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Thread: New to this - Jake has passed

  1. #1

    Default New to this - Jake has passed

    My big man Jake is a big shipoo.*
    He was diagnosed with cushings in Oct 2016. He was put on vetoryl 60mg and seemed
    to be doing great until Dec 2016 when we noticed a blister on his stomach and took him to the vet and they thought it was his thyroid causing skin issues. So we started thyroid meds 0.4mg twice daily and switched his Vetoryl to 30mg twice daily. And again everything seemed to be working. He had an ultrasound on Monday to look at his gallbladder and his gallbladder showed a mucocele started and they wanted to get a second opinion from a clinic that had done a full ultrasound on him in May to determine whether his cushings was adrenal or pituitary. Tuesday morning we got a call to get him to an emergency hospital because his gallbladder was going to rupture in 24 to 48 hours. We rushed alright! If I can attach the email I received from them can anyone tell me what it means long term?

  2. #2
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: New to this

    Hello and welcome to you and Jake! Wow, what a scary week you guys have had ! So glad you were able to get him in quickly!

    Unfortunately, for site security reasons, members are not allowed to upload attachments. So one option is to just go ahead and type the contents of the email into a reply here. Another is to try taking a digital photo of a printed version of the email, and then uploading it to your photo album here as an image. Or you can always insert a link into a reply here if you have access to a document storage website elsewhere. It is true that Cushpups can have an increased vulnerability to gallbladder mucoceles; I surely hope the vets have some good treatment options to offer out to you.

    Also, in terms of Jake's overall health history, can you tell us a bit more about the symptoms and testing that led to his original diagnosis? Also, have you had any monitoring ACTH blood tests since Jake started taking the Vetoryl? The results of any monitoring tests will help us to know how Jake's cortisol level has been responding to the medication.

    Thanks very much for any additional info!
    Marianne

  3. #3
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: New to this

    Just wanted to come back and add that one of our Admins has advised another member that they can convert a pdf file to a jpeg file and upload that way (our site will accept jpegs). I dunno know how to do that myself, but maybe you can try googling the process. So in other words, maybe you can convert the email into a pdf and then to a jpeg...

    Marianne

  4. #4

    Default Re: New to this

    Hi Marianne,
    Thanks for reaching out. So the story begins in late 2015 when Jake went in for something? i'm sorry i can't remember why! They noticed that his tail hair was thinning and noticed he had a pot belly so they started asking questions and suggested we start him on a diet and wanted to run a acth test. The test came back that he was borderline cushings. So we would test him in another 6 months and see what happens. We started diet food but he was so hungry all the time, but no increased thirst or frequent urinating. He went for his annual checkup in June 2016 and they noticed one of his teeth was broken and wanted to schedule a surgery. We finally got a surgery date for Sept 2016 and the day it was to happen they called us and said they couldn't put him under in the condition he was in. They ran an acth test and he was full blown cushings. We started him on Vetoryl 60mg once daily in Oct 2016. His first results came back as follows before starting the med.

    Oct 2016
    Pre = 143.0 nmol/L
    Post = 855.0 nmol/L

    After starting:
    Nov 4,2016
    2nd results
    Pre = 113.0 nmol/L
    Post = 214.0 nmol/L

    At this time they also ran a thyroid test and it came back low but they said it was likely due to the cushings so they would recheck in a couple of months.

    Nov 23,2016
    Pre = 104.0 nmol/L
    Post + 191.0 nmol/L

    All seemed to be going well until Jan 2017 when Jake got a blister like lesion on his belly and it spread over his entire abdomen. They started him on Clavamox for a skin infection. He remained on the antibiotics until Feb 4/2017. On Feb 10/17 they started him on thyroid 0.1mg twice daily and Mar 17/17 increased to 0.3mg twice daily because the numbers were still low. Retested again April/17 and numbers were still low so he was increased to 0.4mg twice daily. Retested again in May and still low and so they wanted us to get an ultrasound to see if the cushings was the adrenal form.
    June the ultrasound showed that his adrenal glands were of equal size so his cushings is coming from his pitutary gland. Gallbladder had lot's of sludge and bile was not moving through. Started him on Ursodiol 250mg once daily. They were no longer concerned about his thyroid they thought the cushings was the bigger problem.

    ACTH JAN 10/17
    Pre = 117.0 nmol/L
    Post = 150.0 nmol/L

    Biochemistry Feb 14/17
    Phosphorus 1.90 mmol/L - Reference Interval 0.90-1.85
    Carbon Dioxide 26 " " " 15-25
    Anion Gap 25 " " " 13-24
    Alkaline Phosphatase 1372 U/L " " 22-143
    Steroid -induced ALP 1226 " 0-84
    ALT 135 " " " 19-107

    APRIL 11/2017
    Free T4 7.1 L pmol/L Range 8-32
    Total T4 <13 nmol/L " 13-50

    MAY 16/2017
    ACTH
    Pre = 108.0 nmol/L
    Post = 245.0 nmol/L

    Total T4 <13
    So after that test we have split his Vetoryl doses to 30mg twice daily. I don't have the new numbers but i will get them.

    Aug/2017
    Jake's bottom jaw was quivering and his appetite seemed to decline. I was worried his tooth was bugging him so off to the vet we went. They couldn't see anything wrong in his mouth so they did an ultrasound. She said his gallbladder looked like the inside of a kiwi and wanted to compare it to the one from May. The next day we got a call that we have to rush him to Guelph because his gallbladder was going to rupture in 24 to 48 hours.

    Guelph findings

    DIAGNOSIS:
    Gall Bladder Mucocele [early]
    Hepatopathy
    Lumbar Pain
    Historical Cushing's Disease
    Historical Hypothyroidism

    TESTS :
    Physical examine
    Abdominal Ultrasound
    Triglyceride Level

    The ultrasound showed there was no obstruction or rupture and that they want to treat his liver with Zentonil for hepatoprotection as well as Clavamox to treat possible bacterial cholangiohepatitis as a cause of his mucocele. The cause of his lumbar pain is unknown but started him on gabapentin 200mg every 8 to 12 hours. We will follow up with them in 2 weeks and see whether he is well enough for gallbladder surgery.

    I'm most certain I am missing some info but this week we have been all over the place. We really thought we were going to lose him.
    Last edited by Squirt's Mom; 08-28-2017 at 09:13 AM. Reason: spacing for ease of reading/less confusion between tests

  5. #5
    Join Date
    Jun 2012
    Location
    Canada
    Posts
    16,150

    Default Re: New to this

    Hello and welcome from me too. So Guelph didn't think they needed to do surgery to remove the gallbladder. (this is often what they do if they worry that it might rupture as that is life threatening)

    What about his tooth? A broken tooth can end up causing infections that can cause a host of problems too.

    Do they think that if the cortisol is under control that they can do surgery on the tooth?

    The gallbladder can cause the liver to also have problems and liver numbers will go up and possible cortisol, which might be why you saw a spike in his later ACTH after it appeared to be getting under control earlier.

    I am in Ontario also. Mississauga.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  6. #6

    Default Re: New to this

    He is scheduled for surgery Oct 3rd for his gallbladder. He has a reassessment for his apparent infection and lumbar pain on Sept 13th.
    We are currently feeding him chicken and rice because he has been off food and yes liver treats!!! He is now refusing to take his meds in cheese but I don't know if it's because he knows it's meds. He has thrown up a few times and seems really lethargic but I think its the gabapentin because when it wears off he seems bright and ready to go. We were told to keep his activities to nil. Only take him out to pee and poo.No stairs no jumping, nothing. I guess we are concerned about the pain and infection. They don't know what the cause is.

  7. #7

    Default Re: New to this

    The tooth doesn't seem to be a concern yet again!

  8. #8
    Join Date
    Jun 2013
    Location
    Canada
    Posts
    1,080

    Default Re: New to this

    Ck and double check with Guelph. I do not want to scare you at all, but Guelph concurred with my family vet about my dog.... turns out they were both wrong. Got my money back from both the vet and Guelph, so please make sure the vet taking care of your pet, knows exactly what they are talking about and have had lots of experience with that particular diagnosis.
    Judi & "mah boy" Keesh

  9. #9
    Join Date
    Jun 2012
    Location
    Canada
    Posts
    16,150

    Default Re: New to this

    I had to keep my dog inactive for 6 weeks, when she had back issue, so with the lumbar pain, that is the recommendation. On top of that you have the gallbladder.

    I think this is different Judi, in that a blocked gallbladder, seen on an ultrasound is a gall bladder that can burst, and that is an emergency type of situation. I believe that is why they ended up at Guelph. Not really the diagnostic so much as the emergency surgery.

    If you run your fingers down the spine on both sides, and you get a ripple effect, I was told this is a pain effect. It is how I constantly had to check my dog to see how she was doing with the back issue.

    Sharlene
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  10. #10

    Default Re: New to this

    Guelph called yesterday and he is scheduled to have surgery on Friday. The laparoscopic surgeon has taken an interest in Jake's case. Fingers crossed.

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