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

Sharlene-I've been reading along with you for quite some time now and I remain confused. This cute little Molly does not exhibit any problems. From what I read, unless I am missing some lines here or there, most of her tests are negative. She tested positive on the ACTH test at some point. Is that the only thing that is out of whack? I know she can be a bit "particular" at times, but so can I :) . I know she strained her back last winter. You just seem to be having a lot of tests and either I haven't been paying close enough attention or I've just really missed something. Can you help me fill in my black hole?:confused:
Hugs,
Susan

Really pleased that you managed to talk to the IMS and now have a plan for Molly. Just out of interest, are there any cortisol related illnesses that Molly's breed are prone to develop?

The latest picture of Henry on the beach was taken on PEI not too far from Cavendish. We've made loads of trips to PEI - there's a great dog outfitters at the gateway village where the lady once altered one of the coats for Hamish.

We did Quebec City and the drive to Tadoussac about 10 years ago - think we'll have to do it again sometime as I was reading that you can do a kayaking trip to see the whales.

Susan, I know it does seem over much when you think of how Molly acts. So, here is why we started down this road:

My vet has been insisting for several years now that molly likely has cushings, due to her elevated liver enzymes, continuing to rise. She said pot belly and thinning hair. Molly's belly goes down when she loses weight and increases when she puts weight on, so I never thought about it. I know she still gets long hair, and needs groomed regularly, her shaved areas always grow back, so I discounted. Her LDDS test that we had each time the vet wanted to check, were negative, so we kept saying not cushings.

Then she had an ACTH and it came back high. I came here and joined in and had an ultrasound, liver enlarged, both adrenal enlarged. Still no symptoms, repeat LDDS, negative still.

Just last month, an ACTH showed her cortisol and sex hormones all high (LDDS in December was still negative)

I've had her liver enzymes monitored regularly since they started to go up. Now they are going up again and the IMS hopes that the melatonin/lignans will help, but it's an unknown. Is cushings causing her to have high cortisol? We don't know. Is it a disease? we don't know. She thinks a liver biposy even if we did one, would show steroid damage due to the high cortisol and not tell us anything more than what we know now. Recommendation is to not have one. Now she has an adrenal nodule too, but we think non secreting.

So that about sums it up. high cortisol positive, ldds negative, liver enlarge, adrenals bilaterally enlarged, adrenal nodule. What do we do about what is going on inside her of her with symptoms not present?

:( I know it seems like there isn't anything wrong at all with molly by her actions and I am thankful for that every single day and watch her like a hawk, dreading any change. Yet there is something, somewhere causing her to produce cortisol. We just don't know what it is for sure.

The fear is that eventually this will cause even more problems inside of her. So anything we can do, to get a handle on stopping or slowing down the damage to her internal organs, is where we are at.

Hope that help explain the situation. I know that many probably are wondering why all the testing with molly when she has no symptoms. It's because what is happening inside of her will eventually cause real problems. I wouldn't have known if I hadn't pursued the ultrasound. I got the ultrasound because my vet had already sold me the vetroyl to start molly on and only by being here did I learn that I should have further testing and Not start her out on vetroyl for no real reason that we knew of at that time. That was what, 3 years ago now.

Here we are, years later, I'm still confused. Everything I know says either molly has cushings and just is in a low percentage of not showing typical symptoms and one of 5% that return negative on LDDS, or she has an underlying disease that is causing it and that we don't know what is.

hugs,
sharlene and molly muffin

MC, I don't know about kayaking, not sure I've seen any of those out on the water. We did the zodiac, which was a lot of fun. We we went ahead of where we thought they would come up and cut the engine and they showed up all around us. It was both thrilling and scary. They are HUGE and made us seem very small. Could have flipped us at any point. I love that drive up the river. We've done it several times and always love it. For awhile we went up to Taddussac almost every year. Molly is a mix, shih tzu/llahso. Rescue, so no real definite history for her.
I don't know if there is anything her breeds are prone too.

hugs
Sharlene and molly muffin

Yay, glad you managed to have the chat with the IMS!! I find this all very interesting that you have been given similar recommendations as mine just gave me, reassuring they think along the same lines! But you have the benefit of knowing exactly where you are with the adrenal panel.

So my understanding is the liver tests will be repeated for Molly and if still high, start the melatonin and lignans. I need to do a bit more reading to find out how they both work exactly. Might be a project for tomorrow.

I wish I could have the adrenal hormones tested but cannot here in NZ. So if we did the same as you we would be going in a bit blind and that is scary mind you if it is not going to do him any harm, maybe worth a try? Mind you Flynn also has very good reason with his various liver nodules to have elevated LFTs, but there has always been the lingering thought of various IMS that something else was going on.

Good to hear the UPC can be a free catch, I have found the first pee in the am, before he drinks and hydrates has given best results. FWIW I agree about postponing liver biopsy and surgery. How did she explain it was not cortisol excreting, with Molly's high cortisol on ACTH?

So we sit tight for another month, then do it all again!! I do like the sound of your IMS Sharlene, gosh she has been putting in the hours so nice she had the time to chat! xx

I know it may seem as though I am fixated on kidney issues, but in reply to Susan's question, I'm going to add the possible spilling of protein into the "hidden damage" mix. I know you are monitoring that, and I think with good reason because I would think that increasing elevation in protein loss would be another prime reason for lowering cortisol, regardless of cause.

Sharlene, I see that the IMS is still totally steering away from maintenance dosing of Lysodren should the decision be made to add something beyond lignans and melatonin. Has she explained why she would prefer trilo? In Molly's situation of of already very large adrenals, an adrenal nodule, and elevated intermediates, I would prefer maintenance Lyso if she were my dog. Heck, maybe Lyso might even decrease the nodule since it has been known to actually necrose adrenal tumors in some cases. Due to lack of overt symptoms, I understand the hesitation to load her, but I do believe UTK would be suggesting maintenance Lyso in this situation [see my clarification in a later reply] and I don't understand why your IMS does not seem to want to even consider it as an option.

Marianne

Sharlene:
You got a lot of information about your Molly, sorry it is not really clear what is going on. I hate when these babies are a mystery. Am I understanding that if the alderstone is low that that is normally a non functioning tumor or is it the opposite? Also I am concerned about Tipper's tumor growth in light of what Marianne said about the Trilostane vs the Lysodren. Now that is making me a little nervous too. It is a shame that nothing is really black or white and leaves so many grey areas. You are so good at this Sharlene that I am sure you will get it figured out. Hope you have a good weekend.
Blessings
Patti

The kidney is actually our first concern at the moment. Thanks for adding that Marianne as it can indeed be a product of high cortisol to have protein loss and kidney damage. Her thoughts is that this could be a kidney damage problem not stones causing the higher UPC. We'll see what the next two test show.
Lysodren maintenance hasn't been ruled out. Her concern is that whatever lysodren does to the adrenal glands will be permanent and she wants to start with the melatonin ligand first. The liver test Trish is to get a new baseline reading before starting the melatonin lignans and then follow up to see if there is any change.
Then if that doesn't help and we have to wait months to see. Then we'll move on to next steps.
She thinks benign because if it was secreting then she thinks that gland would be larger than the other and it isn't trending that way.

Not sure if I covered all the questions or not.
She said that she feels we have time to try and get it figured out as long as we monitor appropriately and adapt as needed. Her motto is cause no harm. So she thinks that with no symptoms she wants to be careful in what steps we take and not tip the scale too far towards something that would not be beneficial while trying to manage the kidney liver.

Thanks for all input it is appreciated. I make notes of any thought and questions advice given and then bombard her with them. Lol. We talk so much other stuff on here that I don't want the serious stuff to get over looked so no fear. I do take notes!
Hugs

Thanks for the additional info, Sharlene. I just want to correct a misstatement that I made earlier, in that for cases of elevated cortisol, I believe UTK would recommend either trilo or loading doses of Lysodren. So maintenance Lyso dosing would not be their suggestion other than in instances when it is the elevation of other intermediates that is the issue. But since your IMS is sort of treating Molly like an Atypical case right now, that is the basis for my interest in the maintenance Lysodren.

This is where my brain starts to hurt....but thank you very much for the explanation. It sure is a puzzling situation.

We're cooking steaks on the grill tonight. YUMMMMMMMM! Gorgeous day-just a tad chilly.

-Susan

I don't think it's over the top Sharlene!! We always say prevention is better than cure!! She certainly is a puzzle, but we are all learning a lot along the way! x

I totally get that Susan, my brain regularly hurts trying to figure it out. :)

Oh yum, steaks. I'm thinking of that for tomorrow actually. Today we are both wiped out from yard work. I got a bee in my bonnet (so to speak) and hit the nurserys this morning. I made one trip and came back with loads of plants, dropped them off, set them where I wanted them to be and told hubs I was off to another nursery to check out what they had. When I came back hubby was in the garden planting what I had set out and on a roll. So I set out the other stuff, and then we started pulling out bags of the black mulch we had bought last weekend and a full blown project was born. :)

Now we are both too tired to even look at the grill, so I'm ordering chinese. Nothing like a hot bowl of won ton soup (this local place makes the best) to really get that good feeling going. So, my plan for the night is to curl up on the couch with hubs, find a good movie and eat chinese till I can't move. Burp and start all over again. (sorry if that sounded gross, but you know how it is with chinese. You eat and 20 minutes later you're hungry again). :)

Molly is already munching on her dinner. I put her on the leash and she laid in the shade and watching hubs doing the planting. A proper supervisory position and I'm sure she'll need a nap soon to recover. hahaha

Marianne, from what the IMS was saying I don't think she wants to do a lysodren load with molly. She might consider a straight to maintenance, or trilostane if the melatonin/lignans doesn't work, but she doesn't seem to want to do a load, since she isn't sure yet, what is causing the high cortisol.
I Think that she is hoping it is the sex hormones that is actually contributing to higher levels of cortisol and that this might have some effect, but I think that is just a hope, not a full blown theory even.

Wow, you know you're tired when you write this and then walk away thinking you posted and come back going..hmm...where is that post I made at.

Hubs is in the pool and I got distracted with his yucky laundry. LOL
hugs
Sharlene and molly muffin

Yep Trish, whatever we can prevent is better than letting it go and then facing something worse later. It is a learning curve isn't. I always find something new with this whole process, whether it be with molly or one of the other furbabys on the forum.

hugs
Sharlene and molly muffin

YUM Won Ton soup, I used to make it but lost the recipe. Must hunt that out again, I ordered some a week or so back and it was not as good!! That sounds like a great plan for the evening, nothing like chilling out after a hard days work in the garden. I have put that off this weekend as the bin is already full!! Need a bit of winter colour though, I think the extent of it today will be finally planting my tulips that have been resting in the fridge for at least a month! Love BBQ weather, nothing like the smell of it of smoky meat :D Sounds like you deserve a glass of that nice wine too!

Sharlene, thanks for posting all the detailed information about Molly. It is always a learning experience with her. So happy that she feels good and doesn't have symptoms.

Just reading about all you accomplished today makes me feel like I need a nap! We have had a beautiful day here too, but I haven't taken very good advantage of it as far as the yardwork. :rolleyes:

Were you able to see any of the meteor shower last night? It was too cloudy here, I checked several times but couldn't see anything. I was very disappointed, I love things like that.

Lol about the Chinese food, so true. And I have to tell you that I laughed my butt off about the twerking comment on our thread. Oh, the visual....... :D :eek: :rolleyes:

Hugs,
Tina and Jasper

I had Chinese take out for tea tonight well it was from there European menu does that count! I haven't been a awake long enough to cook today :D

Oh damn, forgot about the meteors too!!!!!

I set my alarm for 2am when it was suppose to be good viewing. Hubby got up, walked over looked out, said, complete cloud cover, go back to sleep and that was the last thing I remember till morning. LOL :) I love that kind of thing too but it really needs to happen around 11pm, not 2am for my optimal pay attention, be awake time zone.

I had a pretty good laugh over the twerking too Tina!

Tracy, it definitely counts!!

ohhh, Trish, you have a recipe for won ton soup??!!! Share it! err. Find it, then share it! LOL

hugs all,
Sharlene and molly muffin

When Zoe was on melatonin and lignans, after 3 months, her estradiol was normal and the other intermediates had gone done somewhat, did not touch her cortisol which was sky high though.

I hope it helps Molly. Which lignans will you use?

Molly is a puzzle, a very pretty one indeed:)

I wish I could find it, I actually bought some chicken stock in the groceries yesterday thinking I would make my own. A chef gave it to me... it had stock, spring onions, wontons, sesame oil, soy sauce, hmmmm that's all I can remember... oh and a beaten up egg which you dripped in slowly at the end to get that eggy look if you like that. I need to go to an Asian store to get some wontons, none in the supermarket.

Addy, what changes did you notice in Zoe with her intermdiates coming back down?? Did it change her lab values like LFTs or renals?

Good question Trish as that is what the IMS is hoping will be helped is her liver values. Did they help that at all Addy?

Sounds delish Trish. I'll come over and help you look for it. :) :) :)

giggles
Sharlene and molly muffin

I just did another hunt, I think it might have been in my email on an old computer. It was from an old BF who was a chef and I am most definitely not emailing him to get it again :cool:

That would be the main reason I would try them too Sharlene, anything to get liver better is good in my books! Although I have to remind myself all the time with his other liver problems we are unlikely to ever have them normal.

It's good to have a great Chinese nearby for days like today eh?
We had a great one in the UK but are struggling to find one in Canada - our current local one is referred to as 'the bland Chinese' ;)

We had fish & chips from the second best chippie near where we are staying (the best one is closed Sat eve), then we went and bought a BBQ :confused: so I'm now trying to work out how to get all of our stuff and Henry's!!! around it in the car. Looks like Henry will spend the return trip on my lap so let's hope we can have a picnic lunch!!!

Sharlene:
The dogs love the bubbles and when they blow in the wind it is so fun to see them chase after them. I have catnip bubbles for the cats too and they go nutty chasing them around. Hope you enjoy the weekend with Molly and your weather is nice. Will Molly stay with you if you let her off her leash in the yard? That is the best place to do the bubbles. Blessings
Patti

In the beginning, Zoe did not have high liver values, just high cholesterol so I cant really say. The highest her liver values ever went was about 800 - that was also during the time of her really bad IBD flare and she was on a pretty high dose of metronidazole for 3 months so I dont know how much that also may have contributed to her highest reading but then after we removed her tumor and her cortisol was easier to control it went back to normal on the Vetoryl but it had already come down to 500 before then and she was on a much lower dose of metronidazole daily.

It is worth trying I think.

Sharlene,
are you planning to continue to give Molly the Hepato Support? or some other form of Milk Thistle?

Right now I am still with (hepatoma *sigh* auto correct) HEPATO support. There is another one that has the Sam-e that we can switch to but I don't want to do everything at the same time.

Hugs
Sharlene and Molly muffin

Sharlene:
You have the funniest auto corrects, you get the award! Tipper takes the S Adenosyl with the Sam-e in it. Nice morning and the heat is already starting up so the dogs have already walked. Hope you enjoy your day off and have fun outside with Molly. Blessings
Patti

Hi Sharlene I hope you get Molly's issues figured out and resolved. Thank doG she is not exhibiting any symptoms. I give Snuggles Denamarin which is a Sam-e which is prescribed by the integrated medical vet I see in Manhattan.

If the pool is 88, I am coming over..I LOVE 88:D:D:D:D:D:D:D:D

The pool IS 88 (maybe 89 today), grab swimsuit and come on over!

It's a beautiful day out there.

hugs
Sharlene and molly muffin

You'll have to come to my house then Addy. The pool got so dang hot it feels like a Jacuzzi and I can only stand to be in it at night when the air is cool. We had to turn off the solar.

Ok enough about these pools already, Tipper is wanting plane tickets to one of these warm pools as her leg has been off the last few days and she wants some hydrotherapy. She said to tell you she does not pee in the pool either! She does not clean up after herself though, and will ruin and kill any and all pool toys! Hope you had a good weekend Sharlene as you had an exhausting work week and you deserve some R&R. I can just see you with a nice fruity drink lounging by the pool. I guess hubby will have to play the part of pool boy and wait on you! Blessings
patti

Tis true, his new job is pool boy. :)

Molly had a couple days of kind of not feeling great, off her food a bit. Turned the AC on and yesterday she was right as rain and full of energy playing. So funny she had a piece of paper towel she was attacking, then she lost it and was looking all over the floor and behind the door for it, even barked at me to find it for her, next thing I know she was chewing, she'd lost it in her Mouth the entire time!!! Molly is cute but I don't think necessarily brilliant.
Today I notice she was being a bit ginger on her back legs again, and off her food a tiny bit (not a lot or enough to cause concern, but we know right) I'm guessing she stepped wrong and twinged it, probably running up and down the steps to the window seat.
Just had a torrential down pour here that lasted maybe 5 minutes, a river running down the street. Now the sun is out and most things are dried off already due to heat/humidity.

So we've decided that we'll still get away for a few days, even though we can't do a long vacation right now and we've decided to go to Newfoundland and go whale watching. They have the largest migratory whale traffic through there of anywhere, and are in the thousands, all different kinds. If we get lucky and see some icebergs that would be cool too but not sure we will has their season usually ends in june and we can't go till end of june. Still it's all about the adventure, getting away from work and enjoy life. :)

I love that the summer activities are starting around here. We're heading out thursday night to hear a friends friend, sing at The Old Mill, a group of us are going, so that should be fun. Not sure if my hubby will make it or not, but we'll see. Then there is a charity country western dance a couple weeks later, that we haven't decided about. I don't think they would let me bring molly but wouldn't she be cute.

So, life is moving along. I'm sure molly will get over her off day. Poops are wonderful and that is always a sign if those go haywire on us.

hugs all,
Sharlene and molly muffin

Sharlene:
I always wanted to go to Newfoundland, I am so jealous, the whales would be super to see. I am glad you can get away for a bit, you need it. Wonder what's up with Molly being off a little bit?? Tipper's leg was giving her some trouble for a few days so I am glad she had laser today. She is passed out on the bed as it is too hot out today. I see storms and tornado warnings down south, and we are to get a storm later. Blessings
Patti

Sounds wonderful! Sharlene and I hope Molly bounces back to her hungry, energetic self quickly.

I expect it to be back to normal tonight or tomorrow. I think it is her legs bothering her. Now that I know from the IMS that they are both a factor, you can see them get a bit wobbly when one bothers her and she relies on the bad knee to over compensate. Sure enough she just went running in to the living room to grab a toy after slinging water from her beard all over me.

Long as those poops are solid, I know it isn't gastro upset, so it will resolve. :)

hugs
Sharlene and molly muffin

Whale watching sounds so exciting. Very cool getaway:)

Sharlene, how do you find energy to go out on a work night? I must be getting really old. Sounds like a lot of fun though.

Good to hear Molly is good in the poo department. You know all of us and poo. I was sure Koko would have bad poo tonight after chomping on that geese poo but knock on wood, it was ok.:rolleyes::rolleyes::rolleyes:

Kathy, I'll come to your house to try your pool next. The way our weather is going, we wont get into ours until 4th of July.

Sorry to hear that Miss Molly is feeling a bit under the weather, although very pleased to hear that the poops are OK despite that. Maybe a bit of hydrotherapy in the pool?
Your trip to Newfoundland sounds great - I haven't been but maybe one day.... OH went a few years ago and saw loads of caribou crossing the roads.

We just picked the new car up and I'm so not excited, although I'm trying to show some enthusiasm for OH's benefit- is that bad??? I find it difficult to pretend :rolleyes:
It's not helped by the fact that it's an ex-demo and was unbelievably dirty when we picked it up, so they sprayed some toxic stuff around (although did nothing about the actual dirt) and now there's no way Henry's going anywhere near it until I've got the energy to give it a very thorough proper clean. In the meantime I did suggest putting the roof down and driving to the local car wash ;) Oh well, it's only meant to be OH's daily driver so I suppose I don't have to like it - in fact it would be a problem if I did given the appalling roads around here :p

Addy, I can go because, it's tons of fun and because I'm in total denial as to how tired I'll be the next morning :) :) :)

Booked in a bbq for Saturday night with friends. I don't know how it is where everyone else is, but here, it's like we hibernate most of the winter, coming out only for the holiday party season, then back into our caves and then watch out once the good weather starts, because we're all rearing to go go go once the sunshine is out!

I think molly feels the same way, as she had a great walk this morning, full of energy, solid poops, sniffing all the trees and then running to the next one, ate her breakfast, except not all of her dry kibble, which is fairly normal, she's always been a grazer, not a stuffer. So, guess we are back on track.

Uh oh MC, not loving the new ride eh?!! Well, you have the lovely stang to satisfy those, lets go cruising the hwys and back road urges. :) :)

I read that the whale watching in newfoundland should be some of the best. I'm hoping anyhow. :)

hugs
Sharlene and molly muffin