Updates on Mila, 12 year old Jack Russell (Mila has passed)

[loshie]

My 12.5 year old jack russell has recently been diagnosed with cushings (all testing including ultrasound confirmed - pituitary) We confirmed this about a a week and half ago, but right after she developed severe pancreatitis and has been at the emergency vet for 5 days (picking her up this afternoon!) Poor thing also had scar tissue blocking her bile duct in January which she had to have emergency surgery. She's a trooper though and recovered from that amazingly well, and is doing well now although this will delay her treatment on Trilostane.
Even though she's almost 13 she's a ball of energy and loves nothing more than running around in the backyard catching her ball. Because of the cushing's however, she's lost a lot of muscle mass in her hind legs which causes her legs to shake - although she doesn't seem in pain as she won't stop playing. We've tried to have this addressed but because of all these other problems, it's not been on the vet's priority list with her and says that it could be the cushings, arthritis or pain (she had a kidney infection as well) but that he wanted to deal with the more urgent matters first.

That being said, does Trilostane improve muscle mass as well?

Before last week, we had started to take her swimming which should help her exercise without the strain on her joints (plus she loves it!) but I just want her to be happy and able to do what she adores most and that's running and playing catch.

[Harley PoMMom]

Hi and welcome to you and your baby girl from me and my boy Harley! My boy has PDH cushings and pancreatitis too! Getting your girls pancreatitis under control should be the number one priority right now, which I believe your vet is doing. Was a cPL or cPLI test done to confirm the pancreatitis, if so could you post the results of either one of these test? The cPL/cPLI test also gives a range in numbers of how severe the pancreatitis is. Is she on a special diet for her pancreatitis?

I give my boy a supplement called L-Glutamine, it is good for the GI tract and may help with muscle wasting. Here is a link to an article about L-Glutamine:
http://www.scribd.com/doc/23752319/R...th-and-Disease

I was wondering if you could tell us more about your girl, what tests were done to confirm her diagnosis of cushing's? You see, non-adrenal illnesses, like pancreatitis, can create false positives on cushing's tests. What symptoms does your girl display? How much does she weigh? What dose of Trilostane is she on? Do you have prednisone on hand? I am so sorry for all the questions, but the more we know about your precious furbaby the better our feedback will be, ok.

Just remember, you are not alone on this journey, we are here to help you in any way we can.

Love and hugs,
Lori

[loshie]

Thanks so much - this is a great forum!

Yes, Mila is still at the emergency vet, they took bloodwork at 4am but I don't have those results yet. He did say that the cPL was 1000 I think on Monday but I don't have any paperwork from them until we go get her in a few hours.

Basically how it all started was over the x-mas holiday, she was not acting her self, stopped eating, we took her to our vet and he said her liver enzymes were so high, they had put her on IV and she was jaundice, we transferred her to the emergency vet hospital where they discovered she had a blocked bile duct - scar tissue - which they operated on her and removed and flushed her duct. She was there about 5 days and when she came home she was on Tramadol and Clavaseptin.

Because of this, we would do follow up blood work etc., and that is when her vet wanted to test for Cushings because her liver enzymes went down but other things were abnormal.

Unfortunately I don't have all the test results but I have what was performed (I'm looking at the invoices):
April 17th
Canine Total Body Function HW
Urine Cortisol : Creatinine
Urinalysis
April 23rd
Canine Thyroid Panel 4
Urine Protein : Creatinine
May 7th
Ultrasound - I have the results from the internal medicine vet and recommendation: Lliver was diffusely and mildly increased in size - parenchyma was isoechoic, adrenal glands were bilaterally mildly increased in size measuring .77 and .85 cm in diameter, both kidneys were hyperechoic with a subtle but significant degree of pelvic dilatation, suggesting pyelonephritis and possibly explaining the mild proteinuria. No masses were found and the remainder of ultrasound was normal - Pancreas at that time was normal.
Recommendation: consider confirming suspicion of pituitary dependent hyperadrenocorticism via provocative testing. Consider long -term ursodiol, consider urine culture and a long course of antibiotics.
She then had an ACTH Stimulation Test - her results were:
312, 737 & 850

She was prescribed Clavamox for 18 days. Vet wanted to clear a kidney infection before starting Trilostane (so no doses etc, were discussed). On the 18th day of Clavamox, was Saturday where we just took her for the pancreatitis.

Her symptoms are drinking lots of water, increased appetite (we spoke to an animal communicator after the surgery and before cushings was suspected and she told us that Mila says she is so hungry even after she eats her food!) - She's about 20 lbs (although she will have lost weight by the time we pick her up), not really a pot belly but not toned, she does look like she lost muscle mass all over, especially hind legs, hair is fine, but skin seems a bit thinner on her back.

As a side note, we used to give her Sasha's blend for a limp she would have after extended play, that was about 2 years ago and she never had that problem afterwards. Up until December, we were giving her glucosamine and a chondroitin supplement but stopped that once all this started. She also (since she was young) had incontinence due to low estrogen. I did put her on meds for this at one point, but they didn't really help.

For the pancreatitis, would it help to give an oral probiotic?? I work with a Naturopath (not a vet though) and he said it should help ease the burden on the pancreas...


Sorry for the long post, but thank you so much for replying and welcoming me to the forum!

[Harley PoMMom]

I have some of my answers/questions in blue.

Thanks so much - this is a great forum!

Yes, Mila is still at the emergency vet, they took bloodwork at 4am but I don't have those results yet. He did say that the cPL was 1000 I think on Monday but I don't have any paperwork from them until we go get her in a few hours.

Basically how it all started was over the x-mas holiday, she was not acting her self, stopped eating, we took her to our vet and he said her liver enzymes were so high, they had put her on IV and she was jaundice, we transferred her to the emergency vet hospital where they discovered she had a blocked bile duct - scar tissue - which they operated on her and removed and flushed her duct. She was there about 5 days and when she came home she was on Tramadol and Clavaseptin.

Because of this, we would do follow up blood work etc., and that is when her vet wanted to test for Cushings because her liver enzymes went down but other things were abnormal.

Usually HIGH liver enzymes is what red flags a vet to test for cushing's, so I am a little concerned here. If you could get a hold of her test results and post the things that are marked abnormal, it would really help us sort things out.

Unfortunately I don't have all the test results but I have what was performed (I'm looking at the invoices):
April 17th
Canine Total Body Function HW
Urine Cortisol : Creatinine
Urinalysis
April 23rd
Canine Thyroid Panel 4
Urine Protein : Creatinine
May 7th
Ultrasound - I have the results from the internal medicine vet and recommendation: Lliver was diffusely and mildly increased in size - parenchyma was isoechoic, adrenal glands were bilaterally mildly increased in size measuring .77 and .85 cm in diameter, both kidneys were hyperechoic with a subtle but significant degree of pelvic dilatation, suggesting pyelonephritis and possibly explaining the mild proteinuria. No masses were found and the remainder of ultrasound was normal - Pancreas at that time was normal.
Recommendation: consider confirming suspicion of pituitary dependent hyperadrenocorticism via provocative testing. Consider long -term ursodiol, consider urine culture and a long course of antibiotics.
She then had an ACTH Stimulation Test - her results were:
312, 737 & 850

Maybe this was a LDDS test and not an ACTH stim test? Could you check and make sure of this, confusing, huh? The LDDS test has 3 draws, where the ACTH stim usually has 2 draws; a pre and a post.

She was prescribed Clavamox for 18 days. Vet wanted to clear a kidney infection before starting Trilostane (so no doses etc, were discussed). On the 18th day of Clavamox, was Saturday where we just took her for the pancreatitis.

Her symptoms are drinking lots of water, increased appetite (we spoke to an animal communicator after the surgery and before cushings was suspected and she told us that Mila says she is so hungry even after she eats her food!) - She's about 20 lbs (although she will have lost weight by the time we pick her up), not really a pot belly but not toned, she does look like she lost muscle mass all over, especially hind legs, hair is fine, but skin seems a bit thinner on her back.

As a side note, we used to give her Sasha's blend for a limp she would have after extended play, that was about 2 years ago and she never had that problem afterwards. Up until December, we were giving her glucosamine and a chondroitin supplement but stopped that once all this started. She also (since she was young) had incontinence due to low estrogen. I did put her on meds for this at one point, but they didn't really help.

For the pancreatitis, would it help to give an oral probiotic?? I work with a Naturopath (not a vet though) and he said it should help ease the burden on the pancreas...


Sorry for the long post, but thank you so much for replying and welcoming me to the forum!

I am thinking if she showed no signs of pancreatitis before, that maybe the surgery to remove the blocked bile duct may have contributed to her having pancreatitis now. They might have had to handle the pancreas while in surgery and the pancreas is a very fragile organ in that it does not like to be disturbed.

Feeding several very small meals throughout the day is a good idea. Foods high in fat and protein trigger the greatest enzyme secretion, so try to feed her a diet that's very low in fat and try to keep her at her ideal weight.

Hope this helps. You are doing a great job so keep asking questions and we will try to answer them, ok!

Love and hugs,
Lori

[loshie]

Thanks Lori!!
I'll try to find that all out this week as she has to have follow up bloodwork on Friday.
I had called today and the receptionist said it was an ACTH test and gave me those numbers but I'll follow up with the vet.
Glad she's home now at least, resting up. For now, the emergency vet forwarded all her bloodwork that was done to her regular vet and she's on:
Amoxicillin, Metronidazole, Zenequin, Cerenia, Sulcrate suspension, Tramadol and Fortekor.
He said the Fortekor might be a long term as she has high blood pressure which he said is common with Cushings. He recommends if everything is ok for the next week she should start Trilostane soon so I'll see what her vet says on Friday.
Thanks again - I'll ask about the glutamine as well!

[loshie]

Oh, also because of the bile duct blockage her liver enzymes were super high and they did come down but still not normal is what I meant and other levels were off - that's why he suspected cushings, along with the fact that she started to drink a lots of water.
I'll get those results though and post when I have them.

Thanks again,
Melanie

[Franklin'sMum]

Hi Melanie and Mila,

Just wanted to pop in and welcome to you both to an amazing group of people! I am hoping Mila feels better very soon,

Jane, Franklin and Bailey xxx
________
Expert insurance

[loshie]

Thank you so much Jane, Franklin & Bailey!

Mila seems to be doing ok for now, she's happy to be home. We spoke to an animal communicator again yesterday, Mila says her tummy still hurts but Mila was telling us all sorts of funny things that I think she's very happy at least and enjoying life otherwise.

Because her cPL level is still around 1000, we were told to wait until Monday to have more bloodwork, that's when I'll get all the results and testing info to post.

[Harley PoMMom]

Hi Melanie,

I am glad that Mila is home and surrounded by your love and comfort. With her cPL levels being so elevated, I do want to stress how serious pancreatitis is to our furbabies, actually it can be life threatening in some cases. If Mila would show any signs of pancreatitis again, please have her looked at right away.

My boy Harley has high blood pressure also, he takes amlodipine to keep his under control.

I will be looking for your post for the test results and info. I also will be sending Mila tons of healing thoughts and well wishes.

Love and hugs,
Lori

[loshie]

thanks Lori! your healing thoughts definitely helped and she has been doing good all weekend.
we went to get bloodwork done today and her regular vet said she looks really good and has a lot of energy.
as for some results i was able to get from the receptionist:

TSH level .45 ng/ml
Protein/Creatinine Ratio 1.95

and now for the ACTH:

Tube Labeled 0H
Tube Labeled 1H
Tube Labeled 2H
Cortisol Sample 1 ACTH: 312 nmol/L (reference range 28-124)
Cortisol Sample 2 ACTH: 737 nmol/L
Cortisol Sample 3 ACTH: 850 nmol/L

does that make sense?? thanks for your help, when we go get the results - i'll ask the vet for more info and post the bloodwork from today's tests. he did say that he will teach us how to take her blood pressure as he's hesitant to keep her going on the Fortekor (he said that the high blood pressure could have been from being at the emergency vet and doesn't want her to take it unnecessarily)

thanks,
melanie & mila
xox