Page 2 of 70 FirstFirst 12341252 ... LastLast
Results 11 to 20 of 695

Thread: 14 year-old Shih Tzu With Recent Cushing's Diagnosis

  1. #11
    Join Date
    Mar 2011
    Location
    Bloomington, MN
    Posts
    959

    Default Re: 12 year-old Shih Tzu With Recent Cushing's Diagnosis-Few Updates

    Hi All,

    I just have a couple of updates on Hannah. First of all, I checked and her blood glucose level was normal. I also had a UA done on her today and she didn't have any infections or anything really strange. My vet did say her specific gravity was just slightly low. He said hers was 1.023 and normal is 1.025 or more. He said that dogs who are drinking more water have less concentrated urine, but that hers is still pretty good considering I have noticed an increase in drinking. (Sometimes she gets drinks every 15 min., but then she will go for hours without. She goes all night with no drink or trip to go potty).

    He told me dogs should drink about 30 ml per pound per day. Hannah is 10.8 lbs. I am guessing she is drinking about 1.5 to 2 cups (which isn't WAY out of control), if my conversion is correct. My other Shih Tzu, Izzy, also drinks from the same bowl, so this is my best estimate.

    Anyway, I am glad there was no infection present in the urine. I asked him more about her weight loss, rather than the typical gain. He said all cases are different and said it would be okay for me to feed her more to see if she beefs up at all. I asked him if he was concerned about other liver problems. He said at this point he would try the Anipryl and sew what happens. If it doesn't work in two to three months, then he would want to do an x-ray and abdominal ultrasound prior to starting treatment with Trilostane (or something else) to see how her adrenal glands and liver are looking. I asked why the x-ray was necessary and he said that specialists come in from the U of MN to do this and he would ask if the x-ray needed to be a part of it. (It would run about $615 for both). He said sometimes they see enough in an x-ray not to have to do the ultrasound, but he would look into it.

    I asked him about milk thistle and Sam-e, since I have read about it on this site and another one. He said I could try something like that if I want, that it could help support her liver, but not treat Cushing's. I would like to do both, and like the idea of helping her liver. He mentioned Denamarin. Does anyone have any thoughts on this (or any of the others I mentioned)?

    I am still debating when to do the dental. Knowing there could be the cost of the ultrasound/x-rays in the near future I am worried about cost, but I also know the dental is important. My thought is that it would be about June by the time we would do further testing (unless something changes), so maybe I will wait to see what happens with that, then get her teeth cleaned. She was only just due in Feb., so I won't be too far overdue. Plus, I teach summer school so we have a little extra income in the summer if there are more procedures.

    I think I have calmed down a little in the past few days, but I still feel like I watch her like a hawk. There is always this worry that it is progressing before my eyes and that some new symptom will show up. Then there is the fear that there is something else wrong. Diabetes seems to be ruled out from the normal blood glucose test and the UA. She shows no other signs of liver problems at this point either, but does show signs of Cushing's. There is just the weird weight loss with the increased appetite. I guess at this point I am glad her symptoms are limited and she still seems like my happy girl who follows her mom everywhere.

    I have to say again how happy I am to have this site and all of you to help me out.

    Sincerely,

    Julie & Hannah

  2. #12
    Join Date
    Mar 2011
    Location
    Bloomington, MN
    Posts
    959

    Default Anyone Using Chewable Denamarin Tablets?

    My 12 year-old Shih Tzu, Hannah, with a recent Cushing's diagnosis is going to start Anipryl tomorrow (we are going to try it first for a couple of months before Trilostane or something else, if necessary) and my vet is also going to order the chewable Denamarin tablets for her. He said the chewable ones are nice because they are for dogs of all sizes and that Hannah, at 10.8 lbs., will take 1/2 a tablet per day (which is what I found online as well). Does anyone have experience with these tablets? Her ALKP level was 1770 (normal was up to 212, I believe) and I asked to try something that would support her liver. It says they are liver flavored and I'm hoping she'll want to chew them. Otherwise I'm not sure what to do...

    Thanks!
    Julie & Hannah

    Moderator's Note: Julie, I have moved your post with Hannah's update into Hannah's original thread. We, normally, like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, when necessary.
    Last edited by StarDeb55; 03-10-2011 at 06:34 PM. Reason: thread merge

  3. #13
    Join Date
    Mar 2011
    Location
    Bloomington, MN
    Posts
    959

    Default Advice/Opinions for Hannah-Can You Help?

    Hello again...

    I am looking for some other opinions about how to proceed with Hannah. (12 y/o Shih Tzu with recent Cushing's diagnosis). You can read my initial post to see Hannah's test results. The plan as of now with my regular vet is to treat with Anipryl (we started yesterday) for two months and to see if the symptoms have improved. I also asked about something to support her liver and he has ordered Denamarin. We would re-check liver values in two months as well. If the Anipryl is not working, he said he would then pursue other tests (first doing an ultrasound and x-ray) to see how her organs look,and if it still looked like Cushing's, he would then try Trilostane.

    I feel good about that for a couple of reasons-the low risk of problems with Anipryl IF it works, and the fact that I am a teacher and this would then be about the time for our summer break and although I teach summer school, I will have more time to watch her closely, and I will also have more income for tests/treatment. However, I am a worrier and I have been wondering if this is a good decision or if I should do something now. I am so worried about not helping her enough, or doing the wrong thing, or her getting dramatically worse during this two month period. I am also still confused about if it for sure IS Cushing's. She did have high ALKP levels (my vet said this is often a marker), which led to the LDDS test, which my vet said showed she was positive for PDH Cushing's. A few of you also agreed; however, I do know that often more than one test is needed to confirm this disease.

    I am wondering if you would question if does indeed have Cushing's, or if it could be something totally different....or if it is more that it is Cushing's and there could be SOMETHING ELSE too. She does not have diabetes, as her glucose is normal and her urine sample was as well. I know I have read about false positives, but she does have some symptoms (increased thirst/urination, but not out of control, and definite increase in appetite). She has lost weight in the past 9 months (1.5 lbs.) though, not gained, and has been eating more. She doesn't have the potbelly or skin issues. She has no gastrointestinal issues (I know this is another symptom of liver disease) or any other problems, except she does a lot of itching/biting (which she has always done, although it is a bit worse this winter and is usually only a summer allergy problem).

    I did find out there is an IM specialist close to me and for $105 she will meet with us, examine Hannah, and review her other records and make a recommendation. I have spent about $500 this past week and have both dogs due for their exams/heartworm test/vaccines in early April(usually a few hundred for that trip), and still have to figure out when Hannah can/should get her yearly dental (usually about $400). Plus, I know the ultrasound/x-ray is likely in the future (about $650), as well as Izzy's (my other dog's) dental in August.

    I can't decide if it is worth seeing the specialist now, or if I should wait out the two months and see what happens as long as we have already started something. My husband will support whatever I decide, but is concerned about how much money we may be spending. I am as well, and don't want to totally drive myself crazy doing everything and anything, but also don't want to NOT do something I should. I also realize the specialist could recommend additional tests, which it sounds like my regular vet might do this summer anyway.

    Like I said, I am a worrier (and I analyze everything!) so I would love some other opinions. I am so worried about doing the "right" thing, but of course, I have no idea what that is. If you were in my position, what would you do?


    Thanks!
    Julie

  4. #14
    Join Date
    Apr 2009
    Location
    Nebraska
    Posts
    5,606

    Default Re: 12 year-old Shih Tzu With Recent Cushing's Diagnosis

    Julie, When you say increased thirst - can you tell us what you mean? Have you measured the daily intake? Normal intake is about an ounce of water per pound.

    A couple of things stood out to me in your post - you said the urine test was normal and that Hanna doesn't have a pot belly, in fact has lost weight. None of these are indicative of cushing's. That said, was it the UC:CR test (urine). I am told that this test is very accurate and if a dog can concentrate their urine they don't have cushing's.

    I'm not sure if I shared my story with you but my girl Annie (2nd dog diagnosed with cushing's) was misdiagnosed. I was sure she had cushing's - I'd already had one dog with it. She had a false positive on the ldds test. She had 4 false positives on the acth tests. I took her to Kansas State Univ (the closest IMS to where I live) and she even stumped them. Her urine is concentrated, she has no pot belly, she has lost weight. In her case, she had multiple things going on but she has an adrenal tumor that they believe emits signals resulting in cushings like symptoms.

    Also if you read all the intl experts in the field you don't treat a dog without symptoms and that is why I asked about the water intake. Cush dogs drink 'buckets' of water so it is important before answering your question that we know what 'increased' actually is.

    If the water intake is minimal I wouldn't treat with anything yet because there aren't enough symptoms. Also if water intake isn't significant I would invest my money in the teeth cleaning and save up to go visit the IMS if and when the need arises. These tests are costly as you know. I spent $8000 last year and still don't have a definitive answer as to what is going on with my little gal.

    I'm sure others will chime in but I wanted to share my story in the case that it might help. I know its hard to make these decisions... take it all in but don't feel rushed into making a decision because you don't have to treat cushing's right away. Good luck! Kim

  5. #15
    Join Date
    Mar 2011
    Location
    Bloomington, MN
    Posts
    959

    Default Re: 12 year-old Shih Tzu With Recent Cushing's Diagnosis

    Julie, When you say increased thirst - can you tell us what you mean? Have you measured the daily intake? Normal intake is about an ounce of water per pound.

    A couple of things stood out to me in your post - you said the urine test was normal and that Hanna doesn't have a pot belly, in fact has lost weight. None of these are indicative of cushing's. That said, was it the UC:CR test (urine). I am told that this test is very accurate and if a dog can concentrate their urine they don't have cushing's.


    Hi-
    I have not measured her water yet, as I am gone during the day and I have another dog. I don't think they would do too well separated. I will try that sometime on a weekend when I can watch them both closely. I would guess she is drinking about 2 cups or a little over (so 16-20 oz.)of water per day and she is 10.8 lbs.

    I don't know if he did the UC:CR test. I think it was a regular UA because I wanted to see if she had a UTI. He did tell me that her urine concentration was 1.023 I believe, and that normal was 1.025 and above, so he said she was concentrating it pretty well, even though it was low.

    So...I am thinking maybe continue with the Anipryl to see how she does. See if we can do the dental (but I am worried about the 1770 ALKP level) and then watch and wait and maybe check in with the specialist this summer (or when things progress)?

    I want to start her on the Denamarin to help her liver, but I am worried about doing too many things at once. The vet thought that was a good idea and he ordered it and we're waiting for it to come in. He said that would be the only thing that would help change her liver values; the Anipryl would not.

    Thanks again for sharing!
    Julie

  6. #16
    Join Date
    Mar 2011
    Location
    Bloomington, MN
    Posts
    959

    Default Re: 12 year-old Shih Tzu With Recent Cushing's Diagnosis

    Just thought I would update all of you that we postponed the treatment with Denamarin (Hannah has been on Anipryl for a week) and have decided to move forward with an ultrasound on (and decided postpone the dental until we know what is going on with her). She will get the ultrasound next Wed. and hopefully we will know more about what is going on and what/how we should treat. I will let you know what the results are.

    Julie

  7. #17
    Join Date
    Apr 2008
    Location
    Tennessee
    Posts
    6,593

    Default Re: 12 year-old Shih Tzu With Recent Cushing's Diagnosis

    Julie, we'll be standing by for our update.

  8. #18
    Join Date
    Mar 2011
    Location
    Bloomington, MN
    Posts
    959

    Default Update on Hannah-Ultrasound Done

    Hello Everyone-
    Hannah (12 year-old Shih Tzu) had her ultrasound done this morning. I am going to briefly review our situation so you don't have to go all the way back in the thread:

    She had blood work done last month before her annual dental. Her Alk Phos level was 1770 and up to 212 was normal. Nothing else was abnormal except her platelet level was slightly high (which the vet didn't even mention). He asked if I had noticed increased thirst/urination and appetite. I had noticed a slight increase in thirst/urination and she definitely wants to eat and eats quickly.

    We postponed the dental and tested for Cushing's using the LDDS test. Here are the results: The level he measured at the start of the test was 3.7. After four hours it was 1.9. After 8 hours it was 5.4. He said this can basically confirm the pituitary form of Cushing's. The following week I had him do a UA just to be sure things were okay in that area, as Hannah is also on Royal Canin Urinary SO (she had Struvite crystals in her urine about 5 years ago and has been on it since). He said everything was normal, with the exception of her urine concentration being just slightly low. Hers was 1.023 and that normal was 1.025 and above, so he said she was concentrating it pretty well.

    So we decided to do an ultrasound to see what that would show. I don't have the full report yet, but my vet will be emailing it to me once he gets it from the specialist. (They did have a specialist come in to do the procedure because my vet wanted to ensure that it was done well). Basically, it was normal. The adrenal glands were within the normal size range, as was her liver. There was no sign of any tumors or anything abnormal.

    While this is good news, I am left a bit confused. The specialist did say that since we don't have any sort of baseline data on Hannah, it is possible that her adrenals were smaller before, but there is still nothing remarkable about them. I asked if they still think she has Cushing's and my vet said yes-- based on the LDDS test and the clinical symptoms I have seen. He said she is probably at the very early stages. We talked about the current treatment (Anipryl for the past 20 days) and that I could finish out my two month supply and see if I notice improvement or I could stop. It makes sense to me to finish it out and see if I notice anything. He said he would not want to treat with anything else at this point and would just want to watch for clinical symptoms and the doctor who did the ultrasound agreed that he would not do anything else right now.

    I was worried about her liver since that value is so high, but since it looked normal I guess that takes care of that. My vet said even a slight increase in cortisol can cause the Alk Phosphate level to go up quite a bit. Awhile back, we talked about trying Denamarin or something for her liver. He said he didn't think we needed to do that right now and that we can finish out the Anipryl and see if I notice anything and then go from there and possibly put her on Denamarin at that point. (I had read about some possible side effects with Anipryl and Denamarin and sent it to my vet. He had never seen or heard that but said it was up to me and we could wait and just try one thing at a time). He said that with a clean ultrasound he feels good about doing her dental whenever I am ready.

    What are your thoughts about this? Do you think there could be anything else going on? Or is it possible that she is in the very early stages?

    Thanks again for your input!
    Julie & Hannah

  9. #19
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    15,292

    Default Re: Update on Hannah-Ultrasound Done

    Quote Originally Posted by jmac View Post
    While this is good news, I am left a bit confused. The specialist did say that since we don't have any sort of baseline data on Hannah, it is possible that her adrenals were smaller before, but there is still nothing remarkable about them. I asked if they still think she has Cushing's and my vet said yes-- based on the LDDS test and the clinical symptoms I have seen. He said she is probably at the very early stages. We talked about the current treatment (Anipryl for the past 20 days) and that I could finish out my two month supply and see if I notice improvement or I could stop. It makes sense to me to finish it out and see if I notice anything. He said he would not want to treat with anything else at this point and would just want to watch for clinical symptoms and the doctor who did the ultrasound agreed that he would not do anything else right now.
    Hi Julie,

    I'm sorry it's taken so long to get a reply posted! But I'm very glad to hear that Hannah's ultrasound has not uncovered any worrisome abnormalities. And I do want to tell you that it is possible for a dog to have pituitary Cushing's but not exhibit adrenal enlargement on ultrasound. So I agree with your vet that that absence of enlargement does not rule out that diagnosis. The absence of any visual abnormality does make the adrenal form of the disease highly unlikely, however.

    I do think that you have crossed all your "t's" and dotted all your "i's." And I agree with your vet's recommendations at this point. I do believe you have ruled out other obvious sources of trouble, and now the question will be whether or not Hannah ends up exhibiting additional clinical symptoms as time goes on. So at this point, I would carry on as your vet advises.

    Marianne

  10. #20
    Join Date
    Mar 2011
    Location
    Bloomington, MN
    Posts
    959

    Default Re: Hannah-Ultrasound Results

    Below is Hannah's ultrasound report (I knew things were "normal" after they did it, but thought I would post it anyway).

    She was in for her yearly heartworm test/check-up on Sat. and I saw in her records that they want to do a NSAID monitoring profile and CBC in May. I was not aware my vet wanted to do another test so I've asked him to call to explain what that is. (She is on Anipryl-for one month now, and we have a two month supply, so maybe he wants to check something after being on Anipryl??? I don't know). If you know more about what this means, or if it makes sense, please let me know. Anyway, here are her results.
    Julie & Hannah

    forConsult Type: US, SIG: DOB: 20010330, Age: 10 Y, Sex: F ALTERED, Wt: 10.8 kg, Breed: SHIH TZU, Species: CANINE, Images: 1, Case Details: Dog has a history of Cushing's disease. Overall screen of the abdomen.
    Findings
    An abdominal US was performed (Travis Saveraid). The liver, gallbladder, spleen, and kidneys are normal. The adrenal glands have normal size (Left 0.4cm short axis, Right 0.4cm short axis), shape, and echogencity. The bladder has a mildly thickened cranial wall, but is incompletely distended. The stomach, GI tract, pancreas, and general abdominal cavity is normal.
    Conclusion
    1. The bladder wall thickening is likely from incomplete distention and less likely residual change from previous urinary tract infection (no current evidence of urinary tract infection). 2. Otherwise the abdomen is normal.
    Recommendations
    Occasionally patients with biochemical evidence of Cushing's will not have structural changes of the adrenal glands or liver on US. The biochemical testing is consider a more accurate test than US imaging.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •