Min Dachshund waiting for test results to confirm Cushings What should I ask

[loveMyDaisy]

My name is Stephanie and I have a miniature dachshund that is 11 y/o. She started drinking all the time and peeing in the house and her hair is really thin. She also fights to get food (new to her) and has a big pot belly. These symptoms have shown up in the last 3 months. I am not sure that it might have been before that because I had another dog, my poor Sammy that passed away a week ago, so have been tending to him for about a year and may have not noticed little Daisy's symptoms. So I took her to the vet last week and her blood work and urine test showed that she had all the symptoms of cushings. She just had the Low Dose Dexamethasone Suppression Test yesterday and we should get the results back next Wednesday.
I was wondering you anyone could tell me the right questions to ask the vet when we do get our results back. She said there is another test after this to determine whether it is pituitary or adrenal. She said this test will be very expensive and that there is a lot of test that will be needed to balance her meds.
Of course I am going to do whatever I can to make it possible for Daisy to have a quality life, but you just can't get money where it isn't there. Is it possible to start the meds after the test she just had or is that too dangerous?
Thank you for your help and I am so thankful I found this board

[goldengirl88]

Hello :
Welcome, and sorry your baby is having problems. There is no easy way to determine Cushings the tests needed must be done. Try and talk to the vet you go to and see if he will accept payments. After the initial testing it does get a lot cheaper. You will just need to buy meds and testing about every 3 months. If your vet won't accept payments maybe you can apply for Care Credit. It is to pay the vet and they can make the payments real low to help you out. There is just no easy way out of this, or all of us on here would have taken it. We are all strapped for cash etc. because of the same reasons, so know you are not alone. You will need to get your test results- make a folder and keep them all in so you have copies of everything, document all behavior in a diary. Good luck to you and your baby. Blessings
Patti

[Trixie]

hi Stephanie,
I am only dealing with this for about 2 months myself so I am no expert but there are experts here and they will be helping you along with great advice and guidance. This board helped me so much and still does!!
I believe that the low dose dex test will determine whether or not it is adrenal or pituitary caused...it did for my dog you should not need another test for that determination. Others here will correct me if I am wrong.
I'm sorry to hear about the loss of your other dog Sammy. Try to take it one day at a time. We had all the same symptoms as your Daisy has. My dog was diagnosed in April. She is on a pretty low dose of the medication. It took a few weeks for me to notice any change in her symptoms but this past week her drinking is finally more normal, the belly is less bloated no more peeing in the house and she is doing great. (knocking wood!) It can happen.
Yes there is no getting around the crazy costs. We have had 2 acth tests to check the levels after we started the medication. Now it will probably be another 3-4 months for the next one, but once you get leveled off the expenses will not be as bad...just the meds.
If you do get a positive diagnosis you will be on one of two different medications. If your dog goes on vetoryl/trilostane then make sure your vet goes with the "new" dosing which is 1mg per pound of your dog. Seems many problems we hear about come from the dosage being too high. It make take a bit longer to see a decrease in the symptoms but I think it was worth it to not contend with bad side effects or an overdose.
I hope Daisy will soon feel more herself! Don't worry things will get better!! :)
Barbara

[Harley PoMMom]

Hi Stephanie,

Welcome to you and Daisy. I am so sorry to hear that your sweet boy, Sammy, passed and my condolences to you and your family.

Cushing's is one the most difficult endocrine diseases to get a confirmed diagnosis for because not one test is 100% accurate at diagnosing it and other non-adrenal illnesses can create false positive results on all tests for Cushing's.

Strong obvious symptoms do play a huge part in a diagnosis for Cushing's, but usually a vet that is knowledgeable about Cushing's will perform multiple tests to validate a diagnosis for this disease.

The UC:CR, ACTH stimulation, and the LDDS (low-dose dexamethasone suppression) are the tests that are performed most to diagnose Cushing's. The LDDS test can sometimes differentiate between adrenal dependent hyperadrenocorticism (ADH) or pituitary dependent hyperadrenocorticism (PDH). An ultrasound is another very useful tool as it gives a peek at the internal organs and if both adrenals are visualized this can also aid in identifying between ADH and PDH.

If you could get copies of all tests that were done on Daisy and post any abnormalities that are listed that would help us to provide you with more meaningful feedback. Any tests that were done to diagnose Cushing's we sure would be interested in seeing those results too.

How much does Daisy weigh and is she taking any other herbs/supplements/medicines? Does she have any other health issues?

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

Love and hugs, Lori

[Budsters Mom]

Hello and welcome from me too.:)
I am sorry for the reason that brought you here, but so 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. We will do all we can to help. So again welcome to you and Daisy. Daisy is a popular name around here!;):)

Hugs,
Kathy

[molly muffin]

Hi and welcome Stephanie and Daisy. She is a cutie! Love her picture.

I'm very sorry for your loss of Sammy. :(

I'd say we need to see what the LDDS results are first, and take it from there.

Has she had a blood test, like CBC? Things like diabetes and thyroid have the same symptoms and need to be ruled out and can cause false positives on cushings test if they are active. If a CBC has been done do you have those results?

Next if all things do indeed point to cushings, find out how much experience your vet has with treating and with what drugs. There are very specific protocols that have to be followed involving dosage (currently vetoryl is 1mg/1lb) always start low. You can go up, but going down isn't something you want to go through. If using Lysodren to treat, then they need to be experienced with loading and maintenance phase.

Again welcome to the forum.
Sharlene and Molly Muffin

[frijole]

So I took her to the vet last week and her blood work and urine test showed that she had all the symptoms of cushings. She just had the Low Dose Dexamethasone Suppression Test yesterday and we should get the results back next Wednesday.
I was wondering you anyone could tell me the right questions to ask the vet when we do get our results back. She said there is another test after this to determine whether it is pituitary or adrenal. She said this test will be very expensive and that there is a lot of test that will be needed to balance her meds.


Before I forget - don't even think about starting drugs without confirming a diagnosis - way too dangerous.

The good news is that the test you had (LDDS) is the one that can possibly determine which type of cushings you are dealing with. The bad news is that the other test is the ACTH test and it is expensive because it's main ingredient is expensive. Like liquid gold. Your vet may or may not be aware of how you can save money - since your dog is small it won't use the entire container. Here's how it works:

Most vets use a stimulating agent called Cortrosyn but we call it liquid gold because it's that little vial that dictates the cost. The vial is .25mg and instructions say to use entire vial but not all dogs need the entire vial. There have been studies done that show using just 5mcg per kg is all that's needed. Since there are 250mcg in one vial, your vet can get two stim tests out of one vial. This has saved members a lot of money, especially those of us with teeny dogs who can get five and six stims out of one vial.

Some vets are not aware of this so we always provide the url to Dr. Mark Peterson's blog which instructs vets on how to dilute and store cortrosyn for future use. In other words you pay for the vial and they store it for future tests and only charge for their time in future tests.



http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html
You have nothing to lose and everything to gain by printing this out or providing the URL to your vet and asking if s/he will please split the vial.

Kim

[Simba's Mom]

Welcome Stephanie and Daisy, I too have a 11 year old mini doxie, but Simba is not so mini, he loves his food....how much does Daisy weigh, and yes start low on the meds, you can always bump it up later...if needed... When Sim got diagnosed I cried and cried, and then I found this site, and it's been the best thing for me and Simba....I have learned so much and made lots of new friends too...we are all in this together, so settle in, and read some threads its amazing what you will learn...and knowledge is power! Take care!

[SoggyDoggy]

Hi and welcome from me too. I'm so sorry you have had such an awful week. Loosing your poor Sammy and then having to face a diagnosis of cushing's disease! At least we can all say that Cushing's is completely treatable and while expensive, at least you can know that Daisy can live a perfectly happy life when under control.

As for the tests, did the vet happen to mention what the next test was? Kim mentioned the ACTH test, which is definitely used for monitoring the cortisol levels during the treatments, though I'm not 100% sure, it could be another test that is done pre treatment too. It wasn't for my boy, but then his treatment was seriously stuffed up at the start by an inexperienced vet, so I won't go into that. If the next test for Daisy is an ultra sound, I would highly recommend this before beginning treatment. In addition to confirming either adrenal or pituitary cushing's, it will give the vets a chance to check Daisy's other internal organs and make sure there is nothing unexpected there that could be causing issues as well. As already mentioned, cushing's is very difficult to get a confirmed diagnosis on and so many of the symptoms can in fact be caused by other endocrine issues which can confuse results. So basically, an ultra sound is worth doing if you can.

With the ACTH test used for monitoring, I would definitely recommend speaking to your vet about the cost saving methods provided in the link above in Kim's post. Everyone here can vouch for the fact that this is an expensive disease, and saving money wherever we can is always welcome. As a question for you vet, ask them straight out how many cushing's patients they are actually successfully treating. Then confirm that it is your vet that is actually treating those patients, not just patients that visit the practice. You want to feel completely comfortable that your vet knows what they are doing with these drugs as they are very potent and can cause problems if used irresponsibly.

Also ask what treatment your vet is looking to use. There are two types, Lydosren (mitotane) or vetoryl (trilostane). Make sure that they are very familiar with the protocols for using and monitoring whichever drug, ask about side effects and signs to watch out for, in addition to getting some prednisolone. The pred is a safety factor in case Daisy reacts too quickly to the treatment and her cortisol goes too low. It can be scary, but if your vet truly know's what they are doing and is cautious with dosing, you hopefully won't have a problem. I'm honestly not trying to scare you here, many of us have treated successfully without any significant issues, but we have all found that arming ourselves with the knowledge first and being hyper vigilant has been an assett. We are the only voice our babies have so we must be sure to use it. Sometimes it's even difficult to explain what is going on to the vets, but we know that something is just "off". It's those times when you have to listen to your gut and speak up. You know Daisy better than anyone else, so don't be afraid of being pro-active for her.

Anyway, I hope this and others posts gives you enough for a starting point. Whatever questions you have, none are too big or too small to ask so post away. There is also no rules about how long posts can be (trust me, mine always tend to run long :D) so whatever is on your mind, ask away. We are all here to help and hold your hand through this. Take a deep breath and give Daisy a hug for us.

[mytil]

Hi and welcome from me too.

I am sorry for your Sammie's passing.

The others have filled in a lot, and here is a good link in understanding Cushing's, the diagnosis and treatment options - a good start in becoming your pup's advocate. http://www.kateconnick.com/library/cushingsdisease.html

Keep us posted
Terry

[loveMyDaisy]

Thank you so very much for all the great info. I feel like when I go in to talk with the doctor on Tuesday that I will have a good toolbox of questions. I will definitely find out how familiar she is with dealing with Cushings and also get a copy of all the records so far. I am not sure what the next test she said we would go to, if we get a postive result. To be honest I was so upset when I found out that this was what we were looking at, it seemed kind of like a blurr. I had just gotten to the point of being able to do things without bawling from losing Sammy. This is a new vet, because of bad situations with Sammy's diagnosis and treatment. So I am hoping that it is a good one. It is the Banfield hospital inside the Petsmart, my friend reccomended them. But so far they have been wonderful.

Thank you again for so much wonderful support, I feel like you have given me back some solid ground.

By the way to answer some of the questions
She had a urine test and it was so diluted that it was almost straight water
She had a CBC and no signs of diabetes or thyroid issues.
She weighs 14lbs (I know too much)
I will post all the results I get Tuesday. :)

If I could ask one more question, I haven't taken her for walks for about 2 months because she just tires out so much, do you think I should give her exercise or hold off until we have everything figured out? thanks again

[Simba's Mom]

My vet say exercise is good for Simba, but we have cut our walks in half, I think too that he is better when he gets his walk in...

[loveMyDaisy]

My vet say exercise is good for Simba, but we have cut our walks in half, I think too that he is better when he gets his walk in...

Thanks, that's what I thought. I will just let her be the judge. She gets really excited when we first go then just poops out. But everything is just so different now because those walks included Sammy (dachsund/dalmation :eek: mix) and he probably took us a little faster then poor Daisy's lil legs wanted to go.
Tomorrow morning I will start again.

[NoonelovesmelikeNorman]

Hello and Welcome Stephanie and Daisy! First I would like to extend my heartfelt sympathy on the loss of Sammy.
Daisy is just adorable, I am sorry she (and you) are on this journey but you found the most helpful and knowledgeable site to help understand this condition.
I also have what is suppose to be minature dachshund, Norman, who will be 13 later this month, diagnosed in Dec.2012 with cushings. I have a neuro condition and memory is poor so I am not a good one for expert advice as so many others, however, my suggestion would be to find a vet wo is willing to work with you and be willing to take the suggestions of the experts in the group. Call around to see what vets in your area carge for the needed test/ ow often, let them know your situation. And mention you just lost Sammy...you have been through a terriblibly difficult and sad situation lately. Hopefully, Daisy can get tested and on the right dose of medication needed reasobably soon so she can regain her quality of life and live for years. Norman, my dachsund, is on the correct dosage and is doing terrific. It was a roller coaster ride but worth it. He has a great quality of life now.
I wish you and Daisy the very best. You are not alone in this journey.
Peace and love,

Sharon, Norman - Cushings doxie, Millie- mini yorkie pooh

[loveMyDaisy]

I also have what is suppose to be minature dachshund, Norman, who will be 13 later this month, diagnosed in Dec.2012 with cushings.

Thank you so much for the post, Norman is adorable. Is your avatar a recent photo? I so hope that I can get Daisy's coat to look like that again. This site has given me so much hope were none was a few days ago.
Thank you again

[loveMyDaisy]

Well I just got back from the doc. Let me first say thank you everyone for making and supporting this site. I felt like I was informed and able to ask the right questions. I would have been a basket case without you:)
So she definitely is a Cushings doggie. I ask the doc how many patients she has had and she said only 7 in the last 30 years, but 5 of those in the last 3 years. She talked about the latest one being a jack russell that is seeing great results. She was going to call the owner and give them my number to talk about her feelings on the doc and the condition.
So here are the numbers, hopefully I put them down right.

Cortisol Sample 1 14.9 range 1.0-5.0
Cortisol Sample 2 123.6 range 0.0-1.4
Cortisol Sample 3 24.1 range 0.0-1.4

The doc said that her levels are so high that they are consistant with PDH and therefore no further testing needs to be done to differentiate between pituitary or adrenal. She stated that she more then likely has a tumor on her pituitary and that there is no treatment other then medication.
She would like to start her on Trilostane 30mg (she weighs 14lbs) and then after 14 days do teh ACTH test. I asked her if she had considered 30mg being too much to start and she felt that with her numbers and her weight that this would be where she thought was best.
I also talk to her about the diluting of the ACTH and she said she was not comfortable with doing that and felt it was too dangerous to try something she was not comfortable with. She was very understanding about it, but would not budge. I left the information for her to read, so maybe she will reconsider.
Here are the results from the blood work prior to this test
WBC 13.4, RBC 7.75 , HGB 16.4 ,HCT 50.7 ,MCV 65.0 ,MCH 21.2
RDW 14.8, PLT 298.0 ,MPV 7.9 ,Segs-Neutrophil 94.1 ,
Lymphocyte 3.7 ,Eosinophil 0.0 ,Basophil 0.0 ,Monocyte 2.2
ALT/SGPT 694.0 ,Amylase 481.0

I hope I haven't gone on too much. I just wanted to try and give you everything I had.
Thanks again for all your support. It means the world :D

[frijole]

You are doing fantastic! My only concern is that the dosage is too high to start. She admitted she doesn't have alot of experience and she is probably reading from what was Dechra's previous dosing recommendations. They have reduced it to 1/2 of what it was. Leading institutions such as UC Cal Davis have done studies and they were one of the first to reduce the dosing amounts.

I would not ask but tell her that you want to start lower. I know it isn't easy to debate when you are new to this but all you have to do is read thread after thread here where dogs' cortisol went too low and ended up having to reduce it. Plus you can't use a partial capsule so you would have purchased capsules that you cannot use. If you start low you can give two capsules if you increase the dosage.

Others with more direct experience will hopefully chime in.

Re the blood results - can you please post each item with the ranges for normal next to them? That way we know how out of range it is? Each lab is different. Thanks! Kim

[loveMyDaisy]

I was afraid I was putting too much on the page =-0 Here are the ranges that lab shows :)


Test name Range
WBC 13.4, 6.0-17.0
RBC 7.75 , 5.5-8.5
HGB 16.4 , 12.0-18.0
HCT 50.7 , 37.0-55.0
MCV 65.0 , 60.0-72.0
MCH 21.2 19.5-24.5
MCHC 32.3 34.0-38.0
RDW 14.8, 12.0-16.0
PLT 298.0 , 200-500
MPV 7.9 , 6.1-10.1
Segs-Neutrophil 94.1 , 60.0-77.0
Lymphocyte 3.7 12.0-30.0
Eosinophil 0.0 2.0-10.0
Basophil 0.0 , 0.0-1.0
Monocyte 2.2 3.0-10.0
ALT/SGPT 694.0 , 10.0-100.0
Amylase 481.0 500.0-1500.0
Cholesterol 252.0 110.0-320.0

[labblab]

Hello from me!

Can you please go back and double-check the numbers that you have listed for Daisy's LDDS test, and also the reporting units.


Cortisol Sample 1 14.9 range 1.0-5.0
Cortisol Sample 2 123.6 range 0.0-1.4
Cortisol Sample 3 24.1 range 0.0-1.4

The doc said that her levels are so high that they are consistant with PDH and therefore no further testing needs to be done to differentiate between pituitary or adrenal. She stated that she more then likely has a tumor on her pituitary and that there is no treatment other then medication.
Daisy's results do not seem to be reported in the same units as the reference range. For instance, if the normal reference range for the second cortisol sample was between 0 and 1.4, I do not see how it is possible that Daisy's result of 123.6 was reported in the same units. Something has got to be wrong here for her result to be so astronomically high.

Also, it doesn't make sense to me that your vet has concluded that Daisy has the pituitary form of Cushing's because "her level was so high." In order to conclude that a dog has pituitary Cushing's from an LDDS test, either the 4-hour or 8-hour result has to be less than 50% of the baseline value (or the 4-hour value has to be less than 1.4), which certainly was not the case for Daisy. Something seems very, very "off" regarding these test results!

I am sorry to bother you about rechecking the results, but what we are seeing here just does not make any sense. :o

Marianne

[Trixie]

Stephanie--I don't know a great deal about all the numbers on the tests but I will say that starting at 30mg seems a bit high. My dog weighs the same as yours and we started at 12mg. That sounds very low and we have had to come up from there but I was very happy that there have been no bad reactions/side effects with low dosing.
The old dosage instructions for the medication started at 30mg but current instruction is 1mg per pound to start and then test after 2 weeks too see what the levels are.
I agree that you should tell the vet respectfully that you definitely want to start at a lower dose.
Barbara

[doxiesrock912]

Stephanie, 30mg is most likely too high.
20mg all at once was too high for my Daisy, also a black and tan mini-dox who is 9 years old and weighs 11 lbs.

We are down to 7.5mg twice a day. PLEASE show your vet the links on proper dosage because many are not aware that the info packet included with the meds is not accurate according to the manufacturer.

I would suggest to them that they cal Dechra directly and speak with one of their vets.

Your Daisy has the exact same symptoms as mine!

Good luck and welcome :)

[loveMyDaisy]

http://i23.photobucket.com/albums/b371/BEATITUDESMATT5/Daisy8hrtest001.jpg (http://s23.photobucket.com/user/BEATITUDESMATT5/media/Daisy8hrtest001.jpg.html)

This is the copy of her test results, hopefully it will make more sense. Please let me know if you think I should ask for more testing before we go any farther.
Could I also ask, do you think that Daisy could develop these symptoms because of stress. I think she has been under a lot of stress for the last 8 months with buddy being sick. But her symptoms seem so strong along with her blood tests.
thank you for your help.

[labblab]

Thanks so much for posting these test results, and I have to say I am befuddled by the LDDS because I have never seen a result this high. I don't say this to alarm you, but more because I wonder if there was some irregularity in the way the test was administered. I see that the lab even repeated the 4-hour analysis in order to double-check it, and used a "dilution" method.

One thing is sure: your vet cannot know that Daisy has the pituitary form of the disease from these results. These results, if accurate, could be consistent with either pituitary or adrenal Cushing's per the printed "Interpretations" below the test results.

I want to draw the attention of our other staffers to these results, and see if anybody else has some thoughts. So I'll get back to you again a bit later on...

Marianne

[frijole]

I agree Marianne because the numbers are so unusually high I wonder about the test as well. Certainly the symptoms are there. Perhaps do an acth test to see if the cortisol levels are also highly elevated? Not sure. Kim

[loveMyDaisy]

Thank you so much for your concern. I will be watching for the responses to make a decision about where to go from here. Maybe I should call another vet, but I wonder if they will give me advice without doing their own testing?

[frijole]

What has us confused are the 3 numbers on the LDDS test. If you look at the normal range you can see they are off the chart higher. We've seen them a bit over normal but 123.6? Shaking my head.

I wouldn't switch vets at this time. I would however insist on starting lower should you decide to treat. Your vet admitted to only having worked a handful of cases in 5 years - that isn't much experience. Doesn't make them unteachable. If she is unwilling to listen then that's another story. Use the links provided on dosing to help teach her - it's not just our opinion but that of experts in the field so you would be helping her learn. Kim

[loveMyDaisy]

Can someone tell me does it depend on the lab for the normal ranges. I went to one of the links from the resources and found this information for the ACTH test

ACTH Stimulation Test---Unit of measure nmol/L ----Normal levels
13.8 - 137.9 pre

151.75 - 469 post

this seems that her pretest of 14.9 would be in normal levels and post test result of 123 would actually be low
http://www.2ndchance.info/normaldogandcatbloodvalues.htm
When I did the conversion from nmol/L to what my lab used µg/dL it stated they were equal measurements.

This is all so very confusing. I just want her to get better, but now I am afraid this doc might make her worse.

[loveMyDaisy]

So after 3 hours of reading through everything on this site and any link I can find, I just felt that I should do some calling around. I found a vet just 10 minutes from me that specialized in Cushings and is willing to see me for a free consult tomorrow. I feel like I don't have anything to lose by seeing him.
I hope all here would agree that this is the best decision. It may mean a delay in treatment but I am hoping in the long run it is the best decision.

Thought I should add that I have appt with him tomorrow afternoon=-)

[Budsters Mom]

Yes, yes, yes, get all the free information you can possibly get! A free appt. with a Cushings specialist that is only 10 minutes away!! You have hit the Cushings lottery!!!!!:D:D:D:D:D Run, don't walk there!! DO IT NOW!!!!!

Hugs,
Kathy

[loveMyDaisy]

Thanks Kathy =-)

[labblab]

Hi again, Stephanie.

The ACTH test (for which you just posted norms) is an entirely different test from the LDDS which was administered to Daisy, and the results are not directly comparable in any way. The LDDS is solely a diagnostic test for Cushing's; the ACTH is used both as a diagnostic test and also a monitoring test once treatment is underway. One sidebar note: when converting from nmol/L to ug/dl, you divide the nmol/L units by 27.59.

Turning back to Daisy's test, I am still stumped by her results. In the ten years that I've been on this forum, I don't think I've seen a 4-hour or 8-hour LDDS result that exceeded 15. So to see a result of 123 is mind-boggling to me. In honesty, I am not questioning that Daisy has Cushing's. But these test results are hard to explain. I believe I'd want to know whether the lab that performed the analysis has any feedback about those results since they are so excessively above the norm. Have they ever seen results that high before? Obviously, they double-checked that 4-hour result themselves, so they must have thought that something was odd.

Secondly, I'd want to pursue the question of pituitary vs. adrenal Cushing's with the vet. Since the majority of dogs do have PDH, is she just going with the odds in telling you that's what she thinks is the case with Daisy? Because as you can see from the Lab's interpretation instructions, the LDDS results can't confirm PDH. I don't know whether or not this information matters to you. But just so you are aware, adrenal Cushing's has the potential for a total cure via surgical removal of the adrenal tumor. The surgery is risky and very expensive, so it is not an option for everybody. But if you want to know whether or not Daisy has an adrenal vs. a pituitary tumor, you'd need to perform further diagnostics to figure that out. An abdominal ultrasound can be really helpful in that regard.

Last but not least, I agree that our experience here is that starting with a lower dose of trilostane (and working up if need be) seems to be safer and more comfortable for the dogs. If your vet wants you to stay with brandname Vetoryl, you could start with 10 mg. capsules, giving either one or two per day to begin with (for either 10 mg. or 20 mg. daily total). Am I remembering that Daisy weighs about 17 pounds? If so, 20 mg. once daily might be the best place to start. This does turn out to be more expensive because you would be buying two boxes of capsules rather than one. But on the flip side, if you start Daisy out on 30 mg. capsules and her dose has to be decreased, the remaining capsules are worthless to you since they can't be split. Whereas, the 10 mg. can always be combined and used in some combination.

I know this is a lot to throw at you, but I just wanted you to know where my thinking has been leading me...

Marianne

[Trixie]

free consult!!! Yay for you!! Go for it! It's not much of a delay so no worries. :D
Barbara

[labblab]

I see we were typing at the same time. YAY, I totally agree that I think it's a great idea to get the additional consult! :)

[Budsters Mom]

Hey, If you don't go, I will!:D;)

Hugs,
Kathy

[Trixie]

haha...a frenzy of responses sparked by the words "free consult"! :D

[loveMyDaisy]

I agree that I thought I had won the lottery when I talked to the receptionist and then the doc himself called me back. I really feel more hopeful. I just can't imagine though if I didn't have the caring words from everyone here, where we would be. I will definitely post tomorrow evening after we see the doctor.
thanks again

[labblab]

Stephanie, I just want to make sure you saw my reply at the top of this page. Not that I think I'm a genius :o, but just because it may spark some questions for you to have clarified tomorrow. :)

[loveMyDaisy]

Stephanie, I just want to make sure you saw my reply at the top of this page. Not that I think I'm a genius :o, but just because it may spark some questions for you to have clarified tomorrow. :)

Thank you for pointing it out, I had passed it as I scrolled down :o
A lot of good info. I have copies of all Daisy's records so far. I also have several things printed out from here. I am going to talk with him about the numbers this test shows and if he has ever seen it this high.
I am also going to insist that they do further testing to determine whether it is Pit/Adr. I think an ultrasound would be a good route, one because of her symptoms and two her age. Imagine if we treated it to find out later it could have been removed through surgery. I think what you have taught me more then anything is I HAVE BE Daisy's voice and not simply assume that because a person has a vet degree they know everything. Especially with such a tricky disease.
thanks so much

[Budsters Mom]

Marianne, I do not think you are a genius. I KNOW you are a genius!;) :)

Hugs,
Kathy

[molly muffin]

YIPPPEEEEE!! Just saw todays posts. Wow, that is really great. I'd still ask a few questions, like how many have you treated, success rate, which mediation do you prefer to use for treatment, have you had good success for that, what protocols do you use for testing (you want to give the meds with a bit of food in the morning and test starting at 4 hours approx afterwards for the ACTH, if following Dechra protocols, 3 hours later if following UDavis, I think), plus everything else you can think of. :) Free consult, get it all in!! ROFL!

Happy Dance
Sharlene and Molly Muffin

[loveMyDaisy]

http://youtu.be/0vByprTTj1c

http://youtu.be/v9uysqi5eao


I found this video that really helped explain a lot about Cushings and thought I would share. I might already be here, sorry if it is a repeat.

[loveMyDaisy]

Let me start with THANK YOU! For encouraging me to look and question.
I went to the new doctor for the second opinion and he was wonderful. He spent over an over talking to me. He said that he had never seen a number that high. He called the lab (they use the same lab company) and talked with someone. They verified the results.
The doc said that these numbers DO NOT lead him to believe that it is pituitary for sure as the other doctor stated. He said that this test is ONLY to be used to determine a dog has cushings. He said that this high number actually makes him suspect adrenal. He stated that if it is a tumor on her left adrenal they could surgically remove it but if it is on her right adrenal that there are a lot more risks involved because it is so close to the major artery. He did the ultrasound and she has a 4.5cm on her RIGHT adrenal and that where it is at, he does not reccomend surgery. He said that with the size of the tumor it is more then likely cancerous and will eventually spread. He did also say though that just as tumors can full us, so can dogs and Daisy could be a fighter that hangs on with this for a good year or so.
He said he would like to start her on the Trilostane and only 10mg because he goes by 1mg per kg. They will do the ACTH test in 14 days but they mix the drug themselves and therefore the drug will only cost me $56 rather then $223. :)
He said that he did not want to make any prediction on whether this would be enough dose because every dog has been different for him. He has been in pratice for 8 years and has treated over a hundred Cushings dogs.
So I start the meds tomorrow morning. I will give it at 6:30am each day. Then on the 21st she will go in for her first test. They are an animal hospital and someone is there 24hours a day so if she is showing any symptoms of a reaction I can bring her in.
So I apologize if I sound really surface and fact based about all this. I just can't deal with the fact that she has a cancerous tumor, that is what we lost our last dog from just 2 weeks ago.
So I am trying to focus on what I CAN DO.
Thank you for all your help and any advice is really appreciated.

[frijole]

wow you learned alot! sounds like this guy knows his stuff. i only have one concern and that is him 'making homemade trilostane'. I have never ever heard or seen of this... there is alot of controversy over compounding companies as the drugs are not always the same and i would like for you to find out exactly what he means by mixing the drug themselves. Thanks. Kim

[labblab]

Like Kim, I was calmly reading along until stopping with a jolt with the new vet's comment about mixing his own trilostane. First off, you can buy a month's supply of 10 mg. brandname Vetoryl capsules for around $50. Here's just one sample internet listing:

http://www.drsfostersmith.com/product/prod_display.cfm?pcatid=20278

So I can't imagine where that $200 quote came from unless it's for five months worth of the drug. :confused:

Secondly, I agree with Kim, we have never before heard of a vet mixing up his own trilostane to dispense. I would want to know exactly what he means by that. Is he buying raw chemicals and packing them into capsules all on his own?

Marianne

[loveMyDaisy]

I'm so sorry, I totally wrote that wrong, the drug he is going to mix is for the atch test
Sorry
Thanks for looking out for me

[Budsters Mom]

Stephanie,
I am in a similar situation with my fur baby. Yes, the best thing we can do for them is to focus on what we can do with the cards we have been dealt. It is sad, emotional, and very difficult.:( We are here for you and will help in any way we can. I am glad that you found a vet who knows Cushings well, but I am also concerned about him compounding the drug himself. I get Buddy's Trilostane at Diamondback Drugs. They are very reasonable an have an excellent reputation.

Hugs,
Kathy

[molly muffin]

Whew, okay, I had the same reaction as the others.

You did learn alot and it does sound like he has lots of experience and is very knowledgeable about cushings. I only wish we had that for all our babies vets on here.

I am terribly sorry about the diagnosis of the tumor on the right side though :( He is right though, just as with people, our furbabies can be real fighters. Hopefully the vetoryl will help.

You have done awesome and I am very glad that you found such a good vet to watch over Daisy's treatment.

hugs,
Sharlene and Molly Muffin

[frijole]

I'm so sorry, I totally wrote that wrong, the drug he is going to mix is for the atch test
Sorry
Thanks for looking out for me

You said re the acth:

will only cost me $56 rather then $223

And the vet is mixing his own? Everyone on this board would jump for joy at that as some pay closer to $400. Next time you go in please get us more info on this. Two reasons - if this stuff works we want to know what it is... and of course we want to make sure it works! Kim

[Trixie]

I'm so sorry for the news you got today..especially since you recently went through a sad time. So glad though that you have an experienced vet who has a plan for Daisy. Hopefully the vetoryl will control the nasty Cushing's symptoms and Daisy will be more comfortable.
Great job finding the vet..I hope Daisy shows everyone she's a little fighter. :)
Barbara

[Budsters Mom]

I pay almost $300 for Buddy's ACTH tests. Please find out how your doctor mixes to cut costs that much!!!!!!!! A lot of us are struggling financially and this could be a HUGE help!

Hugs,
Kathy

[labblab]

Stephanie, I'll bet your vet may be following these tips from Dr. Mark Peterson re: reconstituting and dividing doses of the ACTH stimulating agent so as to make the test less expensive for smaller dogs. ;)

http://endocrinevet.blogspot.com/2012/03/how-to-dilute-and-store-cortrosyn-for.html

Marianne

[Trish]

Hi there

I just wanted to ask about this vet you have seen, is he a specialist vet and did he discuss this adrenal tumour with a surgeon? I am only saying this as my dog had an adrenal tumour and his was also on the right gland as well and they are operable in the hands of an experienced surgeon. He has had surgery to remove it successfully including removal of tumour that had invaded vena cava, he is now just over six months post op and is doing pretty well! He is 11 just like your dog. Your dog is small so I would presume to have a few years of life expectancy left??

The tumour is on the large side but studies I have read say there is worse chance of spread when they get over 5cm which your doggie is still under. I have copied an article here that outlines some of these risks for you to have a read through. If it was me I would be asking for surgical consult just to make sure you have looked at all options available.

I do not want to second guess your vet as you sound happy with him and he certainly sounds like he gave you a lot of time which is great! Hope all goes well with the meds :)

http://histovetsdhv.files.wordpress.com/2011/09/adrenal-tumor.pdf

[loveMyDaisy]

Trish, thanks for the good information. When I first read your post, I thought maybe I should ask fora referral after all. After reading the information I just don't feel like I could take the chance of putting her through it all. I just feel like the length of life it might give her would not be worth the risk of losing her during surgery. It was really helpful though to read the information, it has given me more peace about my decision. Thank you and I'm so glad to here your baby is doing good and look forward to following your journey. Thanks again

[Trish]

Your welcome! It's always good to read widely about all possible options :) Will be keeping an eye on you guys and sending all my very best wishes your pup does super well! :)