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Thread: Dog not eating and has Cushing's

  1. #11
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,066

    Default Re: Dog not eating and has Cushing's

    Hello to you and little Pookie. I’m sorry I have only a moment to write this morning, but I wanted to explain that we have merged your two threads together so as to create one single, unified thread about Pookie’s diagnosis and treatment decisions. This way, with all of her history consolidated, it’ll be easier for our members to follow along with any new developments.

    I know you have some big decisions facing you right now, so I’m really glad you’ve found us!

    Marianne

  2. #12

    Default Re: Dog not eating and has Cushing's

    I also wanted to add that the MRI that was done on Pookie reflected a stroke. After doing some research, it appears that dogs with Cushings could have strokes. I don't know when she had it, but I feel she must have had it between the time of her cushings clinical signs and now. Just for you future cushing's pet owners. The sooner you get cushing's under control, the better. I also read that adrenal tumor based cushings reflect less clinical signs than pituitary based cushing's regarding water intake and peeing.

  3. #13

    Default Looking for Dr. in Virginia for an adrenalectomy on a dog with Cushing's

    Can anyone recommend a Great Doctor for this surgery?

    Thank you,

  4. #14
    Join Date
    Mar 2009
    Location
    rural central ARK
    Posts
    14,093

    Default Re: Looking for Dr. in Virginia for an adrenalectomy on a dog with Cushing's

    Hi,

    Your latest post referred to "this surgery" but as a stand alone post (not in this thread) no one has any idea what surgery you are referring to and cannot give you any meaningful input. So I have once again merged that post into Pookie's orginal thread. Please try to find Pookie's thread when you wish to talk or to ask any questions. It will be of benefit to Pookie if you will because everyone can refer back to her history. Thanks!

    Now about an adrenalectomy. This is not just a difficult surgery it is one of the riskiest surgeries a dog can have. IF IF IF they are a candidate and they survive the surgery they still have to face a very rough recovery. That is for a young dog in good health otherwise. For a 15 yr old it would be doubly risky, both surgery and recovery. I am not saying for you not to do it but I want your eyes to be fully open. Here is a link to a list of questions that one of our former members created. It has several for you to answer to yourself and several for you to ask the surgeon(s) you talk to:

    https://www.k9cushings.com/forum/sho...-adrenalectomy


    And here is a link to help you find a doctor:

    https://www.k9cushings.com/forum/sho...ther-countries)

    Please read those questions carefully and fully consider the ones you are to ask yourself, especially the one about being prepared to loose your baby girl. That is a very real risk that you must be prepared for.

    Hugs,
    Leslie
    Last edited by Squirt's Mom; 08-12-2019 at 07:00 PM.
    "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.

  5. #15

    Default Re: Looking for Dr. in Virginia for an adrenalectomy on a dog with Cushing's

    Sorry for the confusion. New to forums.

  6. #16
    Join Date
    Mar 2009
    Location
    rural central ARK
    Posts
    14,093

    Default Re: Looking for Dr. in Virginia for an adrenalectomy on a dog with Cushing's

    I understand. It's especially confusing if you are in many Facebook groups where just about every post is a new deal every time! LOL
    "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. #17

    Default Re: Dog not eating and has Cushing's

    Poor little Pookie's Kidney values are up again. She has been on metrondiazole for the past 5 days. Here is her history. We are going to try iv's for 2-3 days and my vet doesn't think the cushings is causing the kidney values to rise; BUN, Creatinine, and Phoshourus. CPL showed a slight positive for Pancreatitis. I hope I don't have to put my baby down and am dropping her off tonight for IV therapy.
    Progression or History:
    Pookie has a medical history of suspected cushings disease (diagnosed 2018) and has been mangaged with a home made diet and herbal supplements. She also has a history recurrent UTIs which has been resolved with antibotics, chronic increased liver enzymes treated with Denamarin, and intermittent anroxeia.
    1.1.19 - Presented to VVC for evaluation of being painful due to excessive panting and vocalizing after attempting to use the stairs. Exam findings note a tense but not overtly painful and pendulous abdomen with subjective cranial organomegaly, stiffened gait, and pain elcited upon extension of right hip and spine. Recommendations were made for spinal radiographs but were declined. DVM discussed different causes for back pain such as IVDD, infectious/inflammatory diseases, and neoplasia. Medical management was elected by owner and Codenie was prescribed. Exercise restrictions were advised.
    ~Feburary 2019 - Pookie developed some intermittent ataxia and difficulty using the stairs. No veterinary attention was sought out.
    6.5.19 - Presented to VVSA for evaluation of possible adrenal dependent hyeradrencorticism. Exam findings note a pendulous abdomen with cranial organomegaly but no discrete mass was felt or pain elicited on palpation. Recommendations were made for evaluation of size of left adrenal gland via ultrasound, MRI, or CT but were declined at this time.
    7.31.19 - Presented to RRAH around ~3am for evaluation of not drinking and lethargy. Exam findings were unremarkable. DVM discussed difficulty in assessing etiology of azotemia in cushings patients. Owner expressed concerns for Pookie possibly having renal failure due to her decrease water intake and wanted to be proactive. DVM offered 48hr hospitalization but owner declined and elected to continue plan outline by BBAH yesterday.
    Presented to RRAH as a transfer for overnight hospitalization and fluid therapies after being briefly evaluated by BAAH. Exam findings were unchanged from previous visit. Pookie was hospitalized, started on IVF therapies (LRS at 38 ml/hr) and administered Ampicillin (22mg/kg IV) every 8 hours.
    8.1.19 - Pookie did well overnight while hospitalized. She was eating well, urinating adequately, vitals were normal, and her renal values improved. She was discharged from RRAH to the owners care. Clavamox was advised to be discontinued and Cefpodoxime was prescribed.
    8.2.19- Presented to BAAH for evaluation of falling over and difficulty walking. Buprenex was prescribed.
    8.3.19 - Presented to RRAH for evaluation of anorexia, restlessness, and red eyes. Exam findings notes lenticular opacity OU, sluggish PLRs, sclearal hyperema OD>OS, and mild epiphovalmucoid discharged. Recommendations were made for sedation due to Pookie's stressful tempermant to obtain diagnostics (bloodwork, urinalysis, eye staning, and tear test) but were declined. A urine collection kit was also provided to owner. Zofran, Entyce, and NeoPolyBac were prescribed along with Trazadone, which is to be given prior to veterinary visits. Recommendations were made for a recheck tomorrow if Pookie is still not eating and to consider an opthamology consult.
    8.4.19 - Presented to RRAH evaluation of anorexia and diarrhea. Exam findings notes mild pL (pelvic limb) ataxic/arthritic gait. Bloodwork was performed. Recommendations were made to continue Entyce, Zofran, Buprenex, Triple Antibiotic Onitment, and daily SQ fluids as previously prescribed. DVM advised to syringe feed every 6 hours with 1 90cal jar of baby food and trying probiotics. Metrondiazole was prescribed.
    8.7.19 - Owner contacted BAAH to relay that Pookie is still not interested in eating and expressed concerns for her to have Addisons and is considering starting Triolstane. Entyce, Metronidazole, and Buprenex have been finished for several days now. Owner elected to give Pookie an additional 24 hours to see if her appetite improves.
    8.8.19- Owner contacted BAAH and reported that Pookie ate some this morning and owner is interested in pursuing an MRI.
    8.9.19 - Presented to BAAH for evaluation of anorexia and no improvements with eye redness. Exam findings include mild conjunctive enlargement, OD- tiny white plaques in center of cornea. Fluorescein stain, urinalysis, and bloodwork (CREA, BUN, PHOS) were performed. Mirtazipine was prescribed.
    8.10.19 - Presented to BVNS for neurological examination. Owner express concerns for Pookie's continued lethargy, progressive weakness, and anroexia.
    Pookie is up-to-date on vaccines. She has not had any coughing, sneezing, vomiting, but suffered from diarrhea about 1 week ago but has improved. She has not been eating and drinking normally over the past week and has been syringe fed with baby food. Her regular diet is Hills Science Diet K/D. She does not travel out of the area.
    Past Diagnostics:
    8.9.19 - BAAH
    Fluorescein stain- Slight uptake
    Chemistry- Values within normal limits
    Urinalysis- See report
    8.4.19 - RRAH
    Complete Blood Count- MCV 60.1 fL (l), MCH 20.9 pg (l), RETIC-HGB 22.2 pg (L), NEU 13.66 K/uL (H), LYM 0.63 K/uL (H), LYM 0.63 K/uL (L), PLT 493 K/uL (H), MPV 13.6 fL (H), PCT 0.67 % (H), otherwise within normal limits.
    Chemistry 17 & Electrolytes- ALT 368 U/L (H), ALKP 1815 U/L (H), GGT 13 U/L (H), otherwise within normal limits.
    Urinalysis (Free Catch)- See report
    8.1.19 - RRAH
    PCV- 44%
    TS- 7.0 g/dL
    Chem 8- tCO *26 mmol/L (H), all other values within normal limits.
    7.31.19 - RRAH
    Chem 8- All values within normal limits
    7.31.19 - Michigan State Univeristy
    Endocrine Test- Cortisol Basline= 181 nmol/L (H), Cortisol 1hr post ACTH= 494 nmol/L (WNL).
    7.29.19 - BAAH
    Urinalysis- See Report
    7.4.19 - BAAH
    Complete Blood Count-MCH 21.3 pg (L), MCHC 31.6 g/dL (L), RETIC 128 K/uL (H), NEU 12876 /uL (H), all other values within normal limits. Chemistry & Electrolytes- BUN 50 mg/dL (H), Cl 105 mmol/L (L), AGAP 29 mmol/L (H), ALT 169 U/L (H), ALP 1378 U/L (H), GGT 19 U/L (H), CHOL 397 mg/dL (H), all other values within normal limits.
    5.4.19 - Michigan State Univeristy
    Endocrine Test- Cortisol Baseline= 102 nmol/L, Cortisol; High Dose Dex 4hr= 125 nmol/L (H), High Dose Dex 8hr= 130 nmol/L (H).
    4.11.19 - BAAH
    Chemistry- ALB 4.1 g/dL (H), ALT ~unable to read value (H), ALKP 1748 U/L (H), GGT 20U/L (H).
    2.13.19 - BAAH
    Abdominal Ultrasound- Left adrenal gland about the same size and calicified.
    913.18 - BAAH
    Dexamethasone Suppression Test- Cortisol; Pre Dex= 1.9 ug/dL, Cortisol; 4hr Post Dex= 2.1 ug/dL, Cortisol; 8hr Post Dex= 1.8 ug/dL
    9.10.18 - BAAH
    Abdominal Ultrasound- Liver enlarged- hyperechoic. Lots of gas present in stomach. Left adrenal gland calcified and irregularly shaped.
    Current Medications:
    Adrenyl Harmony, given as directed once daily.
    Advanced Denamarin (unsure of dose), 1/2 tablet given once daily.
    Fish Oil, given as directed twice daily.
    Ginko Biloba, 50mg given once daily.
    Lignan, 20mg given twice daily.
    Melatonin, 3mg given twice daily.
    Objective
    Vitals: 9:41am 8/10/19 Wt: 8.2 kg. T: 101.8 F. HR: 136 RR: Pant CRT: <2 Other: MM: Pink By: AEB
    EENT: Eyes: ___, Ears: no redness or exudate observed
    Oral Cavity: Teeth are dirty for free from excessive tartar; gums are pink and moist; no gingivitis present
    Lymph nodes: Lymph nodes all normal size
    Heart and Lungs: No murmur detected; lungs ascultate clear
    Gastrointestinal: Normal eliminations; abdomen palpates normally
    Musculoskeletal: Orthopedically sound
    Dermatologic: Skin flaky and hyperpigmented in areas; dorsal alopecia
    Urogenital: Owner reports normal eliminations; external genitalia appears normal; bladder palpates normally
    Body Condition Score: 6/9
    Pain Score: 0/4
    Mentation: Quiet, alert, and responsive. Appropriate.
    Posture of Head and Body: Normal posture of head and body
    Gait: No paresis or ataxia noted
    Postural Reactions: Normal paw replacement and hopping in all 4 limbs
    Thoracic Limb Reflexes: Normal withdrawal reflexes bilaterally
    Pelvic Limb Reflexes: Normal patellar and withdrawal reflexes bilaterally
    Cutaneous Trunci: Present bilaterally at L5 (normal)
    Perineal Reflex: Normal
    Muscle Tone: Normal tone
    Cranial Nerve Function: intermittently delayed menace response OU (possibly ophthalmic in origin) Retinal Exam: Normal fundic exam OU
    Hyperesthesia: No pain elicited on spinal palpation or cervical manipulation
    MRI Report
    BODY REGION & SEQUENCES
    August 9, 2019
    HEAD– Localizers, Sagittal T2W, T1W post-contrast, Transverse T2W, FLAIR, GRE, T1W pre- and post-contrast, DWI/ADC maps, and Dorsal T1W post-contrast images are available for review.
    ABDOMEN–localizers, sagittal T2-weighted, dorsal T2-weighted fat-sat, T1-weighted postcontrast fat-sat images are available for review.
    FINDINGS
    There is mild periventricular T2-weighted/FLAIR hyperintensity with no evidence of contrast enhancement consistent with leukoaraiosis. The subarachnoid space within the sella tursica is prominent. However, a small pituitary gland is present with T1W hyperintensity of the neurophysins as well as subtle contrast enhancement. There is a small pucntate, lesions within the dorsomedial aspect of the left thalamus that is hyperintense on the T2W, hypointense on the T1W, FLAIR with no evidence of contrast enhancement. Best seen on the sagittal T2-weighted images, there are subtle dilation of the caudal cerebellar vermian sulci with prominent visualization of the overlying subarachnoid space. The masticatory muscles show subtle T2-weighted heterogeneous hyperintensity in varying degrees of contrast enhancement. The medial retropharyngeal and mandibular lymph nodes are within normal limits of size, signal, and contrast enhancement. The salivary glands are within normal limits. There are small condylar cysts within the temporomandibular joints. The visible oral cavity is within normal limits. The visible aspect of the nasal cavity and frontal sinuses are within normal limits. The tympanic bullae and ear canals are within normal limits. The orbits are within normal limits. There are multifocal small dorsal cutaneous nodules.
    The right adrenal gland is enlarged measuring 1.6 cm diameter. The cranial pole of the left adrenal gland is enlarged measuring 1.8 cm diameter with mineralization the lateral aspect. There is a small contrast enhancing nodule within the dorsal extremity of the spleen measuring 6 mm diameter.
    There is variable loss of normal T2-weighted hyperintensity of the intervertebral discs consistent with dehydration. There is protrusion of the T12–T13 intervertebral disc space with no spinal cord compression. There is protrusion of the T13-L1 intervertebral disc with mild spinal cord compression.
    CONCLUSIONS
    1) Focal dilation of the caudal cerebellar vermian subarachnoid space may represent mild hydrocephalus ex vacuo secondary to atrophyfrom a historical ischemic infarct. The subtle lesions within the dorsomedial aspect of the left thalamus likely also represents a historical ischemic infarct. Both lesions are thought to be quiesscent on the current study.
    2) Mild periventricular leukoaraiosis may be seen secondary to edema vs. gliotic changes.
    3) Incidental partial empty sella syndrome. This may be seen in canine patients with no associated endocrinopathy (VRUS 2008;49(4):339342). There is no evidence of a pituitary mass, however, a functional pituitary microadenoma cannot be ruled out.
    4) Bilateral adrenal gland enlargement with mineralization of the left. This may be secondary to pituitary dependent
    hyperadrenocorticism. The left sided adrenal gland mineralization may be seen 50:50 in benign and malignant etiologies (VRUS
    1997;38(6): 448-455)
    5) Signal changes to the masticatory musculature may be secondary to chronic hyperadrenocorticism. Chronic bilateral masticatorymyositis is considered much less likely.
    6) Protrusion of the T13-L1 intervertebral disc causing mild spinal cord compression.
    7) Splenic nodule may represent benign (ie. nodular hyperplasia, extramedullary hematopoiesis, hemosiderin deposition) vs. earlyneoplasia (ie. round cell, sarcoma, others).
    8) Incidental temporomandibular joint condylar cysts.
    FEATURED DIAGNOSTIC IMAGE / SUPPLEMENTAL INFORMATION
    Thank you for this referral. We are always interested in hearing any feedback on cases. If you have any questions or follow-up regarding this case, please do not hesitate to contact us at Radiology@SynergyVIP.com or to the specific radiologist's email in the upper right hand of the report. (This contact information is for veterinarian use only, please). Thank you.

  8. #18

    Default Re: Dog not eating and has Cushing's

    I'm waiting to hear back from my vet, but I was thinking if we get those kidney's flushed, that we need to address cushings asap with something that doesn't hurt the kidneys or pancreas. What do you think? Her time may have come.........Sorry for all of you that have to deal with Cushing's.

  9. #19
    Join Date
    Apr 2009
    Location
    York, PA.
    Posts
    10,648

    Default Re: Looking for Dr. on East Coast for Pituitary Tumor Removal

    Definitely addressing the kidney issue and getting her to eat on her own are the top priorities right now. The Cushing's should be put on the back burner as it is a slow progressing disease and it takes a long time before any internal damage occurs. Exactly what medications is Pookie taking right now? And has an urine culture been performed to be sure that the UTI is completely gone?

    Sending hugs, Lori

  10. #20
    Join Date
    Mar 2009
    Location
    rural central ARK
    Posts
    14,093

    Default Re: Looking for Dr. on East Coast for Pituitary Tumor Removal

    I second what Lori said - forget about Cushing's. When my Squirt reached the age of 15 she had developed several other conditions and I made the choice to stop treatment for Cushing's even tho none of her conditions dictated that was necessary. I simply wanted her last days to be as normal as possible without the constant vet visits, pokes, and prods. It was more important to me that she and I be able to enjoy those days instead of worrying about pills and tests. She lived to be a couple of months beyond 16 and I am grateful for every single second of that time we had.

    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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