Jess the Labrador has passed

[jess]

Jess is a 9 year old chocolate lab weighing 26kg (57 lbs). Jess suffered what we assumed was a stroke about 1 month ago and we took her to the vet who confirmed our suspicions. Jess had a strange half hour panting episode 24 hours before the stroke (coincidence?). Post stroke she was circling and generally very quiet (and drinking and peeing lots). The vet gave Jess a steroid injection, tramadol, vivatonin and ranitidine. This vet done no bloods or urine. I was unhappy with this so I changed vet and he done blood and urine tests. Jess wasn't concentrating her urine properly but everything else seemed within the limits of normality. Her liver function was noted as slightly high. I started noticing her slight hair loss, pot belly, darkened nose and adding these signs to the drinking and peeing (anywhere) I asked the vet to rule out Cushings. Jess has just been diagnosed as cushingoid. She has had her 1st dose of Vetoryl this morning as instructed (one 60mg per day). The new vet had prescribed 120mg but after reading here I got him to give us 60mg instead to start at the low end of dosage.

Test results.

Low dose dex suppression result (19th Sept)
Cortisol Basal 103.0nmol/l interval 50.0 - 250.0
Cortisol 3hr post dex 150.0nmol/l
Cortisol 8hr post dex 132.0nmol/l interval 0.0 - 40.0

Comment.
Inadequate suppression of Cortisol at 3 and 8 hours. In the presence of appropriate clinical signs, and supportive laboratory abnormalities, these cortisol results support a clinical diagnosis of HAC. The cortisone injection given 10 days a go should not have influenced these results (unless a long lasting preparation was given).
--------------------------------------------------------------------------
ACTH result (25 Sept)

Cortisol Basal 132.0 nmol/l 50.0 - 250.0 interval
Cortisol Post ACTH H 1062.0 nmol/l 150.0 - 550.0 interval

Comment
Exaggerated cortisol response here would support a clinical diagnosis of HAC.
--------------------------------------------------------------------------

I posted here today just to check that we're on the right track with Jess so far. Thanks in advance.

[spdd]

Welcome to the forum.

Others will be on here shortly that can read and analyze the results.

[Trixie]

Good going on starting with the lower dose. It's much better to start low and if needed increase/decrease from there. This way your dog will be less likely to have adverse reactions. I'm no expert on the test numbers but others will be posting on your results. Hope you see some positive changes in Jess's symptoms soon. It took awhile for my dog but they are all different.
Jess will be due for an acth in about 10-14 days and at that time you'll be able to see if this dose is working or if you need to adjust. Sounds like you're doing a great job.
Hope all goes will for Jess!

Barbara

[jess]

Thanks SPDD and Trixie. Since this morning I've received a personal reply from Dechra advising that they recommend starting a 26kg dog on 120mg once a day. Having said that I'm somewhat happy that I had a read on here and started her at 60mg. Fingers crossed.

[goldengirl88]

Great job at starting on the lower dose!!! Fantastic start. This will help your dogs body adjust to the drug and you can tweak it later if need be. Just be vigilant and watch for any signs of trouble and you will do well. Do you have prednisone on hand? If not you need to call the vet and get some asap. You are going to do great so don't worry. Blessings
Patti

[jess]

I don't have prednisone. It's something I'll ask the vet about tomorrow. Can you please briefly explain what signs I need to look out for and why I need prednisone.

[Trixie]

If your dog were to go "too low" from medication you would see one or more of these: extreme lethargy, vomiting, diarrhea, not eating, maybe the inability to move or get up..those would be the obvious adverse effects.
It's more unlikely to happen with a low dose but always good to know what to watch for. Cortisol level can continue to drop over the weeks so it's good to just be vigilant and watch for any hints of trouble and check levels with an acth within 10-14 days of the start of treatment. That will show you where you are and take some of the mystery out of how it's going.

None of these things happened with my dog but I watched like a hawk and I still do. I also measure her water intake so I can track how things are going. It's not like one or all of these WILL happen...it's just that it could so you just have to be aware. The good news with Vetoryl is if you see anything that worries you-just STOP giving the drug.

Over the course of 6 months my dog has vomited (twice) and she has had loose poops on occasion. At no time was this a reaction to the drug..it just happened as it does with all dogs. I did however withold a dose a couple times just to be sure...it's better to err on the side of safety. When tummy issues cleared on their own by the next day I knew it was just an upset stomach (mystery reasons) and continued back with the Vetoryl.
It will all work out. You're starting low so hopefully you will not encounter any difficulties but always be aware. :)

Barbara

[jess]

Excellent info Barbara:) Thank you.

[Harley PoMMom]

Hi and welcome to you and Jess,

Cushing's is one of the most difficult endocrine diseases to get a confirmed diagnosis for. Other non-adrenal illnesses share many of the same symptoms as Cushing's, such as diabetes and any thyroid problem, have they been ruled out?

When you have the time, we have a wealth of information regarding Cushing's in our Resource Thread in which I will provide you a link to: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10) Do feel free to print anything out. ;)

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

Hugs, Lori

[molly muffin]

Checking in to see how things are going with you and Jess. :) Hope all is well.

sharlene and molly muffin

[jess]

Checking in to see how things are going with you and Jess. :) Hope all is well.

sharlene and molly muffin

Hi, Thanks for asking Sharlene and Molly Muffin. We finally got the results from Jess's latest test after 14 days treatment with 60mg per day Vetoryl.

Basal - 36.7
Post ACTH - 131

The vet thinks the numbers are a bit low but ok and he's quite happy.
Jess is drinking normally and we're pretty happy with her. She's a bit quiet overall, but still loves her walks and food!

[labblab]

It's great to hear back from you, and I'm happy to hear that Jess is doing well. One thing I can say, though, is that I am really glad that you did not start her at a dose any higher than 60 mg. since it is possible -- even likely -- that her cortisol may continue to drift further downward during the next few weeks.

Right now, her "post" ACTH result is just fine (it translates into 4.7 ug/dl for those of us who are more familiar with that measurement). But her "pre" ACTH result is already a tad low and you don't want it to fall any lower (1.3 ug/dl). Normally, it is largely the "post" result that is taken into account for monitoring purposes, and the ideal therapeutic range is 40-150 nmol/L (1.45-5.4 ug/dl). So Jess is good in that regard. But we have been told that the folks at Dechra do not like to see EITHER the "pre" or "post" result any lower than 40 nmol/L (1.45 ug/dl). So her "pre" does fall below that level and that may be what your vet is expressing some concern about.

You will certainly want to watch her very carefully for signs that she is not tolerating this cortisol level, and be prepared to withhold her trilostane and contact your vet immediately if she acts ill. And you will definitely want to test her again at the 30-day mark, and even sooner if she appears to be "off." As I say, given these results at the early 14-day mark I would not be surprised if she ends up requiring a lower overall dose as time goes on.

Please do keep us updated.

Marianne

[jess]

Thanks Marianne, I'm also very glad that I read this site and didn't go with the 120mg that Dechra advised my vet. I don't think Jess would be a very happy dog at that dose. It's interesting to read that she is low already and likely to go lower. I'll keep an eye on her (as always!). I'm assuming you mean to re-test at 30 days from start of treatment as opposed to since the last test? If so, then that's in a couple of days.

Johnny

[goldengirl88]

You are doing fantastic with Jess and so glad you started on the lower dose. As previously stated your Jess may end up on a lower dose than the current one. Did you get the prednisone? You are doing a really good job, just stay vigilant. Blessings
Patti

[jess]

You are doing fantastic with Jess and so glad you started on the lower dose. As previously stated your Jess may end up on a lower dose than the current one. Did you get the prednisone? You are doing a really good job, just stay vigilant. Blessings
Patti

Thanks Patti, We decided we don't really need prednisone as we are only 10 minutes from the vet who operate a 24/7 service. Thanks for the heads up though - good advice all round.

[labblab]

Hi again, Johnny. As for the 30-day testing, I have never been clear in my own mind as to whether Dechra intends for it to be completed one month after the start of treatment or one month after the initial ACTH monitoring. Here's their actual published advisory taken from the U.S. Product Insert for Vetoryl (http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf), which to me is a little vague as to exacty what the 30-day mark refers to.


Once an optimum dose of VETORYL Capsules has been reached, re-examine the dog at 30 days, 90 days and every months thereafter. At a minimum, this monitoring should include a thorough history and physical examination, ACTH stimulation test (conducted 4-6 hours after VETORYL Capsule administration), and serum biochemical tests (with particular attention to electrolytes, renal and hepatic function).

My own thought is that it is generally reasonable to test any time within a window of 2-4 weeks after the intial fourteen-day test, depending upon the initial test results and your observation of your dog's behavior. Since Jess' "pre" level was already a bit low at fourteen days, I'm thinking you may want to test again sooner rather than later. When does your vet want you to bring Jess back for retesting?

Marianne

[jess]

I spoke to the vet's partner this morning as my vet was operating. He thought 2 months from now but I'm pretty sure my vet said 3 weeks from the last test. I think I'll just get her in this week and get a test done and take it from there. We're insured anyway, so we might as well:) As for Dechra's advice I suppose they are saying test, test, test until an optimum dose is achieved, then re-examine the dog at 30 days, 90 days etc. Seems reasonable IMO.

[molly muffin]

Hi, glad that Marianne popped into to let you know about the pre. You really do not want that to go any lower.
One to remember is that every dog reacts differently to any drug, and some are naturally more sensitive to a given drug than others are. We've seen big dogs on small doses and tiny dogs on big doses. It's all about Jess, how she reacts, how she feels and how long a dosage makes her go. I agree that I'd test sooner rather than lower, based upon past members on this forum, reporting cortisol levels continuing to drop even past the 30 day mark.

You'd doing great!
Sharlene and Molly Muffin

[goldengirl88]

Just checking in to see hoe Jess is doing today?? Hope everything is going well. Blessings
Patti

[jess]

Just checking in to see hoe Jess is doing today?? Hope everything is going well. Blessings
Patti


Hi Patti, Jess is just back from the vet and waiting to return in 1 hour for the post ACTH test. She is doing absolutely fine thanks. The vet seemed to think she was a bit sore at the back end and said we should consider NSAID's. Possibly athritis uncovered by the Vetoryl which I fully anticipated. I'll post the results when I get them. To be honest I have no concerns about Jess at the moment apart from the levels being a bit low. The next set of results should let us know if the dosage is OK or not.

[Squirt's Mom]

I'm glad Jess seems to be doing alright but I want to caution you about the NSAIDS. Cush pups should never take NSAIDS unless nothing else works. This class of drugs is very hard on the liver, and that organ is already under stress with the Cushing's. ;) I would first look into things like Dasuquin, Adequan, anti-inflammatory herbs, supplements like Omega 3's, and diet. There are some alternative to NSAIDS and our cush pups need to avoid the NSAIDS if at all possible. I used one with my Squirt, Metacam, and her liver values went off the charts. ;)

[jess]

I wondered about using them and adverse effects. Not worth it then IMO because she seems happy enough.

[goldengirl88]

Leslie is right. I never give them to Tipper. It is too much on their liver. I use Adequan shots. and laser therapy, and am sprinkling Tumeric on her food as an anti-inflammatory. You have to be very careful what you give a Cush dog is not doing more harm, as their body is under enough stress from the disease. Hope this helps you. Blessings
Patti

[jess]

Jess's latest results:

Basal 29.8
Post 153

I'm quite concerned at how low that is. Is it time to lower the dose?

[labblab]

Hmmmm...that is a bit if a head-scratcher, since Jess' "post" ACTH result has actually increased (up to 5.5 ug/dl from 4.7) at the same time her "pre" results have decreased (down to 1.08 ug/dl from 1.3). So I'm honestly not sure what the recommendation would be, given the fact that she is behaviorally doing well and looking good.

Are you located in the U.S.? If so, you and/or your vet can contact Dechra directly to see what they recommend given the timing and pattern of Jess' monitoring tests. Here's the contact info for the U.S. office in Kansas. You can either email or just call them directly.

http://www.dechra-us.com/Default.aspx?ID=365

Marianne

[goldengirl88]

I will second that thought to call Dechra and here is the number866-933-2472 they will start a file on your dog and give you a case number. There are vets there that can help in this situation. Blessings
Patti

[jess]

Just spoke to the vet who had made a few inquiries. The pre level isn't such a concern. It's more the post number they are interested in i.e. The dog's response. I have read elsewhere that <20 pre or post is not acceptable though. Can I just ask, is the ACTH test done after fasting the dog or not? Just to add, also the vet want's to do a thyroid test on Monday in case anything else is going on.

[goldengirl88]

You need to have call Dechra and speak to the vet there. The pre number is important also. I know this first hand as my Tipper's went really low and Dechra was quite concerned. I had to put my dog on a lower dose due to this. The pre number is there for a reason, and not to be ignored. Also after the initial ACTH the dog must be fed a small meal with some fat before any of the follow up ACTH's. If you fast the dog the test will be skewed and you can over dose the dog. Vetoryl is fat soluble, so they need the meal with some fat to adequately absorb the Vetoryl. If the vet tells you to fast the dog you must insist he call Dechra and get schooled on this drug and it's protocols. Do not under any circumstances fast your dog!!!! Blessings
patti

[jess]

Just to clarify, ACTH tests were all done 4 hours after feeding and dosing as normal. We were not asked to fast Jess. I asked because of what I read in this document

http://www.axiomvetlab.com/Trilostane%20Treatment%20in%20Canine%20Cushing.pdf

"Collect fasted whole blood sample four hours after giving Vetoryl"

This is the lab my vet uses for our results.
Incidentally, I'm in the UK and Dechra UK, will only discuss cases with vets.

[labblab]

Axiom's published protocol is very surprising to me because Dechra, themselves (as well as other labs and clinicians), instruct that monitoring ACTHs for trilostane patients should be performed after the trilostane has been dosed along with food. Here's the summary of a recent verbal conversation one of our members had with Dechra:


Marianne,
THANK YOU!!!!! I followed your device and called Dechra. They were very helpful. Not only were my all of my questions answered, they were also explained. They told me that Vetroyl was fairly new in the United States and a lot of vets are not familiar with it's protocol.

1. Trilostane must be administered with food for proper absorption.
2. ATCH testing - No fast- Meal with medication - a smaller meal is warranted if the animal tends to get carsick. Test must be
started within a 4-6 hours, but doesn't have to be completed by
then.
Vets often want to do several tests at once therefore requiring a
Fast. In that case it is advisable to do the ACTH test at a different time.
3. Benadryl - Benadryl shouldn't in any way affect the ACTH test results.

So there is your verification once more! I wish my vet would call!
There are other Cush parents who are going to be getting the same instructions that I was given and won't know enough to look further.:(

Kathy and Buddy:)
As far as that "Pre" result, I would probably ask your vet to contact Dechra on your behalf. It may be the case that Dechra has revised their thoughts about low "Pre" results. It is true that they did not seem overly concerned about "Pre" results back when Vetoryl was first being introduced, but their perspective on that may have changed as a result of subsequent experience with the drug (reflected in Patti's recent communication with them). Your vet can also again verify the importance of giving food with the Vetoryl on test days.

Marianne

[jess]

Just a wee update on Jess. She's now getting .8mg of Soloxine a day for low thyroid levels and she seems to be much better. More lively and seems to be a happy dog again.:)

[Squirt's Mom]

Good to hear from you again and especially to know Jess is doing better! :)

[mypuppy]

Hi,
I'm so happy to hear your baby seems happier now--that's what we want to hear. Jess is a cutie! Love them choco labs, for obvious reasons!

Xo Jeanette

[molly muffin]

That is great news!

hugs,
Sharlene and Molly Muffin

[jess]

Hi again all. Just a wee update on where we are at with Jess. We have noticed a slow down in her. She seems uninterested in most things except her food (typical Lab!) She is lethergic and possibly depressed IMO. She regularly pants at around 7-8 pm most evenings. I let her out for some fresh air and she's fine again (for a while). She was at the vets yesterday for ACTH but there is a nationwide shortage of the tests at the moment and the vet doesn't know when he can get one. The vet told us yesterday that her Thyroid levels are good, and she had blood in urine but it wasn't an infection. The vet today has told us that her liver function has got worse. He wants to get Jess onto NSAID's (he thinks she's in pain at her back legs) but I have suggested to him that we wait for ACTH test results as IMO her levels are going to be low. I can see us having to lower the dose of Vetoryl.

[lulusmom]

We just had another member mention the shortage of the acth stimulating agent in the UK. That has happened a few times here in the states but it was short lived. Since it's been so long since Jess' last stim test, I would recommend that you talk to your vet about doing a blood draw to check basal (resting) cortisol levels. It's not optimum but it's better than nothing, and it should be relatively inexpensive.


Just to clarify, ACTH tests were all done 4 hours after feeding and dosing as normal. We were not asked to fast Jess. I asked because of what I read in this document

http://www.axiomvetlab.com/Trilostane%20Treatment%20in%20Canine%20Cushing.pdf

"Collect fasted whole blood sample four hours after giving Vetoryl"

This is the lab my vet uses for our results.
Incidentally, I'm in the UK and Dechra UK, will only discuss cases with vets.

I am just seeing this for the first time and thank goodness you and your vet didn't use their protocol. I immediately sent an email to Axiom Vet Lab, asking them to correct this unfortunate error. I told them that an ignorant and inexperienced vets would follow their protocol and to do so, would be placing dogs at risk of overdose, not to mention wasting pet owners' hard earned money on an already very expensive test. I asked for an acknowledgment from them so we'll see what happens. Hopefully they will do the right thing.

[lulusmom]

I just received a response from Axiom Labs and they have resolved the issue but I'm not happy with the fact that they left "fasted sample" in but merely added that the manufacturer recommends Vetoryl be given with food. See their response below:


Dear Glynda,

We have altered the document below to include a line regarding giving trilostane with food. To see the new version you will need to go back to our web site and into vet resources;

http://www.axiomvetlab.com/Trilostane%20Treatment%20in%20Canine%20Cushing.pdf

Kind regards

Emma Dewhurst

[jess]

As clear as mud now isn't it? Well done for trying though :) Still waiting for results for Jess. The vet was testing her urine today. Hopefully ACTH will be available soon.

[jess]

Jess's latest blood basal level was 60. The vet said her potassium and sodium levels were out. The vet wants to double her dose to 120mg. Thoughts please.

[frijole]

I don't have time right now to read your entire thread but it looks like you we're afraid your dog had low cortisol due to symptoms and your vet wants to double the dose? No way. Not if the symptoms are still there. Tell us how your dog is doing now please, thanks. Kim

[molly muffin]

When you say sodium and potassium levels are out, do you mean they are not within normal range?

If the sodium and potassium are fine, then how are the symptoms? I would not based upon the last ACTH, double the dose. That is just dangerous, when you are already very close to being in range and the pre number is already so low. I wouldn't actually change the dose at all upwards. I'd wait and do another ACTH, unless you notice Jess haven't abnormal reactions, which signifies that the cortisol has continued to drop (which it Can do), and if that happens, immediately have another ACTH test at that time.

That is my thoughts. But for doubling the dosage, no way.

Sharlene and Molly Muffin

[labblab]

Yes, please do clarify whether or not the potassium and sodium levels are normal...

But without knowing that answer, I think it would be CRAZY to double the trilo dose right now! :eek: :eek: :eek:

What is your vet's reasoning for wanting to do that? Since you are stuck without the ability to perform a full ACTH right now, you are left with only Jess' resting cortisol (which, for the benefit of our U.S. readers, is approx. 2.2 ug/dl). The main benefit of the resting cortisol is to get some reassurance that the cortisol has not dropped too low. It is a far "iffier" proposition to base a dosing increase solely on a resting cortisol. A researcher here in the U.S. has been trying to see if/when baseline cortisols can help with trilo dosing decisions, but much is still unknown. Here is a summary of her work so far:



Historically, the baseline cortisol reading has not had significance for monitoring a dog being treated with trilostane. However, a researcher at Texas A & M who is also a consultant to Dechra, Dr. Audrey Cook, has recently performed a study aimed at investigating whether or not baseline cortisols may have predictive value in assessing whether a dog is being overdosed or underdosed on trilostane. Dr. Cook freely admits that more research is necessary to decide the true clinical significance of this study, but her initial findings suggest that baseline cortisols between 1.3 and 2.9 ug/dl were associated with good cortisol control for the dogs she tested. She recommended full ACTH tests for dogs with baseline cortisols outside that range in order to insure that their post-ACTH results fell within parameters that were safe and effective. Here's a link to Dr. Cook's study:

Evaluation of the use of baseline cortisol concentration as a monitoring tool for dogs receiving trilostane as a treatment for hyperadrenocorticism (http://www.2ndchance.info/cushings-monitorcortisollevel.pdf)

You'll see that Jess' baseline result of 2.2 ug/dl falls right within the range for which Dr. Cook predicts good control of cortisol, and hence, no dosing increase would be recommended in the absence of a full ACTH.

So once again, why does your vet want to increase the dose, especially when Jess has been exhibiting symptoms that would more likely point in the opposite direction?? Yes, this baseline reading is a bit higher than the last one, but this could be due to something as simple as Jess being slightly more stressed at the time the blood was drawn.

Marianne

[jess]

Sorry for not getting back to the forum sooner, I've been away for a few days. OK. Just spoke to the vet and Jess's Sodium/Potassium level was 29.6 (normal). She produced lots of cortisol in her urine (cortisol/creatine) - a measurement of 350. We have now agreed to try Jess on 30mg morning and 30mg evening as a way forward. I assume this is safe to do without access to ACTH testing at the moment?? As for Jess herself, she seems to have been a fair bit brighter the last few days. I wonder if she is better due to us changing her diet from seniors food with little fat to normal adult food. Might the Vetoryl be getting absorbed better? PS Still no ACTH tests available anywhere in the UK.:mad:

[jess]

Hi. Jess has not been so good recently mainly due to this skin condition we discovered http://s778.photobucket.com/user/johnnyecosse/media/81291831-499f-4728-b860-cfacffe33345.jpg.html?state=copy and http://s778.photobucket.com/user/johnnyecosse/media/WP_000529.jpg.html?sort=3&o=2. It seems to have started at the top of her neck and travelled towards the tail. She was also getting into the routine of peeing indoors overnight. The vet has shaved her and we are washing her with Paxcutol every 3 days and applying Fuciderm twice a day. The problem is right along her spine which has appeared more prominent in the last few weeks as the fat goes south to her belly. Any ideas on what exactly this condition is? She's not scratching or particularly bothered by it but she's a hell of a lot brighter since we've started treatment and the peeing has stopped too!
Her latest ACTH (we got it eventually) was

Basal 98
Post 237

[Spencersmom]

Awwwww...poor Jess!!! I hope the rx plan works for her! My thoughts are with you as you work thru this challenge we here are all dealing with! Great group of ppl in this forum to support and offer all levels of wisdom gathered from vast experience!

[Squirt's Mom]

Just FYI - the Fuciderm contains cortisosteriods. ;)

[jess]

Just FYI - the Fuciderm contains cortisosteriods. ;)

I was told this by the vet, so I called Dechra (the manufacturers of Vetoryl and Fuciderm) and they had a chat with my vet and they advised me that the amount absorbed into the skin would be minimal.

[molly muffin]

This looks like it might be calcinosis cutis. A skin scraping would actually confirm if it is this or something else and the best way to treat.

If it is calcinosis cutis, it is caused by high cortisol, and is calcium deposits that push up through the skin and rupture.

This is one possibility only.

I'd have the skin scraping done to find out for sure.

Sharlene and molly muffin

[labblab]

Her latest ACTH (we got it eventually) was

Basal 98
Post 237
Translated into the units of measurement used here in the U.S., the ACTH results would be:

Pre: 3.5 ug/dl
Post: 8.6 ug/dl

Aside from the skin issues, how are Jess's other Cushing's symptoms? These numbers would be OK if all symptoms are being controlled adequately, but if not, a Vetoryl increase would be in order. And especially if the bumps are indeed diagnosed as Calcinisis cutis, I think you will want to lower the cortisol further.

Is Jess still taking 30 mg. both morning and evening?

Marianne

[Squirt's Mom]

If this is CC, no way in you know where would I put more corticosteroids on him when the CC is caused by an excess of corticosteroids to start with...regardless of what the vet thought. ;) BUT that's just me and I can be difficult. :p

[jess]

Yes, Jess is still on 30/30 Vetoryl. Going on to 30/60 soon. Her symptoms are good although the disease is obviously progressing. i.e the fat is going south to her pot belly. Drinking and peeing is fine, no shaking or panting to speak of. My thoughts were exactly the same re:more corticosteroids but the vet says there's no evidence of CC when I asked him if that's what this is. I'll see him on Monday and take it from there. I think I'll push for a skin scrape and proper diagnosis. She's getting ACTH test again in a week or so.

[molly muffin]

Let us know what the scrapings show. It might be some sort of skin infection too.

Sharlene and molly muffin

[labblab]

Yes, a skin scraping is a good place to start. If Calcinisis cutis is suspected, though, I think an actual biopsy may be necessary:


Clinically, the appearance of the skin lesions may lead your veterinarian to suspect calcium deposits as the problem, particularly when the age, breed and clinical history are considered.

Blood tests can help indicate some underlying primary conditions, but for confirmation, it may be necessary to obtain a sample of the calcified area. The tissue samples are submitted for microscopic examination by a veterinary pathologist at a specialized laboratory. Cytology (the microscopic examination of cell samples) is not useful for these conditions, so histopathology (the microscopic examination of specially prepared and stained tissue sections) is used. Depending on the case, your veterinarian may submit a small part of the mass (biopsy) or the whole lump, either to confirm the diagnosis of calcium deposits or to rule out local cancers.

Please do let us know what you find out.

Marianne

[jess]

The vet reckons a biopsy would merely return a endocrine problem as the result and wouldn't help us any so we decided not to put Jess through it. He is also pretty adamant that he's not missing any CC. He says it's not that. He reckons we are getting on top of it with the treatment of Paxcutol and Fuciderm, along with antibiotics now.

[jess]

Hi all, we had Jess at the vets today as she wasn't eating or drinking this morning. She's restless, disoriented, walking around a lot into strange places, into corners and her eyes just aren't normal. She goes to water and food but seems to have forgotten how to eat and drink. The vet said her urine had no signs of infection but there's bacteria in her ears and has given us ear drops. He also said she was tender at her bladder. We are waiting on biochemistry results and thyroid tests. Any advice on what this could be?

[Squirt's Mom]

Did this come on suddenly? Has there been any nausea or vomiting? Loose stools or diarrhea? Did the vet mention the pancreas?

Has she by any chance gotten into something she shouldn't have eaten? Or eaten too much, like sneaking in the dog food bag? Did the vet do xrays of the abdomen? Did the mention a twist in the intestines?

Any chance of a stroke or seizure?

Just thinking of things my babies have been through when they acted in a similar manner - pancreatitis, Bloat / GDV, seizure.

Let us know what the vet has to say and how sweet Jess is doing.
Hugs,
Leslie and the gang

[labblab]

Hi again, Johnny. Did you end up increasing Jess' Vetoryl dose, and were you able to perform a recent ACTH as planned? Anytime a Cushpup is not eating/drinking and acting oddly, the cortisol level has to be suspect. But if everything is fine in that department, I do have a worrisome thought. I looked back in your thread and I don't believe we know for sure whether it is a pituitary tumor or an adrenal tumor that is responsible for her Cushing's. But if it is a pituitary tumor, it is possible that the tumor has enlarged to the point where it is placing pressure on the areas of her brain that control her movement, appetite, coordination, etc. Pacing in circles, wedging into corners, inability to eat and drink, restlessness, change in personality, can all be symptoms of tumor enlargement. I am very sorry to say this, but I experienced many of these symptoms myself with my own Cushpup after we believe his tumor enlarged.

Finding out for certain requires imaging of the head which is quite expensive in the U.S. (CT or MRI). And treatment is also quite expensive (radiation to shrink the tumor or innovative surgery). So I don't know whether you would even consider additional diagnostics if a macrotumor is suspected. But I did want to tell you that this problem may be the cause of Jess' problems. Short of more aggressive intervention, some specialists recommend lessening/stopping the trilostane dose and even beginning supplemental prednisone in order to reduce the swelling and inflammation that is being caused in the brain. But of course this is counter to normal Cushing's treatment so you would want veterinary agreement that an enlarging tumor is a likelihood. Also, I see that you mention that Jess has previously had a stroke, so I suppose it is possible that she has instead had another cerebral event of that nature.

Of all the issues, of course the lack of eating and especially drinking presents the most immediate problem. So no matter what, your vet may recommend at least temporarily discontinuing the Vetoryl to see if that will help.

Please do keep us updated!
Marianne

[jess]

Test results came back with 2 liver enzymes high that the vet's worried about. Alk phos was1575 and the Alt was 152. He reckons there's a build up of toxins due to poor liver function. High levels of ammonia can cause brain problems. I was hoping the problem was Vestibular in nature but I'm beginning to think it's Hepatic Encephalopathy. She's had no Vetoryl today as she hasn't eaten. This started this morning and gradually got worse, so quite sudden. Not eaten anything bad. Thanks for your comments.

[labblab]

Yes, coming on so suddenly makes it look like something other than the issues I mentioned. Elevations in liver enzymes are not unusual in Cushpups, but do these values represent a large increase from previous tests? Since Tess has now been under treatment, you would not expect additional big jumps to be coming unless something new is going on.

[Meg_Elizabeth]

Hi I'm meg! I just read your story and I wanted to offer you some friendly input because my dog has had similar issues and we were at the vet just yesterday.

In terms of the appetite, have you offered any of her favorite foods or treats? When my dog Abby wasn't eating it was because of her vestibular episode and the nausea that came with it. We gave her crushed up dramamine on vanilla ice cream that she licked up. It helped with the nausea and she began eating a little. We tried pumpkin, pieces of chicken, anything. Another time she wasn't eating was when she got into the trash and was poisoned, it made her sick. Could your pup have eaten something bad?

Also, What makes you think its hepatic encephalopthy and not a vestibular issue? im just curious and hoping for the best. Abby hasnt had elevated liver enzymes, so I can't say I'm experienced there. Did your vet offer any advice or a treatment plan?

I will be following your story and I'm here if you need anything or just want to talk. Sorry to ramble on, I just really love pups so much and hate this disease and what it does to them. It's such a struggle and so hard to deal with emotionally and physically. Wishing you the best!

-Meg

[jess]

Just to close this thread with the sad news that Jess deteriorated late last night and we made the call to the vet to put her to sleep. Keep up the great work on this site, it helped us help Jess numerous times.

[lulusmom]

I'm so sorry for your loss. My thoughts and prayers are with you.

Godspeed sweet Jess.

Glynda

[Squirt's Mom]

Oh sweetheart, I am so so sorry to hear this. I know your heart is shattered right now. Please know that we will be here to listen any time if you want to talk. We do understand.

Jess' name has been added to the In Loving Memory thread for 2014 where she will always be remembered and cherished by her family here.

http://www.k9cushings.com/forum/showthread.php?t=5973

Our deepest condolences,
Leslie, Trinket, Brick, Sophie, Fox and all our Angels



FRIEND

I lost a treasured friend today
The little dog who used to lay
Her gentle head upon my knee
And shared her silent thoughts with me.

She’ll come no longer to my call
Retrieve no more her favourite ball
A voice far greater than my own
Has called her to his golden throne.

Although my eyes are filled with tears
I am thankful for the happy years
She spent down here with me
And for her love and loyalty.

When it is time for me to go
And join her there, this much I know
I shall not fear the transient dark
For she will greet me with a bark.

~Author Unknown

[Budsters Mom]

I am so sorry to hear this news about your sweet girl. :o

Fly free Jess, fly free!

[molly muffin]

Oh no. I am so sorry to hear this news. I know your heart hurts losing your precious Jess.
My sincerest condolences
Sharlene and Molly muffin

[Robert]

So sorry for your loss

[labblab]

I, too, am so terribly sorry. But thank you so much for returning to tell us what has happened. I've just seen your beautiful memorial photo of Jess. Her noble face and sweet eyes bring tears to my own eyes. What a dear girl.

Please know that we will always welcome you back to us at any time that you wish to talk or remember or have a story to share. And we will always honor Jess here amidst our other beloved Cushpups who are now released.

Sending you my deepest sympathy and also my fond wishes, always in loving memory of your girl.
Marianne

[mytil]

I am so very sorry to read of the passing of Jess.
My sincerest condolences.

Always remembering your boy here and please do stay with us.
Terry

PS I have linked her name to the wonderful photo you sent.

[My sweet Ginger]

I'm so sorry for your loss. Jess was a beautiful dog. Hug, Song.

[mypuppy]

I am so deeply saddened for the loss of your precious Jess. Now together with my sweet chocolate Princess, running free.

RIP.

Blessings and tight hugs.
Xo Jeanette

[jess]

Thanks for all your kind words. She was, and still is, so special to us. Her best mate, Paddy is still with us and we're all helping each other.

[doxiesrock912]

I'm so very sorry! Paddy will feel lost. Boost his confidence as much as you can and take him to a fun training class or something to get him engaged. It helps them to grieve, keeping busy.