Newbie with questions

[ItchyBear]

Hi, I am so confused by this whole thing and happy to find this forum. :confused: My beautiful 76# 11 1/2 year old diabetic lab named Abby will start on Trilostane tomorrow and I am scared. We are not 100% certain she has Cushings. She has the usual symptoms of Cushings (excessive drinking, urinating, blood sugars are messed up, weak back legs, pot bellied, panting, head pushing, rapid loss of eyesight, thinning of her fur, lethargic..). I do not know if she has a pituitary tumor or an adrenal tumor as of yet because the man who does the ultrasounds only comes once every couple weeks and he won't be here for another week and a half. Abby is not her usual self and am anxious to get her feeling better. She had a ACTH test on Monday and her baseline was 13.2.... Her post was 16. Not typical results. She was extremely nervous and anxious at the vet. Wondering how much of an impact the level of stress and anxiety she felt at the vet can have on the high baseline? Also wondering how safe it is to start Trilostane without knowing where the tumor is located? That is all I will ask for now. I am sure i have a million more questions. Thanks so much....Julie and Abby

[lulusmom]

Hi Julie and welcome to the forum.

I am sorry for the circumstances that brought you here but I'm glad you made it.

You have every right to be concerned because if the only diagnostic test that was done is an acth stimulation test showing normal cortisol levels, trilostane should not be given to Abby. It is disconcerting to me that your vet would prescribe such a serious drug before adequate testing has been done to confirm a diagnosis. No dog with normal cortisol levels should ever be given Trilostane....this was confirmed for us by Dr. Tim Allen, an internal medicine specialist on stuff with Dechra, the manufacture or Vetoryl (Trilostane). I were you, I would call my vet and express my concerns and provide him with the contact information for Dechra. Dr. Allen or other veterinary staff can educate your vet on how Vetoryl works and when it should be presribed. Contact information can be found at http://www.dechra-us.com/Default.aspx?ID=365

How long has Abby had diabetes and is it currently being controlled? If it is under control, it would strange for Abby to have cushing's because high cortisol can make it incredibly difficult to gain the upper hand on diabetes. It would be very helpful if you could provide the abnormal values of blood chemistry and cbc, if done) and please include the normal reference ranges. Sorry for the questions but the more information you can provide, the better equipt we will be to provide meaningful and helpful feedback.

With the rapid loss of eyesight, I am thinking that Abby has a condition called Sudden Acquired Retinal Degeneration Syndrome (SARDS). We have a recent new member whose gp vet misdiagnosed her dog, Copper, with cushing's. Copper was subsequently seen by a specialist and opthamologist who confirmed that Copper had SARDS, NOT pituitary or adrenal dependent cushing's. Rather than retyping the same thing I told her, I am providing a link to her thread below and ask that you please read her thread and let me know if any of this sounds familiar. I will tell you that the little bit of information you have posted sent big red misdiagnosis flags up for me. The one thing that doesn't really fit SARDS is the head pushing (pressing). This is definitely a symptom of an enlarging pituitary macro tumor. Almost all the symptoms, including the head pressing can be symptoms of liver disease. Is the head pressing occurring throughout the day or do you notice it more right after a meal? Has your vet mentioned either of these two possibilities?

http://www.k9cushings.com/forum/showthread.php?t=3512

Again, sorry for asking more questions that providing answers but that's usually how things go initially. You aren't alone any more and I know this is easier said than done but please try to relax. We'll help you and Abby in any way we can.

Looking forward to seeing test results and hearing more about Abby.

Glynda

P.S. I forgot to mention that yes, severe stress as well as uncontrolled diabetes can be the cause(s) of high basline cortisol.

[ItchyBear]

Thanks so much Glynda for talking to me about my concerns. I appreciate it. So my gut feeling of being afraid to start the Trilostane were correct it seems. I want so much for Abby to feel better as soon as possible. She seems so miserable. I will try to answer your questions as best I can.

Abby has been diabetic for six years now and has been pretty controled most of the time up until recently. Now her numbers are high most of the time.

I do not have the results from the blood tests but I can get them from the vet tomorrow and will post them then. He had told me that all were normal except her glucose and her liver values were slightly high.

As far as the head pressing, she's only done it twice now and both times were on my legs. I assumed at first that she was just saying "Mom I feel miserable" and was looking for some loving. Then I read about the head pressing in cushings so assumed that's what it was. Maybe it was just that she needed some extra loving at the time. I don't think either time was right after a meal.
No, the vet hasn't mentioned either liver disease or SARDS.

I'm really curious now if she does have SARDS instead. What can be done about it? We don't have any dog opthamologists anywhere near us (nearest is about five hours away).

I have a lot to think about here. I am just wanting to get that precious girl feeling better. It makes me so sad seeing her not up to par. I'm unsure as to what to do right now.

I'll get the results of the blood work to you tomorrow. Once again, thank you so much!

Julie and Abby

[lulusmom]

Hi Julie,

Do you have any internal medicine specialist in your area? If so, I would highly recommend that you consider taking Abby for a consult. With everything that is going on with Abby at the moment, I feel she needs more than your vet may be able to provide in the way of proper diagnosis and treatment. If you are unaware of specialist in your area, you can use the acvim site and use their search engine. I've provided the link below. If you would be willing to let us know which city and state you are in, perhaps we may have members who can provide you with a name(s).

http://www.acvim.org/websites/acvim/index.php?p=3

Relative your question about SARDS, vets who are experienced with the condition opt to not do anything as most often, the symptoms resolve in time. However, if BG is out of control, treatment of some kind might be an option but with normal cortisol, I think the treatments would be limited to melatonin and lignans and possible maintenance dose of lysodren. This is the standard treatment regimen for "atypical" cushing's. The hallmark of atypical is elevations of adrenal hormones, other than cortisol. These hormones are known as intermediate or sex hormones and they can cause the same blood abnormalies and physicial symptoms that are seen in typical cushing's. I believe most, if not all, dogs with SARDS will have some elevation of these hormones either before and/or after going blind. I also believe it is probably these hormones that are driving Abby's symptoms. If your vet were to submit a blood sample to the University of Tennessee Knoxville (UTK) for a complete adrenal panel, I believe you'd see that at least three or four of the intermediates would be elevated. UTK is the only facility in the U.S. that has the ability to do these panels.

Looking forward to seeing the results of Abby's bloodwork and any urinalyses that may have been done recently.

Glynda

P.S. I just moved and my computer at home is not hooked up yet. I am leaving work now so I won't be back online until tomorrow. Hopefully other members can answer any questions you may have this evening. Hang in there....we'll get you through this.

[jmac]

Hi Julie,

I don't have any advice to offer you, but I wanted to welcome you to the forum and tell you that you have definitely found the right place! Everyone is so caring and there is a wealth of knowledge here, so keep asking questions and trust your gut. I would definitely recommend you look for a specialist, or otherwise another vet who is more familiar with your dog's symptoms.

I'm glad you found this before giving your dog Trilostane. It can definitely be dangerous if not used correctly. Good luck to you and keep us posted!

Julie & Hannah

[ItchyBear]

Thank you Julie and Hannah! (I have lovely cat named Hannah! Such a pretty name). So much information on this forum. It's really appreciated.

[ItchyBear]

Thank you Glynda. I found an internal medicine specialist that my vet works with. Thank you for this information!! I talked to my vet this morning about atypical cushings and he agrees it could be but says they treat them basically the same? He agrees to hold off on the trilostane since I have so many questions. Today we are doing a glucose curve and the vet and I will talk again in the morning. He's being really good about listening to my concerns and sounds like he's willing to work with me to address them. I'm thrilled as I don't know this particular vet that well. Thanks again Glynda. You are appreciated!!

[Cyn719]

Hi and welcome!! Sorry to hear about Abby - My Penny is also 11-1/2 and is also on trilo - she started last Dec - she had a little bit of a time getting adjusted to the meds but right now she seems to be doing better - just adjusted her meds again - Penny is a 82 lb pit lab shephard akita - Glynsda is so right - Yes you do need to wait to see what her results are before you start with this medication for sure - and if Addy does have Cushings this is the place to be!!! They are so knowledgeable and the nicest people you will ever meet!!! If Addy does have Cushings you can speak to the Vet at the Company that makes the Vetroyl - very helpful - If you need the number must of us have it - but lets wait to get the results first !!! Wishing you and Addy the best!!!!!!

xoxo Cindy & Penny

[lulusmom]

Hello Julie,

I am happy to hear that you have found an internal medicine specialist to see Abby. Like I've said a hundred times before, it's difficult enough to wrap your arms around cushing's and when you throw diabetes into the mix, it's enough to make you pull your hair out, not to mention putting a general practitioner to the test. Unfortunately most fail the test. I am therefore glad your vet is listening to your concerns because they are legitimate and he would be wise to let you educate him.


I talked to my vet this morning about atypical cushings and he agrees it could be but says they treat them basically the same? He agrees to hold off on the trilostane since I have so many questions. Today we are doing a glucose curve and the vet and I will talk again in the morning. He's being really good about listening to my concerns and sounds like he's willing to work with me to address them. I'm thrilled as I don't know this particular vet that well. Thanks again Glynda. You are appreciated!!

Julie, if you will look at my prior posts, you will see that treatment for atypical cushing's is different than typical cushing's and it concerns me that your vet believe they are the same. The hallmark of typical cushing's is high cortisol and the hallmark of atypical cushing's is normal cortisol with elevated sex hormones. If Abby has normal cortisol, she should NOT be given Trilostane. The usual initial treatment regimen for atypical cushing's is melatonin and lignans. If after three or four months, no improvements are noted, a maintenance dose of Lysodren is added to the regimen. The efficacy of melatonin and lignans is not high but we have many members whose dogs have responded nicely and we've had others that required the Lysodren.

So how did the bg curve and your discussions with your vet go?

[Cyn719]

Hi Julie - Thinking of you and Abby - checking in to see how the visit and test went? Hoping it went well - :)

[Cyn719]

Hi Julie - Thinking of you and Abby - checking in to see how the visit and test went? Hoping it went well - :)

xoxo Cindy & Penny