Uncontrollable Urge To Pee. Stops On Vomit

[pampa]

**rushing back over the thread and web links to read up (AGAIN) on Cushing's**

OK, so at least you have a direction to go on... Whatever the case, she is going to have to get that tumor out of her so I suspect you are not feeling so very much better after todays developments... :cool:

She has gained weight though and 800 grams in less than a fortnight is wonderful !

What information exactly are you hoping to collect from the urine tests ?... Will you be able to determine "tumor type" or presence of "cushing's" from the urine or is it mainly gneral health levels to determine whether pre-op medication is necessary...

It's all so confusing when its not black & white, isn't it...

Don't forget to update us as soon as you get the results back.

Big hugs to you both.

[Erny]

She has gained weight though and 800 grams in less than a fortnight is wonderful

Yep. I was very pleased with that! The desk nurse thought I'd gone looney when, with Kal still on the scales, I threw my fist in the air and called out "YES!" :cool: I did explain.

What information exactly are you hoping to collect from the urine tests ?... Will you be able to determine "tumor type" or presence of "cushing's" from the urine or is it mainly gneral health levels to determine whether pre-op medication is necessary...

I'm a little confused myself, Pampa. From what I can gather, it's merely a re-run of earlier tests when we were checking out whether Cushing's was applicable. The tests on the urine do relate to the Cushing's and/or tumour type .... not general health. Depending on the results as to what form of pre-op meds Kal is given.

Guy did explain that when they did the blood tests for Cushing's, the "suppression" (of adrenaline, I presume) was not as much as they would expect if it were Cushing's. I think this is why Guy wanted to re-run the urine and blood pressure tests.

OT - While I was at the Vet's, I asked if they were able to do the test on food to determine presence of Sulphur Dioxide (referring back to the other thread/s on that topic). They said "no" .... they don't do those sort of tests. I expressed a bit of surprise, saying that I would have thought they would have, given they are a University Vet Clinic and that surely diet and/or preservatives would play a reasonable part in Veterinary care and diagnosis of conditions. Although Guy agreed with me that diet is important, he said it was a fairly new "thing" to them and that they really didn't know about Sulphur Dioxide and its affects until they heard about the Today/Tonight show (which I think I brought to their attention). :D

God ...... I trust they know more about adrenal tumour removal (adrenaloptomy? ... can't remember the name).

Edited April 26, 2006 by Erny

[Rusky]

God ...... I trust they know more about adrenal tumour removal

rest assured they do, it will be fine.

The trouble with cushings in humans is it is quite difficult to diagnose and I am assuming that the range of tests performed are to make sure it is the cortisone increase caused by a tumour ( malignant or benign) of the adrenal gland and not the pituitary gland causing the problem by an increase in adrenocorticotropic hormone ACHT. Once they have decied it is the adrenal gland tumour causing the problems they need to watch that the tumour has not affected other major organs, so more blood tests, sweat tests( do they do that in dogs?) and urine tests.

They need to make sure that Kal is absolutely as well as she can be prior to surgery to give her the best chance.

Don't watch any TT progs or similar, trust your vets they sound amazing I must say.

I have confidence in your vets, the whole thread has impressed me enormously.

[Muttaburra]

Thanks for letting us know about Kal's progress, and it's very good to know that she is putting on a little bit of weight. If there was any So2 problems, then that should be compensated for now, so it might be possible to try reducing any B supplements for a few days, just to see how that goes.

the range of tests performed are to make sure it is the cortisone increase caused by a tumour ( malignant or benign) of the adrenal gland and not the pituitary gland causing the problem by an increase in adrenocorticotropic hormone ACHT.

These will also help to determine the amount that needs to be compensated for (reduced to prevent post-op complications) prior to surgery.

Although the blood pressure is inconclusive, it needs to be monitored, luckily although elevated, it is not in the very high range.

If only that damn tumor had not been malignant, being so, it means that surgical intervention is necessary, and has reduced many other options for treating the disease. This is the hardest part to accept. The vetinarian care she is recieving sounds excellent and with all the tests being done, everything is set for the best possible conditions for Kal to have the surgery. This is a really big plus in this situation.

So here's a big :cool: and sending you and Kal lots of positive vibes.

[Erny]

God ...... I trust they know more about adrenal tumour removal

Don't watch any TT progs or similar, trust your vets they sound amazing I must say. ... I have confidence in your vets, the whole thread has impressed me enormously.

Oh ... I'm glad you said that, Rusky. Because I feel now we (Kal and I) must rest in their hands. This is foreign to me, as I've always taken so much control over Kal's welfare, training, desensitisation etc. etc. I feel a bit like I'm now about to jump off the deep end at a pool, even though I've done as much of the checks and balances possible to ensure there is water there to soften the impact. I think I'm now in that "holding my breath" stage.

Last night, at about 11.30 pm (after Kal had been resting in her bed for about 2 hours), she all of a sudden began to pant. Panting is not something that is normal for Kal (before she became ill, I used to get concerned that she rarely panted, even in warm weather). She was laying on her side, and even became upright for a while. She looked a bit distressed, and did pointedly look at her abdomine once or twice. The panting lasted for about 1/2 hour or so.

I have no idea here ..... but it crossed my mind as to whether this episode relates to the beginning of a rupture in the adrenal gland? She was ok today, albeit weak again. A 5 minute walk was all she could manage. I will mention this to Guy (the Vet) of course, when he rings me, in case it is relevant/important to know.

ETA: Or maybe it was an episode of elevated blood pressure???

Edited April 27, 2006 by Erny

[Rusky]

I feel a bit like I'm now about to jump off the deep end at a pool, even though I've done as much of the checks and balances possible to ensure there is water there to soften the impact. I think I'm now in that "holding my breath" stage.

hang in there... :p it won't be long now till the op

How is she today?

[Erny]

Hi Rusky. :p Funny how we're thinking and talking in each other's threads. The power of "vibes" can be amazing sometimes, heh?

Kal's 'ok' today. The way she lays and sometimes groans (not unusual ever since she's been unwell) makes me think there is discomfort. I've always thought this was due to IBS (which, as I mentioned in earlier posts, I now wonder if she has this), but in recent times have thought perhaps there is discomfort due to the tumour. Although her Vet says he doubts the tumour would be causing her pain.

I'm waiting for the Vet to call with the results of the urine test. I expect it should be today. Will post again when I know more from that.

Read your last post in your thread. I'm glad Goldie is at least making progress as far as eating is concerned. That's got to be a good sign. Thinking of you and her.

[Tassie]

Hi Erny - just popping in to say "Hang in there" - and sounds like these vets are really taking things seriously, and are on the ball. Still thinking good thoughts for Kal (and the other poorly pups on DOL.)

[dogbesotted]

Erny,

You are still in control of what is going on..YOU have decided to trust the vets who are treating Kal, YOU have decided to learn and research as much as possible and YOU are the one who is Kals primary carer..because you are not a specialist then YOU have sought their opinions, recommendations etc.

Thinking of you both

Hugs

Helen

[dogbesotted]

I have been mulling over this.

If Kals blood tests are nor shopwing the results that would point to cushings disease..has Atypical cushings been considered/ ruled out.

1.

Hyperadrenocorticism is caused by either a tumor in the hypothalamic-pituitary area

(PDH/Cushing's disease) or in the adrenal glands (ADH), or both. Atypical Cushing's

disease can be present with either of these conditions, but cortisol increase often is

not present; probably due to steroidogenic enzyme defects in the adrenal glands.

2.

Atypical Cushing's disease is caused by changes in enzyme function in the adrenal

pathways that prevent the normal flow of synthesis to the endpoints of cortisol and

aldosterone; with build-up of adrenal intermediates, such as androstenedione,

progesterone and 17-hydroxyprogesterone. These intermediates, in turn, are converted

into sex steroids (usually estradiol, not testosterone). This can be genetic, congenital, or

due to disruption of enzyme activity by an adrenal tumour.

3.

Cortisol is increased in dogs with typical Cushing's syndrome (PDH/ADH), and

allows a diagnosis to be made with the usual diagnostic tests, such as ACTH stimulation or

low dose dexamethasone suppression; however, there are a variety of hormonal

presentations in dogs with atypical Cushing's disease, and most often, cortisol is either

normal or suppressed.

4.

It is very common for dogs with atypical Cushing's disease to have an elevation of

progesterone and 17-hydroxyprogesterone (17-OHP).

[Erny]

Now that's interesting, DBS (also scarey!).

So, what this is saying is that Atypical Cushing's could be the condition, even though the ACTH tests she has had don't prove Cushing's, and that she could have a tumour not only on the Adrenal Gland (as we already know it is) but ALSO in the hypothalamic-pituatary gland area?

It is very common for dogs with atypical Cushing's disease to have an elevation of

progesterone and 17-hydroxyprogesterone (17-OHP).

I presume these could be detected by way of blood test/s? But then, by the way it is written, it doesn't sound 100% conclusive. IE If neither elevated progesterone or hydroxyprogesterone were detected, possibly still Atypical Cushing's? Would that mean that a CT scan is necessary to determine whether a hypothalamic-pituatary tumour is present?

;) This is getting really complicated ...... not to mention, by the sounds of it, expensive beyond my capabilities. :sigh: Oh well, what is necessary to be done, will be done.

The Vet didn't call me today, so I assume the test results aren't in yet. If it's ok with you, DBS, I will print off your most recent post and raise it with him, depending on what he has to say.

DBS - once again, you astound me. I wouldn't even know to 'think' about this, let alone to seek the information out. :p Thank you. If you're not a Vet, then perhaps you were in your past life. In fact, your knowledge exceeds that of a many Vets I have had the opportunity to come across. Well done.

[pampa]

The Vet didn't call me today, so I assume the test results aren't in yet. If it's ok with you, DBS, I will print off your most recent post and raise it with him, depending on what he has to say.

Bugger, I was wondering too

Looking forward to you next update, buddy.

Keep on keeping on :p

[dogbesotted]

Hey do not panic! for goodness sake. I was just throwing in some comments NOT saying that Kal has this or hasnt. As there is an adrenal tumour ...then adrenal tumours can/may cause atypical cushings when they are secreting normal levels of cortisol; adrenal tumours present with a variety of increases in adrenal steriods and cortisol may not always be one of them. atypical cushings is due to the changes in enzyme function in the adrenal pathways that prevent the normal flow of synthesis to the endpoints of cortisol and

aldosterone; with build-up of adrenal intermediates, such as androstenedione,

progesterone and 17-hydroxyprogesterone. These intermediates, in turn, are converted

into sex steroids (usually etradiol ). This can/may be caused by an adrenal tumour.

it is worth considering even if only to totally discount.

The process of elimination goes on.

Just a thought.

Cheers

Helen

There is a good contact person in the states. if you like I can Pm his details. ( it is from another list i belong to so i cannot post publically)

[dogbesotted]

http://www.vet.utk.edu/diagnostic/endocrin...client_info.pdf

http://avmajournals.avma.org/doi/abs/10.24...urnalCode=javma

[Erny]

Hey do not panic! for goodness sake.

Don't get me wrong, DBS - not really panicking .... just a bit aghast at the 'extras' that can be involved with Cushing's. (There I was thinking I had a 'reasonable' understanding of what it was all about. ) I was really mainly posting to make sure my understanding of what was written was correct. And please don't think for a minute that I don't appreciate and value your info and input :D. Thanks for the two links. The second link doesn't work for me, but the info in the first link was valuable.

I will raise the matter of adrenal steroid profiles with Guy when he calls me ....

Edited April 28, 2006 by Erny

[dogbesotted]

Erny,

here is the abstract: Your vet can obtain the full paper..but it does cost so i did not get it ( sorry)

Abstract

Journal of the American Veterinary Medical Association

February 15, 2005, Vol. 226, No. 4, Pages 556-561

doi: 10.2460/javma.2005.226.556

Secretion of sex hormones in dogs with adrenal dysfunction

Kate E. Hill, BVSc, DACVIMJ. Catharine R. Scott-Moncrieff, VetMB, MS, DACVIMMark A. Koshko, DVMLawrence T. Glickman, VMD, DrPHNita W. Glickman, PhDRichard W. Nelson, DVM, DACVIM William E. Blevins, DVM, DACVRJack W. Oliver, DVM, PhD

Department of Small Animal Medicine, School of Veterinary Medicine, West Lafayette, IN 47909. (Hill, Scott-Moncrieff, Koshko); Present address is the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996. (Hill); Department of Veterinary Pathobiology, School of Veterinary Medicine, West Lafayette, IN 47909. (Glickman, Glickman); Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616. (Nelson); Department of Diagnostic Imaging, School of Veterinary Medicine, West Lafayette, IN 47909. (Blevins); Department of Comparative Medicine, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996. (Oliver)

Objective—To evaluate adrenal sex hormone concentrations in response to ACTH stimulation in healthy dogs, dogs with adrenal tumors, and dogs with pituitary- dependent hyperadrenocorticism (PDH).

Design—Prospective study.

Animals—11 healthy control dogs, 9 dogs with adrenal-dependent hyperadrenocorticism (adenocarcinoma [ACA] or other tumor); 11 dogs with PDH, and 6 dogs with noncortisol-secreting adrenal tumors (ATs).

Procedure—Hyperadrenocorticism was diagnosed on the basis of clinical signs; physical examination findings; and results of ACTH stimulation test, low-dose dexamethasone suppression test, or both. Dogs with noncortisol-secreting ATs did not have hyperadrenocorticism but had ultrasonographic evidence of an AT. Concentrations of cortisol, androstenedione, estradiol, progesterone, testosterone, and 17-hydroxyprogesterone were measured before and 1 hour after IM administration of 0.25 mg of synthetic ACTH.

Results—All dogs with ACA, 10 dogs with PDH, and 4 dogs with ATs had 1 or more sex hormone concentrations greater than the reference range after ACTH stimulation. The absolute difference for progesterone, 17-hydroxyprogesterone, and testosterone concentrations (value obtained after ACTH administration minus value obtained before ACTH administration) was significantly greater for dogs with ACA, compared with the other 3 groups. The absolute difference for androstenedione was significantly greater for dogs with ACA, compared with dogs with AT and healthy control dogs.

Conclusions and Clinical Relevance—Dogs with ACA secrete increased concentrations of adrenal sex hormones, compared with dogs with PDH, noncortisol-secreting ATs, and healthy dogs. Dogs with noncortisol-secreting ATs also have increased concentrations of sex hormones. There is great interdog variability in sex hormone concentrations in dogs with ACA after stimulation with ACTH. (J Am Vet Med Assoc 2005;226:556–561)

PDF (176 KB) PDF Plus (167 KB)

[Erny]

Thank you, DBS. Have printed this off also, in preparedness for Guy's telephone call .... which I now presume will come Monday.

[Rusky]

any news Erny?

[Erny]

Hi

Yes - spoke to Guy last night. Second Urine test still shows no results to indicate Cushing's.

DBS - I spoke to him about the "atypical" Cushing's. Some of the 'jargon' goes a bit beyond me, but the outcome of that part of the conversation was that, given all the checks and balances and clinical signs etc. etc., he does not believe this to be Kal's condition.

So - we're back to:

1. Benign tumour. In which case it is possible that it is not the cause of any of the symptoms I've been describing throughout.

2. "Phaeochromocytoma" type tumour. If this tumour is as encapsulated as the ultrasound shows, then it will be simpler to remove. We won't know 100% that the tumour has not invaded tissue/blood vessels until surgery.

With the tumour (and, hence, the adrenal gland) removed, this leaves the one remaining adrenal gland. The adrenal gland (on the left side) is small and we believe atrophied. It is possible, though, that it is still functional and will take over the job of adrenal release following surgery. If not, then we have Addison's disease, in which case Kal will require meds to counter balance the affect.

Guy is sending out pre-surgery meds. Kal will be on them for 2 weeks. During this time I am to arrange for surgery to be scheduled for a date directly after the medication course.

Speaking to Guy last night has returned to me some confidence in the possible success of the surgery. I remain, however, acutely aware of the risks.

The good news is that Kal is still holding down the cooked chicken. (I note that she's been groaning from time to time since its introduction, though.) Going by her looks, it would seem she has increased more weight even since the last check. :rolleyes:

Rusky - that's "old Goldie" in your new avatar, isn't it? She's lovely - I can see that in her eyes alone. Hope her health improves with each day. I think of her too. And Pampa's girl. And Lucinda. And Ollie.

[Rusky]

Right well, we need to be very positive. Kal will be in excellent hands, all possibilities are covered and I am sure it will be a good outcome.

I think of all the dogs everyday too, just wanting them to be the best they can be. Thanks for the kind words about my girl, she is laughing in that picture.

keep us updated.