Otter our 9 year old Golden

[Dave]

Hi everyone, My 9 year old Golden, Otter, was diagnosed over the weekend with Cushings. My wife and I had a hard time understanding the diagnosis beacause Otter shows no symptoms of the disease.
This all started a week ago in a routine checkup which indicated high levels in Otters liver. The vet indicated it may be Cushings and wanted to do a LDDS test to confirm. It was confirmed that Otter has a benign tumor in his Pituitary gland. The vet recommended we start Otter on Trilostane. After searching the web and discussing with my wife we made the choice in treating Otter as recommended by our vet.
It was a very difficult choice for us to make. After reading the possible side effects that could happen to an other wise healthy member of our family. I just hope that we've made the right choice.

[haf549]

Dave:

Welcome to the forum. You've found a great place to help you through this. The people on this forum are extremely knowledgeable and sympathetic. We've all gone through what your going through.

Other's will be along shortly who will help you through a lot of the technical details of this disease. Cushings is an extremely slow progressing disease and it isn't necessary to rush into any kind of treatment, specially since you say Otter doesn't show any of the customary symptoms. Trilostane in particular, inhibits the symptoms of Cushings and since Otter isn't showing any, I wouldn't rush into anything. As I said, others will be along shortly to help you sort all this out. How was the tumor on the pituitary gland found; through an ultra-sound? Can you post the actual numbers for any test results.

Please don't rush into giving medication until you've heard from others. Trilostane is a great drug if Cushings is properly diagnosed. My baby Kira has been on it for over a year and is doing very well, though we had a rough start originally. Dosing can sometimes be an issue in the beginning. Hang in there.

Heidi

[Roxee's Dad]

Hi Dave,
Welcome to you and Otter. :) We have many members here with many success stories using either the Trilostane or Lysodren.

Please tell us more about Otter. What symptoms led you or your vet to test for cushing's.

What test were performed and could you post the test and results, including the normal ranges?

I am also curious has to how the Pituitary tumor was confirmed. Was there an MRI to confirm the tumor? or just the LDDS?

The others as I affectionately call them have many years of successful experience and will be along to play 20 questions:p The more we know about Otter, the better we can help you sort thru this. If you have Otter's bloodwork, LDDS and ACTH test results, please post them. If not, please ask your vet or receptionist to provide you copies. They should be happy to do so.

Hang in there, the others will be along to help you sort thru this. :)

In the meantime, there is a great resources section here with loads of great information.

http://www.k9cushings.com/forum/forumdisplay.php?f=10

[Dave]

We brought Otter for his routine exam. Which consists of a blood sample along with Urine and fecal sample. The test came back with high level of liver enzymes. I'm not sure what other test pointed the vet to the Cushing's conclusion. The vet suggested on a whole day of blood work, so my wife brought him in early in the am. Three blood samples were taken at 8,12 and 4.
I don't have the actual numbers from his tests but will get them and post on the forum.
Otter is a healthy dog. He's a big teddy bear, 188 lbs. but not overweight. He has been treated for lyme and has had treatment for ear fungus. Other than that he still plays and is active for his age. I've had many dogs but none more active than Otter at this age.

[Harley PoMMom]

Hi Dave,

Welcome to you and Otter from me and my boy Harley. I am so glad you found this forum, altho I am so sorry for the circumstances that brought you here. You have found an amazing group of people who are very knowledgeable about this Cushing disease.

Cortisol is a stress hormone, one of the "fight or flight" hormones, so severe stress and non-adrenal illnesses will cause false positives results on Cushings tests.

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. Not one test can confirm Cushings or the type of Cushings, thats why you need a qualified GP or IMS for this disease.

Now about Otter's liver enzyme's: Among the liver's many responsibilities are blood detoxification, waste removal and bile production to aid digestion. This large gland is involved in just about every process in the body.Unlike other organs in the body, it can regenerate itself. Since Otter does have Lyme disease this will make his liver enzyme levels higher, even the treatment of the ear fungus will cause a rise in the liver enzyme numbers.

It would really help us to see the results of all tests that were done on Otter...the CBC/Chemistry panel with the results and the reference ranges and the units of measurements, just the ones that are abnormal (high or low). All Cushings tests that were done with the results, and the urinalysis results ~ was the urinalysis test done in-house or sent out to a lab? Is Otter on any herbs or supplements?

Remember you are not alone on this journey anymore, we are here for you and Otter. We will help you and Otter in anyway we can, so ask all the questions you want and we will try to answer them as best we can, ok.

Love and hugs,
Lori

[Dave]

I just got Otters numbers faxed to me. Here's everything;

[Dave]

ACTH stim test;

Cortisol pre 8.4
Cortisal 2 1.1
Cortisal 3 2

Senior Screen;
Total protein 7.2
Albumin 3.7
Globulin 3.5
Albumin/Globulin ratio 1.1
ast(sgot) 39
alt (sgpt) 301
alkaline phosphatase 2782
ggtp 41
total bilirubin 0.2
urea nitrogen 20
creatinine 1.2
bun/creatinine ratio 17
phosphorus 3.5
glucose 98
calcium 10.7
magnesium 1.7
sodium 148
potassium 4.6
na/k 32
chloride 107
cholesterol 501
triglcerides 134
amylase 1449
lipase 629
cpk 88
hemoglobin 15.2
hematocrit 46.1
wbc 5.1
rbc 6.55
mcv 70
mch 23.2
mchc 33
platelet 264
platlet est. adequate
neutrophlis 59
bands 0
lymphocytes 30
monocytes 10
eosinophils 1
basophils 0
absolute neutrophils 3009
absolute bands 0
absolute lymphocytes 1530
absolute monocytes 510
absolute eosinophils 51
absolute basophils 0
t4 1.4

[littleone1]

Hi Dave,

Corky and I would also like to say hi and welcome you and Otter.

You have found such a wonderful group of caring, supportive and knowledgeable people. I know I would be lost without them. They've had to hold my hand several times.

I hope all goes well for Otter.

Terri

[Dave]

Here are Otters test results;

ACTH STIM TEST;
CORTISOL PRE- 8.4
CORTISOL 2- 1.1
CORTISOL 3- 2

Urinalysis;
ph 6.5
Specific gravity 1.026

Superchem,Complete Blood Count,T4;
Total protein 7.2
Albumin 3.7
Globulin 3.5
Alb/Glob ratio 1.1
AST (SGOT) 39
ALT (SGPT) 301
Alkaline Phosphatase 2782
GGTP 41
Total Bilirubin 0.2
Urea Nitrogen 20
Creatinine 1.2
BUN/Creatinine ratio 17
Phosphorus 3.5
Glucose 98
Calcium 10.7
Magnesium 1.7
Sodium 148
Potassium 4.6
Na/K ratio 32
Chloride 107
Cholesterol 501
Triglycerides 134
Amylase 1449
Lipase 629
CPK 88
Hemoglobin 15.2
Hematocrit 46.1
WBC 5.1
RBC 6.55
MCV 70
MCH 23.2
MCHC 33
Platelet count 264
Neutrophils 59
Bands 0
Lymphocytes 30
Monocytes 10
Eosinophils 1
Basophils 0
Absolute Neutrophils 3009
Absolute Bands 0
Absolute Lymphocytes 1530
Absolute Monocytes 510
Absolute Eosinophils 51
Absolute Basophils 0
T4 1.4

[Roxee's Dad]

Hi Dave,


ACTH STIM TEST;
CORTISOL PRE- 8.4
CORTISOL 2- 1.1
CORTISOL 3- 2

These ACTH test results do not seem to indicate typical cushing's. I'm sure someone more knowledgeable will be chiming in on these results.

Could you go back and edit your bloodtest results and insert the normal ranges? :o Just on the results that are listed as abnormal high or low.

ETA:
Actually these ACTH numbers scare me a bit. The ACTH test results are actually on the low side. Was Otter on Trilo before the ACTH test? What were the results of the LDDS?

[frijole]

Dave, I am reading at work and can't do research but I agree that the diagnosis is suspect. Treating cushings is not something to rush and I am hoping you haven't yet given any of the trilostane. Do you have prednisone on hand in case of emergency? It is a must... And if it were my dog I would hold off. You don't have any symptoms of the disease.

There are many reasons that liver enzymes can be high. Cushings is just one of them. Again sorry I am at work but just felt the need to chime in. Hopefully other members with time to converse can add to my post.

Hang in there! Glad you found us. Kim

[Dave]

Sorry I wasn't sure what to omit so I just entered everything. Here is what is High and Low;

ALT 310High 12-118 U/L
Alkaline Phosphatase 2782 High 5-131 U/L
Cholesterol 501 High 92/324 mg/dl
Amylase 1449 High 290/1125 U/L
Neutrophils 59 Low 60-70%
Eosinophils 1 Low 2-10%

There were other results that were borderline.

[acushdogsmom]

Here are Otters test results;

ACTH STIM TEST;
CORTISOL PRE- 8.4
CORTISOL 2- 1.1
CORTISOL 3- 2

Those numbers look more like the results of a Low Dose Dexamethasone suppression test (LDDST) than an ACTH stimulation test (where there are usually two numbers and the second number should be higher than the first number). And if they are the results of a LDDST then those results do look to be consistent with a diagnosis of Pituitary Cushing's (cortisol is suppressed to 1.1 at the 4-hour mark and then starts to climb back up again to 2 by the 8-hour mark)

Did your Vet actually do both tests? The LDDST and the ACTH stim?

[Dave]

I'm sorry these numbers are from the LDDST test. Forgive me but reviewing these tests and researching a million different websites leaves one a bit confused.

[acushdogsmom]

*note to Dave:

I've just found your membership in a queue of new memberships waiting to be approved. I have approved your membership now, so your posts will appear as soon as you post them. :)

(Up until just a few minutes ago, a Moderator was having to approve each of your posts before they could be seen on the message board, so they were not appearing immediately in your topic)

[acushdogsmom]

I'm sorry these numbers are from the LDDST test. Forgive me but reviewing these tests and researching a million different websites leaves one a bit confused.That's okay. :) It's definitely overwhelming and confusing at the start - we've all been through it.

[Dave]

Thanks, I'm actually at work but I entered my home email account. So I could not verify.

[Roxee's Dad]

Hi Dave,
Whew, glad we got that straightened out. I was a bit concerned. I'm just reposting the correct results so other members will have an easier time comprehending Otter's diagnosis.


Otter
88 Pound Golden
9 Years Old
Trilostane - 60mg twice a day


So we have the following test performed:

Low Dose Dexamethasone suppression test (LDDST)
CORTISOL PRE- 8.4
CORTISOL 2- 1.1
CORTISOL 3- 2


ALT 310 High 12-118 U/L
Alkaline Phosphatase 2782 High 5-131 U/L
Cholesterol 501 High 92/324 mg/dl
Amylase 1449 High 290/1125 U/L
Neutrophils 59 Low 60-70%
Eosinophils 1 Low 2-10%

And there were other results that were borderline.

[acushdogsmom]

Dave,

Are you sure that Otter has had none of the usual Cushing's symptoms? No increased appetite, increased water consumption, pee accidents, preference for lying in cool places, changes in body appearance (hair loss, enlarged belly), etc?

Because although the LDDS test is consistent with a Cushing's diagnosis, I'm wondering what made your Vet suspect Cushing's, other than the liver enzyme elevations. Those types of abnormal enzyme elevations (alt, alkphos, cholesterol) are common in untreated Cushing's dogs but aren't exclusive to dogs with Cushing's.

[Dave]

It's hard to say what an actual symptom is in a retriever. Everyone that I've met loves to eat and drink and Otter is no different.
We started by keeping a log on his water intake; it was about 9 cups a day. But I did notice he was urinating more often. He would go to the front door at least three to four time between 6-10pm. He's never had an accident. The only real change that I notice in him is that he's starting to get cataracts. As for his apperance, he seems fine. If you look at him from behind he still has a hourglass apperance. He does however beg... But he's begged since he was a pup.
One thing is that he wieghs 88lbs. while he doesn't have a big belly he does appear heavier, but he does have a full coat.

Trilostane 60mg twice a day.

[zoesmom]

Welcome Dave and Otter -

Here's my favorite explanation for LDDS results and as you can see, if you take it one sentence at a time and compare to Otter's, his results are indicative of PDH.

Low Dose Dexamethasone Test (LDDS)
The protocol utilized for this test is obtaining plasma samples
for cortisol before and 4 and 8 hours after I.V. administration
of 0.01 mg/kg dexamethasone. The 8-hour plasma cortisol
is used as a screening test for hyperadrenocorticism, with
concentrations >1.4 μg/dl being consistent with (not confirming)
the diagnosis of Cushing's syndrome. This test is relatively
sensitive and specific, but not perfect. Approximately
90% of dogs with Cushing's syndrome have an 8 hour postdexamethasone
plasma cortisol concentration >1.4 μg/dl
and another 6 to 8% have values of 0.9 - 1.3 μg/dl. The
results of a low dose test can also aid in discriminating PDH
from ACT, using three criteria: 1) an 8 hour plasma cortisol
>1.4 μg/dl but <50% of the basal value; 2) a 4 hour plasma
cortisol concentration <1.0 μg/dl; and 3) a 4 hour plasma
cortisol concentration <50% of the basal value. If a dog has
Cushing's and it meets any of these three criteria, it most likely
has PDH. Approximately 65% of dogs with naturally
occurring PDH demonstrate suppression, as defined by these
three criteria. A dog with Cushing's that fails to meet any of
these three criteria could have either PDH or ACT. However,
if it has two relatively equal sized adrenals on abdominal
ultrasonography, it most likely has PDH.

(If you want to read more on diagnosis, symptoms, testing, etc, this article is in our resource section, on pg. 2, under Vet symposium proceedings, 2006 - Royal Canin) Open it and go to page 15 for more specifics.

Veterinary Endocrinology Symposium Proceedings (2006) (direct link):
http://www.k9cushings.com/forum/showthread.php?t=209

That said, if Otter has no noticeable symptoms - other than elev. liver enzymes, he may still be in the early stages. Many vets won't treat until symptoms are obvious. But you are saying he's been drinking and peeing slightly more. I like the measuring water thing. Did it with Zoe for a couple years, after she started tx as it gives a good way to assess. Nine c./day for an 88 lb dog is not all that unreasonable (good formula is 1 c. day for every ten lbs of body weight). But then you did say that this is an increase from previously. So that could be an indication.

Zoe - a black lab mix who was 9 yrs and 85 lbs at diagnosis - had virtually no symptoms either, other than elev. liver enzymes and lots of drinking and frequent urinary infections. But those latter two things she'd had her entire life. And in fact, she was a puny eater - just the opposite of most cush dogs. Vet only suspected cushings after doing the senior wellness and seeing her elev. liver enzymes - ALT, ALK PH, etc.

In Otter's case, it might be wise to do an acth test next. That used to be popular for diagnosing and it was the only one Zoe had. However, a positive on the acth woud give you added confirmation and also an indication of where Otter's cortisol levels are - which, in turn, will give you an idea of his progress once tx begins. (It is the test that will be used to monitor his levels on tx) The other thing I'd highly recommend is an abdominal ultrasound. This will further confirm the dx. Though it looks like Otter has PDH, it can't hurt to rule out Adrenal cushings - since it is often cureable with surgery and, iin lieu of surger, would require a different tx approach with the drugs. Dogs with Pituitary cushings normally have adrenals of an equal size and usually they are enlarged. ADH dogs have one adrenal larger than the other. It also will give a look at the other organs - liver, pancreas, intestines, kidneys. Liver is often enlarged in a cush pup. Of course, it can catch other unsuspected things too, so it's big bang for the buck.

Trilostane is a good drug and has increased in popularity dramatically since Zoe was dx'd. She was our vets first patient to use it, back in March '06. At the time only about 25% of the members here were using it. Now that number is probably closer to 60 or 70%. But it is still a serious drug and I recommend that you read up on its use and what to watch for, especially in the beginning. Zoe had a rough start on trilo (I hadn't yet found this forum) and we had to keep lowering her dose, all the way down to 40 mg. until she could tolerate it. Then we slowly increased the dose back up over the course of months. So I always like to see vets start their patients out on the low end of the dosage range. That 60 mg bid is reasonable for Otter - but even at that, some of the larger dogs seem to be more sensitive in the beginnning. Zoe now takes a very high dose - 180 mg bid - which is more than the dose that initially made her sick. And there's been a lot of tweaking along the way. So the best thing you can do is go to our resource section and read, read, read. And feel free to ask any questions that come to mind. Sue/Zo

[acushdogsmom]

Dave - if I'm understanding you corrrectly, you've already started treatment right?

Without the usual Cushing's symptoms, or at least in the absence of noticeable symptoms, I think I would have liked to see your Vet do another test or two before starting treatment, especially because iit's always possible to get a false positive (or negative) result when you do only one test. I'm a huge fan of a thorough diagnostic process (ie. doing more than just one test to confirm Cushing's).

The LDDST tells you if your dog is able (or not able) to suppress cortisol production normally. And sometimes the result can even be very suggestive that the Cushing's is Pituitary. (as the results do seem to indicate in Otter's case)

Another diagnostic test, the ACTH stimulation test, on the other hand, can tell you if the cortisol production is elevated, and by how much more than normal. If the dog doesn't have elevated cortisol production before starting treatment, the Cushing's diagnosis would be questionable, and a drug like trilostane (Vetoryl) or Lysodren (mitotane) wouldn't seem to be indicated because both of those are cortisol-lowering drugs. And you wouldn't want to lower cortisol production unless it's too high to start with.

We must also do ACTH stim testing periodically during Cushing's treatment to tell us if the Cushing's medication dose is correct (if the dose is keeping the cortisol production within a desirable target range), but it's also always a good baseline test result to have before starting Cushing's treatment, because it tells you what the cortisol production level is before adding any Cushing's meds to the mix.

With a med like trilostane, if you wanted to know what the "pre-treatment" cortisol production is, even now after you have started treatment, I suppose you could just stop giving the trilostane for a week or two to make sure it's out of the dog's system completely and then do an ACTH stim test to tell you, without the influence of a cortisol-lowering drug, just what the cortisol production rate is

And ultrasound can give lots of information regarding the health of the internal organs and can also give the Vet a good look at the adrenal glands. The appearance of the adrenals can also help confirm a Cushing's diagnosis.

I'm just a bit surprised that your Vet would have you start treatment on a dog who has minimal (if any) Cushings symptoms and with only the increased liver enzymes and a positive LDDS test to go on.

[Franklin'sMum]

Hi Dave,

Welcome to you and Otter from me and my little one Franklin. I'm also sorry for the circumstances that brought you here, but am very glad you found the forum. :)
The knowledge here about Cushings and other illnesses is truly incredible, the people are wonderful and have saved my sanity on many occasions. Really, these are some of the sweetest, kindest caring people that I've (n)ever met :)

Jane and Franklin xx
________
VAPIR NO2 VAPORIZER (http://vapirno2.net)

[haf549]

Dave:

How long has Otter been on trilostane? Have you noticed any lethargy, vomitting, diahrrea, etc. Did the vet give you any prednisone? That's just in case you notice any of the above symptoms. In that case, you would need to give the pred and stop the trilostane. The pred will kick in within a couple of hours.

Heidi

[Dave]

Thanks everyone for your input.
I have started Otter on Vetoryl he's completed three days and I haven't noticed any bad reactions yet. When my wife and I spoke to our vet he assured us it was Cushing's. In fact he is currently treating his own poodle and said Otter was very similar to her diagnosis, No real typical symptoms other than the blood work. He said he was concerned about Otters liver function and what the numbers indicated on the test.
I lost my last dog very suddenly to bloat and didn't want to make a mistake in not treating Otter as soon as possible.
I think at this point after reading the posts and info the site I'm going to call the Vet and see what our options are. I think the ultra sound is probably my next step.

[AlisonandMia]

Hi,

Just one question from me. You mentioned he'd been treated for Lyme - how long ago was that and what is his Lyme status now?

Alison

[frijole]

One from me too! :D I didn't see if you answered this or not but do you have prednisone on hand to give in case of emergency? Thanks! Kim

[Dave]

Otter is currently being treated for lyme. He's half way thru a month long treatment. Also, I don't have prednisone but will ask my Vet for it first thing in the am. I guess I should have really questioned my vet a little more than I did. I thought treating the disease sooner rather than later would only benefit Otter. A lot of the info that I was told by the vet was way over my head and I only relied on what he told me.

[frijole]

Dave, We have all been there... that is why we are quick to react when someone new comes on board... just to be safe. So many of us, myself included, were so stunned with the diagnosis we left with drugs to treat a disease we didn't understand. There is no rush to treat cushings in most cases.

If you haven't checked it out yet, there is a ton of information on the disease, testing, and the drugs in our important info section. It is very helpful as you get up to speed. And of course, you can always ask us questions as well.

You really need prednisone... I am surprised the vet didn't give it... required with both trilostane and lysodren in the event they get too much. It gives immediate relief. Dogs can get into serious trouble if the dosing isn't right so better safe than sorry.... and I would get it tomorrow if at all possible... just to be safe.

Hang in there and you'll be a pro in no time. Kim

[AlisonandMia]

Otter is currently being treated for lyme. He's half way thru a month long treatment. Also, I don't have prednisone but will ask my Vet for it first thing in the am. I guess I should have really questioned my vet a little more than I did. I thought treating the disease sooner rather than later would only benefit Otter. A lot of the info that I was told by the vet was way over my head and I only relied on what he told me.

I think this makes the Cushing's diagnosis suspect. Any non-adrenal illness can cause false positives on Cushing's tests, particularly the LDDS test. Lyme can also be responsible for elevated liver enzymes - and increased drinking and urination as well.

In your position I'd want to get the Lyme and it's treatment well out of the way and then retest (liver enzymes and Cushing's tests) down the track.

The risk of treating a non-Cushing's dog with cortisol-lowering medications far outweighs the risk of not treating a Cushing's dog - at least in the short to medium term. Cushing's is a disease that does its damage over the long term and treating it is seldom something that needs doing as an emergency measure. Many, many vets will take a "wait and see" approach with an essentially asymptomatic (or even just mildly symptomatic) dog who happens to have possibly positive lab tests - and from what we see here this is almost always the best and safest approach.

Unlike a lot of conditions Cushing's seems to be something that is best treated when the disease has become established and stable. You would think that "prevention is better than cure" and catching it early should be a good thing but it really does appear that making really sure it is what is happening, with at least some of the classic symptoms being present is generally best. Dogs (unlike humans) seem to recover remarkably well from having been Cushingoid and an otherwise- healthy dog can be expected to return to full health with treatment even when they were profoundly symptomatic when diagnosed so the downside of waiting and watching and making sure is minimal.

Good luck and keep us posted.:)

Alison

[acushdogsmom]

In light of the fact that Otter is currently being treated for lyme and also taking into consideration that the Cushings-like symptoms are few (if any) - I think I'd agree with Alison and anyone else who may think that it might be wise to stop the trilostane and re-test for Cushing's again after the lyme treatment is done.

Even though Otter's LDDS test result is consistent with a diagnosis of Cushing's (and Pituitary Cushing's in particular) it's possible, I think, that the LDDS test result may have been false positive. I'm not a vet, but I believe that you can get a false positive when there is a non-adrenal illness also going on and "stressing" the dog's system.

It's still possible that Otter does indeed have Cushing's, but if it were my dog, I'd want to be more sure of the diagnosis (ie have the Cushing's diagnosis confirmed with more than just one Cushing's-specific test) before starting to treat with a cortisol-lowering drug and I think it would be best to re-test for Cushing's a little bit down the road, after the lyme treatment is well behind you - when you can be sure that it isn't the lyme causing any elevations or lows in blood test results (liver enzymes, for example) or possibly causing a false positive on any of the Cushing's specific tests.

I hope that your Vet will be receptive when you talk with him and will understand that you are only trying to do the very best possible for your Otter. By reading the Veterinary literature and talking with other Cushing's pet owners, you are just trying to become as educated as possible about Cushing's diagnosis and treatment so that you can advocate intelligently for Otter and become a well informed partner with your Vet in Otter's treatment plan and care, so that you can get the best possible outcome.

In case you haven't found it, here's a link to our Resources part of the message board. There are several pages of articles and links there which you may find interesting and informative (regarding Cushing's):

http://www.k9cushings.com/forum/forumdisplay.php?f=10

There's also one thread in particular that is meant for parents of newly diagnosed Cushing's dogs:

http://www.k9cushings.com/forum/showthread.php?t=180

Looking forward to your updates. :)

[Casey's Mom]

I totally agree and would stop the Trilostane treatment until further review of the situation. . . . You could definitely do more harm than good at this stage.

[haf549]

Dave:

I'm just going to chime in here and second (third, fourth... ) all the other's opinions that you stop the trilostane for the time being. One of our members, Jeanette (Princess' Mom) stopped giving Princess trilostane quite a while back, when she became asymptomatic. Princess still isn't back on the meds.

Heidi

[Dave]

Hi everyone, Just wanted to update you on the latest with Otter. I stopped by and picked up his prednisone and spoke to another Vet, Otters Vet was not there at that moment. She basically told me that she would have reached the same diagnosis just looking at the numbers from his LDDS test. But did think the ultrasound would also be helpful in the diagnosis... Until she told me the price $500!!! I just cannot believe it would be that expensive. None the less, I'm waitng for Otter's vet to call me as he worked all night yesterday. The Animal Hospital is staffed 24/7/365.
Ok so Otter is still on Vetoryl... What I noticed last night was a dramatic decrease in his water intake. From almost approx. 6 cups between 6-10pm down to 3 cups, also he only went to the bathroom once in that time period as opposed to 3-4 times.
For now I'm waiting to hear from his primary Vet to go over all the tests that he has done to date, and basically tell me how and why Otter was diagnosed with pituitary Chushing's.

[Nathalie]

Hi Dave,

I can only agree with what has already been said to not treat ‘possible’ cushing’s at the same time your dog is being treated for Lyme

If your dog is currently undergoing treatment for Lyme it means that most likely he is on an aggressive dose for Doxi for a total of 8 weeks.

I have a pretty good understanding of the possible multitude of Lyme symptoms and some of the negative side effects that Doxi can cause in some dogs. My dog Phillip was previously misdiagnosed and treated for Lyme based on his symptoms eg. hind end weakness, tremors, not being himself, sore front leg, no energy etc. It turned out to be Cushings, not Lyme.

If Otter where my dog I would treat for Lyme only at this point and get him retested at the appropriate time to check his Lyme status. Then I would re-test for Cushing’s via LDDS test and also take into consideration whether or not the dog shows any symptoms.

If you have a dog with an active Lyme infection, receiving high doses of Doxy and give a cortisol lowering drug at the same time you would not be able to know with certainty what a problem might be caused by. Eg. vomiting, lethargic etc. It could mean that your dog is going into crisis because the cortisol is too low, or the Doxi is starting to aggravate his stomach or a symptom of Lyme. Way to risky in my opinion and hard on the dog as he is also fighting a Lyme infection at the same time as dealing with the drugs. Perhaps we don’t have all the information ... because I don’t understand why your vet would want to treat 2 conditions at the same time especially since the Cushings diagnosis is suspect, progresses VERY slowly, and it is way more important to get a handle on the active Lyme infection.

Some excellent resources on TBD’s http://saluqi.home.netcom.com/ticklinks.htm and also great list you can join.

Good Luck and keep us posted,
Nathalie

[Roxee's Dad]

Hi Dave,

I'm not sure you have decided to stop treatment for now so I was re-reading thru your thread, I don't see where an ACTH test was performed before the Trilo was started. The ACTH test should be used to baseline Otter's cushing's treatment and monitor the effectivness of his dosage. Here is a link to a chart for monitoring Trilo treatment via the ACTH stim test.

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/cortisol/cortisol-acth-stimulation-protocol.pdf

Did the vet mention that Otter should have an ACTH stim test performed within 14 days after starting treatment to monitor progress and prevent an addison's crisis? Electrolytes checked to prevent dehydration?

Here is a link to Dechra's (Trilo)recommeded diagnostic protocol (see page 3)
http://www.dechra-us.com/File/vetoryl_diagnostic_brochure.pdf

I am not saying that Otter doesn't have cushing's but as has been mentioned, no one test should be used to determine cushing's and because it takes so long for cushing's to do it's damage, there should be no rush to begin treatment.

When I first joined this group, an experienced member posted to me that he thought there was a "problem" with my insistance on favoring one of the two meds used for treatment. That statement sent my head reeling and I just wanted to cry because I thought it was going to be so safe and a no brainer. I was so sure it was so much safer. After my time here on this forum, I have seen time and again that some of our cush pups and parents suffer because of rushing into treatment, or failure of the vet to follow proven protocols, giving cush pups continued treatment while they were not feeling well.

One of the vet's that I use had told me he had a cush pup. When I asked him how it was going, he told me the pup died. :eek: I then asked what happened and he told me he should have read and studied more before starting treatment.

Dave, we are here to help you and Otter, as you, we want the best possible outcome for him:) Let us know what your vet says. Read more and become Otter's voice and advocate for proper treatment using time proven protocols.

Give Otter some belly rubs from me. :)