Molly, 13 yr, shih tzu - lhasa aspo - Molly has passed

[molly muffin]

It does have it's moments Vicki.

Leslie, 8 works, Mariannes two and all the others on here help a lot. Can you imagine if I hadn't posted the jpegs!!!!!!! I'd be a wreck for sure.

Sharlene

[Trish]

Hey Sharlene, good morning!! Add my 4-eyes to the mix Just read through the report properly. Had to squint a little but could read it!! Very throrough, I am impressed

[labblab]

It does make me wonder about the sex hormones more now though.

Sharlene, I know you are anxiously awaiting the results of the UTK testing. In advance of that, though, here's a couple thoughts for you to consider. I don't say what I'm about to say to try to confuse things further, but just so you'll be really prepared to discuss the results with the IMS.

This is the thing...Our experience here (and "seconded" by what your IMS has already said) is that I don't think we've ever had a dog with elevated cortisol that didn't also register elevations in at least some of the other adrenal hormones as well. And the big question is, so what does that mean, and how does it really matter????? If Molly had not already exhibited elevated cortisol on the previous ACTH, then I'd be more anxiously awaiting this UTK panel because normal cortisol but elevated intermediates could herald a discussion of "Atypical" symptomology/treatment. But if Molly again exhibits elevated cortisol, I'm really not sure what significance any other elevations really have. Obviously, that's what you'll have the IMS to tell you . And I'll be really interested in her take on whatever the results turn out to be. But I do think that, under the circumstances of Molly's previous ACTH, it would be more surprising if she doesn't have other elevations than if she does. And exactly how that might alter a treatment decision, I do not know. It seems to me that the elevated cortisol (if it is still the case) remains the front-and-center-stage issue in terms of clinical control.

Marianne

[molly muffin]

I don't know Marianne. I mentioned the study that shows almost all dogs seem to exhibit high estriadol that Lori posted. She said that you have to have 2 or more elevated now for them to look at atypical.

I fully expect her cortisol to be high, it was last time, not sure why it wouldn't be this time. The liver is larger, the adrenals are larger.

I don't know what it is that she is looking for either .

I guess the big mystery is that she shows no symptoms of cushings and that the IMS said while one might come back negative on an LDDS, if it is a false negative, that you wouldn't expect all of them to. (although she mentions it as a possibility on the report). I think they might be puzzled too.

I haven't ever pursued treatment because of the lack of symptoms. I don't know if I should have, if I should now, or what. I guess I hope that the UTenn report will round out what is going on inside of molly's body. Maybe it is a matter of which hormones are high and how high. I really just don't know.

hugs
Sharlene and molly muffin

[labblab]

I haven't ever pursued treatment because of the lack of symptoms. I don't know if I should have, if I should now, or what. I guess I hope that the UTenn report will round out what is going on inside of molly's body. Maybe it is a matter of which hormones are high and how high. I really just don't know.

Hey, Sweetie, I don't for one moment question the decisions you've made thus far. There is no doubt but that Molly has been a most unusual girl, and there have been so many unanswered questions all along the way. Like everybody else, I have never been able to make sense of the positive ACTH and the negative LDDS tests. They are in such direct contradiction of one another since a positive ACTH is supposed to have a decent degree of reliability, just as should be the case with a negative LDDS.

I just know there is so much debate about the significance of elevated intermediates, though. And so I worry about the picture getting muddied even further. If the cortisol remains elevated, I'd expect for other intermediates to be elevated, as well, since obviously the adrenal glands are being overstimulated. But what is the cause? That seems to be the million dollar question!

[molly muffin]

Oh Marianne, I don't think you are questioning what I've done so far, but I certainly am. It's hard trying to know the best thing to do when molly isn't a text book case. I have absolutely no doubt that no matter what UTenn shows, that the waters will indeed be much muddier.

Molly isn't moving around much on her foot. She isn't limping but she is laying for the most part. I know it hurts her Somewhere, but I can't find anything at all wrong. I can move the foot and the toes and she doesn't flinch away ,but she also eventually will move her paw out of my hand. I looked between the pads and can't see anything there either.

I think she might need an anti-inflammatory and I am so leery of that. I wonder if what we used on her back would help her foot. That didn't seem to bother her.

I guess I'll have to give her regular vet a call tomorrow and see if I can get any feed back.

hugs all
Sharlene and molly muffin

[Trixie]

Hi Sharlene,
I'm the last one that can shed any light on all the variables of these tests but I think you've made very wise decisions for Molly and it can't be easy to figure it all out and especially since she's had no Cushings symptoms. Hopefully the next piece of the puzzle coming from UTenn will possibly hold the key one way or the other.

I think you were smart not to treat. I would imagine without the symptoms as a barometer treating would be a difficult guessing game that could get dangerous.
In the meantime, this paw/leg issue is still going on..poor Molly. When we took Trixie to the vet with her leg she mentioned a "not too hot" compress...may be worth a try for the little girl. Hope it gets better soon.

Barbara

[Iraklis]

The IMS said she would not do an MRI at this time (that might change who knows) as there is no guarantee that you spend $2000. and that it will show anything. (we were talking at the time about a pituitary tumor)

2000$ for an MRI?

It costs 350 euros (~500$) here...and that's the only positive thing i can think of regarding veterinary practice here...
Maybe you should come for holidays and squeeze in an MRI between swimming

[Renee]

Iraklis, the cost is why most people don't do it. Up here (in Alaska) an MRI is about $2,000 as well. We opted for a CT scan for Tobey, and that alone was $1200. So, really, an MRI is not something most people can do.

[Budsters Mom]

An MRI cost $3500 where I am! Too expensive for most of us.....