Hi everyone! Newly diagonosed sheltie with Cushings...

[Blaze's Mom]

Hi...My name is Trish and I have a 7 yr old Sheltie named Blaze who was recently diagnosed with Cushings. It has been a rollercoaster past few months, but finally having a diagnosis helps. It all started when we moved here to CA a year and a half ago. I took Blaze to Petsmart to be groomed and when they brought him out, I was in tears. They had given him a "feather cut". Long story short, he had short fuzzy hair just like he had when he was a puppy. So after fussing for a week, I finally said no big deal...it will grow out quickly. I found a new groomer who just basically bathed him for the next year. And sheesh...his hair barely grew out. It has been taking forever. Then, all the sudden I noticed some areas on his belly. After a few days, we go to the vets and the poor thing has Ringworm. Well...this went into medicated baths twice a week with a special shampoo we had to buy, along with $200/month meds for Ringworm. All the rugs in the house were thrown away, out came the kennel, and the poor thing barely got much loving in they way of belly rubs, etc that he was used to. No more jumping up on the couch or sleeping on the bed with us. This went on for a couple of months with no sign of it getting better. Then, the doctor called me in and said after much thinking over the weekend, she wanted to test him for Cushings. There was no other reason that he wasn't able to fight the Ringworm. We then went over the symptoms. Insert a huge slap to the forehead! Excessive drinking and peeing, check (diabetes tested before), panting, check (noticed this starting since moving to CA), loss of hair, check, (could be the Ringworm), huge appetite, check (has always grabbed bread, tortillas, my darn bday cake...lol...off the counters for years), several others. So...we retested for Ringworm and tested for Cushings. Cushings test - ACTH- came back positive (will have to get test result info from vet). After 10 days, retest came back good...for 60mg once a day. Well, we stayed on everything, antibiotic, Vetoryn, medicated shampoo/baths, and Thyrosyn. He has been on thyroid meds for years. Another 2 1/2 weeks go by, this is Tuesday...medicated bath day. Bought another bottle of shampoo and asked them to please have a dr come look at his skin. The ringworm keeps getting worse. We are scheduled now for another ACTH test on Friday. The dr calls me that afternoon (my in-laws pick up my dog after his bath) and says to call them. I call twice and they won't tell me anything. They just say you have an appt on Friday for the retest and the dr will talk to you then. 3 days...finally, on Friday we get to our appt. Oh, but no, they are not going to do the test. When the other dr looked at Blaze on Tuesday, he called the vet seeing him now (his original vet is on maternity leave since his dx of Cushings and she is the IMS) to talk to her. He said the meds are not working and to go to twice a day. So...instead of just telling me this on Tuesday and us getting a head start by 3 days, you make me wait for a non-needed appt bc we aren't testing just to tell me to double up the dosage. Thanks. Then, what about the Ringworm getting worse I ask? Ummm....his last test was negative for ringworm. Excuse me??? :eek: The test done a month ago? Yes. What about all the skin issues here that keep popping up all over his body? That is consistent with Cushings. You see I'm not wearing gloves. You mean that he hasn't needed the meds, medicated baths, shampoos, etc for the past month? Well...I'm 99% sure, but we can do another test. Since we are going out of town this next Tuesday for the week and he is staying with my in-laws, yes, please redo. Yep, you guessed it, negative! Ugh!! Nice for them to tell us. So, Blaze stays with his grandparents and when we get back the following Sunday, his belly looks sooooo much better!! We have another ACTH test coming up this Friday (day 14 of the BID change....not 10??). He is at least back up to being allowed on the couch and the bed, etc. I am not sure about any changes in water intake and peeing bc until reading this forum yesterday and today, I didn't know to watch for it. :confused: He does actually take a breath occasionally when he eats now instead of inhaling everything in one breath. We don't dare leave the kitchen door open though when we leave bc if he does get the trash or the counters, we don't want another bout of pancreatitis he is used to getting. So...until I read the forum, I wasn't worried about the Vetoryl. The vet told us to watch for symptoms of too much Vetoryl when he first started on it but never said a word about prednisone or anything. Just bring him in if he collapses or vomits/diarrhea, etc. Not a word said at all about him when we doubled up to 60 mg twice a day. I'm trying to decide what to think. I am going to call and request copies of all his documentation and ask when his regular vet (the IMS) will be off maternity leave. I guess I will also ask if he needs to be tested for his thyroid. Geeezzzz...can I talk or what??? LOL Should I be looking for anything now or asking the vet anything or do I just wait and see??? I really hope his hair grows back, poor thing. I brushed him last night and I swear I removed 15 brush fulls of hair. He went to get groomed today, by a new groomer, and for the first time in months he smells good!~!~ He has had an awful order for the 6 months or so!! Okay...I will shuddup now. :)

Thanks for any advice!!
Trish

[cheydogger]

Hi Trish-

The roller coaster sounds all too familiar while testing for Cushing's. Sorry you have been through so much.

I am new to this site too, so I don't have any advice. However, I have a few questions. Did the vet diagnose Blaze solely on symptoms and ACTH? Did they do a low dose dex suppression test and an ultrasound?

I am glad to hear Blaze's skin condition is getting better!

Take care,

Ro and Chey

[Harley PoMMom]

Hi Trish,

Welcome to you and Blaze, so sorry for the reasons that brought you here but glad you found us.

The starting dose of Vetoryl is based on a dog's weight. A study from UC Davis recommends initiating a dose of 1mg of Vetoryl/Trolstane per kg of the dog's weight. The dose of 60 mg BID seems awfully high to me and has me a bit concerned that Blaze's cortiol will fall too low. Signs of too low cortisol are lethargy, vomiting, and/or diarrhea.

If you could round up the copies of all tests that were done on Blaze and post any abnormal results listed, that would really help us to provide you with more meaningful feedback.

How is Blaze doing? Is his appetite normal?

Please know we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs,
Lori

[molly muffin]

Hello and welcome! It's is amazing the experiences that people will go through in trying to get a diagnosis with this disease. I'd be royally ticked too not to have been told about the negative ringworm test. I don't even know what to say to that one. I wonder though if using the medicated shampoo's etc, when it wasn't needed, could have caused skin irritation, because it does seem that it cleared up once you stopped using the shampoo and meds? Or did it clear up when you went to that increased dosage? I'd definitely want to see the numbers that show that the cortisol wasn't under control.

Every dog is different in what they will need as far as trilostane goes. Some can't tolerate hardly any, while others need a much larger dose. One of the protocols which to me at least seems the safest is to start low and go up as needed. Since you've already started though and have had several tests, then definitely we will be interested in what initial test showed, prior to treatment, and every ACTH since then to see where the cortisol levels are at.
Do you have prednisone on hand if needed? This would be in case, you start to see the symptoms that Lori mentioned, lethargy, vomiting and/or diarrhea. Otherwise, keep an eye on Blaze and stop the med all together if those symptoms appear.
You have certainly been down a bumpy road lately. I do hope that it gets easier as time goes forward.

On another note, besides saying welcome to the board, Happy Thanksgiving!

Sharlene and Molly Muffin

[Blaze's Mom]

Hi Ro!! I think they are basing it solely on symptoms and ACTH; however, when the second one was done, I kept asking “Why am I not bringing him in at 8am like the last time?” I could swear that the first test, the dr said something about testing 4 hours after his meds and a few hours after. I really remember her saying something about two tests bc that is why he had to be there all day. From reading everything on here today, that sounds like one of the other tests. I do know that ACTH is what has been done since. They mentioned a number being much lower and that was a good thing. But then why did he need to double the dosage later? Hmmmm.... :confused: Absolutely no ultrasound done at all. That I know for sure! His skin was so awful that I just assumed the Ringworm was getting worse and worse. I guess it was for awhile, until he started the Vetoryl. I am definitely not complaining about the higher dosage bc his skin was breaking my heart!!

Hi Lori! Thanks! I am going to try to get a copy of all his medical paperwork tomorrow. As for the dosage, they started him on 60mg once a day. After 10 days, ACTH came back "lower"...in the correct range. I do think it was below 5 bc I thought it sounded weird. At the 30 day mark (3 weeks later), his skin was getting worse and the older vet (best way I can describe him) was the one who said the dosage was not enough. They cancelled that ACTH test and said to start giving the pill twice a day. ACTH is scheduled for this coming Friday. As for his appetite…I have a porker butt for a dog. LOL :p He has always had an extremely healthy appetite, and then some!! Raw garlic is about the only thing he has ever not eaten. He used to get into the trash when we left the house. He even learned how to unlock the cabinet that we rigged up!! Not to mention the loaves of bread and bags of tortillas he has eaten due to our not pushing them farther back on the counter or put them up somewhere. Yes, he takes after his mama here! :D Several bouts of pancreatitis previously. Not lethargic, barking up a storm today, as Shelties can only do. No vomiting, no diarrhea. Stools are same as always. He has always been pretty lazy, sleeping a lot, so I don’t think he is any different.

Hey Sharlene! I was one ticked off mommy!! :mad: It wasn’t so much the cost of everything, which didn’t help, but the fact that he was on antibiotics for so long. That can’t be good for him. It didn’t clear up until we increased his dosage. When we left for DC a week ago today, his skin was not good at all. We got back late Sat night and he stayed over at my in-laws. The next morning when I went to get him (2 doors down), I was amazed at the difference! And he went to get groomed today and when they dried him, a lot of the dried, scaly skin came off. Again...amazed!! :eek: Of course, it will take forever for the clumps of hair to grow back I’m sure. He has so many areas of hair loss and we find small clumps everywhere. I do NOT have any prednisone. That was never even mentioned to me. I will have to ask about it tomorrow when I call to request copies of his medical records.

It is interesting reading some of the posts about different characteristics. The licking!!! :rolleyes: I kept watching him lay down in his kennel and just lick the floor of it, and lick, and lick…then the floor here in the living room. I’m thinking what in the world is on my floor or his kennel? He has never done that before. I haven’t seen him do it lately.

Thanks for the warm welcomes and I am sure I will have plenty of questions~!!!

Happy Thanksgiving everyone!!!!
Trish

[Blaze's Mom]

Wow! I just called my vet to ask for a copy of his medical records and they were all "Sure, no problem." I didn't even need to give them a reason! I was worried they were going to be asking why I needed it and thinking I was going elsewhere. We have had a few issues, but that is probably bc we are so picky and high maintenance :D. She said she was going to copy them right now so I could pick them up any time. I will ask about the prednisone when I go in. I think I may take Blaze with me to weigh him. That way he can get a treat, get love on a little by them and realize that the vets can be fun too. ;)

As soon as I get the med records, I will start typing up what testing was done.

Oops...Tasha just called from the vets, and he has a pretty big file. :eek: Guess I won't be getting it till this afternoon...LOL.

I hope everyone is having a wonderful morning!

Trish and Blaze

[cheydogger]

I only know from my experience so far with this disease that an ultrasound was very valuable since Cushing's is caused from one of two places, adrenal or pituitary. I guess it is possible they diagnosed pituitary from a LDDST and an ultrasound wasn't needed for diagnosis. You will be able to tell everyone once you get copies of his records:). If my vet would have went solely on symptoms, senior panel bloodwork, urinalysis, and ACTH stim test, we would have probably been treating the wrong gland. Like I said before, I am new to this too. 80-85 percent of the time it is pituitary related, but it's not a guarantee. Like in my case, it's looking more like an adrenal tumor causing Chey's problems.

I am just curious how your vet diagnosed Cushing's and it sounds like he is treating the pituitary origin.

Take care,

Ro

[Blaze's Mom]

9/21/2012
Pre-ACTH 6.0
Post-ACTH 25.1

Started Vetoryl, 60mg once a day. Continued on thyroid medication and antibiotic.

10/5/2012
Pre-ACTH 2.8
Post-ACTH 2.3

20 days later the next ACTH was due. However, since Blaze’s skin was continuing to get worse, they did not do the test and the vet said to start giving the 60mg twice a day instead of once a day. His next ACTH is scheduled for this coming Friday. These are the only tests done on Blaze. There is no bloodwork, no ultrasound, nothing. So obviously, they are basing their diagnosis on ACTH and symptomology. He is still on thyroid medication but no longer on antibiotics.

Any advice/suggestions?? Thanks!!
Trish and Blaze

[labblab]

I have only a few moments to post, but I have to tell you that I am honestly stunned that your vet would double your dog's trilostane dose without first performing another monitoring ACTH test, after the first monitoring test results turned as they did. I am unaware of any criteria by which a stubborn case of ringworm supercedes a monitoring ACTH test in terms of determining appropriate dosing. And you really do not want your dog's ACTH results to drop much lower than those obtained on the first monitoring test. I am very worried about the dosing/monitoring advice that you are being given, and I will be very anxious to see what the results are on Friday. In honesty, I would be trying to locate a specialist vet with more experience with diagnosing, treating, and monitoring Cushing's.

Marianne

[cheydogger]

Is anyone else concerned how Blaze was diagnosed with Cushings?

Trish- were there any other tests done during the diagnosing of Cushing's?

[frijole]

Holy cow Marianne - good catch on the doubling of the dosage - I didnt catch that.

Absolutely I would be at that vet's office getting copies of all tests and I would run to my car and then find a vet that knew what they were doing. That is scary.

These drugs are not to be taken lightly - they can kill - like any drug if given in too high of a dose. Please trust us and find someone else to care for your dear one.

Kim

[Blaze's Mom]

Nothing. I am a little miffed bc, curiously, they left out the Sept documentation of his file. This was dealing with the ringworm issue (initially dx late July). I was trying to figure out when the first negative test was. I can not find it anywhere and have to assume it was in Sept. I plan on asking to look at his file during our visit and requesting copies of the Sept portion of his chart. But the only other testing ever since moving here to CA was some bloodwork this June due to dental cleaning, Dec of 2011 due to vomiting from getting into Christmas leftovers and thyroid check in October of 2011. Nothing else.

Trish and Blaze

[frijole]

We have several members that live in CA... perhaps they can help you with a new vet if you are interested. Just a thought. Hang in there and know alot of us, myself included have had to switch vets over things.. it is so hard because you pay good money for advice and also expect them to care. Like anything else - not all are created equally.

As my brother says about doctors "Remember 50% graduated in the bottom half of their class". :D

Kim

[Blaze's Mom]

Obviously I can't do anything right now with Thanksgiving being tomorrow, but I will have all sorts of questions for them on Friday. I would also like to know when our regular vet is coming back from maternity leave bc not only do I like her much better, but she is the only one with an internal medicine background that I can tell from looking on their website. She is wonderful with Blaze!! Unfortunately, she was on her last day when she said she wanted to test him for Cushings. Maybe her new baby would like to see Blaze?!?! LOL The vet seeing him now is okay, but doesn't act like she really cares about Blaze. When we got the diagnosis, they acted like this was a normal, typical thing and didn't give me any indication of what to expect from it. When I went to the Dechra website, it said starting dose is 1-3mg per lb. Blaze is 42 lbs, so I am guessing they thought they were starting below the halfway point with 60mg SID. I can only assume they figured it was safe to go to the 3mg per lb mark for the increase. Sheesh...I have no idea. You would think they would start lower due to the good ?? result of his retest on the once a day. I guess we wait to see what the results are from Friday's test. Hopefully, we will know something by Saturday afternoon.

At first, when I told my hubby, all he could say was "Are they vets?" No. "Well, find another vet if you want." said with attitude. But then when I read what the Dechra website said to him, he asked what dose Blaze was on. :rolleyes::rolleyes::rolleyes: So I told him. He gave me a quizacle look with raised eyebrows. Yeah, uh-huh...now what do you say big boy? Ugh!! Do you think I sit here and research this bc I have nothing else to do? Nevermind...that is what he gets for asking what I had found out through all my time on the internet. Sorry...I am venting...lol.

Goodness...I have read so many stories on here that I can't keep them all straight. Please inform me what is going on with all your loving furbabies. Ro, if I remember correctly, your Chey is currently dealing with high blood pressure, right? Poor thing. I know that is super stressful on the both of you!! Leslie, girl, you are a hoot!!! I don’t know your story, but I read about Cindy and Penny…the whole story. But with Cindy in the hospital and you rolling and dragging and taping patients and your stories/jokes….I cried from crying and cried from laughing! Okay…I peed a bit too!! Guess I am worse off than Blaze!! Lori…I don’t think I know your story either. Obviously, I haven’t read as much as I thought I had! Sharlene…I know a little bit about your precious little Molly Muffin. I guess that is what I am worrying a bit about…misdiagnosis. Marianne and Kim…I have read many or your posts, but not your story. Then again, I may have and totally have people mixed up!! I do know that I have already learned soooo much from all of you!! But I also have much more to learn.

I'm rambling again....

Thanks for all your help and support!!
Trish and Blaze

[labblab]

Dear Trish,

I will try to stop back by later today to add some more comments, but I wanted to make sure to remind you that it is crucial that Blaze's monitoring ACTH tomorrow be performed using the proper protocol - otherwise, the test results will be meaningless. He should be given his trilostane in the morning, along with his breakfast (at least a small meal). The test should be completed 4-6 hours after dosing.

He definitely should NOT be fasted before the test is performed. Trilostane is not metabolized properly in the body unless it is given along with some food. And that time frame is also very important. You want to make sure he is tested during the time period that the drug is most active in the body so that you will know what the lowest cortisol level is. This is crucial for Blaze's safety. If you have been reading Dechra's product insert, you already know that his "post" result should drop no lower than 1.45 ug/dl. On his first monitoring test, after being dosed with only 60 mg. for a short time, his result had already dropped down to 2.3. Even remaining on the same dose, we would expect that Blaze's cortisol would have continued to drift downward even more during the initial weeks of treatment. So if anything, your vet might have wanted to DECREASE his dose a bit. This is why I am mortified that it was doubled! :( :eek:

Please make sure the testing is performed properly tomorrow. And as I say, I will be very anxious to find out the results. Additionally, as the others have already said, I too have concerns about the lack of testing in relation to the original diagnosis. But I'll save that for another time...:o

Marianne

[cheydogger]

Hi Trish-

My dog, Cheyenne, has been going through Cushing's testing for a month now. I took her in because she was eating dirt, drinking a lot of water, and peeing a lot. Plus, she is hungry all the time, but she always has been. I had her in for her yearly in July and they detected a heart murmur, so I mentioned that she was exercise intolerant. I thought her heart was causing her to be slow on her walks. They suggested I do blood work, but I declined because I had just been through an expensive, traumatic experience and finances were low. The vet said to watch for coughing, excessive water drinking, etc. Well, it wasn't but a couple months later I started noticing the things the vet told me to watch for. Plus, I discovered Chey had a broken tooth that needed looked at. That is where my nightmare began. Her senior panel blood work and urinalysis along with symptoms, sounded like Cushing's. We then did an ACTH stim test and ultrasound and they were consistent with Cushing's. The ultrasound revealed bilateral enlargement of her adrenal glands, the right being markedly larger. The radiologist said there was a neoplasia in her right adrenal. I saw a surgeon who didn't agree there was a tumor in her adrenal and he turned me over to an internal medicine specialist, who too suspected pituitary Cushing's. The internal medicine specialist ordered two more tests that should point us to pituitary or adrenal. Well, she tested negative for Cushing's on the LDDST and inconclusive on the Endogenous ACTH test. Everyone is completely baffled at this point! I wanted her blood pressure checked, so it was just discovered that her blood pressure is dangerously high! Prior to discovering the high blood pressure, I was to take Chey back to the specialist for another ultrasound done by them, not my regular vet. Now, I am supposed to get Chey started on a blood pressure pill and wait for our regular vet to talk to the internal medicine specialist again. This is where I am. This is why I wanted to see what tests were done in diagnosing Blaze.

[Blaze's Mom]

Ro...I am so sorry you had to go through all that. It royally sucks when our loved ones have to jump through so many hoops to find out what is wrong with them. Has she started the medication yet? I hope she is doing well over the holiday. I hope you are too!!! Give her lots of hugs and treats and belly rubs!!

Marianne...I do know exactly where you are coming from. When I got the documentation yesterday and started reading through it, I looked at the numbers and thought hmmm....she went from pre 6 to pre 2.8 and post 25 to post 2.3. Even if you wanted to take it down just smidgen, then you would increase the meds just a smidgeon. Maybe they were desperate to shut me up and keep me out of there for a while bc of all the complaining I was doing about his skin. I have been looking around online and there seems to be another place nearby (I live in Santa Cruz) and a couple over the hill in San Jose. I will start calling around tomorrow and asking questions about how much experience they have had with canine cushings. I guess we are just damn lucky that their increase may have been on target (lucky guess on their part), but I don't want Blaze treated on the chances of luck!! I know it will be expensive, but I am thinking I should ask for a full blood panel and see if there are any abnormalities??? Anything else I should ask for? Maybe an ultrasound as well? Is it too late for an LDDS??

Happy Thanksgiving everyone!!!
Trish and Blaze

[cheydogger]

Yes, Chey started the Amlodipine today. She seems to be doing ok so far:). Hopefully, her blood pressure will level out.

[Blaze's Mom]

Yea!! So glad Chey has already started her meds! Did she have a good day today??

Marianne....forgot to say....the vets seems to be right on top of the timing issue with ACTH. Not only do they tell me about 3 times when scheduling it, they write it in the chart every time they tell me...lol. They definitely have the 4-6 hours part down pat. Blaze will get his meds around 8am and his bloodwork is scheduled for 1pm...the 5 hour mark. I will be there tomorrow with as much info as possible. Tonight at dinner, my husband said that he is not impressed at all with any of the vets who have taken over Blaze's care since Dr S went on maternity leave. If she is not back soon, we are switching vets. We may do it anyways. I will be calling around tomorrow to see experience they have with Cushings in canines. Supposedly there is one group who does have experience.

I hope everyone has had a great day!!!
Trish and Blaze

[Blaze's Mom]

Okay...so as I sit here with notebook in hand, I don't really know what tests to ask for tomorrow. Should I request an LDDST? An ultrasound? Bloodwork? A recheck on his thryoid? :confused::confused: I have lots of questions for them and will probably sound like a royal "w"itch, but at this point, I don't care. I just want to know if this is the right diagnosis and the right dosage. I really do feel like Cushings is the correct diagnosis, but who knows?

Any advice on the tests??

Thanks!!!
Trish and Blaze

[labblab]

Hi again, Trish.

I hope you guys had a great Thanksgiving, and also that everything will go well today with the vet visit!

I've gone back to re-read your thread from the beginning, and here's my thoughts about Blaze's testing. First off, I don't believe a LDDS would have value right now -- I think the results would be skewed by the trilostane treatment. Also, trilostane itself can cause the adrenal glands to enlarge, so an ultrasound right now could also be of questionable benefit. On one hand, it could certainly reveal whether or not any abnormalities are present with internal organs other than the adrenal glands. Also, if Blaze does have Cushing's and it is caused by an adrenal tumor (rather than a pituitary tumor), the abnormal mass could be visualized. In that event, if you wanted to consider surgery and Blaze is a surgical candidate. he could be afforded a total cure. However, if what the ultrasound reveals is bilaterally enlarged adrenal glands with no evidence of a tumor (which is generally evidence of pituitary Cushing's), you won't know whether the enlargement is confirmation of the disease or just a result of the trilostane itself.

In terms of pursing other diagnostics right now, I guess the key issue for me is Blaze's appearance and behavior. You have listed a number of symptoms that are indeed consistent with Cushing's: excessive thirst, urination, and hunger; panting; skin issues; history of recurrent pancreatitis; low thyroid. Of course, other conditions can cause many of these problems, too. But it sounds as though the trilostane treatment has been helping to resolve these symptoms. If so and if Blaze continues to improve, then that is reason to believe that the original diagnosis actually was correct and there may be no need for a bunch more diagnostic testing. However, I WOULD want to know the current status of many of his blood and urine values. For instance, Cushing's almost always causes elevations in certain liver enzymes, and it can also increase cholesterol levels. Plus, a dog being treated with trilostane should have its "electrolytes" checked alongside the monitoring ACTH tests (this is a simple test of blood chemistries to make sure that no imbalance is being created by the medication).

As you already know, I have major issues with your vet's dosing. So if Blaze were my dog, when you go in today, I would want not only the ACTH performed, but also a complete blood and urine panel in order to check the general functioning of his body. This will include the electrolytes, glucose, and general thyroid reading. The thyroid info is important because sometimes thyroid medication can be (needs to be) altered or even halted after successful Cushing's treatment is started. The thyroid problem can be secondary to the Cushing's, and it may resolve with proper Cushing's treatment. So you don't want to get in the opposite situation of giving too much thyroid medication when it is not called for -- this can cause problems in and of itself.

Others may have different thoughts, but this is what I would ask for today if Blaze were my dog.

Marianne

[cheydogger]

I would ask the vet how they determined his Cushing's diagnosis. How did they differentiate pituitary vs. adrenal. Get all of his lab tests he had done to diagnose Cushing's.

[Blaze's Mom]

Thanks Marianne! I wrote it all down. I have a whole page so far of questions and wants. Fingers crossed!!

Ro...that is just it. All they did was the ACTH test. My original vet (the one with IM experience, not sure if she is an IMS) was the one who wanted to test him. She called me in the last day before her maternity leave. She said she spent all weekend going over Blaze's chart and symptoms bc he should have been fighting off the ringworm much better. She then figured that his immune system must be suppressed for some reason, then she went back looking for things...symptoms. She found them in various spots and that is when she said she started thinking Cushings. But the only test they did was the ACTH. The dosing for the first round and the increase all came from the other doctor (s). No bloodwork or anything.

[cheydogger]

Wow. Like Marianne said, it sounds like the medication is working so he probably does have Cushing's. I just feel, from my own experience, that they started treating without a firm knowledge of the origin of Blaze's Cushing's. I have been told the medication is too dangerous to use unless there is a pretty firm diagnosis and organ of origination. At the beginning of Chey's testing, I felt like they were jerking me around with one more test, then one more, but after learning more about Cushing's, I understand now that a firm diagnosis is needed because the treatments for piuitary and adrenal differ. It is not an easy or fast process. Maybe I am just too sensitive because for one, I still don't have a 100 percent diagnosis after several tests and two, it is looking like Chey is in the rarer category with an adrenal tumor or Pheochromocytoma. Each new story that I read is a learning experience for me.

I hope Blaze's test today shows the medication is doing him some good:)))

[cheydogger]

And at the least, I am really surprised they didn't do a complete blood and urinalysis before the diagnosis and treatment of Cushing's.

[molly muffin]

Sooooo, let us know how it goes today! We'll be waiting! :)
Wow, Blaze is a beauty. Is that right after a grooming?
I love how fluffy they get after a good grooming session. Poof!!

hugs,
Sharlene and Molly Muffin

[Blaze's Mom]

Hi Ro…I don’t think you are too sensitive at all!! Or else I am too…lol I will detail today’s appointment below. All I can do is a huge eye roll!!

Thanks Sharlene! I really can’t remember if that was after a grooming or not…haha. It was taken over a year ago. It is the only picture I have on here and my husband had Blaze with him at the in-laws so I couldn’t take a new one today. But I love the fluffiness as well after a good grooming. Nothing like volume to keep him looking good. 

So…today’s vet appointment. My husband actually decided to go with me. When we get there, I request the Sept paperwork that they “forgot” to copy. No problem, she copied it right off. Then I asked with Dr S would be back from maternity leave. No idea. It has already been a couple of months so maybe just another a month or two…..hmmmmm. So…off we go to the exam room and I am firing off questions. Dr P wasn’t too thrilled I don’t think. I asked about LDDS and ultrasound and she said “Well, we would be going backwards, but we can do it.” I said I knew it was pretty useless now except for maybe the ultrasound. That could maybe give us an idea about pituitary vs adrenal is a tumor somewhere or not. She said we could do it, but the treatment would be the same. Huh?!?! Did I just miss something here?? I then asked why they did not do an LDDS when Dr S had specifically written, on Sept 19 (I see that now that I have dang documentation), that an “LDDS should also be perfomed to r/o Cushings dx. I guess symbol for pt’s family??? Has scheduled LDDS for Friday 9/21/12.” Really???? Then why did you do a ACTH?? They are the same thing. No they aren’t!!! And why do some things say Lysoden and some say Vetoryl. They are the same thing. Nooooo….they aren’t!! You can’t use on one week, and then the other the next week. Holy crap!! Do you work with several Cushings dogs here? Yes. Poor dogs!! (okay…I said that part to myself…lol) Why did we just double up with 60mg twice a day instead of maybe 40 mg twice a day? Bc there is a study saying twice a day works better bc it stays in the system for only 12 hours. Um….yeah…been out there a while. By now she was NOT happy to say the least! She supposedly is going to get me a copy of the study. Woo woo…another eye roll here. She finally asked if I wanted a referral to an IMS. Duh…yes!! Then she said, well were going to do that if his skin was still having issues anyways. Which of course, it is. But she acted like it was so much worse than it really is. At least that I can tell. So, I then requested full blood work to be done today as well. She said to come back in an hour and Blaze and the blood work results would be ready. So we came back an hour later is get this. The dr would not even look at us!!! She walked by, whispered something with Blaze’s name and then walked off. Walked though again without a glance or word. Then up and left for the day. We were given the blood test results and a printout of today’s visit. Ummmm…..what does all the blood work results tell us. That is for you to take to the IMS and they can explain it to you. Oh really??? I don’t think so. I asked for the test, wanting the results today. So they finally got a tech to go talk to another dr and come out to talk to me. My husband said he was outside with Blaze and the dr just beelined right to her car and jumped in. I do think someone has her nose bent out of joint bc we questioned her. Well tough tootie sweetie!! My husband was not happy at all. He said If this is what you have been dealing with all this time, you should have switched vets a long time ago. So…I have put in a call to the animal hospital with the IMS to schedule an appt. We will be writing a letter to our original vet explaining why we felt we needed to switch vets. Supposedly Dr P will be calling us with Blaze’s ACTH results but who knows. Oh yeah….which reminds me. She asked if we wanted to cancel the ACTH and have the IMS do it. I said NO, didn’t I just say I am very anxious about these results? Sheesh….so we did it.

The IMS just called and we are scheduled for next Friday morning. I couldn’t do it sooner bc I have to be at work and give them notice that I have to have that day off. I hate having to wait, but I have been off work for 2 weeks now.

Trish and Blaze

[Blaze's Mom]

Heading out to the movies, but will post bloodwork results when I get back. Everything was pretty normal, but a low high on BUN and ALKP.

Trish and Blaze

[cheydogger]

All I can say is......WOW!!!

[Trish]

Dear gawd, you would wonder how some of them keep their license! so pleased to hear all you said, we are all the best advocates for our dogs and you certainly looked after yours :D:D

Pleased you are writing a letter and that you are seeing the specialist too! Sounds like pretty good blood results :)

Hope you enjoyed the movie!
Trish and Flynn

[Boriss McCall]

That is so scary that this vet is taking care of other cush dogs too. wow!!! so glad you are getting to switch vets.

[molly muffin]

Holy sheep &*^%%$ That is just...wow..yea.. Unfortunately a few of us have had encounters with our vets when we were just shocked at what we were being told. I'm one of them. My vet that has treated molly for 9 years and I had some serious disagreements when it came to what was going on and what was needed at what point. Like hello, not going to start her on vetroyl, even though I bought it, because, I found this forum and the people there gave me all kinds of information and I want to see an IMS and have an ultrasound and another LDDS test. (she had one two years ago that was negative) To which I was told, that I shouldn't believe everything I read on the internet (well duh of course not, you think i'm an idiot) and I pay her to decide what tests need to be run (well, no actually I don't pay you for that), etc, etc, etc. We came to a more cordial understanding after the last LDDS test came back negative for cushings. LOL
So, I think you are doing the best thing possible in getting to an IMS, and definitely writing your regular vet. After all she left her practice in this vets hands, and it could be quite detrimental to the animals whose lives are in "iffy" hands now. Scary stuff indeed.
I'm so proud of you though! You stood up for your baby and nothing is going to get in your way of making sure that all options are covered! Good for you.
Hope you enjoyed the movie, what did you see?

hugs,
Sharlene and Molly Muffin

[frijole]

Good job! You did exactly what you needed to do - you proved that this vet is totally clueless about cushings AND you made her mad because of it. Big deal - she charges the same amount if she's wrong or right. Dogs DIE over issues like this and hopefully she will take it as a call to action and get up to speed before treating the next dog.

But I'm glad you are going to a specialist. Since you were referred by them - be prepared for the specialist to pass info back to that vet's office. It's a courtesy thing. You might have to explain that you want them to tell YOU as well as your real vet is out on maternity leave etc etc and the 'fill in' vet isn't real up to speed on treating cushings.

I'm concerned that they didn't give you a time for your vet to return from maternity leave... you might need to be looking for a new one at a different clinic.

Keep us posted on the specialist!

[Blaze's Mom]

LOL Ro! I wanted to say so much more! But I figured the language wouldn’t get me anywhere.

Trish…Thanks!! Isn’t it just amazing? I am thinking she bought her license at Walmart on Black Friday last year. I will write the lab results below. Trying to decide if I should write them all out or just the abnormal ones. Yep…Dr S will be surprised I am sure, but we will tell her how much we enjoyed having HER as our vet and that we will miss her. BTW, Flynn is adorable!!

Amy…that is why I asked if they were treating other Cush dogs. The search will be on for a new vet though. The place where we have our IMS appointment is a specialty and emergency clinic, no general practice. So it will be interesting when I tell her that we are in search of a new vet bc they apparently work with our current vet clinic.

Thanks Sharlene! My baby comes first and someone had to stand up for him cuz all he does is lay down, roll over, and give you his belly to rub….hahaha!!! We went to see Red Dawn. We really enjoyed it because we were afraid they were going to ruin an already good movie. But they made it it’s own movie and did well with it.

Kim…we are definitely looking for a new clinic. Especially since it will be at least a month or more before she comes back. Do you think the IMS will work directly with me until we find a new vet? I am going to ask her for a recommendation and hope that she will be professional about it.

Okay…so here are the blood test results:
Catalyst DX
GLU 95mg/dL 74-143
BUN 30mg/dL 7-27 ***HIGH
CREA 1.1mg/dL .5-1.8
BUN/CREAT 27 no values given
PHOS 3.8mg/dL 2.5-3.8
CA 9.9mg/dL 7.9-12.0
TP 6.6g/dL 5.2-8.2
ALB 3.1g/dL 2.3-4.0
GLOB 3.5g/dL 2.5-4.5
ALB/GLOB 0.9 no values given
ALT 30U/L 10-100
ALKP 224U/L 23-212 ***HIGH
GGT 4U/L 0-7
TBIL 0.4mg/dL 0.0-0.9
CHOL 242 mg/dL 110-320 **he is healthier than I am!! LOL
AMYL 1016U/L 500-1500
LIPA 657U/L 200-1800
Na 149mmol/L 144-160
K 4.5mmol/L 3.5-5.8
Na/K 33 no values given
Cl 116mmol.L 109-122
Osm Calc 302mmol/kg no values given

ProCyte Dx
RBC 6.56 M/uL 5.65-8.87
HCT 48.1% 37.3-61.7
HGB 17.2g/dL 13.1-20.5
MCV 72.2fL 61.6-73.5*
MCH 25.8pg 21.2-25.9*
MCHC 35.8g/dL 32.0-37.9
RDW 15.3% 13.6-21.7*
%RETIC 1.2% no values given
RETIC 81.9K/uL 10.0-110.0
WBC 11.83K/uL 5.05-16.76
%NEU 75.0% no values given
%LYM 14.2% no values given
%MONO 5.8% no values given
%EOS 4.2% no values given
%BASO 0.8% no values given
NEU 8.87K/uL 2.95-11.64
LYM 1.68 K/uL 1.05-5.10
MONO 0.69 K/uL 0.16-1.12
EOS 0.05 K/uL 0.06-1.23
BASO 0.09 K/uL 0.0-0.10*
PLT 359 K/uL 148-484
MPV 11.4fL 8.7-13.2
PDW 15.7fL 9.1-19.4
PCT 0.41% 0.14-0.46*

Bloodwork: No significant findings. ACTH Stim pending.

Please consider referral to Dr. Burtch at _____. Per Dr. Burtch, there is increasing evidence that some dogs require twice daily Vetoryl treatment. 120mg Vetoryl is within the recommended dose range for treatment of hyperadrenocorticism due to adrenal tumor or PDH.

To differentiate PDH from Adrenal since therapy has been started consider ultrasound of adrenals vs blood testing which can be discussed with specialist.

So……I am guessing she already talked with the IMS…..UGH!! Guess I will be explaining my concerns with the IMS regarding how the diagnosis was made and how the increase in Vetoryl took place, not the fact that we went to twice a day. Shouldn’t we have started slower, like going from 60mg once a day to maybe 40 twice a day…or whatever. This should be interesting.

Trish and Blaze

[Blaze's Mom]

So much for all my meticulous spacing....lol. I astericked a few of the ProCyte Dx values that were close to high.

[labblab]

Trish, I'm appalled by the vet's response to you and relieved that you're gonna be looking for a specialty referral. Not all the information you were given is erroneous, but there are enough distortions or omissions that I would running to find another care provider, too. Here's some comments about what you were told. My comments are highlighted in blue:


I asked about LDDS and ultrasound and she said “Well, we would be going backwards, but we can do it.” I said I knew it was pretty useless now except for maybe the ultrasound. That could maybe give us an idea about pituitary vs adrenal is a tumor somewhere or not. She said we could do it, but the treatment would be the same. Huh?!?! Did I just miss something here??

I've already commented about the way in which the ongoing trilostane treatment has the potential to skew those diagnostics, but the vet is largely accurate as far as the drug options being the same, regardless of whether Blaze has a pituitary tumor or an adrenal tumor that is secreting cortisol. Either Lysodren or trilostane can be used to treat either form of the disease, although it appears as though trilostane may be increasingly favored by some specialists for treatment of adrenal Cushing's. The real value in identifying the form of the disease is if you would want to consider surgery in the event that Blaze has an adrenal tumor. This type of surgery is very expensive and very serious, so some folks know up-front it is not an option, especially for an older dog with additional health problems that would render surgery too great a risk. But if surgery would be option for you and Blaze, the sooner you are armed with that information the better so that you can consider surgical intervention before the tumor has the opportunity to expand further and invade nearby blood vessels.

I then asked why they did not do an LDDS when Dr S had specifically written, on Sept 19 (I see that now that I have dang documentation), that an “LDDS should also be perfomed to r/o Cushings dx. I guess symbol for pt’s family??? Has scheduled LDDS for Friday 9/21/12.” Really???? Then why did you do a ACTH?? They are the same thing. No they aren’t!!!

You are absolutely within your rights to be royally pissed that Blaze was not given the diagnostic blood test you had requested. Although the LDDS and ACTH are both diagnostic tests for Cushing's, they are most definitely not "the same thing." For what it's worth to you, however, the ACTH is actually the more "specific" test of the two. What this means is that a "positive" on an ACTH is actually a more reliable indicator that a dog truly does have Cushing's. The LDDS is more likely to be skewed by the presence of other nonadrenal disease and thereby return a positive result even when a dog doesn't have Cushing's. Different specialists have different preferences as far as which test to perform for diagnostic purposes. So in terms of diagnostics, it's not necessarily a bad thing that Blaze ended up with a diagnostic ACTH, but it is definitely wrong that he was not given the test you had requested and were expecting. And it's true that the ACTH can never differentiate between the two forms of the disease, whereas the LDDS sometimes can provide that info depending upon the way in which the results array themselves.

Why did we just double up with 60mg twice a day instead of maybe 40 mg twice a day? Bc there is a study saying twice a day works better bc it stays in the system for only 12 hours. Sheesh….so we did it.

Your vet is absolutely correct that many specialists and researchers endorse twice daily dosing. But the SIZE of the dose is dependent upon a dog's clinical signs and ongoing monitoring ACTH test results. So just because any given dose is within Dechra's published parameters does not mean it is the CORRECT dose for any individual dog. Every dog metabolizes the drug differently. In Blaze's case, since the initial monitoring ACTH results were already near the low end of the desired therapeutic range, a much more reasonable and conservative approach would have been to split his once daily dose in half, giving 30 mg. twice daily. There is recent research pointing to the likelihood that dogs who are dosed twice daily actually end up requiring a lower overall daily dose than those who receive their medication only in the morning. But at a minimum, even going by Dechra's published literature, you would only increase the daily total in a small increment if a dog's monitoring ACTH was already within the desired range. I am unaware of any current literature that would support doubling Blaze's dose in your current situation. Here's a link to a recent study endorsing the use of lower doses of trilostane when dosing twice daily:

http://www.k9cushings.com/forum/showthread.php?p=80146#post80146

Thanks for listing all of Blaze's labwork. I do see that he has a mild elevation in his ALKP; many Cushpups have much greater elevations in that reading. But it is a relief to see that his electrolytes are all within normal range. So now we'll wait and see how his monitoring ACTH turns out...

Marianne

[cheydogger]

His blood work looks pretty good. I wonder if the medication has brought some of those levels down or if they were around the same prior. The ALKP is only slightly on the high end. Chey's is around 2400. Did they do a urinalysis too? Some Cush pups are harboring UTI's.

I know it can get a little confusing on these types of forums with so many opinions, BUT it seems like most of us are in agreeance about the lack of testing to differentiate PDH/ADH and the vet's lack of knowledge with Cushing's. Um,......... LDDST and ACTH are different tests! Lol. Geez. I just wonder why they did an ACTH test that day instead of the LDDST when it was written in his chart to do the LDDST???? And, ummmm, ADH/PDH are not always treated the same. (Ask Kim, Skye, and Trish). Additionally, there are a couple of different adrenal tumors. Typically, an adrenal tumor needs surgically removed if it can be which can cure the Cushing's and pituitary is treated with medication. Chey would already be on medication if they were treated the same, but since we don't know 100 percent, she isn't on anything for the Cushing's, just heart and blood pressure.

I am glad you are switching vets.

Good luck,

Ro and Chey

[frijole]

Make sure you type up everything done in chronological order (testing and results) for the specialist as it will save them time and no doubt help them.

The thing that stands out to me is that the alk phos levels on the blood panel are really just a tad over normal and cush dogs tends to be much higher than that.

I think if you simply tell the specialist that you are switching vets because they didn't do the right tests, they said that lysodren and trilostane are the same drug etc etc... they will understand and hopefully give you some recommendations as to who to go to.

Scary but thankfully you are on top of things. Think of the poor dogs whose mom and dads aren't. :eek:

Kim

[Blaze's Mom]

Thanks Marianne!! I knew that both meds were appropriate ways of treating Cushings, but when she said they were “interchangeable”, I guess I took that to mean they would give him whichever they had at the time. I knew his original vet had requested an LDDS and I was under the assumption that maybe it was a better diagnostic test. :confused: It could also be that our personalities worked much better than the current vet working with us. I just didn’t realize she would be so offended by my asking questions. Then again, maybe I came across too abrassive or like I didn’t trust anything she was doing. I was trying to get across that my questions came more from how we were doing things, rather than the specifics or what we were doing. Why the ACTH instead of the LDDS? Why double up 60mg each time rather than smaller doses twice a day? My husband was not impressed with her at all, and being law enforcement, he’s fairly good at reading people. But who knows? I just rubbed her the wrong way obviously.

Ro…She did not do a urinalysis. I asked about doing a diabetes test and retesting his thyroid, but she said no to both. She said they would not do a glucose test and that since the Cushings was not controlled yet, there was no need to check the thyroid. The last bloodwork done was back in June of this year prior to bloodwork. Here are those results:

Catalyst DX
GLU 115mg/dL 74-143
BUN 24mg/dL 7-27
CREA 1.0mg/dL .5-1.8
BUN/CREAT 24 no values given
TP 6.3g/dL 5.2-8.2
ALB 3.2g/dL 2.3-4.0
GLOB 3.1g/dL 2.5-4.5
ALB/GLOB 1.0 no values given
ALT 255U/L 10-100 ***HIGH
ALKP 223U/L 23-212 ***HIGH

ProCyte Dx
RBC 7.51 M/uL 5.65-8.87
HCT 51.7% 37.3-61.7
HGB 17.8g/dL 13.1-20.5
MCV 68.8fL 61.6-73.5
MCH 23.7pg 21.2-25.9
MCHC 34.4g/dL 32.0-37.9
RDW 19.3% 13.6-21.7
%RETIC 1.4% no values given
RETIC 105.1K/uL 10.0-110.0*
WBC 9.92K/uL 5.05-16.76
%NEU 75.4% no values given
%LYM 16.9% no values given
%MONO 4.7% no values given
%EOS 2.3% no values given
%BASO 0.7% no values given
NEU 7.47K/uL 2.95-11.64
LYM 1.68 K/uL 1.05-5.10
MONO 0.47 K/uL 0.16-1.12
EOS 0.023K/uL 0.06-1.23
BASO 0.07 K/uL 0.0-0.10
PLT 231K/uL 148-484
MPV 11.0fL 8.7-13.2
PDW 15.1fL 9.1-19.4
PCT 0.25% 0.14-0.46

I guess I was a little shocked that she told me no to the other tests, but then again, I kind of thought the same thing about the thyroid test. I thought they could do the diabetes test though. But I am not a vet, so I am pretty clueless…lol. Like I said above, we may be willing to do surgery if that will cure Blaze of his Cushings. He is only 7, and he has many years left. Shoot, I sure hope so!! He is only “49”, and I am 47, and I think I have many years left too! Hahaha!! How is Chey doing this weekend on her new meds? I am sure hoping she is feeling better and that her bp has dropped. :D

Kim…I have copies of all his medical records now and they are requesting some things as well. I am going to punch holes in them and put them in a binder so I can make sure I have everything. I thought the ALKP would be higher than it is as well, but even in June, it was only 1 point lower. Ewwwww….my coffee is cold after typing all this up….lol. :eek: And I agree totally. If I had not found this forum, I would be following blindly along to everything the vet told us to do. Thank you all sooooo much!!! I would have no clue as to what Cushings really is and anything about the meds. I told her that if I had truly known about the meds, I would not have gone on vacation when they upped the dosage and let my in-laws watch him!!

So basically, I now just sit and wait and hope that the ACTH results come back today. I hate to admit it, but I am not sure which I am more curious about…the results of the test or whether she will actually call me or not. I know it is the results, but I guess I am still a little ticked at her behavior when we came back that I can’t help but wonder. Shame on me….LOL.

Trish and Blaze

[lulusmom]

Hi Trish.

I am a rescuer and have dealt with ringworm in otherwise healthy dogs and in a dog who was ultimately diagnosed with cushing's. It can be difficult to control in any dog, especially if treatment is not being directed by a board certified veterinary dermatologist. Like the others, I am beyond mortified that your vet did so little testing and if that wasn't bad enough, Blaze's dose was doubled, not based on the results of an acth stimulation test and improvement of other symptoms but because the skin condition was not improving. What an incompetent boob. I audibly gasped when I read that and scared my husband half to death. :D I am so relieved that Marianne explained things to you and that you are on the case. Good for you.

What treatment did your vet prescribe for the ringworm? Did she do a culture to correctly diagnose ringworm and was a skin scrape done to check for demodex mites? Adult dogs with cushing's are more likely to have demodex than ringworm but I've seen dogs with both. Ringworm is highly contagious so I wouldn't automatically assume that Blaze's immune system has been compromised by cushing's. Dogs with cushing's do not have splotchy hair loss which is common in ringworm and demodex so I still haven't seen anything yet in your thread that screams cushing's to me. You mention that Blaze has always had a huge appetite and has been counter surfing for years. My brother has had two dogs who were prolific counter surfers and they did not have cushing's.

If Blaze was drinking and peeing to excess, your vet should have immediately done a urinalysis, including a culture to rule out a UTI and to help validate a cushing's diagnosis. Dogs with cushing's lose their ability to concentrate their urine so urine is dilute and urine specific gravity is low. FYI, a fair amount of dogs with cushing's have a UTI at diagnosis.

I have more questions but I have a function to attend so I need to close for now. However, let me just say that your vet(s) are blatant epic failures in diagnosing and treating cushing's. They have absolutely no business taking on any dog suspected of having cushing's and any dog they do treat is at great risk.

Glynda

[Blaze's Mom]

Hi Glynda!! I took Blaze into the vets on 7-25-12 due to ongoing skin condition. We had seen a few of places with round irritated splotches with the hair inside gone. We had noticed that there were chunks of hair laying around the floor at times that continued to fall out. Dr S immediately suspected ringworm and did a scraping that came back positive for Dermatophytosis (Ringworm). She prescribed TGH Conofite 1% to be applied to affected areas twice daily. Recheck done on 8/8/12 with assessment of worsening dermatophytosis. She then prescribed Itraconazole 100mg PO twice a day and medicated baths twice a week. I guess they continued not being able to get respiration info due to panting. I have noticed that on several of his vet visits, which we had already noticed a lot, a real lot, of panting. He started medicated baths. He was next seen on 9/4/12 with continuation of meds. He was then bathed with the groomer noticing many more spots. Hair sample collected for AMT? culture. Next appt on 9/19/12 with new lesions noted along with flea dirt behind his ear. He has never had fleas before. This is when the LDDS was recommended. The ATM on 9/4/12 came back negative as noted this date. Unfortunately, I didn't know this and he continued his meds and medicated baths for another month or so. After that, all the info is mentioned in prior posts. The other symptoms she may have been looking at are:
• increased/excessive water consumption
• increased/excessive urination
• increased/excessive appetite
• appearance of food stealing/guarding, begging, trash dumping, etc.
• sagging, bloated, pot-bellied appearance (not sure on this one)
• weight gain or its appearance, due to fat redistribution
• loss of muscle mass, giving the appearance of weight loss
• exercise intolerance, lethargy, general or hind-leg weakness (not sure on this one either bc he seems to sleep a lot and has for a while now. No weakness, but hard to say bc sometimes he doesn't want to jump up on the bed like he used to but when he does, he seems fine. This could be bc we kenneled him the last few months not allowing him to get on bed/couches due to ringworm) He had free reign of the house while we were home....took up all rugs, no jumping on bed/couches, etc due to contagion.
• 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 (dark splotches and now new hair growth is coming in very dark) ??
• susceptibility to infections (especially skin and urinary)
• diabetes, pancreatitis, seizures (several bouts of pancreatitis)

I really hope this made sense...lol. I put comments where necessary.

[Blaze's Mom]

So...here I sit, the vets closes in 45 minutes, knowing that the ACTH results are just sitting there at the vet's office. How do I know this? Bc I called about a hour and a half ago to ask if they were in yet. They said yes, but a doctor has to read the results and Dr P is not in today. Really?? Shocker!! Why does that not surprise me?? The receptionist said Dr E (the older, male vet who I have never met) was there seeing patients but that he was really good at returning phone calls. He could read the results and call me. She was writing him a note right then. So...I guess I will sit and wait for the next 45 minutes hoping they call me back.

Trish and Blaze

[Blaze's Mom]

Yea!! We got the call! Dr E just called with Blaze's ACTH results and they are good. Pre-ACTH was 2.2 and Post-ACTH was 2.9. I am so glad it was not lower. He also said that he had a Cushing's dog and that the IMS we were seeing on Friday was the one who helped them. He said she is really good. He seemed really nice and I am glad he called us back. Now we can enjoy the rest of the weekend. :D

Have a wonderful weekend!!
Trish and Blaze

[molly muffin]

Oh that is really good news Trish! ACTH results are good and a fine recommendation for the IMS you'll see. Maybe you can see this Dr. E, while yours is away? Instead of Dr. P.

Very good news.
hugs,
Sharlene and Molly Muffin

[Blaze's Mom]

Well...it has been a few days since I have been on here. We have an appointment with the IMS tomorrow morning and they called today to confirm and ask that we withhold food tomorrow morning in case we do an ultrasound. It sounds like we probably will. I don't really know what to expect, or what to hope for. I don't know if I should be scared, worried, optimistic, or what. I think right now I feel a little numb. I sit and watch Blaze and wonder...is he more energetic now? And then I wonder...is he sleeping more often? I do know that he isn't drinking excessive amounts of water, but I also wish I had known enough to measure his water intake before we started meds. His food intake has always been measured and I think he will always be a dog who absolutely loves food. Just like his mama...lol. His skin is still dry and peeling, his hair is still thinning. Another 5 brush fulls tonight while brushing him. However, there is black hair growing in other spots that, I think, are "healing". He still prefers cool places...doesn't stay on the couch or bed with us much. Always ends up on the bare floor. But, for the most part, he is still just as cuddly and loving as he always was. Not sure I'm gonna get much sleep tonight.

I hope everyone else and their precious fur babies are doing well....
Trish and Blaze

[cheydogger]

Looking forward to hearing what you found out today.

Isn't is sad how crazy this disease makes us, the owners? It's horrible. We start obsessing over every little thing. Ugh. I am right there with you.

Still thinking about you and Blaze,

Ro and Chey

[Blaze's Mom]

Just returned from the IMS appointment. I am really impressed with this vet! She and her nurse (male) spent a total of an hour between the two of them talking to me about Blaze before preceding with the ultrasound. They both sat on the floor with Blaze when they came in and answered any and all of my questions and wanted to make sure I was comfortable with everything. The regular vet apparently had not sent over some of the documentation the IMS needed and she was very impressed when I whipped out my notebook with all his medical records copies in it. She made a copy of everything and I called my old vet back in South Dakota, who has seen Blaze since he was born, and the faxed all their med records as well. The IMS informed me that the skin condition is bacterial, not fungal, as the other vet was treating. She gave me meds and a medicated shampoo. Also recommended fish oil. She noticed the mild increase in his BUN from blood test I made the vet run on last visit and did a urine test (which the other vet refused to do when I asked). Results will be back tomorrow and they will call me with them. She also mentioned the doubling of Blaze's Vetoryl instead of gradually increasing while going to twice a day; especially when his ACTH was in the normal range with once a day. I said that was another of my concerns that I brought up to my vet. You can see the previous post about my vet being offended (I am guessing) with all my questions. Okay...on to the ultrasound results:

No free fluid.
Moderately enlarged liver with indistinct areas of hyperechoic texture. No nodules or masses. Normal gall bladder and biliary ducts. Normal vessels.

Normal thickness and texture of spleen. No lymphadenopathy.

Normal kidney size and shape bilaterally. Normal tissue texture. No distention of pelves. No pelvic stones. Normal bladder wall thickness. No stones or sand.

Normal GI tract. No thickening of pancreas or peripancreatic edema.

Mild enlargement of adrenal glands with normal shape bilaterally.
Left = 1 cm Right = .8 cm

Bilateral adrenomegaly, compatible with Pituitary Dependent Hyperadrenocorticism.
Hepatic texture changes compatible with vacuolar hepatopathy.

Today's assessment: Blaze has flaking changes in his skin classic for a bacterial infection. Ultrasound showed bilateral adrenomegaly and changes in his liver consistent with Cushing's disease. Urinalysis (910) pending.

Decrease Vetoryl to 60mg once a day. Simplecef 100mg tablets, 1 1/2 once a day. 500mg fish oil once a day for one week, then increase to 1000mg once a day. Medicated shampoo when going to groomers.

Call her in 10 days or so with update on skin and to discuss time to recheck. Will most likely recommend a blood test plus/minus an ACTH stim test in 3 months, but will want to recheck skin sooner.

She also gave me two recommendations for new vets in the area that they work well with. That was huge relief! I feel very confident with this IMS and so happy we decided to request the referral. I mentioned this forum and told her how grateful I am to have found you all. She said she was all for gaining as much knowledge as possible and that she was big on listening to the parent's information about their baby as they know them best.

So...what do y'all think with all of the above?? On the right tract now??

Trish and Blaze

[Blaze's Mom]

Hey Ro!! The results are in...lol. And yes, it is totally crazy!! Blaze seems to be doing well. He was really good at the vets today; especially given that I had "starved" him this morning. :)

How are you and Chey doing? Is the bp down??

Trish and Blaze

[labblab]

Trish, I'm so happy to read your update!! :)

The IMS sounds like a "keeper" to me. ;)

I'm so relieved to hear about the dosage decrease back to the original 60 mg., and I'll keep all fingers crossed that Blaze's skin issues will now be resolving with proper treatment.

WHEW!!!!!!!!!!!!!!!!!!!!

Marianne

[cheydogger]

Right on. It seems the original vet did have the correct diagnosis then. It just scared me how easily she diagnosed Blaze and started him on meds, not to mention how clueless she was about tests and meds being the same. It sounds like you got a lot accomplished today. Hopefully, the antibiotics heal his skin. Too bad they treated him for fungla all this time.

Let us know what the other results are;)

Chey's BP is down a little:D. We are seeing the IMS for an ultrasound Monday and the surgeon will look at it too. I will keep my thread posted on that.

Good job today!

Ro and Chey

[Blaze's Mom]

Thanks Marianne! I am too! She was great and I look forward to working with them again, as well as finding a new vet. Whew is right! LOL We will be concentrating on his skin now and hopefully that will resolve quickly. Then she will revisit the Vetoryl dosage. She said that the Vetoryl should not be used to try to treat the skin condition….the skin condition should be resolved and THEN look at the dosage. Makes so much sense. :D

Sigh of relief Ro. Here is the way I see it. My original vet, Dr S, was the one who came up with the idea to test for Cushings. Then she left the following day on maternity leave. It was the covering vet, Dr P, who did the other test and all the Vetoryl dosing…initial dose and increase. I think Dr S knew what she was doing, but Dr P didn’t. Either way, we will be changing vets. I will be researching the two recommendations from the IMS. I am sooo glad Chey’s bp is down now. I can’t wait to hear what the ultrasound reveals. Does she seem to be feeling a bit better with the lower bp?

Thanks all…..
Trish and Blaze

[molly muffin]

Yay!!! This is fabulous news Trish. I am sure that Blaze will be so much better having a more knowledgable "team" working on the case. You will probably get a lot more sleep at night too not worry so much. I fully expect that everything will work itself out very well now that you have an IMS on board!

This is a good day for you and Blaze

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Hi Trish,

This is a magnificent report not only the U/S results, but the IMS interaction with you and Blaze. :cool::cool: That is wonderful and I am so glad you have a good IMS on your side!

Hugs,
Leslie and the gang