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  1. #1
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    May. 31, 2010
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    Default GI Issues...resolved? Update 1st post

    Update: ACTH stim and bile acid test all within norms, albumin back to normal. $1100ish to figure that all out, but oh well. Now I'm trying to switch her back to Acana and get off the ZD. At $55 for 17 pounds at 4 cups a day, it's just crazy expensive. I did decide to keep her on Fortiflora proactively.

    Glad to have some good news.


    First - dog is already getting seen by the vet - I'm looking for any ideas based on experiences, maybe tips on things to ask my vet or look for so that we aren't running every diagnostic under the sun, if possible. Sorry this so long!

    The patient is an 8-year old Chesapeake. She's previously been diagnosed with diabetes insipidus. During all that testing, I'm 98% sure she had an ACTH stim to rule out Cushings. We also found out at the time she only has one kidney (through ultrasound).

    Two weeks ago she started having diarrhea. She has food sensitivities so that isn't completely unusual, though rare when diet is kept restricted. I had given her a pig snout and thought that set her off. Fasting, bland diet, probiotics didn't really help, and then she added vomiting after a few days.

    Vet on Christmas Eve - slightly dehydrated, albumin level very low on bloodwork, good bacteria low on fecal. Unknown why, could be IBS, a bug, heading towards HGE, etc. Because she was bright and happy, vet elected not to hospitalize. Shot for vomiting, put on ZD food, prednisone.

    Today was our bloodwork recheck. Stools are normal, no more vomiting, but albumin still low, though not as bad before. My observation is that she still seems to be doing more lip licking and that deep audible swallow that means an upset stomach, more than normal, but not as much as when really sick. Vet wants to do urinalysis to see if there is any protein in urine.

    Today was the first mention of Addison's. We can't test while on the prednisone though. Does anyone have experience with this? Does my description ring any bells with anyone? Any thoughts or tips?

    I can't really have a dog that has insipidus, one kidney, a heart murmur, a little dysplasia and Addison's right? I already call her a medical marvel!
    Last edited by KTRider; Feb. 6, 2013 at 09:02 PM.



  2. #2
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    Jun. 14, 2006
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    Default

    As far as I can tell, there are a wide range of possible symptoms to indicate Addison's and it's kind of the last resort before going to pred in our case. Going to test for that here too. My dog has had loose stools for months, had surgery, been on restricted diet, probios, biosponge, yada yada. It's the last thing we're going to look at before we throw our hands up in the air and do the pred.

    So...I FEEL for you but I don't have much INFO for you. Just jingles!

    Here that ACTCH is about 300 bucks. I've not been able to get it scheduled over the holidays but it's on the list.

    Good luck!
    A good horseman doesn't have to tell anyone...the horse already knows.

    Might be a reason, never an excuse...



  3. #3
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    Jul. 26, 2001
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    Default

    Yep, she will have to come off the prednisone to do the ACTH stimulation test. Often hypoadrenocortisism dogs (addisonian) have small adrenal glands, was that noticed on her ultrasound?

    Certainly could be addisons, as it can present in the same way - but at the same time there are about 100 other things that also present with vomiting/diarrhea as symotoms.

    Easiest way to check it out is ACTH stim and ultrasound. Good luck!!!



  4. #4
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    Aug. 3, 2009
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    Central Indiana
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    Default

    I would imagine if she's missing a kidney she may very well be missing an adrenal gland, which certainly seems logical to predispose her to Addison's. We recently saw a dog with low albumin and chronic GI issues who was diagnosed with something odd; I'll have to check and see what is was. Is this all being worked up by a regular DVM or do you have a specialist hospital nearby?
    Last edited by SarahKing; Jan. 2, 2013 at 10:17 PM. Reason: added info
    Life-long horse lover, dreaming of the day when I have one of my very own.



  5. #5
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    Default

    Urinalysis was normal today. Normal for her anyway, it's always dilute.

    I'm seeing my regular vet, but today was a relief vet. For now the relief vet wants her to finish the prednisone then recheck and maybe do ACTH then. But he wants me to talk to the regular vet next week. He says it could other GI issues but all those tests are much more invasive, so he's thinking better to keep the status quo and rule out Addison's first if necessary rather than go to more invasive testing first.

    Nothing was mentioned about adrenal gland abnormalities when we did her ultrasound, but that's been four or five years.

    She's the best dog ever...I don't want her to have anything else wrong! She's so happy and easy-going you never know she's sick. At least she's also a great patient.



  6. #6
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    Aug. 3, 2009
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    Central Indiana
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    Default

    OK, the patient I was thinking of was DX'ed with protein losing enteropathy, most likely caused by lymphangectasia. The owner was on a budget, so we did not do intestinal biopsies, but treated it as such and the dog is now doing much better. http://en.wikipedia.org/wiki/Lymphangiectasia
    Life-long horse lover, dreaming of the day when I have one of my very own.



  7. #7
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    So I checked back in with the vet and per his staff, they want to test her for Cushings and do a bile acid test. Part of this has me curious - the relief vet suggested Addison's, now they say Cushing's, but those are like mirror image conditions. It seems weird to me. And though I'm usually pretty assertive, for some reason I never want to question my vet.

    From all my reading on Cushing's she doesn't have any other symptoms, except the drinking and dilute urine, but she's an insipidus dog so, that's the norm. Cushing's was ruled out before when we got the insipidus diagnosis. And with the single kidney and possibly single adrenal, Addison's seems a better shot.

    But, I'm not a vet. If you were me would you be asking why a Cushing's test instead of Addison's? With a dog like this would you just get a referral to an internal med specialist? I don't want to seem insulting by asking that.

    Of course we have to wait two weeks anyway because she was on prednisone. So I have time to stew...



  8. #8
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    In a nutshell, you test for "both" cushings and addisons with an ACTH stim. They are either:

    hyperadrenocorticism (Cushings), normal, or hypoadrenocorticism (Addisons)

    In the majority of cases,you will get an answer with the ACTH. In some cases (ie.cushings due to adrenal tumor,and not pituitary dependent),or atypical addisons, you may get more normal results and further testing is required. Generally, the baseline test however is the ACTH stim. So when your vet said test for cushings, he may just simply mean the stim.

    Is her albumin still low? Has she had an ultrasound recently? Lymphangectasia and PLE comes to mind with chronic low albumin.

    Also, you wont insult your vet by asking for a referral to an internist. If my dog had any endocrine disease I would want a specialist overseeing it, even if I have the regular blood and checkups through my regular vet.



  9. #9
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    Well that makes more sense, same test for both.

    We haven't had bloodwork since 1/2 and albumin was better than 12/24 but still low. The other two you mentioned also came up in the rundown of possibilities, but no other symptoms, so I think they wanted to do the ACTH stim first. We are still on the I/D food and all her GI issues are resolved, on the outside anyway.

    She has not had an ultrasound recently, it's been 4-5 years. The vet who did the ultrasound is the local internal med specialist, so I may try to see him again.

    I don't know why I worry so much about asking more questions or for referrals. He seems pretty easy-going. Time to be a big girl I guess.

    Thanks for clarifying!

    Quote Originally Posted by SquishTheBunny View Post
    In a nutshell, you test for "both" cushings and addisons with an ACTH stim. They are either:

    hyperadrenocorticism (Cushings), normal, or hypoadrenocorticism (Addisons)

    In the majority of cases,you will get an answer with the ACTH. In some cases (ie.cushings due to adrenal tumor,and not pituitary dependent),or atypical addisons, you may get more normal results and further testing is required. Generally, the baseline test however is the ACTH stim. So when your vet said test for cushings, he may just simply mean the stim.

    Is her albumin still low? Has she had an ultrasound recently? Lymphangectasia and PLE comes to mind with chronic low albumin.

    Also, you wont insult your vet by asking for a referral to an internist. If my dog had any endocrine disease I would want a specialist overseeing it, even if I have the regular blood and checkups through my regular vet.



  10. #10
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    FWIW, we're doing the ACTH tomorrow for my dog. His digestive issues have not resolved. We've done I/D, Z/D, I've had him on Endosorb and that's the best we've done but we still have GI issues, lots of drinking, dilute urine, etc. (not to mention the surgical stuff we did a few months ago)

    Maybe I'll know more about the whole process after tomorrow and can share with you.

    All of the bloodwork on our end thus far (for the last 4 mos) has been normal. Ultrasounds normal. Radiographs normal. Biopsies of the intestine normal. I really need to get this under control so the next step is to just treat with prednisone for a bit but I want to do the ACTH first.

    Good luck. And jingles.
    A good horseman doesn't have to tell anyone...the horse already knows.

    Might be a reason, never an excuse...



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