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If your IMS can't find another vet with a BP machine you can purchase one online and have your IMS teach you on how to use it.
Here's a link to a couple I found: http://www.vmedtechnology.com/Vet-Dop.htm
http://www.petmap.com/
Oh Sharlene, I know how worried you will be about sweet Molly but I do hope you have a wonderful time visiting your sister.
Love and Hugs, Lori
Have a great time on your trip Sharlene. I know your thoughts will be home with Miss Molly at times, but I hope you can "escape" some of the time and have some fun. It will all be here when you get back. <3
Have fun in the sun Sharlene, if I was your vet I would be listening and reading every word you put down for them!! Be good if the had doggy cam so you could keep an eye on her yourself! They know you and Molly well so with this new BP issue I am sure they will be taking extra special care of her. xxxx
I'm back :)
Molly visited the IMS today and her BP was 150. Whoo hooo. She was almost a constant 180 last week. So this is an improvement. We just need to keep her at that range now. 150 shouldn't cause retinal bleeds and that is important!! We want to save as much of her sight as possible.
They want her switched to a renal diet soon though. We ran a recheck of blood work today. We also are doing a couple other tests, but everything seems to be pointing to kidneys being the underlying problem.
I admit to being emotionally exhausted and half the time feeling brain dead these days. You can't help worrying about them.
I don't know what is going on with my vet lately, but something sure seems to be. No follow up calls in regards to after care, didn't run requested tests while Molly was boarding (the IMS drew blood for those tests today along with the other things she wanted to do) No follow up on the renal diet or finding a local vet near me that can do the BP tests.
This is really not like my GP vet at all, so I'm a bit concerned and it just adds to the stress. Now my IMS said she is going to email some contacts about what would be the best food for molly. She is thinking a vegetarian food, or novel protein with SO index, wet might work best.
My head hurts sometimes trying to keep everything between molly and hubby straight. His surgery is scheduled for mid November.
That's my update on the muffin. :)
hugs
Sharlene and molly muffin
Wtg on the BP constant 150 we,ll take that. So it's pointing towards the kidneys, hopefully a new Noval diet will help.
So sorry your feeling emotionally drained and brain dead no wonder you have had so much to consend with recently between molly and your hubs. So have a huge HUG from me you are doing a fantastic job with both Molly, your hubs and work. I think sometimes you get overwhelmed with everything as its always on your mind day and night but remember to take 5 mins for yourself and regroup your thoughts.
Can you raise the concerns you have with your vet, see what's been going on and if you iron the problems out.
We are all here for you to lean on gawd we,ve all leaned on you often enough so feel free to lean and vent on us. Have another Hug
Oh Sharlene, I'm so glad Molly's blood pressure is down! All fingers crossed that this is just the beginning of a really positive trend. :)
With so much worry on your plate, I feel like a heel bringing up the subject of cortisol yet again. I promise this will be "it" and I'll try to let it go from now on. But in view of Molly's issues with blood pressure and protein loss, in good conscience, I feel a need to talk about the cortisol one more time. Molly's cortisol has been highly elevated for a good while, and I know your IMS is puzzled as to the cause -- for good reason. But it seems as though she just keeps sweeping it under the carpet. Regardless of cause, elevated cortisol can contribute to both hypertension and protein loss. Unless the cortisol is addressed, I'm not sure how you are going to get a totally satisfactory handle on these problems.
The normal reference range for this lab is 6.5 to 17.5 ug/dl. So since at least June of 2012, Molly's cortisol has been significantly elevated. I know your IMS commented on the fact that the cortisol had "gone down," but it seems to me that the difference between 36.75 and 34.5 could just be lab variation or normal daily variation. That does not seem like enough of a decrease to warrant believing that anything has significantly improved during these two years. I know there is a bit of the "chicken-and-the-egg" issue with all of this -- what came first, the high cortisol or the kidney issues? But with the recent onset of the hypertension and the lack of evidence of significant kidney dysfunction prior to 2012, it seems more likely to me that it was not her kidneys that caused Molly's elevated cortisol, but they are instead suffering as a result. At a minimum, the cortisol cannot be helping the problems that now exist. And so I can't help but wonder whether these new developments warrant more urgency in dealing with the dilemma of the cortisol.Quote:
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
ACTH april 2014
Pre 29.5nmol range 2.1 - 58.8 1.06ug [corrected to 2.95 ug/dl]
1hr 283.1nmol range 65.0 - 174.6 10.26ug [corrected to 28.3 ug/dl]
2hr 345.6nmol range 65.0 - 174.6 12.52ug [corrected to 34.5 ug/dl
In the absence of Cushing's symptoms, I do understand the reservations about aggressive treatment beyond the melatonin and lignans that you are trying now. But it just seems to me as though Molly's cortisol is the elephant in the room that your IMS chooses not to address. I would flat-out ask her: with a cortisol level that has remained so highly elevated for this long and given the known impact of steroids on hypertension and kidney function, do you think we can satisfactorily control these issues in the absence of significantly lowering the cortisol in some manner?
(And now I've said my piece, and you can whip me with a wet noodle, and I promise that I truly will not bring it up again...:o :o :o).
Marianne
Go Molly. Go Molly!!!!
Sharlene, I would absolutely bring up your concerns to your vet. In light of the grievous error that Daisy's vet made, PLEASE talk to them. Don't hold back.
I'm glad that your IMS in on top of things though.
I would like to know exactly what is causing her Cortiaol to be high so that it can be remedied.
Hood luck to hubby!
The IMS is suppose to call me today if the lab results come in. I have constantly mentioned the cortisol factor but they seem unwilling to go anywhere with it with her not having classic symptoms. I am thinking to ask to start her on low trilostane to see if it would help. This is all so scary. What do you think?
Hugs
Sharlene and Molly muffin.
After opening up my big mouth, I don't know whether trilo is the way to go or not. But I guess what I'd be hoping for, first, is for the IMS to engage in a genuine conversation as to the significance of the cortisol. It's true that up to now, Molly had not exhibited any outward symptoms. But suddenly she's got two big issues that, as far as I know, are genuinely impacted by elevated cortisol.
I think we've got a quote somewhere from one of the Cushing's gurus stating that in otherwise outwardly asymptomatic dogs who test positive for Cushing's, hypertension and/or significant proteinuria is a sufficient trigger to start treatment. I'll try to look that up again. However, I do realize that the negative LDDS results really muddy the diagnostic waters for Molly and make her case ever so much more confusing.
With that in mind, I wonder if your IMS would be willing to ask some colleagues what they would do in this situation. I do not have the training to know the right answer. But boy, I bet our Molly could generate a lot of conversation at an endocrinology convention!
Bottom line, if your IMS still thinks the risk of intervening with the cortisol outweighs the benefits, then she's the expert. But I'm hoping she'll address the issue straight-on so you'll truly know what it is she is thinking is best, and why. And if she's in doubt herself, I'm hoping she'll bounce the question off some other specialists.
Marianne
P.S. Here's the quote. It comes from Dr. Peterson's blog, and as it turns out, it is in response to a question asked by our own Glynda!:
http://endocrinevet.blogspot.com/201...corticism.htmlQuote:
I am not a proponent of treating dogs with asymtomatic Cushing's disease, unless they have secondary hypertension or proteinuria.
I know what you mean Marianne. We've discussed it every visit. When the retinal bleeds and hypertension where discovered both her and I brought it up to the eye specialist who said she had not seen retinal bleeds caused by cushings. So, she didn't think that was the problem causing the hypertension, but that protein loss, could and would cause retinal bleeds. That is why they chose to go with treatment of the kidney first.
It is very frustrating! I want to do whatever is best for her, but it is hard to pin it down and yes that LDDS is causing the confusion I think as it is consistently negative.
Argggggh
Sharlene and molly muffin