Newly diagnosed Cushings on Trilostane- Restarted trilostane-- no appetite today

[PorkchopDog]

Hi there! My name is Gina and Porkchop is my 8 1/2 yr old pitbull who was diagnosed with Cushings via cortisol/creat ratio, Low dose dex test and a High dose dex test in January. In December, he was diagnosed with hyperthyroidism and at the same time was put under anesthesia for 2 lumpectomies and a dental. He was also experiencing hair loss, which was the reason why we checked his thyroid level. He is currently on levothyroxine .5mgs twice daily. Both of his incisions dehisced and he began drinking and urinating more. (AT the same time, his appetite started to decline- which is not the normal response in a Cushing's dog.) He had chest and abdominal rads taken and was diagnosed with a primary lung mass. Rads have been rechecked and no additional masses have grown at this time. His blood pressure was checked and it was high at 186, so he is now on Norvasc 5mgs once daily. He had an abdominal and thoracic ultrasound which showed a mildly enlarged liver and slightly bilaterally enlarged adrenal glands. His urinalyses show protein int he urine. He has also seen an internal medicine doctor who believes he has Cushing's but may also have some underlying liver issues. On bloodwork, his liver enzymes are elevated. My regular veterinarian participated in the trilostane trials several years ago and is very familiar with trilo. We began him on trilo 1 month ago at 120mgs one daily (he weighed 60 lbs). He has lost 10 lbs and his recent ACTH showed that he is on too much trilo, so we decreased it to 60mgs once daily. Recheck ACTH in one week. In the meantime, his appetite is decreased. We have offered him everything that is edible and he only "picks" at his food, versus his normal ravenous appetite that he has always had throughout his life. I tried giving him remeron, an appetite stimulant, and although it gave him a burst of energy, it did not really affect his appetite. He is completely lethargic and barely eating. Both my internal med vet and primary vet are well aware of his situation. They are having a meeting tomorrow regarding his case and I am hoping they can help him. I know it is stated that trilo should be stopped, if a dog is not eating, but that has not been told to me yet. Any advice that anyone can offer...any additional tests I can do... Thank you for your help!

[Harley PoMMom]

Hi Gina,

Welcome to you and Porchop from me and my boy Harley! My oh my it seems your boy has been through alot, well my dear, we are here for you and Porkchop now, so you'll never walk this journey alone.

I was wondering what the results were of his ACTH tests? And here are excerpts taken from Dechra's Product Insert:


Owners should be instructed to stop therapy and contact their veterinarian immediately in the event of adverse reactions or unusual developments.

ADVERSE REACTIONS:
The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness. Occasionally, more serious reactions, including severe depression, hemorrhagic diarrhea, collapse, hypoadrenocortical crisis or adrenal necrosis/rupture may occur, and may result in death

Owners should be advised to discontinue VETORYL Capsules and contact their veterinarian immediately if signs of intolerance are observed.

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

Re; the protein in the urine, did your vet or IMS do a UPC test on Porkchop to see specifically how much protein he is losing?

Gina, if Porkchop were my pup and was not eating, I would definitely STOP the Trilostane. If he exhibits any signs of lethargy, vomiting, and or diarrhea I would take him to the vet ASAP. Do you have prednisone on hand?

Please know we are here for you and Porkchop, so ask all the questions you want and we will try to answer them the best we can, ok.

Love and hugs,
Lori

[PorkchopDog]

Lori & Harley,
Thanks so much for your response! And thank you for welcoming me to this great Cushing's group! Let me give you some values:
12/15/09- Pre-op labs (no symptoms or sign of anything except hair loss)
ALT 626 H (12-118 U/L)
Alk phos 229 H (5-131 U/L)
Phosphorus 6.4 H (2.5-6.0 mg/dl)
Cholesterol 398 H (99-324 mg/dl)
UA results Protein 2+ H (should be NEG)
SG 1.017 (1.015-1.050)
T4 < 0.2 (1.0-4.0 ug/dl)

1/09/10 Cortisol/Creat ratio: 133 H = Cortisol 20.6 ug/dl range 5-55) / Creatinine 48.2 mg/dl range 100-500)
UA results protein 2+ (should be NEG)
SG 1.008 L (1.015-1.050)
pH 7.5 H (5.5-7.0)

1/13/10 LDDS Pre 6.4 ug/dl, Post1 5.9 ug/dl, Post2 3.7 ug/dl = Cortisol level greater than 1.4 8hrs post is consistent with PDH

1/19/10 HDDS Pre 8.8 ug/dl, Post1 8.0 ug/dl, Post2 4.3 ug/dl = this test was done to determine PDH vs. adrenal tumor... but it is right at 50%: cortisol level is greater than 1.4 ug/dl 8 hours post dex confirming Cushings- Cortisol level less than half the baseline level at either 4 or 8 hours post dex is consistent with PDH
Blood work also repeated on 1/19-
AST 80 H (15-66 UL)
ALT 724 H (12-118 U/L)
Alk phos 373 H (5-131 U/L)
Sodium 155 H ((139-164mEq/L)

1/26/10 Saw Internal medicine Dr. Protein/creat ratio high at 2.3 (I do not have this labwork in front of me to supply ref range)
He stated that diagnostic workup consistent with PDH- Ultrasound did not reveal an adrenal tumor, blood pressure was taken and was started on Norvasc- he stated that the liver enzymes were elevated which is not typical of Cushings, but he thought that there may be underlying liver issues. The lung nodule on rads has remained static, so they beliee it is a primary lung mass vs. metastatic disease. Blood pressure was rechecked and he is doing fine on norvasc dose.

Trilostane was started, but due a bout of diarrhea, it was stopped and then restarted. He has not had any further diarrhea and only one episode of vomiting to date. Because of the stopping of trilostane on and off-- if I couldn't get Porkchop to eat anything, he didn't get his trilostane-- we had to wait until he was on the trilostane consistently for 10 days prior to his ACTH stim

3/2/10 ACTH stim - Pre 1.8 ug/dl Post 0.8 ug/dl -
Normal canine values: 5.5-20.0 ug/dl

Bloodwork repeated:
ALT 352 H (12-118 U/L)
Calcium 8.5 L (8.9-11.4 mg/dl)
At this time, I was told to decrease his trllo to 60 mgs once daily- he started out weighing 60 lbs and is now at approx 48 lbs.

I am supposed to repeat his stim on 3/16. However, after reading so much on trilostane, I decided to stop giving it to him (as far as tomorrow's dose goes), so the repeat stim may have to be done later? My vet called me tonight and also said to stop the trilostane until she talks to the internal medicine dr tomorrow. I've worked at the primary vet office for the past 14 1/2 years as a tech and I feel like I should know what I should be doing right now, but I am at a loss. I feel like I should have stopped the trilo sooner.

Yes, I do have pred on hand, because believe it or not, my other pitbull is Addisonian since 6/02. Although a horrible disease, she only had one initial crisis at the time she was diagnosed and never again. It has been simple to manage, unlike Porkchop's Cushing's!

Tell me if any more info could be helpful and I'll supply it! Thanks so much! It is a relief knowing you are here!

[StarDeb55]

Gina, welcome to you & Porkchop!


he stated that the liver enzymes were elevated which is not typical of Cushings, but he thought that there may be underlying liver issues.

Many of us will beg to differ with your IMS. I am now treating my 2nd cushpup, & the great majority of our pups have elevated liver function tests including ALT, alkaline phosphatase, & cholesterol. In fact, an elevated alk phos is frequently what will point a vet toward taking a look at Cushing's.

I can't comment a whole lot on trilo as I don't use it. I do believe that Dechra's current starting dosing recommendations are, now, on the conservative side, 1 mg/lb, so from what you have posted it appears that Porkchop's dose was pretty darn high. I think Dechra has now found it's best to start at a lower dose, & work up, if needed.

Based on the stim results from 3/2, please DO NOT give any further trilostane. This post results is critically low indicating possible Addison's. You can't restart the Trilo until you have done a stim to see if Porkchop's adrenals are producing too much cortisol. We have had several pups in this group who have been started on Trilo, went extremely low at the first stim like this, & have not restarted medication yet. The latest one in Princess & her mom Jeanette, I believe it has been something in the neighborhood of 3-4 months of no meds. I think the criteria to restart the medication is a return of symptoms, along with an elevated stim result. If I were in your shoes, I would not be giving one of my pups any more trilo with stim numbers like these as you will be at high risk for an Addisonian crisis.

Debbie

[frijole]

Hi and welcome from me! I have never used Trilo but have read about it and the cases here for almost 4 yrs....and if Porkchop was mine, I'd STOP giving it! :p

Obviously the first dose was too high. We have seen that it is best to start LOW and work your way up if need be because of exactly what you have seen happen.

When the acth came back at 0.8 did the vet check the electrolytes? Because I want to make sure all is back to normal and that you don't end up with two addisonian dogs! I am surprised you started giving the trilo right away... normally vets wait for cortisol levels to rise back to normal (normal for cushings is 1 to 5 acth reading). Only then do you start giving it again... or... your dog's cortisol goes low again and.. they get sick, won't eat, are apathetic....

So I would not give trilo and I would seriously talk to my vet about giving prednisone to give your dog a little cortisol high and to make him/her feel better!

I'm sure I forgot something but others with lots of experience will chime in. Hang in there!! You are right to start questioning what is going on and to read up. We have a wonderful reference section with tons of information on proper protocols, etc. Glad you found us! Kim

[Harley PoMMom]

Hi Gina,

When your vet called to tell you to stop the Trilostane did your vet also tell you to give him some prednisone? If not, I would either call the vet back and ask or if Porkchop were my dog I would give him the prednisone on my own.

With your boys post stim being so low it is no wonder that he feeling so yucky and not wanting to eat, the prednisone will make him feel much better...it's like putting cortisol back into his body.

According to Dechra's Product Insert:


Capsules should be temporarily discontinued until recurrence of clinical signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 μg/dL or 40-250 nmol/L). VETORYL Capsules may then be re-introduced at a lower dose.

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

As you can see Dechra wants a post of at least 1.45 ug/dl and clinical signs before any Trilostane can be reintroduced. Taking Porkchop off the Trilostane is very important but I believe getting some prednisone into him is too.

What is Porkchops "POTASSIUM" lab results and/or his "NA/K RATIO" lab results?

FWIW, liver enzymes are usually always elevated in cushingnoid pups, the high cortisol makes the liver work harder, thus the liver enlargens...altho it is usually the ALP that is higher than the ALT.

One other thing you could do for us is type in the reference ranges with the unit of measurements for all the lab results, now all you have to do is go back and "edit" your post, this would help our Lab Expert out alot, she has over 30 years experience, her name is Debbie and I am sure she will be along to read your results.

Trust me when I tell you that you have found an amazing group of people here, they have helped me and my boy tremendously and I know you will be helped also.

Hang in there!

Love and hugs,
Lori

[zoesmom]

Hi and welcome, Gina and Porkchop -

That last acth is not only LOW, it is considered non-stimulatory. And in the past, the original mfr. literature on vetoryl (trilostane) said if there is a non-stimulatory result (i.e. the post number is less than the baseline), the drug should be withheld for seven days. Since those results are not only LOW but widely non-stimulatory, I'd think the safest move would be to STOP the trilo, wait 2 or 3 weeks even, and then get another acth before even thinking about restarting the medicine. (The rec. range for a trilo patient is around 2 - 7.2 ug/dl on the acth.) Usually when we've seen non-stim results here, in members dogs, there is only a .1 or .2 difference in the two numbers.

Not real up on kidney issues, so not sure what the protein in the urine signifies, but Dechra has always recommended not using trilostane in a dog with compromised kidney function. I think you should definitely ask about that. I'm not sure but can't elev. blood pressure go hand in hand with kidney function?? Somebody????

One other point - unless the vet mistated . . . but cush dogs DO normally have elevated liver enzymes. So I'm not convinced those numbers (which seem only mildly high - they can sometimes go much much higher) reflect anything other than a cushings effect. Most cush pups continue to have slightly elev. liver enzyme numbers, even on treatment.

I'm concerned about Porkchop. If it were me, I'd stop the trilo until everything is sorted out. And I wouldn't be restarting trilo (or anything else) until you have some answers about these kind of concerns. It won't hurt if his cortisol creeps back up as cushings is a slow-progressing disease and a few more weeks wait won't matter.

The loss of appetite - did that start immediately when you started giving trilostane?? If he gets some time off of the trilo, maybe his appetite will pick back up. Pred would surely help too. You didn't say how long he was off of the trilo when he first started to get sick and you stopped it. It sounds to me like he probably needed a much longer break and is still verrrry low on cortisol. It can take some dogs quite a while to rebound enough; thus the poor appetite.

Zoe was 85 lbs or so when we started trilo. She got very sick the 3rd day on 180 mg. so we lowered her dose to can't remember what exactly and waited 4 days and yet she got sick again on the second day after restarting. We finally had to lower her dose all the way down to 40 mg before she could tolerate it. That dose, unfortunatley, didn't adequately lower her cortisol tho, so we gradually - over 3 months time- increased it back up. Taking that much slower approach worked for her. We went from 40 to 60 to 75 to 90 and then finally 120 mg - increasing every two weeks or so. For some reason the larger dogs can be ultra-sensitive, it seems. But now, Zoe takes that original dose of 180 mg twice a day, instead of once, and can tolerate it just fine. Please keep us in the loop on how Porkchop is doing. ;) Sue/Zoe

[Harley PoMMom]

Not real up on kidney issues, so not sure what the protein in the urine signifies, but Dechra has always recommended not giving trilostane to a dog with compromised kidney function. I'm not sure but can't elev. blood pressure go hand in hand with kidney function?? Somebody????
Sue/Zoe

Harley has protein loss in his urine due to his elevated blood pressure which is confirmed by UPC tests.


WHAT CAUSES HIGH BLOOD PRESSURE IN PETS?

There are numerous diseases in pets that are associated with high blood pressure:

Chronic Renal FailureIn one study, 93% of dogs with chronic renal failure and 61% of cats with chronic renal failure also had systemic hypertension

Glomerular Disease (a disease of the kidney filtration system)
Whereby protein is lost in urine. It is important to screen pets with high blood pressure for urinary protein as control of protein loss is important to survival time.

Cushing's Disease

...

http://www.marvistavet.com/html/body_high_blood_pressure.html


Glomerular disease (RENAL PROTEIN LOSS DUE TO INFLAMMATION)

When glomerular disease exists, holes are punched out in this filtration system allowing large molecules (like the proteins that one’s body needs to keep) to enter the urine flow and be urinated away into oblivion

http://www.marvistavet.com/html/body_glomerulonephritis.html

I do know when Harley's blood pressure is under control his protein loss is minimal.

Hope this helps.

Love and hugs,
Lori

[Roxee's Dad]

Hi Gina,
I am so glad you made it over here from FB :) I see you have been given some very good advice from our experienced and knowledgeable members. Very glad you stopped the trilo and also believe you should give Porkchop some pred.

Cushing's progresses very slowly and right now we need to get Porkchop back to good health and return his appetite again.

Once again, I am glad you made it over here. :)

[zoesmom]

I have to agree - as somebody also mentioned above - that Porkchops electrolytes should also be checked, in view of those low acth results. Sue

[Harley PoMMom]

I've worked at the primary vet office for the past 14 1/2 years as a tech and I feel like I should know what I should be doing right now, but I am at a loss.


Oh Gina,

Cushings is a confusing, frustrating and sometimes scary disease that we and our pups fight. That's the beauty of this forum. ;):) There are wonderful and loving people here on this forum that know Cushings like the back of their hands. Some vets/IMS just don't get it because they haven't lived with a cushingnoid pup day in and day out. These people have and they do get it!

Please do not be so hard on yourself, just because one works in vets office does not mean they should automatically know how to diagnose and treat every disease, heck, no vet/IMS can do that. :p:)

So please ask all the questions you want, ok.

There is a product called Nutri-Cal that you can give to Porkchop while he is not eating properly.

http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=587&cmpid=01csegb&ref=3312&subref=AA&ci_src=14110944&ci_sku=0027683000000

Love and hugs,
Lori

[frijole]

Here is a link to the reference section I mentioned earlier. TONS of info on trilostane, cushings, everything you need to know. :)

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

[Harley PoMMom]

Let me give you some values:
12/15/09- Pre-op labs (no symptoms or sign of anything except hair loss)
ALT 626 H (12-118 U/L)
Alk phos 229 H (5-131 U/L)
Phosphorus 6.4 H (2.5-6.0 mg/dl)
Cholesterol 398 H (99-324 mg/dl)
UA results Protein 2+ H (should be NEG)
SG 1.017 (1.015-1.050)
T4 < 0.2 (1.0-4.0 ug/dl)

1/09/10 Cortisol/Creat ratio: 133 H = Cortisol 20.6 ug/dl range 5-55) / Creatinine 48.2 mg/dl range 100-500)
UA results protein 2+ (should be NEG)
SG 1.008 L (1.015-1.050)
pH 7.5 H (5.5-7.0)

1/13/10 LDDS Pre 6.4 ug/dl, Post1 5.9 ug/dl, Post2 3.7 ug/dl = Cortisol level greater than 1.4 8hrs post is consistent with PDH

1/19/10 HDDS Pre 8.8 ug/dl, Post1 8.0 ug/dl, Post2 4.3 ug/dl = this test was done to determine PDH vs. adrenal tumor... but it is right at 50%: cortisol level is greater than 1.4 ug/dl 8 hours post dex confirming Cushings- Cortisol level less than half the baseline level at either 4 or 8 hours post dex is consistent with PDH
Blood work also repeated on 1/19-
AST 80 H (15-66 UL)
ALT 724 H (12-118 U/L)
Alk phos 373 H (5-131 U/L)
Sodium 155 H ((139-164mEq/L)

1/26/10 Saw Internal medicine Dr. Protein/creat ratio high at 2.3 (I do not have this labwork in front of me to supply ref range)
He stated that diagnostic workup consistent with PDH- Ultrasound did not reveal an adrenal tumor, blood pressure was taken and was started on Norvasc- he stated that the liver enzymes were elevated which is not typical of Cushings, but he thought that there may be underlying liver issues. The lung nodule on rads has remained static, so they beliee it is a primary lung mass vs. metastatic disease. Blood pressure was rechecked and he is doing fine on norvasc dose.

Trilostane was started, but due a bout of diarrhea, it was stopped and then restarted. He has not had any further diarrhea and only one episode of vomiting to date. Because of the stopping of trilostane on and off-- if I couldn't get Porkchop to eat anything, he didn't get his trilostane-- we had to wait until he was on the trilostane consistently for 10 days prior to his ACTH stim

3/2/10 ACTH stim - Pre 1.8 ug/dl Post 0.8 ug/dl -
Normal canine values: 5.5-20.0 ug/dl

Bloodwork repeated:
ALT 352 H (12-118 U/L)
Calcium 8.5 L (8.9-11.4 mg/dl)
At this time, I was told to decrease his trllo to 60 mgs once daily- he started out weighing 60 lbs and is now at approx 48 lbs.

I am supposed to repeat his stim on 3/16. However, after reading so much on trilostane, I decided to stop giving it to him (as far as tomorrow's dose goes), so the repeat stim may have to be done later? My vet called me tonight and also said to stop the trilostane until she talks to the internal medicine dr tomorrow. I've worked at the primary vet office for the past 14 1/2 years as a tech and I feel like I should know what I should be doing right now, but I am at a loss. I feel like I should have stopped the trilo sooner.

Yes, I do have pred on hand, because believe it or not, my other pitbull is Addisonian since 6/02. Although a horrible disease, she only had one initial crisis at the time she was diagnosed and never again. It has been simple to manage, unlike Porkchop's Cushing's!

Tell me if any more info could be helpful and I'll supply it! Thanks so much! It is a relief knowing you are here!

Thanks so much for inserting the reference ranges & units of measurements. Harley's UPC test (RR is </= 0.5).

Love and hugs,
Lori

[PorkchopDog]

Thank you Sue, Debbie, Kim, Lori and John :) Thank you, John, for referring me to this wonderful insightful forum!!! Your information is fantastic and quite a bit of a relief.

I edited my post with the values and units for Porkchop's labwork.

To answer your questions:
I may have misinterpreted what my IMS stated: his exact statement in regards to elevated liver enzymes was: Porkchop's liver enzymes are elevated and the pattern is not typical of Cushing's disease. This does not exclude the possibility of Cushing's being the cause, but raises some possibility of other liver disease. I know that had mentioned that the ALP is usually higher than the ALT and maybe that is what he meant by not being a typical pattern?

His electrolytes were checked within a vetscreen on 12/15, 1/19 and 3/2. His Potassium and sodium were as follows:

12/15/10 Potassium 4.6 mEq/L (3.6 - 5.5), Sodium 154 mEq/L (139-154)

1/19/10 Potassium 4.5 mEq/L (3.6 - 5.5), Sodium 155 mEq/L (139-154)

3/2/10 Potassium 4.7 mEq/L (3.6 - 5.5), Sodium 146 mEq/L (139-154)

His loss of appetite began shortly after his surgery on 12/15. Because he had a dental, I did not offer him food that evening. His teeth required no extractions and he had mild tartar. Since he was under, the dental was done. The next day he ate, but not with his usual appetite. I owed this to him having had surgery, although I expected him to be ravenous. The next day he continued to eat his treats and people food, but did not finish all of his breakfast or dinner. We began boiling chicken for him and was offering that along with any other wet/dry food he would eat.

On 12/23, his incision began to ooze and had a pus discharge. I warm compressed it and started him on Ciprofloxacin 500 mgs, because it was 10PM and I spoke to one of his vets and they suggested to use the cipro that night, but pick up Clavamox 375 mgs the next day. (Cipro was left over from another pet) By 12/25, both the incision on his back that was oozing had dehisced along with the incision on his elbow. We took him to the ER on Xmas and they cleaned the incisions and recommended that I continue the Clavamox with warm compresses. He was then on Clavamox for 3 weeks... given the dehiscence, Cushing's testing began.

He did not begin the trilostane until after 1/26, but I have to check with my husband to see the date we actually began giving it. His appetite all along had been very finicky and I thought it might have to do with him being on the clavamox. We started trilostane and shortly after he had a horrible bout of diarrhea- we did not know if it was from the trilostane or the variety of foods we were offering him...so, we stopped trilo for about 3 days and put him on low residue dry food and boiled chicken. (The diarrhea resolved.) We began the trilo again and continued with the bland diet. We added in low residue wet when he stopped eating the chicken and then his appetite went completely downhill. We then began offering him everything once again, but he continued on the trilostane. He missed a day here and there when we could not get anything in him to eat. Due to this inconsistent dosing, the ACTH stim got delayed. He began eating Hill's A/D.. a 5.5 oz can for breakfast and almost the same for dinner. He was given 2 cans at a time, but never finished them. I've bought him every food to try, as well as baby food and a variety of human food. He refused pizza crust this past saturday. He will however, eat a handful or more of Great Choice dog biscuits from Petsmart. So, we give him about 20 biscuits and his trilostane in the AM. Tonight, we offered more boiled chicken, beneful dry and Gerber baby food. He picked at the beneful dry. (I'm trying all brands to see if he likes something.) He is also on pepcid 20mgs once daily.

I see that you are all in agreement with stopping the trilo. It is stopped. When my vet called tonight, she did not mention giving pred. However, I would like to start that as well. He is approximately 48 lbs, so I am not sure what dose of pred to give him. I have 5mgs pred at home for Scully. I appreciate the help and dedication this group has to offer. I never expected to get so many responses, that are all so very helpful.

Also, I work full time as a dialysis technician for humans and I am at the vet hospital on saturdays only. I did work there full time for 10 years, but have been part-time for the past 4 1/2 years. Just recently, 1/19, I was attacked by a dog and my foot was injured pretty badly. Badly enough that I've been on short term disability since the incident and I just started PT today. I am hoping to return to work as soon as I have full functioning of my foot. This is no excuse as to why I feel like I have failed my dog and have let this go on too long. I am normally at the hospital throughout the week, even when I am not working, but I have been immobilized in my home and have relied on my husband to bring Porkchop back and forth to the hospital for his tests, rads, bloodwork, etc. I have been dealing with my doctor friends over the phone instead of the usual "in-person chats." I talk to them several times a week and they are well aware of Porkchop's situation, so I feel like I have kept them 100 % in the loop of his setbacks. I'm glad John introduced me to you and I am happy to have you as a truly fantastic resource!

[frijole]

1. Did your dog ever have a tremendous appetite? Most cush dogs don't even breathe between bites, seriously.

2. Re the prednisone - lord I cannot remember the exact ratio for dogs in crisis... it is HIGHER than what I am going to quote you so you should be safe - my prescription is also for 5 mg pills. My dog weighed 18 lbs and in emergency I am to give 1/2 of a 5 mg pill. So I think you would be safe to give one pill - though that is a conservative dose. I am sure someone here will remember the exact amount.

3. It is too bad that so much was going on prior to the dx as it does make knowing what is causing what more difficult. Many have noticed that their dogs become finnicky eaters. You must get some nutrition in that furry baby! I gave mine pedialyte over a weekend when she had a violent flu. (its for babies and I got it at the drug store) I started with just a tablespoon at a time. Gave it to her every hour and it really worked well.

I am relieved you got our collective message to stop the trilo. :o:D;) We are a caring bunch and when we see dogs in potential distress we make sure our voices are heard.

Glad you found us and please do keep us posted. Kim

[Harley PoMMom]

Hi Gina,

First, YOU have not failed Porkchop, now get that thought out of your head, ok.

The reason we wanted to see the electrolyte results were because both trilostane and lysodren have the ability to impair aldosterone production in additional to cortisol production. There can be two parts to an addisonian crisis. If the cortisol drops to low the dog may need a glucocorticoid (prednisone-like sythetic cortisol) replacement- this is tested by using the standard ACTH stim test which tests cortisol and its response to stimulation. Aldosterone is the second hormone that can be impaired.

When aldosterone is impaired the kidneys lose their ability to excrete
the correct amount of potassium, henceforth the potassium levels rise and retain the correct amount of sodium, henceforth the sodium levels drop. When this happens it can be life threatening if undetected and untreated. The Blood potassium level rises and sodium lowers.

You should be monitoring what your dogs potassium (K) and sodium (NA) levels are when on treatment for cushings. You should also be looking at the NA/K ratio- that should always remain above 27. When aldosterone is impaired a mineralcorticoid is needed. Either of these hormones can become imbalanced singularly or both can become unbalanced. So just because a pup has normal electrolytes does not mean they might not be addisonian and visa versa- we have seen some dogs where Aldosterone production has become impaired requiring a mineralcorticoid and cortisol levels have been normal or high. You must monitor BOTH cortisol production with ACTH
stim test and aldosterone production with a chemistry panel checking
potassium and sodium levels.

Now the prednisone: The standard rescue dose of pred is 0.25mg/kg. To find her wieght in kg, divide the
lbs by 2.2...then multiply that result (her weight in kg) by 0.25 and you will have the amount for her weight.

So for 48lb / 2.2 = 21.8kg * .25 = 5.45mg prednisone.

Love and hugs,
Lori

[zoesmom]

Hi Gina -

Wondering, with the weight loss, if diabetes has been ruled out? It sounds like the poor appetite started well before the trilostane, right? And has been pretty consistent ever since the dental in December? The two diseases can sometimes show up about the same time. Just a thought. Maybe our diabetes experts will have some comments???? Sue

[Harley PoMMom]

Sometimes when they don't want to eat, some of us have used "stinky food" to wet their appetite. Grated Parmesan cheese on top of their food, tuna juice and tripe (ewww!).

Love and hugs,
Lori

[mypuppy]

Hi Gina,
I too wanted to welcome you and Porkchop to our wonderful online cush family. I wanted to confirm what Debbie posted earlier as to my personal experience with trilostane. My Princess (7 year old chocolate lab) was diagnosed in October, and not by her gp. Her gp obviously had never treated Cushings, therefore, he never picked up on the symptoms. That's when I referred myself to an IMS who immediately tested for Cushings and her final diagnosis was PDH. We started Princess on 2 (60mg) of trilo once a day, however, only to learn at her 14 day stim her cortisol levels had extremely dropped
(.1). My IMS instructed me to stop the trilo for a week and restart her after one week on 1 (60mg) once a day. In the meantime, I of course, posted, posted, posted on the forum only to learn that I should not restart the trilo unless Princess was experiencing her Cushing's symptoms. So I did not resume her trilo as suggested by her IMS, and Princess has been in remission close to 4 months now, and it is great that she is taking a nice break from these meds. But anyway, all I wanted to say is that you shouldn't lose all hope because there is plenty, and the forum is the first place you can find that among so much more, so do sit tight and be patient. Take the necessary steps to have your precious Porkchop (love the name by the way, haaaaa), and you will hopefully see some good results in his health. I am sorry that you and your Porkchop are being put through this Cushing's test. It definitely isn't an easy ride to say the least, but I do promise that all the advice you get here, it is with your pup's best interest at heart, and yours too of course. Take care of yourself and as Lori says, try not to blame yourself for your pup's misdiagnosis or uncertainty. Seems pretty obvious to me and everyone here you are doing everything in your power to heal that pup, so go easy on yourself, ya here. For now, I'm sending you my best regards and tight hugs (those help sometimes)....Chin up! xo Jeanette

[PorkchopDog]

I posted a response last night, along with thanking everyone for their help, but I don't see it in this thread of posts. I'm new and I am not sure if I posted correctly. I just want everyone to know that I am so grateful for the info everyone supplied to me. Porkchop has stopped the trilostane and he is on prednisone..... and guess what?? He's eaten more today than he has eaten in the past 3 days put together :) I'm excited to see him eat, but at the same time, I'm worried that he may get an upset stomach---so, I am taking it easy. He is also going to get some Nutrical. Since I was feeding him A/D, I totally forgot I could use Nutrical as well...thanks Sue.
My vet did call 8:30AM after speaking with my IMS and they agreed to stop trilo and begin pred... but I already knew that due to my great group of new friends!!!! You are angels!! Thank you! I will keep you posted with Porkchop's progress!!!! Lots of Wags from Porkchop and me!!!!:) :)

[PorkchopDog]

Jeanette...thanks so much for the Welcome and your encouraging words. I feel like this is my second family :) I am hoping that Porkchop is on the road to recovery and I am hoping that I will be posting positive updates in the future. I can't tell you how much I have learned in such a short time having joined this sight. I met a person on FB today whose dog was just diagnosed with Addison's and I told her how helpful this group has been to me and told her to join a similar group. Everyone's posts are full of info... I can't be more grateful!! Thank you! :)

[Harley PoMMom]

Hi Gina,

This is such good news that Porkchop is eating!!! If Porkchop seems to get bloated/gassy ask your vet about giving him Pepcid AC, ok. Harley gets Pepcid AC 20-30 minutes before his Lysodren meal, it really helps with the agitation that the meds can do to their tummy.

Also about post, is this the one you're looking for?
http://www.k9cushings.com/forum/showpost.php?p=26640&postcount=14

Please keep us updated! ;):D

Love and hugs,
Lori

[Harley PoMMom]

I was wondering how long they told you to keep Porkchop on the pred?

And you do realize that Porkchop can not be stimmed while on the Pred and he has to off the pred at least 24hrs before he can be stimmed.

Love and hugs,
Lori

[lulusmom]

Hi Gina and a belated welcome to you and Porkchop.

I think you've received some sound feedback from the others and am very happy to hear that you have discontinued dosing with Trilostane. I'll try not to repeat what you've already read but since I can be a real windbag at times, I won't make any promises. :D

Your vet is correct, Porkchop's elevated liver enzymes are not the usual pattern found in cushing's. The vast majority of dogs with cushing's have pretty elevated ALKP and usually mildly elevated ALT. Porkchop's results are the inverse of that. Having had a dog with a serious case of hepatitis, I know that unlike ALK, the ALT is a liver specific enzyme and if you have more than a two or three fold increase in ALT, it is definitely suggestive of something other than Cushing's, like primary liver disease, cancer, auto immune disease, etc. I noticed that Porkchop's ALT was even higher a few days after the LDDS which looks to me like something other than steroids was still pummeling the liver. Since the LDDS test is prone to yield false positive results in the face of non adrenal illness and stress, I wonder if perhaps LDDS was not done under optimum circumstances. In any event, I was happy to see that the ALT had come down quite a bit on the last bloodwork. How did the ALKP look on the last recheck? Did your vet prescribe liver support such as Denmarin, milk thistle or Sam-e to get the ALT down?

I don't know the answer to this question and while I continue to look, perhaps you can ask Porkchop's specialist if the adrenals glands can be mildly enlarged in a dog that is not cushingoid but rather has an underlying illness that is causing transient hyperadrenal activity. If the answer to that question is yes, then I would have some questions about the cushing's diagnosis. Perhaps other members may know the answer to that question so would appreciate their weighing in.

It is known that a good number of dogs with cushing's have high blood pressure and that unless the dog has other underlying problems that also cause hypertension, the blood pressure usually comes down as the excess cortisol has been brought down to acceptable levels. The last stim test shows that Porkchop's cortisol levels are way too low and I am wondering if his blood pressure has been checked since starting the Trilostane. If not, there is a possibility that Porkchop's blood pressure has been normalized with Trilostane but continued dosing with Norvasc has reduced blood pressure too much. Lethargy and inappettance are not just signs of low cortisol, they are also signs of low blood pressure.

Any number of conditions, especially cushing's will lower T4 levels. More than 50% of dogs with cushing's will have low T4 on bloodwork but this normally corrects itself once the cushing's is under control. Only a small percentage, 10% - 15%, of cushdogs will go on to be diagnosed with primary hypothyroidism. A low T4 may be suggestive of hypothyroidism but a free T4 by equilibrium dialysis should have been done by your vet to confirm the diagnosis before prescribing levothyroxine. Can you let us know if this was done and please post the results? Also, your vet should have mentioned rechecking thyroid levels a month or so after starting levothyroxine. Has this been done?

I am sure sorry for the reasons that prompted you to join our community but I'm glad that John steered you our way. I'm also sorry that you were the victim of what sounds like a pretty serious dog bite and I wish you a speedy recovery.

Glynda

P.S. I'm at work and it took me forever to get this typed up in between interruptions and I see that during that time you posted that Porkchop is doing much better on the prednisone. Yay!!!!

[PorkchopDog]

I am sorry that I am just checking these replies now. I will respond to everyone, but I have decided to take Porkchop to the ER. Although he ate earlier, he seems more depressed than he has been. I would like for him to get some IV therapy and since he will be a "hospitalized" patient, I'm certain they can do another Ultrasound tomorrow. I will update you all once I have more info. The ER doctor that is on is phenomenal and she helped me with my Addisonian dog. I think she is brilliant and I need another doctor to look at his case. I will report later...again, thank you...but, I can't sit by and watch him be such a sad doggie!

[lulusmom]

We'll be anxiously awaiting an update on Porkchop. My thoughts and prayers are with you both.

Glynda

[frijole]

I am thinking of you and Porkchop, sending warm thoughts your way. Keep us worry wart "aunties" informed. ;):D You made a good call I am sure. Kim

[PorkchopDog]

Thank you everyone...

Porkchop got hospitalized and he was put on IV fluids. I don't have any answers. They checked his electrolytes and his Potassium and Sodium were ok. His glucose was ok. His PCV was slightly high die to the dehydration. His ALT has doubled since 3/2/10 to 700 something. His internal medicine specialist works at this practice, so he will get all of his labs, etc. The ER vet said that she could not give me an answer as to what is going on with him. She is pretty certain he does have Cushings...however, she is concerned about his ALT. His alk phos was completely normal, as well as his BUN. (I don't have values-- but will, once he is discharged.) Her plan is to keep him hospitalized on Fluids, have his IMS look at him tomorrow and possibly discharge him in the afternoon. Unfortunately, the ultrasound doctor took an actual vacation day tomorrow and they are without a sonographer....so, I already have him scheduled to return on Thursday for an abdominal and thoracic U/S. She is recommending the possibility of a liver aspirate... but, waiting to see what the IMS suggests. I am sorry I don't have any answers, but any info anyone has, I'd love to be armed with information when I talk to his IMS tomorrow. Oh, and his SG of his urine was still low at 1.005. I'm saying my prayers and hoping he does well overnight, because he was not happy when we left him. He immediately chewed out his Tset and I was brought back to hold him because he was being non-compliant.... totally out of character for him. Thank you everyone for being so supportive!

[Franklin'sMum]

Hi Gina,
A very belated welcome to you and Porkchop, and I am so sorry for Porkchop's issues. About the pred dosage, I was told to give my Franklin 1/2 mg per kg of 'cortate' (essentially the same thing, but a different name/brand.). He's a 7.7kg maltese, so has gotten 3.5 ish mg when necessary.
Please keep us posted,
Jane, Franklin and Bailey xxx
________
RIDERS ASSOCIATION (http://www.bmw-tech.org/wiki/BMW_Riders_Association)

[PorkchopDog]

Good Morning everyone! Just an update: I spoke to Porkchop's IMS at 9:30AM. He said that according to the ER doctor's note from last night, Porkchop seemed to be doing much better today after receiving the fluid therapy overnight. He is still on IV fluids and may or may not remain hospitalized overnight. He is scheduled for a 9:15AM U/S tomorrow, whether he stays or goes home.

His IMS stated that he felt like the low SG was a very important puzzle piece to Porkchop's condition. Porkchop was very dehydrated last night, but his kidneys were unable to concentrate his urine. he does not think there is a "kidney" issue, due to the normal kidney values. He mentioned the possibility of Diabetes Insipidus. Can you believe that Scully, my Addisonian, also has diabetes insipidus and has been on Desmopressin for almost 3 years. It's a rather rare disease. I believe this would be in addition to the Cushing's.... I think we are sure that Cushing's is the disease we are dealing with...but he also has "other" things going on. SOmeone asked earlier if his LDDS test was done under ideal circumstances. He only went to the hospital for his pre-bloodwork and to have the dex given IV. He was then taken home and I drew his post at home. So for the length of the test, he was laying on the sofa in his own home and not stressed...same situation for the HDDS.
He also feels that it may, of course, have to do with the liver. He was not overly concerned that the ALT doubled, since he was "so" dehydrated, he would expect the ALT to be somewhat high. The plan is for today.... although he received 5mgs of pred yesterday, he wants to do an in house cortisol level to see where we are at. He is also going to do a bile acids profile, which gets sent to the lab, so we may have to wait a day or 2 for that. Given the fact that he was tachycardic when he came into the hospital last night, he wants to keep him on fluids throughout the day. He will re-evaluate and see where we are at 3:30PM. He is very "anxious" at the hospital (this being his first time ever being hospitalized) and I did state that if he was too stressed there, that I could put him on IV fluids at home. (Done it before with my Addisonian.) If he should come home tonight, I'll return for an US in the AM.
Other things he mentioned...his bilirubin, BUN, alk phos and glucose were normal. He said that he is not sure what is going on with him, because he has such an array of issues.Is there anything anyone recommends that I should ask my IMS to do?
When I am in work as a tech, I understand all medical language, can form full sentences and remember everything a doctor tells me. When it comes to my pet, I fall apart and can barely speak well.I automatically forget everything I've learned and I can't process the info fast enough to reply to the doctor with good questions. I basically say yes and whatever you need to do to make him better. I'm sorry i don't have more specifics, but hopefully later today I'll have more info....and I will have a pen to write as he speaks. AGain, thank you for your care and concern.

[StarDeb55]

I wouldn't think that DI would be in play just yet. Pretty much all cushpups can't concentrate their urine because of the amount of water they have to consume to keep up with their kidneys working in overdrive. IMO, you would need to determine that the PU/PD is not getting any better with treating the Cushing's, before considering DI. I'm sure some of the others will offer their opinion.

It's great that you had Porkchop at home for all of his diagnostic testing to keep his stress level low. I think because of being able to do that, all of his results are quite valid, & you are dealing with Cushing's.

I'm glad to hear that Porkchop is doing better, but I know he is not a happy boy to be away from home & his Mom.

Debbie

[lulusmom]

Gina, I am the one that was wondering if the LDDS test was done under optimum circumstance, not so much of the stress of being at the vet's office but due to chronic stress of a nonadrenal illness that your vet is trying to figure out. Porkchop's ALT was even higher at the time of the LDDS than it was a month prior which would indicate that something was still hammering at his liver at the time the LDDS was done.

You may be dealing with cushing's but unless Porkchop's crash is the result of his cortisol being too low, the "other things" going on with him definitely need to take priority. Hopefully your vet is doing an acth stim test today and that should shed some light on things.

I think your IM is following a logical path and hopefully the bile acid test will guide him or her as to the next step, which could possibly be a liver biopsy. It really sucks that liver enzyme values are only suggestive of a problem and like cushing's, there is no one test that'll give you the answer you are looking for. I'm keeping my fingers crossed that your vet can figure out what is going on with your boy.

Glynda

[PorkchopDog]

Good Morning everyone :) Just a quick note before bed and I will update everyone with details once I am up. My husband and I picked up Porkchop from the hospital tonight after speaking to a friend of mine that was caring for him...she informed me that they decorated his chart with "will bite" stickers.... he was becoming more and more anxious, panting a lot and they were unable to obtain his blood pressure...or take him for a walk. This is 100000x's out of character for him......so, I called another vet that I work with and asked his opinion and he suggested I pick him up. He was bright, alert, great appetite and the last BP they were able to obtain was normal. The plan for tomorrow would have been to recheck labs, administer meds and see if the bile acids panel came back. If we are going to do an ultrasound, we are going to give him some time to recuperate from this....if the bile acids show a problem with the liver...he will need an ultrasound guided aspirate/poss biopsy of the liver...so...he is going to my regular vet tomorrow for labs and recheck blood pressure and he is home in bed now. AND HAPPY! I know the ER doctor wasn't thrilled with me taking him home, because he wasn't her patient and they don't like to send the specialist patients home in the middle of the night, but I think him staying there...at this point...was making him worse. I will update tomorrow with values ...I must get to bed. We are exhausted! Thank you!

[Roxee's Dad]

Hi Gina,
How is Porkchop doing these days? We do tend to worry a bit.

[PorkchopDog]

Hi John & Friends,
I hope everyone is doing well :) Porkchop is doing ok. His bile acids test came back negative. On his most recent bloodwork from 3/12/10, his ALT is still high at 457 (12-118 U/L) and alk phos slightly high at 137 (5-131 U/L). His T4 (we finally checked it is 1.6 ug/dl (1-4). He still continues to look depressed. I have been giving him SubQ fluids every other nigh, which seems to boost his appetite. He is definitely eating a lot better, but still not his usual amount. He is currently off of the Norvasc....because his blood pressure did return to normal last week. The past 2 times we have checked it since his hospitalization one week ago, it was 170 and 180. So, he will most likely need to go back on the Norvasc. His urine is still dilute 1.003. (I haven't checked his urine after sub Q's have been given. I plan to recheck his specific gravity tomorrow and re-run another vetscreen/cbc and have his pressure rechecked. All of his data will be faxed to his IMS for the next step in the plan. He is still on pred (5mgs once daily) and he is NOT on trilostane. He is urinating and drinking more than ever. I think he'd finish a bath tub full of water if I let him. I plan to write to you once I speak to his IMS. Does anyone have any input or suggestions? Thanks so much!

[PorkchopDog]

Hi everyone. Sorry I have been out of touch. I do not have any good news about Porkchop. After his ER visit, i repeated his vetscreen and CBC twice and his alk phos and ALT are still high. He was restarted on Norvasc since his blood pressure reached 200. His T4 was checked and it was at the low range of normal. On 3/11, he weighed 47.2 lbs. On 3/19, he gained weight and was at 48.3 lbs. Today, he is at 47 lbs. The same scale was used and he was weighed by the same doctor each time. And, his appetite has definitely improved since being off of the trilostane. He has been consistently finishing 2 meals a day plus treats and whatever human food he wants to eat. His urine specific gravity remains low at 1.004 and 1.003. It has been rechecked multiple times. He has an appointment with his IMS on Tuesday, 3/30. I'm very worried. He continues to drink and urinate excessively. And, at times, urine will seep from his penis while he is wide awake. He seems more bright and alert and hydrated. I don't know what his IMS will plan to do. I will keep in touch. Thank you :)

[labblab]

Hi to you and Porkchop!

I'm sorry that I've not had the chance to post to you before, but I've just now quickly looked through your thread. I'm so sorry that you two are still having problems.

One quick question...I see the results of the 3/2 ACTH test that prompted the discontinuation of the trilostane and the start of the prednisone. Has Porkchop had a subsequent ACTH performed, or has the prednisone been given consistently without any interruption? I am wondering whether his cortisol level has rebounded to the point where the prednisone is unnecessary and is instead fueling his increased urination and thirst...?

I know there seem to be multiple issues involved right now, and that is just one piece of the puzzle. But it did leave me wondering. I am guessing that your Tuesday IMS visit cannot come quickly enough for you -- I'm hoping that you'll get some answers!

Marianne

[frijole]

You mentioned that ALK Phos and T were both still high... do you have the numbers? Cush dogs have higher than normal levels and some never really go down much at all.

Like Marianne, I would be interested in the results of acth testing to determine if the cortisol levels are still low or if they have gone up.

I'll be thinking of you!!!! Kim

[Squirt's Mom]

Hi Gina,

How is PorkChop's appetite these days? Any improvement?

Hugs,
Leslie and the girls - always

[PorkchopDog]

Hi there everyone,
Just an update on Porkchop. After his hospitalized ER stay in mid March, Porkchop continued receiving 5mgs pred once daily and no trilostane. His bile acids test came back normal, but his liver enzymes remain high. His blood pressure is controlled with 5mgs Norvasc once daily. His weight is consistent between 47-48 lbs, although before his initial trilostane treatment, his usual weight is 60 lbs. He is going to the vet today to get reweighed and examined. He saw his internal medicine doctor on 3/31 and I was instructed to do another ACTH stim test on him. I stopped the pred and his ACTH results were high, so it was recommended that we start Porkchop on 30 mgs trilostane twice daily. (inital dose was 120mgs once daily, then decreased to 60 mgs once daily) We started the trilostane yesterday and he ate bothe breakfast and dinner, but this morning he was uninterested in his breakfast. He would eat dog treats, so we gave him enough treats in order to give him his trilostane. He was uninterested in anything else I offered him the remaining part of the day except 2 cooked chicken dogs. He will be seen at the vet at 5:45PM tonight, but it seems like I get the best advice from here. I'm so afraid that the trilostane is hurting him. His excessive drinking and urinating returned once he stopped the trilo previously. And he currently seeps urine while he is laying down, standing up, awake, asleep, etc....,. I know it is uncomfortable for him, because he doesn't even realize he is doing it and then when he "feels" it, he gets very scared. Is trilostane really needed to treat Cushing's? I don't want him to be uncomfortable with the urinating issue, but if that is all I have to deal with, I'd be much happier. My husband took his chart with him in the car as to not forget it for tonight's visit, otherwise I would include values of lab results. Thanks for your input.

[StarDeb55]

This leaking of urine that you mentioned is more in line with a urinary tract infection than anything else, including the use of trilostane. I would certainly tell this to the vet, & insist that a urinalysis & urine culture be done. You want to make sure that the culture includes an antibiotic sensitivity which will determine the appropriate antibiotic, if there is a UTI present. Unfortunately, the only way to treat Cushing's is the use of either trilostane or lysodren. The goal is to lower the pup's cortisol levels & those drugs are the only effective method of doing that.

Debbie

[frijole]

Thanks for the update. Also, you mentioned the ACTH was high and so you restarted the trilo.... do you have the number so we know what "high" means? If the cortisol is high it could result in the return of the urination issues. Did you have this issue originally?

To answer your question - no there is another drug called lysodren that can be used to treat. I have used it for 4 yrs. Lets wait to see how this goes first though. Pls keep us posted. Hugs to PKCHP!!

[jrepac]

Yes "high" is somewhat subjective from vet to vet...some want to get it absolutely spot on to a low number and some would say that if the cortisol is lower/lowering, it is ok.. And, some feel it is easier to deal with a dog that has slightly elevated cortisol rather than it being extremely low. Vets have different POVs, like we do!

It sounds like maybe you are giving too much trilo...I am not a trilo expert, but others here have encountered situations where a lower than recommended trilo dosage worked just fine for their pups...

I hate to say that sometimes it is a matter of trial (and error!)

I'm sure it will work out just fine if you speak to your vet and are open, honest and direct w/him (or her)....only you can judge/evaluate how well your pup is doing day to day...

and, yes, the leaky urine very much sounds like a UTI to me....when mine had hers, she'd be "spotting" urine all over the place....

you can clear that up with some antibiotics and may want to consider a daily supplement to counteract UTIs (there are many available); they typically acidify the urine and prevent bacteria from sticking to the urinary tract..

I am sure it will all work out for you!

Good luck!

Jeff

[BestBuddy]

Just for something completely different.

Buddy had a few problems with urine leakage and it seemed to scare and upset him too so I used a Bellyband sometimes. It didn't solve the problem but it stopped Buddy's fear and also made less clothes and bedding changes for me. He didn't wear it all the time but when he did it worked great.

Jenny

[Harley PoMMom]

Is Porkchop neutered?

[PorkchopDog]

Hi Everyone,
Thank you for your responses. We have stopped the trilostane once again. To answer your questions:

Porkchop has had 4 urinalyses done in the past 4 months.
12/15/09 Protein high 2+, Specific gravity normal at 1.017, pH 6
1/09/10 Protein high 2+, specific gravity low at 1.008 (1.015-1.050), pH high at 7.5 (6.5-7.0)
1/27/10 Protein/Creatinine ratio HIGH 2.3 (</=.5)
Renal values have been normal on bloodwork and my IMS ruled out kindney failure
3/11/10 dipstick done: trace protein, specific gravity low 1.003
3/19/10 dipstick done: trace protein, specific gravity low 1.004
specific gravity checked 2 more times in March (dates not documented) but both low at 1.004
While these urinalyses were done, Porkchop had done approximately four weeks on Clavamox for a skin infection, later he was on Amoxi and metronidazole when he left the ER, and he just finished another course of 2 weeks of Clavamox for a skin pustule. A urine culture was never done, because he has chronically been on antibiotics and they would have interfered with the results.

Porkchop was neutered at 5 1/2 months old. The leaking problem is more than a leaking problem....he literally soaks everything he lays on. He drinks bowls and bowls and bowls of water and when he urinates, he stands for over 2 minutes. He is let out approximately 15 times a day. He never lets out small amounts like a UTI would present, he literally urinates buckets of urine. This problem began shortly after his lumpectomy and dental in December09. GIven the increased urinating and drinking and hair loss, we started to investigate for Cushings. When he initially went on trilostane, his excessive urinating and drinking disappeared. His initial dose of trilostane wwas 120mgs once daily, which was then decreased to 60mgs once daily, with no break between the 2. Then we stopped the trilo and started 5mgs pred once daily. Shortly after that, he ended up in the ER. We have kept him off of trilo until this past week. He was put back on trilo at 30mgs twice daily. He only recieved 3 doses before he completely lost his appetite and had a vomiting episode. His ACTH was done on 4/2. His pre sample was 8.6 ug/dl. His post sample was 25.9 ug/dl. No stress factors. I did it at home and he slept on the sofa the entire time. Prednisone had been stopped prior to the test.
We started the 30mgs trilo twice daily on 4/8. Friday, 4/9 he went to the vet and I was instructed to stop the trilo. I will speak to my IMS on monday. In the mean time, Porkchop weighed 60lbs prior to ever starting trilostane. We have been weighing him weekly and although he has not been on the trilo and his appetite has been good, his weight has been consistent between 47-48 lbs. However, on friday he weighed 45lbs. He has been getting weighed on the same scale and by the same doctor. He also seemed "glassy-eyed" when he was on the trilostane this time around for only 3 doses.
I am willing to try anything. I know Lysidren tends to have more side effects than trilostane and I am worried if I switch him, will he even get worse?
His last bloodwork on 3/23/10 revealed:
ALT 425 High (12-118) U/L
Alk phos 309 High (5-131) U/L
On 3/12/10:
ALT 457 High
Alk phos 137 High
On 3/3/10:
ALT 352 High
Alk phos 129 normal
When he was in the ER on 3/10/10-- his ALT was 784 High
Alk phos 149

Bile acids were done and they were normal. His IMS did that test so I don't have the values.

He was heartworm tested and lyme tested as well.

If you recall, in Jan we found a primary lung mass --- he has been re-xrayed 3x;s (last time 3/31/10) and no more masses were seen and the single mass has remained unchanged.

He ate 1/2 of his breakfast this morning, treats throughout the day today, and approx. 1 can of A/D...we offered him 2 cans. He did not touch his dry food or any other brand of dry we offered him.

Any thoughts on what i should do next? I'm willing to do anything. A friend of mine works at a holistic vet....I don't have any experience with them. Any suggestions? Thanks so much!

[Harley PoMMom]

We started the 30mgs trilo twice daily on 4/8. Any thoughts on what i should do next? I'm willing to do anything. Any suggestions? Thanks so much!

Is Porkchop diabetic? Twice daily dosing is usually not recommended unless the pup is diabetic or after the pup has been on the Trilostane for some time and it seems that once-daily dosing is not adequately controlling the cushings.

What is his Bilirubin level on his chemistry panel?

[PorkchopDog]

Thanks for your reply :) Porkchop is not diabetic. My IMS toyed with the idea that he may have diabetes insipidus, but since the trilo resolved the excessive urination and drinking when he was on it prior, he decided that he did not have diabetes insipididus.

Bilirubin:
12/15/09 before any problems: 0.1 mg/dl (0.1-0.3)
1/19/10 0.2
3/03/10, 3/12/10 & 3/23/10: 0.1

Glucose has always been normal as well.

My IMS did tell me that twice daily dosing is not the way trilo studies have been done, but he said that it is a proper way of dosing. Only the studies were done once daily. He also said that giving 30 mgs twice daily is not the same as giving 60 mgs once daily. He said that Porkchop would absorb it differently.

He did eat 2 cans of A/D this AM and he has eaten several treats today. Refused some treats, but ate most of them. He will not touch his dry food at all.

[PorkchopDog]

Hello there :) I spoke to my IMS today and I was instructed to do another ACTH stim test and to check Porkchop's electrolytes. I sent out a full vetscreen/cbc and UA as well as the stim today. He ate some A/D this morning, but seems rather mopey. Drinking and urinating up a storm, as usual. I've been looking into anything I can feed him with high calories.... I have been giving him A/D and I can force Nutrical in him, but does anyone have any other suggestions of foods that may be tempting for him or foods that are high calorie. Someone suggested parmesan cheese on his food, which we tried last night, but he didn't go for it. Any suggestions would be appreciated. Once I have the bloodwork results, I will post. :)

[littleone1]

When Corky got finicky about eating, I gave him homemade meatloaf, ham, and pork roast, along with his rice, green beans, sweet potatoes and pumpkin. He was still getting his boiled chicken, with the other meats added in with it. It might be worth a try. I also mix his ground beef and ground turkey with bread.

Terri

[Nathalie]

In rescue, dogs often come in too thin/emaciated ..

I never had to use it but a lot of people feed Satan Balls to put some weight on the dog ..


The below was posted on one of my rescue groups.

Ingredients:

10 - pounds of hamburger (cheapest)
1 - Lg. box of Total cereal ( or comparable natural brand)
1- Lg. box of oatmeal
1 - jar wheat germ
1 1/4 cup - vegetable oil
1 1/4 cup - un-sulfured molasses
10 - raw eggs
10 - envelopes unflavored gelatin
pinch of salt


Directions:

Mix all ingredients together, much like you would a meatloaf.
Divide into 10 portions and place each in a quart freezer bag and freeze
un-needed portions.
Thaw as needed.

or

http://www.njboxers.com/satin-balls-recipe.htm
Nathalie

[zoesmom]

Thanks for your reply :) Porkchop is not diabetic. My IMS toyed with the idea that he may have diabetes insipidus, but since the trilo resolved the excessive urination and drinking when he was on it prior, he decided that he did not have diabetes insipididus.



Glucose has always been normal as well.


When was his blood glucose last tested? Not the DM expert around here, but we do have several. IF it's been awhile, maybe a retest is in order. Symptoms are so similar to cushings and there can be weight loss as well.

Those are some pretty low USG's in the New Year (tho' not bad in Dec.) I'm trying to sort out the timeline for Porkchop to figure out what went on between Dec. and the New Year and April. Looks like a lumpectomy and dental in Dec. and then the urinating problems got worse?? Once off the trilo, it looks like that's when the USGs fell. Plus, his ACTH numbers were definitely back up there by early April (both these things - while he was off the trilo) so just wondering if higher cortisol could have led to the excess drinking and hence the peeing accidents?

So is this right: You had the higher cush-like results on the ACTH in early April and then restarted him at 30 mg bid, a few days later . . . after a 3 or so month hiatus from it (at 60 mg sid?)? And the next day the vet said to stop the trilo? Because???? Of just the appetite? Any other symptoms of too much trilo at that point? You mentioned glassy-eyed, too, I think? Anything else? And he was given the trilo with food, right? And the excessive peeing started when exactly??? I'm sorry I'm so mixed up but will reread. :rolleyes::rolleyes: Maybe you gave the answers already. I just keep thinking about the dogs here who had unexplained weight loss and how, more than once, it turned out to be DM. So if it's been longer than a month or two since a glucose test, maybe it's time again. Natalie . . . . Can DM crop up that quickly? Sue

[PorkchopDog]

Hi everyone...I have some bloodwork results that are very confusing to me. i have a call in to Porkchop's IMS.

ACTH results: Pre 6.0 ug/dl
Post 13.4 ug/dl
Antechs guideline: Normal response to ACTH Stim Test:
Canine: 5.5 - 20.0 ug/dl
Last dose of 30 mgs trilo given on Friday am 4/9/10.

ALT 512 U/L High (12-118)
Alk phos 431 U/L High (5-131)

Calcium 8.2 mg/dl Low (8.9-11.4)
Glucose 88 mg/dl Normal (70-138)
Bilirubin 0.1 mg/dl Normal (0.1-0.3)

T4 = <0.2 ug/dl WAY LOW (1.0-4.0)
Porkchop is on Levothyroxine 0.5mgs twice daily since December. he has missed 3 pm doses in the past 4 1/2 months. His T4 was checked on 3/12 and it was 1.6. He is getting the medication- not spitting it out, etc. He gets it with his Norvasc. This is very confusing to me????

UA
Dilute Specific Gravity at 1.005 LOW (1.015-1.050)
No more protein in urine

Just a summary-- Porkchop was healthy with no issues, besides minor hair loss on 12/15/09. Due to the minor hair loss, we checked his thyroid which was very low at <0.2. The same day he underwent anesthesia to have 2 lumps removed and biopsied (benign) and a dental. He started levothyroxine. Increased urination and drinking became an issue around 12/23. His appetite also began to decrease. By 12/25, both incisions dehisced. Due to the incision problem, we checked him for Cushings. He had a Cortisol/Creatinine ratio, LDDS, HDDS and an ultrasound. All results pointed to Cushings, pituitary dependent. A chest xray revealed a primary lung mass. Three more xrays have been taken and the single mass has not changed in size and no more masses have appeared. On 1/26, he was diagnosed with high blood rpessure and started Norvasc at 5mgs once daily. On 2/1, trilostane 120mgs once daily was started. His appetite continued to decrease, although he would eat enough to get his trilo. On, 3/3, another ACTH was done and it was extremely low. We begain trilostane at 60mgs once daily. Several days later, we stopped the trilo due to decreased appetite and lethargy and began 5mgs pred once daily. On 3/10, Porkchop ended up in the ER for severe dehydration and was put on fluid therapy. Porkchop left the ER on pred 5mgs once daily and we continued to give him that until his next ACTH test on 4/2. Results were very high at 25.9. Trilo was restart at 30 mgs twice daily on 4/8. Three doses were given and his appetite decreased dramtically. He is now 45 lbs, a skeleton. Drinks and urinates buckets of urine....and is a very sad dog. I am taking your advice on the diets and trying anything he will eat. My husband is making him steak tonight for dinner and I am going to buy the ingredients for several diets suggested. I don't care about the urinating or anything that may seem like a bother...I just want him to feel better. I don't know how to make him better. Thanks!

[StarDeb55]

The reason why you are confused about the stim results is that the range you have posted is for a normal, healthy pup, not a cushpup.
The range for a cushpup under treatment is 1-5 (pre and post-ACTH). When it comes to the low thyroid, was a free T4 by equilibrium dialysis done to confirm? Our cushpups can develop a problem called sick euthyroid syndrome that will give a low result on the regular T4, but will be normal on a free T4. I have an understanding with Harley's vet, now, that any time his t4 comes back low, he will automatically add on the free T4. Both times Harley has had a free T4 done, it has been normal.

Debbie

[Nathalie]

Just wondering if you are giving the Levothyroxine with or away from food?
Was the blood draw done 4-6 h post pill in the am?
As Debbie already mentioned, you want a Free T4 test done to monitor the response to Levothyroxine.

Nathalie

[zoesmom]

I'm so sorry Porkchop is still not feeling better. He is definitely a mystery. I reread your thread and don't really have any answers, but Porkchop is saying that something is just not right. Clearly, he's not diabetic, based on the bloodwork. As for DI, we have had members whose dogs have had both cushings and DI.

He had that really low, non-stimulatory result in early March (after about a month on 120 mg trilo) so you waited a week ?? and restarted him at a lower dose. First off, that seems like a very high dose for a dog who weighed around 50 lbs. Then, on the lower dose he had trouble again and so you had to stop the trilo altogether and start pred. I suspect a longer break may have been needed. Then - correct me if I'm wrong - his next acth in early April produced a post # of around 25? How long had he been off the pred at that point? If it wasn't long enough, that could have caused a falsely elevated result (i.e maybe he wasn't really ready to restart the trilo after all.)

So then you restarted trilo and gave only 3 doses and right away, he got sick. I assume what you just posted were the latest acth results (from after those 3 doses and with no pred in his system?) They are above what is considered a good range for a dog on treatment, so that's where I get really puzzled about Porkchop. Some dogs do feel better when their numbers are allowed to run slightly high. Zoe seemed to feel best when her post number was between 6 and 9-ish. But with a post # over 9 or 10, there is probably not adequate control of the cushings. The goal in treatment w/trilo is 1.5 or 2 up to 7.5 or as high as 9, IF there are no symptoms.

His electrolytes might still be off. It looks like his sodium was borderline high there for awhile? Did the IMS ever talk about giving him florinef after he had that super low, non-stim ACTH? I wonder if that's what he needs? It sure seems like something is way out of whack and I can only imagine how awful he must feel - and the fact that he continues to struggle to keep weight on is extra worrisome.

The fact that his appetite fell off even before you started trilo may or may not be significant. My Zo was a puny eater at the time she was diagnosed with cushings. A very small percentage of cush dogs will NOT have the ravenous appetite (about 15 or 20% according to our one-time vet.) But it sounds like Porkchop ate ok up until the Dec. surgery and then it dropped off in Jan, even before the cush dx.

Beyond that, those are my only thoughts. A DI test might be worthwhile for the peeing/drinking but that's obviously the least of yours and his problem right now. Plus, it wouldn't explain his overall lethargy, lack of appetite, and weight loss.

Occasionally, there will be a dog who cannot tolerate one cush drug or the other. Maybe he's just one of those who can't take trilostane, for whatever reason. Switching, of course, requires a washout period. And you'd want to make sure he was truly back on track - especially with the eating and weight loss - before making any such move. I guess what's most puzzling is how his various symptoms and test results don't seem to coincide with one another as you'd expect. Sure hoping he starts to pull out of it soon. Sue

[StarDeb55]

I don't want to scare the pants off of you, but I think there is another possibility that needs to be considered for Porkchop. The loss of appetite, among several other non-specific symptoms that you have told us about, may indicate the possibility of a macroadenoma. Pit cushing's is normally caused by a microadenoma. The only difference between the 2 is simply size, a macro is > 1 cm. in diameter. When the tumor starts enlarging, & putting pressure on other areas of the brain, symptoms can be very vague, but one of the most common symptoms is loss of appetite. Brachycephalic breeds such as pitbulls, Boxers, Boston terriers are more prone to developing macros. This may be worth checking out. It would not take an MRI to determine this, a good quality CT of the brain should be able to pick this up. CT's are less expensive than an MRI.

Debbie

[PorkchopDog]

Thank you for the comments. My husband grilled a steak for Porkchop tonight and he ate some of it at one sitting and then finished it along with some dry food at another sitting. He also ate some more treats. He did begin Remeron yesterday and I don't know if this has anything to do with it.

Answer to your questions:
A free T4 was added on. I will have that result tomorrow.

I am giving the levo orally (directly in his mouth) after he eats breakfast and dinner. If he doesn't eat, he still gets the pill along with his Norvasc at the same time every day. Blood was drawn approx 2 hours after he was given the pill. Although, I don't know if the lab ran the T4 sample on the pre tube (2 hours) or the post tube (4 hours). I put enough blood in both tubes to run the vetscreen/cbc/t4 on either tube.

There was no waiting period or break between giving the 120 mgs trilo and then decreasing to 60 mgs. I was told by my reg vet and IMS to stop the 120mg and start the 60mg.

Porkchop was off the pred for 1 day prior to the ACTH stim in April. My IMS was aware that he was on pred and was fine with the test being done the next day. He said that given the pred dose was low, it shouldn't interfere with the results. ??

Yes, the recent ACTH results are the results of the test done after trilo was given for 3 doses. Although the last dose was given on friday, 4/9 and then the ACTH stim was not done until monday, 4/12. I waited the weekend to talk to my IMS and he asked me to do the stim when we hung up. I just happen to have everything i need for a stim test in my kitchen cabinet. How convenient :) My reg vet had seen him on friday but did not make any suggestion for the acth stim. He wanted to wait to see what the IMS wanted me to do.

He did not suggest florinef. Isn't florinef given to Addison's dogs? Are you asking because the ACTH stim was so low? His electrolytes potassium and sodium ratio was good. He was in the ER at this time and they ruled out Addisonian crisis. He mentioned Lysodren at Porkchop's last appointment, but said that there tends to be more side effects with that and then recommended the trilo at 30 mgs twice daily.

His weight slightly dropped off in Jan, but I blamed that on his dehiscence, the oozing incisions, and all of the antibiotics he was on. I figured it couldn't had made him feel well. He only lost 2 lbs at that time. During the trilo, he lost all of his weight :(

As for DI, my IMS toyed with that idea, but since the urinating and drinking completely resolved while he was on the trilo first time around, he decided against doing a water deprivation test. My other dog has Addison's disease and Diabetes Insipidus. The drinking and urinating is exactly how Scully was prior to getting Desmopressin.

Scully also had an MRI when we thought that she had a nerve sheath tumor in her brain, but it turned out to be nothing :) I'm not opposed to getting an MRI or Cat Scan. However, it this is macro, is it treatable? I wouldn't want to put him through radiation or chemo and make him feel even worse than he already feels. I know he feels horrible and he looks sad. It is killing me.

My IMS's nurse called today and it seems like he wasn't quite sure what to do next. He wants to discuss with my reg vet before we take the next step. I have been dealing with 2 vets (both my friends) at the practice I work at. I anticipate that they will talk to him tomorrow or Thursday.

Currently, Porkchop ate dinner tonight and treats. He is laying on the sofa or being let out to the bathroom. He is hydrated and seems ok. Just very sad looking. Does anyone think that I am making him suffer? I want to do everything I can for him, but for him...and not for me. I love him and want him to get better. I thank all of you for your comments and concerns :)

[Nathalie]

"I am giving the levo orally (directly in his mouth) after he eats breakfast and dinner. If he doesn't eat, he still gets the pill along with his Norvasc at the same time every day. Blood was drawn approx 2 hours after he was given the pill. Although, I don't know if the lab ran the T4 sample on the pre tube (2 hours) or the post tube (4 hours). "

Because it binds to calcium and soy, it should be given at least an hour before or three hours after each meal, to ensure proper absorption.

Levels peek at 4-6h post pilling - you need to make sure that the blood used to run Free T4 test was drawn in this timeframe to get an accurate result. I always test 5 h post pilling to be able to compare apples with apples.

Nathalie

[StarDeb55]

Gina, the only definitive treatment for a macro is radiation. We have had several pups between the old website & this one who have undergone radiation quite successfully. One of them is January & her pup, Serena. I will post the link to their thread. I believe Serena is well over a year out from her radiation & has been doing well. I made the suggestion about a CT or MRI to simply see if this might provide you with an answer as to what is going on with Porkchop. This is the lab tech talking because with my training, I always feel that there has to be an answer some way, somehow, to medical issues.

http://www.k9cushings.com/forum/showthread.php?t=609

Debbie

[PorkchopDog]

Just an update and I'm sorry I haven't written sooner....

Porkchop's Free T4 was 7... I don't have the ref range in front of me, but I believe it is between 8-40 something. The plan is to repeat the T4 and Free T4 in one week... we plan to do it on thursday, 4 hours post pill. Once those results are in, my IMS wants to put Porkchop back on trilostane, assuming his appetite is back to normal and he had a sufficient break from the trilo.

Porkchop's appetite slightly improved today, after going an entire weekend of nutrical, and forcing A/D. We stopped the Remeron (appetite stim) because it wasn't doing anything. We restarted him on 5mgs pred yesterday per our reg vet. He continues to drink and urinate buckets. He also "trembles." we offered him everything you can imagine to eat over the weekend and he refused almost everything...he did not want string cheese, chicken, beef, hot dogs, treats, dog food, etc. We are picking up ciproheptadine tomorrow (4mgs every 8-12 hrs) to see if it helps with his appetite.

I'm a bit frustrated because my IMS had a conversation with my reg vet on the phone and basically said that he doesn't really know what to do... my reg vet is my friend and so, he informed me of the conversation.

I bought the ingredients to several recipes suggested to me...and he will not touch any of those. I bought him 4 hamburgers from Wendy's yesterday and in the past 2 days, he has eaten all 4...with some dry food. I don't know if he really liked the burgers, or the pred started to kick in.

He will be going back to the reg vet next Monday.... recheck vetscreen/cbc/blood pressure/weight. I'm drawing his T4/Free T4 at home on thursday.

Since he already took the 120 mgs trilo, then the 60 mgs and then the 30 mgs twice daily... they want me to try the 20 mgs AM and 10 mgs PM.... once he has his appetite back. I'm afraid the trilo is going to kill him. I also am deathly afraid of the loading dosing of the Lysodren and both my IMS and reg vet do not want to switch to Lysodren for fear that he will become more sick on that.

Since he was trembling today, for several hours (heart rate and color was good, however dry gums and slightly dehydrated even though he is drinking a ton... I gave him sub Q fluids)...I'm afraid he is in pain?? Why would he be trembling? Any thoughts? Any ideas of what I should tell my vets to do next, since I get the most helpful advice from this group.... I should be paying you guys for visits and bloodwork.

[PorkchopDog]

Hi everyone! Porkchop is going to the vet tomorrow to be weighed and examined. From my last post, (T4 and Free T4 were low), I have repeated both tests and one week after having low results.... his T4 is 2.4 ref range (1-4) and his Free T4 is high at 47. His appetite has improved since being on pred again and cyproheptadine (appetite stim). However, they are talking like they want to try Porkchop on Trilostane again. I can't do it. I am thinking of taking him to a holistic vet to treat the symptoms rather than treat the disease. I am also considering an MRI once I feel he is capable of undergoing anesthesia. I will report back once we have our appointment tomorrow. ANy suggestions in regards to holistic medicine? Thanks!

[Harley PoMMom]

Hi Gina,

I am in agreement with you about the Trilostane. I would not treat a pup who is ill, not eating right, etc.

I know nothing about holistic medicine, so sorry, but I wish you and Porkchop the best of luck.

I think the MRI, if possible, would be a good idea.

Gina, you are doing an excellent job taking care of Porkchop, I hope you realize that.

Keeping you and Porkchop in my thoughts and prayers.

Love and hugs,
Lori

[frijole]

Gina, Sorry can't help re holistic treatment but I just wanted to reach out and say you are doing a great job. I know it is so frustrating but you guys have done a great deal for Porkchop. I send warm thoughts and prayers your way. Kim

[PorkchopDog]

Thank you for your kind words.... I truly hope that we can make Porkchop better. He saw his regular vet today and we repeated his Vetscreen/CBC. His blood pressure was normal :) And, he has gained almost 2 lbs. My regular vet has agreed that trilo and lysodren are no longer suitable options for him, although his IMS still wants him to go back on trilo. I scheduled an appointment at the Animal Wellness Center in Chaddsford, PA for their holistic vet to see if there is anything she can do to make him better. They currently have 2 Cushing's patients that can not take trilo or lysodren and she is treating them with herbs only. Surprisingly, both dogs are doing fantastic. If he does not respond to the holistic treatment, I will be scheduling him for an MRI. I will keep you guys posted and let you know :) Thanks!!!

[BestBuddy]

Dear Gina,

I have been following along on your thread but not posting because there was just nothing I could add. You are doing a great job with the cards you have been dealt with Porkchop and I know you must be disappointed and frustrated that you haven't been able to solve the puzzle.

I decided it was finally time to let you know that myself and probably many others are not posting because they have not got any advice for you but I really wanted you to know that we are all cheering you and Porkchop on. I do so hope you can get to the bottom of this and get some relief for Porkchop and yourself.

Jenny

[Nathalie]

Hi Gina,

Looks like his current dose of Soloxine is to high and could be reduced to from 0.5 to 0.4 BID. My Phillip is 64 lbs and on 0.4 mg of Soloxine which puts him just a tad above the optimal therapeutic range.
Regarding seeing a holistic vet – I love the idea – the problem is finding a good one.
I think what people sometimes forget is that Holistic Veterinarians are Conventional Vets first who decide to further educate themselves and use other modalities as well as conventional medicine.

From the American Holistic Veterinary Medical Association (http://www.ahvma.org/index.php?option=com_content&view=article&id=67&Itemid=91)

“Holistic (or Integrative) Veterinary Medicine is the examination and diagnosis of an animal, considering all aspects of the animal's life and employing all of the practitioner's senses, as well as the combination of conventional and alternative (or complementary) modalities of treatment. When a holistic veterinarian sees a pet, besides giving it a comprehensive physical examination, he/she wants to find out all about its behaviors, distant medical and dietary history, and its environment including diet, emotional stresses, and other factors.
Holistic medicine, by its very nature, is humane to the core. The wholeness of its scope will set up a lifestyle for the animal that is most appropriate. The techniques used in holistic medicine are gentle, minimally invasive, and incorporate patient well-being and stress reduction. Holistic thinking is centered on love, empathy and respect........”


In my experience it is important to make sure that everyone involved knows what the goals are, what timeframe you are looking at and what can and what cannot be achieved with the modality(s) chosen.

If I had a good holistic vet close by that’s where I would be taking my animals. I still would treat with Lysodren but it would be nice to have a vet that looks at my animals at a whole and who would be able to make treatment suggestions that are not part of conventional veterinary medicine.
At the end of the day you know your Porkchop, every treatment type has it’s limitations and may or may not work for a particular animal and if something does not feel right in your head and your heart don’t do it.

Best Wishes,
Nathalie

[zoesmom]

Ditto, to what Jenny, Kim and Lori said. We're all pulling fo you, Porkchop! Sue

[Casey's Mom]

Yes I too did not know what to say because Porkchop is a bit of a puzzle but know that we are here pulling for you.

Love and hugs,