Augie, English Bulldog - update: Our beautiful boy has crossed the bridge

[EllyAugie]

Hello, I am the owner of a 6 1/2 yr old wonderful Bulldog by the name of Augie, today he was positively diagnosed with cushings with the ACTH response test I believe it was. Vet said it was a strong response. We did an ultrasound about 2 mths ago with results looking normal there. His cbc was pretty good except high values in ALKP (880), high CHol (355) and Lipa (1929). PLT was (568)The Urine Analy was normal except the specific gravity was 1.010 ( I am reading the results off his bloodwork but not really familiar with any of these tests ) He began drinking excessive water and having to urinate much more along with accidents in the house. Our vet put him on trilostane med today and we will begin our journey with this disease. I am hoping to gain insight into ways to help him maintain the best health possible such as diet etc. and to make his quality of life the best we can. He is my heart and best buddy, so intelligent and stable. Just the thought of losing him sooner than expected hurts me deeply.
The vet said for him to take the 2 trilostane pills once daily, I read online that splitting them up can be more helpful. Has anyone heard of this? At this time I am only following his instructions.
Also his T4 thyroid was 0.7 and his T3 was 62. We also did another more extensive thyroid and sent to MI State, waiting for those results. I am wondering if he should also be put on a thryoid med or not.
Thanks so much.
Elly

[gpgscott]

Hi Elly, and welcome to you both.

I am not sure about your diagnosis (dx)

You need the TSH, (thyroid stim hormone) values, in order to understand the other thyroid numbers.

Please give us the results of the ACTH.

What you need to understand is that Cushing's is a complicated issue and it is frequently mis-diagnosed.

We need to know the results of the tests done and more about Augies's symptoms.

Please do not begin to administer meds to him without a clear diagnosis.

Scott

[gpgscott]

Elly,

What bulldog type is he?

Scott

[Harley PoMMom]

Hi Elly,

Welcome to you and Augie from me and my boy Harley. As Scott had mentioned Cushings is a hard disease to diagnose, not one test can confirm it 100%. From Augie's bloodwork I see that his LIPA is (1929), could you confirm with your treating Dr. if this stands for lipase.

Any non-adrenal illnesses can skew ACTH tests, so if Augie would have any illnesses such as pancreatitis, his ACTH test would create a false positive. That is why I'm asking you to find out about the LIPA and if it is an abbreviation for lipase because lipase is an enzyme made by the pancreas, and if Augie's lipase is elevated he could have pancreatitis.

I realize this all sounds confusing and maybe alittle scary but we are here and we will help you. I was a total mess when my boy was first dx'd with cushings but these amazing and knowledgeable people here helped me and my boy tremendously.

If I were you and Augie were my pup, I would not start him on any treatment right now until you can get a proper diagnosis. A proper diagnosis is vital to a proper treatment plan. Giving Trilostane to a pup that does not have cushings can be lethal. Please take the time to get Augie properly diagnosed.

Please feel free to ask all the question you want and we will try to answer them the best we can...hang in there, ok.

Hugs.
Lori

[EllyAugie]

Scott, thanks for your response, Augie is an English Bulldog.
Today when we stopped to get his meds we forgot to pick up his test results as I was just coming back from the Dr myself and not feeling well. I do keep copies and will get more info tommorow.

[EllyAugie]

Thanks Lori, Oh goodness, I felt I was doing the right thing following the vets instructions but will get more info about these topics from the CBC u mentioned. I did give him the two pills today as instructed.
He is really not himself.
Thanks for all your help.

[Harley PoMMom]

Do you have prednisone?

[EllyAugie]

No, we dont have prednisone. He has never taken that, the vet gave us trilostane 60 mg, we were instructed to give 2 once daily for two weeks and then come back and do another response test.
Thanks.

[Buffaloe]

Hi Ellie,

You have found a group of serious dog lovers with lots of experience and knowledge about the various types of cushing's disease. Welcome.

We have seen dogs misdiagnosed with cushing's and improperly put on Trilostane or Lysodren with bad consequences. Please watch Augie very closely and if he goes downhill (increased lethargy, vomiting, real loose stools) stop the Trilostane immediately. You should have some Prednisone on hand in case his cortisol goes too low. Many people give Trilostane twice a day. We've never used it but if I ever gave it to Shiloh, I'd definitely give it twice a day rather than once.

How much does Augie weigh and what dose of Trilostane is he on? Most cushing's dogs have an increase in appetite, how about Augie? In addition to the high ALP, was his ALT (another liver enzyme) also elevated? Please post the ACTH results when you can. That is great news that everything looked good on his ultrasound.

I know virtually nothing about thyroid issues so I can't offer anything there. Augie is a young boy and if he does have cushing's, with proper treatment he can live out his normal lifespan with an excellent quality of life. Watch him closely.

Ken

[sunimist]

Hi Elly and Augie...welcome.:) So sorry your Augie boy is not feeling well.

I would be concerned with the high Lipase level. Has he had any vomiting and/or diarrhea or obvious stomach pain?
It would help to know if the Amylase is also elevated. However, if these symptoms do show up, especially violent and
frequent vomiting, I would get him to the doctor immediately.

You said he is not himself, could you elaborate on his demeanor at this time?
Like the others, I would hold off on the Trilostane until other issues are addressed and ruled out.

Please keep us posted on how Augie is doing.

Shelba and Suni

[Harley PoMMom]

Prednisone should always be given to owners when they are starting treatment just incase of an emergency. Sometimes when a pup starts Trilostane he can go thru cortisol withdrawl too fast and then they need the pred. and their electrolytes checked to make them better.

If you notice any of these symptoms; diarrhea, vomiting, lethargy or listlessness, I would take Augie to the ER clinic right away.

How much does Augie weigh?

[StarDeb55]

Ellie, welcome from me & mine, too!! I'm not a trilo parent, so I can only offer limited information. I don't see where you have told us what Augie's current weight is. Could you post that please as the dosage for trilostane is based on weight?

Just to let you know, I'm a medical lab technologist with 29+ years experience, so I can help you understand most of Augie's general lab work. The first thing, as Lori has already indicated, is the lipase is sky high. This is one of 2 enzymes that are measured to see if a pup may have pancreatitis. It would be really helpful if you could post the amylase value, if you have it. If my pup had a lipase value that high, I would be asking serious questions of my vet about pancreatitis. Acute pancreatitis can make a pup very ill, very fast. If it's severe enough, the possibility exists that it can be life-threatening.

Debbie

PS- I see that Lori was posting at the same time, so sorry for any duplication.

[EllyAugie]

Thanks Ken, his Alt was normal at 62 U/L, the scale was 10-100. Does that sound like a good normal? I am not familar at all with these type tests.
He eats 1 cup in the morning and 1 cup in the late afternoon. I do not give him alot of treats in order to keep his weight good. Although, he does give me hints by nudging my leg at the dinner table :) I would suspect he would like to have more than he gets.. Augie weighs 70 lbs.
I will watch him closely with this med.
Even tho his results were normal with his ultrasound, his adrenal glands were at the upper limits of normal in size; each approx 8.3 mm across the caudal pole height. The shape was normal of the gland bilaterally. His total assessment was normal except he had a little benign prostratic hyerplasia which they said was normal for his age. Just in the last two months he has started drinking excessively and urinating excessively.

[Harley PoMMom]

Thanks Lori, Oh goodness, I felt I was doing the right thing following the vets instructions but will get more info about these topics from the CBC u mentioned. I did give him the two pills today as instructed.
He is really not himself.
Thanks for all your help.

Oh Elly,

Trust me when I say I believe we all have walked in your shoes...believing in our vets, and why shouldn't we, they are the ones who hold the degree and have them initials behind their names. :D
You did nothing wrong here, ok and I can see from your post that you love Augie dearly.

Hugs.
Lori

[Harley PoMMom]

Hi Elly,

Besides the excessive drinking and urinating, what other symptoms did/does Augie show that indicate cushings and that lead your vet to test for it?

Hugs.
Lori

[EllyAugie]

Hi Debbie, thanks for the helpful input from all of you. I am looking at his lab results and believe the one you are asking about is abbrev
AMYL- his was 612 the norm being 500-1500
I cant thank you all enuf for your help tonight. I will take heed in your suggestion about getting some pred/ and taking him to the ER if I think things are not right.
I am so appreciative of all this input.
Elly

[EllyAugie]

Lori, I dont know why he thought that, he kept saying he suspected Cushings with him, I dont know why. Funny thing is I did the ultrasound and thought all was well, I was elated actually. We were still concerned about his excessive water drinking and took him in for the cbc and urine analyis. At that point the vet said to remove his water maybe it was a habit..I said I will not remove his water as he is not a hyper dog and has never done this before, there has to be a reason he is drinking so much. At that point after doing my own research I asked for a thryoid test since I found online that a low thyroid could cause them to be thristy. So we did that earlier this week, then he mentioned that an underlying problem could cause the low thyorid so we needed to think about doing the cushings test and the full thryoid panel with the free etc. Which we did, the cushings came back with a strong response and we are still waiting on the better thryoid check from Michigan state.

[Harley PoMMom]

Hi Elly,

Now, please do not think I am bad mouthing your vet, because I'm not, ok...but I believe when Augie's lipase results were so elevated, a cPLI test should of been done instead of an ACTH test. A cPLI test will test the lipase enzyme specific to the pancreas and will be able to tell you really accurately if Augie has pancreatitis.

Cortisol is a stress hormone, one of the "fight or flight" hormones, so if Augie was really really stressed the day he had his ACTH test this could of skewed his results, also like I mentioned any non-adrenal illnesses will cause false positives results on ACTH tests.

I did want to ask you...how are you feeling?

Hugs.
Lori

[EllyAugie]

Lori, thanks for this info, I would have not known to ask about the high result that indicated pancreitis. To be honest no one alerted me anything was wrong with his CBC. I asked for a copy of it this week when I took Augie in for the other tests.
I also meant to answer the question about what I meant about how Augie was feeling. This week he has looked depressed in his eyes and for the last couple of months been sleeping alot. Tonight my husband and i both noticed he was not as sure footed as normal and holding his head down, ( a little disorientated looking) he has gone into the bedroom now and layed down in his bed.
Another reason I was thinking low thryoid was when we did the ultrasound a couple of months ago his hair did not grow back where it was shaved on both sides.
I forgot to mention he takes Tacrolimus drops twice daily in his eyes for dry eye ( been doing this for a couple of years now) This is the only med he has ever taken. I am not sure if that could cause probems with kidneys or not.
I have a touch of viral laryngitis but not nearly as worried about that as I am my Augie :)
Thanks again for everyone's help tonite.

[EllyAugie]

I forgot to answer the questions about anything abnormal with his stomach, he has had no stomach upsets, diarehea or throwing up...just the excessive water drinking and urinating. I was letting him out every hour just about. Honestly, he was drinking so much I was concerned he might bloat but felt he needed to drink for whatever reason. He has been house trained since he was 11 wks old and never had house accidents. Yesterday, he just started urinating in the foyer like he didnt even know what he was doing. I had just taken him out no more than 45 min prior.

[AlisonandMia]

He has been tested for diabetes, hasn't he?

Alison

[Harley PoMMom]

When my boy Harley was first dx'd in Feb. 09, he was 12 y/o, he was also drinking and peeing alot, but he also has a pot-belly, panting, ravenous appetite, some hind-end muscle weakness, hair-loss and always wanting to find a cool spot to lay.

From his first ultrasound it showed that he had prior bouts of pancreatitis :eek: I never knew this, never seen Harley display any symptoms to my knowledge. Harley's vet had a cPLI test done and sure enough is came back elevated. :eek: and he still shows no symptoms of pancreatitis, but he has it.

For the peeing accidents in the house, I use the puppy training pads. I just spread them all around and Harley uses them.

Endocrine disorders such as Cushing's and Hypothyroid can be really tricky to diagnose correctly because their symptoms mimic each other. And Cushings is a very challenging disease to confirm, not one test can confirm Cushings or usually the type of Cushings.

Hang in there Elly, I know this is hard, but we are with you every step of the way.

Hugs.
Lori

[littleone1]

Hi Elly,

I just wanted to welcome you. You have gotten a lot of valuable information here. You will find that the members of this forum are very helpful and caring people.

Corky was diagnosed with Cushings last month. He is now taking 20 mg of Trilo daily. Everyone here has really helped.

I wish you and Augie the best.

[labblab]

Hi Elly,

Welcome from me, too. You've already been given a lot of good information, so I don't have much to add right now. I did want to say, however, that this may not be an "either/or" situation. It is very possible that Augie may be suffering from BOTH Cushing's and pancreatitis. Cushing's dogs are more prone to pancreatitis attacks than are dogs without Cushing's as an underlying illness. Given Augie's symptoms and history, it is understandable why your vet is suspecting Cushing's. But in terms of treatment "urgency" right at the moment, pancreatitis would definitely take precedence over Cushing's. As has already been said, acute pancreatitis can be sudden and life-threatening, whereas Cushing's is a slower, chronic form of illness that creates damage over an extended period of time. If Augie does suffer from Cushing's, gaining control of the disease will lessen his risks of developing pancreatitis in the future. But if he is acutely ill right now with pancreatitis, tending to that will be the more important "first step."

So I will "second" what has already been said. If the trilostane seems to making Augie worse, I would definitely hold off on giving any more for the time being. It sounds as if the elevated lipase may be the first priority right now. Please keep us updated throughout the course of the weekend.

Marianne

[labblab]

Right now, the "bigger picture" is certainly how Augie is feeling. As the others have suggested, if he is doing poorly this weekend, then I would also withhold any more trilostane for now. But I did want to mention a couple of things in response to your question about once vs. twice-daily trilostane dosing. There is still a lot of ongoing research aimed at determining the best dosing strategy for trilostane. Some studies have suggested that there may be benefits from dosing twice a day. However, the two standard protocols with which we are most familiar here still recommend that unless dogs are very tiny, treatment begins with dosing only once a day.

Trilostane remains active in the system for a relatively short amount of time (a matter of hours). For some dogs, symptoms start to rebound later in the afternoon and evening, indicating that the therapeutic effect is wearing off too quickly to maintain consistent symptom relief over a 24-hour time period. In those cases, the recommendation is to divide the daily dose in half, and give once in the morning and once in the evening. At this stage of Augie's treatment, however, I believe I would stick with your vet's recommendation of once-daily dosing (that is, assuming that Augie is not showing any ill effects). After he's been actively treated for a while, you can consider shifting the dosing schedule if his symptoms are not being controlled consistently. But if he does fine being dosed once a day, there is probably no need to alter the schedule. Plus, we have been told by a veterinary endocrinologist here that dogs who are dosed twice daily run a greater risk of having their cortisol levels drop TOO low while being treated with trilostane, and therefore need to be monitored even more closely.

Marianne

[EllyAugie]

Thanks for the supportive welcome everyone and all your help. My husband called and asked them to fax his ACTH stim test over. I am not able to talk with them at this time due to this viral laryingitis I have but as soon as I feel I am not contagious and can talk I will go over myself. His results on the test were Cortisol Pre (2.5) and Cortisol 2 (26.4) tubes were 2 hrs apart. I am concerned about the pancreatis now as you mentioned as the night before he took the meds he did exude a small amount of loose fecal on his bed. Last night I noticed gas and this morning a little of it again on his sheets. He at all his breakfast this morning fine.
He has been tested for diabetes at which time he had the CBC, said no he didnt have that.

Elly

[EllyAugie]

Forgot to mention he has never panted and has had a beautiful coat all his life, other than the hair not growing back after the ultrasound clip. I cant see hind end lameness. He is a large Bulldog so to me he never looked potbellied just big. Also, I never noticed him acting hot. To me it was more the opposite, he would go up to the loft room where it is warmer and also pull his covers around on his bed rather than get to a cool floor.
Ellly

[Harley PoMMom]

Hi Elly,

Strong symptoms are a huge part of making the diagnosis, and a Cushing's savy vet will not initiate any treatment without strong symptoms and a proper diagnosis.

Normal ranges for a healthy dog is: Pre: 2-6 ug/dl and Post: 6-18 ug/dl.
So Augie's Pre: of 2.5 ug/dl?? is normal, and his post of 26 ug/dl?? is high, but if Augie does indeed have pancreatitis, and like my Harley, he just does not show any symptoms of it, this non-adrenal illness could of make this post number high.

If I were you and Augie were my pup, and seeing that he still is not feeling that well, I would stop the Trilostane, at least until you can see your vet and really have a heart to heart talk with your vet about Augie's situation, especially the pancreatitis and him not feeling well, very loose stool like that is not a good sign, that means something is really bothering his system.

Hugs.
Lori

[Squirt's Mom]

Hi Elly,

A belated welcome to you and Augie! :)

I have to chime in with Lori here and say please stop the Trilo! First, not enough testing has been done to confirm Cushing's much less diagnose it; second very few signs are exhibited, and other conditions that will have the same signs have not be conclusively ruled out; third, but most importantly, Augie has gotten worse since starting treatment. Please do not give any more Trilo....(little beggin' person icon).

Cushing's is slow progressing condition so even if Augie does have Cushing's, you have plenty of time to make sure of the diagnosis, the type, and the best approach - which may not be Trilo. So please don't rush into treatment - that could be as bad as not treating at all, and much more quickly fatal. Have that heart-to-heart with your vet about Augie and let him know that you will be involved with your babies care all the way. Once a good vet knows that you are trying to be pro-active, the teamwork can begin in earnest - which is what a cush pup needs.

So you just hang in there! Read all you can, ask lots of questions and we will do our best to help you understand. The collective knowledge here is astounding! What we don't know, we will try to research and share what we find. We aren't docs but we are moms and dads who love our babies to distraction and who live with the various forms of Cushing's on a daily basis. And we are here for you and Augie - you do not have to take the journey alone. We will be beside you every step of the way...even if it is to say "Congrats! Augie is Cushing's free!" If you need a shoulder to lean on, an ear to listen, a hand to hold we are here for that as well.

Keep your chin up!
Hugs,
Leslie and the girls

[StarDeb55]

Elly, there might be a chance that Augie has Diabetes Insipidus (DI), this is not regular insulin dependent diabetes. I'll post a link that has some further information for you, but Alison & I think it might be worth mentioning to the vet. Alison would have probably posted herself, but she is having trouble with one of her arms right now & her typing is rather limited.

http://www.caninediabetes.org/pdorg/diabetes_insipidus.htm

Debbie

[mypuppy]

Hi Elly,
My pup was diagnosed with Cushings close to 4 weeks ago. All I have been breathing these last 4 weeks is this disease. As you, my dog is simply imbedded in my mind, heart and soul, and when I learned she had this, I thought it was the end for her. Up until I went online, researched, researched and ended up on this forum. And because of the people behind these posts, I have been able to get through this a hell of a lot better than I was 4 weeks ago. Stay connected to this forum as much as possible because you will learn a great deal from everyone, regarding tests to perform, test results and treatments. At the same time, along the way, you will probably make some pretty strong connections with a select few, and trust me when I say, it does ease this horrible ride you are on at the present moment. I am so sorry to hear about your pup. My Princess will turn 7 on 11/21, and I can't help at times feel so down that she is sick. We have all watched our pups transition from healthy, energetic, loving pups to low key, sad looking with all these symptoms that they probably can't even understand themselves, and it is dreadful to say the least. I feel your pain Elly. Just know you are not alone, and I know that does not commensate for your pain, but if in fact you are dealing with Cushings, you will learn it is treatable and not the end. I have had trilostane for almost a week now, and decided to postpone treatment until one final test, the LDDS, which was recently done on Thursday. I am awaiting results of that, hopefully Monday so that I can move on with treatment. As Augie, my specialist also recommended 2 pills (60mg) once daily, but I will discuss with her again if that is a good starting point as my friend here Terri suggusted to do. Do not fret Elly, and again whatever you do, stay on and get as educated as possible. By the way, what gp do you go to, because funny, when I took Princess to her gp for her initial testing, and came back negative for DM and DI, he basically left it as a "psychogenic polydipsia"....basically, he said my dog was drinking excessively out of habit also. Interesting your vet said the same. When he told me that it was not good enough for me and that is why I referred myself to the IMS, and she was the one who caught on the Cushings symptoms and recommended the ACTH stim. Thank God I pursued it. Otherwise I'm not sure where my precious Princess would be further down the road had I left it at that. Always go with your gutt feeling and follow through with it. Again, I am sorry. It is a difficult card to have been dealt for our precious pups, but at least we are here for them. Take care of you, Augie, and talk soon....Best regards, Jeanette and Princess


Forgot to mention he has never panted and has had a beautiful coat all his life, other than the hair not growing back after the ultrasound clip. I cant see hind end lameness. He is a large Bulldog so to me he never looked potbellied just big. Also, I never noticed him acting hot. To me it was more the opposite, he would go up to the loft room where it is warmer and also pull his covers around on his bed rather than get to a cool floor.
Ellly

[EllyAugie]

Hello everyone, Yesterday I wrote down the things my husband needed to discuss with our vet ( I have laringytis at this time) and they had a conference call. My husband discussed the high lipa with him, vet felt the high Lipa went hand in hand with the cushings. We have decided to wait until the full thryoid panel comes back this week before we proceed further. Our vet is pretty convinced he has cushings being the response was so strong with the ACTH test. Discussed his nice coat and the fact he was not panting, he seemed to feel we were just lucky in that area. He did state he may need to be on thryoid along with the meds, we will know more this week. Another thing I havent mentioned is in the last couple of weeks Augie's left eye is clouding over more so I am concerned over that as well. The dry eye meds dont seem to be helping the one eye, I never miss dosing him morning and night.
I want to thank all of you for you help and support and say thanks to you Jeanette, Leslie, Debbie for the link ( I will mention DI to him as well)
You have all given me alot of info. For the last couple of years he has had something going on in his sinuses or head. It's hard to explain but it would be as if water was pouring into his sinuses at night along with alot of gulping motions or swallowing like a fish's mouth movement.
It is hard knowing that he may be suffering from this disease. I love him so much and do not want him uncomfortable. Not knowing how long or what quality of life is ahead for him is unsettling to say the least. I feel fortunate to have him in my life as he is one of those very special dogs that dont come along every day. A very gentle, stable, intelligent boy who has been a true and loyal companion to his momma.
Thanks again.
Elly

[labblab]

Dear Elly,

Thank you so much for your update! I do think it is a very wise decision to hold off on Augie's trilostane until you've had the chance to gain more information. And the results of the thyroid panel will definitely be of interest to us all. It seems possible that Augie's symptom profile could be the combination of more than one condition or illness -- and abnormal thyroid function could certainly be one of them. Please let us know what you find out. And here's hoping that YOU will soon be feeling better, as well!

Marianne

[EllyAugie]

Hello everyone. I have Augie's thryoid results and are as follows.

Total Thyroxine (TT4) 16 Ref range Units {15-67} nmol/L
Total Triiodothyronine (TT3) 0.8 L Ref range Units {1.0-2.5} nmol/L
Free Thyroxine (FT4) 6 L Ref range Units {8-26}Units pmol/L
Free Triiodothyronine (FT3) 3.9 L {4.5-12.0} Units pmol/L
T4 Autoantibody 10 Ref Range {0-20} Units%
T3 Autoantibody 7 Ref Range {0-10} Units%
Thyroid Stimulating Hormone 15 Ref range {0-37} Units mU/L
Thyroglobulin Autoantibody* 5 Ref range {0-35} Units%

Endocrinology Interpretatin-Thyroid hormone concentrations are generally low but there is not the elevation of thyroid stimulating hormone that occurs with most cases of primary hypothyroidism. The negative autoantibody results decrease the likelihood of lymphoctic thryroiditis. These results present a diagnostic dilema. The pattern of results in this profile may reflect a metabolic response to other non-thyroidal illness and/or medication and the dog is not hypothyroid. However, hypothyrodism remains a possiblilty, as a small percentage of hypothyroid dogs do not have an elevation of thyroid stimulating hormone. A decision to initiate thryoid supplementation depends on the strength of clinical signs of hypothyrodism and the confidence that there is no underlying illness.

[EllyAugie]

Thanks for everyone's help thus far but from this report and the ACTH stim test... I feel it most likely is Cushings.
If you all feel differently please let me know.
Thanks again for all of your warm welcomes and input.
Elly and Augie.

[labblab]

Hi Elly,

Thanks so much for the report. Others here may have different opinions, but I tend to agree with you -- I think the thyroid results tend to point back towards Cushing's as the underlying condition that is fostering these other abnormalities. I will try to stop back later to write some more. But thanks again for giving us these results.

Marianne

[EllyAugie]

Thank you Marianne, everyone here has already been so supportive. I cant thank you all enough. I am emotional, not sleeping already and worrying that I will make all the correct decisions for him.
Hugs to everyone.
Elly

[labblab]

OK, I'm back with just a couple more thoughts to add. I will say upfront that I am not very knowledgeable about pancreatitis, and so I do not know the extent to which pancreatitis could be the source of other problems from which Augie is suffering. I will defer to others in that regard. But I was especially curious to see how his thyroid panel came out due to your comment that his hair has been very slow to regrow subsequent to his abdominal ultrasound. There can be other causes of coat issues, but slow hair regrowth is a common symptom of both Cushing's and primary hypothyroidism. If Augie's panel had indicated primary hypothyroidism, I might have thought "AHA!" There's part of the real problem (especially since he seemed to be seeking out warm spots rather than cold ones). But since the panel does not support primary hypothyroidism, I do think it makes Cushing's more likely. Bald spots were the very first symptom that I saw in my Cushpup, so I am especially sensitive to that. He had always had a beautiful coat PRIOR to Cushing's. And that was why I was so concerned when I first noticed the thinning.

I would still feel more comfortable with the Cushing's diagnosis had the ultrasound showed more obvious signs of the disease: abnormally enlarged adrenal glands rather than results at the high end of normal. But you can only go with the data at hand. And I don't really know what additional Cushing's testing I would personally be seeking at this point. In questionable cases, we often suggest performing both a LDDS and ACTH blood test. But the LDDS is actually more likely to be falsely skewed by a nonadrenal illness than is the ACTH. So I don't know that a positive LDDS would give me a lot more comfort.

If it were me, I think these are the three additional "steps" that I would still consider at this point, at least in discussions with the vet. The first two are "rule-outs": making sure that DI and pancreatitis are not at play. I know that Cushing's makes dogs more vulnerable to pancreatitis, but I do not know as much about the problems that pancreatitis itself can create. And then, if you do proceed with the trilostane dosing, I would ask my vet about starting back at just one 60 mg. capsule to begin with, rather than two. You told us that Augie really did not seem like himself when you started off with the 120 mg. dosing. Especially in a situation where there are still a few "question marks" about the diagnosis, it might be better to start off at a lower dose. You can always increase it, but it may be safer for him to begin lower. But once again, this would be a discussion for you to have with your vet. And your vet may recommend otherwise.

Elly, hang in there! I know how exhausting it is to be so worried about your pup. But each test has filled in another piece of the puzzle. And I hope you are nearing the end of the diagnostic road.

Marianne

[EllyAugie]

Thank you Marianne.
Warmest wishes to all.
Elly

[Harley PoMMom]

Hi Elly,

I was just rereading your thread and I am now trying to get my thoughts typed here. :eek::) Concerning the pancreatitis, if it were me, I would want a cPLI test run on Augie just to see how elevated his lipase is.

According to the Idexx Laboratories:
Increased glucocorticoid release is an important part of the response to stress. Severe non-adrenal disease can be associated with chronic stress and abnormal responsiveness of the hypothalamic-pituitary-adrenal axis (HPA). An important part of the clinical evaluation of potential cases of Cushing's syndrome is the exclusion of other diseases before testing, which may otherwise lead to abnormal test results and erroneous diagnosis of Cushing's disease.

Also according to their website concerning the ACTH test:

Specificity is good in normal dogs but poor (63%) in dogs with severe non-adrenal disease.

http://www.idexx.co.uk/animalhealth/laboratory/smallanimalprotocols/hpaaeval.jsp#c1

I mentioned before that my boy Harley has pancreatitis, and he also has sick euthyroid syndrome. Harley is diagnosed with PDH and Atypical Cushings but because his cortisol is within the normal ranges he is only being treated for his Atypical Cushings as of right now.

I've been wracking my brain trying to remember when or if I missed Harley's pancreatitis symptoms. I know on the Holiday's Harley got extra table food...ohhh could he play us around the dining room table. I always cook for the Holiday's so there were usually 10-15 people here, and you know, we all would be stuffing our faces/talking and slipping some to Harley. I do remember sometimes the next day I would wake up to a yucky surprise...hmmm. That will not happen anymore.

Now as far as the ACTH stim and the pacreatitis distorting them, I believe it's how severe the pancreatitis is. And I truly believe you won't know this unless you have a cPLI test done on Augie. JMO, of course. Harley's cPLI results were 528 (reference range ~ 0-200) and even though this is elevated Harley doesn't have diarrhea or does he vomit because of it. But like the saying goes...all dogs are different.

I wish you and Augie the best of luck and look forward to your updates.

Hugs.
Lori

[EllyAugie]

Hi Lori, thanks for your reply as well.
There is so much to say and I am not the best typist. I have a daughter of Augie here. Last April I did hormone tests, skin biopsy, ultrasound etc on her due to flank alopecia. Full testing all sent to Un of Tenn. She was 3 1/2 at the time and test came back with high estradiol 93.2 normal range being 31.5-65.5- It was suspected she had ovarian cysts from the hormone test so we did full ultrasound. Nothing there! The 2nd notations was adrenals could be another source but they noted most likely not since she was a young dog. Un of Tenn also sent a sheet on Atypical but at the time I didnt understand that and put it into a file and went by what my vet instructed which was the full ultrasound for cysts. We also put her on .5 of thryoid even tho her thryoid level was 2.2. All of her hair grew back and she has been doing great..I never suspected cushings and was not advised to test for it. But now everything is becoming clear because of Augie. She exhibits no signs such as excessive drininking or urinating but my guess is now in a couple of years she will be doing it too.
I am worried that what if Augie has Atypical not the regular cushings and I read that Trilostane might not be the best choice for Atypical. I asked my vet about this and he said he was not as familar with Atypical. I am sorry for my poor writing trying to explain all of this, I have been reading so much my eyes are just about crossed.
I am mentally tired from trying to take in so much not to mention emotionally down.
On a good note, Augie is taking the meds and I have already noticed an improvement in his drinking and urinating. He is acting perkier and on patrol again from the deck :) His favorite thing to do is stand on the deck and make sure no imposters have entered the yard such as squirrel.
I am pretty depressed since the lightbulb has come on about his daughter most likely too.
Thanks everybody and best wishes to your babies too.
I tried to put a link up so you all could see Augie, did u get it? He's such a beautiful boy. :)
Elly

[labblab]

Hi Elly,

I just have a minute or two to write, but I'm so glad to hear that Augie is doing better. As far as the regular vs. atypical Cushing's issue, Augie DOES have elevated cortisol per the ACTH test. He may also have some elevated intermediate hormones, as well. But due to the elevated cortisol, he does "qualify" as a regular Cushpup. You are right that there is debate among the professionals as to whether or not trilostane is the best treatment choice in the presence of highly elevated intermediates. But there is not universal agreement as to the best route to go in this regard. Since Augie has started the trilostane and is responding well, I don't think there is any reason to switch gears at this point. If later down the road, Cushing's symptoms recur after his cortisol level has been stabilized, I would want to revisit the question as to whether or not other intermediate hormones are also an issue for him (and alternative treatment might be better). But at this point, if the wheel isn't broken, I wouldn't try to change it. Just my two cents worth!

Marianne

[EllyAugie]

Thank you Marianne and Lori, I guess u can see now why I am leaning toward cushings. The picture or full scope of things with his daughter's results last spring causes me to lean toward cushings.
We will continue the meds and monitor etc to see how things go. Also, I feel maybe a ACTH is needed for his daughter "Folle", I asked the vet why they didnt mention that last spring, his reply was because of her age. As you all know theses tests are not cheap and neither are the meds but my husband and I will take care of our babies. I have five Bulldogs, two females (Folle and her spayed mother and Augie and two more males) but only Folle is related to Augie. I am advocate of health testing but cushings is new to me, one thing for sure is with life there are millions of possiblies.
Every one of you have been amazinly helpful on this forum.
Thank you all.
Elly

[Harley PoMMom]

Hi Elly,

If you performed the test on Folle from the Un. of Tenn called
"Adrenal Panel for Dogs and Cats (ACTH Stim) -Test for congenital adrenohyperplasia-like syndrome (dogs, cats), or Alopecia-X, Atypical Cushings Syndrome" As you can see it comes with an ACTH stim test.

http://www.vet.utk.edu/diagnostic/endocrinology/pdf/endo_tests_info.pdf?r2

Harley's estradiol hormone is very elevated too and all his other intermediate's are elevated at just the baseline.

I too am glad to hear Augie is feeling much better...please keep us posted. :)

Love and hugs.
Lori

PS. I think your doing a fine job as a typist. ;):D

[EllyAugie]

Lori, thanks for your reply. From the copies of what I have from my vet it appears he didnt order a full adrenal panel on Folle last spring. The ACTH test was not given....I believe it was a hormone assay from Un of Tenn only, skin punch from Antech and thryoid panel from Mich State ( looking at the skin punch now --it says endocrinopathies such as hperadrenocorticism and hyperestrogenism can cause similar histological findings. Findings were follicular dystrophy with primary and secondary folliular hyperkeratosis.)
Another question if u all don't mind? Do u think when I take Augie in for his ACTH follow up test that I should ask for a hormone assay on him? Or would the trilostane interfere with that?
Thanks all.
Elly

[Squirt's Mom]

Hi Elly,

The Trilo may very well skew the results of a hormone assay since it always elevates one of more of the intermediate hormones. Like Marianne said, as long as Augie is doing well on the Trilo, I wouldn't worry about further testing as far as diagnostics go...tho you will need monitoring testing from now on. If, and that is IF, Augie's signs start coming back even while on the Trilo, then you will want to think about testing for those other hormones which will require a time off the Trilo to get an accurate reading on the levels. So for now, keep on the path ya'll are on and don't worry about those other hormones. ;)

Hugs,
Leslie and the girls

[EllyAugie]

Thank you Leslie, we will continue on with this regimen.
Hugs to you and the girls too.
Elly and Augie

[gpgscott]

it was a hormone assay from Un of Tenn only,


This bit is confusing as a hormone assay from UTK would be the full adrenal panel and would require a stim in most cases.

Scott

[StarDeb55]

Scott, Elly will have to clarify, but I think she is referring to UTK doing individual reproductive hormone assays such as estradiol, & progesterone.

Debbie

[gpgscott]

Same thing Deb, as far as I know the only one which 'requires a stim' is cortiso.

Scott

[StarDeb55]

Scott, I just re-read UTK's lab instructions. They run a reproductive hormone panel consisting of estradiol, testosterone, & progesterone. This is actually not a typical "stim" as we know it because beta HCG is the stimulating agent. You can get baselines on all 3, but only post results on progesterone, & testosterone.


Debbie

[EllyAugie]

Debbie is correct, Our vet was doing a reproductive assay (hormone), cushings was not a thought at that time.
Elly

[Harley PoMMom]

Hi Elly,

How is Augie doing?

[EllyAugie]

Hi All, Augie is doing pretty well so far.
I need to ask you the exact protocol for the follow up test for monitoring the trilostande and how it is done.
If I were to give the trilostane at 7:30 am with food.
Appt time 1:20 for the pre blood drawn then the injection bringing him back at 3:20 pm for the post....is this going to work?
We did that yesterday and I am wondering if it was done correct for the most accurate test results or if it should have been done differenty.
Thanks.
Also he had really improved on his drinking and urinating however after the test yesterday ( I am assuming it was the injection for the post draw) he drank and drank last night. got up at 3:30 am to let him out to potty even tho he had pottied several times before bed.
Thanks for your help.
Elly

[EllyAugie]

Lori, forgot to say thanks for asking how Augie is doing in that last post I made. On the 2nd trip to the vet yesterday for the post draw Augie said no to getting out of the vehicle and revisiting the vet lol
Vet had to come out and get the 2nd draw. Thank goodness otherwise he has been a good patient, doesnt try to bite the vet or anything like that. I felt terrible for him, now he relates a trip or ride to something bad. The vet is relieved he is a good dog, he keeps repeating that to the vet tech, his size alone is imposing to those who are not familar with him.
Augie is the sweetest dog. It is not easy getting a draw from him, veins are very deep. It took them several trys to know just how to get blood from him in the beginning. It has been this way with all vets not just him in the past. Even knowing this it still takes them a minute or so to find it ...so no wonder Augie dreads this.
Elly

[Franklin'sMum]

Hi Elly and Augie,

The acth stim test is supposed to be done 4-6 hours after administering the dose. So if you gave the trilo at 7.30am and the test was done at 1.20pm, you're in the 6 hour zone.
The initial thing me gp vet does is draw the blood for the baseline, then gives the synacthen and takes another sample after 1 hour. So you may be squeezing things a little bit (please keep in mind that I'm only new at this myself.) I'm sure others will chime in soon to let the both of us know for sure.

There's a treatment and monitoring flowchart on the "helpful resources for owners of cushings dogs" page. I don't know how to insert a link, forgive me:o

Franklin usually goes for a stim test 4 hours after the med, so it's all happening within the 6 hours. Hope this helps some,

Jane and Franklin xx
________
Healthy Relationship Advice Dicussion (http://www.love-help.org/healthy-relationship-advice/)

[labblab]

Hi Elly,

Jane is correct in saying that Dechra's preferred "window" for ACTH testing to monitor trilostane treatment is 4-6 hours after taking the medication. My vet always interpreted that as completing the test within that time frame -- not beginning it at the 6 hour mark. Here is the link that Jane is referencing :):

http://www.dechra-us.com/File/vetoryl_Treatment_and_Monitoring_Flowchart.pdf

You will still be learning important information from the test as it was performed. But you and your vet will need to bear in mind that Augie's cortisol level would undoubtedly have been lower had the test been performed a couple of hours earlier. So when you consult the monitoring flowchart for dosing recommendations, you'll need to base any changes on that liklihood -- that for comparative purposes, his cortisol would have been lower. And in the future, you'll probably want to move the timing of his test up.

Marianne

[EllyAugie]

Thanks Jane and Marianne, that info was very helpful.
Elly

[EllyAugie]

Hi All, GOOD NEWS- wanting to share
Augie's test results are here.
Cortisol pre 2.2
Cortisol post 4.7

So, we are staying on the same dose of meds till next test- 4-6 wks, most likely 4 wks.


Elly

[labblab]

YAY, Elly, that's terrific news! :) :) :)

Marianne

[lulusmom]

Hi Elly,

Those are terrific numbers so congratulations!!! Is this the first acth stim test at 14 days? If so, please do keep an eye on Augie as cortisol can continue to drop in the first 30 days. As Marianne mentioned previously, if testing was done later than recommended, then it's possible that Augie's cortisol is lower than the numbers you posted. This makes it even more important that you watch for any signs of cortisol dropping too low in the next couple of weeks. Also, if this is the first stim test since starting treatment, you really should have another one done at the 30 days mark.

Good job, mom, and keep up the good work.

Glynda

[EllyAugie]

Thanks Marianne, I'm so happy, vet called and faxed the results to me.
I hope i can learn my way around this site soon, would like to give support to all of you as well. I am having a little difficulty with it.
I don't know much yet about this disease or what to expect later on. I'm thinking maybe I should just be happy for today with Augie's results being good and not worry so much about what is to come. I do wonder if the meds get harder on them as time passes or what other things happen as the disease progresses. It is comforting to know you all are here for me and others when that may happen. You have all been wonderful. I guess for now, just wanting to stay positive. However, knowing this is a terminal illness it's hard not to worry.

Thanks...hugs to you all and your precious ones.
Elly

[EllyAugie]

Glynda, thank you so much for that advice, I will keep an eye on him. Should I be looking for things such as not eating or getting weak?
This was his two week marker test. Right after his first dose my husband and I vascillated each day about stopping the meds for one thing or another but my gut feeling told me to keep on. Each time I gave it to him I worried that what if I was doing the wrong thing, it wasnt easy.
Elly

[lulusmom]

Hi Again,

I understand your fears of the disease and the treatment. I do remember when my first cushdog was diagnosed at 3 years old. She is tiny, 4.6lbs, and I was horrified, scared to death and worried about her night and day. Those fears abated slowly as I gained a much better understanding of everything. Lulu just turned 8 years old and aside from never getting her coat back, she is doing fabulous. It should also bring you comfort to know that one of our member's dog was one of the dogs in the Vetorly clinical trials. Her dog passed away after 7 or 8 years of successful Vetoryl treatment. My memory is absolutely the pits so I don't remember their names but I believe she passed away from cause(s) other than cushing's. I am hoping that members with a brain that works will come by and give you more information on our famous alumni.

Glynda

P.S. Yes, you want to keep your eyes open and stop dosing if Augie shows any signs of low cortisol such as not eating or eating too little, diarrhea, vomiting, extreme weakness and lethargy. It's normal to be a total wreck during the first month or two of dosing so when you feel like you are going to lose it, get on this forum and talk to us.

[EllyAugie]

Glynda, I had read somewhere to keep a check on these things ( Bun, creatinine, sodium, and potassium levels) and did copy it and take it with me yesterday. But I didnt hear anything back about that. Not sure now he tested for those things as I asked....
Elly

[EllyAugie]

Glynda, this is wonderful information about Lulu. I had no idea they could live so long with treatment.
This post has made my day.
Thanks a million, I hope everyone has a terrific evening..going to tell my husband this news.
Elly and Augie :)

[lulusmom]

Hi again, Elly.

With proper treatment a controlled cushdog can live out their normal lifespan and have a great quality of life while doing it. The stuff you hear about a dog living about two years after diagnosis is a bunch of hooey. I think that two years is just an average based on the fact that most dogs being diagnosed are way up there in years anyway. You are off to a wonderful start in getting Augie on the right track and I think you can look forward to having your boy around for a long, long time.

I did forget to mention to you that you need to make sure that your vet checks Augie's electrolytes every time you have a stim test. Trilostane can have an effect on the aldosterone which is the adrenal hormone that regulates the salt (potassium & sodium) and water. If aldosterone drops too low, electrolytes are thrown out of wack and it can be life threatening. It's a simple, inexpensive test and it's quite possible that your vet may have done this test but didn't mention it because everything was normal. You can always give him/her a call and ask.

Glynda

[StarDeb55]

Elly, even though I don't use Trilo, I did want to let you know that my 1st cushpup, Barkley, was successfully treated with lysodren for nearly 8 years, crossing the bridge at 15 from cause unrelated to his Cushing's. Barkley has a truly wonderful quality of life.

debbie

[MiniSchnauzerMom]

Elly,

I haven't previously posted to your thread but a definite "Congratulations" is in order for Augie's terrific first ACTH test results!


Augie said no to getting out of the vehicle and revisiting the vet lol. Vet had to come out and get the 2nd draw. I felt terrible for him, now he relates a trip or ride to something bad.

I certainly can sympathize with you about Augie the car and the vet. My Munchie would be agreeing with Augie. Besides the fact that he does not want to get out of the car....Munchie no longer wants to get into the car! :(

I've looked at Augie's picture and he surely is one very handsome boy!

Louise

[Franklin'sMum]

Hi All, GOOD NEWS- wanting to share
Augie's test results are here.
Cortisol pre 2.2
Cortisol post 4.7
Elly

Elly,

Yippee!!!:):):)
Jane and Franklin xx:)
________
Digital vaporizers (http://digitalvaporizers.info)

[Roxee's Dad]

Hi All, GOOD NEWS- wanting to share
Augie's test results are here.
Cortisol pre 2.2
Cortisol post 4.7

So, we are staying on the same dose of meds till next test- 4-6 wks, most likely 4 wks.

Elly

Great news, congratulations on a job very well done. :):):)

[Squirt's Mom]

Hi Elly,

GREAT NUMBERS!!!! :D How is Augie acting these days?

Bless his heart! All of mine give me some guff about getting out of the car and going in the door at the vets, but they eventually cooperate. ;) Which may mean that I carry them in then sit in the waiting room as they stare at the door and whine! :p They just don't understand that we take them there to help them.

Keep up the good work!
Hugs,
Leslie and the girls

[littleone1]

Hi Elly,

I'm glad that Augie's test results were good. That's really great.

[EllyAugie]

Hi John, Leslie, Terri, Debbie, Louise and Jane, what a surprise today to have such a terrific cheering crowd for Augie. Thanks to all!!
Debbie, that's wonderul knowing Barkley had such a long life, thanks for letting me know this. I do have my hopes up now for Augie and knowing this really helps my spirit.
Leslie, Augie is acting like he feels pretty good, he's still eating well, his drinking and urinating is more normal now. I can't say that I think he feels totally fabulous but I know he has to feel alot better not having to drink and potty so much... earlier he was out on the deck with me... hung his head and started mouthing ( trys to talk) he's always talked to me but this morning I think he was trying to convey he wasnt feeling the best and was ready to go back in and lay down. I am watching his energy level closely for any signs that things aren't right, usually Bulldogs are pretty stoic so I am keeping my eyes wide open for anything worse. Last week he charged off the deck after a squirrel but hasnt done that since. He does seem to be sleeping a bit more but manages to wake up and go under the dining table as soon as my husband and I sit down for dinner.
Thanks for all of your encouraging words.
Louise, Augie says thanks for your nice words about him, not everyone agrees Bulldogs are handsome lol :)
You all are amazing!
Hugs,
Elly and Augie

[gpgscott]

Elly,

Sorry to be late to the cheering party.

And I also think bulldogs are handsome.

Scott

[lulusmom]

Of course Bulldogs are handsome and some even famous. Meeting Augie prompted me to kick back and tune into one of my favorite videos.

Movie Intro
http://www.youtube.com/watch?v=xfajrH2Ymhc

Box Office Hit
http://www.youtube.com/watch?v=XRSTWw0Py_A&feature=PlayList&p=489A7AEE1AE26965&index=2

[Roxee's Dad]

Hi Elly,


not everyone agrees Bulldogs are handsome lol

I do have to say that not all Bulldogs are handsome. I groom one Bulldog and her name is Winifred (Winnie for short) and she is beautiful.:D (not handsome) She is the only Bulldog I will do because she loves being groomed (weight limits). Her mama has changed from once a month to once a week because she gets depressed if I don't show up on Friday morning. She is the only dog that will roll over on her back in the tub so I can scrub her belly. :D She is absoultely the highlight of my week. :D

When my van shows up, mama opens the door and Winnie runs for the van door, and it better be open or she will scratch at it, jumps in and tries to get into the tub.

But of course I think all "male" Bulldogs are handsome. :D:D:D

[EllyAugie]

Hi all, my husband took Augie back over for an electrolyte test today. Vet called and said all was fine, we asked them to fax results over.
Test was done in house with a catalyst dx
I have no idea what these things are.
reads like this Na 149 mmol/L 144-160
K 5.0 mmol/L 3.5-5.8
Na/K 30
CI 108 mmol/L 109-122 LOW

Hope everyone has a nice Thanksgiving.

Elly and Augie

[StarDeb55]

Elly, everything is pretty much smack in the middle of normal range which is good. To give you a translation of what the abbreviations mean:

K= potassium
Na= sodium
Na/K= sodium/potassium ratio, this value is very important when a vet is looking at the possibility of Addison's. I don't remember what normal range is, right now.
Cl= chloride. It's a tick low, but not enough to break a sweat about.

Debbie

[MiniSchnauzerMom]

Hope everyone has a nice Thanksgiving.


Hope you and all the family have a nice Thanksgiving too! :D

Louise

[EllyAugie]

Thanks Debbie, I was hoping someone would let me know how that looked and what it mean't exactly. :)
Good news is I have finally learned how to make cornbread dressing after all these years lol did a trial run a month ago and it turned out. haha
Hope your Thanksgiving is blessed with lots of love.
Talk to you all soon.
Elly and Augie

[Buffaloe]

Elly,

I've always thought bulldogs were very cool and Shiloh's really intrigued by them. They love them in Georgia! ;);) All the best to you and Augie going forward.

Ken

[labblab]

Elly,

I've always thought bulldogs were very cool and Shiloh's really intrigued by them. They love them in Georgia! ;);)

Ken
Ken, thanks for pointing this important fact out: GO DAWGS!!!!! :p (Even though you and I both know that the Buffaloes truly rule...;))

Marianne

[EllyAugie]

Ken, thanks for your kind thoughts for Augie.

Does anyone know of a cheaper place to purchase the vetoryl (trilostane) meds? I've looked around and so far can not do better than what we are paying, our vet also gave us a prescript just in case I could find it priced better. Augie takes (2) 60 mg daily so it is around $160 a month for just the meds alone.

Thanks, so far Augie is doing well with the meds.

Elly

[Harley PoMMom]

Hi Elly,

Here are some posts from me and 2 other members:


Hi Glynda and Jeff –

Thanks for the information. We really appreciate your responses! Even though we have been reading and researching about Cushing’s, the more we learn we find the more we need to learn! While I had read that different delivery systems for the cortisone for the ACTH exist, I had no idea the gel was less effective! I have been reading so much that maybe I read it and it just failed to sink in, but it did this time…so, thank you, Glynda, we will be sure to ask the vet when we go to see her before we adopt Bree exactly what cortisone delivery method her terrific price includes.

If we adopt Bree, we will keep Diamondback Drugs in mind. I will also contact them to inquire about medication for our epileptic dachshund, Tazmyn. She takes 2 different medications, one of which needs to be compounded. We recently had her compounded drug filled at a local pharmacy and it was $75.00 for 90 days and cherry flavored! (They wanted $90.00, but lowered it to $75.00.) In searching online for a cheaper solution, I stumbled across Center Pet Pharmacy, http://www.centerpetpharmacy.com, and when I called I actually spoke with the owner, Kenny Kramm. I was so impressed that the next time I need to order Tazmyn’s medication I will most likely use them. He talked to me for about an hour about the pitfalls of ordering online. He gave me a couple of websites to check out scam fraud, http://www.nabp.net (The National Association of Boards of Pharmacy) and http://www.nextag.com. He also said to check him out, so I did. I read “The Heart Of A Company” (just Google his name and it is the second link) and cried through a good portion of his family’s story. In a nutshell, he invented palatable flavors for children’s medicine when he had a daughter born with medical problems who refused to swallow her medicine. He then expanded the company into pet formulas. Finally, he sold the company, FlavoRx, and started Center Pet Pharmacy. It will be between 2-3 months before I need to order her medication and if I do order from Center Pet Pharmacy will post my experience on the forum. I almost skipped calling this pharmacy because there are no prices listed on his website. He does this purposefully because he wants his customers to call so he can get to know them and their pets. He says this is the closest he can come in this day and age to the face-to-face service he loves from years gone by.

Glynda, we commend you for taking care of 2 Cushpups! It is obvious why God sent JoJo to you. We are thankful he found such a caring, loving, and knowledgeable home!

Thank you again, Glynda and Jeff, for sharing your experience and advice with us. Roger and I are so thankful we found this forum and are very appreciative of the support, advice, and warm welcome we are receiving from everyone.

Myrna


Hi Barb,

Another search engine for finding meds at their lowest cost that is helpful is called NexTag, I already typed in Trilostane and some Pharmacies/compounders came up.

http://www.nextag.com/trilostane/stores-html


Hope this helps.

Love and hugs.
Lori


Hi...

Just wanted to share my experience with Center Pet Pharmacy...they are the best!!! When Trilo was approved here in the US, I looked all around for the cheapest price, and they were definitely the cheapest. They were also super nice, and Fed-Exed me the pills overnight. I would recommend them to anyone.

Gina

Hope this helps. How is Augie doing?

Love and hugs.
Lori

[EllyAugie]

Thank you so much Lori, I will check out these suggested places.
Augie is doing very well, I am thankful and hope he continues like this.
I did get a quote from diamondback but they said their trilostane was 61 mg, in this case I would have to get my vet to rewrite the script.
theirs was about half the price I am paying now from their quote. Not sure if I can show u all the quote here.
Thanks again Lori, going now to check out centerpetpharm :)
Elly

[StarDeb55]

Elly, diamondback will be compounded trilostane. They can't compound any size that has been release for sale by the trilostane's manufacturer in the US, so that is why it has to be 61mg. rather than the 60 mg. size.

I do need to point out to you that the FDA has recently issued a letter to compounding pharmacies that compounded trilo must be made from the brand name vetoryl without exception. I believe this is still open for a lot of debate & interpretation, so I will point you to the following thread. Please see the 2nd page as Marianne (lablab) gives a very good explanation/discussion about this issue.

http://www.k9cushings.com/forum/showthread.php?t=1354

Debbie

[EllyAugie]

Thank you Debbie for those links and info.
Elly

[EllyAugie]

Hello everyone, I noticed Augie a little more tired today, his head and jaw started shaking tonight. The tremor only lasted about 15 seconds. I called the vet, he said unless he started having trouble breathing he should be fine until tommorow. I plan to take him in the morning to check his electrolytes. I gave him a tsp of ice cream thinking that might help with glucose??? What are your thoughts on this. Do you think we should go ahead and monitor his vetoryl again Monday ( not sure if they can do it on a Sat) ? I believe he has been on the meds 30 days now. It has been 2 wks since his ACTH test. I wish it was the middle of the week where we could get the ACTH test again and sent off, dont u feel this needs to be done immed to check the levels to make sure it is not dropping to low? He is just laying down now and ok.
Thank you.
Elly

[StarDeb55]

Elly, ice cream is a bad idea as dogs are frequently lactose intolerant. If you suspect a problem with low glucose, something like Karo syrup rubbed in the mouth would be a better idea.

If there has been only the one episode, another stim may not be needed, but an electrolyte check might be a good idea. If you see any further episodes, I would be talking to the vet about another stim ASAP.

Debbie

[EllyAugie]

Thanks Debbie, I became concerned as he has never had an episode like this before, I will be so glad when we can get him regulated on his meds just right.
Thanks again.
Elly

[lulusmom]

Hi Elly,

Sorry that Augie is feeling a bit under the weather right now. Please see my comments (in blue below) to your last post:


Hello everyone, I noticed Augie a little more tired today, his head and jaw started shaking tonight. The tremor only lasted about 15 seconds. I called the vet, he said unless he started having trouble breathing he should be fine until tommorow.

Tremors are listed as a side effect of Vetoryl but I don't recall ever seeing a dog with strictly head and jaw tremors. Nevertheless, Augie is early in treatment and you are doing exactly what you should do....closely monitoring and notifying your vet of any possible side effects. I'm not convinced that your vet's response was adequate or appropriate though. Augie's lethargy and tremors could quite possibly be from cortisol dropping too low and respiratory distress is not a common symptom of this.

I plan to take him in the morning to check his electrolytes. I gave him a tsp of ice cream thinking that might help with glucose??? What are your thoughts on this.

I agree with Debbie. Karo syrup or a product called Nutrical would be more appropriate.

Do you think we should go ahead and monitor his vetoryl again Monday ( not sure if they can do it on a Sat) ? I believe he has been on the meds 30 days now. It has been 2 wks since his ACTH test.

Can you please post the results of that test? There should be two numbers, a pre and a post cortisol number. If you don't have a copy of it, your vet should be happy to give you one. In the meantime, would it be possible for you to call the vet and get those numbers from him/her and post them here asap?

I wish it was the middle of the week where we could get the ACTH test again and sent off, dont u feel this needs to be done immed to check the levels to make sure it is not dropping to low?

Absolutely! If it has been 30 days since starting treatment, Augie needs another acth stim test done now in addition to having electrolytes checked.

Thank you.
Elly

[labblab]

Glynda, here are Augie's ACTH results from testing on 11-19:


Hi All, GOOD NEWS- wanting to share
Augie's test results are here.
Cortisol pre 2.2
Cortisol post 4.7

So, we are staying on the same dose of meds till next test- 4-6 wks, most likely 4 wks.

Marianne

[lulusmom]

Thanks, Marianne. Just goes to show how bad my memory really is. I can't remember what it's like to have some semblance of recall because I don't think my memory banks have ever fired on all cyclinders. After going back through the thread, not only did I find where Elly posted the stim results, I also saw that I already commented on the importance of having a 30 day stim test. Where cushing's is concerned, duplication is not such a bad thing.


Hi Elly,

Those are terrific numbers so congratulations!!! Is this the first acth stim test at 14 days? If so, please do keep an eye on Augie as cortisol can continue to drop in the first 30 days. As Marianne mentioned previously, if testing was done later than recommended, then it's possible that Augie's cortisol is lower than the numbers you posted. This makes it even more important that you watch for any signs of cortisol dropping too low in the next couple of weeks. Also, if this is the first stim test since starting treatment, you really should have another one done at the 30 days mark.

Good job, mom, and keep up the good work.

Glynda

[labblab]

Where cushing's is concerned, duplication is not such a bad thing.
I totally agree with you, sister! :) :)

Marianne

[EllyAugie]

Hello everyone. We took Augie in for another electrolyte check after the head tremors, his electorlytes were in the normal range. Dont really know what caused that but it hasn't happened since.
He started a couple days ago with a loose stool, alot of gas, mucous and quite a bit of blood with the BM. Called the vet this morning and they felt it was collitis and said to put him on 500 mg of Flagyl twice daily for 5 days. The vet I spoke with was a different vet than he usually sees, I did tell him Augie was on Trilostane, he said the Flagyl would be ok with the trilostane. Just checking with all of you each step of the way.
It is not quite time for his next ACTH stim test, hopefully that will still be in the normal range. I have noticed him drinking more water again than he has been in the last month.
Hope all of you have a great Christmas and Holidays.
Elly

[labblab]

Hi Elly,

I'm sorry Augie is having intestinal problems. I can tell you that my Cushpup had ongoing intermittent GI problems, and Flagyl was prescribed for him at the same time that he was taking trilostane. So I do not think that the combination of drugs should be a problem. Flagyl has both antibiotic and also anti-inflammatory properties, so hopefully Augie will soon be feeling better. However, if the problems remain after he finishes his course of Flagyl, I'm thinking your vets will want to actually analyze a stool sample in order to get a better idea of want may be going on. And of course, if he worsens or develops other symptoms, it may be the case that they will want you to temporarily stop the trilostane as well.

Marianne

P.S. Did the vet also suggest putting Augie on a bland diet for the next few days before gradually reintroducing his regular food (for instance, mushy white rice and boiled chicken breast)? That may also help ease his intestinal irritation...

[EllyAugie]

Thank you Marianne, it's reassuring when u all give a thumbs up for what is being done. He said to withhold food for 24 hrs. however, I had already fed him the boiled rice this morning mixed in with a tad of his dog food. I have been doing this the last couple of days. I can cook the chicken instead of the small amount of dog food I was doing.
Also, forgot to mention that we were trying .5 of (soloxine) thyroid "trial" since his hair that was shaved several months ago from the ultrasound never grew back in (His thryoid was .8 when we tested him). I stopped the thyroid yesterday not knowing if that was causing him to drink more and maybe causing the intestinal problem. I can always try again later.
Thanks so much for your input.
Elly

[labblab]

It is not quite time for his next ACTH stim test, hopefully that will still be in the normal range. I have noticed him drinking more water again than he has been in the last month.
Elly
Elly, do you already have an ACTH test scheduled for Augie? Since your first monitoring test was done on 11-19, you are right at that 30-day mark when a follow-up is due. If he was doing perfectly OK, you might feel more comfortable "sliding" a bit. But given his intestinal problems, I'm thinking you will want to have it checked again sooner rather than later, just to make sure that his cortisol level is still in the appropriate range. Certainly, if he starts acting lethargic or more seriously "off," the ACTH becomes an immediate priority.

Of course, the biggest issue would be if his cortisol has dropped too low, in which case he would need a break from the trilostane altogether. But with my own dog, it seemed as if his intestinal problems worsened when his cortisol was running higher than we would have liked. I know you are watching Augie very closely. And if he starts improving on the Flagyl, all well and good. But if not, I would encourage you to go ahead and get that ACTH test ASAP, given the fact that we have a long holiday weekend ahead of us, and the last thing you want to be dealing with is a Christmas crisis...:o

Marianne

[StarDeb55]

Don't forget the plain canned pumpkin for a case of the "poopies" like we call it at my house. Just plain pumpkin, not the pie filling.

Debbie

[lulusmom]

Also, forgot to mention that we were trying .5 of (soloxine) thyroid "trial" since his hair that was shaved several months ago from the ultrasound never grew back in (His thryoid was .8 when we tested him). I stopped the thyroid yesterday not knowing if that was causing him to drink more and maybe causing the intestinal problem.

Hi Elly,

Thank you for letting us know about your vets decision to put Augie on thyroid supplement meds on a trial basis. Honestly, I’m a little surprised that your vet decided to do this as the thyroid panel results were clearly inconclusive with a notation that “a decision to initiate thyroid supplementation depends on the strength of clinical signs of hypothyroidism and the confidence that there is no underlying illness.” Augie was diagnosed with an underlying illness, cushing’s, and his clinical signs at that time were consistent with cushing’s. His failure to re-grow his coat on his tummy is also classic cushing’s symptom. After reading the results of the thyroid panel, I personally believe that, like most cushdogs, Augie has or had euthyroid sick syndrome as a result of cushing’s. The excess cortisol really screws with a lot of stuff and it can definitely cause a suppression of T4. The good news is that euthyroid sick syndrome is a temporary condition that corrects itself once the underlying problem has been corrected.

There is a pretty good possibility that with the reduction of cortisol, Augie’s T4 has normalized and the thyroid supplementation created a hyperthyroid situation. Hyperthyroidism throws the body systems into high gear and can definitely cause nervous system tremors, which might explain Augie’s head tremors. Increased drinking and peeing and diarrhea are also symptoms of hyperthyroidism. I’m very happy to hear that you discontinued the thyroid meds and I think your boy just might be on the right track now. Nevertheless, your vet should want to check the T4 again to make sure it has corrected itself.

Augie’s post number on his first acth stim test was 4.7. This is a pretty low number for only 10 days to two weeks on Trilostane. I think you will recall that I expressed concern that cortisol could continue to drop for at least another two weeks and 4.7 doesn’t leave you much leeway. Diarrhea is a classic symptom of low cortisol levels and without the benefit of a 30 day stim test, I’m confounded as to how or why your vet would rule out low cortisol levels as a reason for Augie’s diarrhea and have you continue dosing. Both of my cushdogs treated with Trilostane and if either one of them didn’t eat well or had loose stools, they got no Trilostane until they were 100% again. I remember that my Jojo’s post cortisol level was less than 1 and he was still eating, active and his only symptom was loose stool. Had I not had a timely acth stim test done, we would have been headed for a major addisonian crisis.

I’m at work and trying to type in between constant interruptions so I hope I don’t sound too discombobulated. If I am, I hope somebody will clean up behind me. :o

Glynda

[EllyAugie]

Thank you Marianne, Debbie and Glynda.
Glynda, your post was very clear ... now I wish I had carried him in today for the ACTH test as Thurs is the 4 wk due date. I doubt they can do one tommorow, most likely it will be Monday considering the holidays. The addisons crisis is what i have been trying so hard to not let happen to him by taking him in for the electrolytes test each time something seemed off.
Marianne, after the head tremor the vet told me that if I thought things were off a bit just to not give the dose of trilostane that day. Knowing just the right thing to do has not been that easy for me to call.
Debbie, thanks for the pumpkin reminder too.
I am calling tommorow to make sure we can get in next Monday for the next ACTH test.
Thanks so much to all of you today for your help, you guys are wonderful.
Elly and Augie

[labblab]

Elly, who knows, maybe they WILL be able to do the ACTH either tomorrow or Wednesday. If so, I know that would give you peace of mind. How is Augie doing tonight? If he is showing improvement with the Flagyl and the bland diet, that would lessen my own worry that his cortisol level is the culprit. But you still will want to schedule the test. And does he otherwise seem OK to you? Hopefully you'll be able to talk with your regular vet tomorrow and decide on the best gameplan depending on how Augie is doing in the morning.

Marianne

[lulusmom]

Elly, you have done a superb job of monitoring Augie and taking him for electrolyte tests was very smart of you. If cortisol goes way too low, the electrolytes can be thrown off so good for you for taking the precautions. If ACTH stim tests weren't so dang expensive, I'd have my two tested more frequently just to alleviate my fears of having to reload them. If you think it's rough with one cushdog, try two of them. I work to pay vet bills and my planned retirement has been extended for the foreseeable future....they'll probably find me slumped over my desk with k9cushings.com on my computer screen when my number is up. :D

Glynda

P.S. Does Augie have a history of colitis or any other gastro-intestinal problems? If not, can you think of anything that you may have fed him that could have caused the diarrhea?

[labblab]

Elly, I've been thinking about you and Augie this morning, and am hoping that he's doing better. I also want to "second" what Glynda has said above -- you've been doing a wonderful job of watching out for him. So please don't ever second-guess yourself about that. This darn disease just has so many turns and twists. And it forces us to become paranoid about every illness or "bad day" that our dogs experience -- we're always wondering whether it is Cushing's-related or not. Oh, if only we had that crystal ball!!!!!!!!!!!!

I have been blessed (?) to have three dogs with more than occasional GI issues. Of course, the fact that they have all been Labs and tend to dine on any odd morsel of crap that they can find ANYWHERE does not help...:eek: But with my two non-Cushing's dogs, I just chalk it up to dietary "indiscretion" (I think the technical term is "Garbage Gut" :p;)), reach for the Flagyl and start boiling up the rice. With my Cushpup, I always had to fret and wonder whether or not his diarrhea actually "meant" something. And the timing was always horrible -- it seemed as though it was always right before a weekend or a holiday. :o

In situations like that, it can really be so hard to know what to do. But nobody knows Augie like you do, and so your "mom's instinct" (along with the testing ;)) is one of your greatest tools. But caring for a Cushpup involves a lot of questions and doubts and more questions. So please do not be hard on yourself. You are doing a wonderful job in a tough situation. We have all been there, and truly do understand!

Many (((hugs))) in hopes that Augie is doing MUCH better today!
Marianne

[EllyAugie]

Hi everyone, we got Augie scheduled for Mon ACTH test, now wondering if him being on the flagly will cause any difference in the results? He will be finished with the flagly this Friday.
I do have to be careful what I feed Augie so yes I would say he could have a touch of gastro problems. The only thing I can think of is we have new neighbors for about two weeks now with two agressivie acting dogs...one is a game dog who is growling quite a bit through the fence etc. Our dogs have been a little upset including the neighbors dogs behind us, so alot more barking going on all around. Have been going out with Augie to make his potty trips quick. Last week he went over to the fence line to mark and all of a sudden just started eating the dirt and leaves under the red tips...this is what I believe caused the stomach upset. He has never eaten off the grown like this before, could be the combination of him not feeling great on his stomach and the anxiety of the threat he feels.
Even with the new dogs in their house they can hear us when we go sit on the deck to get some afternoon sun and do it from their window inside. We have a lattice privacy screen so I doubt they see us well, just hear us. Hopefully the new dogs will get used to us and stop with the agression soon. With the economy the way it is the house had been up for sale since July so the past owners were forced to rent it. If their dogs dont improve I have my fingers crossed they move when the lease is up lol.
Augie didnt go BM this morning so I feel he is better since there were no urgent matters.
I will let u all know how his test turns out next week.
Thanks everyone.
Elly

[labblab]

Elly, I don't think the Flagyl should be a problem for Augie's test on Monday. And you may be exactly right -- it may be the combination of the stress and the stuff that he ate that caused his upset. I am so sorry you are stuck with these new noisy neighbors. :(

But I hope everything settles down for you now, and stays that way through the weekend. We'll be anxious to hear how things go.

Marianne

[Annie's Mom]

Hi Elly,
My lab Annie began 60 mg of Trilo the end of October. I found the least expensive to be from Valleyvet.com . They have a special price of $69.95/box if you buy 2 boxes, free shipping and I received the product 2 days after ordering it. They faxed a form to my vet to complete and fax back to them. Center Pet was going to charge something like $8 shipping. I was thrilled when I found Diamondback due to the low cost, but my vet refuses to write a script for a compound drug. On day 22 of Trilo, Annie began having diarrhea. She had not been out of my sight so I know she didn't eat something she shouldn't have; after a couple days on Flagyl, her stools returned pretty much to normal. I too, questioned if it was the Trilo causing the diarrhea, or just her sensitive stomach acting up. Annie has never had a sensitive stomach until her severe pancreatitis attack in early Sept. The vet suspects it was colitis. Now, I monitor her food closely and she only gets her dry kibble (Innova for seniors) and a little bit of canned Innova food as treats; I add 1/4C cooked rice if her stools get loose. Someone here on the forum reminded me to use pumpkin sparingly, as it can create diarrhea if too much is given. I find pumpkin does help for the short term. Annie has intermittent episodes of gas too, and the vet recommended 10 mg Pepcid. I am also going to start Annie on a dog probiotic. I was told by a vet that dogs should not be given the human probiotics. I hope Augie is feeling better quickly and that the ACTH tests come back with a positive outcome.

Barb

[EllyAugie]

Thank you Barb for this info about the trilo and the meds for the loose stool, we keep pepcid on hand so I have that here.. The flagyl and the soft diet has helped him alot. I have been feeding him California Natural low fat.(made by Innova I think)
Augie just had another episode about 30 min ago with the head shaking...this time much worse. When I touched him it stopped, it scared me bad enuf this time to go ahead and give him 10 mg of prednisone. ( he weighs 70 lbs) Not sure if that is enuf. I do feel he is headed toward the Addisons crisis as u all have warned. Hoping the vet is open tommorow to have his electrolytes checked again.
Elly

[EllyAugie]

Forgot to mention I had already given him both his flagyl and trilo this morning early.
Thanks.
Elly

[Harley PoMMom]

Hi Elly,

Oh my, so sorry to hear about this latest episode with Augie, just so you have this on hand...The standard rescue dose of pred is 0.25mg/kg. To find his weight in kg, divide the lbs by 2.2...then multiply that result (his weight in kg) by 0.25 and you will have the amount for his weight...comes out to 7.95mg.

Elly, An Addisonian crisis is a medical emergency. If you think this is indeed what Augie is experiencing then if I were you I would take him now...JMO.

Please keep us posted.

Will be keeping you and Augie in my thoughts and prayers.

Love and ((((hugs))))
Lori

[EllyAugie]

Thank You Lori, will keep u posted.
Elly

[Squirt's Mom]

Hi Elly,

How is Augie after the pred? Did you see a fairly quick improvement in his behavior? Has he pooped since? Any better?

I'm glad your touch seemed to calm him and stop the shaking. Hopefully that will continue to work if he keeps having these episodes. It would scare me to pieces to see Squirt do that! :eek:

Keep in touch and let us know how ya'll are doing.

I hope your Christmas is merry otherwise!
Hugs,
Leslie and the girls - always

[frijole]

Just posting to say that I too will be thinking of you and Augie and sending prayers your way today. Hugs, Kim

[ChristyA]

Elly,
As you probably know, but just to make sure,,no more trilo until you see the vet. If he is headed toward an addisonian crisis that will send him further in that direction and you don't want that to happen. How long was his head shaking episode?
Christy

[EllyAugie]

Hi everyone, after giving him the pred yesterday Augie did not have any more episodes. This morning I didnt give him the trilo before we went to the vet office They do not think he is having a addisons crisis, vet said he has seen no or few dogs have it with the trilo. Cant recall exactly which one of those two statements he actually said. We ran a CBC and electrolyte test this morning. The areas in which he were high was ALKP >2000 U/L (High) PLT 579 L/ul (High) CHOL 358 mg/dl (High) and the low was the- CI 107 mmol/L Vet said to give him a pinch of salt daily for the low CI. He thought maybe the very high ALKP was possibly from me giving him the prednisone yesterday. However from my recollection it was 880 in the beginning before meds were started. We have now put the next stim test a week from this Monday since I gave the prednisone yesterday. He seems to think that the head tremors are not related...however, I do. He never had head tremors in his life. He was also staggering around some yesterday and limping, not in the back but in the front leg. He is back to normal today..:)
I also wanted to say that I dont think the first head tremor was related to the thryoid med because at that time he had not been given the soloxine..he was only on that for 5 days when I took him off. Maybe it is the CI as that has been on the low side all along, ranging from 111 to begin with to 108 and 109. Or maybe it is the very high ALKP. I wouldnt know how high it was yesterday since I gave the predisone.. I am doing my best to keep things going ok for him. I appreciate everyone one of you being there for me and supporting me more than I can say. You have been such a wonderful support system for me. Thank you from the bottom of my heart, I would be a nervous wreck without you.
Hugs to all, I hope your Chrismas was great and I pray for each of you and your babies to have blessings in the new year to come.
Elly and Augie

[Squirt's Mom]

Hi Elly,

Whether your vet has seen it or not, Addisonian crisis DO occur with Trilo. This is one of my biggest problems with using Trilo - vets telling parents it is "safe" when it can and does cause the same problems as Lyso can when not properly administered and monitored.

IMHO, based on Augie's reaction to the pred, I would withhold the Trilo for a day or so and see how he does. It may be that his dose needs to be adjusted. Is he on once a day or twice a day dosing?

The pred will have an effect on the ACTH if it has been less than 24 hours since the pred dose. Otherwise, the pred should have been out of his system in 24 hours and not have an effect on the ACTH after that, tho anything is possible. :rolleyes: I think you are wise to have another ACTH scheduled soon. ;)

The Cl is chloride which is one of the electrolytes. As I'm sure you know, electrolytes can get out of balance with the cush meds and can be an indicator that the cortisol has gotten too low. Regardless of your vets opinion about crisis on Trilo, keep a close eye on Augie and don't be the least hesitant to give the pred if he seems to need it.

You are doing a wonderful job! Keep your chin up, honey; I know Augie is so grateful for all you are doing on his behalf.

Hugs,
Leslie and the girls - always

[labblab]

Hi Elly,

I'm so glad that Augie is doing better today. I wish I could comment more knowledgeably about his low Cl level, but I am hoping that Debbie or one of our other "chemistry experts" will soon be by to help with some more information. We commonly worry about sodium and potassium levels when we talk about Addisonian crisis -- I don't know whether or not it is unusual for chloride levels to be low when sodium levels are normal (and apparently Augie's sodium was normal?), or whether the chloride level signals a specific issue in conjuction with lowered cortisol/aldosterone.

But can you tell us some more about Augie's head tremors? How long did the episodes last, and can you describe more specifically what happened? Even though the episodes may not be the result of over-medication, per se, "shaking/shivering" IS listed as a possible side effect of trilostane. And I will tell you that during the first couple of months of trilostane treatment, my own Cushpup developed intermittent episodes of body tremoring that scared the crap out of me. His tremoring was across his shoulders, and was strong enough to make him literally jerk at times. His cortisol level never dropped too low, and we could never identify a specific cause. And the tremoring did finally stop. But it surely freaked me out in the meantime!

Please keep us updated on how Augie is doing. And I will be interested in hearing anything more that you can tell us about his head shaking.

Marianne

[EllyAugie]

Hi all, trying to address all the issues. Augie's stool is formed now and looking much better. I do think I still see small amounts of blood in it...before it was alot of blood and also blood coming out behind the poop ...pretty heavy, it took about 6 baby wipes to get him cleaned up last week. We are back on solid food today so I will be keeping my eyes open for any changes.
The first head tremor was slight shaking and didnt last a long time.. he was just standing in the living room looking out the window when that one occured. Yesterday he was laying in his bed all comfy when I saw it, it was faster shaking or bobbing, I called my husband to come see it so he would see how much more serious it looked than the first episode. His eyes looked normal, not really like a seizure ( I think of a seizure as eyes rolling back and tongue going back) It appeared to be the head only, bobbing back and forth faster than the first time. We watched it for a minute, I called out to him, he lifted his head with it still shaking like that then I went over and started petting him calmly...it stopped at that point. He sleeps in the bedroom with me so keeping an eye on him is easy. Only for awhile did he stagger or limp yesterday afternoon. Today he is walking normal again and seems to be doing good.
I did give him the trilo after we got back home from the vet office today :( but so far he is doing ok today. I am giving the 120 mg of trilo in the am with his breakfast. (once daily dose) except today, I waited til we got home to give it to him.
You know the one thing I wonder about is.. I have seen posts of others saying how much their dogs improved after starting treatment acting more lively and puppy like. I cant say that about Augie, it has been a long time since he's acted playful. Sometimes I notice his expression and it seems so sad, like he's saying "Mom, u know I really feel like crap" his bottom lip just kinda hangs, like theres no posture left.
I want u to know I am listening to what u are saying about the fact that addisons can occur with trilo, it also says on the med sheet that shivering, seizure like episodes can occur. So why my vet doesnt put that together I dont understand for the life of me. Nevertheless, I will continue to watch Augie and do what I feel is best for him from my gut feeling. Thank goodness my sis had some prednisone and brought it over to me awhile back just in case I needed it.
Thank you all,
Elly

[StarDeb55]

Elly, to be able to give you any valid input about the low chloride level, I really need to see the normal range. After re-reading Augie's thread to review your description of these head tremor episodes, I am honestly wondering if these might not be some type of seizure not related to the trilostane, low cortisol, or an electrolyte problem. Seizures in pups don't necessarily mean that their eyes roll back in their heads or any of the things you might associate with a human seizure. I had a poodle years ago who was epileptic, & he never had any of the "typical" seizure symptoms, one would normally expect. When Augie has had these episodes, does he seem to be aware of his surroundings or is he kind of in a "daze"? Does he only come around after you touch him or get his attention by calling him? If the answer is yes to any of my questions, IMO, I would be asking my vet about the possibility of seizures. I don't want to scare the daylights out of you but I want to alert you to the possibility. I have done a search for information about canine seizures, & this seems to be a pretty good website.

Post that chloride normal range for me, & I'll see if anything sticks out.

http://www.canineepilepsy.co.uk/VetRecource/Clinical_info.htm

Debbie

[EllyAugie]

Hi Debbie, he did seem to be aware of his surroundings IMO ...to me it was more like someone acting like they were really really cold shaking and bobbing. My vet did mention that I needed to be thinking about seizures not related to this. But he has never had a head tremor in his life before he got sick. Bulldogs can have what they call idiopathic head tremors ( for no known reason) , there is an article written by a specialist on this about Bulldogs because of so many who do get them.
The normal range on the CI is 109-122 mmol/L So, his today was not terribly low (being 107). What was off the chart was the ALKP being greater than 2000 U/L the normal range for that is 23-212. However my vet seemed to think the pred could have caused this jump. His ALKP was 880 before we began treatment. Which was high also.
Tonight he actually played with his ball for a few minutes so I am feeling good tonight :)
Thanks again for the link and all of your help.
Elly

[StarDeb55]

The chloride is nothing to worry about. I'm not sure that pred would have cause such a tremendous jump in the alk phos, but I have seen cushpups that have alk phos values into the several thousands.

Debbie

[EllyAugie]

Thanks Debbie, I found a video of an idiopathic head tremor which is very similar to what Augie had. I just read an article that said small amount of yogurt etc would help.
Thanks all.

http://video.google.com/videoplay?docid=-6514190196343182106#

[lulusmom]

Hi Elly,

After watching the video you posted, I was curious so I did some reading. Apparently Bulldogs and Dobermans are the breeds most affected by idiopathic head tremors and the good news is that the dog is normal in every other way and it doesn't develop into neuro problems of any type. I think you've found the right diagnosis...good job! I'm sure you've done your own research but here's a link to some interesting info everybody can read:

http://bulldogsworld.com/headtremor.html

Glynda

[ChristyA]

I watched that video also. Tremors are also found in boxers more and more because of the BYB's.

Dexter had some tremors with Cushing's but his were more of a shiver from the shoulders up than a tremor like in the video.

Christy

[ChristyA]

Just wondering how Augie is doing?
Christy

[EllyAugie]

Hi all, we did the ACTH stim test yesterday and Augie was low so we are dropping down to one 60 mg pill daily now instead of two.
His results were Cortisol Pre <1.0 and Cortisol post was 1.6. I already gave him two trilostane this morning before they called.
I do feel the head tremors were due to the low cortisol and not the idiopathic head tremors since he has never had them before he started treatment. Most Bulldogs who have those type head tremors have them before or around 2 years of age. Even tho his was exactly like those in the videos.
Isnt that something that his electrolytes kept coming back normal even tho he dropped his corisol level like this?
He seems to be doing ok.

Elly

[labblab]

Wow Elly, thank goodness for the ACTH test, and I am wondering whether Augie might benefit from at least a brief break from the trilostane altogether with results that low. Although I am glad that his electrolytes have remained normal, according to the Dechra product insert, it is possible for symptoms of hypoadrenocorticism to develop even without electrolyte abnormalities:


A post-ACTH stimulation test resulting in a cortisol of <1.45 μg/dL (<40 nmol/L), with or without electrolyte abnormalities, may precede the development of clinical signs of hypoadrenocorticism. Good control is indicated by favorable clinical signs as well as post-ACTH serum cortisol of 1.45-9.1 μg/dL (40-250 nmol/L).

If the ACTH stimulation test is <1.45 μg/dL (<40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism (hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.
As of yesterday, Augie was BARELY above that lower limit. So I know you will keep a very watchful eye on him (as you always do!). But if he starts to act "off" in any way, I'd consult with your vet ASAP about giving him a temporary trilostane break in order to allow his cortisol to elevate a bit more before starting back in at the reduced dose.

Marianne

[EllyAugie]

Thank you Marianne for your input, I was hoping someone would comment. I am concerned that I gave him the full dose this morning. I called the vet back and asked if he thought he would be ok since full dose had already been given. He said to just watch him and bring him up if anything looks abnormal. I am a little tempted to give him a small part of the prednisone pill. What do you think? I am trying so hard to keep him from crashing. How long of a break do most give? Since I already called the vet back again with concern about dosing today I am thinking he wont be advising the break. Ultimately, I am Augie's advocate and caretaker. That is why Christmas day I gave the prednisone, I felt he needed it.
Thanks so much Marianne.
Elly

[EllyAugie]

Forgot to add that he did want me to bring him in again for another stim test in two weeks, we made our appt and will keep a close eye on him.
Thanks all.
Elly

[EllyAugie]

Hi Marianne, I didnt mean to put you on the spot with that question so I went ahead and gave him 1/4 of a 10 mg pred pill. I dont think that will hurt him and it will make me feel better for today since he was so low from the test yesterday.
Thanks again.
Elly

[labblab]

Elly, if Augie doesn't seem "off" within the first six hours or so of having taken his trilostane today, I'm guessing he will be fine. It is during that time period that the effect of the medication is the greatest and after that his own cortisol should start to rebound. So if he continues to seem fine throughout the day, then I wouldn't worry about the prednisone. It is good that you have it on hand, though, in the event that something changes.

As far as the timing of a break if a break is warranted, I think it really depends on the dog's behavior (in conjunction with confirmatory testing) -- if they are acting normally, or abnormally, or if Cushing's symptoms start increasing. Since Augie's results were borderline but he is acting normally, it probably does come down to a judgement call as to whether or not a break would be a good idea. It sounds like your vet's judgement right now is that the dose reduction is all that is necessary. As long as Augie is behaving normally, that may be the right call. But I just wanted to give you that additional information, so that you'd be better armed to talk with the vet if Augie starts having trouble of any kind.

That's good that you already have a repeat ACTH test scheduled. If Augie keeps doing OK in the meantime, then you are probably good to go. But if not...you'll know what to talk over with the vet!

Marianne

[labblab]

Elly, we were posting at the same time, so I just saw that you went ahead with the prednisone. I agree that it shouldn't hurt him. So from this point onward, I know you'll continue to watch him closely. Hopefully, though, he'll do fine on the lowered dose.

Marianne

[EllyAugie]

Thank you Marianne, your advise is so helpful. I cant thank you all enough. Every one of you have been so supportive.
Elly & Augie

[lulusmom]

Isnt that something that his electrolytes kept coming back normal even tho he dropped his corisol level like this?

Elly, my Jojo had a post stim of .7 twice which is a lot lower than Augie's and his electrolytes were normal too. Both times he was being treated with Lysodren. The first time it happened, I was shocked because he was still eating like a pig and showed no signs of being loaded. I gave him one dose of prednisone anyway but I'm not convinced that he really needed it. The second time it happened, I wasn't surprised and knowing that his cortisol rebounds rather rapidly, we withheld the meds for a week instead of 10 days before starting maintenance.

One thing I know for sure, there is no template that fits all dogs when it comes to cushing's. We tease each other and accuse our dogs of not reading the book and now we know that Augie didn't either. :D

Glynda

[ChristyA]

Elly,
Thanks for the update. Sounds like you are doing really well getting Augie within range for his cortisol levels, he is in good hands.

Never be afraid to question your vet, or ask any questions here. As you said you are his advocate and caretaker - and I don't think he could have anyone better.

Christy

[EllyAugie]

Thanks Glynda, that was such good information, it all helps shed light on my decision making for him.
And thanks Christy for your support as well.
Take care everyone.
Elly & Augie

[EllyAugie]

Augie Update- Hello all - ACTH stim test done on 1-18-09, we had cut his dosage of trilostane back to 60 mg daily instead of 120 mg daily due to the lower post cortisol level two weeks prior.
This latest test was Pre <1.0 and post 3.4, vet recomended going down to 30 mg daily now since the Pre is still low.
Augie has been very sick this week with pancreatitis and we have not been giving trilostane meds until we can get his Lipa back under control. His blood work is showing 2200 U/L Lipa today and 1960 U/L yesterday. Have been taking him to the vet the last two days for fluids and nausea meds. He couldnt keep any food down yesterday morning and today we tried a tiny bit of rice and chicken, he kept it down but had the dry heaves after. Our vet recommended no more food today and another visit in the morning.
Please send good thoughts for Augie's recovery soon for the pancreatitis, he wants to eat but he can't.
Nite.
Elly

[Casey's Mom]

Poor Augie, I feel for the guy. I know we have lots of members dealing with pancreatitis that will be along in the morning to help. Sleep well and hugs to both of you,

[Harley PoMMom]

Hi Elly,

Concerning Augie's pancreatitis: you will not get a true reading of his Lipase numbers unless you are getting a cPLI or a cPL test done.

When one gets the lipase results from their pups Chemistry report back the Lipase is non-specific because there are digestive lipases, intestinal lipases, lipoprotein lipase and heptic lipase, hormone-sensitive lipase, and lysosomal acidic lipase. But the cPLI and the cPL test for the lipase that is for the pancreas only.

I will also add that my boy Harley has pancreatitis, his Nov. cPLI was 464 (0-200), on his Nov. Chemistry panel his lipase was 403 (77-695) and his amylase was 515 (290-1125). This just goes to show me that my boy's pancreatitis has to be monitored with the cPLI test. His chemistry panel and cPLI were done on the same day.

Will definitely be keeping you and Augie in my thoughts and prayers.

Love and hugs,
Lori

[EllyAugie]

Thank you Lori, we will mention that test this morning.
Had a typo in the first message I sent (his last ACTH) was 2010 not 09 as I said.
I fed him 1/2 cup of rice this morning with a tad of chicken and he seemed to keep it down better this morning without heaving or throwing it up. Just grumbling noises in his stomach.
Thanks for all your good thoughts.
Elly

[Harley PoMMom]

Hi Elly,

The one thing with pancreatitis is that the food that you are giving should be very low-fat, so if the chicken wasn't skinless and 99% fat-free then I wouldn't given it to him anymore. Also very, very small meals 5-6 times a day should be offered to him...the rice is good.

Since I really don't know what you're dealing with I don't know if my suggestions of the food or amounts should be noted...that's why a cPLI or a cPL test is urgent here, IMO.

Please keep us updated and will be keeping you and Augie in my thoughts and prayers.

Love and hugs,
Lori

[EllyAugie]

Hi Lori, thanks for that suggestion and reminder, the chicken was skinless and low fat. I boiled it, drained it and rinsed it before giving to him. His regular kibble has been low fat California Natural.
Took Augie in this morning and they gave him more fluids and nausea meds. They said to give him several small meals today of the rice and chicken and to start back with the trilostane tommorow. I did mention the CPLI panel but the vet said since Augie hasnt had diarrhea on an ongoing basis he didnt feel he needed it. My husband had purchased some puparooni treats and was giving all the dogs one in the mornings. It hasnt bothered any of the other dogs. This was a terrible lesson we learned but both of us will never give a treat of any kind again to Augie. It is hard considering how hungry he acts all the time. Usually if we give him anthing it is so tiny. Now we are putting him in the bedroom when we eat dinner and of course he cries and cries as if we are torturing him. Honestly, we give him barely nothing in the way of treats.
I think he is better today and hopefully will be back to normal soon.
Thanks for your help.
Elly

[EllyAugie]

Just wanted to say again your such a sweetheart Lori, thanks for your love and kindness.
Hugs to you too.
Elly and Augie

[Harley PoMMom]

Hi Elly,

For Harley I give him carrots as treats to eat, now one has to be sure their pup's glucose is within normal ranges before giving these as treats because of the natural sugar content.

I will mention that Harley shows no symtoms of pancreatitis...no diarrhea, no vomiting, nothing...but his cPLI done in Nov. was 464 (0-200).

Hope this helps.

Love and hugs,
Lori

[EllyAugie]

Hi Lori, When I ask them about things I try to be very tactful...they listen and then explain why not. ( Maybe because things are so costly?) This episode was around 400 dollars this week. I never complain about the costs of things tho and my husband has been so understanding about it all Our vet is very caring and loving to Augie and has gone to great measures seeing him immediately through things, fitting me in, not waiting etc. The vets and staff are truly caring and good to us. I also brought it up that on his ACTH stim test his post results would indicate his dose should stay the same but he pointed out that it was his pre they were concerned about and addisons occuring.
I know they made a note on my chart that I asked for the CPLI test.
I hope they don't feel that I am doubting their care because I couldnt find more caring vets and staff. My husband and I plan to adhere to the strict kibble diet when he finishes with the soft diet and if he has another episode of pancreatitis I will ask for the panel. Seems to me it would just be good to know where we stand.
I appreciate all of your help too and all your helpful advice. Augie has held down two small meals today and finally had a bm. :)
Thank you Lori.
Elly

[Harley PoMMom]

Hi Elly,

I don't want to scare you but pancreatitis can kill a pup if not controlled.


Acute pancreatitis can be extremely painful, and can become life-threatening if the inflammation spreads, affecting multiple organs and systems.
http://www.dogaware.com/wdjpancreatitis.html

Re; the cPLI/cPL tests:


Pancreatitis occurs commonly in dogs, but is often difficult to
diagnose because patients with this disease often present with
non-specific clinical signs and because of the limited performance
of currently available diagnostic tests.
Recognising these challenges, Dr Jörg Steiner and Dr David Williams,
of the Gastrointestinal Laboratory of Texas A&M University, recently
developed and validated the canine pancreatic lipase immunoreactivity
(cPLI) assay for the diagnosis of pancreatitis. Serum cPLI is highly
sensitive and specific for pancreatitis in dogs. Serum cPLI concentration demonstrates greater than 80% sensitivity for pancreatitis in the dog (based upon histologically confirmed cases of pancreatitis). In contrast to serum lipase activity, serum cPLI concentration is not affected by renal failure or administration of prednisone, and can therefore be used to diagnose pancreatitis in patients with acute or chronic renal failure, and those patients treated with prednisone.
Due to the promising performances of the cPLI assay, IDEXX has
collaborated with Drs. Steiner and Williams to further refine the cPLI assay and create the new Spec cPL™ (canine pancreas-specific lipase) assay.
The Spec cPL™ assay utilises monoclonal antibody and
recombinant antigen technology to provide faster results, and
is now available through IDEXX Reference Laboratories.

http://www.idexx.co.uk/animalhealth/laboratory/speccpl/diagupdate_0406.pdf

And you can read more about the cPL and the cPLI and pancreatitis here:
http://www.idexx.co.uk/animalhealth/laboratory/speccpl/

The cPLI test cost me $132.50 to have done, no it's not cheap but it is specific to the pancreas and to me it is worth it. ;):)

Hope this helps.

Love and hugs,
Lori

[EllyAugie]

Lori, Thanks for the links and the name of the lab. My husband and I both felt Augie was facing an emergency situation this week.
I appreciate you taking the time to help us with all this info.
Thank you.
Elly & Augie

[Harley PoMMom]

Hi Elly,

FWIW, I think you are doing an excellent job taking care of Augie :) You are a wonderful mom!!

The only reason I am really pushing, and yes I am pushing :p;):) to have that cPLI or cPL done is see whether this is pancreatitis or not. This could be colitis, IBS, IBD...these share the some of the same symptoms as pancreatitis.

And remember, never give Trilostane to a pup that's not eating or feeling well.

Please keep us updated.

Love and hugs,
Lori

[Franklin'sMum]

Hi Elly,

I'm so sorry Augie is having a difficult time right now. Thoughts and prayers are with you both,

Jane and Franklin xx
________
VOLCANO VAPORIZERS (http://volcanovaporizer.net/)

[EllyAugie]

Thank you Jane and Lori for your caring thoughts,
Lori, I have looked at these links and cant quite understand specifically where the lab is that the bloodwork is to be sent to. Is it in the UK?
Can you please put the lab and address up here for me.
Thank you.
I am still worried about Augie, this morning when he ate his chicken and rice his hair stood up on his back and he had the most cross look on his face like he still may be feeling some pain. He didnt throw it up tho. I did not give him any trilostance this morning, still too worried.
Thanks all.
Elly

[EllyAugie]

Lori, I think I found it for the eastern US at these locations, I hope this is correct

Florida Fort Lauderdale 3375B NW 55th Street
Fort Lauderdale, FL 33309
Maitland 9905 South U.S. Highway 17-92
Maitland, FL 32751
Tampa Pinellas Business Park
10901 Roosevelt Boulevard North, Suite 400 D
St. Petersburg, FL 33716
Georgia Atlanta 6300 Jimmy Carter Blvd. NW
Norcross, GA 30071
Maryland Baltimore 806 Cromwell Park Dr., Suite X
Glen Burnie, MD 21061
Massachusetts North Grafton 3 Centennial Drive, Suite One
North Grafton, MA 01536
New Jersey Totowa 80 Commerce Way, Units F-H
Totowa, NJ 07512
New York Long Island 10 Skyline Drive
Plainview, NY 11803
North Carolina Greensboro 7009 Albert Pick Road
Greensboro, NC 27409
Tennessee Memphis 6100 East Shelby Drive
Memphis, TN 38141

[EllyAugie]

Lori, what is the procedure for collecting this particular blood test? I am asking in case our vet is not familiar with it. Is it just a regular blood draw and sent to one of these addresses?
Thanks.
Elly

[Harley PoMMom]

Hi Elly,

On Harley's cPLI test results they say, "Test performed by Gastrointestinal Function Test Laboratory." Here is a link to their website:

http://www.cvm.tamu.edu/gilab/

This is where your vet will send the blood sample to, Dr Steiner heads this lab, he is one of the docs who refined the cPLI.

Gastrointestinal Function Test Laboratory, College of Veterinary Medicine, TAMU 4474, College Station, TX 77843-4474, phone (979) 862-2861.

The cPLI test is a FASTING blood test for a pup, results can take up to 5-7 days to come back.

Hoping Augie is feeling much better and keeping you and Augie in my thoughts and prayers.

Love and hugs,
Lori

[EllyAugie]

Thank you :)
Elly

[EllyAugie]

Hi all, just checking in and giving an update on Augie. We took Augie to the state vet school this Wed and Thurs for more testing since he had been feeling so tired and sick. They rechecked with ultrasound, blood work on Wed, did a low dose dex suppresion test on Thurs, just called me back to say he was suppressed and to stop the trilostane all together for now and to retest him in 2 wks with a stim test. They feel either Augie doesnt need this med or if he does it will have to be a very small dose. We had dropped him down to 30 mg on 1-20-10. His pancreas looked fine, they didnt feel he has pancreaitis and all of his problems of late were due to his cortisol levels dropping so low, we are all hoping he will regain strength and be back to his old self soon.
Augie was commended for being such a great patient at the vet school, he is always a gentleman no matter what he is going through, we are proud of our boy.
Hugs,
Elly

[MiniSchnauzerMom]

Elly,

Thanks for the update on Augie. I'm glad he didn't have pancreatitis but sorry to hear he has been feeling so badly because of low cortisol. Will be watching for your update and Augie's ACTH results in two weeks.

I'm hoping right along with you that he will regain his strength and be back to his old self soon.

Louise

[EllyAugie]

I HAVE WONDERFUL NEWS!! We took Augie to NC state a little over two weeks ago since he was feeling so bad, they ran more tests and said to take him off the cushings medicine for two weeks and retest. Guess what????? He is in the normal range for a dog now. Therefore, we dont know if he had cushings at all or if something else caused him to get a postive diagnosis the first time...such as a case of pancreatiis or some other unknown illness at the time. Vet called and said to keep him off the meds longer and to keep a watch on him and we will retest in a month. I WAS PRAYING FOR THIS OUTCOME WITH THE TEST RESULTS, MY PRAYERS WERE ANSWERED. Honestly, I am full of tears of joy, he is my best buddy. Thank you God.
His pre was 2.4 and his post was 13.8
Thanks for all your support here and I will let you know how his next test is in a month.
Elly & Augie

[labblab]

Elly, thanks so much for your update! Boy, I will be keeping my fingers crossed that Augie's problems are behind him :). It will surely be interesting to see what his ACTH result looks like in a month. I so much hope that it remains within the normal range. But if not, at least you already have some Cushing's experience under your belts. PLEASE keep updating us, OK? And how is Augie actually doing behaviorally -- does he seem to be back to normal?

Marianne

[EllyAugie]

Thank you Marianne, in the last few days Augie has been acting like he is feeling better (much more like his old self) His drinking has not been terribly excessive as it was back in Nov. I am in hopes he got a false positive at the beginning from some other type nonadrenal illness.
Thanks so much for your support and I will most definitely let you all know how things are going.
Hugs, prayers and much love to all.
Elly & Augie

[EllyAugie]

Wanted to note that this ACTH test was ug/dl

Elly

[EllyAugie]

Hello all, Augie has been off the meds for 3 wks now. The last ACTH stim test was normal after being off the meds for two weeks per instructions by the vet school we took him to.
Augie is back up to drinking a gallon of water during the day and having accidents and frequent potty trips. Yesterday he walked in the middle of the living room and just stood there and went, in his normal state of mind in the past he would have never done this. I dont know what to do now since they felt we should leave him off the meds because of his lowered results.
I am at the point to where I feel we have done everything to try to help him and are going no where.
In comparison to our other dogs he is drinking three times as much.
If anyone has any suggestions please let me know.
He isnt acting sick just not himself.
Thank you.
Elly & Augie

[lulusmom]

Hi Elly,

You need to contact your vet and tell him that Augie is drinking tons of water and having accidents in the house. I noticed that his last post stim was over 13 ug/dl so it could be that cortisol is now too high and you are seeing a return of symptoms. You may need to restart the Trilostane before the next scheduled acth stim test.

Glynda

[EllyAugie]

Thank you Glynda, I have called and waiting to hear from him.
I have a couple of questions. On Augie's first test back in Nov his pre cortisol was 2.5 and his post was 26.4. This last test a little over a week ago after he had been off the meds for two weeks was pre 2.4and post was 13.8. The pre being on.1 difference from the first and the last test (keeping in mind during treatment the pre's were mostly <1.0)
I can understand being concerned over his pre values being <1.0 during his treatment but the post values were in range (being controlled) I agree we needed to give a rest however if you read the vetoryl treatment and monitoring sheet it would have indicated keeping on the meds. I have questioned this and the concern seemed to be with the pre being low. I am wondering now if the way his diagnostic test is being interpreted with the normal values is being confused with the monitoring instructions from the vetoryl sheet. In other words on the diagnostic sheet it says a dog is normal in the 5.5-20.00 range and that is why they felt he was normal this last time on his post.
Honestly, i am confused at this point too because when I did ask they said it was the pre they were worried about. What is a safe pre while maintaining with the vetoryl?
I do have one more question, I thought I read on another post here that the trilostane may not be good for the liver. They did note changes (mild diffuse) on Augie's liver at the vet school when they did their ultrasound in comparison to his first ultrasound. They did not aspirate his liver due to it interfering with his low dose dexamethsone test results.
Thanks for any input, I hope this post was not terribly hard to understand.
Elly

[lulusmom]

Elly,

Normally you disregard the pre (resting) cortisol for monitoring cushing's treatment but when a dog has an addisonian crisis, that number becomes very important and anything less than 1 would be a concern. However, Augie's last stim showed his resting cortisol almost smack dab in the middle of where it needs to be and his post was definitely too high for a cushdog. You may be right in thinking that your vet is using the reference range for normal dogs as being appropriate for Augie but to give him the benefit of the doubt, he may have wanted to wait until Augie was symptomatic again before starting treatment. That's not an unreasonable approach when you are treating with Trilostane. When I switched my dog from Trilostane to Lysodren, her post stim was 22 but still not symptomatic. We waited until she was to start treating again.

When you do start treatment again, you need to start Augie on a much lower dose and make adjustments as you go. I can't remember what dose you started with but if it was 60mg, I'd start with 30mg this time. Slow, steady and safe is the way to go.

Glynda

[EllyAugie]

Thank you so much Glynda, I hope we can get to a comfortable place soon with all this.
I appreciate your input.
Elly and Augie

[EllyAugie]

Glynda, I found this link and believe I have an understanding now about how to manage his meds and results. A weight has been lifted off my shoulders.
http://www.georgieproject.com/new/ACTH/summary.html
Hugs and warm wishes to everyone.
Elly and Augie

[Sabre's Mum]

Hi Elly

I saw elsewhere that you had some queries with regards to calcinosis cutis ... which your Augie has been confirmed as having.

You queried whether calcinosis cutis was caused by an over production of cortisol or from reducing cortisol too much?

Calcinosis cutis is caused by cushings and the high amounts of cortisol that the dog produces. When we were trying to find a diagnosis for Sabre (we had to wait 6-8 weeks before we could start testing) I did a lot of research. What I found was that calcinosis cutis is nearly 100% a diagnosis for cushings ... I only found a couple of cases where it was triggered by another issue.

With Sabre, he first started with major pyoderma around his anal area. Initially the vet thought it was something else .... can't remember exactly - I think it was furunculosis. I probably should go back one step. Sabre had his vaccination in October of that year ..... we believe this to be a major trigger for his calcinosis cutis. (Our current vet has confirmed this and said that she had a dog in the UK whose skin was punctured and this triggered calcinosis cutis). This was the first site of his calicnosis cutis .. it took until the pyoderma at the end of December for this area to have quite a lump created here (the injection site). By this time he also had developed a small area on his side. Our vet at the time wanted to do a biopsy on the pyoderma site to check for antibiotic senstivity (thank goodness we did this as he required two strong antibiotics) and also did biopsies on the other two areas as she had no idea what this was.

Sabre progressive got worse with MAJOR hair loss and calcinosis cutis outbreaks on the ridge of his back and some on the side. If you view the gallery there is a picture of Sabre with very little hair on.

What we did ...........

Our concern ... and the vets was controlling infections. Sabre was on high doses of antibiotics for I think nearly 3-4 months for the Pyoderma and at the end of this we finally had a diagnosis of cushings and started treatment. In the inital stages I suggested DSMO to our vet as I found info on the web that it had been used to raise the calicinosis cutis to the surface and heal things much faster. However, we can't get it here in New Zealand and the vet was quite surprised that it was used as she said it was a very old product which used to be used on horses ... I think quite toxic as well ... but don't quote me on this! So ... we tried to keep all his calcinosis cutis areas clean and infection free. I used to shampoo with medicated shampoos ... firstly with Pyohex but we found that this irritated his skin ... then another product which I unfortunately can't remember. We used Epiotic to scuff off any soft scabby areas ... carefully so as not to allow bleeds (which did happen). We also used betadine at one stage and the vet also suggested diluted iodine from the chemist as a cheaper option.. We restarted anitbiotics when we were concerned with a dubious spot which we thought might become infected. About four months after starting Lysodren little furry hair started regrowing and then he finally grew a full fluffy coat ... and became the hairest Vizsla in the world!

Be warned ... it does get worse before it gets better - maybe this is why you queried the over production vs reducing the cortisol too much. Once treated the calcinosis cutis raises to the surface. Only one site ever fully raised with Sabre. In the research I did they talked about nodules ... well Sabre did not have nodules he had plates ... the largest of which was about 4cm x 3cm. They never disappeared at all. We were able to control any infections and only ever had one course of antibiotics when treated with Lysodren and this was a preventitive course as we saw one area that was turning a little weepy and decided that instead of letting it get infected that we would start antibiotics. With the medicated shampoo and the cleaning with epiotic ... and later trying betadine ... things healed ... and his coat grew back. We did actually use a T-Shirt on him in the early stages ... one to keep the flies off him and secondly to stop infections when he decided to roll around on his back ... be warned it is and can become itchy for them.

Once his coat grew back we did not have that many issues with his calcinosis cutis. It was just there. He had hard plates over the main ridge of his back and more towards the rear. He had two large calcinosis cutis plates either side of his anal area ... poor boy!! BUT he was happy and it didn't really seem to bother him. From my experience with Sabre ... he was better in the middle of the controlled cortisol levels with Lysodren ie about 2.5 post ACTH test (Lysodren tries to keep the post between 1-5). When we went lower than this or when he went low he became very itchy. When we were off Lysodren completely for four months (when he went too low) I felt that his calcinosis cutis appeared to get slightly worse and so we always tried to keep him in range.

Elly ... sorry for the essay but I hope it is of some help. I have to cook dinner ... and start night shift so I have not had a chance to re-read what I have just typed. So ... please do excuse the typos etc and I will check tomorrow to see if I missed anything out.

Angela and Flynn .... and our dearly departed Sabre

[EllyAugie]

Thank you so much for that information Angela it gives me hope. I am also sorry about Sabre, what a beautiful girl she was..
Augie's place on his neck where they shaved it is about the size of a small plate and it is spreading now under the area that was not shaved up near the ears and down the shoulders. It is so deep and where a roll is in the middle of his neck it is cracking open on both sides of the roll in about 1'' gashes and bleeding. I put some pictures up on the forum under my profile about a week ago it looks worse than that now. We have been washing it about every two days with oxy dex , now he is growling when we touch it and rinse it, he would never bite me he's just saying nooooooooooo it hurts. We have been using mupricon ointment (which was successful on his forelegs) but those places are not nearly as deep or bad as the neck area, he has also been on 200 mg of simpicef for the skin for about 12 days now. I do believe the dose of trilostane he is on now is not enough, (20mg) and that is why this has come about and why I asked that question about the cortisol being to low or to high. Going to test again tommorow with the ACTH stim test and be sure. I am just so happy to know that this can be cleared up with success by getting the meds right and working on this area, I was afraid it was going to cover his entire body and spread. It just seems that Augie is spiraling down. It has been a time for us to get his numbers right with the pre not being too low and the post where it should be. We have honestly tried to do everythng we can in hopes to get him on an even keel. My husband and I love Augie so much and dont want to lose him yet.
Thanks again for your information and love and good wishes to all.
Elly and Augie.

[Sabre's Mum]

Elly you are more than welcome.

I do remember now that yes .... it was quite painful for Sabre in the early stages with loose scabs, bleeding etc. Initially I just dabbed but as time went by and he healed more I would scuff stuff off.

All the best and take care
Angela and Flynn

[EllyAugie]

Hi everyone, we managed to get Augie in for his ACTH stim test yesterday and the results came back today as pre 1.9 and post 7.1 ug/dl. Last night Augie woke me up drinking and drinking at 12:30 pm, I got up to let him out but he had already gone on the floor, his drinking has increased quite a bit lately. We increased his dose from the 20 mg once daily to 30 mg once daily today. We also took him in this morning for another cbc as I was worried his kidneys were failing him from drinking so much, I could actually here it when he walked sloshing back and forth in his stomach like a drum. Good news is he doesnt have diabetes or kidney failure. We took him in two weeks ago for a CBC when the calcinosis cutis outbreak came about. I noticed on his labs today that his PLT's have doubled from 476 K/ul (on 4-1-10 ) to 852 K/ul today, does anyone know what would cause this? His ALKP's have reduced from 1747 to 1667 U/L, we are hoping the dose increase of trilostane will continue to bring that down.
We are doing a hormone panel next week to check his aldosterone levels ??( what i believe I heard the vet say, could be wrong about the word), I'm thinking he said a hormone assay from the Un of Tn, to see if that can shed anymore light on all Augie's symptoms.
He really is not feeling well at all, we believe the two week off of meds actually caused things to get worse for him and caused this outbreak of calcinosis cutis, it is a very nasty looking wound about the size of a dinner plate.
We are hoping and praying he comes around and gets better soon.
Elly and Augie, good wishes to all.

[lulusmom]

Hi Elly,

Chronic infection or inflammation can cause increase in platelets. Excess cortisol can also cause these elevations but I think the more likely scenario is the active infection Augie has going on with the calcinosis cutis. It's possible that Augie's active infection can also be contributing to the elevated liver enzymes. Is he on liver support such as milk thistle and/or Sam-E? If not, you may want to discuss this with your vet. It really does help.

Your vet is more than likely talking about running an adrenal panel to see if Augie's continued problems may be related to excess sex steroids. Trilostane is known to increase these steroids and this will cause problems for some dogs. Trilostane also lowers aldosterone to some degree which is why it is recommended that electrolytes be checked with every acth stimulation test. With the increase in dose from 20mg to 30mg, your vet is following protocol by checking electrolytes next week. This can be done by your vet without sending a specimen to UTK.

Lastly, I just wanted to mention that I was listening to an audio of a lecture on diagnosis and treatment of cushing's given by Dr. David Bruyette and he mentioned that in his practice, they have not had very good luck with Trilostane resolving calcinosis cutis. Dr. Bruyette is an internal medicine specialist and the Medical Director at West Los Angeles VCA Animal Hospital. I would think it is possible for your vet to contact him to discuss Augie's case. Here's a link to contact information:

http://www.vcawla.com/

Glynda

[EllyAugie]

Thank you Glynda, your response is very helpful and informative. I will also ask my vet to contact Dr Bruyette about the calcinosis cutis. He did mention us trying some herb type remedies today, one of the other vets at his practice also is a holistic vet and suggested us contacting him about trying some of those.
I really appreciate your help.
Elly

[EllyAugie]

I'm trying to show you all a picture of Augie's neck today, I wish I could help it heal. At this time I am bathing it every two days in order not to overly dry it out and using baytril drops on it. I had been using the mupiricon but it didnt look like it was healing so we are trying this now.http://www.k9cushings.com/forum/picture.php?albumid=189&pictureid=1478

[lulusmom]

OMG, poor sweet Augie. That looks so painful...my heart just breaks for him. I really, really hope the baytril drops help. The only other dog I remember on the forum with calcinosis cutis, besides Angela's Sabre, was also an EB. I can't remember his name but he had a really severe case which did greatly improve with treatment.

Please keep us posted.

Glynda

P.S. I was wrong about the other dog with calcinosis cutis. She was a Boxer named Sasha and her calcinosis cutis was every bit as bad, if not worse, than Augie's. She's no longer with us (at the bridge) but the last post we got from her dad said that they finally managed to clear up the calcinosis cutis but it did leave scar tissue.

[frijole]

:eek::eek::eek:

OH MY! I wish I could make it go away for you! Augie you poor thing. That looks painful as hell. I hope the meds work fast too. Hugs, Kim

[Sabre's Mum]

Hi Elly

Yes, Glynda was right re the other dog's breed and name. I was in contact with Mike via email ...as he didn't always post. Sascha was on antibiotics for several months ... they consulted with specialists in the field and they feel that a dog with severe skin issues (Calcinosis Cutis) assosiated with Cushings should be on antibiotics because the infection can get worse quickly and the cushings is bad enough to deal with never mind a run away infection. They tried many different antibiotics and the last one that she was on was Keflex. He also washed Sascha with an antibacterial shampoo twice a week. Eventually with treatment for cushings (with Lysodren) and the antibiotics Sascha's calcinosis cutis healed. In Sacha's case her hair did not grow back in all areas due to the scar tissue.

There was also another member who joined and posted right at the start of their cushings journey - a german shepherd cross who had quite severe calicinosis cutis. But we never did hear from them after the inital postings.

Angela and Flynn

[EllyAugie]

We all thank you so much for your wishes that Augie will soon be better.
We had Augie on 200 mg Simplicef which is potent but I was worried that his kidneys werent handling things well because of all the drinking he was doing, (you would think from his ACTH test this week that his cushings was controlled or very close). But the drinking was every bit as bad as when he was first diagnosed, I asked the vet if possibly he was overloaded with pain meds, simplicef etc that and he thought possibly I might be right and said to cut his antibiotics in half (100 mg). We stopped the rimadyl for pain alltogether. Now I am concerned that maybe I was wrong in asking him this about the antibiotics. I am cutting it so close with Augie by increasing his dose again on the Trilostane but I feel his cushings is not under control yet. I am watching is electrolyte panels carefully, but I am afraid. Our vet recommended giving a pinch of salt due to the CI levels dropping a tad low at times which I have been doing and it was better on his test yesterday (110). I have tried so hard for Augie, taken him all over, done every test and I feel like a failure, I wish so much I could get him on an even keel.

Elly & Augie

[EllyAugie]

Was wondering if I am grasping at straws with these findings and even if I understand what it means.
Here is a thought about the Calcinosis cutis, could it be from the salt increase? I have been giving a pinch daily to keep his CI levels from dropping to low
Elly

Pathophysiology
In all cases of calcinosis cutis, insoluble compounds of calcium are deposited within the skin due to local and/or systemic factors. These calcium salts consist primarily of hydroxyapatite crystals or amorphous calcium phosphate. The pathogenesis of calcinosis cutis is not completely understood and a variety of factors allow for different clinical scenarios to occur. Not sure if these are related but sound like they may be.

This is about hypercalcaemia
http://en.wikipedia.org/wiki/Hypercalcaemia

nitial therapy: fluids and diuretics
hydration, increasing salt intake, and forced diuresis.
hydration is needed because many patients are dehydrated due to vomiting or renal defects in concentrating urine.
increased salt intake also can increase body fluid volume as well as increasing urine sodium excretion, which further increases urinary calcium excretion (In other words, calcium and sodium (salt) are handled in a similar way by the kidney. Anything that causes increased sodium (salt) excretion by the kidney will, en passant, cause increased calcium excretion by the kidney)

[lulusmom]

Hi Elly,

Approximately 80% of dogs on Trilostane do great with once daily dosing; however, because Trilostane has a short half life, meaning it's enzyme blocking abilities are short lived, sometimes a once daily dose isn't enough to keep the cortisol down throughout the day. You can expect the Trilostane to start waning any time after 8 hours so symptoms can get worse at night for some dogs. I noticed that Augie wakes you up in the middle of the night so that could be a sign. My Lulu's symptoms did not resolve until her stim was within the 1 - 5 range so it could be that Augie just needs an increase in dose. Since once daily dosing is certainly a lot more convenient and probably more cost effective, I personally would try the increase in dose first. If the next stim is within range and Augie is still symptomatic, then you definitely need to discuss twice daily dosing with your vet.

Angela is our calcinosis cutis expert so I will have to defer your questions to her on that subject; however, I think I'll do a little research of my own to see if I can come up with anything. It's a rare symptom of cushing's and we don't see it very often but having you and Augie as part of our family is motivating me to learn more about it.

Glynda

[EllyAugie]

Thanks Glynda, I was looking at a video online with Dr. David Bruyette, he was mentioning on some dogs that are harder to control the dosing twice daily as you mentioned can prove to be helpful. It may be what Augie needs. I am going to drop by my vets office tommorow and give him Dr. David Bruyette's phone number and email for a consult. I'm excited about this and hope something good happens for Augie.
Much thanks for all your help, I appreciate all of you being here for Augie and me.
Elly

[lulusmom]

Hi Elly,

I do hope you'll let us know what your vet learns from Dr. Bruyette. Ya know, most dogs with cushing's aren't in pain because cortisol is actually a feel good steroid; however, when it causes conditions like calcinosis cutis and bacterial infections that cause so much discomfort, my heart breaks for them. I'll be thinking good thoughts cuz Augie needs some relief.

Glynda

[EllyAugie]

We've started applying 1% silver sulfadiazine cream, Augie doesnt mind this cream at all, I do believe it is helping more than anything else has. This pic was taken right after I washed him this morning, quite an improvement I would say.
http://www.k9cushings.com/forum/picture.php?albumid=189&pictureid=1485
Elly and Augie.

[lulusmom]

I have to agree with you, Elly, that does look a whole lot better than the last pics you posted. I only cringed a little bit this time. :D I hope that it continues to get better every day.

Glynda

[Sabre's Mum]

Hi Elly

I must thank Glynda for her kind remarks but I must say I am not a calcinosis cutis expert ... just someone who owned a dog who had it for over two years. And .... there have not been many.

I really don't have time to post a full run-down of what I understand to be the causes (research on the net) as I have just worked from 7.30pm till 8am this morning and need some sleep!!!!!

So I will pop back one day when I have time to type something for you. Sorry about the delay but with night shift, the kids, the sick pup ... I will try to get back and post!

Angela and Flynn .... and our dearly departed Sabre

[EllyAugie]

Hi Angela, I put on my thinking cap and looked up again the things that could have caused Augie to have this come about on his neck. Your last message prompted me to go back and do research and read the causes in a search again, one of the things mentioned was trauma, ( I believe you mentioned in one of your replys even the site of an injection could cause it) I had read that before but could think of no trauma, no shots, but tonight I thought about back at the end of Jan we had to take Augie in three days consecutively for fluids. I recall after that episode noticing him not wanting to hold his neck all the way up in a normal arch. I thought at the time it was because he was so tired and feeling bad. I now believe the fluids in the neck area he was given (big camel humps) most likely bruised and stretched his skin and this has now manifested. For a normal dog this would have caused no trauma, the fluids were most definitely needed at the time tho. What a mess is all I can say. Now just need to do my best to clear it up.
My vet also told me earlier this week that calcinosis cutis can progress to the point of depositing calcium in his internal organs, compromising their function so it just may be a process that is coming about, I dont know for sure. Both are possibilities tho.
I wanted to say thanks to Kim too for her well wishes for Augie. And thanks Glynda for taking a look at our progress on hopefully healing Augie's neck.
Elly and Augie

[EllyAugie]

Angela, forgot to add on that last post, hope your pup is feeling better soon . Will be watching for you post.
Thanks.
Elly

[Sabre's Mum]

Hi Elly

I initially did research calcinosis cutis when Sabre was confirmed as having it. Initially as to possible illnesses that cause it and then treatment of it. At the time I really did not look at the causes of it except for that it is generally considered to be virtually pathognomonic for Canine cushings syndrome. What I have recently found … from the research it that it can also be caused from elevated calcium and phosphate in the blood … or abnormal calcium and phosphate metabolism. However, the site … sorry should noted them down … said that dogs can have the same amount of calcium or phosphate in the blood and yet one would have calcinosis cutis and the other not. I have discarded Sabre’s hard copies of his results (Flynn’s file is getting larger by the week) but have managed to keep my computer files and I see that at the time of diagnosis Sabre’s phosphate was 3.8 with normal being 0.9-2.8.

I also found an article for human critical care which also stated that it was caused from high serum phosphate and in the treatment for acute hyperphoshatemia is the administration of phosphate binding salts – calcium, magnesium and aluminum … but to avoid the latter if there is renal failure.

Here is a link to a site which also states the calcium and phosphate causation. http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2009&Category=8057&PID=53734&Print=1&O=Generic

Also through my initial research I did indeed find information with regards to calcification internally. Sabre did not have an ultrasound nor an xray with his cushings diagnosis as we had spent a small fortune just clearing up his pyoderma before we started on testing and we just couldn’t afford it at the time. When Sabre did get ill at the end of his life we did undertake an xray and … although maybe not 100% accurate … he did not appear to have any other calicification internally. I have read an article recently which was for an iatrogenic cushings dog which provides a description of the possibility of internal calcification. The link for this is http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657523/pdf/cvj_04_397.pdf There is a possibility - just a gut feeling that Sabre did have some minor mineralisation internally and that was what ended his life but he did also have a heart murmur as well and it could have been a heart valve issue. This article did get me thinking though as Sabre's PCV started to drop and along with other blood results it showed internal breathing .. his breathing became more laboured as well.

I now have a pup (10 months old) that is on high doses of prednisone and has been for the past four months and I see all the cushings symptoms rearing their ugly heads!!! At least ... I have been a cushings Mum so I can readily identify the reasons for things .... he is quite a lot of muscle weakness with splayed front feet at times and weakened pasterns as well. Flynn has developed little lumps and I am dreading that he may also get calicnosis cutis as well. I heard an audio lecture by Jean Dodds and she said that this indeed did happen to an IMHA dog treated with high dose prednisone ...

Good luck with everything and I hope that I have provided you some information which you may find helpful.

All the best
Angela and Flynn

[EllyAugie]

Hi Angela, thank you so much for your research into this. I am looking at Augie's CBC right now and not sure but think the PHOS might be the one you are speaking of. His on 4-14-10 was 4.8, (on his test the norms were 2.5- 6.8). On 4-1-10 his PHOS was 5.9mg/dL...going to go read the link you provided.
Each one of you have been wonderful with your support for Augie.
We are starting a washout period now for a month and going to try Lysodren next.
Thanks again and Angela, I do hope Flynn is much better soon.
Hugs to all.
Will be in touch.
Elly and Augie

[lulusmom]

Elly, I mentioned this before to you but thought I would post it here for others about the Trilostane washout period. Thirty days is the appropriate washout period unless a dog's post acth stim number is clearly above normal and is overtly symptomatic. In other words, if Augie's appetite increased greatly and he was drinking and peeing buckets after only two or three weeks and a stim done at that time shows a post cortisol well above normal, then it should be safe to start the Lysodren loading. My own dogs took longer to become overtly symptomatic after discontinuing Trilostane than when we discontinued Lysodren. All dogs are different though, so you just never know. We'll be standing by for your updates.

Glynda

[EllyAugie]

Hi group, took Augie to the state vet school earlier this week on Monday for his skin (calcinosis cutis) and hoping to be able to switch over from Trilostane to Lysodren sooner than expected. His calcinosis cutis was spreading rapidly and not getting better. He went off the trilostane the previous Monday. Fortunately, they felt we could introduce the Lysodren earlier than the expected. Amazingly, they felt we could clear up his skin with different antibiotics along with the Lysodren. He was given his first induction dose Monday night but by Wed night he was having a head shaking episode which had also occured with the trilostane when he reach a low point with his cortisol levels. We did adminster 15mg of prednisone late Wed night and did not administer his Lysodren medication late Wed night after the episode either. Vet school has been in touch with us everyday and Thursday were instructed to do an ACTH stim test, fortunately we were able to get in and do so.
Hoping Augie gets a good reading today with the results and can be put on a maintainence dose now.
Will let you know how things are later with the results.
Hugs to all.
Elly and Augie

[labblab]

Oh Elly, all fingers and paws crossed that Augie's all set to shift to maintenance dosing now and that his skin continues to clear!!!!!!!!!!!!!!!!!!!!

You are doing everything that can possibly be done for your boy. I can only imagine how stressful this must be for you. You are a wonderful, wonderful mom.....

Many healing hugs being sent to your sweet boy,
Marianne

[EllyAugie]

Thanks Marianne, I am trying so hard.
Just got his ACTH stim test results in from yesterday with the Lysodren.
Pre was <0.7 ug/dl and post was 0.9 ug/dl
The results notes also stated (result rechecked) I assume since it is so low. From looking at these results it appears I did the right thing giving him the prednisone right after I saw the head tremors and it was also minutes before his next dose of Lysodren was due, I was actually putting the lysodren in the pill pocket when I looked over and saw the head tremors.... that is a miracle in itself.
But it appears the lysodren is working.
I am also waiting on the lab results from the culture on his skin, even tho the new antibiotics are helping the odor clear I am seeing new places oozing so I am still concerned.
Thanks everyone for all your support, well wishes, encouragement and prayers.
We will be in touch with more updates later.
Take care.
Elly and Augie

[StarDeb55]

Elly, you absolutely did the right thing, giving the pred. These results are what is called a non-stimulatory result where the pre & post are basically identical. Unfortunately, this also indicates that Augie's adrenals are not producing cortisol at all. I hope that the vet school is having you stop the lysodren as giving any further lyso with these type of results could place Augie in serious jeopardy of an Addisonian crisis, IMO. I would also think that the vet school may want you to put Augie on prednisone for the next several days. What has the vet school said about these results & giving further lysodren?

I have finally seen the pictures that you posted of poor Augie. I was literally speechless. I have had both of you in my thoughts & prayers that you can get this under control & get Augie some relief.

Debbie

[EllyAugie]

Thank you Debbie, I am calling the vet school right this moment, he had no prednisone yesterday at all or today (just the one time around 11pm Wed night), I thought those results looked very low but I am not knowledgeable enough to know exactly the meaning of it.
Thank you so much!!!

Elly

[StarDeb55]

Keep us posted!

Debbie

[EllyAugie]

Debbie, they were just faxed to me a moment ago, I faxed them straight over to the vet school and also put in an urgent call on their voicemail rigth after I read your message.
I will let you know what they say as soon as they get back with me, sitting by the phone waiting as I write.
Elly and Augie

[EllyAugie]

The vet school called back after I called their emergency number. DR there had gotten my call but was looking over the results of the faxed results. Instructions are to keep him on prednisone (15mg) once daily until next Thurs or Friday (to stop the prednisone) two days before whichever one of those days we schedule the next ACTH stim test, also to take him over today for chemistry panel and electrolyte panel. Augie has not gotten since this morning for a drink of water. He drank over a gallon yesterday. At that time they will know whether he is now addisonian or not.
We are at our wits end trying for Augie, I am very discouraged. Just called my husband off the golf course to come home and help me get him in the vehicle to take him over for the chem panel, I can not pick him up and carry him, he's just too big. He did not want to go yesterday for the stim test and moved very slowly, it was all I could do to get him there by myself yesterday.
Talk to you all later, again thank you for your prayers for Augie.
Elly and Augie

[StarDeb55]

Elly, this is good to hear that they are on top of things, I figured they would be. It's really important that the pred be stopped a minimum of 24 hours before the next stim, as they have already told you, because the pred can read like cortisol & give you a falsely elevated result. I meant to ask you earlier if Augie was eating & drinking ok today, but just didn't quite get there. Since you have said that Augie has yet to have a drink today, the electrolyte check is very important. What happens when a dog goes Addisonian, not only is the cortisol affected, but another hormone, aldosterone, which is produced by the adrenals can be affected, if the Addisonian crisis is severe enough. Aldosterone is extremely important as this hormone regulates the sodium & potassium levels (electrolytes) in the body. Proper electrolyte levels are crucial for proper muscle function. Augie not drinking today may be a sign that something is not quite right with his electrolytes. We will be anxiously awaiting your update later today.

Debbie

[jrepac]

Wow, I hope Augie gets better soon...this sounds like a nightmare for you. I was looking at your pix as well; pretty severe calcinosis cutis. My Mandy is dealing w/a minor outbreak of it...it tends to come and go, like acne. Usually, it is not problematic unless it gets infected. A few months ago, she had a little calcinosis "bump" on her upper leg that got cut during grooming. Well, this turned into a bloody, infected mess. 2 weeks on Simplicef brought it back under control. Right now, she has 3 little lesions that I am treating with milk of magnesia, applied topically. This seems to help, but you need to put it on every few days. It eliminated 2 other spots of calcinosis already and we are working on the last 3. Again, these are small and pimple sized, not out of control. But, I did also use it for the infected region on her leg and the size of the legion reduced dramatically. Just shake it up and dab it on liberally.

Jeff

[Sabre's Mum]

Hi Elly

Just have just caught up with your thread ... skim read so I am sorry if I missed something. Yes, the results are low and the also non-stimulatory. Sabre did the same over the duration of his treatment. The vet school appear to have a good handle on the situation.

From my experience with Sabre .... it is REALLY important that you get Augie into range ie. post stim 1-5 with a "stimulatory" result before you start maintenance. By this I mean a 25% increase (found this somewhere relating to addisons when Sabre was low but can't remember the internet reference) between the pre and the post result. Sabre was a medium size dog (25kg) and took 4 1/2 months to go from low to pre 2.35 post 3.73 - this is when we restarted treatment. Some dog's adrenal glands will regenerate a lot faster. We did stim tests initially every couple of weeks then about every week to monitor his cortisol levels.

Take care and keep us updated
Angela and Flynn

PS Did the vet school do an ACTH stim before you started Lysodren and if so what were the results?

[EllyAugie]

Thanks all for this important information and helpful ideas, Augie electrolytes turned out ok so all is well in that dept :)
Angela, I will keep a good eye on Augie watching for that result to come back up before continuing on. The vet school did not ACTH test him ( I did ask) I assume because he had recently had one, was told it wasnt necessary because we would do another very shortly.
I do have another question that I dont understand at all.
My vet did a parathyroid hormone test on Augie on the 24th, results just came in today.
His PTH was low (7.2) reference range 27-155 pg/mL
His Ionnized Calcium was 1.12 ref range 1.24 -1.43 MMOL/L
Calcium 9.0 ref range 8.9- 11.4 mg/dl
My question is does anyone know what role this low PTH (7.2) in cushings plays?
Thank you.
Elly and Augie

[StarDeb55]

Elly, I'm not totally sure but I think parathyroid hormone controls calcium & phosphorous levels in the body. They may be taking a look at this because of the calcinosis cutis, but please refresh my memory, has Augie had either an abnormal calcium or phosphorous result on any of his labs recently.

Debbie

[EllyAugie]

Hi Debbie, thank you for your reply. His calcium and phosphous have bee in normal range. Today his calcium was 8.8 ref range 7.0-12 mg/dL and PHOS was 5.3 ref range 2.5- 6.8
On 4-14-10 his CA was 10.0 and his PHOS was 4.8
Even tho these numbers are in the normal range I do wonder about their ratio to one another.
I understand so little of all of this but trying very hard and have so many questions.
I faxed that low PTH result along to the vet school too. I did try to understand more by speaking to my vet about it today but honestly none of it makes sense to me. It's all so complex.
Elly and Augie

[EllyAugie]

We had renewed hope last Monday after seeing the specialist but our hope is fading. Augie's sking is mineralizing even more spreading further and cracking open in new places. I'm afraid he cant take much more, some tough decsions are going to be made soon.
Augie has been so strong this last month considering all he has been through. We were planning on carrying him up to see the specialist (internal and dermatologist) for another ACTH stim test and skin recheck the end of next week but honestly I am not sure he can stand this much longer. I feel terrible for him and am having the feeling that nothing is going to cure this calcinosis cutis problem, it seems determined to take over. It hurts him and is driving him crazy. The vet at the school has called us everday and said yesterday that most Cushings cases are not difficult to gain control with but Augie has been one of those rarer ones.
I had to get this off my chest, it all hurts me so bad.
Take care everyone and best wishes to all of you in gaining control of this disease with results and good quality of life for your beloved pet.
Elly and Augie

[labblab]

Dear Elly,

I can only imagine how hard it was for you to write these words, and how much it hurts to see Augie in this condition. I thank you so much for sharing with us what all you are going through. This way we can keep you, Augie, and your whole family in our thoughts and prayers. There may not be any other way in which we can help. But I can promise you that tons of healing wishes are being sent your way.

As I said earlier, you've left no possible stone unturned. So whatever decision you must make, I know it will be the right one because it will be made with love and with Augie's best interest at heart.

Elly, I wish there was some way I could reach across the miles and give you a huge hug myself. But please know that you are not alone. And please do continue to update us, so that we may walk alongside you and offer you all the strength and comfort that we can.

Marianne

[Harley PoMMom]

Dear Elly,

My heart goes out to you and Augie and I will be keeping you all in my thoughts and prayers.

We all know the deep love and devotion you have for Augie. You are doing everything humanely possible that you can and what ever decision you make will be made from the deepest love you have for Augie. We will be here to support you...we love you.

Keeping you all in my thoughts and prayers, always.

Love and (((hugs)))
Lori

[Sabre's Mum]

Hi Elly

Ultimately it is your decision but I would like to provide a glimmer of hope. Sabre's condition was not very good either ... new spots erupting ... skin and scabs cracking ... bleeding ... hence the reason for him to wear a t-shirt. We treated with Lysodren ... but be warned it did get better before it got worse. I do have all my posts from the old site in a Word document ... but it is 64 pages long!!!! I have had a quick read and and see that we decided to start a cheap antibiotic (Trisol) soon after we started treatment .. I think for about 5 weeks from recollection. Even two months after starting Lysodren he was still nibbling on his calcinosis cutis but it wasn't bothering him too much. After a couple of months he started to regrow his hair (looking very closely at the fluff coming back!) . Looking through our photos I see that by 20th June ... about 3 months after loading he had a full coat! My posts about the calcinosis cutis pretty much stopped after this but I recall that with the hair growth it became easier to control and eventually we just ended up with the calcium plates.

Maybe your vet school has not treated a case with calcinosis cutis .... it is not a very common symptom of cushings ... and many vets do not see it. My personal belief (and also of my vet's) is that controlling the infection is first and foremost and with the Lysodren treatment it does eventually rectify itself.

As I said Elly ... utimately the decision is up to you.

If I can help any further please ask away.

Take care
Angela and Flynn

[Nathalie]

Hi Elly,

I am so very sorry for what you and your Augie are going through ..

I was digging through my resources and some people seem to have good results in getting their dogs relieve by applying tumeric to help with inflammation and irritation mixed with a bit of water to a smooth gel consistency on the open sores. It is a natural antibacterial and anti inflammatory.
If you consider giving it a try, you would want to get the organic kind in order to avoid additives. Any good health food store should carry it.

It does stain the skin orange so I would imagine it would also stain blankets and carpets .. but you could put a T-shirt on Augie.

Applying it to a small area first to see how Augie tolerates it for a couple of hours might be a good idea. If he tolerates it well it probably can be generously applied to large areas.

I have never had to use this on my cush dog but would have given it a try when one of my other dogs used to scratch himself to shreds but did not know about it at the time.

Keeping you and Augie in my thoughts.
Nathalie

[MiniSchnauzerMom]

Elly,

I am so sorry that you are hurting so badly as well as your sweet Augie. I do understand how difficult and emotionally painful it is to watch when our furkids are struggling with illness and pain. I've got no words of wisdom or medical advice for you (wish I did), just wanted to be here to support you. I'm so hoping things will turn around for Augie. Please do come and get things off your chest and out of your mind as often as you want. It does help to purge!

Give Augie a very gentle kiss from me. You both are in my thoughts and prayers.

Louise

[EllyAugie]

Thank you all for your loving support, this is tearing me apart. I cant sleep anymore and am exhausted it has me so upset.

Your support and understanding has been more than I can put into words, each one of you are such special people.

The problem with Augie is where the mineralization is located, he can no longer turn his head from side to side as the calcinosis cutis shell is so thick and capping his head around, now moving further down his back and under his face and the sides of his face, chest and now going down his front legs. You can pull the hair back and see it or just see the red areas through certain places. At first it turns red, then it swells up, then it splits open. He can only lay in one position now, can no longer lay on his side. I wish I could believe he could make it to when the maintainence dose stops this from continuing but I dont think he can because if everywhere it is red it breaks open and hardens in those places he will not be able to move at all. This is my observation of what the process is and going to be from the other places. My vet mentioned a couple of weeks ago that if this was further down his body rather than where it is he maybe could have managed.

When he does sit up when I am trying to comfort him he puts his paw up slowly as if he is saying help me, please. I try to pet him gently telling him I wish I could make it all go away and he flinches when I touch him now.

My better judgement tells me that this mineralization is determined not to stop. The reason being is he has been controlled pretty well the entire treatment except for the two weeks we stopped trying to give him a break (this advice was given by the vet school at the time) not something I decided, even at that time being off the meds his post only got up to 13. Then we started him right back up and kept going back up to 30mg again. And again with that dose he had the head tremor just like he did with the lysodren this time. For some reason Augie just has not done well with treatment.

This really has been torture on me because otherwise he is mentally ok not confused but obviously slow and in pain. His facial expressions are so very sad.

I love all you too, thanks again for being here for me.
Elly and Augie

[labblab]

Oh Elly. My heart and thoughts and prayers remain with you all. I am beaming you strength to make it through each difficult day right now (each difficult HOUR right now...:o). What a brave, brave boy Augie has been. And how your own heart must ache to see him this way. Please keep on talking to us as you sort things out. And remember, whatever you decide at this point, we all know that your decisions are full of your love for Augie. It makes me so very sad that you cannot physically touch him now without bringing pain to you both. But he knows how much you love him, Elly, just as we do. Don't ever doubt that he knows and feels your love.

Please do tell him for us all what a dear, good boy he is. And know that we will stay right here by your side.
Marianne

[EllyAugie]

We helped Augie cross the bridge today at 7 pm.
I can't begin to say in words how much this special Bulldog meant to us.
He left my arms into God's arms at 7 pm today.
Thank you all for your loving support.
May my most loving friend now be in peace.
Elly
http://www.onetruemedia.com/otm_site/view_shared?p=adb22b82880688e22cbf42&skin_id=701&large

[EllyAugie]

Our beautiful boy has crossed the bridge, he will forever be in my heart. He was pure soul and a heart full of love.
http://www.onetruemedia.com/otm_site/view_shared?p=adb22b82880688e22cbf42&skin_id=701&large
Rest in peace my love.
Elly

[John II]

Dear Elly,

I am so sorry to hear of Augie's loss. :(

Please be comforted by the thought that you did everything you could for him - and that he knew how you loved him.

You've released him from his pain, and now he is at peace.

[Harley PoMMom]

Dearest Elly,

My heart goes out to you and your husband, I am so, so sorry for the loss of your beloved Augie. Your tribute to Augie was beautiful and so very touching, your pictures captured how very magnificent and regal Augie was and one could tell that he was dearly loved.

My heart is truly breaking for you both because I realize the pain the both of you are feeling right now. But hopefully knowing that Augie is in a better place, feeling no pain, and running free will somehow bring you both some comfort.

Please remember we are always here for you, we understand what you are going through, so please do not hestitate to come here any time, any hour and talk with us, we love you, Elly.

Peace sweet Augie.

With Heartfelt Sympathy,
Lori

[clydetheboosmom]

Oh, I am so very sorry. I have no adequate words, but my heart breaks for you. Please know I am thinking of you.

Lynne, Clyde & Bailey

[frijole]

Elly and family - Augie has found peace. I know this had to be hard for you. You truly did everything possible to make Augie's life comfortable. May wonderful memories of happier and healthier times sustain you as you cope with your loss. RIP dear sweet angel Augie. We will miss you. Kim

[StarDeb55]

Elly, I so very sorry. You absolutely did the very best you could to try to get your boy better, & on the road to recovery. I truly believe he knew that his Mom & Dad were doing every they could possibly do for him. I would like to think that when he raised his paw for you, it was his way of saying thank you, & this will all be ok. I know that words are trite right now, but I will be thinking of you & your husband.

Debbie

[Squirt's Mom]

Dear Elly,

I am so, so sorry to hear this about our sweet Augie. He must have been so miserable, though, to have reacted to touch in such a manner.

Tonite, Augie is pain-free, his skin supple and smooth again and he will never know discomfort of any kind again. He will always watch over you with love for all you did to help him.

Our sincerest condolences,
Leslie, Squirt, Crystal, and, our angel, Ruby

[BestBuddy]

Dear Elly,
I am so sorry. You gave Augie that final gift and showed him how much you loved him by helping him on his way. He is now at peace and you life has just turned upside down. Some battles just cannot be won regardless on how much we fight. Augie is now free from pain and I hope soon all you remember are the good times, memories are yours to keep forever.
Jenny

[mytil]

Dearest Elly,

My heart is truly breaking with your's. I have not posted to your thread but had been following. Just yesterday I went through your photo album again when Augie was well and standing proudly with his show ribbon and the great one of you two in the snow. He is well now and pain free because you had the courage to keep the promise we give all our pups.

Please stay with us.
healing (((((((hugs)))))))
Terry

[Casey's Mom]

Elly, I am so sorry to hear of Augie's passing over. You did everything you good but your poor sweet boy was in too much pain. Godspeed Augie, you are a beautiful boy.

Elly please stay with us.

Love and hugs,

[Boxer_lover]

Elly,

I have been following Augie's story. I am so sorry to hear of his passing. I cannot imagine what you are going through. Just know that he is in a better place and that he is in peace. You were a great mom to him and he will always know that.

Wendy, Ben, Elliott, and Olivia.

[bgdavis]

Elly,

I'm so sorry for the loss of brave, strong Augie. He is at peace now and you and your family are the ones left in sorrow.

Bonnie and Angel Crissy

[Roxee's Dad]

Dear Elly,
I was heartbroken to read of your great loss. My thoughts and prayers are with you and your family. You have released him and made the pain yours, I am sure Augie is watching over you.

[jrepac]

I am very sorry to hear of Augie's passing; I am sure you did everything you could.

Jeff

[mypuppy]

Hi Elly,
I am deeply sorry for your great loss. I know as hard as it is to accept, Augie is in a far greater place. My thoughts and prayers are with you...Love you, xo Jeanette.

[zoesmom]

Elly -

My heart goes out to you. It's so difficult to know when they've had enough, but it surely sounds like Augie was no longer enjoying a 'dogworthy' life. To give him that final release from pain was a true gift and the bravest one of all . . . and the very hardest, as we all know. (((Many Hugs))) Sue

[ChristyA]

Elly,
I am so sorry. I watched your video, what a great tribute to your Augie. He 's a handsome boy. You did as much as you possibly could for him even letting him go.
Run free sweet Augie.
Christy

[littleone1]

Hi Elly,

I'm so sorry to hear about Augie. My thoughts and prayers are with you. He'll now be able to run free, and be pain free without any suffering.

[Carol G]

I am so sorry for your loss -- my thoughts are with you.

Carol

[Sabre's Mum]

Elly

I am so sorry for your loss. You knew what was best for Augie. My thoughts are with you.

Take care
Angela and Flynn

[sunimist]

Elly, I am so very, very sorry to hear of sweet Augie's passing. He was truly the champ of champs and my heart breaks for you and the pain you are going through now.

May God comfort and surround you with His peace in the coming days.
R.I.P Augie as you join all our angels in doggie Heaven.

Shelba and Suni

[Spiceysmum]

Elly,

So sorry to hear about Augie, my thoughts are with you. Your tribute was lovely.

Linda and Spicey

[EllyAugie]

Thank you all for your heartfelt condolences for the loss of my very special companion and best friend. You were all here for me night and day, your support helped me get through a very difficult time, I am deeply grateful.
Words can not express the anguish I feel in his loss.
Augie's devotion to me was unmatched, there was not a day in his life that he was ever anything but a dear angel, he was truly a gift from heaven above. With prayers and the support of many wonderful people God gave me the grace to let him go so he would have no more days of suffering.
I know only time now is going to heal me where I can smile again and cherish the wonderful memories he gave us.

In life I loved you dearly,
In death I love you still.
In my heart you hold a place
no one could ever fill.

Rest in peace my dear friend Augie.
Elly Malonee

[lucygoo]

So sorry for your loss.

Gina

[MiniSchnauzerMom]

Elly,

I offer my belated condolences for the loss of your sweet, handsome Bulldog Augie.

Peace be with you Augie.

With deepest sympathy,
Louise

[maggiebeagle]

We are still here for you as long as you need us.
So sorry for your loss.

[Dutchboy]

I am new here, so was not around for your journey through Augie's treatments. I have read every post in this thread...you went the extra mile for your precious baby in doing all you could do and then gave him the gift of love by letting him go ahead. Augie is with God now; you will see him again...he's not gone; just gone ahead. ((hugs)))

[Franklin'sMum]

Elly,

I am so very sorry for the loss of Augie. That was a beautiful tribute to him. Please know that you are in my thoughts and prayers.

With love,
Jane, Franklin and Bailey xxx
________
blonde girl Cams (http://www.girlcamfriend.com/webcam/blonde-girls/)

[bkdice]

Dear Elly,
My sincere condolences on the loss of your Augie. In the little bit I've read in your thread, it's apparent that this pup meant so much to you. May you always carry his spirit with you.
Kind Regards,
Bettina & Angel Niko

[EllyAugie]

Thank you all for your words of comfort, I found them to be such a source of comfort to me in the last week, I read them all several times.
Elly and always Augie

[katiesmom]

Elly,
I'm so sorry to hear about Augie's' passing. I apologize for the delay in posting this....I haven't been online in several weeks now, and I'm shocked to hear about Augie, and Sherry's' Pepper.

May Augie be in peace, and may your heart heal....it is so hard for pet parents, as they are the ones left behind holding all the pain and heartache. I want you to know you are in my thoughts and prayers.

I'd like to think that we will all be reunited with our pets once again in the spirit world.

Once again Elly..so sorry to hear your sad news!
Please take care,
Hugs&Kisses from myself and my katiebear.