Rose, Age 7, Diagnosed with Cushing's and Hypothyroid - (live in the Bay Area)

[CherylC]

So I have a golden retriever named Rose who is 7 years old and has recently been diagnosed with Cushing's and not-so-recently been diagnosed with hypothyroidism. She has been on Soloxine for her thyroid a few months now and is doing well with that, and she has been on Vetoryl for about 11 days, got her 10-day bloodwork done today and we are waiting for results.

One question that I had (well, my mom had, since she's paying for all these tests) is why she needs to have bloodwork done in another 20 days. This is costing us about $542 each time we do it, and we've already spent around $700 running the tests to diagnose her. Our financial situation is not looking the best right now, and we are having to make some real sacrifices ever since we found out about her Cushing's. On the other hand, I have no idea how much these tests are supposed to cost. I live in the Bay Area, so if anyone is around there and can provide me with some insight on this, that would be much appreciated.

Anyway, Rose's energy seems to be up a bit, although she still has her potbelly and has recently developed some skin tearing/bruising which got infected, so now she's on antibiotics for that as well.

Thank you for reading,
Cheryl

[gpgscott]

Hi Cheryl,

Welcome to you and Rose. Seven is young and with a proper treatment Rose can have the prospect of a full healthly life.

The testing is so darn expensive largely because of the stim agent which is called cosyntropine, then you add two blood draws, preperation of the blood in the Drs. office and overnight shipping to the lab which does the actual test. The costs vary from region but for SoCal sounds pretty average to me. We have a number of members in your immediate area who will be able to confirm this.

So the goal once on maintenence to to keep her stable which will lead to fewer dosage changes and fewer stims. To aid in this you need to understand as much about her condition as you can.

A good start would be for you to post a history of symptoms and diagnostics leading up to this treatment. Many members use their thread here as their treatment diary, it is always available werever you have internet access and there are lots of interested people in the same situation helping you interperet it all.

We like to keep to a one dog one thread format, in time the thread becomes long but the benefit is that all of the information about that pup is in one place and easy to find.

Thanks again for joining and good luck with the treatment. Please let us know more about Rose.

Scott

[mytil]

Hi and welcome from me too.

We have several members who live in and around your vicinity and I am sure they would be willing to talk about their costs etc.

I know it is very hard financially for a lot here - here is a link to several resources that could possibly help - http://www.k9cushings.com/forum/showthread.php?t=212 (for finding sources that could assist in the medical expenses).

Terry

[zoesmom]

Welcome, Cheryl and Rose -

When you say the Bay area, where exactly? We just recently moved from that area to GA, and I thought our vet clinic was high, but that's ridiculous. I'd be interested in knowing the breakdown of that $542 because I have a couple thoughts. Is that for the ACTH test (the monitoring test)?

First off, you shouldn't need to see the vet to get the acth test done so hence, they should not be charging you for office visit. What does your Rose weigh? That does affect the acth costs because of the amount of stim drug they need to use. Also, I discovered that our clinic was charging to 'admit' my Zoe and then tacking on an additional 'boarding' fee because she was put in a kennel, waiting for the second blood draw (usually one - two hours.) One way around that is to let them do the first blood draw and give her the stim drug and then take your dog and go home or to a nearby park and return when it's time for the second blood draw.

In time, another way to save $$ is to have them skip the first blood draw (which gives the baseline/resting cortisol level). However, at this point in Rose's treatment, I wouldn't advise that. But down the road, once she's settled in and doing well and her numbers seem pretty consistent, then that would be another option.

Are they also doing an electrolyte test? That is recommended but again, once you're certain she's stable, it could probably be skipped if she's having no unusual symptoms. Treatment can be costly at first but that should settle down and, barring any problems, you might be able to stretch the testing out to every 4 - 6 months. It's just not a good idea at the start.

All that said, when we moved from southern to northern CA, the ACTH costs did go up. But we never paid THAT much. I'll have to look at my old bills, but I want to say an ACTH ran around $250. (just can't remember if that was with one or both blood draws.) My Zoe weighed 80 lbs so she required a lot of the stim drug.

We lived in San Ramon and there were lots of vets to chose from. The one we used was a big practice and we saw the IMS (internal med specialist) most of the time and she knew her stuff. Plus, Zoe had a multitude of other health issues which complicated things, so that's why we stuck with her. Otherwise, I'm sure we could have shopped around and found a cheaper clinic. But having confidence in a particular vet is important, especially with cushings. Do tell us more about Rose and her cushings journey so far. Sue

PS - you said another test in 20 days. That was my question at first, too. The recommended schedule is at 10 - 14 days in and then at 30 days. I always wondered if that meant 30 days from the day of starting the trilostane or 30 days after the first test. I think the second test could probably be held off until 30 days after the initial test. Naturally, any problems or strange symptoms and you'd do it earlier, for sure.

[CherylC]

Hi zoesmom,

Thank you for your reply. The vet is indeed giving Rose an overall examination to monitor "clinical signs" of Cushing's. Would it be reasonable for me to request them to not do this?

The vet is in Los Gatos, I live on the Saratoga/Los Gatos border. Where did you live? If you know of a more reasonably priced (and good!) vet in the area, please let me know. I am willing to go to San Jose, Campbell, Sunnyvale, Cupertino... any area, really, as long as it's not as far as San Francisco.

Rose is 77.8 pounds.

Here is the breakdown of what we paid yesterday:

1 Cortrosyn 0.25 mg/mL...198.45
1 Exam/Consult, Recheck...44.00
1 ACTH (1 pre, 1 post)...152.87
1 Chem 25...112.97
1 Hospitalization, <12 hours...34.12

I am not including the Simplicef, which was 69.80.

Do you know what the Chem 25 is for and if it's necessary?

Cheryl

[lulusmom]

Hi Cheryl and welcome to the forum.

I must say that I think you hold the record for the most expensive acth stimulation test. I have two cushdogs and if I had to pay that exhorbitant price, I'd have to beg on a street corner. :D My dogs treat with an internal medicine specialist at a speciality hospital and I only pay $244 for a stim test. I am not charged for an office visit, exam or hospitalization. This is a one hour test for heaven's sake and I can't believe they are charging you $34.12 for hospitalization. I've had stim tests done at three different gp vet offices and they never charged for those things either. In my opinion, you are being gouged and I would be looking for a new vet too.

Most vets do not do the stim test inhouse and send the blood samples out to a lab. The Chem 25 is most likely the lab charges.

[lulusmom]

Cheryl, I was just informed by a very credible source that the Chem 25 is actually a blood chemistry panel. The $112.97 would definitely not be a recurring charge. Did your vet actually tell you that the office visit and hospitalization would be charged every time Rose goes in for an acth stim test? If not, then the actual charge for the stim test is $351.32. That's still pretty high.

Now that I know a blood chemistry was done, I'm going to ask that you get a copy of those results and post any abnormal values here, including the normal reference ranges.

[CherylC]

Yeah, my parents and I have been really upset by these charges, and we just don't know what to do. All I know is, I really cannot afford to keep paying like this, and she's due for another one in 19 days.

I hope that some more people from the Bay Area can give me recommendations for other vets who have experience with Cushing's Disease.

This is just getting to be too much, and I feel so guilty over making my parents pay like this, and I also feel guilty for resenting Rose, because it's not her fault she has Cushing's.

Anyway, I'll probably schedule an appointment with another vet (after doing some research, but it'll be something of a shot in the dark) and discuss Rose's condition with him as well as pricing.

Thanks.

Cheryl

[Franklin'sMum]

Rose is 77.8 pounds.
1 Cortrosyn 0.25 mg/mL...198.45
1 Exam/Consult, Recheck...44.00
1 ACTH (1 pre, 1 post)...152.87
1 Chem 25...112.97
1 Hospitalization, <12 hours...34.12
I am not including the Simplicef, which was 69.80.
Do you know what the Chem 25 is for and if it's necessary?
Cheryl

Hi Cheryl, and welcome to you and Rose,

A few of our members in the US have been charged for the entire vial of cortrosyn, for each stim test. I'll leave the math for someone who hasn't just finished nightshift :o, to figure out what might be happening with this. However, most often there is enough cortrosyn in the vial for several stim tests (depending on the size of the pup).
The chem 25 *might* be charged at each stim, if the vet is checking electrolytes (which is a must if you will be using trilostane /vetoryl, as it can interfere with the aldosterone- the thing that keeps electrolytes balanced. If the elec.s become unbalanced the situation can become very serious). Having said that, checking electrolytes without the entire chem panel being performed can easily be done, and I used to get charged about $30 for the electrolytes on their own. They don't need any extra blood test, they just use some of the blood from the (I believe) pre- draw. Gotta say, the hospitalisation charges for 12 hours?? That's insane (IMO). Was Rose even there for 12 hours? And if you will be figuring out a treatment option, and having more stims , your vet should help out and (at most) only charge a re-visit fee, which is a discounted consult fee.
Wishing you luck with finding a knowledgeable vet/IMS, with reasonable prices.

Jane, Franklin and Bailey xxx

[zoesmom]

OK -

As I thought, they charged you for both an office visit (even $44 for a recheck seems high - that's what I paid for a regular OV) And then for the hospitalization while she waited for her second blood draw. I can maybe understand that OV charge, since this was the first follow-up since she started on the medicine. But in the future, there's no reason the vet techs can't just take her in the back for the test and the vet can call you on the phone to discuss when the results are in.

The hospitalization charge - that can be saved, too, if you or your mom can take her after the first blood draw and then return her for the second draw. Some people just go out to a nearby park or take a walk, or even wait with their dog in the waiting room if necessary. You take her home and return if it's not too far. After all, they are only there for an hour or two. You might have to complain and tell them that's how you want to handle it in the future (i.e. - don't need to talk with the vet and don't want to leave Rose in the back between blood draws.) Some clinics might even waive that charge if you complain.

The chem panel is more bloodwork than is necessary at this point. Like Jane said, only the electrolytes test is necessary. It tests just sodium, potassium, for sure, and maybe chloride?? The chem 25 should only be necessary every six months or once a year unless something unexplained is going on as far as her symptoms. If they were looking at her liver enzymes, those come down very slowly and in most cush pups, some never return to normal levels. But for sure, I wouldn't pay for that next time. I know that the electrolytes is a newer recommendation for trilostane users, so I'm not telling you NOT to get it, but we never did that on my cushpup (in four years) unless there was something amiss with her. So perhaps in the future, you could ask about skipping it if Rose is doing great.

The acth charges are the ones you can't get around. And even those seem slightly high. Actually, I think I was paying close to $350 for Zoe's when we first moved up to the Bay area (higher than even So Cal!). But once Rose has a couple of good stim tests in a row (where her cortisol levels seem stable and in a therapeutic range) then you could ask about skipping the first blood draw. Our IMS had no problem with that. I think that saved us almost $100 on the total acth cost. You'll still have the cortrosyn cost but I'd discuss with them how they handle that whole thing with the vials to see if there's some way you can save a few bucks on that.

Hopefully someone closer to your area will have a vet recommendation as we were pretty far out - in San Ramon. And overall, our clinic was one of the more expensive ones and only a little less than what you are being charged. BUT our vet was cooperative about the charges. A little complaining might go a long way and definitely some discussions about what is going to be done each time you take Rose in. After Rose's next test (the 30 day), if she's stable on her current dose, you will only need testing every 3 months after that (unless something seems off with her)

In another test or two - say at 6 or 9 mos., if she seems to be doing well, then you could ask about skipping that first blood draw at that time. That's something you kinda have to base on how the dog is acting when the test comes due. We didn't skip it every time, just because it's good to know what that pre # is to compared to their post #. But we did skip it alot of the times after Zoe was settled on trilostane. Doing all the above, you may be able to get the future test costs down to about $250 - which is what I generally paid onACTH test days. After a couple years, you can probably even stretch that 3 months out a bit longer. Just depends on how the dog is doing. Sue

[CherylC]

Thank you zoesmom. We have switched a vet and she will be going for her second ACTH on October 8th. The price is $200--MUCH improved. The vet is also highly recommended by friends and extended family, so I trust him already.

Trilostane is a life long drug, I believe. Do you mind me asking which website you use to order it from or if you get it from the vet? I've been ordering all Rose's medication from Dr. Foster and Smith, and they're prices are okay, but I believe they're the only reputable ones on the internet. I don't know if I trust 1800PetMeds and places like that...

[CherylC]

Lulusmom--

I have now switched a vet, but the old vet definitely wanted to do the Chem 25 every single time. I had tried discussing or "complaining" to the person at the front desk, but I didn't really like her attitude. It was hard to talk to the vet, who literally did not seem to know what anything cost--she would always refer me to the main administrative assistant (front desk person), which was really annoying. Anyway, I'm just glad we found somewhere else good. I should have asked around earlier, but what's done is done.

[gpgscott]

I don't know if I trust 1800PetMeds and places like that...

I can tell you from personal experience that 800PetMeds is A-OK.

Diamondback is the compounder many of the Trilo people use and I will let one of them comment further on that issue.

Scott

[zoesmom]

Cheryl -

here's a link to Mocha's thread where I just posted the prices that pethealthpharmacy.com charges for compounded trilostane. Have a look and see if they aren't better than what you are paying.

http://www.k9cushings.com/forum/showthread.php?t=2550&page=3

I never noticed any difference in the compounded trilostane vs the vetoryl (the brand name drug, which we had to use the first year or two for Zoe because trilostane was not yet approved here in the States.) Sue

[littleone1]

Hi Cheryl,

Corky and I also want to welcome you and Rosy.

I use Diamondback Pharmacy. I paid $25.95 for 60 - 20mg capsules and the same price for the same amount of 11mg capsules. You can give them a call using their toll free number, and they will give you the prices for what you need. 866-646-2223

I hope this helps.

Terri

[CherylC]

Hi Terri,

Thanks for the recommendation. Do they have a website to order or is it all done over the phone?

Thanks,
Cheryl and Rose

I wish I could post some pictures of her, but they are saved on my computer and it looks like the "insert picture" only takes URLs. Bummer =(

[littleone1]

Hi Cheryl,

They do have a website, but you would have to have your vet or IMS call in or fax a prescription. They also don't give the pricing on their site.

As far as posting pictures goes, I would look under the How To section. This might help.

Terri

[gpgscott]

I wish I could post some pictures of her, but they are saved on my computer and it looks like the "insert picture" only takes URLs. Bummer =(

Hey Cheryl,

Here is a link to a description for posting an avatar, which is the small pic next to your screen name with each post. http://www.k9cushings.com/forum/showthread.php?t=2018

And here is a link with a brief description about how to make your photo gallery. Please let us know if you need more information http://www.k9cushings.com/forum/showthread.php?t=564

Scott

[CherylC]

Hooray! Found a new vet, and he charged me around $235 for the ACTH stim test, less than half the price of my former vet.

He also gave me a very valuable piece of information, but I want to run it by you guys: my old vet had me cleaning her ears and using mometamaxx twice a week because her ears are constantly red.

My new vet says that her ears are red due to allergies and that I should continue cleaning her ears but should discontinue mometmaxx, as it's bad to put anything topical, especially steroids, in her ear as it gets absorbed by the body and can slow down the process of treating Cushing's. Does this sound sensible to all of you?

Also, in case anyone has had experience with this, Rose has had a sore on her lip the past 2 months or so that has NOT been healing, even after a round of antibiotics (also used for the skin tear on her belly). It's caused by repeated trauma due to her continually catching her lower canines on her upper lips, but the old vet said it's also healing slower because of her weakened immune system. I've been cleaning the area with chlorhexidine solution after every meal.

She's also got some skin tears on her belly that also did not respond to antibiotics. Anyone else's dog have this problem? It all just seems a bit overwhelming. I've been putting vitamin E oil on her skin at the suggestion of my old vet, but it doesn't seem to be doing much. I also feel this guilt at spending so much of my parent's money... I don't have a full time job and it's like I feel really worried about Rose but at the same time I worry about the financial strain this is causing on us. Blah just stressed out lol. And SO many questions!

Oh, another one: with her thin, delicate skin on her belly, is it dangerous to take her to the groomer's? I did not notice the skin tears were that severe until after she had been (although I might just not have been paying attention). I saw a picture on the internet of a cat with cushing's disease that had the entire skin on its back ripped off when the groomer after they tried to cut some matts. It was so terrifying. I definitely will tell them to be extra careful, but I don't want anything like that to happen to Rose! (Her picture's up, yay!)

[littleone1]

Hi Cheryl,

I am currently using TRA+Keto to clean Corky's ears twice a weak, as he's had both bacteria and yeast infections in both of his ears twice this year. This was recommended by his vet who is experienced in treating Cushings, and his IMS is aware of it.

I don't know about the grooming, as Corky has never had to be groomed.

I know that our cushpups ammunine system is compromised because of the disease, and it does take longer for them to heal.

I'm glad that you were able to find another vet.

Your furbaby is adorable.

Terri and Corkster

[lulusmom]

How long were you treating Rose's ears with Mometamax and was she receiving this ear treatment when she was tested for cushing's? These ear drops contain a very strong corticosteroid (steroid) which can cause iatrogenic cushing's. I realize you were only using the Memetamax twice a week but I believe that is probably enough to cause cushing's symptoms. Is your new vet absolutely positive that Mometamax is not responsible for the symptoms you are seeing? This drug can cause deafness as well.

[CherylC]

Yikes, for a while... 3 months I'd say. And... her hearing has gotten worse. Oh geez. This sucks; for future reference, what are some safer ear medications?

I'm pretty sure that it is not just the mometamax that is responsible for the symptoms, as her ultrasound showed that she had an enlarged kidney or something as well. I'm assuming that the mometamax would not cause these physical symptoms?

And just typing in "mometamax" and "deafness" brings up all these results about other owners who have had their dogs going deaf because of it. Rose's hearing has deteriorated quite rapidly; I thought it was just old age and that's what my old vet said as well. A lot of the other dogs have had their hearing restored (one through acupuncture?) But this is ridiculous; why are vets prescribing this medication? Do they just not know? I'm definitely bringing this up with the new vet.

And yes, she was receiving this treatment when being tested for Cushing's.

[bernie47]

hi Cheryl,
gee i thought i had it bad, paying $298.00 for ebonies ACTH testing ...glad you found another vet , we are in Perth west Australia..our vets prices are all over the place to !
wish you well with rose ...cushings can be overwhelming ,but these lovely people have helped me a lot ..;)
Catherine.

[gpgscott]

Hi Cheryl,

Yikes, the ears are very good at taking up meds transdermally due to the thin skin and density of blood vessels near the surface. In fact cortisol is compounded and administered to dogs and cats in this manner when they will not take it orally.

As Glynda has said, topical administration of steriods can not only 'slow down' the treatment, it can actually cause Cushing's, all symtoms and labs. An enlarged kidney/s is not a generally recognized symptom of Cushing's.

If this was me I would be seriously considering suspending all treatment for either 30 days or resumption of symptoms which ever came first and then doing a fresh stim.

Best wishes. Scott

[Franklin'sMum]

Hi Cheryl,


What side effects may be seen when taking Mometamax?
May see loss of hearing or balance. If so, contact your veterinarian. These effects are usually temporary. If ingested, the most common side effect of corticosteroids is an increase in the amount of drinking and urinating. Less commonly you may see an increased appetite and weight gain, panting, diarrhea, vomiting, and behavior changes.
from http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=14742

Gentamicin is the ingredient that seems to cause the deafness problems (if they arise). It has long been believed to be a problem only if the dog has a perforated eardrum, however, recent thinking/findings are it can be a problem without perforation. Some vets may not be aware of this.

Franklin's new vet gave me "Cortravance cutaneous spray solution for dogs" when she diagnosed his allergy, which contains ' 0.584mg/mL hydrocortisone aceponate', and she said it can be used for a couple of days on the inside of his ear flap. (I don't spray it, but wet cottons ball with it, and wipe/dab the cotton ball on his ears).

I agree with Glynda and Scott, and if Rose were my pooch, I would speak to the gp/IMS about the validity of test results to date, and see about discontinuing trilo at this time.

Jane, Franklin and Bailey xxx

[CherylC]

Oh man, I cannot believe my vet just kept recommending it to me. I remember questioning her about the ear medication many times, asking, "Do I really STILL need to administer it?" and she's like "Yeah, that would be best." I still have the emails we exchanged about this, and not once did she ever mention the possibility of deafness or the interference with Cushing's.

I'm just thankful my new vet seems to be way more informed, and that I managed to switch before Rose went completely deaf. So far, he said something about her pre ACTH being too low and her post ACTH being too high, but he will review the results with a Cushing's specialist and then call me back. I will definitely ask him about the validity of these results as well as her previous one, and how we should proceed now, taking this mometamax factor into account.

Thank you, sincerely, for all your guys' help and insights. I am SO glad someone mentioned the deaf thing, because I would never have thought to search for that on Google.

Gratefully,
Cheryl

[lulusmom]

Hi Cheryl,

I just noticed that you have not posted the results of any of the testing done to diagnose Rose. Can you please get copies of those tests and post the results here? Can you also tell us if Rose had cushing's symptoms before you started treating with Mometamax? If she started exhibiting symptoms after Mometamax, chances are Rose has iatrogenic cushing's, which should resolve by discontinuing the Mometamax. Either way, Mometamax definitely could have affected all of the testing your old vet did, including the blood chemistry.

[CherylC]

Here are the results from 9/21/2010:

So it goes like: Test / Result / Reference Range / Flag (High or Low)

Alk. Phosphatase / 210 / 10-150 U/L / H
Alt (SGPT) / 151 / 5-107 / H
AST (SGOT) / 28 / 5-55
CK / 123 / 10-200
GGT / 35 / 0-14 / H
Albumin / 3.2 / 2.5-4.0
Total Protein / 6.1 / 5.1-7.8
Globulin / 2.9 / 2.1-4.5
Total Bilirubin / 0.1 / 0.0-0.2
Direct Bilirbuin / 0.1 / 0.0-0.2
Bun / 18 / 7-27
Creatinine / 0.6 / 0.4-1.8
Cholesterol / 253 / 112-328
Glucose / 156 / 60-125
Calcium / 10 / 8.2-12.4
Phosphorus / 5.3 / 2.1-6.3
TCO2 (Bicarbonate) / 15 / 17-24 / L
Chloride / 108 / 105-115
Potassium / 5.0 / 4.0-5.6
Sodium / 145 / 141-156
A/G Ratio / 1.1 / 1.6
B/C Ratio / 30.0 / (None?) / H
Indirect Bilirubin / 0.0 / 0-0.3
NA/K Ratio / 29 / 27-40
Hemolysis Index / No significant effect on chemistry values
Lipemia Index / No significant effect on chemistry values
Anion Gap / 27 / 12-24 / H

ACTH Stimulation:
Pre-ACTH Cortisol: 7.7
Post-ACTH Cortisol: 10.9

I hope that's everything you need. I'm sure you know this, but the reference ranges are also listed for Canine:
Pre-ACTH (2-6)
Post-ACTH (6-18)
Equivocal post-ACTH cortisol: 18-22
Post-ACTH cortisol consistent with hyperadrenocorticism: >22
Post-ACTH cortisol consistent with hypoadrenocorticism: <2
Desired pre- and post-ACTH cortisol on lysodren therapy: 1-5

And they also say: "Dogs with iatrogenic Cushing's disease will have flatline response test results in the low end or below the normal reference range"-- which Rose did not have.

Now, I don't have the paper results (but I will ask for them) from her new vet, but he did say her PRE test was too low and her POST test was too high.

Her ultrasound results from 8/30/2010:

The liver was mildly to moderately enlarged and had a generalized increase in parenchymal echnogenicity with no defined nodular areas or masses. The gall bladder had a mild amount of echnogenic luminal debris with no associated wall thickening or duct dilation. The pancreas was not enlarged and had a smooth capsular surface. The spleen and abdominal lymph nodes were not enlarged. Both adrenal glands were mildly enlarged and measured 1.1 cm in width bilaterally. There were no nodular areas or masses within either adrenal gland. The kidneys had an adequate volume with no internal architectural abnormalities. The urinary bladder was full and had no wall thickening or luminal calculi. The stomach and small intestine were mildly gas and fluid filled and had no abnormally dilated or thickened areas. There were a few hyperechoic nodular areas scattering in the omental and mesenteric fat suspected to represent areas of steatite or necrotic fat. None of these nodular areas appeared hypoechoic and a primary mass was not seen in the abdominal cavity.

Impressions: There is mild bilateral adrenal gland enlargement which would support the diagnosis of pituitary dependent Cushings disease. There is no evidence of a functional adrenal neoplasm on this study.

The liver changes are compatible with a chronic hepatopathy and also likely secondary to Cushings disease.

---

My vet is closed today, so I wanted to ask you guys this quickly:

Aside from Mometamax (which has now been stopped), this is the other food/extra stuff she's taking per day:

- 0.2 mg of Soloxine twice a day
- 3 cups of Taste of the Wild Salmon
- A teaspoonful of Welactin
- 1 Super Joint Enhancer tablet (here: http://www.1800petmeds.com/Super+Joint+Enhancer-prod10496.html)
- Pill pockets
- Other dog treats, like a jerky treat and dried chicken strips
- Epi-otic cleaning twice a day for her ears; I squeeze the solution into a cotton ball, and then squeeze it into her ears.

Do you guys also think rinsing her ears out would be a good idea? Her last dose was 6 drops in each ear of Mometamax on October 4th. On October 8th, the vet said he could still see some of the medication inside her ear. If so, what would I rinse it out with? Tomorrow I am planning to clean her ears with epi-otic.

Thanks.

[CherylC]

And yes--
By checking email records (it's very creepy)... I FIRST started noticing a really thick blood vessel on her belly around June 19 (when I sent an email asking about this) that I was concerned about, and a few days later brought her in and the vet said her belly was distended and she suspected Cushing's. Then June 25 I have another email I sent asking about Mometamax and she said:

"Go ahead and order the 30 g size for Rose, since I may have you use it at a maintenance dose once her treatment course is completed. Instructions for use are : 6-9 drops in each ear once daily for 10 days. After that time, you can use it once or twice a week after you clean the ears.

Continue to clean the ears once a day, and wait until the ear canal is dry before applying the Mometamaxx. After the 10 day course of treatment, you can clean the ears once or twice a week, and apply mometamaxx once or twice a week."

And since then, I had been cleaning her ears twice a week. So it's been 3.5 months.

And yes, her symptoms did increase rather dramatically in the past 3 months, while she was on Mometamax...

[zoesmom]

Hi Cheryl-

Based on the date on your first post, it looks like Rose was diagnosed prior to Sep. 10 ???? And the results you just posted are from her first ACTH and bloodwork after starting on trilo. Since it sounds like there's a possiblity of iatrogenic cushings from the steroidal ear med, what tests were done by your first vet to diagnose the cushings. Maybe an LDDS and/or an ACTH? Just wondering how the vet came to make the diagnosis and what symptoms you'd been seeing in Rose prior to the diagnostic testing. She could very well have regular cushings but if you could post those original diagnostic test results, that would be a help. Best thing for now, as already mentioned, would be to hold up on the trilo until you know for sure what the cushings is. The u/s did say enlarged liver and adrenals and I'm not sure if iatrogenic cushings causes that much effect. But if it' is iatrogenic, stopping all steroids should take care of things.

Regarding the ear med, I'm not familiar with that particular one, but ffrom what other members are saying, it sounds like it has gentamycin in it???? If it does, that is what can cause the deafness. I learned firsthand when I was putting antibiotic drops in my Zoe's ears and she went deaf in a matter of a day or so. I was furious that the vet said nothing about that. She claimed that she looked at the eardrums and neither were perforated and yet, Zoe went deaf. By the time I figured out what was going on, she'd had about 3 or 4 days worth of the ear med. Sooooo.....went back and saw our IMS next (not the one who rx'd the gentamycin) and I asked about getting Zo's ears flushed out to get rid of any lingering ointment and she advised against it, saying that that could force the medicine further into the ear and do more damage. She didn't believe me about the deafness at first, but I said it's online and in the med brochure and she did a quick experiment and realized that Zoe was indeed deaf. So we didn't flush the ears, just to be safe. Then I did some research and read that aspirin can counteract the gentamycin effect (i.e. if given along with the ear med.) It didn't really say it could reverse it, once the damage was done. But I was so distressed about the needless damage that I gave Zoe 1/2 aspirin per day for a week or two. I'm not recommending you do that on your own though, as aspirin can be risky for cushings dogs. But if it turns out Rose has iatrogenic, maybe something to ask vet about.

Long story short, Zoe's hearing never really did get much better. It seemed to come and go after that, and when it came, it was very minimal at best. Loud noises was about all she could hear. That would cause her to turn her head, but it was like she wasn't real sure where the sound was coming from. In fact, I can't be sure she wasn't just feeling vibrations in the air, rather than actual sound. I ended up teaching her some sign language. I know Zoe took those same type of ear meds when she was younger with no problem, but I think the older dogs or dogs with compromised health may be the ones at greater risk. But still......not one word of caution from the vet.:mad::mad::mad:

Just one other thing I noticed. Rose's blood glucose looks out of range - high - on that 9/21 test. Did vet say anything about that? I hope maybe one of our diabetes-familiar people will take a look/see and comment on that. Was that tested any time before 9/21? Symptoms can be similar to cushings. Sue

[CherylC]

Oh, yes, here are the dexamethasone suppression results from 8/31/2010:

Same deal: Test/Result/Reference Range

Pre dexamethasone / 5.0 / 1.0-6.0

Post 4 Hr Dex / 5.7 / Less than 1.5

Post 8 Hr Dex / 8.7 / Less than 1.5

So, the dex suppression test and the ultrasound were all the diagnostic tests run before starting Rose on the Trilostane on 9/9/10.

When you first began dealing with Cushing's Disease, did people stay with their vets or go see Cushing's specialists? I'm wondering if that would not be the best route, but I hear they are extremely expensive. My current vet discusses the test results with a Cushing's specialist, so that should be enough, I guess, but I'm not sure.

If someone could read over the supplements/treats that I'm feeding Rose in the previous post and alert me to any possible red flags, I would really appreciate that.

Thank you.

[CherylC]

Zoesmom--

No, she did not say anything about diabetes. I'd faxed over all her test results to my new vet and he has supposedly looked over everything, but he didn't mention anything about diabetes either.

Looking over the results, yes, her glucose level was tested on 8/10/2010, and it was 128 (range 60-125).

Then the time before that was on 1/26/2010, where her glucose level was 101, within range.

So it looks like her glucose really shot up in those 7 months... can diabetes cause that spike? I will call my vet tomorrow and ask him what he thinks about this.

[lulusmom]

Hi Cheryl,

Looks like you've got Rose on a good quality high protein food so that's good. Most dogs absolutely love pill pockets but make sure you get the kind with no grains. The regular ones are loaded with wheat and dogs with allergies may not do well with them. Everything else looks fine but I would caution you about any dog treats made in China.

[Harley PoMMom]

Zoesmom--

No, she did not say anything about diabetes. I'd faxed over all her test results to my new vet and he has supposedly looked over everything, but he didn't mention anything about diabetes either.

Looking over the results, yes, her glucose level was tested on 8/10/2010, and it was 128 (range 60-125).

Then the time before that was on 1/26/2010, where her glucose level was 101, within range.

So it looks like her glucose really shot up in those 7 months... can diabetes cause that spike? I will call my vet tomorrow and ask him what he thinks about this.

My boy Harley's glucose levels are normal one time and then the next time they are high BUT on his urinalysis, glucose is always negative. I just had this conversation with Harley's vet as I was concerned too with his fluctuating glucose readings. Harley's vet told me she was not too concerned about his glucose unless it gets at least in the 200's or if it shows up in his urine. She said if it would show up in the urine then this is definitely something to be alarmed about and we would need to address this immediately.

[CherylC]

Thank you Harley PoMMom,

I do have the results of a "Senior Screen" done on 8/10/2010 as well, and it included a urinalysis:

Collection method: Free-catch
Color: Yellow
Clarity: Cloudy
Specific gravity: 1.014
Glucose: negative
Bilirubin: negative
Ketones: negative
Blood: Negative
PH: 7.5
Protein: Trace (<100 mg/dL) / Negative-Trace
WBC: 0-2 (Range 0-5 HPF)
RBC 0-2 (Range 0-5 HPF)
Bacteria: None Seen
Epi Cell: 2+ (3-5)
Mucus: None Seen
Casts: None Seen
Crystals: None Seen
Other: Amorphous Debris
Urobilinogen: Normal

So, in your experience, this negative glucose in urine is okay? I will still call and ask the vet tomorrow, but I am a little less worried now.

[Franklin'sMum]

Hi Cheryl,

When we first began this journey, I stayed with my vet. Reading about cushings diagnostics, I questioned him about why we weren't doing things the usual way, and he told me that the "cushings guru" said this is the way they're done. I questioned some more, and was told the same thing. I got to the point where I thought that maybe the internet was out-dated with it's info.
Then I found this group, and I realised my vet didn't have a clue, and his "guru" (upon googling her) is a cat specialist :EEK: (not that there's anything wrong with cats). She had been doing everything her own way, instead of following the correct protocols. (The internet was right, and this group is fabulous!! They educated me, and taught me to question everything, and helped me save my sweet child).
Realising we needed someone who knew what they were doing, I phoned vets within an hours drive, enquiring about their cushings/ trilo knowledge and experiences. I had an appointment with one (who I was going to have consult with regular vet about Franklin's treatment). At that point, we then got a referral to a University vet school for an ultrasound. Our doc there wasn't an IMS, but she has a diabetic cush pup herself, and I was much more comfortable with her making decisions and recommendations for us. Even regular vet said "If I say to do this, and she says to do that, ignore me and listen to what she says". So that was great, and then this year we went to a specialist centre, to an IMS.

Franklin has had glucose in his urine for the last few months, and regular vet said he's not concerned, but would be if there was elevated glucose in blood work.
Last blood work showed slightly elevated glucose. I rang him to ask about further testing re : diabetes, and he said "oh, I hadn't even noticed that, good catch. Probably nothing to worry about, it's only a little out of range".
So, we changed vets, and now have somebody involved in Franklin's healthcare.

Only you know if your vet is engaged in Rose's treatment, or if he/she is willing to learn and keep up. Sometimes a gp just can't keep up, they have hundreds, if not thousands of other patients, and a multitude of health conditions to keep in their heads, and can't keep up with the research and treatment options for each individual condition. Some don't like to be questioned, and really, I think that some just can't be bothered. We've left our vet of 5 1/2 years, and some have left their vets of 20+ years. It's not really answering your question, but you know you, and you know Rose. The question that I think you need to ask yourself is, are you comfortable with his/her treatment and diagnostics of Rose?

I hope some of this is helpful to you,
Jane, Franklin and Bailey xxx

[CherylC]

Update:

So I just spoke with Rose's vet and he said to up her dose to 90 mg trilostane.

I mentioned if the test results were not valid due to mometamax use, and he said that I did not use enough for it to be invalid. And then he talked about iatrogenic cushing's and how that is usually caused by ear or eye drops, but that usually you see a shrinking of the adrenal glands, whereas Rose's are enlarged.

Then I mentioned the high glucose levels and he said that it was elevated but usually not diabetes unless they're in the 300s or 400s. Now I know someone else said their vet said it had to be in the 200s to be worried about, so maybe someone with a more definitive knowledge of diabetes can chime in here.

I don't know if anyone else experiences this, but in answer to Franklin'sMum, so far, I feel okay with his treatment, except for the fact that I always feel rushed when I'm talking to him, especially on the phone. It probably has to do with the fact that I stutter, but I just don't think it's fair of me to have to feel rushed when asking him questions about Rose, especially as a new patient. He was recommended by two of my friends, and I trust their judgment, so I dunno...

Oh well, hopefully we'll see improvement with Rose as the mometamax is stopped and the trilostane increases. I'm going to ask him the name of the Cushing's specialist, though, the next time I see him, which will probably be in a month for her next stim test. This last time, the front desk insisted on the office visit before the stim test, but hopefully that was just a first time visit thing. I don't think it's necessary for me to pay $44 just to ask him the name of the specialist; I could just call him (or, as they do it, ask the secretary, and she will ask him or ask him to call me back.)

My old vet recommended that I wash Rose's stainless steel food bowl with dish soap and hot water every day, because of the sore on her lips. Does this sound alright to continue to do?

Thanks!

[zoesmom]

Hi again Cheryl -

I'm not too familiar with glucose #'s indicating diabetes, but since she was above range, thought it would be a good thing to ask about. I'd trust what the vet said since Rose's blood glucose was only slightly elevated (not that close to 200 or higher) and since she isn't spilling glucose into her urine.

Also, I tend to agree with what he is telling you about the iatrogenic vs. regular cushings because in iatrogenic, it sounds like the adrenals will atrophy:

from
http://www.lbah.com/canine/cushings.htm

"The level of cortisone that results from this exogenous use will cause the adrenal glands to atrophy. The negative feedback loop tells the brain there is plenty of cortisol in the bloodstream, so the pituitary secretes less ACTH. The pet has the symptoms of Cushing's because cortisone is being introduced into its body, not because the adrenal glands are producing it in excess amounts."

Rose's u/s showed that hers were bilaterally enlarged, so more indication it's regular PDH.

Unfortunately, the ACTH is the best test for distinguishing between iatrogenic cushings and regular and Rose had the LDDS.

On the ACTH:
This test is very specific for Cushing's, so false positives are rare compared to other screening tests. It is not as sensitive as other screening tests, particularly the LDDS test. For this reason it is sometimes used in combination with the LDDS test.
This is the only test that can distinguish between iatrogenic and naturally occurring Cushing's. It is the only test that gives reliable results for a dog that has been on cortisone recently. It does not distinguish between pituitary dependent (PD) and non-pituitary dependent (AT-adrenal tumor)."

Sometimes the exogenous ACTH will also be used to determine if it's iatrogenic. But at this point, she's already been on tx and to get anaccurate read, I suspect (pure guess) that she'd have to go off the drug for awhile before doing either test with an eye to determining if it's iatrogenic.

Plus, she was only getting the drops twice a week, right? So I think the original diagnosis is probably correct. The LDDS was definitely positive. So unless she wasn't having any symptoms prior to starting the steroidal ear med, then I think it's onward and upward.

Is she currently on 60 mg once a day? The increase in dose does appear to be warranted based on those last acth #'s. However, we usually like to see dose increases held until after the second ACTH at 30 days because the numbers can continue to drop for those first few weeks. We've seen it happen many times where a dog's trilo is upped after the first ACTH and then trouble develops and you have to back down on the dose again. So just watch her very closely with that new dosage and if she shows any signs of something amiss (not eating, lethargy/weakness, diarrhea, vomiting), stop the trilo and call the vet. Did the vet give you prednisone which can be given in to counteract the effects of too much trilo. (Ironically, a steroid, like those ear drops :rolleyes:) True, for a trilo dog the goal is to have that post ACTH # between 1.5 to 5.5 ug/dl ...... or up to 7-ish, IF the symptoms have resolved. But 10+ is definitely not in the therapeutic range yet. Still, it's close and you don't want to overdose her, if you can help it.

I don't think you need to see an IMS at this point - if your current vet is consulting with a specialist. And he does seem to have a good handle on everything that you've discussed with him. So hopefully, Rose will be back to normal soon and you can take a deep breath and relax! Sue

PS - more on iatrogenic (using the endogenous ACTH - which is different from the typical ACTH):

"Iatrogenic: Dogs with signs of Cushing's Disease due to excessive or prolongued administration of corticosteroid medications will have little or NO stimulation when challenged by exogenous ACTH. This is one of the few methods to ascertain whether a dog actually has Iatrogenic Cushing's Disease

[CherylC]

Thanks zoesmom; I do feel good about his knowledge of Cushing's and the fact that he is consulting with a specialist (my other vet did no such thing). But I am still just gearing myself up to live with a few more months of apprehension as we see how she responds to treatment.

---

Here are the results of her 10/09/10 (second) stim test:

Cortisol Sample 1: <0.7 (Low) Reference: 1.0-5.0

Cortisol Sample 2: 8.4 Reference: 8.0-17.0

The stim tests are every 10, 30, and 90 days right? Or is it every 60 days as well? The vet wants her to go in a month from now, which will be 70 days since beginning treatment...

[littleone1]

Hi Cheryl,

I just wanted to comment on Rose's post test results. The 8-17 range is for healthy dogs that are not being treated for Cushings. The normal range for dogs being treated with Trilo is usually not above 6. That's why your vet increased her dosage and wants to do another test in 30 days.

The testing schedule varies. If a dosage is increased, a stim is done after 30 days. If the dosage remains the same, the test is done after 90 days. Even though the dosage might remain the same, if any Cushings symptoms start surfacing, then a stim test is done sooner. Dechra recommends a dose increase when the post stim is 5.4.

There are times when Corky was to have his stim in 3 months, but he didn't make it that long, as he started showing symptoms.

I hope the new dosage helps Rose.

Terri

[zoesmom]

Hi Cheryl -

So now you've actually had the second acth test (last week, it looks like) and Rose's numbers are headed slowly downward. But they are still slightly above where they should be, so the dose increase does make sense.

How are her cush symptoms, though? If they are subsiding already, then she may not need those numbers too much lower. Some vets are happy if the numbers are down around 5.5 - 7.5 (IF the cush symptoms have resolved.) And actually, my cush girl Zoe did much better overall when her numbers were in that slightly higher range (rather than the 1.5 - 5.5 which is the ideal goal). But each dog is different so, most of all, you should go by how her symptoms are doing. It could be, if they've improved alot, that the 90 mg might be a little more than she needs. But that next acth will tell you that. So GOOD LUCK Rose!!! Let us know how she's doing in the coming days. Sue

[CherylC]

Her Cushing's symptoms have been weird. Shortly after she first began medication, I noticed a decrease in her panting and she was no longer having accidents. Then, after 10 days or so, her panting came back more. More recently, she has begun having accidents in the house again, but her panting is better again.

I don't know if I'm imagining things, but her belly size looks a -teeny- bit smaller, but still very distended. Her belly is the thing that worries me the most right now, as the skin is easily bruised and torn. Her ears are still quite red due to allergies (what we're going to do about it, I have no idea; my new vet just said it's allergies and left it at that, my old vet prescribed the mometamax, which I'll probably never forgive her for.)

Any other cush symptoms I'm not covering? I don't know if this is one, but the skin on her nose is very dry, with little bumps. I use bag balm on the cracks on her feet and thought it might work for her nose, but she'll just lick it off her nose, so that isn't a good idea. The vet's calling me back tomorrow and I'll ask him about that.

Cheryl

[Harley PoMMom]

More recently, she has begun having accidents in the house again, but her panting is better again.

Our cush-pups are prone to UTI's, does her urine have any odor to it, is there any blood in it, is she straining to pee?



Any other cush symptoms I'm not covering? I don't know if this is one, but the skin on her nose is very dry, with little bumps. I use bag balm on the cracks on her feet and thought it might work for her nose, but she'll just lick it off her nose, so that isn't a good idea. The vet's calling me back tomorrow and I'll ask him about that.

Cheryl

My boy Harley's nose is sometimes dry, I apply vaseline to his nose! I believe this dryness is attributed to his high blood pressure and that maybe he is alittle dehydrated. Has your vet checked Rose's blood pressure recently?

Love and hugs,
Lori

[CherylC]

Harley PoMMom--

I had considered vaseline, but laid off it because I was afraid Rose would lick it off and ingest it. However, I am now reading that plain vaseline is not harmful to dogs. I have the "Vaseline Deep Moisture with Vitamin E," so I don't know if that would be safe as well. The active ingredient is White Petrolatum USP (30%). And there is a warning that says "if swallowed, get medical help or contact a Poison Control Center right away", so that doesn't sound good.

If you have your regular vaseline lying around, can you tell me what the back says?

Oh--and inactive ingredients is a whole bunch, including stearic acid, glycerin, glycol stearate, cetyl alcohol, and just a whole mess of stuff =(

Has anyone heard of "Snout Soother"? I'm reading about it online, and it sounds like it's worth trying, and non-toxic if licked off.

[Harley PoMMom]

Harley PoMMom--
If you have your regular vaseline lying around, can you tell me what the back says?


White Petrolatum USP 100% it comes in a little tube and it is what I use on my lips all the time! :p:) It's actually called "Vaseline lip therapy."

[zoesmom]

How about pure lanolin, like breastfeeding moms use for dry, cracked nipples. You can buy it in the baby section at drugstores (Lansinoh, I think). Even though I think they recommend that mothers wipe it off before feeding baby, I'm sure it's impossible to get it all off (very tacky, sticky) so ingesting a little bit can't possibly be that bad. After all, babies!!! It's a natural product which comes from sheep and it does wonders for nipples!! :p:eek: Only thing I'd be concerned about is those bumps - in case it's like a fungal infection???? or something that might require actual medication? Sue

[gpgscott]

Hi Cheryl,

I would not use any combo type product such as the one you have cited. I like the idea of the lanolin because a thin layer will probably help a lot and may be harder to lick off than vaseline which smears easly when warm.

I don't have a container of bag balm here to refer to it but I remember a distinctive smell it has which would lead me to think it has additives you do not want Rose to be licking up.

Scott

[CherylC]

Thank you, everyone. I think I will just leave it alone until I can get a call in to my vet. I also will probably bring her by for another exam as there is a dark brown spot on her belly that looks like a bruise or something, but some of her fur is sticking to it, which makes me suspect something more ominous, like blood. I've only noticed it after she came back from the groomer's. I did tell them to be extra careful around that area, but who knows what might have happened.

It also looks like the area is getting infected again (a lot of really pink, almost red spots, which my old vet said are infections).

Another thing is that I did not do a good job of gauging how much medication she had left and now I've run out of medication, so she is back on 70 mg for a few days until the medication arrives. I feel really bad about this, but it took longer for the vet's office to get the prescription in than I thought it would. Things should go easier in the future as I can just order refills and not need a prescription... unless the dose changes again. I'm juggling with 10 mg, 60 mg, and 90 mg pills. (Actually, with 9 mg pills, as the compounder does not carry 10 mg--that's basically the same, right?)

[CherylC]

Hi everyone,

So far, things have been pretty steady with Rose. She is due for her third stim test next week, and she's currently on 90 mg of trilostane, so we'll see if that needs to change at all.

I was wondering what foods you all feed your Cushingoid dogs. I currently feed her Taste of the Wild Salmon on the recommendation of my old vet, but she's been eating that for 6 straight months now and seems to be getting sick of it. Taste of the Wild does have two other flavors, so I am thinking of alternating between those, but I also remember my vet saying that the omega fatty acids in the Salmon flavor would be particularly good for her. Or, I can even alternate with a different brand altogether.

So yeah... just wondering what other Cushing doggies eat! =)

[marie adams]

Hi Cheryl,

I feed Maddie a raw chicken diet by Northwest Naturals--it has vegetables and fruit mixed in. I have dry from California Naturals-Venison that I give her for treats. I had read that a Cush dog shouldn't have grains in their diet nor beef and if they were in the wild they would be eating small wild life that had eaten greens--which would be in their stomachs chewed up. She has done very well on this diet, but I do give her fish oil, flax seed oil, Vit C, condrontin/gluesomine (sp.), she eats blueberries, and the most favorite of all is her yogurt. When she was having issues with her skin being flakey and her fur looked awful from losing soooo much of it--I started the flax seed and yogurt. I read yogurt was good if they have hot spots on their skin which could be a yeast infection---I had noticed stuff in her ear that had not been there before and read this could be a sign of yeast--so started the yogurt and she begs for it now after she eats her regular meal. So spoiled....:D:D

I hope this helps.:):)

[littleone1]

Hi Cheryl,

Corky eats home cooked meals. All of the meats he eats are at least 93% fat free. He eats ground beef, ground turkey, and boneless, skinless chicken breasts, which are cooked and then rinsed off. He also eats rice, unsalted greenbeans, lowfat plain yogurt, and pumpkin or sweet potatoes. When he takes his evening dose of Trilo, I wrap either a piece of low fat ham or turkey breast around it.

I'm glad to hear that Rose is doing good on the Trilo.

[Franklin'sMum]

Hi Cheryl,

Keeping fingers and paws crossed for a good result, and hope that this dose works for Rose. Franklin is transitioning to homecooked (mainly fish and sweet potato), nice and low fat for him - cush pups have an increased risk of pancreatitis. Any tablets he has (melatonin, heartworm, blood pressure) he gets in a little piece of low fat ham, also.

Hope that helps,
Jane, Franklin and Bailey xxx

[CherylC]

So these are Rose's ACTH stim test results for 11/10/2010:

Pre: 2.6 (Range: 1.0-5.0)
Post: 9.8 (Range 8.0-17.0)

The vet said that her post is still too high, so now we've upped the trilostane to 110 mg. Did any of you experience this with your dogs when finding the right dose? At what point is it reasonable to consider trying an alternative, like Lysodrene or something? Also, the 9.8 is much higher than what it was last time--does this mean she's actually getting worse or are we making some improvement?

Also, I mentioned this to my vet but he said it was nothing to worry about, as her skin is "very bad" right now--she's got these weird things that almost look like welts on her back (underneath her fur), but they are flat. They're an pink/orangeish color and look a little scabby. She doesn't seem to notice at all when I press on it or rub my hands over it. Has anyone else experienced this with their dogs?

Thanks,
Cheryl

[Sabre's Mum]

Hi Cheryl

Sorry I have been busy over the weekend and saw your post but I didn't have time to answer.

I was a Lysodren Mum so can only comment on the results and ACTH test results based on the Dechra product insert which is here in the Resources. From this it says that - if the post is >5.4 to 9.1 to EITHER: Continue on current dose if clinical signs are well controlled. OR: Increase dose if clinical signs of hyperadrenocorticism are still evident. (I see that ZoesMom has given you great guidelines in previous posts).

It sometimes does take a few adjustments to get the right dosage and this can be the case for both Trilostane and Lysodren. If it were me, I would continue on with the Trilostane ... Rose has only been on Trilostane for a few months and you nearly have her there.

With regards to the welts ... it is sometimes quite hard to give you a definitive answer with "words" as descriptions but are these welts firm and appear to break through the surface. Sometimes cushings dogs are suseptible to skin infections but they can also have a condition called calcinosis cutis. It is not a common symptom of cushings and many vets have never seen a case in their practice.

Here is a link to a photo of calcinosis cutis in the early stage before it breaks through and forms a scab. http://en.academic.ru/dic.nsf/enwiki/531289

If you search the internet you can find other pictures but I wanted to show you one that hadn't become scabby as sometimes the scabby pictures look nothing like it is when it first starts. Sabre, our Hungarian Vizsla, had calcinosis cutis before he was finally diagnosed with cushings. Once treated with Lysodren, and with his hair fully grown back, they never seemed to annoy him unless his cortisol levels were too low and he became very itchy. If you do think it is calcinosis cutis I can give you some links that can give you some more information.

All the best and take care
Angela and Flynn

[zoesmom]

Hi Cheryl -

Don't know about the welts but can comment on the dose adjustments. In some dogs, this can be normal. Especially since Rose is big and was started at a reasonably modest dose. As I've mentnioned, my Zoe was 80-85 lbs. and the dose adjustments were frequent. Basically, after she was settled on trilostane, we had very similar acth results and then we'd have to adjust her dose up slightly. It seems like in the first couple years she went from 120 mg, to 150 mg, to 180 mg, and then we toyed with various twice a day combos, etc. depending on her acth tests. It wasn't unusual for her acth tests to go from around 5 or 6 to 9 or 10 - once it rose to 13 or 14. Those results were always followed by a dose change. Also a couple of times, we actually had to adjustherdose downwards. So for us, it was a constant roller coaster ride. Finally in her last year anmd a half or so, she stayed at 180 mg twice a day with good control (I feel that may have been due to another medicine that we added for another condition - IBD and SIBO).

Not that all dogs will be erratic. Maybe Rose just needs to edge up to her optimum dose and then her acth results will drop accordingly and stay fairly consistent after that. For sure, I wouldn't recommend changing drugs at this point. That's not an easy move - requires a a washout period of no drug and a return of symptoms. Anyway, she's close to being controlled on the trilostane. So hopefully, this new increase will bring her down to below 7.5 (the suggested top end of the range for a trilo dog) and she will stay there!

More important are her symptoms. Some dogs whose symptoms are being controlled can get by with acth #'s in the 8 or 9 range. So that's something to consider. If you're happy with how she's doing and she's happy and comfortable, maybe she's ok where she is. Sounds like her skin not quite there yet, tho.

That 110 mg. isn't a real big leap, so if you've simply added 20 mg caps to the 90's, then you can give or withhold them depending on how she seems to be doing in the future. Or you may have to add even a little more - like another 10 mgs (for 30 total) down the road. Obviously, it's cheaper to buy a compounded capsule in the exact strength needed, but until she settles in (and that could take a few more months) then I suggest doing a basic dose (in her case, the 90 mg) with additional smaller dose capsules to add in or hold back for minor dose adjustments. Gives more flexibility that way, like mix and match!:p She's still early on in tx, so just be patient. I think she'll get there soon. Sue

[CherylC]

Thank you for your responses.

I will take a picture one of these days of her skin welts and also her belly--she's had a few skin tears on her belly recently, and it kept getting infected, and then got better, and got infected again. She's on 300 mg of Simplicef and I'm putting Neosporin on it twice a day. Before that, she was on 400 mg of another antibiotic that made her lose her appetite so we stopped it.

Her pot belly is also still quite large, although slightly smaller than it used to be (but I can't be sure; maybe just wishful thinking.)

The vet has said to not worry about her skin just now; he seems to think that getting the Cushing's controlled is the most important thing, and that the rest will more or less follow or that we will deal with that later. One GOOD news is that the open sore on her lip (her tooth always gets caught on it, reopening it) has -finally- closed up. Both sides of her lips are still a bit swollen, but it seems like her body's natural healing powers are finally doing their job.

She also seems to be drinking a bit less water than she used to, and she hasn't had an accident in about a month. Even when she was drinking a lot, though, her accidents were not that frequent--perhaps once a week or less. The main reason we brought her in and suspected Cushing's was her pot belly and panting. Speaking of, her panting has improved as well; she used to pant just lying on the floor, resting. Now, she still pants more than is appropriate after she goes on a short walk, but she seems more comfortable otherwise. So, I guess symptoms like that are surely but slowly improving; for some reason, though, I am fixated on that pot belly, as it obviously weighs her down and causes her to waddle while she walks.

[CherylC]

Here are her 12/11 ACTH results:

Cortisol Sample 1: 0.8 (Range: 1.0-5.0)
Cortisol Sample 2: 6.8 (Range: 8.0-17.0)

The doctor seemed happy with these results and we are staying at 110 mg for now. Her next test will be in 3 months.

On another note, we are now focusing on her hypothyroidism, which the doctor is not even sure if she has or if it's just a side effect of her Cushing's. However, she has been on Soloxine for almost a year now and the vet does not want to take her off it. Does anyone know anything about whether or not it is possible to get a dog off Soloxine should we suspect that she does not actually have hypothyroidism? Or know of any forums or helpful resources for owners of dogs with this condition?

Thank you so much; I am so glad to have found this forum and I feel so much better and relaxed about the way her treatment is going now.

[littleone1]

Hi Cheryl,

Rose's post stim reference range of 8-17 is actually the range for dogs that aren't being treated for Cushings. With those that are taking Trilo, that range is somewhere between 1.5-5.5. Corky's last post was 7.3, and his IMS is also keeping him on the same dosage he was taking.

When did Rose last have a thyroid test? If it hasn't been recently, you might want to have it done so you could see her numbers since she's been being treated for Cushings. Corky has had hypothyroidism for over 10 years. I'm not sure about not giving Soloxine after a period of time. The best person to answer your questions would be Dr. Jean Dodds. She is an expert in this field. Her phone number is 310-828-4804. You can contact her M/T/F from 10 A.M. -6 P.M. Pacific Time. She has also provided advice to our members whose dogs have hypothyroidism. She also has a website. I hope this helps.

Terri

[lulusmom]

One of my cushdogs was diagnosed with hypothyroidism at least a year before she was diagnosed with cushing's. She's been on thyroxine since 2004. When she was diagnosed with cushing's we thought that perhaps the low thyroid would correct itself with cushing's treatment but unfortunately, she was truly hypothyroid and continues to need her thyroid supplement. Your vet can easily do a test to check Rose's thyroid levels. If she is doing well at the moment and all of her symptoms have resolved with cushing's treatment, chances are she is truly hypothyroid. If her thyroid is normal, the soloxine will probably eventually make her "hyper"thyroid and hyperthyroid dogs always have pu/pd (Excessive drinking and urination). Is Rose's water intake normal now?

[CherylC]

She got a T4 Post Pill test on 12/23/2010 and her results were 2.8 (Reference Range 3.0-5.0). That's lower than the range, but the vet said this was at a good level for her, so we're keeping her on 0.7 mg of Soloxine, which she's been on for close to a year.

I suppose this proves that she is truly hypothyroid, as the medication has not made her hyperthyroid.

Her water intake is pretty normal--she tends to drink a lot after she eats and hardly any water in between.

By the way, I'm curious as to what you guys use to treat your dogs' ear infections? I used to give her Mometamax but due to steroids and loss of hearing, I stopped that. Now, she has a little brown stuff coming out of her ears, and they have always been pretty inflamed. He gave me Tresaderm to use and said there are no steroids, but the ingredients say there's corticosteroids. I am also quite annoyed b/c he didn't tell me they needed to be refrigerated and they were holding it for me at the vet's for a couple of days and I don't know if they refrigerated it. He also way overcharged me for it, and I didn't have the presence of mind when he suggested it to say "I'll order it online; please tell me the name of the drops." UGH. It's just one thing after another.

Her Cushing's and hypothyroidism is under control, we switched to a higher quality food (taste of the wild), and her ears are *still* pink and inflamed-looking. At least they don't seem to bother her in the least bit. I've been cleaning her ears with epi-otic once a week and it's only in the last 2 days of the week where there's a smell coming from them.

Does anyone have experience with using Tresaderm? Or natural ear treatments like vinegar and water? I pitched this idea to my vet and he said the vinegar can sting the ear. I know people online have said they use mineral oil and vinegar to alleviate the sting. I definitely don't want her ears to sting, but I am worried about her hearing being affected again by Tresaderm, as it does have steroids in it.

[zoesmom]

Hi Cheryl -

As far as I know, it's not the steroids in ear drops that causes hearing loss - it's the antibiotic gentamycin. My girl Zoe lost hearing due to gentamycin. Steroidal drops, however, (either eye or ear) can affect a dog's cortisol levels and in a cushings dog, you don't want that. Not sure if the steroid effect is significant enough to worry about unless the dog is on steroidal drops for a longer period of time. Short-term may not be much of an issue. But if Rose has an ear infection, there are other antibiotic drops that can be used and which do not contain gentamycin. As for the steroids, if her ears are badly inflamed inside, sometimes we just have to bite the bullet and use things like steroidal drops cautiously and on a limited basis.

But personally, I will never again use any drops that contain the antibiotic gentamycin - on any dog, young or old. They say it only causes trouble if their eardrums are perforated. Not sure I agree as Zoe's eardrums were supposedly ok, But within a day of starting them, Zoe lost her hearing. Interestingly, she'd taken the gent. drops in her younger days with no trouble so I think it is more apt to cause problems in the older dogs, espeically those with other health issues - like cushings, for instance. But why risk it????

Maybe oral antibiotics would be an option for Rose if it's an ear infection? Andn then just flush the ear canal with something safer, just to keep them clean. I'd ask. Glad her #'s are coming down. Those last ACTH results are really very good, if you feel like her symptoms are now well controlled. :) Sue

[zoesmom]

Oh, I also meant to comment on the thyroid. That 3 -5 range on the T4 test is on the higher side than what I've usually seen. Our lab results usually gave a normal range of around 1 - 4. So 2.8 would be ok. However, with Zoe, her thyroid level was always in flux, just like her cortisol level and trilostane doses. She was dx'd hypothyroid about 3 years before theh cushings dx. And over the years, her doses varied from .2 to .8. She started at the higher end and actually did become hyperthroid from too much thyroxine after starting on trilostane. You should become familiar with the signs of hyperthyroid and if you suspect that something's off, then get the vet to do a T4, even if it's not time yet. We did them every 3 mos. for quite awhile, but eventually went to every 6 months. Towards the end, Zoe stayed fairly level on thyroxine at .2 mg.

The other thing is timing. The test should be run at the same time after dosing - every time you do it. If it's 4 hours post-pill, then realize that the thyroid level will continue to drop until the next dose is given. In that case, you wouldn't want them to be at the very low end of the normal range and still have 8 hours to go. Our vet liked to see Zoe's T4 results between 2 at the lowest and up to 4, or even slightly higher, for that reason. But 2.8 seems decent and I wouldn't worry unless it goes down around the low 1's at 4 hours post pill. But again, also be on the alert for signs of too much thyroxine (like artificially induced hyperthyroidism). Zoe became really really restless and edgy when her .8 dose first became a problem. I didn't know that's what it was at the time, but I took her in and, sure enough, the test showed that she needed a dose reduction. Sue

[littleone1]

Hi Cheryl,

I also have not seen that reference range for hypothyroidism. Corky's range has been 1.0-4.0, or 1.0 to 4.7. These have been the ranges for over 10 years.

When Corky has ear infections, he now has to have a special cleaning solution and then I use Otomax, which his vet assures me is safe to use for our cushpups. Corky gets both bacteria and yeast infections in his ears at the same time. Most of Corky's hearing is gone, but I don't believe it was the medications. I believe this is due in part to his age and also because of all of the ear infections he's had.

I'm glad that Rose's Cushings and hypothyroidism are under control.

Terri

[CherylC]

Well, just as we're getting her Cushing's under control, I received some very bad news just this evening.

Rose had been limping for 2 days, so I took her in to the vet today who took some x-rays and discovered bone calcification in both her right and left legs. He said it is caused by severe Cushing's and that it will eventually spread to her hind legs. He prescribed Tramadol, a pain medication, and said she will need to be on them for the rest of her life.

Even with the Tramadol, the loss of limping is not guaranteed. At this point, I just feel bad that she has probably been in pain for some time without my having any idea until she started limping. I also don't know how much of the pain Tramadol will relieve and how I will know she's no longer in pain if her limping does not decrease even with some relief from the pain.

Does anyone also have a dog who's on pain meds indefinitely or know of anyone? Or resources about bone calcification? Thank you.

[frijole]

Whoa. Sorry to hear this... I'm a little surprised. First off - caution on the tramadol and please trust me on this. It is very strong stuff and I gave it to my 16 yr old dog and it was the scariest night of my life. It is an opiate and the dog was walking into walls then standing in a corner with her face facing the wall. If that wasn't bizarre enough she kept pacing and I finally let her pace and went to bed. MISTAKE.

It causes diarrhea! I woke up at 2 am (thank God) and there were piles all over the living room floor. I posted here and come to find out every single one of us had to take the dose recommended by our vets and cut it in half. I don't know if its a cushing's thing or an age thing since alot of our dogs are elderly.

My dog Annie has extreme muscle wasting in her back legs and at times she could hardly stand, kept falling. The head of the animal science department at Kansas State Univ told me about a product that alot of vets are not familiar with called Duralactin. It is 100% natural (milk product) and is an anti inflammatory. The reviews I found online are very very favorable and there have been studies done on it.

No rx needed. I buy online and they are vanilla tasting tablets. My dog gets 1/2 in am and 1/2 in pm. I can TELL when she doesn't take them because the issues return. Much improvement seen in my case. Here is the link when I first discovered it.

http://www.k9cushings.com/forum/showthread.php?t=2635

The tramadol might manage the pain OK but I just don't want you to freak out if you have any of the side effects many of us had. I think there are members that have used it daily for their senior dogs but at 7 yrs old that seems extreme. Perhaps you could see a specialist?

Hope this helps a bit. Kim

[zoesmom]

Hi Cheryl - I have to second what Kim said about the tramadol. Zoe's vet prescribed what was normal for her size (80+ lbs.) - that was one to two 50 mg tabs.giiven two to three times per day. WAAAY too much for her. She was so out of it and I didn't even give her near that much. I don't recall any diarrhea from it though. We ended up giving her one 50 mg. tab per day - in the p.m. and one meloxicam (a non-steroidal anti-inflammatory) in the a.m. but that can be very risky with cush doggies as they are more prone to gastrointestinal problems with melox (any nsaid is not a good idea in cush dogs.) So we were very cautious giving that. But she took that combo for her last year or two for her legs and limping.

I'm wondering if your vet gave you an actual diagnosis (name) for the bone calcification? Because osteosarcoma can be one cause. I've never heard of severe cushings causing that but maybe someone else knows more about it. Sue

[CherylC]

Thanks for replying.

Rose has had 3 doses of 50 mg so far, spaced 8 hours apart, and has been more or less normal. She lies down a lot anyway during the day, dozing off or just staring at me, but when she goes outside, she does her normal business and even took a walk around the yard by herself today. Her limp has reduced a great deal; it is hardly noticeable anymore. The surprising thing is she has had no adverse side effects--no diarrhea, vomiting, unresponsiveness, dizziness, etc. She's a lot perkier than she was yesterday, actually.

The issue is, once school starts up for me next week, I have some night classes during the week and will not be home at the same time every night to give her the middle of the 8 hour dosages. I called the front desk at my vet and asked if I could give her a 100 mg dose every 12 hours instead, and they said it was fine.

That does sound like a lot, but on 1800petmeds, they say the dosage is 0.45-1.8 for every pound of the dog's weight. Rose is 77 pounds, so I'd be giving her about 1.2 mg per pound, which isn't over the prescribed limit. I think I might try just 50 mg every 12 hours first (cutting back), and if her limping worsens, I know she's feeling the pain again, and I probably need to give her more. I just wish I knew how much pain she was feeling and the dose she would prefer to take. Like, the vet told me it's more of a tight, achy feeling, but he still used the word "pain."

I mean, if she really were in a lot of pain, would she whine? She was probably in pain a while before she started showing the noticeable sign of limping, but she never whined or winced or anything. It just worries me that she may be feeling pain that I don't know about.

And no--he did not give me an actual name. He said he will consult with a specialist and then call me back, so I definitely plan to ask him then. It's really weird how there's almost no information online about treating bone calcification in dogs. That must not be the official name, because I can't believe it is so rare that no one has written anything about it. At least with Cushing's, it seems like there is definitely a community out there.

[Squirt's Mom]

Hi Cheryl,

I, too, have had a hard time finding anything helpful on the web about bone calcification in dogs. :confused: I searched off and on all day yesterday but couldn't find much at all. From what I read, it seems that calcification of bone or in soft tissue can have numerous causes and treatments....depending on where the calcification is and what is causing it. But that info was given for soft tissue calcifications, not bone that I could find. The only real references to bone, were in relation to bone spurs caused by calcification.

I think I would be contacting the vet for some clarification on this if it were me. Of course, I can be a bit of a pest when it comes to my babies. :o:p

Tramadol is the human drug Ultram. I am allergic to Ultram - it does me just like Kim described plus makes me vomit uncontrollably. Because of my own reaction to this drug, I have always been leery of giving it to my babies, tho I have used it. Ruby had to have it the last few months of her life and she handled it just fine. Squirt does not handle it well - she gets sick to her tummy, too. So just keep in mind that it can cause problems. ;)

Hugs,
Leslie and the girls - always

[zoesmom]

Glad the tram is helping her, Cheryl. If you're going to try a higher dose, give it a trial run while you can be at home with her and watch her reaction. She's about the size Zoe was so based on what's on Zoe's bottle of tram, her vet was allowing for up to 300 mg./day (see above). Of course, each dog will have a different threshold so......just take it slowly and see how she does.

I, too, searched for the bone calcification. Think I typed in 'canine bone calcification in legs' or maybe front legs. And most of what came up talked about the osteosarcoma and one other type of tumor. Maybe the specialist can shed more light on what it is, because I think it would be important to know if it is an osteosarcoma or something more benign. Hugs to Rose. Sue

[CherylC]

Ha my vet is so unhelpful... I asked him what the official name is and he said it was bone "mineralization". Wow, so much more detailed than "calcification". NOT.

After talking to an internal specialist, he says it's probably not Cushing's related and now says it's either hyperparathyroidism or cancer. We are running a full blood panel to test the amount of calcium in her blood.

I was a little confused at first because we just had her thyroid levels checked out and they were fine, but he says that parathyroid is something different and needs to be checked out as well.

So... yeah. We're just gonna have to wait for results and then go from there. Hopefully her pain is being sufficiently managed on the Tramadol (she acts like she normally does, pretty relaxed and mellow most of the time, so I can only hope the stiffness isn't bothering her too much).

[Squirt's Mom]

Hi Cheryl,

A few links for you to help you in your research:

http://www.peteducation.com/article.cfm?c=2+2097&aid=299

http://www.vetinfo.com/hyperthyroidism-in-dogs.html

http://www.petmd.com/dog/conditions/endocrine/c_dg_excess_parathyroid_hormone

http://www.vet.cornell.edu/labs/goldstein/

http://veterinarymedicine.dvm360.com/vetmed/ArticleStandard/Article/detail/615184

Hugs,
Leslie and the girls - always

[CherylC]

Squirt's Mom--

Thank you. I will give those a read.

[Squirt's Mom]

Mornin',

How is Rose doing?

Hugs,
Leslie and the girls - always

[CherylC]

Sorry, haven't checked in a while!

Well, the blood test results came back completely normal--no elevated calcium in her blood stream, and the vet said some other level had gone down (I forget which) that is usually associated with Cushing's disease, so that is still being kept under control, which is good. She's got testing again next month for that anyway.

As far as her physical symptoms, I think she's doing pretty well. I'm only giving her 50 mg of Tramadol every 12 hours and she seems to be holding up pretty well. I would prefer every 10 hours, but then that causes the feeding schedule to shift to weird times like 4 am, 6 am etc. Every 8 hours seems a bit much. So on every 12 hours, she is no longer limping. She does seem to be walking a bit stiff sometimes, but as far as I can tell she isn't in pain, as she sleeps very soundly at night and seems pretty relaxed otherwise. I don't know if Tramadol is something that the body will get used to and lose effectiveness over time, but I guess I don't want to overdose her now and not have it work for when she needs it even more.

So next steps are the vet is going to contact a specialist and discuss Rose's case with him, as he is not sure what is causing this. He says he has heard of calcinosis cutis which is calcium deposits in the skin, but that he rarely sees it in the actual muscle. Last time he said it was in the bone, so I'm not sure why he said the muscle this time. It didn't strike me as odd until just now, but he didn't seem to know what was going on so I'll wait for his call back after speaking with the specialist.

[Sabre's Mum]

Hi Cheryl

I have tried to do a quick bit of research for you with regards to calcification. I didn't strike much when searching directly for muscle calcification ... however I thought a little laterally and found something more directed at calcinosis cutis. http://books.google.co.nz/books?id=VKa2Wo3Wc-kC&pg=PA373&lpg=PA373&dq=calcinosis+cutis+calcification+tissue+dog&source=bl&ots=GbfCpbyB4g&sig=ayx3WUk3U4TExgMaOExOWQ82bpM&hl=en&ei=zT1PTemjLISkvgOV0uAZ&sa=X&oi=book_result&ct=result&resnum=2&ved=0CB8Q6AEwAQ#v=onepage&q=calcinosis%20cutis%20calcification%20tissue%20do g&f=false

I know when Sabre was diagnosed with calcinosis cutis I had read alot on the condition and found that calcinosis cutis can affect internal tissue in some cases. We did not do an ultrasound in the diagnosis stage and were always concerned about this internal issue but we decided that if it was going to be an issue Sabre was likely to indicate this. Amazingly, when he did have an xray a few days before he passed away ... the only calcium deposits were saw were the ones that we could visually see on his skin.

It would be good to hear the clarification from your vet.

All the best.
Angela and Flynn

[CherylC]

So Rose has been doing well on the 50 mg Tramadol every 12 hours, but I have been wondering lately if she even needs it, so I weaned her off it and she's been off it for a few days now, and there has been no limping. The one noticeable difference is that she has a VERY difficult time getting in the car now, even with steps. I'm calling my vet again tomorrow and asking him if he could refer me to the specialist he spoke to. I called a specialist nearby and they said they charge $175 for a first-time consultation. That's not something I can afford right now, if not completely necessary. I've been doing some more research and learned a new word: calcinosis. I'm wondering if this might not be the official term. I've also read about products like Duralactin and JointMax that seems to have helped peoples' dogs with joint inflammation. I am going to ask my vet if those might help Rose at all.

What will most likely happen is she will go back on the Tramadol and will stay on it for life. Even if I were to go see the specialist, I would have to get the x-rays from my current vet, and I don't want him to think I'm doing it behind his back or anything like that. I know it's stupid politics and stuff; I would switch from him if I could find somebody I know would be better. The specialist center has got great reviews on yelp but they don't have any regular vets there; I asked.

Anyway, she had a blood test done on 2/05/2011.

The vet did not discuss anything negative with me when he called me with the results; he only said he did not find elevated calcium, which was good. There are some high and low levels indicated in the blood test results itself, but I'm not sure what those levels are, so if anyone sees anything of concern, please point them out and I will ask my vet about it.

Total Protein: 6.0 (5.0-7.4)
Albumin: 3.7 (2.7-4.4)
Globulin: 2.3 (1.6-3.6)
A/G Ratio: 1.6 (0.8-2.0)
AST (SGOT): 14 LOW (15-66)
ALT (SGPT): 91 (12-118)
Alkaline Phosphatase: 98 (5-131)
GGT: 23 HIGH (1-12)
Total Bilirubin: 0.1 (0.1-0.3)
BUN: 18 (6-31)
Creatinine: 0.6 (0.5-1.6)
BUN/Creatinine Ratio: 30 HIGH (4-27)
Phosphorus: 5.3 (2.5-6.0)
Glucose: 133 (70-138)
Calcium: 10.3 (8.9-11.4)
Magnesium: 1.7 (1.5-2.5)
Sodium: 147 (139-154)
Potassium: 5.4 (3.6-5.5)
Na/K Ratio: 27 (27-38)
Chloride: 107 (102-120)
Cholesterol: 248 (92-324)
Triglyceride: 128 (29-291)
Amylase: 593 (290-1125)
Lipase: 525 (77-695)
CPK: 56 LOW (59-895)

CBC
WBC: 10.4 (4.0-15.5)
RBC: 6.0 (4.8-9.3)
HGB: 14.9 (12.1-20.3)
HCT: 46 (36-60)
MCV: 76 (58-79)
MCH: 24.6 (19-28)
MCHC: 33 (30-38)
RBC MORPHOLOGY: Normal

Differential/Absolute/%:

Neutrophils/8944/86 (2060-10600)
Lymphocytes/728/7 (690-4500)
Monocytes/520/5 (0-840)
Eosinophils/208/2 (0-1200)
Basophils/0/0 (0-150)

Platelet Estimate: Adequate
Platelet Count: 399 (170-400)

[princessdaddy]

I'm a new member. I live in the Bay Area Santa Clara, CA. I've been reading as much as I can. I would like to know how our Rose is doing now in 2014. What Vet did you choose and are you happy with them? prices, bedside manner, compassion etc. Thank you princessdaddy Angel from the Bay