help to sort out Newman (10 y/o male maltese)

[newman]

Newman is a 10 year old male maltese rescued him at at age 6-7 years. He came with epilesy and was on steriods. I was able after 3 seizures to ween him off. So he has be free from seizures and meds for since. I then was shortly diagnosed with panceatitis and spent 3 days in icu (now on Royal Canine LF food) Then diagnosed 1 year later with Diabetes (so NPH insulin 2 x day) then 10 months blind with cataracts (we did full surgery to both eyes and had to treat with steriod drops 3 kinds for about 6 months he can see :) He was injuried at a groomer and needed stitches :mad: so the vet was concerned about his "pot belly and thin hair on tail" and suggested it my be Addison's or Cushings Well we had a test but was not definate and suggested to wait a month and let him heal from cut and he went back to have a ACTH test that confirmed he was cushy.

Newan started on 11mg of trilostane for 10 days and another ACTH was done they requested I give 11mg 12 hours apart I had not started this and yesterday I knew he was not well which he is now in ICU with iv fluids and a 2+ ketone level I am just questioning if trilostane is just not drug of choice ??? he was diffucult to manage the insulin levels and urinating more. What questions do I ask or what could be going on. Newman is 10lbs on meds of insulin, enalapril for heart murmor, pepcid for pancreas marin for kidney support vitamin. his glucose was 500 now 300 ( not stable which I am assuming is the Cushings ....I am afraid to give eye drops to prevent glacoma because it is a streroid I am afraid to continue trilostane and not sure what to do. I am told today that they want to keep him on iv's and in hospital. I am dedicated to Newman, but when do you ask if it is good to but him through this:confused: I have invested almost 15,000.00 in vet bills and still stumbling with all the road blocks just not sure what disease I am treating????? sorry for so long 1st time here

I have manually approved your post so members can start responding to you. Please check your email for a message from K9C which you need to reply to in order to keep your posts from going into moderation. You may find it in your spam or junk folder.

[frijole]

Boy you have your hands full and are obviously one great mom. Are you working with a specialist? I ask because with so much going on they are much more qualified than a regular vet to deal with these special cases.

I have never used trilostane but it seems I remember reading that you are not to use enalapril and trilostane together. I hope someone can confirm or deny if this is true.

Can you tell us what tests were done to dx the cushings? Its tough because other illnesses - such as diabetes can affect the test results. So the more tests the better. Let us know tests and results/numbers if you have them.

Glad you found us.. it is possible to treat both diabetes and cushings so hold on and others will chime in. Hugs, Kim

[Squirt's Mom]

Hi and welcome to you and Newman! :)

I know what you mean about all those expenses! My Squirt is a $20,000 dog! :p And that doesn't include feed or simple vet visits. :rolleyes: But my babies are my world and I will give up anything and do anything in my power to help them; it's obvious you feel the same way, as do most of us here.

You really do have your hands full and I think Newman is in the best place for him at the moment - in the hospital so they can get him regulated a bit. Getting his BG a bit better controlled is the most important thing right now.

I am unclear if you have started the Trilo or not. I am also unclear if Newman got sick after taking the Trilo. If you have started giving it to him, please don't give any more until you make sure all his meds can be taken with the Trilo. I do think Kim is right about the BP med and Trilo.

The eye drops are a catch-22 unfortunately. They can cause a form of Cushing's called Iatrogenic which is treated by simple weaning the pup off the steroid. However, if Newman needs drops for his vision and steroids are your only option and you are determined to try to save his sight, then you really have no choice. I would talk to his vet to see if there are other drops that will help that are non-steroidal just to be sure I have covered all the bases. ;)

I have two blind babies - one from glaucoma, one from Hydrocephalus. They had already lost their sight when I got them and I gotta tell you, they are amazing! Neither one of them knows they are supposed to be "handicapped", "special needs". All they know is that they are safe, happy and loved. They maneuver around their little world just fine, tho Brick (my Hydro baby) does tend to bump into things more than Trink. Trinket's eyeballs were removed but Brick still has his...which is a great concern for me. I would actually prefer that his were removed as well. Even tho they no long have a purpose for him, they are still capable of developing diseases and sustaining injury. I tell you this to let you know that losing sight for a pup isn't as terrible as we perceive it to be. It is much, much harder on us humans than it is on them. So, if Newman does lose his sight, grieve if you need but know in your heart he will adjust. :)

I look forward to hearing more about your sweet boy and am so glad you found us!

Hugs,
Leslie and the gang

PS. OH! We have a sister sight devoted to diabetes that I know you will benefit from. So pop on over to K9diabetes, register, and tell Newman's story there, too. They are the experts on canine diabetes. Here is the link:

diabetes info
http://k9diabetes.com/forum

[Harley PoMMom]

Hi and I also want to welcome you and Newman!

So sorry for the circumstances that brought you here but very glad you found us as we will help you and Newman in any way we can.

Getting a confirmed diagnosis of Cushing's can be very difficult especially if non-adrenal illnesses are present in one's dog. The reason for this is that not one test is 100% accurate so multiple tests should be done for a confirmed Cushing diagnosis. Non-adrenal illnesses like uncontrolled diabetes and pancreatitis can increase circulating cortisol levels, yielding false positive acth stimulation test results.

Cushing's, diabetes and pancreatitis share a lot of the same abnormalities found in bloodwork, urinalyses and clinical symptoms. So if your vet diagnosed Cushing's in Newman based on one acth stimulation test then IMO, the diagnosis of Cushing's could be wrong.

Trilostane is the chemical name for a medication that effectively treats Canine Cushing's Disease. Worldwide, the only licensed veterinary version of trilostane is manufactured by the Dechra Group under the brand name of "Vetoryl." And according to Dechra's U.S. product insert:
Angiotensin-converting enzyme (ACE) inhibitors should be used with caution with VETORYL Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient’s ability to maintain normal electrolytes, blood volume and renal perfusion. This information, plus more, can be found here: Dechra's U.S. Product Insert. (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf)

Enalapril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors, so careful monitoring should be performed when using ACE inhibitors with Trilostane.

It would be very helpful to us if you could get copies of all test/s that were done on Newman and post the abnormal results here. Please know you are not alone on this journey, and as I mentioned before, we will help you and Newman in any way we can.

Love and hugs,
Lori

[newman]

Newman has had 2 ACTH Stim tests..one in Jan 2011 that was not clear.. and Doctor (yes an specialty doctor) at that time we was injured from a groom at caused 5 stiches. I was ask to wait a month and test again.. so I waited 2 months Diabetes had been all over as I test several times a week. That test came back and confirmed Cushings. Within 2 days he was in for fluids and by test 3 after the 10 day load I was told to double the dose at 12 hours. I did not my gut told me no ...I did continue 1 dose and with in the week I was certain it was creating more problems Newman was hospitalized for 3 days of IV fluids with 2+ ketones and I finally brought him home 2 days ago. His urine is ketone free and glucose free almost with lots of energy. I have not started the 2 pills a day as told of the Trilostane to scarred. I have stuck to Sci. diet WD soft morning and night and dry Royal LF as treats I feel giving him a couple weeks to settle down and eat right will help while I research for 2nd opinion. I too read something about Enalapril ??? But he has a heart murmor so I am so confused

[newman]

Everyone here has been so nice. THANK YOU :)
I am going to go with mama knows best for this week. My week is to get Newman on a strict diet of Vet prescibed food and monitor his unine and take blood glucose every other day ( I hate sticking his lip:( the poor boy is such a trooper :) with insulin 2 times aday.
I just can't bring myself to start the trilo up again and double it as the vet requested. I just feel like something is missing. Newman did have an ultrasound and it did show enlargement of left adrenal gland but he had been on trilo for 18 days the previous ultrasound from Jan 2011 did not. I understand cushings is slow do believe he has cushings because of "pot belly" thin hair on tail etc. but I think I have allowed his too cute face and begging mess up he diet so these next couple weeks are boot camp for him and with hope some education from all of you. So Please Please ask me the questions if I miss anything.:confused::confused:

[Roxee's Dad]

Hi Newman's Mom and a belated welcome from me and mine :)

I / we would really be interested in seeing the results of the ACTH test and any other abnormal results from his blood testing. Cushing's can be tricky to diagnose correctly.

[Jenny & Judi in MN]

I don't know enough to give you any advice but if that is Newman in your avatar, no wonder you couldn't say no. My word, he is adorable

[newman]

Hi Newman's Mom and a belated welcome from me and mine :)

I / we would really be interested in seeing the results of the ACTH test and any other abnormal results from his blood testing. Cushing's can be tricky to diagnose correctly.

6/25/11 Trilo started at 11mg. His meds were and are
NPH insulin 6 units SQ 2x day
Enalapril 2.5mg 1 tab day (heart Murmur)
1/4 tab Marin ( Vit for Kidney and Liver)
1/4 tab of 10mg Pepcid ( for control of Pancreatitis)
Food is sci. diet WD for Diabetes and gastro soft
and Royal Canin Low fat hard as a snack and between meal balance to help with his begging :)
on 7/5 10 days after trilo of 11mg. and one extra visit on day 3 for under skin fluid... his in house results were as follows
THESE ARE THE ONES THAT STAND OUT. GLU 346 ALT 117 ALKP 456
CHOL 330 on the 1stat cg8+ panal glucose 352 NA 141 TCO2 25 PCO2 42.9 BE -2 sO2 75 vet writes blood sugar defin better as is renal values ACTH Tim back on Friday - called me and told me to give 11mg trio am and 11mg pm. I did not start the higher dose because I had to wait for a shipment from compounding so be Tues of that week he had been on just 11 mg and noticed him failing I took to hosp. and they did more blood work and stated ketones +2 blood sugar 500 ( I did not give any insulin so that was one reason ) he had not eaten or drank for the entire day and had vomited. They admitted for 3 days on cont. IV fluids and on day 2 late offered food they treated with short term insulin the first two days and ketones finally dropped to trace on morning of day 4 I was told to start up trilo that night and give 22 units Well I did not, & I found this site and for the last several days w/o trilo his urine is trace ket. and blood sugar (bless his little lip from all the pokes) is 300 to as low as 68 I did increase pepcid to 2 times a day and he has not drank water or pee'd excessively.

[Roxee's Dad]

THESE ARE THE ONES THAT STAND OUT.
GLU 346
ALT 117
ALKP 456
CHOL 330

Can you post the normal values for the above?


on the 1stat cg8+ panal glucose
352 NA 141 TCO2 25 PCO2 42.9 BE -2 sO2 75

I do not see any results here from an ACTH Stim test. It concerns me because if Newman has some trauma around the time of his cushing's diagnosis, the results of the stim may be misleading. I don't believe that any vet should prescribe Trilo, or raising or lowering the dosage without verifying through proper testing procedures. Newman's cortisol could have been high because of the diabetes, or the trauma of the grooming accident or any number of things.

I am just concerned that his levels may be too low and therefore why he is feeling yucky. I see that Lori gave you a link to Dechra and they provide a guide or a pathway to the proper diagnosis and follow up treatment which is very important and in the long run will save you some money and heartache.

Last question... was there an LDDS test or any other testing besides the ACTH test to confrim the diagnosis?

Hope Newman s feeling a bit better and hope to hear from you soon.