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Thread: Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

  1. #1
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    Default Down the Cushings Road Again -- Abbie, 15 year old beagle is now at peace

    Hi, all! As much as I think you are all wonderful, I really didn't want to come back here. As some of you may recall, in 4/2009 my beagle, Maggie, passed away after a two year struggle with both atypical Cushings and "regular" Cushings.

    I didn't remember that I had posted when I adopted Abbie but then saw her picture in my profile and reference in my signature. Here is a brief summary: Abbie was 7 years old when I adopted her in 5/2010 after being treated for heartworm . Two weeks after I adopted her she had to have a bilateral mastectomy, then another surgery due to infection from the internal stitches, followed a few months later by bladder surgery. To the surprise of my vet, during the bladder surgery, he discovered she had never been spayed in spite of two shelters saying she was! Since her last surgery she has been in good health with the exception of reoccurring ear infections and UTIs . Abbie was a "street dog" for an unknown period of time before being picked up by animal control. She then made her way to a beagle rescue. She is very loving, particularly towards children and infants, and was house-trained when I adopted her so I do think she had been with a family with children.

    This summer Abbie had periods of lethargy which I chalked up to the very hot and humid Florida weather. She was treated for a UTI about a month ago and then she started guzzling water and this was a dramatic change for her as she used to barely drink any. After discussions with my vet (the same wonderful one who helped me with Maggie) we decided that it was time to run a full blood panel and urinalysis. I also asked that a UC:CR be run as red flags had started to pop up for me.

    The UC:CR was positive and her liver enzymes were elevated (which had always been in normal range previously). We scheduled an ACTH for Tuesday at which time I will get copies of her lab results. If ACTH is positive for Cushings, I will ask for an ultrasound to be scheduled at our local hospital where Maggie's internist is now CEO.

    Of course I am hoping the UC:CR was a false positive but there are those darn red flags and Abbie continues to guzzle water (and trips outside to pee every two hours -- last night was the first nocturnal trip at 1:00 a.m....).

    I think my vet likes to do a LDDS before the ultrasound. I will do some refresher reading but would appreciate your thoughts on the need for the LDDS at that point.
    Last edited by judymaggie; 10-11-2014 at 02:25 PM.
    Judy H. (Always "Maggie and Abbie's Mom" & now "Sadie Sue's Mom")
    Venice, FL

  2. #2
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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    Hi Judy, and welcome back (although we were perfectly content to let you just be a veteran visitor...). FWIW, if it were me, I believe I'd move straight on to the ultrasound if the ACTH is positive. In view of the excessive thirst/urination, elevated liver enzymes, and positive UC:CR, I wouldn't feel the need to add a LDDS as well. Since the ACTH is the more "specific" test of the two for Cushing's, a positive on the ACTH is actually a more reliable indicator than is a positive on the LDDS (meaning the LDDS is more easily also elevated by other, nonadrenal illness). And even if the LDDS was negative, you would probably still advance to the ultrasound, anyway, due to all the other indicators. So if it were up to me, I'd probably save my money for other diagnostics/treatment.

    Marianne

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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    Hi Judy,

    It is so nice to hear from you although I wish it were under better circumstances.

    Reoccuring ear infections, lethargy, and elevated liver enzymes can be attributed to hypothyroidism, has her thyroid level been checked recently? Usually this is checked when a senior blood panel is done and noted as T4, do you see this noted on her chemistry blood panel?

    Hugs, Lori

  4. #4
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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    Hi, Lori & Marianne! I, too, wish I was just coming by to say "hello" but so very appreciative that this forum is alive and well. I don't think I would have gotten through Maggie's ordeal without all of you.

    Abbie's thyroid has been consistently normal, including the most recent check last week.

    She continues to drink excessively and I decided to measure the actual amount today. I know I read somewhere what is typical but can't remember where that was. Interestingly, two of my neighbors have commented in the last week that Abbie's belly had gotten quite large. I honestly hadn't thought it had but I guess I have a different perspective, seeing her every day. She has not gained any weight so another "red flag". We go to the vet every five weeks to get her glands expressed -- will have to ask the head tech who sees her if she thinks her abdomen has expanded.

    In addition to other things Abbie has had intermittent diarrhea for the last two months and is now on another round of Flagyl and Forti-flora. It has been controlled when on both and then she has a bout of liquid diarrhea. I am definitely going to use the Forti-flora long term. I am supposed to go to once daily Flagyl tomorrow (after one week of twice daily) but her noon-time bowel movement today was liquid. Will talk to the vet tomorrow when I drop off Abbie for her ACTH.

    I have added a pic to Abbie's photo album (also below -- feel free to delete it if it is too large for this forum) that was taken in April on our road trip up to north Georgia to visit with friends -- Abbie hates having her picture taken so it was nice to have someone else take a photo while I was nearby.
    Last edited by judymaggie; 10-13-2014 at 04:42 PM.
    Judy H. (Always "Maggie and Abbie's Mom" & now "Sadie Sue's Mom")
    Venice, FL

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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    Oh she is beautiful, Judy!
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  6. #6
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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    I'm so sorry about the diarrhea on top of everything else, Judy. If Abbie is in the midst of some sort of inflammatory flare, it does raise some concern in my mind about proceeding with the ACTH since nonadrenal illness can also elevate cortisol levels. However, I do realize you're in somewhat of a tough spot if the episodes of diarrhea have been going on for a couple of months now -- will there ever be a really good time to test? The GI issues may be totally unrelated to Cushing's, or they may be connected in some way. My Cushpup, Barkis, had intermittent diarrhea at the time of diagnosis, too, and my IMS told me that elevated cortisol levels can cause certain types of inflammatory GI responses (even though that sounds paradoxical since steroids function as anti-inflammatory agents). I had hoped that Barkis would improve after we started Cushing's treatment, but he pretty much remained the same. So I never really knew whether the two were actually connected in any way for him.

    Anyway, Abbie's picture is adorable and thanks for posting it! And good luck tomorrow with whatever the appointment brings.

    Marianne

  7. #7
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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    Marianne -- it never occurred to me that an increase in cortisol could be related to gi problems. I found the following that was directed toward humans but, as we all know, our pups mimic so many of our issues:

    Cortisol activates the sympathetic nervous system, causing all of the physiologic responses previously described. As a rule, the parasympathetic nervous system must then be suppressed, since the two systems cannot operate simultaneously. The parasympathetic nervous system is stimulated during quiet activities such as eating, which is important because for the body to best use food energy, enzymes and hormones controlling digestion and absorption must be working at their peak performance.

    Imagine what goes on in a cortisol-flooded, stressed-out body when food is consumed: Digestion and absorption are compromised, indigestion develops, and the mucosal lining becomes irritated and inflamed. This may sound familiar. Ulcers are more common during stressful times, and many people with irritable bowel syndrome and colitis report improvement in their symptoms when they master stress management.5 And, of course, the resulting mucosal inflammation leads to the increased production of cortisol, and the cycle continues as the body becomes increasingly taxed.4
    I do think today's problem might have been related to missing one dose of Forti-flora. A neighbor helped out yesterday with "pee trips" and dinner -- she was used to Abbie's regular dinner regimen and I didn't want to add showing her how to mix in the Forti-flora. Tonight was back to pretty firm ... definitely a delicate balance!
    Judy H. (Always "Maggie and Abbie's Mom" & now "Sadie Sue's Mom")
    Venice, FL

  8. #8
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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    Folks: I just dropped off Abbie for her ACTH test. Normal bowel movements last night and this morning so no reason to postpone.

    I did pick up copies of the recent labs. Here are the abnormal levels (with reference ranges):

    Superchem(10/07/14)
    ALKP - 220 High (5-131)
    Total Bilirubin - 0.5 High (0.1-0.3)
    Cholesterol - 661 High (92-324)
    Triglycerides - 471 High (29-291)

    Urinalysis(10/07/14)
    Specific Gravity - 1.012 Low (1.015-1.050)
    Protein - 2+ High (was 3+ on 9/19)
    Blood - 3+ High

    UC:CR (10/07/14)
    Ratio - 18 High (^13 consistent with Cushings)

    Both the vet and I continue to be concerned that there is blood in her urine. Assuming we proceed with ultrasound next, I am hoping that will ease any concerns about her bladder.
    Judy H. (Always "Maggie and Abbie's Mom" & now "Sadie Sue's Mom")
    Venice, FL

  9. #9
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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    The blood in her urine is worrisome to me as well, this usually points to an UTI, has an urine culture and sensitivity test been performed? This type of test will be able to tell you exactly what bacteria is causing the infection and the proper antibiotic that can kill that bacteria.

  10. #10
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    Default Re: Down the Cushings Road Again -- Abbie, 11 1/2 year old beagle

    Hi -- Abbie was treated for a UTI after a cystocentesis showed bacteria and blood in her urine. The cysto was done because she had a crusty discharge that would have contaminated a free flow sample. After 10 days on Clavamox a repeat cysto showed no bacteria but continued to show blood. Since there was no longer any bacteria, we decided there was no need for a urine culture. The urinalysis results from 10/7 were from a third cysto -- again no bacteria but an increase in the blood. My vet explained that there is occasionally a slight bit of blood contamination from the cysto process but level would still be normal or below if that were the cause. We will decide how to proceed with this aspect after ACTH results are in.

    Question: I didn't think it was possible for Abbie to drink any more than she had been but, since being home after the ACTH, she is, indeed, drinking even more. Is this due to the increase in cortisol associated with the test?
    Last edited by judymaggie; 10-14-2014 at 05:46 PM.
    Judy H. (Always "Maggie and Abbie's Mom" & now "Sadie Sue's Mom")
    Venice, FL

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