My Maya

[bayerj52]

Hi. I just found you site today right after hearing that my 13 year old dachshund was diagnosed with Cushings. She has been a begged for a long while but it has increased. She also began to put on some weight rather quickly, gaining 8 ounces in a month. What sent us to the vet were her new nightly episodes of 'reverse sneezing' at about 3AM. Short bouts increased to several minutes to even longer until both she and I got panicked. A visit to the emergency vet revealed an enlarged liver with some mild cardiac and pulmonary involvement. The vet paced her on an antibiotic as a precaution and suggested a regular vet follow up to rule out Cushings. Two later, a complete blood panel pointed toward Cushings with everything else looking pretty good. LDDS results came back this morning revealing 'classic Cushings Syndrome.' so, we're starting vetoryl next week. What can we expect? Thanks a million. Judy

MODERATOR NOTE: Your post has been manually approved so that members can start responding to you. Please check your email for a message from k9cushings. You will need to reply to that email so that your post go directly to the board and are not delayed waiting for approval. Thanks and welcome!

[jmac]

Hi Judy and welcome to you and Maya!

I am sorry for the unfortunate circumstances that brought you here, but so glad you found us! We are a very knowledgeable and caring group and we are here to help you!

First of all, we like to know as much as we can about your dog and your situation. You mentioned that Maya was begging a lot and has gained weight. Does she have other Cushing's symptoms: ravenous appetite, increased thirst/drinking, increased urination, pot belly, frequent panting, hairloss, rear leg weakness, etc.?

Also, can you post all of her test results with abnormal values only (including the reference range)?

Did your vet suggest that Maya have an ultrasound to rule out any tumors/check her adrenal glands and liver?

Cushing's is somewhat difficult to diagnose and there are other diseases with similar symptoms, so we want to know as much as possible to advise you.

Others will be along soon, but in the meantime, please post all of the information you can about Maya so they can help you. Also, you can read through some of the information in the resources section of the site while you wait.

I'm very glad you found us, and please don't hesitate to ask questions. We will be here to support you and Maya in whatever way we can!

Julie & Hannah

[Bo's Mom]

Welcome to Maya...from all your friends who will be with you throughout your journey.

[molly muffin]

Hi Maya and welcome to the board.

I'm a newbie too but you'll find many people here who are a vast fountain of knowledge and experience when it comes to cushings.

Round up all your test results because that is really important when trying to figure out what is going on with our wonderful companions. We have some great people here who are very familiar with what the results mean, what they should be and importantly, what they should not be.

:) HUGS,

Sharlene

[bayerj52]

Thanks for the kind welcome. Well, I don't have any of Maya's numbers for the CBC or LDDS but will get them ASAP. She is hungry all of the time, but is constantly whining all evening for food. She does now have a pot belly due to her enlarged liver. That was diagnosed via xray. Increased drinking, but not a ton. No panting, just a lot of reverse sneezing that can last several minutes. No hair loss of skin problems. I am hoping we caught it early, if that is possible.
Maya used to be a picky eater but now she'll eat anything. She doesn't root around outside like she used to and is not barking as much as before. With two other dogs, she would always chime in, but it has decreased, too.
We plan to return to the vet next Tuesday for a review of the results and begin a plan of action. She stated beginning the vetroyl would be likely with close monitoring. She has not given Maya an ultrasound
probably because the test numbers came back so classically Cushings.
I am just newly retired so I used to be out of the house at least 10 hours a day. My neighbor would check on the dogs and let them out a couple times each day. Even with that, Maya had accidents in the house, both ways. but we thought it was due to her age.
Now that I'm home full time, I seem to be her only comfort. If I am not by her, she wanders looking for me. I want to give her the best life possible. I just don't know anything about the treatment. Thanks already for all of your support.

[Jenny & Judi in MN]

Welcome! My Jenny has had a few episodes of reverse sneezing and they are scary!

We used Lysodren not Trilostane but the specialist I saw in April is putting more newly diagnosed dogs on Trilostane. Hopefully you guys will be able to get on a routine.

I remember the first day Jenny quit having such a ravenous appetite, it was so nice to see her being "normal"

hang in there, Judi

[molly muffin]

awww, Maya, poor baby. I'm sure She is absolutely thrilled with your retirement! :) My Molly follows me around when I'm on a day home from work and her choice laying spot is anywhere near me.

I'm sure some of the others here can give you an idea of what to expect with treatment. I haven't started mine on the Trilostane yet, choosing instead to have the ultrasound done first. (she doesn't have the classic symptoms, Yet) I know of of ppl here though have been through this and can offer some wonderful insight.

I'll offer some moral support and lots of virtual hugs and belly rubs for maya. :)

Sharlene

[GabbySue]

You have found a good place for answers!

My little Min Pin/Dachsund cross does the reverse sneezes too, mostly when she's had a dry cookie, so I try to give her soft treats instead.

Gabby Sue started treatment a couple of months ago but her symptoms responded really quickly, the flooding of urine was the first to stop and I suppose was one of the biggest reliefs.

[bayerj52]

Okay. We went back to the vet today to begin Vetoryl. Maya, our 13 year old, 13 lb dachshund, will receive 10mg every 24 hours. As for her test results, here we go:

Dexamethasone Suppression
Pre Dex = 14.3 RANGE: 1.0-6.0 ug/dL
Post 4hrs Dex = 3.4 RANGE: <1.5
Post 8hrs Dex = 10.0 RANGE: <1.5

CHEM 27 + OSM + TRIG
ALK PHOSPHATASE = 1109 (H) RANGE: 10-150
ALT (SGPT) = 131 (H) RANGE: 5-107
AST (SGOT) = 118 (H) RANGE: 5-55
CK = 253 (H) RANGE: 10-200
GGT = 8 RANGE: 0-14
AMYLASE = 829 RANGE: 450-1240
LIPASE = 663 RANGE: 100-750
ALBUMIN = 3.9 RANGE: 2.5-4.0
TOTAL PROTEIN = 7.0 RANGE: 5.1-7.8
GLOBULIN = 3.1 RANGE: 2.1-4.5
TOT. BILIRUBIN = 0.0 RANGE: 0.0-0.4
DIRECT BILIRUBIN = 0.0 RANGE: 0.0-0.2
BUN = 15 RANGE: 7-27
CREATININE = 0.6 RANGE: 0.4-1.8
CHOLESTROL = 322 RANGE: 112-328
GLUCOSE = 82 RANGE: 60-125
CALCIUM = 11.7 RANGE: 8.2-12.4
PHOSPHORUS = 7.4 (H) RANGE: 2.1-6.3
TCO2 (BICARBONATE)= 26 (H) RANGE: 17-24
CHLORIDE = 104 (L) RANGE: 105-115
POTASSIUM = 5.2 RANGE: 4.0-5.6
SODIUM = 145 RANGE: 141-156
A/G RATIO = 1.3 RANGE: 0.6-1.6
B/C RATIO = 25.0
INDIRECT BILIRUBIN = 0.0 RANGE: 0-0.3

TRIGLYCERIDE = 1451 (H) RANGE: 20-150
NA/K RATIO = 28 RANGE: 27-40
ANION GAP = 20 RANGE: 12-24
CALCULATED OSMOLALITY =310.3 RANGE: 302-330
MAGNESIUM = 3.0 (H) RANGE: 1.8-2.4
T4 = <0.4 (L) RANGE: 1.0-4.0

I also have CBC Standard results but I have probably given you too much information. So, thanks for looking this over. Judy

I am very concerned about the dosage of the Vetoryl . Everything I have read says less is better. Is 10mg too much for a 13 lb. dog? I don't want to do anything to hurt Maya. I read the UC Davis recommendations. It's very different from what we are doing, I think. If anyone has any recommendations, I would greatly appreciate it.

[Harley PoMMom]

I am very concerned about the dosage of the Vetoryl . Everything I have read says less is better. Is 10mg too much for a 13 lb. dog? I don't want to do anything to hurt Maya. I read the UC Davis recommendations. It's very different from what we are doing, I think. If anyone has any recommendations, I would greatly appreciate it.

I believe that 10 mg of Vetoryl for Maya's 13 lb of body weight will be adequate for a starting dose. This dosage is at the low end of what Dechra recommends and I think is a good starting place.

Love and hugs,
Lori

[lulusmom]

Hi Judy and welcome to you and Maya.

Maya has some blood abnormalities that we don't see very often with cushing's, most of which I think might be explained by high lipids (fat) in Maya's blood. The abnormalities I am talking about are the phosphorus, bicarbonate, chloride, magnesium and rather high triglycerides. Did your vet mention this to you?

Can you please post the abnormal values, if any, on the cbc? Did your vet do an abdominal ultrasound to check adrenal glands and surrounding organs? Was a urinalysis done to check urine specific gravity and was a culture and sediment done? I am always a little nervous when dogs are started on treatment with so few symptoms, blood abnormalities that we don't normally see with cushing's and only an abnormal LDDS, which is very likely to yield false positive results in the face of non adrenal illness. By the way, reverse sneezing is not a symptom associated with cushing's.

Granted that dachshunds are at the top of the list of breeds that seem to be over represented in cushing's but I'm a worry wart and as anal as they come. :D

Looking forward to hearing more about your precious Maya.

Glynda

[frijole]

Glynda I am glad you chimed in... I was thinking the same thing when I read the readings. Judy, we see so many cases of dogs that are misdiagnosed that we are very cautious and just want to make sure dear Maya has cushings before moving forward with treatment. Kim

[bayerj52]

Thanks for getting back with me so quickly. Abnormalities in Maya's cbc were only slightly high, including:

MCV = 78 (H) RANGE 60-77
MCH = 26.4 (H) RANGE 19.5-26.0

AUTO PLATELET 125 (L) RANGE 164-510

In the urinalysis, these results were posted:
SPECIFIC GRAVITY = 1.018
GLUCOSE - NEGATIVE
BILIRUBIN = 1+ (H)
KETONES = NEGATIVE
BLOOD = NEGATIVE
PH = 7-5
PROTEIN = NEGATIVE
WBC = 0-2
RBC = 0-2
BACTERIA = NONE SEEN
EPI CELL = 1+ (1-2)
MUCUS, CASTS, CRYSTALS, OTHER = NONE SEEN

Hope this helps. I am totally overwhelmed but truly appreciate your support.

[lulusmom]

Hi Judy,

As I said before, Maya very well could have cushing's but I can't shake the feeling that there may be something else is going on with her as well. She has 1+ bilirubin, low specific gravity and a twofold increase AST. The AST is what has me worried because if you put that together with the high bilirubin and low specific gravity, primary liver disease could be possible.

Did your vet do an abdominal ultrasound? If not, I highly recommend that you have one done. Better yet, you may want to consider consulting with an internal medicine specialist and let him/her do the abdominal ultrasound. They usually have state of the art equipment, including high resolution ultrasound.

Glynda

[bayerj52]

Hi Glynda,
I just made an appointment for an ultrasound for Maya on Monday with our regular vet group. When I receive those results, I will ask about internal vet specialists. We live in the Sarasota/Bradenton are of Florida and most of the specialists need a referral from our vets. In the meantime, I am continuing with the 10mg of Vetoryl once daily and monitoring her closely. We just lost our 8 year old golden to IMHA three months ago. Boy, that was heart breaking! I don't want to go through anything like that again. As ever, thanks. I really could not do this alone. Judy

[lulusmom]

Hi Judy,

If you think you can absorb any more information and have an opportunity to see the vet on Monday, ask him to explain the abnormal blood and urine values. Take a notepad and write stuff down for future reference. When my first cushdog was diagnosed several years ago, I carried a pad of paper with me at all times to write down stuff the gp vet or IMS told me. My memory is horrible anyway so there was no way I was going to remember all that technical lingo they were throwing at me, much less understand it. I can look back now and see that I've come a long way since then. It's a long road that started out really bumpy but it's a pretty smooth ride these days. :)

Glynda

[StarDeb55]

Judy, Glynda asked me to stop by & take a look at Maya's labs. First of all, let me tell you that I am a medical lab tech with 30+ years experience. I'm in total agreement with Glynda that Maya's labs are highly suspicious for some type of primary liver problem rather than cushing's. The huge red flag is the the bilirubin in the urine. This is totally abnormal. Bilirubin is a breakdown product from old RBCs, & should be removed by the liver. When there is a problem with liver function, bilirubin will now increase in concentration in the blood, & the only other place the body can remove it is through the kidneys, thus you see its presence in urine. It's possible that the bilirubin may be due to a blockage in one of the bile ducts in the pancreas/liver area, or there could be several other reasons. I would really press Maya's vet for answers about possible liver disease.

Debbie

[labblab]

Debbie, does the fact that Maya's serum bilirubin was normal have any impact on the ramifications of bilirubin in her urine?

Marianne

[bayerj52]

So, will the ultrasound help clarify the diagnosis of Cushings vs. some other primary liver disorder?

[frijole]

It should. It is important to have it done on a high resolution machine - not usually found at a regular vet's office. The reason is that you will get clearer results which is the purpose of doing it. Also the people reading the results tend to be more experienced and know what to look for.

To be more specific - they would do an abdominal ultrasound to look at all of the organs including heart, liver, adrenal glands etc. They look for tumors, enlargement and much more. They can often determine whether a dog has cushings by the size of the adrenal glands. Cush dogs usually have an enlarged gland or glands (depending on if its pituitary or adrenal).

I went thru diagnosis 'hell' a few years ago with my Annie. She was misdiagnosed with cushings - all tests showed positive but the drugs weren't working... L O N G story we went to Kansas State Univ teaching hospital and had the vets their take a look and we finally had our answer - an extremely rare adrenal tumor but not cushings.

It made me a believe. It was the best money I spent - I wasted thousands of dollars for a year doing all the wrong tests. Hope this helps Kim

PS I wanted to add that before doing the ultrasound I would be asking the vet serious questions about the Bilirubin. It may be that the reading alone are enough to dx liver issues. Maybe Deb or Glynda have some thoughts on what tests are done next for that.

[StarDeb55]

For Marianne, & anyone else who is interested:

There are actually 2 types of bilirubin which makeup are part of the total bilirubin, conjugated & unconjugated bilirubin. Not to go into a detailed biochemistry of bilirubin, conjugated bili is bound to various carrier molecules such a glucornic acid, unconjugated or free bili is just that, free not bound to any other molecules. The liver handles the conjugated bili, kidneys the unconjugated.

I wish I could do a copy/paste of the pertinent section of this link from the Cornell vet school, but there's something about the page that I can't seem to get it to work. I will provide the link, the pertinent section. I think a good explanation of why you can have bili in the urine with a normal serum bilirubin is very well explained. You want to review the first 4 sentences at the beginning of the paragraph that is right below the diagram. It starts with "conjugated bili is not normally found in the urine of domestic animals". The article really explains this better than I can as I'm not a chemist any more.

http://ahdc.vet.cornell.edu/clinpath/modules/chem/tbili.htm

Hope it helps.

Debbie

[bayerj52]

Kim, because my vets's office is an emergency clinic by night, they do have some of the most up-to-date equipment. They invested a great deal to obtain state of the art diagnostic equipment, like digital imaging. The office by day has four vets and three additional emergency vets do night and weekend duty. I do feel comfortable with their level of expertise at this time. I do agree that I don't want to treat Maya for something she doesn't have. In the back of my mind I keep thinking she hasn't had any skin problems, only has had a marginal increase in thirst and voiding. The hunger and begging for food have been around for at least a couple of years and she has lost her hearing around 18months ago. The distended belly has recently been noted. She had gained about 12oz within 6 weeks prior to getting sick. After a round of antibiotics two weeks ago, her weight was back to her original 13lbs. So, fingers crossed, we will know something more definite tomorrow. If there is anything else I should ask, please let me know. Wow! This is so tough. She does seem a little more perky than the past three weeks. Thanks for the support. You folks are brilliant! Thanks, Judy

[bayerj52]

So, Debbie, the bilirubin could be a normal anomaly?judy

[StarDeb55]

Anything is possible, but from what that link says the presence of bili in the urine may come before an increase in bili in the blood where there's a gallbladder issue. It might be worthwhile to ask the vet if a repeat UA is warranted to confirm that positive, just to make sure that it wasn't something else causing a false positive. The strips that are used to do UAs which give results like bili, glucose, protein, etc. can be sensitive to interfering substances depending on which analyte we're talking about.

Debbie

[bayerj52]

Hi Guys,
Just dropped off Maya for her ultrasound. Left the questions about abnormal blood/urine levels. Hopefully will know more when I pick her up this afternoon. She was up four times with loose stools last night so we didn't get much sleep. Hopefully she can rest there. I did not give her the Vetoryl this morning so hopefully the poops will improve. Boy, I hate this. Let's hope we get some resolution soon. Thanks everyone. I could not be doing this without your help. Hard to believe I ran a school of 600 children and 90 adults everyday without blinking an eye and Maya has me on my knees. We will get through this, thanks to you. You are our guardian angels, for sure. Take care, Judy

[Squirt's Mom]

Hi Judy,

I am sure Maya will do just fine. She will have a naked belly when she gets done but should be ok. If they have to sedate her to keep her still she may be a bit groggy but that is the only issue U/S typically pose.

Please let us know what you learn from the test and I hope it provides some great insight.

Hugs,
Leslie and the gang

[bayerj52]

We're back! Maya's ultrasound reaffirms the Cushings, according to my vet and one of her associate vets who actually conducted the procedure while she observed. Liver looked good but her gall bladder was enlarged. So, perhaps that could be the reason for her previous test abnormalities. In addition to that, she had an unusually high volume of bacteria in her stools. So, we will take five days of Primor (180mg per day) and Pro-pectalin every 8-12 hours as needed. I did give her some older chicken jerky last night for the first time in a long while (my bad) and she began the diarrhea within four hours. I'm hoping that's what caused it. We will resume the Vetoryl tomorrow morning, fingers crossed. I am sorry I did not ask a lot of questions. I took a pad and paper with me but I was honestly a nervous wreck thinking the worst. As usual, thanks for all the positive thoughts, recommendations and your incredible knowledge. By the way, this site is one of the referral links on my vet's office website. She was very impressed with your level of expertise. Hope to hear from you soon. Judy

[molly muffin]

hmm, you know my molly developed diarrhea after having some chicken jerky too. I thought it was her food, like a bad batch or something, but she was able to back to that same food bag, little by little about 3 weeks later. I had given her the chicken jerky but then I read something about being careful about any chicken jerky from china. I think it was a year old warning, but better safe than sorry. So anyway, long story short. I threw it out and her diarrhea went away and hasn't returned.

So glad that Mays did well with the ultrasound! Aren't their little tummy's adorable.

:) Sharlene

[Squirt's Mom]

Just FYI - dogs all over the world are getting seriously ill and some have died after eating treats from China. They develop kidney problems similar to Fanconi. This has been going on for over a year (since 2007) and the products are still on the shelves - the FDA has NOT pulled them yet. However, recently the lawsuits have started over the Chinese treats.

Please, please, please read the packages thoroughly for everything you put in your children's mouths, your mouths and your dogs mouths - if it says China anywhere on it, put it back on the shelf. The risk just isn't worth it. ;)

http://philadelphia.cbslocal.com/2012/06/06/3-on-your-side-dangerous-dog-treats/

You can Google and find 100's of links concerning these treats. Please be careful. ;)

Hugs,
Leslie and the gang

[lulusmom]

Hi Judy,

Your vet should have written interpretation of the ultrasound findings. Can you ask for a copy and post those findings for us?

[bayerj52]

We are going back in next week. I can pick up the report at that time. The chicken jerky I bought was made in America. I got it online. My mistake was to not refrigerate it after opening, which I noted the day after I opened them. I think that was the culprit. No diarrhea today for now, at least.

[molly muffin]

oh good to hear it wasn't the chinese jerky. I always check the "made in" now after that experience.

Yea no diarrhea today!!!

[bayerj52]

Hi Everyone. Maya is scheduled for her first ACTH on the 31st of July. My question is: do I fast her prior to the test or do I give her the breakfast with the Vetoryl that morning? The vets's office said to fast her but an article from Dr. Mark Peterson stated she needs to eat and take her meds or her lab results will be skewed. I just happened to look it up after reading some of your threads. I was actually looking for the value range we are looking to see in the ACTH results. So, once again, help! Thanks a million, Judy and Maya.

[Squirt's Mom]

Follow Dr. Peterson's recommendation is my advice and let your vet know why. You could even print off what he says about it for their edification. ;) I would make sure they aren't planning on doing additional testing that really does require fasting, too. If that is the case, you will want to make a separate appt for those tests.

Hugs,
Leslie and the gang

[lulusmom]

Listen to Dr. Peterson. He knows what he is talking about as does the manufacturer of Vetoryl. They will tell you that you must give the morning dose with a small meal and get Maya to the vet within 4 hours of dosing so that the test can be done within 4 to 6 hours post dose. I personally fed my dogs their normal morning meal.

The therapeutic range you are shooting for is 1.45 to 5.4 ug/dl but the upper range can be as high as 9.1 ug/dl as long as symptoms have resolved. You can find this information in our Helpful Resources section. You can use this link.

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

[bayerj52]

You folks are the best! Will I ever get to the point where I am not second guessing everything? I am calling the vets's office tomorrow to tell them that I will be feeding and giving Maya her meds prior to taking her in on Tuesday. I am also making sure they add that to her file for the doctor to see. I could just imagine not giving her the meds and then having them tell me she needs higher dosing! I just don't want to make any mistakes.

[bayerj52]

Hi Everyone, It has been a while since my last post. In that time Maya has had two ACTH tests with results showing a score of 14 on 10 mg of trilostane. We then added an additional 10mg at night and her ACTH score fell to 11 with no noticeable side effects.
Last weekend Maya developed an interdigital cyst. My vet is treating it with a 7-day course of oral antibiotic. During our visit, the vet decided to give Maya a blood test for thyroid problems. Her T4 results came back at 1 (low but higher than her initial test back in July), but the second part of the test was also low so the vest prescribed thyroxine .1mg. I am sorry I have not yet received the paperwork on this current test so I am writing about numbers I don't quite understand.
Maya, a mini dachshund, has never displayed any of the BIG signs of Cushings like hair loss and pot belly. Her begging for food and drinking increased, as well as some of her 'accidents.' Her liver is now normal and she has gained less than 6 ounces since this has all begun. She weighs 14 lbs, which she handles well. My concern is about giving yet another synthetic hormone to my 14-year old baby.
I wish I was a bit more clear on these new test results. I haven't added the thyroxine yet think I should wait until the antibiotic was finished.
You all are so knowledgeable. Any advice would be greatly appreciated. Judy

[molly muffin]

Hi, That's is great that Maya is doing well on trilostane.

It is worrying about the thyroid though and I don't have any experience with that, so will let others jump in with their experiences.

I'm really glad her liver is back to normal. That liver is an amazing organ.

Sharlene and Molly Muffin

[Squirt's Mom]

Hi Judy,

Are you still seeing any of the cushing's signs? Hair loss, increased thirst and appetite, increased urination, and weight gain are also signs of a thyroid functioning below normal. The meds used to treat hypothyroidism are very mild with little side effects so I am confused as to why your vet would feel cautious about treating it. Left untreated, low thyroid hormones can cause some serious issues. If she is hypothyroid, not treating would make no sense and cause Maya some problems totally unnecessary for her to deal with so if I were you, and your vet is sure this is hypothyroidism, I would start treatment immediately.

There is a form of hypothyroidism that is not true hypothyroidism but related to uncontrolled cortisol. If her posts numbers on the ACTHs she has had since July are staying above 9.1 ug/dl and she still has signs, then the cortisol is not under control and could be effecting the thyroid values. Both of the post numbers you gave are too high. ;)

Is the change to twice daily dosing an increase in the total mg she gets every day or just splitting the original dose in two?

Were the ACTH's given within 4-6 hours after her last dose of Trilo that day? If not, the test results may not be accurate.

Was she fasted for the ACTHs? If so, the test results will probably be skewed, incorrect.

Good to hear from you again! Keep in touch!
Hugs,
Leslie and the gang

[bayerj52]

Because her ACTH was 14 on 10mg of trilostane, she was placed on 20mg, 10mg in the morning and 10mg in the evening. She never lost any hair or had a big pot belly. We just saw an increase in hunger, thirst and urination. Then a CT scan verified an enlarged liver.
After her first ACTH and receiving a high reading, I researched the protocals for ACTH testing with trilostane patients. I informed my vet of the need to continue her diet and meds prior to the ACTH, thanks to you. Her values were lower, but her trilostane was also doubled.
Since her treatment on the 20mg, Maya has improved in all those areas until recently. The combination of the interdigital cyst and an increase in accidents caused the vet to revisit her thyroid function. She had no hesitation prescribing the thyroxine considering the results. I am the worrywart.
We get a complete blood workup in 4 weeks to see how everything is proceeding. Our vets have not treated a great deal of Cushings dogs but I trust them. I just wish I had a good internal medicine vet, too. Or better yet, an endocrine specialist. I really don't know how to find one in the Bradenton-Sarasota, Florida area.
I just don't want to harm Maya because of an oversight. You all have been so good at getting me the information to ask the right questions. I didn't know that a dog could have Cushings and Hypothyroidism. Gosh, I didn't know that much on Cushings and am learning more everyday, thanks to you. Hope to hear from you soon. Judy

[molly muffin]

I don't think it is particularly uncommon for cushings dogs to end up on thyroxine for thyroid. We seem to have several members here who are dealing with cushings and thyroid issues. Try doing a search for throxine.

Now about finding a specialist in your area. This link (from our Resource file) lets you do a search, for a small animal internal medicine specialist

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

This page has a lot of resources and some listed for your area

http://www.floridapetpages.com/BusinessListings.asp

Hopefully that will give you some ideas and help you find a specialist.

hugs,
Sharlene

[bayerj52]

Maya has been on the thyroxine for a 9 days now and seems to be tolerating it well. Yesterday I noticed her shivering in the morning prior to her breakfast and meds. Now, this morning, she vomited liquid upon awakening. This occurred only once. Her bm was normal, as well as her appetite. She was shivering again, though. As I was checking her, I noticed another interdigital cyst on a back paw. Obviously, her hormones must be out of whack. I am taking her back to my vets office this morning but I am going to ask about a specialist referral. I am beginning to realize the how tough it is to maintain that delicate endocrine balance. It looks like it is time for more blood work. Suggestions?

[molly muffin]

You are right, it can be very tough. Definitely get Maya checked out, both thyroid and cortisol. Anything could have caused her body to react differently. What did the vet say today?

hugs,
Sharlene

[bayerj52]

Well, May's ACTH results came back this morning. The vet said the results were a little puzzling because the numbers were opposite from what is usually seen. Right now I'm so confused I can't remember what number came first. They were 9.8 and 13. I believe the pre was 9.8 and the post was 13. He is calling Dechra Monday morning to better interpret the testing results. In the meantime, we keep her off the trilostane. Does any of this make sense? I am sorry but I just don't understand this stuff. Thanks for the support. Judy

[labblab]

Well, May's ACTH results came back this morning. The vet said the results were a little puzzling because the numbers were opposite from what is usually seen. Right now I'm so confused I can't remember what number came first. They were 9.8 and 13. I believe the pre was 9.8 and the post was 13. He is calling Dechra Monday morning to better interpret the testing results. In the meantime, we keep her off the trilostane. Does any of this make sense? I am sorry but I just don't understand this stuff. Thanks for the support. Judy
Hi again, Judy, and I'm so sorry that Maya is not feeling well! Since your vet is reporting that her ACTH results were "opposite" from what was expected, I'm guessing that means the "pre" result was actually the higher of the two. Typically, the "post" result -- after the stimulating agent has been given -- is the higher number of the two. Sometimes a lower "post" result can signal that there is insufficient cortisol being generated and held in reserve, and this would trigger a decrease or temporary halt in the the trilostane. However, since both the numbers were "high" for a dog being treated with trilostane, I'm guessing the Dechra folks may suspect that one possibility may be that the two blood samples might have gotten mixed up at the lab, and that is what's accounting for the "reverse" pattern. :o

Regardless, since Maya is not feeling well, putting a hold on her trilostane is probably a good thing until your vet can talk to Dechra. However, in looking back through your thread, it doesn't appear as though her ACTH results have ever been down within the desired therapeutic range for a dog being treated with trilostane. So once her current illness gets sorted out -- as long as it is not trilo-related -- I am guessing that Dechra will recommend a dosage increase. They generally don't want the "post" ACTH level to exceed approx. 9, and they want to hold it even lower than that if Cushing's symptoms have not basically all resolved.

Do keep us updated as to how Maya is doing over the weekend, OK?
Marianne

[bayerj52]

I think you're right about the trilostane. It never has been at 9 or lower. In fact, prior to the 20mg adjustment, her count went up to 22. Since she went to the vet she has not had any additional 'events'. The interdigital cyst is not growing so that's good and she hasn't vomited. Her shivers have not occurred in two days. I am curious to see what the Dechra folks will say. I am currently paying double for the Vetoryl since she gets 10mg in the morning and 10mg in the evening. If she goes to 30mg, then the one pill a day will reduce the price. She currently weighs almost 14 pounds so 30mg is within their acceptable range. I just want her to feel well with without side effects. We will be celebrating her 14th birthday in two days. Hope to have a 'plan' by then. Thanks again, Judy

[bayerj52]

Does anyone know about interdigital cysts? Maya had one two weeks ago, was then diagnoses with hypothyroidism in additions to her Cushings. She was given .1mg thyroxine daily plus a 7 day Rx of baytril. First cyst resolved but now we have a second on a different paw. Went back to vet but no Rx at this time as we are trying to adjust trilostane dosage. In the meantime, this cyst burst open today. I soaked it in 50/50 hydrogen peroxide and warm water, put neosporin on it (all that I had) and covered it with bandaid which she is leaving alone. I worry about recurrence and wondered if anyone has had to deal with this and has any success. Thanks, Judy

[molly muffin]

I don't have any experience with interdigital cysts. I did some reading though after you said that Maya had gotten them and it's not uncommon for them to show up on the foot and they it appears they take awhile to get rid of. Dogs with thyroid issues are prone to getting them too.

I wonder if Leslie's recipe would help for her wash for wounds. You'd have to acquire the herbs to make it but it might be worth trying after you've cleaned out the pus stuff.

http://www.k9cushings.com/forum/showpost.php?p=85280&postcount=446

This is one of the sites I was reading: http://www.collienet.com/health%20topics/Interdigitalcysts.htm

Hopefully some others here have had real experience with this and can help out.

hugs,
Sharlene

[bayerj52]

We are back on the Vetoryl. We are staring on the 10mg twice daily and will consider increasing it in a couple of months. She seems to be doing better now so fingers crossed. The folks at Dechra have been talking with my vet and Maya is in their database. I emailed them and they have been very helpful to me, as well. I am very impressed with their customer service availability. I hope everyone has a wonderful Thanksgiving. For me, I am thankful for this forum and for you. Thanks again, Judy

[molly muffin]

That is good that everyone is talking to each other. Hopefully the 10/10 will work out alright and Maya will get some relief (and you too!)

Happy Thanksgiving
hugs,
Sharlene and Molly Muffin