treat the thyroid than it is to treat Cushing’s. At Ginger’s age, I’d think your primary goal with any treatment would be simply to make her more comfortable. If she suffers from primary hypothyroidism and supplementing her thyroid level eases her skin discomfort, then perhaps you might not even choose to launch into Cushing’s treatment at all. Just sayin’...

labblab

05-23-2020, 09:37 AM

Plus, I’m back again after re-reading your thread, and please correct me if I’m wrong — but thus far Ginger is yet to test positive on a Cushing’s blood diagnostic, correct? Her LDDS was normal back when her T4 level was already abnormally low. In my own mind, that would seemingly make investigation of her thyroid function even more compelling.

Also, as far as *any* type of accreditation, I take it as one piece of information. It’s good to know that any given level of training or expertise or quality has been achieved. But as the old saying goes in relation to human doctors, *somebody* finished at the bottom of every graduating med school class. I’d rather see accreditation in relation to my caregivers or facility rather than no accreditation. But that’s kind of a point of departure. If I’m not comfortable with a vet who works in an AAHA accredited facility, the overall certification doesn’t really mean a lot to me.

Joan2517

05-23-2020, 11:10 AM

Marianne is right. You should test for Thyroid issues first. That's what we did for my Gable. He eventually tested positive for Cushing's and is being treated for both.

LtlBtyRam

05-24-2020, 12:31 AM

Thanks for everyone who has weighed in. We got a call about a 7:30 pm about the urine cytology. The findings came back inconclusive to TCC. I was hoping this would give us more answers about the nodule on the ultrasound, but alas it looks like we will do the BRAF test.

Ginger is quite the conundrum. Sometimes she is scavenging like crazy and other days she will go all day without eating. This was her first behavior which led us to do the LDDS test. It has only been over the last probably almost 6 months where we have started seeing other behaviors. At the beginning when the LDDS came back negative I almost had the atypical test done, as that was my suspicion. Now I just don't know, everything seems so day to day with her. The hair thinning is pretty significant.

Marianne, how do you find out the cost of the MSU test? Should I just ask our regular Western Vet?

I can't tell you all how much this helps to have a network of foiks. I remember when we were going through all of this with Shasta and you all were just as helpful then.

Thanks,
Angela

labblab

05-24-2020, 06:38 PM

Marianne, how do you find out the cost of the MSU test? Should I just ask our regular Western Vet?
Hi Angela, yes, you can ask your western vet to find out current pricing information. For what it’s worth, I pulled out my vet bill that included a Michigan State thyroid panel performed during June of 2019, and the charge was $178. That included the blood draw at my regular vet as well as the analysis by MSU. From their website, it looks as though there are various panels that can be ordered, so there may be some that are less or more expensive. But that’s the amount I was charged for my girl last summer. Her T4 had come back borderline low on her regular IDEXX blood chemistry panel, and I wanted to have further analysis done. Her result on the more comprehensive MSU panel was normal, however, so I was able to table my worry about that.

Marianne

LtlBtyRam

05-26-2020, 01:10 AM

The more I mull things over and think on it I am really wondering about the Thyroid levels. She sleeps a lot more than she use to and I know her hair thinning can also be attributed to that too. The only thing I'm not sure of is the intermittent scavenging behavior. This is just so difficult to decide what to test and what to not test. The scavenging is also tough because it isn't all the time, but enough to be concerning. We went and gave her a bath yesterday and found another crusty area on her skin. We think it is yeast instead of bacteria and so will probably give her another bath on Tuesday. We are happy to report we have not had the excessive licking since we stopped the Apoquel, so we will take that as a win.

Thanks for the charges from you bloodwork Marianne. I just wanted a gauge for the quote when I can ask for it.

Squirt's Mom

05-26-2020, 09:06 AM

I have an autoimmune thyroid disease that requires increasing doses to keep things in balance. When my levels are dropping, meaning I need another increase, I become very thirsty and hungry all the time. So if canine low thyroid makes them feel the same then I can say that scavenging is certainly part of that condition. Over the years I have become a scavenger par excellence! :D

Joan2517

05-26-2020, 11:22 AM

Hahaha! Me too, Leslie!

LtlBtyRam

05-27-2020, 01:22 AM

Hi Everyone,
We just got off the phone with the vet once again. She said if her system were producing cortisol because of the tumor it wouldn't be producing as much as would be needed to see the enlargement of the adrenal glands. This is why she was more inclined to do an LDDS. I did speak with her more about doing the Thyroid test and she mentioned MSU and quoted about $300 for that test about the same for the BRAF test and about the same for an LDDS. At this point we are just lost. I wish I had a better update.

Thanks,
Angela

Remy’s Mom

05-27-2020, 12:20 PM

Hi Angela, FYI, I looked back thru my folder and I paid $230 for Angel’s BRAF test and that included overnight shipping which I had requested to get the test ASAP. I think Sentinel charges around $100 per kit to breeders of those breeds most predisposed to TCC. The thyroid does seem to be on the low side and it would be easy to start Ginger on the lowest dose of thyrotabs (prob .1 mg daily) and see if she feels better. I’ve had some dogs respond very well and others, it didn’t seem to make a difference. Angel reacted to apoquel with high liver enzyme spikes so we discontinued that. She’s fifteen and she has all sorts of little growths, the sebaceous adenomas, vesicles, little cysts. I’ve had several other poodles and they too had a lot of growths. I think it goes with the territory to some degree. Poodles seem to predispose to a lot of things.She will bite at the little warts so I assume they itch. We might try to laser some of the most annoying ones off using a local anesthetic since no one wants to put her under general anesthesia due to her age and the risk to her liver and kidney. I don’t know if any of this helps you but I will say Poodles and bichons seem to have more than their share of weird little skin issues as well as other diseases.
Claire

LtlBtyRam

05-27-2020, 09:51 PM

Claire,
I appreciate the insight Claire. I didn't realize poodles and bichons could be so predisposed to skin issues. Did you find she got a lot more of them from seemingly nowhere while she was on Apoquel and how long did you have her on it. How is she?

Everyone else,
Has anyone used any animal communicators and had positive interactions? Sometimes I wonder what she wants. We don't have a lot to spend on diagnostics and would rather treat. I'm not looking for any diagnosis from a session. I want to know what she wants and maybe know what some of her senstations are.

Back to the medicine part. We are really considering the MSU test. The BRAF test is a little more of a question. I know it would determine TCC, would it help with anything else? If we aren't leaning toward treating the TCC is it still viable? I also have another question about the Ultrasound Findings. Can enlarged adrenals be a "thing" without Cushing's? I do appreciate anything anyone is willing to weigh in on as I tend to analyze any situation from all angles I can find before making a decision.

Thank you to everyone,
Angela

Squirt's Mom

05-28-2020, 10:55 AM

I have worked with two communicators over the years. One is a former member here but she is no longer doing this work. The other is Melissa Sehgal. Here is a link to her website:

https://melissasehgal.com/

And to her Facebook page:

https://www.facebook.com/VEGANMEL

As for causes of adrenal enlargement, I can't answer. Hopefully Lori or Marianne will have some input for you. Logically, I would think anything that causes an increase in cortisol production would cause the adrenals to enlarge simply from the extra work they are having to do but I don't have anything to back that up scientifically. My first dog with Cushing's was initially misdiagnosed because of a tumor on her spleen. The US that found that tumor also found enlarged adrenal glands. BUT when the tumor was removed all the tests for Cushing's - ACTH, LDDS, and UTK panel - showed her cortisol had returned to normal levels. I did not do another US that I recall however...or if there was one I can't remember the results. She had a very serious pancreatic reaction because that organ was moved around during the surgery to remove the tumor and they may have done more during that hospitalization....I just don't recall. I was under extreme duress during all of that. :o But like I said logically it makes sense that those glands would enlarge any time they are doing extra work. My second dog diagnosed with Cushing's was also misdiagnosed with an ACTH result of >50- as high as the labs level went. I never really believed she had Cushing's but I didn't know that for a fact until her necropsy which found normal adrenal glands. She had numerous US over the last 6-8 months of her life due to a host of other health issues and the reports I got always stated enlarged adrenal glands were found. But she was on Lysodren the last few months of her life and that might account for the normal findings with her adrenals in the necropsy, MIGHT....however I don't trust anything I was told about her from her vets. The cause of her death should have shown plainly on all those ultrasounds but not one time did they mention to me that she had an inguinal hernia so I don't trust what the told me about her adrenals. It doesn't make sense that they would be enlarged all that time then suddenly be normal after death. So even based on my own experiences, I can't answer your question definitively.

I can say that based on my experiences I would pursue the thyroid and TCC before considering Cushing's. ;)

Hugs,
Leslie

Remy’s Mom

05-28-2020, 03:26 PM

Hi Angela, I think poodles are predisposed to everything. Bichons are one of the breeds that seem to get TCC more easily. Angel was only on Apoquel a couple of weeks because it sent her liver enzymes soaring. Had to pull her off pretty much everything while we figured out the liver spikes. One of my other poodles would get a staph infection of the skin that resulted in kind of round little crusty spots that seemed to peel. They told me it was because she was a senior dog and their immune system isnt as strong. That we treated with the antibiotic simplicef. With Angel the skin issues seem to be sebaceous adenomas and these little water filled blisters that can be kind of a bluish color. She’s the second poodle I had with the fluid filled blisters. The Bichon is now developing the sebaceous adenomas (the little flesh colored cauliflower type warts)
They are all white/cream dogs. I often wonder if it’s more prevalent in them.

The BRAF test as far as I know is only going to tell you if Ginger has the BRAF mutation for TCC. If you’re not going to try to treat it then I suppose it doesn’t matter as long as they regularly monitor it for progression because if the tumor blocks the ureter or urethra you have a very serious emergency. I agonized about what to do with Angel because as best we can determine she is around 15 now. I hated to put her thru chemo. That said, I don’t regret it because she handled it well (better than me I’m sure) and it has given her 15 months of high quality life. I don’t know if the drug she is presently on (Chlorambucil) is what’s causing some GI upset. I restarted it Tuesday after a drug holiday and now she’s spit up foam a couple of times. I also had another poodle who had an adrenal tumor as well as an extremely bad heart. I think Amanda was around 13. And it was an agonizing decision to have it removed however I felt it was growing fairly rapidly and would begin to impact veins and arteries and other organs so we went with the surgery. Her heart plus her aging kidneys were major concerns but she came thru like a champ and was back to normal within a couple of days. As it turned out it was a benign tumor but it was secreting so she likely would have developed Cushings symptoms. It was her heart disease that eventually ended her life. Fortunately Angel’s heart has been good. Aging kidneys of course and the crazy things her liver seems to do but overall, until this sudden G.I. Upset she’s been doing terrific and you wouldn’t know there was anything wrong with her.

The most difficult part is we don’t know how they feel or what they want. We can only guess and try to put the puzzle pieces together. Sometimes for myself I feel as though the responsibility is overwhelming. What if I miss something? What if I don’t notice a relevant change right away? What if I make a wrong decision? Sometimes when I’m simply exhausted I fear I don’t make the sharpest decisions. The responsibility for our precious fur kids is so awesome isn’t it!!

Good luck, I know you have a lot on your plate to consider!!
Claire

Harley PoMMom

05-29-2020, 06:34 AM

Claire,
I also have another question about the Ultrasound Findings. Can enlarged adrenals be a "thing" without Cushing's? I do appreciate anything anyone is willing to weigh in on as I tend to analyze any situation from all angles I can find before making a decision.

Thank you to everyone,
Angela

Chronic illnesses can cause enlargement of the adrenal glands, I'm including this excerpt from Dr Mark Peterson's blog:
One should never make a diagnosis of hyperadrenocorticism based on the finding of large adrenal gland size alone. Remember that the stress of any nonadrenal illness commonly leads to an overactive hypothalmic-pituitary-adrenal axis. Therefore, any dog with chronic stress or illness can develop bilateral adrenocortical hyperplasia as a physiological response. I know that some radiologists like to diagnose Cushing's disease based on adrenal gland size, but this just cannot be done using this criteria alone (5,6). Dogs with Cushing's disease certainly tend to have larger adrenal glands, but large adrenal glands alone are not diagnostic for this disease.

https://endocrinevet.blogspot.com/2014/01/seizures-and-bilateral-adrenal.html

Hugs, Lori

labblab

05-29-2020, 09:20 AM

Hi again, Angela. I’m so glad Lori has provided you with this quote, because it confirms my same understanding that any serious systemic stress can result in adrenal enlargement. Also, I’m not intending to further “pile on” re: the info your vet is giving you, but $300 seems quite high for MSU’s thyroid testing. Here’s a link to their actual charges for their laboratory testing. Under “Endocrinology” you’ll see various thyroid related options, but their “Canine Diagnostic Thyroid Profile” is $55, and their “Premium Canine Thyroid Profile“ is $79. There are other thyroid-related tests that can also can be added on. Also, I believe you can pay extra for written clinical interpretation to be supplied by their specialists. However, given this pricing, I have to say that $300 seems excessive. Obviously your vet will add charges for drawing the blood and shipping the sample, but still, $300 seems like a lot. I don’t know what kind of relationship you have with her, but if it was me and my vet, I’d simply tell him I’ve pulled up MSU’s testing schedule, and in order to make my decision, I’d like to know exactly which tests he’d be planning to order.

https://cvm.msu.edu/assets/documents/VDL/CHART.ADM.8-Fee-Schedule.pdf

Also, if you do plan to consider thyroid testing, I’d warn you against starting any thyroid supplementation beforehand because, for the time being, it will invalidate the results of any subsequent diagnostic testing. The dog’s thyroid function has to be evaluated in its natural state to be accurate for diagnostic purposes. So if you start it, the supplementation would have to be stopped for a period of time before the testing could be performed.

Marianne

Joan2517

05-29-2020, 11:02 AM

Hi Angela,

Melissa is great. I had a session with her after Lena died and she was wonderful. I have emailed her a few times over the years when something she had said came to me.

LtlBtyRam

05-29-2020, 05:06 PM

Hi all,
Ok let me see if I can get all this in.

Leslie
Thank you for the info about Melissa, the very simplified versions of what you went through with your furkids regarding adrenal sizes, and your personal experiences about thyroid related issues.

Claire
Thank you for the insight on the Bichon and Poodle breeds.

I agree the most difficult part is not knowing how the feel or what they want and yet being required to make all of the decisions.

Lori
Thank you for providing the quote you did. I haven't been convinced it is typical Cushing's and I know I am not a vet, but like I tell others "I know my dog best."

Marianne
Thank you for the link to MSU. I did some more digging on their site. It seems a special mailer might be needed, but I do plan on asking about the specifics of the charges. They have a ton of info on that site and even though I don't understand a lot of it there were some things which just made sense. The special mailer is $136, which makes up most of the price. They quoted I think 270 for the MSU part and everything over is our vet charges. I also read they have to prepare the sample as it is not a "whole blood" sample they want for this test. It is a serum from being ran through a centrifuge and it is supposed to be frozen and can't have certain things happen to it of which I don't understand. I do think the premium panel is our best bet because of the part about non-thyroidal illness known to be present, we may not know for sure but there is a strong possibility.

Links below if you are interested
https://vdl.msu.edu/Bin/Catalog/Catalog.exe instructions for the premium thyroid panel
https://cvm.msu.edu/vdl/laboratory-sections/endocrinology/thyroid-function-in-dogs has a section explaining the difference between the standard and premium panels

Joan
Thank you for chiming in about Melissa and your own thyroid experiences.

I will keep everyone posted on the tests and results.
Now for today. We went and gave her a bath since she has some crusty patches on her skin. She didn't like the bath too much, but she never does. She is comfortable and asleep right now. I would love to post more pictures (and more recent), but she seems to have a knack for knowing when a camera is around and doesn't stay put long enough. We use a natural anibacterial/antifungal for her shampoo it is by Banixx and we really like it.

Thank you all again,
Angela

LtlBtyRam

06-01-2020, 04:09 PM

Ginger had a good weekend. We decided to have her thyroid tested at MSU. She goes in for her blood draw this afternoon. Thanks again for the MSU info Marianne. When I went to the Test Catalog and looked at the premium test the info was mostly over my head, but I did get there should be a special mailer to keep the sample as near frozen as possible and on the fees page the mailer is listed at $136. I am assuming since we are so far from Michigan that is why and I would rather have a higher expense and one blood draw than have to do it multiple times because the sample wasn't good enough.

Squirt's Mom

06-03-2020, 09:54 AM

I hope the test results are back soon so this question can be answered. Let us know when can what they say! I hope Ginger is continuing to have good days!

LtlBtyRam

06-11-2020, 10:41 PM

We got the call from the vet today and her Thyroid panel from MSU came back perfectly normal. We don't know how to feel about that. I guess we do another LDDS to check the cortisol. It seems like her belly has become more "potted" so maybe it is Cushing's after all. I am just concerned the bladder tumor could be the cause of high Cortisol levels. We would hate to start treating and not need to, but we know there is no way to know, so we just don't know what to do.

labblab

06-12-2020, 06:46 PM

Well, I’m proud of you for persisting in getting the thyroid panel performed. That’s very interesting that Ginger’s advanced testing turned out to be normal even though those earlier basic T4 readings appeared to be low. It just goes to show that a basic T4 can be misleading unless it’s evaluated in a broader context.

So at least we’ve got another piece of information, and we can eliminate low thyroid as the cause of any of Ginger’s problems. I know that doesn’t establish what *is* the cause, but at least it helps us to narrow down the possibilities. I sure wish the water wasn’t as muddy for you, though. If you do proceed with a LDDS, we’ll definitely be anxious to hear the results.

Marianne

LtlBtyRam

06-15-2020, 05:57 AM

I've been reading some other threads and doing a lot of thinking, mulling, and just plain wondering. We have been chasing the itching thing for so long and gone to 4 different vets who practice differently. There is another thing which may be coming in to play. I know in our case we have very muddy waters and I think they are even muddier with what I've realized.

Ginger also has white dog shaking syndrome which is tremors. She has had this since we got her in 2011 at age 7. We think although we can't prove she is having focal seizures. It has gotten worse if you move toward her she does this wierd thing where she kind of backs her head away from you in a stuttering fashion. We have also the vets about it and they don't seem to understand the question. It isn't all the time and it seems to happen more when she is startled.

We also had a very odd occurance in which we rushed to the emergency vet in the middle of the night. She was asleep next to us and woke up and stretched. Not out of the ordinary, but then her neck which was all stretched out as she was looking toward the ceiling and got stuck. When she was finally able to bring her head to normal her muzzle twisted. I know it sounds super strange, but that is the only way to describe it. We were concerned about a seizure.

Back to my point. After reading some other threads I am wondering if there is a tumor (pituitary or otherwise) or something else going on in her brain. We just don't know what to do. The scavenging is the worst. The hair loss is just physical. It is just so hard when they seem so hungry.

I wish there was a way to get imaging to see any issues in the skull which were realistic.
Angela

Another thought. In our case I wonder what the possibility might be it is atypical. The vet who interpreted the ultra sound said it wasn't likely as does her primary vet.