My big buddy is hurting. Lab & Giant Schnauzer mix.

[Sammy'sDaddy]

Hi folks, I’m Sammy’s daddy and need your help. Last summer, Sammy, who is 12 years old, had his senior blood screen and a urinalysis done. The vet said she was 90% sure that he has Cushing’s but without further testing, she couldn’t be more specific. She said he may only have 18 months left. I couldn’t afford to do a lot of expensive testing then (and still can't) but I hope that with a little help, I can skip a few steps and check his cortisol levels? and try to find a local vet who will monitor them so I can buy meds online. Maybe I'm way off track. That's why I'm here.
His symptoms are that he has a distended stomach, drinks like a camel, has put on 20 pounds in three years, now 100+ lb. and has really inflamed hips that cause a lot of pain (rapid breathing) in the evenings and with bad weather. I am giving him 100mg of Tramadol in the evenings when his pain is at it's worst. Seems to help a little. Is there something more effective? I also massage the area and put a cold pack on it for a bit. I’ll post the test results from last summer if I can figure out how to do it. I would appreciate any direction that you can give me. I want to improve his life any way I can but have very limited resources. I believe my financial situation will improve this summer but time is ticking away.
Sammy and I are as bonded as two creatures can get and I can't bear to think about losing him yet. His mother was a purebred Giant Schnauzer and his father was a neighborhood, white or golden Labrador that “got lucky”. Through very unfortunate circumstances, he was separated from his mother on day one. I took him on day six and bottle fed him every two hours for months. He was so small, I took him to work with me in a shoe box. He suffered from separation anxiety for much of his early life. He is twelve years old now and very happy but not doing so well physically, and I’m afraid that I am going to be the one who suffers from "separation anxiety" soon. I lived in Spain for a decade, that’s where Sammy was born. He is truly bi-lingual as he was raised in a Spanish speaking household with me as his daddy. I speak both Spanish and English with him here in the States and he loves it. He’s a very special dog. I’m so glad to have found your website. I'd like to know for sure if he has Cushing's, how that might be affecting his hips and and general wellbeing and what more I can do. Thanks

[Budsters Mom]

Hello and welcome!:)
I am sorry for the reason that brought you here, but very glad you found us.
You have come to the right place! There are many K9Cushing's angels standing by to help and stay with you every step of the way. They love details, test results, any information you can get your hands on. The more the better. Others will be popping in shortly to welcome you also.

So again welcome to you and Sammy,
Hugs,
Kathy and Buddy:cool:

[Evey]

Hi Sammy's daddy. I'm pretty new here - my Rio boy is on the verge of being diagnosed I fear - and I don't have much advice but I did want to say that your story of raising Sammy from a wee little pup is beautiful. The people on this forum are beyond lovely and I know that you will find help here.

Give Sammy a pat from me. :)

[Sammy'sDaddy]

Thank you both. What a pleasant surprise to receive replies so soon. :-)

[Harley PoMMom]

Hi and welcome to you and Sammy from me too!

In dogs with Cushing's, usually arthritis pain is masked by the excessive cortisol. Also, if you want you can email Sammy's test results to our forum gmail account which is k9cushings@gmail.com.

Other nonadrenal illnesses share some of the same symptoms as Cushing's such as diabetes and thyroid problems have these been ruled out? Is Sammy taking any other herb/supplement/medication? Does Sammy have an ravenous appetite?

Cushing's is one of the most difficult diseases to get a confirmed diagnosis for and often it is misdiagnosed and that is why vets need to do multiple tests to validate a diagnosis of Cushing's. When you can get those test/s results to us we'll take a look and see how we can help, ok?

If Sammy does have Cushing's we can share some cost-saving ideas such as having the Cushing's medication compounded.

We are here for you and Sammy and we will help in any way we can so do not hesitate to ask any and all questions.

Love and hugs, Lori

[Sammy'sDaddy]

Hi Lori, I sent an email with the results of Sammy's tests to the gmail address. To answer your questions, He is not on any supplement or meds aside from the Tramadol I give him in the evenings. He is not ravenous. I returned to the states three years ago and settled in on my parents property in Southern Vermont. They also live here but we are not in the same house so Sammy has two houses to choose from. In Spain, he lived with another dog and my cat so he always ate whatever dry food he was given without hesitation. My mother has spoiled him rotten, giving him our dinner scraps mixed in with his dry food (crunchies) against my better judgement. Now, he'll go for 24 hours without eating if we don't mix human food with his crunchies. As a result, he has gained at least 20 pounds in three years. I don't know what else to say about his appetite other than he's not hungry all the time. Please have a look at his test results and let me know what you think. If I don't reply quickly, it's because I have never posted on any site and it's taking me a looooong time to get the hang of it. Thanks, Jeff

[molly muffin]

Hi Jeff and Sammy and welcome to the forum.

One of the symptoms of cushings is a ravenous appetite, not like hungry but like starving. Yes to drinking lots of water and peeing a lot. Is he having accidents in the house? He might need to lose some weight, as that can make them feel hot and drink more water too.
The lab results will be posted by one of the administrators so that we can all take a look at them. I'm definitely wondering about diabetes or thyroid. Which can be quickly looked at by checking the glucose result and any T4 result on the lab, and anything else that might be high or low.
I hope that you don't have to experience separation anxiety for a very long time to come.
We are a great support family and will help you try to figure this out.

Welcome again,
Sharlene and Molly Muffin

[Sammy'sDaddy]

Great! Let's talk more after you've all had a chance to have a look at the test results. No to accidents in the house but he's always been able to hold it a long time if he had to (rarely). He seems to breath very rapidly when he's in pain and only through nose sometimes. It doesn't seem to be the same panting as when he's hot.

I want to say what beautiful furry friends you all have. For little guys, they can have a huge presence. ;-)
Good night all, More tomorrow, Jeff

[Budsters Mom]

Hi Jeff,:)
You send me a private message and I did respond. :) I realize that you're having a hard time learning to post, but you're doing a great job. ;) In order to read my response, you will have to go to your private messages. As you face the forum page, they are in the right upper corner under your forum name. Please let me know if you receive that message, as I answered several of your questions. You may need to enable them under your profile in order to get messages back from others. You have to uncheck the box that says "receive messages from administrators only" in order to get messages from other members. I hope that I didn't confuse you more.:confused:

Hugs to you and Sammy,
Kathy and Buddy:cool:

[mytil]

Hi and welcome from me too.

Your Sammy is very sweet (saw the photos you sent to the gmail account). Lori has you covered with the email you sent.

The comment your vet made about only 18 months is not true at all. There are many here who have cushpups being treated for years.

In the meantime, I wanted to reiterate what you already know :) and maybe you can pass this onto your Mom - table scraps in the quantity Sammy is getting is not good at all. I know how hard it is not to share with our furbabies, but most of it is high in fats, sugars, and calories and high fat can cause very serious conditions (pancreatitis and of course obesity). This can cause heart problems and maybe the panting you are seeing is connected to this.

Have you done any additional testing with your current vet?
Terry

[Squirt's Mom]

I have another very real concern with the table scrapes - the seasonings we use to flavor our food can be toxic to our pets. Onion is a prime example and can cause some very serious problems with organs like the kidneys as well as hemolytic conditions. Onion is in a great deal of the processed foods we eat and it isn't always labeled as such, it may simply say "Flavoring". So if your folks insist on feeding her people food, which is good for them, make sure they understand her foods must be cooked separate from theirs with no seasonings and no processed/canned/prepackaged/etc foods - only fresh foods. ;)

[Sammy'sDaddy]

Kathy and Terry,

Yes I received your response Kathy. It was helpful. I'm getting the hang of it, slowly.

Terry, no I haven't done anymore testing with any vet since last summer. I am eager to hear what people have to say after seeing the test results that I emailed and hope will be available to all soon.
Perhaps the next round of tests will not be too expensive, and will help to further Sammy's diagnosis.

Right now I am cautiously optimistic that maybe he doesn't have Cushing's. I understand it's a controllable disease but I can't afford it.

Here is a link for all, to pictures of Sammy last year at the pond. We were having a good time playing with a soda bottle.

https://www.dropbox.com/sh/024jpgndgfz2sde/w9UBjCikMH?v=0mwng

Thanks again, Jeff

[Dodie]

Hi and welcome to you and Sammy! Everyone on this site are wonderful, caring, helpful people. They will give you good knowledgeable advice.
Wishing you the best,
Dodie & Molly

[Budsters Mom]

Oh Jeff,
We sincerely hope that Sammy does not have Cushings. None of us would wish that on any of the these precious fur babies. Cushing's is a nasty disease, but there is hope and it is treatable. This group helps people do what they need to do and find out what they need to know. They offer hope, love, and support for people who are having a hard time finding it elsewhere. At least that is the way it was/is for me. Yes, Cushing's Testing and treatment is expensive. Once the testing phases are over, it becomes much more manageable. Most of us are not wealthy. We are mainly working people that are doing the best we can. Hang in There with us to Jeff. We will do all we can to help.

Hugs,
Kathy and Buddy:cool:

[Harley PoMMom]

Dear Members,

I have uploaded Sammy's test results, they are in a PDF format.

From what I see, those are some pretty good results, the two levels that are abnormal are the Alkaline phosphatase (ALKP - 402 U/L (23-212)) and chloride (Cl - 123 mmol/L (109-122)). Also his USG (urine specific gravity) is low 1010.

Dog's with Cushing's usually have an ALKP that is a lot higher, we've seen some in the 2000 range. The Cl is just outside the normal limits and even being dehydrated can cause this to be elevated. The Cl is part of the electrolytes which include Ca (calcium), Cl (chloride), K (potassium), Na (sodium), and PHOS (phosphorus) and since these other levels are normal I wouldn't be too concerned.

You mentioned that Sammy drinks like a camel, do you mean he hardly drinks water or he drinks buckets of water? Dog's with Cushing's usually do have a low USG because the excess cortisol has their kidneys working harder (peeing) and they have to drink a lot of water to keep up with the kidneys.

I really do think something else is going with Sammy besides Cushing's but do not know what.

Hopefully the others can give some insight so please don't give up on us, yet. ;)

Love and hugs, Lori

[Trixie]

Welcome to the board. I love the story of you and Sammy. That surely sounds like a tight bond you two have. I am also rather new here and won't be of much help with advice on test numbers, but I hope you will get some suggestions that will help Sammy. He sounds like a sweetheart...hope he will feel better soon.
Barbara

[Sammy'sDaddy]

Lori, thanks for posting his results.

He drinks tons of water and when he pees, he'll stay in one spot for 30 seconds or so before moving on to another spot where he'll pee again for a very long time.
I think it was the USG that concerned the vet the most regarding Cushing's.

Barbara, thanks for the nice welcome. We really are as bonded as can be. There is more to our story than I have had time to explain. It hasn't seemed appropriate to tell just yet either.
I'll tell the story in another post sometime.
Thanks again, Jeff & Sammy, Wag wag wag.

[lulusmom]

Hi and a belated welcome to you and Buddy.

I just checked out Buddy's pictures and his blood and urine results and have to tell you that I'm not seeing cushing's here. I noticed the labwork was done almost 10 months ago so they are not representative of what is going on with Buddy today so even if he had symptoms consistent with cushing's, you would need to do that labwork again. As Lori already mentioned, those results were pretty darn good for a dog of Buddy's size and age so way to go, Buddy! I would certainly not hang my hat on your vet's 90% probability of cushing's with so few symptoms, Buddy's physical presentation and so few lab abnormalities. Basically the only abnormalities consistent with cushing's were the mild elevation in ALK and the dilute urine. After reading that Buddy's arthritis is bad enough to warrant Tramadol for pain management, I automatically suspected severe arthritis for the negligible increase in ALKP. As far as the dilute urine, it would help greatly if you would answer Lori's question.

Buddy's picture shows a pretty happy guy, with a great looking coat and an obvious propsensity for eating high fat/calorie food. My mom and your mom would get along great. My mom's dog is not just fat, she's obese and I've told her that if she doesn't quit overfeeding her and feeding her bad food, she will never live out her normal life expectancy. Diabetes mellitus, pancreatitis, heart problems and exacerbated pain from arthritis due to having to support all that weight can be expected. So if Buddy were my dog, I would immediately get him on Cosequin joint support and a healthy diet to get that extra weight off which is causing increased joint pain. I used to order my Cosequin online but you can find it at Walmart now. You can get it in store or online at http://www.walmart.com/ip/Cosequin-DS-Joint-Health-Supplement-Plus-MSM-for-Dogs-Tablets-60-count-Dogs/22083654

Dogs really aren't born picky eaters. That's an undesirable and frustrating trait us humans are responsible for. I was guilty of spoiling my dogs for years but learned that it's relatively easy to cure. After a vet told me I was killing my dog, I listened. All my dogs were chunky and with little effort, all lost their excess weight, looked great, became more active and much healthier. I put their food down and if they don't finish it in 15 or 20 minutes, I pick it up and they wait until next feeding time. Most dogs love green beans so that's a great treat and filler. What dog food are you feeding?

Glynda

[Sammy'sDaddy]

Thanks Glynda,
Keep in mind that those pictures were taken one year ago. I'll take some pics this weekend and post them for a comparison.
His stomach is huge at times and less so at others... I'll pay more attention as to when it's bloated/distended and when it's less so.

Sammy is drinking a ton of water and when he pees, rather than peeing just a little to mark his territory then move to a new spot to repeat the process, he'll pee for 30 seconds or so in the first spot and then do the same in one or two more spots and then he's pretty much done.

He stopped lifting a leg to pee some time ago. It was a gradual process I suspect it's because it hurts too much to stand on three legs. He just stretches his stance out a bit with more distance between his front and back legs and pees.

In the evening when he drinks, and drinks, and drinks, he shifts his weight from one side to the other every five seconds or so and it breaks my heart because he must be hurting.

I just had cervical surgery for a herniated disc as a result of a work accident in 2007 so I've been living with chronic back pain for years and really sympathize with him. I also have arthritis in my back. What a pair! We both know when it's going to rain...;)

His food varies between Beneful Senior and Beneful Healthy weight, but always with people scraps mixed in.
Holy Smokes! I just googled that to check the spelling and what a surprise. Hundreds of complaints about that stuff!

Does anyone have a recommendation for a good senior food that won't break the bank?

I'll pick up some of the meds you recommended at Wallyworld this weekend. The reviews were great. Think I'll start him on green beans too.

Soooooo. Does anyone have any ideas as to how to proceed? Any specific tests to have done to rule out or confirm a particular illness?

Thanks again to everyone! I'm feeling much more optimistic now.

Jeff

[molly muffin]

Hi Jeff, So you share so much already, seems like sharing the back/arthetic pain would be natural for the two of you.
I looked at the labs too and nothing other than dilute urine is there really. The ALKP is not nearly as high as in most cushings dogs.
I think I'd see what it would cost to do a full wellness test that includes glucose and the T4 and a urinalysis to check kidneys, maybe with a UPC in the mix.
If your vet or you really want to pursue any cushing test, IF the new labs show a problem that isn't currently seen, then I'd go with the UC:CR. It's probably the least expensive and while it can't Determine cushings, it can rule it out.
But I wouldn't do that unless regular blood works shows something like the AKLP going sky high compared to now.
I'll let the others talk about food options as I have my molly on a diet for crystals.
I thnk Sammy looks pretty good for his age, so will be great to see some comparison photos.
Most important of anything I can say is to agree with Glynda. Table scraps have got to go so as to get his weight down and help his joints. I know that is going to be harsh (in his opinion and probably your moms) LOL But it is doable. Skip the high fat treats too and maybe use green beans instead.
Does Sammy have any episodes of vomiting or diarrhea? That is always a good indicator of how they are doing and if there is any gastrointestinal upset.
I think so far we're doing okay here right now.
I would definitely think about even if the vet thinks he does have cushings and all labs support that, would you want to treat. Cortisol is a natural component that helps to mask things like pain from arthritis, which can become much worse once the cortisol is lowered. Just something to think about in the long term.

Hang in there Jeff, you are doing great with Sammy and Sammy looks like a pretty happy fella.

Sharlene and Molly Muffin

[doxiesrock912]

Jeff,
I'm new to the forum but I don't see Cushings either and Daisy's AKLP is off the charts like 4000!!!!

Freeze the green beans as a treat:) It give them something healthy to chew on.

[frijole]

OK I gotta admit I am dying to see what a lab and schnauzer mix looks like (avatar too small) and I can't figure out where the photos are Glynda was talking about! Please share. :D Kim

[Harley PoMMom]

Does anyone have a recommendation for a good senior food that won't break the bank?



Here are links to web sites that analyze dog foods and give reviews: http://www.dogfoodanalysis.com/dog_food_reviews/

http://www.dogfoodadvisor.com/dog-food-reviews/dry/

To find the prices you will probably have to google for them.


Soooooo. Does anyone have any ideas as to how to proceed? Any specific tests to have done to rule out or confirm a particular illness?

Thanks again to everyone! I'm feeling much more optimistic now.

Jeff

Like Glynda mentioned, I would definitely have another senior blood panel done so that we can see if anything has changed and then we can go from there.

Panting and increased water consumption can be symptoms of pain, so I think if this were me, I would ask the vet about another pain medicine that could be used with the Tramadol.

Pleae keep us updated, ok?

Love and hugs, Lori

[molly muffin]

Kim, the pictures are via a dropbox link on Jeff's post at 9:10 today.

Sharlene

[frijole]

:D Thanks! Those were cute photos. I'd say the lab genes outweighed the schnauzer ones. :D:D Looks like he has alot of personality. Always fun to put a photo to the name. Thanks, Kim

[Sammy'sDaddy]

Hi Kim, His skeletal structure is longer than that of a Lab. He used to run like a greyhound! His fur at the nape of his neck and down his back a bit is much coarser than the rest. His ears stick out to the sides before drooping, sort of like the "flying nun's hat". Remember Sally Field in that? He is an excellent guard dog although he'd never hurt anyone, way to social. I read that the Germans bred Giant Schnauzers as guard dogs. He's also bilingual. Understands commands in Spanish and English and when he barks, you'd never notice the accent! ;-) Jeff

[Sammy'sDaddy]

Valerie, I love the text drawing of Daisy! Very creative. Jeff

[molly muffin]

Awww, Sammy is a doll. So a luvabug guard dog with the flying nun ears. Now I have the most hilarious visual going on and that is knowing what he looks like. LOL

Our molly speaks english and french. We rescued her from a high kill pound in northern Quebec. She learned quick though, but still loves it when our friends from Quebec would talk to her in French. She'll sit and look at them adoringly. :)

How did your mom take the news of table scrap reduction?

I hope that you are having a good weekend.

Sharlene and Molly Muffin

[doxiesrock912]

Thanks Jeff!
We also live with 2 cats, Gracie and Annabelle Lee. My email signature has all three of them together:)

[Sammy'sDaddy]

Sharlene and Molly Muffin , That's cool about MM understanding French. Dogs are more intelligent than most people give them credit for.

My mother is on board the program. She began feeding Sammy raw chicken necks, legs and gizzards a few months ago in addition to his crunchies. She understands the dire consequences of Sammy's overweight condition. I saw him do a bunny hop with is back legs while going down a short two step stairway this morning. Never noticed before. Anyway, we're serious about helping him lose weight. I started him on Cosequin DS yesterday.

Valerie, What kind of cats do you have? I love them all. I've had cats all my life, even when I was at sea. I was lucky enough to have others in my life that cared for my kitties when I was away.
I want another one but am afraid to bring a cat where I live. There are foxes, coyotes and rarely wolf or bear. Foxes eat cats for lunch.
Would love to see your email signature with all three critters. ;-)

[Sammy'sDaddy]

Hi Lori, I've done some research on UPC and have found that there are different ways of testing with varying degrees of accuracy. Can you be more specific in your recommendation?
The vet said the senior blood screen with T4 and urinalysis with UPC will run $310.

I'm going to call the local Humane Society to see if they will do it for less. I've asked my vet if they'll do a payment plan and am waiting for an answer. I've read that a lot have been stiffed so it's becoming a rarity. Keeping my fingers crossed. I'll keep you all posted, Jeff

[Harley PoMMom]

Hi Jeff,

I believe, if this were me, I would hold off having the UPC (urine protein:creatinine ratio) test done for now, many things can cause protein loss in a dog's urine and it is usually secondary due to another underlying illness.

The senior blood panel with an urinalysis, to me, is a good place to start.

Love and hugs, Lori

[Sammy'sDaddy]

Hi Lori, Great news! I have found a guardian angel of animals who will pay for Sammy's tests. At least the first round, and that is such a great relief.
So, Sammy has an appointment with his vet for Wednesday afternoon. He will have the senior blood panel, urinalysis, stool and heart worm / Lymes test done.
After comparing the results to last summer's test, that should give us some idea of where to go from there.
I'll post the results as soon as I can.
Thanks for all the advise and support, Jeff

[molly muffin]

Oh my gosh Jeff, this is wonderful news!!! I am so happy for you and Sammy!
You're right it is an excellent starting point and who knows, maybe it will tell you (and us! :) ) enough that things can be figured out. Your vet will have his/her own thoughts on the test results too
I"m really just thrilled for you and Sammy. Happy Dance time!!!!! :)

Big Group Hug!!!
Sharlene and Molly Muffin

[Sammy'sDaddy]

Sharlene, So how is Miss Molly Muffin doing? If I understand correctly, you are still not sure if she has Cushing's. Is that correct? Jeff

[Budsters Mom]

Jeff,
WOW! Awesome news regarding Sammy's test expenses!:) There are many everyday angels. I'm glad that one is coming through for you and Sammy. This restores my faith in mankind. Yes, I'll join Sharlene in her happy dance!:D

Hugs,
Kathy and Buddy:cool:

[Harley PoMMom]

Hi Lori, Great news! I have found a guardian angel of animals who will pay for Sammy's tests. At least the first round, and that is such a great relief.
So, Sammy has an appointment with his vet for Wednesday afternoon. He will have the senior blood panel, urinalysis, stool and heart worm / Lymes test done.
After comparing the results to last summer's test, that should give us some idea of where to go from there.
I'll post the results as soon as I can.
Thanks for all the advise and support, Jeff

Jeff, that is great news!! Will be looking for those test results, and we are always here for you and Sammy.

[Sammy'sDaddy]

Thanks guys, more soon, Jeff

[molly muffin]

Hi Jeff, that's right we don't have a firm diagnosis for my Molly. The reason why is that the only "symptom" she has is the pot belly, but she's had that for years before cushings was even on the radar. Then all her LDDS tests, she's had 4 since 2011 have come back negative. She does have a high ACTH, and she has mildly enlarged adrenal and liver and lymph nodes. However, while that Is consistent with cushings, the LDDS and not having any symptoms is not. Add to that her ordeal with a gastrointentinal bug that had her on antibiotics for over a month at the time of the ACTH test and we are unsure of why the adrenals and liver are englarged, but if she was producing cortisol for that issue and for her leg joint issue, then do that long enough and that could be a factor.
None of it is conclusive enough to treat for cushings, so I just keep monitoring her for now. That just hows how very tricky this disease can be to diagnose.
She is currently acting just fine and is a little trouble maker usually. (which we all love). :) However, having my vet go all out with the cushings diagnosis, I had to start learning all I could about it and how to take care of her if this does eventually become a diagnosis for here. And here we are. :) Right along with all the others who are going through the ups and downs of cortisol testing and what else could it be's. :)

I hope you and Sammy are having a good day. :)
hugs
Sharlene and Molly Muffin

[Sammy'sDaddy]

She's adorable! Wow, Cushing's really is difficult to diagnose correctly.

I remember one episode of "House" where, as they often do, they went through several diagnosis before settling on Cushing's. It would be fun to watch that episode again and second guess House now that we know a fair bit about the symptoms this particular illness.

Frustrating as it may be, we're in the right place to figure it out.

I hope to know more tomorrow afternoon, Jeff

[molly muffin]

I think it just goes to show that every dog is unique in their given situation and that is why we try to so hard to rule out everything else before hitting the cushing diagnosis. Many do end up with cushings being the final verdict but the trip to getting there can be an long one. :) Just hang in there. Hopefully this will be something that some weight loss will fix Sammy right up. We'll see how the blood work numbers look when they come back

hugs,
Sharlene and Molly Muffin

[Sammy'sDaddy]

Hello all, Sammy had his senior blood panel, urine and stool analyzed today. I will scan and post the results when I can.

The vet, (same hospital but different vet than last summer), said that Cushing's is still a possibility but it has dropped down lower on the list.

More likely, there may be a kidney or liver issue. We will do an abdominal ultrasound next week.

He tested negative for heart worm but positive for something that can go along with Lymes disease which he's had before. It's also carried by the same tick. Ticks have been really, really bad in southern Vermont due to the recent "mild" winters.

We're continuing with Tramadol and Cosequin DS for his hips and he's also on a course of antibiotics.

Well, that's it for now. I hope all your furry friends feeling well. :-)

[molly muffin]

Something like lyme disease could cause false positive on any cushings test so I'm glad that the vet is pursuing other possibilities first.
We'll all be interested to see any abnormal in the blood work. You only need to be post abnormal high/low with range.

hugs,
Sharlene and Molly Muffin

[Sammy'sDaddy]

Hi all, Below is a NEW link to the photos that you've already seen plus some that I've taken in the last few days.

His lab results from yesterday are there too with 2012's results on the right side of the pages.

https://www.dropbox.com/home/Sammy%20pictures%20%26%20labs%202012%20and%202013

Everyone is invited to have a look. Thanks guys, Jeff

[Squirt's Mom]

It's asking me to sign in? Any ole thing be ok? :p

[Harley PoMMom]

It's asking me a login UN and PW, too???

[Sammy'sDaddy]

I should add that they got his weight and age wrong on the lab work. He weighed in at 107lb. yesterday and is 12 years old. February 9, 2001

[Sammy'sDaddy]

Sorry folks, I'm new to Dropbox too.

Test results here: https://www.dropbox.com/s/4k092ird8m2yiop/Sammy%27s%20test%20results%20for%202012%20and%2020 13.PDF?v=0mwng

Pics here: https://www.dropbox.com/sh/sdzvxshoa22wnm7/S_ys-jEK-k?v=0mwng

[Harley PoMMom]

Hey Jeff, I saw the the results for a CBC blood panel but not for a Chemistry blood panel (this panel checks the levels for the liver, kidneys, electrolytes...etc) did they do a chemistry panel too? Maybe my computer is just not showing it??

[Squirt's Mom]

I see two pages and the second has the ALP, ALT, ect on it.

[Harley PoMMom]

Yep is was me, I see the Chemistry panel now. :o

[Squirt's Mom]

Been there many a time! :D

[Sammy'sDaddy]

Yes, second page. Just scroll down. Jeff

[Harley PoMMom]

Hi Jeff,

The elevations I see are pretty consistent with Cushing's BUT I'm thinking that thoses elevations could be from the tick borne disease Sammy has and if this were me, I would get the TBD figured out first.

Love and hugs, Lori

[molly muffin]

Awww, Sammy is a handsome lad, I must say. :)

Page 2 is what you'd see in relation to cushings, If nothing else was going on. Since there is something else, the tick issue, then those could change once that is addressed fully.

I think he looks like he is doing pretty good and I'd try to get the weight down by cutting out treats and extra and just feeding him his food to see if that works. I know that can be difficult.

I hope you have a good weekend.
hugs,
Sharlene and Molly Muffin♦

[Sammy'sDaddy]

Hi all, Sammy had his ultrasound today. His kidneys and liver are fine, no cancer.:)

Tomorrow, he goes in for a Dexamethasone Suppression test. Probably all too familiar for you guys.

I'm so glad I found a local fund set up to help animals, that is willing to help us, because with tomorrow's test, we're already up to $760 +/- There is no way I could afford any of it. I feel so grateful it brings tears to my eyes.

Thank all of you for your support. It's really nice to know we're not facing this alone. Jeff and Sammy

[Budsters Mom]

YAY! No cancer! I am thrilled for both of you! :) The liver is often enlarged with Cushings and is very noticeable on an ultra-sound. The fact that his liver is fine is an interesting development. Please keep us posted.

Hugs to you and a belly rub for Sammy,
Kathy and Buddy:eek:

[molly muffin]

That is great news! We love to hear good news here. :) So if liver is normal are the adrenals enlarged? If not then it doesn't sound like Sammy is producing cortisol excessively or at least not for very long.

That is wonderful that there is a fund to help those in need with their animals. It's very hard to find sometimes.

Good luck on the LDDS.

Sharlene and Molly Muffin

[Sammy'sDaddy]

His adrenals are fine, however his liver is, well, I don't remember exactly what she said. Slightly enlarged or inflamed but not bad, and that it could be caused by something other than Cushing's. I'll have it in writing soon.
I'll keep you posted, Jeff

[molly muffin]

My dogs liver and adrenals are slightly enlarged and at this time, they think it is from high cortisol production, but don't think the cortisol is because of cushings, but something else. I don't know what yet either and I'm just keeping an eye on the liver enzymes to see what they do on the liver supplement.

You're doing great.
Sharlene and Molly Muffin

[Sammy'sDaddy]

Hi all, According to my vet, Sammy is a cushpup. I'll put the results from his dex test in my dropbox later and post a link. I would like your take on it too. We did start him on Vetoryl today at 2.5mg. per kilo. That equals one 120mg. capsule daily. He'll have an ATCH test done in ten days to check if the dosage needs to be adjusted.

The vet charged $218.40 for 30 capsules but will match any price that I can demonstrate is available, so I need to get that cost down as low as possible. Any sources recommended by you guys would be greatly appreciated. Sammy's guardian angel has done miracles for us but can't pay for his meds forever and no one should have to pay that much anyway.
More later, Jeff

[labblab]

Hi Jeff,

We'll be really interested in those LDDS results as soon as you are ready to post them. I do wonder whether there may still be some question marks about the diagnosis in the face of the active tick-borne illness and the lack of adrenal abnormality on the ultrasound. But since you are already proceeding with treatment, here is some info in that regard.

First, if you Google 120 mg. Vetoryl capsules, you will find a number of online sources with less expensive pricing that will be easy for you to document. For future purchases at this early stage of treatment, though, I strongly recommend that you buy capsules in a smaller dose. This is because dosing changes are common, and there is no way in which you can personally split a 120 mg. capsule into smaller increments in the event the dose needs to be decreased.

Secondly, if brandname Vetoryl poses too great a financial burden, your vet may allow you to consider a compounded trilostane product. Compounded trilostane is prepared by individual specialty pharmacies in whatever custom dose is prescribed by a vet. It is typically much less expensive than brandname Vetoryl. The downside is that a recent study has shown that some compounded products are not as reliable as Vetoryl in terms of consistency of dose and efficacy. For this reason, everything being equal, I often recommend that folks start off with Vetoryl until their dog is stabilized on the drug so as to give a basis for later comparing the performance of a compounded alternative. But in the real world, I realize that both financial and specialized dosing needs may lead to a preference for a compounded drug from the get-go.

If you want to explore comparative pricing, we have many members who have used Diamondback Drugs, a compounding pharmacy in Arizona that ships orders throughout the U.S. They can likely provide any custom dose you could need, other than the exact dosages in which Vetoryl is sold.

Marianne

[Sammy'sDaddy]

Hi guys, Here is the link to Sammy's Dexamethasone Suppression Test.

https://www.dropbox.com/s/vtyub26izv1dtz8/Sammy%27s%20Dexamethasone%20Suppresion%20Test%20Ma y%2021%202013.pdf

Thanks for taking the time to give it a look, Jeff

[labblab]

Hi again, Jeff. I see we were posting right at the same time earlier. Just looked at the LDDS results and they definitely are consistent with Cushing's, and coupled with the lack of adrenal abnormality on the ultrasound, point to the pituitary type of the disease.

However, we do know that the LDDS can return "false positive" results in the face of illnesses other than Cushing's. Out of curiosity, did your vet tell you whether Sammy's adrenal glands were enlarged at all on the ultrasound? At early stages of the disease, some dogs with pituitary Cushing's do have normally sized adrenal glands. But the majority of dogs with the disease do exhibit some enlargement.

Marianne

[Sammy'sDaddy]

:confused:Hi Marianne, They said his adrenals looked normal, and that his liver was a little "bright". I asked what that means, but still don't get it.

I know that treating a non cushdog with this med can be fatal so now I'm a little afraid that maybe we haven't quite nailed this down 100%.

What would you do?

[labblab]

One of the big questions for me would be the status of the tickborne illness. What is your vet's opinion about that -- does your vet think it is active and therefore warranting treatment in its own right? Or does he think it is dormant and not responsible for any of Sammy's current issues?

[Sammy'sDaddy]

I hope this answers your questions, Sammy is on antibiotics for the TBI. She didn't say whether it was active or dormant. I don't know if it is responsible for any of his symptoms.

Did you see his results from yesterday? Jeff

[molly muffin]

I agree with Marianne, alot depends on whether that tickborne problem is dormant or not. If it is dormant, then there is a greater likely hood of cushings.

Sharlene and Molly Muffin

[Junior's Mom]

"We did start him on Vetoryl today at 2.5mg. per kilo."

Isn't that way too high?

[Sammy'sDaddy]

Now I'm unsure again about my vets diagnosis. Is there another test we can do to absolutely prove or disprove Cushing's?
Jeff

[labblab]

"We did start him on Vetoryl today at 2.5mg. per kilo."

Isn't that way too high?
There are different dosing protocols in use around the world, but this would be close to the low end of the initial dosing range recommended by Dechra (manufacturer of brandname Vetoryl). Their range begins at 1 mg. per pound, or 2.2 mg. per kg. So for a dog of Sammy's size (107 lbs.), an initial starting dose of 120 mg. is not excessively high. Paradoxically, our experience here has been that often larger dogs end up needing smaller doses per unit of weight for effective control than do smaller dogs. So Sammy's dose may need to be tweaked. But this is not a starting dose that is too high according to Dechra's formula.

And Jeff, I do not mean to undermine your confidence in your vet. If Sammy's tickborne disease is ehrlichiosis, then I don't think it would normally produce the weight gain and excessive thirst/urination that you are seeing in Sammy. So there would likely need to be an alternative explanation and Cushing's may very well be it. His LDDS is very definitely elevated -- not borderline. But I always feel a little uneasy when all the pieces don't neatly fit into the puzzle, and that''s been the source of my questions.

Unfortunately, there is no single definitive test for Cushing's. The ACTH is an alternative blood test that is less likely to produce false positives. But its downfall is that false negatives are relatively common. If you perform the test and it comes back positive, you might have added confidence in the diagnosis. But if it comes back negative, you still can't rule out Cushing's.

Others may have a different opinion, but I guess if it were me -- since you've already started the trilostane treatment, I'd probably go ahead and continue it. If Sammy responds positively in terms of the thirst/urination/appetite, by default you'd have support that the diagnosis was the right one. And as long as you watch him closely for any ill effects (and stop the Vetoryl immediately if you see any), then you are minimizing the risks of serious problems from overdosing. You do need to be vigilant about appropriate monitoring, though, and that means an ACTH monitoring test approx. two weeks into treatment (the ACTH is used both for diagnostic and monitoring purposes; the LDDS for diagnosis only). What arrangements has your vet told you about in that regard?

Just my two cents worth for this evening! And if you do continue with the Vetoryl, I want to make sure you saw my earlier reply re: lower cost medication!

Marianne

[Budsters Mom]

Jeff,
I purchase Buddy's Trilostane (Vetroyl) from Diamondback Pharmacy. I researched them thoroughly online before settling with them. They come highly recommended. I have not found a lower price anywhere, and I did look! Price wise, you can do much better than your vet, if you choose to stay with brand name Vetroyl. Just by doing a little research online, you can save a significant amount of money. I do not purchase medications from my vet because they are way too expensive. I can get them at Walmart or Costco for a fraction of the cost. As of now, Walmart and Costco do not have Trilostane, so Diamondback pharmacy is the best bet for me. I hope this helps.

Hugs,
Kathy and Buddy:cool:

[Sammy'sDaddy]

Sorry if my posts have been a bit disjointed. We’re having stormy weather and I’ve lost power twice which crashed my pc twice. By the time I’m back on line I don’t know if I’m coming or going. I’m also working on other things online between posts. I’ll try to catch up.
Trees down on the powerlines… If you don't hear more from me tonight, you'll know why.
My vet said that 2.5mg. per kilo is a low dose. I really don’t know.
As Sammy is 107lb., that’s 48.5kg. x 2.5mg.= 121.25mg. per day. Is 2.5 mg. per kg. high?
I found Vetoryl for $109 for 30 120mg. capsules on two websites in the US.
I am thinking that I should ask Sammy’s guardian angel if she’ll forward all the info we have accumulated so far to HER specialist and see what he thinks.
What'da y'all think?

[molly muffin]

It sounds like since you have Sammy started on the meds, the best thing to do is see how he reacts and if symptoms lessen. You'll need an ACTH test 10 - 14 days after starting the medication.
Watch Sammy for any diarrhea, vomiting, refusing to eat or lethargy. (signs of cortisol going too low)
Only an LDDS was done correct? Not an ACTH before treatment? You might have said I have just forgotten.
However, I wouldn't over order a bunch of 120mg pills because dosage does change and you are stuck with what you have. It isn't splittable in capsule form.

Sharlene and Molly Muffin

[Sammy'sDaddy]

Hi Sharlene, Yes, Sammy started the Vetoryl last week and I have noticed changes already.
He is drinking less frequently and less quantity of water. He seems to be a bit more active as well.
You are correct in that he did not have an ACTH but he is scheduled to have one shortly.
I am including a link to my dropbox because I've posted the results of his ultrasound. They are in "medical-ese" so my understanding is limited. I'd appreciate any input you can give me. Thanks a bunch, Jeff

[Budsters Mom]

I am thrilled to hear that Sammy is feeling better and that he's going to have an ACTH test soon. :) There are a lot of mother hen in this group.:D

Hugs,
Kathy and Buddy:cool:

[Sammy'sDaddy]

Oops! I was distracted and forgot to include the link to my dropbox.

So here it is. https://www.dropbox.com/sh/65h9o182jij6sem/7gcnn8Dc_e

[Sammy'sDaddy]

Hi all, yesterday Sammy had his ACTH test. I'll post a link to my dropbox where you can find the results.

As of yesterday, he has been on 120mg. Vetoryl and 200mg. Tramadol daily for 12 days.
He ate and had his meds as usual at 7:00am.

The vet says that his levels are higher than she'd like so he should continue at his current dose until his next ACTH in 30 days.

I would love input from anyone who cares to have a look.

https://www.dropbox.com/home/Sammy%20pictures%20%26%20labs%202012%20and%202013

I would like to say that I'm sorry that I haven't been reading or commenting on anyone else's threads. It must seem awfully self-absorbed of me. At the moment, it's all I can do to keep up with this thread. I am interested on how your furbabies are doing and will try to spend a little time checking out your situations.
Thanks for the support,
Jeff and Sammy

[molly muffin]

Hi Jeff,
Can you repost the link to Sammy's Dropbox ACTH test. This one takes me to my home/files.

Sharlene and Molly Muffin

[Harley PoMMom]

Hi Jeff,

That link doesn't work for me either as it asks me to login.

[Roxee's Dad]

I logged in, but the message displayed was " Sammy's Test does not exist"

[Roxee's Dad]

OK.. I have them now. Let me see if I can get them posted...

[labblab]

Oops! I was distracted and forgot to include the link to my dropbox.

So here it is. https://www.dropbox.com/sh/65h9o182jij6sem/7gcnn8Dc_e
OK Guys, I found an earlier link that works. :)

And Jeff, based on a post-ACTH result of 9.5 after two weeks of treatment, I think your vet is exactly right in leaving the dose unchanged until the 30-day testing.

As a side note, from the timing of the test, it looks as though your vet is following the protocol favored by UC Davis and testing 2-3 hours post-dosing (instead of the 4-6 hour time frame that Dechra recommends). There is nothing wrong with that, as long as the future tests are also done within the same time frame so that you can directly compare all results.

Marianne

[Roxee's Dad]

June 3, 2013 9:41 am

Cort > 10 ug/dl

June 3, 2013 10:38 am

Cort 9.5 ug/dl

Just a note that the draw was less than an hour.

[Sammy'sDaddy]

Yes, you are all correct in the time frame. The vet said that she did the draw after 2 hours, not 4 and that perhaps she should have waited 4 hours. I really don't know why she didn't. They had Sammy from 8-4 yesterday. Next time, should they do a 2 and 4 hour draw?
Sorry about the bad link.

[Sammy'sDaddy]

By the way, His weight is listed in most if not all of the reports as 81.4 pounds but he is 108 pounds. I asked them to change that. I believe that was his weight approximately 3 years ago when they first examined him and for some reason it keeps repeating.

[molly muffin]

They Should do the initial draw 4 hours after eating/dosage in the morning, and then an hour later I think it is, the second draw. That is all there is to it. That makes the first at 4 hours and the second at 5 hours after morning dosage. It doesn't sound like she is very experienced with ACTH testing.
Did you give Sammy his meds that morning? If so at what time? I'm thinking if the initial draw was at 9:41am, you would have had to have fed him and gave him his medicine at 4:41am to be in the time frame needed for testing.
Maybe one of the others can correct me if I am off with my timeline.

Sharlene and Molly Muffin

[Budsters Mom]

I called Dechra myself. This is their current guidelines for the use of Trilostane and ACTH testing...

1. Trilostane must be administered with food for proper absorption.

2. ATCH testing - No fast- Meal with medication - a smaller meal is warranted if the animal tends to get carsick. Test must be done 4-6 after taking meds with Breakfast. The same protocol needs to followed for future tests, so that comparisons can be made.

Vets often want to do several tests at once therefore requiring a fast. In that case, it is advisable to do the ACTH test at a different time.

I hope this helps,
Hugs,
Kathy

[Sammy'sDaddy]

Kathy and Sharlene, Does Trilostane have to be injected or is it in pill form? I'm still a little confused. I assume that the vet administers that med anyway. I certainly didn't.

I agree that this vet is inexperienced with ACTH testing. She is leaving the hospital so I'll probably be using the vet that originally diagnosed Sammy with Cushing's last summer before all this testing. I'll speak with her about how the test was done this time and how we'll do it next time.

I fed and medicated Sammy at 7:00 am. They said to feed and medicate him as usual.

Do either of you think I should have the test repeated correctly or just wait till the next time around in 30 days?
It seems that the test was conducted incorrectly, no?

[Roxee's Dad]

I always took Roxee in for her ACTH testing 4 hours after taking the Trilo. The 2nd draw was always 2 hours after the initial injection.

I wouldn't leave her at the vet, so I would take her to a park close by but had to be back within 2 hours and no eating in between draws.

[Harley PoMMom]

With an ACTH stimulation test a stimulating agent is injected not Trilostane. Most vets/IMS' use Cortrosyn as their stimulating agent. When one is using Cortrosyn the post draw is done 1 hour after injection, with Acthar gel as the stimulating agent the post draw is 2 hours.

[molly muffin]

Trilostane is the medical ingredient of vetoryl.

So you gave it to him at 7:00 and then they tested at 2 hrs, 41 minutes later and then did the Post draw at 3 1/2 hours after eating.

At this point, I probably would not have them redo it right now, unless you notice adverse symptoms, as cost is a very real factor in having these tests done. (unless they are feeling generous and want to redo it for free ;) )

Sharlene and Molly Muffin

[labblab]

Hi again, Jeff!

Here's my two cents worth to throw into the mix. I do not think you need to worry about redoing this ACTH test. As I mentioned earlier, UC Davis does not follow the same testing protocol that Dechra recommends. Whether by design or by accident, the way in which your vet conducted this test is consistent with the way that UC Davis conducts their monitoring ACTH tests: conducting the test 2-3 hours after the morning's dose of Vetoryl (trilostane) has been given with food. So I think you remain in good shape. The goal of the monitoring testing is to catch the cortisol when it is at its lowest point during the day -- in other words, when the trilostane is maximally effective. Since Dechra tells us that trilostane reaches it maximum concentration in the bloodstream approx. 1 1/2 hours after dosing, an ACTH test conducted between 2-3 hours after receiving the drug means that Sammy's cortisol should have been caught at that desired lowest point. Also, if I'm calculating correctly, the second draw was only three minutes short of an hour. So I don't think that is any issue, either.

I cannot tell you why UC Davis prefers the 2-3 hour time frame whereas Dechra recommends testing between 4-6 hours after dosing. But I don't think you need to stress over the timing of this test that has already been done. In the future, do make sure that all additional tests are done consistently either at one time or the other, though, in order to insure that the results are directly comparable.

Marianne

[Sammy'sDaddy]

OK. This all can be confusing but I think I got it now. I can always come back to this thread to refresh my memory before the next test.
Thank you all so much for explaining this to me. I won't worry about re-doing the test.
Sammy is doing better, drinking less and a bit more active. He seems happier too. :-)

[molly muffin]

Good point Marianne, I had totally forgotten that UCDavis recommendation was different.

I'm really glad that Sammy is doing better. :)

Sharlene and Molly Muffin

[Harley PoMMom]

I would like to say that I'm sorry that I haven't been reading or commenting on anyone else's threads. It must seem awfully self-absorbed of me. At the moment, it's all I can do to keep up with this thread. I am interested on how your furbabies are doing and will try to spend a little time checking out your situations.
Thanks for the support,
Jeff and Sammy

Jeff, in no way do we think that you are self-absorbed, we truly do understand how busy "life" can be so please do not worry yourself about not posting on other members threads.

Just pretty please keep us updated about you and Sammy. ;):)

[Budsters Mom]

Oh Jeff,
We all do what we can at any given time. Don't ever feel bad for not being able to post on other's threads. We're all family and are here to help. Please keep us posted on your sweet Sammy.:):p

Hugs,
Kathy