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What a cute photo of Tess. Thanks for doing that... her eyes show she is a sweet soul.
Glad Alison mentioned the potassium in the pedialyte so ignore my earlier suggestion on that. Good catch on her part.
Great news that Tess was able to poop. Not surprised she was a little slow on the walk. Thats ok since her levels aren't all normal yet... she has earned some slack.
Off to work will check in later. Kim
Hi Dottie,
Sooo, you're a terror, huh? :p Is that the same as being a mouthy old broad? That's me. :D:p
I was a bit concerned that you were getting upset with us and am very glad to know differently. We have all been so worried about your sweet baby and were working so hard to help her and you, too. We have a tendency to come across rather heavy when a pup comes to us in crisis but it is only because we want so desperately to get things going in the right direction and save that pup. It could feel as if one were being ganged up on, but that is never our intention and I am so glad you were able to see our true intent. :)
I am so glad each morning to read that Tess has improved even more. You have done such a great job, mom!
Alison did a wonderful thing in catching the potassium levels and steering you to the salt VS Pedialyte. She is very crafty but I have always felt she is a doc in disguise! :);) Alison is one of the many pros we have here.
Keep up the good work!
Hugs,
Leslie and the girls
Hi Everyone. I have Tessie new Labs:
ALB 3.7 2.5-4.4 G/DL
ALT 135 10-118 U/L
AMY 689 200-1200 U/L
TBIL 0.8 0.1-0.6 MG/DL
BUN 33 7-25 MG/DL
CA++ 12.3 8.6-11.8 MG/DL
PHOS 6.2 2.9-6.6 MG/DL
CRE 0.9 0.3-1.4 MG/DL
GLU 102 60-110 MG/DL
NA+ 144 138-160 MMOI/L
K+ 5.5 3.7-5.8 MMOI/L
TP 6.7 5.4-8.2 G/DL
GLOB 3.0 2.3-5.2 G/DL
NOW I got the Blood work from JUNE 5th 2009. I get Tessie Blood drawn once a year. This Is the Lab report that got My Vet to test for cushings.
CHEM 27
ALK. PHOSPHATASE 4891 (H) 10-150 U/L
ALT (SGPT) 139 (H) 5-107 U/L
AST (SGPT) 19 5-55 U/L
CK 110 10-200 U/L
GGT 66 (H) 0-14 U/L
AMYLASE 565 450-1240 U/L
LIPASE 691 100-750 U/L
ALBUMIN 3.7 2.5-4.0 G/DL
TOTAL PROTEIN 7.3 5.1-7.8 G/DL
GLOBULIN 3.6 2.1-4.5 G/DL
TOTAL BILIRUBIN 0.1 0.0-0.4 MG/DL
DIRECT BILIRUBIN 0.0 0.0-0.2 MG/DL
BUN 17 7-27 MG/DL
CREATININE 0.6 0.4-1.8 MG/DL
CHOLESTEROL 439 (H) 112-328 MG/DL
GLUCOSE 108 60-125 MG/DL
CALCIUM 11.2 8.2-12.4 MG/DL
PHOSPHORUS 5.8 2.1-6.3 MG/DL
TCO2 (BICARBONATE) 20 17-24 mEq/L
CHLORIDE 104 (L) 105-115 mEq/L
POTASSIUM 6.6 (H) 4.0-5.6 mEq/L
SODIUM 147 141-156 mEq/L
A/G RATIO 1.0 0.6-1.6
B/C RATIO 28.3 DOES NOT GIVE A NORMAL RANGE
INDIRECT BILIRUBIN 0.1 0-0.3 MG/DL
NA/K RATIO 22 (L) 27-40
HEMOLYSIS INDEX +
Index of N,+,++ exhibits no significant: efect on chemistry values.
LIPEMIA Index
Index of N,+,++ exhibits no significant effect on the chemistry values.
ANION GAP 30 (H) 12-24 mEq/L
T4 0.9 0.9-3.9 UG/DL
Interpretive Ranges:
<0.9 Low
0.9-3.9 Normal
>3.9 High
2.1-5.4 Therapeutic
Dogs with no clinical signs of hypothyroidism and results within the normal reference range are likely euthyroid. Dogs with low T4 concentrations may be hypothyroid or "euthyroid sick". Occasionally, hypothyroid dogs can have T4 concentrations that are low normal.
Dogs with clinical signs of hypothyroidism and low or low normal T4 concentrations may be evaluated further by submission of free T4 and canine TSH. A high T4 concentration in a clinically normal dog is likely variation of normal However elevations may occur secondary to thyroid autoantibodies or rarely thyroid neoplasia. For dogs on thyroid supplement, acceptable 4-6 hour post pill total T4 concentrations generally fall within the higher end or slightly above the reference range.
Please note: As of April 28 2009, the reference intervals were adjusted due to a change in assay performance.
CBC COMPREHENSIVE
WBC 12.5 5.7-16.3 THOUS./uL
RBC 6.99 5.5-8.5 MILLION/uL
HGB 15.8 12-18 G/DL
HCT 45.8 37-55 %
MCV 66 60-77 fL
MCH 22.6 19.5-26.0 pg
MCHC 34.5 32-36 G/DL
NEUTROPHIL SEG 74 60-77 %
LYMPHOCYTES 16 12-77 %
MONOCYTES 8 3-10 %
EOSINOPHIL 2 2-10 %
BASOPHIL 0 0-1 %
AUTO PLATELET 572 (H) 164-510 THOUS./uL
REMARKS: SIDE REVIEWED MICROSCOPICALLY.
ABSOLUTE NEUTROPHIL SEG 9250 3000-11500 /uL
ABSOLUTE LYMPHOCYTE 2000 1000-4800 /uL
ABSOLUTE MONOCYTE 1000 150-1350 /uL
ABSOLUTE EOSINOPHIL 250 100-1250 /uL
ABSOLUTE BASOPHIL 0 0-100 /uL
Sorry this was a three page report. All of this was on the report. This was Tessie normal, before we ever new about cushings. This is the normal blood panel I get for her every year.
Now for the ACTH Test.
ACTH STIMULATION:
Pre-ACTH Cortisol 5.1 ug/dL
Post-ACTH Cortisol 41.5 ug/dL
ACTH Reference Range for Canine:
Pre-ACTH (resting) cortisol 2-6
Post-ACTH cortisol 6-8
Equivocal post-ACTH cortisol 18-22
Post-ACTH cortisol consistent with hyperadrenocorticism >22
Post-ACTH cortisol with hypoadrenocorticism <2
Desired pre-and post-ACTH cortisol on Lysodren therapy 1-5
ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticism (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs woth HAC.*
If the ACTH response test is normal and HAC s still suspected, proceed with a low-dose dexamethasone suppression test.
Dogs with iatrogenic Cushings disease will have flatline response test results in the low end or below the normal reference range.
Ok sorry for this being a book, but I wanted you have every thing that the Lab put on this report. I am wondering if my Vet did a low-dose dexamethasone suppression test and what is this test. How is it given?, do you draw blood for it ?. This Test was done on 7/1/09. So I picked up Vetoryl On 7/2/09 Thursday. Friday morning at 7:00 A.M. I gave Tes her two 30 mg pills. By that evening she did not look good and later on that night around mid-night her front legs were really shaking, when she laid down to sleep her body was shaking and very hot to touch. She was staring at the wall. Her hart was really bumping away, but I still gave her two more pills on Saturday at 7:00 A.M. and by 5:30 P.M. she was vomiting, shaking, could barley hold her weight to pee. Then at 4:30 A.M. Sunday/Monday I rushed her to the Emergence Vet. Then that same day Monday 8:00 A.M. she went to My Vet. Four days on IV. Boy did I wait to long get a glue. Thank God she is slowly coming back. I spoke to my Vet about the BUN today. Its at 33, he said because of the chicken Tes is eating would make it go back up. Tes is jumping off the couch to go bark when the other dogs bark. Its hot here today about 80 in the house with all the windows and doors open, along with fan. Keeping a good eye on her.
Ok this is my novel. Thank you for being able to educate me on how to read lab reports and what to ask my Vet. Dottie:o:):D
Dottie, let's start with the general labwork from 6/5. Tess show the typical elevations in her liver function tests including the alk phos that will usually tip off a vet to look at Cushing's. It's usually the seriously elevated alk phos that is the big giveaway. Don't get me wrong there are other medical problems that can cause the liver function tests to elevate, not just Cushing's. I would agree that the ACTH is strongly positive. From the results you have posted, a LDDS was not done. LDDS results will have 3 values for the cortisol, a baseline which is prior to the injection, a 4 hour post injection, & an 8 hour post injection. To make the diagnosis of pit vs. adrenal cushing's, you take a look as to whether or not the 4 hour result suppress compared to baseline, then you look at the 8 hour to see if that value escapes suppression, & how much.
Now, today's test look pretty good, but, & this is still a BIG BUT, the sodium/potassium ratio is still too low. I calculated it to be 26.2, lower limit of normal is 27.1. This is still indicating adrenal damage, & not enough aldosterone is being produced to keep the electrolytes in balance. I can't emphasize to you enough that this is extremely important as a serious electrolyte imbalance can be life-threatening due to possible cardiac arrhythmia. Did you ask you vet about this, & whether or not Tess should be put on Florinef for several days?
Tess is slowly getting better, but I'm concerned that until that sodim/potassium ratio is back within normal range that little Tess is not out of the woods, yet.
Thanks for posting all of this.
Debbie
PS- I forgot. I would never treat for Cushing's based on the results of only one diagnostic test. Cushing's is the most difficult & frustrating disease to diagnose as there is no single test that is 100% sensitive or specific. Right now, IMHO, an LDDS would be a waste of financial resources. I would have an abdominal ultrasound done to check Tess' adrenal glands, plus you will get a better idea of her overall health as you can see all of her internal organs. You must make sure that the US is done on a high resolution machine so the adrenals are clearly visualized. If you still want to treat with trilostane, I would also suggest you the full adrenal panel done at the Univ. of Tenn., Knoxville. There is another type of Cushing's called Atypical where one or more of the 5 associated sex hormones produced by the adrenal glands may be elevated. If that would be the case with Tess, trilostane would not be an option for treatment as this med is know to elevate these intermediate hormones. Just to show how we got my Harley diagnosed, my GP vet ran the full adrenal panel which showed that not only did Harley have Pit Cushing's, all of the 5 other hormones were elevated, so he is Atypical, too. I took him to an IMS for a consult, I asked what else she needed to confirm the diagnosis besides the full adrenal panel, & abdominal US. She told me that's it. I asked if she wanted to do the low dose, she said no, not needed, the diagnosis can be made on the bloodwork tat was already done & the US.
Hi Debbie your the best for reading this book that I posted. I did ask him the S & P, he said nothing to worry about and that she is getting better. He said the BUN was up from chicken. So should I but a little extra salt on her Chicken? When I put salt on my hand and show it to here she just turns her head. How much salt should I give her? Don't want to over dose her. I also think she is not out of the woods. I will know better how she is feeling when the sun goes down. Its hot here and I live by the beach. Nice breeze throw. OK I will check back. TY again Dottie:)Quote:
Originally Posted by StarDeb55
I really wouldn't add any extra salt to anything as ratio is getting close to normal. I suspect in another couple of days, it very well may be back to normal. I wasn't at all concerned with the minor elevation in the BUN, since the creatinine was normal. BUN can vary due to diet, dehydration, & a number of other things.
Debbie
To Late just gave her some chicken with some salt on it. Wont give her any more this way. What are the ratios for S & P for a dog 23 pounds. Just want to know for my self. TY Dottie
Normal range for any bloodwork is not usually based on weight. I don't really want to bore you with the math details on how this is determined, so let's just simply say they run labs on hundred of what they feel are normal dogs than calculate an overall average, along with some other things. Anyway, normal range for Na/K ratio is 27.1-40.1.
Debbie
Thank you Debbie, I have two black lab's girl boy, one, shitzu, and a white terrier/ Jack-Russell mentality, Bunny stay's very focused on things. Bunny is the one having to many seizures. Her longest was this passed sunday night, almost 7 min. She had a trimmer yesterday evening. I have only heard bad things about the medication for seizures, but I am going to have to think of something. Wish this could be one dog at a time. Mattie my 10 pound shitzu has a hart problem. New this when we rescued him, but last night he got sick vomited a little and again today. Think it might be from the chicken they normal don't get. Hopping it is. Just read that Lab's are prone to cushings. I know were all my pay checks are going for the next months. Its good to know where you spend your money. LOL Do I sound just a little worried still. LOL Ok enough of that. Tes is getting better and staying focused on that. going out in to the sun Dottie:)Quote:
Originally Posted by StarDeb55
Its 12:25 in Souther Cal. Tes ate at 9:30 am, she ate most of her food. She still has not pooped. My husband offered her some chicken, she did not want it. I tried with a smaller pice, she turned it down. I went to check her gums, and she vomited. Liquid and a small amount of this morning dog food. Her glades on the side of her throat are swollen. I check the sides of the throat of my other small dogs. Tes is definitely swollen. I called my VET, left a message. Called the E-Vet. I had blood work done on her yesterday. MY Q. I am taking her to the E-VET. WHAT ARE THEY GOING TO DO FOR HER? What should I tell them to do or look for. Its now 12:35 PDT. Dottie:(
For got. Her front legs are starting to shake again, like if I had given her Vetoryl. This was something she had never had before, only her back legs. She is uncomfortable to lay down. She is just moving around. sitting up lay down. Her head is has a slight shake to it, but not her body. It is really hot here. She was out laying in the sun for about 10 min. I thought that was weird. Dottie
Hi Dottie,
Calm down first...ok? Take a deep breath and let it out slowly. You will get through this.
The ER docs will take a good look at her all over. They will run in-house bloodwork, Xrays, anything else they need to do to figure out what is wrong.
You will need to tell them what meds she has had and when, the food she ate and when, how soon after she ate she threw up and what it looked like, and you will need to tell them her recent history with the Trilo overdose...this is critical.
Then you simply wait....and know we are with you holding your hand.
Let us know what you learn asap,
Hang in there!
Big hugs,
Leslie and the girls
Ok I will take my laptop with me and post from there. I am freaking. I am great with people medical emergence. I have had my share on board the aircraft. My husband had a attract and dbl. bypass surge, durning all of it I was a stone wall, until it was over, but animals I lose it. She has only been on a IV fluid and I don't know what he switched her to. The E-Vet had her on IV and My Vet switched it out. That is it for med's. Going now her gums have changed and she is now panting.
Get her to the ER NOW!!!!!
At E-VETS they are checking her out
Thank God I took the time to yesterday to post her history here. We just printed it out. I flew out the door. OK just waiting. You guys are a blessing. I am not religious, I do believe in her, but I am really worry. TY for you. dottie
Dottie,
Any news on Tess?
Jenny
Dottie,
Please keep us posted.
I have recorded the conversation with E-VET. Do you want me to e-mail t to you?
Is Tess still at the vets? Is she on an IV? That would be my guess as to the problem.
Saying prayers, Kim
How is Tess? Saying prayers too..Lori
Went over her Labs. They are checking her electrolytes. The E-VET is more worried about the dark stole that she had on Wednesday. My Vet saw what it looked on Thursday, because he took her Temperature. Saturday when he took Tes temperature the stole was light brown. I am more worried about her throat or glades in her throat. Vet asked if I wanted to leave her over night. That if she needs a IV it might take awhile. I said I am staying. Ok while type this my Vet called me. He said he would be very surprise if her electra lights were off from yesterday. We both agree that that the A/D canine/feline food that I have been feeding her is very rich. Its the only thing she will eat. My Vet gave it to her to see if she would eat and the chicken that she normally does not get every day, maybe once a week is also to rich. So I am camping here. Leave no man behind is my motto. I am feeling calmer. :o
They are running blood work she is not on a IV yet. They need to do the blood work. Its been almost ten min, so I would think soon for the IV if she needs it.Quote:
Originally Posted by frijole
Ok the E-VET came out to talk to someone else who brought there pet in. I told her my Vet had called, and was Tes on a IV. The E-VET said not yet she wanted to talk about the electra lights.
Any body out there??? Just chat at me PLZ about anything Dottie
We are here Dottie, sorry.
i am here..hang in there. tess is in the best place she can be right now. kim
Dottie, I have merged your emergency thread for Tess into the existing one. If you would prefer another title, please PM one of the mods or administrators & we can change it.
I just got home from work & discovered what has been going on. I'm afraid this is exactly why I raised the concern about the continuing abnormality in the sodium/postassium ratio, & the probable need for Florinef. Please post the electrolyte results as soon as you get them. Did you make the ER clinic fully aware of the severity of the trilo OD & Addisonian crisis? I would also ask them about need for florinef & a cortisol replacement such as prednisone or dexamethasone. I"m home & will keep an eye out for your posts.
I also see you have posted to Dr. Bruyette last night. I think some of us can probably answer most of your questions, so I will be right back to do that.
Debbie
How are you holdin-up?
Hey Dottie,
Here with you, honey.....
Tell me about your other babies....don't you have others?
You aren't showing up as logged in... I am hoping you are conserving battery... please let us know how you are as soon as you can... Kim
Prayers for strength and healing thoughts flowing around you both.
Hi Dottie,
I hope things are going ok. Let us know as soon as you can.
Jenny
I think I mentioned this in an edit to one of my posts yesterday afternoon. Prior to re-starting the vetoryl, I would have an abdominal ultrasound & the UTK full adrenal panel done. The full panel is the only way to determine if Tess is Atypical. If that might be the case, vetoryl is not an appropriate medication for an Atypical pup.Quote:
Ok this has me concern. How do I find out what medication do I give Tessie. I thought it would be Vetoryl, but the more I find out about cushings the more confused I get of what to start her on.
When Glynda refers to adrenal tumors in this question, she is referring to ADH, adrenal cushing's, vs. PDH, pituitary cushing's. With ADH, there is actually a tumor present on the adrenal gland. The only way to 100% determine this is with an abdominal ultrasoundQuote:
With functional adrenal tumors having random secretory patterns involving one or more of the adrenal steroid/sex hormone, wouldn't it be ill advised to treat with Trilostane?
This is really going to have to be your decision, with input from your vet. I believe several of us have indicated our concern about inadequate diagnostic testing being done, along with the fact that Tess is your vet's first trilo patient. We have seen it on these boards, literally dozens & dozens of times, a pup gets into trouble when a vet is not Cushing's savvy, does not follow protocol for using either drug, lysodren or trilostane, & then the pup pays the price. IMHO, if I had been in your position, with either of my Cushing's pup, & my GP vet who is pretty Cush savvy wanting to make one of my boys his first trilo patient, I would have refused. I would have told him, "My dog is not going to be the guinea pig for you to learn how to use Trilo."Quote:
With functional adrenal tumors having random secretory patterns involving one or more of the adrenal steroid/sex hormone, wouldn't it be ill advised to treat with Trilostane?
The only way to determine the presence of a macroadenoma in the brain is either by a CT scan or an MRI of the brain. An MRI is hideously expensive, several thouand dollars, but I believe you can probably have a CT done for <$1000. Imaging of the brain can be done at any time during treatment.Quote:
Enlarging macrotumor as opposed to a drug reaction.
Ok how do I test for this before I but Tes on any drug for cushings?
I can't answer for Dr. Bruyette. The one thing I can tell you is Palmer's Mom e-mailed Dr. Jack Oliver at UTK who is probably the foremost expert in the world concerning the use of trilostane with Atypical +PDH pups. His response was that the trilo would help control the excess cortisol due to the PDH, but eventually trilo will elevate intermediate sex hormones causing a retrun of symptoms.Quote:
Do you have concerns about prescribing Trilostane for dogs that have significant elevations in intermediate steroid/sex hormone levels? In those instances, do you recommend an alternative treatment?
Also would like to know the answer to this.
I wanted to answer some of these questions to the best of my ability for you, because none of us know how long it may be until Dr. Bruyette may respond. I know that you need information now, not a week or two from now..
Dottie, you have done a tremendous job keeping things together since last weekend when you came to us when Tess was in such bad, bad shape. I really give a pat you on the back, because you have had to learn about Cushing's in the worst way possible, when your pup's life is at stake. Please keep posting, asking questions, reviewing the important information section, & by all means, be the "terrorist", & let all of Tess' vets know you expect answers to your questions, & answers that you can understand, not in "vet/medical speak".
Debbie
Dottie,
I'm staying tuned with the rest of the bunch. Looking forward to getting the latest on sweet Tess.
Glynda
Hi Debbie and everyone else. Just need to keep chatting. I am at the same E-VET that said to me that her cushings had gone to Addison's, which is now back to cushing per My Vet yesterday. Seems like its taking a long time to get the blood work done. The E-VET has Tes records from her OD on Sunday/Monday morning so I am covered there. I was up tell 4:00 am researching and reading about cushings, Addison's and cancer.
Ok doctor came out. I recored what she said. Is there any way to post that? if not bottom line. She feels we are dealing with two problems. They found a tumor were she goes poop. From my E-VETS experience these are always cancerous. Her glades in the low legs and under arms are swollen. If the tumor is cancerous, then you all know what that means.Tes Blood work was fine. I will post them when I get home. The tumor is not blocking her from going poop and her stole is normal. I am having them run a in house full panel and will compare it to the one My Vet will do on Monday to send out to the lab that I will get back on Tuesday. They are giving Tes a shot for vomiting, and sending me home with medication that will coat her stomach this is to be given at 3:45. its 2:37 pm late after noon, she said around 5:00 offer Tes food ( warm Chicken and white rice ) if she vomits or does not want food then I am to bring her back for IV fluids.
So the electrolytes are OK? Is that what I am reading? They have no concerns about the overdose or any lingering effects from the overdose?
Did they do a needle biopsy of the tumors or are they planning to do any biopsies?
Are the glands swollen due to infection, from the tumors, or what?
Did they give her any antibiotics, if so what for?
And, for heaven's sake, why aren't they keeping her for IV fluids now? For as much as she has been through this last week, I don't understand that at all. I think I would be stomping my foot and demanding they keep her til she was able to eat and drink, and they had some more idea of what the plan was. But that's just me. :o
keep your chin up! Like Debbie said, you are doing a fine job under terrible circumstances.
Hugs,
Leslie and the girls
OK paying the bill and will read all the post after I get home ty all for being there for me a Tessie XXOO Dottie
I am not sure how to link a recording.. maybe someone else knows..
You said we are dealing with 2 things - you mentioned the tumor. What is the other? Tell us exactly what this vet said when you get back home...
We will be here. Hugs to dear Tess. Kim
Hi Dottie,
Please let us know how Tess is when you get home, ok?
Sending healing thoughts and prayers your way.
Lori