Lady - 11 y/o smooth-coated terrier (Vetoryl)

[Lady's mom]

Hi. Just joined. Lady is a smooth-coated terrier, maybe 11 years old (a rescue who just came walking up my driveway about 8 years ago).

After a variety of symptoms and lots of bloodwork she has been diagnosed with cushing's. Her liver enzyme levels kept going higher and higher, she pants frequently for no reason, her stomach is bloated, she "shivers" without cause, she had severe pancreatitis about one year ago, and a few other symptoms. Then, when the diagnosis came back in early December, a stage 2mast cell tumor was discovered, so cushing's was put on back burner. Now we're ready to begin meds. She will be starting vitoryl on Monday. I have 2 vets closely monitoring her condition, so I feel very comfortable with her support, for now at least.

[Harley PoMMom]

Hi and welcome to you and Lady!

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

My oh my, you and your sweet girl have been through a lot, Cushing in itself can be worrisome but then have pancreatitis and a mast cell tumor on top of the Cushing diagnosis. :eek:

I was wondering if you could tell us more about Lady, such as the test/s that were done to confirm her Cushing diagnosis. Also what symptoms does Lady display because strong symptoms are a huge part of the Cushing diagnosis.

Is Lady on any other supplements/medicines/herbs? How much does she weigh and what dose of Vetoryl did her vet prescribe? Is this dose supposed to be given once or twice a day?

Sorry for all the questions but the more we know about Lady the better our feedback will be.

Please know you are not alone on this journey and we will help you and your sweet girl in any way we can.

Love and hugs,
Lori

[Skye]

hello and so glad you found us! amazing group of people here with loads of experience and knowledge. I have no doubt you will find love, compassion, support, and amazing opinions and advice to help guide you and Lady. These angels have helped guide me and my darling through some very difficult and challenging times, and thanks to them and their knowledge found the guidance to be the best advocate possible for my pet child. Sending you love and hugs. tell us all you can from start to current day! It will help so much!

[Lady's mom]

My answers won't come all at once. Don't want to "pester" my vet about test results right now - we've also been dealing with another issue, my 12yr old pointer who has his 4th rectal tumor and a spot on his lung. Between lady's last bout w/pancreatitis, having stitches removed from another dog's lipoma removals, a sheep with a very bad infection, 14 baby lambs born, the lung tumor diagnosis, and getting lady's meds worked out, I have seen 4 vets and traveled over 400 miles this week.

Anyway, lady's symptoms were as I mentioned in my original post. She has presented just about everything except the extreme thirst and hair loss. She was found to have a slightly enlarged gland, but right now I can't remember which it was, pituitary or adrenal.

She will start vetoryl on Monday, 30mg 2xdaily. She weighs about 35lbs. If she tolerates it, she will have bloodwork done after 2weeks.

She already acts depressed, slightly lethargic most of the time, and prefers to be in a room by herself away from the other dogs, unless I say "go" and then she's ready, so don't quite know how to recognize lethargy as a reaction to the meds.

[addy]

Hi and Welcome,

You have had your hands full. I'm sorry for what you have been going through.

I also am concerned a bit about that starting dose. Or do you mean 15mgs per dose for a total of 30mgs per day? We have found it wise to start Vetoryl/Trilostane at 1mg per pound. Dechra also has recommended the lower starting dose. UC Davis recommends an even lower starting dose. My Zoe was 18 pounds, we started at 10mgs once a day, then went to 15, then 20. BID dosing, the dose gets cut in half to start.

Starting low and working up may sometimes cause less side effects. A dog can still go into crisis on Vetoryl just as with Lysodren. It is not the "safe" drug.

That just my opinion. Others will be along soon to chime in.

Hang in there and I am so glad you found us.
addy

[Squirt's Mom]

Hi and welcome to you and Lady! :)

If there is ever a time to take it slow and for "pestering" your vet, Cushing's is it. ;) Cushing's is one of, if not THE, most difficult of conditions to correctly diagnose because so many other things can cause false-positives on the testing and because the cush signs are shared with many other conditions. The good thing is that Cushing's is a very slowly progressing condition so we typically have plenty of time to make sure it IS Cushing's before starting any treatment. You have paid, and paid well, for those test results; the office staff can make you copies easily without bothering your vet. ;)

If the enlarged gland was found on an ultrasound, it was not the pituitary gland - that gland is located in the head and can only be seen via a cat scan or MRI. If you baby has had an ultrasound that is great as it can really provide some good information not only about Cushing's but about many other organs and diseases.

You certainly have your hands full and I am so sorry for all you are having to deal with all at once. It never seems to come in stages, does it? :rolleyes: But you are not alone. We will be here for you and Lady all the way...and for any of the other pups we might can help you with as well.

I'm glad you found us and look forward to learning more soon.
Hugs,
Leslie and the gang

[Lady's mom]

I was concerned about the dosage amount also. My vet felt that the specialist would not have recommended an unsafe dose, but mistakes do happen so I have decided to call her and double check. Probably won't get a response before Monday, but that will work.

[Lady's mom]

Or whatever it is. One of lady's symptoms is that she is losing the ability to jump up or climb down, whereas she used to be very agile. It seemed pretty sudden.

Can anyone explain to me how this is related to cushing's?

MODERATOR NOTE: I have merged your latest post concerning rear leg weakness with your original thread. We like to keep all the info about each pup in their own thread. This way members can easily refer back through the history if needed.

[Skye]

on the leg weakness.....is there muscle wasting? like in the back end? that is related to cushings.

[Lady's mom]

Or whatever it is. One of lady's symptoms is that she is losing the ability to jump up or climb down, whereas she used to be very agile. It seemed pretty sudden.

Can anyone explain to me how this is related to cushing's?

MODERATOR NOTE: I have merged your latest post concerning rear leg weakness with your original thread. We like to keep all the info about each pup in their own thread. This way members can easily refer back through the history if needed.

Ok. I thought threads would be subject specific, but guess not.

[Lady's mom]

on the leg weakness.....is there muscle wasting? like in the back end? that is related to cushings.

No, there doesn't seem to be wasting as much as weakness. She will start to jump, then stop and look at the spot for a few seconds. Then she will usually go ahead and jump. Occasionally she decides to wait til later.

[Harley PoMMom]

She will start vetoryl on Monday, 30mg 2xdaily. She weighs about 35lbs. If she tolerates it, she will have bloodwork done after 2weeks.



30mg BID, to me, sounds like a high starting dose for a 35lb dog. Dechra, the makers of Vetoryl, verbally recommends a starting dose of 1mg per pound.

UC-Davis suggest an even lower starting dose of 1mg per kg.

This information plus more about Trilostane/Vetoryl can be found here: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Love and hugs,
Lori

[addy]

Hi,

Muscle weakness can be from Cushings. Zoe started by not always wanting to jump in the car, then it progressed to not wanting to jump on the bed, sometimes she would, sometimes not and for her it kept progressing. Her back leg weakness was one of my concerns to decide to finally treat her Cushings.

But again, muscle weakness can be caused by so many things. Is there any type of back injury? Arthritis? The fact that it is "sudden " may be a clue as to not being caused by high cortisol. Zoe's reluctance to jump escalated within a time span of six months. Then the muscle wasting in her rear legs became more noticeable. During that time I would occasionally hear a scraping sound after she walked for awhile. I did not know at the time it was from her hind leg knuckling over and dragging a bit.

So, are there any other clues you might not have yet noticed?

What does your vet say?

Please don't be frustrated with us addressing other issues first. We see quite a few dogs started at wrong doses and then get into trouble or dogs misdiagnosed. We tend to ask a lot of questions at first. I hope it doesn't scare you away.

hugs,
addy

[Lady's mom]

The leg issue can be very confusing, I know. If she didn't have the other symptoms I would think it was arthritis. Sometimes it acts like a depth-perception problem. Ex., she will be in her chair and look down at the floor like she's wondering if she can make the jump. Same thing when getting out of the car.

She does have back problems, and occasionally has bad muscle spasms, but you can easily see the difference. (after her first episode x-rays showed many buckshot pellets scattered along her spine and belly, 3different sizes. We can only imagine what she went through before she found us.)

[Lady's mom]

Vet's office just called. Said recent studies have actually shown that there are fewer side effects starting at a higher dose, so I guess we'll stay w/60 mg per day.

[addy]

http://www.dechra-us.com/Files/dechraUSA/downloads/Case%20Studies/Clinicians%20Brief-trilostane.pdf

latest update for use of Vetoryl can be found above on Dechra's website.


When did the vet schedule the ACTH test? Did the vet explain what symptoms to watch for to make sure your dog's cortisol does not drop too low?

In my opinion, if you are going with that large of a dose BID, I would be watching my dog very closely. It may be just fine. Each pup is different. Even one of the top endrocirnologists in the country did not suggest that large of dose for my pup but perhaps your specialist has had success starting that high. Mine did not.

When do you start?

hugs,
addy

[Lady's mom]

Test is sked for Friday Jan 20. She just had her first dose at 9am today.

[lulusmom]

Vet's office just called. Said recent studies have actually shown that there are fewer side effects starting at a higher dose, so I guess we'll stay w/60 mg per day.

This information is simply not true and in your shoes, I would call Dechra, the manufacturer of Vetoryl and ask them what they recommend as well as ask them about the recent study your vet is referring to. Both Dechra and UC Davis have amassed years of case studies and both determined that it is much safer for the dog to start at a lower dose and make upward adjustments if necessary. There is no charge for you or your vet to speak to an internal medicine specialist at Dechra. Contact information can be found at

http://www.dechra-us.com/Default.aspx?ID=365

The same information we have provided you regarding dosing can be found in our Helpful Resources section. You can read up on Vetoryl (Trilostane) and print out pertinent copies of Dechra and UC Davis material to provide to your vet.

[Lady's mom]

But it looks like the dosage is in the normal range, if I'm reading it right?

She weighs approx 38. Lbs, and is starting at a little less than 2mg per LB., daily, or less than 1mg per LB every 12 hours.

[labblab]

It is true that Dechra's written materials recommend an initial dosing range of 1-3 mg. per pound, and the chart included in their U.S. Product Insert lists a starting total daily dose of 60 mg. for a dog of Lady's weight. But for some time now, Dechra's technical representatives have verbally told our members (and also made these same verbal representations at veterinary conferences) that their most current recommendation is to start dogs at the lowest point in the range: a daily total of 1 mg. per pound. It is very frustrating that the written materials reflect different information. But when I asked Dechra about this issue, they told me that they cannot change the written materials without providing additional exhaustive clinical trials/documentation to the FDA. But from experience gained from vets who are treating dogs in their clinical practices, Dechra's feedback has been that dogs tend to exhibit fewer problems and side effects when they are started at the lowest end of the dosing scale. And as Glynda has said, I have not seen any recent research that suggests otherwise. So we'd be really interested to receive research references to the contrary.

If you do opt to start with the 30 mg. twice daily, I just encourage you to watch Lady very closely and to discontinue the medication if you see any evidence of overdosing such as lethargy, loss of appetite, vomiting or diarrhea.

Marianne

[Lady's mom]

Of course, I am going to watch her closely. I also e-mailed dechra with this question. Haven't heard back yet.

[labblab]

I'm really glad you emailed Dechra. And there's no doubt in my mind whatsoever but that you'll be watching Lady like a hawk ;)!

Please do keep us updated each step of the way.

Marianne

[addy]

We will be here with you every step of the way so just post if you have any questions or concerns.:D:)

The advice my internist repeated to me 3 times, when in doubt, don't give the pill, call.

I am not trying to scare you, just always better safe than the other.


hugs,
addy

[Cyn719]

Hi I am really glad you called Dechra - they are really good with answering questions and it does sound like alot - my Penny was 85 lbs and we started the trilo at 60 mg -- it sound high for a small dog and yes you have to watch so closely cause the numbers can drop so fast as Pennys did -- hope they answer you soon xo

[Lady's mom]

Nothing from dechra yet. She's not due the second dose until 9pm, so there's lots of time yet.

If I do NOT hear from them, I doubt I'll give another dose until I do hear something

[labblab]

You can also try calling them in hopes you'll get a quicker response. When I called most recently, I ended up leaving a voicemail message after hearing a menu "prompt" for technical assistance. I got a call-back later that same day. But if you actually talk to the operator rather than leaving a voicemail, they may be able to connect you directly with a technical rep at the time you call.

Marianne

[Lady's mom]

I called dechra, and was reassured that Lady's dose is in the normal range. I was also reminded that the specialist and my vet both know my dog, and what is best for her. So we are going with the prescribed dose of 30mg twice a day, and she will be tested Jan. 20.

[labblab]

So no mention of starting low at 1 mg. per pound? Hmmm...that's very interesting. I do know that the technical rep with whom our members previously had the most frequent and consistent contact (Dr. Tim Allen) retired from Dechra within the last couple of months. So perhaps the "message" depends upon the "messenger" and the current rep/reps are no longer offering out that same advice.

Regardless, as we've already said, of course you'll be watching Lady very closely. Continued good luck with her treatment, and please keep us updated.

Marianne

[Lady's mom]

"we" seem to be doing very well so far. Lady has just had her 4th dose of vetoryl, and no signs of problems.

One thing the Dechra rep mentioned that I forgot to tell you, was how important it is to keep a journal, so her vet will have all the details needed. Seems so simple, and a great idea.

We had terrible thunderstorms early this morning, and poor Lady was a basket case. There is nothing to be done for her when the storms come on suddenly like that.

[addy]

Good to hear no problems so far. Just don't let your guard down. Also, with Trilostane, cortisol keeps dropping sometimes for a full 30 days or more so, keep that in mind for your ACTH test next week.

We all found Dr. Allen a life line at Dechra and it is sad to me no one at the company seems to have tried to step into his role. When I sent hime Zoe's tests last December, he advised starting her at 10 mgs back then. She was 20 pounds back then and had colitis.

Each specialist has their own way of doing things. Perhaps as they use the drug more, each specialist is getting different results.:)

Keep watch,
hugs,
addu

[Lady's mom]

Just wondering: a few months from now do the cortisol levels even out, or can there be swings forever?

[addy]

Each pup is different. Some will reach the desired range and stay there. Some will stay for awhile and then go up or go lower, some may go too low. It is not unusual to do have to do dose adjustments, which is why they test often, every 3-4 months, with Trilostane.

But you can't just go by the number- you have to go by the dog. The goal of treatment is to reduce symptoms. A dog can be in range but still have symptoms.

The mantra with trilostane has always been start low and go slow because UC Davis had different experiences with the drug then Europe had. The Dechra inserts for the U.S. recomendations were different than the UK. Not sure if they still are.

My Zoe- had really high cortisol 44ug/dl. In the first 10 days she dropped like a ton of bricks down to 11ug/dl. I sure was not expecting that on her small dose.:rolleyes::rolleyes: We were trying to bring her cortisol down slowly because she has colitis/IBD:rolleyes::rolleyes:

Then you read Cindy and Penny's thread and OMG!!!!! What they went through.

Other threads, not much drama. Which is a good thing!!!!

hugs,
addy

[Rebelsmom]

Just to give you and idea of how the cortisol levels can change, my pup Rebel is 30lbs and was on 30mg BID (same as yours) for over a year and a few months ago we dropped him to 15mg BID and has been doing really well on that.

[addy]

How's lady doing? Just wanted to stop by and say hi and see how things are going.

hugs,
addy

[Lady's mom]

Having a bad night, panting really heavy, trembling, moaning some, standing still with head down. Just passed terrible gas.

Looks like a trip to the vet first thing this am.

[lulusmom]

Good luck at the vet's office. We'll all be waiting for your update. My thoughts and prayers are with you both.

[addy]

Hoping everything is okay. Let us know.

Thinking of you and Lady.

Hugs,
addy

[labblab]

Me, too!!!!!!

Marianne

[Squirt's Mom]

How is Lady?

Did you give the Trilo this morning?

Let us hear from you when you get a chance. We are all concerned about your baby.

Hugs,
Leslie and the gang

[Lady's mom]

We're back. No trilo until this pm, per vet.

We believe it was a flare-up of pancreatitis, same as 2 weeks ago. I had run out of her special food, so gave her pills with pedigree canned last couple of days. Probably too much fat. Vet gave her buprenex/cerenia inj, and cerenia pills for 4 days, which worked very well last time.

I also got pred to have on hand, and a case of the low residue food. Also got my boxer Grace tested for thyroid. If it's not one thing, it's 10, but that's a story for another day.

The good news: the stray I saw running along the road on my way TO the vet, was NOT there on my way back! I've got enough on my plate right now.

[Lady's mom]

She's not coming out of this like she did last time, but we think there are neck and back issues too. Added tramadol, and stopped vetoryl until she's back to her "old" self, whatever that is.

[Squirt's Mom]

How is her appetite? Are her stools formed or loose...or does she have any diarrhea? Is she lethargic, very slow to respond?

Did your vet run any tests to check her pancreas? Did they do an ACTH and check her electrolytes?

Please let us know how things are....the Queen of Worry is on her throne this morning about your sweet Lady.

Hugs,
Leslie and the gang

[Lady's mom]

I typed a whole long response to this, but it got lost!

Will try again later.

[Squirt's Mom]

Frustrating, I know! Maybe this will help....

http://www.k9cushings.com/forum/showthread.php?t=1329

[Lady's mom]

Nope. I typed a long response quoting your message, but it's saying my message is too short, and won't post it.

[Squirt's Mom]

OH...that usually means that what you have written isn't long enough. In other words, it won't let you just quote a previous post - you have to type at least 10 characters, I think it is. If what you had typed was very long in response and included a long quote of a previous post, then it may have been too long for a single post....but we have some long-winded folks here, myself included and it takes a LOT to be too long. :D

Edited to add....if you were writing back within the quote box, you may need to write something outside the box that is at least 10 characters.

[labblab]

In order for a reply to "post," there have to be a certain minimal number of characters that fall outside of the quote. So if you are inserting all of your new text within the quote, that is the problem. If you add an introductory sentence or two outside of the quote, that should solve the problem.

Marianne

P.S. I see Leslie and I were replying at the same time!

[Lady's mom]

Ok. Anyway, she ate a little, walked a little, drank a little, and peed a little, then came back inside and crashed at my feet. She's on cerenia for her tummy, and we added tramadol for her back, so it's not unusual that she would be sleeping even more than normal.

She has not had vetoryl since Thursday pm. I am to call the vet back on mon. Am, and if she's not better we'll have to decide which way to go, even if it means postponing the cushing's meds for a few days more.

Advice, please: my dogs all eat dry food free choice, but I want lady to have more low-residue canned. If she gets 1/2 can morning and again at night, with some kibble in between, that should be enough shouldn't it? ( she weighs 38lbs)

[labblab]

As for the food exchange, I think it all just depends on what the calorie comparison is between the kibble and the canned food. Although, if you continue to allow Lady to free-feed on the kibble during the day in addition to the canned food, I'm not sure how you'll be able to control her total calorie intake so that she's not getting overfed. Also, what is the fat content of the kibble? If you really think pancreatitis is at play, then allowing her to continue to free-feed on higher-fat kibble during the day may continue to irritate her pancreas.

Tell us some more about her back problems. Have they been diagnosed, and have they been relieved by Tramadol before?

I will make this suggestion: if it were me, I would not start back on the trilostane at all until Lady has been stabilized both on her new food regimen and also re: the pain medication. With the addition of these new variables, it will be impossible for you to know whether ill GI effects /lethargy are a result of trilostane overdosing, or whether they may be caused by medication and/or change in food. When starting treatment with either Lysodren or trilostane, the monitoring process is made a lot easier when there are no other new variables at play.

Also (and I know I'm sounding like a broken record :o and you'll probably want to slap me :p), when you do start back, I'd talk with your vet about beginning with only one single 30 mg. capsule daily. If Lady tolerates this dosage with no problem for at least a week or so, you can then always add in the second dose. But truly, the experience of so many owners here is that the likelihood of GI issues or other ill side effects seems to be minimized if dosing is started slowly and worked upwards, rather than vice versa.

Marianne

[Lady's mom]

Lady has eaten pedigree small chunks all her life, with no ill effects.
I believe the problem came about when I ran out of the low residue canned food I had started using to give her vet

[Lady's mom]

Omg it did it again!

I already mentioned that lady would not go back on vetoryl until these other problems were resolved; I'm glad you agree.

As to all the other stuff I wrote, I don't feel like typing it all over again. I'm losing patience with myself or this format or my iPad.

Sorry.

[labblab]

I have a lot harder time posting replies with my iPad, too, than with my desktop. I can do stuff like "copy" and "paste," etc., a lot easier with my mouse than I can with my finger! I love using my iPad to browse sites and it's fine for simple kinds of typing, but it's just not as easy for me to write involved "stuff" anywhere. But I am the original techno-geek, so maybe I just haven't had enough practice, yet...:o

Marianne

[addy]

Just catching up, sorry to hear Lady is still not herself. I going to agree with Marianne and then you can slap us both in the face;);)

I hope Lady is up and about soon. Please keep us posted.

Zoe dropped from 44ug/dl all the way down to post 11ug/dl in 10 days on such a small dose. Her colitis flared. She did not feel very good at first. Her arthritic front paw started to bother her, and she was not even in theraputic range.

You just never know.

You are doing a good job,
Hugs,
addy

[Lady's mom]

She is moving around more tonight, but looks "crooked," if that makes sense. Out of alignment maybe.

Guess another trip to the vet is in order ASAP Monday.

[Lady's mom]

Addy, are you saying all these flareups happened because Zoe's levels dropped?

Is there a way to know for sure that was the cause?

[Squirt's Mom]

Hi,

Not Addy but maybe I can help.

What you have been seeing could be because her cortisol levels dropped too low. The only way to know this is by an ACTH. This is why I asked if one had been done when this started and why I asked if her electrolytes had been checked. These two tests will tell if she is/was in an Addisonian crisis - which is when the cortisol has dropped too low.

The signs of a crisis are loss of appetite, nausea/vomiting, loose stool/diarrhea, weakness/shaking, lethargy. When this happens, you stop the treatment, contact the vet asap, and give prednisone if needed.

This has been our concern with her dose - that it is too high to start her on, putting her at greater risk for a crisis.

What Addy has seen in her pup, Zoe, was that as the cortisol dropped into more normal range, she started to experience a problem with colitis (which she already had prior to starting treatment) and arthritis became more obvious. This happens sometimes because cortisol is a natural anti-inflammatory so as it is lowered to normal range, some of the conditions, like arthritis, become more obvious because they have lost the "treatment" the cortisol (anti-inflammatory) was supplying.

With Trilostane, the cortisol can drop very rapidly, making the pup feel bad for a few days. They are experiencing a sort of withdrawal from the cortisol. It has been our experience here, starting with a high dose of Trilo increases the possibility of this rapid drop.

I know that Dechra, the manufacturer of Trilo, told you the dose recommended to you was the right one...and according to their product information, they are correct. However, Trilo is comparatively new on the market, just approved in the US in 2008, I think it was, tho it has been used in the UK for quite some time. Here's food for thought - One on hand, Dechra has spent literally millions on developing this drug and marketing it. Marketing it with the dose recommendation that you were given. To change their dose recommendation now would take literally millions more.

On the other hand, are vets and research scientists who actually use Trilostane, who actually see how it works on their patients. Many of these experts have found that the dogs fair better starting at a lower dose of Trilo than the manufacturer recommends in their literature. They have published their studies to support their findings. UC Davis in CA is just one.

Then, there are folks like us - who live with Cushing's every single day in our own homes plus stay in close contact with other cush parents via this site. We also have members who live and breath canine Cushing's - they study veterinary manuals and journals, attend conferences, talk with world renown specialist in the field, their Cds and iPods don't play music but rather lectures on the canine endocrine system. I'm willing to bet, we have lived and seen more about Cushing's than any one vet probably will in a life time. Not to mention, we truly care about you and about Lady so everything we say comes from that care and from a deep desire to see her do well and live long and happily with you.

How you manage to do anything on a iPad is beyond me! :o I am a techno-idiot. This laptop is bad enough. I lose stuff ALL the time because my thumb taps the pad. I also GET stuff online all the time I don't want - ads and such. :rolleyes: Drives me nuts!

If you need to post several short posts to get everything posted, do that. We can work with it. Once you get used to this format, I think you will love it. It took me a while but now I prefer this setup (vBulletin Solutions) to any other format I use on forums.

Hugs,
Leslie and the gang

[addy]

Leslie hit it right on the head. We all have been worried about Lady's dose. My point with telling you about Zoe is that she dropped fairly quickly on a very small dose and it made her feel crummy. Lady had a good sized dose. It may be that her cortisol has not gone to low and you are seeing her feel crummy from prexisting condtions that high cortisol helped her self medicate, which was Zoe's case, but you may also be seeing her cortisol go to low. You just never know.

hugs,
addy

[Lady's mom]

Ok. Got it.

My arthritis causes my middle finger to be stiff - I know; don't say it. Anyway, it's always hitting an extra spot on my iPad. But I do love this thing. I can do so much w/o going upstairs to my computer.

[labblab]

Ok. Got it.

My arthritis causes my middle finger to be stiff - I know; don't say it. Anyway, it's always hitting an extra spot on my iPad. But I do love this thing. I can do so much w/o going upstairs to my computer.

LOL!!!!!! :p :p My set-up is exactly the same -- I've got the iPad downstairs (where the dogs also hang out ;)) and the desktop upstairs. So I'll toil away for quite awhile trying to type something out on the iPad before I finally get disgusted and drag my sorry self up the stairs to retype it all on the desktop!

[Lady's mom]

Lady is still in a lot of pain tonight, holding her neck at an odd angle. Best meds I have on hand is just tramadol. We'll be at our vet's office early tomorrow for some better pain meds.

I wish I could just hold and cuddle her, but with this kind of hurt she needs her space. Maybe she'll be more comfortable on our tempurpedic mattress?

[labblab]

Poor Lady!! Do you think her pain and odd stance may still signal an ongoing issue with pancreatitis? You may already know this info, but I found this article really helpful when my own dog had an acute pancreatic flare last summer:

http://dogaware.com/articles/wdjpancreatitis.html

It was only through the IDEXX Spec cPL test that the pancreatitis was diagnosed -- her other bloodwork was a bit "off," but not markedly so. We were stunned when the IDEXX result came back so highly elevated.

Whatever the problem, I surely hope your vet can provide some relief for Lady's pain.

Marianne

[Lady's mom]

No, I really believe it's in her back and neck. When I move my hand slowly down her back I can feel her tighten up a little. She did sleep on my bed all night, but doesn't seem any better this am.

When I re-start the trilo, at the lower dose, it will have to be once a day. Does that work as well? I can't cut the capsules.

[labblab]

Yes, under the circumstances, I would think that once a day would be fine to begin with. In fact, Dechra recommends that treatment be initiated with once-daily dosing, and a switch to twice-daily dosing made only if it appears as though the drug's effects are wearing off too quickly and symptoms are rebounding later in the day. However, some clinicians and researchers (like at U.C. Davis) prefer twice-daily dosing right from the get-go due to the short half-life of the drug and the thought that all complications of Cushing's (not just overt symptoms) may be managed more satisfactorily if the drug effect remains more consistent throughtout a 24-hour time period. But there is nothing unsafe about starting with once-daily dosing. And if it turns out that adequate control can be achieved with only a single dose daily, I should think it would make the owner's life easier. With my own Cushpup, we started out dosing twice-daily from the beginning and in retrospect, I always kinda wished we had first seen whether once-daily dosing would have been sufficient. But the dosing questions remain controversial pending additional research.

In case we haven't already given you this link, here is a copy of Dechra's U.S. Product Insert in which many treatment and monitoring issues are discussed, including their recommended dosing schedule and also symptoms of cortisol withdrawal, etc.:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

Marianne

[Lady's mom]

We're home, 2 x-rays, blood tests, 2 inj., 2pain meds, and $350 later. She's sleeping. Her blood work looks good, liver enzymes were 546, which is down from 800+ in November.

Vet could move her neck freely, so he thinks no probs there. Middle back is very sensitive. Couple of places where the bones are very close together, could be causing discomfort. Walking very stiff-legged, rear legs. Stomach looks normal, no fever.

Treat w/previcox and tramadol, add methcarbamol later if needed. Call him tomorrow. If no better by Wed., we'll make an appt w/ims.

[Squirt's Mom]

Word of caution about the Previcox - it can make them feel real good real fast. That in turn makes them forget about the pain which makes them think they can run and jump and play again. If her pain is from an injury or the result of a chronic issue, this could make the actual problem worse. So keep and eye on her and don't let her over do because the Previcox can make her feel like she can do anything! :D I used it with two of my dogs and they both felt better almost immediately. Same result with my brother's dog. I hope it helps Lady, too. Just don't let her do too much. ;)

Hugs,
Leslie and the gang

[Lady's mom]

I've used previcox for many years with several dogs, and I've been really pleased with the results. Some people complain about the cost but I don't feel it's all that much. I doubt if anything is going to get Lady up and jumping around, though.

[Cyn719]

Hi I just say your post about Lady - My Penny has back - lumbar and back leg issues - also bones that are close together --- after reading your post I wonder if I should try the previxo - you seem to have very good luck with it -- I pray Lady starts to feel better -

I use:
Rimadyl
Dasaquan
Adequan shots
Gabapentin
Has been off trilo since September

sending lots of good wishes love and hugssss to you and Lady xoxo

[Lady's mom]

I really think it works well. Over the years I've had a boxer, a rat terrier, a Heinz 57, a German shepherd/chow mix on it, and now Lady. We've never had gastro problems w/anybody. All my dogs live to be 14+ years, and this is what gives them a better life. If one is in extreme pain I will add tramadol for a few days.

I always get the 227 mg size, and either half or quarter it.

Good luck with your fur baby.

[Cyn719]

Thank you so much for the information - I forgot to say she was on the tramadol at bedtime but we had to stop that to use the tramadol - trying to figure out which one helps her more ?? I just called the orthopedic and left a voice message to talk to him about trying the Previcox -- will be checking on on Lady - again thanks:)

hugsssss xo

[Lady's mom]

Lady is still having major trembling episodes. Vet didn't want to add any more meds, but I felt I had to give her methacarbamol for what seems to be muscle spasms.

We'll put her on our bed again tonight, and see how she rests. I don't remember seeing anything this bad before, when she's had back pain.

[Lady's mom]

Lady is feeling better this AM - not 50%, but maybe 35% and improving. Her head is held a little higher, and her tail is wagging. She ate a good breakfast, and is walking a little easier, though still very stiff.

Maybe the threat of having to go to the hospital shocked her!

[Lady's mom]

Just wanted to let you-all know that lady is continuing to improve, and decreasing her pain meds.

Guess I'll have to think about if/when/how to re-start the vetoryl.

[Rebelsmom]

Glad to hear she is improving keep it up Lady :)

[Squirt's Mom]

Glad to hear that Lady is improving and I hope the trend continues until she is back on her feet good and strong.

Hugs,
Leslie and the gang

[addy]

I am so super glad Lady is feeling better:):):):)

I hope she gets back on track real soon.

Hugs,
addy

[Lady's mom]

She was actually "prancing" today, tail up and wagging, and head held high, ears perked up.

It's been a long time since I've seen that.

[Cyn719]

happy happy happy:):):) that Lady is feeling better and prancing around!! Thanks for the Good News!!

Hugssssss xoxo

[addy]

When we here this kind of news we all do the happy dance.

Only problem is we don't have a happy dance icon:o:o:o:o:o

So you have to put up with me writing,

doing the dance, doing the happy dance, we are all dancing,
GO LADY, still dancing!!!!!!!!

hugs,
addy

[Lady's mom]

Now, to come down a little bit....

How do I decide about vetoryl? Whether to try it again, I mean. I will definitely start at a lower dose but I need reminding, WHY should I try it at all?

[Harley PoMMom]

If it were me, I would not start treatment until Lady's clinical symptoms become bothersome.

If you are asking about Trilostane/Vetoryl vs Lysodren/Mitotane, IMHO, Trilostane/Vetoryl would be my first choice given Lady's pancreatitis.

[Lady's mom]

Her liver enzymes were much lower than before, when checked last week - around 500 I think.

Her dex suppression test back in nov. Read 2.4,2.4,5.1.
I believe the next test is due in Feb. Would it make sense to hold off until then?

[Squirt's Mom]

Has Lady had an ACTH since she started the Trilo? That is the test you will want to have done before you re-start the Trilo, or switch to the Lyso. You want either her ACTH results to indicate the cortisol is elevated and/or her clinical signs are raging. If she is scheduled for an ACTH in Feb. by all means keep that appt. ;)

Hope this helps.
Hugs,
Leslie and the gang

[Cyn719]

Hi

How is Lady tonight - is she still tired from the meds? Hope the weather is better tonight:)

hugsss xoxo

[Lady's mom]

Yes, she's still sleeping, but I do believe it's the Ace. She went with the other dogs on their run this afternoon, and seemed perky enough. If she's still droopy tomorrow I may check w/her vet. She has not taken anything else besides the Ace, which was about 24 hrs ago.

Weather is gone, at least for a couple of days.

Thanks for asking about her.

[Lady's mom]

Leslie, I was planning on keeping the ACTH appt in Feb. My concern- not really major - was about not putting her back on any meds before then.

I think it makes sense to try to keep her off all meds until after the test, if possible.

[Cyn719]

Glad she went for her run. If Lady doesnt show any symptoms I agree its ok to keep her off the meds and have the test in Feb -- Penny has been off trilo since Sept and the vet said to let it go until she show symptoms again. Hope she is more awake tomorrow:)

hugsss xo

[Cyn719]

Tomorrow will be 4 days that penny is on the previcox. She seemed a bit better today getting around-hoping tomorrow she is even a little better. I don't remember if u said if lady ever was on rimadyl? Thanks for the info:)

[Lady's mom]

No. She wasn't taking anything for chronic pain. Right before the vetoryl she was having a lot of trouble getting up and down. Then it quickly seemed to get worse the 4 days she was on vetoryl.

Now she is only taking previcox and occasionally tramadol, and is moving around like her old self, from months ago.

[Cyn719]

How do you give the Previcox to lady - does she just chew it - Penny wont - so I crush it and put it over her food - but now that she sometimes eats only half she is not getting all of it Thanks:)

[Lady's mom]

I have the 227 mg pills. One of my dogs takes half a pill in a spoon of moist food, and Lady takes 1/4 pill in a spoon of moist food. Sometimes I give their meds in a spoon of PB, and even have a cat who will stand on her back legs and lick off the spoon!

[Lady's mom]

Lady is doing SO well w/o taking any meds for cushing's. I don't understand what's going on, but I'm very happy about it!

She is not panting, she's moving around a lot easier, no bloat for the first time in over a year, and she's not lethargic.

The only med she's on is previcox.

Wonder why?

[Cyn719]

Pneny is a brat!!:D She smells the pill in everything and spits it out but I did get it in her this am with breakfast - alot of chicken and chicken broth -

Penny has been off trilo since Sept and no bloating not increased eating a little increased drinking but shes been doing good being off it also --- now to deal with the pain and groaning

so glad lady is feeling good :) usually no need to start meds unless the symptons return - my IMS just justs the ACTH level every so often

hugs xo

[Lady's mom]

I guess Lady is not so interesting anymore, since she doesn't have symptoms. But I'm curious: has anybody seen this, where it just "disappears?"

Will it return? ( my vet says there are "a thousand shades of gray" where cushing's is involved.)

[addy]

This a good report on Lady. I am glad I stopped by.

Just sit back and enjoy your pup:D:D:D:D

hugs,
addy

[Harley PoMMom]

Some members that were/are treating with Vetoryl/Trilostane have had their dog's cushing symptoms go into hiatus for a while. Usually this was after their dog's cortisol went too low and the Vetoryl/Trilostane was stopped.

Hoping you and Lady have a long break from this dratted disease.

Love and hugs,
Lori

[Lady's mom]

That's really interesting, and something I wouldn't have expected.

She's more like my LadyBug from a few years ago.

[Cyn719]

Yup. Exactly what Lori said happened to Penny. She was over treated with trilo and since she has been off it she really hasn't had symptoms - just a few here and there. As soon as I think the symptoms are coming back they go away.

[labblab]

You know, there is always the possibility that Lady does not even have Cushing's at all. I went back through your thread and see that she did have some consistent symptoms, but was absent some other hallmark symptoms such as excessive thirst and coat issues. Also, within the last year she has suffered from pancreatitis and chronic back problems, and she had a stage two mast cell tumor at the time of diagnosis. Since she was on the trilo for such a very brief time (just a few days, I believe) but now all supposed Cushing's issues have cleared almost makes me more suspicious that it was some other problem that caused her panting, neck/back pain, sudden mobility issue, and GI discomfort. Perhaps recurrent pancreatitis may be playing a part in things?

At any rate, if it were me, I would definitely not ever begin the trilostane again without first performing another ACTH. And I think I would want it back up in the diagnostically high range (not just in the elevated range for a known Cushpup) before I would start treating again. Just two cents worth to consider.

Marianne

[Lady's mom]

Yes, I agree. She had some problem last night trembling, but it stopped after a few minutes. Don't know why that happens.

[Lady's mom]

I believe her ultrasound showed one slightly enlarged pituitary gland also.

Just got a reminder for her CBC tests to be done in a week.

[labblab]

I'm glad you reminded us of the ultrasound results, because they do raise a bit of a question mark. On an abdominal ultrasound, it would have been one of the two adrenal glands that would have looked slightly enlarged. There is just one single pituitary gland, and it is housed in a dog's brain. It can only be seen via a CT scan or MRI of the head -- both pretty expensive procedures that are not performed routinely.

When a dog suffers from Cushing's caused by a pituitary tumor, the ultrasound will typically reveal either enlargement of both adrenal glands, or both may still be of normal size. When only one single adrenal gland is enlarged, there is a greater likelihood that the dog is instead suffering from Cushing's caused by an adrenal tumor. In fact, in many cases, the adrenal gland with the tumor is really large and the other adrenal gland looks abnormally smaller or almost shrunken up.

So a question would be, was the "slight" enlargement of one of Lady's adrenal glands of any real significance? Where was that ultrasound performed -- was it by your regular vet or by the specialist? I ask becasue the adrenals are very hard to see, and it usually takes pretty sophisticated equipment to be able to get a really accurate view.

Also, I don't believe we ever found out what diagnostic blood testing was done back at that time. Do you know whether it was a LDDS or an ACTH, and also could you find out the results? I think it would be helpful to revisit all those initial diagnostic pieces again in order to try to sort through Lady's situation.

Marianne

[addy]

well, there was a blog by Dr. Peterson, I have to find the link, which also explained that if you do an ultra sound while your dog is going through a non adrenal illness, the adrenal glands can be enlarged on the ultra sound from the non adrenal illness. I remember being upset when I read that as Zoe was having a colitis flare when we did her ultra sound.

Perhaps the unknown explanation pertains to just how enlarged the adrenals are. Perhaps slightly could be from a non adrenal illness?

Just throwing that in the mix.

love,
addy

[addy]

found the blog link

http://endocrinevet.blogspot.com/2011/05/q-atypical-cushings-disease-in-11-month.html

read down to the his paragraph marked "bottom line"

hugs,
addy

[lulusmom]

Addy, abdominal ultrasounds are an amazing tool in diagnosing cushing's and Lady's history is quite different than the dog in Dr. P's blog. There is no doubt in my mind that Dr. Peterson's response would have been a lot different had the dog in question presented as a cushingoid dog. This was an incredible case of ignorance on the part of the vet who posted on Dr. P's blog. S/he diagnosed an 11 month old puppy with atypical cushing's with zero symptoms associated with any form of cushing's but because imaging showed enlarged adrenals and a UTK panel showed elevated estradiol, it had to be atypical cushing's. Now that's scarey! :eek:

I think Dr. Peterson was diplomatic in his response and rather than tell the vet that s/he's a total idiot and recommend that s/he read up on conditons that he chooses to treat (for three plus years), he said "I must admit that I've heard it all now". My impression was the same. I was aghast by the extreme level of ignorance and by the realization that the results of a UTK panel could be so dangerous in the hands of vet this ignorant. I cringe to think what could have happened to this dog had the cortisol been transiently elevated by the IBD which was ultimately diagnosed, treated and resolved.

[labblab]

In Lady's case, the thing that I'm wondering about is, if the "slightly enlarged" single adrenal gland does, in fact, signal an adrenal tumor, what is the likelihood that it could be generating intermittent hormonal releases -- so that she'd be symptomatic at some times and not at others? I just don't know that much about adrenal Cushing's. Glynda or anybody else who knows more about this, what do you think? Wouldn't you expect the other gland to be atrophied, though?

Marianne

[Lady's mom]

Out of town this weekend. Will re-examine all the notes on Tuesday . Ultrasound was done by her IMS at ga vet specialists.

[labblab]

Oh, that's where my Cushpup was diagnosed and treated, too! They are very good, so the ultrasound results should have been accurate. I'd be really interested to read the written interpretation.

Marianne

[Lady's mom]

I didn't see my original thread anywhere, so I'm starting a new one - I'm sure it will be moved.

I've been keeping up with everybody on here but not posting because there's not much to tell. IMO, it's all good news.

Lady continues to NOT show any signs of cushing's, and it's been about a month since any treatment. I think she's lost a little weight, which is good. Her personality seems to be coming back, and her fur is getting longer and thicker in spots.

I started her on melatonin because she is so fearful of many things. She regularly gets 1 mg in am, and I add 2 mg more if we're having storms. It has helped a lot, but not completely.

I probably should have the vet check her out, but "if it ain't broke, don't fix it" is my mantra these days.

[addy]

Glad to hear about Lady. I hope your Cushings holiday continues for a long, long time.:):)

hugs,
addy

[marie adams]

I second Addy's words of a long cushing's vacation!!!

Take care!!!

[Lady's mom]

She did go to the vet today after all, because another dog needed to go. Lady now weighs a little over 27 lbs, down about 7 or 8 lbs from when she was diagnosed. Our vet agrees that we don't need to worry about anything unless she continues to lose weight.

[Lady's mom]

Lady Update

I read here almost daily but have had nothing to contribute. Lady has maintained a status quo with no problems except heavy shedding if all that hair that appeared after her Cushings symptoms vanished.


Now, she's in the hospital, suffering from severe dehydration brought on by bloody diarrhea, bloody vomiting, and bloody urine. She has lost 5 lbs since middle of last week. This seemed to come on rather suddenly yesterday. She is responding well to iv fluids, white cell count is normal, bp low but slowly coming up, red cells slightly low. Her stools smelled a lot like parvo, but vet said it's normal to be smelly when there is blood in it.

They're taking x-rays and also doing an ultrasound. I'm afraid we're going to find something more going on this time. On top of this my DD is also in the hospital with severe back pain and fever. Their hospitals are about 3 hours apart.

Please keep her in your thoughts. She is such a sweet little girl.

[Lady's mom]

Well I can't seem to edit from my iPad. Just wanted to say it's not my DD who is such a sweet little girl - she's 5'11" and very independent!

And she has talked herself out of the hospital!

Now, if Lady can get that lucky...

[frijole]

THat's ok... we'll keep both your daughter and your baby Lady in our thoughts and prayers. Thanks for letting us know. Sending love Kim

[addy]

I am so sorry to hear of the news about Lady. Please know we are here for you.

I have wondered how the two of you have been doing. I am sorry to get this update and hope she pulls through.

[Lady's mom]

She's a little more stable this am, and was sleeping when I called at 8. Ultrasound later today will maybe tell us what's going on, but not sure I want to know.

[frijole]

Know we are here and sending warm thoughts, prayers and strength. You aren't alone on this journey. xoxo, Kim

[Squirt's Mom]

Keeping you both in my thoughts and prayers. Please let us know how Lady is doing when you can. I hope you see much improvement today and she is home soon.

Hugs,
Leslie and the gang

[Lady's mom]

Well, the ultrasound didn't show any tumors, but her adrenals are very small. They've done the ACTH stim test, thinking it might be Addison's! How odd, after confirming Cushings 9-10 months ago.

Her bp is maintaining w/o medication, and she continues slight improvement. Test results will be back tomorrow and if it's not Addison's we will discuss next steps. Vet is thinking possibly intestinal biopsy, but I'm not inclined to do that at this time if we can control symptoms.

The vet asked me if I had a medical background! I told him I had this website and had done research. (should have said I stayed at a Holiday Inn last night, but it was the wrong time for that!)

[molly muffin]

Hope your Lady continues to improve and you can get some answers soon.

Glad your DD was able to get out of the hospital and that she is doing well too. What a time you've had lately.

Hugs
Sharlene

[Lady's mom]

Just spoke with the vet who has taken over Lady's treatment. Stim test results won't be back until Tuesday morning, but she continues to improve. He is hoping to get her into a drug study they are doing, which will help with expenses.

He said it is possible that the vetoryl could have caused Addison's. I would live some feedback on this.

[molly muffin]

Ohhh definitely want to hear more about the drug study. What kind of drug study is it for medicine induced Addisons? and yea, I wouldn't mind hearing feedback on the possibility of vetoryl having caused Addison's too!

dying of curiosity!

Sharlene and molly muffin (because molly is just a neighborhood busy body anyway, she too wants to know)

[frijole]

I'm scratching my head too. Bumping this up in case one of the trilo experts see this and can post thoughts... what has me stumped is you mentioned bloody stools and vomit. Certainly diarrhea and vomiting are signs of overdose (low cortisol) but the bleeding part I don't recall seeing before. Kim

[lulusmom]

When I hear sudden bloody stool and bloody vomit, the first thing I think is hemorrhagic gastroenteritis. My Buster had that a number of years ago and it was scarey! I don't recall that he had blood in his urine at the same time though. If Lady has addison's, the acth stim test will let you know.

Glynda

[Lady's mom]

They were thinking HGE originally, but other factors pointed them to an Addisonian crisis: low blood pressure, low blood glucose, low protein, I forget what else.

So much to absorb. I really expected to bring her home in a box, but now she's stable, off the meds, and eating small amounts. Perked up when the vet tech took her out for a walk this evening.

She is so amazing, and I miss her so much!

[lulusmom]

I gotta think our pups love us and the life they share with us, which is why they fight so hard to overcome things that would kill us humans. They truly are amazing creatures.

[Squirt's Mom]

I am so glad to hear that Lady is improving! :cool::):cool: I know that has done your heart a world of good. You done good, Mom, getting her into the hospital when you did and that will be just one more reason for Lady to adore you.

Keep in touch and let us know how she is doing.
Hugs,
Leslie and the gang

[Lady's mom]

One of life's little ironies :

Grand baby was spending the weekend with us. We were scheduled to go out w/friends Friday night, and DD was going to keep DGD.

But DD was hospitalized, leaving us w/o a sitter. So I was at home to see Lady vomit blood. Otherwise I might not have known who it was until it was too late (we have 4 dogs and 3 cats in the house).

So my DD's illness probably saved Lady's life.

[molly muffin]

So glad that Lady is doing better. Oh gosh, it does sound like DD saved Lady.

You never know how things are going to work out.

HUGS!
Sharlene

[Lady's mom]

Another update: yes, Addison's has been confirmed. Yes, she qualifies for the drug study. This means all tests and all inj. For the next 6 months are paid for, p,us about $800 of the ER expenses, which helps a lot (now at about $3500, I believe.)

I will meet with them today and she can come home!

[Squirt's Mom]

How wonderful that she qualifies! Not wonderful she is Addison's but we will take all the help we can when offered! I hope she helps them understand Addison's and, in contrast, Cushing's in more depth via this and other studies. Keep us informed about the study and most certainly about our sweet Lady.

Here are some links just in case I haven't given them to you previously. The last two are groups where you can chat with folks dealing with Addison's.

Addison’s*

http://canineaddisonsinfo.com/

http://k9addisons.com/faqs/

http://pet-diseases.suite101.com/article.cfm/addisons_disease_in_dog

http://www.inmetrodetroit.com/pets/dachshund/frederick/addisons.htm

http://www.vetinfo.com/dencyclopedia/deaddisons.html

http://pets.groups.yahoo.com/group/AddisonDogs_/

http://canineaddisonsinfo.com/Support.html

Hugs,
Leslie and the gang

[molly muffin]

Wow!!! What absolutely fabulous news in the midst of a dire situation. I am so glad they will help take care of expenses and hoping the new drug will help with the Addisons. There can never be too many options when it comes to treatment for our dear ones.

Hugs, I'm very happy for you and Lady
Sharlene

[Lady's mom]

The doctor feels she may never really have had cushing's, and that it was Addison's all along.

It appears that the first ultrasound was misinterpreted. That there were certain expectations because of the CBC and stim test results, but I'm not a doctor.

More good news is that they took the full rx of vetoryl back, and gave me credit for it on my current bill.

[Lady's mom]

Leslie, a really good article I read - twice, in fact - is in the Whole Dog Journal. Sorry, I'm not good with links.

It's very clear and detailed.

There is also a FB group, linked to the yahoo group, I believe.

[labblab]

The doctor feels she may never really have had cushing's, and that it was Addison's all along.

It appears that the first ultrasound was misinterpreted. That there were certain expectations because of the CBC and stim test results, but I'm not a doctor.

More good news is that they took the full rx of vetoryl back, and gave me credit for it on my current bill.
I am so relieved to know that Lady is doing better, but I have so many questions about the Addison's diagnosis! I've just gone back to re-read your whole thread, and I'm not at all surprised that the opinion now is that Lady never had Cushing's at all. That was pretty much what we were thinking, too, after her response to only the four days on Vetoryl. But I am surprised by the original misdiagnosis. Were all the original diagnostics, including ultrasound, performed by GA Vet Specialists? I don't understand how an Addison's dog could have an abnormally elevated ACTH, and I'm also puzzled by the original ultrasound. Are they now saying that there was actually no enlargement to the one adrenal gland after all?

Marianne

[Lady's mom]

Quoting her discharge papers from yesterday re: the earlier tests.

An abdominal ultrasound performed in November 2011 revealed a mildly enlarged and hyper echoic liver, mild amount of sludge in the gall bladder, and the right adrenal gland was unable to be visualized, the left caudal pole of adrenal measured 0.5cm.

This coupled w/elevated liver enzymes and results of stim test plus pot belly, panning, trembling, pancreatitis, led to the diagnosis. (I just quickly tried to find the stim test results but they're filed away somewhere.)

Yes, everything was done at GVS.
In the ultrasound performed this past weekend, "the adrenal glands were unable to be visualized."

Maybe the other vet didn't know as much as she should about what to look for to confirm the diagnosis. Maybe she conformed her findings to meet her expectations. Who knows?

I'm just hoping and praying that Lady never has to go thru any more crises - she's been thru so much in her lifetime!

[labblab]

If it's not a huge hassle to locate them, I would love to see those original ACTH results. Unless I'm totally missing the boat, I don't see how Addison's originally could have been suspected/possible if Lady's post-ACTH response was elevated above the range for a normal dog. Here's a description by Dr. Peterson of ACTH results that would be expected with differing Addisonian conditions, and none of them include a scenario with an elevated post-ACTH response.

http://endocrinevet.blogspot.com/2011/04/q-atypical-addisons-disease-in-dogs.html

Marianne

[Lady's mom]

Later, after I pay bills, which I should have done a week ago.

[Lady's mom]

I've got some info but I don't know what it is - feel like such a dummy right now.

Nov. 2011 blood tests showed very high alk phos of 804, albumin high at 3.7, globulin low at 2.4.rbc low at 5.09. Hgb low at 12.2. Abs. Lym? Low at .7.

Her dex sup test reads 2.4, 2.4,5.1. This was also in nov. 2011.

Does this tell you anything? I also have another test done in Jan. 2012 just prior to starting treatment that looks different from the others. It is a Buffy coat profile. Alkp 546. Some of the abbreviation were cut off in copying. What was high looks like --cp 9.0,--eos1.8,--plt 479.

Hope you can work with this - looks like a mess to me!

[labblab]

Thanks for hunting up those records! From what the specialist had written earlier, I was assuming they had performed an ACTH on Lady at the time of diagnosis ("stim test").


This coupled w/elevated liver enzymes and results of stim test plus pot belly, panning, trembling, pancreatitis, led to the diagnosis.

Instead, it looks as though they diagnosed her based on an LDDS (Low Dose Dexamethasone Suppression test). Nothing at all wrong with that -- many vets believe the LDDS is the best test to use when a dog is symptomatic. But Lady's results were indeed consistent with Cushing's at that time, so that still seems puzzling to me. Dr. Peterson has told us what the Addisonian profiles would be for an ACTH. What I don't know is how an Addisonian dog would score on a LDDS. I shouldn't think the results would be the same as for Cushing's, but I don't know what pattern you would expect.

Regardless, since Lady is Addisonian now, it is all water under the bridge. I was just trying to learn more about diagnosing Addison's since several symptoms for Cushing's and Addison's overlap. I'd just like to be better informed, myself, so as to be able to offer more guidance to newbies who come to us during the diagnostic stage.

The most important thing for Lady is that she is now receiving appropriate treatment, and hopefully will soon be feeling and acting normally once again. :)

Marianne

[Lady's mom]

No, I be,ueve you're right. But that was done at GVS and I don't have copy. Will ask about it when I go down for her next appt. On Tuesday.

[Lady's mom]

Marianne, if anything, I believe it emphasizes the need for the ultrasound. This is what confirmed the Addison's diagnosis for this vet. I would insist on an ultrasound for my dog if it was ever suggested to "wait and see.". It's not that expensive considering that it could/will save a life.

Of course, they're not readily available either. I had to drive 2 hours to get Lady the exact care she needed.

[Lady's mom]

Just spent all afternoon in ER because Lady has been panting, trembling, and walking stiff-legged, with no appetite. Don't think the ER vet understood my concerns of the possibility of recurring pancreatitis Ddisonian flare-up, etc.

But he says he found a heart murmur! Lady has seen 4 different vets in the past 18 months, and had 3 surgeries and several chest x-rays, and not one of them found heart murmur!

Wonder why I'm skeptical?!?

[molly muffin]

oh my gosh, how very frustrating. Did they find any sign of the pancreatitis?

Unless the heart mumur is New? could that be? something brought on by the stress from everything that has been happening with her over the past 18 months? I'm not actually sure if that is a likely scenerio or not, but may be worth asking the vet about. (your regular vet when you ask them to confirm if there is a heart murmur that is, :) )

Stay strong. It's been a rough road lately.

hugs,
Sharlene

[Squirt's Mom]

Did the ER do an ACTH? Check the electrolytes? Is she still on the pred? Has the dose been tapered down any? If so, she may need to go back up to the previous dose.

How is she this morning? In light of the signs you described, I can't believe they didn't do more than a physical exam! :eek: I think if she is not back to par, I would have her at her usual vets asap this morning.

Let us hear from you!
Hugs,
Leslie and the gang

[addy]

What did they say about the murmur? I have gone through that with Zoe, one vet will hear it, the next vet wont here it, sometimes the same vet will hear it and then not hear it.:eek::eek::eek::eek: If Zoe has one, it is low grade they think.:rolleyes::rolleyes:

Hang in there

[frijole]

I went thru the same thing with both dogs... varied from vet to vet. Not sure that this helps other than to point out that you aren't alone. Kim

[Lady's mom]

The ER vet heard it and asked a colleague to listen who also heard it. He said it can come on quite suddenly, and can be caused by anemia, which she has some signs of.

He wanted to do an x-ray, but I wanted to wait for one of her other vets to confirm it.

He only did blood tests and electrolytes. Only noted "no abnormalities.". Palpated her abdomen, etc., and didn't find any reason to suspect pancreatitis.

She never ate anything at all yesterday. We just got up this morning, so it's too early to say how she is. I may leave off the pred for a few more hours - it's been 12 now- and watch her. He said symptoms could be from too much, but I know they can also be from not enough.

I may get her reg vet to check for murmur today, or may just wait until she goes back to internal med spec. Tomorrow.