Newbie (13 y/o basset hound)

[Nat]

7 months ago I adopted a beautiful 13 year old basset hound from a dogs home. I took her home with me knowing she had just been diagnosed with cushings as I couldn't just leave her there!! Apart from seperation issues all was well, her cushings was controlled on 60 mg vetoryl and aside a UTI she was bright & happy. Over the last few days she has been unwell and had really bad shivering & teeth chattering as well as a lower body temp (even in front of log fire covered in blankets). Today vet has said he thinks she is addisionian - has anyone had this issue? Blood tests tomorrow to see her cushings range then he may start prednisolone.:confused:
Am so new to cushings - its hard to get your head around it all!!

[Rebelsmom]

Have you stopped the vetoryl? That is the first thing that has to be done if she is having an addisons crisis.. How much does your pup weigh? Do you know when the last time she had a ACTH test done and what her numbers were? Sorry to ask so many questions, but addisons can turn very serious very quickly. You should always have predisone on hand in case of emergencies, but like I said the first thing to do is stop the vetoryl. Does she have any other symptoms? Vomiting or diarrhea, or lethargy?

[Harley PoMMom]

Hi and welcome to you and your sweet girl!

So sorry for the circumstances that brought you here but glad you found us.

Melissa is right that the Vetoryl should be stopped, anytime a dog that is being treated with the Cushing medicines, Lysodren or Vetoryl and is feeling ill the treatment should be discontinued until the ACTH stimulation and electrolyte results are known.

We do have members that have had their furbaby's cortisol go too low while on Vetoryl/Trilostane.

Do you have any prednisone on hand?

How much does your girl weigh?

If you could get copies of all test/s that were done and post the results here it would really help us to provide you with more meaningful feedback.

Is your girl experiencing any diarrhea or vomiting?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[lulusmom]

Hi Nat and welcome to the forum.

Addison's would be a likely suspect as shivering and low body temperature are symptoms of hypoglycemia. Addison's dogs do not make or store glucose so blood sugar drops like a rock and this can be life threatening. What testing did your vet do today? If he suspected addison's, he should have instructed you to discontinue dosing and check electrolytes at the very least. Was that done?

We all understand how difficult it is to wrap your head around cushing's and we're here to try to help you make sense of things.
The more information you can give us, the better.

Glynda

[Nat]

Thank you all so much, her last bloods were done 4 months ago and they didn't give me formal results other than everything was ok. They have never told me or given me any pred or even advised me as to what to look out for :(
This is becoming a steep learning curve for me, she is having the 2 stage blood test this morning and so I hope to get results by Friday. I tested her urine and glucose and ketones were negative - thankfully.
When she went to Battersea dogs home last christmas she apparently weighed 39kg, when I saw her and knew I had to give her a forever home she weighed just 19kg. She is now 24.5kg. (who else would give a 13 yr old basset hound with cushings a home - I just couldn't leave her there!!)
Interestingly, since the anxiety of going to the vet last evening, she seems much brighter - is that because she pulled adrenaline from somewhere?? Thankfully, I am pretty quick at spotting when my pets are remotely out of sorts, even subtle signs so hopefully we can rectify this.
Regarding the pred, do you always have some handy and give as soon as you spot the signs and get blood work done or do you give pred and see how they are? Sorry for all the questions, whilst I always knew that taking this lovely lady on wouldn't be easy - I just so want to do everything right for her given the rubbish life she has had!

[Nat]

forgot to say, no D & V, but is up & down with lethagy. The vet didn't say to stop vetoryl but I am there this morning so I will discuss it. I will also ask for electrolytes to be checked as no, they didn't do that either. Do you find that you have to advise your vets now that you know so much about it? :mad:

[JDG]

I am very new with all the Cushings info so I am not in a position to give you guidance. However, I do have to say that I think you are VERY special as to take on this lucky pup. People like you make a difference. If everyone acted as you do we wouldn't have all those poor pups without homes and families. You are an inspiration.
I wish your pup the fastest recovery from what she is going through now :)

[Nat]

Awww, thank you, although I feel I'm the lucky one having her in my life! So, bloods all done, vetoryl stopped after a debate and I made the ultimate decision as the junior vet felt I should carry on until we have the results, but, based on others experience I feel the potential for an addisons crisis is too great versus one or two missed vetoryl. Thank you all so much for your help - I feel this site is going to be a lifeline!!!

[Squirt's Mom]

Hi Nat and welcome to you and your sweet girl! :)

One of the hard fast rules when treating with either Trilostane or Lysodren is never, EVER give it to a pup who is not feeling well. Withholding a dose is always better than risking an overdose. ;)

And, yes, it has been our sad experience that many vets have to be taught how to deal with Cushing's. Too often they don't know how to read the results of the test and while they are telling us things look "good" or are "right where they should be", when we see the actual test numbers, we often see they are either too high or too low. Your vet was remiss in not educating you in what to look for that indicates her cortisol has gone too low and in not giving you pred and telling you when to use it. :(

Good for you for sticking to you guns and holding off on the Trilo until the most recent results are in! Good move, Mom!

Were her electrolytes checked? Those are critical when an Addisonian crisis is suspected so I hope those were looked at as well.

Let us know what you learn...and no more Trilo for now. I hope you start to see an improvement in your baby girl soon as Trilo rapidly leaves the system.

Hugs,
Leslie and the gang

[Rebelsmom]

Hi Nat, I'm glad you stopped the trilo for now. It leaves the system so quickly you should be able to see a difference fairly soon. Be sure and post the results and what they say to do with her once they know. If her numbers are really low I would hold off on the trilo until her symptoms start to return and then start her on a lower dose then re-test.

A lot of us have had the experience of dealing with vets who have little exp with cushings. I myself had to change vets when I diagnosed Rebel and he told me to stop reading the internet!! Luckily my new vet welcomes my thoughts and ideas that come from this forum.

Hoping you see some improvement soon..

[Nat]

Thank you Leslie, yes, bloods taken for electrolytes so hope for those results tomorrow and ACTH possibly Fri or Sat. After I said she didn't have D & V - she promptly vomited!! However, on a good note, she is comfy, asleep on her bed near the log fire and...... no shivering or shaking so far - fingers crossed that she eats a little better today. Not sure what I dislike more - her insatiable appetite or not eating??!!

[lulusmom]

Hi Nat.

I'll take the voracious appetite any day over not eating. When they quit eating, I get really worried because I know something is not right.

A lot of vets do not prescribe Prednisone for a dog being treated with Vetoryl. This is because it has a short half life and should a dog show signs of low cortisol, the dog will usually improve quite rapidly by simply withholding the medication. Unfortunately, we've discovered that this is not always the case so we recommend to our members that they ask their vets for a small supply of prednisone for emergencies.

Since you have expressed Lizzie's weight in kilograms, I am going to assume that you are not in the U.S. I don't know what the protocol is where you live but here in the states if a dog is sick enough to warrant checking electrolytes, and I believe Lizzie was, those results are obtained immediately in office. To wait two days for results could be fatal to a dog with Addison's so I'm relieved that Lizzie is resting comfortably. However, the fact that Lizzie vomited is cause for concern so please keep a very close eye on her.

I will echo Leslie and tell you that more than a few of us have had to lead our vets around by the nose and educate them on the finer points of cushing's. My gp vet is clueless which is why my dogs treat with an internal medicine specialist. In our experience, the number one reason why dog get into trouble here is because the pet owner has placed blind faith in a vet who is inexperienced and didn't follow protocol. Vetoryl is not a benign drug and any vet who prescribes it must follow manufacturers recommendations for both dosing and monitoring testing by way of acth stimulation tests if he or she is to minimize potential risk to their patient.

Dogs being treated with Vetoryl should be tested every 3 months, especially in the first year of treatment. Some folks, myself included, do wait a bit longer but usually not until after the first year and several acth stimulations tests show continued stabilization on an effective dose. Since Lizzie had not had any testing done for at least four months, it does not appear that your vet is adhering to the manufacturers recommendations. Dechra's (manufacturer) dosing and treatment monitoring information can be found in our Helpful Resources Section. Please take a look when you get some quiet time.

http://www.k9cushings.com/forum/showthread.php?t=185

We here in the states have a U.S. Dechra division and they have been very helpful to our members. They have answered our questions as well as worked with our vets to try to resolve problems our dogs are having that may be Vetoryl related. If you or your vet have any questions at all, I would recommend that you contact Dechra UK.

http://www.dechra-eu.com/Default.aspx?ID=38&pcatid=PRIMARY4&catid=PROPGRP14&fid=PROPFIELD107

Glynda

[Nat]

Thanks to you, my Lizzie is bouncing around the house today - I am soooo happy I could burst!!!
If it hadn't been for you advising me to stop vetoryl I dread to think of the consequences!
She has eaten well today, no vomiting and back to barking and chasing my other dog - :D:D:D
So, although I still await the results, I have taken the first steps in finding a vet who has a specialist interest in cushings / addisons so I can ensure she gets the correct treatment. Having seen a miracle in front of my eyes as the vetoryl wears off - I am convinced she was heading for an addisonian crisis.
I am in the uk, so yes, maybe they have different views here but cushings is cushings and addisons will still be addisons where ever you are in the world and I feel so let down by my vet at the moment. But looking to the future, I will always ask for advice on here as I truely feel you saved my Lizzie with your support and advice. I just feel sad for the reasons you are so knowledgeable and why we are all here.

[Squirt's Mom]

Oh, Nat,

I am so thrilled to hear that your sweet girl is back to her old self after such a scare! Trilostane is a miracle drug for our cush babies but it must be handled with care by those who follow protocol.

You are a great mom to have recognized something wasn't right with Lizzie and to reach to find help for her.

Hugs,
Leslie and the gang

[lulusmom]

Hi Nat,

I'm very happy to hear that Lizzie is back to her bouncy cute self. She really is adorable and oh so lucky that you came into her life.

Glynda

[Nat]

Awww, thank you Leslie, thats such a lovely thing to say! It is such a worry, especially when I don't yet fully understand it all. I will get there but seeing her this evening is the best sight in the world :D

[Nat]

thank you Glynda, she really is the most lovely girl!! She and I are both lucky to have found each other and I am proud to be her mom xx

[Nat]

ok, so results are in! She is now addisonian :mad:

ACTH

Pre = 16.8
Post = 35

I spoke to the junior vet as my usual vet isn't back until Wednesday and she was unable to answer any of my questions other than to stop the vetoryl (which I told her thanks to you guys!!)
I asked about pred, she said best to wait until weds!!!
I asked about the electrolytes, first she said they weren't available but when I pushed her - the sample had clotted - so now I don't know what to do!!!???

Any advice now would be truely appreciated as I am so worried especially as it is so nearly christmas.

[Harley PoMMom]

ok, so results are in! She is now addisonian :mad:

ACTH

Pre = 16.8
Post = 35

I spoke to the junior vet as my usual vet isn't back until Wednesday and she was unable to answer any of my questions other than to stop the vetoryl (which I told her thanks to you guys!!)
I asked about pred, she said best to wait until weds!!!
I asked about the electrolytes, first she said they weren't available but when I pushed her - the sample had clotted - so now I don't know what to do!!!???

Any advice now would be truely appreciated as I am so worried especially as it is so nearly christmas.

Are the stim results you posted in nmol/L? If so that would make her post 1.26 ug/dl and her pre .6 ug/dl, ug/dl is what we are used to seeing here. Is Lizzie experiencing any vomiting, diarrhea, and/or lethargy?

If she is not acting like herself in any way, I believe the prednisone should be started. Also it is very important to have her electrolytes checked/known. If this were me I would have her electrolytes rechecked.

[Nat]

Thank you for such a fast reply! I presume it is, I'm having her re bled tomorrow. However, I may just try a different vet if I can get an appt - think I have found one who specialises in endocrinology.

So translated, her results are lower than they should be?

She has more energy for longer bursts but still fairly tired for her, no more vomiting or loose stools, still shaking / shivering but less than she was. And she has actually eaten very well today which is a huge relief!

[Nat]

ps, how did you calculate the results?

[StarDeb55]

Nat, it appears that Lori isn't on at the moment, but I can answer your question. Divide your results by 27.95 which will translate them into ug/dl which is what we are used to in the US. Stopping the vetoryl is always the first step in this situation. As long as Lizzie appears to be feeling ok, eating well, interacting with you & her environment, no vomiting, diarrhea, or lethargy, the pred may not be necessary. If I were in your shoes, I would still demand a small supply of pred to have on hand in case Lizzie does crash, Weds is a very long time to wait especially with Christmas on Sunday. If you feel Lizzie isn't doing well, you can give the pred, & she should start feeling better in an hour or so, which may save you a trip to an emergency clinic. It's really unconscionable that the junior vet wants you to wait until Weds, because a dog that has gone Addisonian can get very sick, very fast.

Debbie

[Squirt's Mom]

Hi Nat,

I agree with Debbie and would call the vet for some pred just to have on hand. Wed. is much to far away if she should get worse.

Hang in there!
Hugs,
Leslie and the gang

[Nat]

Thank you so much.... I will sit on the vet floor until they give me some!

Gosh, I really don't know where I would be without your help xx

[Rebelsmom]

Nat, glad to see Lizzie is feeling somewhat better and is eating. That is always a good sign, but I do agree that I would demand to have some pred on hand just in case.. Merry Christmas to you and you girl.

[Nat]

I have pred in my hand!!!!!!!!!!

So, 2nd opinion sought and I feel so relieved!! She is going to have repeat UCTH, full blood screen on wednesday, he felt that the shaking etc is due to glucocortisone (? spelt right) rather than her sodium / potassium and that the pred will help kick start her adrenal glands. He also felt that she should feel a whole lot better by tomorrow as the vetoryl should be out of her system - fingers crossed!
He checked every square inch of her so I really do feel reassured with this vet. Hopefully we can actually enjoy Christmas now I have pred in the house.
Thank you all so very much for the amazing support and I hope you all have a wonderful Christmas :D:D:D:D

[Rebelsmom]

That is great Nat. Merry Christmas to you both..

[Harley PoMMom]

Hi Nat,

So glad that the vet appointment went well.

Regarding the prednisone and the ACTH stimulation test; Prednisone is a synthetic corticosteroid drug that is used to treat the symptoms of low cortisol levels. Prednisone mimics cortisol so the body recognizes it as such, so the use of prednisone will skew ACTH stimulation results. Has the vet mentioned this?

[Nat]

thank you - yes, so, if pred needed then we need to leave it a week for the ACTH, if we can get away without pred then we go ahead. Either way, full screen will occur Weds. As her glucocortisode levels are so low that is making her coping mechanisms shot to pieces which = such shaking & teeth chattering (which happened again this evening as we popped out for dinner)
She is happy as Larry now we are home! Woohoo!!
My usual vet has been trying to contact me (several times) this is because the vet I saw today requested her notes, I can't bring myself to talk to them as I feel so disappointed & let down and yet strangley guilty as I have been with the vet for 15 yrs. But, I gave myself a talking to... this is not about them or me, this is about getting the right treatment for my girl which is all that counts!
Wishing you all a wonderful Christmas !!!!

[Harley PoMMom]

The Prednisone should clear the system in about a day. Prednisone should be tapered gradually when used for a length of time.

You are such a wonderful advocate for your sweet boy!

Have a very Merry Christmas!

[Nat]

Lizzie update :)
No hiccups over xmas other than vomiting one morning. She has been to the 'new' vet, what a breath of fresh air he is!!
So, he questions why they thought she had cushings and as this was before she came to live with me I couldn't answer but he wants to start again with her. So, trilo is still not being given, repeat ACTH & full bloods taken yesterday - just waiting results. He said he was keen to leave her off any meds and see what happens. The only problem with that is the minute she has an extra drink or little tiddle in the house I am going to be paranoid!
However, I am pleased to report that she remains very bright and eating well and starting to be a little playful again :D
Will post results when I get them, hope you all had a lovely Christmas!

[Rebelsmom]

That is great news Nat maybe you will get a Trilo break for awhile. We have had some members here that have gotten sometimes months long breaks from it before symptoms return. If they do return however I would look at starting her on a lower dose.

[mypuppy]

A bit late Welcome to you and Nat,

As Melissa pointed out, my Princess was one of the few dogs whose cortisol had dropped too low and had to take a trilo vacation for 5 months. I hope your Nat is just as fortunate, in taking a break, that is. It is just a wonderful feeling to have them off the meds and getting your old dog somewhat back. Enjoy!

Tight hugs. xo Jeanette and Princess

[Nat]

Thank you!!!
So, the vet just phoned to say
ACTH pre 2.6. (I have converted it as in uk =73)
Post. 5.7. ( 161)
Sodium. 146
Potassium. 5.2
Glucose. 8

He is going to speak to pathologist to work out when next to repeat ACTH unless symptoms suggest otherwise, he isn't too worried that glucose is a little high, sodium a little low and potassium I think is a little high! But, as she was seriously heading for an addisons crisis I don't think these bloods are too bad! Everything else including liver were all in normal range. Phew.....