Hi, new here (Pika, Chihuahua, Diabetes and Cushing's, on Trilostane)

[pikasmom]

Hi everyone. I found this website through the Canine Support Group at Yuku. My Chihuahua Pika has Cushing's (along with Diabetes).

Pika was diagnosed with Cushing's Disease in late September 2009. She was 8 years at diagnosis. We started seeing symptoms of her gaining a lot of weight (the pot bellied look) and being very lethargic about 4 months prior. The vet at that time could not explain why she had sudden weight gain (she was at 17 pounds) and kept running different blood tests every few weeks. It took switching vets to have her diagnosed.

Pika stated Trilostane in late September. Initially, her dosage was 20mg / day (give 10mg 2x / day). I noticed increased energy after a couple days. However, after a week, she became very lethargic, worse then before treatment. The doctor stated that it was probably too much shock on her body at once and we should decrease it to 13mg / day and just give it to her at once in the morning. She was fine with the lower dosage. 4 weeks after the start of the treatment, she went in for her ACH stimulation. I do not recall what her levels were the first time she was tested (I think Baseline was around 15), but at her test on 10/27/09 her 1hr Cortisol was at 17.9 and Baseline was at 10.8. Her liver levels were also still very high. The doctor raised the dosage to 15mb / day (still given once in the morning). She tolerated that increase as well. Her next (and most recent) ACH stimulation was on December 8th. The 1hr Cortisol was at 11.2 and the Baseline was at 5.2. Her liver levels also showed drastic improvement were only slightly elevated. We decided to try her at 17mg / day (still at giving in the morning).

Pika has her Trilostane in bacon flavored liquid form and I give it to her on a little piece of bread each morning. She sure looks forward to it.

I do not have her next test scheduled yet. She was just diagnosed with Diabetes last week, so I take her back to the vet on 2/16 for a BG test and I will see when he wants to do her next Cushing's test.

--Nicole

[lulusmom]

Hi Nicole and welcome to you and Pika.

I'm very happy to see that you made your way here. I don't have time to cut and paste our exchanges on CSG but I'm providing a link to your thread there so that members can take a look before asking the normal 100 questions. :D

http://caninesupportgroup.yuku.com/topic/1764

[Nathalie]

Hello Nicole,
I just wanted to drop in and welcome you. I can't comment on Pika's treatment as we are treating with Lysodren - but there are lots of people here that have great knowledge and treat with Trilostan.
Cute picture of Pika. :)One of my dogs, Sophie, is a Chihuahua as well.
Nathalie

[littleone1]

Hi Nicole,

Corky and I would also like to welcome you and Pika. You have found a very wonderful group of caring and supportive people who have a lot of experience and a great wealth of knowledge.

Corky is also being treated with Trilo. He's been taking it for 4 months. He is taking 20mg once a day, and all is going well with his treatment.

Others will be along that have much more experience than I do. I'm sorry I can't offer you any advice about treating both Cushings and diabetes.

Terri

[Squirt's Mom]

Hi Nichole and welcome to you and Pika! :)

Just wanted to pop in and say "Hi!" and that I am glad you are here. Haven't read up on you and Pika from the CSG site yet so don't have much to offer just now but will be keeping up with your posts just the same.

Hugs,
Leslie and the girls - always

[BestBuddy]

Hi Nicole and Pika.

Welcome, I will be waiting with you for some Bg results. A lot of us have noticed that there seems to be a continuing drop of cortisol after several months on the same trilostane dosage so keep a watch on her. Those ACTH numbers are getting pretty close to what you need. Also the diabetes makes it a little more complicated because mostly when the cortisol is in the right range a diabetic can require less insulin.

Jenny

[labblab]

Hi Nicole,

Welcome to you and Pika from me, too! Many thanks to Glynda for including the link to your postings on the Yuku forum. I've now had the chance to read through them all, and as usual -- Glynda has already done a great job of introducing you to Cushing's treatment. :)

I was really touched to read about your care and concern about Pika in the midst of a community that does not all share the same feelings about their dogs. I also grew up in a rural state where animals (including cats and dogs) are often viewed and valued in a different way. Thank goodness for all of our friends here, who are devoted to their pups with such a loving connection!!!!!!

I'll be anxious to hear how your vet visit goes today. I really think that Glynda has covered the "trilostane" bases really well thus far. Like her, I am glad that your vet is approaching Pika's dosing increases carefully and consistently. Do let us know what you find out from the vet, OK? And then we can go from there.

Marianne

[rhodesian46]

Hi Nicole,
Glad that you are here. These folks helped me with Pebbles when I was literally freaking. Here you will find medical expertise and people that have dealt with their own Cushings dogs. Hands on experience is always helpful.

We at Canine Support Group and K 9 Cushings are here for the same reason. We want to help. I am so glad that we can work together to help Pika; With Cushings and her Diabetes.

Glynda thank you for helping us on Canine Support Group.We appreciate you!!
Hugs to that adorable "chi" ( Pika)

Marianne

[mypuppy]

Hi Nicole and Pika,
Welcome from me and my Princess (7 yr. old lab). You will not regret finding this forum. I cannot thank everyone here enough for all the support they have provided for me when my Princess was diagnosed with PDH Cushings in Oct. 2009. As your Pika, Princess started treatment with trilostane back in November 2009, however at her 14 day stim test, we learned her cortisol levels went extremely low, therefore, we stopped the meds. We are now into February and I can happily say since Princess has been in remission and is not back on the trilostane. She is happy, engaged, energetic and everything she was prior to her diagnosis. It's a great feeling. So on that note and while you go through this ride with your Pika, try to stay on board here because the advice is priceless, and the people are amazingly loving and wonderful--they truly grow on you, but in a warm and nice way. I wish you all the best throughout Pika's treatment, and I look forward to reading on her good progress. Best regards to both of you. xo Jeanette and Princess

[pikasmom]

Thanks everyone for your comments. And, Jeanette & Princess, congrats to you two!!!!

Pika went in for her diabetes check tonight and we discussed that in two weeks we're going to do another Cushing's test. Her baseline was at 5.2 last time and her 1hr was at 11.2. I guess 5 is normal for baseline and he said he'd like to see her 1hr down to 10. She just started on insulin a week ago, and I know there is alot of discussion about regulating cushing's before diabetes or vice versa. Since her Cushing's has improved drastically since her initial test he wants us to try to get her diabetes a little incheck first. So, she goes back next Tues for another BG check then the following week for Cushing's.

[BestBuddy]

It looks like you are on the right track. Managing diabetes and cushings is really a complicated juggling act.

Untreated diabetes is immediately life threatening so obviously it is important to start insulin and then sort out the cushings diagnosis and treatment. Then the fun begins getting the two diseases controlled.

It is a matter of getting the cortisol lowered to the right number for that dog and making sure they are getting the insulin dosage that works for them.

Good luck and please keep us updated with any results and how Pika is doing.

Jenny

[lulusmom]

I am copying Nicole's thread from the CSG forum and have asked that any future discussions regarding cushing's be done here so as to avoid any confusion, duplication and more importantly, we have sweet Pika's information in one place.


Posted by Nicole on CSG thread 2/16/08 at 8:10 pmHi, thanks for asking. Pika is doing good today. She went to the vet for her BG test (she's been on insulin for a week now). Her level was 228, he raised he dosage to 5u 2x/day. She goes back next Tuesday for another BG test and then we are going to do a 12/hr curve and also her Cushing's test in two weeks


Posted by Nicole on CSG thread 2/16/08 at 8:10 pm
Forgot to add, Doctor did say Pika's 1hr at 11.2 was still a little high and he wants to see that down to a 10. So I guess that along with a Baseline at 5 or under is what we're hoping for in 2 weeks. We were going to do Cushing's test sooner but then Diabetes came up and he wanted to start getting that treated and see how it went before we did the next test.


Posted by Marianne (Pebble’s Mom) on 2/16/10 at 10:37 pmNicole,
Make a note as to if the clinical signs are getting better. For example is Pikas water drinking and urinating not as often? I did a water deprivation test on Pebbles. I measured her water intake for as long as I was up. There is a formula that the vets use that is normal for their weight. SO a pre of around 5 would be great. Some dogs are fine at 7. Others at 3. Make a daily journal.


Posted by Nichole on CSG thread 2/17/10 at 9:03 AMThanks for the info. I did do a water journal when we were trying to determine what was wrong with her until treatment and then thru first wave of treatement. I can't remember know how many ounces of water she was drinking but I did record it everyday and share with the vet and we determined that she was drinking an excessive amount and then she has went back to a normal amount (well other then right before we diagnosed her with diabetes and she was excessive again).


Posted by Glynda on CSG thread 2/17/10 at 7:23 PM
I just wanted to come back and touch on the baseline (pre) and stimulated (post) numbers for the acth stimulation test. Whether the acth stimulation test is being utilized as a diagnostic tool for cushing's or a monitoring tool for the treatment of cushing's, the baseline, also known as resting, cortisol is of little value. It is the "post" cortisol number that is used to determine the efficacy of treatment so I am unsure why Pika's vet is targeting the baseline number for this purpose. A baseline number that is higher than the normal reference range of 2 ug/dl to 6 ug/dl can be indicative of stress or even a non adrenal illness so perhaps Pika's vet thinks that if the baseline cortisol is within the reference range, this might be a sign that the diabetes is being well controlled. I personally wouldn't hang my hat on that theory. The reference range for a normal healthy dog is anywhere from 2 ug/dl to 17 ug/dl but you can throw that out the window if you are dealing with a cushingoid dog. With cushing's, you are shooting for a post number that is within the resting reference range of 2 ug/dl - 6 ug/dl. I am therefore stumped as to why Pika's vet is shooting for a much higher number of 10. As I mentioned earlier, Dechra's literature does say that if a dog is doing well and symptoms are no longer apparent, a post stim number of 9 is acceptable; however, a dog with diabetes may be the exception to that rule. It's been my experience that a cushing's and diabetes savvy vet will want to get that post number down to the recommended range to insure good control of both conditions. I hope I've made a little bit of sense.



Posted by Nicole on CSG thread 12/17/10 at 9:06 pm
Thanks. I re-read how you spelled it all out for me earlier in the thread and went through some of the websites. My only thought of why he hopes for the 1hr to be down to 10 is because he feels that might be a realistic goal to accomplish (where he knows once she hits 10 then we're going to hope for lower on the next test)? Since Pika is not testing every 14 days, maybe he feels that he can't boost up her Trilostane dosage too high and try to get down lower because of the possible adverse side effects? He does call about a week after her mild increase and we talk about how she's doing. He never even brought up the option of testing every 14 days to me. As I mentioned before I live in a very small community I do not think there are very many dogs being treated for Cushing's and a lot of people have the mentality that "it's just a pet". I believe her Cushing's test is about $150 . The vet has even told me he has diagnosed pets with Cushing's numerous times and the owners did not want to pay to treat it. Maybe he just feels that it is unrealistic to ask someone to pay $300/mo for testing and goes about it with small dosages to have the tests further apart? And, the baseline target of 5 is all on me and he has never even mentioned that's what we're shooting for. It just boosts my spirits when I see everything wrong with her and see that a "normal" baseline is 5 and she's at 5.2.

[rhodesian46]

Glynda,
You are way too organized :) I don't mind jumping back and forth on forums. Thanks for posting the link on CSG.

If Nicole posts on the diabetes on CSG and I feel that this is also cushings related I will copy and past if that is OK?

[pikasmom]

I think I have the formats down now for the two sites, hopefully. If I have a diabetes thing that I think relates to the Cushing's, I'll try to remember to post on this thread too.

[rhodesian46]

Nicole,
I was just thinking. When you get the ACTH stim test why don't you sugest to your vet to consult with whomever the blood is sent to?Before I seen a IMS my vet would consult with IDEXX labs( for example) I look att his way. Two heads are better than one!!!. Just an idea Nicole.

[pikasmom]

I had Pika into the vet yesterday for her BG test. At 540pm she was at 397 (insulin & food around 7am). We were going to have her in for her Cushing's test next Tues (mar 2nd) but since he diabetes is still out of wack we are going to postpone.

We have up'd her insulin to be 7 units 2x / day (she was at 5u twice a day). March 2nd she is going in for the BG 12hr curve. That should hopefully shed some light on her insulin regulation. At that appointment, depending on the BG results we are going to then talk about her Cushing's test.

[pikasmom]

Pika was recently diagnosed with diabetes, so she has not had a stim test since she has been on insulin.

With previous stim tests, she would go into the vet around 730am and would not have any food in the morning. I would then pickup Pika after work (around 4:30pm) and the various tests would be performed during the day. I never really asked what time she had the various tests done, but from conversations I believe it was in the morning.

Next Tues, I have an appt for Pika to do the 12 hr BG curve at the vets and when I leave there we're going to setup her next stim test.

I'm sure the vet will tell me, but I'm just curious what everyone else does (just curious if everyone does the same).....

I would drop her off at 730am for the test. But, she would need her insulin that morning (around 7am) and in order to give her insulin she needs to eat, which hasn't been the norm on her stim tests.

When they do stim do your pets still eat and get insulin and they have a different "forumla" they use since she would have that in her body as well? Or, as they making your pets go without the insulin / food that morning (I sure hope that's not the case!)? Or, maybe since I leave her there all day, they will just allow her to eat and have insulin like normal but then just do the tests later in the day?

Thank you!

[labblab]

We've just been having a similar conversation on Bagel's thread. Take a look at Sande's post, and all of the subsequent replies:

http://www.k9cushings.com/forum/showthread.php?p=25956#post25956

Marianne

[pikasmom]

Marianne, thank you so much for directing me to that thread. Since the vet has put her on new food since diabetes, she should hopefully be fine to eat. I'll wait and see what he says Tuesday. Have a great weekend!

[pikasmom]

Received a call from the vet with Pika's stim test from Tuesday. Last test her 1hr was at 11.2. Now it is at 9.4. We are increasing her Trilostane to 1.9ML / day, still only giving it to her once a day as that was working well. Her baseline increased from 5.2 to 6.7, but I understand the baseline is not the number we need to be concerned with. She is setup to go back to the vet on March 30th for another atch stim test and 12hr bg curve.

I realized I mispoke on the Vet and wanting to drop her 1hr down to 10. The vet said that should actually be closer to the 5 range. I realized I was reading from my notes of the labwork and that is what is on there from the lab.

Overall, the Dr is happy with Pika's progress given these two issues and the Cushing's being newly treated as well (since Sept '09). She also had her 12hr BG curve and the doctor raised her insulin now to 7units twice a day. Her highest during the curve was 310 and her lowest was 108.

[rhodesian46]

Nicole,
Can you post the electrolytes results?

[AlisonandMia]

I am a little concerned with increasing the trilostane and the insulin at the same time. Especially when the curve showed a low of 108. I'd think that increasing either could possibly send her too low and increasing both could cause a hypoglycemic crash.

Lowering cortisol makes them much, much more sensitive to insulin.

I don't know an awful lot about diabetes but from what I've seen I'd think that maybe what your curve showed was a slight miss-match between the food and the insulin maybe with the food getting ahead of the insulin (310) and then the insulin "catching up" (108). Maybe some sort of tweaking of the food and timing of the food to even things out is what is needed rather than an insulin increase?

Alison





Received a call from the vet with Pika's stim test from Tuesday. Last test her 1hr was at 11.2. Now it is at 9.4. We are increasing her Trilostane to 1.9ML / day, still only giving it to her once a day as that was working well. Her baseline increased from 5.2 to 6.7, but I understand the baseline is not the number we need to be concerned with. She is setup to go back to the vet on March 30th for another atch stim test and 12hr bg curve.

I realized I mispoke on the Vet and wanting to drop her 1hr down to 10. The vet said that should actually be closer to the 5 range. I realized I was reading from my notes of the labwork and that is what is on there from the lab.

Overall, the Dr is happy with Pika's progress given these two issues and the Cushing's being newly treated as well (since Sept '09). She also had her 12hr BG curve and the doctor raised her insulin now to 7units twice a day. Her highest during the curve was 310 and her lowest was 108.

[rhodesian46]

Pika's insulin remains a 7 u bid. There was not any increase in insulin just the trilostane. The 108 was the nadir( the lowest point on a bg curve, ( the same as the peak of insulin activity.)

Nicole I am still not understanding why your vet doesn't do an ACTH stim test 7-10 days after the trilo increase ? Did you show him Dechra's protocol?
What I am worried about is that once the cushings is controlled that there may be a decrease in Pika's insulin. This may cause Pika to go hypo. This is where home testing woud l be helpful on a daily basis and a curve weekly. You will never be assured that Pika bg's are fine. Some dogs don't show signs of being hypo SOme hide their symptoms.

Has your vet told you what to look for if Pika's cortisol drops too much? What to do if Pika walks away from her food?( inappentance)Not enough cortisol will produce an Addisonian crisis.




CLINICAL SIGNS

At first signs are very vague - listlessness, possibly some vomiting or diarrhea. Ultimately, the disease results in a phenomenon known as the "Addisonian crisis." The animal collapses in shock due to its inability to adapt to the caloric and circulatory requirements in stress. Blood sugar may drop dangerously low. Potassium levels soar and disrupt the heart rhythm because there is not enough conserved sodium to exchange for potassium. Heart rate slows, arrhythmia's result. The patient may not survive this episode.

Source : http://www.marvistavet.com/html/body_addison_s_disease.html

[AlisonandMia]

So her insulin isn't being increased now - it's been 7u for a while? That is a relief!

I do share Marianne's concern about the increase in the trilostane causing a crash in her BG though as lowering her cortisol will make her more sensitive the insulin and her present insulin dose may become too much very suddenly - especially as her nadir was 108 on the present dose of insulin and trilostane.

One more question - was the stim done on the same day as the curve?

Alison



Pika's insulin remains a 7 u bid. There was not any increase in insulin just the trilostane. The 108 was the nadir( the lowest point on a bg curve, ( the same as the peak of insulin activity.)

Nicole I am still not understanding why your vet doesn't do an ACTH stim test 7-10 days after the trilo increase ? Did you show him Dechra's protocol?
What I am worried about is that once the cushings is controlled that there may be a decrease in Pika's insulin. This may cause Pika to go hypo. This is where home testing woud l be helpful on a daily basis and a curve weekly. You will never be assured that Pika bg's are fine. Some dogs don't show signs of being hypo SOme hide their symptoms.

Has your vet told you what to look for if Pika's cortisol drops too much? What to do if Pika walks away from her food?( inappentance)Not enough cortisol will produce an Addisonian crisis.




CLINICAL SIGNS

At first signs are very vague - listlessness, possibly some vomiting or diarrhea. Ultimately, the disease results in a phenomenon known as the "Addisonian crisis." The animal collapses in shock due to its inability to adapt to the caloric and circulatory requirements in stress. Blood sugar may drop dangerously low. Potassium levels soar and disrupt the heart rhythm because there is not enough conserved sodium to exchange for potassium. Heart rate slows, arrhythmia's result. The patient may not survive this episode.

Source : http://www.marvistavet.com/html/body_addison_s_disease.html

[rhodesian46]

The curve was done the same day as the ACTH stim test.

Nicole. Has your vet told you what to look for if Pika cortisol drops too low? Has he told you what to do if Pika walks away from her food and what you should do? It is advisable to keep some pred on hand and if she does walk away to stop the trilo and give her pred the restart at a lower dosage.

Please ask your vet about all of this. I am concerned that Pika could be in trouble( medically) if the vet is the only person to know what to do in a crisis situation. I know that you are going on vacation the first week in April and your MIL is taking care of her. But she needs to also know what to look for as far as Pika goes. I know that you adore your girl and want whats best for her. I am just worried.

Others will chime in shortly I am sure

[pikasmom]

Yes her curve and stim were done at the same time. And, yes I mispoke about increasing her insulin. She was at 7 units and we are keeping here there.

When talking with the vet about the next test, I thought I read the protocol was 14 days, so I obviously read wrong. "EDIT'D - just went to Dechra's webiste and it says 10-14 days after increase". And, the vet is at a seminar the afternoon of the 23rd, so I asked if we could do the 30th. I like doing the testing on Tuesday's as the vet is opened later, so we could get the last BG test at 530pm timeframe. I wasn't planning on starting her until the 8th on the Trilostane increase because DH's parents are watching Pika this weekend and if by chance she does have a reaction I don't want them to have to deal with it, I want it to be on our watch.

So, maybe I will should wait and start her Trilostane increase on March 16th? Then, she is at the 14 day period.

Yes he did electrolytes and said everything was fine, they have been tested before as well and good. DH actually took the call from the vet and failed to asked about what the number for this along w/ the stim were. I then called back and forgot to ask number for this, just for the stim. Sorry, I am still new at all this. Thanks for your help!

[AlisonandMia]

The curve was done the same day as the ACTH stim test.

Curves really shouldn't be done on the same day as a stim test as the cortisol surge caused by the stim (especially when the post is high) will throw the BG out - usually increase it substantially from where it would be if a stim wasn't done. It will often remain elevated for 3 or so days afterwards too. So it is quite possible that her "real" curve (away from a stim test) would have given lower numbers so now I'm really worried about what will happen if she stays on 7u insulin and her trilo is increased - especially if she's going to be left in the care of someone else.

Given that her curve was so good I'm not even sure that her cortisol needs to be lowered any further. Some authorities state that a post of up to 9 or even 10 is fine for a dog being treated with trilostane as long as it isn't symptomatic.

Was the Cushing's diagnosed after the diabetes? And did she show any Cushing's symptoms before the diabetes (there is a huge over lap in the symptoms so hard to tell once they are diabetic). I ask because we see time and time again diabetic dogs diagnosed with Cushing's when they don't actually have it because the symptoms are so similar and because the stress of a non-adrenal illness (diabetes in this case) can and often does cause false positives on Cushing's tests.

If her BG's are so nice with a post of 10 on a stim test (and on the day the stim was done) I'm wondering if she actually does have Cushing's after all.

Alison

[rhodesian46]

Maybe you could start Trilo increase Tuesday 3/9 and then do an ACTH stim and electrolyte check Tuesday the 16th.

[AlisonandMia]

So, maybe I will should wait and start her Trilostane increase on March 16th?

I think it is a very good idea to wait till you are back home and settled before increasing the trilostane dose. I don't think it would be a good idea to increase a trilostane dosage just before a trip away and a change in routine in any dog and certainly not a diabetic - there is just too many things that can go wrong.

Alison

[pikasmom]

Pika has great signs at home. Normal appetite, normal water intake and normal peeing. The vet did say that if Pika wasn't diabetic, he would think her post stim was good at that level. But, he still wants to try to lower it. He keeps stressing that you might go crazy to get her a perfect number on paper and the main thing is to have a good quality of life at home. But, then I thought someone posted at a Cushing's / Diabetic dog should be down around 5 at post.... I'm sorry I might just be getting confused, this is so much info to absorb.

Pika was diagnosed for Cushing's in Sept '09. Blood tests as well as a ton of physical symptoms supported that (lethargic, pot belly, increased appetite, increased thirst). She had a plethora of other tests ran as well to rule out other causes. Her BG level was normal in September and also normal in December (both of '09). Then on Feb 2, 2010 she was diagnosed with diabetes. I took her in on a Tuesday, as the days proceeding she was drinking 3x the normal amount of water and pee'd constantly, so I thought it was maybe a UTI or bladder infection.

I have read alot of information that sometimes a dog is misdiagnosed with either Cushing's or Diabetes and I sure do hope that is the case with Pika.

The 12hr curve and stim is $300. If I have to do it 3 times this month for Pika (the 2nd, then the 16th then possibly the 30th) I gotta do it. But, if I could hold out and hopefully just do one more in March, then I'm only at $600 for the month vs $900. But, then maybe if I do start on the 8th or 9th and check on the 16th everything will be good and I could go a bit longer until the next? Maybe that's too optimistic?

Pika isn't going to be left in the care of someone else long term right now. She is going to stay with DH's parents for 10 days towards the end of April. We are taking her to DH's parents for Saturday night only now for them to do a trial run with the insulin injection so if they have any questions we could run over.

[pikasmom]

Should have also added,vet did do a LDDS for the Cushing's diagnosis.

[pikasmom]

OK, sorry for fifty million post by me in a row ;)

Just talked to DH. We are going to resched the stim for 3/23. Vet doesn't actually do it, and the blood is sent to an outside lab anyways so he will get me the results on 3/25. I am going to increase Tri 10 days beforehand.

I am still confused on her actual level of Trilostane, as it is liquid form. I thought we were doing 1.7 but DH does Tri and he said he is only doing 1.6, so maybe the .3ml isn't that much of an increase?

[rhodesian46]

Nicole,
She did not have a ultrasound when she was diagnosed with Cushings?
$300 for curve and stim test !!!!!! Holy poop!!!!!I paid $140 for a stim test( Cortrosyn) and of course this could very from state to state and the Cortrosyn amount varies with weight of the dog. Pretty expensive stuff. To save the cost maybe you could shop around. Or do the curve your self. What does he charge for the curve?

Also can you post all of the test results from the lab report as well including electrolytes?

Do you have the labwork and tests that were done with intitial diagnosis in Sept 09? ( LDDS test as well)And if so can you post them ? I am curious on what her glucose level was at the time.I am sure others would like to get a better picture on what wasgoing on last year. Also were her liver enzymes really elevated?

Here is a better description of a dog going through an Addisonian crisis

SYMPTOMS AND SIGNS

Common symptoms of Addison's disease include muscle weakness, apathy, fatigue, loss of appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain, low blood pressure (hypotension) that worsens when standing (orthostatic hypotension), hyperpigmentation or bronzing of skin (this condition is known as melasma suprenale), diminished ability to conserve sodium and excrete water, depression, irritability, salt craving, low blood sugar (hypoglycemia), tetany (muscle spasm caused by high phosphorus levels), diminished attention span, numbness of the extremities due to excess potassium (hyperkalemia), and in complete blood counts, an elevated eosinophil count is noted. Because most androgens in the female are produced in the adrenal cortex, females with Addison's disease may have decreased genital and underarm hair.

In its extreme form, Addison's disease can progress to a potentially fatal condition known as an Addisonian crisis. The most common cause is stopping corticosteroid therapy without first tapering the dose. Other causes in clued stress, infection, and other conditions that increase the body's need for cortisol. Symptoms of Addisonian crisis include brown coating on tongue and teethe due to iron released from blood cell destruction; sudden sharp leg pain, lower back or abdomen; nausea and vomiting resulting in dehydration, severe hypotension, unconsciousness, and severe hypoglycemia.

Read more at Suite101: Addison's Disease: Autoimmune Adrenal Insufficiency http://autoimmunedisease.suite101.com/article.cfm/addisonsdisease#ixzz0hIqNx9Yj

Source: http://autoimmunedisease.suite101.com/article.cfm/addisonsdisease

[pikasmom]

Thanks for the info on the Addisonian's. He did say when he started treating her that if she goes too low that is not good either.

Her test pricing is pretty much inline with yours. 12hr curve is $120, then $180 for stim.

She never had an ultrasound.

I believe this is her electrolytes (this is from 2/2/10) as when I asked about it the other week they said "oh her electrolytes are here (and I thought this is where they pointed) -

Phosporous 4.6
Calcium 10.5
Sodium 141
Potassium 5.6
Chloride 99
Bicarbonate 23
Anion Gap 25
GGT 5

What is the LDDS referenced as? Because I'm showing a T4 on 10/24/09 at 2.3. I do recall them saying the liver was elevated before she started Cushing's treatement. Then, on 10/27 check they said her liver levels dropped. But, I'm not sure what that is referenced as (not says "liver").

Glucose on 10/27 was 133. Can't find December's off the top right now and gotta get to work. Thanks!

[bernie47]

hi pikasmom.. i to have chihuahua with cushings..
as i am new also , i read every ones posts and gain a lot of information that i can use to help me under stand what this disease is all about.. i am sure these ladies and guys will be there for you .. wishing all the best ..:)

[rhodesian46]

Nicole,

Would you mind,posting the results of the ACTH stim test and LDDS that was done when Pika was first diagnosed?

[rhodesian46]

I do recall them saying the liver was elevated before she started Cushing's treatement. Then, on 10/27 check they ]Isaid her liver levels dropped.

Here is a list of the liver enzymes. These will be listed on Pika's bloodwork.
1) ALT (alanine aminotransferase) or SGPT (serum glutamic pyruvic transaminase) is a liver specific enzyme.

2) AST (Aspartate aminotransferase) or SGOT (serum glutamic oxaloacetic transaminase)
3) SAP (Serum alkaline phosphatase)
4) GGT (Gamma-glutamyl transpeptidase)

[lulusmom]

Nicole,

The Low Dose Dexamethasone Suppression Test (LDDS) is not part of the blood chemistry panel. You should have a separate sheet that usually says "LDDS". You will see a baseline or pre draw, a 4 hour draw and an 8 hour draw. There is usually an interpretation at the bottom of the page(s).

We are asking for copies of the whatever tests your vet did to diagnose Pika with cushing's because it appears the diagnosis was based on one diagnostic test, being the LDDS. Please refer back and pay close attention to Alisons remarks regarding the curves achieved with a post cortisol of 9 and the timing of the acth stim which was done on the same day as the 12 hour curve. Because none of diagnostic tests can be relied on to be 100% accurate, additional tests should be done to validate and confirm a diagnosis. The LDDS test is great if the dog has no underlying non adrenal illness or severe stress but it is more likely to yield false positives if either of these two conditions are present at the time of the test. The acth stimulation test is less likely to yield a false positive but from what I gather, your vet didn't do any acth stim tests until after you started treatment right?

Pika has been receiving 16mg or 17 mg of Trilostane daily and while your vet has instructed only a 2mg increase, I still share Alison's concerns regarding the possible impact on bg levels. I am the one that told you that a lot of vets that treat dogs with both cushing's and diabetes prefer to get the post stimulation number closer to 5 ug/dl to help regulate both conditions; however, Pika's symptoms seem to be completely resolved with the current dose and given the results of the curve, I would be inclined to continue with the current dose of 17mg and spend the next 30 days working on getting the food and insulin in synch, which by the way would be much easier if you were doing home testing.

I realize that you are afraid of doing home testing but with Pika having cushing's too, you should be much more afraid of not knowing what is going on in her little body, especially at times when you are increasing the Trilostane dose. Your vet and the folks at csg can walk you, your husband and your parents through whatever you need to know to do the testing yourself. Believe me, you'll appreciate having the information right there for you and no doubt, it will save you money. You are very lucky that you are a member of two forums where you can find some great hand holders. Take advantage of that in every way.

Glynda

[rhodesian46]

Nicole,
I found some info on both conditions. Thought you may want to read this.

Question for ya'll? An ultrasound would of confirmed that Pika has Cushings? Or it would tell if there were any more problems as far as adrenal glands ,liver etc. Can you explain this to Nicole?

now you may be thinking that tyler's misdiagnosis couldn't happen again-because it was our vet fault. I don't believe that's true. I had tyler's test results and i fully understand why he thought what he did. But as the internist also pointed out-more than the lab results have to be looked at (symptoms need to be present also).

What is scary, i feel it maybe happening quite often. Just the other day, i responded to a post on a bulletin board concerning a diabetic/cushings dog who wasn't responding. Another woman posted afterward telling about her diabetic/misdiagnosed cushings lab. Her dog also tested false positive . They began lysodren treatment, however her dog deteriorated. Before she could have her dog's adrenal glands sonogramed-her dog died. She doesn't know if her dog died from the lysodren or from a tumor or from another illness. She does know it wasn't cushings.

Not every diagnosis is a misdiagnosis however. But when your dealing with a diabetic/possible cushings dog-it becomes very complicated. Since the symptoms of both diseases mirror each other it gets even more complicated.

Possible situations
bullet your dog could only be diabetic. The stress from the diabetes could be affecting their whole system. This could also cause false positive readings on the cushings tests.
Bullet on the other hand, your dog could only have cushings. The diabetes maybe a side effect. Once the cushings is controlled your dog may not require insulin at all.
Bullet your dog could have both diseases. Once the cushings is controlled the insulin requirement could be significantly reduced or become more manageable.

Source : http://www.weir.net/~lglass/diabetes_cushings2.htm[/url]

[rhodesian46]

Nicole,
Hate to keep on asking you so many questions. Did your vet run a the urine cortisol:creatinine ratio (UC:Cr) This is an inexpensive test that would of been done before any other test was... Urine is collected. This would not tell you if Cushings was present but would tell you if Pika did not have Cushings. Can you check your vet records when Pika was first diagnosed and if so can you post this ?

[pikasmom]

I think some of the records may still be at the vets. I like Glynda's comments about keeping her on the current dosage :) I think you are right and we didn't do the LDDS until AFTER.

I am really grateful for your help, so please don't take it that I don't want to work with you, I just realized I do not have everything and it appears some tests may not have been done..... And, as you could probably tell I am quite overwhelmed with all this.

But these are some results that you wanted to see

AST(GOT) 10/27/09 was 46 and 2/2/10 was 20 - states normal is 13-81

ALT(GPT) 10/27 was 155 and 2/2 was 102 - states normal is 14 - 151

GGP 10/27 wsa 4 and 2/2 was 5 - states normal i s 3 - 19

I do not see a SAP. I do not see the urine cortisol test. But, all records from vet #1 were given to vet #2, so I do not think it was done. Also, she did have the stim in December '09, only that though, that's why I don't have bloodwork from that.

[rhodesian46]

I am sorry you are overwhelmed. I know that you appreciate all of our help and that you love Pika!!! I agree with Glynda on not increasing the Trilo at this time. I know there is too much info for you to absorb.

I so remember when Pebbles was first diagnosed. THese people here advised me to see an IMS. I finally listened after spending a fortune with a regular vet and to boot he had no experience with Cushings and Diabetes. Poor Pebbles was misdiagnosed from day one. So I have learned to ask ask ask questions. Because if I didn't understand I would freak all of the time. As Pika is your life Pebbles was mine. So I know where you are coming from. I have learned to never assume that a vet did the proper testing. And to never assume that a regular vet had all of the training for these complicated diseases. I knew that an Internal Medicine Specialist was the best qualified for her care. ANd I was willing to travel and pay the price for this. My IMS and I were a team. Both of us were for Pebbles and her health.

I am confident that you will do what is right for Pika. I truly believe that. Take a breather Nicole and get all of Pika's records in one place. That is in your hands!!! : )

[lulusmom]

Most labs list the SAP as ALK or ALKP. It is this liver enzyme that is usually the one that is elevated more than the others and tips off the vet that it may be steroid induced.

Nicole, rather than pull your hair out over trying to find test results, simply ask your vet to give you copies of the original tests that were done to diagnose the cushing's.

[rhodesian46]

Good idea Glynda:D

[pikasmom]

I increased Pika's Trilostane on 3/13/10 from 1.6 to 1.8. She had her stim last week. On Friday I got the results and her 1hr was at 10.7 (up from 9.4 a few weeks ago). But that is still better then a few months back when it was at 17. She also had a 12hr BG curve last week (not on the same day!). She was fed (3/4 c WD dry) and insulin (7 units) at 630am. Those results were -

7:50am - 142
10:30am - 124
11:30am - 152
2:10pm - 199
4:00pm - 218
5:45pm - 228

We (dh, vet and I) are going to discuss on what to do with Pika if we should increase the Trilostane more this week. Vet said you can't always go just based upon what the results show. He was so happy with her curve, and knows that everything appears to be working together or her curve wouldn't be so good.

If Pika were your dog, would you increase her Trilostane more? Or, would you leave her with these numbers? I know thoughts alot of people's thoughts about a lot of different tests that should have or should be done. But, that aside - what about increasing the Tri more? Pika is 13lbs. I'm not sure on your pets numbers for the 1hr....

One more side note, since Pika was diagnosed with diabetes, DH has been off work due to an injury. Pika has never been left alone for more then 2 hours in the past 2 months. I know about the increase and possible too low of dropping on the glucose. DH is going back to work on Tuesday. That means Pika will be alone M-F from 730am - 430pm. So, we won't be there to monitor her all day if we increase too much.

Pika also has regained alot of strength in her hind legs. She now stands up on just them to play and jump. She is able to jump back on the couch again, where she couldn't before.

Thanks!!!

[lulusmom]

Hi Nicole,

I'm no expert but I think that's a great curve. If Pika is doing really well and you don't see any symptoms of cushing's, then despite this latest small increase in the the post stim, I wouldn't rock the boat by increasing the Trilostane right now.

[pikasmom]

I realize this topic is quite morbid, but what have you heard of the average lifespan after diagnosis? Someone posted on the diabetes forum I go to the same question regarding diabetes (consensus was same lifespan) but I was curious about Cushing’s.

When Pika was first diagnosed (Sept 2009) everything I read on the internet stated that the average lifespan after diagnosis was only 2 years. I never found out anything if that was treated or untreated Cushing’s. But, I don’t think the information was completely in-check because all the information I read stated that average diagnoses was more in larger breeders at the age of 10-12 with a 2 year lifespan after diagnosis. I only have experience with Chihuahuas, but I thought larger breeds (Shepherds, Labs, etc) have an average lifespan of 12-14 to begin with, so that would put them at the regular lifespan regardless of Cushings.

Pika was 8 when she was diagnosed. Chihuahuas have a lifespan of 16-18 from what I have read. Pika is a regular Chi (meaning not a teacup). I asked the vet about the 2 year lifespan and he didn’t have any information as Pika was so much younger than most dogs he’s seen diagnosed. He was honest and said that he felt Pika’s life would be shortened but not too much. So I am hoping for 14 for Pika. I would like to know if this is really unrealistic, so I could start preparing myself. I just don’t want to be shocked next year at age 10 if we need to put Pika down, when I was expecting it to be further out.

Thank you and again I am sorry for wanting to discuss such a sensitive subject. I’m sure most of us on here have lost pets and I know it’s not easy to talk about.
Nicole (and Pika too)

[lulusmom]

Hi Nicole,

I've merged your latest post with Pika's original thread so that we can keep all of Pika's information, including this last question regarding Pika's expected lifespan with cushing's. If you research the disease online, you are going to find any number of resources that say that you can expect a dog to live for approximately two years after diagnosis. This is a bunch hooey. This may be an average life expectancy based on the fact that most dogs are quite senior when diagnosed so they are at the upper end of their lifespan to begin with.

My Lulu was diagnosed at 3 years old and is now 8 years old so there goes that myth. We also have other members whose babies have been or were treated for many years. As I recall, the babies who went to the bridge, passed away from conditions unrelated to cushing's. If Pika's diabetes and cushing's are effectively controlled, I think you can expect Pika to live out her normal lifespan.

Glynda

[acushdogsmom]

I realize this topic is quite morbid, but what have you heard of the average lifespan after diagnosis?

I asked the vet about the 2 year lifespan and he didn’t have any information

About that "2-year prognosis" ...

http://www.k9cushings.com/forum/showthread.php?t=186

:)

[pikasmom]

Pika has been sick this week and not eating. I usually put her Trilostane onto her food. I tried just putting it in her mouth but it would make her vomit (as on an empty stomach). Finally this morning she started eating. However, her hind legs have become very weak this week. Her last Trilostane was on Monday. Now she has a very hard time supporting herself with her back legs.
I'm hoping since she received her trilostane this morning she will get back to normal.

But has anyone experienced this quick of "going south" before? I'm hoping just a combo of her being weak from no food for a few days and no medication. Thanks!

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about missing doses into Pika’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[labblab]

Pika has been sick this week and not eating. I usually put her Trilostane onto her food. I tried just putting it in her mouth but it would make her vomit (as on an empty stomach). Finally this morning she started eating. However, her hind legs have become very weak this week. Her last Trilostane was on Monday. Now she has a very hard time supporting herself with her back legs.
I'm hoping since she received her trilostane this morning she will get back to normal.

But has anyone experienced this quick of "going south" before? I'm hoping just a combo of her being weak from no food for a few days and no medication. Thanks!
Welcome back to you and Pika, although I am so sorry she has been feeling poorly. You know, from what you are describing, I am actually wondering whether her cortisol has actually dropped too low rather than the reverse. That might explain why her appetite finally picked up again after you had stopped the trilostane for a couple of days. Low cortisol could also account for sudden weakness or lethargy. If that is the problem, then you will need to hold off on giving any more trilostane for the time being. If that is the problem and her cortisol drops any lower, it can be very dangerous for her. She might even need some supplemental prednisone if that is the problem.

The only way to know for certain is to test her cortisol level. Have you told your vet what is going on with her this week? Can you tell us how recently she's had a monitoring ACTH test and what the numerical results were? Also, what dose of trilostane is she taking and how much does she weigh now? I know she's a teensy little girl :o.

If you could fill us in on any other health changes during these past couple of years, that would also be great. For instance, how has her diabetes been doing?

But most importantly, if you haven't already spoken with your vet, I think you need to let him/her know what is going on with Pika as soon as possible. Since this is Friday, you don't want to let things turn into an emergency over the weekend. The best thing may be to take her in to be seen this afternoon so any necessary labwork can be run.

Thanks in advance for this additional info,
Marianne