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Thread: Almost 8 y.o. recently diagnosed, a few questions

  1. #21
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    Welcome back to you and Paddy. Iím very relieved to hear that the extractions went well. But Iíve just now read your updates on the diabetes forum, and Iím sorry to see that the cancer issue is an increasing concern for you two. Given all of Paddyís recent problems including his lack of appetite and difficulty urinating, I canít argue with the decision by the IMS to at least temporarily discontinue Paddyís Vetoryl. As far as giving lignans and melatonin for the elevations in Paddyís other adrenal hormones, I doubt that lignans will be recommended since Paddyís estradiol was still within normal range last April. Thatís the hormone that lignans is most useful for. The IMS may continue with the melatonin for the other elevations. My understanding is that melatonin may also have a mild effect in lowering cortisol, although nowhere as great as the effect of Vetoryl.

    Iíll be very interested in finding out what the IMS recommends on this next followup visit. Until then, please give Paddy a big hug from his friends here, and I surely hope he starts feeling better!

    Marianne

  2. #22
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    I haven't read your posts on the diabetes site but am familiar with Atypical Cushing's. That is what my Squirt started out with. Atypical is a form in which the cortisol is NORMAL but 2 or more of the intermediate hormones are elevated. The only place I know of that tests for this form is the University of Tennessee in Knoxville so if labs weren't run by them there can be no diagnosis of Atypical. The cortisol is the key - if it is elevated then the dog has conventional Cushing's, not Atypical. The intermediate hormones will be elevated in most cush pups so they aren't diagnostic in and of themselves for Atypical

    UTK used to say that they preferred Lysodren for Atypical pups if the cortisol did start to rise. This is because Vetoryl/Trilostane has been shown to cause elevations in these other hormones while Lysodren controls them with the possible exception of estradiol. Estradiol can be produced in some odd places like hair follicles and Lyso works ONLY on the adrenal glands. So if this hormone is elevated then the only thing that reach it is the combination of lignans and melatonin. One or the other won't help.

    I will be interested in hearing what the IMS plans for Paddy. I am very glad the extractions went well!
    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  3. #23
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    I just realized I never posted the results of Paddy's last UTK stim test (from April). It took nearly a month to get them.

    TEST - RESULT (Baseline) / Normal Range (Baseline)** / (Post ACTH) / Normal Range** (Baseline Post-ACTH)
    Cortisol (C) ug/dL : 6.7* / <1.0-5.6 / 7.8 / 7.1-15.1
    Androstenedione (A) ng/mL : 2.48* / 0.05-0.36 / 3.74* / 0.24-2.90
    Estradiol (E) pg/mL : 59.7 / 23.1-65.1 / 56.2 / 23.3-69.4
    Progesterone (P) ng/mL : 1.22* / <0.20 / 1.99* / 0.22-1.45
    17-OH-Progesterone (17OHP) ng/mL : 5.11* / 0.08-0.22 / 6.94* / 0.25-2.63
    Testosterone (T) ng/dL : <15.0 / <15.0-24.0 / <15.0 /<15.0-42.0
    * Above or below reference range **Mean normal range values for neutered male dogs

    Paddy isn't taking anything for his cushings since the vetoryl was discontinued in December.The internist who is handling his diabetes now says that he needs to see someone for his cushings since that could be contributing to his high glucose. The only option is Lysodren, right? I'm still trying to decide if we should do chemo for Paddy's prostate (oncologist recommended vinblastine). I don't think radiation is an option as Paddy would have to be sedated every day for five days, staying at the hospital.. and the cost also seems to make it out of reach. The only treatment he's getting for his prostate right now is an nsaid (piroxicam) and a supplement someone recommended (turkey tail mushroom). He's lost alot of weight since the spring. How worried should I be about starting lysodren and chemo so close to the same time? I'll be calling the oncologist this week to ask about his cushings (that's what our regular vet instructed) and will also need to discuss chemo again before I make a decision about that.

    I'm not sure if Paddy's cushings could've been atypical from the beginning or if it was caused by the vetoryl..? I think the first time the UTK test was done was in 2019. One of the IMS told me to discontinue the melatonin in June or July because of possibly preventing insulin from working.

    Thanks, Marianne & Leslie, for your help. I get really confused & overwhelmed trying to figure all of this out.

  4. #24
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    How is Paddy's appetite? Lysodren is only recommended for cushdogs that have a ravenous appetite because the dog has to go through a loading phase, and the one of the most important things to watch out for when loading with Lysodren is a change in that hunger. Maybe a lose dose of Vetoryl could be an option, however, right now I believe that keeping him off all Cushing's medications would be better since Paddy may be starting Vinblastine, which I see that gastrointestinal problems are an ill side effect and those cushing medications can cause the same issue.

    I'd definitely discuss all your worries and questions with the oncologist and please do let us know what is said, thanks! Give some gentle hugs to Paddy from me and there are huge loving hugs for you as well.

    More hugs, Lori

  5. #25
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    Lori has asked the first question I have on my mind, too -- has Paddy's appetite normalized again yet? And how about his ability to produce urine? I realize his situation is really complicated, and you are having to balance a lot of considerations. It would be hard for any of us to figure out the best path forward right now! But it also seems to me that if the specialists think the Cushing's medication needs to be restarted, that going back on the Vetoryl would be the preferred choice for him right now. It's true that Vetoryl can cause elevations in adrenal hormones other than cortisol, but I don't believe it's been established that those elevations necessarily cause genuine problems for all dogs, as long as elevated cortisol is under control. And given Paddy's current situation, I think resuming his Vetoryl would be the preferred medication choice over Lysodren.

    Having said that, I would think there would be reservations about giving *either* Vetoryl or Lysodren to a dog that is observably unwell -- not eating and not urinating properly. I realize that controlling his glucose level is super important, but if Paddy is not eating or urinating properly, there could be dangers in giving him any additional meds right now, especially in conjunction with the chemo. So I do think it'll be important to find out what the oncologist has to say about all this. And we'll be very anxious to find out right alongside you.

    Marianne

  6. #26
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    Another thought is that any testing for Cushing's would not be reliable in my opinion. This is because everything sweet Paddy has going on is causing stress in the body. Any time the body is stressed the cortisol rises in a natural response to the stressor to help the body cope. So it is very likely that any test for Cushing's will come back positive but is that result trustworthy? I have had 2 dogs misdiagnosed with Cushing's because they both had other health issues going on at the time of testing. One did eventually develop Cushing's but the necropsy on the second one proved she never had it...her adrenal glands were perfectly normal even tho she had not had treatment for some time.

    And I agree with Marianne and Lori...the appetite and urination are important in both diagnosing and treating Cushing's. The medication chosen could cause more problems than it helps. I wish I knew the magic solution to offer but I simply don't. Lori has it right...I would discuss everything with Paddy's oncologist and let him/her direct you.

    We are with you no matter what path you choose.
    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

  7. #27
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    I haven'y spoken with the oncologist yet... I feel like when I do I'll have to also make a decision about the chemo but I'll call them before weekend. They're at Auburn U. as that is the closest one. Also trying to find holistic vet for herbs,etc...maybe accupuncture?
    Paddy's appetite has been better - knock on wood - since having those teeth extracted.He had sores on his inner cheeks from rubbing his face and the tarter . Now, he'll bark at me sometimes if I take too long getting his food ready. He does strain when he pees, though. And some days he poops alot (like, 7 or 8 times). I'm not sure what to do about the weight loss. I don't know how to help him gain weight since the food he's on is rx/ low carb etc for diabetes. I've spoken to Paddy's gp vet and the IMS he's seeing now & no one really has answers or they tell me to talk to one of the other vets. No nutrionist at Auburn either but I'll ask them again about his diet & weight.
    Does anyone feed their pup Dr. Harvey's? I'm trying to give Paddy that along with his regular food (supposed to be good for diabetes & cancer). Instructions are to add oil along with choice of protein. I've read that krill and fish oil are blood thinning,though, same thing for digestive enzymes. Worries me...
    I really do appreciate all of your kindness and help.

  8. #28
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    There are people known as veterinary diet nutritionist who specialize in canine nutrition. I used Monica Segal but there are others such as Dr. Rebecca Remillard.

    Dr. Remillard also has a website http://www.petdiets.com where she does offer consultations and formulation of diets for pets with medical conditions.


    Monica Segal:
    Monica Segal is certified in Animal Health Care through the University of Guelph with studies in animal nutrition,physiology, diseases and parasites, as well as pet care.
    She writes featured articles in many publications throughout North America. Monica conducts seminars and workshops by invitation, hosts an Internet discussion group at K9Kitchen, and authored a book called "K9 Kitchen, Your Dogs' Diet: The Truth Behind The Hype," published in June 2002. Her second book, "Optimal Nutrition" inlcudes a foreword wrtten by Ana Hill DVM, PhD and was published in 2007. Monica lives in Toronto, Canada, with her husband Morley and dogs, Cassie and Tori.
    http://www.monicasegal.com/

    Monica is also an administrator of a facebook group that deals with canine nutrition : https://www.facebook.com/groups/K9Kitchen/

    Leslie, Squirt's Mom, has had diets formulated for her furbabies as well and I'm hoping she will be along to advise you too.

    Love and hugs,
    Lori

  9. #29
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    Quote Originally Posted by PaddysPerson View Post
    I'm trying to give Paddy that along with his regular food (supposed to be good for diabetes & cancer). Instructions are to add oil along with choice of protein. I've read that krill and fish oil are blood thinning,though, same thing for digestive enzymes. Worries me...
    I really do appreciate all of your kindness and help.
    Oil alternatives could be flaxseed, coconut, or avocado?

  10. #30
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    Default Re: Almost 8 y.o. recently diagnosed, a few questions

    I highly recommend Monica and her protege', Jody Zesko. Monica isn't taking as many new clients as she used to but was still taking some last I talked to her about a year ago. Jody has formulated the diet I'm feeding my Tilly. Jody's business is called Spot On Nutrition and her website is-

    https://www.spotoncaninenutrition.com/

    Both Jody and Monica design the diet for YOUR dog...it's not a general diet but specific based on your dog's lab work, breed, age, etc. Both do home cooked, mixed (commercial with toppings/additions), and raw diets...but I am not a fan of raw ESPECIALLY in any dog whose health is compromised in any way but many think it is the only way to go. You can't go wrong with either of these ladies. There is one person I will tell you to stay away from. She is knowledgeable but extremely unreliable...that is Cat Lane with The Possible Canine. I studied under her for several years and know her well.

    As for adding oil....I think I would wait until I knew more about what the future held before I took that step. Most oils are beneficial but as you have learned some do have some effects that can be worrisome with certain health conditions.

    I'm glad he's eating better! A bad tooth can sure take their appetite away. Maybe that's what I need???? LOL

    Hugs,
    Leslie
    "May you know that absence is full of tender presence and that nothing is ever lost or forgotten." John O'Donahue, "Eternal Echoes"

    Death is not a changing of worlds as most imagine, as much as the walls of this world infinitely expanding.

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