MGal
02-18-2023, 01:06 PM
Sasha Fierce is an almost 10 Y.O. mixed breed hound who looks like a Holstein cow! She has always been very healthy, happy, inquisitive and a huge escape artist! She has had some allergy issues primarily due to chicken protein (she no longer gets that) and environmental/seasonal. I’ve had her on Apoquel and gotten Cytapoint injections. She's had number of ear infections, but I understand that is more common in hounds. She has had a hairless spot on her tail for at least a year or longer. It’s about the size of 50 cent piece. Last fall she had a “dietary indiscretion” that gave her bloody diarrhea for a week. When I had her at the ER vet for that, they notified me that she has a grade IV heart murmur.
In the last 2 years, I have noticed increased thirst, which of course also increased her going out for potty. I was convinced it was either Diabetes or Cushings, so I have had her repeatedly tested with CBC’s, urinalysis, and with low dose dex Cushings tests at her primary DVM. All have been negative.
In September 2022, she had her “Senior Wellness” exam which included a CBC and urinalysis. Her DVM reported “an elevation of her liver enzyme ALP. This is a non-specific liver finding and is often associated with chronic inflammation in or around the liver. Her elevation is fairly mild and she is not showing any symptoms of liver disease so it is one we recommend monitoring annually for now. Another change is she has a little protein in the urine.”
In the last 4 months, her thirst has just gone crazy. I cannot keep her water bowls full! Of course, the excessive drinking is followed by needing to go out and potty often. Her appetite also increased. I’ve noticed her weight decreased slightly too. She is though, very active and still very much gets the zoomies and LOVES to go on walks!
Mostly because of the thirst, I had her DVM test her for Cushings and Diabetes again in early December. Cushings was via low dose dex test. Both Cushings and Diabetes tests were again negative.
After the last negative tests, her DVM suggested a pooled urine sample. Her urine protein creatinine ratio tested high, indicating she is excreting excess protein in the urine. Her protein creatinine ratio came back as 1.6. I understand dogs should be < 0.5 Her DVM prescribed Benezapril, which I have not started ,as I wanted to wait until my DACVIM appointment that had been scheduled some months prior.
2 weeks ago, I had the DACVIM appointment for Sasha. An ultrasound was performed. Kidneys and adrenals looked normal, however her liver is enlarged, and there was some “stuff” around her gall bladder. DACVIM was not too concerned about any of those! DACVIM was also not concerned by the protein creatinine ratio of 1.6. Her concern is if the ration is 2.0 or higher. DACVIM did recommend though, changing her diet to low fat, lower protein, and to include grains which I have done.
An adrenal panel ACTH stim test was also performed. DACVIM just called me with results and said Sasha has Atypical Cushings. Her Cortisol had just a minimum increase, but her Hydroxy Progesterone was heightened. I don’t have all the details yet as I am awaiting the write up from the DACVIM.
Now in the 2 weeks since the DACVIM appointment, I have had Sasha on the low fat, lower protein diet. I have also added a daily dose of Fish Oil and give her blueberries often. Sasha seems to be less thirsty and less hungry. When I told the DACVIM this, she suggested holding off on starting the Trilostane (Vetrol) and monitor her for the next few weeks.
I don’t know what to path I should take. Should I be concerned about the protein creatinine ratio even though the DACVIM isn’t? Should I be concerned about the enlarged liver? Should I be concerned about the stuff around her gall bladder? I am not thrilled about starting the Vetrol because I read one potential side effect, albeit rare, would be an Addison’s Crisis; which scares the crap out of me! However, I also know just this diet change alone will not relieve the symptoms to the degree that Vetrol will. Should I start her on the Vetrol? Should I seek a second opinion from another DACVIM?
I have also been reading up on Lignans and Melatonin and that they can help with the Cushings symptoms such as decreasing the Cortisol level. Any thoughts on that?
Like every other pet parent, I just want to do the best by my girl. I lost her littermate at age 4 to AP and Sepsis. I had rescued them when they were just 5 weeks old as their momma had died. I just want my girl to have quality of life for as long as possible.
Thank you so much!
M.
In the last 2 years, I have noticed increased thirst, which of course also increased her going out for potty. I was convinced it was either Diabetes or Cushings, so I have had her repeatedly tested with CBC’s, urinalysis, and with low dose dex Cushings tests at her primary DVM. All have been negative.
In September 2022, she had her “Senior Wellness” exam which included a CBC and urinalysis. Her DVM reported “an elevation of her liver enzyme ALP. This is a non-specific liver finding and is often associated with chronic inflammation in or around the liver. Her elevation is fairly mild and she is not showing any symptoms of liver disease so it is one we recommend monitoring annually for now. Another change is she has a little protein in the urine.”
In the last 4 months, her thirst has just gone crazy. I cannot keep her water bowls full! Of course, the excessive drinking is followed by needing to go out and potty often. Her appetite also increased. I’ve noticed her weight decreased slightly too. She is though, very active and still very much gets the zoomies and LOVES to go on walks!
Mostly because of the thirst, I had her DVM test her for Cushings and Diabetes again in early December. Cushings was via low dose dex test. Both Cushings and Diabetes tests were again negative.
After the last negative tests, her DVM suggested a pooled urine sample. Her urine protein creatinine ratio tested high, indicating she is excreting excess protein in the urine. Her protein creatinine ratio came back as 1.6. I understand dogs should be < 0.5 Her DVM prescribed Benezapril, which I have not started ,as I wanted to wait until my DACVIM appointment that had been scheduled some months prior.
2 weeks ago, I had the DACVIM appointment for Sasha. An ultrasound was performed. Kidneys and adrenals looked normal, however her liver is enlarged, and there was some “stuff” around her gall bladder. DACVIM was not too concerned about any of those! DACVIM was also not concerned by the protein creatinine ratio of 1.6. Her concern is if the ration is 2.0 or higher. DACVIM did recommend though, changing her diet to low fat, lower protein, and to include grains which I have done.
An adrenal panel ACTH stim test was also performed. DACVIM just called me with results and said Sasha has Atypical Cushings. Her Cortisol had just a minimum increase, but her Hydroxy Progesterone was heightened. I don’t have all the details yet as I am awaiting the write up from the DACVIM.
Now in the 2 weeks since the DACVIM appointment, I have had Sasha on the low fat, lower protein diet. I have also added a daily dose of Fish Oil and give her blueberries often. Sasha seems to be less thirsty and less hungry. When I told the DACVIM this, she suggested holding off on starting the Trilostane (Vetrol) and monitor her for the next few weeks.
I don’t know what to path I should take. Should I be concerned about the protein creatinine ratio even though the DACVIM isn’t? Should I be concerned about the enlarged liver? Should I be concerned about the stuff around her gall bladder? I am not thrilled about starting the Vetrol because I read one potential side effect, albeit rare, would be an Addison’s Crisis; which scares the crap out of me! However, I also know just this diet change alone will not relieve the symptoms to the degree that Vetrol will. Should I start her on the Vetrol? Should I seek a second opinion from another DACVIM?
I have also been reading up on Lignans and Melatonin and that they can help with the Cushings symptoms such as decreasing the Cortisol level. Any thoughts on that?
Like every other pet parent, I just want to do the best by my girl. I lost her littermate at age 4 to AP and Sepsis. I had rescued them when they were just 5 weeks old as their momma had died. I just want my girl to have quality of life for as long as possible.
Thank you so much!
M.