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

Hi Julie,

Dogs with primary liver disease have more abnormalities than just ALT and ALKP. Did your vet do a complete chemistry and cbc or did he just do a snap test inhouse? If comprehensive testing was done, can you post all abnormalities? As far as symptoms associated with primary liver disease, dogs don't usually have any symptoms until most of the liver has shut down, usually 75%.

Based on everything you just posted, it sure doesn't sound like Hannah ever had cushing's and in the absence of any symptoms associated with cushing's, I sure wouldn't pursue any diagnostics to rule it out at this point. To answer your question about the LDDS, yes it is more likely to yield a false positive results if there is something else going on with a dog. This would include any non adrenal illness, whether chronic or transient, and stress. So could Hannah's results have been a false positive? Absolutely.

I personally would find an ultrasound more useful than a bile acid test. If liver enzymes are elevated, chances are bile acids are going to be high. FYI, most dogs with cushing's have mildly high bile acids but some have elevations as high as 50.

Glynda

Julie, I'm not around much any more, so I have gone back & read your last several posts. If you don't mind, could you post Hannah's last 3-5 hemoglobin/hematocrits, & the dates they were done. Actually, I would like to see the complete CBC, if possible. I'm looking for drops in WBC, along with platelet counts, besides the H&H. I just don't have the time to go back & re-read the whole thread at the moment. Post how ever many you can find, along with the dates they were done.

I read where the vet apparently feels there is a concern for possible lymphoma. Believe me, I have plenty of experience with that one, too, unfortunately. At any point in time over the past 3-4 months, have either you or the vet felt any swollen glands on Hannah? The normal places to find them would be in & around the lower jaw/neck, or in behind her elbows or knees. When Barkley got sick, I never actually thought to check for swollen glands. All I can tell you is B was "off", the main symptom was a lack of appetite. This was the cushing's boy who never lost that voracious appetite even with him being well controlled by lysodren. He would have eaten until he popped, if I let him, so I knew something was really wrong. After going back & forth between his derm vet & GP vet for 2 weeks, not getting a straight answer from either of them, I threw up my hands, basically told both of them, "I'm spending a bucket of $$$ for both of you to figure out what's going on, & this boy is literally dying in front of me." After I pitched that fit with the derm vet, we got sent to an IMS. She felt multiple swollen nodes on physical exam, & wanted to keep B for an ultrasound & fine needle aspirate of one of the nodes. The ultrasound told the tale, multiple swollen lymph nodes throughout his abdomen. A fine needle aspirate was done on the node in behind his knee, & 24hour later, the verdict was lymphoma. I don't want to worry you to death, but on the remote chance this is lymphoma, there is not a lot of time. On the slim chance it is lymphoma, I can offer you some help with your options.

I'm telling you B's story as it's my long-winded way of saying that I agree with Glynda that an ultrasound would be the best bet, IMO.

Debbie

You learn something new all the time on here. If a dog that has elevated liver ALT's and ALP's is going to test high on a bile acid test, then I guess that wouldn't rule out liver disease after all. arggghhh
I agree, over all, frustrating.

hugs,
Sharlene

THANK YOU, THANK YOU, THANK YOU for your thoughts!!! I am now going to talk to the vet to see if they think I should just do the ultrasound first.

Debbie, I will post results below. Thanks so much for sharing all your thoughts. I honestly think he threw out lymphoma as just an example, but who knows. I have felt nothing abnormal on Hannah. I just checked after I read your post and had my mom check too since she was over. She's with her a lot too, and hasn't noticed anything either.

She has had other abnormal results as well, some of them only since the Hemoglobin and Hematocrit (MCV, MCH, MPV) and Platelets have been high for years.

I will post results in order. I don't have Wednesday's results yet. They usually mail me a copy when I'm not there to pick it up. I just know he said ALKP was 860 something and I think ALT was 260.

I will try to mark "HIGH" with red and "LOW" with blue.

11/6/12
ALB-2.9 g/dL (2.2-3.9)
ALKP-772 U/L(23-212) H
ALT-240 U/L (10-100) H
ALKP-772 U/L (23-212)H
BUN/UREA-19 mg/dL (7-27)
Chloride-120 mmol/L (109-122)
CREA-1.1 mg/dL (0.5-1.8)
GLU-111 mg/dL (70-143)
Potassium-4.7 mmol/L (3.5-5.8)
Sodium-162 mmol/dL (144-160) H
TP-6.1 g/dL (5.2-8.2)
GLOB-3.2 g/dL (2.5-4.5)
ALB/GLOB-0.9 (no range given)
BUN/CREA-17 (no range given)
Na/K-34 (no range given)
OSM cal-323 mmol/kg (no range given)
HCT-39.7 % (37.3-61.7)
HGB-14.3 g/dL (13.1-20.5)
MCHC-36 g/dL (32-37.9)
WBC-12.72 K/uL (5.05-16.76)
LYMPHS-4.23 K/uL (1.05-5.1)
% LYMPHS -33.3%
MONOS-0.7 K/uL (0.16-1.12)
% MONOS-5.5%
NEUT-7.24 K/uL- (2.95-11.64)
%NEUT-56.8%
EOS-0.53 K/uL (0.06-1.23)
%EOS-4.2%
BASO-0.02 K/uL (0-0.1)
%BASO-0.2%
PLT-614 (148-484) H
Retics-86.8 K/uL (10-110)
%Retics-1.3%
RBC-6.94 M/uL- (5.65-8.87)
[COLOR=MCV-57.2 fL (61.6-73.5) L
MCH-20.6 pg (21.2-25.9) L
RDW-21% (13.6-21.7)[/COLOR]
MPV-8.5 fL (8.7-13.2) L[/COLOR]
PDW-10.2 fL (9.1-19.4)
PCT-0.52% (0.14-0.46) H


10/4/12 (My vet ran a test in house and also sent it out to IDEXX Labs at no charge. Here are the IDEXX results)
WBC-12.9 (5.7-16.3 K/uL)
RBC-7.10 (5.5-8.5 M/uL)
HGB-15.0 (12-18 g/dL)
HCT-42.4 (37-55%)
MCH-21.1 (19.5-26.0 pg)
%Reticulocyte-1.1 ( -%)
Neutrophil SEG-56.0 (60-77%) L
Lymphocytes-35.6 (12-30%) L[/COLOR]
Monocytes-3.8 (3-10%)
Eosinophil-4.5 (2-10%)
Basophil-0.1 (0-1%)
Auto Platelet-674 (164-510 K/uL) H
*There is some info about Absolute neutrophil, lymphocyte, etc. if you want it.
*In the remarks it says "slide reviewed microscopically; no parasites seen)

Here are the results for 10/4 from my vet office:
RBC-7.06 M/uL (5.65-8.87)
HCT-39.8% (37.3-61.7)
HGB-14.1 g/dL (13.1-20.5)
MCH-20.0 (21.2-25.9) L
MCHC-35.4 g/dL (32.0-37.9)
RDW-21.0% (13.6-21.7)
%Retic-1.2 (no range given)
Retic-85.4 K/uL(10-110)
WBC-12.49 K/uL (5.05-16.76)
% NEU-55.9% (no range given)
%LYM-34.4% (no range given)
%MONO-5.3% (no range given)
%EOS-4.2% (no range given)
%BASO-0.2% (no range given)
NEU-6.97 K/uL (2.95-11.64)
LYM-4.30 K/uL (1.05-5.10)
MONO-0.66 K/uL (0.16-1.12)
EOS-0.53 K/uL (0.16-1.12)
BASO-0.03 K/uL (0.00-0.10)
PLT-614 K/uL (148-484) H
MPV-8.2 fL (8.7-13.2) L
PDW-9.9 fL (9.1-19.4)
PCT-0.50% (0.14-0.46) H
GLU 109 mg/dL (70-143)
BUN-17 m/dL (7-27)
CREA -1.2 mg/dL (0.5-1.8)
BUN/CREA-14 (no range given)
TP-6.1 g/dL (5.2-8.2)
ALB-2.9 g/dL (2.2-3.9)
GLOB-3.2 g/dL (2.5-4.5)
ALB/GLOB-0.9 (no range given)
ALT-89 U/L (10-100)
ALKP-471 U/L (23-212) H
Na-151 mmol/L (144-160)
K-5.9mmol/L (3.5-5.8) H
Na/K-26 (no range given)
Cl-118 mmol/L (109-122)
Osm CAlc-304 mmol/L (no range given)

9/14/12:
RBC-6.24 M/uL (5.65-8.87)
HCT-34.2% (37.3-61.7) L
HGB-12.4 g/dL (13.1-20.5) L
MCV-54.8 fL (61.6-73.5) L
MCH-19.9 pg (21.2-25.9) L
MCHC-36.3 g/dL (32.0-37.9)
RDW-19.8% (13.6-21.7)
%RETIC-0.5% (no range given)
RETIC-31.2 K/uL (10.0-110.0)
WBC-13.31K/uL (5.05-16.76)
%NEU-67.4%
%LYM-23.8%
%MONO-4.8%
%EOS-3.8%
%BASP-0.2%
NEU-8.98 K/uL (2.95-11.64)
LYM-3.17 K/uL (1.05-5.10)
MONO-0.64 K/uL (0.16-1.12)
EOS-0.50 K/uL (0.06-1.23)
BASO-0.02 K/uL ( 0.00-0.10)
PLT-610 K/uL (148-484) H
MPV-8.4 fL (8.7-13.2) L
PDW-10.5 fL (9.1-19.4)
PCT-0.52% (0.14-.46 ) H
GLU-97 mg/gL (70-143)
BUN-17 mg/dL (7-27)
CREA 1.1 mg/dL (0.5-1.8)
BUN/CREA-15 (no range given)
TP-6.0 g/dL (5.2-8.2)
ALB-2.6 g/dL (2.2-3.9)
GLOB-3.4 g/dL (2.5-4.5)
ALB/GLOB-0.8 (no range given)
ALT-78 U/L (10-100)
ALKP-326 U/L (23-212) H
NA-153 mmol/L (144-160)
K-5.5 mmol/L (3.5-5.8)
Na/K-28 (no range given)
Cl-14 mmol/L (109-122) H
Osm Calc-306 mmol/L (no range given)


8/8/12 (same ranges-I don't have the full print out on this one)
RBC-6.60 M/uL
HCT-36.9% (37.3-61.7)L
HGB-13.7 g/dL
MCV-55.9 fL (61.6-73.5) L
MCH-20.8 pg (21.2-25.9) L
MCHC-37.1
RDW-18.7%
%RETIC-0.4%
RETIC-25.1
WBC-13.04
*Skipping cell % and types*
PLT-610 K/uL (148-484) H
MPV-8.6 fL (8.7-13.2) L
PDW-10.1
PCT-0.47% (0.14-0.46)H
GLU-96
BUN-23
CREA-1.2
BUN/CREA- 19
TP-5.9
ALB-2.7
GLOB-3.2
ALB/GLOB-0.8
ALT-49
ALKP-250 (23-212)
Na-156
K-5.5
Na/K-28
CL-119 (109-122) H
Osm Calc-314


4/9/12
RBC-6.78 M/uL (5.65-8.87)
HCT-39.5% (37.3-61.7)
HGB-14.4 g/dL (13.1-20.5)
MCV-58.3 fL (61.6-73.5) L
MCH-21.2 pg (21.2-25.9)
MCHC-36.5 g/dL (32.0-37.9
RDW-19.3 % (13.6-21.7)
%RETIC-1.0% (no range given)
RETIC-66.4 K/uL (10.0-110.0)
WBC-11.22 K/uL (5.05-16.76)
*I'm skipping the percent/type of each cell (let me know if you need it*
PLT-558 K/uL (148-484) H
MPV-9.3fL (8.7-13.2)
PDW-10.9 fL (9.1-19.4)
PCT-0.52% (0.14-0.46) H
GLU-94 mg/dL (70-143)
BUN-21 mg/dL (7-27)
CREA-1.2 mg/dL (0.5-1.8)
BUN/CREA-18 (no range given)
TP-6.7 g/dL (5.2-8.2)
ALB-3.0 g/dL (2.2-3.9)
GLOB-3.7 g/dL (2.5-4.5)
ALB/GLOB-0.8 (no range given)
ALT-81 U/L (10-100)
ALKP-186 (23-212)
NA-151 mmol/L (144-160)
K-5.3 mmol/L (3.5-5.8)
Na/K-28 (no range given)
Cl-117 mmol/L (109-122)
Osm Cacl-303 mmol/kg (no range given)

2/15/12--Abnormal Results:
MCV-59.7 (61.6-73.5) L
MCH-21.1 (21.2-25.9) L
BASO-0.13 (-0.00-0.10) H
ALKP-437 (23-212) H
Other info. that may be helpful:
RBC-7.07 (5.65-8.87)
HCT-42.2 (37.3-61.7)
HGB-14.9 (13.1-20.5)
WBC-10.80 (5.05-16.76)

I also have results for 1/19/12 and a few from 2011. It took me about an hour to type this, so I need a break. ;) Let me know if you need more though, and I'd be happy to keep typing.

Thanks again SO MUCH!

Julie & Hannah

Julie, there was a very significant drop in Hannah's hemoglobin, 2 grams between April & mid Sept. Subsequent CBC s show that her hemoglobin has recovered quite nicely, so she is definitely not anemic at the present time. Was anything unusual going on in the above time period? Did you notice if Hannah may have had blood in her stool during this timeframe? I'm thinking that she might have had something like colitis with some slow bleeding in her GI tract that dropped her hemoglobin, but she may not have shown signs of being overtly ill. Since her hemoglobin has recovered, I don't think it's anything to worry about, but please double check with the vet. With lymphoma, Hannah would have probably shown a decreased WBC count & platelet count, she shows neither. With Barkley, I had the derm vet telling me he was anemic, the GP vet than asks if the derm vet said anything about B being leukopenic which is fancy word for low WBC. An overall depression of blood cells produced in the bone marrow is frequently indicative of a malignant process of some type. Hannah is not showing this.

To show you the beauty of the ultrasound, when Harley had his diagnostic US to confirm his Cushing's diagnosis, the report comes back that he has a dilated bile duct, along with bile sludge. The IMS explained that at some point Harley probably had a gall stone or stones block his bile duct, they managed to clear on their own, & Harley never got sick enough for me to notice anything amiss. The information about the bile duct ended up being very important about a year later when Harley had repeated episodes of vomiting bile colored material over several days, ended up at the vet on IV fluid overnight, & after reviewing Harley's chart, his GP vet decided that this episode was related to this bile duct issue.

Debbie

Thank you so much for the info., Debbie. I have scoured these results and looked for patterns and tried to make sense of them. Unfortunately, I can't. I can't think of anything different going on during the time the hemoglobin and hematocrit were low. We did check a fecal during that time because I was worried maybe she was bleeding (even though everything looked normal) and it was totally normal. After my vet saw the low hemoglobin and wanted to monitor it, I looked back at all of her blood work and noticed that in back in Jan. of 2012 her hemoglobin was low, but he never mentioned it. It was normal again on her Feb. blood work. Sometimes I think he forgets what we're even monitoring because it has gone from her liver to having a kidney value off once, to the possible anemia, and now to the ALT. We don't know why it recovered, but I'm glad it did...other than the new problem with the ALT.

Do you think it is weird that the ALT was suddenly high 4 weeks after being normal (and she has NEVER had an abnormal ALT level)? I am so surprised at the change. Also, the ALKP has been steadily rising too, despite her being on Denamarin. It worries me that it isn't helping anymore. Do you think that could mean anything?

I read online that dogs with Cushing's can have high platelet levels. I saw this in two or three places. Has anyone else heard of this? It doesn't seem like a common thing I read on here. I realize that we wonder if she does indeed have Cushing's, but if she does, maybe that is why it is elevated.

Hannah did have an ultrasound in April of 2011 , after the LDDS test suggested Cushing's. It was totally normal. Her liver looked normal as did her adrenal glands, although they still thought she could have early Cushing's disease. I guess if we do the ultrasound, even if there isn't some terrible mass, maybe they will see a change. My vet was talking about bile duct stuff, but thought that two weeks of antibiotics and metronidazole would clear that up and it didn't.

She also had a radiograph in August to check her back. They did the side view and the one where she lied on her back. I distinctly remember the vet who did it telling me everything else looked normal internally too. (I know that a mass may go undetected on an x-ray, but it seems there was nothing totally abnormal in August).

These are the things I can say are true of Hannah:
-She is more "lethargic" the past year or so, but that could be due to age, and she definitely has her moments where she is active, looking for food in the kitchen or following me around the house.
-She does take long drinks-30 seconds at least, but between her and my other Shih Tzu they are not emptying the water bowls (we have two medium-sized ones).
-She does sometimes urinate for a long time too, but it isn't several times a day, usually...although she does have her days like that.
-She seems to have phases where she barks at us in the evenings, usually after she has eaten, and she seems to want more food. But then it will randomly stop for weeks at a time. I can't find a pattern.
-She has done some strange things in the last several months, like wander into closets and go into corners. I mentioned this to my vet but he didn't seem overly concerned and thought it could be dimentia. It has not gotten worse, and it seems to come and go as well. At times I have thought she was looking for food, but I have no idea.
-She has had more ear infections and skin infections in the past couple of years. I'm not sure if this is due simply to allergies, or again, if she does have Cushing's if it could be due to that.
-She does have weaker rear legs, but since having the back injury in Sept. of 2011 she has not done stairs or jumped on furniture, so I assume that makes them weaker too.
-She has had some trouble defecating on and off and has needed Lactulose or Mirolax to soften her stools. We have been unsure if it is because the stool is dry/hard or if it was due to her sore back. She didn't always go daily when she was younger, and now it seems like if she skips a day it is too tough to go. With daily short walks (a couple of blocks) I can usually get her to go. When she was on antibiotics I had to stop the Mirolax because the stool was too soft, so it will be interesting to see what happens now that she's finished.

I guess if anything, I have lots of records and info. on my thread and maybe at some point all of the dots will connect and we will figure out what is going on. At this point, I think I am going to look into the ultrasound and see what it shows.

Thank you again to everyone who has offered input and advice. I sincerely appreciate it.

Julie & Hannah

Keep the faith Julie, maybe the ultra sound will tell us something. I had the same thought as Glynda, that it sure does not seem like Hannah has Cushings.

Are her allergies any better?

Sending love and hugs to you and Hannah.

I am also wishing you another


HAPPY BIRTHDAY because it is tomorrow, right?


Enjoy!!!! (as much as you can)

Julie,

Lots of good advice going your way. FWIW I have never thought Hannah had cushings either. An ultrasound is how we determined what was causing Annie's issues. Is there a teaching school nearby? They tend to have better equipment and most don't charge as much (in my case $150 vs $500) and the people reading the film are very qualified.

Hugs,
Kim

Wow-does this recent array of postings take me back! Kudos to you Julie for typing all those test results. I am SURE you were cross eyed when you stopped. I can remember doing that. I am also struck by how much I seem to have "forgotten." All those tests, all those results, and all the funny words and figuring out what they mean. Cushing's......or trying to figure out just what is going on is so complicated. I want to go back to the 1960's!

I have nothing to add to what the others have said. I do admire your thoroughness and sensibility in taking into account Hannah's age when you consider your options.

I'll be here reading. Keep up the good work!
-Susan

Thanks again for all your thoughts. Kim, the University of MN is close. I could go there, but at this point I feel like it just probably makes sense to stick with my regular vet to avoid hard feelings and awkwardness. And we can afford the ultrasound; it just stinks to blow through money on vet stuff. Hopefully the ultrasound will be all we need to rule something in or out.

Yes, Addy, today is the big day!

My dogs collided in the hallway yesterday, head-on, and of course Hannah's eye was hurt. :eek: This time it wasn't scratched though, but all red, like a blood vessel burst. Luckily she wasn't showing any pain and her eye was wide open, so when I called the E clinic they said I didn't need to bring her in. It looks to be almost completely better this morning, thank God. I was also worried she hurt her back somehow, but she seems to be okay. I just need to get through the day without any disasters or injuries!!! :D

Thanks for checking on us!
Julie & Hannah

happy birthday to you

Happy Birthday, Julie!

Happy birthday, Julie.

Happy Birthday!!!

Happy Birthday, Julie!!

Happy Birthday Julie!!!!

Hope Hannah's eye is okay today and that you both have a good day.

hugs,
Sharlene and Molly Muffin

Happy Birthday Julie!!!

I hope you and Hannah are enjoying your day!! :D

Hugs from me and Jasper

Thanks for the birthday wishes, everyone!

Hannah's eye looks great!!! Totally normal!!! You can probably guess, that is the best present I could wish for! :D:D:D

I had a great day at work. My students were very sweet with their homemade cards and little gifts, and my hubby sent me flowers and a really nice card that made me teary-eyed. I feel very fortunate.

I talked with a vet tech from the "acupuncture" vet clinic (easiest way to explain it) today about the ultrasound and bile acids test. The vet gave gave the pros to each one, with examples of what we would determine. I called back with a couple more questions, one being what about waiting a couple more weeks and retesting. I will hear back from them tomorrow.

Thanks again for chiming in with your thoughts everyone. Seriously, I would not make it without you. Even if Hannah doesn't have Cushing's, you are truly the best group of people a girl could ask for!!! :)

Julie & Hannah

Awww, we think the world of you too Julie! I'm so glad Hannah's eye is totally normal today. That little stinker, causing her mom a scare and getting a head knock from Izzy at the same time. LOL

How awesome is that birthday! Sound pretty great. Great kids, great husband. Good things come to good people. Happy Birthday.

hugs,
Sharlene and Molly muffin

Geez, Zoe and I did a head bump the other day and I freaked that I hurt her eye but like Hannah it was okay.

I am so glad you had a good birthday and that Hannah's eye is fine.

Me thinks your students love you:):):);) And we all know why 'cause we love you too:D:D:D

And hubby sending flowers, well, he's a keeper;););)

love ya

happy day after Julie! glad Hannah's eye is ok

Good morning everyone!

I have a question and one happy story to share. First, do any of you give your dog probiotics? What do you use? Any suggestions? The more holistic of the two vets left a message yesterday telling me that she thinks Hannah should be on a probiotic and also that I could mix one part apple cider vinegar with four parts water and wipe her chin with that 1-2 times per day to help clean the area she is still itching. (Either her allergies have not fully subsided, which the vet said is possible, or I'm thinking we could have a yeast issue going on). She wants to see how Hannah is in a week, unless I see something that looks bad. But then also recommended a probiotic.

Yesterday when I got home from work and my husband and I took the girls for their daily (short) walk, Hannah was moving at such a quick pace. She was way out in front of me on her leash instead of just kind of going along with me like usual. And on the way home we always stop and smell a light post and fire hydrant, then cut diagonally across the street to go home. They both know the routine and Hannah usually likes the going home part. Yesterday she tried to RUN the rest of the way home!!!:eek: I'm talking the bounding run-first the front feet, then the back. I have not seen her try to run in YEARS. Of course, I'm not supposed to let her run because they don't want her to hurt her back, so I had to hold her back and eventually pick her up because she really wanted to run!

All I could think was well, her back sure must be feeling good, and she sure isn't acting like a dog that's got problems! It made me so happy to see her like that. You would have never known she was 13 1/2 years old!

I should hear from my regular vet today about her thoughts on a plan of action. I have some recommendations from the other vet. Once I have both I'll make a decision. I may be back later to get your thoughts too! :D

Have a great day!

Julie & Hannah

Hi Julie, I'm so happy to hear that Hannah is feeling so perky! :)

My non-Cushpup Peg has been taking daily probiotics ever since her pancreatitis attack last year. Vetri-Science makes probiotics in both chewable and capsule form, and Peg gets the chewable "Vetri-Probiotic Everyday." It's more expensive than the capsule, but it is so easy to dose her with it that I haven't switched. I'm sure there are lots of other good products out there, too, but I've stuck with this because her GI issues have been calmed down for months now and I don't want to rock the boat in any way! I give her a little less than the recommended dosage for her weight in order to stretch the product a little bit :o, but so far she's done great on it.

Marianne

Run, Hannah :D

It sure makes us feel good to see them happy and playful. That is wonderful, Julie. Enjoy every minute. That is like Zoe the morning after her Tramadol and she is trying to do roll overs in the kitchen:D

I've tried a few probiotics on Zoe. The one that has worked best for her is Gentle Digest Ark Animals. I give it to Koko as well. They get one a day and make sure the probiotic is given a few hours before or after any antibiotic.

I tried some human ones as well but with not as good of results. The holistic pet store told me that is the one she reccommends and that all her customers have good results with it.

Happy Wednesday!

That is such a happy post! Yay! go Hannah! don't you just love their little wiggle butts when they take off like that! hahahahaha

hugs,
Sharlene and Molly Muffin

Hi Guys,

My sweets was super quick again today...not quite as much attempted running, but still a little, and she is perkier than ever.

I talked to the other vet at my regular office today and she was so helpful. We talked for 25 min. and she answered all of my questions and was very direct and specific with her thoughts. What's even better is that she and the other vet (holistic-traditional) agreed on two things: 1. I can just redo the regular blood work on Hannah and see if the level is still high before doing anything else, and 2. They would both do the ultrasound next because they feel it is more helpful to know if there is a tumor or something visibly wrong, rather than doing the bile acid test first. Both seemed to think the bile acid test is still a valuable piece of the puzzle, but thought the ultrasound would be more helpful.

So, it's good to have a plan. I decided to just repeat the blood work next Thurs. (That will be two weeks since the last test and one month since the first elevated ALT level). She recommended that I do the full panel, which also includes the AST and GGT liver enzymes, just to get even more info. They were both glad to hear Hannah is happy and not symptomatic whatsoever.

There is one other thing I'm worried about, regarding Hannah's allergies/itching. I am suspicious she may have a yeast infection on her chin/neck. She is still wearing the e collar, but just goes crazy trying to itch there whenever it's off. That's been a problem before, but it seems worse now, and she just finished antibiotics a week ago (and the area was looking pretty good a week or two ago). I may need to have them do a chin scrape to see. The vet recommended giving it a week to see if it is allergies unless it is really irritated, red, or stinky. I keep trying to smell it, but don't know what it would/should smell like. I almost think I should just have it checked because if that's the main issue maybe I can get her out the e collar sooner. Anyone have experience with yeast infections on the chin/neck area? Any sure signs?

Thanks again for your advice! I'll be looking into the probiotics more this weekend. I want to see if the holistic vet recommends any of the ones you guys have mentioned.

Julie & Hannah

Renee's angel Snoopy had a red yeast problem. I dont have a chance right now to do a search for it, I'll look at lunch.

Julie- what is in Hannah's food as I know some yeast problems comes from diet, the probiotics should also help.

They ususally change the diet, give probiotcs, use the cedar vinager, if I remember, Renee dabbed the spots with the vinager as well but that must sting because, I know I tried it on a spot on Zoe and then dapped some on me and it did sting.

Just a quick update from me....

Hannah does have yeast on her chin/neck. They did an impression smear (just pressed the slide on her skin) and then lightly scraped her skin with the edge of the slide and it was positive. Because her liver is out of whack, the vet did not want to try oral ketoconazole first, so we are using ketoconazole wipes on the area.

She is so itchy on her sides too...and frantically bites at her feet when she has the e collar off. I am worried she may have yeast all over....but she doesn't have any bare spots, or oozing, crusty sores....at least not yet. Just her neck looks kind of irritated at this point. She is getting a haircut on Sun. so maybe I will see more then. I did a bath with ketochlor shampoo on Sat. and that evening she was itching worse than ever with inflamed skin. Not sure if that was from the shampoo, the bath in general, or being outside on a walk. Ugh.

I am sort of irritated that my regular vet has never checked for yeast before and wonder if this has been a problem for a looooong time. I don't know if I should have them test other areas on her or what. It seems like my other vet just gave us an antibiotic for an infection whenever they saw irritated skin, and now I realize that can contribute to the problem!!! I'm glad the vet that also does more holistic stuff told me to use the probiotic and also said to use 1 part apple cider to 4 parts water and to wipe itchy areas. For now, I am doing that on her sides and feet until I figure out what to do. I am so frustrated because I want to help her but then the treatment can also hurt her.

She is getting her blood test again on Thurs. I am planning to do the ultrasound after that, unless things have resolved. I feel like I need to know more so we can move forward with an oral anti-fungal if we need to. I won't let them biopsy anything, so I realize we may not know, but hopefully we can rule out a mass. I'm worried the ultrasound will hurt her back again, like the xray did last summer. We had a month of acupuncture after that. She needs to be in the same position (either on her side, or on her back in the foam). I have a call into the vet to see if we can give her a little Xanax first.

I'll keep you posted. I'm just really frustrated right now. She isn't miserable but I can't help but wonder if this whole itching mess is all about yeast! But I feel like I would see worse symptoms.....it's a mystery.

Julie & Hannah

dang, I am so not good with these searches. I cannot find Rene's posts on how she successfully treated Snoopy's yeast problem. Rene thought it started from sweet potatoes in her diet.

I hope Hannah does not have to have another ultra sound, it seems her back is better and it is so good to read about her feeling frisky .

Maybe the weather will break and we will get a hard freeze. My allergies are terrible and now even Koko is sneezing:eek::eek: Another friend's pup is itching like crazy! Here we go again, a repeat of last winter:rolleyes::rolleyes:

hang in there, winter break is around the corner, can you believe that? Didn't school just start?

Hannah is getting her blood work checked again today to see how the ALT is looking. My mom is bringing her in for me this morning. They are doing a bigger panel this time, and adding all liver values. I also asked about having her thyroid checked, since I don't know that it ever has been. After reading about thyroid issues on here, I thought it might be worth checking. I've asked them to ask the vet what she thinks. If things are still the same (which I assume they will be) we will probably move forward with the ultrasound. I'll let you know what I find out.

Julie & Hannah

I have some preliminary info. but I am waiting for a call from the vet. Hannah's ALT is now 186. I believe she said it was 254 two weeks ago, so it is dropping, but normal is 100 or lower. Another liver value (did not catch which) is also high. I believe she said it was 13 and was not supposed to be higher than 7. Her Bilirubin was normal, which she said was good. Her ALKP is now at 903 and it was in the upper 800s two weeks ago. They also tested her thyroid and it was just very slightly (a couple of tenths) abnormal. She said I could choose to do a full thyroid check for $96 but that dogs with other problems can have thyroid levels that are off, so that is up to me. She said I could proceed without doing anything since Hannah is not acting sick, or I could do an ultrasound to see if we can see more. Her biggest issue is the itching and the yeast at this point. I don't know what to do. I don't know if I check the thyroid to see if it is a problem, and a possible cause of the itching and skin problems, or if I do the ultrasound so we know if we can ever give her an oral med for the yeast, or if I wait and repeat blood work....I have a call in to the vet to see what she recommends.

I looked back at Hannah's ultrasound results and am worried because her birth date is wrong (it says 3/30/01) but the date was 3/30/11 when they did the ultrasound and I'm wondering if they just guessed because they didn't know the age. It said "10 years" and she would've been 12. I also am concerned because it says weight "10.8kg" and Hannah weighs about 12lbs. I am hoping it means pounds and it was one of the times that her weight was a little off because she was moving around on the scale. It does say Shih Tzu, so I sure hope I have the results to MY DOG'S ultrasound! You can bet I am going to ask, though!

I'll let you know more when I have more information, but I certainly would like your input.

Thanks so much!
Hannah & Julie

Crossing fingers and toes for positive results today!!

hugs,
Sharlene and Molly Muffin

I sure would have them double check the results to be sure they are Hannah's. I was at an office visit somewhere recently and whomever I was going to speak with had someone else's file on top and started referring to me as that person. It seems like everything needs to be triple checked these days.

-Susan

Guys, I'm losing it. Right now, I fear I'll be putting Hannah to sleep because she is so itchy and full of yeast/infections that she is miserable and we can't give her oral ketoconazole because of her liver.

I am still waiting to hear from one vet, but I am getting frustrated that I can't get any answers. At this point I am trying to treat what is actually "wrong" with Hannah, and that is her itching. She has been wearing an e collar for several weeks and she is scratching her sides and chest, and she bites her feet and scratches her neck when the collar is off. I wonder if there is yeast all over her body. When I told the vet that is my concern right now and I wondered if we should see if there is indeed more yeast, her answer was that if there is more yeast, they would still treat with the oral med, and because of her liver she doesn't want to do that. So where does that leave me?

I asked the vet tech who called me back to ask her what she would do if it was her dog. I'm confused about where this leaves me. If I do an ultrasound, we still may not know what is wrong. I will not biopsy anything. She is old and I wouldn't treat it if she had cancer anyway, and I don't want to risk any problems from a biopsy anyway. And what if we see nothing abnormal? Then we still don't know what is wrong with her liver. I guess I need to ask what the circumstances would need to be to give her the ketoconazole orally. Do the liver values need to be normal? Should I now do a bile acid test to see how her liver functions? Would that tell us if she could handle it? Do I do the thyroid test for $96 because her thyroid was off by a couple of tenths, and see if that may be the cause for the itching? It still wouldn't fix the yeast.

I am not handling this well today and am on the verge of a breakdown. To top it off, there is now a winter storm watch Sat. night into Sun. and Hannah is supposed to be groomed on Sun. She needs a haircut, especially to get the hair on her neck shorter. I'm worried the weather will be too bad to go (it's a bit of a trip bc I go to an in-home groomer who will just shave her down while I hold her to prevent back issues). The groomer had no other openings before Christmas. So that is stressing me out too, yet I don't even know what will happen.

I just don't know what to do anymore. I worry they are going to think I am crazy at both vet offices, but I am just trying to take care of my dog. They tell me I can wait to do further testing because she is acting healthy, but the problem that actually is manifesting itself, the itching, we can't fix. The ALT dropped 68 points in the past two weeks, but it is still 186, 86 points above normal. And some other liver value (still don't know what) is also high. But Bilirubin is normal. And ALKP is 903.

Ugh. I have to leave soon because I have plans to go to the Timberwolves game with a friend. I probably won't even be able to hear the phone when the vet calls, which is also frustrating. I feel helpless and hopeless right now. And I feel like I am failing Hannah because I can't make her better. I wish I knew what to do...

Julie & Hannah

Okay, deep breaths, in and out, there has to be other ways to treat yeast.
1- did they do a scraping- what kind of yeast is it?
2- what do you feed Hannah?
3- are the topicals not working?
4- did you start a probiotic?

can we try to change her on the inside? I know an aquaintence whose dog had such bad allergies the traditonal vets gave up on her and told her mom to just put her down. She went to a holisitc vet and started her on a raw diet. She has to switch the proteins around, rotate them, but the dog is fine now, has hair, minimal itching, you should see him.

I am bringing this up just so we can talk about what Hannah's diet consists of becuase if she has yeast, I think her diet needs to be meat based with no grain, no sweet potatoes and a good probiotic.

Would that not start the healing on the inside? I am just throwing this out there to start the discussion if you cant use the oral ketoconazole because of her liver.

Maybe you are already feeding that:o:o:o:o


You are not failing Hannah, nor have you ever failed your little girl. Compared to some of the dogs here, her numbers are not as high as some.

The storm will probably end up being nothing, just a bit of snow, it will be fine.

Go enjoy the game and lock it all up for the night. You will be able to think better tomorrow and hopefully others will chime in.

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

Okay, Addy is right, deep, deep breaths, slow.

Now, okay, so, lets see what kind of options are available.

I've got two sites, that talk about the yeast infections:

http://www.westiemed.org/health/malassezia/

http://www.peteducation.com/article....2+2102&aid=321

This stuff you probably already know.

Now, this one is sort of an alternative medicine site, in that I'm mainly reading the comments to see what others are doing for their dogs yeast infection.
One is wiping down with an infusion of steeped jasmine tea. That sounded interesting. Oh and just read another one who is doing the jasmine tea thing and both say it is working. Because of not being able to give ketoconazole, and everyone seems to agree that if there is a preexisting liver condition, then that shouldn't be used, at least orally, then maybe could find something to try on there.

http://www.earthclinic.com/Pets/yeas...ions_dogs.html

As far as food goes, nothing with starch in it, sweet potatoes, etc. that turns to sugar is something that yeast just loves, so if healing from the inside, that might not be a good bet.

I'm just trying to come up with things that might work and save you from having to take that step that would just break your heart. You are such a great mom. I hope you know that.

hugs,
Sharlene and Molly Muffin

well just fyi.a friend has a lab/mix and suffered for months with yeast/skin stuff.she switched his diet to only Natures Variety Instinct Raw Boost and in a short time her baby was not itcy,rashes subsided and is now just a fine happy little boy.i was thinking about putting my two on this,but i wanna wait until milo gets through his stuff.hope this is helpful,pulling for you ...patty and milo

Julie, I don't remember, but has Hannah ever been seen by a derm vet? If she has, then never mind. If not, a derm vet may be able to offer you some hope. Barkley's severe allergies were managed by a derm vet who was very well aware of B's Cushing's, & therefore not steroid containing meds could be used. The derm vet put B on several alternatives which were nothing short of a miracle.

Debbie

ps i have also been using Vetericyn VF spray on milo for his collorettes (skin inflammations under both armpits) and it always helps alleviate these symptoms.it is for wound and infection care you just spray it on 2xdaily.i see it has truly worked for milo when he has his outbreaks.he does not have cc....

I believe I read where some yeast infections can be attributed to food allergies so maybe an elimination diet could help. Also I have read where a 50/50 solution of vinegar and water can be used on the dog for yeast infections as long as there are no open sores.

Sending tons of healing and loving hugs, Lori