Baileypony
02-05-2010, 06:04 PM
I am writing to introduce my dear Bailey. Bailey is a Golden mixed with Chow and Border collie, who we estimate to be about 9.5 years old. He is 50 lbs. We rescued him through a Golden Retriever rescue almost 4 years ago. He came in as a stray, who had obviously been severely abused by humans and dogs alike. He has 3 dog siblings who we happily say are adopted, but we always say I birthed Bailey. He is incredibly special to us.
He came to us very sick and we have since battled many illnesses with him. Among the highlights are two bouts each of ehrlichia and valley fever, a tplo, and mild degenerative valve disease. It is horrifying to imagine his previous living situation and to believe that these conditions went untreated.
He has been struggling with his current symptoms for one and a half years now. We have visited five regular veterinarians and two internal medicine specialists regarding these issues. He has had many tests run without a definitive diagnosis.
Baileys initial and most severe symptom is polydipsia. When this first presented, he was diagnosed by ultrasound and urinalysis with pyelenonephritis. However no bacteria were found on the culture. He was treated with long-term Clavamox and showed dramatic improvements. Unfortunately, shortly after stopping treatments, the symptoms reappeared.
For the last year, we have been battling what look like frequent urinary tract infections. Despite numerous cultures, no bacteria have ever shown up. He has been treated by a multitude of antibiotics, both short and long term, with mixed results. At times he has responded to antibiotics with much decreased water consumption, increased energy, and a better mood. Other times no response is seen. It has been difficult for us and our veterinarian to determine whether an infection is present at various times. In the past we were certain an infection was present as he had much increased drinking, pus, leakage, licking, and nocturia. Those symptoms would clear up after a round of antibiotics. Now it seems that an infection can clear up, but return while he is still on antibiotics. We havent been able to figure out when and if he has an infection, why the mixed results with antibiotics, and why his water drinking is sometimes improved by the antibiotics.
His symptoms have progressed from when they emerged. He currently drinks very excessively, has off and on problems with leakage, and frequently wets his bed at night. He is like a camel storing his pee. He has constant access to our yard with a doggy door. We also take him on a bedtime walk. He will pee a ton, not drink anymore water, but still wet his bed.
We bought a refractometer and over the last year we have carefully measured his urine specific gravity. It generally ranges from 1002-1012, even first thing in the morning. On antibiotics, we sometimes see 1010-1020. When he finished his initial treatment from the kidney infection, we recorded 1026. We underwent a seven day Diabetes Insipidus trial with Desmopressin. Once again Bailey showed mixed results. He ranged from 1004-1033, which was the highest specific gravity we have received. He seemed to require a greater dose of the Desmopressin as the trial progressed, and we did continually up his dosage. We had some recordings of 1015-1025, but also showed some 1004-1006 readings. His water consumption seemed to dramatically decrease at times during the trial and other times he had his abnormal drinking. I know that Cushings dogs can have a positive response to Desmopressin, but we are unaware if his results offer any diagnostic value.
About six months ago, Bailey started to exhibit more obvious signs of Cushings such as increased shedding, which resulted in a very thin haircoat and polyphagia. This continued for approximately two months and then the symptoms subsided. We dont know if the waxing and waning of symptoms coincides with Cushings disease, or perhaps was related to something else. He was treated for valley fever and ehrlichia as both titers returned during this period. Thankfully he has finished treatment for both of these.
With his recent Adrenal panel, we think we are closer to having a diagnosis of Atypical Cushings. I have ordered the flax hulls powder from www.flaxhulls.com. Given that his hair coat is pretty good, I am unsure whether to add the melatonin. I am also unsure how concerned we should be about the presence of an adrenal tumor with the low aldosterone. How likely is it that it would not have shown up on two ultrasounds? Any info on the best dosage of flax hulls and how long it will be before we can hope to see results would be much appreciated.
I realize this is a lengthy history and appreciate you reading this book. This board contains so much valuable information and people. I would be very interested to hear suggestions, comments, and anything that can help us find the way.
Thanks
Cheryl
1/25/10 U of T Adrenal Panel (Combined Dex Supp/ACTH Stim)
Test, Result baseline, Normal Range*, Dex. Suppression 4 hrs,ACTH Stim Result 6 hrs, Normal Range* for ACTH Stim
Cortisol ng/ml 51.5 2.0-56.5 2.8 83.7 70.6-151.2
Androstenedione ng/ml 1.3* 0.05-0.36 0.17 1.30 .24-2.90
Estradiol pg/ml 60.6 23.1-65.1 57.1 49.3 23.3-69.4
Progesterone ng/ml 0.33* 0.01-0.17 0.08 0.78 .22-1.45
17 OH Progesterone ng/ml 0.28* 0.01-0.22 0.05 0.83 0.25-2.63
Aldosterone pg/ml ** 57.2 3.5-139.9 <11.0 63.7 72.9-398.5
These results [X] indicate presence of increased adrenal activity.
Comments: There is some indication of increased adrenal activity, with increase in some hormone levels at baseline. The dex suppression value would indicate this to be a pituitary-dependent condition. Values at stim are normal, except for a low aldosterone value (the latter can indicate the presence of a primary adrenal tumor). Consider items 1 and 4 on the treatment option sheet attached. Also, just the low-dose ketoconazole in item 8 on the TO sheet could be considered.
4/17/09 U of T Adrenal Panel (Combined Dex Supp/ACTH Stim)
Test, Result baseline, Normal Range*, Dex. Suppression 4 hrs,ACTH Stim Result 6 hrs, Normal Range* for ACTH Stim
Cortisol ng/ml 29.5 2.0-56.5 5.5 98.4 70.6-151.2
Androstenedione ng/ml 0.68* 0.05-0.36 0.06 2.0 0.24-2.90
Estradiol pg/ml 25.1 23.1-65.1 32.8 40.2 23.3-69.4
Progesterone ng/ml 0.26* 0.01-0.17 0.07 1.32 0.22-1.45
17 OH Progesterone ng/ml 0.29* 0.01-0.22 0.09 1.66 0.25-2.63
Aldosterone pg/ml ** <11.0* 3.5-139.9 <11.0 14.0* 72.9-398.5
These results: [?] indicate the presence of increased adrenal activity
Comments: Three baseline hormones are marginally to mildly elevated. There was normal suppression on cortisol (<10 ng/ml) at 4 hours post-dexamethasone. Other hormones were also suppressed by dexamethasone except for estradiol which is not unusual. Post-ACTH hormones are within normal range except for aldosterone which is low. Low aldosterone may correlate with the small adrenals observed on ultrasound however other adrenal hormones are not low. Aldosterone may be affected by sodium/potassium/water balance at time of testing. You may consider re-testing aldosterone to assure result. It is difficult to assess the diagnostic value of the marginally elevated baseline hormones when post-ACTH hormones are within normal range. Various treatment option considerations are attached.
11/4/09- Chem Profile and CBC
ALP 788 U/L, Reference Range 20-150
MO% - 6.7%, Reference Range 2-4
HGB 20.3 g/dl, Reference Range 12-18
MCH 24.5 pg, Reference Range 19.5-24.5
MCHC 37.7 g/dl, Reference Range 31-34
PLT 117, Reference Range 200-500
MPV 11.5, Reference Range 3.9-11.1
7/18/09 Chem Profile and CBC
ALP 1019 U/L, Reference Range 10-150
Albumin 2.3 g/dl, Reference Range 2.5-4.0
Triglyceride 189 mg/dL, Reference Range 20-150
T4 1.1 ug/dL, Reference Range 0.9-3.9
11/24/08 Chem Profile and CBC
ALP 101 U/L (Normal)
Chloride 116 mEq/L, Reference Range 105-115
5/6/08- Chem Profile and CBC
ALP 179 IU/L, Reference Range 5-131
CPK 57 IU/L, Reference Range 59-895
5/22/06- Chem Profile and CBC
ALP 189 U/L, Reference Range 10-150
Albumin 2.3 g/dl, Reference Range 2.5-4.0
5/15/08- Thyroid Panel
T4 1.53, 1.0-4.0
T3 (RIA) 68, 45-150
2/27/09 Urine Cortisol/Creatinine Ratio
Urine Cortisol 4.7 ug/dL
Urine Creatinine 116.9 mg/dL
Urine Cortisol/Creat Ratio 13
Urine Cortisol:Creatinine ratios <13.5 rules out hyperadrenocorticism
1/12/09 Urine Cortisol/Creatinine Ratio
Urine Cortisol 2.4 ug/dL
Urine Creatinine 57.4 mg/dL
Urine Cortisol/Creat Ratio 13
Urine Cortisol:Creatinine ratios <13.5 rules out hyperadrenocorticism
8/14/09 Urine Bile Acid: Creatinine Ratio and Urine Protein Creatinine Ratio
Normal
9/24/09 - Abdominal Ultrasound
Normal Abdominal Ultrasound
Left Adrenal 0.51 cm width cranial pole, 0.43 cm width caudal pole
Right Adrenal 0.55 cm width cranial pole, 0.62 width caudal pole
2/10/09 Abdominal Ultrasound
A lot of abnormal findings consistent with the kidney infection
Adrenal Glands were small, but Bailey was on fluconazole.
He came to us very sick and we have since battled many illnesses with him. Among the highlights are two bouts each of ehrlichia and valley fever, a tplo, and mild degenerative valve disease. It is horrifying to imagine his previous living situation and to believe that these conditions went untreated.
He has been struggling with his current symptoms for one and a half years now. We have visited five regular veterinarians and two internal medicine specialists regarding these issues. He has had many tests run without a definitive diagnosis.
Baileys initial and most severe symptom is polydipsia. When this first presented, he was diagnosed by ultrasound and urinalysis with pyelenonephritis. However no bacteria were found on the culture. He was treated with long-term Clavamox and showed dramatic improvements. Unfortunately, shortly after stopping treatments, the symptoms reappeared.
For the last year, we have been battling what look like frequent urinary tract infections. Despite numerous cultures, no bacteria have ever shown up. He has been treated by a multitude of antibiotics, both short and long term, with mixed results. At times he has responded to antibiotics with much decreased water consumption, increased energy, and a better mood. Other times no response is seen. It has been difficult for us and our veterinarian to determine whether an infection is present at various times. In the past we were certain an infection was present as he had much increased drinking, pus, leakage, licking, and nocturia. Those symptoms would clear up after a round of antibiotics. Now it seems that an infection can clear up, but return while he is still on antibiotics. We havent been able to figure out when and if he has an infection, why the mixed results with antibiotics, and why his water drinking is sometimes improved by the antibiotics.
His symptoms have progressed from when they emerged. He currently drinks very excessively, has off and on problems with leakage, and frequently wets his bed at night. He is like a camel storing his pee. He has constant access to our yard with a doggy door. We also take him on a bedtime walk. He will pee a ton, not drink anymore water, but still wet his bed.
We bought a refractometer and over the last year we have carefully measured his urine specific gravity. It generally ranges from 1002-1012, even first thing in the morning. On antibiotics, we sometimes see 1010-1020. When he finished his initial treatment from the kidney infection, we recorded 1026. We underwent a seven day Diabetes Insipidus trial with Desmopressin. Once again Bailey showed mixed results. He ranged from 1004-1033, which was the highest specific gravity we have received. He seemed to require a greater dose of the Desmopressin as the trial progressed, and we did continually up his dosage. We had some recordings of 1015-1025, but also showed some 1004-1006 readings. His water consumption seemed to dramatically decrease at times during the trial and other times he had his abnormal drinking. I know that Cushings dogs can have a positive response to Desmopressin, but we are unaware if his results offer any diagnostic value.
About six months ago, Bailey started to exhibit more obvious signs of Cushings such as increased shedding, which resulted in a very thin haircoat and polyphagia. This continued for approximately two months and then the symptoms subsided. We dont know if the waxing and waning of symptoms coincides with Cushings disease, or perhaps was related to something else. He was treated for valley fever and ehrlichia as both titers returned during this period. Thankfully he has finished treatment for both of these.
With his recent Adrenal panel, we think we are closer to having a diagnosis of Atypical Cushings. I have ordered the flax hulls powder from www.flaxhulls.com. Given that his hair coat is pretty good, I am unsure whether to add the melatonin. I am also unsure how concerned we should be about the presence of an adrenal tumor with the low aldosterone. How likely is it that it would not have shown up on two ultrasounds? Any info on the best dosage of flax hulls and how long it will be before we can hope to see results would be much appreciated.
I realize this is a lengthy history and appreciate you reading this book. This board contains so much valuable information and people. I would be very interested to hear suggestions, comments, and anything that can help us find the way.
Thanks
Cheryl
1/25/10 U of T Adrenal Panel (Combined Dex Supp/ACTH Stim)
Test, Result baseline, Normal Range*, Dex. Suppression 4 hrs,ACTH Stim Result 6 hrs, Normal Range* for ACTH Stim
Cortisol ng/ml 51.5 2.0-56.5 2.8 83.7 70.6-151.2
Androstenedione ng/ml 1.3* 0.05-0.36 0.17 1.30 .24-2.90
Estradiol pg/ml 60.6 23.1-65.1 57.1 49.3 23.3-69.4
Progesterone ng/ml 0.33* 0.01-0.17 0.08 0.78 .22-1.45
17 OH Progesterone ng/ml 0.28* 0.01-0.22 0.05 0.83 0.25-2.63
Aldosterone pg/ml ** 57.2 3.5-139.9 <11.0 63.7 72.9-398.5
These results [X] indicate presence of increased adrenal activity.
Comments: There is some indication of increased adrenal activity, with increase in some hormone levels at baseline. The dex suppression value would indicate this to be a pituitary-dependent condition. Values at stim are normal, except for a low aldosterone value (the latter can indicate the presence of a primary adrenal tumor). Consider items 1 and 4 on the treatment option sheet attached. Also, just the low-dose ketoconazole in item 8 on the TO sheet could be considered.
4/17/09 U of T Adrenal Panel (Combined Dex Supp/ACTH Stim)
Test, Result baseline, Normal Range*, Dex. Suppression 4 hrs,ACTH Stim Result 6 hrs, Normal Range* for ACTH Stim
Cortisol ng/ml 29.5 2.0-56.5 5.5 98.4 70.6-151.2
Androstenedione ng/ml 0.68* 0.05-0.36 0.06 2.0 0.24-2.90
Estradiol pg/ml 25.1 23.1-65.1 32.8 40.2 23.3-69.4
Progesterone ng/ml 0.26* 0.01-0.17 0.07 1.32 0.22-1.45
17 OH Progesterone ng/ml 0.29* 0.01-0.22 0.09 1.66 0.25-2.63
Aldosterone pg/ml ** <11.0* 3.5-139.9 <11.0 14.0* 72.9-398.5
These results: [?] indicate the presence of increased adrenal activity
Comments: Three baseline hormones are marginally to mildly elevated. There was normal suppression on cortisol (<10 ng/ml) at 4 hours post-dexamethasone. Other hormones were also suppressed by dexamethasone except for estradiol which is not unusual. Post-ACTH hormones are within normal range except for aldosterone which is low. Low aldosterone may correlate with the small adrenals observed on ultrasound however other adrenal hormones are not low. Aldosterone may be affected by sodium/potassium/water balance at time of testing. You may consider re-testing aldosterone to assure result. It is difficult to assess the diagnostic value of the marginally elevated baseline hormones when post-ACTH hormones are within normal range. Various treatment option considerations are attached.
11/4/09- Chem Profile and CBC
ALP 788 U/L, Reference Range 20-150
MO% - 6.7%, Reference Range 2-4
HGB 20.3 g/dl, Reference Range 12-18
MCH 24.5 pg, Reference Range 19.5-24.5
MCHC 37.7 g/dl, Reference Range 31-34
PLT 117, Reference Range 200-500
MPV 11.5, Reference Range 3.9-11.1
7/18/09 Chem Profile and CBC
ALP 1019 U/L, Reference Range 10-150
Albumin 2.3 g/dl, Reference Range 2.5-4.0
Triglyceride 189 mg/dL, Reference Range 20-150
T4 1.1 ug/dL, Reference Range 0.9-3.9
11/24/08 Chem Profile and CBC
ALP 101 U/L (Normal)
Chloride 116 mEq/L, Reference Range 105-115
5/6/08- Chem Profile and CBC
ALP 179 IU/L, Reference Range 5-131
CPK 57 IU/L, Reference Range 59-895
5/22/06- Chem Profile and CBC
ALP 189 U/L, Reference Range 10-150
Albumin 2.3 g/dl, Reference Range 2.5-4.0
5/15/08- Thyroid Panel
T4 1.53, 1.0-4.0
T3 (RIA) 68, 45-150
2/27/09 Urine Cortisol/Creatinine Ratio
Urine Cortisol 4.7 ug/dL
Urine Creatinine 116.9 mg/dL
Urine Cortisol/Creat Ratio 13
Urine Cortisol:Creatinine ratios <13.5 rules out hyperadrenocorticism
1/12/09 Urine Cortisol/Creatinine Ratio
Urine Cortisol 2.4 ug/dL
Urine Creatinine 57.4 mg/dL
Urine Cortisol/Creat Ratio 13
Urine Cortisol:Creatinine ratios <13.5 rules out hyperadrenocorticism
8/14/09 Urine Bile Acid: Creatinine Ratio and Urine Protein Creatinine Ratio
Normal
9/24/09 - Abdominal Ultrasound
Normal Abdominal Ultrasound
Left Adrenal 0.51 cm width cranial pole, 0.43 cm width caudal pole
Right Adrenal 0.55 cm width cranial pole, 0.62 width caudal pole
2/10/09 Abdominal Ultrasound
A lot of abnormal findings consistent with the kidney infection
Adrenal Glands were small, but Bailey was on fluconazole.