Eden (13 year old Lab/Pitt - Adrenal tumor/Lysodren) Eden was laid to rest

[Pupsqueak]

I would like to introduce my 13 year old Lab/Pitt female dog that I named Eden. I adopted her when she was around 4 months old, thrown out of a car window and kicked across the street. It was a time when we both needed saving so we became instant friends.

About a year ago, Eden would be asleep on the carpet and would start to 'leak'. Being a good dog mom, I called the vet, who suggested Proin. It didn't help. He then prescribed DES, a hormone. That didn't help either. Within a few months, I let the vet know that she wasn't now leaking but losing full bladder control. I took her in for a thorough exam and the vet found a tumor on her spleen, 8" in diameter. Of course I told him to remove it and brought her home and she was good for about a week. Then she lost her bladder again.

She was always a well behaved dog; had passed her Canine Good Citizen test and was a Certified Therapy Dog. But now she was getting into the trash and doing things that were unlike her personality. Along with this came the heavy panting, in cool weather and the excessive thirst. I GOOGLED her symptoms and all of the results came up Cushing's. I was really convinced when I searched the photos, and saw a photo of a normal dog and one with Cushing's....I thought, dang, that's my dog.

I told this to the vet who disagreed with me because Cushing's dogs will drink until the bowl is empty and have a voracious appetite. (She only drank a lot at night and her bowl was always full.) I asked for the test anyway and you know what..... she came up positive. (I am a good dog mom!)

We did Lysodren for about a week and then she became lethargic. She laid down in the yard in the dirt. I felt so helpless. The vet said maybe too much of the adrenal gland was 'killed' and to start her on Predinsone.

After a dose or two she was back to her normal self.

We have been so good, that the vet said that he didn't want to see her until October.

Well, she started urinating, two or three times a night a few days ago. So, I took her back in, had another ACTH test and her levels are up to "27". So, we are on Lysodren again and just playing this game of getting things balanced.

I guess I just have to be a realist. Heck, if anyone else adopted this dog, I doubt she would still be alive. When we adopt a dog, we rarely think about the time when they become elderly and well, annoy us with the constant carpet shampooing. Honestly, I didn't think it either. But when I adopted this dog, I vowed to myself to save her and that means whatever I need to do to keep her alive.

I want her to have the best and most comfortable life she can have. She's not suffering and her quality of life is great. We walk every day and we still play fetch (for a very short time). Its just that some day, I know I will have to say goodbye. This really hurts.


http://i69.photobucket.com/albums/i74/atrickylittlefox/Eden/mycake.jpg

[Roxee's Dad]

Welcome to you and Eden. Sounds like you and Eden have had a real roller coaster ride. What a terrible way to start off her life, I am so glad that Eden has found you or that you found each other. She is a real cutie :)

How are her symptoms these days?

[frijole]

What a sweet looking dog!

It sounds like you are trying to get her cortisol levels under control. What I don't understand is why you aren't going back to the doc til October? If you were at 27 (I am assuming you are referring to the results from an acth test) the goal with cush dogs is to get them to a level of between 1 and 5 and then maintain.

I'll link some information on how it is normally done to see if this is what was done etc. Meanwhile tell us your dog's weight and the dosage amount and frequency you are on right now. Is it the same or different from the first time? This is important.

Glad you found us! My dog has been on lysodren for 3 yrs now and she is 15 1/2! It is a life saver but you have to get the dosage right and it takes some tweeking sometimes. My guess is the adrenal cortex which was eroded the first round grew back and that is why you are back to square one.

Kim
http://www.k9cushings.com/forum/showthread.php?t=181

[Harley PoMMom]

HI Eden and Eden's Mom,

Welcome to our cush-family, I am so sorry for the circumstances that brought you here...but so glad that you found this forum. These people are amazing...very knowledgeable about cushings...years of collective experience with this disease...you have come to the right place.

What tests were done on Eden to confirm cushings? Do you have copies of the tests and could you posts the results with the units.
Also what other symptoms does Eden show of cushings? I know you said she has excessive thirst, panting and getting into the trash...but does she have a pot belly, loss of hair, weakness in the hind legs..any other symptom you can think of can be helpful.

Please know cushings is not a death sentence for a cushing dog as long as you treat the dog and learn as much as possible about the disease and find a qualified GP or IMS who knows cushings as well.

Not one tests can confirm cushings or the type of cushings, thats why you need a qualified GP or IMS for this disease. And these wonderful people here will help you with everything too.

Read everything you can, ask alot of questions and we will try to answer them. Just remember you are not alone...we are here.

By the way, what is your name...we are so friendly here and hey you is so impersonal.:)

Hugs to you.
Lori

PS. She sure is a sweetie pie...is that a birthday cake for her, by chance, or just a treat for her? And yes...you are a very good Mom.
PSS. Canine Good Citizen test and was a Certified Therapy Dog. That's just wonderful Eden's Mom...you must be so proud of your sweet girl.

[Squirt's Mom]

Hi and welcome to you and Eden! :)

Do you have a name we could use? "Hey you" is kinda impersonal, ya know? ;)

I am a bit concerned about Edens reaction to the Lyso the first time. How much does she weigh and how many mg did she get and how often did she get it? Was treatment started with only one test? This is scary. Cushing's is a difficult condition to diagnose as many other illnesses mimic the condition and numerous things can affect test results. For this reason several tests are used to diagnose Cushing's, and even then it isn't carved in concrete. Point in case:

My Squirt had the LDDS, the HDDS, and an ultrasound, and was diagnosed as pituitary dependent, PDH. After further testing (ACTH's, the UTK panel, and another U/S) she was diagnosed has also having a form of Cushing's called Atypical. A tumor was found on her spleen, too, which was removed ( :eek: OMG was that scary! :eek: ). Since that surgery, her cortisol has been normal. So her docs now say that the original diagnosis of PDH is "highly questionable".

Her case was caught early and her signs were mild, so I never started treatment on her with Lyso or Trilostane, and I am very, very grateful I didn't. Today she is being treated for the Atypical only with melatonin and lignans, tho a maintenence dose of Lyso may be in her future.

I can't stay on long tonite and chat but when I read your story, I had to come share Squirt's with you. It makes me extremely nervous when treatment is started on so little data for a diagnosis. Not only are these powerful drugs that can have some drastic effects when misused or used when not needed, there are times when a non-adrenal illness is causing the cortisol to be elevated. Once that has been addressed, treatment with those drugs may not be needed at all.

I am so glad you found us! There is much to be learned here from the members and our Resources section, not to mention just reading the threads already in progress. Please ask any questions you may have here on your thread and we will do our best to help you understand.

You and Eden are no longer alone on this journey. We will be with you all the way...in fact, we may hound you at times but it's only because we care so much. I hope you find that you feel like family here in no time; I know I did, and that I couldn't have made it the past year or so without these wonderful people by my side. I know at the moment it feels like you have just been handed an execution notice for Eden. That's the way I felt when they told me....and I went off the deep end for a bit there...well, ok...further off the deep end. :p But I now know, the word "Cushing's" does not mean "death"...not at all! So you just put that out of your mind and concentrate on learning all you can about Cushing's. That is the best thing you can do for Eden.

Keep your chin up!
Hugs,
Leslie and the girls

[zoesmom]

Hi and welcome Eden's person....

Wow....I sure can relate to just about everything you wrote about Eden. My Zoe is also a lab/pit mix and she looks similar to your Eden. Is that how Eden looks now, or is that a puppy picture of her?

Zoe was also a rescue at 4 mos. of age. Dumped in ATL and found wandering on a busy street, scrawny, sick, and with bad cases of diarrhea and mange, but thankfully, she was not subjected to the awful things that Eden was. ):
Right after we got Zoe, we noticed the leaking. Little leaks sometimes and virtual lakes when she'd be asleep or have a uti. Always a big water drinker, too. But then the leaking got so bad, we were at a loss. We tried DES with no luck. We knew nobody else would want her. She really had no control most of the time. We even considered putting her down when we couldn't find a solution. But we just couldn't. Eventually, we found out she had a urinary tract anamoly and, at age 1, she underwent a 'double' surgery at UGA - an episioplasty and and colposuspension. We were hopeful, but lo and behold, the leaking started up AGAIN within a couple weeks. Then we tried the proin and BINGO. Results. But she continued to have 4-6 urinary infections a year plus the excess water drinking went on as usual. Zoe never had a big appetite - not even when the cushings showed up at age nine. At that time, she was having another run of uti's and so our vet did a senior panel (blood and urine tests) and noticed elev. liver enzymes. That's when we moved on to the cushings test and dx.

OK, for you - I have a whole bunch of questions. What initial tests were done on Eden? General bloodwork, and urine, hopefully??? If so, can you get a copy and post the 'out of range' results. Most cush dogs also have dilute urine which would show up as a low USG on a urine test. And they also have elev. liver enzymes and possibly other things.

Then did your vet do an acth ( 2 hour test) or an LDDS (8 hr. test) to diagnose? We need to know which and what the results were.
Also, did Eden have any other symptoms besides the leaking urine and water drinking? One thing I found very helpful was to track Zoe's water drinking. I'd measure out 12 c. each morning and then measure what was left the next morning and record the daily amount.

OK....Then once you started the lysodren, what instructions did your vet give you? Dose? How long? What to watch for? Did he provide you with prednisone tablets to have on hand during loading?

Also what does Eden weigh?

When Eden got lethargic after the week on lysodren, did she have any other symptoms besides that? Like not eating, weak legs, diarrhea or loose stool? Did your vet then do another ACTH right away, to see how low Eden's cortisol actually was? He should have, what with putting her on the prednisone.

It could be she wasn't that low and that's why she went back up to 27 so quickly. (Also, how long was she on the prednisone and what dose was that?) Some dogs will get what we call cortisol withdrawal syndrome - just general punkiness when the cortisol starts to drop out from under them. Doesn't always mean their cortisol is too low, though. In other words, maybe she hadn't really 'crashed' - and then with stopping the lysodren and starting the pred, her cortisol jumped right back up.

As someone said, the goal for a lysodren pup is to have their cortisol between 1 & 5 ug/dl on the follow-up ACTH. That would mean they were 'loaded' and ready for a maintenance dose of lysodren. PLUS, note that the second number (Post #) should always be higher than the first ( pre or baseline) number. So if your vet DID do the ACTH when Eden got punky (as he should have done), then we'd also like to know those results. It's a good idea to always get copies of all her test results, from here on out. A good vet will not have any problem with giving you the copies.

So.....now she's back on lysodren, right?? At a loading dose (i.e. daily dose) or something else? We also need to know that. What were your vet's last instructions?

At this point, will wait for your answers. May have some more questions after that. :rolleyes::p;)

Just a couple more thoughts, too. Zoe continued to drink more water than usual, even after her cushings was under control. (That 12 c. that I'd measure out each morning was her average consumption AFTER we started the cush treatment!) There's something called diabetes insipidus which can cause excess drinking (which, in turn, can lead to incontinence.) I always suspected Zoe has had that all her life. What with her low USG's and frequent uti's and drinking issues. But we never tested for it.

But then, about a year ago, our vet started her on something called tylan for her intestinal problems (bad gas, soft stool). Tylan is an antibiotic normally used in chicken feed and bee populations but has proven to help dogs with IBD-type problems. And miracle of miracles, the very day after we started the tylan, Zoe's drinking and peeing dropped dramatically and has remained low ever since. And as far as her uti's - several a year - she hasn't had a single one since then (going on a year now.) I even think she is now concentrating her urine - something she's never ever done before. It was clearly the tylan that caused all these positive changes in her urinary tract, although my vet has no explanation as to why. But it's been a fantastic side benefit. We still use the proin or she'll leak a little bit. But since starting the tylan (also called tylosin*), now she only drinks about 4 - 6 c. of water a day, if that. That's half of what she used to consume, even while on her cushings meds. Before the cushings, it was probably more like 14 - 16 c. of water per day and even higher when she'd have uti's. So the tylan might be something that would also help Eden. But first things first. Let's help you sort out what's going on with the cushings and the lysodren and take it step by step.

Is your vet a gp vet??? An internal medicine specialist (IM) might be your best bet for sorting things out. We started with a gp vet, who was experienced with cushings but not with trilostane (the other cush drug). So Zoe was her first trilo patient and that was kinda tricky in the beginning. That's why I ended up on this forum and my vet and I learned about trilo together. Still, we ended up seeing an IM when Zoe had some rough moments early in her tx. Then we moved and I decided to just go with an IM instead. We've been with this last IM now for two years and she's the one who put Zoe on tylan. With Zoe's many 'issues' and medicines (for urinary problems, seizures, hypothyroid, IBD and cushings!!), I feel much better with an IM in charge.

Sorry to babble on so long. But hope you can answer all the questions and then you'll get some more input. There are some great people here who know lots about cushings. Sue/Zoe

* - I buy the tylan online (no rx needed) in powder form and fill the capsules myself so it's pretty cheap that way.

[Pupsqueak]

She just completed her 7 days of Lysodren and she is still panting heavily and losing her bladder at night. Her last dose of Lysodren in April must have overkilled the tumor because she was weak and listless. I had to counterbalance with Prednisone.
This time, I see no changes; I think we were given a placebo.

[Pupsqueak]

Hi Leslie (and girls)! Thank you so much for the welcome! My name is Lori and Eden had a low dose dex suppression test. I have total faith in my vet and certainly believe he knows what he is doing, but is it possible (without too much discomfort on Eden's part) to determine if this is pituitary or adrenal realated?

Thanks!

[Pupsqueak]

Hi Zoe's mom....I am not sure what type of vet Eden's doctor is. She had the low dose suppression test and then ACTH. The symptoms that alerted me to Cushing's is the heavy panting in cool weather, urination of the floor and the appearance of losing weight. She weighs a consistent 56 pounds. The Lysodren Rx is 1 500mg. tablet twice a day and then 1 table twice a week for maintainence. When she showed signs of listlessness, He suggested 1/2 tablet of Prednisone (I think) for about a week.

He actually suggested putting her into total Addison's to control her symptoms but I don't want to go there yet.

[Squirt's Mom]

Hi Lori,

An abdominal ultrasound done on a high resolution machine will usually go a long way in telling whether it is pituitary or adrenal Cushing's. In fact, it is the preferred way as far as I am concerned primarily because not only will the docs be able to see the condition of the adrenals for determining which type of Cushing's she may have, but they will also be able to see many more of her organs like the liver, gall bladder, kidneys, stomach, intestines, spleen and reproductive organs (if present). This is one of THE most valuable tests a pup can have done when Cushing's is suspected, and even after.

Usually, the pup is simply placed on the table and the machine does the work. If a pup is too agitated or stressed, they may give a mild sedative. I personally can't recall hearing of any pup having a bad time with an U/S, even those that don't handle vet offices well and needed sedation.

I strongly recommend you ask your vet about setting this up for Eden as soon as you can, especially in light of of her reactions to the Lyso.

So she has completed 7 days of Lyso....I assume, and sincerely hope, an ACTH has been scheduled before maintenance will start? It is a very good idea to know where the cortisol level is after loading before starting the maintenance phase. If her cortisol has not come down within desired range, then the maintenance will be a waste of time and money. If her cortisol is too low again, starting maintenance too soon may throw her into a crisis. So knowing where she is after loading is important. I'm not sure what day was her last loading dose, but the ACTH needs to be done about 36-48 hours after that last dose to be accurate.

I really hate to say this, but this comment bothers me a great deal -


He actually suggested putting her into total Addison's to control her symptoms

In fact, it threw up a great big red flag for me concerning your vet's experience in dealing with Cushing's. This is NOT to say that your vet is not an excellent veterinary, but many very good vets have had little to no experience with Cushing's. In Europe, throwing a Cushing's pup into permanent Addison's on purpose is common, tho I am not sure why that is. I am very glad, tho, to hear you say that you aren't willing to do this...just yet, if I understood correctly. Addison's comes with it's own set of nightmares and complications that seem no less difficult to handle than Cushing's from what I have read. Here are some links on Addison's for you so you know what your vet is contemplating:

Addison’s*

http://canineaddisonsinfo.com/
http://k9addisons.com/faqs/
http://pet-diseases.suite101.com/article.cfm/addisons_disease_in_dog
http://www.inmetrodetroit.com/pets/dachshund/frederick/addisons.htm
http://www.vetinfo.com/dencyclopedia/deaddisons.html
http://www.addisondogs.com/support/group.html
http://pets.groups.yahoo.com/group/AddisonDogs_/
http://canineaddisonsinfo.com/Support.html

If presented with this option, you need to know what Eden will face and advocate for her as you believe best.

On thought on the continuing signs even with the Lyso now...what did she eat with the Lyso? Sometimes the Lyso needs a bit of help to get absorbed and oils/fats make that absorption happen. It may be that she needs to have the Lyso given with some warm olive/sunflower/safflower/corn oil, or cream cheese, or peanut butter, and some here fix a special "Lyso meal" with the med.

I really, really hope you will get an ultrasound in the works for Eden very soon. You may be surprised at what you will learn, and it could save her life as it has Squirt's and others here.

Keep in touch and let us know how things are with Eden. We get worried when we don't hear from folks for a while and I'm apt to come looking for you! :p You and Eden are family and we want to know how ya'll are doing.

Hugs,
Leslie and the girls

[Harley PoMMom]

Hi Lori,

Sometimes the LDDS test and an ultrasound can tell if it's pituitary or adrenal cushings, but since there are no numbers with units ( from the LDDS test) for the members to look at they won't be able to give you their honest opinions.

IMHO it doesn't sound like your vet is following the proper protocols for Lysodren, but since I've never dealt with the drug, I can't really state that for sure. His suggestion to put her into Addisons, to me, is just unprofessional.

The symptoms you said Eden has are symptoms of other diseases too.

There were some questions that Sue asked you that you forgot to answer that are very important for us to know.


General bloodwork, and urine, hopefully??? If so, can you get a copy and post the 'out of range' results. Most cush dogs also have dilute urine which would show up as a low USG on a urine test. And they also have elev. liver enzymes and possibly other things.


Please answer these questions as soon as you can and post the results of the LDDS and ACTH tests...thanks :)

Remember your not alone, we are here for you and Eden.

Hugs.
Lori

[Pupsqueak]

Hi Leslie.....I am definately going to talk with Eden's vet regarding the ultrasound and 'shop around' for a vet who may be more familiar with Cushing's.

I now have her on Lysodren twice a week. Her vet is on vacation, so I can only leave messages. She is having trouble getting up on occasion so I've been sleeping downstairs with her at night so she doesn't have to come up the steps to tell me she needs to go potty. She has a appetite but doesn't look herself. Is there anyone in NEPA that knows of a vet that is familiar with Cushing's????

[Pupsqueak]

I'm not sure I am doing this 'thread ' thing properly, but Lori, Eden does have dilute urine but I am unsure of the numbers. I JUST got off the phone with the vet and they are going to copy all of her blood/urine work for me and have it at the desk for me tomorrow. I'll keep you posted. :-)

[Pupsqueak]

P.S. It is hard for me to measure water consumption. Eden has a sister.

http://i69.photobucket.com/albums/i74/atrickylittlefox/wink.jpg


This is Shelby. She's a Shegal. This photo was taken right after she ate her bed.

[Harley PoMMom]

Hi Lori,

That Shelby, she's a cutie, and a little bit of a rascal...huh? :) For an IMS near your area I'll provide a link for you so you can search for one.

http://www.acvim.org/websites/acvim/index.php?p=3

You don't need to fill in the space for "name and organization," just click on the drop down boxes, fill them in, and hit search, and hopefully you'll find one.

I took Harley to the University of Pennsylvania in Philadelphia for his ultrasounds and some other testing, but his regular GP treats him back home here.

Please keep us updated, and best of luck to you and Eden.
Hugs.
Lori

[jrepac]

Eden is real cute!

I would not overdo the lyso, nor put her into Addison's...that is ridiculous. Your vet sounds not too knowledgeable...your dog can have cushings and not necessarily drink down the whole bowl of water and eat everything in sight...it depends on severity. My Aussie never finished the whole bowl of water....just enough to make me suspicious; same thing with the hunger.

Hopefully you can get her lyso to a point where she has controlled symptoms but is not listless...that is the trick...

Good luck

Jeff

[frijole]

She just completed her 7 days of Lysodren and she is still panting heavily and losing her bladder at night. Her last dose of Lysodren in April must have overkilled the tumor because she was weak and listless. I had to counterbalance with Prednisone.
This time, I see no changes; I think we were given a placebo.

please confirm that you are no longer using the prednisone. thanks! kim

[frijole]

Hi! Do get the test results and post them. The ldds test can sometimes tell you what type of cushings you are dealing with.

Did you do an acth test? The lysodren dosage is fine for your dog - within recommended range.

The problem is that protocol is to continue giving the dosage daily until you see signs of loading (loss of appetite or water consumption) . At that point you do another acth test to see if you have lowered the cortisol level enough to go on a weekly dosing regime.

It looks like you did 7 days and that is when you said she was lethargic. did you do an acth test then? What was it? Then you mentioned another one where Eden was up to 27? That is way up there. Cushings dogs should be between a 1 and a 7.

I am not sure I have the timeline right and for us to help we really need exact details of the timeline, dosing, testing... when you can please get back with that info. It will help us help you know what to ask for from the vet.

So right now you are on weekly treatment right? If the dog is having problems with the stairs and urinating those are signs that the cortisol is still too high.

When you started treating after the reading of 27 did you do another load or go to weekly? Did you up the dosage from the original one?

I have 2 dogs also. I measured the water I put in the bowels each day and determined what is "normal" before I started the loading. Then that became the daily water I put out. Then I looked for a total decrease... I have one dish they drink from to keep it simpler.

I agree that your vet does not seem to be up to speed.... or sometimes we find the problem is communication/understanding what is being said. Like speaking Greek. :p It is hard at first and we are here to help you thru this.

So when you can, get us a complete history of what has gone on in chronological order and that way we can help get things going for you. It is great you are getting the records. It helps because it isn't easy to remember the dates, numbers etc.

Good luck!
Kim

[Pupsqueak]

Hi Kim....when I got the reading of 27, I did one week of Lysodren 2 x a day and then the next week (this week) did 2 x a week,per vet orders.

Here is bloodwork abnormalities from 2009 (I have from 2002):


Chemistry 3/2/09
High: BUN, ALT, ALKP

Hematology:
Low: RBC, EOS
High: RDW, PLT
MCHC out of reportable range

Urine: OK


3/11/09

Biopsy Diagnosis: Lymphoid follicular heyperplasia with hemorrhage - spleen


4/14/09

Test: VET-PRO

Out of range: VET Urea Nitrogen (49 H)
VET Bicarbonate (14 L)
VET Cholesterol (540 H)
VET Alkaline Phosphatase (274 H)
VET SGPT/ALT (297 H)
4/13/09

Hematology:
Out of Range: HGB (High)
MCH (High)
RDW (High)
PLT (High)
MCHC out of reportable range (RB9)
HgB sheath timing variability (HI1)

Urine was normal


Dexamethasone tests:

4/14/09

Time 1: 1.9 baseline
Cortisol 6.4
Post dex: <1.0
Post ACTH: 5.0 - 18.0
NG

Time 2: Vet Cortisol 4.0


4/24/09

Cort 1.4 baseline
Immunoassay: Cort 2.7


5/21/09

Cort: 1.9 baseline
test 2: Cort > 10.0
test 3: Cort 19.6

7/24/09

Cort 1.4 baseline
test 2: Cort >10
test 3: Cort 27.7


I have earlier bloodwork but most show the same results with
HCT Polycythemia (high)
LY Lymphocytosis (high)
EO Eosinopenia (low)
MCH and MCHC (high)
PLT Thrombocytosis (high)


I am not sure what else to add......

[Pupsqueak]

Yes, quite the rascal but she's calmed down quite a bit......she doesn't chew beds or table legs or yardsticks anymore......I am going to check out the websites you suggested.
THANK YOU!
Lori

[Pupsqueak]

I am not using the prednisone this time.

Lori

[frijole]

Hi Kim....when I got the reading of 27, I did one week of Lysodren 2 x a day and then the next week (this week) did 2 x a week,per vet orders.

Here is bloodwork abnormalities from 2009 (I have from 2002):


Chemistry 3/2/09
High: BUN, ALT, ALKP

Hematology:
Low: RBC, EOS
High: RDW, PLT
MCHC out of reportable range

Urine: OK


3/11/09

Biopsy Diagnosis: Lymphoid follicular heyperplasia with hemorrhage - spleen


4/14/09

Test: VET-PRO

Out of range: VET Urea Nitrogen (49 H)
VET Bicarbonate (14 L)
VET Cholesterol (540 H)
VET Alkaline Phosphatase (274 H)
VET SGPT/ALT (297 H)
4/13/09

Hematology:
Out of Range: HGB (High)
MCH (High)
RDW (High)
PLT (High)
MCHC out of reportable range (RB9)
HgB sheath timing variability (HI1)

Urine was normal


Dexamethasone tests:

4/14/09

Time 1: 1.9 baseline
Cortisol 6.4
Post dex: <1.0
Post ACTH: 5.0 - 18.0
NG

Time 2: Vet Cortisol 4.0


4/24/09

Cort 1.4 baseline
Immunoassay: Cort 2.7


5/21/09

Cort: 1.9 baseline
test 2: Cort > 10.0
test 3: Cort 19.6

7/24/09

Cort 1.4 baseline
test 2: Cort >10
test 3: Cort 27.7


I have earlier bloodwork but most show the same results with
HCT Polycythemia (high)
LY Lymphocytosis (high)
EO Eosinopenia (low)
MCH and MCHC (high)
PLT Thrombocytosis (high)


I am not sure what else to add......

Curious - why did your vet keep doing the acth over and over? I am trying to piece your story together...

You mentioned your dog had symptoms (bladder) and you pushed for tests. Was that when you did the first acth test? (April 14)

The acth test usually indicates cushings (potential) when the cortisol level is 22.

So you did the following tests:

4/14 post acth 18 (not above normal/cushings)
4/24 post acth 2.7
5/21 post acth 19.6
7/24 post acth 27.7 (above 22, could be cushings)

You said you started loading for 7 days when you were at 27.7 and then you went low. This doesn't follow the testing timeline and results so I will ask for more info. (sorry)

It looks from your tests that your vet diagnosed cushings at 18, you gave lysodren (? dosage, frequency, # days) and the cortisol went WAY low to 2.7. I would suspect this is when your dog got lethargic. Then you went on a 2 x a week dosing of ? how much lysodren... and you are now above normal at 27.7

Did your vet ever do any OTHER tests for cushings like the 8 hr Low Dose Dex Suppression test?

What has your vet said about the high readings for :

HCT Polycythemia (high)
LY Lymphocytosis (high)
EO Eosinopenia (low)
MCH and MCHC (high)
PLT Thrombocytosis (high)

None of these are signs of cushings. It is the ALT and ALK liver enzymes that indicate potential cushings.

I am wondering if something else is going on here. Perhaps I don't have enough of the story. Sorry to push for info but it helps us so much. Kim

[Squirt's Mom]

Hi Lori,

How is Eden doing? Is she still having trouble getting up? Is this something that has come on or gotten worse since the Lyso has been on board? Does she seem to be more of herself now, or do you still feel she "doesn't look herself"? Any loss of appetite or diarrhea? Still losing control of her bladder?

And how are you doing with all this? It's a bit overwhelming at first, huh? (Understatement of the year! :p ) Don't worry, tho. If I can start to grasp a bit of this stuff, anyone can! :p We're here to help you any way we can, so don't hesitate to ask questions...no such thing as a "dumb" question...and I should know! ;):D

Hang in there!
Hugs,
Leslie and the girls

[Pupsqueak]

Yes, she is still having trouble getting up, definitely worse since's she's been on Lyso but I think it is her arthritis. She will still get up to go for our short walk and can make it up and down the front steps (I am right behind/in front of her). She is on Deramaxx and Flexicose. She isn't eating unless I mix her food with canned. She has diarrhea, but that has been going on before.

I am calling the Univ. of PA Vet hospital on Monday for a consultation. There has got to be an easier way for her to go through this. She looks so sad sometimes.

I haven't read a lot of other posts. I am trying to stay on top of my own....thanks for your advise and I WILL be asking more questions.

Thanks!

Lori

[Pupsqueak]

I posted the results yesterday. Please let me know what you think!

[frijole]

Hi Lori! Am headed out but wanted to respond to your post. I saw your post and had some questions about the numbers. Sorry to be a pain...:o Let us know a bit more about what was going on around those dates so we grasp the whole picture. It is hard to help with only pieces of the puzzle. Hang in there. It is tough at first but it gets much easier! Thanks. Kim

[frijole]

Yes, she is still having trouble getting up, definitely worse since's she's been on Lyso but I think it is her arthritis. She will still get up to go for our short walk and can make it up and down the front steps (I am right behind/in front of her). She is on Deramaxx and Flexicose. She isn't eating unless I mix her food with canned. She has diarrhea, but that has been going on before.

I am calling the Univ. of PA Vet hospital on Monday for a consultation. There has got to be an easier way for her to go through this. She looks so sad sometimes.

I haven't read a lot of other posts. I am trying to stay on top of my own....thanks for your advise and I WILL be asking more questions.

Thanks!

Lori

Lori, I didn't see this post last night! Are you still loading? If so, please STOP.

A dog using lysodren will quit eating and have diarrhea when they have had too much of it. I am going to post an important link on loading that was a god send to me when I was loading my dog.

I am glad you are going to seek additional help. I am concerned about Eden. Be sure to bring copies of all previous testing results with you so the new vet has a good idea of what has happened. It will save you time and money. Kim

http://www.k9cushings.com/forum/showthread.php?t=181

[zoesmom]

Hi Lori-

I have to completely agree with Kim. When a dog on lysodren is showing weakness, not eating and having diarrhea, you need to stop the drug immediately.

Going to Univ of PA is an EXCELLENT idea and I hope you can get in there soon.

These tests are still bamfoozling me (and the other members here too, i think)

Was the 4/14 test the first one done (for the diagnosis?) The results you posted for it were:

"Time 1: 1.9 baseline
Cortisol 6.4
Post dex: <1.0
Post ACTH: 5.0 - 18.0
NG

Time 2: Vet Cortisol 4.0"

You wrote dexamethasone test so that IS a suppression test (LDDS, which should have been 8 hours with 3 blood draws. The results are very confusing, tho' What I think it's saying is that Eden's baseline reading was 6.4 and the second reading was 4.

But there are multiple problems with these results....First of all, I'm not sure what that 1.9 is. Then, where it says post-dex and post- ACTH - right after "6.4" . . . those are just the normal ranges that they are looking for in the two different tests and they are not Eden's results.

Then comes Eden's Time 2. The problem there is that there is no indication what time that second draw was taken (at 4 hrs or 8 hours or even how long after the baseline). And the last problem is.....there is no third number at all, as there should be. So the test clearly wasn't done properly.



Then there's this one:

4/24/09

Cort 1.4 baseline
Immunoassay: Cort 2.7

I'm not sure what this test is, unless it was an HDDS? Somebody here will probably know. I assume that the lysodren was then started after the two above tests???? Do you know the exact date you first gave the lyosdren??

Then there was this next test - I assume it was this one (below) - done after Eden took the lysodren for a week and seemed 'off'??

"5/21/09

Cort: 1.9 baseline
test 2: Cort > 10.0
test 3: Cort 19.6"

Now this one, just above, should have been an ACTH - assuming it was done after she took the lysodren -- so I'm puzzled as to why there are NOW three numbers when there should only be TWO. It's like your vet got the testing protocols backwards on the LDDS and the ACTH.

Anyway, I can't sort it all out - but it makes me suspicious that your vet's experience with cushings is limited. So the very best thing you can do for Eden, IMO, is get her to the University asap and get some input from them. And as Kim said, be sure to take all the test copies with you. Certainly, some of Eden's high enzyme readings point to possible cushings. But in truth, the ALP isn't extremely high. Some cush dogs, when diagnosed, have ALP #'s in the close to or in the thousands. Possibly, Eden is in the very early stages of cushings and I think you said initially that she didn't have many symptoms other than the slight increase in drinking and the accidents in the house. Which could be another indication that she is still the earliest stages.

Also, I would recommend you start keeping a journal. Days when medications are given and at what dose, a record of Eden's responses - any time there's any response which seems out of the ordinary to you, and of course test dates and their results, etc. It will really help YOU keep things straight and help the vet determine what's going on.

Keep us posted re: the Univ. of PA. Hope you can get an appt. this week! Sue

PS - and no more lysodren for now (and keep that prednisone handy!)

[Pupsqueak]

We have an appointment on Thursday with a specialist at Univ. of Penn... I'll keep you posted!

[Squirt's Mom]

Hi Lori,

Have you stopped the Lyso?

Hugs,
Leslie and the girls

[Pupsqueak]

Update: Eden is on her second week of Lysodren, maintenance dosage. She is licking herself, biting, scratching her back legs open. I bathed her to see if it would make a difference and gave her one Benadryl. She is wobbly when she walks and occasionally, can not get up from a prone position, even for a piece of meat. This has all happened within the last 24 hours. I'm scared.

[Pupsqueak]

I am stopping the Lysodren, also. Our consultation visit is on Thursday at Ryan Vet Hospital in Philly.

[AlisonandMia]

Do you have prednisone on hand? It sounds like her cortisol is likely a bit too low. If this is the case then the appropriate dose of prednisone should help her feel a lot better within the hour.

How much does she weigh and what size prednisone pills do do you have and what dose have you been prescribed?

Please don't give any more Lysodren for the time being - even if a dose is due.

Alison

[frijole]

Lori, Wanted to make sure you saw Alison's post. Do you have prednisone on hand? What is Eden's weight, what size pills do you have (prednisone) and what dose was prescribed to take?

When did you last give lysodren?

Thanks. Hang in there, Kim

[frijole]

Update: Eden is on her second week of Lysodren, maintenance dosage. She is licking herself, biting, scratching her back legs open. I bathed her to see if it would make a difference and gave her one Benadryl. She is wobbly when she walks and occasionally, can not get up from a prone position, even for a piece of meat. This has all happened within the last 24 hours. I'm scared.

Being wobbly and unable to sit up is a sign of lysodren overdose. You mentioned diarrhea yesterday morning. This is a sign of too much lysodren also.

This is why you should have prednisone on hand. When cortisol levels go to low you give prednisone because it mimics cortisol and makes the dog feel better.

Do you have an emergency number to call your vet? Even if you can't get a hold of the vet I would give the prednisone to be safe. But please if you can tell us what the dosage is just to be sure.

Thanks, Kim

[Harley PoMMom]

Alison,

I found this:

The standard rescue dose of pred is 0.25mg/kg. To find her wieght in kg, divide the
lbs by 2.2...then multiply that result (her weight in kg) by 0.25 and you will have the
amount for her weight. (I come up with 6.36 mg of pred.)??

[SaxLady]

Lori,
Is the appointment at a specialty hospital with board certified doctors? Has Eden had an ultrasound? If the hospital you are going to has a high resolution machine, it would be a good idea to have an ultrasound on her adrenals to determine what type of Cushings she has. If indeed she has Cushings. I read through the posts quickly and may have missed something.
Wishing for the very best for Eden!
Candy

[ventilate]

I just re read your posts. I also want to caution you about using deramax with a cushings dog. The use of NSAID is not recommended for cushings dogs as it combined with the high cortisol can lead to GI bleeding. My IMS and my GP vet both told me they would not give me deramax anymore for my dogs arthritis. She is now on tramadol and Gabapentin ( neurontin) and it is working great. She has not had NSAIDs since her diag 3.5 years ago.
I hope you do have some pred on hand, if your vet has a 24 hr service I would call them. watch your dog carefully. If you have given any lysodren in the past 24 hrs the symptoms you see will probably get worse, if that is the case you would need to go to an emergency clinic as your dog can get very sick. They will need to check the electrolytes as they can be out of normal range when a dogs cortisol gets to low. this can cause the dog to be sick as well.

Sharon

[Harley PoMMom]

Lori,

You are taking Eden to the same University Hospital that I take Harley to for his ultrasounds, they do indeed have high resolution machines and board certified docs., when you get your ultrasound done on Eden ask them to put it on a CD and give it to you so you can take it with you, along with all copies of tests, reports etc.

Hope everything is going ok with Eden and the best of luck with your appt. on Thrusday.

Please keep us updated.

Hugs.
Lori

[frijole]

Lori, Was hoping for an update... a bit worried here. :( Just wanted to make sure you know that lysodren continues to work for up to 48 hrs after the last dosing. With the symptoms you described, if you continued to give it after the diarrhea occurred on Sunday you might need to see a vet before your appointment on Thursday.

It is the electrolytes that are of concern and the wobbliness is a sign of that. Do NOT hesitate to take Eden to an ER if you need to. Thinking of you and Eden... Kim

[Squirt's Mom]

Hi Lori,

Just saw your post...are things ok? Am a bit worried and would love to hear how Eden is this morning.

Hugs,
Leslie and the girls

[frijole]

Nervous Nellie here also... :( Please let us know you guys are OK.

Kim

[frijole]

How is Eden doing? Checking in... Kim

[Squirt's Mom]

Lori? Please let us hear from you and Eden....from a major worry wart -
Leslie and the girls

[SaxLady]

Hi Lori,
I remember your appointment for Eden was today. How did it fare? Let us know.
Candy

[zoesmom]

Me, too.....wondering how Eden's doing and how the appt. went! Sue/Zoe

[Pupsqueak]

Hi. We made it to Ryan Vet Hospital. That place is awesome. They did a 2 hour consult with us and then took Eden for a STIM test (done inhouse), ultrasound, CBC, Chem screen, ACTH test, Chest X-Ray, Abdominal Ultrasound, Urinalysis and blood pressure check. Dr. Walsh saw her and he followed up with two phone calls already.

Her Cushing's seems to be adrenal. One of her adrenals is enlarged. He said there is a 50% chance that it metastasized so an option would be to remove it. However, he can't promise that the large gland is the one that is affected and you just can't go in and biopsy the thing.

I am afraid to put her under surgery again for something that might only get her 6 more months. She has been through so much and the Lysodren seems to be working. I just can't stand to see her, or any other animal suffer needlessly.

I told the vet that I came from advice from this forum. Eden is still happy and wants to be a dog. She gets up when she sees me with her leash. I want to do everything I can for her so her last years are comfortable. I don't want anyone to tell me that I didn't try hard enough.
He said that I don't need to justify anything. He said, "I'm here for you." (and your money...a LOT of it. Just the consult alone was $175).

Now, because of the lessened cortisol in her blood, Eden is favoring her legs. She has degenerative joint disease in her front leg and the back legs are still week. Dr. Walsh said that the wasting of muscle mass was likely due to her disease. He said that she could get it back, or we could get some physical therapy. He is going to fax her paperwork to our vet and he will follow up with it. Dr. Walsh suggested another STIM test in three months. It is a 3 hour drive to Philly and although I don't mind it, I'm sure Eden does. I'm hoping a local vet can do the test instead.

Again, I am so glad I found this forum and THANK YOU to all who have shared their stories and advice. I feel so much better for checking with a specialist. I feel like we are on to something now.

[Pupsqueak]

Her cortisol was still high. After our trip on Thursday to the specialist, she was at 4.96. So, now we are on maintenance.

[Pupsqueak]

I did see it. I have Predinsone on hand. Eden is 22 kg.

[Pupsqueak]

Hi Candy,
Yes, we saw a specialist at Univ.of Pa. I posted our findings earlier today!

[Pupsqueak]

Hi Sharon, I told our vet that Eden was on Deramaxx and if we should discontinue it. (I know you need to stop it with Prednisome). The vet said that the Deramaxx manufacturer does not recommend taking it with lysodren but if the patient has already been on it continuously, then keep taking it.

I am not sure how I feel about this advice. Eden's bowels are very loose.

[Pupsqueak]

I just read this. I am going to call for a CD now.

[Wylie's Mom]

Hi Lori & a very belated welcome from me,

I’m glad your visit to Hospital in Philly went well. Please ask your vet for copies of all the results and please post the information here – the more information you give us, the more the people here can help.

I agree with your hesitation to do surgery… some here have had success with it and some not. I don’t know about the “6 more months” comment, but you have to be concerned with how well your pup can recover from surgery, especially when they’re more “mature” (mine is 12yo). I like how the vet said that you don’t need to justify anything and that he’s there for you… we are too!


I'm hoping a local vet can do the test instead
Yes, your local vet can do the stim.

The 4.96 number that you posted… was that the post number for the stim? And are the units ug/dL? If yes, that is a great number – you want to be between 1-5 ug/dL while treating with Lysodren.

About the Deramaxx, my Wylie got very sick on Rimadyl, another NSAID… IMHO (subjective as it is), I would try something different if possible. In addition to the GI bleeding that Sharon had mentioned, NSAIDs can be harsh on the liver (and kidneys) and many times a Cush pup’s liver is already compromised. Wylie was given Rimadyl for pain relief after a surgery in ’06 – he ended up vomiting & having diarrhea – I thought it was from the anesthesia, but it continued for a few days and then the 3rd day post-op, I saw blood and took him to the ER and found out it was from the Rimadyl. He now gets Tramadol for pain relief when needed with no issues. The following link is a rather lengthy read, but it may give you some alternative ideas (and does include the two that Sharon had mentioned):
http://www.dogaware.com/arthritis.html

If Eden has diarrhea or loose stools often, the same site lists many things that can possibly help with that also:
http://www.dogaware.com/specific.html#diarrhea

Whenever Wylie has unusual stools, I now also re-read an article from the Whole Dog Journal called “Dog Gone Dung: familiarity with your dog's poop will help you detect illness quickly.” You can access it free if you join (for free) this library:
http://www.accessmylibrary.com/coms2/browse_JJ_W163

Again, please get copies of all test results (including the ultrasound comments) and post them here.

-Susy

[ventilate]

Susy;
I want to thank you for posting that link dogaware. I read more about the meds Nike was on and I didnt realize that deramax had issues. I am glad Nikes vet and IMS took her off of it.
Lori; I am glad you went to the specialist. As far as giving the deramax from what my IMS told me was it was not due to interactions with lysodren but with a cushings dog and the cortisol, which is a steroid the combined with the NSAID bad combination. My IMS was adament with me that the risk was to high, she had seen to many issues and would not perscribe it to a cushings dog. My regular GP vet would not either. I guess all vets have a different ideas and treat differently.
Good luck
Sharon

[Pupsqueak]

My 13 year old Pitt/Lab is being treated for adrenal Cushing's. We now have it under control and she is on a maintenance dosage of Lysodren twice a week.
Unfortunately, the lack of cortisol has made her sensitive to the slightest touch. There are places on her skin that are red and she is chewing a nice line of fur off of her leg.

I have contacted the vet and she is on 50 mg. Benedryl 3 times a day (she is 56 lbs.) and I am soothing her with a hydrocortisone spray.

Is there something else I can give her, possibly internally to make her feel more comfortable, like Brewer's yeast?

[forscooter]

Hi,

My dog, Scooter, had terrible allergies that were unmasked after lowering his cortisol. The cortisol kind of "treats" allergies by keeping them at bay. I have a few things you may want to try and do and discuss with your vet:

1) Switch to a hypoallergenic diet and ONLY give this food....no treats except for this food. I used a few that had treats made of the same things. There are also other diet alternatives people have used and I am sure they will chime in.

2) Try another antihistamine. Sometimes one won't work but another will.

3) Use fish oil supplements at mealtimes. It helps the skin but takes a few weeks to see results.

4) Use a shampoo you can use however frequently you need to...something like HyLyt that won't strip the oils from the skin but will help remove any environmental allergens.

5) Try using Selsun Blue shampoo once a month.

6) Aveeno Oatmeal Bath soak....Shampoo, and then put in clean water in tub with the Aveeno mixed in....take a container and keep pouring the mixture on the skin rubbing gently with your hands to get it in there, for 15 minutes. Do not rinse off. Gently towel dry your pup and leave the Aveeno on.

7) Instead of play time in grassy areas, try walks on pavement where there are few weeds and/or grass.

If I think of others, I will post them. Allergies were difficult to deal with and sometimes we did better than others. But don't give up!!!!

As a last resort, we had to cut back on the Lysodren a little bit and raise the cortisol, again, slightly, to find the comfort level for Scooter.

The other idea is to go for the allergy shots. If Scooter's overall health had been better, I would have done this first thing. If you can, and your pup is up for it, this would be my first recommendation.

Hang in there....Beth, Bailey and always Scoobie

[StarDeb55]

Lori, I have merged your new thread concerning Eden's latest issue into her existing thread. We like to keep all posts/information concerning a pup on a single thread, it just makes it easier for all of us to keep up with what's going on with your pup. I have also modified the title to reflect Eden's latest problem. If you would like the title changed to something else, please feel free to PM any of the mods or administrators, & we will be happy to do that for you.

Debbie

[Nathalie]

Hi Lori,
My Phillip has never had any sensitivities but gets quite itchy when his cortisol is too low for him – still within range, but too low for him to feel well. I still have not found an adequate maintenance dose but the goal is to maintain him at the upper end of the range or even slightly above where he feels well and does not show any cushing’s symptoms.
I have a Beagle with vaccine damage who was very itchy for about 1 year and scratched himself literally to pieces until we got his immune system somewhat balanced again and know how hard it is to watch your dog going through something like this. IMHO - my first choice would be let the cortisol rise a bit so he feels better but remains asymptomatic.
Nathalie

[BestBuddy]

Hi,

The following link is an Aussie site but I am sure a lot of the drugs are the same. Benadryl is listed but so are many others so it may just be you need to try one of the other antihistimines. Maybe you could get your vet to suggest which one to try next.

http://www.ingleburnvet.com.au/antihistamines.htm

Jenny

[AlisonandMia]

Did Eden have allergy problems before developing Cushing's?

There is a condition called Calcinosis Cutis that some dogs develop as a result of having high cortisol. Little lumps and plaques of calcium are deposited under the skin. Once the dog's cortisol is lowered to a more healthy level the body sets about ejecting the calcium deposits just as it would any foreign body and it can result in a lot of itching and inflammation while this is going on.

It does eventually resolve but it is a case of things getting worse before they get better and sometimes the dog needs antibiotics as it can get infected and smelly.

You may want to ask your vet if he thinks Calcinosis Cutis is a possibility with Eden's skin, especially if allergies haven't been a big issue for her in the past.

Alison

[StarDeb55]

Alison has brought up a good point about calcinosis cutis.

My other pup suffers from serious allergies & started allergy shots about 2 months ago. His derm vet gave me a list of OTC antihistamines to try, which I'm trying to find right now. He also warned me that not all dogs will respond to any specific antihistamine. You have to try one for about 2-3 weeks, if there's no improvement, then you try the next one on the list. When I find that list, I will post the information for you, but please run any changes in meds by Eden's vet first.

The other thing is that sometimes you have to treat the pup & not the numbers. We have never really been able to get Harley's stim tests to stay consistently <5. He has been running anywhere from 7-11, & because of being a senior at 14 yrs. old, & pre-existing GI issues, both my vet & I feel that as long as Harley feels well, & is not symptomatic at these higher numbers, we will not try to lower them.

Debbie

[Sabre's Mum]

Hi Lori

I see that Alison has posted with regards to the possibility of calcinosis cutis being the issue. Sabre, our Hungarian Vizsla, had and still has calcinosis cutis. It is my understanding the some will eject completely ... however in Sabre's case I have only noticed one spot that this has been the case. At the early stages, it appeared as a reddened area which then got lumpy. In Sabre's case these are best decribed as "plates" ... as opposed to lumps some a 4cm x 1.5cm in size. Initially we used antibiotics as there were issues with infections, however once his hair grew back this has not been an issue. Sabre does go through stages of being itchy and when his cortisol levels go low he is extremely itchy and rolls on his back.

We changed his diet completed to being hypoallergenic - raw venison, raw venison bones and raw veges. We have added Evening Primrose Oil to his diet along with this Flaxseed Oil which he has always had. I shampoo him with a shampoo we get here in NZ called Alovene (it is an oatmeal based shampoo which is left on the skin for 5 minutes before being washed off). When he is really bad I give him an antihistame. There is a pic in the gallery of Sabre last year but it probably isn't zoomed in enough for you to see his calcinosis cutis.

All the best
Angela, Sabre and Flynn

[Pupsqueak]

Thanks for the info! I am keeping the Lysodren where it is now because she is doing so well. I am going to try the oatmeal bath and fish oil. I'm also going to try a different spray. This one even smells strong. I'm afraid it might be burning her. I'll keep you posted!

[Pupsqueak]

Hello everyone~I had stopped posting because I THOUGHT we had everything under control. The itching stopped with hydrocortisone spray and a daily Claritin. We've been hanging in day by day.

Today, Eden vomited in the living room. I could tell that she still had some in her, so I took her outside where she walked into the grass, disoriented and unbalanced. She fell on her side and made no attempt to get up. It was the scariest thing I saw.

I immediately took her to the vet. They did some blood work but kept her for observation. Her ALT liver enzyme is through the roof, around 600. She had blood work in August and the ALT was around 60. So we are trying to figure out what caused it to jump so quickly.

She is scheduled for a liver ultrasound tomorrow (gee...just when our fur was growing back from the abdominal ultrasound in August!).

I know she is 13. I know she won't be around forever. She is a happy dog and wants to walk and eat her 'cookies'. She plays with her toys. She's not ready for the one way trip to the vet. When I took her today, she was wagging her tail and sniffing other dogs. I felt silly for being there and was going to turn around. I'm so glad I didn't.

The worst part about all of this not knowing what's going on and the anticipation of what is going to be discovered next. It would be SO much less painful if pets left us in their sleep.

[Harley PoMMom]

Hi Lori,

I am so sorry you are having these issues with Eden, but if you could post the CBC and the Chem screen maybe Debbie, she's a medical lab tech with over 29 years experience, can see something that is alittle off.

Will be keeping you and Eden in my thoughts and prayers.


Hi. We made it to Ryan Vet Hospital. That place is awesome. They did a 2 hour consult with us and then took Eden for a STIM test (done inhouse), ultrasound, CBC, Chem screen, ACTH test, Chest X-Ray, Abdominal Ultrasound, Urinalysis and blood pressure check. Dr. Walsh saw her and he followed up with two phone calls already.

Her Cushing's seems to be adrenal. One of her adrenals is enlarged. He said there is a 50% chance that it metastasized so an option would be to remove it. However, he can't promise that the large gland is the one that is affected and you just can't go in and biopsy the thing.

I am afraid to put her under surgery again for something that might only get her 6 more months. She has been through so much and the Lysodren seems to be working. I just can't stand to see her, or any other animal suffer needlessly.

I told the vet that I came from advice from this forum. Eden is still happy and wants to be a dog. She gets up when she sees me with her leash. I want to do everything I can for her so her last years are comfortable. I don't want anyone to tell me that I didn't try hard enough.
He said that I don't need to justify anything. He said, "I'm here for you." (and your money...a LOT of it. Just the consult alone was $175).

Now, because of the lessened cortisol in her blood, Eden is favoring her legs. She has degenerative joint disease in her front leg and the back legs are still week. Dr. Walsh said that the wasting of muscle mass was likely due to her disease. He said that she could get it back, or we could get some physical therapy. He is going to fax her paperwork to our vet and he will follow up with it. Dr. Walsh suggested another STIM test in three months. It is a 3 hour drive to Philly and although I don't mind it, I'm sure Eden does. I'm hoping a local vet can do the test instead.

Again, I am so glad I found this forum and THANK YOU to all who have shared their stories and advice. I feel so much better for checking with a specialist. I feel like we are on to something now.

Love and (((hugs)))
Lori

[Buffaloe]

Hi Lori,

I think it is pretty common for the liver enzymes to continue to climb significantly for a dog with an adrenal tumor, even when treated with Lysodren. That recent alt. number is a big jump from August. I would think they would have gotten a good look at Eden's liver from her previous ultrasound but maybe another one is warranted now.

If Eden ever seems unusually wobbly or weak, I don't think there is any downside to slipping her a little prednisone. Adrenal tumors often need higher amounts of Lysodren which can cause gastrointestinal problems, weakness, etc. Your other option would be to reduce or even skip a Lysodren dose. If it were me and my dog was vomiting and real wobbly, I'd give her some prednisone and not give any more Lysodren for a while. I don't think it's all that bad if the post cortisol # from the ACTH test is a little over 5 for a dog with an adrenal tumor. Obviously, these are just my opinions.

Have you ever had a full adrenal panel done on Eden? It would be interesting to know if her aldosterone level is high...symptoms would be hypertension and possible lethargy (low potassium / high sodium). There are drugs that will effectively counter-act the bad effects of high aldosterone. I think a relatively small percentage of functional adrenal tumors produce excessive aldosterone but that is one thing that is easily remedied. 'Might be worth running it by one of your professionals.

I hope and pray that Eden stays happy, healthy and feels really good for a very long time.

Ken

[AlisonandMia]

I'm sorry to hear that Eden is having a hard time.

I agree with everything Ken has said. I'd just like to add that you could have two problems here: one being whatever is causing high ALT and, from her symptoms of weakness and vomiting it sounds like it is possible her cortisol could have gone too low too. Even if it isn't actually too low, if she has something else going on, it could mean she needs a little pred to help her body handle the stress of that. Are they going to do a stim test?

Sending positive thoughts to you and Eden and keep us posted.

Alison

[jrepac]

This sounds like a low cortisol episode, I have to say...

liver scores can be high and the dog can be just fine (I am pretty used to that)...

but, if cortisol gets too low, the dog will be unable to walk/stand (even move) and vomiting is very likely..


Jeff

[Wylie's Mom]

Hi Lori,

What everyone is saying seems to fit - low cortisol. I looked at Wylie's records (last 13 chemistries) and the 2 times that he had a marked increase in ALT (1896 & 407) was when he had his vomitfests. One occured a few days after his initial load and the other happened a week after one of his re-loads; plus, they were both within a week after his 2 lowest post-stim results (3.6 for both). In Wylie's case he seems to do fine closer to a 5 post.

It's a good sign that Eden was acting well when you went to the vet. If it is low cortisol, I believe unlike ALP, ALT can return to normal relatively quickly.

-Susy

[Harley PoMMom]

Hi Lori,

I was wondering how Eden is, I hope everything is ok...I am a person who worries alot because I care alot...we all do. Please let us know how things are going when you can.

Love and hugs.
Lori

[SaxLady]

Hi Lori,
Hoping that Eden is recovering. Praying that it is nothing serious. Let us know.
Hugs,
Candy and always Katrina

[Pupsqueak]

Not much new with Cushing's. She is totally off of meds because the cortisol is staying within range. However, her last ACTH and blood test showed elevated numbers in her kidney and suggests the beginning stages of kidney disease. We are now on a prescription diet.

I have a sick feeling that I won't be posting much longer.

[lulusmom]

Hi Lori,

I am sure that your heart is heavy after your vet discussed kidney disease with you but please don't assume the worst. There is a huge difference between lab values that may be indicative of early kidney problems and lab values that confirm chronic and very serious kidney/renal failure. Early detection of possible kidney disease is not an impending death sentence for a dog and with proper diet and appropriate meds, if necessary, abnormal kidney values can improve and/or remain static for a very long time.

It would help us understand the extent of your concerns as well as provide you with helpful feedback if you would please post the results of the acth stim test and the abnormal blood and urine values, including the reference ranges.

Keep your chin up and we encourage you to continue to post and let us help you in any way we can. Just remember that we are here for "you" and Eden.

Hugs,
Glynda

[Squirt's Mom]

Hi Lori,

I want to second what Glynda has said. Many things can be tried to help Eden so don't give up hope. Post the lab results and be sure to include the units and norms, and I'm sure there will be comments to help you understand more about what they mean.

You have been a great mom all this time and there is no reason to think you will be any less great with this development. I can understand how disheartening this must be right now but hang in there. And don't ever forget that we are here for you and Eden, no matter the circumstances. ;)

Hugs,
Leslie and the girls

[Buffaloe]

Hi Lori,

That is excellent news that Eden's cortisol is under control and she isn't needing any Lysodren.

I'm sorry to hear her kidney values are elevated. If the elevation is not severe, indicating kidney failure or close to it, then they may very well be controlled for a long time. I'm hoping they are just mildly elevated. I'm also hoping the ALT and ALP values are not climbing too much and that she still enjoys her walks and she's wagging her tail.

You are doing the very best job you can do with Eden. I know you are loving her deeply and taking full advantage of her throughout every single day.

Ken

[Roxee's Dad]

Hi Lori,
I can only echo what has already been said by Glynda, Leslie and Ken.

Roxee had some blood test in June of 2008 and the vet came back in the room and told me she was in final stages of renal failure and had only weeks to live. I immediately broke down in tears. I took her to another vet the next day and that vet said her test results were incorrect and due to being dehydrated. Re-ran the test and no renal failure. Yes some of her results were highly elevated (due to cushing's) but no renal failure.


beginning stages of kidney disease

As Glynda said, this is a far cry from chronic kidney disease.

So keep the faith and the special diet, and enjoy every minute you can with Eden. We will be keeping positive thought's and prayers that Eden will be around for a long, long, time.

[Pupsqueak]

Hi everyone---I haven't been posting because thankfully, the Cushing's has been under control. Eden's kidney levels have been controlled by a change in diet. Her arthritis was much better since we started her on anabolic steroid injections. She even gained weight and her fur became much more shiny. She started climbing steps again!

About 2 weeks ago, she sustained an injury to her eye by trying to escape out of the kitchen. She poked it on the plastic part of a baby gate. Sadly, the antibiotics aren't working which is probably a result of her age, immune system and the Cushings. It has to be removed tomorrow. I am so concerned that she won't make it through the surgery but I have no choice. I can't stand to see her in so much pain. She's obviously terminal, but her good days still outweigh the bad.

Wish us both luck. I am an exhausted mess.

[zoesmom]

Oh, poor Eden. I understand your concern about the surgery but it sounds like it's a necessity. Will be hoping and praying and worrying right along with you. These pups can be tough little cookies and Zoe amazed me, time and again, with her ability to snap back. Please let us know as soon as you hear anything from the vet. (((Hugs)))) Sue

[Pupsqueak]

Update: Eden died November 26, 2010. She got to the point where her muscles were so weak that she was unable to stand, even at her food bowl. Her vet diagnosed her with degenerative neuropathy, similar to MS in humans. She got worse throughout the week and eventually didn't even try to stand up. I stayed with her while they gave her the final goodbye. She didn't even try to fight. She was ready. I wasn't. I miss her terribly.

[Roxee's Dad]

Dear Lori,

I am so very sorry for your loss. Eden knows she was very loved.

Rest in Peace sweet girl.

[labblab]

Dear Lori,

I am so deeply sorry for your loss. Thank you so much for returning to tell us what has happened, so that we may join you in honoring Eden and all that she will always mean to you. Her name has been entered on our special memorial thread of of honor where she is surrounded by all our other beloved pups who await us at Rainbow Bridge:

http://www.k9cushings.com/forum/showthread.php?p=22309#post22309

Please feel free to return to us at any time to talk. It will always be our privilege to listen and to share.

With many hugs in loving memory of your dear girl,
Marianne

[jrepac]

So sorry to hear of Eden's passing; you were a good Mom to her!

Jeff & Angel Mandy

[John II]

Dear Lori,

I am so very sorry for your loss. :(
Rest in peace Eden.

[k9diabetes]

I am so very sorry to learn of Eden's passing. I took some time to look at her pictures in your album... what a beautiful girl she was and so obviously deeply loved. It was a final blessing that you let her go when she needed you to relieve her of her body when it had failed.

With deepest sympathy,

Natalie

[bgdavis]

I'm very sorry for your loss. You had each other for a long time and will always be carried in the heart.

Bonnie and Angel Criss

[frijole]

So sorry for your loss. Thank you for coming back and updating us. Eden is free of pain and joins our "band of cush angels" above. No doubt they are all playing, running freely and eating tons. RIP Eden. Kim

[mytil]

I too am very sorry for your loss, my heart is with you.

(((((hugs)))))
Terry

[Squirt's Mom]

Dear Lori,

I am so sorry to hear of Eden's passing. You were such a good mom to her and did all in your power to give her the highest quality of life. When that was no longer possible, you gave her the greatest gift of all - freedom, and I know she is very grateful to you for all you have done on her behalf.

Thank you so much for coming back and letting us know - that had to hard on you. Please know we are here for you if you wish to talk. We do understand and offer you a soft, safe place to fall any time you need one.

Our deepest sympathies,
Leslie, Squirt, Trinket and our Angels, Ruby and Crystal

[Squirt's Mom]

If It Should Be

If it should be that I grow weak
And pain should keep me from my sleep;
Then you must do what must be done,
For this last battle can't be won.

You will be sad, I understand;
But don't let grief then stay your hand.
For this day more than all the rest,
Your love for me must stand the test.

We've had so many happy years;
What is to come can hold no fears.
You don't want me to suffer so
The time has come, please let me go.

Take me where my needs they'll tend,
But please stay with me 'til the end
To hold me close and speak to me
Until my eyes no longer see.

I know in time you will agree,
It was a kindness done for me.
Although my tail its last has waved,
From pain and suffering I'm saved.

Please do not grieve that it was you
Who had this painful thing to do.
We've been so close, we two, these years;
Don't let your heart hold any tears.

(--Author Unknown--)

[Sabre's Mum]

Lori ... I am so sorry to read that Eden has passed. My thoughts are with you.

Angela and Flynn

[marie adams]

Hi Lori,

I am so very sorry you have to go through this time--I know very well it is not easy for I just lost my Maddie Girl Saturday. You feel so lonely looking for them remembering places they would lay--just everything...you will have good days and bad, but everyone keeps telling me it does get better. This is truly a hard time since they were always there day and night for you always by your side--everything in the house, the yard, places we went together reminds you of the good times; so keep those thoughts with you because no one can take them away.

There is a star shining in the sky for Eden--it is the same star I see for Maddie--they will be sharing it.....

Take care!!!

[zoesmom]

Lori- My heart goes out to you. Eden was blessed to have you as her mommy. Sue

[foxandhound]

I am just so very sorry. I wanted to wish you courage and strength. Eden was ready and we will never be. I am so very sorry for your loss. Eden's pain is gone, but the memory, laughter, and smiles remain forever. lots of love and hugs.