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Thread: Ginger-16 yo Poochon (Bichon Poodle mix)

  1. #11
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    Georgia
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    Hello Angela! I want to welcome you back, too, although Iím sorry for the problems that have brought you to us. The other ladies have already given you some great information, and the one additional thought that I might add relates to additional thyroid testing. I see that Gingerís T4 reading was low on both blood panels:

    T4 Date given: 02-08-19 T8:49a
    T4 <0.5 0.8-3.5 mg/dL
    Result Verified The Total T4 result is less than 1.0 mcg/dl. A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism.Please contact Customer Service for this additional testing.
    T4 Date given: 03-17-20 T8:31a
    T4 0.8 0.8-3.5 mg/dL
    The Total T4 result is less than 1.0 mcg/dl. A Free-T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism.Please contact Customer Service for this additional testing.
    Since the result was consistently low on both panels a year apart, Iím wondering whether your vet has discussed proceeding with a more complete thyroid analysis. This would only involve another blood sample, and since skin issues have been some of Gingerís primary presenting problems, Iíd think it would be very helpful to see whether or not she suffers from thyroid dysfunction. Hypothyroidism itself doesnít usually cause skin irritation/itching, but it can leave a dog more vulnerable to recurrent skin infections which can indeed cause those problems. Low thyroid can also cause elevated cholesterol levels.

    Since Ginger has already tested negative on the LDDS, I do agree that Iíd probably want to pursue some of these other questionable areas before proceeding again with Cushingís testing. At her age, the main goal of Cushingís treatment would be immediate symptom relief. So if some of her problems are instead being caused by other conditions, thatís all the more reason to investigate them more thoroughly beforehand. Please do keep us updated, OK?

    Marianne

  2. #12
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    BTW, your new photos of Ginger are sooooooooooooo sweet!

  3. #13
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    Feb 2013
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    United States, Olympia Washington
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    Thank you. I will try and get a picture of her in the next few days. Most of the ones I put in are after grooming, which we don't have done anymore and try to do ourselves. Operative word. Try.

    Off note, does anyone know of a way to trim the hair between paw pads which is low/no risk of hurting them. We are struggling with this.

  4. #14
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    Feb 2013
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    Here is our latest.

    So we spoke to the vet. I asked about Thyroid issues, she said Cushing's would alter the Thyroid levels so there wasn't really a point in further testing. I brought up the tumor giving a false positive on a Low Dose Dex test. She said if her Cortisol levels were high due to the tumor something about the suppression part still being viable. I didn't really understand. We were also told we could get a free catch urine sample and have it sent out for a better "spinning" to get more detailed results, this was going to be about $100 the BRAF test was going to be about $500.

    This was all about 8 pm West Coast US time. Right now we have opted for the free catch urine cytology. I hope everyone is doing ok.

    One other question. Does anyone here put any faith in the AAHA accreditation?

  5. #15
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    So we spoke to the vet. I asked about Thyroid issues, she said Cushing's would alter the Thyroid levels so there wasn't really a point in further testing.
    I’m seriously not happy with that answer. Your vet is absolutely correct that low thyroid readings can be secondary to Cushing’s. If that’s the case, effective treatment of the Cushing’s can result in spontaneous normalization of the thyroid level as well. However, it’s possible for a dog to suffer from *both* Cushing’s and also primary hypothyroidism in its own right. If that’s the situation, the dog requires thyroid supplementation in addition to Cushing’s treatment. And that’s the whole purpose of the more complete thyroid testing in this situation — to see if it seems more likely as to whether the low T4 is secondary to some other condition (like Cushing’s), or whether it appears to be a problem that needs to be addressed independently.

    The Michigan State University Veterinary Endocrinology Lab is nationally known for its thyroid expertise, and here’s a link to its page that answers a number of related testing questions. Blood samples from anywhere can be sent to MSU for their lab analysis and clinical interpretation. At my request, my vet has sent samples there for two of my dogs when we suspected thyroid problems. But even a lab like IDEXX will offer a more comprehensive thyroid panel upon request, too. As you’ll see, measuring the TSH level in addition to specialized measurement of the T4 level aids in determining whether low thyroid readings are likely primary, or instead probably secondary to some other underlying condition like Cushing’s.

    https://cvm.msu.edu/vdl/laboratory-s...nction-in-dogs

    You’ve already generated a lot of expense with Ginger’s diagnostics, with more to come. So perhaps your vet is trying to prioritize the spending that she thinks is most important. I am not a vet, of course, but my personal opinion is that an advanced thyroid profile could be of real value. Depending on the result, you could receive added evidence that Cushing’s is present and also affecting Ginger’s thyroid level. But on the other hand, if thyroid supplementation seems warranted due to genuinely low thyroid function, I can promise you that it’s far less expensive and involved to treat the thyroid than it is to treat Cushing’s. At Ginger’s age, I’d think your primary goal with any treatment would be simply to make her more comfortable. If she suffers from primary hypothyroidism and supplementing her thyroid level eases her skin discomfort, then perhaps you might not even choose to launch into Cushing’s treatment at all. Just sayin’...

  6. #16
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    Plus, Iím back again after re-reading your thread, and please correct me if Iím wrong ó but thus far Ginger is yet to test positive on a Cushingís blood diagnostic, correct? Her LDDS was normal back when her T4 level was already abnormally low. In my own mind, that would seemingly make investigation of her thyroid function even more compelling.

    Also, as far as *any* type of accreditation, I take it as one piece of information. Itís good to know that any given level of training or expertise or quality has been achieved. But as the old saying goes in relation to human doctors, *somebody* finished at the bottom of every graduating med school class. Iíd rather see accreditation in relation to my caregivers or facility rather than no accreditation. But thatís kind of a point of departure. If Iím not comfortable with a vet who works in an AAHA accredited facility, the overall certification doesnít really mean a lot to me.

  7. #17
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    Marianne is right. You should test for Thyroid issues first. That's what we did for my Gable. He eventually tested positive for Cushing's and is being treated for both.
    Joan, mom to my Angel Lena, Doree, Gable, Cooper, Angel Phoenix and now Sibble.

  8. #18
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    Feb 2013
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    Thanks for everyone who has weighed in. We got a call about a 7:30 pm about the urine cytology. The findings came back inconclusive to TCC. I was hoping this would give us more answers about the nodule on the ultrasound, but alas it looks like we will do the BRAF test.

    Ginger is quite the conundrum. Sometimes she is scavenging like crazy and other days she will go all day without eating. This was her first behavior which led us to do the LDDS test. It has only been over the last probably almost 6 months where we have started seeing other behaviors. At the beginning when the LDDS came back negative I almost had the atypical test done, as that was my suspicion. Now I just don't know, everything seems so day to day with her. The hair thinning is pretty significant.

    Marianne, how do you find out the cost of the MSU test? Should I just ask our regular Western Vet?

    I can't tell you all how much this helps to have a network of foiks. I remember when we were going through all of this with Shasta and you all were just as helpful then.

    Thanks,
    Angela

  9. #19
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    Marianne, how do you find out the cost of the MSU test? Should I just ask our regular Western Vet?
    Hi Angela, yes, you can ask your western vet to find out current pricing information. For what itís worth, I pulled out my vet bill that included a Michigan State thyroid panel performed during June of 2019, and the charge was $178. That included the blood draw at my regular vet as well as the analysis by MSU. From their website, it looks as though there are various panels that can be ordered, so there may be some that are less or more expensive. But thatís the amount I was charged for my girl last summer. Her T4 had come back borderline low on her regular IDEXX blood chemistry panel, and I wanted to have further analysis done. Her result on the more comprehensive MSU panel was normal, however, so I was able to table my worry about that.

    Marianne

  10. #20
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    Default Re: Ginger-16 yo Poochon (Bichon Poodle mix)

    The more I mull things over and think on it I am really wondering about the Thyroid levels. She sleeps a lot more than she use to and I know her hair thinning can also be attributed to that too. The only thing I'm not sure of is the intermittent scavenging behavior. This is just so difficult to decide what to test and what to not test. The scavenging is also tough because it isn't all the time, but enough to be concerning. We went and gave her a bath yesterday and found another crusty area on her skin. We think it is yeast instead of bacteria and so will probably give her another bath on Tuesday. We are happy to report we have not had the excessive licking since we stopped the Apoquel, so we will take that as a win.

    Thanks for the charges from you bloodwork Marianne. I just wanted a gauge for the quote when I can ask for it.

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