Page 1 of 2 12 LastLast
Results 1 to 10 of 18

Thread: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

  1. #1
    Join Date
    Aug 2020
    Location
    Alabama
    Posts
    10

    Default Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    Hello everyone, new to the group and thanks for having me! Appreciate how y’all love details, (me too!) so here goes just about everything. Hope it’s not overwhelming TMI.

    I’m retired in my “not so golden” years in Sweet Home Alabama. I’m just a good ole plain country folk with a brain. My fur child is Patch. He’s white with black patches (like a catahoula leopard), long haired American Bulldog mix with a bushy tail. (Yes there is such a breed). Age 12, neutered after I got him and weighs 64 ½ pounds. He’s my companion buddy. Rescued him in 2008 when he was about age 10-12 months old. He was abused and had a back leg injury that never properly healed, but he gets around fine. He’s just so laid back and easy going with a happy disposition in spite of everything. Patch always fear pants from Tstorms. Has arthritis in left shoulder and bad left back leg. He takes many safe natural supplements and vitamins, wet no grain canned and home cookin when I’m not exhausted.

    I’ve been dealing with does he or doesn’t he have Cushing’s for 3 years now. Since 2017, chief complaints: pot belly, unusual panting (other than fear panting from Tstorms) and very restless at night. Up and down constantly. Daytime not so bad. I’ve been to (5) GP vets, a Cardio Vet, (2) Radiologists, (2) Vet Colleges, (2) IMS’s and a Vet Dental Specialist. Met a few very arrogant Vet’s on this journey. Different Labs have been used in testing. Question whether scorings can cause inconsistent readings.

    HISTORY
    3/2011 – 1/2013 – GP Vet - prednisone tablets given (4) treatments
    Mar. 2017 – GP Vet – 1st and only ear infection. Given unknown allergy injection
    June 2017 – GP Vet – 1st and only urine infection. Given antibiotics
    Oct. 2017- GP Vet xrays showed an enlarged heart.
    Nov. 2017- 1st Cardio Vet visit - echo cardiogram, diagnosed Patch with mild enlarged heart and mild aortic stenosis. (can’t take Vetmedin)
    Dec 2017 – CBC – hemocrit 63%, ionized calcium 1.46 mmo/L, PTH measured at low end of normal 0.7 pg/mL. IDEXX Lab testing.
    Feb. 2018 - 1st. ACTH test -1st Vet Univ (Neg.) suspected pre cushing’s. Started Melatonin and lignans.
    Aug. 2018 - 1st IMS - Said asthma/bronchitis. Chastised melatonin and lignans. Lenticular (nuclear) sclerosis in both eyes. CBC- ALP 384, Chol 254. No ultrasound report or findings. Was a horrible experience overall.
    Lab testing unknown.
    April 2019 – 2nd visit Cardio Vet – Echo, CBC, T4 - ALP 1144 u/L, ALT 193 u/L, platelets 771, triglycerides 457 ug/L, T4 normal at 2.2 ug/dL ZNLabs testing.

    THINGS GO DOWNHILL:
    Nov. 2019 - GP Vet - upper molar tooth extraction. (turned out a botched job, no CBC done prior)
    Dec. 2019 – GP Vet- CBC, T4, Urine - showed High BP, now on Benazepril 20mg. Suspected polycythemia. Wanted to do blood letting. Refused he wasn’t experienced. CBC platelet 673,000 u/L, ALT 161 u/L, ALP 519 u/L
    T4 – 1.1 ug/dL normal. IDEXX testing.
    Jan. 2020 - 2nd ACTH test (neg.) 2nd Vet Univ. - Ultrasound. Belly shaved bald. Left adrenal gland, 2.1cm. Right ok. Confirmed polycythemia, now on Clopidogrel (plavix) 75mg, ½ dose daily. Still suspect of cushing’s.
    Ultrasound mentioned a splenic nodule, no measurement given. They wanted an LDDST done. Urine Protein 185.9 mg/dL Lab unknown.
    Feb. 2020 – 3rd visit Cardio Vet - Echo and CBC. No pulmonary hypertension. Polycythemia not from heart. No murmur. CBC showed CO2 Low at 15 nEq/L, ALT high at 193 u/L Choles 280 mg/dL, Triclyc high at 457
    mg/dL, others high, no ALP shown. ZNLabs testing.
    Feb. 2020 – Vet Dental Specialist – major gum surgery after complications from Nov 2019 tooth extraction. Took 2 months to recover. Had adverse reaction to med’s and anesthesia. Traumatized Patch (and me).

    ENTER COVID - NEAR IMPOSSIBLE TO VISIT ANY VET. (expenditures growing!)

    July 2020 – 2nd IMS visit - went prepared with all Patch’s records in a notebook binder along with all disc copies of his xrays. He suggested melatonin for helping Patch’s belly fur regrowth, that was overkill shaved bald for the Jan. 2020 ultrasound. It’s only peach fuzz still, 7 months later. I cautioned him about the BP med interaction. He balked at any of the other supplements I give Patch. Had UPC ratio and free catch urine test. Urine Protein scored 273.6mg/dL, Creatinine 106.3mg/dL = ration of 2.6. Benazepril dosage increased to hopefully lower his protein at 20mg 2x daily. BP stabilized, systolic 120. Antech Accession Lab

    IMS had a 2nd opinion radiologist review the Jan 2020 ultrasound (without my knowledge or consent. I refused full payment, but offered up a 50/50 split. Seems they wanted all or nothing and gave me a full refund instead. Didn’t appreciate them trying to take control out of my hands). This radiologist report stated Patch had primarily hypoechoic but also mildly heterogeneous small mass of the left adrenal gland, likely of the caudal pole (approximately 2.84 cm x 2.36 cm) and mildly heterogeneous spleen with a hypoechoic nodule, likely of the body (0.96 cm x 0.65 cm). Irregular, mildly heterogeneous area also likely within the splenic body (1.10 cm). Small, heterogeneous mass of the spleen that bulges the capsule (1.96 cm x 1.75 cm). Smaller right adrenal gland, measuring 0.43 cm in height at its caudal pole. Mildly heterogeneous liver with at least one, hypoechoic nodule (0.41 cm). (So much more info than original report!)

    Aug 7, 2020 – New Radiologist visit - ultrasound. Report: Left adrenal gland: Cranial pole expanded by a rounded, heterogeneous mass measuring approximately 3.3 x 2.8 cm (this is increased compared to the reported prior measurement of 2.1 cm). The caudal pole measured approximately 0.56 cm. Right adrenal gland: Normal (0.46 cm). Spleen: Ill-defined, approximately 2.3 x 1.0 cm, hypoechoic nodule. Mildly heterogeneous nodule measuring 2.14 x 1.55 cm expanding the splenic tail. (Everything else internally appeared normal.)

    IMS believes Patch has atypical Cushing’s or at least ADH, not sure if cancer. Patch’s adrenal gland/hormones are so out of whack. Originally wanted Patch on mitotane, changed mind and now wants Patch to start 90mg Trilostane (Vetoryl) twice daily. When questioned what made him change his mind he said “sleep.” He thinks when he sleeps he stated. (Just when I thought I’d heard it all.)

    Seeing the posting 07-15-2020, by cken, “Cushing’s diagnosos 14+ yr old Vizsla - Vetoryl start dose?” and responses about the proper mg dosage was a timely huge wake up call for me! THANK YOU! (Patch’s weight is 64 ½ pounds). 180 mg a day IMO is excessive to say the least. Checked all your posted links for info, esp. Dechras site.. feel the 1 mg per pound (2014/15 dosage recommendation) is the way to go. Not sure if 30 mg 2x a day is appropriate or one 60 mg dose in the morning with food of course or to go with initially 0.5 mg/kg even if cost is more. (Feldman study I believe) With Patch’s history of not tolerating most med’s., naturally I’m cautious. Rather be a bit under mg than over and safer than sorry.

    CONTINUE TO PART 2
    Donna

  2. #2
    Join Date
    Aug 2020
    Location
    Alabama
    Posts
    10

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    Newbie Helicopter Pet Mom - Part 2 Continued


    Had a discussion with Dechra Monday, esp. about trilostane and benezapril interaction. (It lowers BP). No info on the Plavix. Vet Tech Services (someone in the forum posted a Dr. Allen there, only just a nice sales rep there named Amanda Allen.) Dechra still refer to 1-3mg/kg. Didn’t elaborate about the 1mg/kg dosage changed protocol. Gave me a case study reference - 2007 by Haley-Sars(?) “Trilostane and ACE Inhibitors” Any help on a link to locate? Dechra stated they’ve seen an explosion of Cushing’s cases lately. Interesting huh? They stated they appreciate groups like here. At least I have a case number for Patch. Phone number 1-866-933-2472, use option #1 for Vet Tech Services.

    To try and make things easier for the new IMS, I emailed him a history outline on Patch Monday morning with some of the links about trilostane dosage learned from this forum (and studies I’d found) to back up my not wanting Patch on 90mg 2x daily. (start low, then increase). IMS emailed me back in what I interpreted as he’s annoyed, not a team player, I’m the Vet not you attitude, seemingly adamant not lowering dosage and knew all abt. the UC Davis study. Didn’t mention he looked at the online wiley, google or other links I sent to prove my case. I stated I was not undermining him, just being precautious for Patch. Not being confrontational in any way. HATE confrontations!

    New IMS seems to be following a 2014 study he sent me “Long-Term Survival of Dogs with Adrenal-Dependent Hyperadrenocorticism: A Comparison between Mitotane and Twice Daily Trilostane Treatment” by C. Arenas, C. Melian, and M.D. Perez-Alenza . This study suggests 3mg per pound.

    https://www.vetspecialty.com/wp-cont...05/paper-1.pdf

    I’m feeling he is resistant to cooperate in a lose dose, given it also appears he keeps referencing for surgery which he knows I won’t risk given all Patch’s problems and age. I’m taking this as a sorta guilt fashion ploy if I won’t do. I wish it were that easy a remedy. He suggested to cancel Monday’s appointment and reschedule a pricey 2nd consultation with him abt the subject matter. It would be insane to do, a waste of time and money, if he is headstrong about the 180mg daily dose. I also questioned him as to further tests, a current CBC and to check Patch’s cholesterol, besides another reck of his urine protein. I canceled Monday’s protein recheck appointment in hopes y’all can help me rethink a game plan here before I do anything. I’m beyond discouraged and my BP is up! I can’t just go along with something that might jeopardize Patch’s well being more than it now is. What’s strange, this IMS gave me online suggestions where to purchase the trilostane, not purchase from them. Could this be a good guy, bad guy situation?

    Nor, I am willing to dish out any more cash needlessly, be taken advantage of/played, or my concerns dismissed even if I disagree on a Vet’s treatment plan. Been that route too many times. I feel this IMS is implying do as I say or go elsewhere. (This seems to be the mindset of many Vets in my area if you disagree on something). This is also a place that refuses to give any financial help/payment plan or accept 3rd party assistance. I did inquire. More on assistance for another post. My goal is to treat Patch safely and with little adverse reactions as possible. Not kill him.

    I am always mindful that I am Patch’s advocate, his voice, and no one has the right to tell me what I will or won’t do when it comes to making health based decisions for him. He’s not a lab rat experiment! I’m also considering seeing an Integrative Med. Vet if reasonably available in my area. I think I’m gonna start using the CBD oil with him again as well.

    What are your thoughts?? Any info on cushing dog’s dental, anesthesia, plavix interaction and CBD oil would also be greatly appreciated. Sorry if I’ve given anyone a headache. Thanks in advance.

    Donna

  3. #3
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,454

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    Hello Donna, and welcome!!!! Sooooooo glad you’ve made it here to us .

    Thanks so much for providing so much in-depth info about Patches. I want to take enough time to read through it thoroughly before posting my thoughts and suggestions. So I’ll be back again later on, but I wanted to at least have the chance this morning to welcome you both to our family!

    Until later,
    Marianne

  4. #4
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,454

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    Hello again! OK, I’m back with a few thoughts to throw out for your consideration. First, though, a couple of caveats. I am not a vet, nor have I had any related training. I am a pet-owner, but one who has focused on Cushing’s here and on related forums since my own dog (now a fur-angel) was first diagnosed and treated with trilostane back in 2004. So I’ve witnessed an awful lot of Cushing’s journeys during these past 16 years. Having said that, the majority of cases are pituitary in origin. Adrenal tumors are far less common and carry a host of variabilities depending upon location, growth rate, malignancy, and effect on adrenal hormone production. There’s far more that I *don’t* know about adrenal tumors than what I do know. But having said all that, here are some thoughts that I do have about Patch’s situation.

    First, let’s start with diagnostics. Unless I’m missing it, it doesn’t appear as though he has ever had a LDDS test performed. Multiple ACTH tests, but no LDDS. I’m wondering whether there’s a reason for that. The ACTH is known to return a large percentage of “false negatives” in the presence of adrenal tumors. Since an adrenal tumor has been suspected for a while now, I’m curious as to why an LDDS has never been pursued. Typically, that test would be less likely to miss making an actual Cushing’s diagnosis for a dog with ADH.

    Speaking of the ACTH, though, you report that Patch’s adrenal hormones (plural) are messed up, and that one IMS has included Atypical Cushing’s as a possibility. Has Patch actually had a full adrenal panel analyzed in conjunction with an ACTH? Historically, the only lab in the U.S. that performs this analysis is at the Univ. of Tennessee at Knoxville. Has Patch had this analysis done, and if so, what were the results?

    Moving on to the Vetoryl treatment, I have several questions. The most important is this: what exactly is the goal you’re seeking? I absolutely don’t mean to be flippant by asking this. But especially since it doesn’t yet sound as though elevated cortisol production has been confirmed, I’m wondering whether actual elevations in other adrenal hormones have been confirmed (via that UTK full adrenal panel, for instance). If Patch does indeed have an active adrenal tumor, then medication’s only role is to control symptoms. These are the symptoms I’ve picked up so far.

    Observable symptoms: pot belly, excessive restlessness (especially at night).

    Possible systemic symptoms: high blood pressure, proteinuria, vulnerability to clotting, abnormalities in blood chemistries and cell counts.

    Do the vets suspect his cardiac condition may also be related? That I don’t know much about at all. But in terms of his other symptoms, it sounds as though both his blood pressure and proteinuria are responding favorably to his existing medication, and the Plavix ought to be lessening the risk of clotting. So the question in my own mind right now would be, are his remaining symptoms severe enough to warrant the risks and monitoring responsibilities associated with a Vetoryl treatment. For younger dogs, I definitely see value in trying to forestall longterm systemic damage caused by Cushing’s. At Patch’s age, however, I’d be more focused on current quality of life. Does he stand to gain enough from the Vetoryl to be worth the treatment downsides?

    And that finally brings us to the Vetoryl itself. Literally, I can count on one hand the number of dogs in recent years who have been started off with a daily dose equal to 3 mg. per pound. Your vet is an outlier of an outlier on this one. Does the fact that an adrenal tumor is suspected change things? Perhaps. But again, as far as I can tell, we don’t yet know whether elevated cortisol is even present in Patch’s profile. So I’m clueless as to why such a humongous dose of Vetoryl would be prescribed.

    As far as your conversation with Dechra U.S.A., it’s frustrating to us that they continue to cite the 1-3 mg. per pound “range” in their conversations and on their product insert, even at the same time that other literature of theirs encourages folks to start off at the lowest possible dose that is likely to be therapeutic. Our understanding is that they feel bound by the wording in the dosing recommendations that were approved by the FDA back when Vetoryl was first introduced in this country 11 years ago. Dechra U.K. and in Europe appear to feel much freer in specifically advising lower doses. And certainly, as you’ve seen in your reading, the majority of clinicians have also adjusted their recommendations downward over the years, as well. Bottom line: there’s no way in which I’d currently start my own dog of Patch’s weight on a daily dose of 180 mg., even if I had evidence of highly elevated cortisol and felt confident that treatment was warranted.

    I know you have other questions, as well, but I’m going to leave this first reply here since I can see I’ve already written a book! But we can talk more again later.

    Marianne

  5. #5
    Join Date
    Mar 2009
    Location
    rural central ARK
    Posts
    14,260

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    Hi and welcome to you and Patches from me too!

    Marianne has cover the bases expertly as always and I have only a couple of things to add. Bear in mind, these thought apply IF and ONLY IF Cushing's is actually ever diagnosed, which to my mind it has not been at this point, plus Marianne's point about the goal of treatment is a very valid one for you and Patches.

    One thing I wanted you to be aware of is recent studies show that large dogs do better started even lower than the 1mg/lb discussed.... closer to 0.05mg/lb, no more than 30mg/day. Here is some info on that (btw, Glynda Pomerantz, the author of the first link, is one of our Admins here):

    https://drive.google.com/file/d/155a...gpCjmRdUz/view

    https://pubmed.ncbi.nlm.nih.gov/22708554/

    Second, I am an oddball and prefer Lysodren to Vetoryl EXCEPT when the dog has ADH. Here is why; adrenal tumors take larger and larger doses as time passes to keep control of the cortisol and high doses of Lysodren are extremely hard on the digestive system plus Lysodren is more apt to cause some serious side effects at such high doses. Hence Vetoryl is best for our ADH pups.

    That's all I wanted to add other than to say I am glad you found us and look forward to getting to know you and your sweet baby boy.

    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.

  6. #6
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,454

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    It’s me, again! I’m so glad that Leslie has had a chance to post, too, and she has given some excellent additional information. I also wanted to return to elaborate a bit more re: my reservations about beginning Vetoryl treatment unless you do have actual evidence that Patch’s tumor is overproducing cortisol and/or any of the other adrenal “sex” hormones (evidence which you may indeed have). We’re aware that another type of adrenal tumor, a pheochromocytoma, can also produce overlapping symptoms such as restlessness, panting, extended abdomen, hypertension, and excessive thirst/urination. In this case, though, it’s not excessive corticosteroids that are being released, but instance substances known as “catecholamines” including epinephrine, norepinephrine and dopamine. Vetoryl has no treatment value at all for elevated catecholamines.

    I’m linking you to an article about pheos. It’s dated 2010, but I believe the info is still accurate. The article rightfully states that pheos are extremely rare, but we’ve actually seen several cases among our members here throughout the years. Once again, this may totally be a moot point. You may already know that cortisol or other corticosteroids are involved for Patch. Or the radiological imaging may rule out a pheo on the basis of location or appearance. But I just wanted to mention this as an example of the complexities that can be involved in sorting out the optimal treatment approach for an adrenal tumor.

    https://www.dvm360.com/view/pheochro...ts-proceedings

    Marianne

  7. #7
    Join Date
    Aug 2020
    Location
    Alabama
    Posts
    10

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    I'm sorry for my delayed respond. Too much going on. First I want to extend my most gracious thank you to both Marianne and Leslie for all your incites and welcoming me! It feels comfortable in knowing I'm not crazy, at least not at the present and it confirms just what I felt, 180mg daily is off the charts and LLDS might be best next step before doing anything. I asked the IMS about it and he stated that with the (2) ACTH's neg. it isn't cortico's but hormones and an LLDS would not be beneficial. Of course I'd like to have a positive diagnosis one way or the other. In any event I will send him off an email today with the provided links you posted (I printed and saved them on my desktop for my reference as I usually do). I doubt his reaction will be any more pleasing than the last reply. Thank you soooo much for that info BTW. I only scan read them, but found they drive home the point to a "T". I also intend to inquire in my email what IMS's intended treatment plan is for Patch. He may or may not give me an outline (or quit because I ask questions). At this point, all is too vague. All I know is recheck UCP, BP and the Trilostane.

    I will pull up my email outline from UN of AL on exactly what they wanted done as I forgot to print that out for reference. They did mention the possibility of pheochromocytoma, but were doubtful and they wanted hormone and LLDS testing. (Hey Patch seems to be the oddball in everything else, so it would be no surprise if he did have pheo) I'll add the UN of AL info in my next post for you later today hopefully. Un of AL is a 3 hour one way drive for me. I know they charge $300 to send out to TN. So cost effective, if I can get the LLDS taken care of locally and sent off to TN for less or free, I'll do that.

    I dealt with a top Professor at UN of TN in the endocrine dept. for Patch's original ACTH and have kept in contact over time. He actually did the lab report. I'm going to reach out to him today to see what he can help me with. It is a 5 hour one way drive for me, and he saved me that trip the first time around.

    Right now, Patch doesn't seem to have excessive thirst or urinating. He drinks about 2-3 qts of water a day. He hardly ever drank much water prior to tooth extraction in Nov, in which I always forced him to with homemade broth as I was concerned. This struck me as odd his not wanting to drink much and I always made mention of it to any Vet. Most of his drinking seems to be because of "dry mouth/tongue/throat" due to his panting and then I give him a little drink with ice and he's good to go. Drinks after a meal or mild activity and doesn't gulp. Goes out to potty about 4-5x daily with the last evening outing about 10- 12. BM's seem ok, I always look, although on rare occasion a little watery (could be from the benezapril/plavix) Seems more restful during the day, but starts getting panting anxious after about 6 pm. Has rarely gotten me up late at night to go out. He's just up and down all night trying to find a comfortable sleeping place. I feel he is having issues regulating his body temperature like he's in male menopause or something. IMS at least agreed with me on this one.

    My original idea was to just order the 30mg and 60mg and only give Patch the 30mg daily regardless, but you both have raised some valid, commonsense, weighty concerns, so that is off the table. Just figured I already had the prescript and wanted something on hand in case IMS kicked me to the curb mindset. Just getting anxious to help Patch, but realize I have to be sure if he even truly has Cushing's before I give him anything in any mg dosage.

    I will add another post later with more info. Thanks once again for your help!
    Donna

    Didn't see any mention in the Aug recent rad report about pheo, but I will re check to be positive.
    "It is important to remember that you are your pet’s advocate, your pet’s voice, so no one can tell you what you will and will not do when it comes to making health based decisions for your loved ones."

  8. #8
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,454

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    So good to hear back from you, Donna. If you already have an endocrinology contact at UTK, by all means, I’d encourage you to update him and request his guidance. Just to clarify a bit more about testing, the full adrenal panel is an expanded version of the ACTH. The protocol for the blood samples and ACTH stimulating agent are identical, regardless of whether the lab analysis is checking on cortisol alone, or instead on cortisol along with additional adrenal hormones. So with the full panel, your local vet can perform the ACTH as usual, but then send it off to UTK. Perhaps UTK did perform a full panel analysis on that first ACTH — it’ll be very interesting to find out, if so. The LDDS involves a totally different test protocol which can also be performed by your local vet, but can be analyzed anywhere nationally by labs such as IDEXX.

    I remain very puzzled hearing your IMS’s reasoning for not proceeding with an LDDS in the face of an adrenal tumor. It’s historically documented that the “sensitivity” of the ACTH (likelihood of correctly returning a positive result for a genuine Cushpup) is lower than the LDDS, and significantly so when an adrenal tumor is present. You can find this same info in a million places, but here’s a quote that I just quickly pulled up now:

    ACTH Test Sensitivity: 73-95% in dogs with PDH and AT. Sensitivity is about 80%, if all studies are combined (looked at PDH + AT or PDH or AT alone). If dogs with PDH and AT are examined separately, the sensitivity is 87% and 61%, respectively.

    Clinical Use: There may be several explanations why the sensitivity of this test is less than might be anticipated. First, a minimum degree of adrenal hyperplasia may be needed before the ACTH stim test is abnormal. Second, the presence of symptoms may not always correlate to sufficient adrenal mass to make the ACTH stim test abnormal. Dogs with adrenal tumors may have reduced adrenal mass (atrophy of non-neoplastic gland) or reduced ACTH responsiveness. The ACTH stimulation test cannot be used to distinguish between PDH and AT because results from dogs with these diseases have significant overlap.
    https://www.vin.com/apputil/content/...748&id=3854240

    On the face of things so far, it still doesn’t sound as though testing has documented actual elevations in any of Patch’s adrenal hormones that might be responsive to Vetoryl. So yep, I’d hold off on dosing until you gain more clarity about the situation.

    As I say, that’s great if you can consult further with UTK. I was unaware that Bama has a veterinary “presence,” but another alternative of which you’re probably aware is Auburn’s vet school. Auburn may be even a further drive, but they do have an internationally renowned Cushing’s expert on the faculty there, Dr. Ellen Behrend. It’s not clear from their website whether she’s still actively seeing patients, but I assume their endocrinological department still reflects her expertise. She has authored many articles that we’ve referenced here over the years. Just a thought if you really feel as though you’re cast adrift...

    https://www.vetmed.auburn.edu/faculty/behrend-ellen/

    Marianne

  9. #9
    Join Date
    Aug 2020
    Location
    Alabama
    Posts
    10

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    After reviewing my Auburn UN report (Sorry Marianne and y'all, I mistakenly said UN of AL originally) they wanted to rule out pulmonary hypertension (did that, doesn’t have), urine creatinine protein ration (did that, high), a LDDS, repeat ultrasound (did that), BP and blood work (did that), and some other testing that only goes through UN of TN. Won’t know until next week when they respond elaborating as to what tests (I assume possibly hormonal testing and/or the adrenal panel) They felt not likely pheo. Yet IMO beliefs are only an opinion.

    Thanks to you Marianne, I rechecked the new August ultrasound report which stated in its conclusions: “Progressive left sided adrenal mass. Consider adenoma, adenocarcinoma or pheochromocytoma”. No other mention of pheo or ADH suspicion either. Begs to question IMS’s mindset in anything at this point no matter, even though this is 2nd mention of pheo.

    Game plan. Found a close by local Vet to do the LDDS on Patch. Will personally meet with him Monday for discussion (and quizzing) about Patch’s medical history and suspected causes prior to the LDDS. I believe he also treats Cushing dogs so this may be an alternate route should that come to be. Had a backup Vet farther away, but this place is so much more convenient for both Patch and I all around and they are reasonable in pricing. They use Antech Lab and results would be in within a day. Depending on these results, the next step will be move onto pheo urine/blood test or move on with proper Cushing’s treatment. Decided best to hold off with contact to IMS until after the LDDS results, if I even bother at all.

    Have spent many hours researching and getting educated about pheo, just in case. Trying not to be focused on could it be cushing’s or pheo, but I need to know one way or another.. Y’all correct, without an accurate diagnosis, can’t treat a may be, could be, with any medication.

    UN of TN is basically a skeleton crew because of Covid and haven't as yet heard back from the professor. I may have to call him at home, since most staff are working from home now. TN is only taking emergency pets from info on their website.

    The one thing I’ve learned over all this time, when presenting Patch’s medical records for any Vet to review, I recopy and remove the Vet’s name and info as experience has taught me, they appear to communicate with each other behind one’s back outside of medical questioning. Unless I am intend to stay with one, they don’t need to know where Patch has been. One Vet I had used for quite a time, overlooked he copied me, his correspondence to a Vet I had gone to for a 1x consult on another of my fur babies. It wasn’t ethical to say the very least. I called both out on it and moved on after that. HIPPA laws normally don’t apply to animals like humans, (unless a state law) but most good Vet’s still believe in the privacy of one’s animal records, unless given permission to disclose. Auburn UN informed me they follow HIPPA.

    Other times I’ve found they neglect to consult together, even if I’ve requested them to do so or they mention they will do so. So many reckless people out there. One never knows what goes on behind closed doors.

    I’ll keep y’all updated.
    Donna
    "It is important to remember that you are your pet’s advocate, your pet’s voice, so no one can tell you what you will and will not do when it comes to making health based decisions for your loved ones."

  10. #10
    Join Date
    Apr 2009
    Location
    Georgia
    Posts
    14,454

    Default Re: Newbie Helicopter Pet Mom needs help/support - 12 yr old American Bulldog Part 1

    Donna, I’m really glad to hear that you’ve got plans to schedule the LDDS. That’s where I’d start, too. If that comes out “positive,” further adrenal hormone testing at UTK may become a moot point. If a dog has elevated cortisol, it’s almost a certainty that other adrenal hormones will be elevated, as well, and Vetoryl would be the recommended treatment across the board for a “functional” (hormone-secreting) adrenal tumor.

    So let’s start with that LDDS, and then go from there.
    Marianne

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •