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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