Desperate for some help

[Amber]

My dog, Amber, is currently 9 years old (rat terrier) and was diagnosed with Cushings and low thyroid levels in December. She began drinking a ton of water and the nhaving accidents in November of 2012 so I brought her to the vet and they tested her urine for a uti. Everything came back fine so he gave me a medication to help strengthen her bladder because he thought it might be that she couldn't control it because she is older and was spayed at a young age. He also told me that if this didn'twork that she should be tested for Cushings and Hyperparathyroid. THe medication didn't do much so I brought her back in December and had the blood work done that stated she had Cushings and a low thyroid level. She has been on Vetoryl and Soloxine for 2 months now. She seemed to be getting better and was getting more active and getting back to being her usual self. Last week, I noticed her being more lathargic and then limping in her hind legs and wasn't as excited to eat as she usually is. I have recently had to coax her to go out and brought her back to the vet Monday because of that and she seemed to have a cold (was cold all the time, sleeping a lot, and coughing). He gave me amoxicillan with prednisone in it to help with her gland and throat swelling. She seemed fine Tuesday, but her limping is getting worse and she is having trouble going up the 2 steps to come inside and today has vomitted 3 times since she ate (I think her stomach is empty now). She has also lost 2 pounds in 2 months and looks very weak and thin. Is this a normal side effect of Cushings? The vet hasn't done any testing since the initial diagnosis. Should I pressure him to do follow up testing? I am VERY concerned and any help would be greatly appreciated. I had a dog that I had to put down 2 years ago that was showing the same symptoms Amber is now. It took the vets 6 months to begin to figure out was wrong with her and she lost 8 pounds and refused to eat. I know this was a long post, but she is my baby and I can't imagine putting her down nor watching her waste away like she seems to be doing. Thanks in advance for any help!!

[labblab]

I am so glad you found us!! Upon reading your description of your girl's symptoms, my very first thought is that her cortisol may have dropped too low on the trilostane. This can create a condition known as Addisonian crisis, and can worsen rapidly and actually become life-threatening. Absolutely, your vet should have done followup testing during these past two months in order to make sure that her cortisol was not being oversuppressed. The monotoring test for Cushing's treatment is the ACTH stimulation test. It should have been first performed two weeks after the start of trilostane, and then again one month later.

But that is all water under the bridge right now. The important thing is taking care of your girl right now. Given what you are describing, I don't think you should give her any more trilostane until this is sorted out. You need to call the vet and tell them how ill she is, and tell them you are bringing her in to be tested. As I said, the desired test is the ACTH stimulation test. But if your vet is not able to perform that test, at the least they should check a baseline cortisol level and also your dog's basic blood chemistries in order to make sure they are all in balance. When cortisol and/or aldosterone drop too low (both of these are adrenal hormones that are lowered by trilostane), a dog's blood chemistries can get totally out of whack. And this is the part of things that can actually become life-threatening.

Here is a link to the Product Insert for Vetoryl (brandname trilostane). It will tell you about the importance of these monitoring tests and the dangers of overdosing:

http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf

I see your dog is already getting a combo drug with some prednisone included. But if her cortisol level is too low, she may need even a bigger dose of supplemental prednisone to make up for the cortisol she is lacking.

Can you tell us how much your dog weighs and also what dose of trilostane she is taking? Also, can you tell us what her dose of Soloxine is?

Marianne

[Amber]

She usually weighs between 19 and 18.5. Her current weight is 17 lbs. The soloxine is .3 mg and she gets half of one twice a day. The vetoryl dose is 30 mg once a day which I give her with her evening meal. I really appreciate your help. I was worried that she is getting too much medication because I read the inserts for the vetoryl and it says to do periodic testing. I called and left a message at the vet. She is holding down a few small milk bones but is still miserable looking.

[Amber]

Would the overdose be causing her weakness and limping?

[labblab]

Yes, weakness and lethargy can definitely be caused by overdosing. I am really worried about your girl, too, especially because your vet did not seem to recognize these warning signs when you took her in on Monday and test her then!

This is a back-burner issue at the moment, but dogs who are dosed once daily with trilostane really should get their medication in the morning with breakfast. This is because the monitoring ACTH tests need to be performed 4-6 hours after dosing (and therefore, during the day when the vet's office is open). The fact that your vet seems to have just turned you guys loose with no instructions nor followup is very worrying.

Do you have an emergency vet available to you in the event your regular vet does not know how to proceed at this point?

Marianne

[Amber]

The vet gave me no instructions on how to gove the meds other than the soloxine was twice a day and the vetoryl once a day. I looked at the inserts and saw that soloxine should be given 30 minutes before meals and vetoryl with food. I have an appt in an hour with the same vet, he is the only one available, but I may have some back up with me (aka my dad) and see if we can get him to test her again. This os the only vet office in the area that was recommended to me, I was warned about all the others. There are a few different doctors in the office though so if need be I'll take her in tomorrow to see the one that owns it. When i took her in on Monday, he said she had a 'bug' similar to a cold and seemed to ignore thecfact that she was limping and attributed her weakness to not feeling well from a cold like illness and gave me the amox and prednisone mixture. Thanks for all your help, I greatly appreciate it!! I will update when I get back from the vet. If they do do the tests, should I skip the vetoryl tonight and give it to her in the am instead or not give it at all?

[labblab]

The testing is a hard call, because under normal circumstances, trilostane is only effective in the body for around 12 hours. It reaches maximum effectiveness after 1-2 hours, and that is why the recommended testing window is 4-6 hours after dosing -- so as to see how low the cortisol is driven at the time of maximum effectiveness. If your dog was feeling and acting well and you were planning routine monitoring ACTH testing, I would recommend that you hold off on the testing until you had switched to morning dosing for at least a few days beforehand so as to stabilize your dog on that dosing pattern.

However, if your dog's adrenal function has been oversuppressed such that a healthy amount of cortisol is no longer being produced at any time during the day, her safety is your primary issue right now and you want the testing done more-or-less on an emergency basis in order to make sure she is not at the risk of collapse.

So having said all that, I would not give her any more trilostane at all until at least some form of testing has been done. The ACTH stimulation test requires a special testing agent that your vet may not have on hand and would have to order. That's why I'm searching for other alternatives such as an emergency vet. Or, as I said earlier, even just testing the baseline cortisol along with basic blood chemistries can give some helpful information. If your dog's baseline cortisol level is higher than 2.0 ug/dl, then it is less likely that she is on the verge of a crisis due to low cortisol. The baseline cortisol reading as well as the basic blood chemistries is just a simple blood draw.

I would definitely print out that Dechra information sheet and take it in to the vet with you for reference purposes. Keep us updated, OK?

Marianne

P.S. Just want to add that of course, something else may be causing your dog's illness right now. But that's where the blood chemistries are doubly helpful, because they can identify other issues that may be going on with her liver, pancreas, kidneys, etc.

[Amber]

Ok I'll see what the vet has to say. She did seem like she had a bug of some kind but to me the weakness and limping weren't related. I did find a few sites that said that prednisone would make cushings worse and a cushings like reaction could happen in dogs that are given prednisone on a regular basis for an extended period. Seems like it could be a hundred different things! if only she could tell me what was going on...

A woman My mother works with uses the same vet and brought one of her dogs in last week as well and his weight is dropping rapidly and he isn't acting right either so she is bringing him bac today as well. Could be that there is something at the vet's office causing this. Will have to wait and see. Thanks again ad I'll update yo when we get back home.

[labblab]

I was momentarily forgetting about the prednisone she'd been given with the amoxicillin. What dose was the prednisone and is she still taking it? If prednisone has been ingested within 24 hours of ACTH testing, the result can be skewed upward (in other words, the prednisone will be registering on the test in addition to the dog's own cortisol reserves). Theoretically, if her cortisol was too low, you'd think the supplemental prednisone would be helping. But it all depends on her insufficiency (if that is the problem) and the amount of the prednisone dose. Plus, the cortisol level might be OK but her potassium/sodium level could be out of whack. So there are a lot of variables to consider.

Bottom line, I think it's good you're taking her in to be seen.

[Amber]

She's been getting 2 ml twice a day of the amox/prednisone mix which is 30 ml of amox with 20 mg of prednisone mixed in. I gave it to her at 8 this morning.

[labblab]

If she's getting 20 mg. of prednisone daily, at her weight, I would definitely think that amount would be more than "rescuing" her from low cortisol right at the moment. It would also definitely render the ACTH test inaccurate right now. So her situation is a puzzle. I suppose the antibiotic could even be causing her to vomit if she's sensitive to it. I think I'd still want the blood chemistries tested right now, regardless. And if she were mine, I'd still hold off on the trilostane, too, for the moment. As I say, until you have the chance to get things sorted out -- including a monitoring testing schedule!

[Amber]

The total mixture has 20 mg of prednisone but she only gets 2 ml of it twice a day. Waiting on cbc and electrolyte check right now and he said she is very dehydrated despite the amount of water she's been drinking. He is puzzled at this point.

[Amber]

Well. Blood work was all screwed up (vets words not mine) her potasium and sodium levels were all over the place plus she is very dehydrated. They are keeping her for a few days to keep her on an iv and monitor her til her levels drop back to normal. Said to stop the vetoryl for a while but going to keep her on the soloxine. He's stumped as to what is causing it. Hopefully she'll br better in a few days and we'll know what's going on. Quite the Valentine's day. Thanks for all your help and I will keep you updated.

[Boriss McCall]

Welcome to the group.
I am so sorry your baby is not doing well. You are right this is no way to be spending Valentine's Day. :(

I hope she starts feeling better soon so you can get her back home. I am glad you found this group. You will get lots of good advice here from very experienced people. Some of them know more about Cushing's then A lot of bets. So you & your pup are in good hands now.

[labblab]

Wow, I'm really glad she's getting those IV fluids. But as we've already discussed, imbalances in potassium and sodium are classic symptoms of Addisonian issues prompted by low cortisol/aldosterone. And I would think the acute dehydration was caused by her vomiting which is also a symptom of adrenal oversuppression. So I'm puzzled as to why your vet is so puzzled and does not seem to be considering trilostane overdose as the likely culprit. Your girl may be in serious need of additional steroidal supplementation right now to replace oversuppressed cortisol and/or aldosterone, and your vet needs to be on top of that. Simple IV hydration may not be enough.

I am giving you the link to the "Contact Us" page for Dechra, the manufacturer of brandname Vetoryl:

http://www.dechra-us.com/Default.aspx?ID=365

Dechra has a technical veterinary staff on hand to field questions if vets are uncertain as to how to identify and treat overdoses. You can even try contacting Dechra yourself with your questions, although they sometimes prefer to talk directly to vets.

Anyway, bottom line is that your vet absolutely needs to check your dog's cortisol level sooner and not later, given what appear to be major abnormalities in her electrolytes. He can talk with Dechra about how to proceed. If she needs to be given supplemental steroids immediately, they can be given in a form (dexamethasone) that will not interfere with the ACTH testing. But the Dechra vets will be able to supply all the details to him.

[labblab]

I'm surely anxious to hear how your girl is doing today! Also, in all the excitement yesterday, I didn't even have the chance to properly welcome you and to tell you what a great job you are doing as her advocate. Kudos to you for going to the literature yourself to find out how the trilostane should be given and tested. Good job!!!!! :) :)

The part that was (is) frustrating me was that it sounds as though you have done a much better job of researching the drug than your vet has! But thank goodness you've been taking such good care of your girl. Once again, we're really glad you found us. And we'll be holding our breaths for an update...

Marianne

[Squirt's Mom]

Yes, I haven't posted but I am reading along and wondering how your sweet girl is this morning. Let us hear from you when you can.

Hugs,
Leslie and the gang

[Amber]

Thanks for all the help and support! Amber is doing much better today. She spent the night at the vet on iv fluids and meds to bring her potasium down. She is still very dehydrated so they are going to keep her til monday and do more blood work then and hopefully she'll be able to come home. She is off all meds for the time being. It seems to me that it is Addisons. I wasn't sure she was going to make it through the night so it was a very welcome call this morning. Will update everyone tomorrow! Thanks again, your help and suppprt mean the world to me!

[labblab]

Whew!!!! Thanks so much for this update!!!! :) :)

Do keep us posted through the weekend, OK? Has your vet talked with you about checking Amber's cortisol level? That really, really needs to be done before she is discharged home.

Marianne

[Amber]

He hasn't but I intend to talk to him about this tonight.

[molly muffin]

Hi, I too haven't had a chance to welcome you yet, so Welcome :)

You're doing awesome. Keep on the vet till he checks those cortisol levels, give him the dechra lit if need be, so he'll understand about testing and risks associated with treating with Trilostane, vetroyl.
I'm so glad your baby is doing much better. That is a very scary situation to be in.

Sharlene and Molly Muffin

[Amber]

Amber is doing MUCH better. Her potassium was at 9.7 Thursday. The vet was surprised she didn't have a heart attack. They kept her on fluids all weekend and she is off all meds for the time being. I will bring her back in 30 days to have her tested again and we'll go from there. The vet thinks that her went from Cushings to Addisons because of the meds. She has gained half a pound over the weekend as well and her mood has improved. She can walk normally too which is a relief. I've been doing some research and I may talk with the vet about the possibility of her being diabetic. The symptoms seems to be very similar to Addisons. I'll have to do somemore research. All her levels are back to normal now and I'm hoping they stay that way. She will be getting lots of TLC!!! Thanks again for all your help and advice! Means a lot to us both!!

[labblab]

I am so relieved to read your report, but like a broken record :o, for Amber's safety I have to ask whether your vet has performed an ACTH stimulation test? He should not be guessing as to whether or not she is Addisonian. The result of that test will tell you whether or not she needs to be maintained on supplemental oral prednisone. Without that information, you can immediately find yourself right back in the same situation with Amber again at risk of a heart attack once she is off the IVs. And the reverse could also be a possibility -- her cortisol could actually rebound rather quickly and she'd be back in need of trilostane again (but at a reduced dose!). All of this is total guesswork, though, without the proper testing and I am really hoping that the testing and retesting you are talking about includes an ACTH. Can you please let us know what the numerical results of her test turned out to be?

Marianne

[frijole]

Just chiming in to reinforce what Marianne has said. I am very happy your little one has survived the overdose. Please know that continued care is required and watching those numbers is critical to survival. Kim

[Amber]

Yes he going to do the testing again in a month. They have to wait until her system gets back to normal or the test results would be scewed because of the stress she was under and all that. She is getting back to normal, or rather how she was before she started acting different and was then diagnosed with Cushings, and eating everything in sight. You'd think she hasn't eaten in weeks the way she acts! She is a touch moody with my other dog and the cat, but I think it may just be that she has to get back into the swing of things and isn't 100% yet. Hopefully in a month we'll know for sure what is going on.

[labblab]

Amber, I am so sorry to keep badgering you, but from you have written I still don't know whether or not your vet has performed an ACTH stimulation test to measure your dog's cortisol reserves. Did he do one in conjunction with this hospitalization? Because right now, while your dog is under stress, is the time when it's important to have that test done in order to see whether supplemental steroids should be given to really get your dog back to normal. You do want to check the cortisol in the future, but you also need to be checking the cortisol now. Please ask your vet specifically about the ACTH stimulation test and whether or not it's been done yet.

Marianne

[Amber]

He didn't do the ACTH because of all the stress she was under and the fact that her potassium and glucose were out of wack would give false test results and treating based on those results could cause a worse reaction than she already had. I will bring her back in a month to get the ACTH testing done again and also check her thyroid function again to see what the next step is. The vet thinks that she may have been misdiagnosed with Cushings because it is very similar to other dieases and has similar symptoms. If she does have Cushings, he will start her at a lower dose than recommended for her weight and see how she does with that. If it's not Cushings, we'll have to see what it is and then base treatment off of that. Cushings can be a tricky disease because it is similar to others and there is no definitive test that says yes it's Cushings or no it's not. Diagnosis is based off of the results and is some what of a process of elimination.

[labblab]

I am very, very sorry to write this. But based on everything that has happened since you first found us, I have to say bluntly that I don't think your vet knows how to properly monitor a dog suffering from either Cushing's or Addison's. Your dog might never have even needed hospitalization in the first place had your vet not ignored obvious warning signs earlier in that week that the cortisol level had dropped too low and performed the ACTH testing then. I'm really fearful that he's put your dog's life at risk. I've just read back through your thread, and now I am not sure whether an ACTH test has ever been performed at any time, as it's not clear what initial diagnostic testing was actually done. So I have to agree, there's every possibility that your dog never has had Cushing's at all. And to start a dog on trilostane and not perform a single ACTH test thereafter, even in the face of a life-threatening Addisonian crisis -- that is just crazy.

I only tell you this because I remain very, very worried about your dog. Of course, I am not a vet myself. But as I suggested earlier, I encourage you to contact Dechra and ask to speak to a staff veterinarian. You can tell them what has happened and ask them whether or not they think ACTH testing is important. I will truly faint if they tell you that the testing doesn't need to be done sooner rather than later! You said you had limited vet options near you, but is there anybody else at all who you could consult with?

Marianne

[Squirt's Mom]

Sweetie, can you tell us what test Amber had that diagnosed the Cushing's in the first place? I can find nothing in this tread that mentions one single cush test given, ever. Please help us understand how this diagnosis was reached in the first place. I am very worried about your pup and if it is as it seems - that your vet started her on very powerful drugs with nothing to support the need for them - then I fear this vet may present a danger to every pet they touch.

So please help us understand how the diagnosis of Cushing's was arrived at for your sweet girl and we will do all we can to help make sure she is on the right path. We are very concerned about your baby. ;)

Hugs,
Leslie and the gang

[Amber]

He did an ACTH test and a few other (I'm certain what they were) that made him believe she had Cushings and her thyroid level was on the low end of normal so he started her on the Vetoryl and Soloxine. He did the tests in December and wasn't sure if it was Cushings or hypoparathyroidism so he tested for both. I don't have a copy of the results so I don't know what the actual numbers were

[Squirt's Mom]

Would you mind asking the vet for copies of all those tests he did in the beginning and posting those result here so we can see them? That would help us a great deal in offering more meaningful feedback. Most vets are happy to give you a copy. Just tell him you want to keep a file at home just in case you have to take Amber somewhere where she may need to see a different vet on an emergency basis.

[lulusmom]

Hi Amber and a belated welcome to you.

I've just read your thread and like Marianne, I am very concerned about your vet's ability to properly diagnose and treat cushing's, according to safe and established protocols. It makes it very difficult for us to provide you with meaningful feedback without the benefits of looking over your vet's shoulder and seeing the results of tests that were done to diagnose your dog and results of any acth stimulation tests that were done after starting treatment with Vetoryl. If any acth stimulation tests were done after starting treatment, unless they were done within 4 to 6 hours after dosing, their usefulness is highly unlikely. I see that you were dosing once daily in the evening which is a no-no. Your vet should have explained all of this to you and if he didn't, that would be yet another red flag that your s/he is flying by the seat his/her pants in treating your dog.

I understand that you don't have copies of tests but please help us help you and your dog by getting copies and posting the results here. I have so many questions, I don't know where to start. :confused: You mentioned that your vet put your dog on a mixture of prednisone and amoxycillin for swollen glands or sore throat? This is not a symptom we see with cushing's so what did your vet say caused this? It is not good to prescribe prednisone to a dog with cushing's or even a noncushdog for that matter, especially if you don't know what the problem is and you simply throw antibiotics and prednisone at it in the hopes it will fix it.

When did you start treatment with Trilostane and did your vet do an acth stimulation test two weeks after starting dosing and/or four weeks after starting dosing?


The vet thinks that she may have been misdiagnosed with Cushings because it is very similar to other dieases and has similar symptoms. If she does have Cushings, he will start her at a lower dose than recommended for her weight and see how she does with that. If it's not Cushings, we'll have to see what it is and then base treatment off of that. Cushings can be a tricky disease because it is similar to others and there is no definitive test that says yes it's Cushings or no it's not. Diagnosis is based off of the results and is some what of a process of elimination.

Oh my gosh, I do hope this isn't the same vet who diagnosed your dog because waiting until she got deathly ill requiring IV fluids is a really bad time to be raising that question. If it is the vet who diagnosed your dog, I would be absolutely appalled by that comment. Cushing's is probably the number one misdiagnosed canine condition so this is another reason why we press members to post results. I realize that you may not have provided us with complete details of your discussions with your vet but based on what you have shared, it looks like your vet hasn't given you a a definitive diagnosis for any of the things your dog has been dealing with.

With all that has happened to your precious pup, the worst of which I believe should have never happened, would you consider consulting with an internal medicine specialist so that you can finally get the answers you need for your peace of mind and your pups quality of life? If so, if you let us know what city you are near, we may be able to give you a name or two. Or you can search for one at www.acvim.org

Glynda

[molly muffin]

hmmm, I have to agree with everyone else. It is super strange that an ACTH wasn't done as soon as the symptoms were noticed of her going down hill. It is the first thing that every small animal internal medicine specialist checks for is a crisis and every Vet ER. Usually an ACTH test is done in conjunction with the electrolytes. It's a package deal and some members Always get the electrolytes checked with every ACTH test, others just if they notice something iffy or off. So that to me is really strange.

Here is the deal. Vets are usually great, but they aren't all experienced enough with cushings, sometimes it requires a specialist to intervene. It certainly did in my personal case. In the end though, the more you learn yourself about the testing protocols, the symptoms and what to watch for, things that can interact negatively with other things the better of an advocate you will be for Amber. You are her voice when she has none and you are the love that makes her try so hard to be everything she can be to and for you.

Hang in there!
hugs,
Sharlene and Molly Muffin

[frijole]

Amber, I just wanted to share with you how I landed here over 8 yrs ago... similar deal. Vet gave my dog lysodren with a totally bizarre dosing schedule (didn't follow protocol) and absolutely NO plans of doing the acth test. At the time I didn't know better but for some reason I refused to take the pills that day.. I told her I would think about it and get back to her.

So I went to my dear friend "google" just like you probaby did and I landed with this group. They told me what you are reading today. I was torn between the relationship with the vet, not knowing who else to go to (new vet) and whether or not these internet people knew what they were talking about.

So.... I checked it out and read articles on cushings, how to treat it, how to test etc and I found out that they were right and my vet was clueless. So I went back to the vet and asked her about doing the acth test and why she didn't have one planned. She was totally lost. She said she would contact her specialist and I asked who that was and come to find out it was not a specialist that works at an office but rather a rep from the lab that they used. In other words I caught her with her pants down.

I walked out of there and never went back. This group held my hand as I worked with the next vet because he was better but I live in a small town of 25000 and he wasn't real well versed either.

I am sharing this story because my dog got better and lived as a result of these people and this site. My dog Haley would have died way before 16 1/2 (she died of old age not cushings) had it not been for the help I got here. It might be free but it is invaluable.

I am here to this day because if you read the other threads you will see there is a whole lot of cases where people need extra help and hand holding. So this sadly happens alot.

Please trust me when I tell you your vet is so lost he/she should be paying YOU for allowing him to 'practice' on your baby. Please get copies of all testing that was done (if any) and run out of that place into another office - if you have a choice.

I worry for both you and your dog. Please know this is sent because I care. Kim

[mytil]

Hi from me too,

I know this must seem overwhelming to you and yes there is a lot to learn about Cushing's and other diseases for that matter. But we are all here to help you and your pup through this. Many here have been where you are now and being the squeaky wheel is what is needed to be your pup's advocate.

These drugs are powerful and to haphazardly use them without following proven diagnostics and protocols can produce these dire results.

I am glad your girl is doing better for now, but please try to find a second opinion and if your vet gets mad at you for doing this, then this is not a good vet.

Ask for copies of all test results.

Please continue to keep us posted
Terry

PS - in the link Glynda provided click the top right where is says PET OWNERS and the drop down FIND A SPECIALIST. This will take you to another menu where you can fill out your State and choose SAIM (small animal internal medicine) for specialty and click SEARCH. You may find one very close to you. And if your vet balks at giving you a referral, go directly to the specialist you found.

[frijole]

Hoping that everything is OK with your baby. Kim

[SoggyDoggy]

Hi Amber,

Sorry I haven't been by to welcome you earlier, but better belated than never :p

Anyway, I just wanted to echo what others have been saying about checking on your vet. I too had an experience with a clueless vet - who in the initial phase managed to bluff me completely - until I caught her at it. My boy was severely overdosed, which the results of the ACTH showed, but because of the advice I got here in getting copies of the blood results, I found out. I had two vets in the same practice try to tell me that his results were spot on, but when I got hold of a copy, I found out that they were reading the wrong ranges, and in fact he had nearly zero cortisol reserves in his system. We were within days of an Addisonian crisis! I took him to an IMS who agreed that he was overdosed and have since had him sorted. When I discussed the situation with the original practice manager, she was absolutely horrified at what had gone on and what I had been told. Of course, having had this place as backup and a resource, I was able to lay everything ou than had gone wrong. The main vet responsible is now under review!

As a result of this though, I would highly advise anyone now, but especially you at this point, to ask for copies of the any and all tests performed to this date so that you can look them over yourself. If you are comfortable, post those results here so that others can help you interpret what is going on. Again, this is what helped me to make sure, but when looking at the test results is when I found they had been reading wrong ranges. This was my experience, but a lack of diagnostic and monitoring tests is equally of concern.

Like others, I am very concerned that your vet is inexperienced with cushing's, and the let's treat and see approach is not good. On the other hand, I am very glad to hear that your girl was doing better a couple of days ago and sincerely hope that has continued! I would still advise you to wait before resuming anything though until you yourself have a clear picture of what is going on and not trusting someone who appears to not understand the serious nature of trilostane/vetoryl.

Do please let us know how she has been going over the last couple of days.

[Amber]

Sorry it's been so long, things have been kind of crazy (not with Amber, she's doing fine). I spoke with the vet again, and he has been doing more research on Cushings but he believes that she may have Addisons instead. At this point, I am just wainting until I can bring her in again to get another ACTH done and then take the results and go from there. She seems a lot better than she had before I noticed her acting weird and was prompted to bring her to the vet in the first place. I have her scheduled to go back March 18 to do another ACTH test and will have to wait about a week after that for the results. When I bring her in for the testing, I will get a copy of all the results of all previous testing (I plan on googling a lot!) and will also get a copy of the results of the most recent test when they come in. I will post all the result here when I get them. We've been having some pretty bad weather around here the last 2 weeks so I've been staying off the roads as much as possible. Thank you again to everyone for your support and advice, you have been confirming my gut feelings and my google results! Once she gets the ACTH done and the results are in, I will talk with the vet and see where I want to go from there. I trust the current vet we are using, but he doesn't seem well informed about these kind of issues. I have made some phone calls to all the major vets within an hour of here and none of them seem to deal with this at all, never mind finding one that is well informed about it. We'll have to wait and see what the results are and what the vet's recommendation is until I make a decision to stay with him or switch vets. Thanks again everyone! I'll try to get on here more often and keep you updated. My baby is doing very well with all the love and cuddles I've been giving her and no meds.

Is it possible that her cortisol and other levels were off due to something else, and not Cushings or Addisons or thyroid problems?? She hasn't shown any symptoms of any of these issues since she's been home from the vet after she was there for 3 days. It almost seems that she just needed a jolt from the meds and then was getting too much. Hmm. It's a tad confusing. I've been watching her like a hawk and have also been tracking her weight so I can make sure she doesn't start to go down hill again. She's back to her usual weight (18.4 lbs) and has been playing non stop. She is back to eating like she is starving to death, which I can assure you she is not, but she has eaten like that since I got her as a puppy.

One other thing that doesn't really have anything to do with Cushings but I am hoping you all may have some tricks: she eats poop. All the time. Her's and our other dog's. She will ask to go outside just to find some to eat. We pick it up and she follows our other dog around waiting for her to poop so she can eat it. I'll take them out one at a time and she still finds stuff to eat. I've tried giving them both the stop poop eating pills, pineapple, every trick in the book. I even try to bring her out on a leash and she refuses to go to the bathroom, no matter how long I stand out there with her. I bought a muzzle and she pulls it off no matter how tight I make it. I even tried tying it to her collar and she pulls it off. I am at my wits end, I don't know what to do. Everything I have tried works for a week or two and then she's right back to it. I have no idea why she does it, but she has since we've had her and she's 10 yrs old now. She does occasionaly eat holes in blankets and her beds, but the last 3-4 months she hasn't eaten any more. I've been buying her lots and lots of chew bones and that seems to keep her occupied. She destroys them in a day or two so I haveto keep a stock of them. She doesn't chew anything else in the house, just blankets and her bed occasionally. Any thought???

[addy]

Gastrointestinal medical problems should be ruled out as a cause for this problem. A maldigestion or malabsorption syndrome may result in nutrients in the food to pass through the dog's intestinal tract virtually unchanged. Since a dog with this type of problem is chronically hungry, the stool may serve as a "between meal snack."

There are many thoughts as to what causes copraphagia, physical problems or behavioral problems are frequently discussed.

There has been quite a bit going on with your pup. We will all be anxious to see the results of the ACTH test.

If your vet choices are limited to inexperienced vets, this will be all the more reason to be the best advocate for your pup. You must be the voice, which means you must have knowledge and be willing to ask questions of the vet.

We are here to help you do just that.

[Amber]

OK sorry it has been so long. Talk about a crazy month. I got copies of all her tests. I'll post those and then give an update.
12/19/12
Low dose dexamethasone diagnostic interpretations
Consitent with hyperadrenocorticism. Further testing required to differenciate adrenal tumor from pituitary dependent hyperadrenocorticims.
Lab tech wrote "Opinion on test: consitent with cushings not adrenal tumor."

2/14/13 (It's a LONG one so I'll post what they marked as hig or low)

HCT High
HGB High
MONO High
PLT High
GLU High
BUN High
Phos High
Glob High
ALKP High
Chol High
Amyl Low
Na Low
K High
Cl Low

2/15/13
ALKP High
K High

3/18/13
PLT High
K High (result was 5.9 normal range is to 5.8)


OK. Vet said that all her results on March 18 were normal and to kee an eye on her and if she started having problems to bring her back in. I brought her in yesterday for her shots and to have her checked because Wednesday and Thursday she wasn't eatting well (which is highly unsual for her) and Thursday morning she had an... episode I'll call it. She went to go outside and started stumbling across the floor and falling over and couldn't seem to get her bearings. I told the vet about it (saw a different vet) and she said since it was a one time thing she wasn't too worried but if she did it again or got worse (by Friday she was getting a little better and eating all her food, albeit a lttle slow still) to call Monday. Well she had another stumbling episode outside earlier today and come to find out she has been doing it off and on for the last 2 weeks. My father didn't want to tell me until he had to because he didn't want me spending more money on tests and freaking out and worrying. The vet is closed today so I plan on calling Monday and informing them of this and going from there. When I witnessed it Thursday my first thought was a mild seizure or stroke. It only lasted a minute or two and once I grabbed her and got her calmed down, she walked fine. SHe has been acting like her back legs are sore so I've been giving her half a baby asprin twice a day when she seems stiff. Not really sure what the vet will do, but I am going to have some type of test done, bloodwork or xrays or something. Another weird thing, her fur is changing. Her head and spots have always been black and she had really thin fur and some bald patches. About a month ago I noticed her head was turning brown and within 1 week her entire head was brown. Now her spots are almost completely brown and her fur everywhere ir getting really coarse and thick. I've mentioned it to both vets and they are at a loss but not concerned. The vet yesterday does think she may have lipid deposits on her eyes or got poked by the cat or something because she has one small white spot on both eyes. I noticed one 3 months ago, the other is underneath her eyelid. She wasn't worried about them, just said to keep an eye on them and if they get bigger or more show up, to call them.

I'm pretty worried about her since she has suddenly gone down hill again. She just seems tired all the time and like she doesn't feel well. Sometimes she won't go down the 2 steps outside to go to the bathroom and wont go back up occasionally, so I have to pick her up. Not sure what's going on but I have a bad feeling in the pit of my stomach that I can't get rid of and has been there since she first started acting funny in October of 2012.

[labblab]

Welcome back, but I am so sorry to hear that Amber is doing so poorly. A few important questions for you... Has Amber been back taking the trilostane again? Even if not, you had said earlier that an ACTH was going to be performed on 3/18 -- did the vet do that? Amber's behavior is definitely not normal, and the ACTH is really important to know what is going on with her cortisol. The ACTH is used to diagnose both high and low cortisol problems, and the issues you are describing with Amber could be residual problems with low cortisol.

Also, what shots was she given? If you told the vet that Amber was not eating and acting ill, I am surely hoping that they did not go ahead and give her vaccinations anyway. Routine vaccinations should never be given when a dog is ill. :o

Thanks in advance for this additional info,
Marianne

[frijole]

We are glad that you came back as many of us were very worried about you and your dog. Sorry but I can't tell if you are Amber or your dog is! :o

Anyway please know that more than likely your dog never had cushings. Please re-read your thread - I just did to refresh my memory. I truly do believe what you are telling us regarding symptoms and that something is up - particularly given the lab results.

In order for us to help we need the whole picture and that requires you answer our questions even if they seem like a pain. On the last long post with all of the lab info - we cannot comment on them unless we have the numbers. So for all the highs and lows we need the result and the range for normal. That way we can see what is most pronounced.

Again it is great to hear from you. This is truly a great resource for help. We understand testing is expensive and hopefully we can gleam some info from your test results. Hang in there and hug your baby for us.

Kim

[Amber]

They didn't do the Acth. They did a regular blood work up and since everything was normal the vet didn't feel that she needed to go through the acth again unless she started getting worse. Given the fact that she has been having these spasm episodes I am going to call the vet tomorrow and get their point of view on it. And they did give Amber her vacs yesterday since she seemed to be feeling better. Had I known shehad had episodes for so long I wouldn't have allowed them to give her her shots. She's not on any meds other than the occassional baby asprin. Here are the numbers from the tests.
2/14
Hct 55.8% norm is 37-55
Hgb 19.1 h/dl 12-18
Mono 2.6 K/ul .3-2.0
Plt 899 K/ul 175-500
Glu 198 mg/dL 70-143
Bun 51 mg/dL 7-27
Phos 9.4 mg/dL 2.5-6.8
Glob 4.8 g/dL 2.5-4.5
Alkp 408 U/L 23-212
Chol 406 mg/dL 110-320
Amyl 442 U/L 500-1500
Na 136 mmol/L 144-160
K 9.6 mmol/L 3.5-5.8
Cl 108 mmol/L 109-122

2/15
Alkp 350 U/L 23-212
K 5.8 mmol/L 3.5-5.8

3/18
Plt 685 K/uL 175-500
K 5.9 mmol/L 3.5-5.8

I just tried to feed her and she only ate the peanut butter pill pocket that I gave her and a few bites of food and then came over is now on my lap and refuses to move. Not sure what is going on but she is scaring the daylights out of me. This is what she did Wed and Thur then seemed to be getting better Fri and was even better yesterday when I brought her to the vet. Today she layed in the other dogs kennel which she only does when she doesn't feel well then has been sitting on me since I got up. I have a touch of pnuemonia but will def call the vet tomorrow and leave work early to bring herin.

[frijole]

What stands out to me is that the glucose was high in February which usually means diabetes. High cholesterol would be another indicator.. Has your vet discussed diabetes with you? That would explain feeling yucky.

Also low K levels can be a sign of diabetes and that was still happening in March.

http://voices.yahoo.com/five-causes-high-potassium-level-485267.html


Kim

[molly muffin]

Hi, and glad to see you back, although not happy that your little one is having problems again. That is definitely not normal.
Even if the vet is resistent to doing a full ACTH test, what about a resting cortisol base draw to just get some idea. It would let you know if this is an addisonian thing or not. Of course if it is high, it could still be because she is having some back leg issues? Has she had an xray to check for arthritis?
I'm at a loss of what could be wrong right now, if all her test results went from wild crazy (possible Addison crisis) to being basically normal.
I hope the others have some ideas. I don't think falling over and having "episodes" is normal in any way at any time. There is a reason, just have to find out what it is.

hugs,
Sharlene and Molly Muffin

[Amber]

They haven't mentioned diabetes but it had been in the back of my mind lately, especially since she was drinking so much. She hasn'tbeen drinking or eating much the last few days, so I will def bring that up to thevet tomorrow.

[Amber]

Theyhaven't done any xraysbut she has been showing signs of arthritis for the last year or so. She just gets stiff sometimes and won't want to jimp up or down or go up or down the steps. Her joints don't feel bad when they check them so they said to giveher a baby asprin once a day. I split them and give her half twoce a day when she seems stiff or sore. One once a day wasn't getting her through the whole day.

[labblab]

I have just read back through your thread, and at this point, I don't see evidence that your vet has ever performed one single ACTH test, either when Amber was taking trilostane, when she crashed, and subsequently when your vet feared that she might have gone Addisonian (or been Addisonian to begin with). This is really unacceptable for a dog who has been treated with trilostane and then subsequently "crashed," or when the Cushing's/Addison's diagnosis is in question.

We had talked earlier about the possibility of you seeking a referral to a specialist. I am really, really, really worried about Amber, given your description of her behavior. I really think you may be risking losing her if you don't get to the bottom of her problems. I am not a vet, but I still believe an ACTH test would be really important at this point. For whatever reasons, your vet has not followed through with the ACTH testing. If we can locate a specialist for you, would you consider consulting with an expert?

Marianne

[frijole]

I don't understand why they wouldn't have thought of diabetes considering the fact that the glucose was high. Also diabetes has the same symptoms as cushings. I suspect that is what you have been dealing with all along and the diagnosis was wrong. Giving the trilostane sent the cortisol low which caused the other problems. Kim

[labblab]

You've told us that Amber's most recent bloodwork on 3-18 was normal. Does that include the glucose level? If so, then it doesn't seem as though diabetes is currently in the mix.

[Amber]

Well, just got back from the vet. THey are keeping her overnight. Her Potassium was the same as last time (5.9 and norm is up to 5.8) but her amylase was high (I can't remember the exact number but I think it was around 12?) and her glucose was a little low. He said she is midly dehydrated but he doesn't know what is causing it. He thinks she has pancreatitis and must have gotten in to something fatty and it upset her pancrease thus upsetting her stomach thus making her not eat. I have no idea what it could be, we don't her anthing but dog food and treats and she hasn't eat much since Tuesday evening. Thye are putting her on fluids and glucose and going to run some cardiac bloodwork because her heart is beating slow and he thought her potassium would be off the charts again. He doesn't know what could be causing her 'episodes' of falling and having trouble getting up for a few minutes, he doesn't think it is anything brain related since she doesn't have any other problems. I'm thinking it may be related to a blood flow/heart issue since he said its beating slowly and sounds sluggish. They gave her some canned food when they put the iv in and she scarfed it so I'm thinking she doesn't feel well in general and is waiting until she is overly hunger to eat anything since she started refusing to eat or only eating a small amount Wednesday and then Friday night and Saturday ate fine, Sunday refused to eat (I even cooked some hamburger meat and rice and she wouldn't touch it, just kept drinking a lot.) I got her to eat about half her food this morning but she was more interested in drinking and trying to keep me from leaving. Hopefully we'll have some answers in the morning.

The vet originally thought it was an addisons again like it was in Feb but since her levels (other than amyl and glucose) were normal, he's stumped. My mother is going to contact the owner of the clinic (she knows him) and ask him to look into it and see what he thinks since this doc is stumped. I asked him if it could be diabetes even though her levels were normal in March. He doesn't think so and went through a list of neurological things that could cause the falling and nothing fits.

Basically, we know nothing other than it's not Cushings (despite the first test results) and it's not Addisons. I did ask if it was possible that she does have addisons but it's not what's causing this issue and he said he highly doubts it and he'll have a better idea tomorrow after doing cardiac bloodwork. Can't say that I feel better, but at least it doesn't seem to be as serious as I thought. I will get copies of all her blood work tomorrow and will post those as well as any updates I get tomorrow evening. If you guys have any ideas, no matter how far fetched they may be, I'd appreciate it. Even if you're just ruling things out.

Thanks again for all the support and advice, I will keep you posted. Here's to hoping we figure out what's going on with Amber soon.

[labblab]

I have only a moment to reply, but there is no way in which your vet can rule out Addison's without performing an ACTH test, which apparently has never been done at any time since Amber began the trilostane and throughout these crises.


While electrolyte levels are important indicators, they are not the definitive test to determine Addison's disease. In fact, with secondary and atypical hypoadrenocorticism, electrolyte levels may not be affected. For definitive diagnosis the dog is given a the ACTH stimulation or response test. This tests the ability of the adrenal glands to produce the corticosteroid hormone cortisol
Amber's electrolytes may not show any imbalance, but her natural cortisol production may be totally inadequate. I absolutely cannot fathom why your vet does not perform an ACTH test under these circumstances.

I'll try to come back again later.

Marianne

[molly muffin]

Amylase is associated with either a pancreatic episode or kidney problem. If she is having a bout of pancreatis, then you will want to feed her boiled chicken and rice, mushy, almost liquid rice. Very small meals, several times a day.
I would still get at least a baseline cortisol test so you'll know what is going on with that. I don't know if an ACTH test would give a false result with the pancreatis going on or not. Maybe one of the others would know for sure, but I do think that it is going to be absolutely vital to get an accurate cortisol reading. That cannot be done without doing a cortisol test.
Hopefully Amber will be much better in the morning.
Hang in there!
Sharlene and Molly Muffin

[labblab]

OK, I am back. Please read this article about Addison's Disease:

http://www.addisondogs.com/addisons/

In re-reading your thread, I see that I have been harping on ACTH testing for quite some time, but I truly do not understand why your vet is not testing Amber appropriately for Addison's. Whether she had Addison's to begin with (instead of Cushing's), or whether her adrenal function is now abnormally suppressed as a result of the trilostane treatment -- either way, she absolutely needs to have an ACTH test performed to determine the ability of her adrenal glands to produce the cortisol she needs. If Amber is Addisonian, no amount of stress and no other physical ailment can stimulate the production of cortisol. So even if she has some other ailment going on as well, her cortisol response will be insufficient.

If you need to, please print out this article to show your vet. Ask your vet why he is not performing an ACTH test. Even better, please please please ask for a referral to a specialist who can get to the bottom of Amber's problems before it is too late.

Marianne

[frijole]

I join Marianne at imploring you get this test and preferably done by a different vet that knows what they are doing. Please understand we've been helping others for many many many years and when we see this it scares us because sometimes the dogs die. They need cortisol to live. If you look up the lab results you can see that it very well could be low cortisol causing this. Don't ignore our pleas. Please. Kim

[doxiesrock912]

PLEASE take the advice of the other members here and go to an Internal Medicine Specialist asap! Whether Amber has Addison's or Cushing's, both MUST be treated and heavily monitored properly!

Yes, both are treatable when done properly and this is of the utmost importance! When not done properly, the outcome can easily become disastrous.

[Amber]

Amber did have an ACTH done in December before she started taking the soloxine and vetoryl. She was diagnosed with Cushings based on the results and was given soloxine and vetoryl and was getting better until Feb, when she crashed and ended up at the vets for a few days because she was having an Addinsonian crisis. I took her back in March to have her retested but the vet recommended that we do regular blood work first and her levels were normal (K was 5.9 norm is up to 5.8) so he recommended that we just keep an eye on her and if she started showing symptoms again to bring her back in. He doesn't think another ACTH test is necessary because her CBC is coming back normal, for the most part (potassium is staying just above normal.) He said that is she had Addisons or Cushings, her cholesterol, potassium, glucose and others (can't remember them all) would be out of wack. When I hear from the vet in the morning after they do the cardiac bloodwork, I'll ask him again if an ACTH would be helpful in getting a better idea of what is going on and will also ask the owner of the office (knows my mother) what his thoughts are and if he has any other suggestions.

I did try to give her some boiled hamburger and rice last night but she wouldn't touch it, not even when I just gave her the meat. I didn't have any chicken on hand and she tends to like beef better. They gave her some canned food tonight and she ate it, so I will get a few cans and see how she does with that. Is there any type of food I should try to feed her since her Potassium is always slightly high? I feed her Science Diet Mature Adult Small and Toy. That is occassionally hard to find, so if that isn't available, I give her the small and toy light that our other dog eats. The vet has recommended that I give her the highest fiber food I can buy because she has a problem expressing her anal glands and normally acts like she's starving to death no matter how much or how often you feed her and on the light food she lost a lot of weight even when we gave her twice the recommended amount for her weight.

I'll update everyone tomorrow evening and let you know what tests were done, the results and what the vets are recommending. Thanks again for all the suggestions.

Is there anything not related to Cushings or Addisons that you can think of that may be causing this?? There isn't anything she could've gotten into outside or in the house other than the occasional rabbit droppings in the yard. Just seems like since October of 2012 she hasn't been herself and hasn't been feeling 100%. I know she's getting old and that even though she may have seemed fine before that she may not have been, but it just seems like she went from being her usual playful happy to a really old, ill crabby dog overnight with no cause. She'll be 10 in July. She's still very clingy (more so than usual) with me and she has been occasionally sitting with my mom (doesn't happen often), but she is growling at the cat when she walks by and grumbles at our other dog when she sits with me too. Not sure if it's because she just isn't feeling well (let's face it we all get grouchy when we're sick) or what, but it just isn't like her.

Thanks again. Night everyone. Hope you get more sleep than I will tonight.

[doxiesrock912]

Hoping that Amber feels better soon!

You mentioned that they did perform an ACTH test, was Amber fasted or not? This can make a difference and also depends upon whether or not she was already taking one of the Cushing's meds.

Since your vet is stumped, I wanted to verify that the ACTH testing is indeed being done correctly.

[Amber]

Just had a thought after reading that article. The ACTH results from Dec are (hopefully I'm reading this right) Pre Dexamethasone 5.4, range on the result is stated as 1.0 to 6.0 (article says 1 to 4); Post 4 hr Dex 2.0, reference range is less than 1.5; post 8 hr Dex 1.5, reference range is less than 1.5. Her T4 was 1 and the reference range is 1 to 4.

Based on the article you linked, her pre dose level was high, not normal. Does that change the results?? I know a lot of bloodwork is based off a slightly different 'normal' range based on the lab and/or doctor, but 4 is quite a bit different than 6.

It also says "Occasionally, hypothyroid dogs can have T4 concentrations that are low normal. Dogs with clinical signs of hypothyroidism and low or low normal T4 concentrations may be evaluated further by submission of free T4 and canine TSH." Should she have her T4 retested? He originally recommended the ACTH and T4 test because he thought that she had hypothyroidism (our last rat terrier was suspected of having that too but by the time they did the test, it was too late and we had to put her down before we even got the results and I was seeing the same signs in Amber as in Gracie when she first was getting sick which is what prompted me to take her the vet in the first place) and he had mentioned Cushings in passing but was almost certain that it was hypothyroidism or hyperparathyroidism (he mentioned both.)

Just something that hit me on the way to bed.

[doxiesrock912]

I'm fairly new to this myself so I'm going to defer to the true experts on this forum. From what you're saying though, asking to test both may not be a bad idea at all!

Good luck!

[Amber]

I didn't feed her when I brought her but brought her food and they fed her and said that it didn't matter. She wasn't on any meds at the point. She had been on... something to help her control her bladder because the vet recommended that for 2 weeks before the ACTH test because of her age and she was spayed. I originally brought her the vet because she had suddenly started having accidents in the house and was drinking a lot of water. I thought she had a UTI or something but they tested her urine and everthing came back fine, just diluted because she was drinking so much. We tried the medicine and it helped a little but she was still having the occasional accident and wasn't acting like herself so I brought her back in and they did the ACTH, diagnosed her with Cushings and she started taking the soloxine because her T4 was on the low end of normal and the vetoryl for the cushings. No follow up tests were done until Feb 14 when she had the addisonian crisis and we stopped all meds after that and she hasn't been on anything since other than the occasional asprin because she was acting as if her hind legs were sore and I thought it may be her arthritis.

[doxiesrock912]

This really is starting to sound similar to what we went through with Daisy. Shortly after she was spayed, she would have "leaking" incidents which they said can happen because of the hormonal changes.

Ask if there could be an underlying infection. It is amazing how many symptoms that Daisy had which resolved or lessened once she was given the Baytril for her skin infection. It was by sheer coincidence that we came to this conclusion because nothing else fit.

Daisy does have Cushing's, but some things didn't quite fit.

[Harley PoMMom]

Just had a thought after reading that article. The ACTH results from Dec are (hopefully I'm reading this right) Pre Dexamethasone 5.4, range on the result is stated as 1.0 to 6.0 (article says 1 to 4); Post 4 hr Dex 2.0, reference range is less than 1.5; post 8 hr Dex 1.5, reference range is less than 1.5. Her T4 was 1 and the reference range is 1 to 4.

Based on the article you linked, her pre dose level was high, not normal. Does that change the results?? I know a lot of bloodwork is based off a slightly different 'normal' range based on the lab and/or doctor, but 4 is quite a bit different than 6.



Those results, I believe, are from a low-dose dexamethasone suppression test (LDDS ) not an ACTH stimulation test. An ACTH stimulation test does not take 8 hours to complete, a LDDS test does.

When interpreting the LDDS test, follow these guidelines: If the eight-hour postdexamethasone administration cortisol concentration is above the reference range, then evaluate the baseline and four-hour postdexamethasone administration cortisol concentrations to see whether cortisol suppression occurred during the eight hours. If at least 50% cortisol concentration suppression is present at the four- or eight-hour time points, the definitive diagnosis is PDH and additional adrenal function tests are not needed.

Amber's 8 hour post was 1.5 ug/dl, the cut-off is < 1.5 ug/dl...Amber's 8 hour post is only a smidgen higher.

[labblab]

I'm back again this morning, and still so very worried for Amber. Lori is right -- those initial diagnostic test results are for an LDDS (low dose dex test) and not an ACTH. An LDDS cannot diagnose Addison's at any time. Regardless, even if Amber truly had Cushing's with an ACTH to match back in December, that has absolutely no bearing on what her cortisol level is now after having been treated with the trilostane and after suffering through at least one Addisonian crash and being persistently ill. Trilostane treatment itself has the capacity to permanently suppress adrenal function in a few dogs who take it. This means that a normal amount of cortisol can never again be produced naturally by a dog.

Since your vet has never administered even one ACTH test at any time, it makes me wonder whether he is capable of doing the test. It involves having a special, expensive stimulating agent on hand and perhaps he has chosen not to order it.

I have said it over and over again and in so many ways that I don't know what else to say. I just feel helpless right now. Yes, it's true, other lab abnormalities do often accompany an Addisonian crisis. But please read that article and print it to show your vet. The only way to rule out Addison's with certainty is to perform an ACTH test of her current cortisol reserves. Her testing in December has no bearing on her cortisol now. If nothing else, he should at least be checking her resting cortisol. That is not the definitive test that the ACTH is, but as you say, at least it would give some indication as to her current cortisol level. Even if he doesn't have the necessary stimulating agent on hand to do an ACTH, he can at least draw the blood for a resting cortisol. There is absolutely no reason for him not to at least do that much.

But backing up, you have nothing to lose other than money by performing an ACTH. And then you would definitively know that Addison's is off the table. These repeated emergency hospitalizations have to mount up to more expense than one properly executed ACTH would have cost along the way. Please ask your vet point-blank: "Do you have the stimulating agent on hand so that you can perform an ACTH test -- NOT an LDDS test?"

Please read that article. Don't those symptoms sound exactly like Amber's issues???

Marianne

P.S. You have asked about thyroid issues. Is there a reason why the soloxine was stopped along with the trilostane? What is her T4 level now? In the midst of this hospitalization, surely the bloodwork that your vet has ordered contains a basic T4 level. If it is still low, then yes, some further thyroid diagnostics are undoubtedly warranted. But that doesn't change the need to check the status of her cortisol production.

[Tina]

I only have a quick minute to post, but please listen to everything that Marianne, Lori and others are saying. I am no expert but my Jasper went through an Addisonian crisis back in Sept due to becoming over suppressed on Lysodren. The test you are describing that Amber had does sound like a LDDS test rather than an ACTH stim test as Lori has mentioned. This cannot diagnose Addison's.

When Jasper had his crisis, his electrolytes were a bit off, but not severely out of wack like you would expect. But his cortisol was almost 0 when it was checked. :eek: Even my vet was shocked. He was in the hospital on IV fluids and required injectable dexamethasone as well as oral prednisone later to get the cortisol stablized, along with Percorten injections to stabilize the electrolytes. He needed to be on a fairly high dose of prednisone for quite some time after the crisis. It was terrifying, and in hindsight I know that I am fortunate that my boy is still with me. He is still unable to produce his own cortisol and we treat him for Addison's now.

This is nothing to mess around with, and I don't understand why your vet is not checking Amber's cortisol level, at the very least a baseline level. Especially since she has had a crisis before. Please pursue this further with your vet.

Tina

[molly muffin]

Hi! I just got home from work and came on to check and see how Amber is doing today. Hope to hear a good report!!!

Hang in there, don't get disheartened.
hugs,
Sharlene and Molly Muffin

[molly muffin]

Is there any news on Amber yet? Is she home from the hospital? did they figure out what was going on?
I know tons of questions, worry wart here. Hope everything is okay. Let us know when you can .. please.

Sharlene and Molly Muffin

[Amber]

OK Amber is home now. They gave her a shot of procorten and said she perked up with that and was doing much better. They gave her iv fluids and flushed her system before giving her the procorten. She had been eating at the vet (they gave her all wet food) and she has even gained some weight. She seems a little tired and has been laying on my bed since we got home but is better than she was. I'm thinking she didn't get much sleep there because of the other dogs and different people (she gets a little cage aggressive at the vet.)

They did some cardiac tests that should be back the beginning of next week and we'll go from there. The vet is worried about her heart since it is still sluggish and not beating very hard. He is almost certain that it's Addisons but doesn't want to do an ACTH until her system has time get back to normal after all this. He's recommending that we wait 2 or 3 months then do an ACTH (I was under the understanding that what was done in December was an ACTH not LDDS) but he wants to see what her cardiac enzyme results are before doing anything further. He said to watch her and he is thinking in about 3 weeks or so she'll start to get weak again and start falling over and when she does to call them and they will give her another procorten shot (said it may have to be a monthly thing where I bring her in for a shot) but doesn't want to give her any more of the shots until he gets her cardiac results. He said the procorten can perk up the heart as well because it changes the cortisol level and that may be why she was doing better once they gave it to her. I'm going to watch her VERY closely and see how she does the next few days.

The vet also said that he thinks the trilostane she was on Dec to Feb screwed up her adrenal glands and that her body might take a while to adjust and that she should not go back on that. He said occassionally dogs will react poorly to it even if they have cushings and that she may be one of them.

The other vet that owns the practice agrees with him and also suggested we wait at least a month before doing an ACTH. The doc we have been seeing seemed a bit... annoyed that we ad called the other vet and asked him to check on her and take a look at her file, but I'm glad that we did. He also suggested giving her a mix of canned and dry food instead of just dry. I'll have to mess with the amounts to find the right mix.

So as of now, she's still not on any meds and we'll wait to do anything else until her cardiac bloodwork comes back. I do plan on having them do a good once over on her to check her joints because she still seems to favor her back leg (could because she as locked in the cage for 2 days with minimal time outside) but I'll keep an eye on her and call them if need be.

[frijole]

First off, thank you sooo much for coming back and updating us. We care very much about you and dear Amber. We have been here for years and stories like this are very hard for us because all we can do is offer advice - Amber's life is really in your hands and all decisions are yours, not ours. That makes these situations very hard.

But you came to us for advice and while you do not know us I hope that you know we care and have been helping others in situations just like yours for many many many years.

I share this because I am begging you to get Amber to a different vet. Your vet is right - Amber is most likely Addisonian. The problem is that you don't send a dog with Addisons home without prednisone. I'm not sure how long the percorten shot will last but you have to continue to give Amber meds for the Addisons or she is going to die and it might not take 4 weeks.

What is Percorten-V: Percorten-V is a corticosteroid used to treat conditions in which the body does not produce enough of its own steroids, such as Addison's disease.

How it works:
Canine Addison's Disease is a condition where a dog's adrenal glands don't work properly. Normal adrenal glands produce mineralocorticoids that help regulate many bodily functions such as metabolism, blood pressure, and stress response. Percorten-V is a replacement therapy for the mineralocorticoid deficiency in dogs with Addisons disease.

Cautions:
Do not use any preventative vaccines such as Percorten-V without checking with your veterinarian. Talk to your veterinarian about any side effects that seem unusual or bothersome to your pet. Percorten-V should not be stopped suddenly. Percorten-V should not be given to pregnant dogs, or dogs suffering from congestive heart disease, severe renal disease or edema.

As you can see a shot of percorten is a short term thing. It is not a cure for Addisons and for a vet to give you a shot and send you home, refuse to do an acth test once again and to tell you that he is concerned about the heart?! Are you kidding me?

With all due respect this vet, the other vets that he talked to are all over their heads and either afraid to do an acth test, don't know how to do one, don't have the cortryson on hand to do one, whatever but I can tell you that they are lost and sending you down a path that you don't want Amber to go down.

There is no reason for Amber to die. You can go and get an acth test from another vet and immediately get her on prednisone and she can live a normal life. Please please go back and read all of our posts. We are just volunteers trying to help. We have no skin in the game and would LOVE for your vet to be right but he isn't. He is hurting your dog not helping. Amber can die from this.

I don't know how I can be any clearer. Please trust us and go get help from a real vet. Kim

[Harley PoMMom]

I agree with Kim 100%. Please, please get Amber into a vet that will/can do an ACTH stimulation test, this test is vital to Amber's life.

We are very, very worried about your girl and care about you both very much.

Love and hugs,
Lori

[molly muffin]

Amber is not the fist dog we've ever seen go into Addison's due to vetoryl or lysodren, but she is the first dog that I have ever seen to not be properly treated for it. Of course her heart beat is low, dogs can die from not having enough cortisol in their bodies, it's a life necessary component of both dogs and humans. This can cause heart failure, renal failure, kidney failure, I could go on and on. Prednisone should be prescribed for a daily dose, along with the shot and then hopefully slowly weaned to just needing a shot once a month. In the mean time though Amber has nothing. You never Ever want a dog to collapse and then treat them. I don't know if you can sue a vet for malpractice, but you have actually documented enough just on here of what this vet has done that you'd have a case. How sad is that. :(

You don't stay with a vet because you like them, they are a friend, if they aren't administering proper treatment. I hope that you don't think we are just being alarmist, when in fact, we really aren't. This isn't even the tip of an iceberg of the what can and most likely will go wrong without proper care.


In an Addisonian crisis, the lack of adrenal hormones depletes sodium levels (hyponatremia) and body fluids (hypovolemia), resulting in potassium retention (hyperkalemia), bradycardia (slow heart rate), hypotension (low blood pressure), associated cardiac arrhythmias (abnormal heart beats), and collapse. In other diseases, hypovolemia and shock cause tachycardia (rapid pulse); In Addison’s, the pulse slows. Low blood sugar levels (hypoglycemia) can cause seizures. Vomiting and diarrhea are common.

I'm so sorry that this has happened, but really, if you believe nothing else that we say, believe that we only want Amber to have good care and to come out of this okay and for you to once again not have to worry every second.

Think please about this.

hugs,
Sharlene and Molly Muffin

[labblab]

One more voice here, pleading with you to take Amber to another vet who knows how to properly treat Addison's. If Amber suffers from low cortisol, the Percorten will not help with that. What Percorten is designed to do is replace missing aldosterone, the adrenal hormone that regulates the balance of potassium and sodium. But it does nothing to make up for lost cortisol. As Kim says, if Amber's cortisol is low, she needs to be treated with a steroid replacement such as prednisone to make up for it. There is absolutely no excuse for your vet refusing to test Amber's cortisol level in order to see whether she needs prednisone. What he is doing, or rather not doing, is so very dangerous for Amber. As Kim says, it may kill her.

Please, please, please help your dog. We know you love her. Please get her the help she heeds before it is too late.

Marianne

[jmac]

Hi there,
I haven't posted to you, but just got caught up on Amber. Everyone is giving you good advice, and I've learned over the past two years that these people know more than most vets about Cushing's. They've helped countless people and their vets with their dog's treatment. PLEASE - take Amber to a vet for an ACTH test. You do not want to wait this out. Amber is in danger. We just want to help you and your dog. You've spent lots of money already. This test will tell you where Amber's cortisol is and what you need to do. We are worried about her and just want the best for both of you.

Julie & Hannah

[Tina]

Thank you for posting an update on Amber, but I have to say I feel sick as I read it. As I posted before, my boy went through an Addisonian crisis and even though my vet was on top of things, it was still life threatening. And this happened very quickly. And by quickly, I mean things deteriorated in less than an hour.

As everyone here has said, Percorten does NOT replace cortisol, it is a mineralocorticoid replacement to regulate the sodium and potassium. It must be given every 26 days or so, it is not a one time treatment. Prednisone or another steroid must also be given to replace the cortisol. In addition, the electrolytes must be monitored at specific intervals to make sure the Percorten dose is adequate. You would never want to wait until she "gets weak again and starts falling over", by then it could be too late. The cardiac symptoms that Amber is experiencing could be entirely related to the Addisonian crisis.

Kim, Sharlene and Marianne have posted everything else that I would want to say. PLEASE take Amber to a vet who will do an ACTH stim test, or at the very least a resting cortisol level. I too am very worried about her. She could go into shock if not treated properly, and things could very quickly become irreversible. Please get the proper help for her.

Tina

[labblab]

It's me back again. I've been tossing and turning all night worrying about you and your sweet Amber. Amber has never really been well since you first came to us in February. She has been suffering too long. Please, please tell us what you need in order to get her in to another vet who will know the correct way to handle Addison's. We are here to help you, but you have to tell us what you need.

These are the two critical pieces of information that you and your parents must understand. It is different from what your vet is telling you but your vet is wrong. This is what is true.

1. An Addisonian dog must have a test of its cortisol level immediately. The test cannot wait.

2. If the cortisol level is too low, the dog must be given prednisone to replace the cortisol or the dog may die. Percorten alone is not enough.

Are your parents opposed to getting a second opinion? Would it help if you have more articles that explain the correct way to test for Addison's and treat it? I have never seen one single article or textbook that says your vet is handling things in the right way, but we have a million articles that explain what should be done instead. We will put together a whole list if you need them to read and show your parents. We can do that today.

Are you having a hard time finding another vet? We can help with that, too. Thank goodness for the internet, because it makes searches like that very easy.

So please tell us what you need. We will help you with anything you need. We know how much you love Amber and how horrible you will feel if she dies because you don't take her to a vet who knows how to treat Addison's. Please let us help you today. Please.

[jmac]

Hi there,

I woke up thinking about Amber too, and was hoping to see a post from you. Marianne said it perfectly. We are all worrying. We all want to help. We know this situation is very, very, very dangerous. Amber could die. We don't want that to happen. It is imperative that you move quickly. Like she said, our experts here can provide you with more articles and resources, and can help you find a vet too. In the long run, taking Amber to get the ACTH test and getting her on prednisone will cost less than what you've been dealing with/will continue to deal with based on your vet's advice. I really hope you read this soon and will run, not walk, to get Amber to a vet.

Sending lots of prayers for Amber,
Julie & Hannah

[Squirt's Mom]

My! It is good to hear from you again! And especially good to hear that your sweet girl survived this latest ordeal.

Now, I'm going to as kind as possible but very blunt. Your vet is killing Amber. If you want to spend any more time with her, you need to RUN to a new vet TODAY. It has been some time since I've seen a vet as incompetent and incapable of handling Cushing' as your current vet. He is deadly for cush pups, honey, deadly for your sweet girl. It is a freaking miracle she is still here today. Your vet has no clue what they are doing.

Your vet may be wonderful in all other areas, he may be the sweetest, kindest vet in the whole world - that means nothing if they so not understand Cushing's and cannot follow an established protocol when using a powerful drug like Vetoryl (Trilostane). Your vet has repeatedly demonstrated they do not understand Cushing's and is not following protocol. For Amber's sake, I am begging you to get her to another vet asap, preferably an IMS who can sort out the mess your GP vet has created for her.

This disease nor it's treatments need to be this difficult nor harsh on the pup. It's fairly simple - others have paved the way for your vet. All your vet needs to do is follow. But he doesn't seem to be able to do that. I have been absolutely dumbfounded at the way he has handled Amber. :eek: And terrified. :(

Terrified that the next post from you would be to tell us your sweet girl was gone. I, none of us, want to hear that and I know you aren't ready to face that loss. Sweetheart, this is the only reason we are talking so desperately to you about the way your vet is handing Amber - we don't want him to kill her with mismanagement and that is the direction he is headed just as fast as he can get there.

Honey, vets are only human. They are not perfect; they do not know all. Some are very good in all areas but Cushing's. This may be the case with your vet. However, the disease Amber has is Cushing's so it doesn't matter how good the vet is in any other area - he doesn't understand Cushing's, he doesn't understand the disease your girl has. You and Amber don't work for him - HE works for YOU. For Amber's sake, I'm begging you, please get her away from him. Please.

These good folks have given you proof and can document what they say with scientific support. This is not a guessing game. For Amber, this has become a life and death situation - not a game in any sense of the word. Sweetie, you must, MUST, step up to the plate and speak up for Amber. She cannot speak for herself and she is depending on you to speak for her.

Surely you can see how much we care for you and for your sweet girl? How badly we want her to be well and on the right treatment path? How desperately we do not want you to lose her now? There are a number of us who have lost sleep worrying about Amber and you, constantly checking in to see if she survived, praying our hearts out that she did once again survive. Our purpose isn't to demean your vet; our purpose is to save your girl if possible. Our purpose is to help you and she have many more years to share in health, not in and out of life-threatening hospital stays.

Please listen, please take what is said to heart, please get Amber to a new vet, please. Today. I do not want to be required to list her name in the In Loving Memory section for a long, long time to come. Please listen, please take action.

Hugs,
Leslie and the gang

[doxiesrock912]

PLEASE find a qualified Internal Medicine Specialist for Amber NOW before it's too late!

If you have a Cornell veterinary hospital in the vicinity I highly recommend them, just GO somewhere else.


Daisy's GP vet came highly recommended, but he too doesn't know enough about Cushing's and taking a chance with Amber's life is NOT the way for them to learn.
We're staying with him for routine visits, but not for the Cushing's treatment or anything associated with it and I highly suggest that you do the same asap.

We can stress how important this is!

[Tina]

Just popping on to see if there is any news on Amber. I am thinking about you and hoping you have taken her to see another vet. Sending prayers out that she is ok.

Tina

[Squirt's Mom]

Mornin' sweetie,

How is Amber this morning? Does she seem stronger? Is she eating and drinking ok? How are you holding up? This is so hard on you, too, we understand that and we are here even if you just need to scream.

You are in our thoughts and prayers.
Hugs,
Leslie and the gang

[Mel-Tia]

Hoping you are both ok and that we hear from you soon

Big hug for you and a kiss for Amber

Mel
Xxxxxx

[molly muffin]

Hi, checking in and hoping that you and Amber are doing well and that she has made a turn for the better. So hard to see our babies when they aren't well.

hugs,
Sharlene and Molly Muffin