Wow, that's good there is finally a diagnosis for Jett. Glad your vet is willing to listen and learn- that is the sign of a truly good vet. Bet he looks for atypical cushings now! There are risks associated with over-suppressing the adrenal glands, especially since Jett has normal and not high cortisol levels. Lysodren suppresses all adrenal function, which could make Jett Addisonian (hypoadrenocorticism). You can treat Addison's disease, and some vets actually prefer to make a Cushing's dog Addisonian and then treat that, because it has a better prognosis. Melatonin suppresses sex hormones, so it should treat all of Jett's symptoms that are attributed to his Cushings. Flax seed competes with estradiol on the receptors, so there is less estradiol effect. One thing I would still highly recommend is that ultrasound to make sure Jett doesn't have an adrenal tumor. Those should be removed ASAP to prevent them from invading major blood vessels (it's bad). This is the entire treatment sheet from UT: Steroid Profiles for Diagnosis of Atypical Cushings Disease: Test Results/Treatment. Clinical Endocrinology Service (Phone-865-974-5638; Fax-865-974-7147; Web-www.vet.utk.edu) College of Veterinary Medicine, The University of Tennessee Where positive test results of increased adrenal activity are present, consider the need for: 1) Ultrasound. To rule out the chance of a primary adrenal tumor (AT) being present. 2) Melatonin. Often used as a first treatment, especially if alopecia is present, since it is cheap, has few side effects and is available in health food stores or via nutrient suppliers on the Internet. Typically, a total dose of 3 to 6 mg is given q12h. Use regular melatonin rather than rapid release or extended release products. Melatonin has anti-gonadotropic activity, and it inhibits aromatase (converts androstenedione and testosterone into estradiol) and 21-hydroxylase (lowers cortisol level) enzymes. Monitor treatment effectiveness via improvement in clinical signs or serum biochemistries, or by repeat of steroid profile. Expect positive results in 3 to 4 months. 3) Melatonin Implants (DermatoninTM). Available for dogs. (WWW.MELATEK.NET). Sizes are 8, 12 and 18 mg for 50 lb dogs, respectively. Effects last 4-6 months. NOTE: Melatonin and flaxseed oil with lignans are used together when estradiol is increased. 4) LysodrenTM. Lysodren is very effective in lowering cortisol, androstenedione, progesterone or 17-hydroxyprogesterone levels. NOTE: Estradiol is not always suppressed by LysodrenTM, so determining a baseline estradiol level 1-2 months post-Lysodren will determine efficacy. 5) Flaxseed oil with lignans (FSO). The lignans in FSO have phytoestrogenic activity, and may compete with estradiol for tissue estrogen receptors with less biological effect. Lignans also inhibit aromatase (anti-estrogen) and 3-beta HSD (lowers cortisol) enzymes. Sources for animals include health food stores or Internet sites such as WWW.BARLEANS.COM. Give SID, one tsp per 25 lbs on food, or one FSO capsule (1000 mg) with lignans. Lignans without FSO are available, with a suggested dose of 40 mg EOD (30 lbs); see WWW.VITACOST.COM/NSIFLAXSEEDLIGNANS. 6) Ketoconazole. Possibly effective for hyperestrinism when combined with melatonin and lignans. 7) Androgen treatment. For estrogen/androgen imbalance or low androgen levels. (E.g., methyltestosterone or anabolic steroids (expensive) such as OxandrinTM). Androgen treatment may have positive effect in reducing estradiol level via negative feedback effect, and may also have replacement value. Monitor liver function when androgen treatment is used. 8) Trilostane. Available in the UK and Europe, but not approved in the U.S. The drug can be used in the U.S. with FDA approval (see PlumbÂs Formulary, 5th Ed., pg 778 & 886). Note: trilostane always increases 17-hydroxyprogesterone, and frequently increases estradiol and androstenedione as well. LysodrenTM may be preferred for Atypical CushingÂs cases. FURTHER NOTE. Care should be used in switching from trilostane to LysodrenTM. Allow adequate time for either drugÂs effects on adrenal tissues to subside before making a change in treatment. (E.g., one month off drug; return of clinical signs of CushingÂs; or post-ACTH stim cortisol levels within normal range). 9) Specific hyperestrinism treatment. ArimidexTM and AromasinTM have particular indication for treatment of hyperestrinism in dogs, but kinetic studies are lacking  they inhibit aromatase enzyme. 10) Ovarian Remnant or Retained Testicle. Ultrasound or exploratory surgery. 11) For clarification, phone Dr. Jack Oliver (865-974-5729) or Dr. Kellie Fecteau (865-974-5833). In summary, atypical forms of adrenocortical disease (ACD) occur in dogs and cats (i.e., normal or subnormal cortisol response to the usual adrenal function tests). For dogs, it is common to have elevation of progesterone and 17-hydroxyprogesterone (17-OHP). Increase in androstenedione and estradiol occur frequently, but less so than for progesterone and 17-OHP. Testosterone is increased only rarely. Several patterns of hormone increase occur, so running the complete steroid panel will be the most advantageous, in terms of diagnosis of suspected ACD. Also, it is most meaningful to perform an ACTH stimulation test so that comparisons of basal vs. stimulated hormone concentrations can be made. Usually the stimulated values give the most meaningful information. For cats, infrequent samples are received for testing, but recent case reports implicate progesterone as being increased along with adrenal androgens and testosterone. From: J.W. Oliver, Proc. ACVIM Forum, pp. 541-543, 2002, and ACVIM Forum, pp.471-473, 2007. I am moving on Labor Day weekend to Sanford, NC. I didn't buy a practice yet, though. Banks don't want to lend me money until I have at least 5 years experience, preferably 7. I will try in 5 though. I work at a practice in Fayetteville, NC. It's a very busy practice and since there is not a specialty practice in town, we get to do a LOT of cool stuff. I am learning orthopedic surgery and all kinds of cool things since we basically have to fix everything with what we have (and we do have lots of good toys like ultrasound, in house lab, great surgery equipment, etc). The practice is truly a service to the community as it is very inexpensive, which is needed in Fayetteville- it's not a rich town. So I am very happy there, at least for the next couple of years. Thanks for asking!

There is only one of you and your life is the result of the choices you make. PLEASE listen to the doctor. My husband has severe coronary disease with very bad circulation. He is not diabetic. However due to poor circulation, an ingrown toe nail he wouldn't see about was the start of his demise. The infection would not clear up due to poor circulation where not enough blood below the knee. After the infection, gangrene, and 5 surgeries, he only has a stump for a right leg. You are dealing with a serious problem. It will not go a way by itself. Have a pulmonologist do tests and find the problem now. How much can you enjoy your trip when you can't walk? Is it worth it? Why not get the tests, bypass surgery or medicine to help correct the problem, and then the trip? Life is too short as it is, don't give it up as my husband did. Can't go back and change the past. I sincerely wish you the best. Lynn

I'm here JensWrens! Are you just curious about the Kitchen you posted or are you planning a new Kitchen yourself? The Kitchen I remember from 2008/2009 (JensWrens' Finished Minnesota Kitchen from 2009) had a long bank of windows behind the sink - are you planning to redo your Kitchen again or are you building a new home? Regarding the layout you posted, unfortunately, I have to agree with the others that it's not very functional. The prep sink has no workspace around it and faces the wrong way (it should face the range) There's no real Prep Zone - there's a "wannabe" Prep Zone, but no real one. With the prep sink all by itself and all usable workspace either behind it, across the aisle in the other small island, or across the aisle and off to the left or right of the range. The MW and Speed Oven (I assume that's what SO stands for) are located far from where they would be useful The "Butler's Pantry", if that's what it truly is, should be located where it's useful - usually b/w the Kitchen and DR. Instead, it almost looks like a secondary Kitchen (for the cook? or for a caterer?) or, maybe, a baking kitchen - except the ovens are on the other side of the wall in the main Kitchen. The Cleanup Zone is in the outside island where the seating is - and where the dirty dishes can be seen far and wide, as well as those dishes being "in the face" of anyone sitting there. Where is dish storage? I'm assuming in the small islands behind the cleanup island - but the one across from the DW appears to be all sink or all butcher block with shallow & narrow drawers - so those won't work. The other small island might work. Where is the DR? Would the dish storage be convenient to the DR and any other table space? If you must have two rooms, then I would create a scullery for the Cleanup Zone and have everything else in the main Kitchen - including move the MW and SO into the main Kitchen. But, that now means a long walk to clear the table or set the table. It also means that the main Kitchen, where you spend most of your time (over 80%) is spent in the less-desirable location - an interior room with no natural light other than the light from the scullery or other, distant rooms. The food storage appears to be split into two separate pantries - and they are widely separated from each other. (As are the refrigerator & freezer, but that isn't necessarily an issue.) Where will groceries be brought into the Kitchen? Most likely, one of those pantries and either the refrigerator or freezer are going to be quite a hike from the entrance - if not all of them being too far from the entrance. The aisles are too narrow - they look like around 39" or so. The five island seats are all lined up like ducks in a row - not very conducive for conversation. I'm not convinced the depth of the seating overhang is at least 15". Even if it is, I recommend deeper - at least 18" - b/c seating behind the Cleanup Zone will subject to splashing as well dirty dishes in front of them. That little stool on the end of the cleanup island doesn't look like anyone except a very small child would fit The DW is in the way of getting to the prep sink from the top pantry (if it's open while someone is prepping/cooking) Personally, I'd rather remove that wall and incorporate all those windows into the main Kitchen. Here's an attempt to show you the zones in a zone map. It's difficult to place the primary Prep Zone b/c there really isn't any good one. Zone Map: . Workflow: .

ont_gal It is a good thing that you had your gall bladder removed in 1977. In 2012 (I live in Ontario, Canada) I had an ultrasound for something I did not have (thankfully) but the ultrasound did show gall stones - how many and how big I was not told and neither was my primary doctor. I have never had an attack - and it is now 2018 and I am a senior citizen (well in age...). I wrongly assumed I would be able to have my gall bladder removed before it became an issue. Apparently in Ontario you can't have just the gall stones removed (I have been watching too much U.S. TV). I even managed somehow to contact the office of Toronto's main gall bladder doctor and was told that I was right that it would be better to have it dealt with at the time rather than to wait for an attack. But that OHIP would not cover the cost. Of course it is now considered a pre-existing condition for travel insurance and I am obsessed with it! I do know the signs - my doctor said to pay attention to sharp pains in the area of the belly button or to symptoms resembling a heart attack. Many people go to Emergency thinking they are having a heart attack when in fact they are suffering a gall bladder attack - but that the gall bladder does not need to be removed immediately - as in the person is not turning yellow. So they are given a letter to give to their primary GP who then in turn will make a referral to a specialist - which in Ontario you know how long that would take. Of course Murphy's Law being what it is, people who have been through the Emergency heart attack/really a gall bladder attack do not go to Emergency the next time they present with heart attack symptoms and of course they are having a heart attack. I hate the fact that when I have a cold and really cough etc. that I can get pains in my side - or I pull a muscle etc. I realize that I could die before I have a gall bladder attack, but still it is a pain in the neck and I wish that I did not know I have gall stones. I have had an acid based kidney stone and that was a "treat". Neither I nor my husband are a drain on OHIP's services. We go once a year to the doctor. I have one prescription, he has 2 only for eye drops and that is it. I can't take meds for cold/flu etc. so that pretty much wipes out everything and I do not have high b.p. or cholesterol. That is my sad story. I am happy that you do not have to worry about the issue. If I were 20 then I could understand not removing the stones but the entire gall bladder in case the stones returned, but being past 65 I would prefer to take my chances.