Cairo, 8 year old staffordshire bull terrier just diagnosed

[Alison]

Hi all,

Our staffy has just been diagnosed with Cushing's - just got told yesterday so he's not been started on treatment yet as his vet will discuss it with us tomorrow when she's back in.

I don't know if this is something that's been steadily brewing for a long time or not but we've always joked about him liking to eat - he'd eat till he burst if he was allowed.

We lost his "brother from another mother" two years ago and after Neo's death was when we really noticed a change in Cairo. He seemed to be very anxious out on walks, stressing, panting and would only go as far as it took for him to toilet then he wanted to go home again. We just thought he was grieving for losing his buddy.

In the last few months, he gained a lot of weight - he went up to 28kg which is heavy for a stafford. He's a big boy and his ideal weight would be about 23 - 24kg so I guess it's not a huge weight gain. Despite cutting his food and treats down, he didn't lose any weight.

Then we noticed he started developing some bald spots and the skin round his bum looked dark and just not right. Then the tip of his tail when bald - that rang alarm bells for me and I initially thought that it was his thyroid - which would explain his weight gain, lethargy and anxiety.

The vet ran some bloodwork (I don't have any results for this) and said that his thyroid hormone was low but his TSH was normal which basically ruled out his thyroid, so he had a low dose dex suppression test on Friday. We just got the results yesterday that he has pituitary hyperplasia.

I'd have taken a thyroid problem over this any day but now I need to make sure he's getting the best care and treatment possible.

We'll be speaking to his vet tomorrow to see what the next step is regarding medication, etc but I really wanted to know if there is anything I should be asking her?

What's the best medication for him (Lysodren isn't licenced here in the UK). Are there any alternative therapies that can be tried? Should there be any dietary changes to help him?

Is there anything else I should be asking the vet?

I'm really devastated about this. It's bad at any time but it's exactly a month short of the two year anniversary of Neo's death and it just feels like we're away to go through another devastating time (Neo's illness came suddenly and was very upsetting).

So glad I found this forum and hope that I can find out as much as possible to help my boy.

Alison

[Squirt's Mom]

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[Harley PoMMom]

Hi Alison,

Your membership approval has now been finalized so your posts will now be publicly visible just as soon as you write them.

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

If you could round up copies of all tests that were done on Cairo and post any abnormalities that are listed, that would be great. We would also be interested in all results from any Cushing's tests...Thanks!

Having a vet/IMS that is Cushing's savvy is a real plus, so if this were me I would ask the vet if they are knowledgeable about Cushing's, the treatment protocols for Cushing's, and ask how many Cushingoid dogs they have treated. I would also want to know if when they treat with Trilostane/Vetoryl do they go by Dechra's or UC Davis treatment recommendations. These are just some of my own thoughts and I am sure others will be along to share theirs.

Does Cairo take any other herbs/supplements/medicines? Any other health issues?

Please know we will help in any way we can so do not hesitate to ask all the questions you want. ;)

Love and hugs, Lori

[Alison]

Thank you for the welcome.

I'll ask them for copies of his tests tomorrow - he's not had loads of tests done - just for his thyroid and then the low dose dex suppression test.

The vet we normally see is really good with him and she's been patient at explaining things as well - I do trust her (which is more than I can say for my own doctor!!). I'll ask all the relevant questions. I believe they'll be using Vetoryl but I'll ask which treatment protocol they'll be using. Will she or should she be familiar with the two protocols with being in the UK?

Cairo isn't on any other meds - apart from a short course of Noriclav two weeks ago for an ear infection. He's always been so healthy (or I thought he was) which is why this has come as such a shock.

I have Addison's myself and I'm fairly up on that but Cushing's is freaking me out because all I can think of is "tumour".

[Roxee's Dad]

Hi Alison and welcome to you and your Staffy :)

I am so glad you found your way over here. Their is an abundance of information here and many members to help and share experiences.:)

[Harley PoMMom]

I believe they'll be using Vetoryl but I'll ask which treatment protocol they'll be using. Will she or should she be familiar with the two protocols with being in the UK?

Yes, I think that she would of read about both of these two treatment protocols. The biggest difference between Dechra and UC Davis is the initial starting dose: UC Davis -
The UC-Davis current recommendation is to initiate trilostane therapy at 1 mg/kg once daily. That dose is continued for about one week until a veterinary re-check can be completed. This article can be found: Comparing therapies for canine hyperadrenocorticism (http://veterinarynews.dvm360.com/dvm/article/articleDetail.jsp?id=460965&sk=&date=&pageID=3)

Dechra's -
The starting dose for the
treatment of hyperadrenocorticism in dogs is 1.0-3.0 mg/lb (2.2-6.7 mg/kg) once a day based on body weight and capsule size.

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


I have Addison's myself and I'm fairly up on that but Cushing's is freaking me out because all I can think of is "tumour".

So sorry to hear that you have Addison's, then you know Cushing's is the exact opposite of Addison's. Most dogs (85%) have PDH (pituitary-dependent hyperadrenocorticism) in which there is a small and usually small growing tumor of the pituitary gland; the other 15% have ADH (adrenal dependent hyperadrenocorticism) and have a tumor of the adrenal gland/s.

If a dog has ADH, then a cure is possible with surgery.

One thing I want you to know is that Cushing’s is a treatable disease. With proper medical management, close monitoring and owner observation, most Cushingoid pets can live to their full life expectancy, with complete or partial resolution of clinical signs, and good quality of life!

Love and hugs, Lori

[Alison]

I'm not sure if the vet will phone me or my mum so I've given her the list of questions to ask as well. I said to her it might be better to phone first thing and just ask if we can pop in and speak to her and that way we can pick up any meds he needs at the same time (and ask for his lab results.)

The vet did say that Cushings wasn't life threatening the way Addison's is and that we didn't use Lysodren here as it wasn't licenced here plus the Vetoryl was reversible if the dose was too high where as the Lysodren isn't. We'll get more info tomorrow though and I'm doing a mountain of reading - I need to know as much as possible because Cairo can't speak for himself so he needs me (even though he's in the huff with me for all the poking and prodding he's had over the past few days).

[LtlBtyRam]

Way to go with the mountain of reading. Good luck and the people here are wonderful. I will be on the lookout for more details from your journey.
Angela

[molly muffin]

Hi Alison, glad you found your way over to the forum. :)

Welcome. :)

I replied over on the Facebook page, but I'll say it here too. Knowledge is key. The more you know about cushings and treatment and testing protocols, the better things will go. You are one step ahead just because you know about the opposite. So, that is the biggest risk, you don't want the cortisol to go too low that you get into an Addison crisi, which is not actually get Addison, but falling into that low zone. It is one reason that when you start the vetoryl, you want to have a pred rescue does on hand, just in case. You'll probably never need it, which is great, most don't.
It is why we always recommend starting at the low end and working up as needed. The body seems better able to tolerate it too, when the dose is started at the low end of the scale.

Welcome to the forum
Sharlene and molly muffin

[Alison]

Just a quickie.

The vet's just phoned. She says he's definitely got Cushing's but he's not had it long. I'm getting to pick up a copy of his lab results so I can post them later.

He's to be started on 120mg Vetoryl (he's 28kg).

[goldengirl88]

Alison:
Welcome to the group. Sorry your baby is having troubles. I know you had an LDDS test right? There are other tests that are done also, ACTH, Urine, and Ultra Sound are all used to get a confirmation of the Cushings and what type you are dealing with. Since these are powerful drugs used on Cushings I personally would want more confirmation that my dog has it, and what type.I use Vetoryl, and I can tell you the single most important thing with using it is to start on a low dose. It gives your dogs body time to adjust to the drug. Some vets start these dogs on a high dose and they have problems. If you want to minimize the risk to your dog start low. Just be vigilant about watching him and you will do fine. As far as diet goes I was told by a nutritionist that they need a low density, medium protein diet. Keep a daily doggie diary on your dog . You will need it to refer back to. Make sure your vet has experience treating Cushings as it will save you time, money and heartache. Hope all goes well. Blessings
Patti

[Junior's Mom]

Alison, DO NOT START ON THAT DOSE. It is way too high, and you are just asking for trouble. The 2 different recommendations are much lower than that. Either 1mg/kg, which would be 28mg for your dog, or 1mg/lb, which would be 60mg. You are much better starting with the lower one. It may take more dose adjustments, starting low and working your way up, but it is much better for your dog. Don't worry about arguing with your vet, you are the only one who can speak for your pet.

[Alison]

Oh heck. We're just back from the vet. She says she's starting him on a dose that's in the middle of the Dechra recommendations - 3mg per kg. She's booked him for an ACTH stim test on 17th September.

I've got his lab results - just away to scan them and work out how to post them up.

[molly muffin]

You only need to post the abnormal high/low results and the full LDDS or ACTH result which is a couple numbers with the ranges for each. Easier to just type those out. We see better results with starting on the low end of the scale and working up usually. So 60mg for starting.

Sharlene and Molly muffin

[Junior's Mom]

Those are OLD recommendations from Dechra. Unfortunately a lot of vets do not keep up with new studies, and many of the products inserts still seem to be old. Dechra recommends 1-3mg per pound now. UC Davis, 1mg/kg. Tell your vet NO.
My dog has been on vetoryl for about 5 weeks now. He weighs 50lbs (22.68kg). I started him on 20mg, twice a day. I believe the twice a day makes more sense. He has done very well, no problems at all. After his first acth test, which MUST be done 10-14 days after starting, and every time there is a dosage change, I increased his dose to 25mg twice a day, as his cortisol levels were still to high.
Don't worry, you will be fine as long as you follow protocol. If your vet won't listen, then find a new one. There is no rush to treat.

[Alison]

I've got his lab results now

http://i41.photobucket.com/albums/e283/Alison556/Lab-results1.jpg

http://i41.photobucket.com/albums/e283/Alison556/Lab-results2.jpg

http://i41.photobucket.com/albums/e283/Alison556/Lab-results3.jpg

[Junior's Mom]

Alison, I'll tell you how I look at it, and I'm sure the many on here with much more knowledge than me, will correct me if I'm wrong.
Your dogs cortisol levels didn't go to the levels they are now overnight, they built up over time. Many systems are dependant on cortisol. The body has been trying to adjust all along to the levels increasing. A large dose will cause a big drop in the cortisol quickly. So not only is there the sudden shock to the system due to the change, but they could get too low, causing an addisons crisis.
Like with many other things we take, weaning them slowly off the cortisol levels their body has been used to, is much easier on the system, and a much safer way to go.

[Roxee's Dad]

Dechra protocol ..


Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range.

It seems to many of us here that the larger dogs seem to need less trilo per kg than the smaller dogs do.

Please be sure your vet gives you some rescue predisone to keep on hand for any emergency.

Within a week or so, you may notice less thirst and ravenous appetite, but of he refuses to drink or eat and seems lethargic... stop the trilo and call the vet immediately.

I am sure you will do just fine :) but in any case you have lots of friends here that will be around to help and just listen if need be. :)

[Alison]

I've had a good read of Dechra's leaflet for Vetoryl and it certainly says that for his weight, the starting dose should be 120mg.

Read the adverse reactions though and that's scared the pants off me.

Is there really any serious risk to this medication? Or are they just covering all basis for every possibility? I don't want to kill him with medication. My mum's scared to give him it and I'll admit that I'm a bit scared too.

[Roxee's Dad]

As with any medication human or canine, their is always possible side effects. In most cases of concern is when a pup goes too low on the cortisol. Resulting in lethargy, loss of appetite, not willing to drink water and diarrhea. Many times this results in a trip to the ER for testing and fluids.

This is why many of us recommend starting on the lower dosage and working up if necessary. It may take a bit longer to get control, but we feel it is a better and safer method.

Like I mentioned before, it does seem the larger dogs need less trilo per Kg than the smaller dogs.

I am trying to read the test below and am having trouble seeing the numbers. Did the vet do an ACTH test to baseline Cairo?

[spdd]

I'm going to jump in here and give my 2 cents worth. My dog was 65 lbs. We started him once a day at 58 mg and over a period of time there was no change ( 3 weeks) . We bumped it up to 68 mg and again no change for awhile then suddenly we had a couple of good ones. Peeing and thirst were the main issues. Then there was some weakness in his back end so the dose got reduced to 65 mg, still once a day. My dog crashed and at the time I had no idea about prednisone as the vet never mentioned it. He was literally minutes away from being euthanized and the vet said it was time.
Well "mah boy" is still here cause I brought him home and paid no attention to this vet. She also as a sidenote did NOT do the ACTH test at the proper times, again I found out later all thanks to this forum.
I have been to 5 different vets which include a teaching veterinary college and an IMS. All vets have had different comments and diagnosis. My point is that being an average size dog the dose my dog got was too much for him. Please do NOT give a large dose to your dog. Start out at the 1mg and build up if need be. I was told just last week that it can literally take months for a dog to respond to treatment. Every dog is different.
I come here now for all my advice and this is coming from someone that has no faith AT ALL in forums, until I came to this one. They know what they are talking about.
My dog is still a mystery, after now 4 months of problems and I'm no expert at all on here, however I've learned a few things, and I almost had my dog put down until I listened to what was being said to me here.
Hope this helps you in your decision about the dosage.

[goldengirl88]

Alison:
Please start him on a lower dose and work up from there. We are all here to help you, and make sure nothing happens to your baby. The people on here have a lot of experience with this, more than most vets do, so please trust in them. Blessings
Patti

[Alison]

Lord, now I'm worried.

She didn't do an ACTH stim test - just the LDDS test. He's to get the Stim test on 17th September after 2 weeks on the meds. Boy were they expensive.

I'll try and type out his lab reports as they appear in the hope they make sense.

[Alison]

Oh and we weren't given any prednisolone but I do have 1mg, 2.5mg and 5mg tablets in the house, along with hydrocortisone (the joys of a family with Addison's and ulcerative colitis!!) Are human prednisolone OK to use if necessary?

[Alison]

Here are the lab results - hope I've typed them out correctly. There are three pages:

Page 1

SNAPshot Dx

CORT 83nmol/L

8 hour post low dose dex
...Both 4 and 8 hour <27.6nmol/L - Normal
...Both 4 and 8 hour = 27.6 - 41.4 nmol/L - Inconclusive, consider repeating in 6-8 weeks
...Both 4 and 8 hour > 41.4 nmol/L and >50% of baseline -
.......Consistent with Cushing's syndrome; consider HDDST to rule out adrenal tumour
4 hour <41.4nmol/L or <50% of baseline and 8 hour >41.4nmol/L and >50% of baseline -
.......Consistent with PDH
4 hour <41.4nmol/L or <50% of baseline and 8 hour >41.4nmol/L and <50% of baseline -
.......Consistent with PDH
4 hour >41.4nmol/L or >50% of baseline and 8 hour >41.4nmol/L and <50% of baseline -
.......Consistent with PDH


Page 2

SNAPshot Dx

CORT 101 nmol/L
baseline cortisol


Page 3

SNAPshot Dx

CORT <14 nmol/L
4 hour post low dose dex
Await 8 hour post result for interpretive comments

[Harley PoMMom]

Oh and we weren't given any prednisolone but I do have 1mg, 2.5mg and 5mg tablets in the house, along with hydrocortisone (the joys of a family with Addison's and ulcerative colitis!!) Are human prednisolone OK to use if necessary?

I believe that would be ok. The standard rescue dose of pred is 0.25mg/kg.

So for Cairo's weight of 28kg, from my calculations the rescue dose would be 7 mg.

If I am reading those LDDS results correctly they are :
Baseline = 101 nmol/L

4 hour = <14 nmol/L

8 hour = 83 nmol/L


Converted to ug/dl, which is the units we are used to seeing:
Baseline = 3.66 ug/dl

4 hour = <0.51 ug/dl

8 hour = 3.01 ug/dl


Most times the cut off value is 1.4 ug/dl, so I believe those LDDS test results are indicative for PDH. However, I am in agreement with the others that the starting dose for Cairo is too high.

UC Davis protocol advises a starting dose of 1mg/kg which in Cairo's case would be 28mg. Dechra verbally recommends starting at the low end of their dosing scale which is 1mg/lb, so for Cairo's weight in lbs that would be 61.6lbs and a starting dose of 60mg.

We have seen dogs that do well with no adverse side effects when started at an initial low dose. If Cairo was my dog I would start him at 30mg...just my 2 cents worth. ;)

Love and hugs, Lori

[Alison]

I did say to the vet that the dose was higher than I'd thought he'd be on but she said that it was smack bang in the middle of the recommended treatment regime and was fine for him.

I'm terrified I kill him!

Would giving him 120mg every second day work? There's no way of splitting the capsules and I don't think the vet would agree to reducing the dose if she believes him to be on the right dose.

[Roxee's Dad]

Trilostane only remains in the system for about 12 hours. a little less or a little more. Part of the reason that twice a day dosing is seen more and more. Every other day would cause a roller coaster ride.

You are Cairo only voice and advocate. I would at least ask if we could start at a lower dose as you are not comfortable starting so high.

as Lori indicated...

UC Davis protocol advises a starting dose of 1mg/kg which in Cairo's case would be 28mg. Dechra verbally recommends starting at the low end of their dosing scale which is 1mg/lb, so for Cairo's weight in lbs that would be 61.6lbs and a starting dose of 60mg.

You may want to print out the links and send them to your vet. UC Davis is world renown in the treatment of canine cushings and testing, monitoring protocol.

[Alison]

I'll speak to the vet tomorrow. The last thing I want to do is cause him more problems.

Just spoken to someone else who is in the UK and her dog (roughly same weight) was started on 120mg too but he was reduced down to 30mg daily. Sounds like over here they do start them on the higher end of the scale. :rolleyes:

[Roxee's Dad]

That's why Veterinary medicine is still called a practice.... just don't practice on my dog..right? LOL

You are his only voice and advocate... You will be fine :) after all the vet works for you.

[Alison]

I'm always terrified about questioning the medical profession - human or animal - cos they're meant to be the experts!

[Roxee's Dad]

I think if you calmly tell him your concerns, and your stress level, he will be glad to accommodate you and give Cairo a lower dose.

You will be okay :)

A few of us had had discussions and disagreement with our vets. If my vet wasn't willing to work with me, he was fired and another vet was found. I finally found a vet that would have open discussions and worked with me and my concerns. We all learned from the experience.

Ha ha .. I remember one time he was a little upset and said " I went to vet school for this !!!" the discussion was about an ear medicine that side effects were loss of hearing... anyway he excused himself, went and looked it up then came back an apologized LOL I loved this vet because he was willing to listen and discuss.. BTW, he stopped using that ear med on the local police station canines :-)

It was this group right here that helped me research it... there is not much that gets past this group of members right here :D

[FemaleK9]

If you are torn between the advice you are getting from your vet and the advice you are getting from the folks on this forum, listen to these folks! I did, and I'm so glad I did!

My vet wanted my dog fasted before the first ACTH after she had been on Vetoryl for two weeks. I'm so glad I posted full information, because the people here picked right up on it and warned me that the test has to administered after the dog is given their Vetoryl dose with food - as it is always to be given. Testing a fasted dog means the test will be invalid, and basing dosage on such a test could result in an overdose, because the food is needed for the Vetoryl/trilostane to be fully effective. Without the food, the Vetoryl isn't fully absorbed, therefore the dog's cortisol is not fully controlled, and the test will read higher levels of cortisol which could lead to an unneeded increase in dosage.

I had a discussion with my vet, who thank goodness was willing to work with me and learn something, but I had to go over a stubborn and rude technician first. And it helped that, thanks to the people here, I had the reference information printed out as well as website addresses that they could check, not just my own opinion.

If you make it clear that you are just concerned for your beloved Cairo, not trying to be a confrontational know-it-all, you should be able to convince your vet to start at a much lower dose. The only risk to the lower dose is that you may need additional ACTH tests and several dosage increases before you arrive at optimum control - and you might not (my dog was started low and stayed low). High doses risk going into an Addisonian crisis and even possible death.

Your vet may be comfortable with that risk, but if you aren't, you really need to be brave and speak up.

[molly muffin]

Calmly expressing your concerns should in no way be threatening to a good vet. They should understand that you have fears that need to be addressed and that it doesn't hurt to take a more cautious road when the owner has concerns.
So many of us have been down this path and it can be hard having that first discussion, but after you've had one, you'll find the next 100 to be a piece of cake. :)

Sharlene and Molly Muffin

[addy]

I'm always terrified about questioning the medical profession - human
or animal - cos they're meant to be the experts!

As my husband always says- just because they went to school doesn't mean they got an "A". There are a lot of "D" vets and doctors out there.;);););)

You must be the voice for your pup and that means never blindly following doctor's orders and it also means asking questions when you have them and it can also mean saying "NO".:):)

No worries, we will get you ready!!!:):)

[Trixie]

Addy's husband is so right! Not all health professionals (animal or human) are created equal! You can only hope they will listen to your concerns and work with you so you can feel confident and comfortable with the choices made.
I grew up with parents who would never think of questioning a doctor and didn't, so I understand how you feel. Sometimes it's intimidating to even ask a question, but a good doctor/vet will welcome your concerns and answer your questions...if they don't , it's time for a new one! ;)

Barbara

[Alison]

I've not had a chance to speak to our vet yet as she's on days off and I wanted to speak to her, but I contacted Dechra and this is the reply I got:

Thank you for your enquiry regarding Vetoryl. Please be reassured that the dose of Vetoryl prescribed by your veterinary surgeon for your dog is consistent with the recommended dose range on the Vetoryl datasheet. We are unable to discuss the details of individual cases with animal owners so if you have any concerns regarding the treatment of your dog with Vetoryl, we would advise you to discuss these with your veterinary surgeon. If your veterinary surgeon would like to contact us to discuss the case further they would be very welcome to do so.

I hope this helps you with your enquiry.

[frijole]

Wow this is strange - not like what we have seen before.... are you by chance located outside of the US? That might explain it. Thanks Kim

[goldengirl88]

Allison:
Are you located in the US?

[Alison]

Yeah, I'm in the UK

[Squirt's Mom]

...is consistent with the recommended dose range on the Vetoryl datasheet.

Note that phrase - studies done after the datasheet was published supports starting at a lower dose than originally recommended. Your vet may not be familiar with these studies (posted on the first page of your thread) and may well appreciate being brought up to speed. ;)

[Alison]

Our vet is in tomorrow so I'll go and see her and take that with me.

He seems to be OK - no diarrhoea or any other side effects.

[Junior's Mom]

Nice to see you again Alison. So you have started administrating the 120mg then? How many days has it been so far? Have you noticed anything different at all?

[spdd]

Because she's in the UK.. the FDA rules are applying to her, that's why Dechra won't start a file with her.

Don't feel bad, for us in Canada they won't either.

[Alison]

He's had three days of the 120mg - I'll speak to his vet tomorrow though - she's part time since she had her baby and I'd much rather keep consistency and speak with her. He seems to be fine - haven't really noticed any changes for better or worse.

[lulusmom]

Hi Alison,

I am so sorry that Dechra was of no help to you and even sorrier that they have given you a false sense of security. I am so angry at them right now for their cavalier attitude, I could spit nails. We in the U.S. are lucky to have a Dechra division fully staffed with vets who will speak to us owners directly; however, I believe we have had a few members here in the states who got a response like yours. The fact of the matter is that Dechra has been negligent in safeguarding our dogs against overdosing based on their current recommendations. One of our admins, Marianne, has been in touch with Dechra here in the U.S. more than a few times and they told her that they hadn't updated their package inserts due to cost constraints but they are verbally recommending that treatment be started at the lowest recommended dose. Once this drug was approved in the U.S., the sale of Vetoryl skyrocketed and so did the documented experience. It has been used to treat dogs here for over seven years and clinical trials by UC Davis and others indicate that Dechra's dosing recommendations are quite risky.

If you want proof for your vet, please print out a paper entitled "Update on the Use of Trilostane" authored by Dr. Ellen Behrend, a board certified internal medicine specialist, and contributor to Dechra's continuing education program. This paper comes directly from Dechra's website and I highly recommend that your vet follow Dr. Behrand's dosing and monitoring protocol included in this paper. I have included the url below. You will find a relevant quote from Dr. Dr. Behrend which reads,


Originally, the recommended starting dose for
trilostane in Europe was 2 to 10 mg/kg Q 24 H.
However, as experience with the drug grew, it
became apparent that lower doses were needed.
Accordingly, the dosing recommendation on the
U.S. package insert is 2.2 to 6.7 mg/kg Q 24 H.

Dr. Behrend suggests that this amount is still too high by stating that,


My recommended starting dose is either 2 mg/kg
Q 24 H or 1 mg/kg Q 12 H, with adjustments
made as needed based on adrenocorticotropic
hormone (ACTH) stimulation testing.

www.dechra-us.com/.../Case%20Studies/Clinicians%20Brief-trilostane.pdf

So Dechra's own paid expert veterinary specialist ignores the low end of the range (2.2mg/kg) and would start Cairo on 2mg per kg which equates to 56mg once daily. This would most likely be bumped up to 60mg which is an available dose from Dechra. UC Davis would probably start Cairo on an even lower dose based on their own extensive experience with the drug....so shame on the rep at Dechra who supported your vet's decision because it's in accordance with the packaging insert.

I know from experience that questioning your vet is uncomfortable, even when you know what you are talking about but when you are new to the canine cushing's world, it's even harder. How can you possibly argue a point unless you understand it. It's my hope that the credible reference material we are giving you will 1) help you understand things better and 2) give you a lot more self assurance when asking questions of your vet. If your vet dismisses you and assures you that he knows what he's doing, don't believe him because we've given you the proof that he doesn't.

Now having said all that, it could very well be that Cairo will tolerate a 120mg dose but it could very well be that he doesn't and he ends up in an emergency clinic on iv fluids and steroid supplementation and costing you a lot more in hospital bills and more than the usual number of acth stim tests. I personally wouldn't take that chance, especially when world reknown experts like Drs. Ellen Behrend and Edward C Feldman have my back.

Glynda

P.S. I started this post this morning and just now finished and see that in the last several hours, you posted that Cairo has been on 120mg for three days and tolerating it. I'm glad but that doesn't mean he's out of the woods so please keep a very close eye on him. I could delete my post but decided to keep it here because I think it is important information for anybody who may read your thread.

[molly muffin]

Hi Alison,

Checking in to see how Cairo and you are doing.
Hope everything is going well.

Sharlene and Molly Muffin

[Alison]

Hi Sharlene,

He's doing fantastic. He's had his first ACTH Stim Test and the vet was really pleased. His cortisol levels were 88 and the range was 50 - 150.

When she saw him she couldn't believe how well he was looking - the shine's coming back on his coat, he had his twinkle in his eye and looked so much more happier. She says he's got his mojo back.

He's also lost about 2kg in weight and looks less bloated than he did. He's still not able to go for huge long walks - we let him dictate the distance he goes and he's probably only managing about quarter of a mile but he's showing interest on his walks and sniffing and snuffling about the place.

He goes back on Monday for his second Stim Test (that's the four week mark from starting on the Vetoryl).

He's still got his little bald patches but I'm not expecting them to get better for a while yet, but as I said, he's less bloated looking, isn't drinking and peeing the way he was and isn't scrounging food all the time either. He looks a much happier boy.

[Alison]

I probably shouldn't have started another thread about the Synacthen shortage here in the UK but I've come back to this thread to try and keep things together.

Cairo seems to be still doing OK - since we can't get the stim test done, he's been getting baseline cortisol and electrolytes done.

We've noticed a tiny little bald patch though - his skin looks fine - it's just a little round bald bit. He seems fine in himself - but I worry because he doesn't always show illness - when his cortisol levels dropped too low, he was running about like a mad thing while we took the call from the vet - no sign that his cortisol was too low.

Is a new bald patch something to worry about?

[molly muffin]

You can always get a skin scrapping and have it checked to see what it is. That is probably what I would do. It could be anything and you really don't know if you need a special shampoo, or antibiotics or something until you know what it is.

Glad to hear that he is doing okay other than the skin patch.

The baselines have been good?

Sharlene and molly muffin

[Alison]

Yeah, his baseline for last test was 67 (2.4)

[molly muffin]

That is a good baseline

Sharlene and molly muffin

[goldengirl88]

Great number for your baby!!

[Alison]

Cairo wasn't himself so off to the vet we went. Poor soul has an awful sore ear and we never noticed :( His ear wasn't red or anything - the infection was deep down it.

He's feeling a bit better I think but he seems to be really anxious out on walks - he's panting something terrible and is really clingy - he's very clingy in the house as well.

He's not due for a blood test till the end of May but I'm wondering if we should get it done sooner just to check?

[Harley PoMMom]

Is he on an antibiotic for the ear infection? If so, could you tell us what it is?

[Alison]

He's got Aurizon drops for his ear infection - he got his first dose Tuesday last week.

[Squirt's Mom]

Just so you know - the Aurizon contains Dexamethasone, a glucocorticoid, similar to Prednisone which can cause Cushing's signs to become stronger. Here is a link about the ear drops -

http://www.drugs.com/vet/aurizon-can.html

[Alison]

Ahh, could that explain why he seems a bit off this week? It's awful not knowing if he's feeling poorly or not - wish I spoke dog! :(

[goldengirl88]

If it were me I would not be using this because it will make him have more Cushing's symptoms like Leslie said. I have read many time that oxygenated olive oil is good for fungus, ear aches etc. You can get it online. You must be sure the eardrum in fully intact before medicating with anything, just so you know in case this happens again. Blessings
Patti

[Alison]

He was meant to have them for a week so tonight would be his last application. It never dawned on me about the steroids in the drops - I guess I never thought that drops in the ear could affect his Cushings.

Poor lad - if it's not one thing, it's another.

He hasn't been eating much but we assumed it was because he was feeling icky with the sore ear.

I'm thinking we should maybe get his bloods checked? Can it be done even though he's been on the Aurizon?

[goldengirl88]

If it were me I would wait a week or so. How is he doing after the drops? Do the ears seek to be better? Blessings
Patti

[Alison]

I ended up not giving him the drops on Monday or today - the vet said that as long as we got them over the weekend, it should be fine. He was getting really stressed out getting them. I can do anything to him - apart from ear drops - he just HATES getting them.

Today, he seemed to have a definite spring in his paw - he seemed a lot happier. His ear seems to be fine - I didn't try too hard to have a look though as he's still in alert mode to the drops so I'll give him a day or two to get over it.

Now I'm wondering if the steroid in the drops did affect his Cushings and now that the drops have been stopped, he's going back to normal.

[goldengirl88]

You just never know about these pups! You can usually smell if they have something going on in there, but I would still have the vet look in next time to make sure it is gone. That drives them crazy anything with the ears. Blessings
Patti

[molly muffin]

Mine has ear issues too, and she runs if she sees me shake a bottle, thinking it's the ear drops or she is getting her ears cleaned. She still gets it done, but it's a bit of an ordeal. Keep an eye out for him to start shaking his head. Sometimes they look clear on the outside area, but deep inside there is still some bacteria.

Hope you don't ever have to go through the ear thing again! :)

Sharlene and molly muffin

[goldengirl88]

Just checking in to see how Cairo is doing?? Hope you both have a good day. Blessings
Patti

[Alison]

We've had to go through ear trauma with horrifying regularity recently. Our old lad (no longer with us) had terrible bother with his ears and when it first started, it was a nightmare doing it but he soon learned that the ear drop bottle meant a tasty treat and he'd run into the bathroom and assume the position when he saw me with the bottle. Sadly, the same is NOT happening with Cairo - he just runs and hides when he sees the bottle and when I get a hold of him, he's giving me the eye and does the clacking of teeth to tell me that he's not happy. Ten drops the vet said - yeah, right, we have to assume the "squirt and run" technique. There is no time to be counting drops.

His ear seems to be OK but I'll definitely keep an eye on it.

I don't know if he's lazy or not feeling well or just suddenly enjoying car rides but he's obsessed. We live on quite a steep hill and I've not been feeling great, my mum has a chest infection just now, so I've been putting him in the car, driving up the hill and then going for our walk on the flat - now he doesn't seem to be wanting to walk - he wants back to the car!!

He's also fast panting a lot on walks - like he's stressed and he's constantly looking for his tugger toy to carry - he likes carrying things - it's like a comforter for him the way you give a baby a soother. He's panting and darting back and forth and sitting in front of you till he gets his toy, then he seems to be happier once he's carrying it. Not sure what's going on there.

[goldengirl88]

My Tipper is like that in the car. She used to love the car and sit in her car seat. Now she is uncomfortable in her doggy car seat, so I removed it and pit a pillow on the car seat so she has some padding. The redistribution of fat is bothering Tipper I think, it makes their skin thin, and crowds their organs if they lay a certain way I guess. Just watch the heat, as Cush dogs cannot tolerate the heat. Blessings
Patti

[Alison]

Normally my mum comes out with us but tonight she was waiting on my brother calling round so I just went to take Cairo out myself - we got 10 yards from the gate and he sat down and he was trembling like a leaf and just wouldn't budge - that is not like him.

Eventually my mum had to come out just to get us started and she went back home and he did carry on walking but he wasn't his usual self. He seems really stressed on a walk. I gave him his toy to carry to try and soothe him a bit but when I asked him if he wanted to go home, he turned round and all but ran down the road.

We've noticed that the edges of his ears have lost their fur as well so he's going to the vet tomorrow afternoon.

He's not eating much and his drinking is normal and his peeing is normal as well but he just doesn't seem right. It's such a worry.

[Alison]

Just thought I'd share a couple of pics of him

http://i41.photobucket.com/albums/e283/Alison556/Photo0195.jpg

https://farm8.staticflickr.com/7071/13698435253_ff7118d384_b.jpg

https://farm8.staticflickr.com/7321/13698391965_a6376e2bbb_b.jpg

[goldengirl88]

He is a beautiful dog. I see what you mean about the toy. I mentioned that Tipper acts really strange at times too, like she is afraid of something. I know this Vetoryl can change their personality, and Tipper is afraid of every noise. When her cortisol is at a lower range I can tell by her reaction to things, she is more afraid of noises etc. Hope you get things worked out. Blessings
Patti

[Alison]

Yeah, he seems to be scared of something. Shaking and trembling. A lorry hissed it's air brakes and he hit the ground.

I took him somewhere different last week for a walk and he was really scared as well - like he couldn't handle unfamiliar territory.

[goldengirl88]

I know what you are saying that is exactly what Tipper does. She almost pulled out of her harness one time trying to get in the house when the wind blew and it scared her.

[molly muffin]

I wonder if his cortisol is low. When it gets low, they can't always handle stress situations or anything they perceive as stressful as good as they use to. I'd ask them to do at minimum a baseline and electrolyte to check.
He is absolutely lovely. The pictures are wonderful, thanks for sharing.

Sharlene and molly muffin

[Alison]

I'm hoping the vet will check his bloods tomorrow - though the appointment isn't a great time - it's at 5.10pm and he gets his meds at 10am - so that'll be 7 hours after his vetoryl.

Something just isn't right and I guess I'm more worried because he's not been getting the stim tests - just baseline cortisol - due to the synacthen shortage here.

And thank you - I'm a bit biased but I think he's a gorgeous boy.

[goldengirl88]

I hope the vet is able to help you. It is a shame about the shortage, is there nothing that can be done to get some?? I hope all goes well. Blessings
Patti

[molly muffin]

What if you give it at 11 or 12 tomorrow? That would put you at least in the 6 hour window when the vet seems him at 5.
Yes I agree, it seems off doesn't it.
Crud about the shortage still. I thought they were going to be getting some in?

Sharlene and molly muffin

[Alison]

The vet said that stock was coming back in but we've not been told we can get the stim test done yet.

Good thinking about the timing of his meds. Never thought of that. Will it be OK to give him his meds 2 hours late for one day then go back to normal times?

[molly muffin]

I would probably give it an hour early the next day, same the following to get him back on his regular time.

Sharlene and molly muffin

[Alison]

The vet phoned and changed his appointment earlier so that he was within the 6 hour window for a stim test.

Just had a phone call from her to take him back - he's to get an emergency steroid injection - his levels are way too low.

I don't know the numbers yet - I just feel sick.

Will report back later.

[Tina]

Hi Alison,
I just checked in real quick from work and saw what is going on with Cairo. Please ask the vet to check his electrolytes also, as they can get out of whack when the cortisol gets low. If they are abnormal, he may need some additional medication to stabilize them. He may need IV fluids also.

This happened to my pup also. Try not to worry, you are taking him right back and the steroid injection will get him on the right track.

I will check back in later.

Hugs,
Tina and Jasper

[molly muffin]

Well there you have it, now you know why he couldn't handle the stress of noise or being outside away from you, his cortisol went low again.
That dose he takes now is lower than the before when he went low correct? He can't go back on vetroyl/trilostane unless his symptoms come back, he might need steroid for awhile even. If he ever does have to go back on vetroyl, then he goes at a lower dosage, but for now don't worry about that.

Ask them to check his electrolytes and make sure that they are okay.

Let us know, we'll be worrying about you both

hugs
Sharlene and molly muffin

[Alison]

That's us back. It was the night vet we saw and she wasn't quite as forthcoming as our own vet. I asked how low his cortisol was and she just said "low". From past conversations with our own vet, if his cortisol was below 5, then they start worrying (and I need to go back and look at the conversions) so it was obviously below 5.

He got a steroid injection and he's on 5mg prednisolone for a week and go back next Friday for a baseline cortisol. Of course we stop the vetoryl as well.

I asked the vet if his electrolytes had been checked and she said no, it wasn't necessary :confused: We'll need to wait till Monday to speak to our own vet.

He actually seemed to be a bit better by the time we got home, so I'm assuming the injection had started to have some effect - he looked happier that's for sure. Poor boy. :(

[goldengirl88]

Oh that poor baby, that is why he was so afraid, he had no cortisol in the fight or flight mode. I do not agree with the electrolytes not being checked as that can cause real problems. I just don't understand some if these vets attitudes with things that can be fatal, it just amazes me. I am glad to hear he is feeling better already. Blessings
Patti

[Alison]

I feel just so bad that I thought I was being kind, taking him different places for different walks and the poor baby was terrified.

I'm a bit fed up that his electrolytes weren't checked and I'll now need to wait till Monday to speak to his regular vet. I know that if my Addison's plays me up, I'll drink water with some salt and sugar in just to give myself a bit of a boost and I'm wondering if I should do something like that - or even give him rehydration drinks? Just in case?

[Harley PoMMom]

Without knowing for sure if any or what electrolytes are unbalanced I would not try any liquid supplementation, such as pedialyte, right now because these types of solutions may have high levels of potassium and some dogs with unbalanced electrolyte may already have elevated potassium levels, just my opinion.

Hugs, Lori

[Alison]

Thanks for that. I'll keep an eye on him, and hang off till I speak to his regular vet. He ate all his dinner tonight and is now lying, quite content, snoring his head off. He seems quite calm and relaxed now.

I swear we could see him brightening up considerably on the journey home - it was like his lights got switched back on.

[molly muffin]

That is probably a very good way to describe it. Before he would have been a constant state of anxiety and with a bit of help, he could just relax and enjoy himself again. A good snooze is always enjoyment to a dog. (you can tell by the way they end up on their back belly to the world half the time! :) )

hugs
Sharlene and molly muffin

[Alison]

You mean like this? lol

https://www.flickr.com/photos/14032726@N03/13786681714/in/photostream/

[goldengirl88]

I agree with what Lori said, and just wanted to add that if you did give him like Pedialyte it would then skew any electrolyte test you vet does and you would not have a true reading, so as you said I would hang on for your regular vet. Blessings
Patti

[molly muffin]

I mean Exactly like that!
haha
sharlene and molly muffin

[doxiesrock912]

Alison. that picture is hysterical!

[Alison]

He decided at 11pm last night that he wanted to play!!

He seemed to have a good night and this morning he wasn't bad. He went on his walk and it was left to him for how far he wanted to go. He was fine on the outward journey but he started struggling and fast panting on the way home so he's not 100% yet.

We'll just have to take it easy with him and see how he goes.

[goldengirl88]

I am so glad he was not afraid on his walk. I was worried about him when he went low. So glad you got him to a vet. I hope he continues to improve. Blessings
Patti

[Alison]

He wanted to go a little further on his evening walk but the further he went, the further he'd have to go home so we had to tell him it was home time. He's still not himself - normally we have a little chase and run but he didn't want to.

I know from personal experience when cortisol goes low it can take a few days to get over it so we'll just take it easy with him and let him dictate how he wants to play it.

He didn't eat much of his dinner tonight and he's still awful clingy. He just can't get close enough :(

[goldengirl88]

My Tipper is real clingy when she does not feel well. These dogs are smart and they stick close to the person who cares for them in case they need help. I am hoping you get you vet and fond out about the electrolytes as that could be playing a a role in this. Just keep him close and watch for any signs of distress. I truly hope he is just taking a while to spring back to his normal self. Blessings
Patti

[Alison]

He's still not right. Still very clingy and didn't want to go far this morning - just far enough to go to the toilet and he's still stressing when he's out :(

We'll need to speak to the vet tomorrow - but is it normal for them to take a while to get back to normal after their cortisol has dropped so low?

[molly muffin]

It can take awhile yes. Speak with the vet on monday about having the electrolytes checked. Also, it might not be bringing the cortisol up enough, although 5mg should. Rescue is very small dosage but he has been down this road before of his cortisol going to low. Even 60mg vetroyl is too much for him.

I wouldn't take him on very long walks. He might think he can go, but his energy level is going to be very low and not sustainable. For now, I'd let him out to do his business, then back into where he feels most comfortable.

He probably feels safe with you, as we now know this is an indicator of still low cortisol levels for him.

Sharlene and molly muffin

[Alison]

Thank you. I always think that prednisolone doesn't act quick enough - I have Addison's and take hydrocortisone as it's in your system quickly but I guess it's different for dogs - I wouldn't use dex as an emergency injection as again it takes too long to get active - but that's from a human perspective.

Just away to take him out for his afternoon stroll. I'll do what I did yesterday and not let him continue even if he wants to.

I feel quite neurotic - though I did say to the vet I felt I was being a neurotic mum - but I wasn't cos he was ill.

[goldengirl88]

You are not being neurotic, it takes a watchful eye to manage these Cush pups well and you are doing a great job. Blessings
Patti

[Alison]

Just spoken to the vet. We've to take him back in to get his electrolytes checked and I'll ask her to recheck his cortisol levels.

He's just not picking up at all.

My mum asked what his cortisol levels were on Friday and she said they weren't even registering.

I could cry.

[molly muffin]

Omg. That is danger low. He might need some iv fluids and larger shot of pred or dex.
Since this is is second crisis, please do not restart vetroyl unless 1) symptoms come fully back. 2) a test shows that his adrena l glands are now functioning.

Hugs
Sharlene and Molly muffin

[Alison]

We're back. They took more blood to check his electrolytes - the vet will phone later today with his results. He got another steroid injection and we've to increase his prednisolone from 5mg a day to 10mg twice a day and he goes back on Friday.

The vet said that it wasn't worth checking his cortisol today as they normally leave it a week before checking. He said the 5mg was quite low for a dog of his size hence the increase.

[Alison]

The vet's just phoned. His electrolytes are fine which is a relief.

She's not sure what's going on but she says it's like he's storing the vetoryl and will tick along OK but it's like it's building up in his system and then he's crashing which she says is not good.

He's to take it easy this week - no heavy exercise, no long walks and he goes back on Friday to get his cortisol checked again.

[goldengirl88]

Glad to hear the electrolytes are ok. The thing that concerns me is that the vet states he is storing up the Vetoryl, which it leaves the system within 12 hours. I am wondering how she then thinks this is possible?? That is the reason many use it, as it goes out of the dogs system. I am wondering bout the dosing you were doing. How many mgs and how many times a day? The dose may be too high, needs split up, or reduced all together. I definitely would give no more Vetoryl until he is well, and until this is figured out. He is lucky to get thru that Addison's crisis as well as he has. Hope he continues to improve. Just know you will want to ask what his numbers are any time this would happen, instead of the vet just saying he is low. Blessings
Patti

[Alison]

He was on 60mg once a day but if and when he's to go back on it, I'll see about twice daily dosing. It might be more stable doing that?

She couldn't give us numbers as his cortisol levels weren't registering :(

The vet just said it was as if he was storing it as he ticked along for quite a few weeks fine, then he suddenly plummetted.

[goldengirl88]

I am not thinking this vet is understanding how trilostane works, or he would not say the dog is storing it. How much does Cairo weigh? He should have started out on this at 1 mg per pound. If it is over that then that is the problem that his dosage is too high, and he is OK for a while until it takes the cortisol down too low into Addison's. If he is on the correct dosage then there is something wrong. How experienced is this vet at treating Cushing's? Blessings
Patti

[Alison]

He's lost a wee bit of weight and is now 27kg (about 60lbs)and was on 60mg.

Could it be that he's just needing a lower dose? We can only get Vetoryl in 10mg, 30mg, 60mg or 120mg doses here. Obviously we can mix and match to get the right dose if it's in between available strengths.

[molly muffin]

Yes just a recap for those who don't know. Cairo was on 120mg and crashed. Vetroyl was lowered to 60mg and once again, a crash.
In England they cannot currently have a full ACTH done, so base cortisol and electrolyte monitoring is all that is available.

Cairo, should not if and when symtoms come back, go onto 60mgs of vetroyl again. The dosage should be lower and perhaps even a spit. At 60lbs the 60mg was a decent dosage to be at, but he'd already crashed once on 120mg. I'm thinking now, a lower dose split of like 20/20, (you can get compounded trilostane). You could also try a 30mg AM and a 10mg PM. But not a 60mg of any combination since he crashed on that. That is IF symptoms come back completely.

Patti is correct. Vetroyl does not store in the body, in 12 hours it leaves the body. That doesn't mean that too large of a drug wouldn't send him into a crash, which we have seen. Every dog reacts differently and some are more sensitive, and it appears that Cairo is one of the more sensitive.

Hope that helps to clarify.
:)
hugs
Sharlene and molly muffin

[Alison]

Thank you. Yes that helps. He goes back on Friday to have his cortisol checked so we'll see what that says but I'll make sure he doesn't go back on that dose again and I'll ask about twice daily dosing as well.

When he was on the 120mg, his cortisol dropped to 17 and was caught on his routine stim test - he wasn't showing any symptoms of low cortisol at that point which scared me cos I didn't know if I'd recognise if he was too low - though I really didn't want to have to put it to the test.

We did get the stim test done on Friday - so I'm assuming we're back up and running with the synacthen now thankfully. I wonder if this would have been caught earlier had he been getting the stim tests.

I assume his cortisol will be quite high on Friday since he's going to have been getting 10mg pred twice a day? It was increased today because he wasn't picking up as well as hoped.

Oh, and I'm not sure if we can get compound trilostane over here - I've never heard of compound medications for dogs - but I could be wrong. I'll ask.

[goldengirl88]

Please post the results of the testing you had done so we can see if we can make anything out from it. Sharlene is right her needs a much lower dose and I would go with the 20mg morning and 20mg evening also. You so not want him to crash again. Blessings
Patti

[Alison]

I don't have his results in any paper form so I've went hunting for what I had.

His first stim test after diagnosis and being on 120mg was 88

He was left on 120mg but our vet was on holiday and it was a different vet that did his next stim test.

Cortisol was 133 on that stim test and that vet said to leave him on the 120mg.

His next stim test was done by our normal vet and she phoned urgently to say that his cortisol levels were only 17 and we were to stop his vetoryl for 10 days and repeat the stim test.

Next stim test was over 700 (can't remember the exact number) so she started him on 60mg this time and repeat stim test was to be done after 3 weeks.

Results after that were 60 (November 2013 and this was fasted)

January 2014 - 55 (baseline only and he'd been fasted)

February - 67 (this was baseline cortisol only and he'd had his breakfast with his pill - prior to this, we'd been told to fast him but then I found out that he should have been getting food)

[molly muffin]

These values are all nmol correct? I think that is the unit used in the UK.

Sharlene and molly muffin

[Alison]

Yeah, they are. Just trying to remember the conversion - it is posted somewhere - divide by 27.49?? Is that right?

[molly muffin]

you divide by 27.59

is first stim test after diagnosis and being on 120mg was 88 (3.18 ug)

He was left on 120mg but our vet was on holiday and it was a different vet that did his next stim test.

Cortisol was 133 (4.82ug) on that stim test and that vet said to leave him on the 120mg.

His next stim test was done by our normal vet and she phoned urgently to say that his cortisol levels were only 17 (0.61ug) and we were to stop his vetoryl for 10 days and repeat the stim test.

Next stim test was over 700 (25.37ug) (can't remember the exact number) so she started him on 60mg this time and repeat stim test was to be done after 3 weeks.

Results after that were 60 (2.17ug)(November 2013 and this was fasted)

January 2014 - 55 (1.99ug) (baseline only and he'd been fasted)

February - 67 (2.42ug) (this was baseline cortisol only and he'd had his breakfast with his pill - prior to this, we'd been told to fast him but then I found out that he should have been getting food)

[molly muffin]

Was he on pred after that first crash? That could have made his next stim (700nmol) go up a lot, because it is actually the abnormal of all of these.

[Alison]

No, he didn't get put on pred - just told to stop the vetoryl for 10 then repeat test and that's when it went up to over 700.

Having said that - all the previous tests were done fasted as we'd been told he wasn't to get anything to eat - then I discovered on here that he should have been getting his vetoryl with food so prior to the February test, he'd been fasted.

BTW - the vet we saw today (wasn't our usual vet) put his pred up to 10mg twice a day to try and get some improvement in him - is that OK for a 60lb dog?

[goldengirl88]

In my opinion the whole thing started off wrong. This dog should never have been started on 120 mg. This has all been mismanaged by these vets and I thank God your dog is still alive after all this.please make sure you feed him and give his Vetoryl and have the testing completed within 4-6 hours after taking the Vetoryl. Every time you take him for a test take him at the same time of day. Let us know his stim numbers , before doing anything with the dosage no matter what this vet says. Please let him fully recover, then go low and slow with any changes. The 20 mg in the morning and 20 at nite will be a lot safer for him to start back on. Same dogs can have real sensitivities to this drug, so low and slow is your best bet. I feel so bad for this dog. He must feel rotten after all this. There is a lot of experience on this forum, and you can trust what they tell you, we only want to keep your dog safe which is paramount after all this mess. We will all be here to help you every step of the way. Give Cairo a hug for me he sure deserves it! Blessings
Patti

[Alison]

I do appreciate all your advice and every time I went to the vet, I expressed concerns and told her what I'd been told but she was convinced she was doing the right thing going by Dechra's recommendations. When she put him on the 120mg, that was right in the middle of the dosage guidelines and even now, she says that 60mg is the bottom end of the recommended dose for his weight.

It's become obvious that Dechra need to sort out their literature that goes out to vets - they maybe need to instruct vets to start low and slow instead of having them hammering drugs into the dogs.

Nobody feels worse than I do. I can't forgive myself for what's happening to him.

[molly muffin]

OMG, of course no one feels worse than you do about what Cairo is going through and it's really only because you got him in and demanded that they do the tests that he has made it through this.

I blame Dechra completely for the mess, along with vets, but I can tell you that here in Canada and in the UK it is not like in the states,where you can pick up a phone and talk to Dechra personally about what to do. We can't and are told that they will only talk to the vets themselves and the vets are told they need to speak with the manufacture reps who sell/provide the the medication. They haven't updated their literature and they won't from what I understand. The reps read the same literature by the way that is included in the medication inserts, so we are rather royally screwed on this and have to fight for every little step.

On the forum here, luckily, we keep up with the latest studies and what the universities and professional IMS's are doing with cushings. That is really the only edge that us who are not in the states have, is a forum like this.

In the UK it is even harder to get compounded trilostane. It can be done, but it's not easy and most vets haven't a clue they can or how to go about it. My vet here in Canada didn't have any knowledge about it either, and only when my IMS mentioned it and thank goodness I have that in writing, was trilostane considered an option.

It's darn hard and you have and will continue to be Cairo's champion, I know that.

I'd have to go back through our thread, but was an ultrasound ever done? or is that even an option? It might be worth it to see if it is possible, just to see what is going on inside of Cairo. Something to think about and maybe talk to your vet about.

Even though 60mg is on the low side of the recommendation, what works is unique to any dog, and those are only guidelines. We know that Dechra in the states is no longer starting dogs out at the high end of the range, but at the low. I wish the rest of the Dechra world would get on board and put that info out to every vet. *sigh*

Okay, I'm ranting at this point. I just want you to know that we DO know that you care and are doing your very best for Cairo and we understand that it is sometimes an uphill battle with the vets.

hugs
Sharlene and molly muffin

[Alison]

Thanks Sharlene:) I tried getting in touch with Dechra, and as you said, they won't have anything to do with me.

I think an ultrasound was mentioned at the beginning but if my memory serves me well (which most of the time it doesn't) the vet said that the LDDST indicated pituitary based so it wasn't worth putting him through the ultrasound. I was just saying to my mum tonight though that I wonder if it's worth getting it done. Only problem is that Cairo doesn't sedate well - and I'm convinced that's down to the Cushings - I don't know if I'm right or wrong - but many years ago, I had to get a gastroscopy and I was sedated and don't remember a thing about it - but most recently, since my Addison's diagnosis, I had to get one and they gave me extra steroid before it, sedation and I fought like a mad woman and I reckon it was down to the extra steroid. Anyway, I digress. I think if I can ask her to sedate him and let me be there for the ultrasound so I can keep him calm, that could be an option - but I don't know if they would let me do that. Vets here seem to be a bit funny about you being around when things are getting done - like the vet the other day (not our normal vet) asked if we wanted her to take him away to get his injection - err, no, he stays with us.

I really did try though to get the vet on side about the initial starting dose but because of the Dechra literature, she wouldn't be swayed. I suppose I can see where she was coming from - the manufacturers literature said one thing and the neurotic owner was saying something different. I've no idea how UK vets can be informed about new research in the US if Dechra aren't going to sort out their literature.

Has Dechra US actually stated about the lower starting dose? If they have, I have the urge to write to Dechra UK and rant at them. I did have a look on both sites and the literature seems to be the same.

[flynnandian]

http://www.medicanimal.com/setSessionLocaleProductList/category?category_id=MA-PRESCRIPTIONS_A_Z-BY_NAME_U_Z&locale=en_GB

it is much cheaper with a prescription from your vet.

[Alison]

Thanks for that - I got his first lot from the vet (nearly fainted at the price) but I started getting prescriptions and get them from either Medicine4Pets or Animed. Animed are slightly cheaper but the service at Medicine4Pets is excellent.

It's almost half the price of getting it from the vet - it's actually shocking how much more expensive it is from the vet.

[goldengirl88]

Just know it is not your fault about Cairo, I know you love and care for him. Dechra certainly is hurting a lot of dogs by not changing their instructions and updating things the way an responsible company should. The vet, now there I have a problem. They should be keeping abreast of the changes as we are if they are treating dogs using this drug, there is no excuse for their ignorance. As far as the vet not being swayed, she does not have a life outside her office with this dog. So if things go wrong, it will be you that is impacted not her, so if it were my dog I would not allow her to do this. She has already made many wrong decisions that could have been fatal. I would tell her if she cannot compromise after all the errors she has made I would go to someone with a knowledge of this disease and that is willing to work with you. This is your dog, not hers so you will have to put your foot down, as far as her making final decisions. There are many vets that know very little about this disease and it's treatment, I have one of them. My dog would be dead if I let him make the decisions. Instead we go over what is going on, and after I consult with everyone on this panel, I then make the final decisions. He knows it must be that way, and believe me anyone on here can tell you how many times I have gotten into it with him over my Tipper. I know when he is wrong and I must face the facts and confront him with the issues. It is not fun let me tell you, but I do what I have to do. You are the only advocate for Cairo so please consider what I have said. I only say it out of my deep love for all animals, and don't want you to lose your dog, not to blame you. Blessings
Patti

[flynnandian]

buying vetoryl from the vet is indeed very expensive. lots of bonus for the vet selling it at those high prices. half of it is profit.
glad you found a cheaper way to buy vetoryl.

[Alison]

I've had a good talk with my mum and said to her that when he goes back on Friday, if the vet won't listen to us, we need to try and find a vet that will. We're a bit restricted here as there are only two other vets local to us and I've not heard great things about them. There is another vet miles away but he might be worth speaking to.

I just want to check though - the vet has increased his prednisolone to 10mg twice a day - for a 60lb dog, is that OK?

His stools are a bit loose - not diarrhoea - just a bit squishy and he is absolutely stinking - could it be the pred causing that?

He's still not managing much of a walk and we're not letting him go far - just enough to toilet then home again.

[goldengirl88]

I will have to let someone with prednisone experience answer your question. I believe you are doing the best thing for Cairo searching out a new vet. I am so sorry he is not feeling well, but he has been through a lot, and to his credit survived all this. Hopefully he will be on the mend soon and you will be able to get him straightened out. He is a beautiful dog and looks like he kept most of
his muscle. I am sure everything will work out once he gets to feeling better and
gets on the correct dose. Blessings
Patti

[My sweet Ginger]

"I dose prednisone or prednisolone at 0.1-0.2 mg/kg/day. If the dog develops polyuria and polydipsia (PU/PD) or any other signs of iatrogenic Cushing's syndrome, I would lower the dose as needed. I rarely, if ever, give a higher dose than 5-mg per day to ANY dog. The 5-mg dose is the average human maintenance dose, and we see very few dogs that weigh over 70 kg."

I found this on one of Dr. M. Peterson's blogs as a response to a question on Addison's topic. I know Cairo is not yet proven permanently Addison's but he's having an Addisonian crisis, right?
20mg daily seems a lot. Is this 10mg BID for a short term use? How many days are you supposed to give it to him?

[Alison]

Yes, he had a crisis - his cortisol levels weren't even registering when they were checked on Friday last.

He got a steroid injection on Friday night and then he was started on 5mg once a day on Saturday but he wasn't picking up so we took him back to the vet on Monday and he had his electrolytes checked and the vet gave him another steroid injection and said to increase the pred to 10mg morning and night until he goes back on Friday - they don't want to have him on that any longer - so it'll be 3 days on 20mg and then on Friday, he'll get the 10mg in the morning and then he's at the vet.

He's certainly peeing for Scotland at the moment but we knew that he would with the steroids.

I'm now just questioning everything after what's happened to him. I didn't know how quick he would pick up after starting the steroids but I don't want him to be getting too much either.

[Alison]

If he's on a high dose of steroids, even for 3 days, would he need weaned down off it?

We're a bit dubious about giving him 10mg in the morning and at night. He's had 10mg this morning but we're thinking of not giving him the night time dose and changing it tomorrow to 5mg in the morning and 5mg at night.

I don't know what to do.

We're even wondering if once he's off the steroids if we should get a different vet to retest him for Cushings.

[goldengirl88]

I think I would get another vet to test him. This vet seems to have really messed all this up and I would not be trusting her. Remember to feed him and Vetoryl given, then the test within 4-6 hours. I take my Tipper at the same time of day every time she is tested. I don't have experience with prednisone, so I cannot speak to that question. I would start off new with someone else willing to listen to your concerns and willing to work with you. I am so sorry you and Cairo are having a bad time. My Tipper has some issues this morning too, so I am watching her for signs she is too low. Blessings
Patti

[Alison]

I feel absolutely sick with worry (and all this worry isnt' doing my Addison's any good). I've got to pop out this afternoon so I'm wondering if I should go into the other vet and ask them about their experience with cushy pups.

[goldengirl88]

I would, and ask if they are willing to work with a knowledgeable owner?? I just looked on Dr. Mark Petersons blog. This is what he says:
Stopping the prednisone abruptly can cause destabilization of the metabolism. So that is your answer, he must be gradually taken off. The recommended rescue dose is 0.1- 0.2 mg. Any polydipsia or polyuria going on you must reduce the dose. You will need to get Cairo's file, so the new vet can look it over. Just be
honest and tell them your concerns about Cairo's safety. Wishing you luck, and hoping this new vet will be a better choice for you and Cairo, as you don't want the same situation you just had. Blessings
Patti

[Alison]

We're arguing with ourselves about the 2 x 10mg pred doses a day. He had 10mg this morning and certainly seems more like himself but we're not sure about the 10mg at night. My mum's wondering if we should give him just 5mg instead of the 10mg and instead of not giving him any. The peeing seems to have calmed down as well. Yesterday he seemed to be desperate for a pee all the time but today it's a lot more normal.

I will certainly be querying about weaning him down. My mum says to wait till we take him back to our vet on Friday and see what she says and if we're not happy, then we'll hot foot it to the other vet. I know what she means but I'm still worrying

[Squirt's Mom]

I would think you could tell if he needs the pred tonite or not. If he seems to be backsliding, I would give what the vet recommended. ;)

[My sweet Ginger]

In another one of his responses I read that some vets prescribe higher doses to help with inflammation , etc. for a short term use only for a few days and then gradually reduce the amount down (usually by half each decrease) to the ideal maintenance dosage. So I hope that's what your vet is doing to jump start his system tho 20mg seems quite high.
I wouldn't know how but if you do, maybe you can try to get on Dr. Peterson's blog and ask him and see what he says? Google - Q&A: what's the ideal prednisone dose for dogs with Addison's diease? - and go from there and I hope you will be successful talking to him. You will see many links to him.
In regards getting a new vet, how about try to find a good IMS (you may have to travel a long distance) and get a consultation? If your vet is otherwise nice and willing to work with you, follow the new IMS's direction on how to treat Cairo from now on but get all testings done by your regular vet as that will save you a lot of money. Be upfront about it with your vet and all three of you are going to work as a team to treat precious Cairo. You may need a referral from your vet but you're not obligated to see who she normally refers her patients to. You can research and find the one you like and it could end up who she recommends.
That's what I ended up doing with my dog and the costs are less than half with our regular vet. She just performs tests for us and I must say she is not thrilled about it as far as I can tell. When I think about my Ginger's well being and I'm her ONLY voice, magically it takes all the fears away that I had toward any professional and I become brave:eek: to my surprise. You just have to make her understand that you, the owner makes the final decision for YOUR dog and not her.

I hope Cairo gets better really soon but be patient as it takes time, weeks or months to find out what's really going on inside their body and how to stabilize their whacked hormonal balance back to ideal level. I'm so sorry you have go through all this but things will get better. I will pray for you and Cairo.

[Alison]

Thanks all. I'm just away to take him for his evening outing so I'll see how he is. If he has less energy than this morning, we'll maybe give him 5mg instead of 10mg of pred. I don't want him pinging off the ceiling by giving him too much.

I did think of contacting Dr Peterson - I have before when we had no synacthen here for his advice and he was lovely and replied quickly.

What's an IMS? I'm not sure if we have specialist vets here. We do have the veterinary college about 100 miles away but you need a referral there and it's whether my vet would do it or not - but if you don't ask, you don't get.

This will teach me for feeling smugly satisfied that Cairo was doing so well. It's brought us down to earth with a crash though I was worried if I'd recognise the signs that all was not well but I guess at least it's shown me that I did recognise the signs but I most certainly wouldn't have wanted this to happen just to show me :(

[Woodydog]

Hi Alison

I've been reading your thread I'm from Scotland too and used a fab IMS internal Medicine Specialist if you demand your vet refers you then they have an obligation to do so. Let me know where you are and I will see if I can help with the IMS. I used a fab one.

[Squirt's Mom]

IMS = Internal Medicine Specialist

[My sweet Ginger]

Good and good. I'm sure Dr. Peterson will reply quickly as he sure will recognize the urgency in Cairo's situation. Please, let us know what he says.

That's wonderful that Tracy can help you with finding an IMS in your area, a good one. There are good ones and not so good ones from my experience.
Just request for a referral to see a specialist which I think is within your rights as a patient and probably she will refer you to whom she usually works with who you're not obligated to go to. If there's a better one around, go see that IMS. I hope Cairo keeps improving.

[Alison]

We're just back in from a short walk - he wanted to go further but we're not risking it. He was skipping along, although he was panting - but so was I because it's quite warm here today. He is having rather long pees. The higher dose of pred this morning seems to have worked a bit better though we're still wondering if we should be giving him another dose tonight :confused:

[Alison]

Am I better contacting Dr Peterson through his website or posting a comment on his blog? Anyone know?

[My sweet Ginger]

What about the one you were successful contacting him the last time and got a quick reply? Or why not all?;):eek:

[Alison]

Hahahahaha. It was his blog I posted on last time.

[My sweet Ginger]

You'd better get on it then. It's 2:10 EST here yet. Good luck.:)

[goldengirl88]

I would try the blog, and if nothing go to other means of contacting him. I would be cautious like you in this warm weather about him walking. Tipper can't go when it is hot or humid because of her heart, or when its real cold. I know how you are feeling, and worrying that cannot be good for you. I know when they used to make me take prednisone it was a gradual reduction to get off it. I also read something very interesting about prednisone, that the liver makes it into prednisolone. If your dog has any hepatic issues you should use prednisolone instead of prednisone. All this stuff you have to learn we should all be licensed vets by now!! Hope you get an answer quickly. Blessings
Patti

[Harley PoMMom]

I think asking Dr Peterson's on his blog is a good idea. I just looked at his blog concerning addison's and many people have asked questions to which he has answered. Here's a link for anyone interested in that article: Q & A: What's the Ideal Prednisone Dose for Dogs with Addison's Disease? (http://endocrinevet.blogspot.com/2011/02/q-whats-ideal-prednisone-dose-for-dogs.html)

Hugs, Lori

[Alison]

I've emailed Dr Peterson (since it was fairly long winded) but I'll post to his blog as well - belt and braces approach!!

My mum phoned our vet to say that he was as bright as a button so should we hold off giving him the other 10mg pred tonight as we didn't want to overdose him and we certainly don't need him up all night either. The receptionist said that if the vet said twice a day we should give it twice a day but she'd get her to call back - we're still waiting and they closed an hour ago.

He was absolutely starving so he's had his dinner - minus the 10mg pred - I hope we've made the right call but he's so bright and chirpy, he doesn't look like he needs it.

I knew about the synthesis (or whatever you call it) re prednisone but it is prednisolone he has.

Honestly, in days gone by, you trusted your doctor or vet to know exactly what to do but nowadays you've got to become your own research expert to make sure that things are getting done properly.

[Harley PoMMom]

What worries me is that since Cairo is on such a high dose of pred that a tapering might be needed. If Cairo seems to be "off" than an additional dose of pred may need to be given.

Hugs, Lori

[Alison]

That's what's worrying me as well. There's no way that I'm going to just stop it. If we're told just to stop it, then that's going to be the final nail in the coffin with the vet.

We didn't give him the dose tonight, so he's had 10mg today instead of the 20mg they said but we'll keep a close eye on him. As I said, he seems very bright so far which is part of the reason we didn't want to give him even more steroid.

[molly muffin]

Now a days you have to be up on everything it seems. What is great is that we have more access to information too, which in the old days we wouldn't have had.

No they haven't put out anything different to the vets here I don't think, however, on various phone calls with members, they have suggested starting at low end range.

Sharlene and molly muffin

[goldengirl88]

You are doing the right thing. Dr. Peterson says to taper it off, so that is the correct procedure. I cannot believe that your vet never even addressed this situation with you and just gave you the prednisolone but failed to give instructions on weaning him off to prevent further problems. She is very careless in my opinion. Yes gone are the days of letting your vet handle things. It puts a lot of pressure on the owner to check everything the vet is doing to make sure it is right. My vet has made so many errors that would have been fatal that it is pathetic. I only use him as there are no other vets where I live, and I need him for prescriptions etc.I basically tell him what needs done when something comes up and he does it. That is our relationship as I do not trust him. Thank God for this forum, my girl probably would not be here without it. Blessings
Patti

[Alison]

Well, he's a lot better this morning. He had a nice walk - not too far - but no puffing and panting and stressing.

I confess we didn't give him the extra 10mg last night - he was totally hyper off the morning dose. We tried to speak to the vet last night but nobody phoned us back.

My mum spoke to a vet this morning who said that the prednisolone wouldn't be making him hyper - he was just feeling better - and to keep giving him 20mg a day - he said that was quite a low dose for him.

I beg to differ on all that. I know what high dose steroids do and 20mg prednisolone is equivalent to 80mg hydrocortisone and that's a massive dose.

I've not heard back from Dr Peterson yet but I realise there is a time difference so I'll keep an eye out for a reply.

[My sweet Ginger]

??? 20mg prednisone is quite a low dose for him? Wow!
I don't know what to say to that. If Cairo is feeling better now does he still need 20mg? Why not start to wean him off like 5mg in AM & 5mg in PM so on and so for until he gets down to his maintenance dose?
I wish I knew more about this.:(

Too bad you haven't heard from Dr. P yet. Hope he replies today.
Hang in there, Allison. You are a wonderful mom to Cairo.:)

[Squirt's Mom]

Pred doesn't make you feel hyper?! Oh, I beg to differ! Pred will make you feel all kinds of weird and do strange things - I just finished a short round myself not long ago and could tell some tales! That vet does NOT understand drugs in the least it seems. :rolleyes: I think I would suggest they take an equivalent dose for humans for the same amount of time then tell you it didn't make them hyper! :D

[Alison]

Oh I know. I have Addison's and when I had to get a tooth out, I needed extra steroid cover but they gave me double what I really needed. I was bouncing all over the place and really agitated and starving hungry, so telling me that it's not the pred just doesn't cut it.

[molly muffin]

I think Leslie was trying to do hand stands and jumping jacks at the same time when she was on the pred. :eek: :D:D

That is a vet who has never had to take a steroid themselves eh. ;)

You on the other hand on doing just great with Cairo and know a thing or two about the pred stuff.

hugs
sharlene and molly muffin

[Woodydog]

Hi Alison how is Cairo tonight still good I hope

[Alison]

He seems to be well tonight. Still peeing for Scotland but I'm knackered. What was meant to be a gentle stroll turned into our usual "staffy pace" walk - it's like a bloomin route march. He was racing up the road though he did slow off a bit on the way back - in total, it's probably less than half a mile he's doing but it's all he's getting to do just now.

He's just had his dinner which he scoffed down like he hadn't been fed in a week. It's nice to see him eating properly. He's content after his dinner so I'm not too worried - he's not trying to scrounge more food (unless somebody has fruit on the go - he loves an apple)

[Alison]

Hahahaha, I can imagine. I was meant to rest after having an extraction and I was cleaning and looking for food, lay down, jumped up, looked for more food, had chicken noodle soup and got a noodle stuck down the socket so went back to the dentist, got home did more cleaning, ate some more - you get the picture! LOL


I think Leslie was trying to do hand stands and jumping jacks at the same time when she was on the pred. :eek: :D:D

That is a vet who has never had to take a steroid themselves eh. ;)

You on the other hand on doing just great with Cairo and know a thing or two about the pred stuff.

hugs
sharlene and molly muffin

[goldengirl88]

It would seem everything this Dr. says is wrong!!! Good thing you know about the pred. I am glad he is feeling well. Hope he continues to improve, and now you can take a deep breath and relax as your baby will be OK. Blessings
Patti

[Alison]

It's quite worrying really - maybe I'm doing the wrong thing not giving the dose the vet said but poor Cairo was sitting bolt upright in his bed last night, eyes wide open, looking totally wired - and that was on half the dose the vet said, so goodness knows what' he'd have been like on the full dose.

We'll continue to keep an eye on him and fingers crossed for Friday.

[goldengirl88]

Just checking in on Cairo. Hope he is doing better each day. Are you tapering him off the pred? Did Dr. Peterson answer you? Blessings
Patti

[Woodydog]

How is Cairo today Alison

[Alison]

Dr Peterson didn't reply :( I'll try again - nothing like stalking somebody.

He seems to be not bad though he was a bit slow on his walk tonight. Mind you, I had been shopping and just took him straight out and told him no running cos I had 3 inch heels on - so not sure if he didn't fancy me falling over on him or if he was just not in the mood. He seems alert enough but he was content just to stroll up the road, snuffling in the grass.

Vet's tomorrow.

We've not started to taper him yet as I'm not sure how quick to do it for him - plus he's not been on the dose they said as I felt it was far too much. He wouldn't be able to sleep if I'd given him that big dose.

[Woodydog]

Fingers crossed for your vet visit tomorrow

[Trish]

Hi Alison

My dog has been on prednisone recently, admittedly for a different reason. He was on it for allergies which were out of hand. He weighs 13.5kg, his dose was 5mg twice a day for a 5 days, the 5mg once a day for 5 days, then 5mg every 2nd day for three doses. We did get him off it quick as it played havoc with his liver numbers that he had tested while on it his ALP shot up to 4000+. This dose may well be different to a dog in Cairo's situation so don't go by that, just showing you how my vet weaned it down.

Good effort walking Cairo in 3 inch heels! I'm impressed :)

[Alison]

It wasn't easy! Admittedly, they were platforms so you could take a bit off the height but I must've looked ridiculous, mincing along!!

That's useful to know for the weaning down - it gives me something to compare what the vet says tomorrow. My gran takes pred for an inflammatory condition and I know how I wean her down if she's had to increase her dose but I'm guessing it's not the same with the dogs because with her, the lower she gets to her maintenance dose, I go to 2.5mg and then 1mg tablets.

I'm hoping his bloods tomorrow are good. I can't believe how anxious I am about it!

[Trish]

One other bit of info, my vet also told me that when he discusses prednisone doses with his clients who are also nurses (like me) they freak out (also like me :D) at how high they are compared with people. He said dogs bodies are different in the way they metabolise prednisone and hence often need more than what we think when compared to human doses. :)

[Alison]

Ahh, you see I freaked out at the vet wanting him on 20mg pred a day - that's a massive dose as far as I'm concerned but nobody explained what your vet explained. They just said that the pred woudn't cause him to be hyper - which is a lot of hooey because it does and he is!!

[Trish]

Flynn did not go hyper on it at all, he acted fine and I was real happy it sorted out his allergies so fast and this is after trying a ton of different foods, creams, showers etc so it was a kinda last resort. But not liking the liver numbers going sky high. Apparently happens a lot and we are testing again soon to make sure they come down. He also has IBD and his IMS recommended treating that with pred if it got out of control. Recommendation for the IBD treatment was 1mg/kg twice a day initially, so that would be quite a big dose. Hopefully we do not have to go there. So these doses of pred can change depending on what they are treating them for, I think the experts here have a record for what the rescue dose should be for addisons dogs though, maybe someone has mentioned that earlier in your thread and I have not read back far enough! But I think if my dog was hyper and sitting up in bed in the middle of the night with his eyes wide open would freak me out!!! You do what you gotta do :) Good luck at the vets today and I will be looking for the update later!

[Alison]

Quick update. We thought he was getting baseline cortisol but she decided to do a stim test to see how his adrenals were working, so he's had first bloods and synacthen injection and we've to go back for 1.30 for second blood draw.

She says she's not putting him back on vetoryl because 60mg is a tiny dose for a dog of his size and he's not coping with it. I asked her about a smaller dose twice a day but she said no.

Obviously his blood results are going to have an impact on where we go next but we can't leave him with untreated cushings so if the symptoms do come back, we have to see another vet, one that will work with us.

She did say about a referral to Glasgow vet school - that's an option.

[goldengirl88]

If it were me I would not listen to this vet. She has given you so much bad information. I would go to the vet school or to another vet. Hope it all works out so Cairo can resume feeling better. Blessing
Patti

[My sweet Ginger]

Take the referral and run! She not only doesn't sound like a team player but also stubborn and not up to date. Get all the copies.

[Alison]

sort of a result!!

His baseline cortisol was 96 nmol (3.5ug I think). She's away to run his next blood to see what he stimmed to and then phone us.

She said she's going to phone the cushing's expert at the vet school and ask his advice. She says that her concern is that putting him back on vetoryl may damage the adrenal cortex which is why she's hesitant but she's going to seek expert advice. I said me and my mum had been talking and wondered if 20mg in the morning and 20mg in the evening might be the way to give a lower dose and more stable result. She said that could well be the way to go but she's going to speak to the experts at the vet school.

[My sweet Ginger]

Now that sounds a lot better than what was said in your previous post. Getting an expert's guidance is always the way to go if you are now sure so I feel a lot better with this approach.

[Alison]

It's much better - she only suggested it when we went back for the second blood draw. My first message was after the first blood draw and we were in a bit of a panic at the thought of him not getting any treatment at all.

[My sweet Ginger]

It's good that she's changing her tone but we still have to keep on eye on her with every decision she makes to keep Cairo safe.;)

[Alison]

I know. But I'll be checking every suggestion on here first!!

[My sweet Ginger]

Yeah, unfortunately that's what we have to do with so many incompetent and inexperienced vets with cushings these days.
I'm so thankful that these expert angels are watching over us for our fur babies 24/7. Bless them for their constant dedication.:cool::cool::cool: With many thanks.

[Alison]

I'm still waiting on her phoning back with his stim results. I guess she's still trying to get a hold of the guy at the vet school.

We did confess that we hadn't given him the 20mg pred per day as he was fine on the 10 and she was fine with that. Said not to worry because he obviously had done fine on the 10mg and it made it easier to wean him off it.

[labblab]

Quick update. We thought he was getting baseline cortisol but she decided to do a stim test to see how his adrenals were working, so he's had first bloods and synacthen injection and we've to go back for 1.30 for second blood draw.

She says she's not putting him back on vetoryl because 60mg is a tiny dose for a dog of his size and he's not coping with it. I asked her about a smaller dose twice a day but she said no.

Obviously his blood results are going to have an impact on where we go next but we can't leave him with untreated cushings so if the symptoms do come back, we have to see another vet, one that will work with us.

She did say about a referral to Glasgow vet school - that's an option.
I am so sorry to tell you that for an ACTH stim test to have any accuracy, a dog must be prednisone-free for at least 24 hours prior to the testing. Otherwise, the stim result is skewed by the supplemental steroid and is not an accurate reflection of the natural cortisol production. The other alternative is to substitute dexamethasone for the pred during the day/s prior to testing because dexamethasone does not affect the result in the same way.

Was Cairo prednisone-free for 24 hours? If not, I'm afraid your money is wasted. I think a consultation with the vet school is a very good idea.

Marianne

[Alison]

I thought that the ACTH stim test wasn't worth it on the pred - he had a dose this morning at 10am and we said to her was it right to do the stim test with him on the pred and she said that pred had no effect on the stim test.

She's just phoned and his post stim results are 175 (6.3). She says that it's a bit higher than she would have liked.

My mum asked again if the pred would not have affected the test and was told not at all, she wanted to make sure that his adrenals were still working and they were.

I know from an Addison's point of view, we don't get stim tests whilst taking hydrocortisone or pred - it either has to be replaced with dex or stopped (which is risky if you're diagnosed Addison's)

Oh, and just to double check - he's been on 10mg prednisolone. We've to give him 5mg tomorrow, 5mg Sunday, miss Monday and then 5mg Tuesday and then stop it - does that sound right?

[Woodydog]

Alison have pm,d you my boy went to Glasgow vet school and we saw some wonderful people there

[labblab]

I believe your vet is mistaken.


ACTH Stimulation Test: Prednisolone, prednisone and hydrocortisone will cross-react in the cortisol assay and give falsely elevated results. Such therapies should be avoided in the 24 to 36 hours prior to the test. Dexamethasone does not have this effect so it can safely be used prior to confirmation of diagnosis without causing assay interference.

http://thehormonelab.com/handbook/adrenocortical-function/canine-hypoadrenocorticism-addisons-disease

From an article by Dr. Peterson:


It is possible, however, that you are measuring some of the prednisone in the assay for cortisol, especially if you are giving the prednisone within 24 hours of the ACTH stimulation test. Prednisone and prednisolone will both cross-react in the cortisol assay to falsely increase the measured serum cortisol values.

I'm really afraid you need to consult with somebody who knows what they are doing, both in terms of Cairo's prednisone taper and also his long-term treatment path.

Marianne

[My sweet Ginger]

Other than Cairo's adrenal glands are stimulating I'm not so sure if those pre and post numbers are quite accurate with prednisone still in his system when the test was performed. I'm sure there's something that you can print out and show it to her why this test may not be accurate and request for a redo. It is so hard and frustrating, isn't it?
I guess another question for Dr. P. Has he replied to your email yet?:mad:

How far is Glasgow vet school from where you live? Can you go there and get a consultation? I'm really not sure about your vet.

[My sweet Ginger]

Thank you Marianne.;)

[lulusmom]

Your mum was right to question the impact of prednisone on an acth stimulation test. Your vet's comment that it has no effect on the test is simply not true. It can either blunt the response or depending on the dose of prednisone, it can falsely increase cortisol on an ACTH stimulation. It is very unfortunate that the stim test you just paid for cannot be used to assess the true cortisol levels. This type of thing upsets me greatly as it's a struggle for most of us to find the money to pay for diagnostics and treatment. Many sacrifice and forego their own needs to give their dogs a better quality of life. We don't need uneducated vets wasting what little resources we have and more importantly, placing our dogs at undue risk while wasting our money. Bottom line is that the dose of prednisone you gave Cairo less than 24 hours before the stim test, could very well have artificially elevated cortisol levels, meaning the post stimulated cortisol would most likely have been lower had you waited 24 hours after the last dose of prednisone. If a vet were to increase the dose based on artificially elevated cortisol, it could throw a dog into a life threatening crisis.

I highly recommend that you share some educational material with your vet on this subject. I have provided a link below to Dr. Mark Peterson's blog entitled, Trilostane, Prednisone, and ACTH Stimulation Testing in Dogs with Cushing's Disease. You can either provide the link to your vet or print out the blog. Either way, I sincerely think she needs some continuing education so as to not do this to future clients and their dogs. If I were you, I would also ask her to waive any charge for the acth stimulation test.

http://endocrinevet.blogspot.com/2013/11/trilostane-prednisone-and-acth.html

Glynda

P.S. I see that Marianne posted before I had a chance to finish my own....that's what happens when work gets in the way. :) In any case, my post validates Marianne's and you now have two links to information for your vet.

[Alison]

If Cairo wasn't still under their "care" at the moment, I'd be kicking up hell. There must've been about 5 or 6 stim tests carried out while he was fasted - he got his vetoryl on the day of the test but we were told he wasn't to get food and then I found out that it was really important that he did have food with the vetoryl - so these tests were all a waste of money - and at £115 per test, I could weep. I don't work any more due to my own ill health and he's not insured so it's not as if I have money flooding in.

Between me and my mum, we asked her three times if the pred would not have an impact on the test and she said not at all - she wanted to make sure that his adrenals were functioning properly after the vetoryl over dosage.

The vet school is probably about 100 miles from us give or take a bit. It's a long journey for Cairo - he's never gone that far before in the car, but if I have to take him there I will. I need to go and start speaking to the other couple of vets here though to see how experienced they are. If they are any good and I can get him moved, then I kick up hell with the vet.

I don't know whether to cry or scream or both.

[goldengirl88]

Ask the vet for a refund from those tests. See what kind of reaction you get from her! Get your money and get rid of her before she kills Cairo, sorry to be so blunt, but this is horrible, she is dangerous. Blessings
Patti

[My sweet Ginger]

Oh my lord, I feel your pain. That was a lot of wasted money on you and also a lot of unnecessary torture on Cairo. Why don't you just do the opposite to whatever she says from now on if you decide to stay with this vet.:eek: I think Cairo will be safer that way.:rolleyes:
What you need to do is to take a few deep breaths and channel all that bottled up energy into finding a better Cushings experienced vet for Cairo as he needs one ASAP and give your piece of mind to this vet at a later time.
If you end up going to Glasgow, how about breaking up the ride and take a few breaks on the way like every 30 minutes or so. Hopefully that will help him.

I have to say one thing tho. I can see her point of doing the test to see whether Diamond's adrenals were stimulating at all as my own IMS said the same thing and we ran an ACTH test just for that purpose so we didn't skip the pred on the day of the test as it was necessary for her to function but to say that prednisone won't affect the result is so wrong and would make me doubt everything else she says about anything.

[molly muffin]

Feel free to do both and loudly. I mean Wail it out out. :) Sometimes its can be very therapeutic.

You do know the things to ask any other potential vet going forward though. So that is good. You can ask, how much experience do you have with cushings, what sort of treatment, fast with testing or non fast with test, do you think pred has any affect on acth testing, what kind of dosage would you recommend with a 30kg dog, etc etc and just see what they say.

hugs
Sharlene and molly muffin

[Alison]

It's a holiday here this weekend I think but I'll go to the other two vets in the area and speak to them. They might even be a bit cheaper for all the necessary tests - I can live in hope.

I maybe didn't pick her up properly when she said the pred wouldn't have an effect on the test - she maybe meant that she'd still be able to see if the adrenals were functioning - though I realise the actual numbers would probably be out because of the pred.

It's just a nightmare. I feel like I'm letting him down but we've been with that vet for so long that I'm almost scared to go elsewhere in case they're worse - you know, better the devil you know? I can't let this go on though for his sake.

[Alison]

Thanks Sharlene. One of the other vets here used to be a partner with the vet we're with but he left many years ago and set up on his own. I'm not sure why - though somebody I know goes there and she said it was because he wanted to keep the personal touch - the practice we're with got huge and less personal.

[goldengirl88]

You need peace of mind especially since you are not well yourself. Cairo needs to feel better and be safe. This vet cannot provide either. It will be OK, and it will work out, just go to the other vets and ask the proper questions before committing to them. I understand you don't want to go from the frying pan to the fire so just ask questions up front this time. How is Cairo acting now? Does he seem like himself? We are all in this with you, so it will work out. Blessings
Patti

[My sweet Ginger]

I left our vet who we'd had an excellent relationship with for over 10 yrs once I'd realized my Ginger's safety was at risk if we went with her instructions and I didn't think twice about it and I'm so glad that I did when I did. Sometimes you just know it and this is coming from a person who second guesses everything she does.:o
From the sound of it tho I don't think she will be topped easily. I'm sure you will be able to find a better vet and you are not failing him.
We all can see how much you love and care for him and trying do do everything possible to make him feel better and safe. You just can't give up. Things will get easier and better so hang in there.:)

[Alison]

Thank you so much guys. I'm welling up at the support we're getting.

It's kind of hard to say how he is. In the house, he's just lying in a sunbeam sleeping (snoring his head off) but if anyone moves, he's up and moving too. He's eating like mad - but then that'll be the steroids - but he's not scrounging food (unless it's something he likes, like toast). He's panting on walks but I'm not sure if he's just panting with the heat or not - I'm starting to doubt myself. He normally walks at a heck of a rate with me but he's not doing that and this is where I don't know if he's not hurrying because he's not feeling good or because he's gotten used to us making him go slow this week.

He seems happy enough - got a glint in his eye. He seems to be very slow on the way home but is it because he's pooped or because he doesn't want to go home? I'm not sure. In the vet, he was absolutely hyper and frantic. I was sitting on the floor with him and he nearly killed me, jumping all over me and panting and licking - but he was in the vet.

[goldengirl88]

Well there you go Cairo knows a bad vet too!!!! Maybe his body is still recovering from all of this and he is slower because of that. He has been thru a lot, so it's good he is up and still doing his walk. The heat is bad for Cush dogs so it could be that too.I think he deserves an extra special treat, maybe his favorite food?? Blessings
Patti

[Alison]

He's very much a ladies dog. I caught him about to have a bit of a nip at the male vet the other day!! He's a monkey.

He's got another sore ear as well. First it was the left ear and now it's the right, so that's me back to ear drops - he's gonna love that. I have to bribe him with mini sausage rolls to get his ear done. He's got me wrapped around his paw!

[Woodydog]

And that's the way it should be Alison :D hang I there you are doing fab, maybe in the heat just give him a little walk see how he goes with the panting :)

[Trish]

You have heat in Scotland?? :D Alison, I am glad Tracy has sent you a message about the Glasgow vets, I remember I was very impressed with them when she took Woody there. It sounds like your vet is not very well versed in cushings disease. My vet has said he does not see a lot of it, the testing is complicated too if they are not doing it all the time. I think seeing the specialist would be an excellent decision. With what they say and suggest what your vet does they may be able to work together with you, but you need a good plan in place. Or maybe after all this you will be more comfortable with a new one. I think I would be in your shoes, but defnititely get that referral to Glasgow. What dog would turn down a sausage roll, needs must :)

[Harley PoMMom]

To find a vet that is knowledgeable about and experienced in treating Cushing's is important BUT that will not always happen. To me the one important thing in a vet is if they are willing to work with you, I mean as a team player.

This forum has an amazing amount of collective knowledge, experience, and a wealth of reference material, so if the vet you have isn't Cushing's savvy but is willing to work with you, I think that would be adequate, because hey, we can help with the Cushing's!

Hugs, Lori

[Alison]

We do have a bit of heat!! It was 59F here today!! That's tropical for us!! LOL

Hopefully the guy from the Vet School will be in touch with her on Monday and we can make a start on getting him sorted.

Failing that, we're off interviewing new vets.

[goldengirl88]

How is Cairo today? Hope all is going well and that he is improving. You will find a vet you can work with, so don't worry. I hope you and your family and Cairo have a blessed Easter.
Patti

[molly muffin]

That is true what Lori said, even if a vet isn't knowledgable if they are willing to learn and be a part of a team, that can work too. Renee and Leslie are both great examples of team work with their vets.

hugs
Sharlene and molly muffin

[Alison]

Well, there's nothing wrong with his reflexes, that's for sure. He's got an ear infection again (other ear this time) and nearly got me when I went to put the drops in. I can do anything I like to him - but he HATES anyone going near his ears with drops.

He seems to be OK. He hurried up the road tonight and really wanted to go further but we'll just take it easy with him just now.

[Woodydog]

Oh there quick when the want to be. Glad he is doing well, and hopefully the vet school will get back to you soon Ian Ramsey is very well versed in cushings and has published some papers on it. Hope you and Cairo have a happy Easter :)

[goldengirl88]

Happy Easter to you and Cairo and I hope he is doing well today. Blessings
Patti

[Alison]

Thankyou all and I hope you all had a happy Easter too.

The ear drops are like Mission Impossible. How to find different ways to administer them - though the whole time, he's watching out of the corner of his eye and it's really disconcerting, wondering if he's going to whip round and air snap and scare the living daylights out of us! LOL

He seems to be OK. Still doing a lot of panting on a walk but it's getting hard to decide if it's the heat, him being a bit heavy or his illness. I really should try and video him for an opinion.

[goldengirl88]

Alison:
That Cairo is one tough cookie when it comes to the ears. I had to laugh at the air bites, Tipper has been known to do a few of those. That would be great to see a video of him, he is just beautiful. There is another dog on here Butters that he reminds me of. Hope he is well and getting stronger. Blessings
Patti

[Woodydog]

Hi Alison

How is Cairo today, hope you've managed to get the ear drops in without getting into trouble :)

[Alison]

Man, the ear drops are a trial. He's not intentionally biting at me - air snapping to voice his displeasure but if I'm not quick enough to get my hand out of the way, he gets me - and that's with a muzzle on!!

So far, we did sausage roll on the floor so as he bent down to get it, I squirted the drops in (the vet said 10 drops - yeah, right, we do squirt, massage and run). Yesterday, we thought we were going to have to heave him into the bath (he hates being in the bath and won't move) but put the sausage roll on the closed toilet lid (not hygenic I know) and whilst he was sniffing at it, drops went in. Today, I was in a hurry and just told him no nonsense but we did sausage roll to the floor again and got them in.

He was bad this morning - really listless and puffing and panting when he was out but on this evening's walk, he seemed fine - bright eyed and skipping up the road and we had a little game of chase with his toy. We have to do that whilst my mum checks a side road - there's a big dog around here that is bad with other dogs but his owners never have him on a lead, so if it's about time for him being out, we have to hang back and check down the road to make sure he's not there. Last thing Cairo needs is the stress of this other dog.

It was a holiday today so the vet school didn't get in touch with our vet as they were only open for emergencies.

I had done a bit of reading for alternative treatments in case they say no more vetoryl and I printed off a bit on ketoconazole and anipryl but the vet said no to both. She said ketoconazole was really toxic to dog's livers and both were not reliable treatments and neither was licensed here for use in Cushing's. Ahh well, it was a thought.

Hopefully the vet school will get in touch with her tomorrow.

I'll definitely try and video him but you'll have to excuse any of my puffing and panting!! We have a really steep hill to get up onto the road he's been getting walked on. Between us, I dont' know who pants the most!!

[Woodydog]

That made me laugh squirt and run lol. At least your getting them in. When woody had an eye infection I had to put drops in his eye it was not mean feat trying to get them in whilst he thrashed about and head butted me a few times :D

Oh I know the feeling of peeking round corners and side streets for not so friendly dogs my only trouble was Woody was the non friendly dog hated them, so I was always on guard whilst out.

Hopefully the vet school should get back to you tomorrow Ian Ramsey is pretty good at that. Let us know if he contacts you, just make sure you write it all down or like me you may forget some of it

[molly muffin]

You don't have to worry right now about Cushing's until symptoms come back and is cortisol is naturally high again. Doesn't sound like he is there yet.

Shake the bottle of ear meds and my Molly is off like lightening! Lol

Hugs
Sharlene and Molly muffin

[Alison]

God, I hope Cairo never gets an eye infection - that would be even worse!

Cairo doesn't like other dogs either but we deal with it. We do a lot of standing behind parked cars - if ever cars are broken into around here, we're going to be prime suspects. It's the off lead dog aggressive dogs I can't cope with. I mean if your dog hates other dogs, why would you let it run loose?

Ian Ramsey will be phoning the vet, not me :(

Cairo sat and watched me cut the sausage roll up, sitting licking his lips, then I picked up the bottle of ear drops and he ran like hell!!

[goldengirl88]

Alison:
This is sounding more and more like a comedy. Cairo is too funny. Tipper does not like other dogs either. She is an alpha female, and she let's them know immediately! I had a very large dog run up to me once in my old neighborhood. Tipper will fight anything no matter how big. I picked her up on my shoulder and he is trying to climb up me and get her. I was not going to let that happen, I began kicking at him and hitting him with my free hand. I looked up as I heard someone talking, and there stood his owner looking out the door. I was so mad, he never attempted to help me. The dog got me on the leg, and the arm, but he did not get Tipper who I was having a problem holding as she wanted to kill him.The man told me to stop kicking at his dog! Tipper was wanting down to go after him, she let me know she was mad at me for not letting her get him!! I was up most of the nite so we are resting now. Hope that big dog never runs into Cairo, as Cairo is a pretty formadible opponent. Hope he enjoys his nitely walk.
Blessings
Patti

[Alison]

Oh God, poor Tipper and poor you. Cairo doesn't like other dogs because he's scared of them! He was attacked by a lhasa apso and it just ruined him with other dogs. He's such a scardey cat.

We were walking up the road one day when this dog appeared from nowhere. It attacked Cairo and I jumped in to help him, tripped over him and fell flat on my back with two dogs fighting over the top of my head!!! And I wonder why the poor boy gets stressed when he sees another dog - probably scared I'll squash him flat!!! LOL

[goldengirl88]

Wow that sounds like a dilemma, on your back in the middle of a dog fight! Hoping Cairo is doing well this today. It is rainy here today and we are having a rest day as I am not feeling all that great today. Hope the vet school will be getting in touch soon. Blessings
Patti

[Alison]

It was hard to know how he was this morning because it was chucking it down with rain and Cairo just doesn't do rain. He got to the front, took one look and had to be pushed out!!

[goldengirl88]

Alison:
He is too funny. Tipper doesn't mind the rain unless it gets into a hard down pour and then she is scared to death and I have to let her in the closet. Was he always not liking the rain? He just does not like it, but has no fear of it? I am going to talk to my vet on what we are going to do with Tipper and the thunder problem. Absolutely nothing will calm her down, and she made her blood pressure go up one day last year during a storm, and it broke blood vessels in her eyes. I do not want that again, and she has a heart murmur now, and does not need this. Those collars do not work for her as I was told you have to leave them on all the time and she is allergic to them and scratches herself raw. The vet does not want to give her tranquilizers, so I don't know what to do, but we need a plan asap, not after it starts. Blessings
Patti

[Alison]

Cairo's not frightened of the rain - he just doesn't like getting wet. Even when he was a tiny puppy and we were toilet training him, we'd be standing in the garden with him, getting soaked whilst we held an umbrella over him so he didn't get wet!!!

He is scared of thunder storms though.

Have you tried a thunder shirt for Tipper? It's supposed to be reassuring to dogs that are frightened - thunder, fireworks, etc

http://www.thundershirt.com/

You'll possibly get them cheaper if you hunt around.

Another thing could be Bach's Rescue Remedy - do you get that over there?

Neo, our old lad (now at the Bridge) was terrified of fireworks - absolutely terrified - to the point that he knew that when the clocks changed in autumn and it was dark on his evening walk, that meant scary noises and he would be frantic up until spring when it was light again. We tried everything for him - even valium but all that did was made him so dozy that he was going to hurt himself. We just had to let him hide, turn the volume up on the TV and let him deal with it himself - so Tipper hiding is maybe the only way she can cope with it and maybe you just have to let her hide somewhere dark and cosy and safe. We tried DAP diffusers and a drug called Zylkene (it was expensive) but they didn't work for him either - the Zylkene was supposed to help but it's one of these drugs that needs to build up over time so no use for one off storms or fireworks. We used to use amythist essence - a lady I know makes up gem essences for a variet of conditions and as a rule, there is huge success with it but poor Neo was a dog that was too clever for his own good - he knew it was going to happen and just worked himself up into a frenzy even when there was no noise.

[doxiesrock912]

Daisy doesn't mind polite dogs but if one sneaks up or runs up to us, God help them. She doesn't realize that she's tiny :)

Wow, as far as ear drops or anything like that, she just gives me that sad look and tolerates what I do. I guess I'm very lucky.

[goldengirl88]

Alison:
Tipper's problem is she was afraid of thunder before all this, and her cortisol being at a lower level now makes her less able to handle stress. We have the thunder shirt, it does not work on her. Plus Cush dogs are hot and the closet is stuffy and makes her pant. I try to put a fan in there. She gets beyond frantic and feels more secure in the dark corner of the closet. I do turn the TV up loud. It's funny she is not afraid of fireworks, she knows the difference. Some way short of a sound proof closet, I need to fix this problem. How has Cairo been today? Blessings
Patti

[Trish]

Hi Alison

Hope the ear drops are going a bit better. Drop, treat, drop, treat, fighting it, no treat!! Aww poor Cairo! Gawd, I would hate if I had an aggressive dog, that must suck for owners like that. Why on earth do they not keep them fenced in, that is so dangerous with them on the loose like that. So thankful that Flynn can go play without the fear of him attacking another dog, he is definitely a lover not a fighter!

Have you heard from Glasgow Ian?? I remember we all thought he was great when he treated Woody. If your vet is not getting back to you, I would perhaps try speaking to him myself. :)

[Alison]

What about a crate for Tipper that you could cover with a blanket? It would be dark and cosy but not as hot as the closet? Do you actually have a thunder storm season so to speak that you could then use the Zylkene? I take it the collar you used was a DAP collar (dog appeasement pheromone)? You can get plug in diffusers and a spray for on bedding if that's any help? Or maybe something like my alternative lady does - the amethyst essence? I'll have a good think of things to try.

Trish, we have the drops sussed. First day was a pain but it's less traumatic now - bit of sausage roll in his bowl and while he's trying to get it out, in the drops go. No problem!! He's not stupid though - parks his rear in a corner till the sausage roll is in place!

I am honest in that Cairo isn't keen on other dogs but people round here are a nightmare - won't admit to the fact their dogs are bad with other dogs - we had the giant poodle running off lead plus a little dog (not a poodle but looked like a poodle but bigger - bichon frise maybe?) and that is a really nasty dog. It got out the garden one day and came for Cairo big time and my mum was frantic shouting at the owners to come and get it but none of them would pick it up because it was biting them as well. We had both of them tonight - nasty little dog and nutty big dog but Cairo was ace - didn't bother with either of them - he was such a good boy. He doesn't normally start trouble - but if a dog starts on him, he will retaliate and that's what worries me - even though he's on the lead and under control, if anything happened, he'd get the blame because of his breed.

We didn't hear from the vet today so will give her till tomorrow to see if Ian got back to her. She's on call this week so it's going to be after 5 when she phones but the vet is open till 7 so we can phone to find out if she's heard from him and if not, I'll phone him myself.

[Squirt's Mom]

even though he's on the lead and under control, if anything happened, he'd get the blame because of his breed.

This is just SOOOOO unfair! My Pit mix, Crys, was treated the same way and she was as sweet and goofy as they come. :( Cairo's avatar reminds me of her - their coloring is similar as is the head shape...I love seeing his pic as a result. :)

Crys loved other dogs but they didn't always love her exuberance so I always had to watch her, and them, closely. She might want to play but if they took it wrong she would get the blame. When we walked, Crys on a lead, and another dog came up to us, I would just sit on the ground with my arms around Crys just in case. That way it was obvious I was doing all I could - they just didn't know I was protecting HER.

To make matters worse, Crys had horrible Pica and would eat the muzzles off of her face! So had one made for her out of thick leather and metal. She looked like Hannibal Lector in it which didn't do anything good for her general image. :( But it was the only way we had to protect her from herself - she would eat anything except glass.

I hope you hear from the vet today. If not, I would probably in the clinic in someone's face today. :D

[goldengirl88]

Alison:
Tipper will not stay in a crate when scared she would bite it and dig to get out until bloody!! Also I do use the diffuser for her, but it has not really worked. It is a shame because of Cairo's breed he would be the one blamed if one of these dogs running of lead got into it with him. I never understood people that let their dogs run! I am a nervous wreck if Tipper leaves the room and I don't see her. It is raining here today and dreary. Tipper will not be walking unless this stops. We had her blood pressure and weight done at the vets mtis morning. How is Cairo today? I hope he is getting stronger every day. Blessings
Patti

[Woodydog]

Alison

How is Cairo today? I have Ian,s email address if you want it, he may not deal direct as you aren't a client yet but you never know.

Trish it's a different Ian from the one woody dealt with, this Ian is head of small animals specialising in endocrine system but he gets a good write up I only met him once with Emma at our first consult.

[Alison]

Cairo seems to be fine today. Operation ear drop is continuing nicely - we have it sussed! :) We've still been limiting his walks but we can start to take him a bit further now and see how he goes.

The vet phoned this evening. She had spoken to Ian at Glasgow Vet School and also to somebody at Dechra and she says both said the same.

Cairo is not to go back on Vetoryl until his post stim results are above 400 (14.49) and even then, he's to only get 30mg daily. I asked about twice daily dosing and she said that most dogs do fine on once daily dosing and both the vet school and Dechra said once daily dosing.

In the meantime, we've to keep an eye on him for signs of hunger, thirst, excessive urination - the usual and once he's showing signs again, take him back for another ACTH stim test. She says maybe in 2 -3 weeks, so now it seems it's just a waiting game for him to start showing cushy symptoms again.

Poor Crys - it sucks that they get judged because of their breed. What's pica? We don't muzzle Cairo unless he's getting something horrible done. He's not really a problem outside but even if he was, we can't get a muzzle to fit - they're either too big or too small - he's very wide across the cheeks. We tried fitting him for a basket type muzzle as they are kinder but again, it was either too tight or too big and riding up into his eyes.

I just don't get why people let their dogs walk off lead near roads. I don't care how well trained a dog is, if it gets a fright, fear will take over and it will bolt - we saw that at bonfire night last year. We were walking down the road and a girl and her dog were walking up the road - all dogs were on leads. Just as we passed a garden, the family started letting fireworks off. Honesty nearly deafened us as we were right next to them. Cairo got a fright and jumped forward but I reassured him, but the poor girl's dog got such a fright, it ran. The lead was wrenched out of her hand and the dog took off. We were all furious, she was upset and I hope her dog ran for home and got there safely - we've never seen her again to find out.

People think staffies and pits are tough - they should be in our vet when they're in - the other day, there were three staffies there, all sitting shaking and crying! Real tough guys!! LOL

[Squirt's Mom]

Pica is a condition that drives the body to crave non-food items. Humans and dogs can get it I know but not sure about other species. Crys would walk away from a bowl of good fresh human food to eat an Azalea bush or CD or video game or the couch - anything but food! The only thing she did NOT consume was glass. Thankfully we never had any blockages or injury that required surgery.

[Alison]

Ahh, got you. When I was in the ambulance service, we had a patient like that that we used to pick up to take to day care. He'd eat cigarette ends, leaves, socks, you name it, he ate it. He throw a sandwich away and go and eat paper or empty out a cup of tea and fill his cup from the toilet bowl :eek:

[Trish]

OMG how awful for that poor man! Aww that's a shame it is not the lovely Ian we knew, but good to hear he has a good reputation.

So the plan is to wait and see if symptoms come back and then retest? I hope Cairo does good for a long time to come!! :)

[Alison]

So do we. It's horrible being on the waiting game again though.

[goldengirl88]

I am with you on that one, I can tolerate many things, but waiting is not one of them. I hope Cairo gets straightened out from all this. At least now you have some help from Dechra and the vet school. Hope you have a good walk with no rogue dogs running around to ruin it. Blessings
Patti

[molly muffin]

Checking in to see how Cairo is doing. Hope all is well with him and you.

hugs
Sharlene and molly muffin

[goldengirl88]

Allison:
I missed hearing how Cairo was doing, I hope all is well and he is continuing to improve. Blessings
Patti

[Alison]

Thank you so much for asking after him.

He seems to be fine - though I'm paranoid but hopeful.

He's back to being hungry - you can rustle a wrapper without him looking to see if you have something to eat but we gave him a bit extra for his dinner and he didn't eat it all so he's obviously not as hungry as we thought he was.

Peeing and drinking are OK.

He had a very slight panting session tonight on his walk - but then he was fine again.

To be honest, I'm not sure what to do. I don't know if we should leave well alone at the moment, or take him back for another stim test just to check how things are going.

[molly muffin]

How long as it been since the last one?

I honestly do not think that he has gone back to cushings yet, as he wouldn't leave food if that was the case. My molly will leave food in bowl that she grazes on all day long, she Might finish it at night, but no guarantee. However, she will bark at you till you give her, one dental treat and one veg treat every night. After which she is fine and that food is still in her bowl that she didn't Really want.

As long as everything is fine, then I don't think he is back to cushings. You are still giving the prednisone?

hugs
Sharlene and molly muffin

[Alison]

His last Stim Test was 18th April and his post stim numbers were 175nmol/l.

He's been off the prednisolone since 22nd April.

Sometimes it's hard to know if he's feel yuck or just being lazy - he's the least energetic staffy I know - doesn't jump, really doesn't run much.

[molly muffin]

If you feel like he is going low again, then take him in. You know, if he doesn't want to walk or eat, if he is scared to go outside of down the hill, etc. All the prior symptoms of when he went low.

hugs
Sharlene and molly muffin

[Alison]

I don't think (or hope) he'll go low again - I'm waiting on him going Cushy again - but maybe we'll be lucky and he won't. That would be just fantastic if he didn't. I can live in hope.

[goldengirl88]

Allison:
How is Cairo doing? He is not back on the Vetoryl right? Is he beginning to show signs yet? I hope you are both doing well. Blessings
Patti

[goldengirl88]

Alison:
I forgot to ask, did they do any blood work when he had his stim test?

[Alison]

No, he's not back on the vetoryl. The vet school said that he was only to be started back on it if he stimmed to 400 or more - he's not had a stim test but doesn't seem to be showing symptoms.

At the time of the stim test, they didn't do blood work but I took him back and asked them to check his electrolytes and they said they were fine. I didn't get any figures - just told they were great.

[Alison]

Well, the lad must've been feeling good this evening. Our evening stroll turned into an extremely brisk walk - he was on a mission. We left my mother standing - she's got a sore foot and was miles behind and eventually gave up. He was ready to go for miles but we had to go back and find mother!! LOL

[goldengirl88]

That is too funny, but seriously good news. He would not be doing that if he did not feel better. That makes my day knowing he is doing well. Blessings
Patti

[Alison]

We've been so used to him plodding that it was a bit of a shock to the system! On the way back, there was a girl in a driving school car, away to do her parallel parking - he spotted her and stopped dead and stood watching her. I swear he was assessing her parking abilities. The driving instructor spotted him and started laughing. He totally put the poor girl off. I was waiting on him holding up a score card! LOL

[Trixie]

Good for Cairo!! Energy back and brisk walking says it all!! Happy he's doing so well. Too funny about his parking observations!! :D

Barbara

[molly muffin]

That is excellent news! I don't think he is too low and unless he is showing signs of cushings, extreme hunger/thirst/peeing, then he is probably at a good place with her cortisol for now.

hugs
Sharlene and molly muffin

[molly muffin]

That is hilarious! Cairo has a new job, scoring the driving applicants! hahaha

hugs
Sharlene and molly muffin

[Woodydog]

Alison

Go Cairo lovely to hear he is doing well, maybe he was thinking "I could do that better than her" well he is a boy after all :D