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

[Budsters Mom]

Okay Sharlene, you have two options for getting through the next 24 hours. Either you can take the batteries out of the little muffin or you can program her on a loop like a little electric train. That way she will run out her batteries on her own. LOL

I know, it's not really funny, but lightening the mood is always good. Our pups are bouncing off the walls after the Acth. Takes a while for it to wear off. Big hugs in the meantime.

[Dixie'sMom]

Sharlene, I know its been a long journey for you and a very confusing one. I've read quite a bit of Molly's story but at 261 pages my eyes just won't hold out to read it all. I have been following consistently since I joined the forum tho. The atypical cushings appears to be just sooo "atypical" that every single pup is showing different symptoms and there is not much consistency between cases. I'm not lucky that Dixie has Cushing's, but I am lucky she is a very typical case and has been so easy to manage so far. (Keeping my fingers crossed it stays that way. )

Molly is very, very lucky to have you and the Hubby to take care of her with your kindness and generosity and always going the extra mile to make sure she is getting the best of care. I have faith that this will all get sorted out soon and you and Molly can enjoy some peace.

[labblab]

Hey Sharlene, sounds like your plan is all in place!

Since Molly is already picky about eating, I understand why you might want to wait on the dietary change if for no other reason than just not altering too many variables right as you're starting out on the trilostane. It'll be interesting to see if there is any effect at all on her appetite. Who knows, maybe she'll be one of our very few contrary pups who gain a better appetite when the cortisol is lowered. I don't think you had joined the forum yet when one of our long-term members, Sue, was here treating her Zoe. But darned if Zoe didn't always stop eating when her cortisol started heading north!! It was the craziest thing, but Sue knew Zoe so well that she could always tell it was time for a cortisol check when she'd leave food in her bowl.

One other question occurs to me, and that is about fish oil. Tina had mentioned it earlier. I know it has been prescribed for Jasper, and most of the stuff I've been reading recommends it, as well, for treatment of protein loss. Here's a quote from that IDEXX roundtable discussion on proteinuria:

...we have antiproteinuric therapies that seem beneficial. These are interventions that can lower the magnitude of renal proteinuria. The most common are dietary protein restriction, dietary fish oil supplementation, and interventions that interfere with the renin-angiotensin- aldosterone system. In veterinary medicine, that latter group includes angiotensin- converting enzyme (ACE) inhibitors, such as benazepril or enalapril. In terms of reno-protection, the interventions that are supported by studies are ACE inhibitors and dietary fish oil supplementation. In dogs, for example, there is evidence that ACE inhibitors decrease proteinuria and renal lesion magnitude concurrently.10 In addition, a multicenter trial that Dr. Grauer led indicated that ACE inhibitors are antiproteinuric and potentially beneficial in spontaneous glomerular disease.11

Fish oil supplementation is also antiproteinuric and renoprotective in dogs,12 but there is no evidence yet of fish oil’s benefits in chronic kidney disease. Ongoing clinical trials in which Dr. Sanderson is involved are evaluating the potential benefits of long-term fish oil supplementation in dogs with spontaneous chronic kidney disease. There is reason for excitement.

https://www.idexx.com/pdf/en_us/smal...ound-table.pdf

So fish oil may be something else you want to discuss with your IMS if it has not already been mentioned.

[molly muffin]

They put her on omega supplement 3 weeks ago. I think that would have fish oil I. It. But I will check. It was first thing we added along with the vision supplement. The omegas can cause diarrhea too they said. Joy joy. We have had diarrhea all week off and on. Poor muffin. I will never be able to use poops as a determination for the trilostane or eating either. So that has always given me pause to think but we have to do something.

Oh gosh Susie that would be a long read indeed to try to go through all of this thread. Lol. I was trying to say how frustrating it has been for such a long time not knowing what to do for her. We have had a lot of really good times though and only a few real problems so far. Thank god. Text book cases are definitely easier I think to diagnose. It is always a roller coaster ride though that's for sure.
Molly isn't typical atypical either since she has the high cortisol too and normally you don't with atypical. She also has the high sex hormones though that is a sign of atypical but with low aldosterone which is often seen in adrenal tumors. Argh. See I over think this stuff too much sometimes I think. Lol. Drives one batty. Will need a straight jacket at some point I think. Rofl

Kathy you never fail to crack me up. Lol. I was considering the programming a loop and letting her go option. I think we are past the worse of it though and she is getting back to normal activity level.

Hugs
Sharlene and Molly muffin

[judymaggie]

Sharlene--I do want to go back and more of Molly's journey but the quote below really caught my eye. My Maggie (who was the reason for my joining this forum several years ago) was finally diagnosed by UTenn folks with atypical Cushing's with an overlay of "regular" Cushing's after testing showed the exact same pattern you describe below.

Molly isn't typical atypical either since she has the high cortisol too and normally you don't with atypical. She also has the high sex hormones though that is a sign of atypical but with low aldosterone

We treated Maggie with melatonin implants and lignan extracts. A maintenance dosage of Lysodren was also recommended but, at that point, Maggie was too ill to tolerate it.

I wish you all the best with Molly's care along this roller coaster!

[molly muffin]

Just checked and the very first thing in the Omega supplement is fish oil, so we're covered Marianne! Thank you for thinking of that.

Judy, it's so hard when they have a couple different things going on. My IMS opted not to go with the lysodren maintenance dose, as it is so tricky with molly not having the normal symptoms and with her low appetite and diarrhea, she (my IMS) said she wouldn't trust we'd be able to tell if the lysodren over did it and thinks we can manage the trilostane better. Hope she is right.

I hope Abbie is going to be an easier case to handle than Maggie. I'm following your journey too. A lot of twists and turns on this journey and darn if they don't throw a fork in the road in too every now and then just to keep us on our toes!

I do love the forum though. I just don't know how on earth I'd managed all of this without the people here. That straight jacket would have already been buckled up!!!!
My IMS said something yesterday that I thought was very nice, as we were chatting about results and working out a plan. She said, "it is so good to be able to talk to you as it is more of an exchange, than me just explaining, not that I mind explaining, but you already know all of this, so we can throw ideas back and forth and you understand what I am talking about, medications, dosages, risks, tests, protocols, etc." That was sweet. She had started to tell me about trilostane testing protocols, give in the morning, with food, test 4 - 6 hours later, test in 10 - 14 days and I swear I didn't say anything, was just letting her talk and then she stopped and said, I know you already know all of this. And I'm like, yea, I do, as I tell people the same thing all the time, but it's nice to know we are on the same page with it all too, as not all vets are. She started laughing and asked if she passed and I said, yep, you did, we'll be a good team. LOLOLOLOL

Hugs,
Sharlene and molly muffin

[Dixie'sMom]

I had remembered you saying that they added the Omega's to Molly during the last visit so I never mentioned it to you, but the Omega's are great for eye health so you are getting a two for one in giving her those. The retina docs recommend them highly for their eye patients and it sounds like great for kidney health. I'm glad your energizer muffin has wound down. Have a restful weekend!

[molly muffin]

It is interesting, the eye supplement, was engineered by vets, based a great deal upon studies of humans with retinal bleed and loss of focal point eyesight, add this in with the studies on dogs, and we are hoping that it will at least help give her some eye support.

Yep, she seems back to normal today, so the ACTH testing has worn off I think. Whew. It's cold and windy/damp here today so she isn't all that interested in going outside either. I'll probably have to convince her it is a good idea to go for her late afternoon and evening walks, as she isn't a fan of being wet and damp. (well really who is) When she ignores the rational, we really need to go outside so you can pee discussion, I just pick her up and out we go. A lot easier with a small dog, as impossible to pick up a big dog and do that. LOL

hugs
Sharlene and molly muffin

[Budsters Mom]

So glad that Molly is back to her normal Molly self.

I can just see that time to pee discussion. Lol Yes, it is so much easier to pick them up when they're small.

[apollo6]

Glad to hear Molly is doing better.
Sending love and hugs
Sonja,Apollo and little Ariel