Newly Diagnosed, Worried about Treatment Effects (Chio)

[Harley PoMMom]

That "Baseline Pre <0.5<" is his baseline cortisol level measurement, the "<" means that it was less than 0.5, which is low; however, since his post numbers were good I believe we shouldn't put any importance on that pre number. Another thing I wanted to tell you is that we have seen some really high ALP (liver enzyme) levels, I mean in the 3-4000, Cush dogs are notorious for having very elevated ALP numbers and those high numbers do not necessarily mean liver cancer, just changes to the texture/appearance to that liver.

We are here for you, remember that, oh, also remember to breathe

Hugs, Lori

[ChiosMom]

Lori,

Breathing can be hard....as my pet stress, worry, and anxiety gets worse (seeing them getting older, start having weird symptoms) I keep telling myself I should really find a way to not get so riled up (meditation, etc.) and to simply "take things as they come", but as I tell others: how can I not worry when my pets are my essentially my children? Especially my dogs, and Chio is my soul pup.

I did get word from the vet and thankfully they saw no cancer cells in either biopsy (the chest one was 100% lipoma, fat) but the results on the liver state that state the sample was poorly and they recommend another for a better determination. So that is so-so, but vet thinks it's likely still that there's no cancer regardless of the sample being rated as poor. It shows another problems but that's due to his liver disease so that was expected. At this point I will take this as a positive and maybe recheck in a month after his pancreatitis and anemia is stabilized. It's so tiring.

Here are the written results from vet: "...Great News on Liver sample! Relatively that is though... NO CANCER!!!! but evidence of the cushings disease is seen in the Liver cells https://www.merckvetmanual.com/digestive-system/hepatic-disease-in-small-animals/canine-vacuolar-hepatopathy..."


and results per the liver sample from the cytology report/Pathologist: "Description: two slides was received. A microscopic evaluation was preformed. Interpretation: Poorly cellular sample with evidence of vacuolar degeneration and possible mixed inflammatory cell inflammation. Comments: small numbers of nucleated cells consistent with hepatocytes are present. Some of these demonstrate mild vacuolar change supporting vacuolar hepatopathy. There may be increased lymphocytes and neutrophils relative to what is expected or peripheral blood contamination. This could suggest concurrent hepatitis. Overall, the sample is poorly cellular with abundant magenta granular material resembling ultrasound lubrication gel. It could be beneficial to obtain additional aspirates in an attempt to increase the nucleated cell concentration for cytologic evaluation. Please ensure very thorough cleansing of the skin to remove ultrasound lubrication gel prior to sample acquisition as this often exhibits cellular visualization of cytologic specimens."

At this point we will be removing the sutures to his chest surgery in another week or so, starting him on a GI pancreatitis low fat diet asap, and recheck the bloodwork CBC and CPL in about 3 weeks. We will be holding off on any Cushing's meds at this time. I asked if surgery and overall stress (the number of vet visits over the last month, stress from my own health issues, his allergies are really bad right now, etc.) could contribute to Chio losing some weight (or muscle) in his chest/shoulder blade area (this is another newish thing I've noticed) and was told Cushing's could also account for muscle loss/atrophy. I told the vet I was concerned that all these things (liver enzymes, abnormal ultrasound, pancreatitis, the unknown anemia, more boney appearance in the shoulders/front part of the body) all seem to be happening very fast (ie last 1-2 months) and was wondering is something else could be a factor and he believes it is soley Cushings.

I am tired, Chio is tired, so maybe we should just enjoy life right now, stay fast with current issues, and maybe redo some tests later on unless something significant changes in the meantime. He is still happy, energetic, more or less himself, and I would imagine all these tests are more exhausting on him than they have been on me. I just still worry that there is something else going on....but that could be my over-worrying mind. Any thoughts, opinions, concerns with the above results?


Thank you <3

[Texas12]

Hello,

Was wondering how Chio was doing?

[Squirt's Mom]

I am glad to hear that no cancer was found! That is always good news! The changes observed with the liver are consistent with what we see in a cush pup. That does not mean something else couldn't be in play but the liver goes thru a great deal of changes while the cortisol is high in a cush pup. The vet is correct in that the things you are seeing could be attributed to Cushing's...other than the weight loss. Most cush pups gain weight, not lose. BUT there is no rule book for this disease and we have seen pups who did lose VS gain so it is certainly possible. But I think you have stated the right game plan for right now when you said this:

...maybe we should just enjoy life right now, stay fast with current issues, and maybe redo some tests later on unless something significant changes in the meantime.

I hope you are feeling better. It is so hard when we are not on the beam ourselves while dealing with a sick pup at the same time. As caretakers we often put our own health aside and focus all our energies on our babies and in time our bodies say, "That's enough!" and force us to sit down for a minute. So take a little time to rest and do something that brings you joy while Chio is recovering.

Hugs,
Leslie

[ChiosMom]

Hello,

Was wondering how Chio was doing?

Hello Texas and thank you for asking: he is pretty much back to normal as far as I can tell. Appetite came back, he's bugging to go on his walks again and pouting when it's not time yet, still no diarrhea or vomiting, poops normal, and his chest sutures are healing very well. In all regards I would say he is feeling much better (other than his allergies) than last week with the stress of vet visits, surgery, etc.

I am glad to hear that no cancer was found! That is always good news! The changes observed with the liver are consistent with what we see in a cush pup. That does not mean something else couldn't be in play but the liver goes thru a great deal of changes while the cortisol is high in a cush pup. The vet is correct in that the things you are seeing could be attributed to Cushing's...other than the weight loss. Most cush pups gain weight, not lose. BUT there is no rule book for this disease and we have seen pups who did lose VS gain so it is certainly possible. But I think you have stated the right game plan for right now when you said this:


I hope you are feeling better. It is so hard when we are not on the beam ourselves while dealing with a sick pup at the same time. As caretakers we often put our own health aside and focus all our energies on our babies and in time our bodies say, "That's enough!" and force us to sit down for a minute. So take a little time to rest and do something that brings you joy while Chio is recovering.

Hugs,
Leslie

Hello Leslie and thank you for your response: I am thankfully feeling better but emotionally still have that "what-if..." worriedness in the back of my mind that is draining. I don't like worrying so much, or side-eyeing Chio when he does something a little out of character so I'll need to figure out a way to take that in stride better. Over-worrying isn't healthy and I need to remind myself he is happy right now, mobile, like himself again, and to enjoy that! I probably shouldn't be crying about weight loss without measuring his number day to day - it's more-so I can see (and confirm with his collar and harness fitment) that he has either lost weight or muscle mass in the shoulder/chest/neck area and his cheeks aren't as full as they once were. Again not drastic, but enough where I can tell. I am hoping it is just due to all the vet stuff this last month, allergies, my stress and his stress, and nothing serious we missed in his last testing....but even if muscle wasting is common in Cushings/Liver Disease pups anything happening by my definition of fast is concerning...but there I go again worrying for the future and not enjoying the now while we have a now.

Sutures will be taken out on the 14th, he'll be starting his GI/pancreatitis food transition today, and I'll be staying positive

[Squirt's Mom]

yeah.....I've been in your shoes with the worrying more than once when it comes to my babies! What you are going thru I call "twitching" - noticing every teeny thing that MIGHT be different and feeling your hair stand on end while your mind runs thru every horrible possibility it can come up with each time. It does get tiring and wears the eyeballs plumb out! Just try to take a little time every day to simply enjoy - the sun, the rain, playing fetch, belly rubs (yours or his), a book, a movie, a phone call, a meal, etc. It's hard to do sometimes but we have to remember that they need us so we have to take care of ourselves a little bit too.

Hugs,
Leslie

[ChiosMom]

yeah.....I've been in your shoes with the worrying more than once when it comes to my babies! What you are going thru I call "twitching" - noticing every teeny thing that MIGHT be different and feeling your hair stand on end while your mind runs thru every horrible possibility it can come up with each time. It does get tiring and wears the eyeballs plumb out! Just try to take a little time every day to simply enjoy - the sun, the rain, playing fetch, belly rubs (yours or his), a book, a movie, a phone call, a meal, etc. It's hard to do sometimes but we have to remember that they need us so we have to take care of ourselves a little bit too.

Hugs,
Leslie

Hello Leslie and thank you for your response,

So the worrying is a little less the last few days, but I still feel like something is not quite 100% with Chio. But he seems happy and in a couple days he can get his sutures out! Though I did have a thought that maybe someone can shed some light on until I see the vet....


So in March before we started the trilostane, Chio's water intake was extreme and he needed to pee SO MUCH as well as his other outwardly signs of Cushings as stated in the first couple thread messages. It really was his water/urination that prompted me to take him to the vet again though and do more testing, as that came on fairly quick and was quite out of the norm for him at that time. Fast forward to now, and he has since been off the Vetroyl for almost two weeks (13 days) and I have noticed that he hasn't gone back to drinking/urinating a lot. I know trilostane stays in their system for a very short amount of time, and I would imagine by now Chio is long past having any meds in his system. Wouldn't I be seeing his drinking/urination going back to extreme levels like before we started medication? Could him having mild anemia (still unknown cause)/mild pancreatitis cause his drinking/urination to seem "normal" when they were not normal before? It's all very suspicious...or perhaps not, but I try to be observant. Also, I noticed that he has started to cough/gag at night time, and will need to inquire about this with the vet too as I'm unsure if it's allergy related, pancreatitis related, or perhaps a lung/heart issue....we ruled out a collapsed trachea on his last vet visit.

On a positive side though, he loves his new GI food!

[Harley PoMMom]

I'm not sure as to why his drinking/urinating have returned to normal since the Vetoryl has left his system. As for the gagging/coughing at night he could have acid reflux so I'd ask the vet about giving him Pepcid ac.

Lori

[ChiosMom]

Chio went in yesterday to get the sutures out, and for me to go over my concerns about his upper body slimming and the gagging at night.

He didn't lose any weight (he actually gained an ounce) so the vet wasn't concerned about the slimness in the upper half as he really is a bit overweight anyway. I inquired about the oddness about the water intake/urination not going back to how it was pre-Vetoryl, and he thought that was interesting too and was not sure why that symptom has not returned. He mentioned the gagging seems to be acid reflux or possibly nausea due to his bad allergies at this time (we did a new xray and he saw no collapsed trachea, no enlarged heart, or any other weirdness that may account for the gagging and lip licking) so he recommended to try Chio on omeprazole (Prilosec) at night. Pepcid would be fine as well.

He stated 5mg would be a good starting point for Chio, but I see neither medication comes in a 5 mg at the store: I am assuming as long as the medication is a tablet and not a capsule or anything "time released", I can split the tablet in two if I can only find 10mg?

Chio is going back again in another week to retest the anemia and pancreatitis. Whew

[Harley PoMMom]

He mentioned the gagging seems to be acid reflux or possibly nausea due to his bad allergies at this time (we did a new xray and he saw no collapsed trachea, no enlarged heart, or any other weirdness that may account for the gagging and lip licking) so he recommended to try Chio on omeprazole (Prilosec) at night. Pepcid would be fine as well.

He stated 5mg would be a good starting point for Chio, but I see neither medication comes in a 5 mg at the store: I am assuming as long as the medication is a tablet and not a capsule or anything "time released", I can split the tablet in two if I can only find 10mg?

Chio is going back again in another week to retest the anemia and pancreatitis. Whew

For Harley I bought the 10 mg and split them in two, and yes, you want the regular Pepcid ac. Wishing you good luck with the vet visit next week!

Lori