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Thread: Diagnosis

  1. #11
    Join Date
    Dec 2020
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    Default Re: Diagnosis

    Her cholesterol and creative kinase are elevated too.

  2. #12
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    Dec 2020
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    Default Re: Diagnosis

    In may of 2020 her urinalysis was normal.

  3. #13
    Join Date
    Apr 2009
    Location
    Georgia
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    15,292

    Default Re: Diagnosis

    OK, I've finally made it back here and I'm so glad to see that Leslie has also stopped by. She makes several excellent points, and I agree that it's very helpful to take a look at things from every angle possible. Frankie does present some question marks, just as Leslie has noted. The elevated ALT but ALP still within normal range, and normally appearing adrenal glands are the two oddities that I also especially note. However, so many of her other symptoms are indeed consistent with Cushing's, so I do understand the basis for the diagnosis.

    As for the benazepril and dietary restriction, you're right that Frankie's proteinuria is the basis for that treatment. Chronic proteinuria can end up harming the kidneys, and moderating the amount of dietary protein that's ingested can lessen the amount of protein that ends up spilling into the urine. Cushing's is a systemic illness that can cause proteinuria, so if Frankie truly has Cushing's, this is another reason why you want to directly treat the Cushing's -- in order to lessen or eliminate the underlying cause of the proteinuria. One probably dumb question, but have you compared the calorie count of the new renal food to her previous food? It may be the case that her ongoing hunger may be partly due to a lower calorie intake. I'm giving my non-Cush Lab some prescription GI food right now, and it has quite a few less calories per cup than does her regular food. So I'm needing to feed her more to make up for the difference.

    You mention that Frankie had a full thyroid panel performed before starting the supplement. I'm interested in hearing a little more about that. Sometimes the results of thyroid testing can suggest that a low thyroid reading is most likely secondary to another condition, such as Cushing's. Kind of like with the proteinuria, once the secondary condition is effectively controlled, the thyroid readings may end up normalizing. However, hypothyroidism can also be a primary problem in its own right, of course. But I'm just wondering whether Frankie's thyroid testing offered any clues in that regard. Over-supplementation of thyroid can cause excessive thirst and urination, so I'm wondering how recently Frankie's thyroid level was checked. I'm assuming along with this other recent bloodwork, but I just thought I'd mention that.

    Returning to one of your original questions, yes, Vetoryl dosing can require significant adjustment both up and down. Even though there are indeed certain unanswered questions about Frankie's presentation, if she were my own dog, I believe I'd follow your vet's suggestion right now and try the two-week increase. As he says, if that doesn't improve her symptoms and her labwork, then I'm all for a repeat ultrasound and any additional diagnostics that your vet thinks may be helpful. Since her cortisol level has been trending upward instead of downward, I don't think you're putting her at risk by continuing with two more weeks of the medication. But if that doesn't improve the situation, I'd want to do more investigation, myself.

    My heart goes out to you, because I know how worrying the uncertainty must be. And especially right now during the holidays and in the midst of all the other worry in the world, it's a very upsetting time to be facing these challenges with your sweet girl. But we'll stay right here by your side, so do continue to bounce off any more questions or thoughts that come to your mind.

    Marianne

  4. #14
    Join Date
    Dec 2020
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    12

    Default Re: Diagnosis

    You are so kind and comforting. It took us a long time to get to the diagnosis in large part due to her presentation. Her thyroid was checked recently and is at the lower end of the therapeutic range. At first we thought her increased appetite was habitual due to change in schedule. Now that we are working from home, she doesn’t go to daycare much. In true goldendoodle form, she loves the people there most anyway. I have an appointment scheduled with a veterinary nutritionist in 2 weeks to see about diet accommodations. The change in her urinalysis changed this summer but I mentioned an increase in urination and drinking a year ago. She’s happy and still loves her walks, she just urinates large dilute quantities of urine and is hungrier than normal. Her legs tremor sometimes when sitting or standing but it doesn’t seem to bother her. She’s had so many tests, I’m just baffled. Maybe she does have nephrogenic diabetes insipidus and the polyphagia is due to protein loss. It’s not massive but not normal. We just upped her benazepril as she was on an extremely low dose. Her use is 10.06 at this point and proteinuria 3.0.

  5. #15
    Join Date
    Dec 2020
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    12

    Default Re: Diagnosis

    Her beautiful tail has thinned, too. Her coat is thinner but not awful.

  6. #16
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    Dec 2020
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    Default Re: Diagnosis

    We have definitely been feeding her more to compensate for calorie differential. In sdddition we add canned pumpkin, seeet potatoes, blueberries, green beans and carrots to her diet. We started feeding 3x a day yesterday which we think helped. We are trying to begin exercising her again now that her incision is healing. She mast cell tumor was subcutaneous on her hind thigh/leg.

    I really can’t thank you enough for your encouragement.

  7. #17
    Join Date
    Apr 2009
    Location
    Georgia
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    15,292

    Default Re: Diagnosis

    It sounds like you are doing a wonderful job of taking care of Frankie! My avatar is of my sweet Cushpup Lab boy, Barkis. He passed away a number of years ago now, but I still remember clearly how upsetting it was to see the bald spots developing on his sides and haunches. He really suffered from hind-end weakness, too, prior to being treated with trilostane. Coincidentally, he also had a mast cell tumor successfully removed from his hind thigh, too. He developed the tumor several years prior to his Cushing’s diagnosis, so I don’t think the two were related at all, and he was never troubled with mast cell issues again after the removal. I’ll surely be keeping my fingers crossed that the Vetoryl dosing increase may finally make the difference in Frankie that you’re hoping for.

    Marianne

  8. #18
    Join Date
    Dec 2020
    Posts
    12

    Default Re: Diagnosis

    Thank you so much Marianne. I would totally think Frankie’s is all kidney related except for the increased hunger which started before her food switch. That’s the only symptom that doesn’t fit anywhere. End of October she swallowed my socks which she hadn’t done since she was a puppy. She had an X-ray then which showed nothing on her spleen. She is recently hesitant to jump on the bed and doesn’t follow me as much. She wasn’t interested in playing in the snow either. Her legs sometimes tremoring is definitely upsetting although it is not every day. She does love her walks though. She’s also become very bossy. She still is drinking more and peeing large dilute volumes. Any other ideas?

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