12 1/2 year old chow/shepherd mix dignosed w/ cushings

[Siriusli]

My dog Ruby has had a tough time these past 2-3 years. She began having serious skin issues around 2007 with scratching, licking, hair loss and secondary staph infections. At first I thought it was hot spots. We went from one vet to another, tested her thyroid, spent loads of money, were given Cephalexin and medicated shampoo and were told time and again it was food allergies. I tried every diet under the sun, finally settling on a home cooked diet of whitefish, sweet potato and chickpeas (along with supplements, including salmon oil). Finally, a year ago, the recurring skin infections cleared up. However, she really began slowing down. Sleeping a lot. Having trouble with the stairs (I live in a 3rd floor walk-up). Spacing out. Occasionally getting stuck in corners. A lot of trouble dealing with the summer heat. Weakness. Thirst. Almost, but not quite, having accidents in the house ( often only being able to make it just inside or outside the front door) A persistent cough (chest x-rays revealed only "age related calcification") getting worse and the skin issue recurring.One night she was panting so heavily (even at rest) that I took her to the emergency clinic, who swore up and down that Ruby was in severe pain due to arthritis and sent me home with painkillers. I took what they said with a grain of salt (not really buying the severe pain bit) and took her to my vet who diagnosed Degenerative Myelopathy. After researching DM, it sounded right. As it's an auto-immune disease, i felt it somehow tied in with the skin issue being an immune response. At this time my vet also decided to check Ruby's thyroid function, the results of which came back low (hypothyroid) and put her on thyroid medication. She began drinking massive amounts of water. 10 days after beginning the thyroid therapy, she woke me one morning with restless pacing around my bed and I thought she had to pee. As I took her out she started having full body tremors and collapsing. It almost seemed that she was having seizures of some kind. It was VERY scary, I raced to the above mentioned emergency clinic, where they x-rayed her back ( for disc injury) and her lungs. They also did blood work and said her kidney's seemed fine as well. Again they told me she was in severe pain and sent me home with Rymadil, which I did not give her. I called my vet and asked if she was having a possible reaction to the thyroid medication who said it was unlikely but possible and to cease giving her the medication for a few days. The next day she was doing a bit better but was still having tremors and I took her to my vet. He said her neurological functions were normal. It was at this point that we began discussing Cushings disease and decided to test a urine sample. The results indicated that further testing should be done and she then had the Dex Suppression test, the results of which came back consistent with Cushings. My vet thinks she is a good candidate for Trylosane but I'm scared to give it to her even though he wants to start her at half the dosage for a dog of her size (60 mg/ 60 lbs). She's improved 90% since the tremors episode and since quitting the thyroid med. I don't know if it's coincidence or maybe she's very sensitive to drugs. I don't want to give her anything that might make her worse or harm her. Any advice? Thanks!

[zoesmom]

Hi - Adorable picture of Ruby! Sorry, though, for the circumstances that brought you here.

So just to be clear. She's now on no other medicine, having stopped even the thyroxine? First thing we usually ask is ..... can you please post the results of recent tests, particularly the cushings tests - and any bloodwork, thyroid test, etc. Post all #'s and notations on the cushings tests and anything out of range (high or low) on the other labwork. If you don't have copies, it's a good time to start collecting the results from the vets, to keep in a file at home. It's pretty standard practice with cush parents.

Many of her symptoms do sound like cushings, but some do not. Like the tremors. My Zoe had seizures and it's possible that's what happened with Ruby. Hard to say without seeing it, but it does seem like possibly some kind of seizure- and there are different kinds besides the grand mal. There are videos online of dog's having various kinds of seizures that might help you determine if that was what happened. Don't have the links right now, but maybe I can find them. Low thyroid levels can cause seizure activity and like your vet, I would be surprised if the thyroid medicine itself caused that kind of reaction. Was a thyroid test done a month or two after starting that med, just to make sure her dose was right? (Hypothyroidism can also be a consequence of cushings and in some dogs, it will improve once they are their cushings is controlled.)

The getting stuck in corners and spacing out might be indicative of a pituitary tumor that's on the large side (called a macroadenoma) but it could also be a sign of something simpler, like canine cognitive disorder (i.e. doggy senility/dementia). When you say spacing out, can you describe that a bit more. That might also be some type of seizure.

You don't have to rush into treating cushings as it doesn't progress quickly. You can take your time, read up as much as you can in our resource section here, post those test results in this thread, and ask any other questions that you can think of.

Then, when you feel more comfortable, the trilostane will be a good choice. A dose of 60 mg is a reasonable starting dose - I'd feel better about that for a 60 lb. dog than 120 mg - at least to start. We've learned around here over the years that starting a dog out slowly on trilostane is the safest approach. You can always up the dose if needed, after the first and second ACTH tests.

Used properly and with monitoring tests, trilostane can make a huge difference in a cush dog's quality of life. Most all will have a good resolution of symptoms and live out their normal lifespan. My Zoe was dx'd at age nine and took trilostane from the start. She crossed the bridge this past March so she spent four years on trilostane. So I can tell you that there's nothing to be afraid of, as long as you educate yourself about the treatment protocol and your vet is also familiar with it. Sue

[apollo6]

Love the picture of your Ruby.
Welcome
Before you even think of treatment, you need to know if and what kind of cushing it is. I just skimmed through your post.Apollo has the pituitary cushing. Apollo had skin liaisons, black skin, sores on his body, loss of hair both sides of body, hair loss on ears, tail, sores on tail, pot belly, extreme thirst, hunger.

this is a brief run down on the three types with pictures.
http://www.kateconnick.com/library/cushingsdisease.html
this is the companies website
http://www.dechra-us.com/Default.aspx?ID=316&pcatid=PROPFIELD465&catid=PROPGRP37&fid=PROPFIELD469&ProductID=PROD247
this is the email contact if you have questions
http://www.dechra-us.com/Default.aspx?ID=316&pcatid=PROPFIELD465&catid=PROPGRP37&fid=PROPFIELD469&ProductID=PROD247
Dr. Allen will even call you back and answer your questions.

The test I did were: full blood panel, urine cortisol, ultrasound of abdominal(determine if one or both adrenal glands similarly enlarged(in my case both) enlarged liver, kidney, scaring on pancreas. and an ACHT STIM. Only after going to two specialists did I make a decision to start Trilostane. I decided which treatment I felt best for Apollo.
I agree with Sue , start at a low dosage. I listened to this formum , when the vet said 30mg. the people here said to high, start at 10mg. which I did and have no regrets for questioning my vet. Apollo has always been sensitive to vaccines, medications and has a sensitive stomach. I trusted the experience these people have gone through. We are not vets but we have insight and knowledge.
Protocol on dosage.
The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed.
1 kilogram = 2.20462262 pounds
The reason I say this is I have read to many threads were the vet just looks at the old formula.
Weight Range (kg) Weight Range (lb) Starting Dose (mg) Once Daily
≥ 1.7 to < 4.5 ≥ 3.8 to < 10 10
≥ 4.5 to < 10 ≥ 10 to < 22 30
≥ 10 to < 20 ≥ 22 to < 44 60
≥ 20 to < 40 ≥ 44 to < 88 120
≥ 40 to < 60* ≥ 88 to < 132* 180

* Dogs over 60 kg (132 pounds) should be administered the appropriate combination of capsules.
After approximately 10-14 days at this dose, re-examine the dog and conduct a 4-6 hour post-dosing ACTH stimulation test, and take action according to Table 2.
Apollo is 10lbs and I insisted on starting at 10mg not the 30mg recommended. He started in June is doing fine and now is starting at 12.5mg to see if it will help with his hind leg weakness.
I know others will come and post who have larger dogs on Trilostane.
I am very conservative and cautious when it comes to medication for myself and Apollo. But please be aware each case is different what works for one might not work for another. You are not alone.
Hugs Sonja and Apollo.

[Siriusli]

Hi and thanks for the feedback! i finally got copies together of Ruby's medical records. What, exactly am I looking for? One other question...one of the supplements recommended for her DM is selenium (200 mcg 1 x per day) which I was giving her in addition to other supplements, but I stopped giving it (along w/ the thyroid med, after she had that tremor edisode. Could this have reacted badly with the thyroid medication? I know it can be toxic in high doses.

[zoesmom]

Hi -

On the cushings test, guessing that it was the low dose dex suppression test (LDDS)? If so, then it should have something like a baseline or pre-cortisol # plus a 4 hr. number and an 8 hr number. Post all of those (and the hours, if noted). Ruby would have been there for about 8 hours for that test. Also we need to know the units of measurement (usually in ug/dl or maybe nmol/L)

The first urine test was probably the urine cortisol:creatinine ratio and since your vet said it indicated further testing needed, we probably don't need that one, but if they did any other measurements on the urine - like urine specific gravity (USG), that would be helpful, too. On the general labwork, post anything that was out of range (high or low.) And the normal range for those things. Should be right on there.

Don't have any answer on the question of the selenium and possible interactioin with the thyroxine but maybe somebody else will. (That DM, by the way - not diabetes mellitus but degenerative myelopathy, for those who are skimming. ;))

Also if you have them, please post the thyroid tests done and the results. What dose of thyroxine was Ruby taking for the hypothyroid and how long did she take it before she had the epidsode? Sue

PS - Dates of all the testing would be helpful as well.

[zoesmom]

Low thyroid levels can cause seizure activity and like your vet, I would be surprised if the thyroid medicine itself caused that kind of reaction. . Sue

Whooooaaa, quoting myself again :eek::rolleyes:

I'm wondering if Ruby could have had a seizure because she hadn't been on the thyroxine long enough . . . . or, more likely, because she needed a higher dose. Zoe still had seizures every now and then after starting thyroxine and we'd check her levels and often find it was because she needed a higher dose. She required several adjustments over time, and her dose edged up to .8 mg. at one point. After being on that for awhile, she started having symptoms of hyperthyroid (i.e. too much thyroid med) So it's something to be monitored regularly when a dog is on thyroxine, especially if things still seem 'off'. It's not something that is as obvious or risky as, say, too much or too little of a cushings drug. In other words, dogs can usually coast along for some time on a slightly too high or slightly too low dose and only have very mild symptoms. But if something seems amiss, it's always a good thing to check. Aggression in a formerly 'mellow' dog, for instance, is one of the most common presenting symptoms for hypothyroidism. Other signs can be subtle and develop slowly over time. But I think if a dog suddenly develops seizures, that might indicate thyroid levels are off and have been for a while. Sue

[Siriusli]

Hi -

On the cushings test, guessing that it was the low dose dex suppression test (LDDS)? If so, then it should have something like a baseline or pre-cortisol # plus a 4 hr. number and an 8 hr number. Post all of those (and the hours, if noted). Ruby would have been there for about 8 hours for that test. Also we need to know the units of measurement (usually in ug/dl or maybe nmol/L)

The first urine test was probably the urine cortisol:creatinine ratio and since your vet said it indicated further testing needed, we probably don't need that one, but if they did any other measurements on the urine - like urine specific gravity (USG), that would be helpful, too. On the general labwork, post anything that was out of range (high or low.) And the normal range for those things. Should be right on there.

Don't have any answer on the question of the selenium and possible interactioin with the thyroxine but maybe somebody else will. (That DM, by the way - not diabetes mellitus but degenerative myelopathy, for those who are skimming. ;))

Also if you have them, please post the thyroid tests done and the results. What dose of thyroxine was Ruby taking for the hypothyroid and how long did she take it before she had the epidsode? Sue

PS - Dates of all the testing would be helpful as well.


okay, here are the test results...

URINE CORTISOL/CREATININE:URINE CORTISOL
9/15/2010
Urine Cortisol Result 15.4 Reference Range ug/dL
Specific Gravity 1.012

Urine Creatinine Result 77.2 mg/dL

URINE CORTISOL/CREATININE: URINE CORTISOL/CREATINIE RATIO
Urine Cortisol/Creat Ratio Result 62



DEXAMETHASON SUPPRESSION
9/22/2010
Pre-dexamethasone Result 4.5 Reference Range 1.0-6.0 ug/dL

Post 4 Hr. Result 2.8 Reference Range ug/dL

Post 8 Hr. Result 3.4 Reference Range ug/dL



TOTAL HEALTH PLUS CHEM 27
6/28/2010
T4 Result <0.4 Reference range 0.9-3.9 LOW

*everything else on this test was apparently within the normal range except:
ALK PHOSPHATASE Result 247 Reference range 10-150u/L HIGH

TCO2 (BICARBONATE) Result 25 Reference Range 17-24 mEq/L HIGH

and here are thyroid results from last year
6/28/2009
ADD ON FREE T4 (ED) + TSH : FREE T4 (EQUIL. DIALYSIS)
Free T4-ed (ng/dL) Result 1.1 Reference Range 0.7-3.7 ng/dL

Free T4-ed (pmol/L) Result 14.2 Reference Range 9.0-47.4 pmol/L

ADD ON FREE T4(ED) +TSH : cTSH
cTSH Result 0.30 Reference Range 0.05-0.42 ng/mL


I was giving Ruby the Thyro Tabs (0.5 mg 2 x per day)for about 10 days before the tremors started

[zoesmom]

So how is Ruby doing and are you still holding up on starting the trilostane? Remember, you can take your time with this diagnostic process.

Her LDDS results are consistent with cushings. Sometimes, the results can indicate which type of cushings it is (adrenal or pituitary) but Ruby's results do not, meaning it could be either kind. Her uc:cr was high as expected, which was why your vet did the LDDS. The Elev. ALP and low USG and the low thyroid inJune (which wasvery low, in fact) also all point to cushings. Sometimes we see other elevations in things like ALT, cholesterol, lipase so just assuming those were in the normal range. (possibly, they were at the high end of normal range when the labwork was done?)

Given her other health conditions, there's the chance of the LDDS (as well as the other cush test - the ACTH) producing false results, so it couldn't hurt to ask for an abdominal u/s next.

So.....I'm wondering if your vet has mentioned doing one. It can tell a lot - based on the size of the adrenals, liver, and also can reveal other conditions with the organs. If one adrenal is larger and one smaller, that would indicate an adrenal tumor causing the cushings. An AT might alter the treatment approach if you go the drug tx route. Or, in good candidates, surgery can provide a permanent cure. Surgerry carries risks and is not cheap , so many owners opt to use medicine for adrenal cushings.

With PDH, the adrenals will be of equal size - usually enlarged. Liver is almost always enlarged in cush dogs. If it were my dog, I think that's what I'd do next.

You said her clinical symptoms were basically skin and drinking/peeing, having trouble with stairs and the spacing out?? Any other muscle wasting (like in the head). Zoe's head started to look skeletal, for instance. Pot belly? And how about her appetite? Anything at all?

The tremors I'm really not sure about (were they tremors, some sort of mild seizure, whatever . . .???) I'm still not convinced that the thyroid medicine caused that and given her very low thyroid test in June, she should probably be back on the thyroxine. (In time, if her cushings is controlled, she may be able to come off that drug.) It's too bad your vet didn't run another test when Ruby had the episode after 10 days on the med. That might have told you if her dose was too high, too low, or appropriate. I wouldn't start her on both trilostane and thyroxine at the same time. So maybe she should go back on the thyroxine first, then test T4 again, and see if she needs a dose adjustment. Get that all smoothed out before introducing a cush drug. Last year her results were in range but on the lowish side so she was probably heading in that direction. Hypothyroidism can affect their skin, too. '

So I'd still suggest taking it slow and discussing these things with your vet. Like first, maybe reintroduce the thyroxine with the idea of testing her for that again in a month or so, to make sure the dose is right. Second, I'd ask for an ultrasound, for sure. Then, you'd get further confirmation of the cushings & which type, giving you a better idea of how to proceed with that. Sue

PS - Did you say how much Ruby weighs?

[Siriusli]

"So how is Ruby doing and are you still holding up on starting the trilostane? Remember, you can take your time with this diagnostic process."

Ruby is doing much better. The tremors stopped completely within a day and a half. I stopped the thyroid med immediately. Of course, no one can be sure that it's not just a coincidence. I still haven't started the Trilostane. My vet (actually, it's my vets colleague, as my vet was off the day the tremors started and I wanted Ruby to be seen immediately) has not mentioned an abdominal ultrasound. He also said that with Trilostane, we don't necessarily have to know which form of Cushings we're dealing with. In any case, it can be difficult to actually get to talk with either vet without making an appointment. And of course, there's the financial factor. Since June alone, vet bills have amounted to close to $2000. This is not including all of Ruby's food and supplements. The emergency vet clinic (not my regular vet) was $600...and for what? They took x-rays, told me she didn't have a disc problem or any injuries, said she was in severe pain and gave me Rymadil, which I did not give her. I disagree with the pain diagnosis. They told me the SAME EXACT THING when I brought her there in June for excessive panting and weakness. At that time, they gave me some other painkillers which did nothing but make her dopey. Whatever. Essentially, they told me exactly NOTHING. And all for a mere 600 bucks.


"Given her other health conditions, there's the chance of the LDDS (as well as the other cush test - the ACTH) producing false results, so it couldn't hurt to ask for an abdominal u/s next."

About how much does an ultrasound cost? As it stands now, I've been pushed almost to the limit these past few months, financially speaking. I'm a nursing student and only working part time. I don't even have health insurance for me!!! I'm very frustrated. Had just ONE of the many vets I've taken Ruby to in the last 5 years mentioned Cushings as a possibility, I might not have wasted so much time and money. And I would've possibly been spared having to make the difficult decision of whether or not we can afford to do an ultrsound.As far as the Cushings issue, I had to do my own research and bring up the possibility of hyperadrenocortisim two weeks ago when she got so ill. Can someone tell me...just what am I paying these vets for???!!!!!


" Or, in good candidates, surgery can provide a permanent cure. Surgerry carries risks and is not cheap , so many owners opt to use medicine for adrenal cushings."

Aside from the expense, Ruby is too old for surgery. I'm not even 100% sure of her age. I know I've had her just over 11 years. She was likely 1-2 years old when I found her (she found me:).

"You said her clinical symptoms were basically skin and drinking/peeing, having trouble with stairs and the spacing out?? Any other muscle wasting (like in the head). Zoe's head started to look skeletal, for instance. Pot belly? And how about her appetite? Anything at all"

She has muscle wasting in her rump and back legs. We attributed that to the DM. But no, not her face. I don't know if I would call it a pot belly, but she's definitely gotten a lot thicker in the belly area (she's 62 lbs). Her appetite is good. She doesn't steal food or anything like that. But she certainly doesn't refuse it either. She has become more of a scavenger in the street, though. I often have to pull chicken bones and rotten food out of her mouth on our walks. She was never like this when she was younger. She was always a very dainty and refined lady:p



"The tremors I'm really not sure about (were they tremors, some sort of mild seizure, whatever . . .???) I'm still not convinced that the thyroid medicine caused that and given her very low thyroid test in June, she should probably be back on the thyroxine. (In time, if her cushings is controlled, she may be able to come off that drug.) It's too bad your vet didn't run another test when Ruby had the episode after 10 days on the med. That might have told you if her dose was too high, too low, or appropriate. I wouldn't start her on both trilostane and thyroxine at the same time. So maybe she should go back on the thyroxine first, then test T4 again, and see if she needs a dose adjustment. Get that all smoothed out before introducing a cush drug."

My vet had scheduled a follow-up visit after 2 months on the Thyroxine. When Ruby had the attack, my vet said to stop giving it to her and see if she improves, which she did. But as I said, that could be coincidence. Could I give her an herbal supplement to help her thyroid function? I have something from PetAlive.com called Thyro-Pet which contains bladderwack, astragulus root, siberian ginseng root, and stinging nettle. I haven't given it to her yet. I know she needs treatment for her thyroid. I'm just scared of anything now!

"Last year her results were in range but on the lowish side so she was probably heading in that direction. Hypothyroidism can affect their skin, too."

No- the skin problems have been going on for YEARS now. Basically, some sort of dermatitis that turns into a staph infection. She's been tested for mange, ringworm, you name it. It's never-ending. '

"So I'd still suggest taking it slow and discussing these things with your vet. Like first, maybe reintroduce the thyroxine with the idea of testing her for that again in a month or so, to make sure the dose is right. Second, I'd ask for an ultrasound, for sure. Then, you'd get further confirmation of the cushings & which type, giving you a better idea of how to proceed with that. Sue"

I agree. I will send my vet an e-mail. I don't know why I feel like I'm being a nuisance to her. I know I shouldn't feel this way. I have every right to be pro-active and ask a lot of questions concerning my animals well-being. In any case, thank you so very much for all of your feedback and help.

Lisa and Ruby

PS - Did you say how much Ruby weighs?[/QUOTE]

She weighs 62 lbs.

[zoesmom]

Aside from the expense, Ruby is too old for surgery. I'm not even 100% sure of her age. I know I've had her just over 11 years. She was likely 1-2 years old when I found her (she found me:).


Surgery - not necessary to treat a dog with adrenal cushings. And like you you said, age would be a big consideration. As is the location of a tumor and the overall health of the dog. So there are still the drug options. However, generally in cases of AT's, the drug of choice would be lysodren. Trilostane is being used more often in recent years in those cases, but I'm not sure what the drawbacks/advantages would be. We have a couple members whose dogs have adrenal tumors that are using trilostane. But it's a newer drug and thus, the jury is still out on whether it's as good a choice or not. Also, if it were an AT, it might mean a longer loading period with lysodren and an overall higher dose to gain control of the cushings. So that would be the reason to know what you are dealing with - PDH or AT.


[She has muscle wasting in her rump and back legs. attributed that to the DM. I don't know if I would call it a pot belly, but she's definitely gotten a lot thicker in the belly area (she's 62 lbs). Her appetite is good. She doesn't steal food or anything like that. But she certainly doesn't refuse it either. She has become more of a scavenger in the street, though. I often have to pull chicken bones and rotten food out of her mouth on our walks. She was never like this when she was younger. She was always a very dainty and refined lady - these can be common signs of cushings. Not all dogs have all symptoms so . . . .

The frequent skin infections could also be because of cushings. Cush dogs are overly prone to all sorts of infections of various kinds.

Since they've been going on for years, it's possible that she was subclinical for both hypothyroidism and cushings for awhile now. Of course, if you'd tested for these things sooner, the results might have been inconclusive if that was the case.

We all completely understand the difficulties of keeping up with the costs of this disease The diagnostic process is, usually, the worst. But I won't deny it - even in the treatment stage, costs can be ridiculous, depending on how a particular dog does. Do check out our resource section as there's information there on sources for financial assistance for vet care. I think the most popular is Care Credit -- which I'm not sure, but I think it lets you pay over time - which most vets won't do otherwise. Hugs to Ruby. She's so darn cute! Sue

[Siriusli]

Sue,
Thank you so much for taking the time to respond and answer my questions so thoroughly. I did send an e-mail to vet, expressing my concerns and questions. I think Ruby is cute too although I think the pink sweater kicks up the cuteness factor a few notches. I call that photo "Little Ruby Riding Hood" LOL! And your Zoe is a lil' sweetie, as well!

[gpgscott]

I think the pink sweater kicks up the cuteness factor a few notches. I call that photo "Little Ruby Riding Hood" LOL! And your Zoe is a lil' sweetie, as well!

A little 'bling' around the neck would fit very nicely with the hoodie:D

[Franklin'sMum]

one of the supplements recommended for her DM is selenium (200 mcg 1 x per day) which I was giving her in addition to other supplements, but I stopped giving it (along w/ the thyroid med, after she had that tremor edisode. Could this have reacted badly with the thyroid medication? I know it can be toxic in high doses.

Hi,

Thyroxine can interact with a number of other meds, (listed at the link below)
http://www.drugs.com/search.php?searchterm=thyroxine&is_main_search=1 , and according to "Pills for Pets" by Debra Eldridge, DVM, Citadel Press 2003, side effects are uncommon, but overdose can show up in serious heart changes, increased respiration, excitability, panting and nervousness.
The book also says it increases metabolism, and diabetic pets may need to have their insulin levels adjusted. (Realising DM in Ruby's case isn't diabetes, but thought that info may come in handy for others.)

Now, also in the book regarding selenium is this- selenium can be toxic if given in large doses. Signs can range from hair and nail loss to nervous behaviours and even acute death. Supplementation should only be done under proper veterinary/nutritionist guidance. (Which you have been :))

Sorry I couldn't be more help with your questions :(

Jane, Franklin and Bailey xxx

[zoesmom]

overdose can show up as . . . excitability, panting and nervousness.

This was exactly what happened to Zoe, when she was on .8 mg and she was showing signs of hyperthyroidism from too high a dose. She was extremely restless and yes, excitable seems like the perfect description of what happened. Lots of pacing, etc. You mentioned restlessness and pacing, which is one of the reasons I asked about Ruby's dose and if your vet had tested her after putting her on the thyroxine. The other reason was that I wondered if maybe her dose wasn't enough for her, and if what she had was a seizure. But apparently . . . . continue reading . . . .

in Jane's link, there is information saying that too much thyroxine (which is basically like med-induced hyperthyroidism) can lower the seizure threshold. So it seems that if thyroid levels are either too high OR too low, it could trigger seizures. In Zoe's case, low levels apparently contributed to her seizures and when her levels went high, she only had the extreme restlessness, pacing. Unfortunately, you don't have any way of knowing if one or the other was the case when Ruby had her episode since your vet didn't do a follow-up test to see where her thyroid levels were.



Now, also in the book regarding selenium is this- selenium can be toxic if given in large doses. Signs can range from hair and nail loss to nervous behaviours and even acute death.
Jane, Franklin and Bailey xxx

Sounds like the selenium could also have been a factor if too much of it can also cause nervous behaviours. Back to square one, I guess.:rolleyes:

If you do decide to put her back on thyroxine, a much lower dose would be the way to go and then maybe test about two weeks in, just to be safe. Sue

[Siriusli]

well, i've sent Ruby's vet an e-mail addressing both issues yesterday but still haven't gotten a response. hope to hear from her this weekend.

[Siriusli]

can you believe it...no response from my vet as of yet. i also called yesterday. left a voicemail saying i needed to speak with her about some of my concerns. i also sent an e-mail on sept. 10th about Ruby's skin infection returning(before the tremors and emergency clinic visit) and didn't get a response. initially, i gave her the benefit of the doubt but at this point i'm just really upset. i had a lot of faith in this vet (and lord knows, we've been through several) but now i'm beginning to feel that she doesn't give a damn. why do i have to drag Ruby back in for an office visit if all i want to do is ask some very vital questions? this is just unacceptable. i don't know what to do.

[frijole]

Hi and welcome! I have been thru 'vet hell' and it is tough. Perhaps your vet simply forgot or some emergency came up. Regardless - only you can tell if the vet is mentally engaged in your case or not. You know what to do if he isn't. ;) Just be sure you have copies of every test done and records - it makes switching much easier since you don't want to have to do tests over again if you don't have to.

Hang in there! Kim

[Siriusli]

it turns out, the office has been having serious computer issues and had to replace almost all of them. my vet called me sunday night and was very helpful. i'm glad, because as i said, i like her and trust her judgment. thank you very much for the support. it makes me feel a lot better knowing there are other people out there who love and worry about the well being of their animal friends.