Jean and Snickers, 3½ y/o Beagle Chihuahua (Update: Snickers has passed) [Archive] - Canine Cushing's Information and Support Forums

Snickers

02-02-2010, 09:58 PM

Wow! That about sums up the last 10 months of our ordeal!
And after documenting the long ordeal I have posted a book!

Snickers was being a really bad dog one day in late April. He pulled my
leftover plate of food into the chair and was having a session meant for a King. Unfortunately he got caught! In his haste to get away his hind legs hit the plate he was eating from and rather than push himself out of the chair he slid and landed on his right rear leg.

At the time he was extremely overwieght, (my mom loved to give him lots of treats and food from her plate) and was 35.5 pounds. After several opinions and consults it was determined that the best course of action was amutation of the leg as it was broken in 2 places and suspected ligamnet damage. This began a long road of issues. He was found to have a thyroid issue during blood work for
the surgery and started on Levothyroxin.

A week into rehab and his incicion pulled open and was in really bad shape for healing. We had to do reconstructive surgery on the incision and place drain tubes and long term rehabilitation to get him over this ordeal. It was 8 weeks before he lost his stitches!

During recovery he slipped on the floor somehow and injured his remaing knee on his hind leg. The good news was that it was only a partial tear of the cartlidge and complete grounding was possible for recovery. This made the need for wieght loss even more important. 8weeks in the crate with NO wieght on his leg. Needless to say potty breaks were as stressful on me as on him! We could not use the lift n aid as his incision was already a struggle and I had to hold him in my hands for him to potty.

His diet was changed to Science Diet Light from Natures Best to assit with getting the wieght off while he was recuperating. We also treated him with ice cubes versus food snacks! The therapy worked for his leg, he got his stitches out and was adapting quite well. He dropped from 35.5 pounds to 17 and slowly came back up
to 21 as his leg got stronger.

Then came a strange skin calcification on his rump, initial thought was a secondary infection due to all he had been through. Treated and slow slow healing but we got through it.

It's now November and the poor guy has been through hell and survived and is doing well but still has no hair regrowth from his surgery in April. And now has patches of skin issues all down his spine. On more anibiotics and discussion of possible Cushings. While he was really young for this to be thought of as an issue initially the Vet suggested testing just to be sure.

So we do the full panel of tests an 8 hour ordeal and the lab looses the blood draws! Now we have to redo them. In the meantime the patches of bad skin are on his head, his belly and his spine. The day we get a positive diagnosis on the Cushings they also breakout on his front leg, elbow and under the leg (kinda like in thearmpit).

The vet starts him on 50 mg Ketoconazole twice a day for 1 week and then 100 mg twice a day. And a change in diet to the Science Diet Skin and Coat. In addition we give him A1/N Nutritional supplement. After a month we are seeing some improvement and vet was pleased with his progress during follow up visit.
By now the skin on his head, belly and leg are pretty bad and are very slow to heal. It is decided that for these areas the best bet is to surgically remove them. This was done a week ago. Now he has additional bald spots tons of stitches and little to no regrowth of hair from the initial incident in April.

Initially he had issues with water, frequent urination, gulping his food,
looking for food constantly and potbellied. The food issue is actually
improving and he is not finishing his meal all at once. He still drinks alot but with other animals in the house it is tough to regulate if it is less at this pont.

So now we are looking for suggestions and information on how to help him overcome some of the serious side effects of this disase as we treat the disease itself. Is there a better Science Diet food? Is the prescrition I/D diet avalid possibility? (I have found this suggested in a few areas on the net) My prefrence is to remain with Science Diet as I am a merchandising Rep for the company and use my first hand exposure in my work frequently. But if I could find a supplement to this or an alternate selection in the line I would be happy!

I will add that due to ignorance I did not amass a ton of questions and valid test results from the vet. I do have an appointment on Friday for his stitches to be removed and plan to ask for copies of everything. The vet chose the Ketoconazle as first choce due to the issues he faces and taking the least harsh of availabe treatments. I have since done lots of research and found that for most this is not the drug of choice. I would love to hear from anyone with experience on this drug. I have found very little first hand information on this course of therapy for Cushings.

Snickers 3 1/2 year old Beagle Chihuahua mix
20 pounds
Ketoconazole 100 mg 2x's daily
levothroxin 300mcg 2 x's daily
A1/N Nutritional supplement 2 pumps daily
Benedryl 2x's daily (A miracle for the itching)
Science Diet Skin and Coat 1/3 cup 2 x's daily
Tripod since 4/09
Thyroid diagnosed 4/09
Cushings Diagnosed 11/09 PDH
Surgical skin removal due to calcifications 1/25/09

littleone1

02-02-2010, 10:31 PM

Hi Jean,

Corky and I want to say hi and welcome to you and Snickers.

Snickers has been through so much recently. Don't worry about writing a book. The more information you post, it helps eveyone get a better understanding of what is actually going on. This really helps our members to provide feedback.

You have found a very wonderful group of very caring and supportive people who have a wealth of knowledge and experience. Others, with much more knowledge and experience than me, will be along to help answer your questions and give you some good advice.

Terri

frijole

02-02-2010, 10:31 PM

Wow, what a write up! Welcome and glad you found us.... you just hit the jackpot for info on treating cushings!!!!

We are all cush parents and have been thru alot ourselves so our collective experiences will guide you and for FREE! :p

You said the diagnosis was in November - do you have records from the tests? It would help to know which were done and the results.

During the recuperation from the leg issues was Snickers on any form of steroid drugs? Other than the Ketoconazole does Snickers take any other drugs?

Tell us as much as you can, ask questions, and you will find a ton of information in our resources section. Again, you are not alone on this journey! Kim

Oops! Forgot to share my dog is over 16 now and has used lysodren for over 3 yrs to treat her cushings.

Snickers

02-02-2010, 10:42 PM

Thanks for the welcome!

"You said the diagnosis was in November - do you have records from the tests? It would help to know which were done and the results."

When we got the diagnosis I was somewhat overwhelmed and it wasn't just with this. Work, family and the holidays, daughters college graduation and life were doing me in. I did not obtain copies from vet or do much research in the begining which is not normal for me. Now that I have, I can't wait to obtain his results when we see the vet on Friday and I will post them as soon as I can after that. I know it was a full 8 hour testing done and have seen and heard the name but for life of me do not recall what it is. I also know vet waited for results to medicate and change diet as the tests were also to determine if adrenal versus piturutary.

"During the recuperation from the leg issues was Snickers on any form of steroid drugs? Other than the Ketoconazole does Snickers take any other drugs?"

You know, now that you ask there may have been a period of time (short time) where he was and now that you have asked I will have to check on his records. It seems that he may have been for a short time when he first hurt his leg during recovery.

His curent meds and supplements:

Ketoconazole 100 mg 2x's daily
levothroxin 300mcg 2 x's daily
A1/N Nutritional supplement 2 pumps daily
Benedryl 2x's daily (A miracle for the itching)

frijole

02-02-2010, 11:04 PM

Snickers

02-02-2010, 11:27 PM

If it is an 8 hr test it is probably the low dose dex suppression (LDDS) and you are right - it sometimes can determine which type of cushings a dog has. Do you know whether it came back pituitary or adrenal?

It did come back as pituitary

How is the skin issue? I know some here have used the oatmeal baths with some success. I didn't deal with that so I am not alot of help but others will chime in later no doubt.

The skin issue is horrible at best! With the 3 worst areas having been surgically removed last week there is some improvement but we are dealing with the healing process there. He gets his stitches out Friday! The other areas are well into the healing stage and has caused such a loss of hair that he now looks like a designer dog wearing his hoodies and t-shirts to stay warm!

Was a blood panel done prior to the LDDS? Am curious if the liver enzymes were high. Also am curious if diabetes was ruled out. It mimics cushings symptoms and with the weight issues I wanted to be sure.

In April they did a full CBC and diabetes testing prior to his surgery and other than the thyroid everything came back ok. I believe another CBC was done in Nov with the additional blood work for Cushings. It should also have been done last week prior to his surgery as they wanted to ensure his numbers were down before putting him under. I am diabetic so the slow healing was a real indicator there for discussion with the vet before she ruled that out.

His wieght issue was pretty much overfeeding/treating. Once I told my mom she could NOT feed him and stressed how bad it was hurting him he started immediately losing the wieght.

MiniSchnauzerMom

02-03-2010, 12:48 AM

Hi Jean,

Wanted to drop in and say "Hi and Welcome" to you and Snickers. Another who gives ice cube treats. I thought I was the only one! :D

There is a specific skin condition associated with cushings called calcinosis cutis. Sabre's Mum (Angela) posted a picture of Sabre, her Hungarian Vizsla, who had the skin condition when he was diagnosed with cushings. I'm including the link for you, if you want to take a look and see if it is similar.

http://www.k9cushings.com/forum/album.php?albumid=97&pictureid=783

Will be watching for your updates and posting of Snickers lab results.

Louise

Snickers

02-03-2010, 01:11 AM

[QUOTE=MiniSchnauzerMom;24555]Hi Jean,

Wanted to drop in and say "Hi and Welcome" to you and Snickers. Another who gives ice cube treats. I thought I was the only one! :D

There is a specific skin condition associated with cushings called calcinosis cutis. Sabre's Mum (Angela) posted a picture of Sabre, her Hungarian Vizsla, who had the skin condition when he was diagnosed with cushings. I'm including the link for you, if you want to take a look and see if it is similar.

Louise

This could be very similar, however in smaller patches and worsening conditions if that makes sense! The 3 areas where we had them removed, his head, belly and underleg (kind like the armpit) were all in reachable spots where he self cleaned and scratched into some pretty inflamed areas. He also has several black spots (like blackheads) on his belly. I will try in the next several days to get a few good pictures to post. Right now with all the stitches he kinda looks like a frankenstien puppy but we love him even more because of it!

One encouraging thought is that he is healing much easier and faster than when he had is amputation! With all the stitches there are 2 very small spots I am concerned abuot. I did clean him up really good with F3 wipes from the vet again today.

I truely believe that he has had this issue far longer than anyone guesses. All the issues we had when he had his surgery were blamed on his thyroid. And the sypmtoms do mimic each other so I can see where it wasn't tested and diagnosed earlier.

Snickers

02-03-2010, 01:29 AM

Ok I just wanted to also ask another question which is part of what really got me started on this research drive finally!

I have found that diet for cushings is really confusing. Recomendations appear to be

High levels of protein
Low levels of fat
Low amounts of fiber
Low levels of purine
Sufficient potassium and sodium content, especially if the dog is on medication for Cushing’s disease
An adequate quantity of water

So far Snickers appetite has gotten better- IE not wolfing down his food, sometimes walking away and not eating all of it till later.

His water consumption is about the same. Will gulp down 2 cups of water several times a day.

Always wants to lick skin which was never a previous issue, thinking sodium may be too low?

Currently on Science Diet Skin and Coat. Have compared the protien in this to other varieties and it is actually pretty high. 27% I believe.

Nothing helps me to see his measure of potassium and purine. What signs would direct me into knowing that his food is sufficient in providing these levels?

He also gets several skin and coat varieties of treats on a minimal basis.

Due to wieght issues I do have to be careful as with bieng a tripod he has to stay right around the 20 pound range and could stand to lose 1-2 pounds again as the switch in food has allowed him a bit of a gain. The Science Diet Light he was on for 9 months is pretty high in fiber and probably didn't help his worsening condition so we do not want to make that switch again.

I do prefer to stay on a commercial/prescription Science Diet Product and would interested in hearing what others are using with success.

Franklin'sMum

02-03-2010, 07:23 AM

Hi Jean,

Welcome to you and Snickers. I only have a moment to post and my comments are in blue.

I have found that diet for cushings is really confusing. Recomendations appear to be

High levels of protein
Low levels of fat
Low amounts of fiber
Low levels of purine
Sufficient potassium and sodium content, especially if the dog is on medication for Cushing?s disease
An adequate quantity of water

Always wants to lick skin which was never a previous issue, thinking sodium may be too low?Licking can be an indication of a food allergy. You've just changed his diet, yes?

Currently on Science Diet Skin and Coat. Have compared the protien in this to other varieties and it is actually pretty high. 27% I believe.

Nothing helps me to see his measure of potassium and purine. What signs would direct me into knowing that his food is sufficient in providing these levels? Have you tried phoning/emailing the company to get this infomation?

He also gets several skin and coat varieties of treats on a minimal basis.

Due to wieght issues I do have to be careful as with bieng a tripod he has to stay right around the 20 pound range and could stand to lose 1-2 pounds again as the switch in food has allowed him a bit of a gain. The Science Diet Light he was on for 9 months is pretty high in fiber and probably didn't help his worsening condition so we do not want to make that switch again.

I do prefer to stay on a commercial/prescription Science Diet Product and would interested in hearing what others are using with success.
Some members in the US have found that Hills sometimes uses artificial preservatives (BHA/BHT) and these have been banned in some European countries for being suspected of being carcinogens.

Someone more knowledgeable than me will be along shortly, I'm sure. I'm so sorry for the issues you and Snickers have been having. Once again, welcome.

Jane and Franklin xx
________
Lovely Wendie99 (http://www.lovelywendie99.com/)

AlisonandMia

02-03-2010, 08:38 AM

Hi and welcome from me too.

Re the diet, the usual recommendation is simply high, good quality protein and low fat. The protein helps with muscle strength and low fat is mainly because of the increased risk of pancreatitis that can come with Cushing's.

I am guessing the low fiber is probably recommended for an untreated Cushing's dog particularly because of the abdominal distention and enlarged liver - they can certainly get pretty uncomfortable with a stomach full of food and you would think that a lot of fiber would add to this discomfort. I have seen low fiber recommended, but not by all authorities.

The recommendation for low purine is something that appeared decades ago in one researcher's recommendation and seems to have been repeated ever since, particularly on the internet. I don't think purines do an otherwise healthy Cushing's any harm and my dog's vet certainly never said anything about a low-purine diet being necessary. In fact my dog's diet probably was pretty high purine and she was very healthy and happy once her Cushing's was controlled.

If a treated Cushing's dog is going to have problems with the electrolytes (potassium and sodium) as a result of the Cushing's treatment it will be low sodium and too high a level of potassium. I have read that a treated Cushing's dog should not be on particularly low-sodium diet and you may want to steer clear of a lot of potassium-rich foods, just to be on the safe side.

It sounds like the Ketoconazole has probably lowered his cortisol level from the way his appetite has decreased. Is his appetite back to what is normal for him? Have you had an ACTH stim test done since starting treatment to check that this has in fact happened and that his levels haven't dropped too low? Also a dog on Ketoconazole should be getting regular liver-function tests as Ketoconazole can, unlike the other Cushing's meds, be very hard on the liver. Is your vet monitoring Snickers' liver?

Alison

frijole

02-03-2010, 09:20 AM

Alison is right about the diet.. I would worry more about the skin issues than the cushings when considering diet.. except always stick with low fat foods.

Am curious, did your vet explain medication options with you? I only ask because we rarely see Ketoconazole used. If I am right (working from memory here) we have seen it with cases of adrenal cushings and atypical cushings - not pituitary. Just wondering. We have seen dogs have to switch to lysodren or trilostane, often because of the liver issues that Alison mentioned.

Have a great day! Kim

Snickers

02-03-2010, 11:16 AM

Thanks for the information!

Always wants to lick skin which was never a previous issue, thinking sodium may be too low?Licking can be an indication of a food allergy. You've just changed his diet, yes?

Actually I should have been more specific- He is licking us more and more- Trained as a puppy excessive licking was not acceptable and has really had no issues untile he started the meds.

Nothing helps me to see his measure of potassium and purine. What signs would direct me into knowing that his food is sufficient in providing these levels? Have you tried phoning/emailing the company to get this infomation?

Good Idea! I should have thought of that!

I do prefer to stay on a commercial/prescription Science Diet Product and would interested in hearing what others are using with success.
Some members in the US have found that Hills sometimes uses artificial preservatives (BHA/BHT) and these have been banned in some European countries for being suspected of being carcinogens.

Hill's is preserved with "preserved with Mixed Tocopherols and Citric Acid, minerals (Ferrous Sulfate, Zinc Oxide, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite)" I do not think any of the roducts have the (BHA/BHT) but I could be wrong. The above is from ingredient list on Skin and Coat

Someone more knowledgeable than me will be along shortly, I'm sure. I'm so sorry for the issues you and Snickers have been having. Once again, welcome.

Jean

Snickers

02-03-2010, 11:24 AM

Alison,

Thanks for the info! I have added additional questions answers below.

The recommendation for low purine is something that appeared decades ago in one researcher's recommendation and seems to have been repeated ever since, particularly on the internet. I don't think purines do an otherwise healthy Cushing's any harm and my dog's vet certainly never said anything about a low-purine diet being necessary. In fact my dog's diet probably was pretty high purine and she was very healthy and happy once her Cushing's was controlled.

Where is the source of "purine" I have ths far not found a good description or definete source of this nutrient.

If a treated Cushing's dog is going to have problems with the electrolytes (potassium and sodium) as a result of the Cushing's treatment it will be low sodium and too high a level of potassium. I have read that a treated Cushing's dog should not be on particularly low-sodium diet and you may want to steer clear of a lot of potassium-rich foods, just to be on the safe side.

It seems we have found conflicinting information on the potassium. All information I have had seems to state "Sufficient potassium and sodium content, especially if the dog is on medication for Cushing’s disease" So what is sufficient......

It sounds like the Ketoconazole has probably lowered his cortisol level from the way his appetite has decreased. Is his appetite back to what is normal for him? Have you had an ACTH stim test done since starting treatment to check that this has in fact happened and that his levels haven't dropped too low? Also a dog on Ketoconazole should be getting regular liver-function tests as Ketoconazole can, unlike the other Cushing's meds, be very hard on the liver. Is your vet monitoring Snickers' liver?

She has tested but I have not gotten actual results. I will get them Friday when I request a copy of all of his tests.

His appetite is about normal at this point but not wolfed down in seconds and constant scavanging. Still tries to get to the cat food though!

Snickers

02-03-2010, 11:30 AM

Kim, thanks for the answers and info. I have replied to your questions below.

Alison is right about the diet.. I would worry more about the skin issues than the cushings when considering diet.. except always stick with low fat foods.

Obviously due to the wieght factor low fat has been a way of thinking for quite some time. The Skin and Coat he is on may be helping as well but still working on the skin issues. I am looking for any supplemental foods/snacks which might help increase the additional protien and sodium he may need outside of the normal diet.

Am curious, did your vet explain medication options with you? I only ask because we rarely see Ketoconazole used. If I am right (working from memory here) we have seen it with cases of adrenal cushings and atypical cushings - not pituitary. Just wondering. We have seen dogs have to switch to lysodren or trilostane, often because of the liver issues that Alison mentioned.

Once again I have to plead ignorance in the initial stages. Vet explained that there was additional options but it was her opinion that the Ketoconazole was his best bet as it is less harsh to get them started. He already had so many issues my guess is she wanted to try the simpler approach first. She is currently on maternity leave so I will be working with a different vet for several weeks. This is more of the questions I have for them on Friday!

Jean

Franklin'sMum

02-03-2010, 09:45 PM

Always wants to lick skin which was never a previous issue, thinking sodium may be too low?Licking can be an indication of a food allergy. You've just changed his diet, yes?

Actually I should have been more specific- He is licking us more and more- Trained as a puppy excessive licking was not acceptable and has really had no issues untile he started the meds.
Woops, my bad, sorry

Nothing helps me to see his measure of potassium and purine. What signs would direct me into knowing that his food is sufficient in providing these levels? Have you tried phoning/emailing the company to get this infomation?

Good Idea! I should have thought of that!

I do prefer to stay on a commercial/prescription Science Diet Product and would interested in hearing what others are using with success.
Some members in the US have found that Hills sometimes uses artificial preservatives (BHA/BHT) and these have been banned in some European countries for being suspected of being carcinogens.

Hill's is preserved with "preserved with Mixed Tocopherols and Citric Acid, minerals (Ferrous Sulfate, Zinc Oxide, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite)" I do not think any of the roducts have the (BHA/BHT) but I could be wrong. The above is from ingredient list on Skin and Coat

This is from Caz/Teddy's thread, "Teddy-10 year old Havanese-advice diet/supplement
http://www.k9cushings.com/forum/showthread.php?t=1317&page=7

With respect to the BHA, I believe that Science Diet and other low quality foods use this chemical preservative to stabilize the animal or other fats. Good quality foods include named fats are BHT and BHA free. If you have time to cook for Teddy, then my hat's off to you because I barely have time to cook for the hubby and I these days. However, if you'd prefer not to cook, there are many excellent good quality, balanced dog foods out there that are much, much better than Science Diet. Before I switched my dogs to Primal raw, I fed them Natural Balance which is a really good food and they have single source protein foods for dogs with allergies. If Teddy has allergies like my little Maltese, the sweet potato & fish or duck & potato dry food would probably work well. I used to buy the canned and the dry and mix it. All five of my furkids loved it but not as well as they like their raw food. If you want to try a grainless food, check out the foods that are top rated with six stars at www.dogfoodanalysis.com

Glynda

Jean

Hi Jean,

Oh crap, I lost the first quote in the copy/paste. Anyway, it was Christine (Caz) stating that Hills potato and salmon (I think) uses BHA/BHT, but doesn't list it on the ingredients.

If you want to read it, click the link, and Christine's post is #67 and Glynda's reply to it is #68.
BTW, the liver needs protein to help regenerate, and the best source of protein seems to be quality meat, as opposed to a grain based protein, which is harder for pups to digest.

Hope that helps some, and all the best,
Jane and Franklin xx
________
Nevada Dispensary (http://nevada.dispensaries.org/)

Snickers

02-03-2010, 10:23 PM

Jane

Oh crap, I lost the first quote in the copy/paste. Anyway, it was Christine (Caz) stating that Hills potato and salmon (I think) uses BHA/BHT, but doesn't list it on the ingredients.

I think this is actually a Natural Balance Product. Quite some time ago we had Snickers on Natural Balance and he did not do well on it and we put him back on the Natures Best product from Science Diet.

I just did some Nutritional Training with Hill's and I do believe they are now all preserved with a durivitive of Vitamin E naturally. I should be getting some written documentation on this and will do some further research.

Jean

Sabre's Mum

02-03-2010, 10:46 PM

Jean

Welcome from me.

I have just caught up on your thread ... sorry usually read a lot and post when needed but I have my own major issues with our 7 month old vizsla and have been otherwise occupied.

With regards to the calcinosis cutis. Sabre still has lots over his body - mainly down the spine area - slightly either side. Initially they were just a skin malformation - for want of a better word. They then progessed into hard calcium plates and they remain that way today. Once treated on Lysodren more areas came up and only one area rose to the surface and healed. Thankfully his hair has grown back ... just more like a labrador than the short hair of a vizsla.

If you google search "calcinosis cutis picture" you get a few varying degrees of it but it might help you better than my "from a distance" photo of Sabre.

Take care
Angela, Sabre and Flynn

MiniSchnauzerMom

02-03-2010, 11:13 PM

Jean,

The link below (College of Veterinary Medicine, The University of Georgia) contains a picture of a dog with calcinosis cutis and hyperadrenocorticism about halfway down the page (pic #2).

http://www.vet.uga.edu/VPP/clerk/Zwicker/

Louise

Franklin'sMum

02-04-2010, 08:31 AM

Hi Jean,

Ok, my mistake. Just going by what was written. Sorry for any confusion about the branding. How's Snickers doing today?

Jane and Franklin xx
________
Zoloft Settlement Info (http://www.classactionsettlements.org/lawsuit/zoloft/)

Snickers

02-04-2010, 10:41 AM

Hi Jean,

Ok, my mistake. Just going by what was written. Sorry for any confusion about the branding. How's Snickers doing today?

Jane and Franklin xx

Not a problem!!

He is an itchy little guy! It is somewhat funny to watch his antics in an effort to "scratch" his stitches on his head! He knows we watch him like a hawk. So whenever that paw gets ready to go we are on him! He now gets on his back and rolls his head on the floor looking for relief! The other two areas are covered by his sporting cool hoodie! It is quite comical for a dude who does not like being on his back at all.

The Benedryl really helps but we have not been able to bathe him since last Tuesday and with the terrible skin issues he has that doesn't sit to well for him.

He has an appointment to get these out tomorrow morning and I sure it won't be soon enough for him.

Jean

Snickers

02-05-2010, 03:33 PM

Well Mr. Snickers did so well at the vet today! He was able to have all stitches removed and only after 10 days! He does have 3 smal spots that even with after all we did got infected. This is still a very POSITIVE outcome as his last surgery in April of 2009, it took us 8 weeks before his staples/stitches could come out.

The areas of infection helped the Dr to determine that an increase in his Ketoconazle to 125mgs 2x's per day was warrented. This was in addition to the fact that water consumption and peeing has not really came down with the medication thus far.

The remaining calcified skin is improving in all but 1 area which has gotten worse in the last 10 days. We are trying a new treatment. Every day we will treat 1/3 of his body with DMSO (Dimethyl Sulfoxide Gel). This is commonly used with Horses but known to be effective in canines as well. Basically it helps the body reabsorb the calcium, so rather then treating topically to remove it this should help internally to reabsorb the extra calcium. Because he has so much skin that is covered with this in differing degrees of healing each area will be treated every thrid day rather than allow him to take in more calcium then he can use by treating all areas daily. This route will increase the time it takes but will overall be better for him.

For the infection from his incision he is now on Clavamox 125mg 2x's daily and a daily or twice daily as needed scrub with Chlorhexidine.

When I saw his liver panels I was actually able to discuss the issue inteligentlly with the Dr this time! YEAH for this board as I had some ideas on how I would like to go. I have seen several using SAMe and Milk Thistle so I inquired about using these as supplemental. The Vet actually has a product called Adenosyl which has both of these as well as N-Acetyl, L-Taurine, Zinc Ascobate, Milk Thistle, Pyridoxine HCI, B-Complex Proprietary Blend and D-Alpha Tocopheryl Acetate. We are giving him 100mg daily.

As for the decision to treat with Ketocanzole- The group is currently treating 22 dogs of differing ages with Cushings. Of these all but 1 is being treated with Ketocanzole. The other one is on Segline(sp). There are 2 basic reasons for this, one is that to follow up with the ACTH/Stim test is $300 and treating with Milotane is appoximately $1500 a year.

Where I am currently paying $24 a month with the Ketocanzole which will go up slightly with the increased dosage. The Vets are concerned with the cost factor involved and for Snickers the harshness of the other meds due to his age and overall condition from the last year.

Rather thandoing a batterry of tests the plan is to redo the LDDS when we think he is at an optimum dose which is only $78. This is to be determined alot through evaluation on both my input and the vets. It does appear that if we get to aggresive with his dose it will be easier to bounce back within several hours and not as hard on his system. The nice thing is I have a plan at the vets kinda like insurance where I pay nothing for an office visit and recieve a discount on most other services. So I can bring him in as often as I think he needs to be evaluated.

On a side note, if this does not work as a treatment they are prepared to initiate the Lysoderm (sp) if he gets to a point where he is showing signs of setbacks or no improvement. This would be followed up by the vet with inout from some local contacts using this method.

Prior to this appointment I was very concerned with the initial treatment and overall confidence of the vet after all the other cases I have read as well as all the vast amount of information here and on the net. I actually felt very informed and involved in the decisions for his treatment. I owe this group alot for helping me find my way to the right questions so I could get the appropriate answers!

On to the blood work. I am not listing everything here that was within normal ranges. There are way to many and I have already written a book! (Don't want to lose your intrest just yet!)

11/28

PLT (high) 537 Norm (200-500)
ALKP (high) 1706 Norm (23-212)
ALT (high) 638 Norm (10-100)
AMYL (low) 437 Norm (500-1500)
Crea (low) .40 Norm (0.5-1.18)

LDDC

Samp 1 8.6 (1.0-5.00) Norm

Samp 2 DEX 3.9 (0.0-1.4) Norm
(4.5 hours post)

Samp 3 DEX 3.2 (0.00-1.4)norm
(8 Hours post)

Main note I see in this is :

1. Cortisol level less than half the baseline at 4 or 8 hour post-dex is consistent with PDH

2. Cortisol level less than 1.4 4 hours post dex is consistent with PDH

If niether of these conditions are met further testing is needed to differentitate PDH from adrenal tumor Cushings.

PDH or AT Cortisol level suppressed by less than 50% at 8 hours

PDH only Cortisol level suppressed by >50% at 8 hours.

CBC from 1/26

PLT (now)448 Norm (200-500)
ALKP (high) 1196 Norm(23-212)
ALT (high)393 Norm(10-100)
AMYL (norm)585 Norm(500-1500)
Crea (low) .40 Norm (0.5-1.18)

I know the ALKP and the ALT is inreference to his liver. We are going to recheck these in a few weeks to see if the additonal treament helps bring these down further. Not sure what the AMYL is and how we got this down or how the plt came down within range.

Jean and Snickers!!!

Oh my this really is a BOOK!!!

Snickers

02-06-2010, 12:38 PM

Is it normal to see almost immediate results from a slight increase in meds?

Snickers Ketoconazle was upped by .25 2x's daily yesterday. Gave him the new dose last night and again this morning.

When I got home from Bingo last night there was still water in his bowl and he wanted to "play" he now once again has toys all over the floor! Months ago that was a daily thing but it has been awhile since he really wanted to play. He even played tug/fetch a few times before settling down and laying on his favorite toy.

This morning he did not finish his water bone dry again and seems more alert and active.

Jean

maggiebeagle

02-06-2010, 04:30 PM

Happy to hear things are going well. It's always nice to have them playing again.
Virginia and Angel Maggie

frijole

02-06-2010, 05:12 PM

I wish I could answer your question but to be honest, like I said Ketoconazle is seen in about 1% of cases here and so there is limited knowledge. I am hoping someone will be able to answer your question. Typically we see people after they have used it for a few months and are having to switch to trilo or lysodren.

I am hoping one of them can at least chime in... but in the meantime, to the best of our knowledge, the ACTH stim test is the test that is supposed to be used to monitor ketoconazole use (not the LDDS test). Here is some of the veterinary literature:

http://www.k9cushings.com/forum/showthread.php?t=207

(The thread is called "Guidelines for monitoring Lysodren therapy with ACTH stimulation testing (Auburn)" but they also do talk about ketoconazole - there just wasn't enough room allowed to put the wrord ketoconazole in our thread title)

In that thread, you'll see the following:

http://www.vetmed.auburn.edu/uploads/81/83/81830a52bfaaf4c1b889e5e3d20db2a9/Cushings-Therapy-Recommendations.pdf
Auburn Endocrine Diagnostic Service
ACTH Response Testing in Dogs with Cushing’s Disease

Periodic ACTH response testing is recommended in all dogs with Cushing’s disease treated with either lysodren or ketoconazole.
General guidelines for ACTH Response Testing

1. ACTH response testing is recommended after the initial induction period (7-10 days of daily lysodren), then 3 months, and 6 months later. Periodic retests at 6 months intervals are recommended, if the patient is responding well to treatment (earlier if not).

2. “Ideal” values in a Cushing’s dog receiving either lysodren or ketoconazole are pre-ACTH cortisol, 30-110 nmol/L; post-ACTH cortisol, 30-110 nmol/L. In other words, we like to see measurable cortisol levels which do not rise above 110 nmol/L after ACTH. Here's another one:

http://www.k9cushings.com/forum/showthread.php?t=203

or more specifically, within that thread,

Treatment Options for Canine Cushing's Disease
A presentation by Richard W. Nelson, DVM, DACVIM
University of California, Davis
Davis, CA, USA

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2003&PID=6660&O=Generic

Ketoconazole

Ketoconazole, with its low prevalence of toxicity, ability to reversibly inhibit adrenal steroidogenesis, and negligible effects on mineralocorticoid production, is an alternative to mitotane for the medical management of canine hyperadrenocorticism.

Ketoconazole affects steroid biosynthesis by interacting with the imidazole ring and the cytochrome P-450 component of various mammalian steroidogenic enzyme systems.

Dogs seem to tolerate ketoconazole better when the dose is gradually increased over time. In addition, because this drug is an enzyme blocker, twice-daily administration has been necessary for the long-term management of these animals.

The initial dosage of ketoconazole is 5 mg/kg bid, given for 7 days. If no problems with appetite or icterus are noted, the dose is increased to 10 mg/kg bid, given for 14 days.

An ACTH stimulation test should be performed after 10 to 14 days of therapy at the higher dose and while the dog is still receiving ketoconazole.

The goals of therapy are the same as those of mitotane therapy: the lack of an adrenocortical response to ACTH and clinical improvement without illness developing.

If a hypoadrenal response to ACTH (i.e., post-ACTH plasma cortisol concentration of between 55 and 140 nmol/l) is not obtained with a dosage of 10 mg/kg bid, then the dose should be increased to 15 mg/kg bid.

Approximately half of the dogs that respond to ketoconazole require 15 mg of ketoconazole/kg bid to maintain control of the hyperadrenocorticism. Approximately 20% to 25% of dogs do not respond to the drug as a result of poor intestinal absorption. Adverse reactions are primarily a result of hypocortisolism. The dose should be reduced or therapy discontinued if anorexia, depression, vomiting, or diarrhea is observed. Glucocorticoid treatment may be required if an overdose is suspected.

Rechecks, including an ACTH stimulation test, every 3 to 6 months are recommended.

I'm sure there is additional information within our resource section but this at least confirms that acth testing should be done to monitor results. I hope this helps. Kim

Snickers

02-08-2010, 01:15 AM

Friojle

Thanks for the information. I have been doing tons of research on the Ketoconazle and find it difficult at best to get clear and concise information regarding it, ecspecially firsthand.

While it appears to be a less than acceptable method for many it is working wonders thus far for Snickers. Of the 75% of dogs who respond to this treatment there is so little information! I find the same to be true of information for dogs with cushings as young as he is so I guess we will be doing some things by trial and error and somtimes plain out trusting our vet who seems to be having good luck with thier treatment plan.

One of the repeated statements I have found is that although initially the ACTH is recomended, it is not uncommon or an issue using clinical examinations and owner input and opinion in lieu of repeated ACTH testing. So I have found a bit of renewed faith in the vets handleing his care. That said, with all the information and input here I know what to request should I become uncomfortable with this plan of care. I will initiate addtional thyroid checking and keeping a close watch on his liver functions which do appear to be dropping.

So now I need help with a Hot Sheet of information that the family can be aware of and know when to seek immediate help should I not be in town and to reassure myself I know myself what the warning signs are. I plan to post this right with his daily medication and schedule so that it is easily accessible. The list I have thus far:

Warnings of to Low Cortisol

Lethargy
Nonappitites
Vomiting
Diareha

Warnings of to High Cortisol

Excessive thirst
Ravenous Appetite

On another side note I see new hair growth! It's very minimal and more "peach fuzzy" then his normal coat but there is some noticeable hairs on his most noticeable bald spots. If I wasn't applying medications to his skin issues I may not have seen them as they are pretty short! So we have seen lots of encouraging signs and while this is good I am still to apprehensive to get to overjoyed.

Another marked improvement is how well his incisions are healing. I would never have expected this to go so well after our last experience with surgery. Even the areas where he did experience infection are improved to almost healed since Friday.

Jean and Snickers

Squirt's Mom

02-08-2010, 10:24 AM

Hi Jean,

What a good plan to post his meds and signs to watch for in case of problems! Very good idea! Good mom!

It is good to hear that Snickers is showing some improvement and I hope you continue to see even more as the days go by!

Hugs,
Leslie and the girls - always

Snickers

02-08-2010, 11:03 AM

[QUOTE=Squirt's Mom;24952]Hi Jean,

What a good plan to post his meds and signs to watch for in case of problems! Very good idea! Good mom!

I periodically go out of town for work from a few days to a week. I am the keeper of information on the lil guy! LOL So I had to come up with something as I can tell the girls (22 and 16) and hubby (an otr truck driver) over and over what they need to do and watch for. We all know that as soon as your out the door they forget the "DETAILS".

Now I just need to make sure I have all the signs to watch for and I can have this up and available for all to check as needed

Jean

Snickers

02-09-2010, 07:17 PM

I do prefer to stay on a commercial/prescription Science Diet Product and would interested in hearing what others are using with success.
Some members in the US have found that Hills sometimes uses artificial preservatives (BHA/BHT) and these have been banned in some European countries for being suspected of being carcinogens.

Someone more knowledgeable than me will be along shortly, I'm sure. I'm so sorry for the issues you and Snickers have been having. Once again, welcome.

Jane and Franklin xx[/QUOTE]

Jane,

Just wanted you to know that I did go through my contacts to Hill's and asked about these issues and will copy the reply below. On a good note they are also asking thier research vets about our best options on what formula they would recommend.

Hill's Reply RE: BHA/BHT and my request if these were in the food and not included in the ingredients as I checked to see if they were there.

"One detail that goes without saying is that we would never have anything in our foods that is not disclosed. We have the highest quality standards and ethics in the industry. We also produce almost 100% (can't remember if it's 98/99,etc) of our own diets...so a third party can't add anything without our knowledge. Most other companies can't say that. "

Squirt's Mom

02-09-2010, 07:41 PM

Nathalie

02-09-2010, 07:46 PM

Hi Jean,

I know you mentioned that you would like to keep him on a kibble so I checked out the list of ingredients of their so called ‘prescription’ Potato & Salmon Formula

Potato, Potato Starch, Salmon, Potato Protein, Pork Fat (preserved with Mixed Tocopherols and Citric Acid), Soybean Oil (preserved with BHA, propyl gallate and citric acid), Natural Flavor, Dicalcium Phosphate, Fish Meal, Potassium Chloride, Powdered Cellulose, Fish Oil, Iodized Salt, Calcium Carbonate, Choline Chloride, vitamins (L-Ascorbyl-2-Polyphosphate (source of vitamin C), Vitamin E Supplement, Niacin, Thiamine Mononitrate, Vitamin A Supplement, Calcium Pantothenate, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Riboflavin, Folic Acid, Vitamin D3 Supplement), Vitamin E Supplement, DL-Methionine, Taurine, minerals (Ferrous Sulfate, Zinc Oxide, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite), L-Tryptophan, preserved with Mixed Tocopherols and Citric Acid, Beta-Carotene, Rosemary Extract.

Hmm … it looks like they have to throw in a whole bunch of supplements to make up for what is lost during processing and lack of vegetables and spray with pork fat to make it appealing to the dog.
I would also be really interrested how much/little real Salmon and not gill/tails and heads in comparison to the potatos/starch is in this kibble.:rolleyes:
Myself, I am a strong believer in a fresh, grain/soy free, human grade diet with as much variety as possible. Health starts with a species appropriate diet.
I am not surprised that Hill’s does not discredit their own product. ;)

You may find the following article interesting.

http://www.bornfreeusa.org/facts.php?p=359&more=1

Like I said – this is my opinion – ton’s of information out there.
Nathalie

Squirt's Mom

02-09-2010, 08:20 PM

Snickers

02-09-2010, 08:23 PM

Hi Jean,

I fed Science Diet for many years, but no longer will. As I have learned more and more about canine nutrition, Hills just simply does not meet my standards any longer. But Hills isn't alone in that. ;) My dogs did fine on Hills, in fact, I credit it with saving the life of one of my Danes. BUT, fine is no longer good enough. I aim for optimal today, and most commercial feeds are not optimal.

I feed Innova, Eagle Pack, California Natural, Taste of the Wild, Wellness, Solid Gold, and, when I can afford it, Acana or Fromm. For my cush baby, Squirt, I home-cook and soon will be for my ortho pup, Crys. Goldie is my psycho pup and very finicky so her diet varies quite often.

That's my 2 cents worth! :)

Hugs,
Leslie and the girls - always

PS. IMHO, Hills did not answer your question. ;) It was a simple yes or no question - are these things in your feed or not.

They did however put me in direct contact with one of their top DVM's whom I left a message for late this afternoon and am waiting on a call back from. I actually met this guy when I visited the Hill's nutrition center last year and look forward to discussing this issue with him.

I in a perfect world, I would probably look at a home cooked option but I know myself to well and would be getting it done in a "rush" and miss something critical.

Snickers

02-09-2010, 08:25 PM

Hi Jean,

Since Nathalie posted the ingredients, I will go ahead and mention one other preservative very often used in fish products found in commercial feed - that is ethoxyquin.

Check it out. ;)

Hugs,
Leslie and the girls - always

I was just reading that about fish ingrdients used in foods and saw this mentioned. We do not use this as an option at this time as we are currently still using the skin and coat. Thus far this has been working well. The vet did advise that the most important part of his diet should be lower protien of a high quality.

Snickers

02-09-2010, 08:41 PM

[QUOTE=Nathalie;25080]Hi Jean,

I know you mentioned that you would like to keep him on a kibble so I checked out the list of ingredients of their so called ‘prescription’ Potato & Salmon Formula

Potato, Potato Starch, Salmon, Potato Protein, Pork Fat (preserved with Mixed Tocopherols and Citric Acid), Soybean Oil (preserved with BHA, propyl gallate and citric acid), Natural Flavor, Dicalcium Phosphate, Fish Meal, Potassium Chloride, Powdered Cellulose, Fish Oil, Iodized Salt, Calcium Carbonate, Choline Chloride, vitamins (L-Ascorbyl-2-Polyphosphate (source of vitamin C), Vitamin E Supplement, Niacin, Thiamine Mononitrate, Vitamin A Supplement, Calcium Pantothenate, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Riboflavin, Folic Acid, Vitamin D3 Supplement), Vitamin E Supplement, DL-Methionine, Taurine, minerals (Ferrous Sulfate, Zinc Oxide, Copper Sulfate, Manganous Oxide, Calcium Iodate, Sodium Selenite), L-Tryptophan, preserved with Mixed Tocopherols and Citric Acid, Beta-Carotene, Rosemary Extract.

Hmm … it looks like they have to throw in a whole bunch of supplements to make up for what is lost during processing and lack of vegetables and spray with pork fat to make it appealing to the dog.
I would also be really interrested how much/little real Salmon and not gill/tails and heads in comparison to the potatos/starch is in this kibble.:rolleyes:

My understanding of the product is that it is a limited ingredient source product to minimize ingredients associated with skin allergies. By limiting ingredients they are adding supplements to the food for sound nutrition. I am looking at the Potatoe and Duck formula D/D as an option. The issue is that it is not stocked in my market so sourcing it I have to go direct to Hill's. I am a bit more leary on any food containing Salmon or other fish source ingredients.

Jean

Nathalie

02-10-2010, 06:27 PM

This post explains it nicely what a true elimination diet is, it’s purpose and how to .

http://onibasu.com/archives/kn/137565.html

from the above link:

“A true elimination diet is where you feed one food that the dog has never had before, and only that food (no supplements, treats, chews, etc.), for up to 90 days. This is to determine for certain whether a dog has a food allergy, to offer symptom relief for dogs that do have food allergies, and then to determine exactly which foods a dog is allergic to by adding individual foods back into the diet, one at a time, waiting a week in between adding each new item to see if the dog reacts to it.”

“It is important to realize that you should not continue to feed a limited diet to your dog once you have identified food allergies as the source of their problems. Instead, you need to reintroduce other foods, one at a time …”
I think after reading this post you might look at those ingredients in a different way.
Any dog can develop food sensitivity if being fed the same kibble day in day out over an extended period of time – that is where variety comes into play.

If I am not mistaken it has not been confirmed that Snickers Skin issues are due to food sensitivity so it could be due to a number of things eg. vaccination, pesticides . I may of missed it but did your vet ever rule out calcinosis cutis? Dogs with health issues need wholesome food for nourishment that helps them to flourish and not only sustain – if a fresh diet is not for you then Leslie has given you some good kibble choices. Or perhaps this article will give you some ideas as well http://www.b-naturals.com/newsletter/feeding-tips-for-enhancing-your-dogs-nutrition-december-2009/

Like I said – there is much information available aside from manufacturer websites.

Best Wishes,
Nathalie

Snickers

02-18-2010, 01:45 PM

We are going to the vet later this afternoon and I have a question for those of you who have had issues with both the thyroid and cushings.

Snickers has been on medication for Hypothyroidism since April of 09. He began medication for Cushing's in Dec 09. We have seen lots of improvement but there seems to be some recurring issues with urination and and drinking.

These are also signs of hypertyroidism. Somewhere I read that a cushing's dog thyroid issues can be changed when control of the cushings is apparant. I obviously am planning on requesting a check on his thyroid but was curious if others have had experience with this being an apparant effect of having the cushings in better control.

His dosage of the thyroxine has never changed in any previous testing rechecks it has always been fine with the dosage he was on.

Jean

StarDeb55

02-18-2010, 02:05 PM

Jean, the one comment I will make is that any T4 test that come back low on our cushpups needs to be confirmed by a free T4 by equilibrium dialysis. Low thyroid in our pups may actually be due to sick euthyroid syndrome which is due to the cushing's, the dog is truly not hypothyroid. Once the Cushing's is under control, the T4 will return to normal. My vet & I have an understanding that if any of Harley's regular T4's come back low, he is to call his lab & add on the free T4.

Debbie

Snickers

02-18-2010, 02:21 PM

Thanks!

So I am not just spinning info in hy head!!!!

I personally think I am overmedicating his thyroid condition now that the cushings has been diagnosed and treated. I really hope his vet gets back from maternity leave soon! She I want to believe would have tested this last visit when they upped his dosage of ketocanzole!

Jean

lulusmom

02-18-2010, 02:27 PM

Hi Jean,

We've had more than a few pups, including my own, that were diagnosed with hypothyroidism before they were diagnosed with cushing's. A lot of the symptoms overlap so it's not uncommon to normalize the thyroid function and not see resolution of symptoms. A great deal of the time, it is the cushing's that is causing the low t-4 and thryoid function will normalize once the cushing's is under control. My dog, however, has primary hypothyroidism so she will remain on thryoid supplementation. As Debbie already mentioned, it's possible that Snickers had sick euthyroid syndrome and with effective control of cushing's, continuing the thyroid supplementation (levothyroxine) could be causing a hyperthyroid situation.

The first thing you need to do is determine is if the Keto is effectively controlling the cushing's. This can only be determined via an acth stimulation test. Because Snickers is being treated with keto, your vet should also do bloodwork to check liver values. Routine chemestry panels often include measurement of T4 and/or T3 so if Snickers has become hyperthyroid since starting treatment of cushing's, the bloodwork should give you a clue.

I hope this helps.

Nathalie

02-18-2010, 05:24 PM

Hi Jean,

Per Dr. Jean Dodds “if you stop the thyroxine even after years of therapy, it takes 5-6 weeks for the pituitary-thyroid axis to be reactivated to its original capacity [whether low or normal] .“

So once the cushings is under control and you stopped the thyroid replacement you would need to wait 5-6 weeks until you can test thyroid function.

The below info is from Behavioral Issues with Thyroiditis: Theory and Case Review (http://www.k9cushings.com/forum/showthread.php?p=23229#post23229)Dr. Jean Dodds

“While diagnosing thyroid dysfunction in companion animals can be particularly frustrating, especially when used for wellness screening of potential breeding stock, veterinarians may fail to appreciate that a simple total T4 test is usually nondiagnostic. In fact, the in-office testing of T4 has recently been shown to produce unreliable results in 52% of dogs and 62% of cats, and therefore should not be used even as a general diagnostic screening test. Complete thyroid profiling is the most accurate and correct way to diagnose thyroid dysfunction when coupled with clinical information about the animal. “

“Monitoring of thyroid therapy should be performed at 4-6 hours post dose, and at that time the T4 and free T4 values should be in the upper third to 25% above the laboratory’s normal reference range. Rechecking thyroid profiles on animals receiving thyroid supplement is best accomplished by performing the complete profile, and is essential for those animals with autoimmune thyroiditis to determine whether the autoantibodies present are waning. If the client has financial constraints and the case is not thyroiditis, a post-pill T4 and freeT4 will usually suffice.”

My Phillip is hypothyroid as well and I always have the lab check his levels.

What are some things that can affect basal thyroid activity ?
A. Results may be affected by the following:
• Basal levels affected by certain drugs
• Basal levels lowered by estrogen; raised by progesterone
[sex hormonal cycle effects]. Test during anestrus
• Thyroid levels are suppressed slightly (up to 25%) by corticosteroids, sulfonamides, overdosing iodine (kelp), and phenobarbital
• Rabies vaccination within previous 45 days can elevate TgAA by ~ 25%

Nathalie

BestBuddy

02-18-2010, 05:52 PM

Hi Jean,

Buddy had started on thyroid meds a few months before the cushings dx and treatment. After a few months of trilo his thyroid was tested and it showed he needed to be taken off the oroxine. We did a follow up Free T4 at 3 months and 12 months and his thyroid function was in the normal range. So yes any time you add major medications you probably need to keep a check on the thyroid to see what is happening.

Jenny

Snickers

02-18-2010, 07:58 PM

Wow

Great help!

The covering vet was not all that concerned about his thyroid and checked his record and stated that he was due for a recheck in 1 month. I explained that my research led me to believe that we could be overmedicating this condition and the signs of that were present, even though these signs can also be from the cushing's.

To ease my mind they ran the test. They just called the and advised that the "quick results" that they read at the clinic were >7!!!!

She was wowed by the fact that I caught this and pushed for the test as they have not seen this so suddenly in thier other cases. Mr Snickers has to be an original!

So our plan is to gradually decrease his thyroid med's and wean him off the so his body can begin to function on its own. Then 1 month after I have him off of them we will retest.

So I was on the right track! I feel really good right about now!

His skin condition has improved dramatically between the antibotic, the wash and the DMSO we have seen great results.

After lots of research and review and discussions back and forth I have begun a swith to Nature's Best Lamb and Rice food. Right now I am doing 60% NB and 40% SD Skin and Coat. NB Lamb does not have corn or wheat and contains a higher quality protien so I am hopeful this switch will help him as well. He still needs the additional Omega Fats for his skin so I don't want to completely cut out the skin and coat until we resolve all of his skin issues.

He also lost 2 lbs in the last 2 weeks, but we were hoping for that so it is a good thing. I had adjusted the quantity of feed slightly and with the "extra" activity that we have seen returning this covered it well!

Jean and Snickers

BestBuddy

02-18-2010, 08:03 PM

Snickers

02-18-2010, 08:09 PM

Jean,

Good job. Our 4 legged friends don't have a voice so we have to be that for them. I know the vets and specialist have the equipment and resources but we are living every day with our dogs and can tell when something is not quite right.

Well done.

Jenny

Thanks Jenny!

It does give me that "feel good feeling" that for my guy I was right on track! I still don't recall exactly where I initially read that this could be a concern, so earlier today when I tried to find what I had read I was a bit lost but sure of myself in my belief that this needed addressed

Jean

Nathalie

02-18-2010, 08:15 PM

Snickers

02-18-2010, 08:18 PM

Snickers

02-18-2010, 08:25 PM

Jean - it does take 5-6 week after you stop supplementing with thyroid replacement before production goes back to original capacity. If you test any sooner I would be concerned that the result is not accurate.

More info can at the link from my previous post.
Nathalie

Nathalie,

She wants to wean him down very slowly because of the high readings and he is due for some other routine testing in about 6 weeks, so I will make certain that he has a check again at 5-6 weeks after dosing has stopped. Thanks for making certain I understood that because there is a bit of overlap there!

Jean

Nathalie

02-18-2010, 08:49 PM

Snickers

02-18-2010, 09:00 PM

Forgot to mention ...
If you have not had a full thyroid panel done, when you recheck it might be a good time to do so. I used Hemopet (http://www.hemopet.org/) (Dr. Jean Dodds) to run the panel. Most labs do not differentiate between age, size, breed in their 'ranges', Dr. Dodds does and she will also write up a report and give treatment recommendations – lots of bang for your $ in my opinion.
Nathalie

I will keep this in mind!

One thing that now makes sense is how even on the thyroid medicine none of the symptons that initiated the initial test had truely gone away. Some did improve but the skin and hair had not improved at all until we started treatment for the cushing's. So in researching I have a suspison that the sick euthyroid syndrome is most likely where he was in April when the vet first diagnosed him as hypothyroid.

Seems every couple weeks I am researching something new and getting to a better understanding and diagnosis on the dude!

Sabre's Mum

02-18-2010, 09:19 PM

I have to concur with Nathalie - Jean Dodds at Hemopet is brilliant. She has helped me out with my younger Vizsla's IMHA issues after someone recommended her to me.

All the best
Angela, Sabre and Flynn

Snickers

03-23-2010, 06:30 PM

Ok I am sitting here totally stunned and not sure where to turn....

Snickers had been doing very well, hunger controlled, drinking controlled, hair regrowth progressing, overall skin condition improving----Overall doing very well.

He had some strange breathing going on last week so we went to see the Vet and there did not appear to be any internal issues, thought control of the cortisol may be letting allergies bounce around that we hadn't dealt with.

Went on antibotics and a better antihistimine. Took him in for a follow up and DR had a surgery getting started and asked me to leave him so she could run some xrays as he still had some funky breathing going on.

Just had a call from her. What appears to be calcifications, just like on his skin, seems to now be showing up in his bronchial tubes. Could be from Cushings, could be from cancer.....Sending xrays out to a radiologist for follow up. Should have more details in next 24 hours.

Needless to say I am stunned.....

She did discuss that should they determine these are calsifications due to Cushings we will need to switch him to Trilostane....Not sure I can afford the testing that goes along with this change.

Poor guy has gone through so much since April of 2009 when he had his leg amputated and our journey from one set back to the next started....

lulusmom

03-23-2010, 07:54 PM

Hi Jean.

I am so sorry to hear that you have been dealt another worry with Snicker's last trip to the vet. I know this is easier said than done but try not to worry until you have something to worry about. I'm keeping my fingers crossed that this is something that can be resolved with treatment. I am curious as to why your vet thinks that if this is a case of bronchial calcification, you will need to switch to Trilostane. Can you find out and report back on your next update?

You've got plenty of prayers being said and positive thoughts being sent your way.

(((Hugs)))
Glynda

Snickers

03-23-2010, 08:41 PM

Ran into vet, she was leaving as I was arriving to pick the due up. They ran some blood work along with the xrays.

The ALKP is now 1993 23.00-212.00 is normal this was previously going down

ALT is now 690 10.000-100.000 is normal. This as well had previously been going down

Also, I missed mentioning in earlier post as I was totally in oblivion....He has been licking at his feet and has sores on all 3 paws now. Even though I spray with Stop Chew it doesnt phase him.

This in addtion to the new calcifications has her basically certain that although he appears to be doing well from all outward signs with Ketoconazle she thinks internally it is not doing the best job.

She told me as she was leaving she is trying to find a cheaper route for the ACTH Stim testing. Right now the cost is stated at $350 for the clinic but she knows there are some options to cut the costs.

So I am trying to figure out where to even start on pricing and sourcing Trilostane. Best case scenario is that these are from the Cushings and treatment is even a tighter control then what we appear to have on the Ketoconazle.

Jean

littleone1

03-23-2010, 11:01 PM

Hi Jean,

I'm sorry that Snickers is experiencing these problems.

Corky's stim test is $250.00, which is slightly higher, as his IMS has to use Cortrosyn instead of using the gel when doing his tests.

Corky has been on Trilostane for 5 months now. I didn't find the treatment hard to monitor. I was more afraid of Lysodren.

Depending on the dosage, if it has to be compounded like Corky's does, I get it from Diamondback Pharmacy. I recently got a 90 supply for under $35.00. They have a standard mailing fee in the US, which is only $4.00.

I hope this helps.

Terri

Snickers

03-23-2010, 11:17 PM

Terri

Did you have to have a script for it first? How long did it take to get there after placing the order?

Ya know as soon as she says that this is our course then I will want to act immediately. I also am curious as to thoughts of "loading" since he has been on Ketoconazle since December.

I have found some information that cushings can cause these in the bronchail tubes as well as on the kidneys and bladder so it does seem like the vet is headed in the right direction.

Jean

lulusmom

03-24-2010, 12:16 AM

Hi Jean,

Ketoconazole is really, really tough on the liver and it's more likely that it is the ketoconazole that is causing the big increase in the liver enzymes. Plus, it is very possible that the ketoconazole is just not working so the cortisol is going unchecked. The profound effect on the liver and questionable efficacy are the primary reasons why ketoconazole is rarely used any more.

There is no loading with Trilostane. It is given once a day in the morning with food. Because Trilostane has a short life, it's enzyme inhibiting abilities don't carry through the night so some dogs never see a resolution of symptoms and must go on twice daily dosing. I have one cushdog that did fine on once daily and one did great on twice daily.

If your vet does not treat a lot of cushingoid dogs, she may not know that she doesn't have to use a full vial of cortrosyn, which is the stimulating agent used for the acth stimulation test. Cortrosyn comes in a .25 ml vial which is equal to 250 micrograms. Your vet only needs to use 5 micrograms per kg for the test. So if Snickers weighs 20 pounds, that's about 10 kg, so your vet would only need 50 micrograms for each acth stim test. She can split the rest of the vial into syringes, label them with Snicker's name and refrigerate for up to 30 days and freeze for 3 to 6 months. In other words, you could get 5 stims out of one vial of cortrosyn. That should cut the cost considerably so be sure to discuss this with your vet.

I hope this helps.

Glynda

frijole

03-24-2010, 12:19 AM

Jean, Maybe someone here knows but you want to make sure you ask the vet to check into the wash out period between drugs. I don't know how long Keto stays in the system but when switching between lysodren and trilo you have to wait 30 days to switch drugs to make sure all the lysodren is out of the system. Kim

littleone1

03-24-2010, 08:49 AM

Hi Jean,

You do need a script for the Trilo. I live close by, so I just get mine delivered to the house. I'm not sure how long it would take for a delivery. I'll get the toll free phone number for you, and you can give them a call. They also have a website.

As has been mentioned, there is a 30 washout period when switching between Lyso and Trilo. I don't know about the Keto. If you will be switching the meds, please check with your vet to find out if there is a washout period of time and how long it is.

Terri

littleone1

03-24-2010, 09:10 AM

Jean, the toll free no. is 866-646-2223. Their web site is www.DiamondBackDrugs.com.

Terri

Snickers

03-24-2010, 08:38 PM

Terri

Thanks for the info.

If I understand correctly Ketoconazle has a relativly short life in general. So I will be sure to check for any waiting period once the decision is made. Right now I am keeping him on his meds as previously prescribed.

I hate the waiting game.....wanna know and wanna know now is usually how I operate best. I have done some research and found minimal information but it does appear that this can happen as a result of the cushings. However what I have read also states that prognosis is not very good once it has made it to this stage.

So I decided I needed to just quit reading for now, wait for the Radiologist Report and possibly an appointment for a specialist and then go from there.

I couldn't go out to work today and I know the rest of the week will be horrible! How do I acknowledge all those healthy pets, when it seems like my heart is right on the verge of losing my bestest friend? I work in and out of Pet stores all day......

Jean

Jean

littleone1

03-24-2010, 10:19 PM

Hi Jean,

You are very welcome.

I totally understand about the waiting game. I'm still doing the waiting game, waiting for Corky's full adrenal panel test results.

I know how you feel about reading so much information. I totally got burned out for awhile, and I really needed to take a break.

I'm wishing you and Snickers the very best.

Snickers

03-27-2010, 11:32 PM

Well it has been a long week but we have a new plan!

As much as I hate the idea of Trilostane we are moving Snickers to it as it seems to be his best bet right now. I worry about going to far with this medication and going to far in the wrong direction and he is so young!

Vet sent his xrays to a radiologist specialist, can't recall what she called him. He concurs that the spots on Snickers bronchial tubes appear to be calcifications consistent with the cushings. While this condition can have a very harsh prognosis they believe that this has been caught in the early stages and not caused pulmanary issues which is where the poor prognosis comes from.

So we are going to proceed to change his meds to Trilostane dosing am and pm. Vet has decided that we will wait till Wednesday to begin this switch as I dosed my last pill yesterday evening of the Ketoconazle. I could easily get this from Walmart so having to order the Trilostane is going to be nerve racking as I know I tend to forget until the last minute with my own meds and have done so with his. They are a phone call away and at most a 30 minute wait so going mail order for this is going to take some adjustment. Gotta find a new routine!

The good news is she is "stepping" outside the norm to help me with the cost of the ACTH Stim testing. I was originally told around $350 per test. So I am going to purchase the actual med they inject, it will remain at the vet and provide multiple doses. It will cost me $40 a vial. Then $45 for the draw. She is still working on the actual lab costs. Overall though this will hopefully allow her to provide me a huge savings over the initial costs as I know that $350 is just out of my reach.

He will have his first ACTH Stim test done a week from Thursday. So what do I truely need to be concerned with on the Trilostane? I know the inappetite, diareaha, muscle weakness, and lethargy are all concerns with this med.

Do I need prednisone on hand for adverse reactions?

How long after the first dosage do you normally see any adverse reaction?

Should this be given with food or before/after food? The Keto I always dosed after meals as I judged how he was doing by how well he ate.

What is your supplier and average cost for this med? The Keto has run me about $28 a month so I know this will be more.

Thanks!!!

Jean

littleone1

03-27-2010, 11:57 PM

Hi Jean,

I personally feel better treating Corky with Trilostane than with Lysodren. He's been taking Trilo for over 5 months now. He had to have his first stim test after 10 days. The next stim was done after 30 days, and then after 3 months.

I, myself, would be concerned about the switch in such a short period of time. From the information I've gathered and received, a normal washout period would be 30 days.

You might want to get some additional information on this. I hope everything goes well.

Terri

lulusmom

03-28-2010, 12:26 AM

Jean, can you tell us how much Snickers weighs? You've probably told us before but I don't want to go back and reread your entire thread. Also, what dosage has your vet prescribed for Snickers? My 7 lb Pomeranian started on 15mg twice a day and did well on it. You need to keep watch and discontinue dosing if Snickers quits eating, vomits, has diarrhea and is extremely lethargic. A lot of vets don't prescribe prednisone because Trilostane has a short half life, meaning it's enzyme blocking abilities start to diminish after 8 hours or so. Dogs normally rebound just by discontinuing the dose; however, I always kept it on hand just in case. Your vet probably won't mind giving you a few pills.

My best advice for pricing Trilostane/Vetoryl is use the toll free number for Diamondback that Terri provided. Ask for Mike or Roy and tell them you are member of this forum and ask for pricing. They are the owners, are super cooperative and are familiar with our forum.

Glynda

Snickers

03-28-2010, 07:05 AM

Glynda,

Snickers is currently at 23 lbs. He fluxuates between 20-23 lbs off and on for some reason!

She hasn't given me the dosage yet! I know this sounds bad, I pushed for answers yesterday during very busy clinic hours. She was great about returning my call, but i missed getting that info from her. SHe gave me a 800 number to call on Monday to order meds for the first round, she is calling the script into them. I believe it is most likely a local pharmacy as she told me if I order on Mon I will have by Tuesday. I will get more info when I stop in on Monday. So once I have info I can begin shopping around.

I couldn't wait patiently any longer for info! Results came in Fri evening (which I found out yesterday) and I was a believer that no news was bad news.

Jean

Soo many questions, it;s kinda like starting all over!!

Snickers

03-28-2010, 07:09 AM

Terri

I'm going to talk to Vet again about the washout period and see what I can find. I hope it's ok to get going quickly.

I know the goal is to get things changing quickly to keep these calcifications from progressing any further.

Jean

Snickers

03-30-2010, 01:15 AM

Ok after some research and advise back I have found that a washout period for going from Ketoconazle to Trilostane is really not required due to the short half life of Ketoconazle. Snickers last dose was Fri pm, so he has been untreated for several days and we are already seeing some changes.

Trilostane was ordered today and should be in Weds morning. $57 for a 30 day supply! Once his ACTH is done I will be able to start pricing once I know what initial maintenance dosage is going to be. Starting off with 12.5 2x's daily.

His wieght does seem to fluxuate 20-25 ls and was last wieghed at 23lbs. However as his breathing issue continues his activity level is getting lower and lower and his appetite is increasing since being off the Keto. i'm sure his wieght is up a bit. In the last year he has gone from 35.5 lbs to 17lbs and is at his best around 22-23 lbs as a stable wieght but it is pretty tough keeping him there right now.

Getting him down to 17lbs was tough, but since his hind leg had been amputated and his remaing leg injured we really had to drop him down to build up his leg from injury before we could get him mobile without as much concern for reinjury.

So Weds evening will be first dose and I will be out of the house early Thuursday morning so its going to be rough until I get back home. Should only be gone 3-4 hours so I most likely will delay second dose till I get home.

I don't like the idea of this medication and it scares the crap out of me. I know many here use it, but we have had sooo many setbacks in the last year and I have handled each one with the let's get through this attitude and this time I just see so many obstacles to overcome. There is the concern of when is enough enough... It just won't go away!!!!

Jean

littleone1

03-30-2010, 06:57 AM

Hi Jean,

I'm glad you'll be able to start Snicker's on the Trilo. Corky will be starting his new dosage today of 25mg once daily. He currently weighs 17.7 pounds. It seems like your vet is starting Snicker's on the lower dose, which is 1mg per pound.

I know that your scared, but I'm hoping that all goes well with the treatment.

Terri

Snickers

04-11-2010, 11:16 AM

Snickers has been on Trilostane now since 3/30/10 12.c mg 2x's per day. He isscheduled for his ACTH on 4/16.

I have noticed some slight hesitation when he approches the 2 steps coming inside. Each step is about 8-10". Lastnight after coming up the steps he sat down and has not stood up on it since. He was out exploring in the yard quite a bit yesterday and was more active then he has been in a while. He did not stumble or fall or anything, he just sat down and has not stood since. He has had a previous partial cruciate injury to this leg in his knee shortly after his amputation. Then he would try to walk , and beared wieght on his leg. This morning he won't even drink or urinate. He has eaten though.

He has kept his leg out striaght but doesn't act like he is in pain. I did give him a doggie asprin as his joints in his front legs have been swollen from another outbreak of the calcionouses (sp).

Since he has already lost one hind leg we don't have alot here to work with. I have read where others have had issues with hind leg weakness and am concerned that he is not tolerating the Trilostane. I know in my heart that he can't tolerate another surgery, the Cushings seems to be advancing even with the medications.

I am taking him to the this morning but was hoping someone may be on between now and then who might be able to offer some first hand experience.

I am afraid that today will be the day I have to make that decision on whether to proceed at any cost or finally let him rest in peace.

Jean

Harley PoMMom

04-11-2010, 11:22 AM

Jean,

I think the twice a day dosing might be too much for Snickers. Maybe if you lowered the dose and only gave it once a day Snickers would feel much better...JMO.

Love and hugs,
Lori

labblab

04-11-2010, 12:12 PM

Jean, I agree with Lori that it may just be the case that Snickers' trilostane needs to be adjusted -- that he is overmedicated right now. Before you make any irreversible decision, I urge you to wait until you can check the status of his cortisol level. Aside from not wanting to stand up, does he otherwise appear to be normal? Will he eat and drink?

Marianne

Snickers

04-11-2010, 02:08 PM

It truely is a sad sad day here.

Snickers tore his knee out, I found a mass/knot on his jaw while at the vets. Another large patch of calsinosis in the skin on his neck forming. His breathing got really bad again in the car.

So we had to make the ultimate sacrafice and let him pass on to a place where he can once again chase butterflies and breathe without issue while suffering no more pain.

he was my buddy, my companion, my bestest friend and some days the only living thing I had contact with oustside of work. Walking back in the house without him damn near brought me to my knees.

Jean

Snickers

04-11-2010, 02:16 PM

Marianne

He wouldnt drink or urinate. His cruaite (sp) was complety torn this time and his breathing was shallow at best, but painful if he tried to take a deep breath.

Spots on his lungs from the calcifications showing up on xrays and we just had to let him go. I gave him a bath last night and brushed him out and found the "hard skin" of new calcifications forming which was evidence that this condition was way further progressed then even I was allowing myself to accept.

Jean

Harley PoMMom

04-11-2010, 02:44 PM

Oh Jean,

I am so sorry for your loss, the decision of having to let them go is never an easy one, but it is one that is made with deep love and devotion.

Please know that we will always be here for you, and please do let us know how you are doing.

With Heartfelt Sympathy,
Lori

frijole

04-11-2010, 03:06 PM

Jean, I too am saddened by the loss of Snickers. You did the right thing and I hope that all the wonderful memories of a younger, healthier Snickers sustain you as you mourn the loss. Please know you are always welcome here and we'd like to hear from you when you are up to it. RIP dear sweet angel Snickers. Kim

MiniSchnauzerMom

04-11-2010, 03:20 PM

Jean,

I was saddened to read your post about Snickers and am very sorry for your loss.

Peace sweet Snickers.

With Sympathy,
Louise

Roxee's Dad

04-11-2010, 03:44 PM

Dear Jean,

I am so very sorry for your pain and heartache. Know that Snickers is in a good place and watching over you with love and affection. You relieved his pain and suffering by making it yours, there can be no greater sacrifice.

Hugs and tears.

Squirt's Mom

04-11-2010, 04:53 PM

Dear Jean,

I am so sorry to hear about Snickers. You both fought hard. He is no longer struggling to breath, or walk, or play but once again whole and strong.

You gave him the greatest gift of all - freedom from his damaged little body. Snickers will always be grateful to you for this as well as the loving care and devotion you showered on him.

Please be good to yourself and remember we are always here for you.

Our deepest sympathies,
Leslie, Squirt, Crystal and our angel, Ruby

BestBuddy

04-11-2010, 06:15 PM

Jean,
I am sorry to hear about Snickers. He is now released from that tired old body. Letting him go showed how much you loved him.
Jenny

littleone1

04-11-2010, 06:17 PM

Hi Jean,

I'm so sorry to hear about Snickers. He is now in a better place, free from all pain and suffering. My thoughts and prayers are with you.

John II

04-11-2010, 06:49 PM

Hi Jean,

I am also so sorry to hear about Snickers. But please know that you did all you could and then you did what you must. :(

His suffering is over and the butterflies are nervous. :o

My thoughts and prayers are with you. :(

gpgscott

04-11-2010, 07:02 PM

I am so sorry Jean about Snickers, and I know he is now without pain and his spirit is free to play with all of the others.

Scott

Carol G

04-11-2010, 09:43 PM

Jean,

I am so sorry. My thoughts are with you.

Carol

Casey's Mom

04-11-2010, 11:22 PM

Jean, I am so sorry about Snickers and your heartbreak. Please stay with us and post whenever you can - we are here for you.

Love and hugs,

Snickers

04-12-2010, 10:39 AM

Thanks for all the prayers. Yesterday as I read each one another round of cleansing tears would burst forth. My heart achs but I truely know I did what was best for Snickers.

He passed so peacefully that I hold on to that thought through the roughest moments as it was his way of letting me know that I was giving him another gift.

When the Vet softly told me he was gone and I looked at her and saw the tears in her eyes as well, I knew we had fought the fight of a lifetime and done all that we could. There was not a dry eye in the office as we left.

While I held him I pictured him just over a year ago jumping and chasing butterflies in the driveway. He would look at me with this wonder in his eyes as to why did he always just miss them. I told him that soon he would be chasing all the butterflies again and that he just might get lucky and chatch one!

I will always wonder why for him this disease progressed so swiftly he wasn't even 4 years old. With the reinjury of his remaining hind leg surgery was not truely an option, with the issues from the cushings there would have been little hope of recovery. It was already attacking him internally and the ketoconazle and later the trilostane was most likely started to late in the process to make much of a difference.

Jean

clydetheboosmom

04-12-2010, 01:06 PM

Oh, I am so very sorry for your great loss! Please know I am thinking of you and hugging you!

Lynne, Clyde & Bailey

zoesmom

04-12-2010, 06:10 PM

Jean -

I'm so sorry.....I know how devastated you must be. Snickers, for one so young, had put up a good fight. I completely understand your decision to let him go. As hard as it was for you, it's clear you were thinking of him, first and foremost. Hugs. Sue

Franklin'sMum

04-12-2010, 08:05 PM

Jean,

I am so, so sorry to hear of Snickers' passing. I'm sure he is very grateful to you for setting him free. My thoughts are with you at this heartbreaking time.

Jane and Franklin xx
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Aunt Jana

05-15-2016, 03:44 PM