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Thread: New to Cushings

  1. #191
    Join Date
    Feb 2019
    Location
    Spring Valley, Il
    Posts
    169

    Default Re: New to Cushings

    Hi everyone,

    I apologize for my little rantóI have been so stressed lately with all the meds I have to put into my little babyís body.

    In fact, since she is still on amoxicillin for her liver I just called doc to ask him if it would be ok to give Annie a cerenea tab at midnight again because Wednesday is her her Lysodren day and that might give her some extra tummy protection. He gave me the ok so thatís what we will do until sheís off the amoxicillin.

    Plans forward, the hubby and I have a fishing trip planned to leave on the 18th of July. We had hoped we could take Annie with us. Well, as a mostly hysterical pup mom we decided to board her at our vet. I was assured they would be all over her, which I know to be true, but I will also be asking for a stim test plus complete bloodwork since her recent liver episode. If I need to ask for anything else,please come forward. Blessings to you all. Karen

  2. #192
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    13,967

    Default Re: New to Cushings

    Hey Karen, we all have “those” days — we know where you’re at ;-)

    After me harping about getting a stim test done ASAP, you’ll probably be stunned to hear me suggest that if you cannot proceed with the ACTH before you leave, you might best wait until after Annie has returned home again subsequent to your trip. You can go forward with the other bloodwork if you like while she’s boarded, but at this point, I’d wait on the ACTH until Annie has both fully recovered from this GI episode and is also back home in as stress-free an environment as possible. Both physical illness and emotional stress have the potential to elevate cortisol levels and skew test results for both the ACTH and the LDDS. As we’ve probably already discussed, in the effort to reduce stress on their dogs in conjunction with the test, some of our members even opt out of leaving their dogs caged at the vet during just the intervening hour between the test draws. Unlike most other dogs, Annie may be exceptionally calm while she’s boarded at the vet, but I just want to mention this consideration.

    Having said that, I forget how long you’ll be away. If it’s for a really lengthy time, then maybe your vet will want to proceed in your absence. But I just want to mention the pros-and-cons so that you can make the most informed decision.

    Marianne

  3. #193
    Join Date
    Feb 2019
    Location
    Spring Valley, Il
    Posts
    169

    Default Re: New to Cushings

    Hi Marianne,

    I always appreciate your input! We decided it would be in Annie’s best interest to board her at the vet while we are gone. There are so many things that could go wrong I won’t even mention them.

    Everyone at the clinic knows her so well and the other vet takes her small dog to work with her everyday. There are also a couple of employees in their boarding section who also take their pups to work. Annie has made friends with all of them and on the occasional slow day, they will let Annie out for a free run around the whole office with the office “pack”.

    After the first day or so I’ve been told she settles right in. I’m still going to ask for a stim test and a redo of her liver values at doc’s discretion. She’s almost done with the amoxicillin. We won’t leave until the 18th and we will be gone about eight or nine days. If you have any other suggestions please let me know. Blessings, Karen
    Last edited by Katy1; 07-10-2019 at 03:01 PM.

  4. #194
    Join Date
    Feb 2019
    Location
    Spring Valley, Il
    Posts
    169

    Default Re: New to Cushings

    Hey Everyone,

    Now I’m in panic mode, not because Annie is sick, but because she’s ok and now I’m just waiting for the next “shoe to fall”,. I really try to be a positive person, but the minute I even try to feel comfortable, we have a set back—either human or other.

    Today I checked her in for boarding at the vet for a week starting on the 18th-26th. We have been waffling between taking her with us or leaving her here. With the severe heat even where we’re going in way northern Minnesota, it’s supposed to be hot up there too. I decided it’s not worth taking any chances, and now she has become somewhat of a celebrity at the clinic, so she will be staying home.

    I can guarantee you I’ll cry all th way to Madison, Wisconsin because I will feel guilty for leaving her and also just missing her. I’m such a mess.

    I did emphasize the need to do a stim test and recheck her liver panel. She has shown some minor symptoms of the cushings. Panting, even when she’s been in a very cool environment most of the day. Her scull feels more boney and she has more strange bumps on her head and back. She has also has had to to outside during the night.

    I will try to send updates on Annie as receive word on any labs run. Blessings to you all. Karen
    Last edited by Katy1; 07-15-2019 at 06:40 PM.

  5. #195
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    13,967

    Default Re: New to Cushings

    We’ll be watching for those updates, Karen, and hoping that all goes well for all three of you! I know it’ll be hard to leave Annie behind, but we caregivers do need moments of respite in order to strengthen ourselves for all the challenges that inevitably arise once we return home once again. Travel safely, and good luck with the fishing!

  6. #196
    Join Date
    Jun 2018
    Location
    Chicago Suburbs
    Posts
    16

    Default Re: New to Cushings

    Hi Karen,
    It’s been a while since I’ve been out here but I just got caught up on Annie’s status. Annie is in good hands at the vet so I hope you are able to enjoy your fishing trip.

  7. #197
    Join Date
    Feb 2019
    Location
    Spring Valley, Il
    Posts
    169

    Default Re: New to Cushings

    We are home from our fishing adventure and itís taken me 4 days to recover! I know this is not the ďfishing channelĒ, but for anyone who has ever fished the Lake of The Woods in either the US or Canada, itís not a vacationóitís work. However, my hubby caught and released a 31 inch walleye which equates to 11 poundsóhis lifetime record for a walleye.

    Iím so thankful that we decided to leave Annie home. It was so hot and the closest vet was a 2hr. drive. While Annie was boarded I asked that they run another stim test and a follow-up liver panel......and I also asked for a skin scrape because I had been feeling bumps and lumps along her spine and I was so scared she was developing CC.

    Before I post the important stuff, I have to admit the joke was on me ....again!!!!!!! Doc did not do a skin scrape because the lumps and bumps I felt on her spine was pine tree sap. I felt so stupid. We have three big white pines in the backyard and Annie is always sniffing underneath the branches for bunnies. I spent all my away time worrying for nothing.

    Ok, stim test results: preó4.1. Range 1.0-5.0
    Postó9.1. Range. 8.oó17.0

    Her liver results were still high which really concerns me. When we picked Annie up I couldnít talk to anyone about the test results because the clinic had been slammed with emergencies and doc was in surgery with all his techs.

    After Annieís past bout with whatever, we put her on 250mg of ursodiol once a day and I was praying that would make a difference. Her recent ALP was 1134, GGT-13, and everything else on her panel was in the high range.

    I found an internist about an hour away and I want a second evaluation. She is part of another specialty clinic but we would not have to fight the Chicago traffic. I donít know whatís normal anymore.

    Annie acts fine, she is actually a brand new pup since her gallbladder surgery but..............

    Help! Blessings, Karen

  8. #198
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    13,967

    Default Re: New to Cushings

    Hello, Karen, and welcome home to everybody :-))))))). Even though it wasn’t necessarily relaxing, I’m so glad you and hubby were able to take this trip together. It sounds like a much needed break from the routine. And I’m especially glad to hear that Annie is generally doing well, too!

    But getting back to business ;-), here’s a couple of thoughts on the Cushing’s/liver front. Annie’s cortisol level continues to elevate, and is now even more highly out of therapeutic range for a Cushpup being treated with Lysodren. The range that you cited with her ACTH result is the normal range for a dog who does not have Cushing’s when the test is being used for diagnostic purposes. It is not relevant to Annie’s situation. For a dog taking Lysodren, you want both the pre-ACTH and post-ACTH levels to range between 1.0 - 5.0. Annie’s post-ACTH result is now almost two times higher than is desired. To the best of my recollection, here’s her ACTH testing history:

    Pre-treatment diagnostic post-ACTH level: 17.2

    Post-ACTH result at the end of her loading phase and the switch to maintenance: 2.0

    May monitoring test: Pre-ACTH of 0.6; Post-ACTH of 6.4

    Current result: Pre-ACTH of 4.1; Post-ACTH of 9.1

    Since her cortisol level has consistently been rising, we’d conclude that her maintenance Lysodren dose has been too low. Whether or not you could get it back down into therapeutic range simply by increasing the maintenance dose or whether you’d need to reload, I do not know. But if you do nothing and let the current pattern progress, I’m guessing that her cortisol will just keep on increasing unchecked as her adrenal tissue continues to regrow.

    This elevating cortisol level could explain both the return of some Cushing’s symptoms and also the lack of improvement of her liver values. Those liver elevations are classic Cushing’s symptoms. Even when cortisol levels are well-controlled, liver elevations don’t necessarily ever return to normal. But when cortisol is not well-controlled, improvement is really unlikely. The good news is that if those elevations are indeed the result of Cushing’s, they may not ever be particularly sinister in terms of actual liver damage, but instead may largely just be “markers” as to the presence of higher levels of circulating steroids.

    How have Annie’s glucose levels been trending? Have they remained hard to regulate, or have you achieved some consistent control? If her diabetes has remained under better control and you’re not noticing a strong rebound in Cushing’s symptoms, maybe just increasing her maintenance Lysodren dose will continue to buy you some more time before you’d have to consider reloading. I just don’t know, and I think it may indeed be a wise idea to consult with a specialist who has more experience with the management of complicated cases such as this.

    But the bottom line is that I’m really glad to hear that, right now, Annie is doing well. Every single good day is a special gift, that’s for sure!

    Marianne

  9. #199
    Join Date
    Feb 2019
    Location
    Spring Valley, Il
    Posts
    169

    Default Re: New to Cushings

    Marianne and anyone else out there in cushings land. I guess the only positive thing I can offer with regard to Annie is that her glucose level is stable for the time being. Doc ran a fructoseomine test before we left on our trip and it was good. I donít have any numbers but this is just an FYI.

    I just watch her behavior and she seems so normal. Tomorrow, I'm going to try to talk to docóand have a serious discussion about his comfort level in treating her. All of a sudden, I feel like we have been shoved off to the side. I realize he has the pressures of managing vet offices in two small towns 25 miles apart. Iím not making excuses for him, but now Iím faced with the realization that Annieís tri-conditions are more than he can deal with.

    I think when we grabbed Annie and rushed her to Chicago for her gallbladder surgery, doc thought his job was done. Maybe Iím wrong because he has taken such good care of our girls over the the past five years, but maybe Annie is just too much.

    Marianne, thank you so much for putting all of the numbers in perspective for me. Math and numbers are my mental enemy! If anyone has any other suggestions, please chime inó-Iím always open for opinions, suggestions, anything...... you all are the best people on the planet! Blessings, Karen

  10. #200
    Join Date
    Mar 2013
    Location
    California
    Posts
    4,359

    Default Re: New to Cushings

    This is whay I choose to focus on today. Do with it as you wish. My time with my little Buddy is gone. He's not coming back. I spent so much of my time worrying over the tomorrows, that I lost all of my todays and I can't ever get them back. Annie is acting fine. Take the time to rejoice in that, before it's too late!

    Annie acts fine, she is actually a brand new pup since her gallbladder surgery[/QUOTE]
    Kathy and Angel Buddy. The mightiest of all lizard hunters!

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