Harley's visit to the Univ. of Penn.

[Harley PoMMom]

Hi everyone!! Glad to see alot of you have made it here, I was so worried that I had lost you's just when Harley and I found such loving and supporting friends. So, Harley's U/S showed and Confirmed: Gallbladder wall hyperplasia, right adrenal nodule (7.3 mm at caudal pole), left adrenal gland normal in size ( high end of normal range), small splenic nodule, and an enlarged liver. Also confirmed: Hyperadrenocorticism ( suspect pituitary-dependent). His blood pressure was elevated at 180 mmHg. They collected a sterile sample of urine to test for a urinary tract infection. They performed an endogenous ACTH level to see if this will help to determine which type of Cushings he has and I also requested they run a full adrenal panel through the Tennessee lab. Someone will call me with the results (endogenous ACTH, UTI, full adrenal panel) next week, then finally we can start Harley on meds. Dr. O'Neill (Univ. of Penn. woman IMS) is leaning towards trilostane for treatment and I am just not sure, what do you all think? His NEW vet back here in York, which I had a consult with on Monday said he's not real keen on treating Cush pups with trilo, but he would do whatever I wanted to do and he really was interested to hear what Univ. of Penn. diagnosed and what they wanted to treat Harley with. Dr. O'Neill did tell me to take Harley off the raw food diet, so now I'm feeding him Innova senior.

Lori and Harley

[Lulusmom]

Re: Harley's visit to the Univ. of Penn.

Hi Lori.

I am glad to see that you made your way here too.

Can you tell us why your vet suspects that Harley has pituitary dependent cushing's. Just asking because from everything I've seen, the ultrasound findings don't clearly indicate PDH. My memory is bad and without the benefit of your thread on cc.net, I can't remember if perhaps Harley had an LDDS test that was consistent with PDH. In any event, the endogenous acth should give your vet a good indication as what you are dealing with.

I'm glad to hear that you are going to request a UTK adrenal panel. This is so important for anyone that is contemplating treating their dog with Trilostane. This test takes quite a bit longer to get results so I wouldn't expect them for about 10 days.

I think you need to get a confirmed diagnosis before you decide on an appropriate treatment. Surgery is usually the first option for an adrenal tumor; however, if treatment is chosen over surgery, then Lysodren would be a better choice of treatment. Trilostane is very effective in reducing cortisol; however, it is known to always elevate one or more of the intermediate sex hormones with long term use. This is particularly problematic for dog that already has sex hormone elevation(s). This is the reason why the UTK adrenal panel is so important before making your final decision.

My dogs are thriving and healthier than ever since switching them to a commercially prepared raw diet so I am curious as to why Dr. O'Neill had you change Harley's diet??

Glynda

[Harley PoMMom]

Re: Harley's visit to the Univ. of Penn.

Hi Glynda,
Harley's LDDS test results, taken 3/30/2009, were:
Suppression, 4samples
vet cortisol......................5.9................. ..............1-6...(resting)..uG/DL
Time 1:...........................10AM

vet cortisol......................9.5................. ..............uG/DL
.............................................Canin e...
.......................................POST DEX:..<1.0
.......................................POST ACTH:.5.0-18.0
Time 2:...........................2PM

vet cortisol.......................11.4............... ..............uG/DL
Time 3:............................4PM

vet cortisol.......................12.1............... ...............uG/DL
Time 4.............................6PM

I thought these numbers were pointing to adrenal cushings, but since the U/S did not differentiate between pituitary or adrenal, they are running the adrenal panel thru UTK lab. I was considering a CT scan on Harley's brain to see if we could find a pituitary tumor, do you know if anyone has had any luck with that? I asked down at Univ. of Penn. they didn't seem too hopeful that they would find a tumor.

As far as the raw food diet, I was making Harley's food at home, not getting the commercially prepared raw diet, like BARF, what do you feed your furbabies? If you don't mind me asking?

Thanks alot for replying back to me.....Harley and Lori

[Lulusmom]

Re: Harley's visit to the Univ. of Penn.

Hi Lori,

Thanks for posting those LDDS results again. I now remember looking at them and thinking "adrenal tumor". The ultrasound results are more indicative of an adrenal tumor as well. The UTK panel does not differentiate between PDH and an adrenal tumor but the endogenous acth does so I'm glad that your vet will be doing one.

My dogs eat Primal organic, hormone and antibiotic free chicken. I buy the frozen nougats. You thaw out what you need in the refrigerator and serve it up.

Glynda

[Squirt's Mom]

Re: Harley's visit to the Univ. of Penn.

Hi Lori,

So glad you to see you and Harley made it here!

I'm not well versed on the LDDS, but from the ultrasound does sound more like ADH to me. Usually with PDH, both adrenal are enlarged and relatively close in size. The one adrenal being so much larger in Harley's U/S, makes me wonder if he doesn't have an adrenal tumor. That could be good news, tho! Adrenal tumors are the only form that offers a cure, in the US currently anyway. Will be looking forward to the andogenous ACTH results along with you and everyone else!

Sounds like the folks and U Penn are some fine docs! I'm glad you have a source like that so close!

Hugs,
Leslie and the girls

[Wylie's Mom]

Re: Harley's visit to the Univ. of Penn.

Hi Lori,

FWIW - I feed my cushpup Primal chicken also. I used to give him kibble and after reading an article on Raw Green Tripe, I added some of it in his diet. I've been trying for years to get Wylie's coat softer - it's always been dry. I tried supplementing with olive oil, Foster's & Smith 3V caps, fish oil...nothing worked. After a couple weeks of supplementing with some tripe, his coat started to get softer. He then was diagnosed with Cushing's and now has an IMS vet. In December I decided to get rid of the kibble and switch him to raw. The IMS did not like that idea and sent me several articles, basically being worried about bacteria with a dog having a compromised immune system. I was torn because she has a valid point, but I had seen for myself what a little raw can do (improved coat in Wylie's case) and what I've read of kibble also worried me. In the end, I decided to go with the raw.

Alison (Alison & Mia) had posted an article or link to an article about somone going to a veterinarian conference and commented on the "bacteria hysteria" that was present. For me, it helped put things in perspective.

-Susy

[Harley PoMMom]

Re: Harley's visit to the Univ. of Penn.

Hi Susy,
"The IMS did not like that idea and sent me several articles, basically being worried about bacteria with a dog having a compromised immune system." That's what the IMS said to me too, so you know me, all worried, have to switch food for Harley so he doesn't get sicker. UGH. This so hard sometimes, trying to do the right thing for your furbaby. Harley loved the home-cooked meals, so I compromised and give him alittle cooked lean meat and some raw vegs w/ his innova, he wolfs it down in seconds. Do you think that is ok?

Harley and Lori

[Wylie's Mom]

Re: Harley's visit to the Univ. of Penn.

A raw (uncooked) diet is different from a cooked meal. A properly handled & cooked meal shouldn't raise as much of a bacterial concern to your vet, IMO. I primarily give my pup Primal or Nature's Variety (Raw), about 70%; and some cooked Chicken & rice, about 20%; the rest is a mix of commercial treats and frozen veggies/fruit and a little kibble for his toy. I think it's apparent that my Wylie likes the cooked Chicken & rice the best, the way he violently eats it. Sorry, I can't really give you an opinion - I don't think I know enough about dog diets - plus, I don't really know how I feel about kibble anymore. I gave Wylie kibble for about nine years - I only give him a little now because I can't put raw or cooked food in his buster cube!

-Susy

[Buffaloe]

Re: Harley's visit to the Univ. of Penn.

Hi Lori,

I think I mentioned before, Harley sure is a cool looking dog. If Shiloh ever ran into him, I know she would just love him...she'd flirt with him like a school-girl.

Shiloh had a very large adrenal tumor, a very successful adrenalectomy in 2006 and is doing great today at 14. Most certainly, if Harley has an adrenal tumor it is very much on the small side. At 7.3 millimeters, that is about 1/8 the size of Shiloh's tumor and much smaller than most we have seen here. That is very good news! The results of the LDDS test indicate that it could be an adrenal tumor. What the chances are based on the LDDS test, I don't have a clue. Hopefully, the endog. ACTH test will give you more certainty. The adrenal panel is also a great idea. Most dogs with adrenal tumors secrete an excess of one or more of the intermediate hormones. If Harley has any elevated intermediate hormones, I think Lysodren would be a better choice than Trilostane.

I'm sure no expert on diet but I discuss it with my vet quite a bit and Shiloh is an awfully healthy dog at 14 1/2. For her kibble, I've always fed her Solid Gold Hundenflocken. I just buy the very best canned food I can find and give her about 1/4 can/day. I buy those cooked chickens at Costco and give her the white meat along with some organic brown rice and some brocolli, green beans, carrots, etc. I feel real good about giving her the chicken, organic rice and veggies and she loves it. Her only supplements are glucosomine and fish oil, every day.

You sure are going the extra mile with all of Harley's testing. I hope and pray it all pays off beautifully. All the best to you and Harley and Shi sends your cool boy kisses.

Ken

[barney's mom]

Re: Harley's visit to the Univ. of Penn.

Hi Lori,
I just wanted to say hello and welcome!
I see that we are neighbors! I just moved to York, PA six months ago. I have a border collie who has pituitary cushing's and is on Lysodren. I moved from MD and we were seeing an IMS there, but have just been seeing a regular vet here. It is nice to know that U of Penn is an option if needed.
Nice to see someone so close!

Cheryl

[Harley PoMMom]

Re: Harley's visit to the Univ. of Penn.

Hi Cheryl,
It is comforting to know that you and your border collie (would his/her name be Barney?) live so close to Harley and I. What vet are you seeing down here? The Univ. of Penn.that Harley went to was in Philly (Matthew J. Ryan Veterinary Hospital), although I was told there is a Univ. of Penn. located in MD.

Hi Ken,
Harley's head is getting so big from all the compliments!!:>) We thank you and Shi for them. I think I will look into buying those cooked chickens at Costco, thanks for the info.
I also hope and pray something soon sheds some light onto what type of cushings Harley has, the IMS and his NEW vet did tell me that he is in the early stages of cushings (how they really figure the stages, I don't know), maybe b/c he hasn't lost any of his hair????
I really appreciate that you told me the story about Shiloh and explained to me about the size of the adrenal tumors, I have been trying to look that info up and could not find much. When I get Harley's test results back I will post them and hopefully you will chime in then too.

Bless all of you, Harley and I are so happy and lucky to have found such supportive and loving friends.......Harley and Lori

[barney's mom]

Re: Harley's visit to the Univ. of Penn.

Hi Cheryl,
It is comforting to know that you and your border collie (would his/her name be Barney?) live so close to Harley and I. What vet are you seeing down here? The Univ. of Penn.that Harley went to was in Philly (Matthew J. Ryan Veterinary Hospital), although I was told there is a Univ. of Penn. located in MD.

Yes, he is Barney
I live in west York and we were in the process of looking for a vet up here in York when my other dog Beth got in a scrap with my sister in law's dog and ripped her eyelid. We took her to Dover animal hospital and she was stitched up by "Dr. Rick" (that's what we call him, and his last name escapes me at the moment) He has been absolutely awesome and I was very lucky to find him.
Barney has been seeing him ever since he developed a corneal ulcer that is very slow in healing. He is coming due for a stim test, and if all is well and stable, I would like to have Dr. Rick continue to treat him for cushings as well.
He did have a stim test there a few months ago but the Dr and I don't see eye to eye on his treatment (his stim has been slowly trending upward and the other doc didn't want to tweak his meds or miniload him again since technically he was within normal limits, I will be astounded if he is still normal and not high, although he remains asymptomatic. but lol that's a whole other story)

What vet do you see here?
I am glad that Harley saw a specialist for diagnosis. The vet my dog used to see originally diagnosed Barney with adrenal cushings due to a poor quality ultrasound and was going to treat him with much higher doses of Lysodren to supress the adrenal tumor. All his other tests were positive for cushings but inconclusive for the type of cushings. The IMS found he had pituitary cushings and I shudder to think of what would have happened had we begun therapy on high doses. (he loaded on a bird dose)

Cheryl

[Harley PoMMom]

Re: Harley's visit to the Univ. of Penn.

Hi Cheryl,
I live in Strinestown, it's a little town about 10 miles north of York.
How is Beth doing with her eyelid? What breed is Beth? When I was searching for a new vet for Harley (long story about his old vet ), Dover Area Animal Hospital is one I called also, they told me Dr. Anne Parker was their vet that was up on Cush dogs and I was going to go there but the Sunday before we were to go to Univ. of Penn., (which was on Tuesday 14), I noticed Harley was overdue for his rabies shot, so Monday morning I got up early and starting calling vets that I talked to before and asked them if they could get Harley in for his shot and the only one that would schedule me in on that day was Shiloh Vet. Hospital in Manchester, boy were they a life saver I believe I am going to call John Ingold Vet. hospital, located at 2200 west market street b/c he has a 24 hour emergency service of his own, in which HE is on call for, just to have him for a back-up for Harley.

Let me know how you make out with Barney, and I will pray his limits will be normal. How did your IMS find out Barney had pituitary cushings? Harley's diagnosis is still up in the air as to adrenal or pituitary The IMS at U of Penn thinks pituitary, but I'm not so sure.

Take care........Harley and Lori

[barney's mom]

Re: Harley's visit to the Univ. of Penn.

Beth's eye has completely healed. Dr. Rick did an amazing job at stitching her up. Her eye was ripped back at the outer corner completely through. I can't even see the spot if I look for it. Beth is a pound puppy whose pappers say she is a german shepherd mutt. The vet doesn't think she is a shepherd. I've looked online at dog pics of black and tan kelpies that could be her twin. So who knows

I have heard wonderful things about Anne Parker at Dover.

Barney was hard to diagnose. One ultrasound showed that one of his adrenal glands were enlarged. His stim as well as his endogenous ACTH came back inconclusive. He had a horrible painful episode in which we didn't know where the pain was coming from at the time (it turned out to be a herniated disc) and during his work up they did two more ultrasounds as well as an MRI that got much clearer images of the adrenal glands. Bilateral enlargement indicated pituitary cushings.

I like the idea of having a vet on call that you are familiar with. My best friend takes her dog to Dr. Ingold! She loves him but snuggles doesn't have any health problems, so I guess she hasn't really seen him in action.
(what a small world eh?)

I was looking at Harleys ultrasound and it does show both glands enlarged. Doesn't one gland usually atrophy in the case of an adrenal tumor? (its been awhile since Barney's diagnosis, forgotten alot of the specifics)

[Harley PoMMom]

Re: Harley's visit to the Univ. of Penn.

Hi all,
Dr. O'neill (Univ. of Penn.) called me on Sunday to tell me that Harley's adrenal panel bloodwork, somehow, got messed up, so today Harley is at his vet getting the panel redone again to be sent to UTK. Dr. Oneill did say that he does not have UTI (good news), but his Endogenous ACTH results are not back yet.
So, if you all would please keep fingers, paws crossed that Harley's bloodwork panel gets done right today and we receive the results soon (I know around 2 weeks), I'd appreciate it!!
Harley and Lori