Rusty the Beagle (UPDATE: Rusty has passed)

[missbeagle]

Hello everyone,

Rusty was diagnosed with Cushing's back in March of 2010. The vet that diagnosed him is a new vet to me. Right away he was pushing Lysodren, but it kinda scares me because of having to have an antidote handy and because I am a teacher and will be starting back to school again in the next few weeks. (I will not be home during the day to be able to monitor him).

I decided to do the more holistic approach (flaxseed and melatonin) and see what my old vet of 20+ years said (read get a second opinion) in Pittsburgh when I returned home to visit. My old vet ran a few tests of his own and also agreed that Rusty has Cushing's. When I told him of my apprehension about Lysodren, he said I could use Trilostane, which I have a script out for now.

Between work and the shock of having Cushing's I forgot to get Rusty on some Denamarin for his slightly elevated liver enzymes. Bad Mom! In April an ultasound revealed that his liver was homogeneous, but mildly enlarged and of normal echogenicity and shape. His adrenal gands were just outside of normal range at 7.4mm and 7.1mm.

His liver values in March were ALT 233 and ALKP was 412. I have begun giving Rusty his Denamarin now that we are back in North Carolina and after getting a second opinion from my older trusted vet in Pittsburgh.

My vet in Pittsburgh has agreed that we can start Trilostane after about 10-14 days of the Denamarin. He has instructed me to give Trilostane once a day at 120mg and to restest again at the 14 day mark. He is currently on one 425mg of Denamarin once a day.

Also in March my new vet here in North Carolina ran an ACTH stem test that was processed by Dr. Oliver in Tennessee.

Cortisol pre 40.3 and post 258.7
Androstenedione pre 1.0 post 1.90
Estradiol pre 114.8 post 133.2
Progesterone pre .21 post 2.90
OH progesterone .37 post 4.45
Aldosterone pre 62.1 and post QNS

I was wondering if after I start the Trilostane on Rusty (probably about Labor Day weekend) if he will lose weight because of the medicine. (He is 20 pounds overweight due to his Cushing's). Or will I have to continue with the diet dog food, green beans and long walks to aid in his weight loss?

Thanks in advance,

Gretchen Kozen
Rusty 8yo IT male beagle
weight 61 pounds

[Roxee's Dad]

Hi Gretchen,

I would like to welcome you and Rusty to k9cushing's. I do have to warn you, we tend to ask a lot of questions. :p

Could you tell us what symptoms Rusty was suffering from that led you to take Rusty to the vet?

How much does Rusty weigh?


His liver values in March were ALT 233 and ALKP was 412.
Can you publish the normal ranges for these values?

The others as I affectionately call them will be along shortly to help you and Rusty get through this. Hang in there. :)

[Bagel's Mom]

Hi Gretchen!

Beagle? teacher? North Carolina? Deja Vu!! All those apply to me too!!

Bagel was diagnosed in March 09- My vet is top of the line but it was still touch and go as I researched total Cushings info for so long!

We decided on Lysodren because the trilo was very expensive and hard to get sometimes then. ( Lysodren ain't cheap!)

I hated the loading phase, and I read so much from Dr. Feldman from UCLA-Davis..There are lots of links to him here...So when I KNEW she was loaded ( before the entire 7 days) I stopped giving it to her.
She has NEVER had a day where I needed the prednisone...I also learned from those articles to space it out over several days instead of just one dose..and to give it with fatty snacks like cream cheese to help it process better.. And a pepsid 12 hour relief every day before breakfast....
Bagel has never done anything half way...She became diabetic in October last year....So add the insulin shots to that..but GOOD NEWS is that she has done fine on all of it. She never has consistent test results, her blood glucose runs high often, but she is doing GREAT and happy and today is our last day of freedom together as I go back to school tomorrow.We are trying to remain positive..;(
She is bathed in much prayer and faith for sure.! Whatever route you go, I wish the best for you guys!!
Sande

[Squirt's Mom]

Hi Gretchen,

Welcome to you and Rusty! :)

I am assuming some of the intermediates were elevated? Could you post the normal ranges for the values from UTK? Just edit your post rather than redoing all that. ;)

If a pup has elevated cortisol along with elevated intermediate hormones, the pup is considered to have true Cushing's and the usual treatment is Lyso or Trilo. One thing you need to be aware of - Trilostane will always cause one or more of the intermediate hormones to rise and in a pup with those hormones naturally elevated, this can cause a problem. Lyso is the drug most often used with these pups as it will address the cortisol and all of the intermediates without raising any of them.

The expection to this is estradiol; it can be produced in areas of the body other than the adrenals. Lyso and Trilo work on the adrenals and pathways so they will not address estradiol produced outside the adrenals. This is where the lignans and melatonin come into play as they will work any where in the body.

Another thing you need to aware of is that Trilo has the same potential to cause damage that Lyso does. Trilo is touted as "safer" but that is not the case. It can and does destroy the adrenals just as Lyso can. When I first started this journey, I felt the same way about Lyso and preferred the Trilo. But the more I learned about both, the less comfortable I was with the Trilo. Today, Trilo scares me much more than Lyso does.

Along with the results from UTK you would have gotten treatment suggestions. Can you tell us what those were? They are usually listed on the bottom of the results as numbers; ie - "your vet may want to try #'s 1, 2, 3 , 5". UTK and Dr. Oliver are the leaders in Atypical research so whatever they recommended as treatment is the way I would go first. Did they recommend the Trilo over the Lyso?

Could you post the results of the testing your baby has had to diagnose Cushing's? Please list the actual results along with the units of measurement (ug/dl, mnol/l, ect) and the normal ranges for that lab. Different labs use different measures and norms is why we ask for those to be included.

As for the weight...some of what you are seeing is the enlargement of the liver, which is common with Cushing's. As treatment progresses, you will see some of that belly shrinking as the liver's work load is lessened. Cushing's also causes fat deposits; these will require exercise and good nutrition just as with any over weight pup. But as her hormones come back to normal levels, you will see changes in her, it just takes time. ;)

You are off to a good start, so keep up the good work! I am sorry you have a need for a group like this but am very glad you found us. I look forward to learning more about you and your baby in the future.

Hugs,
Leslie and the girls - always

[MyRudy]

Welcome, you have come to the right place for questions about Cushings! I recently found this site after my dog was diagnosed with Cushings and put on 60 mg Vetoryl. My dog weighs 44 lbs and the 60 mg was too much for him, just wanted to caution you on the 120 mg dosage. If I were you, I would start at 60mg and increase it if that does not do the trick. I have read about way too many dogs that were prescribed higher dosages than necessary to start with and, like with my dog, it threw them into addisonian-like crisis.

My dog was lethargic, not eating or drinking and could barely walk for several days.

One other word of caution: Be sure to have prednisone on hand just in case!

Donna

[missbeagle]

Other than Rusty being grossly overweight, I did not notice any real "symptoms" with him. He went to the vet in March because his sister ran into him at top speed, rolled him and he yelped in pain! The vet thought he has a torn ACL, but a few days of Tramadol and he was as good as new.

Roxee - Rusty weighs 61 pounds.

Squirt's Mom - here are the results from the SCTH stim test from the Univ. of Tenn.

Cortisol pre 40.3 and post 258.7 normal is 70.0-108.5
Androstenedione pre 1.0 post 1.90 normal is .68-7.92
Estradiol pre 114.8 post 133.2 normal is 30.0-65.6
Progesterone pre .21 post 2.90 normal is .55-1.70
17 OH progesterone .37 post 4.45 normal is .37-2.87
Aldosterone pre 62.1 and post QNS normal is 72.9-398.5

In April an ultasound revealed that his liver was homogeneous, but mildly enlarged and of normal echogenicity and shape. His adrenal gands were just outside of normal range at 7.4mm and 7.1mm.

The assessment from the ultrasound recommended -

1. The mild adrenomegaly is suggestive of pituary dependent Cushing's.
2. Prostatomegaly; consistant with BPH
3. Mild hepatomegaly, also consistant with endrocrinopathy associated changes

On a whim today I email Dr. Oliver and to my surprise he emailed me back. He seems to think that Rusty has a Sertoli tumor, but because of his weight 61 pounds, neutering is not feasible now because of the possible weight gain associated with that.

Dr. Oliver suggested that Trilo is NOT the way to go for me. He recommended I continue with the melatonin and get some HMR lignans from www.swansonvitamins.com instead of the ones that I was giving him (flaxseed in a box from Wal Mart). I thought I was giving him the correct lignans but apparently I am not. <sigh>

It is so cylical, weight up, hormones up and nothing seems to work. Even the diet dog food supplemented with green beans, starch blockers and a 20 min daily walk. (He is lucky he can go 20 min in the NC heat and humidity).

Rusty had a urine/creatinine (Sp?) test and scored a 20.

In all, he has had an ACTH stim test, an ultrasound, urine/creatinine test and a low dose dex test.

Any other questions, please fire away.

Gretchen and Rusty

[missbeagle]

John -

Normal values for my IDEXX lab are :

ALKP 412 u/l normal is 10-150
ALT 233 u/l normal is 1-107
Chol 653u/l normal is 112-328
AMYL 1581 u/l normal is 450-1250
TRIG 163 mg/dL normal is 20-150
GGT 19 u/l normal is 0-14
ANION GAP 25 mEq/L normal is 12-24

other than that his Chem panel results were normal.

Gretchen and Rusty

[Squirt's Mom]

Hi Gretchen,

Thanks for the extra info...it is very helpful! Now I'm gonna be a pain and ask for more. ;)

Do you have the results of the LDDS and ACTH? If you would post those, again with all the norms and units, that would be wonderful.

I am glad you got to communicate with Dr. O. He has been a great help to many of us here, myself included. His recommendations are the ones I would take above all others when dealing with elevated intermediates whether the cortisol is elevated or not. ;) JMHO

You are doing a great job in providing info and this will help us give you the most meaningful feedback.

Hugs,
Leslie and the girls - always

[missbeagle]

Leslie -

ACTH results are:

Cortisol pre 40.3 and post 258.7 normal is 70.0-108.5
Androstenedione pre 1.0 post 1.90 normal is .68-7.92
Estradiol pre 114.8 post 133.2 normal is 30.0-65.6
Progesterone pre .21 post 2.90 normal is .55-1.70
17 OH progesterone .37 post 4.45 normal is .37-2.87
Aldosterone pre 62.1 and post QNS normal is 72.9-398.5

Sorry I do not have the LDDS results as that was done by my vet in Pittsburgh and he is on vacation until this Thursday.

Gretchen and Rusty

[Squirt's Mom]

Ah, ok! I thought she had had a separate ACTH as well as the UTK panel.

Thanks!
Hugs,
Leslie and the girls - always

[missbeagle]

Leslie - What is a UTK panel?

[Squirt's Mom]

The UTK panel is what your baby had done at the Uni of Tn in Knoxville (UTK). It tests for cortisol as well as the intermediates and is the only lab in the world we know of that does this testing.

Sorry if I confused you!

Hugs,
Leslie and the girls - always

[missbeagle]

Leslie -


UTK did his ACTH results.

Gretchen

[Squirt's Mom]

Some folks, like me :o , had their pups tested with everything available. So she had the UTK panel as well as a separate ACTH and that is what I was thinking your baby had done as well. I understand now that the only ACTH she has had was the one included with the UTK panel, which is just fine.

Hugs,
Leslie and the girls - always

[lulusmom]

Hi Gretchen,

I am very glad that you communicated directly with Dr. Oliver. For Dr. Oliver to think a sertoli cell tumor is involved, you obviously shared the ultrasound results and the fact that Rusty is intact right? I think the prostatomegaly in an intact dog with the hefty elevation in estradiol was probably the the tip off for Dr. Oliver and I'd love to know if he gave you the reasons for his speculation. In any event, I'm glad that you are going to continue with the melatonin and lignans.

While the abnormalities you posted in bloodwork are consistent with typical cushing's, Rusty is not symptomatic and a cushing's savvy vet would not treat with Lysodren or Vetoryl (Trilostane). The reason for this is that symptoms are not an option, they are a necessity in confirming a diagnosis. Without symptoms the chances of a misdiagnosis are much, much greater. Again, I'm glad you are not moving forward with Vetoryl treatment.

Some of us have learned that not all diet food is actually diet. What are you feeding Rusty? There is at least one study that I am aware of on obesity in cushingoid dogs. The results were pretty surprising. They found that cushing's is not a primary factor in obesity and that obese dogs are usually obese because they eat too much or they are eating too much of the wrong food. My first cushdog, Lulu, was overweight simply because she was eating like a pig before she was diagnosed with cushing's. I used to free feed and always left kibble down. Actually in looking back, Lulu wasn't the only one that was tubby. My healthy Maltese got pretty fat on the free feeding with grain laden kibble. After three bouts of oxalate bladder stones, I took them off of kibble, as their vet recommended, and put them on a commercially prepared rawfood diet. I was astounded that the excess weight came off rather easily and both became a lot more alert and active. Rather than attempting to block the starch, we eliminated the starch (grains) all together. Perhaps that's something you might want to try. There are a number of companies that make good quality grainless canned food and kibble and fortunately, both Petco and Petsmart have started carrying them.

[Harley PoMMom]

Hi Gretchen,

Welcome to you and Rusty from me and my boy Harley! I am so sorry for the circumstances that brought you here but so glad you found this forum and we will help you and Rusty any way we can.

Cushing's is a slow progressing disease and it is a clinical disease too. Strong symptoms are a huge part of making the diagnosis, and a Cushing's savy vet will not initiate any treatment without strong symptoms and a proper diagnosis. Non-adrenal illnesses and even stress can create false positives on LDDS tests. According to Dr. Feldman, who is a renown cushing's expert:
What has changed is a desire on the part of some pharmaceutical companies and some specialists to have more and more dogs diagnosed. This has resulted in more and more dogs being treated for Cushing's that, I believe, do not have Cushing's. The key in deciding which dogs to treat is to only treat dogs with obvious and bothersome clinical signs. http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=672663&sk=&date=&%0A%09%09%09&pageID=2

The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. And currently Dechra recommends starting 1 mg. per pound.


Darn! I, too, would be concerned about starting Apollo at 30 mg. :(

The most recent recommendation of Dechra, the company that makes Vetoryl, is to start dogs off using a formula of 1 mg. per pound. So in Apollo's case, that would be 10 mg. of Vetoryl instead of 30. I found this out by talking directly to one of their technical representatives in their Kansas office. He is a vet, and his name is Dr. Allen. Either you or your vet can call him directly, as well, to get this updated information:

http://www.dechra-us.com/Default.aspx?ID=365

Your vet is probably following Dechra's published dosing "table," which does recommend 30 mg. for dogs weighing between 10 and 22 pounds. But if he would be willing to call Dr. Allen at Dechra, they could talk about Dechra's revised recommendation. And Vetoryl is sold in 10 mg. capsules, so obtaining it in that dose will not be a problem. Plus, if it does turn out that Apollo needs a higher dose, it will be easy to keep adding on additional 10 mg. increments.

I know it may not feel too comfortable "questioning" your specialist about the dosing. But hopefully he will also think it is a good idea to call the Dechra rep in order to have a direct conversation about their new dosing recommendations. Dr. Allen is really nice and happy to discuss questions with both owners and vets.

Marianne

Here's a link to a thread on our "Resources" forum that provides treatment and monitoring information published both by Dechra (manufacturers of Vetoryl) and also UC Davis:
http://www.k9cushings.com/forum/showthread.php?t=185

Please know we are here for you and Rusty and we will help you in any way we can, so ask all the questions you want and we will answer them the best way we can, ok?

Love and hugs,
Lori

[maggiebeagle]

Welcome from a fellow beagle lover. I lost my Maggie in December at the ripe old age of 14 (or so) after three years of successful treatment.
Sounds like you are getting alot of good advice. Good luck on your Rusty's treatment.

[addy]

Hi and welcome,

Zoe is on melatonin and lignans for 3 months, her symptoms are not yet strong enough to treat, mainly, bilateral hair loss and rat tail. We watch and wait.

I took both of my dogs off grain and it really made a difference. Their treats are blueberries, blackberries or very small pieces of cooked turkey breast, sometimes veggies. I measure everything and if they start to put weight on, I cut back on their food. It was the only way I could keep the weight off either one of them. I probably go over board, watching their weight but I think I am obsesive compulsive!!!!!!!!:eek::D

You will get alot of good advice here, the moderators are so very well informed.

Again, welcome.
Addy

[missbeagle]

In March, Rusty was put on Iams Reduced Calorie food from the vet. I needed a script for it. It's not the regular Iams food. I was told to feed him for a 40 pound beagle which was 2 cups of food a day or roughly 400 calories. I kept a "food journal" and watched what I fed him. I even added a starch blocker and green beans to his diet. He goes for nightly 20 minute walks. Even with all of this, he has not lost a pound. When we returned to Pittsburgh, he didn't want the green beans so I took him off of them. Then the Iams food was on a recall for salmonella <sigh>. Now he is eating 3/4 cup of Purina One Lamb and Rice twice a day without the green beans. When I get my next paycheck I am going to start him on the diet dog food again. (Maybe the salmonella will be all gone by then).

He needs to lose 20 pounds. Any other suggestions are welcome. Dr. Oliver suggested that neutering my boy now would possibly cause him to gain more weight and he is at maximum density now.

Maybe the correct lignans will help him. I did not know that I was giving him the wrong ones. The paperwork from UTK is confusing it says flaxseed and also HRT lignans. I had no idea I have been wasting all of this money at the health food store and Wal Mart by purchasing the wrong lignans.

We'll see what happens.

Gretchen and Rusty the beagle

[missbeagle]

Lulusmom -

Yes it seemed to be the "tip off" that Rusty is indeed intact. He was a former field trial beagle that I never neutered. I have had had him since he was 8 weeks old. My question for Dr. Oliver today is this:

1. Do I have a Cushing's dog that has a sertoli tumor too?
2. OR do I have a sertoli tumor dog that is behaving like Cushing's?

I'll wait and see what he says and I'll let you know. I'm sure he is swamped on a a daily basis by a LOT of people.

Gretchen and Rusty in HOT NC

[addy]

Hi,

When Zoe was on Hills prescription food she gained a pound in the first 2 weeks. :mad: It had corn in it in addition to the rice. I had never fed Zoe corn. She was on that food for about one year and we battled weight gain constantly. When I finally was able to switch to a food without corn or grain, the weight melted off. She has a sensitive stomach so I can't switch foods easily. If you can't go off grain completely, maybe a food without corn? Just a thought, the corn seemed to fatten Zoe up considerably:(which is why when the IMS suggested Hills prescription W/D for her colitis recently, I had to decline, it too had corn. The corn also made her chew her paws more than usual.

Hope you hear from Dr. Oliver soon.

Addy

[Squirt's Mom]

Often "light", "diet", and so forth on commercial feeds are misleading. The company may take some of the fat out but they fill in with carbs...which can really pack on the weight.

Do you free feed? This method of feeding often leads to obesity in our babies tho it is more convenient for us. Your best bet is to use portion controlled feeding on a schedule. If you use a commercial feed, give him less than the recommended amount on the packaging. No commercial treats as they are usually chock full of calories. Instead use carrots, green beans, pineapple, apple, banana, lettuce...just about any fresh veggie or fruit he will eat.

If he doesn't start losing weight with this approach, then I would recommend you contact someone to design a diet for him. There are several people who do this and I will be happy to give you some names if you wish.

And just an FYI...many of the feeds carried by vets are not that good. They sell them not because they believe they are the best feed but because the pet food manufacturers give them a deal. Most vets know very little about nutrition so don't be fooled into thinking that a feed is good just because it is prescribed. ;)

Hugs,
Leslie and the girls - always

[Todds Mom]

Welcome Gretchen & Rusty!

Your Rusty so reminds me of my beagle Todd. Todd is in the process of getting tested for Cushing's . We go this Thursday for his 8 hr blood test. No sure what is called. Todd weight is around 44.6. His weight has been that for the last several yrs. I now have him on his dry dog (Chicken Soup for dog lovers) and mix that with cooked vegetables (green beans, carrots, squash,peas) and he loves it. I am not sure if he lost any weight yet, we will find out Wednesday. What are Rusty's symptom's?

[missbeagle]

I have not ever free fed Rusty his entire life. He has been portion controlled always. As for the Cushing's symptoms like hair loss and lethargy, he has NONE. He has been tested three times for T4 and is NEGATIVE for thyroid issues. He has had a SCTH stim test, an ultrasound, a LDD test and a urine/creatitine test. At the beginningof the thread I posted all of his blood work.

He originally went to the vet because his sister rolled him while they were playing (yes my 61 pound beagle plays) and he yelped in pain and developed a limp. That's when the vet ran some blood work and discovered the high hormone levels.

Gretchen and Rusty

[Bichonluver3]

Hi Gretchen & Rusty!!
Welcome to our family.
I have Chloe on melatonin and non-chemical cold processed ground flax hulls I get online. She gets SDG but Dr Oliver told me SDG & HMR are comparable (he told me I would only need to switch to HMR if she had loose stools). I noticed good results within a couple of weeks. I checked our regime with Dr Oliver and he said to continue as the results were so good. I love that man! Glad you have contacted him. We are not using any of the other meds but others here can better advise you on those.:)
Again, glad you are here. The folks here are beyond amazing with their knowledge, experience and compassion.
Carrol & Chloe

[SasAndYunah]

Hello Gretchen and Rusty :)

I would like to comment in general on feeding. I read the vet had said to feed Rusty the amount of food for a 40 lbs dog. But....what is that amount? Is that according to the label on the package? For every brand of food that is of course different but my own dog, Yunah, gets Royal Canin. And the label on the bag says to feed a dog her size/weight 120 grams a day. But, in reality she gets 60 grams a day. That's half of what they advise. And Yunah is a very active dog, she's my service dog so she works a lot, we go on 4 walks a day and she will walk a total of about 15 till 20 km's per day. Still she gets half the recommended amount of food. She doesn't get anything else for treats or such , just her 60 grams of dry kibble. So what I want to say is, that I feed her with "my eyes". If she gains too much, I feed less... If she looses weigth, I feed her more. It's never a steady amount throughout the year. In winter, she needs more food because it's cold outside and she needs to burn more energy to stay warm. In summer it's warm and she needs less because she is less active when it's hot. So don't be "scared" to feed Rusty a lot less then the recommended amount of food. And as with people, dogs (and humans) alike can differ greatly in their metabolism. Two dogs of the same breed, same sex, same age and same activity level, can need very different amounts of food :)

If I were you, I would start feeding Rusty on 60% of what is recommended and take it from there...and see what happens. If he gets too hungry, divide the total amount of food over 3 or even 4 meals during the day, this will ussually help. Or else give him his food in a foodball for example, so it takes him a lot longer to "gather" his food. That would also give him some extra excercise...:) And if you want to feed "snacks" use his kibble..and retract that from his total daily amount. I keep 10 pieces of kibble apart to use as treats throughout the day, works very well :)

Saskia and Yunah :)

[missbeagle]

Saskia -

First off, Rusty weighs a staggering 61 pounds. He ideally should weight about 40 s ome pounds. He has NEVER been free fed in his life.

On the Iams restricted calorie diet, the package says to give 1 cup in am and 1 cup in pm for a 40 pound dog. That is the equivalent of 434 calories for the day. I have added green beans as a filler and a starch blocker to his food and take him for about a 20 minute walk daily.

That is all he can stand with the heat and humidity here in NC. It's like a 400 pound man taking a 20 minute walk.

He has been on the restricted calorie diet since March and has not lost a single solitary pound. <sigh>

As for symptoms of Cushings, he has no hair loss, no wierd things with his fur and other than being hungry all of the time, that's about it.

Thanks,

Gretchen and Rusty

[missbeagle]

Does anyone know if a Cushing's dog can tolerate Wellness core reduced Fat dog food? I am thinking of switching Rusty's food.

Also, does anyone know about limiting the purine levels in dog food too?

Thanks,

Gretchen and Rusty

[Casey's Mom]

I give Casey Wellness Core reduced fat - it is a very good food as far as I can tell and she really likes it!!

[SasAndYunah]

Hi Gretchen and Rusty,

I can relate to the heat and humidity. We just had an extended period of that and I felt "paralysed" because of it :)

What I was trying to say (and being Dutch, I don't always do a good job expressing myself in English :eek: ) that feeding Rusty the amount that the package says would be for a 40 lbs dog, may still be way too much for him. The label on the package is just a guideline and one can feed less or more, depending on wether the dog gains or looses weigth. And these guidelines don't even have to be close to what the dog truly needs. So if a dog does not loose weigth on the amount of food that is recommended on the label, the conclusion is that the amount is still too much (providing there is not some medical issue causing it of course) Anyway, I just wanted to say that the amount of food recommended on the label is not a "fixed" amount, one can vary with that amount depending on the dog loosing or gaining weigth :)

All our best,

Saskia and Yunah :)

[AlisonandMia]

Hi,

I too have noticed that the amounts of food recommended for a certain weight of dog seem to be incredibly "generous" to say the least - probably enough if they were hauling a sled through snow but too much under almost any other circumstance! I have never had or seen a dog that needed anything like the amount recommended for their weight on the packet. It is quite a while since I fed a commercial diet but I remember thinking that if we had fed the dog we had back then the 1 1/2 cups or whatever was recommended for her size she would have been wider than she was high in less than a week! She would have been lucky to get a 1/3 of the recommended amount and even then she still had a tendency to gain weight very easily and very often needed to be fed a little less for a week or so. I always managed to keep her slim (my husband tended to be a bit generous so I had to decree that she got less food every now and again;)). She lived to be 17 years of age (active and healthy to the end) and I believe that had a lot to do with the fact she was never allowed to get overweight - despite her own best efforts in that direction.:)

So not only are the recommended amounts incredibly large (are they just trying to sell more dog food?) there is also a huge difference in how individual dogs utilize the calories they take in so feeding by numbers - a certain fixed amount for a certain size of dog - is never going to be anything but a very, very rough guide. A horse that can live on the smell of an oily rag is often referred to as an "easy keeper" and this term is also sometimes applied to humans and dogs - and it looks like Rusty is one very easy keeper! Beagles tend to be that way and they love their food too and don't seem to have much of an "off switch" when it comes to eating either. And as dogs age they seem to become more and more able to convert food to fat - much like us humans.

The amount of food my dog needs in winter -v- summer probably varies by something like 40% - much less in summer than winter. In summer he only eats a very small amount and sometimes I wonder if he isn't sort of "solar powered" or something. He doesn't lose weight and become too thin so I know he is getting enough calories even if it doesn't seem possible with the tiny amount he is taking in each day. As the weather changes in the spring and autumn I am forever tweaking the amount of food I feed him - he gained a few ounces (I could see it on his ribs) early last week when we had a warm spell and I forgot to reduce his food slightly. All I had to do was feed him fractionally less for a three days or so, the tiny bit of excess weight melted off and now I've gone back to feeding him a little more than I did to get him to shed the weight and a little less than he was getting that caused him to gain weight. I've found that temperature seems to affect how much they need to eat more than does exercise.

If Rusty is maintaining his weight on whatever amount of food he is on now that indicates that the number of calories he is getting is more than he as an individual needs - so cutting the amount he is getting now by 1/3 to 1/2 would probably be a good idea. As Saskia said spacing small feeds through the day can help make them feel they are getting more and adding freebies like green beens and broccoli is a tremendous help too.

Another thing that crosses my mind is that is it possible that a neighbor is giving him a little something to eat over the fence? That has happened before and can lead to weight problems and even more serious health issues and even death depending on what and how much they feed the dog.

Alison

[missbeagle]

Well, Rusty seems to have some health issues as well. He has elevated liver enzymes, he is overweight and he has Cushing's.

Dr. O says he is indeed a Cushing's dog that may/may not have a Sertoli tumor on his testicles. He advised that I have my local vet re-check into that again.

Rusty is at least 20 pounds overweight. I'm not sure if that's because of the Cushings, the heat and humidity here in NC and nor getting as much exercise, or because I'm just plain feeding him too much.

I don't see the neighbors sneaking him food over the fence because we don't have a fence or neighbors.

Thanks again for the feedback everyone. I am going to stop by the pet food store and pick up a bag od the Wellness Core Reduced Fat diet and see if that gets him anywhere.

BTW, I have cut his food again. He just gets 1/2 cup in the am and 1/2 cup in the pm. His correct lignans will be here any day and then I can work on getting his estrodiol levels down and hopefully lose some weight.

Have a blessed day everyone,

Gretchen and Rusty

[missbeagle]

Hello everyone,

My dog Rusty has been diagnosed with atypical Cushing's disease this past Spring. He is currently eating Sammy Snacks weight management, taking his HMR lignans and melatonin. When I went to the pet food store last month to inquire about switching his dog food, she handed me a bottle of Casey Pet Daily Essentials and wanted me to try it. It is a sprinkle on that I have added to his food for the past 6 weeks or so. I wanted to wait and see how he did on the supplement. It was originally made for Casey who had Cushing's Disease.

If you google Casey pets you can read the story of how it was started there.

Rusty is back to his great old self! I am waiting a bit to get him going on Lysodren and in the next several months I will be looking into the possibility of him having a Sertoli Cell tumor.

There are some bottles available on eBay from Casey Pet or you can order from the Casey Pet website.

The powder has worked well for Rusty and I am going to continue using it.

I just wanted to share this product with other dog owners who are fighting Cushing's disease.

Respectfully submitted,

Gretchen Kozen and Rusty in North Carolina

[missbeagle]

Rusty has lost three pounds in the past month. I'm not sure if it is due to a change in his diet or getting him on HMR lignans along with the melatonin. Yeah! Last Saturday he was 59 pounds. I can't remember when he has ever been under 60. He's eating Sammy Snacks, getting some yogurt and his supplements. At least he's going in the right direction.

I have one quick question. Rusty needs his three year DHLPP shot but I am hesitant to have the vet give it. When if ever is a good time to get it? I need it to board him occasionally when we go away and to take him to doggy day care.

Thanks,

Gretchen and Rusty the Beagle

[lulusmom]

Hi Gretchen,

Congratulations on Rusty's weight loss. Can you share his secret with me...I've put on a few lbs in the last three years and could use some help. :D

With respect to the DHLPP vaccine, as with all vaccines, they are to be given to healthy dogs only. You and your vet are the best team to discuss and decide on a thumbs up or down based on Rusty's current health status. I'm very happy to see that your vet is in step with the current three year vaccine guidelines. There are still way too many vets that continue to administer unnecessary annual boosters.

[apollo6]

I agree on the vaccine issue. Too many vets over do the vaccines.
Hugs Sonja and Apollo

[missbeagle]

Hey guys -

Dr. Oliver is recommending that I get Rusty neutered because of a possible Sertoli Cell tumor, but I am leery of the anesthesia risks for a Cush pup that already has elevated liver enzymes. He gets daily Denamarin pill in the am before breakfast.

Any input that anyone has regarding anesthesia and a Cush pup us welcome. Is one method of anesthesia better than another?

Thanks,

Gretchen and Rusty

[frijole]

Gretchen - I was concerned as well. My dog was diagnosed at age 12 1/2 and she had to have her teeth cleaned every 6 mos and go under anethesia. Long story - they explained that what they use is easily reversible, meaning if the dog goes into distress they can bring them out quickly. There probably are more than one kind.

I hope others comment as well... just sharing my story. My dog lived another 4 yrs so she went under plenty with no issues.

Kim

[Harley PoMMom]

Hi Gretchen,

Back in December Harley had a dental cleaning and had 3 teeth extracted. I, too, was very concerned about him and the anesthesia. His vet assured me, like Kim has mentioned, that if he would show signs of distress that they could bring him out of the anesthesia really fast. Harley's liver enzymes are always elevated and back in December his ALP was 761 (5-131) and his ALT was 272 (12-118).
Harley came through the dental and the extractions with no complications.

Love and hugs,
Lori

[littleone1]

HI Gretchen,

I was also concerned about Corky having anesthesia when he had 3 teeth extracted and 2 masses removed in his mouth in January. His vet also reassured me that the anesthesia he was using was safe for cushpups. I know that Corky was monitored very closely. I took him in at 7 A.M., and he was home with me by 11:30 that morning. Corky came out of the anesthesia very quickly and didn't have any problems.

Terri

[missbeagle]

Hi again all -

Thanks for the anesthesia answers. I'm just a worried mommy is all. :o

I wanted to post Rusty's Low Dose Dex test results too.

Cortisol Pre 3.2

4 Hours 0.8

8 Hours 1.7

My paperwork tells me that Cortisol levels less than half of the baseline level at either 4 or 8 hours post is consistent with PDH.

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

So when I do the math, I get 1.6 and Rusty is 1.7.

Are we catching this SUPER early? Or is he not that bad yet?

Thanks,

Gretchen and Rusty in NC

[gpgscott]

Hi Gretchen,

There are many different types of anestesia some harsher than others. I would just make sure the Dr. doing the surgery has a full history on Rusty and that you OK the use of the gentlest meds which are usually a bit more expensive.

If this was my dog I don't think I would treat with either Lysodren or Trilostane at this time. I would proceed with the neutering and continue with the melatonin/lignans for a while to see what that does for his intermediate hormones. He is also very large and overweight pups are more prone to hyperestrinism.

Scott

[Squirt's Mom]

Hi Gretchen,

I agree with Scott - I wouldn't consider Lyso until he is neutered and the issue of the sertoli tumor is addressed. My reasons are based on my Squirt's own history - she was diagnosed with PDH and it was confirmed with five cushing's specific tests. However, it turned out she had a splenic tumor and once it was removed, her cortisol returned to normal. She does remain Atypical, tho. We are currently waiting on her latest UTK panel to confirm the cortisol. If it is still in the normal range, that will make 2 years since her surgery that it has remained normal.

Cortisol is the body's natural response to stress - whether external or internal. So any time the body is stressed, as with a tumor, it responds by releasing appropriate hormones, including cortisol. This natural response to stress can skew Cushing's testing causing false-positives - as in Squirt's case.

So don't rush into treatment with the Lyso until you have eliminated anything than might cause elevated cortisol - like the sertoli tumor. ;)

Just my 2 cents worth based on my experiences...

Hugs,
Leslie and the girls :D - always

[missbeagle]

Hi everyone,

Tomorrow Rusty and I go the V*t to see what's the latest with him. He is scheduled for a 3 year DHLPP shot, a fecal exam and probably a bortatella shot too.

I'm not sure it's a good idea for shots because of the Cushings. Does anyone have any suggestions about when it is OK to give a shot to a Cushings dog? :confused:

Also, there is a possibility that he also has a tumor in his testicles. My husband basically said at dinner tonight that his quality of life is not diminished so why do anything at all? Isn't that just like a guy when it comes to neutering???

I tried to tell him that the vet was wrong before. He told me that the meds Rusty needs to keep his female hormones (intermediate hormones - see page one) in check could be had at the local grocery store. I was giving him flaxseed from the box and melatonin. I was totally WRONG with the flaxseed from the box. :mad: It wasn't until I email Dr. Oliver that he said I was giving the wrong flaxseed. That's when I heard about the HMRLignans. I'm not regretting that email conversation.

I'm apprehensive about neutering an 8 year old dog, what the anesthesia would/could do to him. Maybe my hubby is right and I should leave well enough alone? But then again IF he has the tumor in his testicles, then it could metastasize elsewhere in his body.

I am very apprehensive about tomorrow's vet visit (at 4pm ET so send good thoughts my way). I am looking for info or thoughts regarding this neutering procedure.

BTW, Dr. Oliver told me that if it was his dog, he would get him neutered and then run another ACTH test in two months. I'm just a worried momma tonight.

Thanks,

Gretchen and Rusty in warm NC

[frijole]

Gretchen, Good to hear the update. First off re the shot.... I have never had the DHLPP shot with my dogs but I googled it and it said it shouldn't be given to a dog with any immune deficiencies... I know that some cush owners have discussed with their vets getting a waiver for rabies shot for the same reason. It boils down to where you live and whether the shots are really needed given your dog's lifestyle. So you might have a conversation with your vet.

I wish I could remember the reasoning but I know I have read here that it DOES help to neuter male dogs with cushings. Interesting that your vet said you need the hormones and Dr Oliver is saying he recommends neutering.

I am bumping this up hoping someone can give you better input than I can! Good luck tomorrow! Kim

[littleone1]

Hi Gretchen,

Corky will not be getting any more vaccines. Due to his age and his medical issues, he will be getting a waiver for the rabies shot. In addition, after getting the other vaccines for so many years, they have built up in his system, so they are no longer necessary for him because of everything else he has going on.

I hope everything goes well tomorrow.

Terri

[labblab]

Hi Gretchen,

In making the vaccination decision, I agree with Kim that you should talk with your vet about the likelihood that Rusty will be exposed to these diseases based upon his lifestyle and the area in which you live. And of course you also need to assess his overall health at the moment. Here is a quote from the vaccination guidelines published by the veterinary school at UC Davis (revised 11/09) (http://www.vetmed.ucdavis.edu/vmth/small_animal/internal_medicine/vaccination_protocols.cfm):


These are only general guidelines, as the vaccine types recommended and the frequency of vaccination vary depending on the lifestyle of the pet being vaccinated, i.e. indoor vs outdoor pets, travel plans, kennel/boarding plans, and underlying disease conditions such as immune-mediated diseases or pre-existing infections such as FIV infection. Because these factors may change over time, we recommend the vaccination plan for each individual pet be decided by the owner at routine annual examinations, following a discussion between the veterinarian and the client regarding the animal's lifestyle in the year ahead.

You will see that UC Davis cautions against vaccinating dogs that suffer from immune-mediated diseases. These are diseases in which the body's immune system is actually OVERACTIVE and is fighting against the normal cells and tissues of the body itself. With these types of diseases you do not want to overstimulate the immune system even further by administering vaccinations, and treatment involves purposely suppressing the immune system by administering steroids or other medications. Even though naturally-occuring Addison's Disease is often the result of abnormal autoimmune activity, I do not believe that Cushing's is currently thought to be caused by an overactive immune system.

However, I think you also have to weigh risks vs. benefits carefully when considering vaccinations for dogs with the opposite problem: compromised immune systems. Cushpups may definitely fall within this group -- especially depending upon their stage of treatment, and their stability on treatment. However, from some experiences of my own with human organ transplant patients, I've been told that people who are chronically immunosuppressed may actually be more aggressively targeted to received certain vaccinations because they are even more at risk to develop these illnesses than the general population. Of course, there are many individual factors to consider. Also, vaccines based on killed viruses may be acceptable for immunosuppressed patients whereas vaccines that use live virus may never be OK, or can only be used in certain situations. I think that most rabies vaccines are now based on killed virus. However, DHLPP may typically use live viruses (although some of the component vaccines may be available in a killed form?). This is something you'd need to talk over with your vet.

If you take a look at the UC Davis link above, you can read more about each specific vaccination and Davis' related recommendation regarding each one. However, the long and the short of it is that I don't believe that there is any one "right" answer when it somes to Cushpups and vaccination. I think it all depends upon age, individual risk factors, and your dog's overall health condition. You never want to immunize a dog who is running a fever or battling an active illness/infection. But as far as the impact of a chronic health condition -- like Cushing's -- I think you and your vet have to decide which option presents the greatest risk vs. greatest protection for your own dog.

Marianne

[Squirt's Mom]

Hi Gretchen,

About the neutering - I don't think it is the neutering that is the factor here but rather the tumor that neutering will remove. Most importantly, removing the tumor may remove the possibility of Cushing's. Perhaps if you explained it to your husband this way, he would be more willing to contemplate this "horror" for Rusty. ;)

I hope the v*t visit goes good today; let us know what you learned and decided.

Hugs,
Leslie and the girls :D - always

[Harley PoMMom]

I am very apprehensive about tomorrow's vet visit (at 4pm ET so send good thoughts my way). I am looking for info or thoughts regarding this neutering procedure.



Hi Gretchen,

Nothing to add to the good advice given, just sending positive and good thoughts your way.

Love and hugs,
Lori

[missbeagle]

Just checking in to report about the v*t visit this afternoon.

When I asked the vet to explain to me why he thinks that Rusty has a Sertoli tumor, and I inquired with the ultrasound that was done in March, he responded with a thorough exam in his "boys." He said he could not feel anything and that if he had a tumor that it would have showed up on the ultrasound.

So I guess he's now telling me that Rusty doesn't have a Sertoli tumor. I guess that's a good thing. I never thought that he had one anyway because it would have showed up on the ultrasound. :confused: :eek:

I declined on both the bortetella and the distemper shots. He really doesn't go any place that warrants it. We are thinking about going on vacation next year and the vet said we could board Rusty with him there.

We discussed Lysodren. (Oliver said Trilostan wasn't for my pup). He said we could do a low dose load so as not to overload him too fast. When I asked the vet about his success rate with Lysodren, he said he only has one Cush pup now. So I'm not sure how much experience he really has with this. :eek:

He told me that most people who have Cush pups can't afford the treatment and eventually give up and quit halfway. I think he's figured out that I'm in for the long haul and want to give Rusty all the help that I can. I'm sooo glad that I have insurance through VPI now! :)

He said that I would be a good candidate to administer Lysodren since I'm super anal about stuff when it comes to my pups.

I'm going to continue with the HMR lignans and the melatonin for the rest of Rusty's life.

I just need to figure out when.

Should I be asking for the name of an IM doctor in Raleigh since he does not have a long track record with Cush pups?

Any other thoughts are appreciated. He also said that Rusty has a grade II heart murmur.

I'm not scared yet, just still apprehensive.

Thanks for the good thoughts and the input.

Gretchen Kozen and Rusty in NC

[apollo6]

Dear Gretchen
Can't give you much input. But if it is a tumor, it should be removed.
It is a man thing. My husband would not go to get Apollo neutered. I had to. As to vaccines there is quite a controversy on it. I will no longer getting Apollo vaccines nor the rabie shot, due to cushing's.
But I stopped the vaccines a few years ago. Discovered the effects of the vaccines can last 3 years or more. I had titer blood panels done showing Apollo was still protected.
This may help in deciding on vaccines.
http://www.weim.net/emberweims/Vaccine.html
Sonja and Apollo

[missbeagle]

Hi again everyone.

I called VPI (Veterinary Pet Insurance) yesterday and inquired about coverage for possible Lysodren treament for Rusty. They told me that if the meds meet all three requirements then they would reimburse me the cost. 1) It has to be ordered by a vet, 2) It has to be FDA approved and 3) it has to be used on a covered condition.

So I meet all of those requirements.

My problem is my vet currently only has one dog he is treting for Cushings with Lysodren. He mentioned that he has lots of Addison's dogs, but not many Cushings.

Should I be shopping for a more experienced vet? Or do you thing between Dr. Oliver and my own vet conferencing together about Rusty, that I should be ok with trying Lysodren therapy? :confused:

Thanks in advance,

Gretchen and Rusty in NC

[Squirt's Mom]

Hi Gretchen,

Ideally, a vet will have quite a bit of experience treating Cushing's using either drug but that is not always possible. The most important factors are 1) your Cushing's education and 2) your vets willingness to work with you as a team, listening you to, and learning together. An arrogant vet who won't listen to you, or the experts in this area, is dangerous and would mean you need to find a new vet before starting treatment.

So, you have to determine if you vet is willing to work with you, and you have to educate yourself in order to be an effective advocate for Rusty.

We are here to help you learn what you need to know to help Rusty. Our Resource section has a lot of good info and, of course, the first-hand experience of our members is yours for the asking. Remember, you are not alone. We will walk with you every step of the way.

You are a good mom or you wouldn't be here looking for help for your baby, so I have the utmost faith in your ability to tackle Lyso treatment. The scariest part is now - contemplating the treatment. But once you are going and as you learn more and more, your confidence will grow and the fears will fall to the wayside.

Here is a link from our Resource section about using Lyso. It has info from the experts as well as tips from our members who use it.

http://www.k9cushings.com/forum/showthread.php?t=181

Many members keep this handy when treating with Lyso and several have shared it with their vets.

Keep your chin up and know we are here for you and Rusty!

Hugs,
Leslie and the girls :D - always

[Harley PoMMom]

Unfortunately, Lysodren is not FDA approved in treatment for canine cushing's.




We and others have approached the FDA in the past about getting op-DDD approved in the dog and there is about zero chance of that happening.

Dave Bruyette DVM DACVIM

[labblab]

I called VPI (Veterinary Pet Insurance) yesterday and inquired about coverage for possible Lysodren treament for Rusty. They told me that if the meds meet all three requirements then they would reimburse me the cost. 1) It has to be ordered by a vet, 2) It has to be FDA approved and 3) it has to be used on a covered condition.

So I meet all of those requirements.

Oh Gretchen, I'm not sure whether or not VPI will cover the cost of Lysodren based on what they've told you. You see, Lysodren is not an FDA approved treatment for Cushing's in dogs. Even though veterinarians have used it for years, it is a prescription medicine that is approved for humans but is used "off-label" for treating dogs. Only Anipryl and Vetoryl (trilostane) have been approved by the FDA for treatment of Cushing's in dogs. So you may want to push VPI a bit further in advance in order to find out whether or not Lysodren truly would be a covered treatment. I know this probably sounds like splitting hairs. But "splitting hairs" is something that insurance companies are experts at doing...:(

Marianne

[missbeagle]

I found this link,

http://www.fda.gov/forconsumers/consumerupdates/ucm151209.htm

Although it does say off label use, it is FDA approved. Dunno, I will call when I get the chance.

"Off-label," or "extra-label," means veterinarians can legally prescribe human drugs to animals for uses not listed on the label, or for other species or at different dosage levels from those listed on the label. But because dogs may react unpredictably to human drugs, says Stohlman, it's beneficial to have treatments available that have been studied in dogs and approved specifically for them.

Thanks,

Gretchen and Rusty in NC

[missbeagle]

Hey everyone -

I just called VPI and inquired about the FDA approval. I was told as long it is an FDA approved drug (for humans OR dogs) that I am approved.

I have a $50.00 deductible with my policy and have to meet that amount and then I should get 90% of the cost of my Lysodren back!

Yeah! :D

Gretchen and Rusty in NC

[missbeagle]

Hi everyone -

I read the thread at

http://www.k9cushings.com/forum/showthread.php?t=181

and I'm trying to calculate how much Lysodren Rusty needs. He weighs 59 pounds which is grossly overweight for a beagle, I know.

When I divide 59 by 2.2 I get 26.8 times 50mg per kg of weight is a staggering 1341 mg of Lysodren for a loading dose?

Am I doing the math wrong, because this number of 1341mg scares me a lot?!

Thanks,

Gretchen and Rusty in NC

[frijole]

Yes that is right. Actually the range for protocol is 25 to 50 mgs with 50 being the high end of the range. Vets tend to prescribe dosages that are easily given (hard to cut a pill into less than 1/4) I would guess your vet would prescribe either 1000 (a pill in the am and one at night) or 1250 (a pill in the am and 1 and 1/4 pill at night)... just guessing on that.

What did your vet recommend?

I didn't read back in your thread as I am getting ready to leave but be sure to read our important tips prior to starting the load. I will check in later. My little girl Haley required more than normal amounts of lysodren to load and at 15 lbs she was on 1500 mgs! Yep... she was certainly an exceptional dog. ;)

Kim

[missbeagle]

Kim -

The vet said he would do an IDEXX Cortisol panel first when we start Lysodren loading.
IDEXX??????

I thought the normal protocol was an ACTH Stim test?

He said he wanted to start on a LOW dose and for me to be home to monitor Rusty between days 7 to 9. What a LOW dose was, he did not know and said he would have to look it up.

My current vet only has ONE Cush pup and that scares me. He says most people don't pursue Cushing's treatment because of the expense.

I emailed Dr. Oliver about three days ago and he hasn't responded.

Rusty is currently on lignans and melatonin for elevated intermediate hormones.

My vet's inexperience with Cushings does not give me a fuzzy feeling. I am very concerned about an overdose, especially at these levels of Lysodren now that I know my math is correct.

Thanks,

Gretchen and Rusty in NC

[frijole]

Gretchen, I'm going to be real honest... I just read over your history starting at page one and I cannot see where you ever said that Rusty has exhibited any signs of cushings. Did I miss something? Because if you don't have any symptoms, please do not start treatment. You can hold off and if they show up start then.

I also do not see where you got a diagnosis as to the type of cushings. If it is atypical cushings then usually a loading dose is not done. Totally different animal. If it is pituitary cushings then you go thru the daily loading.

Given your vet's admitted lack of experience I would not do one thing until I either switched vets OR got an expert on board to tutor your vet thru this process. Lysodren is a wonderful drug that saved my dog's life but you don't mess around with it. It would be like a general practitioner trying to figure out chemo meds and doses on a person.. not good.

Please set me straight if I missed anything. Thanks! Kim

[missbeagle]

Kim -

Rusty has is a pot bellied appearance, and he drinks a lot of water, he also has a vociferous appetite.

He has been diagnosed with atypical pituitary dependent Cushings. He was diagnosed through ultrasound (April 2010), a low dose dex test (July 2010), an ACTH stim test (March 2010) and a cortisol/urine test (July 2010) too. I'm worried about further damage to his kidneys and heart because of the excess hormones. He was diagnosed with a heart murmur (Grade II) about a month ago when we went to see Dr. Ward.

I am hoping that Dr. Oliver, my vet (who attended UTK) and myself can get him through this. I am just waiting for Dr. Oliver's reply to see what he thinks about my current vet's lack of experience.

Hope these answer your questions.

Gretchen and Rusty

[frijole]

Thanks for the very thorough update! If Rusty is atypical then the dosing amount at 50 mgs is per week and not daily. I know Dr Oliver has helped countless others. Just make sure he knows that your doc is really inexperienced and you will be counting on very specific instructions regarding dosing, testing etc. You are doing a great job of advocating for Rusty and should be proud. Keep it up! Kim

[missbeagle]

Does anyone know if Dr. Oliver is on vacation these past two weeks?

I am waiting for him to get back to me before I proceed with Lysodren treatment for my Cush pup as my regular vet admits that he is inexperienced with Cushings.

I emailed him about Rusty on the 2nd and have not heard back from him at all! He always responded right away or within 48 hours of my emails.

Also, does one need a referral from the regular vet to see an IM specialist?

Thanks in advance,

Gretchen and Rusty in NC

[lulusmom]

Hi Gretchen,

Dr. Oliver is usually very good about responding to his emails so if you have not heard back from him by now, I'm wondering if he got it. You could call U Tenn and ask them if he is away at the moment. Dr. Oliver is the expert on atypical but in looking through your thread, I notice that Rusty does not have atypical cushings. The results of his LDDS and the abdominal ultrasound indicate that he has pituitary dependent cushing's.

Dr. Oliver is very diplomatic so I'm not really sure that you will get a direct answer from him about your vet's lack of experience. Dr. Oliver can make recommendations on atypical treatment but he is not the "go to" guy for treatment of pituitary dependent cushing's. I would agree with Kim that given your vet's very limited experience with cushing's you should consider consulting with an internal medicine specialist. Unfortunately, most specialists do require a referral but I'm sure your vet would be glad to give you one. Who knows, he may even be relieved to have a specialist directing treatment. My two cushdogs treat strictly with a specialist; however, when my second cushdog was diagnosed, we had a gp vet that worked in coordination with a specialist. Rusty could have the best of both worlds.

I forgot to mention previously that a low loading dose is not always the best approach. It can drag out loading for what seems like forever and it can cost you more in pills and acth stim tests. A survey on Lysodren loading among veterinarians, both general and internal med specialists, was conducted and the results showed that the majority of general practitioners were much more likely to load at low doses due to their fear of adverse reactions. In contrast, the majority of specialist were much more likely to prescribe max recommended loading dose of 50 mg/kg. My two itty bitties (4.5 lbs and 6.5 lbs) loaded at 50 mg/kg

Glynda

[missbeagle]

Glynda -

Thanks for the update. My vet has been telling me that Rusty has atypical Cushings. You are the first to tell me that Rusty has true Cushings disease. My vet tells me I have 2 years with him left either with or without treatment. I don't believe a word of that after rading what others have to say here.

I was under the impression that the IM doctor would become Rusty's actual vet and not leading the treatment with my vet. I have been hesitant to ask for a referral because I don't want to make my vet mad at me and because I was hoping to hear from Dr. Oliver.

I will go ahead and ask for a referral to a IM vet in Raleigh which is where the IM vets are. Rusty well being is tantamount to my vet's current inexperience.

Do you think the IM vet would accept my VPI insurance for Rusty?

Thanks again Glynda, ;)

Gretchen and Rusty in NC

[lulusmom]

Hi again,

If all dogs with cushing's only lived for two years, neither one of my cushdogs would be with me today. Lulu will be 9 on Monday and she was diagnosed almost 6 years ago. Jojo's age is unknown but he's up there. He was diagnosed three years ago and going strong. Don't believe that two year stuff. There's a whole lot of dogs here that disproved that malarkey. I think that number is used a lot by vets based on the fact that most dogs with cushing's are old to begin with and even without cushing's, their life expectancy is probably less than two years.

My dogs treat strictly with an IMS so yes, if you want a specialist to handle Rusty's care from now on, then go for it. I mentioned the IMS and gp vet working as team in case you didn't want to abandon your current vet. You can go either way but given your vet's very limited experience, I think putting Rusty in the hands of an IMS is an excellent idea.

A lot of specialists do accept pet insurance but you'd have check with the facility. You can always ask when you call to make an appointment.

Glynda

[missbeagle]

Hey guys -

I called the vet's today and requested a referral to an IM specialist. He was out and I was told that they would give him the message tomorrow.

Fingers crossed for a good referral,

Gretchen and Rusty in NC

[Squirt's Mom]

WOOHOO!!! Way to go, Mom! :D:D

[missbeagle]

I finally heard back from Dr. Oliver and he said he would work with me and my vet if my vet would OK it. :)

He also told me that
>>>many now avoid the loading dose by giving the combination of melatonin, lignan and maintenance mitotane. and

My vet said instead of running an ACTH stim test, that he would only run a Cortisol test through IDEXX. I have been reading what others have to say at http://www.k9cushings.com and I do not recall reading about just checking the Cortisol levels before administering Lysodren based upon an IDEXX test result. Would this be the proper protocol?
>>>I'm not sure if he means only a baseline cortisol level or not. If so, most prefer doing the ACTH stim test, and ultimately getting the post-Lysodren treatment level down to 5 ug/dL The cortisol continues to be monitored periodically when on Lysodren, so it doesn't go too low.

I just wanted to check in. I have not heard back from my vet yet about an IM specialist vet.

Later,

Gretchen and Rusty in NC

[missbeagle]

Hi folks,

I called my vet the other day and he still hasn't gotten back to me with the name of a specialist. :(

Do you suppose it's because he doesn't want to refer me or because he doesn't know one? :o

Thanks,

Gretchen and Rusty still waiting in NC

[frijole]

Hi folks,

I called my vet the other day and he still hasn't gotten back to me with the name of a specialist. :(

Do you suppose it's because he doesn't want to refer me or because he doesn't know one? :o

Thanks,

Gretchen and Rusty still waiting in NC
Hard to say. I can't remember if you said you trust your vet or not but if he/she is having a hard time coming up with a specialist to refer you to then perhaps you could pick one yourself and then have him/her refer you.

Here is a website for locating specialists. Write down their info and then go to their websites, google their names and see if you can find out more about their backgrounds, specialties etc.

Another avenue is to go to a vet school if their is one in your area. I ended up going to Kansas State Univ as we have ZERO specialists in my state. They were wonderful and their prices were LESS than my regular vets for most tests.

Here is a link to the site:
http://www.k9cushings.com/forum/showthread.php?t=182

Kim

[missbeagle]

Well, I finally heard back from my regular vet (one week later). He said that he would be glad to give me a referral to a specialist and asked which one I would like to go to. (I thought that was his responsibility??)

I also told him that Dr. Oliver said he would consult with him on the phone too.

Why does a referral to a specialist take soooooo long? :confused:

Gretchen and Rusty

[missbeagle]

OK. I FINALLY called NC State and made an appointment with an IM Specialist.

I am soooooo scared! They are quoting me between 700 and 1000 dollars for testing for Rusty. They also tell me they might keep him overnight. YIKES!!

I know they are going to re run the ACTH Stim test because his last one was in March. They asked me to bring the ultrasound picturs with me . I had an ultrasound some in April, but there are no pictures, only the report. <sigh>

They also mentioned running a low dose dex test too. His last one was in July. That would mean two days of hospitalizations and perhaps two overnight stays if I am thinking correctly.

They said they can help me with the VPI Insurance for Rusty! That was probably the best thing I have done for him. I got it when he was a little pup and was eating everything from the garbage and bring dead animals from the woods. I got it on a whim, but I'm super glad that I have it now.

Does anyone think they would do another low dose dex test since my last one was at the end of July?

I am Ok with another ACTH stim test and maybe another ultrasound too.

Any advice or thoughts? As I mentioned earlier, I am super scared!

I will have to take a day off of work for this too!

If anyone has any advice about preparing to see the IM specialist, please let me know.

Thanks,

Gretchen and Rusty

[Harley PoMMom]

I would get an ultrasound done and if you are going to let this IMS treat Rusty then I would get the ACTH stim done too. I would not get the LDDS test done. The ultrasound will more than likely show you if this is PDH or ADH by the size of the adrenal glands.

When I take Harley to see his IMS, I take a note pad and a tape recorder with me. I tape record the whole session, I have a very feeble mind and forget alot! And I can't write that fast so the tape recorder comes in very handy. My note pad is usually my questions that I need answered from the IMS.

I also take Harley's food and water along and a cooler with food for me.

Hope this helps.

Love and hugs,
Lori

[missbeagle]

Lori -

Rusty had a ACTH stim test back in March that showed he had Cushings. It was also confirmed by an ultrasound in April. I followed that up with another vet (my old vet in another city) by running an low dose dex test and a cortisol/creatine test. Every test points to Cushings.

NC State is a teaching hospital and it's about 2 hours away. I'm Ok with a ACTH test and possibly an ultrasound again. I'm just wondering how often these tests need to be repeated.

I kinda figured that the IM specialist would want to run their own tests.

I was just wanting to speak with an IM because my vet currently has only ONE Cush pup. I am wanting someone else on board to help my vet and me through this.

Thanks,

Gretchen and Rusty near the beach in NC

[littleone1]

Hi Gretchen,

I haven't posted on your thread, but I have been reading it. I don't understand why you would need a referral from a vet for an IMS. If you feel that you need an IMS, this should be your call. Also, I don't understand why an LDDS test would take so long. It is an 8 hour test. When Corky had his done, he didn't have to stay there. I was able to take him with me and just had to make sure that he was back in time for the 2 /four hour draws.

The LDDS doesn't cost that much. As Lori said, I would have the ACTH stim test and the U/S done.

The ACTH stim test needs to be done any time there is a dose adjustment. Since Corky is taking Trilostane, if there is an adjustment to his dosage, a stim test is done in 30 days. If there is no adjustment to the dosage, then a stim would be done in 3 months, unless there are clinical signs that start to resurface. If I see clinical signs returning in Corky, I have an U/S done when he has his stim test, because he does have an adrenal tumor which has been increasing in size.

I hope this helps.

Terri

[missbeagle]

Terri -

NC State is 2 hours away from me. My appt is at 11am and they tell me that because it's a teaching hospital that things will run kinda slow when I get there, with regard to previous vet records, re-diagnosing??, and running tests.

NC State needs a referral from my vet for me to get to see an IMS. My vet told NC State that Rusty was diagnosed with Cushing's in March. But it wasn't until I went to see him last month that I inquired about treating him. Before that he did not offer. I am suspecting it is because of his lack of experience with Cushing's.

I have Googled and tried to find another vet in my area that has some experience, but have come up with nothing. My vet is the ONLY AHAA vet in my city.

Hope this helps.

Gretchen and Rusty at da beach in NC

[Harley PoMMom]

I still would have the ultrasound done because their machine is probably a "state-of-the-art-machine," and not found in one's regular GP office. This can tell you all kinds of information about Rusty's internal organs, which is very important. This is how I found out about Harley's pancreatitis.

The ACTH test is really up to you, since you did have one done in March but that is 9 months ago. I am sure his results would probably be elevated but, if it were me, I'd want to be sure that they were still elevated. Ask them to do a post draw only, no pre draw/baseline draw.

Hope this helps.

Love and hugs,
Lori

[missbeagle]

Just had one quick question. Has anyone heard of using Astragalus Root for Cush pups? It's herbal.....just wondered.

Thanks,

Gretchen and Rusty

[missbeagle]

Hello again folks,

I am getting apprehensive about my IMS appointment at NC State at the end of the month. Rusty is a a happy boy with a bog appetite who eats a bit more than he should and is otherwise OK. His last blood work showed elevated liver enzymes and I have had him on Denamarin for the last few months.

I am wondering if it is not yet time to treat with Lysodren or Trilostan.

I know the IMS will tell me what I should do. But the thing that scares me the most is the fact that I am going out of town six days after we see the specialist. I will be going home to see my father on the 26th through the 30th.

If the IMS puts him on meds on the 21st, isn't that a bit too close to Christmas for my regular vet to run an ACTH stim test in the event that Rusty loads /adjusts to meds quickly?

I am a teacher and am not home most of the day. The 20th is the first day of Christmas break and I go back to school on Jan 2nd. I guess my question is when is good to start treatment? Or should I not treat at all and let the disease progress as it will without treatment????? :confused:

My hubby seems to think that we should leave well enough alone. I'm a little concerned already about the progression of the disease because he already has elevated liver enzymes and a grade II heart murmur.

Thanks in advance,

Gretchen and Rusty in NC

[Squirt's Mom]

Hi Gretchen,

The signs are an important part of not only diagnosing Cushing's but also in monitoring once treatment has begun. If Rusty isn't displaying any signs, then it will be very difficult to see when the drug has made changes that indicate the cortisol is being controlled correctly. With no signs, it would be very easy to cause an Addisonian event - meaning the cortisol would drop much too low.

The appetite and drinking are the two main signs used to determine when a pup is loaded using Lyso, which is the treatment I personally would recommend since Rusty already has elevation in his intermediates. The same two signs are used to determine whether the Trilo dose is working or if it needs to be tweaked.

A cush savvy vet will know this and will not treat without the presence of signs. With the level of cortisol shown on Rusty's UTK panel, I would expect that he is displaying signs such as an increase in appetite, perhaps begging for food or treats more often, getting in the trash, staring at the cabinet where his food is kept, begging from folks at the table where he didn't before, maybe even showing some food aggression that is not like him. He may be needing to go out to pee more often than before, peeing longer, or stopping on walks to pee more often. He may drink more water, staying at the bowl longer or returning more often than he used to. These are all things to look at and for in Cushing's, plus many others, but these are usually the most obvious.

As for repeating the LDDS, I'm not sure that is necessary but the IMS may feel it is. Repeating the ACTH and ultrasound would be prudent. Do you know if the BPH diagnosis is considered firm or just a possibility? If it were me, I would want a look at his reproductive system as well as the abdominal organs usually looked at, to make sure there is no tumor or other problem that could be causing the elevations in his hormone levels.

I know this is scary to contemplate, but you are going to be just fine. The docs at NC State will take good care of him if he has to stay overnite. I would think you could take him back and forth to the school for testing but one never knows. I won't hurt to ask, though. ;)

Keep in touch and let us know how things are going, ok?

Hugs,
Leslie and the girls :D - always

[missbeagle]

Leslie -

A cush savvy vet will know this and will not treat without the presence of signs. With the level of cortisol shown on Rusty's UTK panel, I would expect that he is displaying signs such as an increase in appetite, perhaps begging for food or treats more often, getting in the trash, staring at the cabinet where his food is kept, begging from folks at the table where he didn't before, maybe even showing some food aggression that is not like him. He may be needing to go out to pee more often than before, peeing longer, or stopping on walks to pee more often. He may drink more water, staying at the bowl longer or returning more often than he used to.

Yes he has a ravenous appetite, once or twice he went throught the garbage (before we got the puppy gates), he stares at the door where we keep the food. When we go on walks, he peeps on everything but that is because he is not neutered.

Do you know if the BPH diagnosis is considered firm or just a possibility?

As far as I know it was a guess on my regular vet's part. :confused: When I asked him to prove it to me, he said that there was nothing in the ultrasound that indicated that he had BPH since it came back with no infiltrations or nodules noted.

NC State is 2 hours from my house. That would be a lot of gas back and forth. Rusty is worth it I know. I just haven't found a way to tell my husband that I have made this appointment. My husband doesn't think Rusty is sick, since he is a fat and happy beagle. He doesn't want to hear it when I try to explain to him what's going on. He frequently tells me that all things will die eventually and that I am "playing God" and avoiding the inevitable. It could be because he works in the death industry and is desensitized about these kinds of things.

Thanks a bunch,

Gretchen and Rusty in NC

[missbeagle]

I took Rusty in yesterday for a weigh in to check his weight loss program.

He is down in 58 from a whopping 64 pounds in March. Woo Hoo!

I also picked up his medical records in preparation to take to NC State at the vets while I was there. I'm kinda perturbed at the vet for the information that he gave me. He gave me the notes from the visit in October when I was inquiring about Lysodren and shots, Super old blood work and notes from March of 2010 and notes from the abdominal ultrasound in April of 2010. He DID NOT include copies of the LDDS test that was run in July or the Stim test results from March of 2010.

I am going to take the LDDS and the Stim test results myself. It just irked me as to why he would send bloodwork results from March to NC State. It felt like he was not including a lot of information for the IMS to go on. Is this normal for a vet to send minimal information to the IMS?

I finally told my hubby and although he does not think that Rusty is sick at all, he seemed to be OK with things.

The one thing that the vet noted was that Rusty has a ventral perianal mass/adenoma. When I asked about removing it, he said he could not do that. He added that he did better if it drooped down a bit more than it does. Rusty is an intact male pup and when I googled it, I discovered that sometimes male dogs get these. I learned that castration sometimes makes them go away.

Could this perianal adenoma be causing Rusty's elevated intermediate hormones? Hmmmm.......the vet never said either way. Could I get Rusty neutered with a Grade II heart murmer???.....I think that could be risky.

Any thoughts from anyone are greatly appreciated.

Gretchen and Rusty near the beach in NC

[missbeagle]

Ok folks -

On Monday the 20th at 11am I have scheduled an appointment with the IMS specialist at NC State.

I have no ideas which doctor we will see, I just get the one that's working that day. When I get there I will meet a 4th year vet student and will take it from there.

I am OK with another ultrasound and an other ACTH Stim test and some blood work. Anything that is probably a waste of my hard earned money.

Does anyone have any helpful hints of what to do, what to ask, not ask, record or take notes?

I am hoping this will be a positive experience for the two of us. I am just wondering what to ask or not ask.

I am basically going to try and get Rusty on some Lysodren as my vet here does not have great experience using it. I have no idea as to when I will start with Christmas and New Years and going out of town for four days. Then I go back to work on Jan 3rd with two twelve hour days that first week of Jan because of teaching Graduation Project. No one will be home to monitor him should he need me. :( Any ideas when I should start???

Thanks in advance,

Gretchen and Rusty in NC

[frijole]

Gretchen, I had to take Annie to K State which is a 5 hr one way drive - the closest IMS to where I live. What I did was type up a brief synopsis of her case which I gave to them. I am very glad I did. I too was greeted by a yr 4 student and she asked a few questions and listened to my story but it is so easy to forget something so you are wise to think ahead.

I'd start off with a paragraph summarizing the reason you are there - and what your concerns are. Then below that I'd chronologically provide them with tests that were done (with dates) and any drugs Rusty was put on etc. This will give them the big picture they need to help you. That way you make sure that the IMS on the case gets everything they need to help you.

Kim

[Squirt's Mom]

Hi Gretchen,

I just noticed an older post where you asked if anyone used Astragalus for their pups. Yes, I give it to Squirt and have for 2 years now. She gets 3 drops of a tincture made by Eclectic Institute that I purchase from Mountain Rose Herbs.

http://www.mountainroseherbs.com/

She also gets 3 drops of Burdock glycerite from the same manufacturer.

As for why your vet sent old records and didn't send the newer ones, who knows. Maybe a clerical error, maybe an intentional act. I have had dealings with human docs who were so arrogant they resented any me wanting a second opinion and were really tacky about sharing records. :rolleyes: But, regardless of the reason, the IMS at NY State would benefit from seeing the most recent tests done for Rusty so if you don't already have them, I would go back and ask for those records before you make the trip.

When Squirt went to see the IMS for the first time, we took all her records, films, and I took my notes. Of course, we were just starting out on our Cush journey so it wasn't difficult to know where to start - we started at the beginning. Dr. Sessions went over all her tests and talked to me about what they meant, which agreed with what her GP vet had said. He didn't give her any more tests as hers were quite recent and her case was apparently clear-cut at that point. If Rusty were mine, I would want another ultrasound for sure and another ACTH might not hurt. The UTK panel is another consideration to check his intermediate hormones if nothing else shows up.

You might go back through your thread here and look for questions you posed to us. Ask the IMS about those concerns. I would definatly want to know about that tumor in Rusty's gonads - is it dangerous? could it be causing all his problems or any of them? would it be better to leave it alone or remove it? Make a list of everything you have observed in Rusty - any changes in his behavior, moods, patterns, etc. over the last year or so. Don't be afraid to ask the IMS any question you have - even if you think it is silly.

Keep up the good work! You are doing a great job, Mom!

Hugs,
Leslie and the girls - always

[missbeagle]

Ok everyone,

We will be starting our journey to the IMS tomorrow between 8am and 8:15am. Our appointment is at 11am ET. Good thoughts and prayers are appreciated.

Does anyone know how to keep a Cushing's pup who hasn't been fed breakfast from going bananas? The paperwork says NOT to feed him in the am. That means no Denamarin, no melatonin and no HMR Lignans. :(

Any ideas are welcome. I guess I could give him a cookie or two.
But I don't want to feed him, as I don't need a lecture from the IMS.

Thanks,

Gretchen and Rusty in NC

[AlisonandMia]

Unless a dog is going to have surgery, in which case total fasting including no water after a certain point is necessary, what they are worrying about is fats from a meal turning up in the blood and messing up blood tests - that's why they ask that the dog be fasted.

It should be ok to give him something like green beans to make him feel "loved" in the morning. He probably won't be totally impressed but it could help.

Check if this is ok with the vet first, though!

Alison

PS: You probably need to talk to the actual vet though - you may find a receptionist will simply say "no" to be on the safe side whereas the vet him/herself will likely ok it.

[Squirt's Mom]

Hi Gretchen,

Travel safe and let us know how things go today. If it were me, I wouldn't give him anything to eat just to be on the safe side. Alison is right about the fats but sugars can also mess things up and since diabetes is often connected to and confused with Cushing's, I wouldn't take any chances.

I hope you are happy with the docs you see and the treatment they give our Rusty...AND that you get some answers and a plan to work with! ;)

Hugs,
Leslie and the girls - always

[missbeagle]

Hi everyone -

I am sitting in Starbucks writing this and the vets are giving Rusty the once over. They are going to aspirate the bump on his bum to make sure it's nothing bad. They are going to look that over under the microscope too. It hasn't gotten larger or smaller since Feb/March so I don't really think it is much other than an adenoma.

The vets tell me I can do either Trilostane or Lysodren. Dr. Oliver said that Rusty should do Lysodren because his intermediate levels are elevated. I am not sure who is right. The vet (young guy maybe 30 - who teaches there) at NC State says he is more familiar with Trilostane than Lysodren and even mentioned giving me pred just in case! Yeah!

They are going to run a CBC and a chem panel. They said maybe a stim test and an ultrasound. That would happen after they conferred with yet another doctor.

The one thing the young vet mentioned was blood clots that can break loose and travel in Cush pups. I am going to ask about heart meds/blood thinner when I go back. Does anyone know about blood clots? This was new news for me today.I'm just waiting on the phone call to go get himand start the two hour journey home to the beach.

Wish us continued luck on our journey today.

Gretchen and Rusty (ouch my bum hurts)

[missbeagle]

Ok, now we are staying overnight and will have more tests in the morning.

Tomorrow theywill give him a full abdominal ultrasound, 3 x rays (side, side and back) and to another calcium test.

They think he has hypercalcemia. They will be looking for a tumor in his tummy. His last ultrasound inApril was clean and I am seriously hoping this one will be too.

They also aspirated the thing on his bum. It could be a malignancy and maybe producing the excess calcium in his body. if that's the case, we'll get him neutered and they will take off the thing on his bum should it be malignant.

My hubby told me tonight that maybe I shouldn't have messed with things. I came here to NC State looking for lysodren help not expecting this.

Does anyone know if hypercalcemia is caused by Cushing's? he does not have the bad skin that sometimes the Cush pups get.

I am worried more than I want to let myself think I am tonight. he has to be back at the vet's at 8am tomorrow for his testing.

Thanks in advance,

Gretchen and sleepy Rusty in NC (my bum still hurts)

[frijole]

I'm sorry I can't help you with the hypercalcemia question but I wanted you to know I was following your story and I remember having to overnight earlier this year when at K State Univ... similar tests. I am sure you are in the very best of hands. Keep asking them to explain things to you in English and you will get your answers. I'm sending my best to you, hubbie and dear Rusty. Best of luck with the tests tomorrow. Kim

[missbeagle]

We are finally back home after spending two days at NC State Vet Hospital. On the first day they did bloodwork, aspirated the lump near his rectum and ordered tests for the second day.

The second day he underwent an abdominal and a parathyroid ultrasound as well as a liver aspiration, urine culture and a PTH test for ionic calcium in his blood.

On the first day he had elevated calcium levels in his blood. He had a reading of 12.9. They suspect a parathyroid glad adenoma because when they ultrasounded his thyroid one side was enlarged and the other was not. I am waiting for results of the specific ion calcium test to come back to confirm this. I might have to wait as long as a week for the results.

The also took a fine needle aspirate of his liver from a 1 cm cyst in the caudoventral aspect of his liver. I was told the ultrasound technician was not concerned about this lesion. But they took the sample anyway.

Because his calcium levels are somewhat elevated, and if the ionic calcium test comes back positive, then Rusty might have a tumor on his parathyroid gland. That would have to be surgically removed at some point before any additional calcium loss is seen in his bones and filtered through his kidneys.

Right now, their first concern is the elevated levels of calcium (hypercalcemia) and to get that under control.

The second thing that was elevated was his BUN and creatine. BUN was 36 and Creat was 2.2. Not super high, but high enough to cause concern, especially since he has high calcium levels. They want to rule out a kidney infection too just to make sure.

The third thing was to get Rusty neutered when I can. (I'm thinking when I financially can as this trip was expensive).

After things are ruled out or have come more into focus based on test results, then I am to treat his Cushing's disease.

I am not looking forward to three or four days of Rusty going back to NC State for parathyroid surgery. But I will have to cross that bridge when I get there and figure out which of the two options is best for him. The first option is thyroid surgery to remove the mass, the second option is they inject ethanol into the enlarged gland and it destroys itself. I would have to leave him there in order to check calcium levels post operation and to make sure he does not go into a calcium crisis.

The other good news was his adrenal glands were not enlarged at at ALL Tuesday. Both of them were normal in size. :)

Happy to be back at home,

Gretchen and Rusty

[missbeagle]

Another Rusty update -

They think he now is renal secondary hypo-parathyroid. The vets at NCSU want to maybe put him on calcitriol depending on what they find when he has yet another blood test and another urine sample later this week.

He is currently taking a Pepcid AC twice a day ...10mg and has been placed on Hills K/D.

The NCSU vet thinks his elevated levels of Calcium in his blood are being caused by the beginnings of kidney failure. They still don't want to treat him for his Cushings until I get a few more things under control.

Does anyone have any advice for both a Cush pup that has kidney issues as well?

Rusty will be my 5th dog that has kidney problems. His dad also had this as well.

Thanks in advance,

Gretchen & Rusty in NC

[Harley PoMMom]

What are Rusty's creatinine, BUN, and phosphorus levels? Also, have they checked his blood pressure?

My Harley has Cushing's and kidney disease, and I know there are others that are knowledgeable in these areas too...we will help you in any way we can, ok.

Love and hugs,
Lori

[missbeagle]

The vets at NCSU didn't give me the printouts of things. His blood pressure is normal.

His creatinine was 2.2 and his BUN was 36.

I don't have the levels for his phosphorus.

Hope this helps.

Gretchen and Rusty in NC

[missbeagle]

Here's my update on Rusty.

I went BACK to the vet yesterday for chem panel bloodwork and a sterile urine sample. The IMS is checking to see if he really has elevated BUN and Creatinine levels in his blood. It was expensive and I only had a tech appointment too. $175.00 for both tests - OUCH!

I should have the results on Monday or Tuesday.

The vets at NC State did not hear a heart murmur but my vet says Rusty has a grade II. They asked me yesterday about putting him on enalapril for his heart. I have another dog that lives with my dad who has been on this for years.

I'm not sure who to believe about his heart.

Also, could Rusty's untreated Cushing's be causing his possible heart murmur and his kidney problems?

Thanks in advance,

Gretchen and Rusty in NC

[Harley PoMMom]

Hi Gretchen,

If it were me, before starting my pup on anything, I would want to know for certain if the creatinine and BUN are definitely elevated. Although I am no vet, Rusty's heart murmur, I wouldn't think, should not be that hard to diagnose.

My other Pom, Bear, has a heart murmur and he does not have Cushing's...had him checked for this dratted disease.

Enalapril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. They are indicated in the treatment of mild to severe chronic heart failure in dogs. They are also used for treating high blood pressure. Here is a link to a good article about whether to use ACE inhibitors or not: To Give or Not to Give... Ace Inhibitors http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2010&Category=&PID=56301&O=Generic

Waiting anxiously with you for those creatinine/BUN results and keeping you and Rusty in my thoughts and prayers.

Love and hugs,
Lori

[Franklin'sMum]

Hi Gretchen,

Have you had Rusty's urine checked lately? I'm thinking microalbuminuria/ proteinuria may give a hint of possible kidney problems, if the blood work has been inconclusive due to his other issues.
My little boy Franklin is on enalfor (enalapril maleate) for proteinuria, that's one of the other uses of the drug.

Jane, Franklin and Angel Bailey xxx

[missbeagle]

Jane -

We ran a urine test on Friday. I should know the results on Monday or Tuesday. The IMS wanted to double check his urine and kidney functions to rule out an infection or figure out if he does have early kidney disease on top of his Cushing's.

Gretchen and Rusty in NC.....waiting on snow and ice

[missbeagle]

The IMS called yesterday to tell me that Rusty does indeed have early kidney failure. He wants to continue the prescription food and add enalapril too. As of right now he does NOT want to treat his Cushing's disease. <sigh>. I am wondering why this is!

His latest bloodwork shows that his BUN is 41 and his Creatinine was 2.2.

I am to have one more calcium test done, as his was normal on the latest bloodwork.

I am working on signing up for the K9 Kidney list.

Rusty will make my 4th kidney dog. <sigh>

He will be 9 in April...this is so unfair.

Gretchen and Rusty in still snowy and icy NC

[gpgscott]

Very sorry to hear about the kidney failure.

We have had the misfortune to have had a string of cats with early onset renal failure, it is so sad to see an otherwise youthful animal struggle so.

Hoping the diet and enalapril help retard the kidney failure.

Scott

[missbeagle]

Scott -

So do I.

Gretchen

[Squirt's Mom]

Dear Gretchen,

I am so sorry to hear of Rusty's diagnosis. :( I wish I could help but it sounds like you already have plenty of experience in this area unfortunately. :( Unfortunate for you, but lucky for Rusty that his mom knows what to do for him. I have wondered when I see one of our members with more than one cush pup if The Universe doesn't place them together, knowing the pup needs that particular mom or dad. So I have to think that in spite of his illness, Rusty is one lucky fellow to have you as his mom.

Please keep in touch and let us know how things are going. You and Rusty are family. Go seek out any and all info and help you can find for him, but just remember we are here and we care very much about the both of you.

Hang in there!
Hugs,
Leslie and the girls - always

[Harley PoMMom]

The IMS called yesterday to tell me that Rusty does indeed have early kidney failure. He wants to continue the prescription food and add enalapril too. As of right now he does NOT want to treat his Cushing's disease. <sigh>. I am wondering why this is!

His latest bloodwork shows that his BUN is 41 and his Creatinine was 2.2.



Both of the cushing's medicines, Trilostane/Vetoryl and Lysodren/Mitotane should be used cautiously in dogs with hepatic or renal disease.

One priority of a dog with kidney disease is making sure they are drinking plenty of water...with a dog with Cushing's Disease this is no problem.

Another main concern with dogs with kidney disease is loss of appetite...well, our cush-pup, their appetites are pretty good!

It's actually a catch 22 with a furbaby with Cushing's Disease and Kidney Disease. The excess cortisol, in the long run, will damage the kidneys but in the early stages of kidney disease the excess cortisol helps the pup drink plenty of water and have a good appetite, which they need. what does one do? :(

Love and big hugs,
Lori

[missbeagle]

My IMS called yesterday to tell me that after consultation with other doctors at NC State, he will be treating Rusty for his Cushing's after all.

He wants to put him on Trilostane 20mg twice a day. When I looked this up at Dechra's website, it is a low dose. Thoughts anyone? Rusty is down to 55 pounds now and I can actually lift him up. His high weight was 64 in March. For a beagle that's huge!

I'm not sure how I feel about this since his intermediate hormones were elevated in March when we ran the ACTH Stim test that went to UTK. Dr. Oliver wanted me to do Lysodren, but my IMS says he has more experience with Trilostane.

I have printed out some of the literature from Dechra's website and the IMS says he will give me more information too.

I just wondered about the dose of 20mg twice a day for a 55 pound dog and the IMS mentioned that he will not be giving me prednisone. I'm not sure if that's because when I looked up the dose, it was low or because you really don't want to give prednisone to a kidney pup.

Thoughts and suggestions are welcome!

Gretchen and Rusty in melting NC

[missbeagle]

Bump.....bump

[labblab]

Hi Gretchen,

I apologize for not having the time right now to read back through your thread more completely (so as to really know the context of your current questions). But I didn't want you to stay hanging here without any feedback. So maybe if I open my big mouth, it'll get the ball rolling! :p

Re: the trilostane dosing, a total of 40 mg. a day really is not that far below the amount currently recommended by Dechra. I know the printed materials give a starting range of 1-3 mg. per pound, but Dechra's U.S. technical representatives are verbally recommending an initial dose no higher than 1 mg. per pound. So at Rusty's current weight of 55 pounds, a starting dose of 40 mg. is a bit low, but not drastically so. Dechra does still generally recommend that treatment begin with once-daily dosing (shifting to twice-daily only if symptoms do not appear to be well controlled throughout a 24-hour time period). But we have encountered a number of specialists who prefer to start with twice-daily dosing right out of the gate.

Re: being given prednisone, if I were you, I'd ask the IMS for his reasons for not supplying it. Truth be told, I think that very rarely does a dog being treated with trilostane experience an acute episode of low cortisol that actually requires prednisone "rescue" for genuine safety purposes, as opposed to just temporarily discontinuing the medication and allowing the cortisol to naturally rebound. But for your own peace of mind (during nights and weekends!) and the comfort of your dog in the event of a cortisol drop, I think it's worth pursuing further with your vet.

Last but not least, we've experienced a lot of back-and-forth conversation on the forum re: the advisability of treating with trilostane in the face of pre-existing intermediate hormone elevations. Here are a couple of threads that you might want to look over:

http://www.k9cushings.com/forum/showthread.php?t=1896

http://www.k9cushings.com/forum/showthread.php?t=2616

Good luck with Rusty, and hopefully you'll soon have some comments here from other members, as well!

Marianne

[missbeagle]

Hello everyone again.

We have yet another change of plans per the IMS. Because of the cost effectiveness of putting Rusty on Trilostane, instead of giving him 20mg twice a day, the IMS wants to put him on the 30mg tablets twice a day. :confused:

He will run an ACTH stim test 10 days after starting treatment.

I'm scared and apprehensive, but I want to help my Cushing's boy.

Thoughts and suggestions are welcome.

Gretchen and Rusty in NC

[labblab]

We have yet another change of plans per the IMS. Because of the cost effectiveness of putting Rusty on Trilostane, instead of giving him 20mg twice a day, the IMS wants to put him on the 30mg tablets twice a day. :confused:

He will run an ACTH stim test 10 days after starting treatment.

When you say "cost effectiveness," I am wondering if this is because your IMS wants to use brandname Vetoryl, and two 30 mg. capsules are less expensive than four 10 mg. capsules?? Brandname Vetoryl is only supplied in the U.S. in dosage strengths of 10, 30, and 60 mg. capsules. Compounded trilostane can be obtained in virtually any dose OTHER than those three. But if your vet prefers that Rusty start off on the brandname product, the 60 mg. total dose may work out to be cheaper than a 40 mg. total dose. Or he is referring to something else entirely in terms of cost effectiveness?

Once again, I cannot comment on Rusty's other health issues but just from a dosing standpoint, a total daily dose of 60 mg. is only a smidge above the "1 mg. per pound" forumula. So I don't think that should be cause for alarm. And your vet's plan to administer an ACTH test ten days into treatment corresponds with Dechra's recommended monitoring protocol. So the dosing and monitoring sound fine to me.

Marianne

[missbeagle]

Marianne -

Yes, he was thinking that the twice a day dose of 30mg would be cheaper than the twice a day dose of 20mg.

Rusty weighs 55 pounds.

Is this close to the recommended dosage for a dog his weight?

Thanks,

Gretchen and Rusty in NC

[labblab]

Yes, it is almost exactly what Dechra would recommend as a daily starting dose for a dog of Rusty's weight. The formula they are endorsing is 1 mg. of medication per each pound of weight. So at a weight of 55 pounds, the twice daily dose of 30 mg. (for a daily total of 60 mg.) is almost exactly what they would recommend.

You may see references elsewhere on the forum to the dosing protocol recommended by the vet school at UC Davis. Their recommendations for initial dosing are more conservative than those of Dechra -- in fact, half the dosage. Due to their own clinical experiences with the patients in their practices, specialists may choose to endorse one protocol over the other. But both protocols have plenty of advocates and are accepted as standard recommendations.

Marianne

[missbeagle]

Marianne -

Thanks so much as this is a sorta scary time for me as Rusty also has the beginning stages of kidney failure.

The IMS is hoping that by finally controlling his Cushing's that we can slow the progression of the other.

When I asked him today about his intermediate hormones, he answered that he does not usually worry about the intermediate hormones since they normally accompany atypical Cushing's and Rusty has normal Cushing's disease.

He said that he thought just one was elevated, and I thought they all were??? Dunno, I will have to look later when I get the chance.

I'm just nervous because my regular vet didn't even carry this medicine and he only has one other Cushing's dog. NC State is shipping it to me.

Please keep your paws crossd for us.

Thanks,

Gretchen and Rusty in NC

[Harley PoMMom]

Hi Gretchen,

Before I started Harley on 10mg of Vetoryl he had a CBC/Chemistry blood panel done. Harley's creatinine was 1.2, which was well within the normal ranges.

Only 10 days on the 10mg of Vetoryl I had another blood panel redone, this time his creatinine went up to 2.5. From what I am reading subclinical renal dysfunction may be unmasked by treatment of Vetoryl.

I have also read that Vetoryl should be used with great caution with dogs that have kidney disease. The risk of hyperkalemia developing should be considered if Vetoryl is used in conjunction with potassium-sparing diuretics or ACE inhibitors.

I do understand how scary this is, please remember we are all here for you and Rusty and are here to support you.

Keeping you both in my thoughts and prayers...wishing you both the best...keep us updated, ok?

With much love,
Lori

[missbeagle]

Guys -

I got this today from Dr. Oliver at UTK.

I looked at the hormone test results, and hyperadrenocorticism is definitely present. Cortisol level at stim is significantly elevated for an intact male. And the estradiol levels are very elevated, and this can cause essentially all the clinical signs of Cushing's. It's been my experience, seeing test results of dogs that are on trilostane, that androstenedione and estradiol (only estradiol in Rusty's case) are increased by trilostane. This may not cause a problem for weeks to months, but a lot of these dogs will begin to have signs of Cushing's disease again, and I attribute this to the elevated sex hormones (the two above in particular). Many veterinarians treat dogs with this type profile with melatonin, lignan and maintenance Lysodren. I'd be glad to talk to your IMS at NC State if he has questions about melatonin and lignans.

Regards, Jack.

Thought this might be of interest.

Gretchen and Rusty in NC

[Squirt's Mom]

Hi Gretchen,

I am probably one of the last hold-outs here against Trilo usage in pups with elevated intermediates. The comment from Dr O in the email you posted is the reason I maintain the position that Trilo is not the best choice for pups who already have elevated intermediates. UTK research in this area has shown that Trilo often causes the intermediate to elevate/increase while Lysodren will lower all with the possible exception of estradiol. However, UTK and Dr. O are the only ones doing this research on the intermediates so there are no other research/studies to compare to.

Estradiol can be produced outside the adrenals and Lyso works only on the adrenals - this is where the lignans and melatonin come into play. They can lower estradiol that is being produced outside the adrenals.

Now, having stated my opinions, we have had several pups here who had elevated intermediates and were treated with Trilo with no problems. Not every dog will react to the Trilo with increased intermediates. My Squirt is Atypical but her cortisol has been creeping up and her androstenedione was much higher on the last UTK panel so she recently started Lyso. For me, using Lyso is much less worrisome. ;)

Hugs,
Leslie and the girls - always

[missbeagle]

Leslie -

I am still giving Rusty his melatonin and HMR lignans anyway. I figure it might be actually be helping him.

Gretchen and Rusty in NC

[missbeagle]

Hey everyone -

Rusty's trilostane arrived yesterday from NCSU. I have an appt this afternoon with the vet to check his BUN and Creatinine levels since he's been on enalypril.

I'm not sure when I will start the trilostane as I have a half day at work today and Monday, and then it's back to the grind again.

He's on 30mg BID and the package insert says to dose once a day. He weighs 55 pounds. Yup, that's my Chunk Monkey!

Does anyone know why my IMS would want to dose twice a day?

We are going to run a stim test 10 days after I start the meds.

It says to give with food....is that his regular dinner or can I wrap it in some cheese or lunchmeat and then feed him?

How soon should I see results? Rusty doesn't pant, he just has the huge appetite and drinks a lot. He's NEVER had an accident in the house, even with the kidney issues.

Thanks,

Gretchen and Rusty in NC

[addy]

Hi Gretchen,

I had emailed Dr. Allen at Dechra about starting my Zoe on Trilostane. He told me I could do 1mg. per pound at once or twice day dosing. If it was twice day dosing cut the dose in half. This was an email from him just a few weeks ago.

I was suprised at the twice day dosing but perhaps because of the short life of Trilostane in the pup, and experiences they are seeing here in the U.S., the manufacturer has changed it up a bit for their suggested dosing protocal.

Perhaps that is what your vet is going by.

Hugs,
Addy

[lulusmom]

It's a judgment call by a vet to go with once daily (SID) or twice daily (BID) dosing. Some vets, including my old gp vet, opt to start dogs on BID based on a few studies that show BID is beneficial for some dogs. This is because Trilostane has a short half life and some dogs simply will not see a resolution of symptoms throughout the day with one daily dose. SID dosing works for the majority of dogs, and because it's certainly more convenient for the pet owner, I think most vets will start a dog on SID. If a dog has diabetes or the vet wants to avoid the possibility of having to determine later on that BID dosing is appropriate, a vet will recommend BID dosing from the start to ensure adequate 24 hour control of cortisol. I have two cushdogs, one was on SID and the other on BID. Both were controlled beautifully so you just never know.

Glynda

[missbeagle]

Hi everyone -

Here's Rusty's latest bloodwork from Friday 1-21-11. The normal ranges for IDEXX are in the parenthesis.

ALK 481 (10-150) HIGH
ALT 175 (5-107) HIGH
GGT 16 (0-14) HIGH
Amylase 1823 (450-1240) HIGH
Albumin 3.1 (2.5-4.0)
Total Protein 6.2 (5.1-7.8)
Globulin 3.1 (2.1-4.5)
Total Bilirubin .2 (0-.4)
BUN 51 (7-27) HIGH
Creatinine 2.0 (.4-1.8) HIGH
Cholesterol 584 (112-326) HIGH
Glucose 81 (60-125)
Calcium 11.3 (8.2-12.4)
Phosphorus 4.4 (2.1-6.3)
Chloride 104 (105-115) LOW
Potassium 6.0 (4.0-5.6) HIGH
Sodium 142 (141-156)
A/G Ratio 1.0 (.6-1.6)

I'm waiting on the IMS from NCState to call me as my normal vet is off today.

I'm hoping to start finally treating his Cushing's disease maybe later this week. This blood draw was to monitor whether the enalipryl was helping or hurting his kidneys.

Thanks,

Gretchen and Rusty in NC

[missbeagle]

God this is getting frustrating! I had Rusty's bloodwork drawn on Friday and neither vet has called me to discuss it. :mad:

I'm not sure if my regular vet needs to speak with my IMS or the other way around.

I just want to hear from one of them. Grrrr! I have the trilostane in my possession but I'm not sure when they want me to start it.

PLUS, the blood work that we just did was to see if the enalypril was working for his kidney issues. With the increased BUN, I'm not sure and I'm not a vet.

It is also interesting to me that enalypril does not mix well with trilostane.....hmmm.......

Waiting for a phone call in NC,

Gretchen and Rusty

[Squirt's Mom]

Hi Gretchen,

Aggravating, ain't it! :rolleyes: I hope one of them will call you soon.

I noticed the BUN was up but the creatinine was down...however, I'm not sure what that means so I kept my mouth shut! :p I do know that the BUN can be affected by several things. I hope one of the gurus will be along soon and give us some insight.

Hugs,
Leslie and the girls - always

[missbeagle]

Leslie -

The IMS finally called and the cell phone DIDN'T RING.....it went straight to voice mail.....Grrrrrr!

All he said was his azotemia was stable and that my vet was on board with starting him on trilostane and that I should do an ACTH stim test in about 10 days after treatment.

When I called him back to discuss his voice mail, I got his office voicemail. Grrr!!!:mad:

Thanks,

Gretchen & Rusty in rainy NC

[missbeagle]

One more question -

How does the stim test work? Do I give the medicine and then the vet runs the test?

I'm working on figuring out my ten days out just to make sure it's not on a Sat or a Sunday. The vet is closed on Sun and only open til noon on Saturday.

Does anyone think that finally getting his Cushing's under control will slow the progression of his kidney problems?

Thanks,

Gretchen and Rusty in NC

[missbeagle]

Folks -

There's a lot going on with Rusty now.

After speaking witht the IMS twice today already (and it's only 11:30) he has redeemed himself.

I am to hold off with the trilostane until he checks with the manufacturer again and I am to continue giving him his Enalapril.

He was not aware of the contradictions between the two drugs.

He will call me back when he finds out more information. He needs to consult with the manufacturer and the pharmacy at NC State.

We're not sure if the kidney disease is idopathic or if the Cushing's is making it worse.

He also mentioned that the kidneys filter trilostane too. Maybe he's thinking about doing some lysodren?

I don't know. I will post more when I find out.

Please keep your fingers crossed.

Gretchen & Rusty in NC

[lulusmom]

I am to hold off with the trilostane until he checks with the manufacturer again and I am to continue giving him his Enalapril.

He was not aware of the contradictions between the two drugs.

Your IMS may have redeemed himself to you but if what you say is true, he has a long way to go before I'd give him a pass. It is downright scarey that an IMS could be so ignorant about a serious drug he has prescribed to a patient and it is shameful that the calls to the manufacturer and the pharmacy were not forthcoming until you enlightened him. I mean really, what if the combination of those two drugs always caused permanent and irreversible injury or even worse, were fatal most of the time. This is just another example of why it is so important that pet owners be proactive in their pets' medical treatment and do their own homework on anything they put in their dog's mouth or apply topically.

To answer your question about the acth stimulation test. You would give Rusty his morning dose with food and get him to the vet within 3 to 4 hours after dosing. This will insure that the test can be done by your vet well within the recommended time range of 4 to 6 hours after dosing. Some people say give a small meal on the day of the acth stim test but I never limited my dog's meals when they had their stims.

[Harley PoMMom]

If you do want to continue treatment with Trilostane, maybe ask your IMS about switching the hypertension medication to amlodipine besylate. Amlodipine besylate is classified as a "calcium channel blocker" and not as an "ACE inhibitor" so there should be no contradictions between the Trilostane and the amlodipine besylate.

Link with info about amlodipine besylate. http://www.marvistavet.com/html/body_amlodipine_besylate.html

Love and hugs,
Lori

[missbeagle]

Hi everyone -

I heard back from the IMS again today. He tld me that he had spoken with the manufacturers of Vetoryl and gave me the OK to give Rusty the Cushing's medicine even though he is taking enalypril for his protein issue with his urine.

Rusty weighs 55 pounds now and will be taking 30mg BID of vetoryl. His enalypril dosage is 10mg once a day.

I'm kinda scared because the drugs are not supposed to work well together. Dechra apparently told my IMS that the dose of enalypril is low and there should not be any reaction between the two.

I am to start him on the meds (probably this Friday) and stim him within 10 days of starting the meds. He says he wants to run electrolytes too. I know that is good.

The IMS said the Amlodipine besylate that Lori mentioned is not needed at this time because Rusty does not have high blood pressure.

Does anyone have thoughts or concerns?

Thanks,

Gretchen and Rusty in NC

[labblab]

Gretchen, if Dechra has given the green light for you to proceed with the enalapril/trilostane combination, then I would think it would be OK. We have had other dogs who have ended up being prescribed both medications simultaneously, and the wording in the Vetoryl product insert is phrased as a "caution" rather than an outright prohibition. I think that implies that the complete medical picture and dosing pattern for each individual dog will determine the advisability of giving the drugs together. And now that your IMS has consulted with Dechra re: Rusty's specifics, I think you've covered those bases.

The trilostane dose of 30 mg. BID along with monitoring tests at ten days sounds good to me. I believe that if the enalapril were to cause problems for Rusty, you would pick that up in the electrolyte check. So I'll be crossing my fingers and wishing you and Rusty a ton of good luck once you launch into treatment!

Marianne

[missbeagle]

Ok, so Rusty starts his Trilostane tomorrow! :eek: YIKES! I'm super worried about him, his enalypril, his Cushing's and how he is going to react to the meds. I keep telling myself that I got what I wanted, help with treating his Cushing's. At the same time, I am dreading it. I am going to give him his first pill tomorrow about 7am and will be leaving the house about 9am to go to work. Will I be able to notice anything during those first two hours?

Cross your paws for us,

Gretchen and Rusty in NC

[Harley PoMMom]

Will I be able to notice anything during those first two hours?

Cross your paws for us,

Gretchen and Rusty in NC


After oral dosing trilostane is rapidly absorbed and peak concentrations are seen in healthy dogs after 1.5-2 hours. Concentrations return to baseline levels after 10-18 hours.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2010&Category=&PID=56127&O=Generic

Since Trilostane is rapidly absorbed and peak concentrations are seen after 1.5-2 hours, I would believe you should be able to notice if something is off...but as the saying goes...all dogs are different and each dog can react differently to the same medicine.

Keeping all paws crossed here!

Love and hugs,
Lori

[missbeagle]

Hi everyone -

I gave Rusty his first Trilostane/Vetoryl pill this morning. I was crying last night because I was scared about what might happen to him. Then I looked again at his dosage and his weight. My IMS is treating him for a dog that is 10 pounds lighter. Rusty weighs 54 pounds and is on 30mg twice a day now. I'm hoping that nothing goes wrong with his meds. After I saw that his dosage was on the light side, things were a little better to handle last night.

I guess my biggest fear is that he will miss his "steroid high" and be gloomy all of the time. My IMS said that he should not have a personality change with his meds.

Paws still crossed here,

Gretchen and Rusty in rainy NC

[Squirt's Mom]

Hi Gretchen,

You may see a little bit of withdrawal signs in the first few days as Rusty's body adjusts to the lowered levels, but this is not unusual so don't panic if he just seem "off". If you see signs of the cortisol going too low, he will be obviously unwell, not just blah.

I am sure you and Rusty will do just fine! Keep in touch and don't hesitate to ask questions or voice any concern you may have. I think in a few days, you will see your old boy coming back and these fears will be behind you then. ;)

Hugs,
Leslie and the girls - always

[missbeagle]

Super Bowl Sunday update - checking in about Rusty.

Friday was great, no problems.
Saturday was good too, he didn't quite finish his dinner though. He left about 20 pieces of food.
Sunday, he really didn't want to eat breakfast, but eventually ate about 3/4 of it. What was left over we put in a kong for Super Bowl treats during the game. His BM is normal, no vomiting.

He does get rather sleepy for about 2-3 hours right after I give him his meds.

His appetite is a little off since starting the Trilostane. Should this be a cause of concern?

I got his fish oil, COQ10 and his Trilostane into him this morning with no trouble.

Thanks in advance. One week to go for the ACTH Stim test.

Gretchen and Rusty in NC

[Harley PoMMom]

Rusty's sleepiness and his appetite being off would be a concern to me. I don't know if you are aware of this but CoQ10 may lower blood pressure, at least it did in human studies: http://altmedicine.about.com/cs/herbsvitaminsek/a/Hypertension.htm

Please keep us updated and wishing you both the best of luck.

Love and hugs,
Lori

[missbeagle]

Rusty had a good dinner tonight and went to the dog park with his sister for a bit this afternoon too.

I just had one question about his 10 day stim test.

Should my vet be taking a baseline AND a cortisol stim test? Or just a stim test?

I have to have him dropped off about 8:30am on Valentine's Day for his bloodwork and my vet only has two Cush pups. :(

I'm just checking on him is all.

Thanks,

Gretchen and Rusty in NC

[labblab]

Hi Gretchen,

I believe that Dechra's recommended procedure for monitoring trilostane treatment is to perform a complete ACTH stim test at the 10-14 day mark. The complete ACTH combines both a baseline cortisol reading, followed by a subsequent cortisol reading after the stimulating agent has been injected.

In the past, in order to reduce costs at some point in the monitoring process, I do believe that some members and vets have agreed to eliminate the baseline draw and only perform the post-ACTH draw. But I don't have personal experience with this and cannot comment on it. Maybe some other folks will be able to give you more feedback about this.

I'm really glad to hear that Rusty seems to be doing well!

Marianne

[missbeagle]

Hello everyone,

Rusty has been doing pretty well except for one thing. He's been having accidents of the deuce kind in the house. It's not runny or bloody, just small accidents.

His appetite is a smidge off, though he wants to eat and takes his meds in a piece of lunchmeat willingly. :)

He didn't like the senior canned food that I accidentally grabbed at the store either. He did eat his breakfast when I fed him some canned food that he did like though.

Should this be a cause of concern with starting the Trilostane? :confused:

Should I call the IMS? :confused:

His stim test is scheduled for Monday morning.

Thanks,

Gretchen and Rusty in Wilmington, NC

[labblab]

Gretchen, whenever you're feeling concerned about Rusty's behavior, I think it makes sense to relay that info to your IMS. I'm guessing that he'll tell you to just sit tight and continue to monitor Rusty, but if that's the case, that will be reassuring for you.

I myself cannot account for the new accidents in the house if the poop is formed and there does not seem to be urgency such as would be the case with diarrhea.

As far as his appetite being a bit "off," decreases in hunger, thirst, and urination are typical effects of the medication and are welcome changes for most Cushpups who are symptomatic prior to treatment. However, I can't remember offhand whether Rusty exhibited excessive hunger. If not, I can understand why a decrease in his appetite would be more concerning to you. But from what you're describing at this point -- only a slight change -- I would think that you'll likely be told to just continue to monitor him closely. But by relaying this info to the IMS, he can factor it into his decision as to the optimal timing for Rusty's ACTH test.

Gretchen, you're doing a great job of taking care of Rusty. Hang in there!

Marianne

[missbeagle]

Thanks Marianne -

I spoke to the IMS this afternoon. He said to go ahead and keep giving Rusty the Trilostane and as long as he's not having diarrhea or vomiting that he should be ok for now.

Fingers crossed for good bloodwork on Monday!

Gretchen and Rusty in NC

[missbeagle]

Hi everyone,

Rusty pooped in the house last night and threw up too. This morning he really doesn't want to eat much. I could not get his fish oil into him. I made him egg whites and mixed with his food and he did not want to eat them.

I have called my IMS but they told me he is in rounds until probably ten this morning.

I'm guessing his electrolytes are out of whack. He did drink some water and did eat a little food, but not much. His eyes are bright and his gums are pink. He just has no interest in eating this morning.

Thanks,

Gretchen and Rusty in NC

[frijole]

Gretchen - the lack of appetite and vomiting are signs of low cortisol so I would hold back on the trilo. I would have them do an acth test to be safe and verify cortisol levels.

If Rusty continues to be disinterested in food you might buy some pedialyte to put in his water (I mixed it 50/50 and bought the kind without flavor). This will provide nourishment and help the electrolytes until you can get with the vet etc.

I assume the poop was firm or you would have mentioned it. That part is strange except it could be an aging thing. My Haley as she got older would have accidents - she couldn't hold it anymore.

Keep us posted.
Kim

[missbeagle]

He ate a bit just now - 9am......but I need to get off to work.....I'm thinking of skipping his trilo this morning.....

Thoughts? The IMS still hasn't called me back, and Rusty is my vet's 2nd Cush pup.

Thanks,

Gretchen and Rusty in NC

[labblab]

Gretchen, I agree with Kim about holding off on Rusty's trilostane this morning. Since you are dosing twice daily, you can always resume this evening if the IMS thinks you should do so. But I too am concerned that the vomiting is a signal that his cortisol level is being pushed too low too quickly.

Marianne

[missbeagle]

Kim and Marianne -

I did not give Rusty any of his meds this morning. I am to feed burgers and rice over the weekend.

The IMS thought it was good that he finished the can of dog food (he wouldn't eat any dry) this morning about 9am.

I am to give him a pill tonight and another one tomorrow morning.

I have to get him to the v*t's office at 8am tomorrow for a stim test and an electrolyte check too. They close at noon sharp so I am a bit under the gun here.

The IMS thought his tummy was a little upset with the trilo.

He seemed in better spirits when I left for work this morning.

Keep your paws crossed for us,

Gretchen and Rusty in NC

[Franklin'sMum]

Keeping fingers and paws crossed for you and Rusty, and hope that the cute little guy is okay :).
Reassuring hugs,
Jane, Franklin and Angel Bailey xxx

[labblab]

I have to get him to the v*t's office at 8am tomorrow for a stim test and an electrolyte check too. They close at noon sharp so I am a bit under the gun here.

I'm really glad, too, that Rusty seemed to be feeling better by the time you were ready to head off to work!

Just wanted to double-check the timing of his testing tomorrow, though. According to Dechra, the stim test should be performed 4-6 hours after giving the morning dose of trilostane. Is that what your vet is planning, as well?

Marianne

[missbeagle]

Marianne -

I have to give Rusty his pill about 7am and then have him to the v*ts's office at 8. It is my understanding they want to stim him within two hours of taking the pill.

They are going to do both a baseline AND a stim test. They are also going to check electrolytes too.

Gretchen and Rusty in NC

[lulusmom]

Hi Gretchen,

It sounds like your vet is using the UC Davis protocol which does call for doing the acth stim test within two to three hours after dosing.

Glynda

[missbeagle]

We are at the vets now. My IMS wanted to check his electrolytes. Will post more later
when I find out what's going on

Gretchen and Rusty in NC

[frijole]

Great... been checking in all day. Hugs, Kim

[missbeagle]

Ok,

Here's your update. I called the IMS when I got home from work and found that Rusty had vomited the food he did eat this morning. <sigh>

I called the IMS and he wanted me to run an electrolyte panel ASAP. Off we go to the vet's office, before they close.

They tried THREE times to run his blood work through the IDEXX machine and every time it got an error reading. They called IDEXX and they had no clue what was wrong. The vet did not charge me anything.

They referred me to the after hours animal clinic. After waiting and hour and fifteen minutes for 15 minutes of blood work, here's what I got.

BUN 87 (7-27) HIGH
CREA 2.8 (.5-1.8) HIGH
BUN/CREA 30
PHOS 9.5 (2.5-6.8) HIGH
CA 12.3 (7.7-12) HIGH
TP 7.2 (5.2-8.2)
ALB 3.4 (2.2-3.9)
ALT 239 (10-100) HIGH
ALKP 880 (23-212) HIGH
GGT 11 (0-7) HIGH
TBIL .4 (0.0-0.9)
CHOL >520 HIGH
AMYL 1758 (500-1500) HIGH
LIPA 718 (200-1800)
GLU 121 (70-143)
Na 152 (144-160)
K 5.7 (3.5-5.8)
Na/k 27
Cl 114 (109-122)
OSM CALC 331

I came home with some Flagyl and a 1000ml bag of lactated ringer's solution. I gave him some fluids, a Cerenia pill, and 250 ml of fluids.
So far he has kept everything down.

I will hear back from the IMS and the regular vet sometime tomorrow morning.

I might be looking into a phosphorous binder tomorrow too.

Thanks for the good thoughts and vibes.

Paws still crossed here,

Gretchen and Rusty in NC

[frijole]

Bumping this in hopes Deb has time to read this today as our blood panel expert.

The cerenia pill (aka vomit pill) is a wonderful thing. I had to give it to Haley a couple of times and thats all it took to calm down her tummy issues.

Glad you were able to get the panel done last night - what an ordeal huh? Kim

[lulusmom]

Hi Gretchen,

I've included Rusty's prior bloodwork results below, including the normal reference ranges as different labs were used. It is clear that kidney values continue to climb and I think Rusty need to be on phosphate binders asap.

BUN 87 (7-27) Prior 51 (7-27)
CREA 2.8 (.5-1.8) Prior 2.0 (.4-1.8)
PHOS 9.5 (2.5-6.8) Prior 4.4 (2.1-6.3)
CA 12.3 (7.7-12) Prior 11.3 (8.2-12.4)
ALT 239 (10-100) Prior 175 (5-107)
ALKP 880 (23-212) Prior 481 (10-150)
GGT 11 (0-7) Prior 16 (0-14)
TBIL .4 (0.0-0.9) Prior .2 (0-.4)
CHOL >520 Prior 584 (112-326)
AMYL 1758 (500-1500) Prior 1823 (450-1240)
Na 152 (144-160) Prior 142 (141-156)
K 5.7 (3.5-5.8) Prior 6.0 (4.0-5.6)
Cl 114 (109-122) Prior 104 (105-115)

When I was researching kidney disease, I found some really good info on the dogaware.com site. Here is an excerpt from the page on phosphorus binders which indicates that your Rusty's phosphorus levels are way too high. I believe this is what is making him sick and it will continue to make him sicker as phosphorus levels continue to increase in the gut.


It's important to control phosphorus levels for dogs with kidney disease. The goal is to maintain blood phosphorus levels no higher than 4.5 for dogs with early-stage kidney disease (creatinine up to around 2.5), 5.0 for dogs with moderate-stage kidney disease (creatinine 2.5 - 5.0), and 6.0 for dogs with late-stage kidney disease (creatinine > 5.0).


http://www.dogaware.com/health/kidneymedical.html#phosphate

Given the warnings from Dechra that Vetoryl should not but given to dogs with poor kidney function, and Rusty's kidney function appears to be worsening, is your IMS questioning the wisdom of continuing the Vetoryl treatment?

Glynda

[Harley PoMMom]

I agree with Glynda, a phosphate binder is needed.

Here is a link to an article about phosphate binders: http://www.vetoquinol.ca/documents/Quoi%20de%20neuf/Articles/Round%20table%20discussion.pdf

Lori

[missbeagle]

Lori and Glynda -

His appetite has been for for the past 36 hours. When I went to the vet last night it was to check for electrolytes.

Does anyone know where I can go into a store and buy a phosphourous binder? My vet is now closed. I asked about it when the girl called to check on him.

My IMS is also gone until Monday.

Thanks,

Gretchen and Rusty in NC

[Harley PoMMom]

I really don't know...but here is a link with info where you can get Phosphorus Binders: http://members.verizon.net/~vze2r6qt/supplies/binders.htm

[Squirt's Mom]

Hi Gretchen,

If you have a Whole Foods in your area they might have some. Also, you might talk to a druggist.

Hugs,
Leslie and the girls - always

[missbeagle]

I have put in a call to the emergency vet where we went last night when the IDEXX machine wouldn't read his blood.

I have to wait until the vet comes in at 8:00 for her to call in a script. I have also asked for another bag of LRS as I have been giving him fluids since last night.

Rusty is my 5th kidney dog. The IMS checked with Dechra and the NCSU pharmacist before he gave me the go ahead for trilo. Grrrrrr

Paws crossed that the emergency vet gets me abinder asap. I asked her about them last night too. I guess she thought I would have gotten one called in by my IMS or the regular vet.

Thanks,

Gretchen and Rusty (I don't feel so good) in NC

[Harley PoMMom]

Positive and healing energy being sent your way, keeping you all in thoughts and prayers too.

Love and hugs,
Lori

[missbeagle]

The emergency vet never called me back.

Rusty ate a pouch of Ol' Roy this morning. I know it's not that great for his kidneys, but at least he ate something.

He has been keeping his food and water down. His stomach is pretty empty, so he has not been pooping either.

I only have 500ml of LRS left in the bag. I am going to try to get that in him today.

The husband and I went into Walgreen's and CVS last night looking for amphogel as a phosphorous binder. I just found out it was OTC from K9kidneys. Neither one had any, but Walgreen's can get me some by 2pm tomorrow. I will be calling them later today.

I feel like I was let down by the emergency vet and the regular vet too.

Paws crossed that his BUN, Creatinine and Phosphorous levels decrease asap this week.

Gretchen and Rusty in NC

PS. I don't think I'm ever giving Rusty trilo again. <sigh>

[Squirt's Mom]

Hi Gretchen,

How is Rusty this morning? I hope you are seeing some improvement and that you get the phosphorus binder today.

Hugs,
Leslie and the girls - always

[Harley PoMMom]

Right now getting him to eat anything is important. Will Rusty eat a hard-boiled egg? Or eggs cooked in any way? Harley loves eggs. Also Harley will eat baby food, the first-stage variety, this type has no preservatives, additives, especially no onions!! He likes the chicken and turkey ones best. I can get Harley to eat eggs and baby food when he didn't feel like eating anything.

I think once you get the binder in him and get that Phosphorus down Rusty's appetite will pick up. Did your vet/IMS schedule another chemistry panel?

When I took Harley off the Vetoryl, it only took 10 days for his numbers to return to their normal ranges.

Keeping all paws crossed here.

Love and hugs,
Lori

[missbeagle]

Lori and Leslie -

My husband is cooking breakfast as we speak. He is going to make soe whites for Rusty after he cooks the eggs for us. He always likes the extra whites in the bacon fat/grease left over in the pan.

I am going to try to give him the last 500ml of the fluids sometime today.

Right now, he is outside enjoying some warm sunshine with his sister and barking at the other dogs too.

He is drinking water on his own and has not thrown up since Friday afternoon. <yeah>

Hugs,

Gretchen and Rusty in NC

[Harley PoMMom]

Lori and Leslie -

My husband is cooking breakfast as we speak. He is going to make soe whites for Rusty after he cooks the eggs for us. He always likes the extra whites in the bacon fat/grease left over in the pan.

Yum yum Rusty should like this!

I am going to try to give him the last 500ml of the fluids sometime today.

Right now, he is outside enjoying some warm sunshine with his sister and barking at the other dogs too.

This is a good sign that he is feeling better.

He is drinking water on his own and has not thrown up since Friday afternoon. <yeah>

Another very good sign that he is feeling better...yeah!!!...keep us updated...please!

Hugs,

Gretchen and Rusty in NC

Love and hugs,
Lori

[Squirt's Mom]

Hi Gretchen,

Barking with his sister sounds wonderful! So does the breakfast! I'll be as honest as I can be here - when I read Ol' Roy I nearly puked. :eek: I had a cat nearly die from eating that garbage and as I have learned more about nutrition, it really turns my stomach. ~~shiver~~

But as Lori said, eating anything right now is important to keep his strength up and some pups just seem to LOVE the worst possible feeds. :rolleyes: Give him whatever he will eat for now. Just don't give him any organ meats as they are high in phosphorus - the enemy of kidney pups as you well know unfortunately. :(

I think you are absolutely correct in your thinking on the Trilo, too, BTW.

Hang in there and know we are here with you! Oh! and hug your hubby from me - he is very sweet to cook for Rusty.

Hugs,
Leslie and the girls - always

[missbeagle]

Today Rusty drank water and ate a bit of food.

His phosphorous binder - Amphojel - will be here tomorrow around 2pm at Walgreen's and my husband will pick it up on his way home from work.

I got 250ml of LRS into Rusty tonight too. That leaves me with 200 for tomorrow morning....maybe if he'll let me.

I will try to get more LRS tomorrow.

I need to discuss this weekend with my IMS from NCSU and maybe my vet.

Happy Valentine's Day! :)

Gretchen and Rusty in NC

[missbeagle]

I finally heard from my IMS this morning as I missed his call on Saturday morning. I am to continue to give his flagyl and pepcid ac. He wants me to offer him nothing else to eat besides the Hills K/D. I got a can of Mighty Dog into him this morning and gave him 200ish ml of fluids last night. He said if he was drinking and eating on his own that I can quit the fluids for now. I just had a bag of fluids because he had diarrhea and was vomiting on Friday when we thought his electrolytes where out of whack.

I have my Amphojel coming today. I might give him some tonight. My IMS thought his elevated levels could be due to dehydration because he started his treatment for this Cushing's disease.

He had his first BM since Friday night this morning. It was watery but there was no blood like there was Friday night when we went off to the vet to check his electrolytes.

Gretchen and Rusty in sunny NC

[Harley PoMMom]

I know with Harley it was the Vetoryl that made his kidney values climb so high. Like I mentioned before, only 10 days off the Vetoryl and all his Kidney values came back with-in their normal ranges.

Has a Chemistry panel been rescheduled for Rusty?

Love and hugs,
Lori

[missbeagle]

Lori -

I am to check back in with the IMS on Wed or Thursday this week.

Rusty had kidney problems before starting Trilostane. I am wondering if I should just not treat his Cushing's if this is how it's going to go.

The IMS wants me to feed him only Hills K/D and nothing else to help lower his phosptate levels. It was 9.5 on Friday. He has been lucky to eat at all over these past few days.

I am wanting to give a phosphate binder too.

Thanks for the cyber hugs,

Rusty and Gretchen in NC

[clydetheboosmom]

Hi -

I'm always catching up on the board, and I don't think I have replied to you before, but I wanted you to know that I am thinking of you and Rusty and hoping things are better and that you know more soon :)

((((hugs))))

Lynne, Bailey and Angel Clyde

[lulusmom]

Hi Gretchen,

If Rusty were my dog and had these kidney values, I would be hesitant to treat the cushing's until the numbers improve. Your IMS may be right that kidney values were elevated due to dehydration but unless I knew that for sure, I'd want another chem panel done when he is feeling better to see if kidney values have improved.

Glynda

[missbeagle]

Hi everyone.

Rusty is at the v*ts now. I am worried about his not eating since coming off of Vetoryl for his Cushing's Disease. His phosphorous was 9.5 Friday night. I got some Amphojel from the pharmacy but it was peppermint flavored with saccharin and I didn't want to give it on an empty stomache. I feel better now that he is where he can be taken care of. I just hope his kidneys have not gotten more compromised for the four days he was on Vetoryl. He did perk up when I put him in the car and he was alert at the vets too.

He ate a bit last night but nothing this morning. I gave him pepcid to help with his stomache acids,

I am blaming my IMS for giving me the go ahead for Vetoryl. My husband is concerned about me spending money on Rusty, but I don't care. He's my baby.

The IMS checked in and is OK with him being at the vets. They will call me when they know what's going on with him. They are taking a complete chem panel soon, I would think. I dropped him off about 10:45 this morning.

Paws crossed that his kidneys are not worse,

Gretchen and Rusty in NC

[addy]

Oh Gretchen,

I am hoping Rusty comes home and is better. I understand why you are so upset with the IMS. You thought you had all your bases covered and trusted what was told you.

When I used to get upset when a doctor overdosed or misdiagnosed me, my brother in law (who is in medicine) would tell me "Well now, medicine is not an exact science." That statement never made me feel better:mad: That's why I am so paranoid, I suppose.:rolleyes:

Saying prayers for you and Rusty and that this all turns out okay. At least he was not on the Vetoryl very long.

Hugs and Prayers,
Addy

[Harley PoMMom]

Sending positive and healing energy your way. The good thing about Vetoryl is that it is short-acting so I am praying Rusty's numbers will come down just like Harley's did.

Keep us updated, ok?

Keeping you all in my thoughts and prayers.

Love and big hugs,
Lori

[Squirt's Mom]

Add my thoughts and prayers! Let us know when you learn something.

Hugs,
Leslie and the girls - always

[labblab]

Gretchen, I'm so sorry you've had this setback with Rusty, and I hope that he'll bounce back quickly. I know it's impossible not to feel angry about what has happened, (and not to quote Addy's brother-in-law :o) but sometimes medically it truly can be a very difficult proposition to know in advance how a given patient will react to a specific medication or treatment. Especially in this situation where the hope was that the treatment for the Cushing's would improve Rusty's kidney condition.

You were very thorough in educating yourself, and it also sounds as though the vets ended up performing the proper consultation to "OK" going ahead with the Vetoryl. So I hope you won't be hard on yourself as far as second-guessing the decision to begin treatment. It was a reasonable decision, and it's a shame that it has not turned out well. Thank goodness you were monitoring Rusty closely so that the problems were identified.

I'm surely hoping that we'll soon be hearing that Rusty is back home again and doing much better.

Marianne

[missbeagle]

OK folks,

Here's you update on Rusty. The vet's office called about 4pm for me to come get him.

Here was his bloodwork from 11:30 this morning.

GLU 96 (70-143)
BUN 85 ( 7-27) HIGH
CREA 3.4 (.5-1.8) HIGH
BUN/CREA 25
PHOS 6.7 (2.5-6.8)
CA 11.3 (7.9-12.0)
TP 6.4 ( 5.2-8.2)
ALB 3.1 (2.2-3.9)
GLOB 3.3 (2.5-4.5)
ALB/GLOB .9
ALT 161 (10-100) HIGH
ALKP 538 (23-212) HIGH
GGT <0 (0.0-7)
TBIL .2 (0.0-0.9)
CHOL 434 (110-320) HIGH
AMYL 1892 (500-1500) HIGH
LIPA 1618 (200-1800)
Na 159 (144-160)
K 5.3 (3.5-5.8)
Na/K 30
Cl 120 (109-122)
OSM CALCIUM 341

That bloodwork was before they gave him 500ml of fluids.

I brought home a can of Hill's K/D and he ate it right up. It was even better when his sister wanted some and she ate it with him.

I am going to be taking him to the vet for the next three days and letting them give him 500ml of fluid per day to flush his kidneys out.

I will probably try it myself on Saturday after we get back from the vet's with follow up bloodwork.

I just hope that his Cushing's kicks back in and he will eat and drink his little heart out and I won't have to worry too much about his kidneys.....hey a girl can dream can't she?

Thanks for the good thoughts and vibes. It is well appreciated here.

The battle is on!

Gretchen and Rusty in NC
Yeah mommy, I have food in my tummy!

[Harley PoMMom]

It's very good to see that the phosphorus has come down...YES!!!

Is your vet still having you give him the Enalapril? If so, this could be why the creatinine has climbed up just a bit but this should level off.

Sending big, big hugs and lots of love,
Lori

[missbeagle]

Lori -

He has not been on anything other than pepcid 10mg since Thursday when I took him off his Trilostane.

Gretchen and Rusty in NC

[missbeagle]

Between last night and this morning Rusty ate the whole can of K/D. Some of it I baked in the oven too and made treats out of it.

He went to the v*t and had another 500ml of fluids this morning. I will do the same all the way to Saturday.

We will recheck his BUN and Creatinine levels then too.

Please keep your paws crossed for us. Although his appetite is back and he's perky doesn't mean he's out of the woods just yet.

We need to get his azeotemia under check.

We are discussing Azodyl too. :rolleyes:

Thanks for everyone's good thoughts.

Gretchen and Rusty in NC

[Harley PoMMom]

Although his appetite is back and he's perky doesn't mean he's out of the woods just yet.



Although that is true but we need to keep thinking positive, right?! An increased appetite is a positive sign!...all paws crossed here!

Love and hugs,
Lori

[missbeagle]

Hi everyone,

Here's the latest on Rusty's bloodwork.

BUN 48 ( 7-27) HIGH
CREA 3.1 ( 3-.5-1.8) HIGH
BUN/CREA 15
PHOS 3.8
Na 152 (144-160)
Na/K 30
Cl 110 (109-122)
PCV 53%
Total Protein 7.0

The vet wants me to continue giving him 500ml of SQ fluids everyday until we get his numbers as low as they can go.

I got some aluminum phosphate and tried it myself just to make sure it was odorless and tasteless and it is! I have been adding it to Rusty's food for the past three days and his phosphate is in the normal range already!

Should I be putting some fish oil or CoQ10 into his diet again? Any advice is appreciated.

Thanks for those who have been keeping us in your thoughts.

Blessings to you all this holiday weekend!

Gretchen and Rusty, Wilmington, NC
Cushing's and Renal Disease
(pepcid ac, Hills K/D, 55# Beagle)

[Harley PoMMom]

Should I be putting some fish oil or CoQ10 into his diet again? Any advice is appreciated.


I use both of these supplements for Harley and since CoQ10 has been proven to help lower serum urea and creatinine in human patients...so my advice to you would be to add them both back in.

Keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[Harley PoMMom]

Hi Gretchen,

Just wondering how you and Rusty are doing. When you get a chance please let us know. Keeping you and Rusty in my thoughts and prayers.

Love and hugs,
Lori

[missbeagle]

Lori -

I have been giving him 500ml of fluids daily since last Friday. He has had fluids every day since last Monday. Today is day 10 of 500ml per day. We will go in for another renal panel on Saturday morning. This will make his 4th blood draw of the month too.

He is a fat, happy, squishy boy. I'm very hopeful for even lower numbers than last week. He has been drinking out of the bowl too.

He woke us up last night to go pee. That was my job to take him out too.

He's getting Hill's K/D canned and a bit of his sister's wet food to make it palatable. I am still feeding him his Sammy Snacks dog food. I quit giving him the Hill's dry stuff (it has waaaaayyyyy too much fat in it and I'm toooo scared of getting pancreatitis). :D

Do you think I could treat him with Lysodren? I've been thinking about just doing nothing.

Thanks for checking in on us. :D

Gretchen and Rusty
Wilmington, NC

[Harley PoMMom]

Although Lysodren is metabolized in the liver, Lysodren is excreted through the kidneys as well. With Harley, while loading, we did see a small elevation in his creatinine levels.

Another main point with Lysodren, the induction or loading phase, when the dog's appetite is off this is a sign of a dog being loaded. With a pup having renal issues and going through the induction phase of Lysodren, I think it would be very hard to distinguish whether a dog was loaded or having kidney problems...JMO.

So happy that Rusty is feeling better...hoping for great numbers.

Love and hugs,
Lori

[missbeagle]

Rusty has been acting his normal, happy self. He's eating canned kidney dog food and some low protein food too. He doesn't care for the Hill's K/D dry dog food much these days.

I'm pretty confident that he will have super blood work tomorrow and that he was one of the pups whose BUN rose when they started Vetoryl.

I have been giving him 100mg of CoQ10 to help with his creatinine levels. I would like to start adding his HMR lignans and his melatonin again along with fish oil back to his daily routine.

We go for bloodwork in the morning about 9am ish ET.

Does anyone have an opinion as to which one I should start first?

Blessings to you all,

Gretchen and Rusty
Wilmington, NC

[Harley PoMMom]

I, too, have been kicking the idea around about starting Harley back on the melatonin. The lignans just have too much fiber for him.

Found this article about melatonin: Melatonin ameliorates oxidative stress, inflammation, proteinuria, and progression of renal damage in rats with renal mass reduction. (http://www.ncbi.nlm.nih.gov/pubmed/18077597)

All paws crossed here for great lab numbers.

Love and hugs,
Lori

[missbeagle]

Lori -

Here are his latest lab results.

BUN 49 (7-27) HIGH
CREA 2.8 (.5-1.8) HIGH
Phos 4.5 (2.5-6.8)
Na 155 (144-160)
K 4.9 (3.5-5.8)
Cl 115 (109-122)
BUN/CREA 18
Na/K 32

Yeah!

We are going to try Sub Q fluids every other day, or I can stay with every day if I feel like it. When I tried to give him his fluids this morning, he squeaked for times and I gave up. They gave him fluids at the vet's though.

So far so good. The vet said I could also add fish oil to his diet now. I also called and am going to pick u p a bottle of Azodyl next week.

We go for a re-check in two weeks.

Thanks for the good thoughts!

Gretchen and Rusty
Wilmington, NC

[Harley PoMMom]

Those numbers are looking pretty darn good! Great job Gretchen!


The vet said I could also add fish oil to his diet now. I give Harley wild salmon oil (capsules) which I purchase from Monica Segal's website.

Continuing to send positive and healing thoughts. ;):)

Love and big hugs,
Lori

[missbeagle]

OK,

So far so good. Rusty is on fluids once in a while and he's now on Azodyl, pepcid AC, Hill's K/D canned food, fish oil and CoQ10. If his numbers improve even more after the 12th, I can space out the fluids even more.

We go in for more blood work on March 12th. :o

I was wondering if anyone could figure out why my vet does not have him back on enalypril. I think my IMS said it was because Cush pups tend to have thromboembolisms, but I can't remember.

I had a kidney dog that was very similar to Rusty. He was a fat, happy beagle who weighed about 60 pounds and who also eventually got kidney disease.

He died of a thromboembolism that came on suddenly. He was happy and eating, but one day he died right after dinner.

I am trying to prevent this from happening with Rusty.

Should aspirin be OK too?

Yes, I will try to call my IMS tomorrow, to get a better answer.

Thanks,

Gretchen and Rusty in NC
Rusty...kidney food is yummy....so is the bottled water.

[Harley PoMMom]

If it were me, unless Rusty had high blood pressure I would not put him back on the Enalapril. For the thromboembolism, you might ask your vet to treat Rusty with a very low dose of aspirin.

I get Harley's aspirin compounded, he is being given 5mg daily.

Keeping you all in my thoughts and prayers.

Love and hugs,
Lori

[Sabre's Mum]

Hi Gretchen

I have been following your posts and thread but I have no experience with kidney disease. Our little Vizsla - Flynn (not so little and now nearly 2 years old) was diagnosed with Steriod Responsive Meningitis (SRMA) and immune mediated hemolytic anemia (IMHA) when he was 6 months old. Along with his immuno-suppressant meds we also gave him a ultra-low-dose aspirin as the highest cause of fatality with IMHA dogs is pulmonary thromboembolism. The dose we used was 0.5mg/kg every 24 hours. At the time he got 1/8 of a low dose aspirin tablet (tablet size was about 75mg) - tiny to cut but we managed JUST! With IMHA dogs this has been researched and found to be effective.

Definitely discuss it with the vet and see what they think.

Angela and Flynn

[missbeagle]

I heard back from my IMS from NCSU about the enalypril and treating him to avoid a possible thromboembolism. He said that Rusty was put on enalypril originally for protein loss in his urine. (I thought I knew that, but have seemed to have forgotten over the past month).

I asked about giving him aspirin and he said no. He said there is new research out there that indicates that thromboembolisms are best treated with Plavix.

I googled it and found this.

http://www.physorg.com/news198345749.html

Researchers in the University of Georgia College of Veterinary Medicine have found that clopidogrel may be a safe and effective treatment for dogs that need long-term anticoagulant therapy. In addition, it may offer a safe alternative to NSAIDs for treating dogs at risk of thromboembolism due to concurrent therapeutic use of corticosteroids.

Pretty cool stuff. He said that he would like to run some kind of platelet test to check Rusty's clotting factor. At this time he would be assuming that Rusty has a predisposition to having a thromboembolism just because he is a Cush pup.

As far as the fluids go, I haven't given him any since Wednesday morning, when I took him to the vet's to have it done. I tried the night before and he was waaayyy to wiggly to have me give him 500ml of fluids.

So far he's on, CoQ10 100mg twice a day, 1000mg of fish oil twice a day, his Hill's canned K/D mixed with a bit of his sister's canned food and some Sammy Snacks dog food. I am adding an aluminuim hydroxide phosphorous binder and he is getting Azodyl which I started on Monday too. Rusty has gained some weight and now weighs 57 pounds instead of 54 that he did a month ago. I think it's probably the Hills food. It is high in fat content.

He's been drinking, eating and acting otherwise normal. I am hoping that his Cushing's can help his kidneys along with the other meds as well.

I just wanted to know if anyone has heard of Plavix for Cush pups? Is it safe for kidney pups as well?

Thanks,

Gretchen and Rusty
Wilmington, NC

[labblab]

Gretchen, I don't have any info about using Plavix in Cushpups. But unfortunately, one piece of bad news that I can pass on is that Plavix is very expensive and won't be available in the U.S. in generic form until around this time next year. A typical monthly human dose can cost between $150-200. I don't know what the dosing would be for a dog of Rusty's size, and whether it would need to be compounded for him (I can't remember off-hand whether Plavix tablets can be safely split). Has your IMS talked with you yet about dosing and sourcing of the Plavix?

Marianne

[missbeagle]

Marianne -

Nope, my IMS has not discussed anything with regards to dosing. He was just throwing it out for consideration to help protect against thromboembolism since I had inquired about it.

He also said that he would only be guessing about Rusty's clotting factor since he has not checked that.

I was just wondering if anyone knew if it was OK for a kidney pup as I could not find much information about it. I'm a little leery since Rusty had that reaction to Vetoryl/Trilostane with his BUN and creatinine numbers.

Thanks,

Gretchen and Rusty
Wilmington, NC

[missbeagle]

Hello -

Just a quick question.

Has anyone had success with Ginko Biloba or Valerian for Cushing's?

Thanks,

Rusty and Gretchen in NC

[missbeagle]

Here's our update from the vet visit on Saturday 3-13-11.

ALPK 836 (10-150) HIGH
ALT 244 (5-107) HIGH
AST 29 (5-55)
CK 96 (10-200)
GGT 17 (1-14) HIGH
AMYLASE 1952 (450-1240) HIGH
LIPASE 252 (100-750)
ALMUMIN 3.2 (2.5-4.0)
TOTAL PROTEIN 6.5 (5.1-7.8)
GLOBULIN 3.3 (2.1-4.5)
TOTAL BILIRUBIN .2 (.0-.4)
DIRECT BILIRUBIN .1 (.0-.2)
BUN 70 (7-27) HIGH
CREATININE 2.8 (.4-1.8) HIGH
CHOL 837 (112-326) HIGH

GLUCOSE 90 (60-125)
CALCIUM 11.8 (8.2-12.4)
PHOSPHOROUS 5.1 (2.1-6.3)
TCO2 (BICARBONATE) 15 (17-24) LOW
CHLORIDE 108 (105-115)
POTASSIUM 5.4 (4.0-5.6)
SODIUM 145 (141-156)
A/G RATIO 1.0 (.6-1.6)
B/C RATIO 25
INDIRECT BILIRUBIN .1 (0-.3)
TRIGLYCERIDES 121 (20-150)
NA/K RATIO 27 (27-40)

ANION GAP 27 (12-24) HIGH
CALCULATED OSMOLALITY 330.8 (302-330)
MAGNESIUM 2.9 (1.8-2.4) HIGH

T4 .5 (1.0-4.0) LOW

WBC 8.8 (5.7-16.3)
RBC 7.71 (5.5-8.5)
HGB 19.3 (12-18) HIGH
MCV 70 (60-77)
MCH 25 (19.5-26)

URINALYSIS


COLLECTION METHOD - FREE CATCH
COLOR - COLORLESS
CLARITY - CLEAR
SPECIFIC GRAVITY 1.010
GLUCOSE - NEG
BILI - NEG
KETONES - NEG
BLOOD - NEG
PH 6.0
PROTEIN 2+
WBC 0-2 (0-5) HPF
RBC - NON
BACTERIA - NONE
EPI CELL - NONE
MUCUS - NONE
CASTS - NONE
CRYSTALS - NONE
OTHER - SPERM
UROBILNOGEN - NORMAL

It's not great, but it isn't bad either. They still want to treat him for high blood pressure. I'm going to call again today and see what they want to do.

Thanks again everyone. Your thoughts and prayers are appreciated.

Gretchen and Rusty in Wilmington, NC

[Harley PoMMom]

You're doing a great job, Gretchen!


They still want to treat him for high blood pressure. I'm going to call again today and see what they want to do. Forgive my feeble mind :eek: does Rusty have high blood pressure? Or are they wanting to treat the protein loss? And if so, has an UPC been done recently?

Keeping you and sweet Rusty in my thoughts and prayers.

Sending love and hugs,
Lori

[missbeagle]

Lori -

His first high BP reading was Saturday. It was 210. :eek:

Both vets thought that I was still giving Rusty enalapril once a day. I quit everything when he went south on the Trilostane. Yes he does have protein loss in his urine. We will test him again next Thursday and see how he's doing. :)

He is still eating and happy. I asked my vet to lower the price for fluids and he said yes to me. Instead of $17.00 I should be paying $8.00!

Happy dance!

Gretchen and Rusty in NC

[Harley PoMMom]

Lori -

His first high BP reading was Saturday. It was 210. :eek:



Oh, poor Rusty, I am sorry to see that high blood pressure is in the mix now. :( My boy, Harley, is on Benazepril and Amlodipine to control his high blood pressure.

Sending positive energy your way and as always, keeping you both in my thoughts and prayers. Keep us updated and I will be hoping that Rusty's blood pressure will come down to normal with the enalapril.

Love and hugs,
Lori

[missbeagle]

Lori -

No worries. Both my IMS and my regular vet thought he was still taking the enalapril for protein loss and for BP.

This was his first high BP reading.

I took him for fluids today at the vet. As long as he's eating and "squishy" he'll be fine.

It is especially helpful that he's cut the price on the fluids for my "Short Stuff." :D

Thanks,

Gretchen and Rusty in NC

[Harley PoMMom]

That is wonderful that your vet gave you such a discount on the fluids and that was ingenious on your part to ask...I never would of thought of that! :o

So happy that Rusty is eating good and doing so much better.

Love and hugs,
Lori

[Harley PoMMom]

Hi Gretchen,

I was just wondering how you and Rusty were doing, when you get a chance, let us know. :)

Love and hugs,
Lori

[missbeagle]

Hi Lori -

My father passed away unexpectedly and things have been scattered ever since.

Rusty is doing OK I guess, I haven't been home in 2 weeks now because of his passing.

Rusty's IMS seems to think that his high blood pressure is due to the sodium in the LRS. They have asked me to cut his fluids to once a week. My vet and i don't exactly agree with that, but we are trying it. He went and had fluids yesterday, my husband took him. They were thinking about giving him 1/2 saline solution. Hubby says he's doing well despite not seeing me for two weeks.

I found this,

http://www.naturesfarmacy.com/store/details.php?prodId=336&category=42

I was wondering if anyone knew anything about it or has tried it.

Thanks,

Gretchen in PA and Rusty in NC

[frijole]

Sending condolences... So sorry. Hugs and love, Kim

[Harley PoMMom]

Oh Gretchen,

I am so sorry to hear of the loss of your father...sending huge and loving hugs your way.

Keeping you all in my thoughts and prayers.

Love and more hugs,
Lori

[missbeagle]

Hi folks,

I took Rusty to NCSU yesterday to be evaluated by the doctors there for a cruciate ligament tear. They have determined that he has torn his ligament and does need surgery.

He will be on fluids, before, during and after. He surgeon is Dr. Simon Roe, the head surgeon for the orthopedic unit at NCSU. He is peronally doing his surgery. He feels that his cushing's disease has brought on his cruciate ligament tear because of muscle weakness. Here is a link to his credentials.

http://www.cvm.ncsu.edu/docs/personnel/roe_simon.html

He will have a board certified anesthesiologist and will be in the intermediate care following surgery. He has already had pre operation x rays to check on his heart, he has had pre surgery bloodwork drawn yesterday (they have not emailed me the results of yet) and he has been checked and cleared by the cardiologist.

So it looks like we are good to go.

He will also have 8 weeks of limited movement. <sigh>

I was wondering if anyone had experience with this type of surgery and what I can expect.

His surgery has been scheduled for Tuesday the 17th about noon.

Any suggestions and good thoughts are welcome.

Gretchen in NC
(Cushing's and Renal Disease, Pepcid AC, Purina NF, CoQ10, Fish Oil, Azodyl, Aloh powder, 50lb. Beagle boy)

[StarDeb55]

Gretchen, I've been through it twice. Once with my 1st cushpup, & 18 months ago with my Lhasa (no cushing's). We have had a fair number of members whose pups have had cruciate ligament ruptures that really can only be attributed to the Cushing's. When it comes to recovery, keeping a pup quiet is the absolute key. You will have to leash them to go outside for potty trips, no horsing around, or attacking like a maniac, no jumping, basically nothing. What I did with my first boy was set up a play pen sort of thing in the middle of the living room, where he had a little more room to get comfortable, rather than crate confinement. This seemed to work well. On my second time around, the surgeon told me to get some type of sling support to help with potty trips, & mobility to go outside. My Lhasa displayed his "Lhasatude", wanted no part of a stinking sling, & seemed to do ok simply being leashed to go outside.

Debbie

[Altira]

How is it going?

[missbeagle]

Hi everyone,

His surgery went well. They monitored his BP and it's been almost 8 weeks since his operation.

We've been carrying him in and out since Christmas. He's been putting weight on his leg and so far so good.

We've had to cut his food back too and he's lost about 6 pounds since the operation in January.

So far so good (knock on wood). We go back for his evaluation in early April so we'll have to keep carrying him out and in.

On another note, I found this at Swanson Vitamins, where I purchase their HMR Lignans for Rusty. It is called adrenal essentials. Due to Rusty's kidney disease, I can't put him on Trilostane and I am trying to treat him with Lignans and Melatonin.

https://www.swansonvitamins.com/SWC063/ItemDetail?n=0

I was wondering if anyone had any input either pro or con. I am considering ordering some.

Thanks,

Gretchen

[Harley PoMMom]

Hi Gretchen,

Thanks so much for the update and so glad to hear that Rusty's surgery went well.

I don't know anything about Adrenal Essentials made by Swanson Vitamins, sorry. What does your vet have to say about them?

Please do keep us posted and sending tons of huge and loving hugs...Lori

[missbeagle]

Rusty's rabies is due in July. Would you give a rabies vaccine to a Cushing's and chronic renal failure pup?

[Harley PoMMom]

No I would not. Harley did not receive any vaccinations due to his untreated Cushing's and kidney problems, this decision was made by my vet and I.

[lulusmom]

Rusty's rabies is due in July. Would you give a rabies vaccine to a Cushing's and chronic renal failure pup?

Absolutely not. My cushdogs are not in chronic renal failure and their IMS and I say no more rabies vaccines. If your local animal control hassles you about it, ask them if they accept medical waivers and/or titers.

[labblab]

Gretchen, is Rusty still seeing an IMS at NSCU? If so, I'd ask for his/her opinion about the rabies vaccination, taking into account how recently Rusty was previously vaccinated and also his current health issues/lifestyle. I see you live in North Carolina and therefore may be subject to a higher risk from rabies like we are here in Georgia, especially if Rusty spends much time out in a yard unattended. Just within the last three weeks, a rabid fox, raccoon, and kitten have all been identified within about a 20-mile radius of me. The kitten was a cute little stray that was handled by a bunch of folks at a local Starbucks prior to being turned in to a nearby vet. The kitten appeared to be perfectly healthy, but died the next day -- after having nipped the vet. It turned out to have been rabid, so the vet and other folks who handled the kitten are now undergoing rabies shots. Last spring, three dogs very near me were attacked and bitten by a rabid raccoon while the dogs were standing outside the door on their own backporch.

Your IMS will know whether you live in an area that carries similar rabies risks. If so, taking Rusty's specific health/vaccination history into account, I think it becomes a professional judgement call as to what the best course of action would be on Rusty's behalf.

Marianne

[Squirt's Mom]

Hi Gretchen,

I have briefly looked into the ingredients in the Swanson's product you mentioned. It contains licorice which promotes adrenal activity (more appropriate for Addison's than Cushing's) and that would be a concern for me. Personally, I don't care for these combined herbal products. I feel it is always best to use herbs, supplements, ect. individually, adding one at a time to the pup's regimen. I haven't had time to look at each herb contained in this product yet, but none of the usual herbs for Cushing's seem to be included.

Before I spent money on this, I would do some in depth research on each ingredient and it's effect on the adrenal activity - do they help decrease cortisol or do they have the potential to raise it? Will they stimulate the kidneys, the liver, the digestive tract? Look at each one individually. ;)

The herbs listed in my texts as typically used for Cushing's include astragalus, dandelion root, burdock, nettle, Siberian ginseng, kelp, ginkgo, milk thistle, and Rehmannia. TCM (Traditional Chinese Medicine) herbs include Long Dan Xie Gan and Mai Men Dong Tang (Ophiopogon root).

I will do a bit more digging into these herbs in the Swanson's product as soon as I can - time is not working in my favor these days lately! :rolleyes:

Hugs,
Leslie and the gang

[Squirt's Mom]

Ok, here is what I have learned today about the ingredients in this product -

Eleuthero root – immune stimulate; lowered cortisosterone in stressed rats. (Kimura, 2004) but worsened hormonal stress indicators in humans. (Gaffney, 2001)

Gotu kola – anti-dermatic (skin issues), peripheral vasodilator, anti-arthritic inflammation, antioxidant, wound healing, diuretic, nervine/brain tonic

Withania somnifera (Ashwagandha) – osteoarthritis, help build muscle, calming propertied, cardiotonic, antibacterial, antifungal, anticancer, immune booster; Withania sonifera *increased* corticoid levels in stressed rats. (Singh, 2000)

Shatavari root (Asparagus racemosus) – promote lactation, demulcent (provides protective coating and soothes tissue), diuretic, aphrodisiac, antiseptic, antidiarrheal

Siberian Rhodiola root – immporve cognitive function and fatigue

Schizandra chinensis – free radical scavenger, protects liver from toxins, may stimulate liver repair, lung and kidney support, sedative, **possible interaction with corticosteroid medicines**

Chamomile – eyewash, mild sedative, flatulaence and mild colic, antioxidant, topical wound treatment, antispasmodic, anti-inflammatory, antimicrobial, stimulates digestion, expels worms

DMAE – can cause skin tightening, possible benefits for ADHD, increases life span of quail :p

Hope this helps....

Hugs,
Leslie and the gang

[Altira]

Rusty's rabies is due in July. Would you give a rabies vaccine to a Cushing's and chronic renal failure pup?

IMHO No... no way... no more shots. Those vaccines last a lot longer then they claim.

There is all sorts of things out there that say not to give rabies shots to sick dogs. There is even places that mention aplying for a temp or permanant exemption. At the very least I'd put it off.

[missbeagle]

I spoke with my vet and was told not to purchase the Swanson product.

So I guess on we go, with treating his chronic kidney diesase which is a direct result of his Cushing's.

I am on the Yahoo kidney list as well and those folks there are great. Yunhee is now a moderator over there. You might remember hjer and Harry from here.

Thanks for the advice and for your research. The time you guys spent on Google is much appreciated. :):rolleyes:

Gretchen

[missbeagle]

Should I get standardized astragalus or astragalus root? Is one better than the other?

I gave him astragalus root before and it seemed to help with his kidney issues.

Thanks again,

Gretchen

[Squirt's Mom]

Hi Gretchen,

I use an Astragalus root tincture, 1:1, 2000mg. The tinctures and glycerites are easier for me to use since they are liquid. Plus, the pup's digestive system isn't asked to process the root itself. Tinctures will give you the biggest amount of the essences of the root. I have used Eclectic Institute brand until this last purchase and bought some made by Nature's Answer. Won't be purchasing any more of their products in dropper bottles, tho. Their bottles really, really, really suck. The caps hold liquid after shaking so controlling the amount that is dispensed is almost impossible. I threw the Nature's Answer products away. :rolleyes:

I am really glad you decided not to try the Adrenal Essentials. Something to always keep in mind about things like this is that they are made for the human body, not animals. So the amounts of the ingredients may be way too much for the smaller bodies of our companions. Another reason to use individual herbs, supplements that we can control. ;)

Hope this helps!

Hugs,
Leslie and the gang

[Harley PoMMom]

I am on the Yahoo kidney list as well and those folks there are great. Yunhee is now a moderator over there. You might remember hjer and Harry from here.


Gretchen

I do remember Yunhee and her sweet Harry, and I am glad to hear that she is a moderator over at the Yahoo kidney site, you will receive great advice over there as they are very knowledgeable about kidney issues...please do keep us posted, ok?

Love and hugs,
Lori

[Altira]

Hope all is going well...

[missbeagle]

Hi guys -

I just wanted to give you an update on Rusty.

On May 12th we had to take him to the ER vet to be admitted because his kidney levels had suddenly spiked. He had a BUN of 215, Creatine of 8.5 and his phosphorous was at 11.

After six days of round the clock IV fluids his levels had come down and had stabilized.

I have been giving him 400ml of IV fluids every day since he came off of his IV flush.

Today he had his first grand mal seizure. He lost all bodily functions too. When I first found him he was laying on his dog bef and was panting heavily. His eyes were rolled back in his head. When I picked him up, he was like a rag doll.

I call ed the vet and rushed him in. By the time we got there he was fine (little bugger). He was eating cookies and hanging out in the waiting room. I would say the seizure only lasted about 3 minutes.

The IMS had prescribed Plavix in the past, and now the vet and I feel it might be appropropriate to start him on it in order to prevent a thromboembolism.

The vet does not think the seizure was related to his kidney disease, partly because his numbers were higher and he did not seize then.

I was wondering if anyone had any experience in using Plavix with a kidney/cushing's pup.

Thanks in advance,

Gretchen & Rusty
North Carolina

[Harley PoMMom]

Thanks so much for the update and I am so sorry to hear about Rusty's seizure, so scary.

I have never used Plavix but have done some research and it should be used with caution when kidney disease is present. Just wondering if a low dose of aspirin could be a better substitute??

Sending you both huge and loving hugs and please do keep us updated.

Love and more hugs,
Lori

[missbeagle]

Lori -

****Just wondering if a low dose of aspirin could be a better substitute??


====>>>> The vet said this should be a better blood thinner than the aspirin. She said most people who are on blood thinners are on asprin and something else too.

I saw the same information about Plavix at drugs.com. I am going to pick it up, but might wait a bit to give to him as it can't be mixed with his acid reducers.

Thanks,

Gretchen and Rusty

[missbeagle]

Good morning everyone,

Rusty had an awesome day yesterday. He ate a bit of breakfast and had dinner all on his own without needing an appetite stimulant. :-)

His after dinner schedule went like this:
Dinner 8:30
Aloh3 8:45
CoQ10, 10mg amlodopine, 5mg enalapril, 1 Azodyl 9:15

one small seizure with incontinence 9:30 lasted about a minute
another small seizure with incontinence at 10:57 lasted about the same

He didn't seem to lose consciousness. I captured the 10:57 one on my phone.

He didn't get his Prilosec last night as I was hesitant to give it to him.

I was wondering if anyone could give me some input as to whether the Aloh3 combined with the amlodopine and the enalapril precipitated the seizure.

I am desperately trying to find his trigger.

The vet says his PCV is holding at 24% and he has non regenerative anemia. She wants me to continue with the Hi-Vite drops and his retic count was .06. :-( We are going to start epogen. Any suggestions are appreciated.

Thanks,

Gretchen and Rusty, NC
Cushing's and GN/CRF
10 yrs. old

(10mg Prilosec, Royal Canin, Azodyl, 3 tsp AlOh powder, 35lb. Beagle boy)

[Altira]

Geez my mom has a dog with seizures. Has had it for years. She gives bromide? And phenabarbatol? He doesn't get seizures too often now. She has to feed him diet food because he eats so much.

[Squirt's Mom]

Hi Gretchen,

Nice to hear from you and Rusty again! :)

I wish I could help, but I know absolutely nothing about your circumstances. Hopefully those who do know will be along soon.

How is Rusty today?

Hugs,
Leslie and the gang

[missbeagle]

Hey guys,

Rusty had another seizure last night. Do any of the mods know of a anti seizure medicine that I can give that doesn't effect the kidneys? Here's what the vet found during an ultrasound they performed on Tuesday morning.

Physical Examination:

Weight 33.9 pounds; continued loss
Rusty is fairly bright and alert; tolerant nice boy
Limited abdominal ultrasound: static, non progressive L hydroureter with no evidence of obstruction
New finding of sludge in the gallbladder that may be a risk for obstruction/stasis (mildly elevated ALT and normal TBili at this time so no evidence of clinically significant obstruction)
Urine culture pending
Recheck renal profile: PCV 25%, BUN 96 mg/dL, Creat 4.4 mg/dl (up from 4.3), PO4 is normal at 5.5 mg/dl today

Diagnosis:
1. L hydroureter-static, non obstructive
2. Gall bladder distension-severe; apparently of low clinical significane at this time but with incrased risk for acute gall bladder episode/stasis
3. Proteinuric CKD-long standing with progressive anemia
4. Normotensive (on medication)-historically hypertensive
5. Recurrent UTI, severe BPH
7. New onset seizures

Anything is welcome at this point.

Thanks,

Gretchen and Rusty, NC

Cushing's and GN/CRF
10 yrs. old

(10mg Prilosec, Royal Canin, Azodyl, 3 tsp AlOh powder, 35lb. Beagle boy)


__,_._,___

[Harley PoMMom]

From my searching I found that sodium bromide is used in patients with compromised renal function.


Sodium bromide is preferred for dogs with kidney problems.: http://www.canine-epilepsy.com/FAQ.html

Sending you and sweet Rusty huge and loving hugs, Lori

[labblab]

In addition, I believe the bromides (sodium or potassium) are less likely to have undesirable interactions with either trilostane and Lysodren. The one drawback is that it can take an extended period of time for the bromides to reach the therapeutic level that will inhibit seizures. So depending upon the urgency of getting his seizures under control, Rusty might need to start off on a combination of phenobarb and a bromide, and then undergo a transitional period during which the phenobarb is decreased and the bromide is increased until the phenobarb is discontinued altogether.

Marianne

[missbeagle]

Thanks Ladies.

I admistted him to the ER vet last night for supervision in case he had another one. He slept fine last night. No seizures. :)

My husband doesn't want me to take him to NCSU and I would like to take him to see if they can do anything conservatively for him as to minimize his seizures.

I realize he has a lot of other health problems, and might not be with us much longer.

Thanks for the input. Gretchen and Rusty

[missbeagle]

Hey gang,

He is at NCSU intermediate care ward tonight. He's at doggie night care there. They are watching him for seizures tonight. They have an EKG hooked up to him too. He has a catheter in if he has a seizure so they can administer valium to stop it.

They ran a CBC. I will post results tomorrow. They are going to check him for blood clots and perform some x-rays on his spine and heart (thoracic cavity) to check for diskospondylitis and for heart enlargement. They are also checking his blood clotting factor to see how quickly his blood clots.

Here's a link to an article on diskospondylitis. It is a spinal infection that happens when you get UTI's. I should know some more tomorrow.

http://rottweilerhealth.org/pdfs/sept_disko_betbeze_02.pdf

It could also be a macroadenoma on his pituitary gland too. He's not a candidate for an MRI or a CAT scan because of the anesthesia. They are trying to figure out where the seizures are coming from by process of elimination.

Tummy wubs to everyone!

Gretchen and Rusty

[molly muffin]

I hope they can get this figured out. I'm sure at this point you all need a good nights sleep without fear of seizures.
Crossing fingers.

HUGS

[missbeagle]

Folks -

We've had a rough few days here. On Friday Rusty was at NCSU overnight for seizure monitoring, blood tests and a neurological work up.

Here are some of his diagnostic test results from last Friday.
BG 171
Azo 50
PCV 28%
TS 6.2
BP 120
RBC 3.74 (5.7)
HGB 8.4 (13.8)
HCT 25.3 (39)
moderate thrombocytosis 669 (190-468)
moderate lymphopenia 0.190 (.594)
BUN 107
Creatinine 5.2
Phos 7.3
ALKP 155 (16-140)
ALT 160 (12-54)
GGT 7 (0-6)
Anion Gap 20.8 (11.2 - 19.9)
Na/K ratio 24 (27.7 - 35.9)
Amylase 1614 (236-1337)
Reticulocyte count .90% non regenerative, normocytic, normochromic anemia
Urine culture - negative
TEG - Hypercoaguable R (4.5) K (.08) Angle (80.1) MA (74.1)

He was placed on an EKG machine to monitor for seizures that thankfully he did not have while overnight at NCSU.

They have placed him on 1/4 (18.75mg) of a 75mg tablet of Plavix to help with this hypercoaguability. He gets this once a day.

They found some back pain along his cervical spine. They have placed him on 150mg of gabapentin twice a day to help with that. I have a 10 day supply and I am to figure out how he's doing on it. He's really drowsy for about 3 hours after I give it.

They also put him on zonosamide 50mg twice a day for seizures. They warned me that he could still seizure while on the meds. He did just that on Monday night. He had two seizures about 45 minutes apart. I called NSCU as instructed and they told me to give a zonosamide right after the first one, and again at his normal time. Then they told me to take him to the ER vet ocernight for monitoring. He did not have a seizure there either.

He is still getting his Prilosec at night and his Azodyl when I can get it into him. He is eating well on the Royal Canin dog food. He seems to really like that food. I have been mixing about 1 Tablespoon with some Merrick's canned food, water and some small pieces of steak. I am then pouring this over his Royal Canin food and he sucks it up. After eating, I am syringing 1.5 teaspoons of ALOH mixed with some broth to bind to hid food.

Is giving him zonosamide and gabapentin going to further harm his kidneys?

Between the seizures (either due to a macroadenoma from Cushing's Disease or his hypercoaguable blood) NCSU cannot say for certain what is causing his seizures without an MRI. Rusty is not a candidate for an MRI due to the need for anesthesia and the additional risk that poses to his kidneys.

He is still getting 400ml of fluids once a day.

Thanks in advance,

Gretchen and Rusty, NC
Cushing's and GN/CRF
10 yrs. old

(10mg Prilosec, Royal Canin, Azodyl, 3 tsp AlOh powder, 33lb. Beagle boy)

[missbeagle]

Folks -

He had another seizure at 4pm after which I gave him 50mg of zonosomide, and his regular dose at 7pm. At 7:30pm I gave him 50mg of gabapentin for his back pain and about 9pm I gave him his BP meds.

I took Rusty to the ER vet last night about midnight because his heartbeat felt irregular and his breathing was laboured. They admitted him and said he had a slow heartbeat. They gave him some drugs and his heart rate came right back up.

Rusty was released from the overnight ER vet this morning. His heart rate came up with some more drugs <sigh>.

The ER vet says that like last night, too many sedatives in his system at once, zonosamide, gabapenten, and amlodopine caused his heart to slow down. He said he was glad that I brought him in. He said if I didn't that he would have probably had a cardiac event because his heart rate was so slow. The vet has my papers, so I don't have any specific information for you guys now.

I have a call out to his IM at NCSU and the vet says they will call too.

He was tired, but perky this morning. He ate some cookies at the vets too. I am going to take him something to eat later this afternoon.

I just wish I could get these #$%^ seizures under control.

Please continue to send good vibes out to us here in NC.

Thanks everyone,


Gretchen and Rusty, NC
Cushing's and GN/CRF
10 yrs. old
(10mg Prilosec, Royal Canin, Azodyl, 3 tsp AlOh powder, 35lb. Beagle boy)

[Squirt's Mom]

Hi Gretchen,

I am reading along and feel so useless...like a boar hog with teats. I so wish I had something to offer that might help you and Rusty. But all I have are those positive thoughts, prayers and healing white light - which are flying your way.

You are so brave and Rusty is so lucky you are his mom.

Many hugs,
Leslie and the gang

[missbeagle]

Folks,

The IM at NCSU is recommending a blood transfusion at this time over an injectible like epogen or aransep. I am told by my vet that this would be risky because of his thromboembolisms because of his Cushings. His PCV is 20% now.

Any advise on transfusions vs. injectibles is very welcome.

Thanks,

Gretchen and Rusty, NC
Cushing's and GN/CRF
10 yrs. old

(10mg Prilosec, Royal Canin, Azodyl, 3 tsp AlOh powder, 35lb. Beagle boy)

[molly muffin]

oh my gosh I don't know a darn thing about blood transfusions in canines. :( I'll send you as many hugs and well wishes as you can stand though.

The IM is aware of all of Rusty's history right? The thromboemblolisms specifically? Can the vet call the IM and discuss this?

Whatever you decide you know we are all here for you.

HUGS
Sharlene

[missbeagle]

Well here we are back at NCSU.

They have Rusty on an ECG, his heartrate was back up again to almost normal.

They were going to watch him for seizures tonight and check with another doctor about a blood transfusion.

Apparently we are almost at the end of the road. Despite everything, he's bright, alert and appears perky. that's what makes this harder.

Any and prayers and good wishes are welcome.

Gretchen and Rusty, NC

[mytil]

Oh Gretchen, I am so sorry I wish I could give you some useful input on this (I just do not know), but you have my prayers and tons of positive thoughts for your boy.

(((hugs)))
Terry

[Squirt's Mom]

Aw, Gretchen,

How incredibly difficult this has to be for you. Surely there is something that will help our sweet Rusty, surely. If I am saying this to myself, I can only imagine the conversations you have had with yourself. You and Rusty both have fought so very hard from day one. I wish I had some magical insight for you but all I have to offer is my thoughts, my prayers, and healing white light, along with...

Many hugs and belly rubs,
Leslie and the gang

[jmac]

Gretchen,

I'm so sorry Rusty is struggling so much. Sending prayers your way...

Julie & Hannah

[Altira]

Me two... I wish I could help too. All I can say is I know that when they have seizures they don't know it's happening. And they dont normaly do any harm unless they last a long time. They are dreadful to watch I know. But probably you already know that. We cleared out an inter waiting room when my Kodi had one.

((((hugs))))

[molly muffin]

Hoping for a good day for you and Rusty too.

Hugs,
Sharlene and Molly