new to board ~ Kona has passed

[3bostons]

Hello, I am now one of the confused pet owners about cushings. My 10 year old boston, Kona, has been recently diagnosed with cushings and I am scared to death of starting the meds of Vetoryl 2 x day, 10 mg. that has been prescribed.
Hers was found thru blood work, the only other signs was she had an ultra sound done and the hair did not regrow, then the water consumption and constant peeing of gallon a time it seems. SHe acts so normal other than those things, the real concern I have is her AKLP went from705 in Dec 2011, to 1823 in Feb and then 7611 in July, when the final tests were done to confirm. My question is I have never heard of the AKLP being so high, could this all be a mistake? They have tested the thyroid and did a full panel of tests but honestly I dont know what all the numbers mean other than they read normal, if you want to know any of those I can tell you them though if it helps.
I have read alot about this disease and know its hard to diagnose but the idea of giving her meds that could make her feel worse scares me, these are the times you wish they could talk even for one minute, to tell us how they feel now. Sometimes I think not medicating her until she was showing signs of feeling ill would be better and I really am hoping to find some input from others who know more of this disease, so thank you ahead of time for your thoughts.

[Steph n' Ella]

Hello Kona and owner! I am sure someone will be along soon but in the mean time welcome! Lots of people here have had years of experience administering vetoryl and will help you through the scary bits. Read some more here and get all of your test results ready and post!

[addy]

Hi and Welcome,

I am glad you found us and we can help sort things out. Do you have any of the test copies to show the abnormal ranges? What other tests were done to diagnose Cushings? Can you tell us how much your pup weighs?

We all arrive here shell shocked, scared half to death. Once we start learning and reading and having support of others traveling the same journey, it does get easier.

Sorry you have to go through 20 questions, it is our initiation:).

Take a deep breath, slow down, it will all be okay.

[frijole]

Welcome! Surely that alkphos reading is a typo/error on the test?! Please call the vet office to confirm... I've seen readings in the 2000's but never 7000's!

OK.. to your questions - I cannot comment on the dosing amount for trilostane because I don't know your dog's weight - please let us know. Most vets start low intentionally and ignore the dosing recommendations from the drug manufacturer Dechra. I would start low as well.

But before we get to that - we will want to help you confirm that your dog has cushing's as it is very very often misdiagnosed. Please get copies of the tests done and post the results. Also if you could post any abnormal levels on the blood panel that was done that would be helpful. Finally, on the ultrasound there should have been a written report - if you could type that... it provides a wealth of information.

With liver enzymes that high I would not ignore it. The reason cush dogs drink so much water is because they are peeing so much - not vice versa. The urination is caused by issues including kidney failure so you really can't ignore it when it is extreme unless of course the dog has other illnesses is extremely old etc.

The drugs used to treat cushings don't make them feel worse, they save their lives. When things go wrong is when an owner doesn't follow dosing instructions and/or a vet is inexperienced or asleep at the wheel. If used properly your dog could live a very normal and happy life. My dog was on lysodren for 4 1/2 yrs and died at the age of 16 1/2... from old age and not from cushings. She had no pain whatsoever.

So know it is not a death sentence and alot of what you read is pure rubbish. So if you can get those test results and tell us more about your baby we will help you all we can! Kim

[3bostons]

Hi and thank you for your support and words of advice, it is scary reading all the stuff that could go wrong with the meds and things and it is all so overwhelming, all I want, like all of you, is for her to be happy and healthy. We have 3 great bostons and only one of them has been fairly healthy, my little guy is 9 years old and has been going blind for the last two, Kona has had two previous cancers, both removed and not returned and now this, cushings, its devastating.

But back to the tests, I did double and triple check with the vet regarding those ALKP numbers, they are correct as far as the vet is concerned, I have questioned that repeatedly. Doesnt seem right does it? The ultra sound I dont have any info from, in fact it was originally done to view her liver, and it was that night that really got things rolling on more tests. They of course shaved her belly for the US, that night she was pacing, whining and could not sleep, I had to go to pet emergecny, they could find nothing but gave her pain meds and she was finally able to sleep, but the next morning her whole belly was black and blue like she had been drop kicked, I was horrified. I did all but accuse the vet of doing something, how could I not, a US should of been simple right? anyways they started more tests then and said the bruising could be from cushings, the only good thing about the incident was her liver and other glands all looked normal.
As far as her other blood panel all came back in the normal range except the ALT, at 229 and the ALKP at 7611. They told me that with that number and the bruising that she is at high risk for stroke also. They did the LDDSR and endogenous ACTH and I have asked for results, but so far the only one I got was from the first test of the day and those have the above mentioned numbers. I was told they did not flucuate much at all thru out the other tests of the day but I dont have the document to back it up. So after that test, the bruising, the lack of hair regrowth, the drinking and urinating, they have concluded cushings. She weighs 26 lbs and like I mentioned, have put her on 2 x day 10 mg vetoryl.
I am going to call again regarding the other two test results from that last cushings test and I will post them if I get them.
Thanks again, you are the only ones who may understand what I am going thru.
Deb

[3bostons]

Ok, got the ultra sound results but the office cannot locate yet my other 2 test results from the cushing test, still looking.

ultra sound
Liver: WNL
Gall bladder: mod full, small amount of sludge
GI: WNL
Renal: WNL
Spleen: WNL
Adrenal: bilateral adrenomegally (left 0.72cm, right 0.8-0.9 cm)

Thats all that is on the page,
Deb

[3bostons]

Ok I just got the test results from the endogenous acth
8am 97 (normal is 15-110)
3pm 70 (normal is 0-30)
5pm 106 (normal is 0-30)

The notes from the lab is at MSU and states these findings are consistent with cushings of the pituitary type, and that the numbers would be much lower if it was adrenal tumor.

So.... I guess its true? Im still puzzled by the alkp numbers though, you would think that high of number she should be in liver failure, but shes pretty happy and herself except for a few things.

[lulusmom]

Hi and welcome to the forum.

I too am puzzled about the severe elevation in ALKP but not for the same reasons you are. Dogs are the only species on earth with a steroid activated ALKP isoenzyme. High levels of cortisol does not damage or kill liver tissue but rather it causes an over accumulation of glucogen in the liver. The thing I'm puzzled about is that with such high levels, one would expect the liver to be enlarged because of this accumulation, yet Kona's liver was within normal limits on imaging. :confused: I can tell you that these elevation are the common pattern we see in cushing's but a normal sized liver isn't common.

Were there any other abnormalities on the bloodwork? If so, can you post those, along with the normal reference ranges. The endogenous acth test is used to differentiate between adrenal and pituitary based disease so you can't use that to confirm a diagnosis. Hopefully your vet can find copies of low dose dexamethasone suppression test so you can post the results for us.

It is rare that a dog with cushing's has a stroke and if bruising is an indication that a dog is at high risk of stroke, my little cushdog, Lulu, would have stroked out many times over. She has horrible bruising. She's pretty much bald and every time they draw blood from her neck, the bruise is huge and takes forever to go away. It's natural to be afraid of the drugs because they can cause some nasty side effects but if the pet owner is vigilant in watching their dog for side effects and vet who prescribes them is experienced with the disease the drug he's prescribing, side effects can be minimized and quite often eliminated completely. My little one was diagnosed 7 years ago and has treated with both Trilostane and Lysodren. She weighs 4.5 lbs and was on some pretty hefty doses of both drugs. She's still with us, sans most of her hair, but she's a happy girl in remission for almost a year. We're enjoying the vacation from cushing's drugs and hope the wave lasts for a good long time.

I had a second cushdog who passed away in June. He also did well on treatment for five years. We're not sure what took his life so quickly but we suspect it was probably a hemorrhaging brain tumor. He weighed 6.5 lbs and was also on a larger dose for a small baby and did well on both Trilostane and Lysodren.

Unless a dog with cushing's has had the disease for a very long time and complications like bacterial infections develop due to a severely impaired immune system, the dog isn't in pain nor do they feel sick. They get lethargic and may sleep more and develop an intolerance to exercise but they aren't suffering. As a matter of fact, dogs with arthritis will benefit from the anti inflammatory properties of the excess cortisol in the bloodstream. These dogs will begin to feel the aches and pains of arthritis once treatment lowers cortisol levels.

Because cushing's progresses at a snail's pace, there is time for you to absorb as much information as you can so that you will feel more comfortable with whatever decision to make. We were all fruitcakes on the heels of the diagnosis and I discovered that the more I learned, the more at ease I became. Taking the time to educate ourselves is the only way we can become the best advocate we can for our dogs. After all, we are their only voice.

Glynda

[3bostons]

Wow, you are so very helpful and full of info, thank you so much.:)
I am confused again though, isnt the numbers i posted of the all day test from the ldds? I was thinking they were and that confirmed the cushings, the acth test was just the second test done to confirm where it was coming from? Thats what i was thinking, am i still missing more test results? Thank you for your help, this whole board is so full of good information.

[Squirt's Mom]

Ok I just got the test results from the endogenous acth
8am 97 (normal is 15-110)
3pm 70 (normal is 0-30)
5pm 106 (normal is 0-30)

Does the lab refer to these results as an "endogenous ACTH"? It sure looks more like the LDDS since there are three values given but since I am not all that familiar with the endogenous ACTH, this could be what one looks like and I have just missed it. :o Could you verify whether this is the LDDS or an endogenous ACTH?

You're doing a fine job, Mom, hang in there!
Hugs,
Leslie and the gang

[3bostons]

Hello, and yes I messed up I realized when looking at the report again, geesh guess I would not make a good doc :p
The numbers posted are the ldds, the endogenous acth was 4.9 and the average range for that is 6.7-25.0, so that is the low number referred to in the notes. So, the readings at 8,3 and 5 pm are the cortisol low dex . Sorry for the mixup, but thanks for understanding.

Also I have noticed something with Kona in the past few months that is new but was not worrisome. She has always been such a quiet sleeper, meaning my other 2 bostons, and my hubby for that matter, all snore up a storm and the joke has been that me and Kona should sleep in another room where its quiet, lol, but now she is snoring too and rather louldy. I wondered is she sleeping more soundly? I mentioned to the vet because its one of those things that make me think that she isnt too uncomfortable to be able to fall into such deep sleep I hoped. Not sure if it was related at all to the cushings but its only began recently.

[3bostons]

Also, I was wondering, if you tend to agree that it may be cushings. WHat would your thoughts be on my starting Kona on the vetoryl 1x day instead of 2x, only to see how she reacts to the meds, and if no reaction then go to the 2x day? Just something Im thinking of doing, I always lean to less meds with everything including me, can always increase, harder to correct too much.

[3bostons]

Hi all, I know you have lots of posts to read but I was curious if anyone had time to look at the numbers I posted to tell me if that is consistent with the cushings? I will list them again just to make it easier, endog acth 4.9 ref range 6.7-25.
cortisol 97 ref 15-110 8am
70 ref 0-30 3 pm
106 ref 0-30 5 pm

SHe still does not exhibit much difference other than the drinking and peeing, she is more ravenous too but she still follows me around, wants to go where I go, does all her usual things, mention walk and she runs for the door so its so hard to want to medicate her other than the obvious thirst problem. I am still searching for all input and ideas I can get and appreciate all that you guys do !
THanks, Deb and Kona

[Squirt's Mom]

Hi Deb,

It would help us give you input if you could round up the lab work she has had done and post the abnormal results here. If the ALT and ALKP are the only abnormalities, then don't worry about it as you have given us those values. However, if there were any other values that were too low or too high, please list them along with the units of measurement (like ug/dl or mnol/L) and normal ranges for each value. Please and thank you. :)

As Glynda said, the endogenous results is not a test that diagnoses - it differentiates between adrenal or pituitary. SO Kona seems to have had only one test for diagnosis - the LDDS. It always makes me nervous for pups to be started on either of these drugs based on the results of a single test - because Cushing's is so hard to diagnose and so easy confused with many other conditons that share the same signs and will result in false-positives on the Cushing's tests.

Is her appetite voracious? Does she act like she is starving - and I mean that literally...starving. Not that she likes to eat all the time, not that she always begs for treats - that she is frantic to eat 24/7 eating any and everything trying to be satisfied?

Does she pant for no reason?

Does she seek out cool places to lay and avoid the heat?

Here is a list of the common signs seen in Cushing's from Kate Connick's site. Look this list over and see what signs Kona is displaying and note what she is displaying that does NOT fit this list -

From Kate Connik
The most common symptoms include:

• increased/excessive water consumption (polydipsia)
• increased/excessive urination (polyuria)
• urinary accidents in previously housetrained dogs
• increased/excessive appetite (polyphagia)
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• bony, skull-like appearance of head
• exercise intolerance, lethargy, general or hind-leg weakness
• new reluctance to jump on furniture or people
• excess panting, seeking cool surfaces to rest on
• symmetrically thinning hair or baldness (alopecia) on torso
• other coat changes like dullness, dryness
• slow regrowth of hair after clipping
• thin, wrinkled, fragile, and/or darkly pigmented skin
• easily damaged/bruised skin that heals slowly
• hard, calcified lumps in the skin (calcinosis cutis)
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures

http://www.kateconnick.com/library/cushingsdisease.html

We have so little info on Kona it is hard to give you the answers you seek. But based on what we know so far, I would not be rushing into treatment in your shoes. You have more than enough time to learn as much as you can AND to make absolutely sure Kona does in fact have Cushing's. ;)

Hugs,
Leslie and the gang

[3bostons]

Hi Leslie, thank you for the reply for Kona and me. All the other tests were in the normal range, the only ones not were the alt and alkp. Everything else is all in the normal ranges. Is there another test they can do on her? They have only done the blood work, the acth and the ldds, please let me know if there is another test I can request.

As far as symptoms she does show some of them. Like she has not regrown any hair on her belly after the shaving for ultra sound in Feb 2012, she did bruise severly from the US with no explanation, she was panting alot and we found she had UTI and after the dose of antibiotics it cleared up and seems the panting has slowed as well. She is avoiding the sun where she has always been a sun goddess, now she prefers the shade or indoors. No change in her appearance to me, no weight change, no skin issues, other than the hair regrowth I mentioned, no pot belly. The vet seems to think that she is standing differently on her front feet and felt that could be tendons weakening, a symptom, I dont see it the way she does but shes the vet right? We live in a remote area on 10 acres and so we spend alot of time outside in the yard and garden and she is still always right with me, she still chases squirrels, she just acts so normal with the water intake and excessive urination being the biggest changes. As far as food, she is hungry all the time, I have to keep her away from the bird feeders because she is even eating bird seed if she gets over there. SHe inhales her food when fed but she doesnt bother the other two for their food because they wouldnt allow it.

I hope I have provided more info to help you help me, Im just so confused as to medicate or not and really need advice.
Thanks so much,
Kona and Deb

[Squirt's Mom]

Hi Deb,

Ok, she has had an ultrasound, a great diagnostic test for Cushing's and many other things as well. (Sorry, I somehow missed that! :o) It shows her adrenal glands are both slightly enlarged, which is what we normally see in PDH. In cases of adrenal based Cushing's, we typically see one large gland while the other is much smaller, or even atrophied.

So for valid diagnositic testing, Kona has had an LDDS and an ultrasound plus a differentiating test - the endogenous ACTH. An elevation in ALKP is very common in cush pups but not so much elevations in other liver enzymes, like the ALT. When there are elevation in liver enzymes other than the ALKP, that could indicate liver damage or disease. However, nothing shows on her ultrasound that would indicate that. I'm anal enough that I would want the liver checked out thoroughly just to be sure there is not a problem there as the elevation in ALT might indicate. Other elevations we often see on labs are cholesterol and triglycerides as cush pups cannot process fats as they should.

Kona is displaying some signs but I'm not clear on how strong they are or how much of a problem they are for Kona or you. Keep in mind - treatment is not a cure; it simply helps some of the signs like peeing and drinking and feeling like they are starving. In later stages, treatment helps prevent organ damage sustained after years and years of being washed in excess cortisol. Note the "years and years" part. This is important because it means there is SELDOM reason to rush into treatment until we are convinced our baby does have Cushing's, we have really studied the treatment options, we have ruled out everything else that could possibly be causing the signs we are seeing (like hypothyroidism, diabetes, liver and kidney disease to name just a few), and educated ourselves for the journey to come - a life-long journey. ;)

I think, in your shoes, I would do just what I did when Squirt was first diagnosed - wait and learn as much as I can, do every test I could afford to do, ask 1000 questions, read 10,000 studies, and ask 1,000,000 more questions. Squirt was diagnosed early in 2008 as having PDH based on five tests - LDDS, HDDS, ACTH, UTK panel, and two ultrasounds. After the second ultrasound, I was told about a tumor on her spleen and once it was removed, her cortisol returned to normal and remained that way until last summer (2011) - 3 1/2 years later. ;) If I had started her on treatment, as some tried to push me into (elsewhere, not at K9C), she would have died when that tumor ruptured and she would have been on some powerful drugs that she did not need, putting her at risk.

So, that is what I would do for now. Take a deep breath, try to relax enough to start learning a little bit about Cushing's and the treatments available, make sure there is nothing else that could be causing the signs you are seeing in Kona...and keep asking questions as you learn. Taking a few days or even weeks won't make that much difference in the treatment results and could make the whole experience much, much better for you and for Kona because your comfort level will soar as you learn which transfers to Kona. ;)

I am sure others will along with their input, too. We are all here to help each other but the bottom line is that the decisions are always ours alone to make, and face the consequences of. But we are never, ever alone...neither are you and Kona.

Hugs,
Leslie and the gang

[labblab]

Hi Deb,

For what it's worth, I do believe I would move forward with treatment if I were in your shoes. These are the abnormalities you have noted: excessive thirst/urination/hunger, panting, seeking out cool places, slow hair regrowth, elevated liver enzymes, and bilaterally enlarged adrenal glands on ultrasound. These are all pretty classic Cushing's symptoms. Since the vets have expressed concern about Kona's bruising and possible tendon weakness in addition to the sky-high ALKP, I'd be inclined to follow the recommendation to start treatment.

One oddity about the testing is that the LDDS is normally performed at intervals of 4 and 8 hours after the baseline draw. It appears that Kona's LDDS sampling took place at 7 and 9 hours afterwards. I'm not sure what that was about. However, it is usually the 8-hour reading that determines the general Cushing's diagnosis, and since Kona's results far exceeded the listed norm at both 7 and 9 hours, I guess that covers the 8-hour time frame. As far as the endogenous ACTH test, I'm sorry I can't be helpful with the interpretation. But it is a test we see very rarely and I am unfamiliar with the results. The bilateral adrenal enlargement is definitely consistent with pituitary Cushing's, however.

The twice daily dosing of 10 mg. sounds reasonable to me based upon Kona's weight. However, if you'd feel better starting off with only 10 mg. once daily, I see no reason not to ask the vet to do so. The only trade-off is that you may end up necessitating some extra dosing changes with corresponding monitoring ACTH tests along the way.

So that's my two cents worth to throw into the mix!
Marianne

[3bostons]

Thanks Leslie and Marianne, I tend to agree with you both and thats definately causing my confusion. :confused: Leslie, I tend to agree that I would want to see more negative results from Kona herself before I began meds because like Ive said a few times she seems normal except for a few "minor" issues, by minor I mean not life threatening and it does seem like I may have more time to decide. But... maybe she has had this for longer than I am aware of and it is causing more internal health issues that I cant see. So Marianne, thats where I tend to agree with you that maybe I should start. Oh also, I may of messed up the times, but her testing was done in the 4 and 6 hour intervals.

So, just to update you.. I was able to talk to her vet again today regarding my questions. I re-questioned the abnormally high alkp numbers and she agreed that it is way high for what they usually see in cushings, and it could mean liver disease and it could of already come from having had cushings for longer than I have been aware, (I will horrible if thats the case) or it could mean just that she has liver disease. SO, I asked what the meds will do if it is liver disease and of course it may not be good since she wont be able to metabolize it, (scary) So I asked why not test the liver, and due to the severe bruising from the ultra sound she is hesitant to biopsy the liver because it could cause severe internal bleeding, and or stroke would be possible, not to mention she is hesitant to even do a second ultra sound due to the bruising.
So, she suggested to start the meds and I will go back sooner than the usual first timing for a test and if the alkp is higher, stop the meds and decide to take the risk of liver biopsy. If they are beginning to lower, then stay on the same dose for another week then come test again to evaluate any change needed in meds.

This is so horrible of a decision, now Im messing with her liver, or maybe I already did by not catching cushings sooner ? I dont know, but I dont feel good right now. I think Im going to do the meds and go see her as suggested. :(

Thanks for your help, I really needed it, its good to know I have someone to talk to who understands what this feels like.

[Harley PoMMom]

Hi Deb,

What about having a bile acid test done? The bile acid test is one that measures how the liver functions and performs and is mostly non-invasive. In performing this test, the dog is fasted, blood is drawn, then the dog is fed a fatty meal. Two hours later, the blood is drawn again. The blood tests measure pre- and post- meal levels of bile acids, the acids stored by the gall bladder and secreted by the liver. If the levels are high, there may be a problem with the liver or hepatic vasculature.

Love and hugs,
Lori

[labblab]

Oh Lori, that is such a good idea! Deb, I would definitely ask your vet about running this test in order to better gauge the status of Kona's liver function.

Marianne

[3bostons]

Lori, that sounds like a great idea! Thank you guys for your help, i am going to call her in the morning and find out for sure. Now maybe i will sleep a bit better, except for the anticipation now of the idea of a different test, thanks again
Hugs, kona & deb

[molly muffin]

Oh that is such a good idea!

hugs,
Sharlene

[winston's mama]

Hi Deb, I'm new to this board too, and also have a boston who has high liver enzymes. ALP are in the 2500 range & ALT is 334. My vet is pretty much baffled by my 8 yr old Winston's test results. I asked about the bile acid test for fear of liver disease (my Winston has been on Phenobarbitol & Potassium Bromide for almost 6 yrs due to grand-mal seizures) But my vet either is clueless or they truly don't suspect liver damage. He didn't feel it was necessary?! I think I've done more research on the diseases & drugs than the vet in these past few weeks because I'm the one asking the vet for certain tests, not them suggesting the tests to me...
Anyway, Winston definately has all the signs of Cushings so I started him on a low dose of Trilostane 10 days ago just to introduce the drug slowly to his system... His Cushings symptoms are getting progressively worse so I plan to up his dose tomorrow. (He weighs 19.5 lbs & he's on 3 mg of TS 2x per day, VERY LOW DOSE, But that's because I'm scared of the possible side effects with his other meds...
Please keep us informed of what's going on with your sweet girl Kona...
All I do now is research & educate myself on Cushings & other possible things that could be wrong with my baby Winston, it's a long hard road but my baby is worth it.
BOSTONS ARE THE BEST!!! I AM INFATUATED WITH THEIR SWEET, PLAYFUL, & LOVING PERSONALITIES!!!
Good luck to you & sweet little Kona...

[3bostons]

Hello to a fellow boston lover stacey ! :D We too love our little guys they are such love bugs and do follow me everywhere too. THey each have such distinct little personalities and are sooo easy to love !

Sorry to hear about winstons health issues though, I have heard about these guys being more prone to the seizures, so glad to hear the meds are working for him and keeping him seizure free for so long. Im with you in going slow on these meds, and especially since you have other meds already that could conflict, I would be doing lots of homework just like you. I have been doing my own research too about all of this cushings and there is just so much to learn and so many differences, its all very confusing.

As far as Kona, she was prescribed the vetoryl 10 mg 2 x day, but I too wanted to go slow so I started her on 1 x day and watched closely. I took her back yesterday to recheck blood and if the numbers had not dropped we were going to do the bile acid test. Well, first off she is dropping weight, a good thing, she was at 26.9 and now is 24.8, she used to weigh around 20 so that was a good sign. Then her blood work was still high, but it has only been a week and only at 1/2 the dose so I was glad to see it. Her alkp was 7611 down to 6955, and alt from 219 down to 213. We didnt do the baseline cortisol test only because I had insisted on the early recheck, they will do that next week on the regular appt for sure.

SO the vet suggested that I now go to the 2x day for the next week and see if we can get her numbers down more and maybe relieve some issues. I am more comfortable doing that now, and if she contines to lose the weight we may be able to go back to the 1 x day. One thing that was worrisome was now they detected a SLIGHT heart murmur which can be from the cushings which is the other reason they said to up to the 2x day and see if we can get this under control before any more issues come up.
You mentioned only doing 3mg a day, are you using vetoryl? If so, Im curious as to how you are able to go so low with the pills being in 10mg ? ALthough you are not supposed to touch the meds, I thought about doing it anyway, opening the pill and dividing it in half so I could do her dose of 15 mg instead of the 20 if that turns out to be too high. The vet told me not to but I think its only due to liability, I think I could do it myself if needed, and i would.

Please keep us updated too as to winstons condition and what you decide on your meds for him.
Hugs, Kona and Deb

[Boriss McCall]

Welcome little Kona & Deb,
I to have a BT & love them all to pieces.;) I have never had a dog so intune to my feelings & love me so much. Boriss & I are stuck to each other like glue. He is 8 years old.

You are a couple of steps ahead of me. We are still in the testing phase with things. He had his full blood panel, urine culture, LDDS test last week & this week he does his Ultra sound. Like you I am SCARED to death with this whole treatment thing.

He sounds a lot like your baby. He isn't showing extremes signs of the disease. More thirsty than he used to be.. but, not buckets of water like others mentioned. Of course accidents in the house & he will lay by the food bowl in the evening. He does this thing that my husband & I call shopping for food.. :p He will go all around the living room sniffing & licking the carpet looking for crumbs to eat.
I don't think he is at the "starving" stage. But, he used to never care about food & now he wants his dog food.
He is more lethargic these days when he used to be hyper & play all the time.

oh & I also noticed the other night he is snoring louder than he used to.

I am so afraid with the meds he might just lay around even more. BT's are supposed to be fun & silly. I hate to see the life being drained out of him. :(

I am glad your vet is letting you start your treatment on a low dose. Boriss weights 28lbs now. He normally weights 26lbs. My vet wants to start at 30mg a day. That sounds high to me... scary..

Is your baby having any adverse affects to the pills if not that is a plus? :)

I am by far no expert & only learning about a disease I have never heard of until a few weeks ago.

I am sure someone else will say something. but, it doesn't sound like a good idea to break the pill open yourself. scary...
There are places you can get the drugs compounded to a different dose. But, who am I to say I am clueless so far. Maybe that is an option. But, I have always heard that even with human drugs it is a bad idea.

I will probably start treatment soon. I can't decide if now is the right time. Mainly do to fear of the meds.

But, my vet did say not to let it go too long so other organs don't become affected.

Good luck & welcome.. I hope we can all get our babies back to normal. I am looking forward to seeing my crazy BT again.

Amy & my boy Boriss

[Squirt's Mom]

If so, Im curious as to how you are able to go so low with the pills being in 10mg ? ALthough you are not supposed to touch the meds, I thought about doing it anyway, opening the pill and dividing it in half so I could do her dose of 15 mg instead of the 20 if that turns out to be too high. The vet told me not to but I think its only due to liability, I think I could do it myself if needed, and i would.

Hi Deb,

No, it is not a good idea to open those capsules and divide them yourself. In the first place, Dechra warns against handling the meds. In the second, you cannot be sure of the division of drug vs filler in the mix if you divide it. So you may get the full dose in one portion and none in the other. ;) If you need a smaller dose, compounding is the only way to achieve this if pills can't be cut into smaller pieces efficiently.

Hugs,
Leslie and the gang

From the Dechra product insert -


HUMAN WARNINGS:
Keep out of reach of children. Not for human use.
Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you.

[3bostons]

Hi guys, yea I did read about not supposed to touch the meds because it is like a chemo drug used in humans. The vetoryl is small capsules with the powder in them, and I have the same kind of pill for her milk thystle that I break open and divide and I know its a WAY different med I just thought if thats what it takes then I would do it, no worries, not at that point yet for now going with the full capsule.

Amy that is funny about your little Boriss snoring more cause that was something I noted about Kona too, she never used to snore and then all of a sudden shes snoring up a storm, must be the deep sleep this cushings can put them in ?? Like I have read all over the place, all these guys can have so many different signs. Kona does what you described about licking the carpet for crumbs, especially where the other two had eaten like she hoped they had dropped some, then I noticed her eating birdfood around my bird feeders, and the same thing, sitting at the dinner bowl right on time, or a few minutes before, making sure I didnt forget it was dinner time.

It sounds like these guys are about the same weight, and I would agree with you that the 30 a day seemed high, she was originally prescribed 20 per day but I started her (like you probably already read) on 10 per day for first week and today is now 2nd day of increase to 20. So far no adverse reactions, I think, maybe, she isnt drinking as much water today. Could be my wishful thinking, but I really dont see her at the water bowl so much so far today. I think I may agree about the cushings can effect other organs cause like I said the heart murmur was never there before and it CAN be related to cushings, which is why my vet encouraged me to go to the 2 x day like she originally wanted. I am no expert either but these are the things I am noticing and learning as we go. Maybe you could ask your vet about starting low and see how he does and then increase ?? I dont know, I did it without asking but it made me feel better and it was only short term and now I feel better with the full meds. One week at the low dose and there was definate signs of improvement. We go back next tues for the regular blood check and I have higher hopes that it will be even better, but it doesnt mean I am not still watching her like a hawk becuase of the increase of meds, I have predisone on hand and she is with me 24/7.
Keep me posted on what you decide cause it sounds like we have some similar things going on.
Hugs, Kona and Deb

[Boriss McCall]

I thought the snoring thing was odd too when it started in the last couple of weeks. I find it comforting now.. Just hearing.. knowing that he is still curled up right beside me all night.

Are you doing the 20mg all at one time in the morning? I can't decide if I want to ask to the vet if I can do it that way or 10mg in the am & 10 mg in the pm. I was just reading about trilostane side effects & it said something about for some dogs less side effects & better results if you break it up??

I dread the next time I need a pet sitter to stay with my babies when I am out of town. Sounds like too much to trust someone else with. I would be a worry wart.

You & Kona give me hope. I love seeing pups that this is working for & running relatively smooth. I am sure nothing will easy the constant worry or the scary things running thru the back of our minds. But, I am happy for you & the success thus far.

Yay!! :D:D:D

Amy & Boriss

[winston's mama]

Hi Deb, to answer your question about the low dose Trilostane...I have a compounding pharmacy right down the street so my vet called in a prescription for the 3 mg pills. I too was afraid to open the Vetoryl capsules & I don't plan on ever doing so.

Winston was initially prescribed 10mg Vetoryl 2x per day when I had him at the emergency hospital for a horrible melting corneal ulcer. (That's how he was diagnosed with Cushings, was at the ER.) Anyway, they had him on that dosage for 4 days when he was in the hospital since they were caring for his eye with drops every hour... When they let him come home, he was so lethargic & lifeless that I was afraid he wouldn't make it through the night. I spoke w/ my regular vet who suggested I stop the Vetoryl to see if Winston would bounce back. (I didn't know if it was the Cushings, the eye ulcer, or the Vetoryl that was making him act so lifeless???)
He did start to act much better within a few days after I stopped the Vetoryl so that's when my vet & I decided to try the lower dose Trilostane just to be safe. He's got so many other health issues going on right now so I have to be extra cautious...at this point I don't even know if we're going to be able to save his eye.

On a lighter note... I'm happy to hear that Kona is doing well with her treatment! I think starting her on 1 pill & working your way up is the smart way to go.
I'm anxious to hear some good news about her progress & her test results...take care!!!

[3bostons]

Hi Amy, I am dosing her twice a day and didnt realize that makers of vetoryl suggest once daily until reading heare. But my vet thinks the splitting up and keeping an even amount going in the body is better, so I dont know, so far ok, but its way early. It will be something to consider (1x day) if this doesnt work out. All of my bostons have pretty touchy tummies, I cant mess much with extras or meds on them cause it usually dont settle well so that also was a concern when starting but so far no upsets at all.

See I learned something else today, never thought of the compounding pharmacy, in fact I dont even know if there is one around me, but I will be finding out now. Im so glad the lower dose is working for you so far too, that was a fear of mine, her becoming lifelesl and lethargic, we always want them happy and healthy, and full of life like we know bostons are. So, I will definately be looking for that option if needed, im just praying and hoping that this helps and not hurts. Ive said it before, this is just such an awful disease for our pets to get, its not right when they live such short lives anyways, breaks my heart.

[3bostons]

By the way, I have a question about the prednisone. Why does it work so quickly to help if they have issues with Vetoryl? Does it put back the very steroid into the body that the cushings is causing the body to make too much of in the first place? Is that what does it, it just reverses them back to the cushings state right? I keep forgetting to ask my vet that question.
Thanks everyone,
hugs, Kona and Deb

[molly muffin]

There has also been studies showing that twice a day on a low dose works really well for some dogs. So I don't think if it is working that it is something to be concerned about. Every dog responds differently to what their needs are and what their bodies will take and do better on.
I figure that this disease, whatever works best IS the best. (I don't actually know if that made any sense but hope so)

hugs,
Sharlene

[Harley PoMMom]

By the way, I have a question about the prednisone. Why does it work so quickly to help if they have issues with Vetoryl? Does it put back the very steroid into the body that the cushings is causing the body to make too much of in the first place? Is that what does it, it just reverses them back to the cushings state right? I keep forgetting to ask my vet that question.
Thanks everyone,
hugs, Kona and Deb

If a dog's cortisol drops too low while being treated with Lysodren/Mitotane or Vetoryl/Trilostane predisone is often prescribed. Predisone is a synthetic corticosteroid and is similar to cortisol, therefore when a dog's cortisol levels are too low predisone is usually given.

Hope this helps.

Love and hugs,
Lori

[3bostons]

Thanks Sharlene for the input. Im glad to hear that is ok to administer twice if thats what works cause so far it seems to be ok with Kona.

I did locate a compounding pharmacy yesterday too, just in case we need it because my vet had not mentioned it but now i know theres an option other than the full capsule dosage if needed.

[Boriss McCall]

Boriss is & has always been know to eat grass & puke at least once a week. I think that is just something that BT's do?!? Do your babies do that? oh & they like to gas up the room whenever possible.:eek::cool::D little stinkers.

Maybe your vet is going with this way of treatment. I found this today on this website http://www.2ndchance.info/cushings.htm
Trilostane (Vetoryl, Modrenal)

Trilostane is a relatively new option for pet owners in the USA. It has been used longer in the UK (It was licensed by the US FDA in 2009 for canine Cushing's). It works equally well for pituitary (PA, PDH) and adrenal (AT, ADH) Cushing's cases. It is, perhaps, somewhat safer than Lysodren and its success rate is about equal to Lysodren. ref

Its effects are quite similar to lysodren although it does not appear to be as severe in its effects on adrenal tissue as lysodren is. It should not be given when your pet’s kidney or liver tests are abnormal or when certain heart medications have been administered in the recent past. It seems to work best when the suggested daily dose is divided and given every 8-12 hours with food (no more than one calculated total daily dose per day).

Positive signs that the medication is working include increased activity, more exercise tolerance, decreased thirst and urination and less panting. Negative reactions to look for include vomiting, lack of energy, listlessness, diarrhea and loss of appetite. These signs do often go away or lessen with time or dose adjustment, but always bring them to your veterinarian’s attention immediately.

Pre-marketing research indicated that trilostaine should be less capable of producing the occasional (and even irreversible) adrenal gland damage (Addisonian reaction) than Lysodren. This now appears to be untrue. So dogs on trilostane need to be just as closely monitored as those on lysodren and prednisone tablets need to always be available at home for emergencies.

As with lysodren, the drug must be begun cautiously and ACTH stimulation tests need to be run periodically to judge the drug's effectiveness.

Although trilostane must be given more frequently and at a higher cost, it is an alternative for dogs that do not tolerate lysodren well.



Heres to smooth sailing & happy healthy vibes for all our babies..

Amy & Boriss

[3bostons]

Amy yes they are little gassers :eek: but if i dont mess with their food by giving extras then its usually not too bad now. My girls LOVE cheese, but we pay the price the next day if they have a tidbit :p

Something else i realized that was a sign maybe now that i think of it. My girls are the same age, grew up together and have always snuggled together, my little man always sleeps by himself, but thats just how they all have been. Then last winter i was noticing that kona did not want to snuggle with her sister anymore :( her sis would snuggle up and kona would leave the bed, her sister would get this funny look on her face and follow her and try to snuggle again, only to have kona get up and move again. It kinda made me sad for the sis because she was so used to it. Now i am thinking it was the cushings making her over heated all along and now she cant do the extra body heat?? I hope the meds will get her readjusted and be able to snuggle again cause winter is fast approaching us here.

Does anyone know if that is something that could happen in time of the meds? Do they begin to regulate heat better, she already doesnt pant like she did but she tends to overheat quickly.

[molly muffin]

Oh poor sis. Cuddles are important for us and for them. yes once the cortisol goes down the overheating feeling should go diminish too.

Liver for molly, any kind of liver treats will clear the room. Now she only has them if someone sneaks them to her when we meet up while out on our walks. All the neighbors seem to carry treats in case they run into her and she KNOWS it the little brat. She'll hold her paw up sort of pretty and quizzical and they are done in. She has them right where she wants them and has our windows all wide open in the middle of summer and sweltering heat, just so we can breath.
:) :) :)

Sharlene and molly muffin

[Boriss McCall]

ha! Molly sounds like a charming girl.:)

Boriss is so gassy at this point I am used to it. :eek: His favorite thing to do is wait until we both get our bodies & heads under the covers at night. I call it a dutch oven.. stinky!!!

The cuddling does make me sad. : ( Boriss does that with our other dog. Everytime she gets close after a few seconds he gets up & moves. Pearl has figured it out now. She will get as close as she can without touching & just wait to see what happens.

I tell you what.. one of the hardest things for me has been trying to find the balance of a healthy pup who is only 2 almost 3 & a cushy pup.

I don't want Pearl to feel neglected or get jealous. Its hard..
so, now when we go on walks if we go too far for Pearl's sake (she has LOTS of energy) I just carry Borris the rest of the way when he is pooped. It is a good arm workout!

I hope you have a good weekend with your babies!

hugs,

Amy & Boriss

[3bostons]

They do now to play us dont they Sharlene ? My hubby gives in those cute little whines and eyes and I just laugh and tell him, ok no complaints later then :p He works away from home and is gone alot so he figures he has time to make up for, gotta love em.

Thats good to know that the cuddling could come back, I feel sorry for her too, I hope she can get back to normal.

Amy I know what you mean, I want to keep a close eye on Kona but still try to make the others know life is still normal for them and its hard. I find car rides are difficult cause two of them may be chilled but Kona is hot so window open? window closed? Its a challenge to keep everyone comfy. I used to love cuddling up with all of them on the couch to watch a movie, but Kona now is not into the warmth so then she sits off by herself, its just not the same.

Hope everyone has a good long, healthy weekend with their little ones. No issues okay pups? Lets have a fun last of summer weekend :p

[3bostons]

I was thinking about all of this last night, couldnt sleep :( but that happens alot lately, mind racing with questions when I lay down. And tues we go back for more testing so its coming up soon.

Anyways, with konas dosage being 10 mg 2 x day, it dawned on me that if they have to change the dosage will it have to be split to keep the am and pm dosing the same? You wouldnt want to have a higher dosage one time a day would you? Also, Im sure this has been asked, but once you find the dosage that works, is there ever a point where things are normal or is there always going to be the worry that something could change again? Just wondering if anyone here might know these answers.

thanks, kona and worried mom

[3bostons]

Hi everyone, well today was Konas 2 week check, and for the most part all went ok except for one new change :confused: In her blood panel the GGT is now high, Feb it was 5, July it was 3, with a ref range of 0-7, today it was 15, ref range still 0-7.

Other results though were better:

Alt from 219 to 88 today (yea !)
Alkp from 6955 to 6059 today not great headed in right direction
baseline cortisol 3.3, 4.7 to 7.1 still kind of high but better

They said the GGT could indicate something else with the liver but based on the other tests dropping they said they would not worry yet and to retest in 2 weeks. This is another new lab code for me and I am hoping some of you may know more about it than me so I can not worry any more than I already do :p

Also I voiced my concern over diet and nutrition contributing and they told me it has nothing to do with it. Two patients of theirs have never had a drop of commercial food in their lives and have cushings, one of them even is on the raw diet, and yet still has cushings at age 11. So, little as it may be, it made me feel a little better that maybe I did not do this to her.

Thanks for any input on the GGT, once again I am lost :(

hugs, Kona and Deb

[3bostons]

I am a bit stressed again over this new result but I wanted to let you know there was a full blood panel done today and I have any other results that may be needed in relation to deciding if I should be more concerned over the GGT, two that came up lower are:

Chol was lower, it was 335 and now down to 295, range of 110-320
AMYL still low at 448 range of 500-1500

Other than these mentioned, all the rest are in the normal ranges but I can provide any that you may need.

[molly muffin]

This is what I just copied about GGT. I'm still learning alot of this stuff to, but maybe it will help you to know what to ask your vet about.

GGT - Gamma Glutamyltransferase - This enzyme is has it's highest concentration in the kidneys and pancreas, but it is also found in the liver and other organs. The major proportion of GGT in the serum seems to come from the liver. Elevations of GGT in disease seem to stem from new synthesis rather than leakage, therefore the changes seen due to disease are not spectacular. Large elevations of GGT are more commonly associated with pancreatitis and bile duct obstruction.

I don't know if either of those would necessarily pertain to Kona, but certainly ask your vet for their opinion.
They might think this is part of the strange liver results (the super high ALP) and that is why they want to retest in 2 weeks. Also to rule out an abnormality in the testing itself to make sure the GGT result is a true one.

Hope this helps some. Don't stress yet, just keep an eye out for any change in behavior and talk to your vet. I'm sure others with more knowledge will be along to give their opinion on the result.

hugs,
Sharlene

[3bostons]

Hi Sharlene,

Thanks for the info, I too had found that but wasnt really sure how to take it. I was told that the low AMYL means the pancreas is not stressed ? So I would take that to mean no pancreatitis ? But what or how serious is the bile duct obstruction I wonder, if thats what it is. I have been in tears trying to sort all of this out, if she has a liver issue then I have to take her off the vetoryl, which means any improvement there will go away, so will I be left to decide to treat the liver or treat the cushings? I just want to do what is right for her and its just hard to know:(

[molly muffin]

Okay, so that is good, probably not Pancreatitis. Most commonly bile duct obstruction seems to be a tie in with pancreatitis. Maybe that is one reason that she wants to retest?

They would probably do a urinalysis to rule out if it is a bile problem. Bilirubins level is urine.

I know it's hard and the whole thing is horribly stressful. Nothing easy with this disease that's for sure.

hugs,
Sharlene

[labblab]

Hi Deb,

Just wanted to let you know that Cushing's itself can cause an elevation in the GGT as well as the ALKP and ALT:


Hyperadrenocorticism is associated with mild to moderate increases in total serum ALP activity in about 85% of cases. Similar degrees of elevation may be seen with GGT activity, and in 50% to 80% of dogs a mild increase in ALT activity is noted.

I will grant you that if Cushing's is the cause, it seems a little odd that Kona's GGT would just now be showing an elevation when her other liver values are heading down. But each one of those liver enzymes are measuring something different, and perhaps the GGT has just been slower to reflect the effects of the previously uncontrolled cortisol level, and will now take a while to come back down, too. Since Kona has only been on the higher dose of trilo for a week now, I think your vet's recommendation makes sense -- to wait and see what the next round of labwork reveals. I'm assuming you will also have a full ACTH performed at that time?

I know it's so hard not to worry. But I do think the downward trend for the ALKP and ALT are good signs. And hopefully the next testing will show a decline again for the GGT, too.

Marianne

[3bostons]

Hi There,
I guess my concern is if the trilo is hurting her liver to cause the elevated ggt, is two weeks too long to wait? I wondered the same thing, why would some test results go down but yet this one is up?? Does it mean the trilo is not working well with her liver? So many questions, sorry, i just dont know what to think.
Thank you so much for listening and responding, i have no one else to talk to about this.

[labblab]

My understanding is that the issue with trilo and liver disease is not that trilo actually hurts the liver. Instead, if a dog has liver disease that is preventing the liver from working as it should, the trilo will not be metabolized properly leading to inconsistent/unpredictable dosing. In Kona's case, we have no reason right now to believe that her liver is not functioning properly. Her other liver enzymes are going down, and apparently her bilirubin and other blood results were all normal. So no, there should not be any issue with waiting a while to see what the retest shows.

If her GGT is still elevated at her next re-check, that may be the point where your vet decides to go forward with that bile acids test. That test is really a good indicator as to whether or not there are really problems with the way the liver is working. In the meantime, as hard as it is, I'd try to release some of your worry about this. This result may just have been a temporary elevation of some sort.

Marianne

[3bostons]

Thank you Marianne for the encouraging thoughts and support ! You made my day off to a better start. I just dont want to be causing her more harm than needed, as Im sure we are all in the same boat.

Yes all her numbers are within range now except the obvious alkp,the amyl, and now the ggt. So I will try and be ok with this unless I notice any more change, then I will head back before the 2 weeks. This am, though she was right back at the water bowl as soon as she got up, which she hasnt been doing as much lately. SO, wait and watch I guess.

My husband just says "do what you have to do" he likes to be there for the good but when stuff like this comes up, he just wants me to take care of it, makes it hard sometimes :( so I really appreciate all of you and what you do !

[molly muffin]

Welcome to the club of husbands who are out of their comfort zones when it comes to this kind of thing. Mine adores Molly but he isn't really a part of the "what to do" aspect, saying only that "you have read up on this and know more than me about it, so you are better equipped to make the decision"s. Scary prospect sometimes and I did make him do some Google searches and reading so as to be able to talk about options and what is going on. Sorry bud, you have homework! LOL

It is overwhelming to us and to our partners and to our babies who are going through it. I think we just take one day at a time and be ready to at any time adjust on the fly.

You can talk to us any time at all. We all need that reassurance and the knowledge of others who have walked this path and still walk it. It's what helps us to get through it.

Hugs,
Sharlene

[3bostons]

Thanks Sharlene, glad to know my hubby is not the only one. Good idea on the homework though, maybe mine should get some too :D

You guys are fantastic, cant thank you enough, my vet seems "too busy" for details sometimes and I just want to hold her in one spot until she answers my questions.

Thanks again !
hugs, Kona and Deb

[Boriss McCall]

Oh how I know what you are both saying about the husbands. Since I took action & now know what cushing's actually is.. It some how became all my worry & care taking. It is SO stressful. :(

In fact Sunday night out of no where (according to him) I had a sobbing episode & cried myself to sleep. That is the only way to release the stress sometimes. He just doesn't get it & hides from the sadness.

This is hard! Hang in there..

[3bostons]

Hey I just learned something new, tell me if anyone disagrees.
Yesterday was Konas blood work test with the cortisol injection as I said earlier. Well first thing this morn shes back at the water bowl and now all morn back to drinking LOTS. I called the vet to see if there was any relation to the cortisol test done yesterday and was told, Yes, give it another 24 hours and it should be back to where she was ! Why did they not inform me of this ?? So, I hope they are right and looking to see if anyone else has experienced this. For now I will hope this gets back to where she was at least.

Hugs and hopes, Kona and Deb

[3bostons]

Ok, in case you are wondering, it is true. It can happen, obviously because they inject them with what is already causing the issues, cortisol. So, it make sense that the body will be out of whack again for a while. Happy to say she is back to where we were before the vet visit, water consumption back to some what normal, at least back to what it was :)

[labblab]

Hi Deb, and sorry that nobody got back to you sooner, but YES we have heard of other dogs having the same temporary reaction after an ACTH stim test. So Kona is in good company. ;)

Glad to hear that things are back to normal now. :)

Marianne

[infoviewer]

Yes it is true, my CoCo will follow me around for two days looking for food, then he is back to his regular eating. Hugs, JoAnne

[molly muffin]

There is always something new to learn it seems.

Hugs,
Sharlene

[3bostons]

Hi there, yes you are right this is an always learning kind of situation.
But the vet could of warned me I thought, oh well, now I know for next time :p
hugs, kona and deb

[3bostons]

Ok guys just wanted to talk, today is konas next appt for check up. last time her GGT was up so if its gotten higher now it could mean other liver issues. Needless to say the nerves are back this am :(
she seems to be doing ok, still hungry, but maybe not so much as once was, water intake is less but still more than the others, but she is active and seems more energetic so Im worried and still not sure. I, like so many others, dont want to be missing something thats right in front of me again.
thanks for listening !
hugs, kona and deb

[Squirt's Mom]

Let us know what you learn today, Deb! Here's hoping things are looking much better.

Hugs,
Leslie and the gang

[Steph n' Ella]

I can't remember if you have Kona on milk thistle or any other meds to help with the liver...can you remind us?

[3bostons]

Hi, yes she has been on milk thistle since last January, it was once a day but since May she has been on twice a day. Thats the only other supplements she has right now. Do you know the difference of the milk thystle that is "standardized extract" ? Does is make any difference?

The results from Mondays appt were mixed, most better but now the cortisol is back up so they want to increase to 15mg 2 x day. She did suggest I could do what I did last time and only do the increase on the morning dose for a few days to see how she does and then go to the 2 x day.

ALT 49 range 10-100
ALKP 3535 range 23-212, but down from 6059 2 wks ago
GGT 10 range of 0-7
cortisol 4.2 / 13.0

THe ggt is down from 15, 2 wks ago, but I was also told they dont worry about that number as much in dogs as they do in cats so she said not to worry about it and at least it is down. THe alt is finally in range and with all the numbers heading in the right direction except cortisol it meant it was time to increase but have to watch very closely again. We had to order the compounded tabs to be 15, so I wont be starting her for a bit until I get them in the mail. The scariest part for me is we live remote, the vet is 200 miles one way, so every trip to get there takes about 4 hours, I just hope and pray for no emergencies with these meds.

Thanks everyone for your help and support,
hugs kona and deb

[molly muffin]

Glad that the ALT is down in range now.

200 miles! Lord have mercy! I'd be having a heart attack at the mere thoughts. Make sure you have the prednisone on hand and that should get you through anything that might crop up. Sounds like things are going well so far though, which is awesome news.

Take care!

hugs,
Sharlene

[Boriss McCall]

This made me think of you today.


http://www.youtube.com/watch?v=IvlYNMo0QvQ&feature=player_embedded

Hope things are going good!:)

[3bostons]

OMG that is so cute ! They are so funny arent they? My little ones were talking too when I played this, my little guy was dancing around and looking to see where the sound was coming from. My husb works away from home and is gone alot, and if I tell them "dad is coming home today", geesh you would think there was a fire, they get so excited and run from the door to the window and whine and talk, its so much that I soon learned not to say that to them until its close to the time he is actually going to arrive, otherwise they will go on and on until I have to make them stop. :D Hard not to love these guys !

How is little Boriss doing? I will go check your thread to see if you posted any new news, hope he is doing better.
hugs from kona and family of bostons :p

[Boriss McCall]

BT's are the BEST! My husband does the same thing with Boriss when I am coming home from work. I can hear him squealing & freaking out when I am still in my car in the driveway. They are very vocal with their love & excitement. :D

It makes me so sad to see so many on this board... :( Of course I would fall madly in love with a breed of dogs that gets Cushing's more than most breeds. Funny thing is as many that are on here I have several friends with BT's. None of us had every heard of it until Boriss got it. I once had a friend with 5 of them at once. Going to her house made me end up getting one because it was SO exciting over there. Dogs going nuts all over the place.:p

[Steph n' Ella]

Yes! Those numbers look good! I'm not sure about the difference in milk thystle (standardized extract)?! Maybe someone with more experience with milk thystle will be by...

[Harley PoMMom]

Do you know the difference of the milk thystle that is "standardized extract" ? Does is make any difference?

Standardized means, when used in supplements, standardized extracts help guarantee a consistent dosage strength, or potency, from one batch of the herb to the next...which I believe is very important.



The results from Mondays appt were mixed, most better but now the cortisol is back up so they want to increase to 15mg 2 x day. She did suggest I could do what I did last time and only do the increase on the morning dose for a few days to see how she does and then go to the 2 x day.

ALT 49 range 10-100
ALKP 3535 range 23-212, but down from 6059 2 wks ago
GGT 10 range of 0-7
cortisol 4.2 / 13.0


Thanks everyone for your help and support,
hugs kona and deb

I think increasing her dose is reasonable but I'm just not sure about dosing her twice a day, as of yet.

Love and hugs,
Lori

[3bostons]

Hi Lori, thanks for your input. So you agree that maybe just increasing to 15 1 x day to start is ok also? That means total she would get 25 per day. How long do you think I would give it until I did 2 x day, should I wait 2 wks for the retest or just if I notice not much change and shes handling it well ? My thoughts were that maybe an extra 5 mg a day could be all she needs and I like to go slow on the increase for sure.

Thanks so much,
hugs kona and deb

[3bostons]

Curious if cushings or vetoryl can lead to aggression ? This weekend my girls who are both 10, both spayed, both grew up together were in a couple of fights! I had to break one of them up, never, never had this happened before. THey were doing the circling of each othere with all the hairs raised after I broke them up and had to seperate them for a while. The 2nd fight I was able to stop with just my voice but now Im wondering what is bringing this on?

Im supposed to start Konas increase and now Im wondering if the meds is causing this change or is it the cushings or what ??

[Nikki]

I don't know if this is any help but I figured I'd give you my input!
Max is my dog, and my mom has 2 other Boston terriers. They all grew up together (I just took Max about a year and a half ago, he was always "my dog/loved me the most" but living in apartments I couldn't keep him, so he stayed at my mom's until I was able to have him move in with me). They all got along together great, would all sleep huddled together on my moms bed. I bring Max by my mom's house at least 3-4x a week. Around 6 months ago he started distancing himself from the other dogs. He would do everything he could to stay away from them. When they would try to jump on him and play, he would growl and sometimes nip at them. My mom and I decided that this was because Max felt so awful, and he just wanted to be left alone. We think his aggression was more of his way of saying "stay the hell away from me you crazy dogs".
So I don't know if this helps you at all, but figured I'd share :)

[Squirt's Mom]

Hi Deb,

I have a pack of "special needs" babies and I am prone to taking in strays and fosters on top of that. Dogs can sense when another dog is not "normal" and sometimes that causes arguments as the "normal" dog tries to exert dominance over the "weaker" members of the pack. This is an instinctual behavior of pack organization.

This could be what you are seeing - your other baby senses that Kona is not quite "right" and is trying to usurp her position over Kona. Jealousy could also be in play if your other baby senses that Kona is getting a lot of extra attention these days that didn't used to be the norm. Squirt gets very jealous when I give meds in a treat to someone else so I started handing out treats to everyone when it was time to give any of them meds.

I don't recall hearing of the treatments causing aggression but someone else may have a different experience.

Just some thoughts to share...

Hugs,
Leslie and the gang

[3bostons]

Hi thanks for the info, glad to hear you dont think its the meds or condition that could lead to agression. It became a major concern since I am supposed to up her meds today.

Nicki, I kind of wondered the same thing, maybe just not feeling herself and not wanting to be bothered, at least thats what I am now hoping. I just hope now they dont have issues, I dont need them fighting with everything else going on :(

Leslie, I can relate a little to your special needs pack. Of my 3 bostons, only one has turned out healthy so far. My little guy (definately small for a boston) has had issues his whole life, he will be 9 tomorrow, and now is blind and has been going blind for the last few years. He has allergies, breathing issues, joint issues, skin issues etc but he has the biggest heart of gold and loves everyone, size is of no concern to him :D It breaks my heart when he bumps into things and I try my hardest not to move things in the house just for him. He gets meds too and I have to do the same, everyone gets a tidbit at the same time. I try to show equal attention to them all for the reason you said, dont want to create jealousy.

But thanks guys, I didnt think of that, it could be just that, sis knows something is not right and Kona not feeling good may just put the right mix for arguments. I know I could do the same thing when I dont feel good :p

[Boriss McCall]

You are not alone in this.. Mine have been getting into it a little. But, I think I am to blame cause I OVER baby Boriss sometimes.:o

I am trying to get better with balancing out the attention. But, I do notice when Boriss isn't feeling all that great he is grumpy.
Seems to be getting better now that he is on meds & feeling more normal.

[Harley PoMMom]

Hi Lori, thanks for your input. So you agree that maybe just increasing to 15 1 x day to start is ok also? That means total she would get 25 per day. How long do you think I would give it until I did 2 x day, should I wait 2 wks for the retest or just if I notice not much change and shes handling it well ? My thoughts were that maybe an extra 5 mg a day could be all she needs and I like to go slow on the increase for sure.

Thanks so much,
hugs kona and deb

Twice a day dosing is recommended for dogs that have diabetes plus cushing's, it is also suggested if clinical symptoms seem to increase in the evening.

[3bostons]

Sorry to hear that for you too Amy, I dont like to see these guys fighting. Im hoping they wouldnt do that when I was gone, I know they usually would do it around us for one of the reasons mentioned. To me its just another sign of her not being her :(

Thanks for the info Harley, she was doing alot of panting and lip smacking at night, and both of those symptoms have disappeared so maybe thats one reason she was on the 2 x day, so I think I will just do the increase in the am for now and see how it goes.

Hugs everyone, Kona and deb

[3bostons]

Does anyone know what they add to the meds when they compound them? I know I should of asked when we ordered them but I just got to thinking what if something they add to it upsets Konas tummy, how will I know if its from the increase of meds or from what they add?
We ended up having to order them from wedgewood, and they do the chicken flavored chewable tabs so I know they add something but I should of asked first, darn, missed another question :confused:
SHe just started them so of course Im nervous and just hoping for no tummy upset or other issues.
I decided to only do the am increase to 15 and am leaving the pm dose on the regular 10 mg tabs that I have too.
thanks, kona and deb

[Squirt's Mom]

Hi Deb,

You can call Wedgewood and they will be happy to tell you what is in the chewables.

Hugs,
Leslie and the gang

[Boriss McCall]

I got Boriss's pills from wedgewood. I didn't know about the chewable tabs. I might have to switch to those. Seems like it would be much easier than trying to hide them in a treat all the time. Right now he has the capsules & hasn't had any trouble with their mix.

Hope your pups are living peacefully with one another again.:) I know Boriss has always been moody when it comes to Pearl. He just wants to be in my lap non stop & she wants all the attention too. :rolleyes::p

Good luck with the dose increase. I have a feeling things are going to work great for Kona.

[3bostons]

Hi Amy, yep they do the chewables in chicken flavor only but at least its got some good flavor, (i hope) I did call wedgewood and the pharmacist said the only 2 ingredients that could cause some upset is they add lactose and yeast along with chicken flavor, which was unspecific. But so far so good, no upset at least, but if there is then we will have to go back to the regular capsule form.

THey are doing ok, but now I have to watch them a little more close because those hackles are up more than I have ever seen on them with each other :( But then last night they sat together when we watched a movie, only for a short time but it was nice to see.
hugs, kona and deb

[Boriss McCall]

I bet your kids will come around. ;) I guess everyone sensed the shake up in the house with Kona. I bet once things are back to "normal" they will be too.

I am going to try the chewables next time if they work good for you. Boriss get so tired of things i am going to have to mix it up. Plus the other day he was trying to chew the capsule. :eek: Guess I didn't haven it hidden in the treat good enough.

[molly muffin]

Hey Deb,

Hope Kona is doing well and the kids aren't scuffling as much.

Sharlene and Molly muffin

[3bostons]

Hi Sharlene and Molly,
Things have been a bit rough the past couple days, but thanks for checking.
hugs kona and deb

[FrecklesMom]

Hi deb, just stopping by to see how kona was doing. Hope everything starts to improve! Although I only have one dog when freckles doesn't feel good with people around she frequently disappears into my bedroom. If my daughter bothers her she does get kind of nippy so I think thats whats going on with the dogs. Sometimes i just have to set up a barrier and give her alone time until she feels better.

Hugs, freckles and diane

[molly muffin]

Hi Deb,
I hear it's getting chilly in Alaska now. I hope that Kona is going okay and the rest of your family and of course you!

Hugs,
Sharlene

[3bostons]

Hi guys, it was so nice to see someone saying hello and checking on kona. Its been tough for a while now, not sure whats going on, we go back to the doc tomorrow for more testing.
Then my little guy who is blind went into seizures, not sure whats going on there either. Geesh, when it rains it pours and its all so heartbreaking. Someone had a puppy they needed to rehome and called me, but my heart just wasnt ready for that right now :(

Sharlene its an odd fall, its supposed to be colder than it is, we had a snowfall about 2 weeks ago but its long melted and the days are back in the 50's when normally they would be in the 20's by now, but hey kona and me arent complaining :D

Diane, I hope freckles is doing good too, I will read some posts today and try to get caught up.

hugs, kona and deb

[3bostons]

By the way Diane, I cant believe you only have one boston, my husband says they are like potato chips, cant stop at one :D:) If it were up to him we would have a whole pack of the little love bugs.

[FrecklesMom]

Deb, it really is heartbreaking to see them struggle, thank goodness they have you to help them along the way. Non pet people don't understand how our furbabies become such important and loved members in our family. I joke with my daughter that freckles is my second daughter. I even get their names mixed up much to her dismay. LOL Most of my life I have always had two bostons. When the first of my pair of bostons went to her great reward I couldn't find a single healthy looking boston for sale to get a second so never got a second. When both were gone it took me a long time before I found freckles. Here in Arizona there just doesn't seem to be as many good breeders around and when you find one they only sell to show homes. I'd love to have more than one they are so much fun. :-)

Hugs, freckles and diane

[Steph n' Ella]

Show doggies aren't sooo bad ;) Sometimes you can work out a deal with a breeder to co-own. Pay a handler to run around the country following the judge that likes your dog and they will finish up the champoinship very quickly and painlessly. Also, having a dog that is expertly trained by a handler isn't half bad!

I wish Ella's breeder would have found someone to take her in and give her a good home after she finished. Eight years was WAY too long for her to have been cooped up in a kennel!

[3bostons]

Hi all, its been a bit since Ive been able to post with lots going on around here but I wanted to get your input on Konas last test results. Her BUN was slightly up and the cortisol numbers are indicating it might be a sign that we need to decrease meds but they said to leave her at the 15 mg am and 10 mg pm for the next 3 months. My concern will be her crashing of course, so I wanted to see what you thought.

Bun 28 range 7-27
alt 44 range 10-100
alkp 2491 range of 23-212 (but way down from start at 7241)

cortisol 1.6 and 9.7

according to vetoryl, when the high exceeds 9.1, its time to lower but my vet feels its ok with the other numbers being better.

I was wondering if I shouldnt decrease the am dose back to the 10 also to put her back at 20 mg per day ?? I hate to question her advice but 3 months just seems long if she is on the verge of too much meds.

Hugs, Kona and deb

[Squirt's Mom]

Hi Deb,

Yes, that post is too high. 9.1ug/dl is the MAX recommended by Dechra and that is only if all signs are controlled. Is Kona showing any signs or are they all well controlled? Basing the dose on other labs is not protocol - the ACTH and signs determine dose, not ALP, ALT, or BUN. Those values can all indicate problems that have nothing to do with Cushing's. ;) Trusting our vets is good but blind trust is not. Question them, show them the information from Dechra concerning testing ranges and what needs to be done based on those results. You can find all that info in the Helpful Resource section. By their response, you will know whether to continue trusting or get a second opinion.

Hugs,
Leslie and the gang

[3bostons]

Hi Leslie, thanks for the info. I did question the post because we were looking at the ref ranges from dechra as we talked and it showed right there the max is 9.1, but she said most vets will actually go to 10, so she was ok with it.

Kona is better with the water drinking, and no panting at all anymore, but still no hair regrowth from the belly shave for the us last Feb, still hungrier than the other two but then she has always been the first one to the dinner bowls. She has been playing more lately, not much but its a good thing to see. So, another opinion you think? Im worried about over dosing her. If they do crash, what happens after wards? I know you stop the meds and give the pred, go for retest, but then what? Do you wait to restart or do they resume based on the new tests?
hugs, kona and deb

[Squirt's Mom]

Hi Deb,

In the case of the cortisol going too low, with Trilo all you do is stop the med and give pred if the signs are strong enough. If there is vomiting and diarrhea, you would want an ACTH and the electrolytes checked asap to see where things stand. You would then wait until the signs return fairly strong, have another ACTH, and adjust the dose based on that. Since Trilo leaves the body so quickly, using the pred isn't always necessary.

Can you tell me if the ACTH was performed within 3-4 hours after her last dose? And was she fasted before the ACTH? These factors will have a huge bearing on the results so they are important.

Hugs,
Leslie and the gang

[3bostons]

Hi Leslie, that is good to know that I may not need the pred right away, I was not aware of that, they made it sound like it would be an emergency situation for me to give the pred right away. I was stressing over that because if she is sick how the heck am I going to get a pill down her :eek: I fogot that I did learn on this board that vetoryl does leave the body soon, so it would make sense to see some return after stopping the meds, thanks again for that info.

As far as her test, it was done 4 hours after the meds and breakfast, and then 2 hours later for the second.

Maybe I am mixed up in my thinking of the cortisol still being high, I was thinking too much meds but is it opposite? That maybe it would mean an increase? Reason I wonder is her last tests were 4.2 / 13.0, so the cortisol did come down this time with the 1.6/9.7. So maybe thats why they said to leave her meds as is for 3 months ?
Yikes, this is so confusing, maybe I am overthinking it all:confused:

hugs, kona and deb

[molly muffin]

Hi ya Deb :) How are you and Kona (and gang) doing?

Hope you are all staying warm and healthy. I know you are really far from a vet and I worry with winter showing it's not so pretty head already.

Is Kona still doing okay? Staying at the same level I mean.

Take care, answer when you have the time
Sharlene and Molly Muffin

[Boriss McCall]

I was just thinking about you & your pups too. Hope all is well & you aren't too cold yet.

[molly muffin]

Hi! Wishing you, Kona and the gang a Happy Thanksgiving!

hugs,
Sharlene and Molly Muffin

[molly muffin]

Hey Deb,

Wishing you, Kona and the whole gang a Merry Christmas!

hugs,
Sharlene and Molly Muffin

[3bostons]

Its been a while since Ive been on this board but wanted to update you on Kona girl. She is doing great, today is day 528 since being on vetoryl this whole time. The dosage has remained steady now for the past 6 months and we go back next month for a re-check. She turns 12 soon and acts like a pup still at times, so once we got the meds and dosage figured out she is living a normal life, I never used to think it was going to happen. So, for any of you just learning about this horrible disease, it is possible to manage.

On another note, one thing my vet and the makers of vetoryl had not been approached about before I asked them last summer, was, what happens when another dog eats the poop of a dog on these meds. I always pick up after my fur kids on a daily basis. But my neighbors got a new pup last summer and it had a habit of straying over here and before we realized what was going on, it got very sick but would still show up here and I finally caught her in the act, eating Konas poo, she was sick but still eating it ! She didn't seem interested in the others just Konas, which makes me wonder if the meds put off some kind of odor that it liked? The dog is now 15 months old and has never came in heat, and has constant bowel issues which no meds have been able to correct yet. The makers of this med are looking into possible connections and how much of the medicine is passed thru. They DO know it would of caused the pups original illness but are not sure of long term effects and so far, she has never been normal since caught eating it. I doubt we will ever know the actual facts, but my vet has been working with Dechra, the makers of the meds, trying to find some answers so maybe we will, or at least be more aware of the possibilities.
So, just an additional warning with these meds to make sure you clean up as good as you can, and if you have a poop eating pup or dog, beware.

[molly muffin]

Deb!!! I am so happy to see you post again. I've often wondered how you and Kona and the rest of the gang are doing. :) So, I am thrilled that things are going so well for Kona and the long anticipated stabilization arrived finally.

That is a very interesting item you have brought up about the poop of a dog on vetroyl. It makes perfect sense that it would pass through and into the waste and affect any other animal who consumed it. We will be very interested in hearing what your vet and the makers of the drug determine about long term side effects.
I am sorry for the pup though who has not had things easy from the sounds of it since eating the poop. :( You have though issued a warning for others to be ware and you are contributing in an important area to the continued research into this drug. Thanks.

I hope that everything is going well for you and the gang.
Great to see you again,
hugs,
Sharlene and Molly Muffin

[3bostons]

Hi Sharlene, nice to hear from you too. Hope things are going well with you and your family too !
Yes its been nice having her finally stabilized on the meds, and even thru the holidays at that :) Its an expensive treatment I will say that, too bad I cant get RX insurance for them, ha ha But they are our kids so its what we do. I know some people have 2 dogs at a time with cushings and I don't know how they do it between the vet runs and the meds, whew
As far as the pup, yes will be interesting to see what they come up with and I will definitely post it here. I was thinking last summer when this all came up of posting the info here and its sad Im just getting around to it :( I will keep you posted if we hear anything else.
Take care,
Deb

[3bostons]

Hi, been a while since we have posted. Kona's cushings has been under control and doing great, will be two years this winter.
Had a recent episode come up and my first thought was she was crashing from the cushings but all the symptoms didnt quite add up. Long story short went to the vet and now find out she has Diabetes on top of Cushings :( For those of you who know, the symptoms are so similar and needless to say a bit nerve wracking on differentiating between the two. It is early for diabetes diagnosis but my vet is warning me about the complications I could have in the future of trying to tell which one is causing the issues. I would rather of had it been the cushings still causing problems than to be dealing with two diseases now.
Im told this is rare, and that usually they have diabetes first, but leave it to my girl to be out of the ordinary. :rolleyes: Anyways now I am looking for advice and input and not sure if I can ask here. I looked on the K9Diabetes site but could not find any others dealing with the same situation. Since she has both Im not sure if one or the other is better, any suggestions? Can my login and info from this site transfer to the Diabetes site?
The other thing now is she was also due for her next cushings test but was told we have to get the diabetes numbers under control before the cushing numbers will read right. As of today still drinking water by the gallons and peeing the same, the panting has subsided and next glucose test is mon 9/22.

Thanks everyone

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about the diabetes diagnose into Kona’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[lulusmom]

When was the last acth stim test done and can you please post the results. You mentioned that the next glucose test is scheduled for 9/22. Is Kona on insulin? Did your vet discover the high BG on a routine blood chemistry and if so, can you get a copy of the results and posts the highs and lows here? How long had it been since you had checked Kona's cortisol levels when she became symptomatic again?

I'm glad you've visited k9diabetes. I highly recommend you join. You'll have to go through the usual process there but you can join with the same user id. That actually makes it easier for us to find you over there. The diabetes folks can teach you how to do home testing, which I highly recommend given that Kona has both conditions.

There are a number of members who have dealt with both conditions so I'm hoping those that have will chime in and share their experience. Right now getting the BG regulated is very important.

Looking forward to receiving more information from you.

Glynda

[3bostons]

Hi Glynda, thanks for the reply. I was able to do a search and found some other posts on the Diabetes board but none that answered my questions so I wasnt sure where to ask them, here or on the other board. Konas last acth was in June and these are the results. I know the ALKP still looks high, but it is the lowest its ever been and she has been doing great on the current dose of 20 mg Vetoryl, 2 x day.
Baseline cortisol: 5.4
2 hr post cortisol: 2.6
ALT 105
ALKP 1880
BUN 15

Yes they did do blood and urine tests and yes they put her on 3units of insulin 2 x day started last Friday.
Those results were a mile long, not sure if you need all the numbers but the main ones read as follows, and they did run a cortisol test even though it was mid day, just to see if it was off the charts but it wasnt, it was at 4.7

alkp 1881 (norm for kona)
alt 225
glu 511 should be 70-143
amyl 549
bun/urea 16
potass 4.8
sodium 140
the rest were all normal ranges

her urinalysis:
glu 1000 should be 0
ket negative
ph 7.0
leu 100
ubg norm
bil negative

They did find a mild UTI and put her on Clavamox for a week also, but they said the glucose numbers were in the scary range and thats why they put her on insulin right away. They were sure it has nothing to do with cushings because of how high those two numbers were.

It sure came on suddenly, it started last Thursday night, I could tell she wasnt feeling herself and had started drinking a little more, nothing alarming at that time, then after she ate dinner she wasnt feeling good then wouldnt sleep that night, she acted like she couldnt lay down, she would try and then pace around and stand still, but not lay down. THis went on all night till about 3 am and then she finally layed down and fell asleep. The next day is when the water consumption and peeing started but she wasnt ravenous like they said she could of/should of been. They started her on a low dose of the Insulin and I can tell its not enough cause she still at the water bowl alot and cant sleep thru the night without getting up yet. We go back next monday for next glucose test and yes they want to teach me how to do it at home.
I just have so many questions about mixing the two diseases and the meds, can they interfere with each other? If so, what will happen and so many more I just dont know if I should ask here or the other board?
Thanks so much for your help, Never would I of thought she would have to deal with another problem, poor girl.

[lulusmom]

Thank you so much for all the information. I can honestly say that I think your vet has handled this quite well and I would agree that it was not uncontrolled cushing's that caused the elevated blood glucose. Both stim test results were awesome so that's a really good thing.

Aside from diabetes normally being diagnosed first, it is not unusual for a dog to have both diseases. Because Kona is already stabilized on Vetoryl, any concern about the introduction of vetoryl dropping insulin requirements and throwing her into a hypoglycemic episode is eliminated. If there is a silver lining to any of this, that's it. Other than that scenario, there shouldn't be any problem administering Vetoryl and insulin. We've seen lots of members who successfully treated their dogs for years so I know you're frazzled but hopefully that brings you some comfort.

The best thing you can do right now is get on over to k9diabetes and join up. Let me know when you do and I'll post a link to your thread here on k9d and a link to your k9d thread here. That way we can all stay updated.

Glynda

[3bostons]

Thanks Glenda, and I did just finish signing up over at the diabetes site, if you want to do the link that would be great.

Im glad to know there are others dealing with the same thing that may be able to offer some advice. I guess I have another situation to learn about.
Thanks for your help.
Debbie and Kona

[lulusmom]

Your thread isn't showing up yet at k9d, probably because you haven't validated your membership yet. Please check your email.

[3bostons]

Ok, its all set now, where will I see the link?
Thanks again, you guys were so helpful in the beginning of her cushings and I think I will find the same help on the k9d board too.

Its just worrisome as to be able to tell whats what since they are so close in symptoms
Thanks again !

[lulusmom]

Okay, Deb, a link to your thread on k9diabetes is below. I've also posted a link to this thread on k9diabetes. It looks like they've gotten you off to a good start. Don't worry about duplication because not everybody is a dual member so don't leave out anything you think might be helpful. There is no such thing as too much information.

http://www.k9diabetes.com/forum/showthread.php?t=5958

[molly muffin]

Hi Deb, I just wanted to say hello. It's been a long time and it's good to see you.
So sorry to hear that Kona has had diabetes added to the mix now.

I know the great group at k9diabetes will be a huge help.

hugs
Sharlene and molly muffin

[Renee]

Hi Deb, I'm in Alaska too. Are you in Anchorage? Sounds like you have a really great vet. Are you seeing Dr Love? She's the only IMS in Alaska, but I have not seen her for my pug's cushings, only been to see her with some rescues that needed to see an IMS.

[3bostons]

Ok, just realizing that her original symptoms last thursday night could very well of been pancreatitis. Doing some research I see that dogs with cushings can be prone to pancreatitis. Have any of you experienced this due to cushings?
When I explained to my vet the symptoms leading me to the reason to go to the vet, she had no thoughts or explanation for the pain and discomfort only concern was the elevated BG. I did a simple google on the two and come up with this so did she miss something? I realize she is not a specialist in this area but it sounds like something she may of recognized. I read that all of this could be related to pancreatitis, which in turn could be related to cushings ! I would hope and much rather have this be the case. I go back to the vet tomorrow am, just wanted to see what any of your thoughts are though.

[3bostons]

Hello Sharlene and Molly Muffin ! How are you two doing? Nice to hear from you too, yes this diabetes thing has me confused as you can tell from my earlier post, now i wonder ....

Hello Renee, fellow Alaskan, I didnt know anyone here was from AK too. I am up farther north, outside of Fairbanks so thats where I travel to for the vet is Fairbanks. She has been great with the cushings, and my regular vet was gone when I went in last week with the new symptoms so Im concerned that this other one may not be as up to speed on all of this? I dont know Dr Love, which clinic is she at? Is she a specialist? I didnt know there was one in AK. Might be worth checking into.

[Renee]

Dr Love travels between Anchorage and Fairbanks, so yes, you should be able to see her. She is the only IMS in all of Alaska. I have seen her previously, with rescues (polar pug rescue), but not my pug that has cushings. It may be worthwhile seeing her, just to have her go over everything and do a second opinion. I'm not sure what clinic she rotates at in Fbx, but in Anchorage, she rotates in at Pet ER.

[molly muffin]

Pancreatis is Very common with Cushing dogs. They might need pain meds and they would definitely need several small meals. No large meals during the day. We have found on the forum that chicken and rice cooked to a mushy consistency works well with them. Just add more water when cooking the rice.
If that is what this is.

[3bostons]

Did not know of Dr Love coming to Fbanks, excellent to know. Does she work much with cushings or just the diabetes or other diseases?

I guess Im just hoping it could be cushings related, something easier to handle like pancreatitis. I guess tomorrow I can find out more. I do like doing research so I guess thats why Im digging at other possiblities. I know they will know best, Im still just hoping for Konas sake. :(

[Squirt's Mom]

Cush pups can't process fats normally so their diet typically needs to be lower in fat content than usual. The pancreas is one organ that is affect by fats in the diet and when it has troubles it becomes inflamed resulting in pancreatitis. The condition is not always caused by an excess of fats in the diet, tho. ;) But since our babies don't process fats normally, they are more prone to upsets in this organ.

[3bostons]

thanks you guys, as usual I can find good information and comfort here. Its so early with only one visit to the vet for the diagnosis and am anxious for tomorrows visit to find out more. Hard not to think about it and want more answers.
Its so hard to tell if Kona is feeling any better or not, sometimes she seems to be and then times shes not, but definately still at the water bowl constantly, that hasnt improved in the past week yet. I remember when she started the cushings meds it only took a few days and the water consumption slowed way down. Just looking for better results now.
Will let you know how tomorrow goes.

[3bostons]

hello all,
Still dont have Kona regulated with her new diabetes, but at times it looks better, ugh, this is hard. My question is, she was due for her cushings test last month but her diabetes was way out of control then so we couldnt do it. Do you know how under control her BG needs to be before we can do the stim test? Since these 2 diseases run so similar I worry about continually upping her insulin dose when it could actually be cushings ?? How will we ever know which is the issue? I dont want to put off testing cushings for too long.
Thanks,
Deb and Kona

[jas77450]

Been reading a little on your thread. Don't know what you found out yet but my Cosmo had cushings, Then diabetese and frequent acute and chronic pancreatitis. If it is pancreatitis please whatch the fats...it will set them off quickly. He would vomit and not eat when he had acute pancreatitis. I will read more and try to find your baby's symptoms. Hope you get answers soon.

[molly muffin]

Hi Deb, I understand, it is so difficult when it comes to the testing to know what is going on. I think though that you could go ahead and do the cushings testing as long as you are having some sort of control. You do want to know how the cortisol is doing as that might be affecting why you can't get the diabetes controlled.

Hope things will get better and more settled soon.

hugs

[3bostons]

Thanks, I have placed a call to my vet to see if we can go ahead and do the test with her numbers where they are. Waiting to see what she thinks. I think it will at least ease my mind to know that at least one of these diseases is under control still.

[jas77450]

Thinking of you...hugs!

[3bostons]

Hello, its been a while. Konas cushings has been doing great, we haven't had to change her dose in almost 2 years, today is day 1075 since her diagnosis. Her diabetes has been more of an issue over the past 6 months, but still doing better overall.
We lost one of our bostons in March and and not long after that I began to notice changes in Konas behavior, at first I thought maybe depressed because he was her buddy, but now it has gotten worse. She is showing major changes, like dog dementia was my first thought. She gets lost in the house, will pace for long periods of time, howls for no reason, gets a blank look on her face, it has been a challenge to get her to eat, I have cleaned out the fridge trying to find something, anything, she will eat, and with diabetes on top of it all, that creates its own challenge. She just is not herself. After speaking with my vet, shes thinking its macroadenoma causing all of this, all cushings related. But she also has a heart condition and with all her health issues, she is not a candidate for any type of surgery. Not to mention, I do not want to put her thru anymore.
My concern is what can I expect to happen and when do I have to say enough is enough? I was told as the tumor continues to grow and press on her brain, she will continue to decline mentally and could start seizures, do I wait that long? Is that far off? Or is all a wait and see game?
This is all so heart breaking to watch happen and I feel for her every day, she brings me to tears to see her not be happy. Every now and then she does get what I call a moment of clarity but they don't last long, for the most part its just a daily challenge.
I guess I'm just looking for advice from someone who may of experienced this too, I mean should I let it go as long as she does eat something and is not in any obvious pain? This baby girl has been thru so much in her 13 years, I just don't want her to suffer.
Thanks so much,
Kona and Deb

[cherylhare]

I feel for you! I dont have a answer as Im going through the same thing but will see what others have to say!

[molly muffin]

Hi Deb, good to see you again, but I'm very sorry to hear that Kona is having problems now. :( She's done really well for a long time.

If it is a macro, then yes, the dementia will get worse eventually and it's possible she might have seizures. I think as long as she is enjoying things around her, she is probably doing okay.
If the seizures Do start, then you'll have to evaluate at that time, as they can be debilitating, but not all dogs get them.
One thing that might help with the dementia is NOVIFIT. You can find it at amazon or one of the other online pet pharmacies. Several people have used it from the forum.

[labblab]

Hi Deb, good to have you back, but I'm very sorry that it is with such worrisome news. For what it's worth, we believe that our own Cushpup suffered from an enlarging macroadenoma even though we did not receive diagnostic proof via imaging of his head. He suffered from many consistent symptoms, however. And unfortunately, they were very similar to Kona.

Over a period of a couple of months, we saw a steady decline in his cognitive and neurological function. He never developed seizures, but he became unsteady on his feet, paced around the house, started soiling himself, and totally lost the "spark" in his eye that had signaled the proud and happy dog he had always been. It was as though the dog we had known had totally left us even though his body remained. The scales were totally tipped when he stopped eating and drinking. It is kind of hard to describe exactly how that happened. It is not only that he became pickier and pickier -- it was almost as though he had forgotten how to eat and drink. He would try to bend his head over his water bowl and lap his tongue, for instance, but not far enough to even reach the water. That was the point that we were forced to make the final decision. We could have tried to support him longer, but we chose not to when he could no longer nourish himself on his own. We felt it was time to release his spirit.

I wish I could give you a definitive answer so as to spare you some of the pain that we experienced ourselves. But I'm afraid it really does become a wait-and-see situation. Even though our boy could still stand and walk there at the end, we believed he otherwise had no real quality of life left. That is such a hard call for any parent. But knowing and loving Kona as you do, I think you will make the decision that is best for her at the time that is best for her. From what you are describing, the loss of appetite may become the tipping point for you just as it was for us.

I am so sorry you are having to go through this, especially after losing your other baby in March. Please keep us updated, OK? We are here for you and Kona, no matter how things turn out.

Sending many hugs,
Marianne

[My sweet Ginger]

Here's our story just to muddy things up a little. :o
Pretty much from the start of my pup's Lysodren treatment she exhibited many of the signs Marianne and you have described in your posts except she doesn't constantly pant. Only sometimes.

All of us, her IMS, neurologist and myself were in the mindset of 'let her have whatever she wants' as she was thought to have a macro tumor and wasn't expected to live much longer.:(
Well, that was Jan. of last year and the macro theory has been thrown out the window some time ago and my Ginger is still hanging in there. She's not strong by any means. She's incredibly weak and has dementia with all of the classic signs it brings along. She's also on 5 different medications for for life it seems for her seizures, high BP, hypothyroid, inappetence and chronic IBD/colitis. She also gets occasional UTIs.
So yes, she has little to no quality of life for a long time but she's still with us because a long ago I vowed to myself that I will keep her as long as she eats and is not in any pain. We've come to accept her new normal as her normal and she sort of has her routine:o in a very limited way. Also she still brings us joy in her own way by just being my sweet Ginger.:)

With all of these being said I have to admit that I've questioned myself many times and still do if we are truly doing things right by her by keeping her and I know some of you may not agree with me on that but I just don't know any other way as long as she is eating and drinking and not in any pain and walking. I think everybody's situation is different and only you know the best when the time is or not so I'm not even asking for any thoughts here. I just wanted to share 'our' story. Thank you, Song.

[3bostons]

Hello and thanks for the replies.
This is hard to watch, and looking back at some odd signs before, I think now its been going on for a while. For instance last winter she began going to the water bowl and sniffing the water, (for long times) and sometimes drinking or as you described trying to drink but her tongue not always touching the water, and sometimes just walking away. I had mentioned to my vet but at the time she had no idea what was going on. I even began thinking there was something wrong with our water that she was smelling so I switched all of them to bottled water only to find she still did it and just gave it up to an odd habit she created. Then she started not liking her regular foods or snacks, and sometimes just holding her treat in her mouth and eventually dropping it, this started when we lost our little boy and when I started thinking she was depressed.
For now I have found one thing she will eat and although it takes her a long time to eat,(she licks her food more than eating) she is still eating and drinking. But yes her quality of life is either pacing or sleeping and the happy little personality we have known for so long is not there, and that's what makes me feel bad and wonder if she is comfortable. Its the little moments of clarity that keep me holding on I guess, cause there will be moments she will run and try to play but only for a few minutes or so, then its gone. But she howls or cries during the night and I don't know why, is she painful or just not right? I have a hard time deciding anything when she is still eating and drinking and getting around ok, its the quality of life that I struggle with. I'm afraid of making the call too soon, or too late. Ironically too, on her last cushings test, her numbers were almost perfect, the best they had been, and now this.
We lost our little guy to what we think was a heart attack in March, he was not sick at all, he was 11 y/o and blind, but he was fine one minute and the next he fell over and was gone, it was heart breaking, but I don't know which is worse, losing them suddenly or having to watch them go thru what Kona is going thru and having to make the call for them.
Thanks for your thoughts and support, I knew you guys would understand what this feels like.
Kona and deb

[3bostons]

Thank you Song, that is my struggle right now, she is eating and drinking, even if slowly, and still gets around, so do we accept her new "normal" or not. I understand your way of thinking too, it is hard no doubt.

[My sweet Ginger]

Yes indeed, Deb.
I'm just following my heart. That's all I can do but I will not let her suffer. That much I know. Hugs.

[3bostons]

I have debated even coming back to this board because my heart is aching so much and not sure how to say what I want. But I think others have the same questions I did, of when to say when and it is hard. But thru this I learned, go with your gut on when it is time because no one knows these babies and how they are feeling better than the owners, I am regretting not listening to mine.

Friday the 21st, I was at the vet with Kona and going over all her unusual symptoms of pacing, whining, howling, licking her food and taking a long time to eat, but she was eating. Just not herself, lethargic at times an unresponding to my voice. I was thinking then it was time to let her go, but the vet encouraged me to try this other med that may help her to relax and is known to help with seizures and MAYBE with the macro tumor. So I did. Got home (which is a 3.5 hour drive one way) and started the meds and there was no noticeable change and then Monday night she wouldn't eat and I knew now there was an issue, but she seemed to be sleeping peacefully, but by midnight she was crying in pain and convulsing and thrashing around, it was awful. Like I said I now had a 3.5 hour drive in the middle of the night to get her back to the vet in a state of panic, frustration, and pain for her having to go thru this. I know theres no way to tell how long before these tumors cause this kind of problem, and I don't blame the vet, but I do blame myself, because I had a feeling.
So, I'm left with feeling horrible for not making the call on Friday like I had a feeling I should have and having to watch her go like that. It wouldn't of mattered if the vet was closer, she still should not have suffered at the end like that and I blame myself.
I came across another vet who told me, list the top 5 things about your pets personality that you and your pet love, and when 3 or more of them are gone, its probably time to think about letting go especially in this type of situation.

[Harley PoMMom]

Oh Deb,

I am so sorry for the loss of dear Kona and my heart goes out to you at this most difficult time. Making the decision to let them go is just so hard, and when we love our babies so deeply we try to do anything we can for them. There is no room for guilt here, you did not do anything wrong, your love for Kona was so obvious.

We do understand your pain so please do come back at anytime to talk to us.

With Heartfelt Sympathy,
Lori

[Greybeard]

I'm so sorry for your loss. watching them go back and forth, and have those moments of clarity makes it so hard to know when it's time. I wonder myself all the time how I'll be able to make that call. It is the very worst part of having a furry best friend... But I know we wouldn't trade the hurt for all the joy they give us. Hugs to you.

[judymaggie]

Deb -- my thoughts and prayers are with you during this difficult time.

[molly muffin]

Oh Deb, my heart just broken reading your post. It is hard I think because as Lori said, we try everything to make them feel better and hope they will return to those things that we love so much about them.
I don't know if I wouldn't have tried something that might give her a chance too, but that doesn't erase what happens if it doesn't work.

My sincerest condolences.

[Robert]

So sorry for your loss praying for you and Kona. Don't be hard on yourself about the last half day. I know would have given the pills a chance if a vet told me they may extend reasonable. Quality of life even for a week. It's such a hard call to make. Think of what you did and how you looked after Kona all those years

[mommyslittlegirl]

Just want to let you know how deeply sorry I am for your loss of Kona.. My Kiki has extreme muscle weakness and if they offered me a new pill that they said might help her and extend her life, I would try it. Even if it was for a week or a day. So you did nothing wrong with trying.. I can tell how much you loved your fur baby. And always will. She would say thank you for a great life and tons of love.

[3bostons]

Thanks everyone for the kind words, its been a rough week. I know she had a good life, she was so loved and happy even thru the cushings up until the last 6 months or so really. But I cannot help but feel guilty for not acting on my gut instinct, the last thing in the world I wanted was for her to suffer.

Debbie

[Squirt's Mom]

Dear Debbie,

I have read your post a couple of times and start sobbing every time. It reminds me so much of my sweet Tasha who's cancer moved to her brain. I knew when she woke up that morning something was wrong, bad wrong, but she seemed to improve the longer she was up - then she seized and big time. I, too, let the vet talk me into an injection and new meds to give at home. They didn't help, she kept seizing. But when we walked into the vet's office she acted so good, as if nothing at all was wrong. It shattered me to see her that way after watching her the days prior and knowing why we were there, knowing what she had been thru.

We did the best we could, Debbie. We wanted to believe the meds would help, that the vets really did know, that our sweet girls could get better even if only for a little while. Kona knows that, too. She knows you always did your utmost for her, always.

Stay in touch and talk to us any time. We understand only too well how you are feeling. I don't think the particulars matter - guilt is just part of the grief process. But don't hold on to it for long, 'k?

Our deepest sympathies,
Leslie, Trinket, Brick, Sophie, Fox, Redd, and all our Angels



FRIEND

I lost a treasured friend today
The little dog who used to lay
Her gentle head upon my knee
And shared her silent thoughts with me.

She’ll come no longer to my call
Retrieve no more her favourite ball
A Voice far greater than my own
Has called her to His golden throne.

Although my eyes are filled with tears
I am thankful for the happy years
She spent down here with me
And for her love and loyalty.

When it is time for me to go
And join her there, this much I know
I shall not fear the transient dark
For she will greet me with a bark.

~Author Unknown

[molly muffin]

You know how it is Deb. The gut says now is time but the heart never gives up hope and trying to fix. It's a battle and one that many of us have been through.
If you had gone with your gut would you not wonder if you could have done more? Most go through one or the other if these scenarios no matter what the choice you've made is. :(. I sometimes think that guilt is always a part of the good bye no matter what. I don't like it but we have seen too often on here that there is no perfect answer or time.
Big hugs. A good life is a great gift.

[Jenny & Judi in MN]

I am so so sorry for your loss. I know you'll continue to beat yourself up but we don't have a crystal ball and you loved Kona. At least you were with her and she wasn't alone at the end. hugs, Judi