Possible Cushings...

[trippyjanet]

Hello everyone. I am so glad I found this site. As of now, we are waiting on the tests to see if my rat terrier, Jersey, has Cushings. He just turned 12 years old and has had so many health problems over the years. He has been experiencing a lot of weight gain (he is 30 pounds and should be about 12ish), he has tore one if not both of his ACLs, he has an enlarged heart, excessive thirst, he is always warm, he has spots on his back of hair that falls out, his tail end is missing the hair, he has wrinkly skin on his tummy--overall, he is a mess. I have another rat terrier, Sarge, who is 9 that is healthy as can be, so we always chalked it up to getting Sarge from a breeder and Jersey's problems because he came from a petstore that was closed down due to the conditions, but we are rethinking everything now.

On Monday, I came to pick Jersey up and he started crying out. He never cries out so we knew someone was obviously wrong. We went to the vet yesterday and were told he now has a slipped disc, but the vet is also questioning Cushings due to his history and his symptoms now. After doing some research, it seems completely possible that he has Cushings, but we will know more when his blood work comes back. I have been at a loss as to what to do with my baby, but after reading, it seems like if it is Cushings, Jersey has a fighting chance! So, I just wanted to share my story and what is going on with my fur babies in hopes that we can find something out and work to get him better! I know he has a lot of life left in him and I want him to live it happily.

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[Harley PoMMom]

Hi and welcome to you and Jersey!

I am sorry for the circumstances that brought you here but very happy you found us.

If you could round up copies of all test/s that were done on Jersey and post any abnormalities shown, here, that would help us to provide you with more meaningful feedback.

Is Jersey on any herbs/supplements/medicines?

If Jersey does have Cushing's, just want to let you know it moves at a snails pace so one does have the time to get a confirmed diagnosis of Cushing's.

We are here to help in any way we can so please do not hesitate to ask any and all questions.

Love and hugs,
Lori

[kimlouise]

Hello, hello, jersey,
I have an unwell dog charlotte (on this forum) possible cushings and bilateral ruptured cruciate ligaments, two back legs.
I have tried everything and have found the following have helped significantly:-
jointguard (glucosamine formula)
Ester Vitamin C
Meta b complex to help absorb the vitamin C
BARF raw food diet
flaxseed oil
Animal homeopathy including pain relief has given extraordinary results in two weeks. A company in perth( google wholistic animal medicines) australia, has amazing information on pet health. This is where I started from.
I am also starting my dogs on vets all natural products and shark cartiledge.
Plenty of rest and mozart mediatation and soft gentle string music, on the most stressful day in the mornings puts them both off to sleep so their little bodies can rest and regenerate. I also have charlotte on 1 x 1000mg fish oil tablet a day, and that has been helping.
Two weeks ago we were devestated and with homeopathhy and the hope of a surgery, we are hopeful. I hope you can work something out for jersey. A old lady once told me when my son was young and critically ill with leukaemia, girly you can have all the best doctors in the world, the best medicine but the only thing that will save your son is LOVE. How right she was!. Give jersey lots of love,which I am sure you are already doing, there is pet massage called T touch therapy also. And lots of love and peace to you, I hope things improve.
Kim

[trippyjanet]

Hi and welcome to you and Jersey!

I am sorry for the circumstances that brought you here but very happy you found us.

If you could round up copies of all test/s that were done on Jersey and post any abnormalities shown, here, that would help us to provide you with more meaningful feedback.

Is Jersey on any herbs/supplements/medicines?

If Jersey does have Cushing's, just want to let you know it moves at a snails pace so one does have the time to get a confirmed diagnosis of Cushing's.

We are here to help in any way we can so please do not hesitate to ask any and all questions.

Love and hugs,
Lori

I will definitely share any of the scores/tests once we receive them. I do make all of his food, so I supplement his food with joint supplements (glucosamine/MSM), vitamin c, multivitamin, probiotics, healthy coat EFAs, and kelp. He is also on meds for his enlarged heart and his thyroid issue. We have been dealing with so many issues with him and in all honesty, I don't care how long it takes or how much money, I just want my little boy back. Thanks for all the support--we should know more tomorrow or Friday at the latest.

Loni

[jmac]

Hi Loni-

Welcome to the forum! I am so glad you found us, as we have a wonderful group of kind, knowledgeable, helpful, and caring people. I know I would have really struggled trying to make decisions and decipher all the information you get when you face Cushing's. The most helpful thing for me has been all of the support we provide each other.

As Lori mentioned, the best thing you can do is post all test results you have with the abnormal values, and then people can give you their advice and opinions. We'll look forward to hearing more from you about Jersey.

Please don't hesitate to ask questions as they come up. We're now with you on your Cushing's journey!

Julie & Hannah

[trippyjanet]

Thanks everyone. In the case the tests do come back positive, I have a call into the UW-Madison Vet Hospital. After talking to the receptionist, apparently, their doctors are very knowledgable and treat Cushings quite frequently. We are fortunately to have some of the best hospital for people here in town, so I am hoping the same goes for the Vet Hospital. I am going to see how much an initial consultation costs there. What do people normally charge? Currently, I have pet insurance through out vet so any visits themselves are free and we pay for a portion of services. I am getting more hopeful by the day and reading all the pages and pages of information on here! Also, (probably a silly question) but would you go right to the UW Hospital or have my regular vet handle it if he is familiar and trust me, I have no problem approaching him on the subject of his knowledge...I am not shy :)

Ok, I did talk to the coordinator at internal med at the UW Hospital. She indicated that they see Cushing's quite regularly and that is where people are referred to. She said my regular vet could to the ACTH test (I may have mixed up the letters) in his office and then I could go there for treatment. I think after reading all of the posts here I have so far, I have decided that although I do truly like my vet, I would prefer to see a specialist when I have one literally right down the road from my work. The initial visit is $160, and they said an ultrasound runs about $300 if one were to be ordered--not completely unreasonable in my opinion. If I have to start this journey with my boy, I feel really hopeful about the tools (this website and the hospital) that I have to utlize!

[Harley PoMMom]

Also, (probably a silly question) but would you go right to the UW Hospital or have my regular vet handle it if he is familiar and trust me, I have no problem approaching him on the subject of his knowledge...I am not shy :)

No such thing as a silly question. Many of us have found that our GP's are not that knowledgeable about Cushing's and many of us had to fire our GPs, not because of the lack of knowledge but mostly for not willing to listen to what we were saying. If your vet is willing to work with you as team player and even if your vet is not knowledgeable about Cushing's but is eager to learn as much as s/he can than, IMO, it boils down to that YOU have to feel comfortable with your GP being the primary care giver of your furbaby.

Many members have an IMS and a GP that confer back and forth.

[trippyjanet]

Ok, the first blood test has come back for Jersey. His cortisol (ACTH) came back as 5.3 (high) on a 1.0-5.0 reference range. We have his ACTH stim test scheduled for tomorrow. What do you guys think of the results? Still possible for Cushing's? Thanks again!

[Squirt's Mom]

Hi,

I'm a bit confused. The ACTH is the stim test so why would you repeat the ACTH again tomorrow?

Also, the range listed as normal, 1.0 - 5.0, is for a dog being treated with Lysodren, not for an untreated pup. Is Jersey taking Lysodren for his Cushing's?

Is this perhaps a resting cortisol test that was done without a stimulating agent?

Sorry for more questions as opposed to answers but I'm confused! :p:confused::p

Hugs,
Leslie and the gang

[trippyjanet]

You guys know better than I do, so I am repeating what the vet said--sorry if it is confusing, it is all so new to me that it is hard to understand. The test I have in front of me, it was a simple blood test. The one tomorrow is where they take a baseline sample and then inject cortisol (I believe) and something about giving him food and then retesting his levels. Does this not sound correct? Jersey is not on Lysodren or any other meds for Cushing's currently.

[Squirt's Mom]

ok...I bet those results you posted today are from a resting cortisol test. They just see what level the cortisol is without any interference from agents to stimulate or suppress. The ACTH is a stimulating test, the LDDS and HDDS are suppression tests...each tell different stories about cortisol in the body. ;)

It does sound like the ACTH is what they are doing tomorrow. The LDDS and HDDS take three blood draws, the ACTH takes two. The LDDS and HDDS are both tests that take all day - 8 hours - while the ACTH takes 2-4 hours. One of the stimming agents they use is called cortrosyn and if that is the one your vet is using, here is a good way to save a few dollars on the ACTH -

How to Extend Your Supply of Cortrosyn and Lower the Cost of ACTH Stimulation Testing
http://endocrinevet.blogspot.com/201...cortrosyn.html

Hugs,
Leslie and the gang

[labblab]

Ok, the first blood test has come back for Jersey. His cortisol (ACTH) came back as 5.3 (high) on a 1.0-5.0 reference range. We have his ACTH stim test scheduled for tomorrow. What do you guys think of the results? Still possible for Cushing's? Thanks again!
I think I can help make some sense of this. :) The two tests (ACTH, and ACTH stimulation test) are measuring two entirely different hormones.

ACTH is a hormone released by the pituitary gland, and its function is to regulate the amount of cortisol produced by the adrenal glands. ACTH levels vary throughout each day, according to circadian rhythm. But a single sample draw can help shed light on various hormonal abnormalities. For instance, a high ACTH level can be consistent with both Cushing's disease and Addison's disease. So since Jersey's ACTH sample came back in the high range, that could indeed be consistent with Cushing's.

The ACTH stimulation test is a different test, and measures cortisol and not ACTH. It involves an initial blood sample that measures baseline or "resting" cortisol, then injecting an agent that does the job of ACTH to stimulate the adrenals to produce cortisol, and then a second blood sample is drawn 1-2 hours later to test the cortisol level a second time. The ACTH stimulation test is used as both a diagnostic test and also a monitoring test in conjunction with Cushing's treatment. But the bottom line is, the two tests are measuring two different hormones.

Marianne

[trippyjanet]

I think I can help make some sense of this. :)


The ACTH stimulation test is a different test, and measures cortisol and not ACTH. It involves an initial blood sample that measures baseline or "resting" cortisol, then injecting an agent that does the job of ACTH to stimulate the adrenals to produce cortisol, and then a second blood sample is drawn 1-2 hours later to test the cortisol level a second time. The ACTH stimulation test is used as both a diagnostic test and also a monitoring test in conjunction with Cushing's treatment. But the bottom line is, the two tests are measuring two different hormones.

Marianne

Thank you for making it crystal clear! Is 5.3 high enough for that to mean Cushing's or do you generally see it in a much higher range? This is what he is having done tomorrow. They said he should be there about 3-4 hours. Do you know if the test results are immediate or something that would need to be sent out? If those numbers come back still consistent with Cushing's, we will then take Jersey to one of the IMS here at the University for further treatment, as I don't believe his doctor will have handled this much in the past. This is all so confusing at first, but I have been put at ease after reading everyone's post that this will in fact not be a death sentence for Jersey--something we can treat and hopefully that means we can get him up and mobile again, lose some weight, and have some of his other problems go away. Right now, the excessive thirst and panting are making nights not to much fun for us. Thanks again and I will post the next test results as soon as I receive them!

[labblab]

In honesty, not many ACTH tests are reported here, and I'm afraid I don't know any specifics about interpretation. I just know that "elevated" ACTH can be associated with Cushing's. I'm much more familiar with ACTH stim tests (measuring cortisol) as are many other of our members. So once you get those results, we'll be really anxious to "look them over" with you. The results are generally sent out for laboratory analysis, so don't be disappointed if you have to wait a couple of days.

Marianne

[trippyjanet]

In honesty, not many ACTH tests are reported here, and I'm afraid I don't know any specifics about interpretation. I just know that "elevated" ACTH can be associated with Cushing's. I'm much more familiar with ACTH stim tests (measuring cortisol) as are many other of our members. So once you get those results, we'll be really anxious to "look them over" with you. The results are generally sent out for laboratory analysis, so don't be disappointed if you have to wait a couple of days.

Marianne

Agggh! More of the waiting. I am such an impatient person normally and all of this waiting is absolutely killing me. I keep telling Jersey we are going to figure it out, although this may be me more mentally convicing myself than anything :cool: Thank you again for all your help.

[trippyjanet]

Just got back from our vet. He performed the ACTH stim test. The test results say:

pre-acth
cort > 10.0 ug/dl

post-ACTH
cort > 30.0ug/dl
(6.0-17.0)

The vet wanted to put him on Vetoryl. Now, after reading everyone else's posts, I am not sure if this is all the testing that is needed to say affirmatively that he as hyperadrenocorticism. I told the vet that we wanted to go to the IMS and he seemed a little put off. In fact, he didn't even come to talk to us when we went to pick up Jersey (had previously discussed the test over the phone). I explained that I wanted to go to a specialist and I wasn't sure how often they see Cushing pups there and the nurse said that they had 8 Cushing pups right now. Although 8 may be a lot for their office, I am not sure that is enough experience for me.

I am going to make an appointment with an IMS and besides an ultrasound possibly, would there or should there be anymore testing that Jersey should understake before starting his meds? Thanks again!

[Harley PoMMom]

Even though the ACTH stimulation results are consistent with Cushing's, given the other health issues Jersey has, if it were me, I would definitely be seeking the advice of an IMS. I think an abdominal ultrasound would be a great idea to have done.

Other non-adrenal illnesses can cause the adrenals to become enlarged and thus produce excess cortisol. Since an IMS is very knowledgeable and experienced with dogs that have multiple health issues, an IMS is especially prepared and trained to care for pets that may be facing multiple health problems.

Love and hugs,
Lori

[StarDeb55]

I haven't posted to you before, so here's a belated welcome from me. I do have a question concerning the 5.3 result that you posted yesterday that there seemed to be some confusion as to exactly what that test was. Was that test actually done in the office & not sent out to a reference lab? If it was, this test was probably what is termed a snap cortisol test which is simply a resting cortisol as Leslie has already stated. The use of a snap cortisol test as part of making the diagnosis raises a red flag for me as to the experience your vet has with Cushing's, even though they say that there are presently 8 cushpups they are taking care of. An ACTH stim is what should have been done to begin with, & now you have had to pay for 2 tests.

Debbie

[trippyjanet]

Thank you. The first test that was done was supposed to be tabulated in the office, but their machine broke, hence the reason for the test to be sent to a lab, but it appears to have just been a resting cortisol test.. I was not impressed with only having 8 patients with Cushings, nor was I impressed with him not discussing treatment options with us, instead of just saying this is what we are going to do. I do like the vet, he has been great to us over the years, but I do believe this is something that could have been caught a long time ago and I hope the waiting has not cause too much irreversible damage to Jersey.

[StarDeb55]

Yes, this is what I thought. It's a snap cortisol which is totally inappropriate for the diagnostic phase of Cushing's. It may be appropriate for monitoring drug therapy, but as far as I know, we have seen no studies to support that a snap cortisol can even be used to monitor drug therapy in our babies.

Unfortunately, you are not the first one to find that a general practice vet whom you have adored for a number of years, is woefully inadequate when it comes to diagnosing & monitoring our babies. I have been very fortunate that my GP vet has treated a huge number of cushpups, so I have every confidence in his ability to take care of one. If I have to ever do this, again, I would stick with my GP in a flash. (I've already done this twice, so I certainly hope I don't have to do it, again.)

Debbie

[trippyjanet]

Thank you so much Debbie. This just confirms my wanting and needing to go to the IMS...You put so much trust in your GP and unless I found this board, I probably would have never thought twice about his course of action. Thank you to each and every person here! I am sure more questions will come...I am making an apt. with the IMS this week.

[Squirt's Mom]

Hi Trippy,

Let me share my Squirt's story with you. She was originally diagnosed with PDH (pituitary based Cushing's) in early '08. After extensive testing - LDDS, HDDS, ACTH, UTK panel and two ultrasounds - that diagnosis was changed because of a tumor found on her spleen via ultrasound. Once the tumor was removed, her cortisol returned to normal and has stayed within normal range since. If I hadn't pushed for all testing available, my Sweet Bebe would not be here today. And, she would have been taking a very powerful drug that she did not need.

Cortisol is one of the body's natural responses to stress of any kind - internal or external; it is one of the "fight or flight hormones". This is one of the reasons diagnosing Cushing's is difficult. Not only do many other conditions share signs with Cushing's, the tests can come back with false-positives in the face of non-adrenal illnesses. (Cushing's always involves adrenal activity, regardless of the type.)

One of our mods says that the abdominal ultrasound is the test with "the biggest bang for the buck" because not only should they be able to see the adrenals which will help with diagnosing Cushing's, they should also be able to see many other organs that could be causing the problems you are now seeing that could impact the testing for Cushing's, as in Squirt's case. I cannot recommend this test highly enough. It saved my baby's life. ;)

Having to change vets is never easy no matter the reason. I moved back to ARK from TN and lost the best vet and vet clinic we have ever had. Our GP vet here knew nothing about Cushing's but he is the one I chose anyway and here is why. The others I talked to either obviously knew nothing but acted as if they did which would have put my baby at risk and/or wouldn't listen to me when I talked, argued with her treatment plan, told me the changes they would insist on....in other words, they would not work as a team with us. So I chose the doc who admitted he knew very little, that he was uncomfortable treating her, BUT who was willing to listen, learn and work with me as a team member. That was over a year ago and I have been pleased with his treatment of both of us, as well as my other babies. When things started getting a bit too tough for him, he never hesitated to suggest an IMS and is working closely with him, continuing to learn. In my book, that makes him a great vet. ;)

The most important thing I have learned since Squirt was diagnosed is this - I am her only voice. If I don't learn all I can and if I don't speak for her, no one else will. I have to fight for her when needed no matter what. We are our babies first and last defense, their advocate. The more we learn the stronger we will be in these roles. My family here at k9c taught me what I needed to know to fight for my Sweet Bebe and continue to teach me today. I think you might be surprised when you realize just how much you, too, have learned already...it sorta sneaks up on ya! :D;)

Keep talking, keep reading, keep asking questions - we will be here to help in any way we can. You are doing a great job so far!

Hugs,
Leslie and the gang

[trippyjanet]

I have an apt. for Jersey with an IMS here at the University on Wednesday. I am excited, but terrified at the same time. I keep reading here and almost hoping that it is Cushings, so we can finally manage something, but part of me is afraid they will find something that can't be treated...I am sure these are just normal worries. I had asked my GP for his records and he gave us about 2 sheets of paper, which has not made me happy. I need to go back tomorrow (they are closed today) and see what else they have and also get his x-rays that they took this last week.

Part of me is really reconsidering my GP as a whole. I have 4 furbabies and 3 of them have issues. Part of me wonders whether a switch to the vets over at the University as a whole is worth while. Does anyone here do that or do they see a regular GP for everything..I dont even know whether there is GP at the University of just specialists. So many questions...Also, is there a point when Cushings has progressed too far to treat? I am afraid, now that I am reading and learning more, that Jersey has had Cushings for a very, very long time..

Thanks for the continued support.

[Harley PoMMom]

My furbabies have both a GP and an IMS. I use the IMS for ultrasounds and for other illnesses that my GP might not have enough knowledge about.

Many dogs go for a long period of time, meaning years, before being diagnosed with a confirmed case of Cushing's. This disease moves at a snail's pace and takes a long time to do any real harm to the internal organs. So, no, I do not believe it is too late for you to treat Jersey.

Love and hugs,
Lori

[trippyjanet]

Jersey goes in at 11 today...trying not to think of it or I will be an absolute mess. I was a little disappointed in his GP yesterday. The IMS wants his most recent x-ray that was taken last week and although I have already paid to get the x-ray, my GP wants another $18 to put it on a disc....it seems like $$$$ is all they think about sometimes. Uggh, it has been such a long couple of months, but more so a long 2 weeks while we have been seeing Jersey's symptoms increase. I really hope we get some good news today--we really could use some good news for a change! Wish us luck, I am sure I will post today with my questions/concerns.

[Harley PoMMom]

Wishing you the best of luck and keeping you both in my thoughts and prayers.

Love and hugs,
Lori

[trippyjanet]

So the positives-- I really like the specialists at the UW.... But i am now seeing just how little my gp knows... Jersey had elevated tests results long ago that we were never told about and they drug their feet on releasing his records to the Ims... Needless to say jersey is getting all the tests now and an ultrasound and we will be withdrawing all our other animals from this vet .... More to come around 5 tonight when we go back ...

[Harley PoMMom]

I am so sorry to hear that the GP dropped the ball :( I am glad to see the IMS is on top of things and will be anxiously waiting for your next post.

[trippyjanet]

Apparently shortly after we left jersey started having trouble breathing and they had to intabate him.... They have put him under anesthesia until they can get everything under control .... Will know more later ... Poor little guy just can't catch a break but at least we know he is in the best possible care now... Hoping for the best ...

[Squirt's Mom]

Please stay in touch and let us know how he is doing.

Hugs,
Leslie and the gang

[lulusmom]

I'm sending positive thoughts and saying prayers for you and Jersey.

(((Big Healing Hugs))))
Glyna

[trippyjanet]

Just got the call from the vet... They woke him up and he is doing okay... Going to get him now and will post test results and treatment plan after I talk to the doc!

[Harley PoMMom]

My non-cush pup, Bear, gets very anxious when he is left at the vets. With his last surgery that had to transfer Bear to ICU and put him in an oxygen tent because he was so upset and began panting very heavily that he could not breath right.

Sending huge and loving hugs and keeping you both in my thoughts and prayers, Lori

[Squirt's Mom]

Oh, so glad to know he is awake and doing better! I know you won't feel ok until he is back in your arms, tho! ;)

Hugs,
Leslie and the gang

[Jamie]

Best wishes from Jessy and Jamie!! We are thinking of you.

[lauraperla]

Just about to go to bed but checked in to hear how he was doing.. glad he's ok and hope you both have a restful evening after the drama of the day!
Saoirse is not the best at the vet's, even when she has her ACTH stim I don't leave her now, we go away between the 2 blood draws.

Laura and Saoirsexx

[trippyjanet]

Ok, deep breath....we are back home now after a very, very long day. I will say that I will be taking all my fur babies to UW Madison now..they provided great care and I feel very comfortable with their knowledge....

I did get my test results back without any sort of fighting like with my other vet and I will post the results below (only abnormal results):

Total CO2 16.0 (19-30)
ALT 134 (14-87)
Alkaline phosphatase 1359 (20-157)
Cholesterol 331 (149-319)
Total Plasma Protein 8.1 (5.6-8)
RDW 14.4 (12-14)
Platelet Estimate 700 (175-500)
WBC 17.19 (5-14)
SEG 12.377 (2.6-10)
Lymph 0.172 (.7-4.3)
Mono 2.922 (.11-.93)

Based on the ultrasound and tests, he has pituitary cushings...Treatment plan is trilostane 30 mg every 12 hours...they gave us emergency prednisone just in case and we are to go back in 4 weeks for another stim test (pending no further complications). I really hope this all works for our sake and his....I am just so upset that we had to let it gets so bad before having a correct diagnosis.

The doctor said he should go back on dog food (I make all of his food) and named a few names, but we are waiting on the protein test before deciding which on to go on. What does every feed their dogs? I want whatever is the best for him...

I want to say thank you so much to everyone here for educating me enough to know that my last vet was not doing enough testing before starting the treatment. I am so thankfully that if Jersey had to go into respiratory distress it was at the hospital today and not his previous vet.

[Harley PoMMom]

Based on the ultrasound and tests, he has pituitary cushings...Treatment plan is trilostane 30 mg every 12 hours...they gave us emergency prednisone just in case and we are to go back in 4 weeks for another stim test (pending no further complications). I really hope this all works for our sake and his....I am just so upset that we had to let it gets so bad before having a correct diagnosis.

Could you post the findings of the ultrasound for us, please...Thanks!

For Jersey's weight of 30 lbs a starting dose of 30 mg twice a day seems a bit high to me but I am a worry wart. Also according to Dechra's product insert an ACTH stim test should be conducted 10-14 days after starting the Trilostane.

I am happy to see that they did give you prednisone in-case of Jersey's cortisol going too low. The symptoms of too low cortisol are but not limited to: lethargy, vomiting, diarrhea, or Jersey not acting like himself.


The doctor said he should go back on dog food (I make all of his food) and named a few names, but we are waiting on the protein test before deciding which on to go on. What does every feed their dogs? I want whatever is the best for him...



What diet a dog should eat really depends on the dog's specific health issues and what that particular dog does well on. I feed my non-cush dog Primal right now. Here is a link to a website that rates dog food: http://www.dogfoodanalysis.com/dog_food_reviews/

Please do keep us posted and wishing you both the best of luck.

Love and hugs,
Lori

[trippyjanet]

Last night none of us slept very much. Jersey seemed to have a raspy voice from the intebation and just kinda uncomfortable all around. He poop seems to be getting soft, so I am going to hold off on giving the second Trilostane pill until I get some pain pills in him and talk to the doctor. He seemed to be kinda whinny all night long and would sleep for about 30 mins or so at a time...

The ultrasound says:

preliminary report-
Liver-hyperchoic to spleen. Hypoechoic nodule caudal Le 1.53x0.90 cm. A few cysts, largest 0.54x0.33cm.
Gallbladder-Polypoid wall, sludge, small (Pt. is reported not to have eaten today).
Spleen-pinpoint echogenci foci
Left Kidney-Pinpoint echogenic foci. Very small cortical cysts. Linear echogenic lines traversing the cortex from medulla to capsule.
Right kidney-pinpont echogenic foci. Very small cortical cysts
Left Adrenal-0.94/1.40cm
Right Adrenal- 0.97/1.09 cm
Jejunum-0.55/0.51/0.53 cm. Layering is wnl.
Pancreas-Rt lobe has an increased echgenicity. Nodule 0.39x0.31cm Le lobe not identified.

[Squirt's Mom]

Hi Trippy,

Did they give you copies of the tests for Cushing's? Like an LDDS or ACTH? These would be very nice to see just to make sure. Cushing's cannot be diagnosed on blood chem labs and an ultrasound only so I am assuming they did cushing's specific testing.

About the feed - I totally disagree. Commercial feeds are very, very seldom better than home made foods. It's just that vets are trained that we aren't smart enough to do that without causing problems and they have been taught that people food is bad for them - which is absolutely incorrect. Table scrapes that we eat are not good for them but people food is. ;) That is one point. The biggest point is that you don't want to make any feed changes which might cause digestive upset which would make it very difficult to determine if Jersey was sick from the meds or the feed changes....and digestive upsets are one of the signs that the cortisol has gone too low. So, no feed changes right now for sure. After he is settled in on a dose that works for him, then you can think about a diet change. If you would like help making sure his diet is balance, I can direct to you some folks who can help with that.

Please keep in close touch over the next few days and do make that appointment for 10-14 days from now - not 30. ;) I am soooo glad they gave you the pred. Did they tell you when to use it and how?

Hugs,
Leslie and the gang

[trippyjanet]

Jersey finally had a good night last night and slept through most of the night. I have one given him one pill/day instead of the prescribed two pills a day and have already seen notable improvements. His panting has decreased dramatically, even with our 85 degree day yesterday. He also is eating a lot less and at a normal speed and most importantly, he drinking has gone back to normal. I keep thinking something is wrong with him because he is not drinking buckets and buckets of water. I am not sure how fast these type of symptoms should decrease but his seemed to decrease within about a day....is this normal? He was barking and wagging his tail and giving kisses this morning! He hasn't slept much in the past two days, but last night and still this morning, he is finally sleeping, which means I was finally able to get some sleep! He did take a few steps this morning out going potty and they were much more stable than they have been...so I am really hopeful this is going to be our wonder drug!

I think I will call the doctor today and see 1) if we can have the stim test moved up to about 2 weeks instead of a month and 2) see if we can stick to the one pill/day since we have seen since a great improvement. Thanks again everyone for all their support.

One a side note, with out GP refusing to release records to our IMS and also not telling us that Jersey had notable increases in a couple of his blood tests that we were not told about, we decided to pull all 4 animals from that GP and wil transfer all care to the UW Hospital here.

[trippyjanet]

Hi Trippy,

Did they give you copies of the tests for Cushing's? Like an LDDS or ACTH? These would be very nice to see just to make sure. Cushing's cannot be diagnosed on blood chem labs and an ultrasound only so I am assuming they did cushing's specific testing.

About the feed - I totally disagree. Commercial feeds are very, very seldom better than home made foods. It's just that vets are trained that we aren't smart enough to do that without causing problems and they have been taught that people food is bad for them - which is absolutely incorrect. Table scrapes that we eat are not good for them but people food is. ;) That is one point. The biggest point is that you don't want to make any feed changes which might cause digestive upset which would make it very difficult to determine if Jersey was sick from the meds or the feed changes....and digestive upsets are one of the signs that the cortisol has gone too low. So, no feed changes right now for sure. After he is settled in on a dose that works for him, then you can think about a diet change. If you would like help making sure his diet is balance, I can direct to you some folks who can help with that.

Please keep in close touch over the next few days and do make that appointment for 10-14 days from now - not 30. ;) I am soooo glad they gave you the pred. Did they tell you when to use it and how?

Hugs,
Leslie and the gang

I was thinking about maybe making an appointment with a nutritionist to make sure Jersey is getting what he needs. I follow the Whole Pet Diet and also supplement with many vitamins and minerals to ensure he is eating a balanced diet, but if you know of some people that might be able to help us, I would gladly like to know. I do personally think that homemade food is better because I can control what goes into it and I can change it based on their needs...plus, all my animals know when I am cooking for them and they love the food...perhaps with Jersey's decrease in appetite to a normal level, we can still continue on the homemade food--I think that would make me feel better than going completely to regular dog food.

Thank you!

[Harley PoMMom]

Usually the symptoms of excessive thirst and urination take a week or two to abate and not just one day. It is very observant of you that you have picked up on this and now will be giving the Trilostane once a day. I also believe that having a ACTH stimulation test in 2 weeks is the right move to take.

Glad to hear Jersey is improving but what for signs of too low cortisol which could be: vomiting, lethargy, diarrhea, or Jersey not acting himself.

Please do keep us posted.

Love and hugs,
Lori

[labblab]

I'm one of the people around here whose Cushpup also showed big improvement in thirst and urination in just 1-2 days, so I know it can happen :). But I totally agree with you -- since you're seeing dramatic improvement in such a short time, I would want to stay with the single pill for the time being.

Marianne

[trippyjanet]

I'm one of the people around here whose Cushpup also showed big improvement in thirst and urination in just 1-2 days, so I know it can happen :). But I totally agree with you -- since you're seeing dramatic improvement in such a short time, I would want to stay with the single pill for the time being.

Marianne

I thought it was just me seeing improvements in just such a short period, but when you are constantly having to get water for him, all night long, you can tell a difference. He actually slept 5+ hours at a time last night without needing water...no vomiting, no problems going outside, he is perkier today. He is actually chewing on a trachea now, which is his favorite chew and something he hasn't done lately...It is a great day--so far!

[trippyjanet]

I just talked to the vet. We agreed upon keeping Jersey on the one trilostane a day instead of 2 since he did well on it, and we will re evaluate after the first stim test in 2 weeks to a month. Discussed the 2 weeks versus month for retesting and she said they didn't like too test to often and knew the manufacturer recommended 2 weeks for the retest. It was up to us. She also wanted Jersey on dog food so that we could monitor the calories for weight loss. We agreed on a dog food that I liked until I could consult with a nutritionist for a homemade plan to ensure he is getting the right amount of calories and vitamins/minerals to get him down to the right size. I really like that she did not dismiss me wanting to pick the dog food and ultimately wanting to make my own dog food. She also listened to my concerns about the higher dose of the trilostane and we came to an agreement.

It is a nice change to work together for Jersey's overall health. He has been passed out most of the day today. I think after having no sleep for the last couple of days he (and I) need it. My other dog is just as tired, as he was always up making sure Jersey was okay. I also got another prescription for the tramidol for when he gets achy, as he seems to do well on that. Going to pick up his dog food tonight and weigh him here, so we can start closely monitoring his weight loss progress!

[Squirt's Mom]

Please just tell me it isn't Science Diet.....

[lauraperla]

I'd ask her to confirm to you what his calorific daily intake should be and carry on with your home diet, just measure accurately and monitor the calories. There are free apps that will give you calorie amounts for almost all foods on their search function ( I use 'my fitness pal' it is super easy).
I just don't see that you need to put him onto dog food at all.

Laura and Saoirse xx

[trippyjanet]

Please just tell me it isn't Science Diet.....

haHa! no, but you know that's what was recommended. I stayed from Fromms..I have been feeding my other boy that for quite some time.

[trippyjanet]

I'd ask her to confirm to you what his calorific daily intake should be and carry on with your home diet, just measure accurately and monitor the calories. There are free apps that will give you calorie amounts for almost all foods on their search function ( I use 'my fitness pal' it is super easy).
I just don't see that you need to put him onto dog food at all.

Laura and Saoirse xx

I am fine with the commercial dog food until I ensure his homemade food is fine nutritionally and calorie wise. Once I confirm that, he will go back to the homemade diet for sure.

[labblab]

Re: the monitoring testing...Dechra itself does not generally recommend increasing a trilostane dose until after 30 days, as long as the dog appears to be doing well and there is evidence of at least some symptom resolution. This is because cortisol levels tend to continue drifting downward during the first 30 days of treatment, and prior to making dosing increases, it is better to first wait to see just how low the cortisol will end up on any given dose. That being the case, I believe one of Dechra's biggest rationales for the 14-day testing is the reverse -- to make sure the cortisol is not already dropping too low at that "early" stage, necessitating a dosage decrease.

I believe a few specialists are indeed starting to "tweak" Dechra's ACTH dosing schedule a bit by holding off on the full stim test until closer to the 30-day mark -- but once again, only as long as the dog appears to be doing well and there is some degree of symptom resolution. I've heard of at least one specialist who suggests performing a simple baseline (or "resting") cortisol test at the two-week mark, reserving the full ACTH stim until the 30-day mark. Even though the baseline cortisol gives much more limited info, as long as it is safely higher than approx. 2 ug/dl (Dechra's lower cut-off for the desired post-ACTH treatment range), you can perhaps feel more comfortable that the dog is not being oversuppressed on that particular dose.

I mention these "tweaks" because I am guessing that you are encountering something similar with your new university specialists. It's not that they're unaware of Dechra's guidelines, but instead that they've adopted a few alterations in their general recommendations to patients. I'm really glad that they seem to be listening to you and that they are willing to work with you to incorporate your preferences and requests. Since you will be watching Jersey so closely and monitoring any changes in his behavior, I think your feedback to the vets will be very valuable in judging whether the testing should come earlier or somewhat later within that 30-day time period.

Marianne

[trippyjanet]

Just a quick update...cannot believe the changes I see in Jersey already. His food intake is back to normal. He is not even finishing his full amount in one sitting, but instead eats about 2/3 of it and then the last 1/3 later in the day or before bed. We are able to sleep through the night as his water intake is much more normal now. AND, when we came home from errands today, he had picked himself up out of his bed and walked a few feet on his own. He even walked outside a bit on his own without any assistance from us. We are not letting him due too much at once, but it is amazing from the dog that was scarfing food and water and could barely move to a dog that is eating and drinking normal and trying to get some movement back in his legs.

We are going to work on some water therapy in the next few days to see if we can get some more strength back in his legs. I am so thankful that we can get a second chance with our boy and we are not wasting any of it. Although he cannot walk, he has a stroller and we take him out for walks with our other dog, so he can at least get some fresh air and not be cooped up all the time.

I can't wait to see the changes to come!