Roxy, Miniature Schnauzer (SARDS, Diabetes, Cushings) (Trilostane to Lysodren)

[jk9cuts]

Hi all,

I am new here and just wanted to introduce myself and my furbaby Roxy.
Roxy went blind from SARDS in August.2008. In March 2009 she started drinking alot and messing in the house, also losing weight (3 lbs. from January). She was diagnosed with diabetes on March 25, 2009 started Vetsulin. In April I had her tested for Cushings. The test was positive. She was started on 30mg Trilostane once a day. On May 11, she was changed to Humilin N insulin. Her bg have been high..her lowest reading has been 362. Tuesday I took her back to the vet and requested another stim test for her. He wanted to up the Trilostane, which he admited to me he knows nothing about without doing another Stim test. He felt ithe stim was not necessary
The vet also increased her insulin from 5u to 7u bid. This has helped bring her bg's to the 100 range.
I took Roxy to a different vet on Friday, I had a gut feeling and needed a second opinion. The new vet did a ACTH test on Roxy and her levels were not near where they should have been after 37 days on Trilostane. Sorry I forgot to ask for the results.
Anyway it was either up the Trilostane from 30mg and have it compounded to the right dose ($$$) or switch Roxy to Lysodren and start loading her at 250mg twice a day and do another Acth test on Wednesday or Thursday. The new vet has NO experience with Trilostane, as did Roxy's normal vet. Didn't find this out till he admitted it to me on Tuesday. After weighing my options I decided to start loading Roxy with Lysodren. We started loading on Saturday and I am happy to report .......no ill effects so far.

During the course of Roxy's examine the new vet found bladder stones along with Roxy's bad teeth. I knew about her teeth but BLADDER STONES!!! The old vet totally missed those. Once we get Roxy healthy enough she will need surgery to get rid of the bladder stones and clean and pull her bad teeth.

The new dose of 7u Humilan N BID is doing a great job in keeping her bg in the 100 range. I am suppose to do a curve before I take Roxy for her repeat ACTH test. We may have to drop the dose once we get the cushings under control.

The new vet wants Roxy on the science diet W/D food. I just don't like this food and have decided to switch Roxy to Canidae Platinum or something like W/D but better quality. Lower protein for the bladder stones, but still a quaility food.

Any thoughts or advice would be appreciated.


Judy and Roxy (PA, USA)

Roxy, canine, Miniature Schnauzer,Birth date 11-14-99, 9 y/o, F (spayed),
weight 14.4, Sudden Acquired Retinal Degeneration Syndrome (SARDS dx 8/08),
Diabetes Mellitus dx
3/25/09, Humilin N 7 U twice a day
Cushing's syndrome (dx with ACTH stim test on 4/21/09,
Trilostane 30 mg started 4-23-09 once a day, Started loading Lysodren 250 mg Bid
on 5-30-09
diet/nutrition: Canidae Platnium
The other girls that rule the house:
Misty, Beagle, 8-18-95 13 y/o F (spayed)
Jenna, Miniature Schnauzer, 10-23-02, 6 y/o F (spayed)
Baylee, Miniature Schnauzer, 5-9-05 4 y/o F (spayed)

[Squirt's Mom]

Hi Judy and welcome to you and Roxy! :)

Honey, my heart just stopped when reading your post about switching from Trilo to Lyso....from what you said there was no wash-out period between the two drugs? This can be VERY dangerous! :eek: Please, please keep a close eye on Roxy. The two in the system at the same time can cause a crash, an Addisonian crisis, as well as other problems, if my memory serves me.

Is this correct, that there was no time with nothing between the two?

I've got something to take care of right now but will be back to talk more later. Just HAD to know if there was a wash-out or not!

Glad you found us!
Hugs,
Leslie and the girls

PS. All the info in your signature is interesting and we would love to hear about all your babies, but this isn't necessary on our site. We keep all yours and Roxy's info on one thread so we can always look back and get any past important info. Just an FYI that will save your fingers some pounding on the keys!

[Rusty's Mom]

Welcome and holy smokes!

I know it must be so frustrating to be dealing with vets who know nothing of the drugs they are prescribing. Considering the diabetes, etc., you might want to shop around for an IM vet. You are spending good money, and it sounds as though you are willing to step up treatment and the costs thereof. Therefore, you might as well get the best for your money. The chances of finding one who treats Cushpups is greater than with the GP, in my humble opinion.

You will receive great pointers from the very experience-educated ones on this site.

You're in my thoughts. I'm Hoping Roxy is doing better.

MJ

[jk9cuts]

No just switched from one to the other.

[frijole]

Hi Judy

Chiming in with the others... I have always read that you need to wait 30 days before starting the next drug to make sure it is all out of the system. I will see if I can find a link for you but in the meantime I would be phoning the vet and asking about it. Make sure he researches it before giving you a "yes".

Meanwhile I would be inclined to hold off on the lysodren. Sorry to hit you with this but I just wanted you to know it isn't one person's opinion.

Also could you please tell us your dog's weight? I want to check the dosage amount just to be safe.

Thanks
Kim

[frijole]

I found it! This is from Dr. Jack Oliver who is very knowledgeable regarding cushings. He is a specialist at the University of Tenn Knoxville. Google his name and you'll see what I mean. I am putting the link below but here is his quote regarding switching from trilostane to lysodren.


Trilostane. Now available in the U.S. as VetorylTM from Dechra Veterinay Products. NOTE:
Trilostane always increases 17-hydroxyprogesterone (some cross-reactivity with pregnenolones in
assays??), and frequently increases estradiol and androstenedione as well. LysodrenTM may be
preferred for Atypical Cushing’s cases. FURTHER NOTE: Care should be used in switching from
trilostane to LysodrenTM. Allow adequate time for either drug’s effects on the adrenals to subside
before switching treatments. (E.g., one month off drug or normal post-ACTH stim cortisol levels).
http://www.vet.utk.edu/diagnostic/endocrinology/pdf/Steroid%20Profiles%20for%20Diagnosis%20of%20Atypic al%20Cushing's.pdf


It appears to me that this vet isn't familiar with this and so please feel free to quote Dr. Oliver. Find out what the results of the last ACTH was. You shouldn't restart lysodren until the 2nd number is a normal reading (above 22). The system needs to be clear of the drug before starting the next.

I am so glad you found us!!!!

Kim

[Roxee's Dad]

Hi Judy,
Another welcome from one Roxy parent to another:D. And from one fur parent of four pups to another, :D.

The others here have given you some really good advice about washing out the Trilo before starting loading with Lyso. When you get a chance, please post which test were given to diagnose cushings. There really is no one test that can positively diagnose cushings. Please also post Roxy's test results and ranges. (only the abnormal values)

If you don't have the test's and the results, ask your vet or receptionist to give you a copy. Mine usually know to fax them to me before the vet even call me to discuss. They will be happy to give them to you.

One of the best testing is the UTK adrenal panel, we can talk about this later. There are some really good experienced people here that can help you sort thru this once they see the test that were performed and the test results.

It is really important to confirm a cushings diagnosis before starting treatment. Treatment on a non cush pup can be very harmfull.

Looking forward to hearing more about Roxy.

[frijole]

Hi Judy

It is me again... I reread your thread saw where you said Roxy is 14.4 pounds. The dosage amount is between 25 and 50 mgs per kg of weight. Convert her lb to kg and she is 6.53 kgs. Multiply that times the MAXIMUM recommended dose and it is 327. You indicated you are giving 500 mgs daily (2 x 250) PLEASE STOP GIVING LYSODREN IMMEDIATELY.

Did the vet give you prednisone to give in an emergency? If not, call them and get some because even if you cease giving it the drug continues to work up to 48 hrs. You will KNOW if Roxy needs it. When dogs cortisol goes too low they oftentimes cannot get up and look near death. Give the prednisone and it mimics the missing cortisol and makes the dog perkier/more normal.

I have 2 schnauzers myself. Poor Roxy seems to have gotten about every ailment a schnauzer is prone to get. :(

My Haley is now 15 1/2 and has been using lysodren to treat her cushings for 3 yrs. The people here saved her life I have no doubt. My vet was inexperienced and I had to find a new one... I was wondering if you live in a metro area where there might be an internal med specialist vet. Here is a link to check out:

http://www.k9cushings.com/forum/showthread.php?t=182

Haley also had bladder stones. If they didn't do a sonogram I wouldn't have surgery because there is medication that can be given to dissolve them - depending on the size and location. When Haley got them she had blood in her urine. Have you noticed that? I used that awful food for too long and I agree - your choice is much better.

I am wondering with all the things going on with Roxy that it might be time to see a specialist that has a little more training and can treat multiple diseases. Giving someone chemo drugs without following protocol makes me very nervous. Heck maybe she doesn't have stones? ;)

You obviously are a fantastic mom having been thru SARDS and diabetes. I think someone mentioned that diabetes can give false positive results on some cushings tests.... so again, someone who is seasoned might take some pressure off of you.

Sorry to be the bearer of bad news but it appears there was a mixup with the dosage. Please let us know that all is OK. We are worry warts and care very much.

Hugs
Kim

[Squirt's Mom]

Hi again,

I'm back...I have found myself in much the same situation we are concerned about with Roxy. :eek: Last week I was given some new meds and am confused about what to do with the old ones....keep on taking them, too?... stop and just use the new? I am postitive my doc explained this very carefully to me, but my memory SUCKS and I didn't write anything down. :rolleyes: AND it's Sunday, of course! geez.... But enough about a feeble-minded, loud-mouthed old broad. :p

This isn't our typical welcoming approach for new family members...jumping in and giving you something to worry about as if you didn't have enough already! :o It's just that like Kim said, we are real worry warts and we immediately love every baby we meet here. As a result, we try to treat each one as if it were our own....panic attacks and all! :eek::p:D

Ok...let's look at this a bit closer; I am going to try to reply to your first post in pink...don't hold your breath, tho :D



Hi all,

I am new here and just wanted to introduce myself and my furbaby Roxy.
Roxy went blind from SARDS in August.2008.

There is some evidence of a connection between SARDS and Cushing's. In the Resources section you will find some info on that. Glynda has more to share on this connection, too, I'm sure. It is something she has done some research on in the past.

In March 2009 she started drinking alot and messing in the house, also losing weight (3 lbs. from January). She was diagnosed with diabetes on March 25, 2009 started Vetsulin.

We don't deal with diabetes at our house but several here do and I'm sure they will be along to share their experiences soon. Our sister site, K9diabetes.com is a great place to learn and find support for dealing with diabetes. The link to this site is: http://k9diabetes.com/forum. Another link for you about both conditions is:

Canine Hyperadrenocorticism, Diabetes Mellitus, or Both?
http://www.vet.uga.edu/vpp/clerk/Zwicker/


In April I had her tested for Cushings. The test was positive.

If you don't mind, it would really help if you could tell us what test(s) Roxy has had and the actual results along with the units of measurement (ug/dl, mnol/L, etc) and normal ranges. We aren't vets, but we have seen literally 100's if not 1000's of these results and we can help you understand what they mean for Roxy.

She was started on 30mg Trilostane once a day. On May 11, she was changed to Humilin N insulin. Her bg have been high..her lowest reading has been 362. Tuesday I took her back to the vet and requested another stim test for her.

Good girl!!

He wanted to up the Trilostane, which he admited to me he knows nothing about without doing another Stim test. He felt ithe stim was not necessary.

I take it from the info below that the Trilo was not increased at this time? What did he base the need for an increase on? Were her signs not controlled?

The vet also increased her insulin from 5u to 7u bid. This has helped bring her bg's to the 100 range.
I took Roxy to a different vet on Friday, I had a gut feeling and needed a second opinion.

Those gut feelings can be lifesavers! No one knows Roxy as well as you!

The new vet did a ACTH test on Roxy and her levels were not near where they should have been after 37 days on Trilostane.

Ok...so Roxy was on Trilo for 37 days as of 5/30/09, right? Then the same day she started 500mg/day of Lyso? Did she have both meds on the same day?

Sorry I forgot to ask for the results.

Many of us never thought to get copies prior to our babies being diagnosed with Cushing's. But there are several good reasons to keep a file at home... if you ever had to see a different vet, like on vacation, you will have all her info in hand. Some of us also keep a daily journal on our babies...food and water intake, pee and poop history, sleep patterns, moods, behaviors, etc. That way you don't have to try to remember when she pooped that strange purple stuff! :eek: A lot of vets find these diaries helpful, too.

Anyway it was either up the Trilostane from 30mg and have it compounded to the right dose ($$$) or switch Roxy to Lysodren and start loading her at 250mg twice a day and do another Acth test on Wednesday or Thursday.

~~ shiver~~

The new vet has NO experience with Trilostane, as did Roxy's normal vet. Didn't find this out till he admitted it to me on Tuesday.

So neither of these vets have experience with Trilo? Do they have any experience in treating Cushing's? A Cushing's savvy vet is a great thing to have, but more important is having a vet that will talk to you, listen to you, and work with you as a team. If this doc is willing to do that, then don't give up on him just yet. Squirt's vet is young but had treated several cush pups, however, Squirt is not the typical cush pup, so Dr C and I have learned together. THAT makes her priceless IMHO.

After weighing my options I decided to start loading Roxy with Lysodren. We started loading on Saturday and I am happy to report .......no ill effects so far.

Man! That is such good news! But please, please do keep an eye on her today and tomorrow. Trilo has a relatively short life in the body, but Lyso stays and works for about 48 hrs. For this reason, it may be more critical to have a wash-out when switching from Lyso to Trilo, I'm not sure about that. But after 37 days on Trilo, I cannot imagine going immediately to Lyso. This is definitely a red flag on the new vets experience to me. But, like I said, don't give up just yet...see if he will work with you first.

During the course of Roxy's examine the new vet found bladder stones along with Roxy's bad teeth. I knew about her teeth but BLADDER STONES!!! The old vet totally missed those. Once we get Roxy healthy enough she will need surgery to get rid of the bladder stones and clean and pull her bad teeth.

The new dose of 7u Humilan N BID is doing a great job in keeping her bg in the 100 range. I am suppose to do a curve before I take Roxy for her repeat ACTH test. We may have to drop the dose once we get the cushings under control.

This is not unusual when dealing with both conditions. I hope this holds true for Roxy, or better yet, that when the Cushing's is under control, the BG will level out on its own! One can hope, right?! :)

The new vet wants Roxy on the science diet W/D food. I just don't like this food and have decided to switch Roxy to Canidae Platinum or something like W/D but better quality. Lower protein for the bladder stones, but still a quaility food.

Oh, good move on the SD!!! Do you know what kind of stones? I think struvite stones are the most common in dogs. Has she had frequent urinary infections? I'm not sure that lower protein is important in treating bladder stones, but I will have to do some research to be sure. I do know that getting the PH balance correct is the goal for preventing them, as well as getting rid of any infection in the urinary tract. It seems that for struvite stones the diet needs to be based on higher animals sources than plant sources...again will have to double check.

Any thoughts or advice would be appreciated.


Judy and Roxy (PA, USA)

Roxy, canine, Miniature Schnauzer,Birth date 11-14-99, 9 y/o, F (spayed),
weight 14.4, Sudden Acquired Retinal Degeneration Syndrome (SARDS dx 8/08),
Diabetes Mellitus dx
3/25/09, Humilin N 7 U twice a day
Cushing's syndrome (dx with ACTH stim test on 4/21/09,
Trilostane 30 mg started 4-23-09 once a day, Started loading Lysodren 250 mg Bid
on 5-30-09
diet/nutrition: Canidae Platnium
The other girls that rule the house:
Misty, Beagle, 8-18-95 13 y/o F (spayed)
Jenna, Miniature Schnauzer, 10-23-02, 6 y/o F (spayed)
Baylee, Miniature Schnauzer, 5-9-05 4 y/o F (spayed)

We have four girls at our house, too! :D Ages 5-11, weights 10 lbs - 50 lbs., all very much loved as I'm sure yours are.

This has gotten long enough but I have some links for you that I will put on another post.

I am so glad you are here and hope to learn more about you and Roxy soon, not to mention the others girls. :)

Hugs,
Leslie and the girls

[gpgscott]

Hi Judy and Roxy,

Very glad you found us and joined.

Kim and Leslie have given you much advice, it is all supported by professionals.

Please cease administration of the Lysodren right away, it will not hurt Roxy to be without treatment during this period between treatments which is referred to as a 'washout'

Please let us know as soon as you have read these new posts and where you are going.

Scott

[jk9cuts]

PLEASE STOP GIVING LYSODREN IMMEDIATELY.

We lost power and I already gave her the second dose before I got on here.

Did the vet give you prednisone to give in an emergency?

She did give me prednisone!!!!

I have 2 schnauzers myself. Poor Roxy seems to have gotten about every ailment a schnauzer is prone to get. :(

I have had schnauzers for 30 years and this is the first with all these problems.


No blood in her urine.

I am wondering with all the things going on with Roxy that it might be time to see a specialist that has a little more training and can treat multiple diseases.

I think you are right. I live about an hour from Pittsburgh PA!!!
Anyone know a good specialist???

So far we are ok..........Just a scared worried mom here.

Judy and Roxy

[frijole]

GREAT! OK - now lets focus on Roxy. How is she acting? OK? As I said they say "you know" if a dog goes to low. They have a hard time standing up and look near death. If this happens give the prednisone. Since I am worried about your vet - pls tell me the dose she gave for the prednisone. ;) My schnauzer is 17 lbs and the little pill is cut in half.

I do remember a member who went to a specialist near you.. maybe someone here remembers the name.

[frijole]

Adding - the prednisone might take a couple hours to kick in but it mimics the cortisol that has been removed from the system and makes the dog feel better.

It's a little late but I'm giving you a link on how lysodren works and signs to look for as a reference. But please do not give any more lysodren. Let's give Roxy a chance to detox. http://www.k9cushings.com/forum/showthread.php?t=181

[jk9cuts]

The dose of Prednisone is 5 mg.

Roxy is sleeping right now on the bed behind me.....acting normal. (so far)

[MiniSchnauzerMom]

Judy,

Wanted to extend my welcome to you and Roxy from me (Louise) and Munchie....another MiniSchnauzer.

I, too, am as concerned as the other members about your little girl, Roxy and the current situation with the cushings meds. I am not a vet but I am an owner whose Mini was misdiagnosed, put on Cushings drugs and became ill.

Ahhhh, I am relieved to see that you're in good hands with Kim right now and that Roxy continues to be alright.

Louise

P.S. Munchie also had bladder stones. He had the calcium oxalate stones as opposed to the struvite type. We can talk stones later. :D

[frijole]

Great. Roxy is sleeping. Lysodren tends to tire dogs so this is normal. I'm going to try to explain how it works in laymans terms - here goes:

Dogs with cushings produce too much cortisol and the goal of treatment is to reduce the cortisol production WAY down. The acth test is done before treating to know where you started and thru out loading to monitor progress. The goal with cush dogs is to have a cortisol level of between 1 and 5. (its the 2nd number on the acth test) Lysodren eats at the adrenals (which produce cortisol) and this reduces cortisol. The trick is to get to the 1 to 5 level and then maintain it after loading phase.

If a dog has too much lysodren then they don't have enough cortisol which they need to survive. That is why prednisone is given. It mimics cortisol.

The big question in all this with Roxy is what is the effect of having been on trilostane and NO WASHOUT have? I don't know if we have ever seen this.


Is Roxy alone all day tomorrow or is there anyway someone could check in at lunchtime? Just being cautious here. Kim

[MiniSchnauzerMom]

Oh, just thought of something. If, in fact, it does become necessary to give Roxy the pred, it will probably have an impact on her blood glucose (elevating) but it will only be temporary.

Louise

[AlisonandMia]

And another thing - if her cortisol goes very low at any point it will very likely result in very low BG as well.

A lot of dogs with more than one condition - especially when one of them is diabetes - are managed by a specialist.

The Cushing's-like condition that comes with SARDS is not necessarily the same as "normal" pituitary Cushing's and dogs with SARDS very often don't respond to or handle treatment with cortisol-lowering meds like Trilostane and Lysodren very well at all and quite a few vets don't recommend treating the "Cushing's" as (a) the results are not good and (b) the "Cushing's" aspect of SARDS very often abates spontaneously after a while (about 6 months I think) although diabetes could make this "not treating" thing more problematical. It is of course possible that a dog could have SARDS and "regular" Cushing's as well, I guess.

That increasing the insulin did bring the BG down so well makes me wonder if she really does need anything to reduce cortisol. The diabetes people will be able to comment on that in a more meaningful way though.

Alison

[frijole]

Oh, just thought of something. If, in fact, it does become necessary to give Roxy the pred, it will probably have an impact on her blood glucose (elevating) but it will only be temporary.

Louise


Louise - Haley is 16 to 17 lbs and her dosage is 1/2 of a 5 mg prednisone. Roxy's vet rxed 5 mg for a dog 14.5 lbs.

Am trying to determine if given what you just said aboug BG levels Roxy would be better off on half a tablet should it be necessary.

Kim

[jk9cuts]

I will be working tomorrow for about 2 hours. So I will technically be here.

So if necessary I should give a half of predisone?

[AlisonandMia]

Just one question - are you home testing her BG?

Alison

[forscooter]

Just chiming in here...you do want to keep an eye on her blood glucose levels while giving prednisone...not a reason not to give it if she needs it, but you do want to watch. If by chance, it does cause a temporary elevation in glucose levels, you may need to just give a bit more insulin. Dosing would need to be determined by a vet. But it can help in case you need it (speaking from human experience here...)...

I would definitely want the input from a specialist here bc of both conditions. It is my understanding that the diabetes should be under fairly good control before starting Cushing's treatment. I will stand corrected by the diabetes parents if I am wrong. But I do think it is very difficult to get either under control until you get the one under control and the diabetes is usually the priority.

I know you are getting good blood readings now, but I am wondering what is impacting what at this point? If I misread something, please excuse me. It just stuck in my head that you started the Cushing's treatment prior to getting the better BG readings?

Also, can you tell us what tests were done to diagnosis the Cushing's? Perhaps I missed that too and I need to go back and look.

Just one more thing....about the bladder stones...not all stones can be dissolved by medication. Scooter had calcium ox stones that only could be surgically removed. He had about 20. He made out fine with the surgery...they are not uncommon in Cushpups.

Sending lots of good wishes to you and Roxy!
Beth, Bailey and always Scooter

[frijole]

I am unsure of the dosage for the prednisone. That's why I asked Louise. Your dog weighs less than mine by a few pounds and that is why I'm inclined to err on the side of caution and go with less to be safe.

I am glad you will be around to keep an eye on her.

Alison - do you know the recommended dosing for prednisone by chance?

Kim

[AlisonandMia]

The usual "rescue dose" of pred (ie for when a dog goes low) cited is 0.25mg/kg or as close to that as you can practicably get. Some seem to sometimes need a little more than that and some seem to do fine with less.

Alison

[MiniSchnauzerMom]

Louise come lately here....I was not positive about the amount of the rescue dose either. Munchie was given 5 mg. of Pred also but weighed more than Roxy. It was actually more than he needed at the time but he did fine and it did the trick.

As Beth said, stones aren't uncommon in Cushpups and MiniSchnauzers can be predisposed to them too. Munchie had 59 calcium oxalate stones and his were small enough to be removed via urohydropulsion (no surgery).

Louise

[jk9cuts]

I am home blood testing. I was getting readings in the 400-500 range until Tuesday then I am getting readings in the 100 range. I got a 79 at 6 hour post shot today.
I am so confused and scared right now.

I have to find a specialist!!

[frijole]

Here is a link to specialists. I found 2 in Pittsburgh but am not familiar with suburbs etc. so there may be one closer:

http://www.acvim.org/websites/acvim/index.php?p=3

[AlisonandMia]

What dose of insulin is/was she on and when? Was an increase in insulin responsible for the decrease you saw lately. The numbers (dose of insulin) won't mean a lot to me but it will help the diabetes people out.

Beth is right. When a diabetic is suspected of having Cushing's (and it can be awfully hard to conclusively diagnose in a diabetic) the usual preferred thing is to have a really good go at controlling the diabetes which means (if necessary) taking the dose of insulin up to a point where insulin resistance is proven and any other factors taken into account before embarking on cortisol-lowering treatment. The general view is that if the BG is controllable and the numbers are pretty good most of the time then Cushing's is very unlikely.

I think that with the recent drop in BG with an increased dose of insulin and also with the little bit of a Lysodren load that has been started that you will need to keep a very close eye on those BG readings over the next few days and maybe even think about backing off on the insulin a bit just to be on the safe side particularly if you are not going to be able to be with her every minute. I don't know a whole lot about diabetes but the fact that you are getting such low numbers (good in themselves, I know but you don't want them lower) so soon after an insulin increase and that her cortisol may well have been lowered too really worries me.... Lysodren goes on working to lower cortisol for about 48 hours post dose, BTW.

I agree - you need to get to a specialist as soon as you can.

Thank goodness you are home testing that BG!:)

Alison

[forscooter]

Judy,

One thing that can happen, and again speaking from a human point of view here, is when a person gets used to high BG readings, that is if usual readings are in the upper ranges and then come into a normal range (which we know is a GOOD thing)....it can throw you off until you adjust. So some funkiness can be due to that. I went out one night, forgot where I was and where I was going, sat there, couldn't figure out what to do, thought I was too low....but no, I was right on target. I was told the brain gets used to all this glucose so when you lower it relatively quickly or see a drop like that, it can make you think things are off-balance. Just so you are aware of that too....

However, it doesn't mean not to watch the cortisol signs too...

I know you are scared...I was scared when Scooter went low a few times...and I have scared myself with my sugar a few times but here are some rules you can go by for tonight...

if in doubt of the blood sugar, test. It doesn't hurt to check and test and make sure things are within a good range.

if in doubt about the cortisol, and Roxy seems off and her sugars aren't too low, then give some prednisone. That's my opinion and I am not a vet. But prednisone won't really hurt anything either...it is temporary. Scooter did well on only 5mg and he was a 65 pound dog. So, if you are scared but need to give pred, maybe start off on the lower end of the dose and then just check the sugar here and there. Some diabetics aren't as affected by prednisone as others are. You will only know if you give it and then watch how she responds.

As long as she is alert at the usual times, not vomiting or having diarrhea, not so lethargic it is like she can't move, you can hold off on the pred, I think...again, this is my experience and opinion...

From what it sounds like, she isn't in any immediate danger, so please try not to be too scared right now (I know easy for me to say), but honestly, I think you should be OK until morning when you can call around for another opinion...just stop the Cushing's treatment for now...

Hang in there bc this will all work out! It really honestly will!!!
Beth, Bailey and always Scooter

[acushdogsmom]

At the ACVIM website I did a search for Specialists in Small Animal Internal Medicine in Pennsylvania and found an Internist listed in Wexford named Dr. Dana Kellerman.


Name: Dana Kellerman
Specialty: Small Animal Internal Medicine

Status: Diplomate
Type: Active
Species: Small Animal
Work Address:
Pittsburgh Vet. Internal Medicine
13055 Perry Hwy.
Wexford, PA
United States

It wasn't easy to find a phone number or a website for this Specialist though, but after some digging I did find the following information:

Dr. Kellerman may be working out of a clinic called Bradford Hills Veterinary Hospital (See: http://www.bhvh.net/services/internal.html ) which seems to have the same address as the one listed for Dr. Kellerman at the acvim website. It doesn't have her name listed anywhere on their website that I could find, but they do say that they have Internal Medicine Specialists on staff there, or at least I think they said that they do. Dr. Kellerman's own phone number at the Bradford Hills Clinic might be: (724)935-3990
(see: http://www.brownbook.net/business/21423474/pittsburgh-veterinary-internal-medicine )

I did find a website for another Specialty Clinic in Pittsburgh called the Pittsburgh Veterinary Specialty & Emergency Clinic which seems to have at least two boarded ACVIM Internal Medicine Specialists working there along with several other different kinds of veterinary Specialists (dentistry, ophthalmology, surgery etc). Looks like this Specialty Clinic is new (2008) and it appears to also be very high tech. If I lived in or near Pittsburgh and needed an Internal Med Specialist for my dog, I'd check this place out for sure.

They also seem to also have a 24 hour ER, which is a very good thing just in case you ever need help when a regular vet's clinic would be closed, and especially good if your dog's chart from the Internal Medicine Dept. is also available to the ER Vets there (with all details of the diagnosis and treatment) and it seems to me that they'd be able to reach your dog's Specialist if need be, even in off-hours..


Pittsburgh Veterinary Specialty & Emergency Clinic (PVSEC) is the most comprehensive, multi-specialty veterinary center in western Pennsylvania, with the region's only on-site MRI for pets and 24/7 emergency care. Our new home is conveniently located off I-279 at 807 Camp Horne Road, just ten minutes from downtown Pittsburgh

Anyway, here's the links:

http://www.pvs-ec.com

http://www.pvs-ec.com/internal_medicine/index.php

http://www.pvs-ec.com/internal_medicine/doctors.php


Dr. Johnson has a wide range of clinical interests and skills, with particular interest in urinary disease, immune-mediated disease, oncology/chemotherapy, endocrinology, ultrasound, endoscopy and cytology.


In particular, Dr. Lurye is interested in the monitoring and management of diabetes in dogs and cats.

Pittsburgh Veterinary Specialty & Emergency Clinic
807 Camp Horne Road
Pittsburgh, PA 15237
412-366-3400

They take credit cards and they apparently also accept Care Credit.

(what's care credit? see: http://www.carecredit.com/vetmed/whycc.html )

You might (or might not) need to be referred to an Internal Med Specialist by a GP Vet, but if you ask for it, a GP Vet should be glad to give you the referral you need.

I had an Internal Medicine Specialist on my cushing's dog's case. Best thing we ever did! Started off as a referral for a second opinion, but we quickly realised we wanted her to be directing our dog's treatment for the long-term. So we said so. We insisted, actually. And she stayed on his case as his main treating Vet (for everything even remotely related to the Cushing's) for more than 6 years.

Sometimes the ACVIM online database is not as current as it should be, so some Specialists may not be listed online yet, even if they are indeed accredited ACVIM Diplomates or their contact info may have changed. So there are sometimes more boarded specialists than the online database might indicate or they may not be working where the listing says that they are.

You can contact the ACVIM by phone (there's even a 1-800 number) if you want to check for other Internal Medicine Specialists in your area.

http://www.acvim.org/websites/acvim/index.php?p=109

Hope this helps.

edited to add: Looks like there's a member at the k9diabetes board who is in or near Pittsburgh and who has an Internal Med Specialist Vet for her dog Daisy, and she loves her dog's Specialist!

See Natalie's reply on the next page of this thread, or just click here: http://www.k9cushings.com/forum/showthread.php?p=5353#post5353 for details

[k9diabetes]

Hi Judy,

I was very interested to read that the Cushings type symptoms that comes with SARDS can be temporary and that it does not necessarily respond to lysodren or trilostane...

I suspect that Roxy won't be in too much trouble as long as you stop the lysodren because it looks like the ACTH response was such that the Trilostane wasn't really doing much to lower her cortisol.

Which I hope means that there's not much effect to "wash out."

But you definitely would see significantly lower blood sugar when giving lysodren, regardless of whether she needs the lysodren or not. Which you can see in that plunge in blood sugar.

So you've stopped giving lysodren, yes?

The ACTH stim test also should increase her blood sugar for a few days so there is a very real possibility that this amount of insulin will be too much once the cortisol released in response to the test clears if, at the same time, her cortisol production remains decreased by the lysodren.

It's a little simplistic but not much... there is essentially a direct link between cortisol levels and blood sugar levels.

High cortisol leads to high blood sugar

Giving prednisone is essentially giving cortisol so that leads to higher blood sugar.

Low cortisol from too much lysodren leads to lower blood sugar.

You do need a specialist... what has been occurring is really scary.

Cushings is a disease that just requires someone who knows the protocols backward and forward and follows them carefully. That's before you add in the diabetes! With the direct link between cortisol and blood sugar, it gets even trickier.

So you need an expert.

Glad you're close to a larger metropolitan area as you should have some choices. Usually the big specialty hospitals will have more than one IM.

Natalie

[k9diabetes]

Hi Judy,

I have good news for you!! :)

Lisa, mom to Daisy, at the diabetes forum has an IM she LOVES and that IM is in Pittsburg!! :cool:


OK Just got a call from the Internist who is on vacation SO GOD BLESS
DR LISA ASSANDRI OF NORTHVIEW VETERINARY HOSPITAL PGH PA!


Here's her thread at the diabetes forum... http://www.k9diabetes.com/forum/showthread.php?p=15855&posted=1#post15855

From their ad for a dermatologist:


NVSS is located in the beautiful western region of Pennsylvania. The referral base for our hospital has been established for over 30 years and draws from 455 doctors.

NVSS is part of the Northview Veterinary Hospital System. Also included in the system are Northview Animal Hospital ( a 6 doctor AAHA general practice), Northview Veterinary Rehabilitation Center, and Northview Veterinary Emergency Center ( a 24 hour ER Center). Antech Regional Stat Lab and RadioCat, located within the facility, complement the system. The NVSS philosophy is to provide compassionate, quality, leading edge medicine for all of our patients. To that end, the hospital is equipped with all the amenities associated with a state-of-the-art facility: Digital Radiology, Helical CT, Fluoroscope, Color Doppler Ultrasound, Storz


Dr. Lisa Assandri, Dipl. A.C.V.I.M. 412- 364-5626


She's also listed on the Pennsylvania Veterinary Medical Association as a member.

Natalie

[acushdogsmom]

Dr. Lisa Assandri sounds terrific!

And it's always great to get a client's perspective too ... so it's great to hear that Lisa (Mom to Daisy at the k9diabetes board) is so happy with Dr. Assandri. :D

P.S. "IM" or "IMS" = "Internal Medicine Specialist" Vet. :)

And "Dipl. A.C.V.I.M" means she is a Certified (or some may say "Boarded") Internal Medicine Specialist Vet

[jk9cuts]

Lisa, mom to Daisy, at the diabetes forum has an IM she LOVES and that IM is in Pittsburgh!!

Thank you for this info. I am going to call.


Wanted to let everyone know Roxy is still doing fine. No adverse effects.
Talked to the vet this morning and I am feeling better. Roxy goes on Wednesday @ 2:00 for another ACTH test. I am going to sticky note myself to remember to get a copy of the results.

[gpgscott]

Lisa, mom to Daisy, at the diabetes forum has an IM she LOVES and that IM is in Pittsburgh!!

Thank you for this info. I am going to call.


Wanted to let everyone know Roxy is still doing fine. No adverse effects.
Talked to the vet this morning and I am feeling better. Roxy goes on Wednesday @ 2:00 for another ACTH test. I am going to sticky note myself to remember to get a copy of the results.

Let me suggest that the ACTH be sent to UTK for a full adrenal panel, I will place a link. If you do it now the upcharge is not great and it will give you information that may shape the treatment.

Best to you both. Scott

http://www.k9cushings.com/forum/showthread.php?t=198

[frijole]

Glad Roxy is doing fine. I have to wonder if she even has cushings as other have mentioned... and am grateful you found us so we could halt the lysodren for now at least. AND you must keep us posted on how your visit with the new doc goes. I am sure the specialist will give you peace of mind you clearly deserve. You have a lot going on with Roxy and its nice to know you have one person you can count on vs multiple vets.

Hugs
Kim

[forscooter]

Great news, Judy! I am so glad too that you have an IMS lined up. I do think in Roxy's case, this will be your best way to go. Just had to check in and make sure she was doing A-OK!!! And yes, please do let us know how things go!!!!
Beth, Bailey and always Scooter

[MiniSchnauzerMom]

Hi Judy,

I, too, am so glad you have a recommendation from somebody for a good Internal Medicine Specialist for Roxy and plan on setting up an appointment. It is a big relief to hear she is still doing fine too. :D

My Mini. Munchie, has multiple health issues and a specialist was the route I took for him and his care (actually the little guy now has 5 specialists :eek:) Wouldn't think of taking him elsewhere.

Give your Roxy some extra petting from me...and Cousin Munchie says "hi".

Louise

[Squirt's Mom]

Hi Judy,

Just dropping in to check on you and Roxy. Let me hear from you when you get a chance!

Hugs,
Leslie and the girls