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

Sharlene:
Sounds lime you had a good old time car shopping. The cost of new cars is just astronomical now. I hope you get something that you like to drive if you are going to keep it for a while. Good to hear Molly's foot is not acting up. Your work is going to give you grey hair!! Thank God for the weekend so you can unwind. I miss the corporate world sometimes, but it was very draining. The doggies just did their second walk and the sun is out and really nice. Have a good Sunday. Blessings
Patti

we have a Prius IV and I love those heated seats in the winter! Warms you up much quicker than the car heater.

I am about being a team player whatever is going on and I don't need someone trying to be a hero and messing things up by interfering when a team is working on an issue. I had to write an incident report on Friday for that very reason. It's my own fault in a way for not taking the management position when offered so I could just handle these things.
I miss the days of being home not worrying about working and happy bliss. Lol
I can't do that now as it is all about Molly's needs and those needs are speedy. So. No win. No work no money. Work money but a lot of stress too.
I'll survive it just has to be dealt with.

Oh new cars are very expensive. I like low miles used to get a better deal.
Hugs
Sharlene and Molly muffin

Sharlene:
I know what you mean, we had people like that at work too, and they are all about themselves. Hoping Molly is starting of the week well. Did you find a car yet? I am getting nervous about these storms coming, so I have to get something safe to give Tipper. Blessings
Patti

Hi Sharlene,
I agree, stress stinks!! Worry stinks too! Hate those nights where you wake up and can't shake the worrisome thoughts and stress related angst. :(

Hoping your work day was better today and whatever was going on there has settled down.
How's Molly doing today? She's not limping anymore, right? I hope not!

Barbara

I love new cars! So exciting.

I have usually bought used in the past, but 2 years ago, I bought myself a brand new car, exactly what I wanted. I figured that if I was going to drive it for at least 10 years (or more!), I would get the exact one I wanted, and brand new. I still love it. And, it handles like a dream in the Alaskan winters.

Sharlene:
I hope a better day at work?? What's going on with the weather up there?? Tipper is on high alert!! There has to be a better way. Hope Molly's foot is still good. Blessings
Patti

We're expecting rains starting overnight tonight and its a system that isn't going to move out quickly but stall over us from what they said, so lots of rain. I'm a bit worried, remember last year guys?!! All that water. (if you don't know or hadn't heard about last years toronto floods, pics are posted in the albums)
I'm wondering if I should just stay home or what in case we get floods again. I might do that, right now they are saying 23 - 35mm, but that could be more, it just depends. I'll check weather in the morning and decide.

Renee, what kind of vehicle did you end up getting for the Alaskan winters?

No, nothing yet. Getting a vehicle is a slow process for us. Mainly because we can only go look on Saturdays due to work and time constraints. And if you are going to put down that kind of money, then we're going to be picky. Yea, we keep ours a long time too, so it best be right. LOL Currently we sort of know what we want and there aren't any used low miles 2013-2014 available. So, patience grasshopper!

Work, *sigh* LOL Today was like being in the Antarctica, with the big freeze. Sort of like working with a teenager. Gads. Hormonal still ya think? :) No worries though, I will deal with it. :)

So, molly is doing okay, no limping ,but she is more careful with it sometimes, weird, will stretch and stick it out in front of her. (would that be a ligament, tendon issue?)

hugs,
Sharlene and molly muffin

Sharlene - I bought a Chevrolet Equinox. I don't live out in the country here, so I'm not battling serious snow storms that need a big truck, but we do get bad snow and icy weather for about 6 months out of the year. It handles the icy roads and snow very, very well.

I actually test drove a few vehicles, decided exactly what I wanted, then ordered the exact one with all the features and specs I wanted. When the car arrived, it had exactly 3 miles on it. It took a while to arrive, but it was worth waiting for the car I wanted. I am very, very patient and particular when making big purchases, so I never rush or settle. My last car, I had for 9 years before upgrading. I expect to get at least 10 out of this one.

My niece bought a chevrolet equinox down in LA. She Loves it!

hmmm..Maybe I'll take a look at those if it handles ice and snow well.

Thanks!
hugs,
Sharlene and molly muffin

Quote:

---

Originally Posted by molly muffin

We're expecting rains starting overnight tonight and its a system that isn't going to move out quickly but stall over us from what they said, so lots of rain. I'm a bit worried, remember last year guys?!! All that water. (if you don't know or hadn't heard about last years toronto floods, pics are posted in the albums)
I'm wondering if I should just stay home or what in case we get floods again. I might do that, right now they are saying 23 - 35mm, but that could be more, it just depends. I'll check weather in the morning and decide.

---

Oh Sharlene, I do remember that awful storm and the toronto floods :eek::eek: Do be safe and let us know how things are going, ok?

Hugs, Lori

Good to hear that Molly is doing ok, although I'm guessing that the rain won't be welcomed by her either.
Sorry to hear that work isn't great at the moment - sounds like tomorrow would be a good day to stay home and let things defrost!
Stay safe - sounds like you may need a submarine instead of a car;)

Maybe I get something with a submarine option package. :) :)

Molly will hate all the rain, looks like the greatest amount should be in the morning. I need to keep connection with internet through at least 3pm tomorrow. You never know what rain and storms will do with the power situation. I better charge things tonight, just in case.

Molly started, of course, favoring her foot while on her last walk. Not limping exactly but certainly favoring. You can tell by the gait. I just can't find anything Wrong with it! So frustrating.

grrr
hugs
Sharlene and molly muffin

Sharlene:
I know you must be so frustrated with Molly's foot. Trying to figure out all the things going on with our babies can be a daunting task to say the least. I am still working on Tipper's tremors. It is dark and pouring down rain. Tipper was up and on the alert almost all nite. I must get something from the vet, although I do understand him being hesitant as she is allergic to everything, and certainly does not need her breathing depressed as sedatives do. There has to be a better
way. Blessings
Patti

Sharlene, hope you and Molly are safe and dry and both feeling well!

We're good here. Lots of water but the drains seem to be handling it okay. I've seen the city out checking for backup already so that is good.
Molly doesn't seem to care at all. It's just raining, no thunder or lightening so she of course is having a nice little snooze in the dining room, stretched out and snoring for all she is worth. Pretty deep sleep, she didn't even acknowledge that the post came. LOL

I did go ahead and elect to work from home, just in case today. I'll check the basement in a bit to make sure nothing is coming in. Hubs said that if it does, just move stuff out and he'll wet vac it when he gets home.

hugs all,
Sharlene and molly muffin

Hi Sharlene:
It is a torrential down pour and really bad wind. Coming from the vets lots of pounding on the roads. Tipper is beside me on the bed and resting. She was very unsettled on the way to the vets in this. He only saw her level of being terrified at about 40%. He is not wanting to give Tipper Valium. I knows where heis coming from. He is scared if something happens to her from this I will blame him. She is so allergic, and let's face it I know these drugs are not good for dogs. I may have to investigate L Tryptophan or Valerian. That is about all I have not tried. I will discuss this with the IMS tomorrow too. Hope your basement holds out, that is a pain I am sure you can do without is moving things. Blessings
Patti

Oh no - I hope the basement stays dry. We used to be on the river and our basement flooded every time there was heavy rain, and they reckoned it was caused by the magnolia tree roots, so they chopped them and when the next rainstorm happened I went to the basement and the apple store (which always flooded first) was totally dry. Elated I turned round to discover one of the other rooms had flooded instead :eek:
It's good that the rain isn't bothering Molly. I hope these dreadful storms end soon.

Glad you are all ok! and happy to hear your drains are working well :)

Hope your still dry and Molly is doing well.

Should we build an ark?? I have all the animals!!

Hehehe I Know you do Patti!

Well, we did get water in the basement but not bad and I was able to mop it up. I just cannot figure where it is coming in at.

No way do I want to finish off the basement as long as I don't know and can't fix it. We've had the side around the house dug out and gravel laid, so should have good drainage. I don't know.

Molly is fine, rain stopped for today. We had our walk. She had her dinner and now I'll be starting to cook our dinner. Hubs has to get packed as he is out of town for the next few days.

hugs
Sharlene and molly muffin

Next heavy rain, you need to stand inside the basement and see where the flow is coming from. I would think you could see the area that first gets wet and correspond that to outside where a drain may be needed. A French Drain system is fairly easy to do yourself and could help if you can find where the water builds up.

I hope Molly's toe is better!
Hugs,
Leslie and the gang

I hope you guys are ready for the next chapter in the molly saga, because U of Tenn results are in and Molly continues to Baffle. Here goes:

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
1hr 283.1nmol range 65.0 - 174.6 10.26ug
2hr 345.6nmol range 65.0 - 174.6 12.52ug

This has actually decreased

Pre levels that are off:

Estradiol 103.4 baseline 30.8 - 69.9
Aldosterone <11.0 11-139.9pg/ml (normal range baseline 72, post 23 (she is close on the post at 23.7)

Estradiol being raised isn't abnormal usually as Lori mentioned was found in recent study.

The POST number that are out of range are as follows:

Androstenedione base .41 (range .05 - .57) 1hr 4.54 2hr 5.97 (range .27 - 3.97) HIGH
Estradiol base 103.4 (range 30.8 - 69.9) 1hr 105.2 2hr 129.1 (range 27.9 - 89.2) HIGH
Progesterone base .29 (range .03 - .49) 1hr 3.83 2hr 3.94 (range .10 - 1.50) HIGH
17 OH Progesterone base .38 (range .08 - .77) 1hr >25. 2hr >25. (range .40 - 1.62)
Aldosterone pg base <11. (range 11 - 139.9 1 hr 23.7 2hr 57.4 (range 72.9 - 398.5)



Comments: Baseline values are within reference range except for moderate estradiol
elevation. On the contrary, most of the post ACTH values (either after 1 or 2 hours) are
significantly elevated except for aldosterone that is lower than the reference range. Although
estradiol may contribute to clinical signs, it is not a good indicator for adrenal activity, since estradiol may be secreted
also by peripheral tissues (adipose, skin). In this case the source is not known.
Occasionally aldosterone concentration may be related to Na/K/water balnce.

page 3 of my upload lists treatment options.

My IMS said a couple things. Her ACTH cortisol levels have actually gone down since the previous
ACTH.

With the high other levels of hormones, there is concern that this Might be what is causing
the liver and adrenals to be enlarged. That what we want at the moment is to see if
we can get her liver enzymes to come down and have an actual decrease in the enlargement.

Her suggestion and what we discussed is to start with melatonin and lignans and give it 4 months
with a retest on the liver enzymes (i think I'd like before and after) and see if there
is any effect. She doesn't want to go to lysodren, even the maintenance dose Yet, but if there is
no reaction in the time suggested by Tennessee, then that could be on the plate at a very small dose.
Vetroyl, she feels would not be a good option, because it causes the adrenals usually to enlarge and we don't want
that with the tumor there.

Molly continues to be a puzzle, by not displaying signs of cushings other than on ultrasound, so no clinical signs
her cortisol lowering on it's own, even as a tumor shows up.

I have a meeting to discuss with her over phone on Friday, so I have till them to come up with what I want to do.
Get your input hats on peeps.

One of my questions will be, is the cortisol, hormones embalance, feeding the adrenal glands possibly feeding the tumor.
Could these have led to the creation of the tumor itself.

If we try this melatonin and lignans and they don't work we can also go to an aspiration of the liver or biopsy option, which my husband does
not want to do.


It was funny, the IMS, said, I want to email this to you, give you time to review and study and then discuss.
I understand that I am talking with someone who has more knowledge of these issues than most people.
I just laughed. I mean what can you say, but I thought it was nice that she recognized that and didn't
try to BS me about anything and just say, lets do this or that.

So, that is where we stand right now.

I think the IMS showed a lot of respect for you. I would take that as quite a complement.

I wish I had some insight. Molly is just amazing!

Renee, I definitely take it as a complement and it makes it much easier to exchange opinions and have frank discussions. My other IMS though was also very good with discussing options and opinions, but this one seems to go the extra mile, with calls, emails, etc and just being open and honest in her opinions. If she doesn't know, she says so, and then says, what she thinks and ask the same back from me. Her first words today was how is molly and do you have a minute to talk. Then followed up conversation with I want to send this to you, give you time to read and see what you think, and then can we talk tomorrow and I begged off till Friday, since my thursday is swamped at work. And she was like sure, call me.
I feel very lucky to have gotten her this time as my prior IMS was unavailable for the day I wanted. Glad I took the chance.

hugs
sharlene and molly muffin

Hi Sharlene, I am just now getting home late so will wait until tomorrow to look over Molly's results more carefully. But her huge decrease in cortisol per the repeat ACTH is indeed a surprise. One thing I am noting, though, is the low aldosterone. Per Dr. Oliver, that abnormality can be found in conjunction with a primary adrenal tumor that is affecting the adrenal cortex. So that finding actually may not be a big surprise since you already know about the presence of the tumor.

Quote:

---

For hyperadrenocorticoid cases that also have low aldosterone levels, this pattern can be indicative of a primary adrenal tumor, and ultrasound is indicated to confirm a tumor's presence or absence.

---

Marianne

Hi Marianne. Do you have a link for that quote I can send on to the IMS. In treatment options they mention an ultrasound but not this specifically. I wonder though.... Wouldn't that mean the adrenal gland should be functional and active and how would that play into her cortisol dropping which I haven't heard or read of outside of treatment unless it was non cushings related. It is very bizarre. I was ready to say yea it must be secreting but then this and still no clinical symptoms. There is in fact both food and water in her bowls from today's meals.
Did I mention she is bizarre?! Lol
Hugs
Sharlene and Molly muffin

Is there any chance a pheo could cause these results? The decrease in cortisol is puzzling in the face of the tumor - unless it is not a cortisol secreting tumor after all. Do pheo's ever cause such fluctuations in the level? I'm just navel gazing as I really don't have any real insight. Hopefully Marianne and Glynda will be able to help - our amazing gurus.

I think it is just wonderful that the IMS is so open to working with you and understands that you are special....just as we do. I have no doubt you will figure this out and make the very best decisions for sweet Molly Moo. You always have, ya know. ;)

I wish I could help more, but I am basically useless to you and Molly. :o BUT I can, and do, keep you both in my prayers and thoughts.
Hugs,
Leslie and the gang

Woweee now that is a tricky one to get your head around, so pleased you are onto it as I have never got these adrenal hormone results in any sort of order in my head! Interesting about how it might be related to the adrenal nodule. I think I might get these done for Flynn at some stage. I have read that hepatic nodules can be linked to adrenal hyperplasia. I will dig out the study on the weekend when I get a chance to sit at my own computer!

Sharlene, I really like your new IMS, I love how she is taking your own knowledge base into consideration. Yes, your old one was great too, lucky you have two good people you can connect with. x

Hi Sharlene, here's the link for Dr. Oliver's research summary -- I should have given that to you above:

https://vetmed.tennessee.edu/vmc/dls...Diagnosis_.pdf

Re: the fluctuating cortisol level -- the only thing I can think is that adrenal tumors can stimulate "bursts" of hormone secretion; the activity is not always constant nor consistent. So perhaps that is what has been going on with Molly, and there has been fluctuation in the timing and amount of release of the various adrenal hormones?

Sharlene:
I am sorry you have so many things on Molly's report to sort out. Do you feel the report was more positive than what you were expecting? Thank you for your help with my Tipper, you are always there when I need you. Hope Molly continues to do well in spite of all the baffling data. Blessings
Patti

ugh, I'm useless and don't understand most of those numbers and what they mean. It seems to me that starting with the melatonin and lignans can't be harmful and maybe could be helpful, so that seems like a reasonable thing to do right now.
Wish I could be more helpful. :confused:

Barbara

Sharlene:
I don't know how much help I will be but when my head clears up from all this stress I will go over Molly's numbers. Take care of yourself, as I know all about the stress brought on by this. Blessings
Patti

Sharlene, unfortunately I am clueless about those values so I can't really be much help, I am sorry, but I am praying for Molly and her health issues get resolved quickly!

Hey Sharlene!

Checking in to see how the chat went with the IMS and what Molly's plan is!! Hope you have some good news! x

Sorry, work was brutal and I didn't get a chance to call her today. I just sent her an email apologizing for that, sent her the quote from Dr. Oliver and link to the whole thing, told her I was willing to try the lignans and melatonin if she thought that might work on molly's liver, adrenal glands. Asked her how often we need to monitor for tumor growth.
Apologized again for being a bad patient and not getting back to her and asked her when would be convenient for us to have a chat.
I've been swamped at work so no time to pop in today.
I'll try to touch base on the forum later on tonight when I get a few moments to myself.

hugs all, I hope you are each doing well.
Sharlene and Molly muffin

Bummer work is tooo busy, I have had a bit of a week like that as well. TGIF/S for me! Hope your evening gives you a chance to sit down, catch your breath and playtime with Miss Molly xxxx

Sharlene:
Has Molly just gotten ultra sounds, or have you had a CT scan done on her tumor. I am thinking of getting one on Tipper if I can swing it. They cannot be certain if it is invading anything with a Ultra Sound, so I need to know that for sure before making a decision. I am waiting on the IMS to answer me, as I know how busy she is. I don't know about you, but sometimes all this information makes me crazy! Blessings
Patti

No I haven't gotten one on Molly. They told me it wasn't invading anything including the vena cava at this point. They also didn't think that an MRI was needed.
Yes it does make you crazy. Absolutely!

Hugs
Sharlene and Molly muffin