Poor Pitiful Pia - Pia has gone to heaven

[knitbunnie]

Pia is my nearly 8 year old French Bulldog who, for unknown reasons, had a stroke three years ago. She woke up from a nap and was paralyzed on her left side. She went through therapy, a whole lot of therapy, and acupuncture which really helped a lot, and recovered with a limp and some left-sided weakness. She's such a sweet girl, and I feel like it's not fair for her to have yet another major health crisis. Here she is:



So on to the possible Cushings and the lead up to where we are now. She normally ate a diet of homemade food of beef, rice, fruits and veggies that was recommended by her actupuncturist/vet when she had a stroke. I supplemented with Merrick Cowboy Cookout dry to balance her diet. The company stopped making it, so about 3 weeks ago we switched her dry food to Fromm's Beef Frittata Dry. And that's when the problems started - bloating, gas, lethargy, excess thirst resulting in excess urination. I switched her to another Merrick product, and mostly fed her the homemade food. The bloating/gas have improved but not resolved, but the thirst is still there, and she's urinated in the house a few times this past week at night. This is completely uncharacteristic of Pia. Even when she had her stroke, she held her urine until we carried her out to the yard and helped her to stand with a sling.

I called the vet's office on Monday, and she was seen today. I collected some urine this morning - clean catch on a clean serving spoon. I honestly suspected diabetes, but her urine and blood glucose levels were completely within normal limits. She was needled at the vets for a sterile urine culture, so that's in the works. They suspect either pancreatitis or Cushing's or both.

Below are her "off" lab results and some input from the vet as to why on several of them.

ALT - 146 U/L (normal 10-100)

Lipase - 5660 U/L (normal 200-1800) Vet says this is suspicious for either Cushing's or pancreatitis along with the elevated ALT.

TT4 - 0.8 ug/dl (<1.0 ug/dl is low) Vet said it's because of the stress of being ill

Her lymphocytes are low (0.9) as are her eosinophils (0.01) and the vet also said this was a stress reaction.

For now, the vet has put her on Royal Canin Gastrointestinal TM Low Fat Canned Dog Food, and started Reglan for the bloating. We're to wait for the results of the urine culture (three days) and see how Pia does with the Reglan and diet change. If nothing changes, she recommends an ultrasound and a Low Dose Dex Snap Test.

With the over $300 expense of today's visit, I'm tapped out. The next round of testing is about $400. I can do it after the 1st of the month. Is this realistic?

Since Pia has been having night-time accidents, would it be awful to restrict her night-time water intake? I will do whatever I can for Pia, but if the expense of the tests can wait two weeks, it would be a relief. If not, I'll figure something out.

I thank you all for any and all input, good or bad. I'll listen to advice. That's why I came here.

[frijole]

Sorry you had to find us but glad you did. Cushing's doesn't just pop up after a diet change which is what you have described. Based on the lab results - the alt is a liver enzyme but it's alk phos that is usually in the THOUSANDS that is a sign of cushings. The lipase is not a sign of cushings but really tends to be present with pancreatitis. I would suspect that vs cushings and would not spend ONE DIME on cushings tests at this time. It could also be kidney issues which would explain the urination.

When kidneys are acting up they use up all the hydration and that is why dogs drink more - so NO do not restrict water as it is important Pia has as much water as her body needs. Sorry but the urination will continue until she is cured.

Again - if those are the only items that were high on the blood test I would not rush to test cushings. I'd check out the tummy issues. Pancreas issues are serious and painful so don't waste time. There is a specific sPec test you should have done and I pray Lori or someone else with experience sees this and can help you tonight.

Meanwhile you might want to switch to very easy foods to digest like white rice (overcook it so it is mushy and include some of the rice juice) and water, perhaps chicken breast if she can handle it.

Kim

[Simba's Mom]

Welcome to you and Pia, what a cutie! So glad you found this site, you will learn a lot, and get encouraged along the way. There is no question too big or too small, so settle in and get comfortable...

[molly muffin]

Hello and welcome. I agree with Kim, my first thought too with those test results and the symptoms you have described is pancreatis. Very small meals, several times of day, as bland and low fat as possible, as kim mentioined.
The Cple test is specific to pancreatic attacks and I would ask for one of those immediately based on these results.
Lori does have experience with this, so hopefully she'll be around soon.

Welcome to the forum by the way. Pancreatis or cushings, you're here, we adopt you

hugs,
Sharlene and Molly muffin

[knitbunnie]

Thank you all for some answers that give me hope for my sweet Pia. I'd rather she be completely healthy, but if I have a choice between a bout of pancreatitis and Cushings, it sounds like pancreatitis is the lesser of the evils.

We have had our share of dog woes at my house. Our other wonder-pup is Maggie, a nearly 15 year old Boston Terrier. After numerous surgeries and many medications in her eyes, she became totally blind at age 7. As old age crept up, her ever-present grade 1 heart murmur increased to a 3-4 with mitral valve regurg. She's on enalapril and Vetmedin. In January, she started to have seizures, and now she's on phenobarbitol as well. Did I mention that she's nearly deaf? We love her so much♥

If I sounded less than generous with my desire to put off further testing for a few weeks, I hope this helps people to understand why. We are of modest means, but we are responsible pet owners, and if you all recommended immediate testing, I'd whip out a credit card and do it, and worry about paying it off later.

Pia tried her first meal of Royal Canin Gastrointestinal TM Low Fat Canned Dog Food. She hadn't eaten much of anything today, so she had half a can. She really liked it. This is the first time in days that she has licked her bowl clean. She's to have 3 meals a day with Reglan half an hour before each meal, with feedings about every 8 hours. Tomorrow, I'm going to try a third of a can per meal. I don't want to starve her, but I don't want to stress her. The vet said to give her 1 to 1 1/2 cans per day.

[doxiesrock912]

It doesn't sound like Cushings. Honestly, I would spend the money with an IMS vet to determine what is truly going on.

General vets only know so much and certainly not enough about Cushings etc. Best to start where you know they have the knowledge in my opinion.

Don't restrict water intake as others have said because this is the dog's natural way of flushing out excess toxins or whatever is out of balance from their systems. In the case of Cushings dogs, they're trying to rid themselves of excess Cortisol.

I do understand completely about the money because I am unemployed and Daisy's diagnosis couldn't have come at a worst time. This is why I'm advising you to see an internal medicine specialist since in all likelihood your general vet will recommend one anyway if they can't figure out what is going on.

Please be aware that an infection can also hinder the accuracy of Cushings tests so it is important that that be cleared up or ruled out first.

Good luck.

[knitbunnie]

If Pia hasn't improved dramatically within the week, I'll look into an IMS. That would be a more than 200 mile round trip, to near Palo Alto, CA. Yes, I live in the boonies. But Pia's worth every mile.

Thank you for the suggestion.

[Harley PoMMom]

Hi and welcome to you and Pia,

Lipase, when elevated, can be indicator of pancreatitis but other things can make the lipase high, lipase is non-specific because there are many types of lipase. To really confirm if Pia has pancreatitis then I would ask your vet about having a spec cPL test done on her. A link with info about the spec cPL test: http://www.idexx.com/view/xhtml/en_u...jsf?SSOTOKEN=0

If pancreatitis is suspected then a diet very low in fat is recommended. Also keeping her hydrated is important. Feeding several small meals through out the day helps a dog that has pancreatitis. Kim mentioned the mushy rice, which is good, and I would give, along with the rice, skinless, boneless, low in fat chicken breasts.

If this were me, I would have the spec cPL test done and if the results validate the diagnosis of pancreatitis I would not have any tests for Cushing's performed. Once the pancreatitis is under control and if symptoms continue then I would resume the testing for Cushing's.

Please know we are here for you and Pia so please do not hesitate to ask any and all questions.

Love and hugs,
Lori

[Squirt's Mom]

Hi and welcome to you and Pia!

I wanted to be sure you understand the seriousness of pancreatitis. This condition can be quickly serious while Cushing's takes years to get serious so don't let yourself feel that pancreatitis is preferred over Cushing's tho I do understand where you are coming from. I just want you to understand that pancreatitis needs attention now, today, but the Cushing's could wait for a while.

The ALP is nothing to be concerned about at such low elevations. We have seen that value waay on up there - my own babies is off the chart often. So don't panic over that. It is the lipase and T4 (thyroid) that need further investigation. I wouldn't be happy with a thyroid level below 1 and would want a full thyroid panel run. Hypothyroidism mimics Cushing's, sharing many of the same signs, and it is so easy to treat. So if I were you, I would want that checked out and the pancreas checked out asap and forget about Cushing's right now - based on what we know so far, I would say that is the least of your concerns and may never be a concern.

I'm glad you found us and look forward to hearing more about your sweet girl. Even if it turns out she does not have Cushing's, you are both family now and we will want to hear from you often.

Hugs,
Leslie and the gang

[knitbunnie]

Pia is having a generally quiet day. She's always been a rather stoic girl, uncomplaining and not given to fussiness at all, so it's hard to tell if she's in pain. She is so not interested in walking or playing. All she wants to do is eat her small portions of food, lap ridiculous amounts of water, and sleep. Even getting her to move her little rump outside for potty is a bit of a struggle. She had another accident in the house last night. My carpet machine is getting a workout!

I read somewhere on the net that sweet potatoes are a good snack for a dog on an ultra-low-fat diet. I microwaved one last night and cut it into small pieces. She likes it and is happy to take her Reglan wrapped up in a little piece of it.

Should I encourage activity? Or should I let her lay around? She has a couple things that drive her into a frenzy of activity - my talking through a paper towel roll or banging big sticks together. She perks up if I do either one, but I'm not sure if it's a good idea to get her excited. She has this thing for sticks that bang together. She even loves when I clank my knitting needles together. Sweet, silly girl!