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

  1. #1
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    Default Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

    Hi everyone, I'm Sharlene and my lovely dog Molly has been diagnosed with Cushings for 5 days now.
    I've been reading over the site and I've cried many tears while reading the various posts. Some tears for you and your loving companions, some for Molly, some if I am honest, for myself.

    Molly weights 19.2lbs. She has in the past been prone to crystals forming, so she has been on SO dog food for years. She takes Glucosimine because she has a hip joint that isn't grooved really deep enough and she's had some issues with that in the past. In fact, it was a sore leg and a pot belly that causes her to be tested for cushings 2 years ago, results of which were negative, from a DEXA test. Hence the glucosimine. Her ALP's have been high consistently and we try to balance that using the SO food, that encourages her to drink more water and the crystals not to form. She only had them once, that was enough.

    This morning I went and picked up copies of her lab tests going back 2 years.
    I'll post any that were off with the appropriate ranges:

    2010 physical
    ALP 518 (20 - 150)
    everything else within normal ranges

    2011 physical
    Albumin 46.7 (26 - 44)
    Protein 78 (51 - 72)
    ALP 764 (5 - 151)

    2011 DEXA
    Cortisol (Base) 82.2 (20 - 300)
    Cortisol (DEXA) - 4 hours 28.7
    Cortisol (DEXA) - 8 hours 35.1

    Not Cushings

    2012 March physical
    Albumin 44.1 (26 - 44) (barely out of range)
    Protein 76 (51 - 72)
    ALP 1121 (5 - 141)
    ALT 139 (6 - 118)

    At my request we redid the ALP and ALT along with the ACTH test a week ago

    2012 June tests
    ALP 1003 (5 - 141) (this has actually decreased a bit since March)
    ALT 152 (6 - 118) (while this has gone up a bit since March)

    Cor1 - Cortisol (base) 172 (30 - 300)
    Cor 21 - Cortisol (ACTH) - 1 hour 924
    Cor 22 - Cortisol (ACTH) - 2 hour 1014

    Lab states, that in a normal animal Cortisol will increase above 250 but not above 600.
    The results are consistent with Cushings Disease; Pituitary-Dependent Hyperadrenocorticism

    okay, so now that is out of the way, my vet, who has been Molly's vet since we brought her home as a rescue baby at 11 months, feels that this has been caught at the very earliest of stages. Her recommendation is to begin treatment with Vetoryl 30 mg. In fact, it is sitting here on my desk right now. It is the monster in the closet, under the bed, or in my case, in front of this computer monitor.

    So I asked her why begin treatment now,( actually she has called me once since they told me on Wednesday, to discuss and then we spoke again today, when I went to pick up copies of lab results) and she said, that although it is not clinically necessary to start right now and we can decide when we would want to start medications for the cushings, that her experience is that when treatment is not started, the risk increases greatly for dog to develop diabetes and/or pancreatitis. That she feels and she has had good results with early treatment. I asked also about the Davis study suggesting a lower dose and she said that the Davis study is already out dated compared to more recent studies, from universities around the world. That she has had good luck with this dose for Molly's size. Starting the medicine she said would be followed up with tests at day 10 - 14 (she suggested day 12) after starting treatment and then based upon how molly is doing, either 4 weeks or sooner if she feels that it is needed.

    So, that is where we stand. She didn't say start right now, because as she mentioned we might not have tested at all and it wouldn't have been caught until some other time, when I brought her in for a problem of some sort. True enough I suppose. She thinks it is an opportunity to prevent any further complications and to get her sorted out and on the road to a "maintenance" life, which would hopefully be a long one. She also said, that it is possible that once the cortisol levels go down, that we will see some arthritic issues since she had a spell with joint pain last year. She outlined what we'd use to treat that if it does occur, which would be Glucosomine first, pain meds possibly, laser and finally injections if none of the other options work.

    I find myself second guessing how well I thought molly was/is. She does lay around more, but has a great time playing when she wants to. She doesn't eat all at once every day, usually she eats maybe half or even less, and then later will finish off (around dinner time). She drinks, but not overly so and we in fact try to encourage her to drink since she had issues with the crystals forming. She does have some times when she doesn't want to jump up or she has to make a running leap for that window seat she loves. And yes, there is the pot belly. (we thought she just really loved those treats a tad bit too much and that is probably still true)

    Have I been in denial? Maybe. Yet people on the street can't believe she is 9 years old, thinking her much younger.

    Will starting her on the medications sooner rather than later lead to less complications and a better over all life? I don't know that either.

    Really, I know a lot and I know nothing. That about sums up the gist of it.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  2. #2
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    Hi Sharlene and welcome to you and Molly

    There will be plenty of more knowledgeable members stopping by to say hi and help in any way they can. My confusion or concern is the lack of appetite and thirst. Usually a dog with cushings has a very healthy appetite and can never seem to get enough water to drink.

    It is possible to get a false reading on cushings test if the pup is experiencing any other health problems. Has an ACTH stim test been performed, The way I have always understood cushings diagnosis is that no one test is conclusive and cushings can be somewhat difficult to diagnose at times.

    Hang in there and check back often, things can be kind of slow on the weekends and close to the holidays.

    Oops I see the ACTH has been done so maybe a Low Dex test to confirm.
    Last edited by Roxee's Dad; 06-30-2012 at 04:28 PM.
    John (Roxee & Rozee's Dad)

  3. #3
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    Hi John,

    Yes the ACTH was done, results in first post. Appetite depends, she would woof down a bag of treats like there is no tomorrow if you let her, she loves her can food, but the dry food, some days she will graze at it and others she'll eat it all at breakfast. Water, yea, same concern here, she doesn't overly drink, although she has a bowl of water in the bedroom at night, because she will get up and get drinks during the night most of the time.
    I actually had the same concerns and mentioned them today to the vet. She said that not all dogs display the same symptons but that she does feel that the cushings diagnosis is correct.
    I don't know if it is or not and that is why I haven't jumped on starting her on medicine. The liver is high, the cortisol is definitely there in the ACTH test.
    Weekends are for good times, relaxing and enjoying not having to do the work thing. I hope everyone is enjoying this one. For us, it's a long weekend too. Love it!
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  4. #4
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    Hi Sharlene

    Did they determine which type of cushings it may be? One thing to be aware of, in most cases, treatment is usually used to treat the symptoms, such as excessive hunger, excessive thirst and frequent urination.

    In some cases where it's adrenal based, surgery may be possible thereby a cure. The medications Lysodren and Trilostane do not cure cushings, only treats the symptoms.
    John (Roxee & Rozee's Dad)

  5. #5
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    I am headed out the door so don't have long to post but your dog doesn't have typical cushing's symptoms. A cush dog is ravenous and would eat anything and never leave a kibble EVER. I'm glad you did not start any meds. The world experts all agree you do not treat until there are symptoms even if the dog has cushings. You are right - UC Davis does recommend lower dosing and we have found over the years and experience from many hundreds of people who have come here that starting low is the ONLY way to go.

    I want to convert your test results when I return. Are you from outside the US? The numbers are higher than normal and I think it is the unit of measure used by the lab. I'll check in later.

    Hang in there and don't fret this diagnosis - Molly will be fine. Kim

  6. #6
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    John,

    The lab said Pituitary-Dependent Cushings, not adrenal based. And they think that the symptoms will start to show that literally it has been caught very early. That the excessive food and thirst will probably be some of the first symptoms that she develops. She has had accidents in the house, but not consistently, so I wouldn't attribute them to cushings.

    Kim, I'm in Canada. Not sure what the conversions would be, but have included the lab ranges as given. Yes, my vet acknowledges that there is no cure, only symptom treatment. Her concern is the other possible illness that could occur and might be preventable such as diabetes, which molly currently has no signs of. In fact, molly other than the liver and the cortisol and belly has no signs of cushings. In most cases she wouldn't have probably been tested at all.

    Sharlene.
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  7. #7
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    Thanks Sharlene,
    I am very interested in following yours and Molly's thread.

    Shih Tzu's hold a very special place in my heart.
    John (Roxee & Rozee's Dad)

  8. #8
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    I am curious. If this is not cushings, and my vet is adamant that it is, what tests should I ask for? What else could it be. The sudden increase in the ALT's is what is worrying, along with the cortisol going up.

    I want to take care of whatever the problem is, I just don't know what to do. Another talk with the vet and she is definite that starting early prior to typical cushings symptoms can help to prevent other organ problems from developing.

    I don't know what to do.

    The ALT only results are:

    54 (10 - 118) 2010
    110 (6 - 118) 2011
    139 (6 - 118) March 2012
    152 (6 - 118) June 2012

    As you can see, those numbers are just going up like crazy and pretty quickly too. I was told they really get worried once the number hits (double normal results, which would be 236. Vet thinks Vetoryl will get the cortisol under control so that she won't end up with any major organ damage.

    Thoughts?
    Sharlene and the late great diva - Molly muffin (always missed and never forgotten)

  9. #9
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    Hi again Sharlene,

    I was just wondering, was a High resolution ultra sound performed? Usually to take a look at the adrenals and other important organs. In many cases one or both adrenals may be enlarged due to the cushings. This is because they are working overtime to produce the cortisol.

    I do remember Leslie's story about Squirt and the ultra sound found something wrong with her spleen which in turned caused a high cortisol count. She will probably be around soon to elaborate.

    Another question, I see the ACTH test was performed, was there another test like the LDDS, performed after the ACTH test to determine if it is indeed pituitary based.
    John (Roxee & Rozee's Dad)

  10. #10
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    Default Re: Molly, 9 yr, shih tzu - lhasa aspo, cushing diagnosis

    Hi Sharlene,

    I wanted to offer you a belated welcome from me. I also have two Shih Tzus and love the breed!

    First, Molly sure is a cutie! My dog, Hannah, also had crystals in her urine and has been on Royal Canin SO food for 8 years. It has helped her out a lot!

    Hannah was diagnosed in March of 2011 after routine blood work before a dental. Her Alk Phos level was high and my vet asked about Cushing's symptoms (water increase, urinating more, ravenous eater, etc.) She was drinking and urinating a bit more, but I don't know that I would have contacted the vet about it. He did a LDDS test that day and she did test positive for pituitary Cushing's. We had an ultrasound done a few weeks later just to be sure things were normal there and they were. My vet also felt that we caught it very early and said that for many dogs it takes years for things to progress.

    I still have not started treatment on Hannah over a year later. We did try Anipryl for a few months because I knew it worked in some dogs and had basically no side effects and didn't have to be carefully monitored. Her ALKP level did drop, but I didn't notice much of a difference otherwise so we decided to stop the Anipryl. She has now been taking Denamarin, a liver supplement, for about 6 months and her ALKP level returned to normal. It was over 800 when we started and was about 200 a few months ago.

    Since I know the main way to determine how she is doing is by monitoring her eating and drinking, I don't feel comfortable starting her on a stronger drug unless I am sure I will be able to see a difference. She definitely gets several drinks a day, but she is not emptying a water bowl and she is not peeing constantly. She does LOVE to eat and does beg me for food sometimes, but it isn't out of control. She has a full coat, no pot belly, no skin issues...just some hind leg weakness. I have decided that until she has more significant symptoms I don't want to treat. My vet strongly supports this, as did the IM vet we saw. I know there could be some damage being done, but I don't feel comfortable risking it with powerful drugs.

    I am glad you are taking the time to think about what is best for Molly. I know others will be by to offer more "expert" opinions on what is best for her. I would definitely take some time to think, read, and educate yourself before jumping into anything.

    Also, I know ALT and ALKP are different liver enzymes, but the high normal end for ALKP here is 212 and Hannah's was over 1700 when she was diagnosed. I definitely understand your concern, but I don't want you to panic. I wonder if a liver supplement would help Molly as well. I know many people on this forum use one, so that might be something to look into.

    Please keep us updated on what you decide and always feel free to ask questions. You have found a wonderful place of helpful, knowledgeable, caring and supportive people!

    Julie & Hannah
    Last edited by jmac; 07-02-2012 at 01:14 PM.

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