Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

Molly's ears were checked by the vet this morning. No outward sign of any infection left, but still a tad pink, so we'll continue for 3 more days to get rid of anything micorscopic that might be left in there. Over all good and her lymph node in her neck appears to have gone down. (it was a bit enlarged in August)
So over all good. Discussed getting that next ultrasound, which will be the new year based on my schedule and weather issues.

I'll post a new comparison test history. Her ALP and ALT are the highest they have ever been, Albumin just a tad out of range, and it has fluctuated over the last two. So main thought for myself right now and suspicion, is that she might have more sludge in her gallbladder than she did in June. Just something I've noticed on the forum here, is that when there is more sludge, the ALP Always has gone up. She had some sludge previously, not enough to cause a blockage, but that is one of the things we'll look at on the ultrasound and also her liver and lymph nodes are the next thing to check out thoroughly. We Expect that her adrenals will remain bilaterly enlarged to some point, as will the liver, because we think she Is producing cortisol over normal amounts, but the reason is unknown and pituitary cushings still remains a possibility.

So there you have it gang. Molly acts normal, a bit older perhaps, but still basically happy, and her numbers, are going up, which is indicative of something, we just have to keep trying to figure out what that is.

hugs all
Sharlene and Molly Muffin

MOLLY MUFFIN TEST HISTORY

ACTH (2 draws - this is due to the agent used by the vet) June 2012
Cor1 - Cortisol (base) 172 (30 - 300) 6.23 ug
Cor 21 - Cortisol (ACTH) - 1 hour 924 33.49 ug
Cor 22 - Cortisol (ACTH) - 2 hour 1014 36.75 ug

Lab states, that in a normal animal Cortisol will increase above 250 but not above 600.
The results are consistent with Cushings Disease; Pituitary-Dependent Hyperadrenocorticism

LDDS - May 2011
Cortisol (Base) 82.2 (20 - 300)nmol 2.97ug
Cortisol (DEXA) - 4 hours 28.7nmol 1.04ug
Cortisol (DEXA) - 8 hours 35.1 nmol 1.27ug

LDDS - August 2012
Cor1 - Cortisol (base) 30 - 300 range nmol/L 2.86 ug
Cor34 - Cortisol - 4hrs < 27.59 nmol < 1 ug
Cor38 - Cortisol - 8hrs <27.59 nmol < 1ug

LDDS - December 2012
Cortisol Base 87.2 nmol (30 - 300) 3.16 ug
Cortisol 4 hr <27.59 < 1 ug
Cortisol 8 hr <27.59 < 1 ug

not cushings

Ultrasound July 2012:

Liver: mildly enlarged, diffusely hyperechoic and margins rounded
gall bladder: moderate amount of echogenic debris present
stomach: moderate gas
left kidney: hyperechoic speckling in the cortex and mild derease in corticomedullary definition
left adrenal gland: mildly enlarged with caudal pole larger than the cranial pole
Urinary bladder wall: mildly thickened at the apex, although lumen is not fully distended.
Mucosa: mildly hyperchoic and irregular and two small calculi present
right kidney: similar in apperearance to the left kidney - small non obstructive calculi present
right adrenal gland: upper reference of size to mildly enlarged
lymph nodes: mildly enlarged

Test Histories:

ALT - 54 (10 - 118) May 2010
ALP - 518 (20 - 150) May 2010

Albumin 46.7 (26 - 44) April 2011
Protein 78 (51 - 72) April 2011
ALT - 110 (6 - 118) April 2011
ALP - 764 (5 - 141) April 2011

Albumin 44.1 (26 - 44) (barely out of range) March 2012
Protein 76 (51 - 72) March 2012
ALT - 139 (6 - 118) March 2012
ALP - 1121 (5 - 141)

ALT - 152 (6 - 118) June 2012
ALP - 1003 (5 - 141) June 2012


Albumin 46.8 (26 - 44) August 2012
Protein 74 (51 - 72)
ALT - 144 (6 - 118) August 2012
ALP - 1054 (5 - 141) August 2012
and finally Urine gravity 1.038 August 2012

Thyroid Mini Profile - all within normal ranges December 2012

Albumin 47.3 (26 - 44) - December 2012
Protein 73 (51 - 72) - December 2012
ALT 125 (6 - 118) - December 2012
ALP 1229 (5 - 141) - December 2012
Cholesterol 10.39 (2.50 - 9.90) - December 2012 (I was told to ignore this due to possible sm amount food in the AM)

Urinalysis all normal, no crystals
gravity - 1.035 (clear, dark yellow, concentrated) - December 2012


ALT 132 (6 - 118) - June 2013
ALP 918 (5 - 141) - June 2013
Sodium 143 (144 - 162)- June 2013

Urinalys specific gravity in May was 1.020 which is more dilute than it was.
Hazy, Leukocytes Ca 70 leu/ul, WBC 3 - 5/hpf (1+), Bacteria 2 - 5/hpf (1+) cocci

December 2013
Albumin 44.9 (26.0 – 44.0) – December 2013
ALP 1479 (5 – 141) – December 2013
ALT 167 (6 – 118) – December 2013
Hmm, she didn’t give me the urinalysis other than the microscopy part, which is fine, but she had said,
Urine specific gravity 1.032 protiens all fine – December 2013

So, her albumin is back up a bit, and her ALT and ALP are the highest they have ever been even with the heppato support. Thyroid, glucose, cholesterol, bili’s all within normal ranges.
Due to weather and work schedule over the holidays I won’t be able to get an ultrasound till the new year.
Discussion with vet said, that perhaps with molly getting older, and her not showing any symptoms of anything wrong, these values might end up being her new normal, unless the ultrasound shows a problem with the things we want to check, liver/lymph nodes/adrenal glands/gall bladder. Kidneys are working fine, and nothing else Really shows up in the blood work or urine to suggest what might be causing her liver values to increase.

That's a lot of testing, and some baffling results!

Hi Renee, I always re-post the history so I don't have to scrolling through the thread and my papers each time I want to refresh my memory. I agree, I think we all agree, molly has been baffling us all for years now. We started being told in 2011 that it was cushings, and some things say yes, some things say no. Which is why we monitor blood work so frequently, so see if anything changes enough to point us in a definite direction. Sometimes that is all you can do. IF she had typical symptoms, along with the ACTH and ultrasound, we'd be on medication. If we only did the LDDS, she wouldn't. Since we've done all of them, and no symptoms still (typical anyhow) she isn't, but we continue to monitor as it could change one way or another at any point. It's a doozy eh.

Hugs,
Sharlene and Molly Muffin

What symptoms does she display? Are you just following blood work, or are there active symptoms you are dealing with too? Forgive me, your thread is very long...haha, and I have not been able to read all of it!

Hi Sharlene

Just having a look through the results, so good to have it all in one page. I do wish we could insert tables in here. I saw someone do it once but I have never figured it out!!

Pleased her little ear is nearly healed up!

Flynny's albumin has been on the high side at times, a comment from IMS was that not much puts it up other than dehydration so I wonder if she was fasted for the tests it could cause it?

Her ALP has been up since the beginning of these tests, like May 2010. That is 2 1/2 years now!! So I would have to think if it was anything real nasty like tumours etc then it would have declared itself and done something a little more dramatic than the slow rise we have seen. ALT relatively stable. But I get what your saying about wanting to know what is going on and agree ultrasound is the way to go. Maybe the mild liver enlargement is causing it, did she have many doses of steroids when younger for any reason?

Oh good lord, no one could go through and read all of this. It's mostly giggles anyway, as we don't have too many issues with Molly.

Molly symptoms according to the vet is pot belly and thinning hair. That's it. She doesn't over drink, she is prone to crystals and doesn't drink enough in fact. I have to give her SO food or she Really doesn't drink enough.
No ravenous appetite either, she picks and chooses through her food and grazes through it during the day. Her weight has been pretty constant, and the only issues she generally has is ear infections started this year and she is prone to some stress colitis when she is boarded, seems to pick up some bacterial intestinal bugs pretty easily, nothing chronic though.

So, that is why we haven't done anything with her medically, other than liver support. Her liver numbers started going higher a number of years ago (not where they are this month though, sheezz) about the same time she got the first bout of crystals and intestinal bug.

She has a couple lipomas we are watching that we've also tested to verify that is what they are, and she has a hip joint that the groove isn't formed deeply enough in from birth, you'd never notice unless she tweaks it, but arthritis will be an issue for her in that leg most likely.

A bit of sludge in the gallbladder, a couple small stones, neither big or enough to cause blockage on last years ultrasound.

That's about it.
So mostly Molly's thread is about how funny she is, unless something comes up. She is one of our forum diva's for sure. :)

hugs,
Sharlene and Molly Muffin

This is why I love her thread, a bit of light relief and a laugh is just the ticket on this forum sometimes!! We love our little Miss Molly xxxxxxxx

No, Molly has never had steroids since I've had her at 11 months old. Doubt if she did before, based on what I know of that situation.

Fasting, she might have been, they did the testing while we boarded last time.
I'm not overly worried about the Albumin unless it were to shoot up.

I think the only one that freaked me and I know that it can go up, is the ALP that she had dropped down into the 918 in June from 1229 Dec 2012, and then a jump of over 500 points up in 6 months was a bit much.

Quote:

---

A mildly elevated level of AP is found in normal dogs and cats when they are immature.

When AP is elevated in mature pets, most causes are associated with a liver problem that prevents bile flow (such as cholestasis in cats ) or bile duct obstruction (gallstones) – particularly when GGT enzyme is elevated equally or greater.

Other causes are Cushing’s disease, Corticosteroid medications, Hepatic Lipidosis (fatty liver disease) in cats, Colangiohepatitis /Triad Disease in cats, FIP in cats, Hyperthyroidism in cats, hypothyroidism in dogs, Less commonly: diabetes, kidney failure-related hyperparathyroidism, liver and bone cancers, liver-toxic dietary toxins (like aflatoxins), widespread granulomas, abscesses, pancreatitis, upper intestinal inflammation, anti-seizure medications, autoimmune diseases, gallbladder mucocele, occasionally with mammary tumors, healing fractures and an occasional liver reaction to anti-arthritic NSAID-medication. Mild persistent elevations are more of a worry in cats than in dogs.

Alkaline phosphatase levels sometimes go up in dogs with failing hearts and in genetically-based, copper storage diseases of Dobermans, West Highland White and Bedlington terriers, as well in pregnant cats.

---

Some of those can be ruled right out, so liver, gall bladder, gastrointestinal, heart would be I think likely culprit possibilities unless cushings Is in play. Other possibility is the vet saying this could be if nothing shows on ultrasound, molly normal. I don't know if I really believe molly normal though, just in general, there is a reason, question is whether or not that reason is something to be concerned about or not.

I'm not freaking over it though. :) I'll behave. hahahaha I will get her in as soon as weather and work allow, prob jan or feb for the ultrasound. They are crazy booked up and people on holidays at the clinic right now, so nothing worked out scheduling for immediate.

Thanks for looking over Trish. It's so valuable to have opinions from others too. We look at so many of these test results on the forum and yet when it comes to our own, it's like doubting what you know. LOL Does that sound a bit weird? I think it does.

Hope everyone is having a good weekend and ready freddy for the holidays. You guys know what I am doing right....... yep....Procrastination 101~!

I should be wrapping gifts and I have found a million excuses including a nap, not to do so. (I'm blaming the nap on molly, she looked way comfy in the blanket on the couch)

And wrote another book!

Hugs,
Sharlene and Molly Muffin

Book schmook, some of us need a few more words than others is all!!

I know exactly what you mean, when its your own baby it's different, the ability to rationalise can fly right out the window which is why I value all your the groups opinions so highly!

I wonder about those lipomas and fatty liver, Flynn has tons and while we know the cause of his high ALP/ALT I wonder if they also enter into the mix.

Oh gawd, Mum just rang and wants me to take the electric wine chiller thingy over... cannot find it anywhere :eek: think it might have been a present she gave me... one of those ones that I have never really used and put somewhere :eek: going to enter the garage and that is never fun there is so much junk in there!!!