New To Forum - Keesh has crossed over [Archive] - Canine Cushing's Information and Support Forums

goldengirl88

06-29-2013, 08:34 AM

Hello:
I just wanted to welcome you to the group. Sorry your baby is having troubles. What tests were done before starting treatment, and could you post the results please? That way the others can help you with this. Just a few tips to keep in mind; start a diary on your dog so you have it for reference. If you are using Vetoryl call Dechra and start a file on your dog. There are vets there on staff to help you with problems. Learn as much as you can from the people on here. If you can, get an internal medicine specialist. If not you need a vet with experience treating this disease, who definitely knows what he is doing. That will save you a lot of money and heartache in the long run. God Bless you and your baby.
Patti

addy

06-29-2013, 08:38 AM

spdd

06-29-2013, 10:12 AM

Could someone please tell me how to insert the test results ? It was a PDF file so I changed it to png but no matter what I use it won't let me copy and paste. The forum wants a url to insert... thanks so much and thank you for your responses. I was told that if the tumour was malignant, that Trilostane wouldn't do any good.

lulusmom

06-29-2013, 11:21 AM

Hi and welcome to you and Keesh.

You can email your test results to k9cushings@gmail.com and one of our staff members can post results on your thread for you.

Squirt's Mom

06-29-2013, 11:24 AM

spdd

06-29-2013, 01:35 PM

The response here is overwhelming for me. I really appreciate it. The dog is not doing well so it's doubly appreciated. I have emailed the test results to admin for them to post. Thank you again. Hopefully I can support some of you as well.

spdd

06-29-2013, 01:37 PM

Hi and welcome to you and Keesh! :)

You mentioned a tumor. Could you tell us what tumor he had been diagnosed as having? Did they say he had an adrenal tumor causing the Cushing's?

I'm glad you found us and look forward to learning more about you both.
Hugs,
Leslie and the gang

I haven't had him tested for which tumour it is. I suspect pituitary as he used to have seizures. Nothing major, just head down and some chattering, but then again smelling another dog he did the same thing.

spdd

06-29-2013, 01:41 PM

Hi and Welcome,

I understand your concerns so I am glad you found your way here. We need to look at a few things to try to determine the lack of response you feel you are seeing.

1-what tests were done to diagnosis Cushings and what were the results

2- how much dose your pup weigh and what is the dose and which medication were you given to treat Cushings?

3- I am going to assume you were given Trilostane (name brand Vetoryl) and if so, you should be having an ACTH test done within the next few days - cortisol is checked 10-14 days at the start of dosing.

It could very well be Keesh's coritsol is not where it needs to be yet. It is not unusual to have to tweak doses in the beginning.

Was diabetes ruled out?
Was a UTI ruled out?

Welcome aboard and sorry for all the questions but we need more history to help sort it all out. The more you can tell us, the more test results you can give us, the better it is.

Hang in there, it gets easier.

He was tested for diabetes and it was ruled out. That was my first thought.
He had a small amount of infection in his urine, but he stepped in the catch container I used, however the veterinarian said that probably would not give the result they got. He was tested twice, two different times.
He will be tested again after being on the meds for 3 weeks. He weighs approximately 65 pounds and is on 58mg dose once daily of Trilostane.
The test results will be posted by a member of staff here, once they get my email.
Thanks for all the interest.

Trixie

06-29-2013, 02:11 PM

We started the same medication in April. It took almost 4 weeks before I saw a decrease in symptoms for my dog Trixie. In fact her drinking got even worse the first few weeks of treating. Some days she drank 50oz of water and peed all day. I wasn't good about being patient but that's what it takes.
Finally it began to decrease, but it did take time. More time than I expected. We did increase her dose very gradually since then. There is constant tweaking. Drinking was our main symptom too so it's my gauge to see how Trixie is doing. We got down to normal and then it started to increase a bit again so we are again increasing and tweaking the dose, this week there was improvement.
You'll probably soon see some changes over the next few weeks if not sooner.
Barbara

lulusmom

06-29-2013, 03:09 PM

I just checked out the labwork you posted and they are very difficult to read. I tried magnifying but that just enlarged what was already unreadable. Can you give me the date of the test for each document. Looks like two blood chemistries and one UCCR. Document 1 looks like all was normal with the exception of ALP which was only mildly elevated and ALT which was also mildly elevated. The numbers look like ALP 183 and ALT 145 but I can't read the normal reference ranges for either.

The UCCR, which looks like it was done on the same date as the doc 1 blood chemistry looks like result is 22 x 10-6 which according to the interpretation is abnormal (high) but this can happen in the face of stress or nonadrenal illness. I'm mentioning nonadrenal illness because the second blood chemistry (doc 3) shows ALKP normal with much higher elevation of ALT. Albumin is also elevated a bit which is usually due to mild dehydration, especially if fasted for the tests. There is a section on doc 3 at the bottom that says "Endocrinology". I can't read it at all so it would be helpful if you could type those three rows out for me. I've looked at a whole bunch of bloodwork over the years for my three cushdogs and about hundred members and from what I see so far, cushing's would not be my first suspect but will wait until you post the endocrinology part of the test. If doc 3 is the most recent bloodwork, I'd be more concerned that there is something else is going on that is assaulting the liver. With PU/PD (excessive drinking and peeing) being the only symptom and with blood abnormalities (ones I can read) not being the usual we see with cushing's, the cushing's diagnosis is suspect.

Do you have the results of a urine analysis? I would be interested in seeing the urine specific gravity. I am hoping that the endocrinology results include an acth stim test but it doesn't look like it to me. The first line looks like T4 which is thyroid and the other two lines I can't make out. If those other lines aren't the results for an ACTH stim test that is consistent with cushing's, I personally would stop dosing until either an acth stim test and/or a low dose dex (LDDS) test can be done. Actually based on the bloodwork, I'd be looking for something other than cushing's.

Looking forward to your next post.

spdd

06-29-2013, 04:10 PM

I'm going to forward you the email with the PDF they sent. I was told the ACTH test was done. I asked for the reports and this is what they sent. I will try to get the urine report from them. Thanks for your input.... now I wonder if they are just trying to get more money from me. They have been his vet since he was a puppy so I trusted their judgement, but what do I know.

lulusmom

06-29-2013, 04:17 PM

Okay. I'll check the email. It could very well be that the part of the endocrinology results I couldn't read are the acth stim test. I'll be right back after I have a chance to take a look at your email attachments.

lulusmom

06-29-2013, 04:48 PM

spdd

06-29-2013, 05:39 PM

Okay, just took a look and yes, I could read those much better but now I'm very worried because there is no acth stimulation test or low dose dex test results. Also the latest bloodwork is not consistent with cushing's and for that matter, neither was the first blood chemistry. If your vet didn't do one or both of these and Keesh were my dog, I'd stop dosing immediately.

Can you please see if you can get a copy of the acth stim test from your vet? If Keesh does have cushing's, it is impossible to determine which form of the disease Keesh has without doing an abdominal ultrasound. Did your vet tell you if Keesh had pituitary or adrenal disease?

Glynda

P.S. The endocrinology section of the test result was a thyroid panel and T4, Free T4 and TSH are all within normal range.

They told me they took an acth test and I thought those were the results that I sent, obviously not, but I told them about this forum and I wanted their current test results . I will get a copy of those results from them next week as it is a holiday weekend here in Canada and they won't be open until Tuesday. I'll send it when I get it. The vet does not know if it's pituitary or adrenal, but said the Trilostane is good for both. No ultrasound was taken, but they did x-rays and all organs looked good. I can't remember if they offered to do an ultrasound. This getting up every 2 hours in the night has been going on now for a month. I hate to admit it, but the vet said to get men's depends for him as he will dribble at times when asleep.
Oh, how we love our dogs. Is the acth test done over a period of hours? They took him in and did blood work, then administered a drug, then took blood every couple of hours. This was the better part of a day. It that the acth test? That is the same one they want to do on July 11th. I am supposed to give him the Trilostane at 8:00 a.m. then bring him to the vet at 1:00 p.m. They said he would be there for a couple of hours.

molly muffin

06-29-2013, 07:55 PM

The ACTH test, you give him the trilostane (always with a bit of food for better absorption), and then you take him in and they test within 4 - 6 hours. Because you are here in Canada, they typically do use a compound agent for the test and do two draws instead of just the normal one draw that they use in the US.
Your results will be in nmol I am guessing.

You mentioned there was an infection in the urinalysis? This can cause excess drinking and peeing too and can also cause the ACTH to be a false positive. Were you given meds for an infection? Sorry you might have said and I missed that part.

Sharlene and Molly Muffin

lulusmom

06-29-2013, 08:26 PM

It sounds like your vet did a low dose dexamethasone suppression test (LDDS). It's an eight hour test. The ACTH stimulation test takes a bit more than an hour. I was hoping that they did an ACTH Stimulation test as it is less likely to yield a false positive result. No matter what, I'll be looking forward to seeing the results.

Glynda

Budsters Mom

06-30-2013, 10:40 PM

Just popping in to check on you and Keesh. This is all very overwhelming at first and I just want to make sure you're doing okay.
Big hugs,
Kathy

spdd

07-01-2013, 04:18 AM

Thank you again for your concerns. Nothing has changed, matter of fact I think he is actually drinking a bit more. There has been absolutely no improvement since starting Trilostane 13 days ago. They did not give me any medication for a suspected infection found in his urine. They only said how diluted it was, which of course would be with all the water intake. He's happy, eating, no diarrhea but becoming very stubborn and I find at times he's just not as obedient as he used to be. Guess we all get a little stubborn in our old age.

spdd

07-05-2013, 03:03 AM

Keesh unfortunately is not doing well. Yesterday he collapsed and for most of the day had extreme difficulty getting up. I took him to vet and they increased his dose of Trilostane by 10 mg. Vet said that he had injured his tendons in one leg and this is all due to Cushings deterioration. He is still scheduled for another test on July 11th and yet after 18 days on Trilostane there has been no improvement. In one day he changed rapidly. He cannot do even 2-3 stairs anymore and overnight tonight he had 2 accidents in the house. We are up with him every 2-3 hours and yet he still peed. They have also prescribed Tramadol and said to start him back up on low dose Metacam. He had Metacam awhile ago but after a few weeks threw up. Vet said that he possibly could have thrown up due to the Cushings aggravating the Metacam use. I know it upsets the stomach in some dogs, but he always got it on a full stomach. As the vet put it, this is our last kick at the can. He is so enthusiastic about things yet his body just won't co-operate anymore. How easily the tears come now.

Trish

07-05-2013, 03:35 AM

Awww so sorry to hear that, did the vet do xrays for the leg injury or is any other testing needed?

I know some owners here do not use the non steroidal which Metacam is and just use the Tramadol as pain relief, so maybe if the dose was enough you could do without the Metacam especially if he reacted badly to it previously.

I think he needs an acth now if he has been on the meds for a couple of weeks, I am no expert and the others will be popping in later when they wake up but I think they are meant to be tested after 10 days and certainly if they are unwell. Maybe you should ask your vets to do that testing and also push for treatment if he does have a UTI.

Hope KEesh is feeling better in the morning, but I think that testing should be done to check he is not too low.

Trish :)

spdd

07-05-2013, 04:01 AM

Vet thought at first and so did I that he had a stroke. He was walking with his paw turned completely upside down after he collaped, leaning to one side and favouring the one leg . He most time after that episode now needs help getting up. She tested for nerve damage, but he immediately righted his paw when tested. That was a good sign. Awhile ago they said that the myelin in his spine was being interrupted and now the Cushings has further aggravated it causing the back weakness. We know his hips are ok, it's his knees that have created problems. His first dose of Metacam will be this morning along with 68 mg of Trilostane and 1 Tramadol every 12 hours. I honestly believe that his Cushings in malignant and that's why there has been no improvement. Hopefully today and tomorrow there will be some, but slowly I am coming to the realization that his quality of life is far from good.

Trish

07-05-2013, 04:51 AM

Hi
I see from the earlier posts in your thread from our more experienced members they were concerned about the cushings diagnosis and you were going to chase up his results and post them. Did you get hold of them?

I am concerned about Keesh, especially as he has not had a test at 10 days and he has worsened. He could have something neurological occurring but it could also be his cortisol dropping too low, is he peeing and pooping normally, eating and drinking? Their cortisol can drop quickly and that is why that 10 day test is recommended as it can be very dangerous if it goes too low and they need Prednisone if he gets acutely unwell. They should have given you some for use in an emergency. I do not think it was good your vet increased his meds when he has deteriorating symptoms without testing his acth. I hope some of the more experienced members are here soon to advise you better. But I really think you should consider pushing your vet to do these tests for the safety of your dog.
Trish

spdd

07-05-2013, 05:09 AM

I sent the test results to admin and they questioned his diagnosis. So do I for that matter as there is no other signs of Cushings other then the peeing and drinking. He is peeing and pooping ok, albeit a lot of peeing. He has had a history of small siezures, nothing drastic just some teeth chattering, which has been almost non existent for weeks now. He never got spaced out when having them, was fully coherent. Another thing that would set his seizures off was smelling another dogs scent, at times when we were on walks. The vet said that you cannot give steroids when on Metacam, so no prednisone. When he gets his doses in an hour or so, I will see if there is any improvement today.

Trish

07-05-2013, 05:49 AM

Sorry I think I am confusing you!

Regarding the Prednisone, you only give it if his cortisol was going to low from the trilostane, this can come on suddenly hence the advice to have Prednisone on hand as it can be an emergency situation.

We do not know for sure if his current symptoms are neurological OR if they are caused by his dropping cortisol level as we do not really know where we are with that as he has not been tested since starting trilostane 18 days ago. Which is why he should be tested, and I do not understand why your vet did not do an acth and just increased the Trilostane which I think is potentially dangerous..

Honestly, if I was you I would not give his Trilostane this morning at least until the more experienced members here can advise you.

spdd

07-05-2013, 06:40 AM

Thank you for your concern and input. I went to feed him this morning and he ate with some prodding, but he collapsed again and wouldn't get up until I helped him. He certainly isn't himself at all so far today and when he goes down, he waits for me now to help him up. He won't get up on his own, which yesterday he did. I've spent all I can now on him - just paid another $128.00 yesterday and he has the upcoming test to pay for next Thursday. I can't get him to the vet today, they are 45 minutes away.. so everything will have to wait until Monday, and God willing he lasts that long.

Squirt's Mom

07-05-2013, 07:14 AM

Sweetheart, please do not give any more Trilo for now. I am getting more and more concerned that the drug could be causing some, if not all, of what you have been seeing recently. The good thing about Trilo is that it can be stopped and restarted without losing ground. ;) So if I were you, I would stop dosing Keesh for now.

labblab

07-05-2013, 07:17 AM

Omigosh, I agree 100% with everything Trish has been saying and I am frantic with worry that Keesh has been overdosed with the trilostane and is in an Addisonian state! Given Keesh's degeneration, I cannot believe your vet increased his dose yesterday without performing an ACTH test along with a check of his blood chemistries. I do not believe you should give any more trilostane at all until you know the status of his adrenal function via blood testing. If it has been oversuppressed by the trilostane, the situation can become life-threatening in very short order and he may need special medication prescribed immediately.

Before giving him any trilostane again, please call the North American office of Dechra (maker of brandname Vetoryl) and tell them exactly what is going on with Keesh. They are located in Kansas here in the U.S.: 913-327-0015. I hope they will instruct you to have your vet call them immediately for guidance.

Please keep us updated, OK?
Marianne

spdd

07-05-2013, 07:28 AM

Does Dechra give advice over the phone? I am located in Canada so I hope that isn't an issue with them. He's extremely bad right now, and it's like he's giving up right before my eyes. I'm a mess, just like some of you others have been. I'm sick to my stomach and the tears are immeasurable.

addy

07-05-2013, 07:33 AM

I agree 100% with Marianne, your vet should not have increased the dose without doing an ACTH test.:eek::eek::eek:

Please dont give any more Trilostane and try to call Dechra.

spdd

07-05-2013, 07:39 AM

I will be calling them today for sure.

labblab

07-05-2013, 07:55 AM

Dechra has vets and vet techs who offer technical advice over the phone, and I believe their Kansas office serves all of North America. They will field calls from both pet owners and also vets. However, depending on the questions and issues, they sometimes tell owners that they really need to talk directly the vet instead. And in honesty, from the sounds of Keesh's situation, they may tell you up-front that he needs to be seen by a vet on an emergency basis. But they will tell you that.

Kansas is in the central time zone here in the U.S., and I am hoping that the technical staff there has not taken a long weekend, what with the Fourth of July holiday. But please at least try calling them as soon as they open up for business today, and do let us know what they say. Do you have any emergency vet that is closer to you than your regular vet?

Marianne

spdd

07-05-2013, 08:08 AM

There are no emergency vets near me- the closest one is an hour away. I'm really hoping Dechra can give me some advice. Right now Keesh won't get up at all no matter how enticing I try to make it, nor will he even try when I try to help him. I know he needs to pee, but it's not happening. No vets are open right now at all for me to take him to. I'm really annoyed now that you have told me she shouldn't have prescribed a higher dose without the test. I had faith in my vet, obviously I shouldn't have.

labblab

07-05-2013, 08:26 AM

Do you have any prednisone? That is what he needs if his cortisol has dropped too low. And if his aldosterone has dropped too low, I am hoping that somebody will be by soon who knows what type of home supplementation you might be able to give him that would help with a potassium/sodium imbalance.

Marianne

addy

07-05-2013, 08:35 AM

Could I ask to clarify- it has been eighteen days on Trilostane, they upped the dose but durring these eighteen days, no ACTH test has been done?

labblab

07-05-2013, 08:38 AM

Addy, I do not think an ACTH has ever been done, either diagnostically or for monitoring purposes. It sounds as though a diagnostic LDDS was performed, but we have not seen the actual test results.

Squirt's Mom

07-05-2013, 08:43 AM

Sweetheart, if you don't have prednisone, I would take him on that hour drive and get him to a vet asap. Ask a neighbor to help you load him in the car if needed. You might try some Pedialyte for the other possible imbalances but I would want him checked for an overdose ASAP. ;)

spdd

07-05-2013, 08:56 AM

Addy, I do not think an ACTH has ever been done, either diagnostically or for monitoring purposes. It sounds as though a diagnostic LDDS was performed, but we have not seen the actual test results.

Lulu's mom had the test results sent to her by me.

spdd

07-05-2013, 08:56 AM

Could I ask to clarify- it has been eighteen days on Trilostane, they upped the dose but durring these eighteen days, no ACTH test has been done?

Yes 18 days on Trilostane but no ACTH test done during those 18 days.

spdd

07-05-2013, 09:00 AM

As soon as the vets open around here I will take him and give them a full rundown on what has gone on. I was able to get him up about 15 minutes ago, he went outside, peed and stared into space, then sniffed my car tires. He was able to get up the 3 steps ok, so maybe the Metacam helped there. He also seems to be more stable on his feet, but his thirst has increased 3 fold just this morning. I'll keep you informed. Even if they do an ACTH test today if I can get them to , I won't get any results until Monday.

spdd

07-05-2013, 09:12 AM

Just got off phone with vet... and I am really angry. It was an LDDS test done and not ACTH - which is scheduled for next week. I am trying now to get him in today for ACTH - just want to tell you I am being polite in my phrasing of "really angry." It's not what I have been saying out loud.

UPdate... he is going today for ACTH test at 1:00 and when I questioned doctor re LDDS being done she said that is what they use to diagnose and the ACTH is after treatment is started.

Squirt's Mom

07-05-2013, 09:14 AM

Make SURE they also check the electrolytes today when they do the ACTH. This is critical so don't let them miss this part. ;)

spdd

07-05-2013, 09:21 AM

Thanks.. will do. Maybe whatever the ACTH test doesn't show, I should get them to do. For a $45.00 dog he sure is getting expensive, but worth it.

Budsters Mom

07-05-2013, 02:05 PM

Yes Cushing's testing is expensive. Many of us struggle, or have struggled with that!:o Once testing is complete and dosages are stabilized, the cost goes down considerably. Yes, we all believe that it's worth it, but sacrifices often have to be made. Please post those ACTH results when you have them. Xxxxxx

molly muffin

07-05-2013, 02:07 PM

You want a full ACTH test with electrolytes tested today. The fact that he is now up and walking after withholding the Trilostane today, is significant I think.

The LDDS test result was not part of the test you send (PDF) I don't think they gave it to you and you were going to get it when you had the next appointment. We'd really like to see that result.

They also never gave you antibiotics I think you said, even though there was a small amount of infection found in his urine. Without antibiotics that could get worse. The LDDS test can be off due to the infection too.

I question him being on Trilostane without seeing those results and based upon his actions since being on it. (not good)

Go get'em girl! You can do this!
Sharlene and Molly Muffin

Trish

07-05-2013, 05:48 PM

Yay everyone chimed in, thank goodness you did not give him the Trilo and got him to the vet. We will all be waiting to hear how it went today, hope Keesh is feeling better. I would also ask them to give you a bit of Prednisone just to have on hand if his symptoms took a dive. I sincerely hope they are not wanting to continue the Trilo until you have a definite diagnosis. Hope it went well today! :)

spdd

07-05-2013, 05:56 PM

So we are back from leaving at noon for the test and it is now 5:45. The little bugger was like a new dog on the way to the vets. He acted and was absolutely normal upon arrival ( it figures). They did the ACTH test and I asked for special bloodwork including his electrolytes. She said the excessive drinking will effect the reading of the electrolytes. He was just as normal coming home and was able to jump in and out of the van on his own. After he got home he was extremely thirsty. On the vets advice she said to not withhold water. He drank almost a bowlful and then proceeded to throw up 3 times. I called vet immediately to see if the testing could have anything to do with it. She said no, but if it continues to call back in 1/2 hour. He is not hungry all he wanted was water. I do know that at times when we used to play hose, if he ran after too much water he'd throw up. I'm hoping it is not a reaction to his Metacam again. Certainly up and down in the last couple of days. Test results may be in tomorrow but probably on Monday. In the meantime she said to continue with the extra dose of Trilostane. I think I'll just forget that until I know what the results are. Thank you all for your input and support. You really are wonderful people here.

Trish

07-05-2013, 06:14 PM

So glad to hear Keesh is feeling better apart from the vomiting, maybe it was because he was dry from the travelling and then gulping it down.

Have I understood this right... she did not do the electrolytes because the excessive drinking would affect it?? Did she not think the Trilo could have affected it with him going so flat?? Honestly if that is right, I think you need to find a new vet!! I agree with you to ignore the advice and not give any Trilo until you have the ACTH result. Some of these vets need to go to Cushings school and come and read here for a while to learn what to do!!

Hope he keeps food etc down, did she give you some Prednisone to use in emergency?

molly muffin

07-05-2013, 06:31 PM

Just so you know, when the ACTH test is done, it dumps all the extra cortisol into the system. This causes them to eat more, drink and pee more than they would do normally. It doesn't affect all dogs this way but sounds like it has Keesh. So, this should go back to where it was before the test, in the next 48 hours.

You did good and I'm glad to see that he is being perky. I think that is a sign that withholding the trilostane is a good thing. He was pretty bad while on it and that makes it suspect.

Vets can be pretty gung ho to hand out the vetoryl. Mine was for sure. I had even bought the 30mg vetoryl before going to an IMS, having an ultrasound and an LDDS test. All with no signs of true cushings. Not giving it doesn't hurt Keesh, but giving it when it isn't needed could be pretty bad. That is why you always have to be sure. Just because your vet at the time is sure, doesn't mean that it is true. You'll know by how Keesh is doing.

Still no antibiotics for the infection?

Sharlene and Molly Muffin

Roxee's Dad

07-05-2013, 08:26 PM

Just throwing my 2 cents in here. You vet is doing everything "BUT" following Dechra protocol. Please check this link and print out the protocol. Never ever increase dosage without an ACTH Stim test. It sounds like he is just guessing and I sure hope he doesn't think he knows more than the manufacturers of the drug. You can share this manufacturer protocol with him. Sometimes we have to deal with the vet we can get and we have to help them do it correctly. This is a very easy flow chart to read and use as a reference.

http://www.dechra-us.com/files//dechraUSA/downloads/Client%20Literature/47902_VETORYL_10mg_Treatment_and_Monitoring_Brochu re_Update_3_2_ps.pdf

Your vet doesn't even have a baseline to know if the cortisol is indeed lowering or increasing... it's a dangerous game of russian roulette. :( I totally agree with you holding back that extra 10 mg that he asked you to start, at least until the results of the ACTH are back.

I am keeping all fingers and paws crossed here that Keesh continues to feel better.

spdd

07-06-2013, 09:08 AM

Sometime in the night (and we are up with him every 2-3 hours to let him out) he peed in the house twice but also ate his supper in the night sometime. This morning without meds other then Metacam-(2nd day on that)- no Trilostane no Tramadol - he is lethargic, no interest in anything, but he did eat a good breakfast.
As far as I know the Electrolyte test was done, it was when I requested it she made the remark that it could be a wrong reading due to the drinking. No prednisone was given to me, and in all honesty I forgot to ask for it. It was a confusing day yesterday. I went to go get him and the doctor wasn't there, she was due back from their other clinic shortly. They said they'd give me the dog but I'd have to come back and see the doctor. I left him there for about 20 minutes, came back and there were no consult rooms so the vet and I stood outside in a hall and discussed the dog. She is adamant that his hurt leg was causing the collapsing issues, and he does seem better with that now. He can take the stairs and is not wobbly at all. I notice now he is dripping a lot from his mouth which is new. Hopefully that is due to so much liquid in his system. They also said he was pretty stressed as in their cage he was licking the bars, a sign they said of stress. With kids you can pick them up and cuddle them and try to make them feel better, you just can't do that with a dog. I lay on the floor with him and he couldn't care less if I was there or not. We have even moved to sleeping on the couch downstairs, so he doesn't have to climb the stairs.
If I get the test results today I will post them - if not it will be Monday. I'm not in good shape today- can't concentrate on anything other then the dog. Forgive me for not replying on some of the other threads... I can't get my head on straight.
Thank you for the extra information you posted yesterday, you are all a wealth of information.

spdd

07-06-2013, 10:00 AM

Test results came in, but the technician says I have to wait for doctor to call me, and it's her day off.
I did get the two readings I was concerned about.
ALP is 155 down from 183 taken on May 24th
ALT is 246 up from 145 taken May 24th.
I have no idea what this means and will do some research, but according to the technician, he is not being overdosed on Trilostane.

frijole

07-06-2013, 10:15 AM

It is good that those two liver enzymes are down but that has nothing to do with the test that should have been done. What you posted are liver enzymes which come from a regular blood panel. When a dog is on cushings meds the test that needs to be done on a regular basis is called the acth test. It measures cortisol. That is the result we are talking about. The technician is full of crap if he/she is saying your dog isn't overdosed based on the liver enzymes. It would be like saying I don't have cancer based on my pulse rate.

It is important that we help you get up to speed on what to say/ask when speaking to these people. Right now you are your dog's voice and only hope. Your dog can lead a very normal and happy life but you must start to understand what is going on. I say this because it doesn't appear to me like the tests being conducted are the right ones.

Go back and read our responses - we have repeatedly said we are very concerned that your vet is not doing the acth test but is adjusting the dose on your baby. That would be like adjusting insulin on a diabetic without doing a glucose reading or deciding to give someone chemo without confirming there is a cancer. It is absolutely scary.

I don't have time to re-read the entire thread right now so I'm not sure if we ever linked you to some basic info. I am going to post some links on what cushings is, how trilostane works etc so that you can read and get up to speed. Please ask us questions. Understand that if you choose to not switch vets that is OK but that you must start questioning their approach. Dogs live very normal lives once the dose is correct - they can die if it is not. So far as we can tell your vet is not even measuring the dosage by doing the acth test. In my opinion your dog is suffering needlessly because of this.

Here goes:
http://www.k9cushings.com/forum/showthread.php?t=180

http://www.k9cushings.com/forum/showthread.php?t=185

http://www.k9cushings.com/forum/showthread.php?t=5428

http://www.k9cushings.com/forum/showthread.php?t=214

I know it can be overwhelming but if I can learn it, so can you! :) Kim

Squirt's Mom

07-06-2013, 10:16 AM

uh, those test results have nothing to do with the cortisol nor the Trilostane. So I hope this is not all they did yesterday. The ACTH will have two numbers - a pre and a post number. This is the test that will tell if his cortisol is too low or not - not the blood work that shows ALP and ALT. Two different tests showing different things altogether. ;)

I hope your sweet boy has a good day!
Hugs,
Leslie and the gang

spdd

07-06-2013, 10:23 AM

Not knowing what to ask for I just asked about the ALP and ALT - I don't know what to ask for re the ACTH test. I will learn more about that test when the vet calls.
She didn't have a base line as far as I know as they only did the LDDS test in the beginning and this is the first ACTH test.

Thank you all again... can't say enough how great you all are.

frijole

07-06-2013, 10:29 AM

Right now the only thing you should focus on is the result from the acth test. You simply have to ask what the results are. There will be two numbers - get them both. We'll explain what it means later. Don't let them tell you "it came back normal" or any such thing - get the two numbers. You really need to get a copy of all tests done. Start a file so you can refer to them. When they do this test the two readings (numbers) are one to two hours apart. I'd really also like to confirm the times of each reading (it's on the test results) because if they didn't follow protocol (instructions) the test could be invalid.

This test tells you what your dog's cortisol reading is - meaning how the drug is working. Please take some time to read up on this stuff so that you are more comfortable in talking to your vets. Kim

labblab

07-06-2013, 12:37 PM

The other thing you will especially want to know is whether the levels of potassium and sodium are normal. These are the two blood chemistries that can be imbalanced if the trilostane drops the aldosterone level too low. So the ACTH results are one half of the Addison's equation (cortisol), and potassium/sodium is the other half (aldosterone). Don't worry -- you're going to be an old pro at this in just a few days. ;)

molly muffin

07-06-2013, 12:59 PM

First, Ontario vets should know what an ACTH test is, you had one already scheduled for next week I believe with your regular vet.

I'd call them back and ask the vet tech, if they did an ACTH test yesterday. Then ask for the results. I know my results actually had 1 pre value and then 2 post values (they used a compound) normally there is 1 post results. Those are the numbers that will tell you how the cortisol is. So, lets find out if one was done first and the result. That is the most important thing to know right now.

(saying normal doesn't cut it because we have seen way too many vets say that only to find out that they are not looking at the correct range - it is different for a dog on Trilostane than a dog that is not yet on any medication)
Then ask for the Sodium and potassium result and range if they will give that to you too.

That will get us started.

I know this is VERY difficult, and no one comes into this knowing much if anything about cortisol, testing and what the results mean. We all learn it and this is a good forum to help walk you through anything and answer your questions.

Baby steps, hang in there. But this is very important.

Sharlene and Molly Muffin

spdd

07-06-2013, 01:37 PM

molly muffin

07-06-2013, 02:02 PM

Ohhhhhhhhh okay I misunderstood that and they won't tell you over the phone other than to say they are normal. Okay got it!!!

Well, I'll just say we have seen hundreds of the darn things. (test results, not dogs LOL :) )

It might be normal range and this might be a leg issue. (did they say what kind of leg issue? Torn ACL? etc) It may not be that the cortisol is low, maybe it needs to go up as the vet suggested. Maybe it is something else entirely.
I would see if they will give you (unless they already did) something for the urine infection, or retest to verify if it is still there as that can just be a real bugger to deal with too. At least have a chat with the vet about that too.
(taking notes right? :) )

I do know how frustrating it is (I wanted to mention this yesterday and forgot) how they can be just Dying you'd think when they are at home, but get them to the vet and they are doing just fine, tail wagging, doesn't look like a thing is wrong with them. It makes it very difficult for the vets sometimes to get a real idea of what is going on.
Sometimes it will help if you can video (like on your cell phone or camera) when they are acting off. Just to prove to the vet that you aren't losing your mind, really! :)

Hope today is going well!
Sharlene and Molly Muffin

Tina

07-07-2013, 04:23 AM

Hi,

I just had a chance to read about Keesh and am checking to see how he is doing now. Has there been any more vomiting since he drank all the water after the vet visit? And is he able to get up and walk around normally? How about his appetite, is he eating normally? And how is his energy level?

It sounds like you have not given any more Trilostane at all, is that correct? There is no way to know if he was overdosed, or if his cortisol went too low without seeing the results of the ACTH stim test. I would not give any more Trilostane until those results are available.

The other thing you will especially want to know is whether the levels of potassium and sodium are normal. These are the two blood chemistries that can be imbalanced if the trilostane drops the aldosterone level too low. So the ACTH results are one half of the Addison's equation (cortisol), and potassium/sodium is the other half (aldosterone). Don't worry -- you're going to be an old pro at this in just a few days. ;)

These results are very important also, so please post the sodium and potassium results when you get them also.

I am also wondering about the report that he might have a UTI, and was this ever followed up on. An infection can cause increased drinking too. Also, if you are going to continue with Trilostane, please ask your vet for prednisone to have on hand in case of an emergency.

It sounds like Keesh is doing much better than before you took him in to the vet, and I hope he has continued to improve. I will be looking forward to an update on your baby.

Tina

spdd

07-07-2013, 04:37 AM

I am happy to report Keesh is doing better at least as of yesterday. No more vomiting. He started off slow, but progressed during the day. He is off the Trilo for now. He is eating, his walking is good, able to navigate the 3 stairs easily, but not interested in much of anything. I did mention a squirrel in the backyard and he got up to look.
The vet told me even though it was her day off, she'd check on his acth test and phone me, but she didn't. The vet does not know I took him off the Trilostane, she told me to continue with the extra dose, but I haven't.
They didn't do anything about his UTI, but I'll get another sample and take it in. All they said was a slight infection and heavily diluted urine.
I want all his blood work and acth results from the vet tomorrow and will post what was done and the results.
His leg issue seems to have resolved itself, but thinking back there was a very enthusiastic little girl here the day he was having so many issues, she didn't cause his collapse, but I did see her push his back end down and had to tell her she couldn't do that. Right after she did that, that's when he started to walk with his paw turned upside down. Vet checked for nerve damage, but all was ok.
I will be back tomorrow with the results... hope you all enjoy the day today.

Squirt's Mom

07-07-2013, 07:51 AM

Oh, I'm so glad to hear that Keesh is doing better! That tells me he was being overdosed and you did the right thing to ignore your vet's advice to continue the Trilo. Way to go, Mom! :cool:

Now, keep ignoring her until we see those test results....and make her address the UTI asap. That can't wait and can get serious if not treated so don't let her push that aside.

Let us know how Keesh is doing!
Hugs,
Leslie and the gang

spdd

07-07-2013, 11:58 AM

He's back to his stubborn self at least with his food. His food is a long story for another time. Since stopping Trilo and him getting over his ACTH test his drinking has reduced drastically which means his peeing has too. I'm very suspicious now of his diagnosis. Tests will tell I guess.

molly muffin

07-07-2013, 03:29 PM

I know, it is always suspicious when you take them off cushing meds and they improve. I'd be suspicious too.
Hang in there! Are you having the cruddy rain and humidity too? I swear we are sweltering here and Molly doesn't want to go very far on her walks before she turns around and heads back home. She isn't a fan of humid. (me neither!)

Sharlene and Molly Muffin

spdd

07-08-2013, 03:37 AM

Yup the rain and humidity has been bad. I so look forward to summer and seems we've had 4 days of sunshine so far. Summer is almost half over. I was in the wedding business for years and decided this summer I'd get out of it to enjoy the weather for a change rather then work every single weekend. Seems I should have stayed in it at least this summer.
Keesh had an accident last night even though his water intake was drastically reduced yesterday. He can't seem to go without peeing anymore then 3 hours tops.
The ACTH test results should be available today so we will have a better idea of what's going on.

Judi & Keesh

Tina

07-08-2013, 08:44 AM

Hi Judi,

Just checking in to see how Keesh is doing today. Looking forward to seeing the lab results.

Tina and Jasper

spdd

07-08-2013, 12:13 PM

Getting the vets office to send me the results is like pulling teeth. The vet finally phoned at 11:30 this morning, but that was only after I had called and asked for a copy of the reports. I have since spoken to her-told her I took Keesh of Trilo-and still nothing sent from their office even after asking the vet again.
Here's what I know.
His cortisol reading she said prior to Trilo was 395
Friday when being tested his baseline was 149
1 hour after - 188
2 hours after- 200
She said it should be between 80-120 but said that obviously the Trilostane was working.
She is telling me to stay on 68 mgs and she will call on Wednesday. She is baffled as to why his peeing and drinking slowed down after removing him from the meds.
I think when she calls on Wednesday, I'm going to ask for a referral to Guelph Veterinary Hospital... and see what is really going on.
She doesn't think he has a UTI as the reading was so low and said that she didn't want to put him on antibiotics just yet. His method of peeing doesn't seem to be UTI, he pees too long at one time... (shaking head.)
When if ever they send the results, I will post them.. until then that's all I have to go on.
Frustrated???? Just a little, but Keesh is fine, we'll see how he is after being back on meds.

frijole

07-08-2013, 12:26 PM

Note to mods - I'm at work so I can't really look at this right now but this seems off. It appears to me that when you convert the cortisol level BEFORE cushings it is at 14 which would mean it is NOT cushings. Can someone please look into this. Thank you! Kim

Roxee's Dad

07-08-2013, 01:05 PM

His cortisol reading she said prior to Trilo was 395 (14.31)
Friday when being tested his baseline was 149 (5.4)
1 hour after - 188 (6.8)
2 hours after- 200 (7.2)

She said it should be between 80-120 (2.89 - 4.34)

spdd

07-08-2013, 01:10 PM

Thanks you for the conversion, but I don't have a clue what it means. Could you please explain? Thanks

Roxee's Dad

07-08-2013, 01:19 PM

Was that 395 number a pre or post ACTH Stim test?

spdd

07-08-2013, 01:26 PM

It was pre ACTH test. He's only had one ACTH test and that was last Friday. I don't know where she got the cortisol count of 395 from unless that shows on the LDDS which he did have a 2-3 weeks ago.

Roxee's Dad

07-08-2013, 01:34 PM

I will have to wait for Kim to come back as I am not that familiar with Keesh's history without gong back and reading through from the beginning.

But from Dechra's published protocol...

In normal dogs, pre-ACTH cortisol concentrations are usually between 0.5 µg/dL and 6 µg/dL (14 and 165 nmol/L)

and post-ACTH concentrations between 17 µg/dL and 22 µg/dL
(470 and 606 nmol/L).
• Regardless of the pre-ACTH cortisol value, a diagnosis of
HAC can be confirmed by a post-ACTH concentration of more than 22 µg/dL (600 nmol/L) in a dog with compatible clinical signs.

It seems to me if that 395 was a post result, then Keesh falls within the range for a non cushings pup. But let's wait for Kim to get back.

Squirt's Mom

07-08-2013, 02:02 PM

The three numbers are throwing me as well. It almost looks like a LDDS instead of ACTH but the timing is wrong for the LDDS. :confused:

spdd

07-08-2013, 02:06 PM

Thanks - I got faxed copies of the ACTH test and someone told me to get the times but there isn't any. It's exactly what I said in the previous email

Cortisol 0 hours is 149
1 hour - 188
2 hours - 201

His bloodwork is as mentioned earlier -
ALP-155
ALT-246
but new thing is Urea is 11.6 and should be 3.0-10.0

I'm so confused, I can't accomplish anything in the last little while.
All your input is so much appreciated, I mean it sincerely.

Judi & Keesh

Roxee's Dad

07-08-2013, 02:26 PM

So I think Kim is right and reffering to

Cortisol 0 hours is 149
1 hour - 188
2 hours - 201

According to Dechra...

In normal dogs, pre-ACTH cortisol concentrations are usually between 0.5 µg/dL and 6 µg/dL (14 and 165 nmol/L)

So Keesh at 149 nmol/L falls within the normal range for a normal non cush dog of 14 and 165.

Again according to Dechra:

Regardless of the pre-ACTH
cortisol value, a diagnosis of
HAC can be confirmed by a
post-ACTH concentration of
more than 22 µg/dL (600 nmol/L)
in a dog with compatible
clinical signs.

So both her post ACTH numbers fall well below the 600 nmol/L

I think Kim is saying that we do not have a confirmed diagnosis of cushings here. Let's wait for her or one of the other admins or mods to stop by and confirm.

labblab

07-08-2013, 02:33 PM

Hi Judi,

I'm trying to make sense out of this info, too. First off, I think it is common in Canada for the ACTH to have two "post" numbers one hour apart -- Sharlene has commented about this, too, when her Molly is tested. So I do think it was an ACTH that was performed on Friday and those are the results you are showing. The good news is that they are not too low so we needn't worry that Keesh's cortisol was oversuppressed at that time. Remind us though, did Keesh get his trilostane on Friday morning before the test (and at what dose?). Also, do you know how many hours later this ACTH test was performed?

I am still wondering about his potassium and sodium levels, though. Those are the electrolytes we keep harping about. Were they both within normal range? The symbol for potassium is "K" and the symbol for sodium is "Na" if the words themselves are not written out on the lab form.

It is hard to know what that "previous" cortisol reading corresponds with. I guess, presumably, it was the baseline for the LDDS. If so, it is quite high for a baseline reading. But I've checked once again, and the LDDS is not included in the lab summaries that you sent to our gmailbox. It must have been performed at a different time, or by a different lab. Can you please, please, please get those diagnostic LDDS results for us?

I truly do not know what your vet means when she says that Keesh's cortisol reading "should" be between 80-120. If those are units of nmol/l, John is right that they would convert to approx. 3-4 ug/dl. I am unaware of any therapeutic range or guideline related to Cushing's treatment that is that narrow. So I am clueless as to what she is referring to, unless she is aiming for the very middle of Dechra's optimal therapeutic range which is 1.45 - 5.4 ug/dl.

So to recap, remind us as to whether (and if so, when) Keesh had his trilo on Friday prior to the ACTH testing. Second, can you get those potassium and sodium readings? And third, can you please get the results of the diagnostic LDDS test?

Thanks so much!
Marianne

labblab

07-08-2013, 02:37 PM

Just wanted to pop back to let people know that this was a monitoring ACTH subsequent to trilo treatment, and not a diagnostic ACTH. And I don't believe that Keesh missed more than possibly one dose of trilo prior to the testing. So Friday's test numbers have to be interpreted in that light, and not in terms of the validity of the Cushing's diagnosis. The jury is still out as to what that previous cortisol reading represents.

frijole

07-08-2013, 02:56 PM

I am on a quick lunch break - my interpretation of her comment regarding "this was pre trilostane" was that the reading on the test PRIOR to taking trilostane was 395. By PRE I took it to mean "before starting trilostane" (go back and read how it was written) My assumption was the vet only gave her that number because that's the only one that counts. Given everything she's been through my concern was whether or not the dog ever had cushings.

Only owner can find out from the vet for sure if it was an acth test and get the 3 numbers from that test to verify. Kim

Roxee's Dad

07-08-2013, 03:04 PM

His cortisol reading she said prior to Trilo was 395 (14.31)

So prior to Trilo, Keesh's cortisol reading was 395 (14.3) which is higher than the the norm for a non cush pup.

Friday when being tested his baseline was 149 (5.4)
1 hour after - 188 (6.8)
2 hours after- 200 (7.2)

and these are the results after taking the Trilo. which are a little higher than the recommended target range for a cush pup on Trilo.

So we need to confirm that Keesh had her dose of Trilo approx 4 to 6 hours before this ACTH Stim test.

labblab

07-08-2013, 03:05 PM

Yes, I agree with you Kim, that we need to find out what that "pre trilostane" number represents. Judi, just want to repeat that the earlier test (LDDS?) was not included in the results you sent to the k9cushings gmailbox. You will need to get those test results yourself and tell us what they were (and also for certain whether it was an LDDS that was performed).

Marianne

spdd

07-08-2013, 03:42 PM

Here is everything, finally got the LDDS results which was taken June 13-
It says

Cortisol 0 hours - 395
Cortisol (4 hr Dex) - 72
Cortisol (8 hr Dex) - 134
This was prior to any meds at all

His ACTH test was after giving him Trilostane between 6:30 and 7:00 a.m. He had - 68 mg - I had given it to him prior to everyone telling me not to.
I brought him to vet shortly before 1:00 p.m. and do not have any times as to when they ran it.
I did not give him any over the weekend at all and he improved.
Potassium reading on Friday was 5.3 - s/b between 3.9-5.7 according to the report and Sodium was 147- s/b between 143-155
You guys are saints... honestly.

labblab

07-08-2013, 04:14 PM

Good job getting these results!!!!!

Alrighty then, if I've done the conversions correctly for the LDDS, here they are for those of us in the U.S.:

Baseline: 395 nmol/l (14.3 ug/dl)

4-Hour: 72 nmol/l (2.6 ug/dl)

8-Hour: 124 nmol/l (4.8 ug/dl)

You've not given us the laboratory norm for the 4/8 hour values, but on the face of these results they appear to be consistent with pituitary Cushing's (the 8-hour result is much higher than the typical norm, and both the 4 and 8-hour results are less than 50% of the baseline). I repeat that the baseline reading is really, really high which makes me wonder whether he was highly stressed at the time the test was performed. But anyway, the results are consistent with Cushing's.

As far as the monitoring ACTH, we want that test to be completed 4-6 hours after dosing in order for the result to be directly comparable to the dosing guidelines. By 12 hours post-dosing, theoretically the drug has exited the system and the cortisol level has drifted back upwards again. So what this means is that if Keesh's testing was performed significantly later in the day, the cortisol levels on his "post" draws were higher than they would have been had the test been run earlier in the day. However, again on the face of it, it does not seem likely that they would have been low enough for him to have been suffering from Addisonian symptoms as a result of low cortisol.

Also, his sodium and potassium levels were normal. Soooo...thankfully, it does not appear as though he was being overdosed with the trilo. And we are sort of back to square one as far as figuring out what was making him feel so badly and also why he seems to be doing better now that he is off the meds. I guess I need to look back and read his story over again from the very beginning. So I'll try to do that as soon as I have a chance.

Marianne

spdd

07-08-2013, 04:19 PM

No normal values were on the report other then the Cortisol 0 hour which was 15-120
The 4 and 8 hr results are blank.

By your remarks should I restart the Trilostane? I'm at a loss now as to what to do. I assume if I start him on it they need to monitor him again with testing.

labblab

07-08-2013, 06:08 PM

Gosh, Judi, I think I'd be hard-pressed to start back up with the trilostane right now if Keesh's thirst and urination are now normal after having been OFF the meds since Friday. I've just looked back through your thread and see that those were his only Cushing's symptoms and even those seemed suspicious to us since he also was suffering from an untreated UTI at the time of initital testing. You've also noted that Keesh was really stressed while at the vet for his ACTH testing, and given how high his baseline cortisol was for the LDDS, I'm betting he was really stressed then, too. And high levels of stress can elevate the cortisol readings on both these tests. Last but not least, it seems odd to me that his ALKP has come down but his ALT (which is more liver specific) has elevated pretty significantly since the last testing. I remain really unsure about the Cushing's diagnosis.

I always think it's important to come clean with a vet, though, so they know exactly what's going on. So if Keesh were my dog, I would tell the vet that I have not been dosing since Friday because I was afraid he was overdosed. And now, I am reluctant to start back up again because the supposed Cushing's symptoms have resolved now while he is not taking any trilostane at all. There still seems to be more to the puzzle, but I would be anxious to see whether the excessive thirst and urination ever re-emerge at this point.

Marianne

spdd

07-09-2013, 03:44 AM

Good Morning Everyone. I told the vet yesterday that I had not given him his Trilostane. She was well let's say taken aback I think. Even with her knowing she asked me to give him the 68 mg again and that she would call me on Wednesday to see how he was doing. I mentioned before that even one of the owners at the vet hospital where I take him said that if he had a dog with Cushings- he'd be taking it to Guelph. I am going to ask for them to send us there and get to the bottom of this. Keesh does stress easily. He hates the vets, and is a real Mommy-Daddy's boy. He needs to have us within eyesight no matter what he's doing.

frijole

07-09-2013, 06:57 AM

So given her advice what are you going to do? Kim

spdd

07-09-2013, 07:13 AM

I'm at a loss what to do, honestly. The last thing I want to do is harm Keesh in anyway, whether with or without drugs. His meds are due in about an hour if I give them to him. I contacted a local vet yesterday morning in town here and he was impressed by my knowledge all thanks to everyone here. I asked if he would review all the results and we could take it from there. He refused and said that I should take him to Guelph, have them send him their analysis of Keesh then he would look at him. There are only two places in Ontario that are really knowledgeable with Cushings. Guelph the vet university and somewhere in Toronto. I know my vet is being overly cautious i.e. as in not loading him with an antibiotic and possibly making him sick until the levels are good. My suspicion is with everything that has gone on that he is having liver issues and I want to get him on milk thistle. With no other signs of Cushings, I am leaning towards leaving him for now as he is acting perfectly normal. It's driving me crazy as to what is best for him.

labblab

07-09-2013, 07:22 AM

Would it be difficult to take him to Guelph? If not, I think that's what I'd do if he were mine. And if he is acting normally again now, I would just leave him off the trilo until he's been re-evaluated by them. I think that would give any repeat diagnostics more validity -- starting again from a clean slate. The thing is, genuine Cushing's symptoms don't just come-and-go. So it doesn't make sense that you would not be seeing at least a small rebound in the thirst/urination if they were truly Cushing's-related.

I'm also wondering whether the increased mobility problems while taking the trilo might have been because the lowered cortisol was unmasking some arthritic issues.

All in all, I can't say I disagree with the recommendation to first consult with Guelph. That doesn't mean you have to stay with them forever, but just to get their input as to what is really at the basis of any of Keesh's abnormalities.

Marianne

spdd

07-09-2013, 07:36 AM

He does have some arthritis in his knees, not his hips though. Months ago they told me it was the myelin not getting to his back legs through the spine. That's when we started the Metacam, after looking at his x-rays. They couldn't see any interruption in the spine but that was their diagnosis. Getting into Guelph could take literally weeks, I'm not sure.
He right now is perfectly normal - no extensive hunger, no accidents, thirst is normal, and no excessive peeing. I'm convinced to keep him off the Trilostane, and if I see the symptoms come back then I'll take it from there. In your opinion if they return prior to me getting to Guelph, should I start him back up on it? The other issue is double dosing. I read that Trilo is effective for about 12 hours. It would make sense that most of his peeing and drinking happened at night because he was dosed in the morning around 7 or so. Would splitting the dose help in his case?

frijole

07-09-2013, 07:47 AM

I totally agree with Marianne's opinion and your 'gut' on this - I'd leave the trilostane alone for now and if you could go to the other facility for peace of mind that could be just what you need. I know this is hard - had a similar situation myself and I travelled 5 hrs each way to a teaching hospital after a year of confusion. I got answers and my vet was wrong - my girl didn't have cushings. Hang in there . Kim

labblab

07-09-2013, 07:56 AM

If you really think it will take that long to set up a consult at Guelph, you might want to go ahead and start the process. If Keesh is still totally normal when the appointment rolls around, you can always cancel. But that way you would not have to wait so long to be seen if the wheels come off the cart again.

If trilostane does seem appropriate again in the future, yes, you can always opt to give a half-dose twice daily. But virtually every Cushing's expert makes a huge point of saying that the symptom profile is really the key diagnostic when it comes to this disorder. None of the blood/urine tests can identify the disease with certainty so in the absence of any consistent symptoms, a Cushing's diagnosis is always suspect.

Please do keep us updated either way, though. Otherwise, we'll worry about you guys!

Squirt's Mom

07-09-2013, 08:54 AM

Guelph! Guelph! Guelph! :D;):D Then let us know what they say. ;)

And if he were my baby, I would not start the Trilo again until they had seen him. ;)

spdd

07-09-2013, 10:49 AM

I called the vet to set up the consultation with Guelph. Hopefully I'll hear soon and certainly let you know what is going on. I'm still going to contribute to this forum... you people are marvellous. I'm hoping I can be of some support to those that are going through the same issues.

Have a great day everybody !! Big kisses from Keesh.

labblab

07-09-2013, 11:00 AM

Judi, I just saw your post welcoming one of our newbies and my heart filled to bursting with your kind words. Thank you so much, and absolutely your support to everyone here will be a gift.

spdd

07-09-2013, 11:42 AM

Judi, I just saw your post welcoming one of our newbies and my heart filled to bursting with your kind words. Thank you so much, and absolutely your support to everyone here will be a gift.

Thank you.. but you have been absolutely terrific with me, and although it's a forum, it's renewed my faith in people, it really has. I marvel at the generosity, knowledge, and downright heartfelt caring of the people on here. It really is amazing and I should thank each and every one that has had the kindness to reply and help with my problem. You guys "ROCK."

molly muffin

07-09-2013, 11:53 AM

Judi, just because you are going to Guelph doesn't mean you leave us!!!!! We're family now and you and Keesh are a part of it, no matter what happens. Cushings, not cushings, whatever!!!

I did a consult with Oakville/mississauga ER Vet Hospital for Molly and her cushings.
Guelph I hear is excellent. The writer for Stargate, took his dog there for radiation treatments and they were very good.

huggers
Sharlene and Molly Muffin

spdd

07-09-2013, 12:18 PM

Sharlene... I wouldn't leave this forum for all the tea in China. I did get told the consult fee alone at Guelph is $150.00 - geez.. can't they read reports? LOL - I'll be around a lot, checking in everyday to see how everyone is doing.

Hope you and Molly are well...

molly muffin

07-09-2013, 01:41 PM

It was like that for the oakville/mississauga hospital too. 75. just for the referral to go there, then 150 or 160 consult fee for the IMS, plus testing, etc. A spendy day for sure (that was where I had the ultrasound done) However, it was worth I think, for us at least.
We are hanging in there, amongst flooding, power outages and the whole thing.
hugs,
Sharlene

spdd

07-10-2013, 12:07 PM

Keesh has an appt. with the Ontario Veterinary College on Tuesday July 16th. I haven't heard about a referral fee yet, but I can imagine what the OVC will cost.

This is going to be an adventure for sure.

molly muffin

07-10-2013, 03:43 PM

Hmmmph, if your vet didn't tell you they were going to charge you a referral fee then they probably didn't. I swear mine charges if you look at them cross eyed.

They also didn't recommend it themselves and I had to push to get a consult with an IMS and have an ultrasound done.

July 16th isn't too bad to get into Guelph.

hugs,
Sharlene and Molly Muffin

spdd

07-10-2013, 03:46 PM

Well I've been warned by others that Guelph is super expensive. If they want to charge exorbitant prices, then my dog shouldn't be a learning tool, or they can pay me - LOL.
I'm sure he'll get the best of care there, and I'll be able to get to the bottom of this finally. I'll let you know the cost and what they said.

spdd

07-16-2013, 05:06 PM

Sorry I haven't been on here much lately. It's wedding season and I'm at my busiest time.
So.... my vet forwarded all test results from Keesh to OVC and they phoned me. By the look of the tests they agreed it was Cushings and would I re-start the Trilostane at the increased dose prior to bringing him in. I argued that after 18 or so days there was no change in him but in all fairness had not given the increased dose a chance. So late last week I increased to 68 mg ( One pill at 58 mg (60?) and one at 10 mgs. Within 2 days there was a huge difference in him. We are now 4 days on that dose and he's like a new dog... and I have breathed a huge sigh of relief.
Now today he went to OVC - 3 hr drive there and back - he was in from 10:45 this morning until 2:40- they gave him a thorough exam, shaved his belly, gave him an ultrasound and catheterized him for a good pee sample. They are still of the mindset that he is a cushings dog, however because I caught it in time he is not showing the other symptoms other then his thirst and peeing all the time.
That has stopped in the last 2-3 days- PTL - and the ultrasound plus pee sample I should have the results he said sometime tonight when he phones.
Now to do a bit of bragging here ( ahem) - they said they would have to sedate him for ultrasound etc. They said he was so well behaved they didn't have to, however I would have paid to see them get him on the table and on his back. He hates his back, but the table has a soft trough their back goes into, so chances are once he was in it, he just wouldn't fight. He never was a fighter. I'd also like to have seen him catheritized but he was good when they took him away from me twice.. and of course happy to see him Momma again when it was all over.

So for those that have tried the Trilostane, don't give up if you don't see improvement for up to 3 weeks. Check the dosage and try again.

They also told me to get him off the Metacam due to kidneys that could be affected and put him back on Tramadol but reduce it from 100 mg to 75 mg. I only give him 20 CC's of Metacam every other day, but they said stop it.

I also have started him on milk thistle and within 2 days his breath was tolerable.

So it looks like I have "mahboy" for a little while longer. I will let you know what the ultrasound and pee test results are when I get them.

As I type this he is passed out completely, he's had a very busy, and possibly traumatic day.

Breakdown of cost from Ontario Veterinary College is:
Exam: CA Internal Medicine, initial referral consultation - $150.00
Ca Ultrasound Abdomen $ 465.00
Urinalysis, complete-routine $ 42.50
Bacterial culture, aerobic and anaerobic, companion/other (anoultn) $ 150.00
Government grab $ absolutely no tax- almost fell on the floor
Total $ 807.50 plus gas - LOL

Budsters Mom

07-16-2013, 05:25 PM

Hi Judi,
I am thrilled to hear that Keesh is feeling so much better! That is so awesome!:D you are very fortunate to have a veterinary college available for Keesh. Three hours drive is quite a distance, but for me, it would be worth my peace of mind. Big hugs for you! You are doing a wonderful job being Keesh's advocate.

molly muffin

07-16-2013, 06:25 PM

Yay Judi. I don't think it cost any more to go to Guelph than it did for me to go to the Oakville/Mississauga Hospital. A longer drive maybe. LOL I bet Keesh is really worn out.

Wedding season! Whoo Hoooo. I thought you were going to retire. LOL Once a planner, always a planner eh. :) I'm not sure I'd be able to resist either.

Good job. Great report on Keesh and so glad everything is going better.

hugs,
Sharlene and Molly Muffin

spdd

07-16-2013, 06:48 PM

Thank you for the upbeat remarks. FYI I did give up most of the wedding business, but still doing floral arrangements and the odd co-ordination.

So OVC called and the ultrasound shows an enlarged liver with rounded edges, no liver disease and the results are consistent with cushings. He said there is no concern at present with these results.

The adrenal glands are normal which makes them think the Trilostane is doing it's job and actually was doing it before I took him off it. They have said it's definitely pituitary cushings.

Now if the urine analysis comes back and he has UTI, I'm going to be right back where I started wondering - maybe I just can't accept he has cushings...I should know better.

addy

07-16-2013, 08:06 PM

I am so glad your pup is feeling better. Good job and worth the drive.

Just for others reading this I am not sure sure how accurate this statement is as Vetoryl/Trilostane does not erode the size of adrenal glands, Lysodren does. Vetoryl/Trilostane may actually enlarge the adrenal glands.

Perhaps it is just worded wrong or I am misunderstanding it;)

The adrenal glands are normal which makes them think the Trilostane is doing it's job and actually was doing it before I took him off it.

There are cases of dogs with Cushings that do not have enlargement of adrenal glands.

Roxee's Dad

07-16-2013, 08:13 PM

Yay !!! Great job and good report. :D

Keeping everything crossed that Keesh continues to improve.

spdd

07-17-2013, 05:11 AM

I am so glad your pup is feeling better. Good job and worth the drive.

Just for others reading this I am not sure sure how accurate this statement is as Vetoryl/Trilostane does not erode the size of adrenal glands, Lysodren does. Vetoryl/Trilostane may actually enlarge the adrenal glands.

Perhaps it is just worded wrong or I am misunderstanding it;)

There are cases of dogs with Cushings that do not have enlargement of adrenal glands.

If I recall correctly the vet said that cushings no matter what type can enlarge or have an affect on the adrenal glands. I may be wrong here, but that's how I took it. He also said that was a deciding factor in the diagnosis of pituitary cushings. I had no idea that Trilostane can enlarge the glands....I'm going to inquire about that further. Thanks.

addy

07-17-2013, 08:35 AM

You are right, usually we will see bilateral enlargement or one adrenal enlarged depending if it is pituitary or adrenal Cushings. A few dogs may have normal size adrenal glands and still have Cushings.

My concern with the way the wording of the sentence was that people reading it may think that treating with Trilostane keeps the adrenal glands from enlarging, which is not the case as I understand it.:)

No worries:):)

spdd

07-17-2013, 09:48 AM

I have another question for all you experts. Hope I'm not becoming a pain. Keesh wasn't really hungry yesterday before we left on our trek. I did get some food down him in order to give him his meds. He did not eat last night, nor will he eat this morning. Not being a stupid dog, he figures the big chunks come from my hand with meds inside so that is what he waits for. I gave him a couple of small pieces of meat this morning to test my theory. Sure enough he ate it but won't eat from his bowl. Is it ok to not give him his Trilostane until he's so hungry he will eat from the bowl? This is a stand off between him and myself. He's actually gone 2-3 days without eating to the point where he'll get the dry heaves ( so do I when extremely hungry) just to prove HIS point. That was when he was younger but I don't want to jeopardize our progress by waiting. Thoughts???

lulusmom

07-17-2013, 10:37 AM

Do not give Trilostane to a dog who is not eating. This is one of the first signs that cortisol is too low and vomiting makes that possibility even greater. Do not give Keesh anymore Trilostane until he is feeling better. If either one of my cushdogs acted he least bit off, they came off of Trilostane for a few days or until their appetite returned. Sometimes dogs do get an upset stomach, just like us, but the symptoms are the same as insufficient cortisol so never assume that it's anything else. Trilostane has a short half life, meaning it's effects are short lived. Once you withhold a dose, a dog usually bounces back rather quickly.

I did want to comment on a statement made by one of your vets in a previous post that because Keesh's adrenal glands were normal, that was a sign that Trilostane was working. That really isn't the case with Trilostane as it almost always enlarges the adrenal glands. It's been a while since I've read some of the case studies on this so I don't know how long after starting medication that this abnormality would occur. I'll try to find a link to a study on this and will provide it later.

I haven't been proactive in reading threads lately so I don't know Keesh's history until this point but regardless, do not give him any more Trilostane and call your vet to let him/her know what is going on.

Glynda

spdd

07-17-2013, 10:46 AM

Thank you.. that's good to know about withholding the Trilostane. I have a call into the vet for several reasons, and I'll bounce that off her about normal adrenal glands and see what she says.

lulusmom

07-17-2013, 10:57 AM

Here is an excerpt from a study sponsored by Idexx Labs regarding Trilostane's affect on the adrenal glands:

Because Trilostane inhibits cortisol synthesis, but does not induce necrosis of the adrenal cortex, over time, the adrenal glands do NOT shrink but rather enlarges (continued or even increased? ACTH stimulation), have increased ultrasonographic distinction of the adrenal cortex from the medulla (early during usage) and may develop a heteroechogenic, nodular appearance with irregular shape (longer term usage.)

You can find this at url: http://www.vmsg.com/files/Dr-Ortega-Notes-02-15-07.pdf

Here is the url to an abstract of a study entitled, "Changes in ultrasonographic appearance of adrenal glands in dogs with pituitary-dependent hyperadrenocorticism treated with trilostane":

http://www.ncbi.nlm.nih.gov/pubmed/14703251

spdd

07-17-2013, 11:12 AM

Thank you again. That was really informative. Why is it that I have this gnawing feeling that Keesh isn't a Cush dog. I don't think it's non acceptance, it's all the other signs that aren't there and his test results weren't that bad. The only sure sign I have that Trilostane may have helped was re-introducing him to it after almost 3 weeks of non-responsiveness and then within 2 days of starting again he's fine? I keep thinking that it was a fluke. Something still isn't sitting right with me. I must be in denial.

lulusmom

07-17-2013, 11:24 AM

Nothing about cushing's sits right with many of us but things start to fall into place a lot more if we continue to learn everything we can. You are well on your way and around here, asking questions and doing your own research is the only way you are going to learn how to be an excellent advocate for Keesh. I haven't had a chance to recheck your thread so I can't offer my personal opinion as to whether the facts as you've presented them could indicate a possible misdiagnosis but I'll try to get that done today. In the meantime, I'm hoping other members who have remained more active can offer their feedback.

Please let us know what your vet has to say about the latest information you provide him/her on Keesh.

Glynda

Roxee's Dad

07-17-2013, 11:54 AM

I will go thru the thread when I get back and try to put together a summary to date, but last results were:

June 13
Here is everything, finally got the LDDS results

Cortisol 0 hours - 395
Cortisol (4 hr Dex) - 72
Cortisol (8 hr Dex) - 134
This was prior to any meds at all

July 8th
His cortisol reading she said prior to Trilo was 395 (14.31)
Friday when being tested his baseline was 149 (5.4)
1 hour after - 188 (6.8)
2 hours after- 200 (7.2)

She said it should be between 80-120 (2.89 - 4.34)

His bloodwork is as mentioned earlier -
ALP-155
ALT-246
but new thing is Urea is 11.6 and should be 3.0-10.0

lulusmom

07-17-2013, 12:33 PM

His ACTH test was after giving him Trilostane between 6:30 and 7:00 a.m. He had - 68 mg - I had given it to him prior to everyone telling me not to.
I brought him to vet shortly before 1:00 p.m. and do not have any times as to when they ran it.
I did not give him any over the weekend at all and he improved.
Potassium reading on Friday was 5.3 - s/b between 3.9-5.7 according to the report and Sodium was 147- s/b between 143-155
You guys are saints... honestly.

Okay, so we already know that protocol was breached as the stim test was not done within four to six hours of dosing. If proper protocol had been followed, the results would be interpreted as being too high if Keesh was still symptomatic but without further clarification from you, I'm not sure that test should be relied on for much of anything other than a drain on your finances. I believe that you had quit dosing Keesh prior to the acth stimulation test but did give Keesh his dose the morning of the stim test. How long had he been off of Vetoryl prior to that morning? I ask because while Vetoryl isn't supposed to have a cumulative effect on the adrenal glands, like Lysodren, which actually erodes the adrenal cortex with large cumulative doses, but based on what I've seen here, I'm not so sure Trilostane doesn't have a different type of cumulative effect. We've seen dogs' cortisol continue to drop well into 30 days so it would be very difficult to make an accurate assessment of Trilostane's effect on Keesh's cortisol levels based on one stim test that was done outside the specified time frame after only one dose. I'd feel a lot more confident in those results if you tell me that Keesh had at least three or four days of dosing prior to the stim test. Yes, some dogs can show drastic signs of overdose after one capsule but most do not.

Glynda

spdd

07-17-2013, 02:21 PM

Keesh was off his meds prior to his test for 4 days i believe, and back on for only 1 when tested. He got his 68 mg between 6:30 and 7 a.m. and was in the vets for his ACTH test just prior to 1:00 p.m. They didn't give me any times as to when they did the test. I'm assuming that the time frame wasn't right for that test.

So I just got off the phone with my vet. She advised that I don't split the dose of Trilostane. Re the Metacam it's always a risk when on Metacam so I have to balance the benefits against the risk. It's a grey area she said.

She did not have the OVC results and I'm still waiting re his urine sample, but I am to continue his Trilo and he is going in for another ACTH test on August 2nd - she said a 2 hour test. I'm supposed to give him his meds about 8 a.m. and bring him in about 12:30 - so hopefully this will give me a better idea of how he's doing.

lulusmom

07-17-2013, 03:26 PM

I am very concerned that your vet doesn't seem to understand that Keesh may not be able to tolerate the dose he's been prescribed. I am assuming that you told her that he is not eating and for her to tell you to continue dosing is simply wrong. If you didn't tell her, you should call her back and tell her and if she still tells you to continue dosing, I'd be hard pressed to trust her to treat my dog safely and effectively.

Please see an excerpt from the packaging insert from Dechra, the manufacturer of Vetoryl (Trilostane):

Side effects generally involve an over suppression of the adrenal glands (hypoadrenocorticism, also known as Addison's Disease). Look for the following side effects that may indicate your dog is having a problem with VETORYL Capsules or may have another medical problem:

Depression, lethargy or decrease in activity.

Change in bowel movements (such as diarrhea or loose stools).
Vomiting.

Stops eating or loses all interest in food.

As VETORYL Capsules control the hyperadrenocorticism, there should be a decrease in food and water consumption to normal levels. There should also be resolution of excess urination. If, however, there is a dramatic decrease in appetite or the dog stops drinking water, it could be an indication of a side effect requiring treatment.

spdd

07-17-2013, 03:43 PM

I haven't given Keesh any meds today, she is aware that he is not eating. She suggested he might be in a little pain due to yesterday and to give him a Tramadol. I won't start up again until he decides to eat, but the little bugger will probably engage me in a battle of the wills. This could last for a couple of days at least.

Keesh needs at least a couple of weeks without prodding from vets and getting his meds on a consistent basis . We haven't had that luxury yet other then part of the 18 days where it wasn't working. If we could get at least a good week where he eats, takes the meds and no outside influences, I could get a better reading on him and how he really is feeling. Without the Metacam, he really has back end issues with the knees. It really works for him but I can't give it to him either without him eating. Sometimes we are caught between a rock and a hard place. Today that is happening for sure.

Budsters Mom

07-17-2013, 08:47 PM

I am so sorry. It is really hard when they are not eating. We worry about them so much!:o Sending you big hugs and lots of healing energy to Keesh.

lulusmom

07-17-2013, 09:06 PM

If I were in your shoes, I'd 1) provide a copy of the information I posted earlier to the vet if she gives you any flack at all for not following her ill advised recommendation to continue treatment and 2) continue to withhold the Trilostane until he starts to eat normally. Once his eating is back to normal, you can start treatment again. If he stops eating again within a few days, it's highly likely that the dose is simply too high, at which time you may want to consider reducing the dose. Stick to your guns and your gut.

lulusmom

07-17-2013, 09:35 PM

Why is it that I have this gnawing feeling that Keesh isn't a Cush dog. I don't think it's non acceptance, it's all the other signs that aren't there and his test results weren't that bad. The only sure sign I have that Trilostane may have helped was re-introducing him to it after almost 3 weeks of non-responsiveness and then within 2 days of starting again he's fine? I keep thinking that it was a fluke. Something still isn't sitting right with me. I must be in denial.

I have a very short memory and have to rely on my good buddies like Kim and John to remind me of my own opinions. :o I just went back and reread your thread and I see that I questioned the diagnosis a while ago. You are certainly not in denial.....you know Keesh better than anyone and you are thinking logically. You aren't the only one who has had a gnawing feeling that Keesh doesn't have cushing's. Most of the staffers here have questioned it, which should tell you something. Cushing's is a very graded disease, progressing at a snail's pace. My two dogs were beyond symptomatic before I started treatment and I'm quite sure both had been affected by the disease for at last a year. Unless there isn't something else going on with Keesh, you have plenty of time to sit back and observe your boy while you enjoy life with him. If he starts showing symptoms again, then you can decide if you want to restart treatment.

Glynda

P.S. The two things I failed to pick up in my review of your thread was Keesh's breeding and his weight. Can you please confirm those for me?

Roxee's Dad

07-17-2013, 11:00 PM

History as best as I could gather it. Please let me know if there is anything else to add or any corrections.

Keesh - 13-1/2 Y.O. (LAB?)
65 pounds and is on 58mg dose once daily of Trilostane

Signs -Thirst and peeing.
He had a small amount of infection in his urine - No meds for infection. Urine also diluted.

June 13
LDDS results Prior to any cush meds.

Cortisol 0 hours - 395
Cortisol (4 hr Dex) - 72
Cortisol (8 hr Dex) - 134

6/29 - On Trilo for 10 days with no change

7/5 -
-collapsed and for most of the day had extreme difficulty getting up. Vet upped dose of Trilo by 10 mg.
-Prescribed Tramadol and said to start him back up on low dose Metacam
-ACTH test, extreme thirst, no appetite.
-Vet recommended to continue Trilo but Trilo was stopped by guardian.

Baseline was 149 (5.4mg) (15 - 120)
-1 hour after - 188 (6.8mg)
-2 hours after- 200 (7.2mg)
-ALP is 155 down from 183 taken on May 24th
-ALT is 246 up from 145 taken May 24th.
-Urea is 11.6 and should be 3.0-10.0
-ACTH test was after giving him Trilostane between 6:30 and 7:00 a.m. He had - 68 mg / brought him to vet shortly before 1:00 p.m.
(Note at least 6 hours between dosing and ACTH test maybe more)
-Potassium 5.3 ( 3.9-5.7)
-Sodium 147 ( 143-155)

7/7
Keesh is eating, walking well and able to navigate stairs.
-evening - no appetite, less drinking, less urination.

7/9
No Trilo

7/12 ish
-Restarted Trilo at increased dose of 68mg
-Keesh has improved

Ontario Veterinary College on Tuesday July 16th

-Taken off Metacam
-back on Tramadol but reduce it from 100 mg to 75 mg
UltraSound:
-enlarged liver with rounded edges
-no liver disease
-adrenal glands are normal
-results are consistent with cushings
-definitely pituitary cushings
-Awaiting Urine analysis

Follow up ACTH on 8/2

molly muffin

07-17-2013, 11:29 PM

Well goodness. Keesh certainly has a stubborn streak a mile long. :) Hopefully Keesh will start eating soon and then you can get into a regular routine and see what is what.

Hang in there!
hugs,
Sharlene and Molly Muffin

goldengirl88

07-18-2013, 09:28 AM

I am sorry your baby is not eating. That is the worst thing to watch. Please take Glynda's advise strongly as she knows everything there is to know about this disease, and then some. I hope things turn around for you and your baby. Blessings
Patti

spdd

07-18-2013, 09:42 AM

Well, Keesh didn't eat last nite and wasn't very interested this morning. His excessive thirst and peeing came back yesterday afternoon and has continued. I finally got some food into him this morning, (enticed with a tsp. of gravy) and he at the whole bowl. It's so weird when you can breathe a sigh of relief just because your dog eats a meal. Because he went back to his two original symptoms I gave him his Trilostane this morning. We will see if the thirst and peeing now continue. One day without and he's back to where he started. I am really hoping today he's better then yesterday. I blame yesterday on the trauma at OVC possibly. Frustration abounds right now.

Re his breeding. I was told he was a cross between Viszla and Keeshond, hence the name, but I only see golden retriever and collie in him. He currently weighs approximately 67 pounds.

His new symptom which has nothing to do with cushings , he can't bark or howl anymore. He tries but hardly anything happens. He's like a dog with severe laryngitis. I don't think I want to know what may be causing that.

goldengirl88

07-18-2013, 10:10 AM

Please call your vet. Keesh is showing a symptom of nerve paralysis of the larynx this can be very bad. Cushings can cause tracheal issues, and of course the larynx is right there. This I am stressing can be bad if this is what is happening. I am not trying to scare you but they lose their voice, and their bark with this problem. The reason I know is I discussed this with the IMS because Tipper has throat problems. Pleas look into this asap.Blessings
Patti

goldengirl88

07-18-2013, 10:11 AM

I forgot to say this could also be the reason he does not want to eat.

spdd

07-18-2013, 11:50 AM

Thanks, the vet is aware of the bark or non-bark etc. I will leave him a couple of days before I have him prodded and poked again. This non-barking started about 3 months ago, maybe a bit less. He loved to howl when he was happy, now he just tries. It's sad, but I'll have it looked at.

Dechra called, or at least the Canadian subsiduary call Vetoquinol in Quebec. Dechra refers Canadians to them. The lady could not give any advice,they aren't allowed to other then she said, it is recommended to not split the dose. I told her that I was under the impression that Dechra in the U.S. starts a file on a dog when contacted by the owner. I hope I was right telling her that, I thought I read it here, but she wasn't aware of that either.

As of right now, Keesh is almost back to his usual self, I really hope I can get about 3 consistent days out of him. He took the stairs today but yesterday and last nite he wouldn't. That's a huge improvement.

Trixie

07-18-2013, 12:12 PM

Hope Keesh is doing okay today. It is so frustrating to not see the consistency! I feel your pain! We have had some luck and Trixie had almost a week of "normal"! Just as I was thinking everything was rosie it turned around yet again and symptoms started creeping back. Ugh.

Since Vetoquinol was pretty much unhelpful can you deal with Dechra in the states even if you're in Canada? They must have an 800# to call for free I would think. Why would they care where you are...if you're using the medication, won't they set up a file for you too..what difference does it make where you call from?
Hoping Keesh continues to have a good day and that his appetite is back to normal. :p
Barbara

goldengirl88

07-18-2013, 12:15 PM

Yes you are right. Dechra does start a file in the US and give you a file number on your dog. They have vets on staff there to help also. Very different how things are there. Glad you are getting it looked into about the larynx as it is serious. My IMS had to use a scope to determine Tipper's as dogs have a gag reflex and have to have anesthesia. Not sure a regular vet has those capabilities, but maybe where you are it is different. Blessings
Patti

spdd

07-18-2013, 03:58 PM

Dechra can't help me at all. I got told that due to FDA regulations they are not allowed to discuss meds etc. with Canadian consumers. I said there are no files started for dogs with the company Vetoquinol here in Canada, and she said they were sorry, but there was nothing they could do. So... I either get my info from my vet, or nowhere. I'm really miffed at that.

I guess I should re-phrase that last statement. I'll get my info here.

Budsters Mom

07-18-2013, 04:01 PM

Well that sucks!:mad::o Yes, my dear! This is exactly where I found the correct information!!!! Big hugs,

Trixie

07-18-2013, 04:28 PM

Isn't silly red tape maddening! What the heck difference would it make if Dechra made a file for you since the Canadian affiliate will not?
It's just plain stupid. I guess they ask your phone# and address? How would they know if you told them you lived in the states? Not that I'm suggesting you lie..just wondering how they would know.
Barbara

spdd

07-18-2013, 04:37 PM

Cause when I phoned they asked me for my name and phone number, tranferred me to someone else, then they asked where I was located. They took it from there with the FDA etc.

molly muffin

07-18-2013, 05:15 PM

I think it is ridiculous too. I couldn't even get them to talk to me.
In the UK they have no option for contacting Dechra directly from what I understand. Looks like we are the same way here.

Our vets by the way, get their information on dosing from the Decrhra sales rep and the insert. I figured that out from when I went all yeehaw about starting my molly at 30mg for 19lb dog and I talked about studies and current dosing recommendations for starting and the answer was, they could talk to the company rep but this is what they have recommended to the vets. I'm like never mind and that was the point where I asked for the consult to the IMS and an ultrasound. Which by the way I learned I should do from yes, the forum! here. :)

It is just different between countries I think. I don't WHY the company can do one thing in the states and has to do something else in UK and Canada. It might be the same for Australia too. I wonder about New Zealand.
Something is just no right about all of that. grrrrr

Sharlene and molly muffin

goldengirl88

07-19-2013, 08:34 AM

So sorry that happened to you. It is a shame because they have been a big help with Tipper. Blessings
Patti

lulusmom

07-19-2013, 12:45 PM

I am so sorry that you hit a road block with Dechra. It's simply not right that non U.S. residents don't have the consumer support we do here. For what it's worth, I have written to Dechra U.K. to see if they could give me contact information for our non U.S. resident members who don't have the benefit of the valuable resources they offer in their Dechra U.S. subsidiary. I have no idea if they will respond but if they do, I'll let everybody know.

molly muffin

07-19-2013, 01:44 PM

Thanks Glynda, that is really appreciated by all of us non US residents.

Sharlene and Molly Muffin

spdd

07-19-2013, 03:24 PM

Thank you for taking the time to do that. It will be interesting to see if they do respond and what they say.

spdd

07-20-2013, 10:01 AM

No eating again this morning. I got food into him yesterday morning and some real liver yesterday, but he's not responding with me trying to entice him. I've tried chicken, hamburger, beef and some liver .... nothing. I can't get his meds into him unless he eats. I used to feed him twice a day, but with this no eating now, I've reduced it to once a day, hoping he'd be hungry when meal time came. I'm so frustrated and I just spent another $289.00 on his new prescription. He's cost well over $3000.00 since we started this adventure, and the last thing I expected was him not eating.
I still don't have his urine analysis from the OVC-vet says it takes 72 hours to grow cultures, but yesterday afternoon neither she nor I had any results and she said it was due . Will have to wait till Monday now.

goldengirl88

07-20-2013, 10:11 AM

Have you talked to the vet yet about the possible larynx paralysis? This can and will make them not eat. Blessigns
Patti

Squirt's Mom

07-20-2013, 10:20 AM

How often has been getting the Tramadol?

What are the possible side effects of tramadol: Get emergency veterinary medical help if your pet develops these signs of an allergic reaction: hives; difficulty breathing; swelling of the face, lips, tongue, or throat. Stop using tramadol and call your veterinarian at once if your pet has any of these serious side effects: seizure; a red, blistering, peeling skin rash; or shallow breathing. Less serious side effects may include: drowsiness, and weakness; vomiting, constipation, loss of appetite; blurred vision; insomnia.

http://www.1800petmeds.com/Tramadol-prod11064.html

Does he act like he wants to eat but doesn't or is he flat not interested in food at all? Have you tried putting foods in a blender to make a mush in case there is something in his mouth or throat causing pain to chew / swallow more hard or solid foods? Have you tried stinky foods like sardines, tuna, Parmesan cheese, cod? Does he have any digestive issues like constipation or diarrhea, nausea?

Not eating is such a stressor on everyone. :( I feel your pain having just gone through this with Squirt a few months ago. Every waking minute was focused on finding or making something she would eat, anything!

Don't try to give him the Trilo as long as his appetite is off. Just concentrate on getting him to eat. ;) If you don't have Nutrical or something similar, get some to have on hand just in case. It will supply the vitamins and minerals he needs.

spdd

07-20-2013, 11:05 AM

Keesh has always been a bit picky with food. The texture is a big thing with him. Gravy is ok, but not too much. Anything new he throws on the floor, at one time would roll in it then maybe he'd eat it.
He doesn't act like he wants to eat at all, at least anything that I offer him . I just actually put the food in my hand and he took a few bites. He wanted some cold meat slices when that came out of the fridge though. If I blended the food, he wouldn't eat it, anything that is mushy that I've tried before he refuses. He doesn't have any digestive issues that I know of. I constantly monitor his poop-even that sounds funny to me, but I have to.
When a puppy we tried about 6 different kibble with him, that's when I knew he'd actually get the dry heaves from hunger but wouldn't eat. He finally settled on Beneful,( I know it's not the best) but he's eaten it for years and loves it when you come in with a fresh bag, his ritual then is a snack out of the bag.
Re the Tramadol, because the prescription was not in until yesterday I had one pill left at 58 mgs. He got that yesterday. He is now supposed to get 65 mgs, down from 68. He's acting normal, just not hungry. I will see how the weekend goes, but yesterday he actually barked 4-5 times in a row. I was shocked. Sounded normal too. This dog is more confusing then a heavy calculus exam, and certainly he has gotten stubborn in the last little while. Not listening is one big thing and I know he can hear.

Squirt's Mom

07-20-2013, 11:26 AM

You know Beneful "isn't the best"...have you googled it and researched it? If not, you might want to, today. ;) With picky pups it's tough to even think about switching once you find something they'll eat but sometimes it's sure worth thinking about and looking into.

spdd

07-20-2013, 01:09 PM

I know about Beneful not being a good dog food, however he's been on it now for almost 14 yrs. I have tried every seniors dog food going, he won't eat anything but Beneful.

Budsters Mom

07-20-2013, 01:10 PM

Just chiming in on the Beneful thing. That stuff is crap! Okay, I said it!:eek: It has corn listed as the first ingredient followed by chicken/meat by products. You don't what to know what "by products" consist of!:eek: Meet should always be the first ingredient! Rosie was eating the puppy version when I adopted her. I couldn't wait to transition her off of it. She scratched at her face, neck and chest incessantly. I cringed when I had to buy a bag to transition her. :eek: Thry should not be allowed to sell it and call it nutritious!:mad: Rosie is finally off of it. She had no problem with the transition, as it was done very slowly. She is hardly scratching at all now. I will quote Leslie here, Corn is not for dogs. It is for cows."

goldengirl88

07-20-2013, 02:16 PM

Could you whirl a magic concoction in the blender and put it inside a syringe and feed it that way? You can get the larger sizes off the vet. Have you tried meat baby food? It is easy to suck up in a syringe, and they seem to like it. Blessings
Patti

Squirt's Mom

07-20-2013, 02:50 PM

I have a big syringe like thing that was used to feed babies, human babies. I don't even know if they still make them or not but they do come in handy when I can't get meds down Squirt any other way. I mix with food then in the syringe and in her mouth. Your method of rubbing on the roof may be less stressful for your baby, tho. That didn't work with Squirt! :D

lulusmom

07-20-2013, 05:18 PM

I am quite concerned with Keesh as every time you start dosing him again, he quits eating. That's a pretty good indication that the dose is either too much for him or he may possibly be a dog that can't tolerate the drug....or it could be that he has laryngeal paralysis and every time you lower his cortisol, the swelling and and inflammation increases. Cortisol is the body's natural steroidal anti-inflammatory so a cushddog with joint problems or laryngeal paralysis are going to feel better with high cortisol levels. Basically uncontrolled cushdogs are self medicating.

Dogs don't lose their ability to bark, howl or make any other noise for no reason so I'm very curious as to what your vet did to determine why this happened and continues today? This is not normal; not seeing the usual blood abnormalities common in cushing's is not normal; seeing normal adrenal glands in a dog who is collapsing from the severe progression of the disease is not normal; it is not normal for cushing's to give a dog long term laryngitis; it's not normal for a vet to be so ignorant about following proper protocol after administering such a serious drug; and it's not normal that somebody at a teaching hospital, I assume in internal medicine, is equally ignorant about the appearance of the adrenal glands before and after treatment with Trilostane.

I know you have little choice of vets in your area but is there any other options for Keesh?

Glynda

spdd

07-22-2013, 11:16 AM

What a rollercoaster. A bride came on Saturday and Keesh barked perfectly normal about 6-8 times. I was sooooo glad to hear it. I have gotten food into him the last 2 mornings and his meds, but he doesn't eat as much as he used to, even before he got sick. Guess older dogs like some people, just can't eat as much. We had a walk yesterday, but I noticed he tired easily and it wasn't a long one.
Re the Beneful dog food. I really know it isn't great stuff, but he always has meat with it. I have cooked for this dog now for years only because I couldn't get him to eat anything else so I figured he'd have to get nutrition elsewhere.
Swallowing a rock years ago ruined our meal times around here. For 2 weeks solid he was not allowed to eat any dog food re the vets advice. (What does that tell you about any dog food.) He had to have rice and chicken or rice and hamburger meals until his stomach and intestines healed. From that point on mealtimes became a nightmare unless there was some people food in that dish. He has always had additives to his kibble and still does to this day. Spoiled much???? You bet !!
Glynda.... he is going for another ACTH test in a week and a half. I will have them check his throat then. The regular vet didn't seem too concerned and I never mentioned to OVC which I can't believe I didn't. I will also ask why the adrenal glands are normal. Could it be because he hasn't had a consistent supply of Trilostane? He's been on and off it, but back on it now everyday since Saturday.

Squirt's Mom

07-22-2013, 11:49 AM

LOL No wonder he's picky! Who wants that old dog food when there's other stuff that is soooo much better! :p Squirt and Trinket are a bit that way; Brick and Sophie are like "Mikey" and will eat anything. :D But anytime Mom is in the kitchen there are four mutts underfoot eagerly waiting for things to drop - because they know it will happen! :D

My concern with Beneful isn't the nutrient value or the ingredients, tho they both play a role in my concerns...it's the number of dogs becoming seriously ill and dying who are eating this feed. I read some of the stories then read some of your posts about things that have happened to your baby and it made me nervous. So that's why I said to google and read some of these reports. Since you are mixing kibble with human foods, it would be much easier to switch than if he were eating kibble alone.

Hugs,
Leslie and the gang

spdd

07-24-2013, 07:24 AM

A good two days with "mah boy." Eating and drinking normally and because his urine isn't as diluted, he is now ruining the lawn again. Never been so happy to see brown spots on a lawn.
I am slowly switching him over to Nutrish dog food, he isn't totally balking at it, but when I brought it home, gave him a few kibbles from my hand and he ate it. I think I tricked him though and he thought it was treats.
I still do not have his urine culture results back and it's been over a week. I called vet and they don't have it either. They said the college would call me directly, so looks like I have to make a call to them today.
Everyday I think about every one of you and what you have gone through and are going through. You are all so supportive and for that I am very, very grateful.

goldengirl88

07-24-2013, 07:53 AM

Glad your baby is feeling better. I just wanted to comment on the food though. Nutrition is very important with these dogs, and Nutrish is by no means a food I would feed my dog, although it is a step up from Beneful. Do you have a pet store nearby, or go on the internet for a high quality food? They need high quality low density food. I am just saying this because what they eat while in this disease process is as important as the other aspects of their care, and maybe more so. Have you taken the dog to the vet to rule out laryngeal paralysis? That is what I would be concentrating on is these two issues, the diet, and the larynx. I hope your baby continues to do well. Remember the decisions you make impact the probability of your dog making it thru this disease. I say this only out of caring about your dog, and trying to save you from heartache. Blessings
Patti

spdd

07-24-2013, 08:14 AM

Patti... I thought Nutrish would be a good food. What do you suggest?

More good news... we got a howl out of him a few minutes ago. Daddy came home and his howl was standard.

frijole

07-24-2013, 08:27 AM

I am not disagreeing that nutrition is important but simply want to point out that this dog sometimes isn't eating at all. If the dog will eat Beneful vs other foods and has since a puppy then Beneful it is because it's better than no food at all. Also the food could be enhanced by adding nutrition to it if need be.

Yes diet is important but there is no 'cushing diet'. What you look for is a diet that is low in fat but yet has plenty of protein. That is it. You look for foods that have more meats and healthy items towards the front of the ingredient list than grains. Grains are typically filler used by companies to make more money on the food as they are less expensive.

Kim

goldengirl88

07-24-2013, 09:34 AM

I understand some food is better than no food, my suggestion is that maybe you could try a food with no grains and fillers, and simply see if he will eat it instead of the Beneful and Nutrish, but slowly combining it with the current food. If he does , it will be beneficial for him to get away from the fillers. There is a site that compares all the top dog foods by ingredients. Just search for reviews of top dry dog foods or canned whatever you prefer. The food you are feeding is better than no food at all, put it that way. They are simply grocery store low quality foods. You need a low density, protein rich food. Just keep a handle on the protein as the nutritionist cautioned me about it. Every one uses something different. I combine Tipper's food with some natural, no salt, no anything added chicken breast. She eats Newman's Own Organic Chicken Food for Seniors. That does not mean your dog must eat this. It has never been recalled, and doesn't get any ingredients from overseas. It is lower in fat than many of the top dog brands, and is made from human grade organic chicken, and that is why I use it. I only give her 3/4 of a cup throughout the whole day of 3 mini meals with fresh cooked chicken added. She weighs a little over 17 lbs and according to Dr. Brown the vet at Newmans Own she could eat up to 1 1/4 cups for her size. I have spoken to him personally and have gone over what I am feeding Tipper with him, and together after talking to the nutritionist this is what I feed. He has even suggested Lentils as a substitute for some of the food, in order to lose weight, as they are lower in carbs. I try to keep her weight down, and also keep her from being hungry by feeding smaller meals more often. I am by no means trying to offend anyone for what they are feeding their dog, just trying to help them to better deal with the impact Cushings has on their dogs bodies, and why nutrition is important in this equation. I have used a well respected nutritionist for this, so I am not just spitting things out I think sound good.If they won't eat you have no choice and I understand that. Sorry if there was any miscommunication on my part. Hope your baby continues to do well. Blessings
Patti

spdd

07-24-2013, 12:15 PM

I haven't taken any miscommunication here at all. I appreciate everybody's input. As this is a new journey I'm on with Keesh, I need and appreciate all the feedback I can get. I thought considering Beneful was his meal of choice since a puppy, it couldn't be all that bad considering he is going to be 14. I didn't read about the seriousness of it until just a couple of days ago, even though I did know it wasn't a great food.
So.... I will hit up a pet food store and try to get something more nutritious for him. He's such a little bugger though at times with food, here's hoping it isn't a waste of money.

goldengirl88

07-24-2013, 12:46 PM

So glad you will look into the food. I hope your baby continues to do well. This disease keeps you on your toes. You are keeping a watchful eye out for your baby and that is the most important thing. Blessings
Patti

doxiesrock912

07-24-2013, 04:01 PM

Make the food switch gradually by adding more of the new to the old brand. Do this over a period of a week or two so that it's not a shock to his system.

Daisy has eaten Royal Canin dachshund formula since she was a pup. Our IMS said to stick with it for now.

molly muffin

07-24-2013, 05:48 PM

You can always throw some cooked chicken in with it. We know he likes the good stuff. :)

Did the college have anything for you today?

Nice to hear that Keesh has got his bark back, some what at least. :)

hugs,
Sharlene and Molly Muffin

spdd

07-24-2013, 06:01 PM

OVC just called. There is no UTI infection after growing all the cultures.
He barked again today once - good thing.
Chicken is a staple in any food he gets, along with many other people products that are good for him.
He has had another good day. Over to the park then all the way around the block. He's a happy boy. Hope he holds onto this at least till a week Friday for his 2 hr test, and then maybe I can breathe a sigh of relief. It's amazing how good you feel just because they now eat normally.
I think the Metacam has upset his stomach just a little. He tried to eat some grass today after lazing under the tree shade while I got some yard work done. I gave Metacam 2 days in a row and usually I give it to him every other day. He is still climbing the stairs on his own and far nosier then he's been in a long time.
We are going to retire tonight just a little more relaxed.
I will be thinking about Kaibo tomorrow and all the other furry best buddies on here that are working their way through this disease.
Only one thing that is new, he's nesting for some reason. He was scratching at the broadloom when it was time for bed, so I put an old sheet on the floor, he crumples it all up then lays down on it. Hmmmm!! weird?

goldengirl88

07-25-2013, 07:38 AM

So glad your baby is doing well, and I hope he continues to eat. This is nice weather to walk a dog in compared to what we have had for weeks on end. Blessings
Patti

spdd

07-25-2013, 08:51 AM

Looks like I spoke too soon, or it was the rise before the fall. Keesh is in terrible shape today. He cannot walk, his back end is shaking, he's panic struck and panting. He could not make 2-3 stairs to go outside this morning and does not want to eat. He fell at the front door and when I finally did get him outside, it was like he just didn't know what to do even though he did poo. He is aware of things, but my heart is broken. I cannot do anything more for him. I will wait a couple of hours as I just gave him a Tramadol, but at this point I am planning to make a call to the vet in a couple of hours and have him cross that bridge. He had his Metacam yesterday, so I know it's not a meds issue. I can't put him through anymore of this. He isn't himself today at all and I think he's telling me it's time.

Mel-Tia

07-25-2013, 09:03 AM

I know it's so very hard to know what to do for the best.

I just wanted to post to let you know you aren't alone right now.

Hoping you see some improvement today so you don't have to make that call

Big hug, love
Mel
Xxxxxx

lulusmom

07-25-2013, 09:10 AM

Have you been giving Keesh Vetoryl? If so, you may want to get him into the vet asap and have a stim test and electrolytes checked. If cortisol is too low, prednisone can make him feel better rather quickly. Making the selfless decision to release our babies from their pain is one of the most difficult thing we have to do. I apologize if my suggestions offend you, but I want you to understand that every symptom you just mentioned are all symptoms of low cortisol and aldosterone, both of which are easily remedied but you have to do an acth stimulation test now to find out. Once those tests have been done, your vet can give him prednisone to see if he responds.

Glynda

spdd

07-25-2013, 09:24 AM

I understand you can't take the ACTH test without food in his stomach ( not sure about that ) and he hasn't eaten. I have made the call to the vet and am taking him in at 10:30 - it is 9:23 now. I asked them to do an x-ray before any major decisions are made. I have resigned myself almost completely that it is time. I will be back later today and update everyone. It is so very sad to watch him.

Squirt's Mom

07-25-2013, 09:51 AM

Sweetheart, PLEASE have an ACTH done before you make this decision. His cortisol could easily be too low and easily fixed with meds. Do the US if you wish but please, please do the ACTH as well. It won't matter whether he has eaten or not in this situation so please have this done when he goes in.

We are with you all the way, honey, and pray you bring your sweet boy back home this morning.
Hugs,
Leslie and the gang

goldengirl88

07-25-2013, 10:14 AM

Please, please listen to Leslie and Glynda. This could just be low cortisol. I understand you unselfishness and not wanting him to suffer, but this is a decision that cannot be reversed. You need to clearly think on this a while and get him checked for low cortisol first. Please I want you to think about this that is all I am asking of you. Please give him one last chance and see if the cortisol is low. Instead of xrays I would spend the money on checking cortisol and electrolytes. Please get him checked. I am praying for him and you. God Bless you both. Patti

Mel-Tia

07-25-2013, 12:24 PM

Hope the appointment went ok. Sending you a big hug

Mel
Xxxx

spdd

07-25-2013, 12:26 PM

So I am back from vets. Keesh is too. He acted perfectly normal once at the vets and on the way home, he actually climbed into the chair twice to look out the window. I have a van so it's not an easy feat. This dog just boggles my mind. We will wait to have the ACTH test done a week Friday and in the meantime see how his quality of life is. He hasn't and won't eat today, came home drank a pile of water and proceeded to barf twice, which he normally does if too much water. I am thinking the Tramadol kicked in and he is walking better. Honestly it was like his back end wouldn't co-operate at all, and was drunk. It just wouldn't work. It is now. He has not has his Trilostane today nor Metacam. He's 4 hours behind for his dosing. The vet said he is borderline in regard to quality of life, so I just couldn't do it. The strain of all this completely exhausts me, but "mahboy" is here for at least a little while longer. My mind went completely blank at the vets, ( I should be slapped) and did not ask about electrolytes. She also suggested that an x-ray wouldn't be the best thing as it will only show progression in the arthritis in his knees. She didn't want to waste my money, but said she'd do it if I really wanted it. I chose to wait until next week. I asked her to take him for a short walk to see for herself. She said they do a figure 8 with the dog and twice she said he almost fell. Getting home he took the cement stairs like a champ, jumped out of the van ok, so you see where my mind gets boggled over this dog. I need to go have a nap now, I cried so hard earlier, I'm beat.

P.S. Thank you for all the wonderful thoughts and suggestions. So much appreciated, especially today.

Squirt's Mom

07-25-2013, 12:33 PM

Oh, sweetie, I am so glad you and Keesh are back home. In Tasha's last months, I went through much the same thing with her. She would act as if she were on her last leg, simply could not take any more and I would take her to the vet where she would prance and act like a puppy almost. :confused: I told myself it was because she loved the vet and staff so much (she lived with them for several months) and just got excited seeing them again. She'd come home and be much better for a while. The time came when there was no longer any doubt. She did perk up "that" day a bit when she saw Doc and the girls but they could tell themselves she was done. I hope Keesh is with you for a long time to come and when his time does come, you will know as I did with Tash.

Many hugs,
Leslie and the gang

goldengirl88

07-25-2013, 02:00 PM

Oh my God I am so glad you are home, I have been a nervous wreck for you. Please if they did any blood work call and ask about the electrolytes, it is not too late. Have you thought of Cold Laser therapy? It is helping Tipper with her hind legs real well. It is not really that expensive here, as the other things we have had to do. A series of 5 treatments @ 135.00 then 1x a month @ 37.00What about Adequan shots like Tipper is getting? I am willing to try anything and if you are, I will keep giving ideas to try and help your baby. Please give him a chance, and see after the ACTH, he has made it this far don't give up hope please things sometimes turn around. Blessings
Patti

spdd

07-25-2013, 02:14 PM

I don't know about Adequan, I'll investigate but he did have a series of Cartrophen shots in May. It didn't help at all. They were $49.00 per shot. I'll look into the laser though, there is a vet in town here that advertises laser, just don't know what type.

Just called the local vet - Keesh's first laser therapy is Monday at 10:00

lulusmom

07-25-2013, 03:22 PM

I'm more than flabbergasted that your vet did not do an acth stim test or check electrolytes after you explained all of the horrible symptoms you saw today. They are classic addison's symptoms caused by low cortisol and possibly aldosterone. Every one of his symptoms have red flags with "low cortisol" written all over them and your vet is recommending that you wait until next Friday to have a stim test? The fact that a stim test is scheduled for next Friday would indicate that your vet expects you to continue to dose with Vetoryl. If Keesh were mine, I would eat shards of glass before I gave Keesh Vetoryl, and if I did, I would cut the dose in half. I would also make my vet toe the line in following proper protocol.

I'm still a nervous wreck for you and Keesh. I cannot believe you took Keesh to the vet to be euthanized and your vet didn't even ponder the fact that he/she has a dog who has crashed on Vetoryl for the second or third time, showing every symptoms of Addison's, acting like he's dying minutes or hours earlier but seems to have recovered miraculously after withholding Vetoryl. That is classic presentation of a dog recovering from an overdose of Vetoryl, so in the absence of a more logical explanation, low cortisol brought on by overdosing of Vetoryl should have been ruled out by your vet today. Why is s/he not seeing this and doing what should be done, like an acth stimulation test or at the very least, checking electrolytes? Please, please consider looking for another vet to treat Keesh.

molly muffin

07-25-2013, 03:35 PM

Omg. I can't believe your day. I can't write now but will when I get home. Hang on there!

Hugs
Sharlene

goldengirl88

07-25-2013, 03:57 PM

Glynda is so right on. I think you need to get to another vet and I am shocked also that the vet did not insist on an ACTH. Keesh could have an electrolyte imbalance, which can be dangerous in and of itself. Please get them to speed this test up to this week, like tomorrow. I would seriously think of going to another vet, this vet's lack of knowledge could harm your baby or even worse. Please reconsider, everyone is trying to look out for you so nothing bad happens. Blessings
Patti

Trixie

07-25-2013, 04:57 PM

I'm sorry you had such a scare with Keesh! He bounced back rather quickly. Was it your sense that it wasn't related to the Trilostane?
Did the vet say not to give today's dose?
You and Keesh have both been through a tough morning...how is he doing this afternoon?
I hope he's doing okay..and you too.

Barbara

frijole

07-25-2013, 05:24 PM

Like Glynda I'm going to get to the point - if you go back and reread your thread many of us, including you have been concerned about the diagnosis as a result of what seems to be low cortisol when given trilostane. I agree - the vet is either stubborn or confused or both. Please find someone else to take care of you and dear Keesh. Kim

molly muffin

07-25-2013, 08:09 PM

Did you call the vet hospital in Guelph? They too thought that Keesh had cushings, so I am wondering what they would have to say about this latest development. It does seem that every time Keesh goes on treatment, that things go wrong. It is really scary.
How close are you to Mississauga? That is where I live. I used the Oakville, Mississauga Hospital, but I'm not sure, maybe Guelph is closer to you.
I sure do hope that Keesh continues to bounce back tonight.

Hugs,
Sharlene and Molly Muffin

spdd

07-26-2013, 05:26 AM

The saga continues. Keesh drank and drank yesterday. The vet told me to give him his Trilostane if I could get food into him before 2 pm. I thought the excessive drinking was because he missed his dose. I hand fed him at noon, dosed him ( 4 hours later then normal) then hand fed him again for supper as he was hungry. HE usually has morning and evening meals. He peed in the night last night. On his blanket and on the rug. He seems to be fine this morning, but I'm going to go to local vet and get bloodwork done today if I can get an appt.

On another note, glad to see the update about Kaibo. He's on his way home soon.

Sharleen I'm in Alliston, and use Dufferin Vet Hospital in Orangeville. I have called the Alliston Vet clinic re getting cold laser for Keesh on Monday, so maybe I'll take him there for electrolyte testing.

spdd

07-26-2013, 09:26 AM

I have now switched vets as of this morning and going to a local one here. I have some test results to take them, and they are going to ask Dufferin Vet Hospital to forward his file to them. I'm not sure if I'm making the right decision, but with him constantly needing monitoring I need to have a shorter travel time. I sure hope I don't tick off his regular vet that he's had since a puppy but when you told me his Electrolytes should have been ck'd yesterday, she was all for euthanizing him, and I got a wake up call about this is the 2nd time he's crashed when on Trilostane, I thought it was time to move on. Today at 1:00 he will have the electrolyte test, Monday his laser treatment and guess I'll have to re-schedule his ACTH test with the new vet. He enjoyed his walk this morning, promptly came home and ate 3 weiners (cause that's all I can get into him) even though he's ignoring roast beef for some reason. I am also going to ask about an appetite stimulant and change in food. Sure hope next week is better then this one not just for me, but for everybody. If I get the electrolyte results I'll post them, if not everyone have a super weekend.

OOhhh just noticed I am now a senior member on here. I'm flattered.

frijole

07-26-2013, 09:32 AM

To save yourself some time and possibly money I would go into the new vets office with a typed up history of all testing, dosing and symptoms. You can use your thread to help you write it. Start at the beginning so the new vet has the entire picture. They don't need a book but they need to understand what has gone on with Keesh. Also you need to be listening for remarks to see if the new vet seems to have any more experience/knowledge than the old. Again if you read our comments you will know what to look for out of the new vet.

Good luck - praying this is a step in the right direction. I know it is hard. I live in a small town and went through the same thing with Annie. I only wish I had done it earlier but ... Go get em mom! Kim

lulusmom

07-26-2013, 09:35 AM

Your vet is dangerous and I do hope you start asking questions before blindly following her instructions. The fact that she has yet to rule out low cortisol and is telling to you to continue dosing, at Keesh's expense, is outrageous. If she were standing in front of me right, now I'd have no qualms telling her that she needs to pick up a book and educate herself before she takes on another cushing's patient. If you feel obliged to follow such misguided and risky instructions, then before you do, please ask your vet to call Dechra, the manufacturer of Vetoryl and discuss Keesh's case. Your vet could use some education and who better to get it from than the horse's mouth. It's free of charge there is absolutely no reason why your vet can't honor your request. Keesh's well being is in your hands and if your vet refuses to make that call, that's just one more reason you need to find another vet asap and get Keesh some quality care by an experienced veterinary professional.

Roxee's Dad

07-26-2013, 10:48 AM

A few pages back, I did put a short summary / history together. You may want to print that out with corrections if any. :)

lulusmom

07-26-2013, 11:49 AM

It looks like I was typing when you posted your second post this morning and am just now seeing that you will be having Keesh seen by a new vet. GOOD FOR YOU!!!!!

spdd

07-26-2013, 12:17 PM

A few pages back, I did put a short summary / history together. You may want to print that out with corrections if any. :)

thank you so much.. will be taking it and the other results I have with me.

Trixie

07-26-2013, 02:15 PM

Hoping you get some help for Keesh today with a new vet. This disease is an awful roller coaster...ups and downs..so hard to know what's going on sometimes. Glad that Keesh seems to be a bit better though..walking and eating wieners..sounds like he's feeling okay today. Let us know how it goes at the vet.
Barbara

Budsters Mom

07-26-2013, 02:27 PM

Fingers, toes and paws crossed, that this new vet is exactly what Keesh needs. Xxxxxx

goldengirl88

07-26-2013, 05:03 PM

Hi:
I just wanted to throw my 2 cents in the hat here. I hope you had checked before switching vets to see if the new vet is experienced in Cushings, if not you need to be checking asap. Even though I understand your old vet has seen Keesh since he was a puppy, she could have killed your dog being so uneducated about Cushings. Please take control of Keesh's fate and listen to the advise on here, and demand what you know and have been told by the experienced people on here that Keesh needs. He has come too far in his life to be let down by a vet that doesn't know what they are doing. Please get the ACTH and get this new vet in touch with Dechra. Insist they talk to the vet there any time something new comes up. That way you have put a system of checks and balances in place to make sure your boy gets what he is supposed to and doesn't get anything he shouldn't. I would not go to the vet if they don't follow your instructions and call. There have been too many close calls already, the next could prove fatal. You are following a lot of the advise on here and I commend you for that. Stand up and be Keesh's fearless advocate and demand the best for him. You love him and certainly want to get him as well as possible. I am so glad you are going to the cold laser treatments I suggested. It has helped my Tipper and she only has to go once a month now. He will sleep a lot the first 5 treatments as it gets all the cells in his body that have not been working to start up and get going to heal him. Tipper slept a lot and was tired the first few. Now she is ok and doesn't tire out from it. We aren't trying to be bossy and order you around, we just don't want a fatal mistake made with your baby. When it comes to my Tipper I will lay it on the line with anyone, nobody messes with my Tipper or their head will come off! You need to get the fight in you stirred up and stop taking crap off of uneducated vets. If they know upfront what you expect, they will respect you more, as they know you won't put up with crap. I have had some knock down drag out battles with my vet, and he knows not to mess up on anything with my dog as I am right there watching. So get your war face on and go to battle for your baby! You are the only one who will keep him safe, trust your gut instinct. I know you can do this from talking to you. Blessings
Patti

frijole

07-26-2013, 06:35 PM

Amen to what Patti just said. No more mister nice guy - your dog is depending on you to be his voice. You are armed with the info you need to make sure the next vet is up to the challenge. Kim

molly muffin

07-26-2013, 08:11 PM

Hi, hope Keesh is doing better today.

Just a reminder to everyone, not only did she go to her vet, but she also took Keesh to Guelph Vet College. They wanted a follow up ACTH on Aug 2nd. Adrenal glands were normal, liver was enlarged.
What exactly did they say about whether they thought Keesh had cushings or not.
The main thing and the only way to tell for sure is if you have been giving trilostane and then on give him trilostane on the morning of ACTH test and take him in within 4 hours for the test.
It seems that every time that Keesh goes onto vetoryl, that he has a very bad reaction. Whether this is from going too low or not, we don't know as the testing has never been done at the correct time to show what is really going on. You take Keesh off the vetoryl for a few days, he perks back up, urination increase, he goes back on trilostane and the cycle starts all over again.
Is that about right?

Just trying to get a clear picture in my head about what is and has been going on.

hugs,
Sharlene and Molly Muffin

doxiesrock912

07-27-2013, 12:13 AM

Daisy and I went through 3 vets before we found someone experienced enough with Cushings. Hopefully, Keesh is going to an IMS specialist.

spdd

07-27-2013, 06:31 AM

Sharlene you are right. Keesh started on 58 mg of Trilo for a period of just over 2 weeks or so without any change. It got bumped up another 10mgs and I only got 2 good days out of him without any symptoms. Two times now when he has started back up on Trilo, his hind end goes and it's panic time. The vet college did confirm he was a cushings dog and they only recommended that I take him off Metacam completely due to possible kidney damage that could be done, and drop his Tramadol from 100 mg to 75mg, which I rarely give him.
I am leary of this new vet we saw yesterday. He didn't know why Keesh's Trilo was uneven amounts, he only thought it came in even amounts and I couldn't answer that because I don't know where his previous vet got her meds from. He is an older vet and I thought he'd have quite a bit of experience, however he said he needed to see Keesh's charts from the previous vet before he'd recommend anything. I guess that's fair but the other thing I asked about was quality food, he hands me a bag from his supply and the first thing on it was corn. " Not impressed"
He took a blood sample and I should have his electrolytes result sometime today. Keesh did have a good day but last night and the previous he peed in the night. He is out 4 times during the night but no appetite and this peeing plus increased thirst again has started. I tried chicken, beef and even bacon yesterday, no go, but I did get 3 weiners into him in the morning and a grilled cheese in the afternoon. Not a good diet but something is better then nothing.
The vet at the college has 11 months left before he gets his degree, however they take the dog and see an IMS specialist together then the student brings him back with their findings. I am going to call him on Monday, tell him what is going on and ask him what is next. Funny though when he did call on Wednesday with the urine results, I told him how good Keesh was doing and that I had my dog back. That didn't last long.
Everyday seems to be a new adventure. I let him out this morning and noticed he isn't walking as well as yesterday, and he now has completely given up going up the staircase to visit Mommy in her office and has for the last couple of days. Yet yesterday on the way to the new vet he got up on the seat again and stuck his head out the window and I let him only because it's been months since he was able to do that and we were just going through town. This walking thing comes and goes.
I'll post later when I have his electrolyte results.

There is one other vet in town and I'm going to call them today as well and see if they have experience in Cushings. I am limited as every town around here is small including my town. The other alternative is Barrie, which is just as far as Orangeville.

goldengirl88

07-27-2013, 08:26 AM

I understand your dilemma with the lack of vets in a small town. That is my problem also. The way I corrected the deficiency in my Vet's knowledge was to come here first and ask questions, research all the issues, and come back here and get opinions. That is how I deal with my vet. He knows nothing about Cushings. To save my girls life I do whatever is necessary to get the information for the problem she is having. I then instruct the vet as to what needs to be done. I also make him call Dechra and involve them so absolutely nothing goes wrong.You may have to result to the same method. If so, you are going to have to speak up, and tell the vet what they need to do. It is scary, but this has saved my Tipper from several mishaps my vet would have made so far. Will Keesh eat baby food? I know you are giving him anything to get something into him, try if possible to go low fat so you don't have a flare up of pancreatitis. My vet wanted to put Tipper on his food too, the first ingredient was corn also. Forget that so I just ignored him and kept with my regular food. Make a list of what you are going to ask the student to find out for you. Then when they get back to you write down the answers. We all tend to forget things because there is so much going on with this disease. That way you don't have to try and remember. I am praying for Keesh to pull thru all this and move forward feeling and eating better. Hang in there it will get better. Blessings
Patti

spdd

07-27-2013, 04:49 PM

Electrolytes came back normal. His appetite is just not there. He is ok though for now. I have an appt. with the 3rd vet office tomorrow as they said they are all experienced with Cushings. I am not taking the dog, going to talk to them and feel them out.

2nd vet that did electrolyte test said to me that he rec'd all reports from the college and from 1st vet. He says now that the college said it was ok to split the Trilo dose, yet the college told me not to.

He also said something about his kidneys that's why the college recommended no more Metacam, and that's the first I've heard anything about his kidneys. I find it difficult to understand the 2nd vet over the phone due to his heavy accent. I knew it was a gray area re Metacam and kidneys, but didn't know that Keesh had issues, and to tell you the truth with the accent, not really sure if he does.

My mind is completely boggled at this point and every day I wake up wondering if Keesh is ever going to be himself again. His drinking and peeing continues with hardly any appetite. We are worse off now then when we started this. At least he'd eat before.

scoora

07-27-2013, 08:50 PM

I know what it's like to have a completely boggled mind. My Scoop's eating was so strange. I hope Keesh's eating gets better.
Hugs

goldengirl88

07-28-2013, 08:44 AM

Please don't give up hope yet. maybe the third vet will turn this all around. Very good idea going to see the vet first and feel him out. You just need the right person that knows what they are doing, and get them in contact with Dechra and get them involved in Keesh's case. You need all the help you can get to straighten him out before he wears out from all this. Keep positive, it is going to be ok, just get a good Dr. and it will all fall into place hopefully. I am praying for you and hoping Keesh gets on the right track. Blessings
Patti

molly muffin

07-28-2013, 09:30 AM

Good morning, this is one reason it is very important to get your own copies of all the lab results. Renal issues can have the same symptoms as cushings too, so it's something that has to be looked into if any of the lab values are off. Do you have copies of those? If so you can post the abnormal results and we can all give you our input. Any urinalysis results?

hugs,
Sharlene and Molly Muffin

molly muffin

07-28-2013, 10:00 AM

Okay, I had a complete brain cramp, you have posted all the blood work. Do you have a copy of latest urinalysis? I see the BUN (urea) went up into just out of normal range on the 07/08/2013 result.

There was mention of a possible infection urinary, when you first posted here, that was not treated, but then Guelph testing confirmed no UTI at this time. However, one of the vets, the second one that has all the first ones records? mentioned kidney and I think that might have been because of the BUN, or perhaps he has some urinalysis results that you don't have copies of?

What I am wondering is if the BUN value has gone up. The next thing I would wonder about is the creatine, and protein in the urine.
Renal issues (urea is connected to the liver, the liver converts protein to urea) I would think could cause a liver to become enlarge and the adrenal glands to remain normal, as Keesh's is.

Now comes the real question of whether or not the BUN value went up because of the food problems (very possible) or is the BUN the main issue, causing the food issues (also possible).
So I guess in essence, what you want to know is what came first, the cart or the horse.

Has a Urine-Protein Creatinine Ration ever been done? If not, it might be good to have that done, just to check out the kidney function. I think this needs to be ruled out as a possible issue.

Hugs,
Sharlene and Molly Muffin

spdd

07-28-2013, 10:59 AM

The last urinalysis was done by the college and I don't have that report, however can get it on Monday when Keesh goes for laser. I'll mention what you have just said today when interviewing the 3rd vet. Thanks for posting that just in time for me to ask. My appt is in 1 1/2 hrs.

spdd

07-28-2013, 03:50 PM

So vet # 3 doesn't even use Trilostane in their practice.... go figure. Not sure what to do now other then call OVC and maybe get some direction, plus I think they owe me a free urine test.

Sharlene, a cortisol creatinine ratio test was done and it came back as 22x10 which I'm told is the first indicator of cushings as normal dogs are 10x10.

Vet today won't do anything until she sees all reports. Wouldn't discuss any issues re BUN value etc.

frijole

07-28-2013, 04:08 PM

I understand you aren't interested in switching drugs but I thought you were not convinced your babe has cushings. Why not try the new guy out to get his opinion on that because if Keesh doesn't have cushings it doesn't matter what drug the vet uses.

I understand if you just don't want to waste time but... to me if the vet uses lysodren instead it means it is an older vet and I would ASSume (I know careful right) would have more experience treating cushings.

Hang in there. Kim

PS OOps... I just remembered you WENT THERE today. So what did he say when you went over Keesh's history? Did you learn anything at all?

spdd

07-28-2013, 06:18 PM

I went to 3rd vet today. They are the ones that don't use Trilostane. No opinion from them, they want all of Keesh's reports first which I said ok to. 1st vet is going to think I'm nuts as they are the ones with all the data and they just sent all of it to 2nd vet yesterday . I don't want to use Lysodren, his adrenal glands are normal and I'd like to keep them that way at least until I can get to the bottom of this.
I have learned from all of this that 3 different vets have different opinions. Not in the diagnosis, but in the comments they have made. i.e. today I said the college wanted me to reduce 100mg to 75mg of Tramadol. Vet today said 100 mg is a very low dose, so my first thought would be why would I reduce the dose? (even though he rarely gets it, but probably will now that I've stopped Metacam). Sometimes I think I'm second guessing their opinions, but I'll know more when I hear from the 3rd vet after they have gone over his results. I do know that if I don't start taking at least one of their advice, they will probably all drop me. I will see what the college says tomorrow.
As for Keesh, he had a great day, ate supper (not hand fed) and actually showed signs of hunger. I did have him out quite a bit today, but he's one happy boy tonight. I can sleep easy at least for tonight.

Hope everyone had a good weekend, and ready to start a new week.

frijole

07-28-2013, 06:23 PM

:D Please know i was not suggesting a drug change... right now I think nothing is the answer.. as you say until you can get to the bottom of everything. Did you bring your write up for him? Did he even look at it? How disappointing if he didn't. He needs to understand you have been through the royal ringer and don't need to do a bunch of the same tests over again... Kim

molly muffin

07-28-2013, 06:27 PM

I saw that about the UC:CR urine cortisol test, I'm talking about protein creatinine ratio which is specific to kidney issues. Just as the urine cortisol creatinine is specific to how much cortisol is in the urine.

A few of our members have to watch kidney protein levels and this is a good test to let you know if something is going on there.

Here is how I would summarize this, short version :) Testing, ACTH, UC:CR possibly consistent with cushings, enlarged liver, no enlargement on adrenal glands, give Trilostane. Every time, you give trilostane (vetoryl) Keesh reacts badly, stops eating, often can't get up with back legs, panting, weak. Stop trilostane, gets better, start again, goes back to worse.
Either, there is no cushings and so the medication is having a bad effect on a dog without cushings, something else is going on in addition to cushings, or Keesh can't tolerate and has a high sensitivity to trilostane.

That is what the vets all need to be taking into consideration.

not sure if that helps or not, hope so
hugs,
Sharlene and Molly Muffin

spdd

07-29-2013, 06:08 AM

I'll find out if that protein creatinine ratio was ever done. Thanks so much.

spdd

07-29-2013, 11:13 AM

No one can find anything in regard to protein creatinine ratio in any of the reports, so I assume it wasn't done.

Took Keesh for laser therapy this a.m. and no reports as to the x-ray I paid for re knee problems. Only a comparison from a year ago re hips and spine which we already knew were fine. Wonder if that is why vet #1 didn't want to take another x-ray last week that I asked for to compare?

Laser not done, don't know what knee to start with, if in fact now it's his knees at all.

No prednisone given to me as vet #2 where I was at, needs to read more of his chart to tell me dosage and strength. Left there in tears.

Now I'm told I should go to Toronto Academy of Veterinary Medicine by vet # 2 as I'm getting pieces of information that contradict each other, which is understandable but not acceptable.

If vet # 2 can find anything in charts in regard to knee issues from x-rays we will start laser tomorrow and get prednisone.

We are now in month # 3 and no better off still then when we started.

goldengirl88

07-29-2013, 12:01 PM

You can do it dear. Get them to pull all this information together and tell them to stop lollygagging around before something happens to your precious Keesh. Get all the reports, see if you can get the urine test done correctly for protein. Just call them and tell them enough excuses you are coming for the reports and want them ready to pick up. it will work out. Just try to move on this quickly as I know Keesh's eating situation. You need one reliable Cushings knowledgeable person to work with, and to give all the reports to. I know you feel overwhelmed, so take one step at a time, but get them all done quickly to get Keesh some help. It will all come together once you get the reports and a good vet or hospital. We are all here to help you, as God knows I sure needed it when I started this journey. Get on the vets and don't accept any excuses from them. I am praying for you and Keesh. Blessings
Patti

labblab

07-29-2013, 12:38 PM

Gosh, I'm sorry you guys are having such a hard time! Just wanted to note, though, that a urine protein creatinine ratio (UPC) is not a test that is typically performed unless there are specific abnormalities in the blood or urinalysis (most specifically, abnormal protein level noted in the urine) that seem to warrant further diagnostics. So that test will not be included in a general urinalysis, and it is not surprising if Keesh hasn't had it done if the only kidney abnormality that he has exibited in any of this labwork was that mildly elevated "Urea" reading from the blood draw.

BUN (Blood Urea Nitrogen, also sometimes just called Urea) is also commonly used to diagnose kidney problems, although it is not kidney specific, and values may be elevated for other reasons, particularly if you did not fast your dog for 12 hours before the test was done. If BUN is slightly above normal but creatinine is in the normal range, the odds are that the kidneys are fine, especially if the urinalysis is also OK (normal urine specific gravity and no significant amount of protein in the urine).
◦Values in the high 20's, up to even the mid 30's (around 12.5 mmol/L) if the dog was not fasted, are not a concern if other values (creatinine, urine specific gravity, protein in the urine) are normal. Dehydration and stress can also contribute to elevated BUN.

You certainly can still ask the vet about Keesh's kidney status, but I just didn't want you to think that somebody has necessarily dropped the ball if that test hasn't been performed. Hopefully it just means that all his other kidney-related labwork was normal. It would be so good if you can get copies of all those lab results yourself, though. Usually the lab sheet giving urinalysis results will specifically suggest that a UPC be performed if it seems warranted by the numbers.

Marianne

spdd

07-29-2013, 02:51 PM

Just got off the phone with the vet college. They did a routine protein check on his urine and found nothing so they said it wasn't warranted to go further.
The vet he saw there said he didn't need to see him, he's convinced it's pituitary cushings. He is still adamant he shouldn't be on Metacam, but if it's makes his quality of life better why not.
As of right now I am in limbo, 2nd vet doesn't want to work with him and 3rd vet doesn't use Trilostane, so I don't even know where I'm supposed to go at this point.
As far as getting all test results, seems vet # 1 doesn't want to release everything or hasn't so far. Think a trip to their office is warranted with guns blazing.
So tired of this.. but I'll keep on, keeping on.

goldengirl88

07-29-2013, 06:14 PM

That vet cannot keep Keesh's records from you. You go girl with the guns blazing and tell him you want them pronto. How ridiculous is he, and you have been going there since Keesh was a puppy. I would look into the side effects of Metacam. I have no knowledge of it. Maybe others on here can speak to why they want Keesh off of it. Has keesh had all the testing done for Cushings? I don't remember at this point? If not I am shocked the vet at the college would want him treated if they have nothing to go on? Keep going you are doing good. Get these dead weights moving!! Blessings
Patti

molly muffin

07-29-2013, 06:48 PM

Marianne is right, if they checked for protein in the urine and there isn't any, then then elevated Urea, doesn't mean anything bad. In that case, you don't Need the UC:CR

Check off so far,
Not Renal
Not Thyroid
Not Diabetes.
No elevated Lipase, so probably not pancreatic.

That really does leave cushings as a culprit most likely, but maybe early culprit.
What do the vets think about Keesh's not eating and reaction to the trilostane.

Sending you lots of hugs. And see, we are making progress, in that some things have been ruled out and those are important things.

Maybe split dose, of 30/30 ? for trilostane? see if that works better for Keesh? Is the current dosage at 58? I assume the vet is getting this compounded from somewhere? Do you go pick it up at the vets office?

Hang in there,
Sharlene and Molly Muffin

frijole

07-29-2013, 07:08 PM

OK... am hoping I can finally add value to your thread! :) I remember my vet giving Haley Metacam and others telling me not to give it. I simply didn't remember why. And I know some cush dogs have used it.

I just did a search on the forum (by the way - it is very helpful feature) and it is never to be given when cushings is not controlled! OK so if Keesh does have cushings we know it isn't under control because you have the symptoms. Here is what Glynda posted about her own dog to someone else:

Jojo's internal medicine specialist, under no circumstances, would prescribe Metacam until an acth stimulation tests showed that his cortisol was where it needed to be. It is not only the adverse impact on the liver and kidneys that are concerning, the stomach ulcerations/perforations resulting in internal bleeding scares the stuffing out of me. Warnings on the label are very clear that NSAID should not be used in conjunction with corticosteroid hormones because the potential risk for side effects is increased.

I wonder what would happen if you ceased giving the metacam? Kim

spdd

07-30-2013, 05:40 AM

Here is my confusion with Metacam. Keesh started it about a yr. ago prior to Cushings diagnosis. He started to vomit occassionaly after awhile and I figured it was the Metacam but he was on a high dose so I decreased it and gave it to him about every 3rd day. Vet # 1 said that with Cushings undiagnosed and taking Metacam that the combination of the 2 would probably make him sick. She said this after the Cushings diagnosis. The vet college told me yesterday that you don't want to give Metacam to a cushings dog due to irregular steroid values as Metacam can alter it. Now I'm totally confused. I thought Metacam was a NON STEROID anti inflammatory so how can it affect his steroid level? I gave Keesh Metacam yesterday and he climbed the stairs now 3 times today yet wouldn't the last 2 days when I didn't give it to him. I also know that Metacam can affect their kidneys and his are fine right now, so that is a concern. Some are affected, others aren't but I'm thinking quality of life here.
None of the 3 vets nor college have given me any advice re Keesh not eating - however he's really selective and at this point I'm not sure if he's playing games with me or not. He'll eat people food, but put something in his dish and he walks away. I still think that could be a battle of the wills, but not sure. That is one of the most frustrating things I am going through.
His current dose of Trilostane is 65 mg down from 68. He has been on this dose now for 1 1/2 weeks and is due his ACTH test. It was booked for this Friday, but the vet college didn't advise it so soon. He said maybe give it another week. I do or did pick up his Trilostane at the vets office but not sure where I can get it now.
I never heard from vet #3 re getting his records, they are the ones that don't use Trilostane, so I'm hoping I hear something today.
I used to take a vets word as the gospel, but certainly don't anymore after this journey I've been on. Peace of mind doesn't seem to exist. I've looked up Cushings Specialists and IMS specialists in this area and nothing. I was considering taking Keesh back to the vet college for regular check ups, but his IMS vet is being tranferred this week to emergency services, so I'd have to start all over again with someone new and who knows how long they'd be around. Guess it's a drawback from a teaching facility.
So in summary

- vet # 1 is upset as we conferred with not only the college but 2 other vets and she was way too willing to put Keesh down last Thursday

- vet # 2 doesn't want to treat Keesh as he hasn't got enough experience with Cushings, doesn't know dosage, hasn't read Keesh's charts, and I'm just not comfortable with him. An incident happened at his office yesterday, not with Keesh, and I thought it was appalling. I'll save that for another post. It made me physically sick. He also suggested another clinic to take Keesh too. Wouldn't give me prednisone until looking further into his history.

-vet # 3 - they don't use Trilostane and I haven't heard from them re getting records . When I phoned for appt. to discuss Keesh, they said they were highly experienced with Cushings. I didn't see that when I got there at all.

On another note though. I did read some of Keesh's history records from vet # 1-the one that wanted to put him down. A side note she made about me personally was that she didn't think I was telling everything to them about Keesh. That made me a little angry. Why wouldn't I tell them everything about him? Does she think I'm in denial? I didn't get a chance to read further, but I certainly plan on it.

labblab

07-30-2013, 07:36 AM

I remain so sorry that you are receiving so much contradictory and unsatisfying guidance! It is truly a dilemma as to which vet to turn to for oversight. As inconvenient as it may be, perhaps returning to the vet college is the best of several less than stellar options...:o

As far as the metacam, here's a pretty detailed article I found that may help make more sense as to the warnings about combining NSAIDS with steroids (such as higher levels of circulating cortisol). I can't speak to the specialist's comment about any actual effect upon the cortisol itself, unless he meant that the thought the metacam might affect the proper metabolism of trilostane due to possible gastric absorption issues. But it's the potential for gastric distress/disease with which I'm most familiar. Here are a couple of quotes from the article I'm going to give you.

It is very difficult to predict which corticosteroid/NSAID combinations(drug formulation, dose, dosing frequency, treatment duration) will result in adverse effects in any individual patient.Therefore, concurrent therapy should only be done when medically necessary and with close and careful patient monitoring...

Treatment of GI toxicity is intensive and mainly symptomatic. Anorexia and/or vomiting are frequently the first indication of GI ulceration and perforation. Any dog or cat that becomes anorectic or vomits while on combination NSAID and corticosteroid therapy should be promptly evaluated by a veterinarian.

http://www.cliniciansbrief.com/sites/default/files/sites/cliniciansbrief.com/files/Complications.pdf

Absolutely you are dealing with quality of life issues right now, and you are the person who is best able to make determinations as to which risks are worth taking on Keesh's behalf. Mobility issues are indeed a concern. But the appetite issues are seemingly a primary problem right now, so I want to make sure you factor in the possibility/likelihood that the metcam use may be a contributing factor to chronic GI irritation that is affecting his desire and ability to eat and properly digest food. If you still feel the need to continue dosing him with the metacam, at least you may want to consult with the vet school about adding in a gastric-soothing drug as is discussed in this article.

Marianne

goldengirl88

07-30-2013, 08:06 AM

I guess at this point going back to the veterinary college is your only option. In a way maybe it will be good to get someone new. Maybe you can sit down with them and go over all these concerns. Make sure you ask all the questions then, so you do not have to keep relaying messages through students. I would cover all my bases if it were me. I would get the Cushings issue and dosage down, then the eating problem, and mobility problem. You need to get a referral from the vet for the cold laser therapy so you can get that started as soon as possible. I feel that will really help Keesh's back legs. I know this is overwhelming with all these vets, but that is what I would do if it were me. Hang in there it is going to get better, but again you need to move on it. I am concerned after reading the other posts about the Metacam. Please heed the good advice given on it as it sounds as if it can cause big problems which you don't need. Try to get the earliest appointment possible at the vet school. Maybe you could ask when you call about the most experienced Dr. with Cushings there, and ask to have an appointment with them. I know sometimes at these schools you can get the teaching professor, as I have done that in the past with another animal years ago. I am so sorry you are in this predicament, but keep going for Keesh's sake and get some resolution to help him. Blessings
Patti

scoora

07-30-2013, 08:34 AM

Can being on Metacam for like 10 days and then going off it still cause problems? My Scoop was on it last November after his ear surgery.

spdd

07-30-2013, 08:43 AM

No I don't think that amount of time will create problems. It was many months into Keesh taking Metacam before he started to vomit, and even then it was a rare occasion. Still don't know if it was the onset of Cushings and Metacam combined or just Metacam. He has now been on and off it at a low dose for a few weeks. He seems to be fine. Sometimes he goes 2 days without it. On the syringe I only go to 20 which is a low dose for his weight.

The only organs that are not normal in Keesh is his liver. It is enlarged with rounded edges, which could be the result from using Metacam.

Squirt's Mom

07-30-2013, 09:58 AM

Be aware - the kidneys do not show up on lab work as damaged until they have lost something like 75% of their function. ;)

Trixie

07-30-2013, 01:37 PM

wow..so sorry you are having such problems with all these vets and opinions and feeling like there's no one that's helping at this point.
I don't have enough knowledge to make suggestions but I hope it helps you get through all this to know we're all here pulling for you and Keesh! I hope that this all gets sorted out by a good vet who knows what's going on!
I just looked at Dr. Mark Peterson's site and I see he did a lecture a couple years ago for the Ontario Veterinary Medical Association....maybe you should contact this group and see if they can help you. Or maybe contact Dr. Peterson's office in NY or by email and possibly he can recommend someone near you who could help? Or maybe consult with him via phone or email?? Other's have done this so maybe they will chime in and say if it would be worth it.

I don't know exactly where you're located but I just was messing around with google and found a site where The Canadian Vet Journal posed ethical questions to vets. There was a question about Cushing's and a vet named Dr. Michael McNeil in Jackson's Point Ontario responded about treating with Vetoryl/Trilostane....Ontario is pretty big so this could be of no help if he's far from you...but he's from the Keswick Animal Hospital..if it's anywhere near you it could be worth a phone call to see if he has Cushing's experience.

There must be someone there who can help Keesh!

Barbara

Trixie

07-30-2013, 01:45 PM

Just in case you want to see what found here are the links...I don't mean to overstep...this may all just be nothing

here is the link where this vet answers an ethical question re Cushings disease...just scroll down a bit to question from Sept 2012. I like his answer to the question posed about Cushings--treating vs. putting down and also being compassionate about fees!! Maybe this guy is a gem and maybe he's even near you!? His answer make me think he is one of those "amazing" vets.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500113/

and here is the vet's bio/info

http://daltonroadanimalhospital.com/team/michael-mcneil/

molly muffin

07-30-2013, 06:06 PM

I think Jackson Point, Ontario would be real far from where she lives. It's out on Lake Simcoe in cottage country.
Good job looking up though!

hugs,
Sharlene and Molly Muffin

spdd

07-30-2013, 06:15 PM

Thanks... won't hurt to contact him. You guys are great.

Got call finally from vet #3 who doesn't use Trilostane. He says he's a cushings expert, then proceeded to say that Trilostane can cause sudden death sometimes so he prefers other medicine. He was willing to work with me using it, so does vet # 2. Looks like I will have to tell both of them how this works and they will need to study up on it a little more. That doesn't leave me with a lot of faith in either of them so there is no respite from the worry.

spdd

07-31-2013, 04:56 AM

spdd

07-31-2013, 05:08 AM

Call me dense, but could someone answer these questions for me?

Keesh weighs 65.8 pounds or at least did a week ago. He is on 65mg of Vetoryl once daily. Although his peeing and drinking has decreased, his appetite is still on and off, but a little better. My question is, is this dose the proper amount? I know I should make an adjustment if needed after his ACTH test which is postponed until next week, however my vet needs guidance in this area as well.
I told him that previous vet must have compounded the prescription, but he has to check where he can get this done. I don't want to screw up anything right now. Keesh is doing well so far at least since last Friday, and I am going to have to take control of this medication for him as no one around here which you know, is knowledgeable enough .

My other question is, knowing the metabolism of this drug, would he be better off splitting the dose? I'm mentally justifying that if I do this then the meds are in his sytem longer, however I don't want to rock the boat by splitting it when so far it is going ok.

All my knowledge I have taken to the vets, I have learned here and current vet is impressed, just wish he knew as much as I do, and it's all thanks to you on here. You are all saints, honestly.

labblab

07-31-2013, 07:27 AM

These are all good questions, so you are not being dense at all!

The weight of a dog is used as the determining factor regarding dosages only at the very beginning of treatment. Different specialists adhere to different protocols in that regard, but the formula of 1 mg. per pound is one that is advanced by Dechra and it is used by many clinicians. So as an initial starting dose, approx. 65 mg. as a daily total would be reasonable for Keesh.

However, once a dog starts treatment, all subsequent dosing decisions are based solely upon the results of the monitoring ACTH tests and degree of symptom resolution and, conversely (as may be true for Keesh), unwanted side effects. The drug is metabolized differently by every dog, and so you can end up with a very wide variation in optimal dosing irregardless of weight.

As to once vs. twice daily dosing, I think the jury is still out as to which should be the "standard" protocol. For diabetic dogs, twice daily dosing is generally recommended to correspond with twice daily insulin injections and to keep the endocrinological system as consistently balanced as possible throughout the day. For other dogs, individual factors again come into play depending upon how quickly the drug is metabolized. For some dogs, the drug wears off relatively quickly and symptoms rebound at night. For them, twice daily dosing is preferable. However, other dogs may end up acting oversuppressed with twice daily dosing and actually do better with only a single morning dose that then allows their cortisol to rise again somewhat later in the day.

The veterinary program at UC Davis and some specialists seem to prefer twice daily dosing from the get-go. But Dechra and some other specialists recommend that a dog be started with once daily dosing and only switched if symptoms are rebounding in the evening. From a practical standpoint, it is certainly simpler for the owner to only dose once daily, especially since each dose needs to be given with food. It is also probably cheaper since generally one capsule of any dose will be less expensive than two capsules of even a lesser dose.

As far as obtaining Keesh's trilostane, even if your vet was previously having it compounded, one option (although likely more expensive) is simply to buy brandname Vetoryl. Here in the U.S., Vetoryl can be purchased directly by owners from online pharmacies upon presentation of a valid prescription. I am guessing the same is true in Canada. If Keesh remains on the same dose, then the 60 mg. Vetoryl capsule should be close enough in dosage to what you are currently giving him. Or, if you want to switch to twice daily, you could shift to 30 mg. capsules (although that will increase your overall cost).

Given all the issues you've been having with Keesh, I don't know that a trial period on the brandname drug would be such a bad idea, anyway. It is possible that the compounder used some type of filler, etc. that has not agreed with Keesh. Shifting may not make any difference at all, but at least it would be one more variable over which you'd have a bit more control.

Hope this info makes sense, and don't hesitate to keep asking those questions!!

Marianne

Junior's Mom

07-31-2013, 08:50 AM

http://www.universalpetmeds.ca/medications/Vetoryl/60mg

Here is a pharmacy in Canada, based in Toronto. $109.97 plus gst, for 30-60mg capsules.

goldengirl88

07-31-2013, 09:18 AM

spdd

07-31-2013, 10:00 AM

Thanks guys. I checked out the med pharmacies that will ship or are in Canada

Here are the prices for 60 mg vetoryl - 30 capsules

Universal Pet Meds - 109.97

Pet Pharm - $105.99 plus dispensing fee of $9.99-have to order 3 month supply

Canada Chemists - $95.65 plus dispensing fee of $9.99

Pets Drug Mart - no pricing on site but emailed for pricing.

I do not know what the shipping is for any of these, but will ck it out.

spdd

07-31-2013, 10:10 AM

I don't know if you are able to get the US pharmacies to send you drugs? If so I buy mine at Lambert Veterinary Supplies it is much cheaper. They mail it free if I buy 2 boxes. As Marianne said with all of Keesh's issues maybe it would be advisable to use the brand name Vetoryl. The dosage is 1mg per pound per day. There is a pharmacist at Lambert's 800 number to help you. Get an RX off of the vet to purchase online, get as many refills as he will give you in case that is the correct dosage you don't have to keep going back to the vet for more refills. Lamberts phone number is 1-866-344-6337 my drug rep is Nancy she is very efficient. Let us know about the progress. Blessings and Prayers to you and Keesh
Patti

Thanks Patti... I chk'd out Lambert and they cannot ship internationally throught the website, however I contacted them via email and asked if they can ship if I fax or email the prescription. It is unlikely probably due to FDA regulations again, but it is worth a try. They are the cheapest I have found even with shipping.

goldengirl88

07-31-2013, 12:42 PM

I hope they can ship it to you. If you get two there is no shipping charge. Geez you get a hard time with everything you try to do! Keep going you are doing great. Blessings
Patti

goldengirl88

07-31-2013, 12:43 PM

Is it possible you have a relative in the US who could get the shipment and get it to you or is that not good?

spdd

07-31-2013, 02:05 PM

Geez... I do have friends in Florida, once in awhile they come up this way. She's a long haul truck driver after being a nurse for 18 yrs. Makes more money she says. I have a brother in Vermont and a nephew in the U.S. airforce stationed in California, maybe he can get a discount? ( just kidding)

A hard time with everything I try to do is literally the story of my life. I could write a book, but I'd have to put it in the fiction section, cause absolutely nobody would believe what total screw ups have happened to me since a kid. A sense of humour though I was blessed with, so that keeps me going.

Side note: both the college and vet # 3 have said to NOT give Metacam with Trilostane... so he's off Metacam as of today and on Tramadol. I can't reduce his capsules to 75mg, so have to get another prescription with the lower dose.
Vet # 2 told me to give him both but a smaller dose of Metacam!!! Sometimes you could literally pull your hair out huh????

goldengirl88

08-01-2013, 10:16 AM

You poor thing. You sound like me. All I seem to get is bad luck. You are just having a terrible time of things, but keep on keepin on. Your Keesh needs you. Are you getting things straightened out about the records etc? I hope that vet gave you Keesh's records without any problems. How is Keesh doing eating? This will all work out so don't get discouraged by some experiences with vets. Seldom do I hear of anyone on here having luck with a vet that knows what they are doing with Cushings, so you are not alone. That is why it is up to us to get the information to help our babies. You have a good support system on here, so just keep involved with the forum, and asking questions that will help your dogs journey. God Bless You and Keesh.
Patti

spdd

08-02-2013, 04:26 AM

I don't know if you are able to get the US pharmacies to send you drugs? If so I buy mine at Lambert Veterinary Supplies it is much cheaper. They mail it free if I buy 2 boxes. As Marianne said with all of Keesh's issues maybe it would be advisable to use the brand name Vetoryl. The dosage is 1mg per pound per day. There is a pharmacist at Lambert's 800 number to help you. Get an RX off of the vet to purchase online, get as many refills as he will give you in case that is the correct dosage you don't have to keep going back to the vet for more refills. Lamberts phone number is 1-866-344-6337 my drug rep is Nancy she is very efficient. Let us know about the progress. Blessings and Prayers to you and Keesh
Patti

Pricing from Lambert is $180.00 U.S. funds for 60 capsules at 65 mg including shipping. Duty and taxes are extra. I have to find out the rate of duty on this and I assume taxes are 13%.

Keesh's eating is still an issue. He is eating, but completely off his schedule. Not hungry at all in the morning and sometime around noon will consider food. He's active and happy though, had his 2nd laser treatement which seems to be working. For the first time in ages, he's lifted his leg to pee, normally it's a squat.

labblab

08-02-2013, 06:59 AM

If that price quote is for 65 mg. compounded trilostane rather than 60 mg. brandname Vetoryl, I think that sounds awfully expensive. If you want to stick with compounded drug, you may want to try to get a quote from Diamondback Drugs in Arizona. Many of our members use them for compounded trilo, and I'd be curious to see whether their pricing will be less. I'm guessing it will be.

Marianne

goldengirl88

08-02-2013, 07:54 AM

I just looked at Lambert as I thought the price you gave was high it is 65.95 for 30 capsules of 60mg. Are you doubling the dose to get that $ amount? I am sorry you are continuing to have such a hard time. How is Keesh eating? When is his ACTH scheduled? BLessings
Patti

goldengirl88

08-02-2013, 07:55 AM

What is Keesh eating now? I am so glad to hear that the Laser therapy is helping him. Did it make him tired? Blessings
Patti

goldengirl88

08-03-2013, 09:29 AM

What is going on with Keesh? I was just wondering how he is doing and if he is eating any better? I hope you both have a good and quiet weekend. Blessings
Patti

spdd

08-03-2013, 09:33 AM

Here is a copy of the email Lambert sent me.
"It would be around $180.00 Us dollars for 60 capsules, with shipping and handling, this doesn’t include the taxes and duties, those will be collected when the order is delivered."
This was sent by Shannon Snider of Lambert and it is a 65 mg dose.

His ACTH test is scheduled for sometime next week, but when a vet asks you what another vet charged for the same test... I really get a little worried.

I am at my wits end with Keesh. He won't eat and the odd time I have to scoop the food up and feed him by hand. I've cooked everything for this dog and nothing is working. He seems fine, still climbing stairs but how are you supposed to give him his Tramadol and Trilostane unless he eats. I have now only put kibble in his dish and it's definitely a standoff between him and me. I hope it's ok to NOT give him his Trilostane this morning, cause I don't want to risk anything nor for that matter waste a pill. He ate some chicken last nite... hand fed of course. Gotta get something into him, but it's past the point of ridiculous.

Needless to say I am in a completely foul mood as this has been going on and off for awhile. I hate to admit it, but I'm losing my patience with this food thing.

He has had two laser treatments with another 2 scheduled for next week. He is completely off his Metacam and there doesn't seem to be any real significant improvement, but at this point the dog is completely baffling me. He jumped into the van on his own and got from the back to the front seat on his own when I ran into a convenient store, so who knows? Other times he needs help... just can't figure him out.

frijole

08-03-2013, 10:11 AM

My heart goes out to you. I'd skip the trilostane too because you don't give it to a dog that isn't eating. Frequent urination is less important than getting him to eat so what the heck. Kim

Squirt's Mom

08-03-2013, 10:37 AM

This could be tough for a few days but if I were you, I would stop the Cushing's med for now and concentrate on getting his eating back up to par.

Since he seems to be feeling well, not as if he is suffering from malnutrition, I would try this. To start with, no more treats or human food - none. Put his normal food in his bowl, leave it for 30 minutes, then pick it up. If he hasn't eaten it all, or even any of it, pick it up anyway. Do not offer anything else to eat until the next meal time. Then offer his normal feed in the normal amount. Leave it for 30 minutes, then pick it up, whether he has eaten it all or not - pick it up after 30 minutes and do not offer anything else to eat until the next meal time. Keep doing this for a few days. If this is a behavioral thing or if he has developed the preference for variety, this feeding method should get him back on course. We remove all other temptations other than the feed they are supposed to eat and offer that for a short period of time until they are back to eating normally. You must be strong and not give in to those pleading eyes. ;)

If this fails, I would ask the vet for an appetite stimulant. But I would not even try to give the Trilo if his appetite is off.

spdd

08-03-2013, 10:56 AM

My biggest concern was not giving the Trilo... but you've answered that question for me, so I feel a little better.
I'll do the feed method you suggested and see where that goes. Thanks

Harley PoMMom

08-03-2013, 01:32 PM

Has Keesh's not eating issue just started out of the blue or has this been a concurrent problem? If this just started I am wondering if something is going on in Keesh's mouth such as a bad tooth. Maybe trying baby food or putting the food in a food processor/blender and making like a puree would help???

goldengirl88

08-03-2013, 01:57 PM

Try not to get too frustrated with the eating thing as he will sense it. I agree with the Leslie method, as it could be behavioral. These dogs are going thru so much with their bodies from this disease that is probably why you are seeing so many different things Keesh is doing. You will notice him walking better in a while from the laser treatments. I truly hope he eats. I know you said you were in a lousy mood because of his eating, but just remember there are others on here that are not as lucky, and have lost their dogs. I don't care whatever Tipper does, it does not matter to me as long as I see her sweet face, I don't care about anything else. Keesh loves and needs you now, he is not trying to do this on purpose, his whole world has changed, and he is probably upset with all this too. It will work out, just keep going. Blessings
Patti