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

Hi Julie-

It sounds like you're on a real roller coaster ride. I imagine it is very distressing for you. It is always so very hard for me when the pups are suffering and we cannot explain to them what they are going through and why and what we are trying to do to make their lives better or at least more comfortable. Having to take into consideration the amount of money that each procedure costs only adds to our burdens.

I am thinking of you and Hannah and hope you have seen some positive signs over the weekend.

-Susan

Hi Julie,

I hope Hannah's procedures will start to have some benefit that lasts longer and longer. I'm not sure how those procedures actually work, but it would make sense there would an accumulative effect as the treatments progress. I hope that is the case with Hannah and you are soon seeing more of your old girl's self coming out.

Have fun in school! I have to admire those who teach and work in the school systems - I would be in jail the first week! :p So, in my book, you are all very special people who take a whole bunch of crap from every corner with very little equitable compensation. In other words, heroes. ;)

Hugs,
Leslie and the gang

Hi Julie! How is Hannah doing? Hope she continues to get better.
How is school preparations going? Hope you get a fun class this year!

hugs,
Sharlene

Hi Julie,

Happy Labor Day!

I am a wee bit worried about you and Hannah. I hope things are okay and you have been busy getting ready for the school year.

Let us know when you have a chance.

Sending many hugs

Hi Guys,

Sorry I've been MIA lately. You're right, Addy, I have been busy getting ready for the school year. Last week was lots of meeting and preparation for the year, but there is never enough time to get things ready, so I usually work late most nights. I switched all of my files over to hanging files this summer too, so that was a pretty big project. I love how organized everything is though! I also de-cluttered in my room so it is more open and calm feeling, probably just for me, but I needed it! :D

I've been working a lot this weekend too. I like to be as prepared as I possibly can with routines, procedures, and activities to ensure things go as smoothly as possible. Yesterday I was running around getting things laminated and buying stuff for some of the team building games I'm going to have the kids play.

Thankfully, Hannah is holding steady for the most part. She is no longer having difficulty getting up from lying down, and she isn't doing so many strange things with her left back leg. She occasionally wants to trot outside, but the back left toes drag. For the most part, she walks pretty slowly, but she is still walking, so I am happy with that!

She had acupuncture and a laser treatment (at the same time because the vet who does acupuncture now has the laser) on Friday. We had to see a different vet from the one who has been doing the acupuncture most recently. We saw him last September for acupuncture when she first had problems and it went okay, but he doesn't quite have the same caring and patient personality Dr. Nicole has. Hannah did okay Friday, but really struggled with the needle insertion. He told me he doesn't remember ever having a dog who struggled so much. I wasn't sure what to do with that statement. Am I supposed to reprimand her or something? I just thought it was kind of strange. Obviously I don't like to watch my poor dog struggle anyway. At any rate we got through it fine. She was calm after he got the needles in.

We are going to get another acupuncture (and possibly laser) treatment next week with Dr. Nicole, and then we will see how she's doing. That will have been four treatments. I told them I cannot afford to keep this up indefinitely. He suggested one more treatment, then possibly some laser treatments for a few weeks (would only be $180 total) and then probably a laser every 3-4 weeks. At this point I think we are waiting to see if there is any more improvement, or just maintaining where we are. They charge about half the price for laser, which is wonderful. I can get 6 treatments for $180 and I was paying $150 for 3. A tech does it at this clinic, rather than a vet, but that's fine with me.

We all agree that Hannah doesn't seem to be in pain and that is everyone's first concern. Her back was not as tense Friday. He said he really could not evaluate her though because she just tried so hard to get back to me whenever he tried to do anything. So he mostly went by what I described at home. They still think there may be some neurological thing going on with the back left leg, but don't really know.

Peeing and pooping are going okay for now too, although Hannah has decided she will not poop in our yard or if we walk down our street. I don't know why. So for the last 2 weeks I've been driving her to a park about 6 blocks away to poop. She loves to smell a few trees and posts and then without fail, she poops. It never takes more than a minute. I'm pretty sure she has me trained on this one, but it is so difficult for her to go if she misses a day, that I would rather keep up with this than deal with the alternative. I'm thinking I might phase it down to every other day and see if the short walk here on our street at least keeps things moving.

I try to not think about the future because I know winter will be extremely difficult. She had a tough time on the icy snow last year and she is so much weaker and so unsteady on her back legs that I fear it will be a disaster. We may have to try to figure out another plan. Right now I am just glad she is doing okay because the next couple of weeks are really stressful and busy for me. If she can stay stable that will help me stay sane! :p

Again, sorry I haven't been around much. I haven't forgotten you, and I still try to check in at least once a day. I just don't have the capacity to be as diligent as I would like.

Thanks for checking in on us and thinking of us!

Julie & Hannah

Great to hear from you Julie and glad Hannah is hanging in there fairly well. I think (not that you asked) that I would mention to Dr. Nicole the struggle Hannah had with the other doc and how she kept trying to get back to you. Tell Dr. Nicole of the other doc's comment and ask her opinion on the whole scenario. I think at the very least Dr. Nicole should be aware of your experience.

I guess this is your last day off for a bit. What age kids do you teach?

-Susan

Hi Julie,

Happy to hear from you. Figured you were busy as this is a hectic time of the year. I'm glad that Hannah appears to be a bit improved. Enough to walk slowly at least and get up and down.
I hate the ice and snow thing in the winter. All that slipping and sliding is not good for us our precious pups.

Take care, check in when you have time!

hugs,
Sharlene

So glad to hear about any improvement for Hannah. I am not looking forward to the ice and snow either but maybe it will be like last year, a mild, no snow winter. Of course then allergies will be worse. I think we can't win.:):(

I was hoping you were busy and glad to hear you were. I worry about you and Hannah when I know you are both having a hard time.

Not to worry about things here. You just take care of yourself, your class and Hannah and Izzy. I think she did train you well to go to the park every day. Good job Hannah!!!!:D:D

Happy New School Year!!!!!

Hi Guys,

Thought I'd post an update on Hannah. First, I am happy to say her back is much better (we think she is pain free) and she is walking quite well and sometimes even trotting. I continue to be amazed at the wonders of acupuncture. She had four treatments (one per week) and we did laser immediately after the last two acupuncture treatments. The plan for now is a laser treatment this week (it will be almost two weeks since the last acupuncture) and then maybe just try laser treatments every 2-4 weeks to keep things under control. Another possibility is to do acupuncture every six to eight weeks.

Unfortunately, with this good news comes some bad news. First, Hannah's allergies are terrible. She had skin irritations all over-her chin, neck, groin, tail...and I knew she had to see the vet. My parents took her for me during the day on Friday. She got Clavamox and GentaVed (a spray steroid) that I need to use twice per day for two weeks. It does seem to be providing her some relief, thankfully. She has been wearing a cone for about 10 days, but I have to do something to control her urge to scratch and lick. The spray seems to have already reduced the redness significantly. I hope it isn't going to affect any Cushing's issues by being sprayed on her skin short-term.

The second part of the bad news is that she had blood work done again on Friday because last month her blood work showed low hemoglobin and hematocrit so the vet was worried about her possibly being anemic. I looked back at past blood work and saw that it was sometimes low, but then would be back up in the normal range. He had not noticed that until I told him, but said we needed to monitor it closely and do another test in 2 weeks to a month. It was worse again this time. Her hemoglobin, hematocrit, MCV, and MCH. At this point they are not horribly low, but lower than last time. The results came in the mail yesterday (since they mailed them Friday afternoon) but I have not yet talked to the vet about them. Basically he told me last month that there isn't much to treat anemia other than finding the underlying cause. She did have a stool sample checked last month and everything was clear-so no traces of blood. She also has high platelets and they have continued to get higher. Her Chloride was also a little high this time-I've never seen that one off before.

From my reading, it sounds like there could be something wrong in her bone marrow. I'm going to see what the vet says, of course, but I would not pursue any sort of bone marrow biopsy at this point. I just wish I knew what was going on. We've fixed one thing and now are onto another issue, which could be pretty serious. I'm very worried about it, especially because my vet seemed so concerned last month. So, I guess I'll see what he has to say when we talk.

She still seems happy and healthy at this point, and like Addy says, I try to make the most of every day because I have no idea how long she has, and I've assumed we were close to the end so many times for the past year. It was last Sept. 27th that we went to the ER vet with her first back issue. It was my anniversary so I remember it very well; it was not how I planned to spend it. It's now been almost a year and there have been many ups and downs.

Hannah got her face trimmed, nails trimmed, and sanitary area cleaned up today instead of getting a regular grooming, which was planned. Luckily, it went okay and I just held her while she did it. Her hair is not that long and I didn't want to risk putting her through grooming after just getting better. I was worried the grooming caused it in the first place.

I talked to the groomer last week about how to groom Hannah from this point forward. I explained the situation, which I'm sure is hard to completely understand over the phone), and she asked me if I had thought about letting Hannah go. Not as in not being groomed, but as in should I put her to sleep. I really like this woman, and she has done a great job with my dogs and always does little extras at no charge, but this bothered me. She really hesitated before saying it, and really meant well, but I didn't like it. I explained that she was nowhere near that point and that she had drastically improved, but that I just didn't want to put her through a strenuous grooming session and wondered if I could stay with her to help/if I should try the bath at home and have her do the cut/etc. She was receptive to any of these options, but it still bothered me that she asked. The plan is to go in a few weeks and I will bathe her the day before and then bring her in the next day and stay with her while she cuts her hair.

I apologize again for being so absent from the site. I have been working 12 hours most days since school started, and often work from home in the evening before I go to bed. I try to check in daily, but have not been able to post much. Lately with all the meds Hannah has been taking, the morning and evening routine have felt like part-time jobs. Luckily I don't have to get up in the middle of the night for any meds, but it is about a 30 minute process in the morning to feed her, give all the meds in the right order and at the right time, and get her outside and then back in her cone for the day. Of course I love her and will gladly do it, but I am definitely tired and wishing for more sleep. My class has been great so far, so I am incredibly grateful not to be feeling stressed out because of student behavior.

If anyone has any suggestions or thoughts about Hannah's blood work or any more info. about what this could mean, I would love to hear it. I will let you know what the vet says when I hear from him. Sorry for the very long post. I just wanted to share everything on my mind at once.

Julie & Hannah

I cant help with the blood work but hopefully someone else can. I am so happy Hannah is trotting and walking better. I know that sinking feeling from when Zoe was falling down and smashing her chin after her surgery. It is so hard to watch.

I am not advocating this but, the owner of our Pet Outpost has a little bichon poodle mix. He had such bad allergies, all the vets told her to put him down that there was nothing more they could do. She switched him to a commercial raw diet and after a few months his skin healed and his hair starting growing back. She has to rotate his protein every few months but he has done really well.

So you, Marie and I all have anniversaries coming up, almost the same week:D:D:D It is a small world.

Don't worry about the forum, we know you have your hands full. I know how much time it takes from my own experience with Zoe for feeding and potty breaks and medicine before work. Did I tell you my boss has just started to figure out I never changed my hours back?;););) With it starting to get light out so much later, I will probably switch back at the end of the month.

I know how hard things are right know, sweetie. All we can do is take it one day at a time and be happy for each extra day we have.

I love the thought that we were both in the car yesterday cuddling with our two pups:D:D:D:D When I read that, I still cant wipe the smile off my face.

Warm, fuzzy thoughts for you, Julie. Kisses to Izzy and Hannah.

With all the commotion and to do in the news lately, I want to make sure I thank you for being a teacher. Many years ago, my hubby was a principal in Harlem. He had so many interesting and moving stories to tell. So, I have such respect for our teachers and am always thankful for anyone in the profession.:):):)

love ya

When Ella's blood work came up with mild, non-regenerative anemia, her breeder was immediately worried about autoimmune hemolytic anemia (AIHA). Vets think there is a genetic component to AIHA and it run is some lines of English Cockers.

After 8 weeks of super-strong antibiotics, Ella's anemia resolved and I am hoping that it was just a result of a bladder infection (but then again she was just on the low end of the range in her pre-op blood work last month...and I KNOW she was infection-free then...arg!)

This can be linked to rheumatoid arthritis in dogs...I am thinking about all of poor Hanna's back/leg pain... :confused: :confused: I really hope this is not the case for poor lil Hanna.

So glad to hear that Hannah's legs and back seem to be better. I'm sure it is very hard trying to keep up with Hannah and Izzy and the kids at school. :)
Hopefully her next blood work will show better numbers on the blood work.

hugs,
Sharlene

Hi Julie,

How is Hannah doing? How is school going? Can you believe that it is already almost a month that you've been back at school! Time sure seems to fly. I hope you are both doing well.

hugs,
Sharlene and Molly Muffin

Hi Julie. I am new to this forum. However ever since I joined this forum I have read your whole post. I am waiting to see how your poor Hannah is doing. I too have a cushpup. I am reading yours because I also don't want to give those medications. Please update.
Thanks Rose and Napoleon

Hi Everyone-

I apologize for being absent for so long. I did still occasionally check the forum, but I have been crazy busy with work, and have not even been checking my facebook page much, which is pretty unheard of for me. I am in the midst of parent-teacher conferences too, so there have been some long days.

Hannah is doing very well. Her back has healed again (I am a firm believer in the miracles of acupuncture) after having four treatments (one per week) of acupuncture and a few laser treatments. The last two times we did acupuncture followed by laser. She got groomed last weekend, which was also very stressful for me, because that is what may have caused some of the issues the first time. She got a laser treatment on Fri. because the vet felt it would be better to do it first. I bathed her myself on Sat. and took her to the groomer for the haircut on Sun. I stayed with her and held her or supported her the whole time. It went very well. She is still happily trotting on her walks.

Her allergies have been pretty bad. She has been wearing a cone for a month (almost 24 hours a day) and has had a couple of skin infections. We have been using the steroid spray as needed because now the cone itself irritates her neck at times. :(

She was just retested to see how her hematocrit level was (because the vet was worried about anemia) and her levels were back up a bit, and into the normal range. I was thrilled about this good news. He sent her blood out to be checked (at no cost to me, which was also wonderful) because it was a much more expensive and sensitive piece of equipment and it was even a little better according to them. He still feels that she is borderline anemic and we should continue to monitor it, but they know she is not bleeding internally because they checked her stool and something about her cells not needing to regenerate to keep up with blood loss.

I am so thankful for literally each and every day that she is well. And now well means something different that it did a couple of years ago. If she eats, trots on a walk, poops, and wags her tail, it has been a good day. I give her tons of hugs and kisses every day, but I wish I had more quality time to spend cuddling with her and Izzy.

This is my tenth year teaching, but it is the busiest I have ever felt at the beginning of the year. We have some new initiatives and I am on some new committees and doing extra things at work, but I feel like I have little time left for my own life. I have been feeling guilty for not calling friends back, for not being on the forum, for not being home with my dogs more, and for neglecting my husband because I am working or sleeping when I am home.
I do hope things will calm down a bit after conferences next week. My husband and I are going to try to get away for a couple of days when we have some time off next week, but I am worried about leaving the dogs with my parents. I know it would be good for me, but we'll see. I still do check in from time to time and I want you to know I think of all of you daily.

Rose, Sharlene, Steph, Addy-my Hannah is okay. Thanks for checking on us, and I am so sorry I have not responded for so long. Rose, I will try to read up on Napolean and see if I can be of any help.

Thinking of all of you! I hope to be back up to par on here again very soon!

Julie & Hannah

Quote:

---

Rose, Sharlene, Steph, Addy-my Hannah is okay

---

then I can smile for I worry about you two.:D:D

so glad to read this.

Yay! Try not to work tooo hard...Lol! <<-------Pot calling the kettle black!

Hi guys,

I have an update on Hannah. We have a new development and I'm not quite sure what to make of it. Hannah went in to have her blood work done again yesterday. They have been monitoring her hemoglobin and hematocrit because she was borderline anemic a couple of times. Last month it was normal, but her ALKP was up a little bit, at 465.

The vet called me today and told me her hemoglobin and hematocrit were okay, but her liver values are BOTH up. Her ALKP is 772 and her ALT was 240 (normal range is up to 100). She has never had elevated ALT before. The vet said he wasn't sure what to think. She has been on Denamarin for about a year and a half, and we haven't changed anythings else. I am nervous because I know it is more concerning when the ALT levels are high. He said they usually start by running a course of antibiotics and metronidazole (flagyl) in case there is some infection causing this. Hannah will be start the meds tomorrow for 14 days and then he wants to recheck. If her ALT is still elevated, he wants to do more testing, probably another ultrasound. A month ago, her ALT was 89. I just don't know what to think.

I did leave a message tonight to ask the vet if there is any chance she could have a tooth infection causing this. He did not do her yearly dental last spring because she had so many other issues. He said her teeth looked okay and since she was having so many other issues he didn't think she really needed one. Hannah has had many teeth pulled; I think she has about 10 left. So I know she doesn't have good teeth. I don't know what I would even want to do if they wanted to do a dental since her liver values are not good, but I'm trying to figure something out.

For now, I'm trying to just tell myself to wait the two weeks and see what happens. It stinks that it will be right around Thanksgiving and my birthday (11/26). The last thing I want is to find out she has a liver tumor on my birthday or something.

Hannah's doing pretty well otherwise. Her back is great and we get laser treatment every 3 weeks. Her allergies are still bad, but she is a happy girl and is not showing any signs of illness.

Any advice or thoughts you have are much appreciated.

Thanks!

Julie & Hannah

Sorry I can't help - hope that Deb sees this as she understands bloodwork! I assume you haven't noticed any symptoms that are new or you would have mentioned them. Sending love and healthy thoughts your way! Kim

Hi Julie,

That is great that Hannah's back is doing so much better.

You know, Molly's ALT's went up like that in March and she had diarrhea, etc. The vet I have, thinks it was a stomach bacterial upset of some sort. Only it seems that the ALT can go up for any reason that could cause the liver to be involved and damaged. It seems to take much longer for the values to come down. Molly was on the antibiotics and the flora stuff for a long time and while the numbers started to come down, they hadn't reached normal yet.

So could be anything really causing it and wait and see what the antibiotics do for her. Retest and see if the ALT starts to come down. Just be aware that it could take longer to come down than it did for them to go up.

Do hope Deb sees it, she'll know a lot more about it.

On a separate note. I hope school is going well for you. Thanksgiving coming soon!

hugs,
Sharlene

Hey Julie,

Thi has some good info for you to read:

http://veterinarymedicine.dvm360.com...date=&pageID=2

FYI- metronidazole can also affect the liver

I am sorry you have to be worrying about this with your birthday and turkey day approaching (Happy Almost Birthday To You!!!!!)

Hannah does not have a liver tumor- dont even go there girlfriend.

Hugs and Bigger Hugs and Biggest HUGS EVER!!!!!!!!!!!!!!!!

Hi Julie-I think we always have enough on our plates just to deal with what we know.....not project any "what-ifs." Don't go borrowing trouble. Do the meds and retest in two weeks.
Hugs to you and Hannah.
-Susan

Hi Julie,

You're sounding a bit like me and that can be dangerous, friend! :eek::p

Right off hand I can't think who but we have seen all those nasty liver values come down in other pups as well as the ALKP - which I am repeatedly told not to worry about. Like that does any good. :rolleyes:;) When we were still in TN, the IMS sat for about 20 minutes explaining to me what a wonderful organ the liver is, how much total abuse it can take and come out unscathed, how it is one of the only organs that can regenerate itself, healing itself, and what a wonderful barometer the liver is for the rest of the body. So don't panic just yet. You are doing a wonderful job caring for Hannah and I know you will continue to do just that.

Hugs,
Leslie and the gang

Hi Guys,

Thanks so much for offering me your thoughts and your reminders to just take things one day at a time. I always jump to the worst case scenario for everything. It seems easier to prepare for the worst somehow, but I am definitely trying to be better about that. I have the quote "worrying will never change the outcome" saved on my desktop and I open it whenever I need a little reminder; unfortunately, the thing I do best is worry! I am happy to report that I am doing very well just giving the meds and not worrying about what will happen in a couple of weeks. Thank you for helping with that! I will take Hannah in the day after Thanksgiving to have things checked again. And we will go from there. I did talk to my vet Thursday to ask if she could have an infection in her mouth from no dental last summer. He said that because she has been on and off antibiotics from skin infections from allergies he didn't think so. But I know it has been at least two months that she hasn't been on an antibiotic because she's been wearing the cone. We will see what happens in a couple of weeks, I guess.

Hannah seems to be doing well and is happy. She got her face trimmed up and her toenails trimmed yesterday. Then my mom helped me give her a bath and she was so stinkin' cute after...trotting around looking for treats and doing her best to look cute, tilting her little head to the side and staring at us, just hoping for another. You'd never know anything at all was wrong with her...or that she was 13! :D

I am actually looking forward to this freezing weather we are supposed to have the next couple of days because I am hoping Hannah's allergies will stop. I would love to get her out of the cone. She would love it too!

I appreciate knowing I have your support and advice and that everyone here "gets" how it feels when something is wrong with my dog. Don't know how I would make it without all of you!

Julie & Hannah

Hi Julie,

Thank you for checking in on Jasper and me, and your kind words. I first want to say what a cutie Hannah is. My Mom has an 11 yr old Shih Tzu named Sassy and she is just a sweet little thing.

I have been reading in your thread and others for quite some time, but am not always able to post on everyone. I am so glad to read that Hannah's back is doing well. I remember first reading about her laser treatments on your thread and asking my vet about that for future reference. I wish I knew more about lab results to be able to offer some feedback there, but I just don't. I usually go on the internet to read about everything, and then like you, I worry myself sick. You sound a lot like me with the worry, I try not to, but it always creeps in. Even though rationally I know it does not help or change the outcome like you said. I need lots of help with that one day at a time thing! I am hoping the antibiotics work for her, and the results are better in a couple of weeks, and that she continues to feel well.

Ok, it is bitter cold here today, and so windy, after being almost 80 yesterday, sheesh. So I suspect it is cold for you also. Here's hoping Hannah can get out of the E collar!!


Take care Julie, and thanks again for checking in on me and my boy.

Hugs, and belly rubs for Hannah,

Tina and Jasper

Sweetie, I am thankful everyday we all have each other.

I can totally picture Hannah being so proud of her bath and cuteness and I love the fact that she still does that after everything she has been through.

I too hope we have a colder winter with normal temps. Zoe is hardly chewing her paws right now, no sneezing, I keep wondering if it is the higher cortisol levels helping her as our grass is still green and was just cut last week. It did not affect her as it had been.

Love you and thank you for thinking of us and writing.

We love therefore we worry. There is a probably a mommy syndrome that should be thrown in there somewhere. Mommy and Daddy I should say, because we might be the ones on here, but the guys in our lives have worry fits too, they just deal differently. Okay, now that I've acknowledged that we all have someone in our lives, wives, husbands, partners, friends, etc. Back to our worrying. Sheeezzz.

Omg, these guys totally know how to work the "how cute am I, give me a treat" thing. That head to the side tilt maneuver. I think they hold it in reserve for when they think it is possible they might Not get that next treat.

I am glad that Hannah is doing so much better. She really had us scared there for awhile. I hope that cone can go away with the cooler temps too. It has to be so frustrating for them. I'd be a wreck if I had to wear a cone around my neck all the time.

Thanks for popping in and checking on us. Hopefully you are one of those getting a 3 day weekend this weekend and will be able to enjoy an extra day to yourself !

hugs,
Sharlene

Is it time for your birthday party????



'cause, I dont want to miss it

I don't have birthday party plans yet, Addie, but the big day is Monday. It's almost always over the Thanksgiving holiday so it's going to be weird to have it during the week. My students are SO excited; they've already been making me cards. They all want to buy me presents but I tell them a card and excellent behavior is all I want. (I work at a school where about 90% of families are low-income, so I don't want them to spend their money on me!).

My Hannah-bear gets her blood test tomorrow. I am dreading it, yet I guess I'm ready to know where to go from here. Honestly, the best birthday present I could get would be for her results to be better. Please keep us in your thoughts and hope for the best. I'll post tomorrow afternoon after I get the results.

Julie & Hannah

fingers crossed for Hannah and Happy Birthday Julie!

I think that is an excellent birthday wish Julie and I hope it comes true.

That is very sweet of you with the students. I'm sure they are very excited to be around on teachers birthday. :) I bet it will be a wonderful day!

Happy Thanksgiving

hugs,
Sharlene

Hi Guys,

Not good news. Her liver values did not drop. ALK is about 860 and ALT is about 260. We are going to do a bile acids test next week, and then go from there. He recommends an ultrasound after that, depending on the results. I couldn't quite get as much information as I'd like about how to proceed, and I know that is partly because he doesn't know what is wrong. I just want to know if it is worth it to spend the $425 on the ultrasound. If it isn't going to change the treatment plan then I'm not sure if we should spend the money. He said it could be something like lymphoma as opposed to just a liver tumor or liver disease. I don't know if treatment would change even if it was lymphoma. I guess I'll hope to get more information after the next test.

Julie & Hannah

Julie, Hugs, I know it is worrying about the high liver values. Molly has the same thing, high ALT, high ALP, and everything else on the blood work is normal. I will be very interested to hear what your vet has to say. Now will the bile test, confirm or rule out liver disease?
Is there any way to rule out lymphoma without an ultrasound?

There is nothing more to be done this week, so just try and have a good Thanksgiving. Next week will come soon enough.

hugs,
Sharlene

Well, how much of these increased values can be attributed to her Cushings?


I am just wondering. I cant tell you not to worry because you are like me and will worry anyway.

I am hoping someone will come along and help shed some light on this all.

I am so sorry you are having to worry about this now. Try to take it one day at a time. Hannah is okay today so baby steps for now, Julie.

(((((((((((((((((((((((((((((((((((hugs))))))))))) )))))))))))))))))

Julie, I too am so sorry you are having to worry about this over the holiday weekend and your Birthday. :( I am like you also and can't help but worry.

Sharlene, Jasper had a bile acids test when we were trying to figure out what was wrong before we determined the Cushings diagnosis. It is my understanding that it is a very specific test for liver function, and if normal, will rule out liver disease.

I agree with Addy - is there a reason that your Dr doesn't think the elevations are related to the Cushings?

Hugs to you and Hannah,

Tina and Jasper

Dearest friend, I am very greatful for you too. You are always here for me and as Jeanette said, our bonds are strong. I dont know what I would do without you either.

We'll get Hannah figured out, sweetie and we will all hold your hand while we do it.

Keep the faith and eat lots of turkey. :):)

love you tons (((((((((((((hugs)))))))))))))))))))))))))))

Julie I can fully empathize with you. We went into that "dark closet" with Palmer. Seemed to be full of questions without answers. The testing and the treatment gets more expensive each time you run another test trying to get a concrete answer from somewhere.

This is a frustrating opinion to hear, but do what you can with what information you have and what resources you have. We ran all but one test/procedure on Palmer. What I got out of that was a certainty that I had tried everything I could do to save him. For us, that was a very high price (dollars) to pay. I don't regret having done any of it.

You have some very valid questions for which you should be able to get answers. Vets are stuck in the middle because we want to know the future and they don't have much better a handle on it than we do.

Try not to worry all the time. I know how hard that is to do. Maybe tomorrow the vet could answer some of your questions. Maybe the answers will make it easier to decide your next step. I always have said I'd rather have bad news than no news (answers) because bad news is something concrete I can deal with. If you listen real hard, your gut will give you some guidance as to what is right for you.

Meanwhile, have fun with Hannah. Enjoy today. It's all any of us has anyway.
Huge Hug,
Susan

Thank you so much for your well-wishes and your thoughts, Addy, Susan, Tina, Sharlene, and Judi. You have no idea how much I appreciate it. You gave me some good things to think about and my brain has been working on overdrive. I have lots of questions I need to write down for when I have a conversation with my vet.

As for why he doesn't think the elevated ALT values are related to her Cushing's-I think I asked that the first time it was elevated and I believe he said they don't commonly see the ALT elevated with Cushing's, that it is usually just ALKP. I don't know if that is correct or not. It seems that from what I can remember from the forum it is usually the ALKP that is elevated.

I made a call to the holistic/traditional vet that does Hannah's acupuncture and laser therapy because I love the vet we see there and she is very practical and direct with me. She is not in until Tuesday so I am hoping she will make some time to call me. I also found out they do ultrasounds there for $356 and at my regular vet it is $425. I do know the guy who does them at my regular vet has "the best equipment" according to my vet, so I wonder if there is any difference in the quality. I have to decide if it would be worth doing the ultrasound at the other vet to save money. I'm not sure what that would do to the relationship at my regular vet. I do like them and they are really close to my house and it is easy to get in for an appointment, while the other vet is a bit further away, and it's not as easy to get in.

I also was a little confused because my vet kind of suggested going right to the ultrasound until I asked about the bile acids test (not by name, but by explaining what I'd read) and then he said that would be a good thing to try next if I'd like, because it will tell us how well her liver is functioning. He said then I could decide if I want to do the ultrasound. The bile acids test is just over $100, and I assume that no matter what it tells about her liver it would probably warrant further investigation into what is going on, so maybe he was thinking I could just skip to the ultrasound???

I am not opposed to the ultrasound, and although I don't want to spend several hundred dollars figuring this out, especially around the holidays, we can afford it if we need to. I just want to be sure since I will not put her through a biopsy or fine needle aspirate, that they feel they will get valuable info. that may alter how we proceed with treatment. I know no one can look into the future, but I'd like to have another conversation about it.

Meanwhile, I have read about liver disease in dogs and there are many symptoms, so obviously I can find things like, "yeah, Hannah is more lethargic than she used to be," but that has been true for over a year. She really doesn't have any other signs, so if she does have liver disease, I assume it is in the early stages. Also, I don't know what to make of the fact that she was borderline anemic for a few months, which is why we were doing the extra blood tests, and that seems to have improved and stayed consistent but then the ALT elevation popped up, along with the fact that the ALKP has gone from 475 to 860 since early Sept.

Hannah has been on Denamarin for a couple of years and it seemed to be working well; her ALKP dropped to just above normal (at 250 or something). It seems to me that the Denamarin is not doing anything at this point. I'm not sure what he would even put her on or if we would stick with the Denamarin and change her diet. She is also on a prescription diet for crystals in her urine (she's been on it for about 8 years) so I don't know if that would cause issues.

Hannah also does not have a ravaging appetite at all. And she still has no potbelly, no panting (she never seems hot), and her water intake is definitely more than the average dog, but it is not crazy. She still holds her urine all day and all night. In fact, she would be content going out in the morning around 7:00, at about 4:00 when my husband gets home, and then around 9:00 or 10:00 before we go to bed. We usually let them out one more time between dinner and bed, but Hannah doesn't always want to go. She still has a full coat of hair, although my groomer says her coat has changed (but I don't notice anything) and her hair grows back after it's cut. There are times when I still wonder if she has Cushing's, yet her LDDS test was supposedly definitive for Pituitary Cushing's, and she did have leg weakness, as she stopped wanting to jump on furniture. That also came along around the time her back problems started, so who knows. And her allergies are still out of control and not being controlled by cortisol, as it sounds like happens for many dogs.

I don't know. Now I'm rambling. I guess I just wonder if she has Cushing's or if there is something else that has been going on that is affecting her liver values, as well as the Hematocrit and Hemoglobin.

As Susan said, not knowing is frustrating, and that is true for me also. The only thing to really do is get more information. I think I have decided that I will do the ultrasound if it makes sense/seems necessary, but I won't put her through anything invasive. She is 13 1/2 and has risks as it is. I know I have given her a very happy life and have prepared for the end so many times with her, that the one thing I can say is that it gets a little easier each time. I know that when that time comes it will be what she needs. And I also know that "that time" may not be soon. I just want to do what I can for her to make her comfortable and happy.

I just feel like there may be some dots that have not been connected here, and that something else may be going on with my girl. I will say, I am doing quite well taking one thing and one day at a time. My husband has mentioned it several times. He said he is so proud of how well I have handled the waiting because he knows how much my Hannah means to me. I'm proud of myself too. I definitely have some weak moments, but I have to remember that we don't even know what's wrong yet, and that it doesn't mean she is going to die immediately. I just need to take one thing at a time until we get more info. and can develop a plan. I'm all about having a plan, so that is something I can handle. :)


Thanks to anyone who read this novel! You can see it was a place for me to get all my thoughts out. If any of you have any other thoughts or advice to share, I'd love to hear it. The internet can only tell me so much, so I love to hear from those of you with more knowledge and experience!

Thanks again for thinking of us. It means the world to me!

Julie & Hannah

Hi again,

Okay, bear with me one more time. I was just catching up on a few threads as my hubby makes breakfast, and saw that Marianne wrote this on Blaze's thread:

the ACTH is actually the more "specific" test of the two. What this means is that a "positive" on an ACTH is actually a more reliable indicator that a dog truly does have Cushing's. The LDDS is more likely to be skewed by the presence of other nonadrenal disease and thereby return a positive result even when a dog doesn't have Cushing's.

Does that mean I am correct in my thinking that maybe Hannah does not actually have Cushing's, but could have some other disease that caused those results on the LDDS? And that it has just slowly progressed over the past year and a half? She has never had an ACTH test. I know many of you asked me what her cortisol levels were. My vet said he could certainly do an ACTH if I wanted, but that it was more what they used to determine the dosing for meds because we wouldn't know what Hannah's "normal" cortisol level was. The IM seemed to agree that it wasn't necessary. I know it isn't cheap either, so I didn't push. I wonder if it would tell me anything at this point??? What are your thoughts?

Julie & Hannah

hi Julie, as you know I can relate to many of the things going on with Hannah, as I have the same thing going on with Molly and still nothing definite. I did the ultrasound and I do think it added to my knowledge, it didn't change the fact of not treating right now for Cushings due to the LDDS being completely noncushings, while the ACTH showed very high levels of cortisol.

It is definitely baffling when you get all of these mixed messages from the very test results that we rely on to try and tell us what is the best course to follow with our little furballs.

So, here is what I would ask you.. what exactly would you do for Hannah, treatment wise at this point? And maybe that will help you to determine what you need to know. I think the bile acid test would be good as it is liver disease specific and if she has liver disease, then you probably would not treat for cushings, even if by chance she has that too, the liver disease is the most important to deal with. (I think this might be my next test for molly too after reading what your vet has said and Hannah's test results, see you help even when confused yourself!)

If the bile tests come back negative, that is a relief and not probably a factor in anything else going on with Hannah. At that point, whether yes or no, you can probably put off getting the ultrasound for awhile as Hannah has no real symptoms of either cushings Or liver disease at this point. Sort of do a save jar idea for the ultrasound and get it after the holidays.

ALT's can go up if they have had any sort of gastrointestinal issues or kidneys, in that everything seems to affect the liver. I opted to get just an ALT/ALP test done later to see how those numbers were doing and they had changed downward, not enough but some over a period of I think a couple months. I'll be ordering another one of those in the near future, to see if the Heppato Supplements (same as your Denamarin) has helped.

Anyway, baby steps, don't over stress this and just try to do one step at a time, so it doesn't overwhelm you all at once.

You can ask what kind of ultrasound equipment the holistic vet has, knowing that you have some time to make a decision on which you might want to use. If you decide to go with the cheaper option, then just be straight forward with your vet and say, that the place that gives her the acupuncture, does it cheaper, but you can ask that the report be shared with your vet, or you can bring them a copy that you get for them to add to their records.

I know that this is so very stressful to go through. Hannah is a happy little thing though and that is really what is most important. She is enjoying her life with you thoroughly and you with her.

Hugs,
Sharlene and Molly Muffin