Gabby Sue, JRT with Cushings

[GabbySue]

Hi,
My name is Tiffany and I have a 10+ year old Jack Russell Terrier that was recently diagnosed with Cushings. I will get all of her lab values and post them this weekend.
Gabby has been with us for 5 years, we rescued her from a rescue. She had tummy issues when we first got her, she started making herself vomit and brought up needle point thread, this went on for almost a year and then stopped. I gave her all the things to replenish her gi tract, but she has on occasion had some upset stomach a few times a year so not much to worry over. However this last fall we noticed that at times she seemed really hungry and would dive into other dogs bowls, not a good move, but it was it's own reward. She was putting on weight from this and I had to cut her back from her 1/4 cup of Orijen( I rotate formulas) but this seemed to just make it worse, she would even jump on the counter and get a whole bowl of cat food, or get into the dog crock of food, so she would get about 3 days worth of food and it seemed like she would gain weight from that. It was a cycle that she would go through over and over.

I took her in for pre-dental bloodwork in February that showed her Liver values were really elevated, but due to all her bingeing I knew that her liver was really taxed from processing all that extra food,so she was put on liver support( it's like Denamarin) and on her recheck a month later they were improved, she had her teeth cleaned and about 2 weeks later she seemed to be off, and she was drinking alot and having accidents in the house which wasn't like her. She also was panting alot and seemed to be really weak in the rear, she couldn't jump up on the bed and I had to pick her up. She also stopped running after squirrels.

I immediately thought of kidney issues as her urine was really dilute so until I could get her in I fed her a homemade renal diet.Her belly seemed bloated after she digested all of her binges and her head looked smaller. When the vet saw her they ran the usual labs and except for her sugar being slightly elevated(but she had just gorged on dog food when she tore the heavy wood lid off the crock and jumped in and ate til she was full) ,and her liver values were increased again. I was also worried about pancreatitis with all these binges, luckily she's been safe from that.
The vet encouraged me to have an U/S done, but they use a consultant specialist that I don't care for, so I took her to another specialty practice. He liked to do things in order so she first had a low dose dex test that was inconclusive for which type of Cushings so I next brought her in for an U/S and an ACTH test that did confirm PDH.
She was started on Trilostane 5mg on May 14th and had her followup ACTH test this morning. Her binges have stopped but only because we have rigged the crock so that if she touches it a tower of bowls crash down. She's not panting as much but still has alot of muscle weakness. Her water intake is slightly less but we have to take her out immediately after meals still. The only difference that I have seen is that I offered her a treat yesterday and she didn't try to bite my thumb as she snatched the food, she always took treats nicely, but since the Cushings symptoms started you risk losing a finger!

I'm thankful for all the resources here and was well versed when I went in to the specialist and knew which questions to ask.Thoug I am a nurse it was so helpful to have case histories and experience to help me understand what my dog was going through. I can't thank you all enough for putting my mind at ease as I thought the worst and found that the opposite is true, this is a manageable condition and I hope to have many more years with my gardening buddy!!

[mytil]

Hi Tiffany,

I wanted to welcome you to our site. Sounds like Gabby Sue is in good hands.

How much does your girl weigh?

Looking forward to seeing the test numbers.
Terry

[addy]

Hi and a Huge Welcome from me and my pups,

Your pup's background sounds a bit like mine. Zoe came out of animal control, she is about the same age as Gabby Sue, been with us for 5 years and is my gardening buddy; so those things in your post made me smile.:)

There is hope, so never lose sight of that. Zoe was diagnosed 2 years ago, started treatment 1 year ago and is still happily helping with flowers:):):):):) I will admit it can sometimes be a bit of a roller coaster ride but there are quite a few members that have had smoother sailing:D:D:D:D

I am so glad you are now family. Ask questions, tell us everything.

hugs,
addy

[GabbySue]

Morning

Gabby was up to 13.5 pounds, yesterday she was 10.4 pounds and looks so much better, she's smaller than our cat so the heavier weight is hard on her.
I did notice that she swallows alot of air while she eats and also when I crate her when I leave for work, so I've been giving her Simethicone and that's really helped, she's not getting bloated, I feel it's helped her abdomen tuck back in since it's not being so stretched furthur from the air.

Here are her initial labs
Urinalysis
Spec Gravity 1.007 (low) 1.015 to 1.050
PH 7.5 (high) 5.5-7.0
the rest was normal except for a trace amount of blood


Low Dose Dex
1st 0 hr 5.2
2nd 6hr 2.7
3rd 8hr 5.5

done by ANTECH Normal cortisol level less than 1.4ug/dl
Hyperadrenocorticism Cortisol level greater than 1.4ug/dl 8hrs post dex.


Her abdominal U/S revealed bilaterally enlarged adrenals and no tumours on them nor her liver.


Her ACTH test that day was 96

I don't know why there wasn't a starting value on that one.

I should know by tuesday what her ACTH test was on friday due to the holiday. Her vet did start her off on the lower dose of Trilostane 5mg as he could always increase the dosage. He did tell me she "read the book on Cushings" when it came to symptoms ,so he joked that hopefully she would continue reading the same book and do fine.


The biggest thing we've noticed amongst everything is the hind end weakness, she just isn't able to jump up like she did, though that has also been a blessing as she was able to jump onto the counters and eat anything she could find if it wasn't put away, but she was so ravenous that she bit the heavy wood lid and would pull it off and climb in the 10 gallon stoneware crock with the dogs food in it. One day my husband went out in the yard and and he came back in and found her in the crock with her belly stuffed and she couldn't get back out!

She missed her first Low Dose Dex test as she was supposed to be NPO ,but she got into the food the night before again and that's about 3 days worth of food so she wasn't going to have an empty stomach for at least 2 days. We've been able to keep her from bingeing now for nearly 2 weeks so that is a huge milestone.
After reading so many stories on here, I'm glad we caught this disease early, so that Gabby can be with us for more years to come.
She was rescued from a rescue. The reason I say this is that I adopted her from a woman that rescued her from an older woman who was blind and Gabby had spent much of her time in a crate there. However it wasn't all that better at the rescue womans home, she lived in a dirt pen with a shelter in the garage. the day I took the ferry down to Long Island to pick her up I noticed on the way back she was loaded with fleas, not just a few, hundreds,they were crawling across her face they were so bad, despite the woman saying she gave her a bath the night before. Gabby was afraid of the other JRT that we rescued with her, she has a long scar on her left front leg from "one of their little spats" sadly the other girl is no longer with us,she was so dog aggressive and no amount of training or behavior modification worked, and it was a really sad thing.

Gabby has some pretty funny set front legs so they bow out when she runs fast and it's really cute to watch, but she's always with me when I garden, she'll run off to chase a squirrel but comes right back. We have a black cat and black squirrels, and one day Gabby ran after what she thought was a black squirrel, it was not, it was the cat,who wasn't too pleased that she was chased after. I told Gabby that "Payback is a Bit&H!" and sure enough one day Gabby was just sitting in the driveway when our cat came speeding down the drive and buzzed her with her paws and got her back!!
I've had JRT's and Parsons over the years, and my last JRT always was with me when I worked in the garden so to have Gabby as company was such a comfort to me after my other girl passed away. Nothing seems to bother Gabby except that at times she needs to be picked up to get on the bed to sleep with me and she gets along well with all of our other dogs, we have Labradors and 2 other small rescue dogs.
Gabby's so special in her own little way.

[MBK]

Welcome, Tiffany.

I loved reading your stories about Gabby! I can just picture her stuck in the crock of food! I am partial to JRTs and have 2 of my own. Alivia is 14 and has cushing's (which has inexplicably been in remission, without treatment) and Maxwell, almost 12 and healthy as can be.

This is a great place for information and support on all things cushing's. There are a lot of knowledgeable, kind people who can help and answer any questions. They were a great help to me when Alivia was first diagnosed and when I went through some scary times with her - including a very severe bout of pancreatitis. Ali is doing pretty well now.

Anyway, I will leave the medical questions to those that know far more than me, but I had to welcome another JRT lover! I hope Gabby continues to improve.

[GabbySue]

I finally got the results of Gabby Sue's ACTH test done last friday (the vet called my cell which I don't use much so we played phone tag for 2 days)

She's been getting Trilostane 5mg every morning.
Ref range
Her Pre level - 5.2 (high) 1.0 - 5.0 ug/dl
Her Post level-7.1 (Low) 8-17 ug/dl

Note at bottom states -Post Trilostane: Pre& Post cortisol levels between 1.5-9.1 ug/dl indicate optimal control.

Gabby is drinking less and has only had a couple of wettings, she's still pretty hungry and tried to eat something in my hand while I was taking a bite the other day, which in my house is pretty pushy and not allowed,I don't care how darned cute you are.
She's slightly better about treats but will grab a finger. She's still weak in her rear legs, she seems stronger to me since she's been able to jump by herself onto the bed more often instead of me picking her up. Her belly looks so much better and she's not so distended like she was, hair hasn't grown in any where they shaved her for the blood draws, and her face is still smaller to me,I think because of the loss in mass on her head her eyes are more prone to irritation and are weepy at times,so I'm rinsing them for her which she tolerates. I'm hoping this goes away as her head returns to normal.

Does this level show that we are on our way to a good control?
What should I be watching for since her pre level was near the upper end of the base range?

The vet asked how she was doing and I told him all the above so he said we should increase the dose to twice a day.
In my fog when he called at 7am(I work 2nd shift so I'm usually sound asleep then ) I asked him how this would affect her testing as I was imagining them having to wait 4 hours after her 2nd dose which would be at 8:30pm with her dinner and a vet trying to draw blood on her at 1am,and he said not at all, they test after the am dose.Good thing -I wouldn't want to have to bring her in for testing in the middle of the night!LOL!!!

[lulusmom]

The acth stim test looks pretty good to me and improvement in symptoms is a good indication that the current dose may be adequate. We've seen a lot of dogs whose cortisol has continued to drop within the first 30 days so I highly recommend that you wait until the next stim test to determine any dosing changes. Has your vet instructed you to schedule a stim test at the 30 day mark?

[GabbySue]

No the vet recommended checking it again in 2 weeks since he changed the dose already to Trilostane 5mg twice a day.

Should we have waited to change the dose??
The vet didn't think it sounded like her symptoms were under control yet. I am going to watch her closely though since this change is double the dose she started on by going to twice a day.

[marie adams]

Hi Tiffany--welcome to you and Gabby Sue. She is a cutee!!:)

I can see you are already getting your questions answer by the experts. They are all full of wisdom and knowledge.

Please keep asking questions because we learn a lot that way. There are links here you can look at also to help also.

Welcome to the family!!!

Take care!!:)

[Squirt's Mom]

Hi Tiffany and welcome to you and Gabby Sue! :)

Ain't this fun?? :D I see you shaking your head, "nooooo..." ;)

Right now it seems like your worst nightmare come to life, huh? Boy, do I understand that and remember it well! When my Squirt was first diagnosed, I thought my whole world was ending. I felt so helpless, angry, frustrated, confused, guilty, sad, afraid...man, was I afraid. She had been my constant companion for 10 years at that point and I couldn't imagine a day without her by my side. But, it's now over four years later and she is still by my side, still the light of my world, and she is happy as can be. Well, as long as her brother and sisters don't breath on her, that is. :rolleyes: She is the Queen of Dogdom and lets them all know it! :p

You hold fast to what that vet said - Cushing's is a very slowly progressing condition. You and Gabby Sue are in the best of hands here - the collective knowledge is astounding and not limited to Cushing's. We offer the greatest support as well - unbeatable, in fact.

Keep asking questions and we will do our best to help you understand. Read, read, read, then ask more questions. No such thing as too many questions or a dumb question, 'k?

I'm glad you found us and look forward to more Gabby tales!

Hugs,
Leslie and the gang

[GabbySue]

Shaking my head "noooooooo!!!'
today I feel scared about her dose that it may work too well too quickly, but she's normal(yeah right she's a JRT, not even close...) for her still. I'm still shocked how fast she eats and even more surprised she hasn't choked yet.


I know they say that Cushings is a slow progressing disease, but it seems like in Gabby's case she went from 0-100mph in just a short few months. I don't know maybe because I am a nurse I'm always looking for what's not right and I picked up on it sooner than later, the only thing my husband picked up on was Gabby trying to jump on the counters for food and flooding the floor after she ate.

Thankyou for all the support.I'm learning so much about this from all the threads. I went on the memorial pages last night and that was touching.


Tiffany

[marie adams]

Their eating is amazing with Cushings. There were times I thought I had not fed Maddie because she would still have her bowl between her paws (she was laying down) and looking at me like aren't you going to feed me--I thought I was losing it beccause I started to doubt whether I HAD feed her. She started to take food off the table and counters which she had never done since maybe she had been a puppy. She would lick the floor in the kitchen--even the rugs. Then she would snort like a pig while sniffing around the kitchen for something else.:eek:

You will get through this--just keep an eye on her to see the changes--you will know when she is where she needs to be. You also have the tests to judge by. We are all here to help you so keep asking the questions or if yhou just need moral support--let us know. :)

[GabbySue]

Update on Gabby

I can't believe how much of a difference a month of being on Trilostane has made!!
Her face has started to fill back in, she's got more strength in her back end,she's back to chasing (and missing badly) the squirrells, her water consumption is back to normal and she hasn't had any floodings on the floor.I think her coat feels better to me and it's coming back in,even her eyes have stopped tearing.
The best part is she's not food crazed like she was, I can even redirect her away from the other dogs food bowls which just so didn't happen before, she would dive in without thought of the consequence. The other morning I told her to "Sit" after she finished and she did! She's looking like the Gabby that she was before, even the belly has tucked back up nicely, not all the way yet but I'm impressed.
When she rode in the van yesterday for her test she would usually try to walk in the back and look for treats which are now locked in a crate, this time she nestled on her bed between the seats and fell asleep on the ride.

Her vet is recommending that we recheck her now in 3 months, he said her numbers look really good. Her weight is 10.9# which is around her baseline of 10-11#.

She's been getting Trilostane 5mg every morning and evening.
x Ref range
Her Pre level - 4.0 1.0 - 5.0 ug/dl
Her Post level-5.1 (Low) 8-17 ug/dl

Note at bottom states -Post Trilostane: Pre& Post cortisol levels between 1.5-9.1 ug/dl indicate optimal control.

I am so happy that we caught this so soon and she's back on the right track to being -ahem- "normal"!

Tiffany

[lulusmom]

Yay!!!!! Way to go Tiffany and Gabby. That was a great update!

[Squirt's Mom]

Hi Tiffany,

What a great update! I am so happy that your sweet girl is coming back to her old self again. Ain't that a wonderful feeling!? :D

You're doing good, Mom!

Hugs,
Leslie and the gang

[GabbySue]

My husband called me tonite at work and said that Gabby didn't want to eat her dinner,only took a few bites but she did eat her Trilostane pill and that her back leg was shaking. I thought that it might be that she ate the rest of her chewy and she was trembling from the change in barometric pressure, so I had my husband give her something for her tummy in case. There was lightening and she is afraid of thunder and fireworks, which we've had plenty of this July 4th.

When I got home from work though she seemed weak to me and was trembling all over, her stool was formed and only slightly soft, no diarrhea or vomiting,but Gabby NEVER misses an opportunity for food and tonite she turned up her nose at the bite of canned food I offered.

I gave her some Prednisone I keep on hand, but I am wondering does this mean she needs to have a dosage reduction or does she need a period off of it?? I've read that some dogs need a break. I'm going to call her vet in the morning and see what he recommends. I feel so awful as she just looks terrible. She can't sleep with me because I'm in with the new puppies which makes me feel even worse as she sleeps with me everynight.(actually she takes turns sleeping with us both so my husband and I were under the impression that she slept with only one of us,sly girl, but she mostly sleeps with me ;) )

[Squirt's Mom]

Hi Tiffany,

Gabby Sue needs an ACTH and her electrolytes checked this morning....it needs to be done 24 hours after the last pred dose - and no more Trilo for now. ;)

Let us know what the vet says and how she is doing, 'k?

Hugs,
Leslie and the gang

[GabbySue]

I spoke with the vet this am and Gabby is to continue on the prednisone 2.5 mg till tuesday,hold the Trilostane and then call him and give an update and get her in for an ACTH test then.

Gabby was much better by this morning, ate a bit more slower than usual but no tremors. I'm relieved that she turned around so quickly and that my instinct was correct that it was the Trilostane and not her being tweaked out by the weather.

[frijole]

Good job mom! Glad the prednisone worked and you had some on hand to give. Hopefully others will confirm but I am pretty sure that if you continue to give prednisone up to the day of the acth that the results will not be meaningful because the prednisone mimics cortisol and will skew the results. I cannot remember how long you are supposed to wait after the last prednisone to test.

Kim

[GabbySue]

I'm going to followup with a call to him on monday for exact directions just to make sure those $280 ACTH tests aren't a waste of time and money.
(and that is with using a small amount from the bottle to save on cost but this is a highend vet clinic and I am paying for their overhead)

[Squirt's Mom]

Hi Tiffany,

Any time a pup has experienced their cortisol going to low, and that is sure what it sounds like Gabby went through, it is never a waste of money to have an ACTH done. ;) An ACTH is the only way to know where the cortisol is for sure; their behaviors are a huge indication but the proof is in the blood work. ;)

Hugs,
Leslie and the gang

[GabbySue]

I did talk with the vet clinic today, Gabby's specialist isn't there today so he'll call me tomorrow. She was shaking last night with tremors in her legs, mostly the rear legs and had tried to make herself vomit, but we did have thunderstorms for a while so that may have added to how she is feeling. After some meds for her tummy and a little sedative she was better. She just doesn't respond to Rescue Remedy.If she hadn't felt so crappy on friday night I never would have been able to push the pred down her throat(she wouldn't take any food and that is the only way to get her take meds)

I meant a waste as in if I'm not told the correct instructions, for the last 2 of Gabby's ACTH tests I was told by the office staff to have her fasting and no water after midnite and no meds, which I knew wasn't how the test was done but had to call and clarify just to make sure.
I brought it to their attention that if I died and my husband had to bring her in he wouldn't know and would be bringing a dog in for nothing. :(

[GabbySue]

Finally heard back from Gabby's vet, she's going to have an ACTH test tomorrow morning. No more Pred.
Luckily she only has to be there for an hour this time so I can drop her off and do an errand then pick her back up. I'm sure she'd rather be home in the AC with a meaty bone.

Just a question, Are Cushing's dogs more prone to infections?

Gabby has a fungal infection on both ears, I think she picked up something while rummaging under the tarp on the woodpile hunting mice and chipmunks. She's never had anything like this before. Also a few months back her spay sutures seemed to be poking her and got a bit reddened and swollen when her abdomen had enlarged.(you can feel them just under the skin, whomever did her spay did a bad job with closing her incision) If I decide to have them removed and repaired what concerns do I have with her Cushings?

[Jenny & Judi in MN]

Hi: good luck with the ACTH tomorrow. I think Cushing's dogs are more prone to infections.

If the vet wants to continue Gabby on prednisone, see if her dose would work with liquid prednisone. My Jenny is on prednisone now but her dose is pretty low so the liquid works great for her.

[frijole]

Yes, without question cush dogs have a hard time healing and fighting infections - their immune systems are compromised. (some more than others)

Question - when did you give the last prednisone? I'm asking because it takes 48 hrs for it to get out of the system (remember it mimics cortisol so if its in the system your reading will be skewed or higher cortisol). They recommend waiting 48 hrs from the last dose to do an acth test so you can really see where the cortisol levels are. Kim

[GabbySue]

That is what I thought as she nver had any problems before. The main worry I have is her spay scar because of those sutures poking her. Do dog with Cushings need to do anything differently before any surgery?/ Do they still get their meds the morning of or do they hold it??

Her last Prednisone was this morning, he wanted to do one 24 hours after her last dose. Her symptoms have resolved, no trembling today at all.

I got a call from my husband that the clinic called with the instructions for Gabby's test- No food or water or medications after midnite. This is the 3rd time they have given incorrect instructions and I am going to speak with the office manager about this. :mad:

[frijole]

I used to get so upset also.. front desk personnel are so used to fasting for blood draws they don't even THINK. Its a shame. Well its good that you at least have a day without prednisone. Just know that the results will be slightly higher (better) than if she had another day off of it.

Good luck and we are all anxious to hear the results. Paws crossed! Kim

[GabbySue]

Since I wasn't going to run her in until about noon, I will call and have them ask the vet if he wants to wait another day.

[GabbySue]

I called and asked her vet this morning and he said either today or tomorrow was fine, so based on what you guys were recommending to wait 48 hours I'm having her tested tomorrow instead.
It didn't seem to matter either way to him

[frijole]

Great. Keep us posted and give your gal a hug for us ok?!! Kim

[molly muffin]

Just checking in to see how things went at the Vets today.

Sharlene (and Molly Muffin)

[GabbySue]

Frustrating. I was told it would take an hour and they were to call me when she was done, but they"Forgot" so I ended up being an hour late to work,at least they trimmed her toenails this time, but it took 3 times to get my bill done correctly,I had a credit from the over charge the last time and they were overcharging me for the test by $ 35. It just adds up....

Gabby refused to eat this morning and I could hear her belly gurgling. She tremored all the way to the vets and had diarrhea when we returned. When I left she was hiding under the bed and I couldn't get her out. I'll have the results tomorrow of her ACTH test, however I asked if I could give her a dose of Prednisone since her sypmtoms returned now that she's been off of it for 48 hours and her vet said yes.

Giving Gabby the pred was another matter, she turned into a raging JRT and attacked me twice, I finally got her head covered in a towel and stuffed the pill down her throat. She isn't the type of dog that you can just give her something unless she eats it of her own accord, so treating her when she is sick and won't eat it is very difficult, and depending on the severity I feel will eventually be the end of her if she is "noncompliant" with taking meds unless they are in food and she is in the frame of health and mind to take them.

This really is my biggest worry that I will be unable to help her as she just is so vicious when it comes to forcing medication into her and I will lose her because I can't get the meds into her.

[molly muffin]

Oh that little brat. I totally understand. My molly will Not take a bill, wrapped in food or anything else, she eats the food and spits the pill out. Now I have a pill syringe, you put the pill in the end, stick it in her mouth and push really fast, far enough down that she has to swallow it and Then give her a "treat" or her food, or something special. I got mine from the vet's office, maybe yours would have something like that too?
By the time she has realized what I've done she has already swallowed it and can only bite the plastic if she tries to go that route.
It is very worrisome to have one that is that adverse to medication. Keep trying though, maybe you can come up with something that will work with her.

HUGS,
Sharlene

[GabbySue]

Brat is being nice ;) I wish that pill pusher would work, I just can't get near her mouth and she will attack (think a 10# CUJO). The towel trick worked so I'm going to cross my fingers it works again if I need it.

Tonite my husband said she didn't eat but did drink and came out from under the bed and hopped around and wagged her tail then went to her dog basket bed. I'm hoping by tomorrow morning she's feeling better and eating.

Does this happen that dogs need to come off of the Trilostane for a while??
I'm concerned that her symptoms returned after being off of Pred for 48 hours.( she had a total of 4 days of it, then off for 2 and and her ACTH test today, had a dose of Pred tonite)

[Squirt's Mom]

Hi Tiffany,

There is a product called Green Tripe (you don't want to know what it is :p ) that dogs absolutely LOVE. It stinks to high heaven and I don't recall a pup of mine ever turning it down. You might see is Gabby Sue has an interest in the tripe and if she does, you can use it to give her meds.

I use it to give the SAMe to Squirt because she has figured out all the other pilling tricks. :rolleyes: She gets about 1 tsp of the tripe with the SAMe pill either crushed or broken into tiny pieces mixed into it. She thinks it is a special treat just for her as none of the others get this. :D I used the tripe with Crys, too. She had crystals in her urine and was on antibiotics often so she got where she wouldn't take pills but she loved the tripe and would eat it with the A/B in it every time.

Just a thought.

Some pups have a reaction to the stim agent used with the ACTH and are a bit off following the test for a little while but it doesn't last more than a day usually. Do keep a close eye on her for signs her cortisol is too low and give the pred again just as you did before....if needed.

Let us know how things are going!
Hugs,
Leslie and the gang

[GabbySue]

Oh yes we do know what raw tripe is and all I will say is the dogs love it, but my nose does not!!! A friend gave me some raw frozen and years ago and it defrosted on the way home. It does wonders for dogs with bad tummies and I'm going to pick up some tomorrow.

Today the vet called me and said that Gabby had essentially no Cortisol in her system (which explains why she looked like she was dying last night until the Prednisone kicked in) I brought her in straight away for an Electrolyte panel, he seemed to think before the labs today that she was now Addisonian( great ANOTHER forum to join,LOL!!)
However she isn't all the way there yet, she doesn't have any Cortisol but is still producing Aldosterone, so no DOCP injections, but he's going to recheck her next week and in the mean time continue with the Prednisone 2.5mg everday. This does explain the tremors and other symptoms. I offered her a small bite to gauge how she was feeling this morning which she took right away so I gave her the Pred in a bite of wet food just in case that was all she wanted, I got her to eat a few bites of food last night and she ate her breakfast today,albeit a bit slowly.

Labs
Cortisol pre 0.7 (1.0 -5.0)
1 hour post 0.7 ( 8-17)

Her lytes were BUN 22 (7-27)
Creat 0.7 (0.5-1.8)
Na 143 (144-160)
K 4.8 (3.5-5.8)
CL 115 (109=122)

ALT 86 (10-100)
ALKP 95 (923-212)
chol 180 (110-320)
AMYL 602 (500-1500)
Lip 811(200-1800)
The only thing that was low was her sodium.

Any thoughts on what is going on with her???

[lulusmom]

Hi Tiffany,

Based on the test results your posted, I think your vet nailed it. Gabby Sue's cortisol is too low and must be supplemented for the foreseeable future. Every dog is different so there is simply no way to predict if or when the adrenals will recover and start overproducing cortisol again. Prednisone is a lot cheaper so enjoy the cushing's holiday while it lasts. My dog hasn't had treatment for almost a year and her recent post cortisol is only 8.2 ug/dl. Her appetite is huge but her urine is still concentrated and her recent bloodwork was excellent. Needless to say, we're staying on holiday for the time being. :D

Glynda

[GabbySue]

I'm just a bit more scared now than I was before, and puzzled. I know how bad the side effects of the prednisone can be, but obviously this is a life or death issue she has to have it or she will die.

Does this mean that unless her body starts overproducing cortisol again that she will stay on the Prednisone indefinitely??? What is the long term prognosis with this?
What are some of the effects you have seen with your dog on pred?
Do you notice that they urinate/drink more or not because you are essentially bringing them back to normal?

My vet was amazed that a month ago her bloodwork was normal and she was doing so well now a month later she is in this state.

I feel like I'm back where we started but a different and same disease!!

[Jenny & Judi in MN]

I went through this recently too. We had done an ACTH on Jenny in December where she was normal so when her appetite ceased in January I refused to consider cortisol.

In April her cortisol was pretty much nonexistent. She has been on daily prednisone since then.

Our specialist told me to just keep with the prednisone until she starts showing Cushings symptoms. He doesn't want her to be raging hungry or miserable again. So he wants me to be alert so we can nip it in the bud if she would start producing cortisol or too much cortisol again. So far I can see a change in her appetite if I don't give her the prednisone every day.

My specialist also told me that when I take her in to check things out I could probably save money and not do the full ACTH while she is so low. He said if the pre test is low odds are we won't be starting cushings treatment so we don't need to inject her or do a post test at this time.

That is just my IMS opinion but my Jenny was really low. I freaked also when I realized her situation but it hasn't been bad. She is perky and happy and eating when she gets her pred. good luck! Judi

[frijole]

I can understand your fear but just know that your vet did the right thing. You did the right thing by knowing not to wait and to get her in. She got too much of the drug and her cortisol went low. This can happen with both lysodren and trilostane. The prednisone saves their lives when cortisol production ceases.

Did you post the results of the acth? That would tell us how low she went. Anyway - one of two things - either you get a break from treating cushing's and instead you give prednisone which like Glynda said is MUCH cheaper ;) or in a few weeks she starts showing signs of cushings again and you resume treatment at a smaller dosage.

So right now your dog is Addisonian (a disease that is the opposite of cushings and in your case caused by the trilostane). It could be permanent and it could be temporary. Only time will tell.

Do not sweat it. Just give the teeny tiny pill and you will see your dog feeling better each day. Judi just went thru the same thing so she is a great source of info.

Hang in there and keep posting questions as they come up. Kim

[GabbySue]

Thankyou Judy! Good to know about the test.

The difference in the 2 days that Gabby was off the pred for her test she crashed really quickly and wouldn't eat and was lethargic and tremoring, and like Jenny in the words of my IMS, " she has like no cortisol in her body". I too freaked!!
Tonite my husband reported no tremors and she ate normally and was gazing at him and falling asleep in his arms. A very happy Gabby!
I guess we'll just be on the look out for the Cushing's symptoms to reoccur and since we know well what they are it shouldn't be too hard to miss.
Maybe this isn't so bad afterall...

[GabbySue]

I posted her level above which pre and post were 0.7.

Her vet she wasn't true Addisonian yet but if she was there was an injection of a hormone DOCP( which I'll have to look up) that the vet gives every 28 days as well as the prednisone.
He did tell me the Addisons is easier to treat than the Cushings.

[GabbySue]

Gabby is still on the Prednisone every morning. And so far she's normal,no increased peeing and I haven't noticed any real change to her appetite, she's back to her old old self of always trying for an extra kibble but not trying to get into anything.

I have a question for those whose dogs have been on this? -

Gabby seems to be fine all day but at times towards the evening she gets restless, a word I would use to describe it is "tweeked" (almost like she does when there is a thunderstorm coming) but by morning she seems normal . We've also noticed that she has a tremor in her right front leg that comes and goes.
Is this from the pred wearing off or what? What is the tremor about ? Her activity is normal and her coat has started to finally grow back on her neck where she was shaved.
I have to call her vet tomorrow and give him an update , is there anything that I should be asking him about?

[frijole]

Your vet is right - the addisonian state could be temporary. You are giving prednisone because it mimics the cortisol that your dog requires to live. Once the adrenal cortex grows back your dog will probably start producing cortisol. For this reason it's natural cortisol and the prednisone might be too much - so you should be looking for signs of cushings returning.

You mentioned appetite, restlessness at night and leg twitching/trembling, all of which are signs of cushings. My point is be sure to mention this to the vet. He might want to start weaning you off of the prednisone (reduced dosage not cold turkey) to see what happens. Once a dog has been on prednisone a while you can't simply stop giving it - because they can crash and be seriously ill.

So report what you see and pay attention like you are. Eventually you will want to do another acth test to see if cortisol is being produced. Good job. Kim

[Jenny & Judi in MN]

Jenny never twitched but her blood sugar was all over the place because the prednisone did not last 24 hours in her system. We cut her dose in half and give it to her twice a day with her meals.

huge difference. appetite is consistent, she is consistent. Her hair is black again vs. silvery gray.

I do need to call my vet when he gets back from vacation. I know he wants to test her cortisol again but she isn't ravenously hungry and physically she is getting better not worse.

let us know what you find out about the twitching. Maybe Gabby is producing cortisol on her own so you'll need to cut back on the pred. Is she hungrier or drinking more?

[GabbySue]

Gabby did have an ACTH test a week ago it confirmed she had no cortisol, but in order to do the test I had to pull her off the pred and after the first day off of it she wouldn't eat and was very lethargic, by the second day she was just wanting to hide under the bed, she was restarted on the pred that afternoon.

I thought since it was pituitary based that the medication(Trilostane) works differently and doesn't destroy the adrenal tissue.

Gabby was never like this before she was diagnosed and while she was on the Trilostane (it's different than her reaction to storms). I believe this Addisons like crisis started when we had a litter of puppies and Gabby could not sleep in the bedroom with me, she is now back sleeping with me as of this sunday so with her "stress" removed and her life back to normal I'm especially vigilant for any signs of the Cushings coming back.

I'll ask him about weaning and retesting when I talk to him tomorrow.

[frijole]

You are right about the difference between lysodren and trilostane... I never used trilo so am hoping someone that did or that knows can explain what happens with trilo dogs that have gone low. Regardless you look for the same symptoms because it shows whether or not the dog is producing cortisol again. Cush dogs often pace at night and are restless. An untreated cush dog often has leg tremors. And yes dogs with too much trilo have been known to have tremors (ughhhh it is never easy is it?)

Keep paying attention and write it down so you remember to cover it all with your vet. Like I said my guess is he'll slowly reduce the predisone frequency to test how Gabby does. He'll do it based off your feedback. Good luck. Kim

[Squirt's Mom]

Hi sweetie,


I thought since it was pituitary based that the medication(Trilostane) works differently and doesn't destroy the adrenal tissue.

Unfortunately, many people, many vets included, think that Trilo (Vetoryl) is entirely safe because it works differently than Lysodren and is out of the body much sooner than Lysodren. However, in Dechra's information - Dechra is the manufacturer of Vetoryl - they plainly state that total adrenal necrosis is possible....just as it is with Lysodren.

Whether the pup has a tumor on the adrenal or the pituitary, it is the adrenal glands that take the brunt of treatment whether the pup is on Trilo or Lyso. The goal and job of both drugs is to stop the adrenal glands from producing and releasing cortisol continually - they simply do it in different ways.

If you were led to believe that Trilostane was completely safe, I am so very sorry. If vets would take a little time to read the information provided they might stop telling clients this drug is worry-free compared to Lyso because the literature clearly lists the same risks as Lysodren. This is why I try so hard when someone comes here terrified of Lysodren to ease their minds that there is no reason to fear Lyso more than Trilo. Some pups do better on Lysodren than they do on Trilo - and just the opposite as well; some do better on Trilo than Lyso. One of the saddest things I see is when the parent is so afraid of Lysodren they keep their pup on Trilo even when it is clear that drug isn't working as well as it should for their pup.

We always hear that Addison's is easier to treat than Cushing's. In fact, in some European countries, killing the adrenal glands to induce Addison's is how they treat Cushing's. You will find some US vets that prefer that approach as well. So while it isn't the result we had hoped for, it isn't the end of the world when the adrenals are damaged beyond their ability to regenerate. ;) Here are some links on Addison's just in case this does turn out to be a permanent conditions for sweet Gabby Sue.

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

Hang in there!
Hugs,
Leslie and the gang

[GabbySue]

Leslie

Thankyou for the links and information. My vet did tell me that dogs can and do die on this drug Trilostane and that it could cause an Addisonian state which he also mentioned was preferable and easier to treat but not the goal. He told me that my "text book case" dog stopped reading her text book!!!

I don't know why but I do hope that her adrenals recover and she can go back on the Trilostane. I have more of a fear of her being on the Prednisone long term even though I know it acts differently for an Addison state.

Another question?
Do any dogs ever revert back to a "normal" state permanently , neither needing Trilo or Pred??Or possibly just temporarily?

[frijole]

Leslie



Another question?
Do any dogs ever revert back to a "normal" state permanently , neither needing Trilo or Pred??Or possibly just temporarily?

Yes! We've seen it with both trilo and lysodren dogs... it is bizarre and rare but it does happen.

But mostly, cush dogs are cush dogs and you really do learn to live with it. I had one dog with cushing's and another with a rare adrenal tumor... the tumor case taught me that cushing's is a walk in the park.

The toughest part is the beginning and especially when the cortisol goes low as you are sort of in limbo trying to figure it all out.. it is mentally draining - but totally doable so you can do it! :D

I can tell you've really been reading up and learning which exactly what you should do. Awesome job, truly. Hang in there and keep asking. Kim

[GabbySue]

Another question

Does anyone split the Prednisone doses and give it twice a day?? I was thinking it would give her better symptom relief( inappetance and some tremors in the morning, with a withdrawn attitude)
Gabby is not herself in the morning, she's quiet and doesn't want to readily take her meds on tasty food tidbits and has even left her food, but after her pred kicks in she's good and by evening is "normal" and eats like usual.
She had some labs today which aren't back yet but I'm wondering if the Pred needs to be increased???

Tiffany

Oh and BTW we happily rescued a Min Pin from yesterday that was to be euthanized from the ACC NY, got him pulled by a fabulous rescue group as he wasn't even ever going to get on the adoption floor because of his age which they said 10, he doesn't look a day over 6, but he is heavy and needs a diet. Gabby thinks he's cool!!

[molly muffin]

Hey Tiffany,

I can't tell you about the prednisone, because I've only had to use it for my golden retriever and she as a once a day dose. I'm sure others who have used it or had more experience with it can answer your question.

I do want to say congratulations on your new member of the house hold. :) Way to go for adopting him and saving him. Poor little guy. I bet he is thrilled or will be once he gets settled and adopts you right back. What's his name? Do we have a picture yet? LOL A little chubby guy eh. Bet he's a cutie.

Hugs and congratulations again,

Sharlene

[Jenny & Judi in MN]

congrats on your min pin! what a great thing to do!

I think I"ve told you before but we switched Jenny to twice a day for her prednisone. Her cortisol has been very very low since April and once a day dosing wasn't lasting for 24 hours, she wouldn't have an appetite in the morning, and it messed with her blood sugar

my vet was fine with cutting the dose in half and giving it to her twice a day. She eats twice a day at 6 am and 6 pm so it has worked well for us. We get the liquid prednisone now, makes it easier to tweak the dose. I'd try it if I were you. Jenny's appetite has been very consistent since we changed.

[GabbySue]

His name is now Bram (like Bram Stoker- Dracula) and he is 13 # 5 1/2 oz for a dog that should weigh about 10#. He was a stray on the street, found on 8/3/12 and I saw his picture 8/5 by chance and he was already on the death list. The only give them 3 days.

He's already bonded with us and once he's over his kennel cough he will be able to be with the rest of the family.

http://i941.photobucket.com/albums/ad260/CrossBay/Bram.jpg

This photo makes him look slender!!LOL!!!

[Roxee's Dad]

Oh what a wonderful thing to do and he so handsome. :D

[jmac]

He is such a cutie! Good for you for adopting him! :)

Julie & Hannah

[molly muffin]

Oh he is sooo adorable! Love the name Bram. Very cool. I can't imagine the poor guy out on the streets. Who wouldn't want to just take him home with them!

Sharlene

[Jenny & Judi in MN]

he does look like a vampire, what a cutie! my non cushings poodle is very overweight. we were doing ok with his meals at 150 calories. but his treats kicked him over and the vet said 150 calories total for everything. poor Bram, time for a diet!

[Squirt's Mom]

Hi Tiffany,

What a lucky boy Bram is to have landed in your loving arms! :) He is a doll and looks to have a bit of mischief in him so there may be oodles of fun on the horizon for you and Gabby both.

As for the pred, ask the vet asap. I don't think it would be a problem especially in light of her behavior in the mornings but be sure to clear it with them...also that will allow them to make a note in her chart for future reference. ;)

Hugs,
Leslie and the gang

[GabbySue]

I ran Gabby over to my regular vet for them to run the blood tests and send them to her specialist while I was there with my oldest Lab for Labs and xrays for him, needless to say I spent a van payment and half in just 1 short hour. (and will be taking my Lab to Gabby's vet for an abd u/s next week)

Gabby's specialist vet was reached on his vacation and now thinks she has converted over fully to Addisons, she is shaking in the morning and at night but seems okay during the midday and has some decrease in appetite. I am taking her in tomorrow morning for an injection of DOCP and she is staying on the pred.

Her tests are
Cortisol 0.8 low-1.0-5
and the highlights of her electrolyte panel
BUN/Creat ratio 28 high 4-27
Her BUN was normal 28 5-31
Magnesium 1.4 low 1.5-2.5
Sodium 135 low 139 -154
Potassium 5.7 high 3.6-5.5
Chloride 97 low 102-120
her cholesterol was good at 248 and triglycerides were 202
her ALP 35 so it seems her liver is back to normal.

I have a nearly full bottle of Wedgewood pharmacy Compounded Trilostane 5mg chewables if anyone needs them.

I'm hoping that Gabby will feel much better after her injection tomorrow, she isn't quite herself but still manage to run a squirrel up a tree this morning when she shot off like a rocket and ran as fast as her little legs could go!!!

Tiffany

[molly muffin]

That is good that the liver has kicked in and seems to working correctly. Very important little organ that liver.
A good way to tell how they are doing is by their actions and I'm pretty sure that chasing a squirrel up a tree and running as fast as she can is a good sign that she's feeling pretty sprite!
So glad to hear that.

Hugs,
Sharlene

[Squirt's Mom]

Hi Tiffany,

So glad to hear that Gabby Sue is up to chasing squirrels! :D:cool::D That IS a good sign! I hope she chases every squirrel who dares to cross her path...well, in her yard where she is safe. :p

You can contact you vet to see if they have any other clients who might could use Gabby Sue's left over Trilo. Animal shelters and rescues are another source to check. It is technically against the law to sell or even give these meds away but places like the shelters and rescues are usually more than happy to take them. Here is a link to a thread here where we have discussed ways to help others with the meds we have and can't use.

http://www.k9cushings.com/forum/showthread.php?t=1119

Hugs,
Leslie and the gang

[GabbySue]

Thankyou for the tip on what to do with Gabby's meds.

She got an injection of Percorten this am and it is drastically cheaper than treating the Cushings. :)

I can see why some vets just "convert" their patients.

[Bo's Mom]

Hi Tiffany,
Gabby Sue situation sounds like what we are now experiencing with my poodle Bo. I am learning so much from reading your posts.
And, congratulations on the adoption!!! He sure is a cutie.

[GabbySue]

I think that Gabby Sue is going back into Cushings.
Her appetite is heavier and she has started drinking alot more water that it is noticeable in the last couple of days and have figured out it is her that is having peeing accidents. (we have another dog with a bladder defect so it can be hard to rule in or out who the offender is)
My question is, she takes prednisone everyday , how long do I hold the Pred before she can be tested for her ACTH levels again?? I am going to call my vet first thing in the morning, and hope her specialist is available.

Gabby Sue also had an injury about 6 weeks ago, she went running across our property and as she was tearing out there not looking she tripped into the drainage area and tore her Cruciate in her left hind leg, so I've been cold Lasering it and she's been treated with pain meds but they don't do surgery for it on 10# dogs. She's made a remarkable recovery, but can't chase after the squirrels quite like she used to,but will again in time!

[Harley PoMMom]

If Gabby Sue has been taking the prednisone for a while then a slow tapering is what has to be done. I believe 48 hours with out any prednisone is needed for an ACTH stim test.

So sorry to hear sweet Gabby Sue has had a Cruciate injury and am hoping for a very quick recovery.

Sending tons of healing hugs and love,
Lori

[GabbySue]

Good to know, she's on 2.5mg a day so I'll cut it in half tomorrow, but hope that the vet calls me back before that. I have a feeling he's going to laugh as she will have "stopped reading her textbooks"!!! He said before she was such a textbook case, until she went into Addisons...:rolleyes:

[molly muffin]

oh poor Gabby Sue. Ouch. Hope she improves soon. I'm sure it is aggravating not be able to go after that squirrel as much as she'd like to.

hugs,

Sharlene

[Jenny & Judi in MN]

poor Gabby Sue, hope her leg heals! We tapered Jenny off the pred for her last ACTH and it went surprisingly well.

Sounds like you caught things just in time. My IMS guy told me he wouldn't consider treating Jenny for cushings again unless she had symptoms and her pre and post numbers were both over 2

Like you, he didn't want her to wind up in full blown cushings again.

hope you are heading it off at the pass! Judi

[Harley PoMMom]

If Gabby Sue starts to feel yucky while tapering the prednisone, Dexamethasone can be used instead because it does not interfere with the ACTH stim test.

[GabbySue]

I'm not happy to report that when I called her specialists office this am, that he is out of the office til tuesday and that I should bring her in on monday, when I told them there was no point as nothing could be tested I was then told that one of the other vets was supposed to get back to me today,no one ever called me.
The vet did tell me that he could always be reached but it seems that his office staff doesn't seem to think it's a priority.So on monday I am going to call and clarify that if that is the case I will find another practice.
I cut her Pred dose in half today and will give her the same dose tomorrow and then cut it again on monday/tuesday and then again wed/thursday and have them check her the following monday, at least my nursing degree is good for something , but again I'm really not happy with the lack of follow through with this renowned practice,and it's worse with their orthopedist...

[molly muffin]

oh that is sooo frustrating! I hope you can get a decent response out of them.

Well, exactly. You know what to do and can go forward with that, but it is still good to have your vet be available and when not available to have others on the team, aware of all issues and how to deal with them.

hugs,
Sharlene

[molly muffin]

Hi Tiffany!

How is out Gabby Sue doing? What did you decide to do about the vet thing, staying or finding someone else?
Hope Gabby Sue is doing real well and recovering from injury to her leg. How are the cushing symptoms, have they come back fully?

hugs,
Sharlene and Molly Muffin

[molly muffin]

Happy Thanksgiving to you and Gabby Sue!

hugs,
Sharlene and Molly Muffin

[GabbySue]

I decided to stay with the specialist as I do like him,he is knowledgeable and just take the office staff with a grain of salt, (okay a few grains, some lime and some tequila ;) )

Gabby was retested last week, before that the vet told me to just watch her and let that be our guide to see how long she was to go before she needed another Percorten injection. Gabby was doing so well (normal drinking,peeing, and her usual appetite and trying to sneak some kibbles from the Min Pins bowl) I forgot to look at the calendar when I realized that she had gone nearly 2 months since her last shot and had been on the lowered daily Pred dose of 1.25 mg.
Her activity is totally normal, she chases after the squirrels and can even jump up on the bed as long as no Labs are in the way. She's healed up well from her ACL rupture and I laser the leg if she holds it up or has a tremor in that leg I know she's done too much. Her coat has come back in and then some, my husband remarked the other day that she went from a smooth coat JRT to a broken, she does have a much heavier coat than she has ever had.

So Gabby is still an Addison's dog, she isn't totally so she doesn't need any Percorten at this time, her electrolytes were normal. The vet feels like I do that the stress of not being able to sleep with me for nearly 4 weeks while I was in with the litter of puppies was what set her off the deep end, but she has stabilized and seems to only need the Pred. He told me to call if she showed any signs of needing to be retested , otherwise just gauge how she is.

Her pre level was 0.7 --1.0 -5.0
post ACTH was 0.7 --- 8-17

Lytes
NA 148 (144-160)
K 4.5 (3.5-5.8)
CL 117 (109-122)
I'm working Christmas and New Years - we nurses never get many holidays off, so a big splurge instead of presents, the Prime Rib will have to wait for the weekend when I have time to make it and enjoy it. I bought Gabby a package of squeeky squirrells for Christmas, I think she will have better luck capturing one of those than the real ones!!

Hope everyone has a wonderful Holiday Season!!

[molly muffin]

Hey! there you are! So glad to hear from you. That is wonderful about Gabby Sue. Oh the poor little thing just did not take it well when you weren't sleeping companions.
I'm really thrilled that she is recovering from her recent incidents so well. Good for her. She's something eh. :)

Have a wonderful Holiday Season! Catch you on the flip flop if not before. Don't over do it!!

hugs,
Sharlene and Molly Muffin

[GabbySue]

Thanks Sharlene!!

Yes she is something, even Dr Knaack was laughing at her,she is the most not normal dog,but surprisingly healthy and that for me is the best gift of all.
I count my blessings on that one.
For there but the grace of God go I....
Hugs

Tiffany

[molly muffin]

Merry Christmas Tiffany to you and Gabby Sue!
Hope she is continuing to do okay and wow all the doctors! :)

Have a safe and wonderful holiday!

hugs,
Sharlene and Molly Muffin