My big boy Gable - sweet Gabe is now at peace

[Joan2517]

He hasn't peed in the house except those two times, once when i was late and the other I'm sure my husband didn't let him out before he left for work. And with Cooper, forget the diapers...he managed to get out of the ones I got for him even with the underpants that went with them!

I'm going to have Gabe tested again with all of your concerns mixed in with mine and talk to them about the CBD oil for Cooper probably this weekend.

[Joan2517]

Okay, we didn't do the ACTH test, but here are his results from regular blood work from a couple of weeks ago. Just the Highs. His thyroid was still low, so we raised the dosage. He did more blood work today to make sure it's not too much. Gable was up all night with bloody diarrhea and threw up bile twice. I brought him a stool sample, checking it for giardia. Gable hasn't had a normal poop in so long that I can't remember the last time it was normal. I'm thinking he has pancreatitis. That could explain all the gastro issues.

Superchem
Alk Phosphatase: 572 / ref range: 5 -131
Total Bilirubin: 0.4 / ref range: 0.1 - 0.3
Magnesium: 2.6 / ref range: 1.5 - 2.5
Triglycerides: 732 / ref range: 29 - 291
PrecisionPSL: 179 / ref range: 24 - 140

Complete Blood Count
Platelet Count: 491 / ref range: 170 - 400
Neutrophils: 11234 / ref range: 2060 - 10600

Thyroid was 1.2 / ref range: 2.5 - 6.0

Thoughts?

[Harley PoMMom]

Pancreatitis could definitely be a possibility considering the elevated PrecisionPSL, triglycerides and taking in account of the vomiting episode and diarrhea. Small and several meals being fed throughout the day is recommended for pancreatitis, starting off with a bland diet is usually required too. Does his diarrhea have an organish color?

[labblab]

In terms of the acute issues, yup, pancreatitis sure seems like a consideration.

In terms of the other lab abnormalities, I’m afraid several are consistent with Cushing’s: elevated ALKP, platelets, neutrophils, and triglycerides; ongoing low thyroid. Now, at least a couple of them could probably also be caused by pancreatitis as well — I just don’t know about that. But in the absence of the pancreatitis, I’m afraid I would think these abnormalities would warrant moving onward with a more specific Cushing’s test. How about his urine? Was that analyzed by chance?

[Joan2517]

Pancreatitis could definitely be a possibility considering the elevated PrecisionPSL, triglycerides and taking in account of the vomiting episode and diarrhea. Small and several meals being fed throughout the day is recommended for pancreatitis, starting off with a bland diet is usually required too. Does his diarrhea have an organish color?

Not orange, but kind of tan...I'm not home all day and even though sometimes kibble is still left over from breakfast, no one seems to eat all day. I feed them Wellness grain free original, sometimes with the freeze-dried turkey bits.

[Joan2517]

In terms of the acute issues, yup, pancreatitis sure seems like a consideration.

In terms of the other lab abnormalities, I’m afraid several are consistent with Cushing’s: elevated ALKP, platelets, neutrophils, and triglycerides; ongoing low thyroid. Now, at least a couple of them could probably also be caused by pancreatitis as well — I just don’t know about that. But in the absence of the pancreatitis, I’m afraid I would think these abnormalities would warrant moving onward with a more specific Cushing’s test. How about his urine? Was that analyzed by chance?

Yes, I was not happy to see all of those Highs. I'm not sure if his urine was ever tested. How does the ACTH test work with him not being on Vetoryl?

[labblab]

In terms of urine, it would be good to rule out any urinary tract infections and also to check the specific gravity and see how dilute it is. As far as a diagnostic ACTH, it’s fine for a dog to be fasted if that’s what the vet prefers. Of course the LDDS is the other option, and I don’t know whether you’d prefer to do a LDDS or not. Everything being equal, most clinicians view the LDDS as the diagnostic gold standard. But it’s always kind of a toss-up in my own mind. The LDDS returns fewer false negatives, so you’d be less likely to “miss” making the diagnosis if Gable truly has Cushing’s. Plus, it may help distinguish between pituitary and adrenal versions. But if the ACTH is positive and you move on to treatment, it’s really nice to have that initial stimulated cortisol result to use as a baseline against which to judge treatment effectiveness. So each test had it’s own pros and cons. Of course, either way you’ll want him to first recover from any acute illness.

[Joan2517]

In terms of urine, it would be good to rule out any urinary tract infections and also to check the specific gravity and see how dilute it is. As far as a diagnostic ACTH, it’s fine for a dog to be fasted if that’s what the vet prefers. Of course the LDDS is the other option, and I don’t know whether you’d prefer to do a LDDS or not. Everything being equal, most clinicians view the LDDS as the diagnostic gold standard. But it’s always kind of a toss-up in my own mind. The LDDS returns fewer false negatives, so you’d be less likely to “miss” making the diagnosis if Gable truly has Cushing’s. Plus, it may help distinguish between pituitary and adrenal versions. But if the ACTH is positive and you move on to treatment, it’s really nice to have that initial stimulated cortisol result to use as a baseline against which to judge treatment effectiveness. So each test had it’s own pros and cons. Of course, either way you’ll want him to first recover from any acute illness.

We did the LDDS and it came back negative for Cushings. I'm not sure if I got a copy of the results from them. I'll have to look. So far the Metronidazole is not doing its job. He doesn't seem to have to go as much, but when he does it's still diarrhea.

[labblab]

Duh! I’d completely forgotten about the LDDS — so sorry!

[Harley PoMMom]

Not orange, but kind of tan...I'm not home all day and even though sometimes kibble is still left over from breakfast, no one seems to eat all day. I feed them Wellness grain free original, sometimes with the freeze-dried turkey bits.

Not orange is good! Has he been eating this food for a while? And if so, I wonder if they changed the ingredients in that food, as these manufactures can do that with dog food without notifying the public.