Please, any advice appreciated - RIP Kayne

[Jessicad]

Hello,
I am luckyto have been guided to this forum from some awesome people on the canine cushings facebook. I appreciate any and all asvice anyone has to offer. I have a 10 year old pitbull who was extremely healthy. The only thong was he started urinating inside every once in a while. Besides that he showed no signs of pain, he ate well and was very active. The first test the vet started with was a urinalysis which showed he had a little bacteria in his urine so he was put on antibiotic. His urinalysis also showed a high level of protein/creatine was elevated as well as the alk. Phosphates. The vet said he had some signs of cushings like the pot belly,urinating inside, and muscle mass loss on his head. We then did a stim test which he said confirmed he was cushings. We then did a loading dose of lysodren for 5 days. It wasnt until the 6th day that kayne became very weak, rear legs were letting out on him, slept all day, would not eat. He was then put on prednisone for a while because he just wasnt picking back up. Id say for about a month. My now 80 pound dog is down to 65 and lost muscle mass in his entire body and seems bery sluggish and depressed. While on the prednisone he had these little bumps on his entire back which were popping and he lost all of his hair and got a infection. After antibiotics they began to clear up and just revently his hair began to grow back. The one vet I saw said it was not cc and another said it was. In the meantime now he began walking in circles getting stuck in wierd spots under chairs or or on sides of beds and his balance seemed off. We then weened him off the prednisone hoping it was just a side effect of the prednisone which it was not because he is still doing it all. We never continued the lysodren because the vet said he was to sensitive to it so now he wanted to try the mitotane. After three days on the mitotane the same exact things started to happen not eating very weak and lazy so i immediately stopped the medication. Since the three days on mitotane he has now started to have head tremors. They are real fast a couple seconds and if you talk to him they stop right away. I am not sure what is going on with him but i do know that he was completely healthy until he started getting treated for the cushings. I just got all his test records an if anyone has the time please check them out an let me know if you see anything. Please and thank you in advance. I just have to figurenout how to post the test results?????

[Squirt's Mom]

Hi!

Glad to see you made it here!

Help me here - did he start on Vetoryl then go to Lyso? Lysodren and Mitotane are the same drug is why I ask....Mitotane is the brand name, Lysodren the generic. So if he went from Lysodren to Mitotane, he didn't switch drugs, just switched from generic to brand.

Most of us simply type out the test results. We need to see something like this for ONLY the abnormal values (too high or too low) on the blood work that shows things like the Alk Phos -

ALKP 1500 500- 750 ug/dl (EXAMPLE)

For the ACTH, we need to see all the numbers given, should be a pre and post number along with the little letters and normal ranges given. For the LDDS, there will be 3 numbers along with little letters and ranges.

Hugs,
Leslie and the gang

[Jessicad]

Oh Leslie, glad you found me on here. All these drugs i mess them all up. You are right he loaded on the lysodren the switched to the vetoryl for three days. Ok let me type up his resujts for ya to check out. I really really really appreciate it

[Harley PoMMom]

Hi and welcome to our family!

Sorry I only have a moment to post, but did want to ask one question for now :eek: Was diabetes ruled out?

I'll be back later and I am sure others will be by to welcome you and share their advice.

P.S. Thanks Leslie for guiding her here ;) Leslie is just such a wonderful person!

Hugs, Lori

[Jessicad]

Ok i hope i am giving you all info needed.
1st urinalysis- protein 3 plus
Specific gravity-1.013 1.015 - 1.050
Wbc- 4-10 0 - 3 HPF
Urinalysis after antibiotic
Protein-2 plus
Then we sid a senior screen
Alk phosphates- 1553 10 - 150 ug/dl
Alt (sgpt)-258 5 - 107 U L
Ggt-65 0 - 14 U/L
Potassium-5.7 4.0 - 5.5 mEq/L
Na/k ratio-26 27 - 40
Anion gap-28 12 - 24 mEq/L
T4 - 0.5 1.0 - 4.0 ug/dl
Free T4- <0.3 0.6 -3.7 ng/dl
Free T4 - <3.0 7.7 - 47.6 pmol/L
Neutrophil seg- 90.5 60 - 77%
Lymphocytes- 5.1 12 - 30%
Eosinophil- 0.8 2 - 10%
Auto platelet- 527 164 - 510 K/ul
Absolute lymphocite-602 1000 - 4800 /uL
Absolute eosinophil-94 100 -1250 /uL
Urine protein/creat -3.4
Urine Creatinine - 23.1 mg/dL
Ok then the stim test before lysodren
Cortisol sample 1-5.3 reference range 1.0-5.0
Cortisol sample 2-29.9 reference range 8-17
There is a spot for pre and post and there is nothing input there.
Then the stim test after the loading dose of lysodren done the very next day after last day of loading
This one is fillednin for
Pre-910
Post-1110
Cortisol sample 1- 1.9
Cortisol sample 2- 2.0
Im assuming all the results that are not normal are the bold printed results? I think im just going to upload pics so you can check it out because honestly i dont know what i am looking at or for

[Harley PoMMom]

Can you go back and edit your post to add the reference ranges along with the units of measurement, as an example...ALT 150 U/L (5-50)...Thanks so much!!!

[Jessicad]

Thanks sooo much Leslie is great full of so much knowledge. She has helped and guided me through this and i appreciate it. I have uploaded pics of the results in a album on here if you are unable to open it or make out what it says i can upload it to my computer to make it more clear. And no the vet never mentioned diabetes???

[Squirt's Mom]

Leslie is great full of so much knowledge.

Pooh! I know next to nothing compared to some of the folks we have in house here! You are in for a surprise! :D But thank you! :o

[Jessicad]

Oh i hope so.
Were you able to see the results in the album or are they not clear enough

[Squirt's Mom]

It is hard to read the pages uploaded so if you would be so kind as to edit the values to include the normal ranges that would be great!

Just from what I can see, it seems there is possibly an active infection and or allergic reaction somewhere, along with possible liver damage/disease. Diabetes is something I would want ruled out if it hasn't already been. On the lab it would show as GLUC for blood sugar level. That along with a urine dip stick test should tell the tale for diabetes.

Has Kayne been on any meds before the Lyso and Vetoryl and Pred? Anything he has been taking for some time?

[lulusmom]

Hi and welcome to the forum.

I know it takes a lot of work to post lab work but am wondering if you could please give us the normal references ranges for just those values that are either high or low. You can do this simply by editing your post. Did your vet do an abdominal ultrasound to determine which form of cushing's your dog has?

The stim test that was done one day after the last loading dose is too low for comfort, especially since Lysodren has a cumulative effect for at least 48 hours. That means that if the stim test was done a day later, those numbers would have been lower. How long after you discontinued Lysodren that Vetoryl was started. Did your vet do an acth stimulation test before starting the Vetoryl to make sure that your pup's adrenal glands had recovered from the Lysodren? To start adminstering vetoryl to dog whose adrenal glands are severely necrosed by Lysodren is a recipe for disaster.

I don't want to scare you but the neurological signs you are seeing could be the result of an expanding pituitary macroadenoma. It is well known that treatment with either Lysodren or Vetoryl can accelerate the growth of a macroadenoma. It could also be neurotoxicity caused by giving Vetoryl to a dog whose adrenal glands have not regenerated enough. If it were my dog and I didn't know if my vet made certain that the adrenal glands had not only recovered but were generating too much cortisol again, I would not put another capsule in my dogs mouth until I knew for certain.

Glynda

[Squirt's Mom]

ahem.....^^^^ Glynda, one of those resident gurus I was talking about! ;)

[Jessicad]

Ok let me fix the results for ya. He did have a urine infection then had antibiotic in which it went away. Kayne has never been on any meds he was as healthy as you an get until now. The vet first started out in the direction of liver disease but then ruled it out and went on testing for cushings

[Jessicad]

ok guys i scanned all the test results now into the album so they are clear and I numbered them in order how he gave them to me. I hope you can read them now.
After Kayne had the bad reaction to loading of the lysodren i took him off immediately then he was put on prednisone for about three weeks and we slowly weened him off. His last dose of lysodren was on 12/17 and he did not start the vetoryl until 2/12 which I only kept him on for three days. The vet never did another stim test inbetween the two but he did do bloodwork and he basically said wait until he starts acting like a cushings dog again so when he started to urinate inside is when he wanted to start the vetoryl. It wasnt until the Vetoryl that the head tremors started and are still happening. I did alot of research and chatted with a couple people on cushings sites so I am aware that there is a chance it can be a macro. Today Kayne is definitely getting stronger his appetite is coming back. I know he will never get his muscle mass back but that is ok. I just want him to enjoy life. Right now all he does is pace the house, walk in circles, gets stuck under chairs and on sides of beds, up all nite long pacing and urinating inside. It is a very very hard thing to watch. I am terrified to leave him alone. I just dont understand how he could go down hill so fast in a matter of three months he went from a normal strong very strong dog showing no neuro signs or no signs of being a old dog to being this sad old lazy dog who is so confused. When we went to the vet the first visit he did do a xray and said his bladder was enlarged. In three months he has lost prob 15-20 pounds. I dont know what to do at this point. I have spent all my savings at the vet. i have no more money to keep taking him to a vet that is doing nothing for him. When I talked about the neuro things he was doing he said it could be ccd which I dont know if that comes on this strong and fast???? His eyes dont twitch or go side to side but I do notice the third eye is out alot more then it should be and if he is woken up out of a sleep they kind of sink in real fast but then go back to normal???? I dunno i just dont know what to do??? I definitely know I can not treat him with the cushings meds which I am ok with but I just want him to enjoy life again.

[molly muffin]

Hi! sending you a big wave. So glad you found the forum! Yay!

Kayne has had some problems for sure. I don't think that he is sensitive to lysodren, I think he crashed, was on the prednisone for a while as a resuce dosage, but isn't now, and then did vetroyl for approximately 3 days before he showed once again a sign of crashing. I'd add that he also never showed any of the circling getting lost in corners episodes until After the Lysodren crash.

Let me know if you need any help with the labs. (I'm Sharlene from Facebook cushings page, glad you found your way into the forum too)

hugs
Sharlene and Molly muffin

[Jessicad]

Sharlene, yayaya im glad you found me. I will take any advice or guidance you have to offer. You have already been so great. I made a album on here of all kaynes test results please look them over le me know what ya think. And yes you are right kayne ahowed no neurological signs at all until after the loading dose of lysodren and never stopped.

[Jessicad]

Quick questions, after the lysodren crash how long does it take for the adrenal gland to fully recover?
Macroadenoma-Whats the average life span?
Neurotoxicity??? If by chance this is the case will he snap out of it? Or would he pretty much be poisoned?

[molly muffin]

On lysodren, sometimes they remain without adequate cortisol production and this is called Addisons.
I know you can't afford the ACTH right now, but what about getting a baseline cortisol test. That shouldn't cost Nearly as much, it's a regular blood test and see where he is at.

Macro depends on how fast it grows and what pressure points it is on.

Neurotoxicity - I don't know. Maybe one of the admins would have an idea.

I'll look the labs over when I get a chance. How is he doing today? Great picture by the way. That boy definitely needs a belly rub. :)

hugs,
Sharlene and Molly Muffin

[Squirt's Mom]

Would the vet let you make payments or work off an ACTH cost? Mine has let me clean floors, walk and feed, change / wash beddings before - it doesn't hurt to ask. ;)

[Harley PoMMom]

When a dog's cortiol drops too low, usually the adrenals will regenerate but sometimes they do not and the dog will need a regular supplemental glucocorticoid, such as prednisone. The adrenal glands also produce mineralocorticoids, and if they are eroded too much then this will have to supplemented also. This is known as an Addison's crisis and it is vital that the dog be checked and the appropiate measures be done.

[Jessicad]

Would there be any signs if he was addisons now?
After his loading they ran a blood test to see if he was addisons they said if he was his electrolytes would be off and he said they were not. So your saying request a baseline cortisol test? Thats what you would do for your next step? I will call tomorrow and get that done. He is doing good today paceing all over the house but eating which makes me very happy. Please whenever you get a chance check out his labs. This site ia great. If only i new back then what i know now.

[Jessicad]

Anne,
Unfortunitely i have a small balance of 200 dollars still at the vet so im sure they wont let me run up any more of a bill but that would be nice. You are very lucky to have a vet that will let you help at the clinic to help with your bills.

[Squirt's Mom]

Ok...in editing your post with the lab values I see something that is VERY concerning to me and could account for much of what you are seeing....and makes me wonder about your vet, truthfully!


Free T4- <0.3 0.6 -3.7 ng/dl
Free T4 - <3.0 7.7 - 47.6 pmol/L

This tells me Kayne is HYPOTHYROID - easy and inexpensive to fix! Has the vet said anything about this at all?!

[Squirt's Mom]

The T4 had been missed and it is also low! These are all part of the thyroid function and Kayne's is off, no question in my wee mind at all!


T4 - 0.5 1.0 - 4.0 ug/dl

[Jessicad]

Anne,
Nope he has never mentioned that at all in fact i have no idea what it even means.
So hes not cushings? Or thyroid on top of cushings?
Is this thyroid a big deal? Are the symptons hes having symtems that usually come with thyroid issues? Omg i new something wasnt right thank you soooooo mich for looking at his labs. Ok so what do i do? How do i tackle this? Believe me I am really wondering about my vet as well and have been thats why im doing so much research. Its so hard to find a good vet and they actually are well talkes about ...crazy thank you so much

[molly muffin]

omg leslie you are so right.

This needs to be addressed pronto, and as leslie said, is inexpensive to treat and might solve alot if not all of Kaynes problems. Good lord, imagine a vet missing that. That's not even just a tiny decrease that could be caused by cushings (In case that is what they said) that is a full out ailment.

Just so you know, this take precedence over the baseline cortisol, although I'd want that too. He needs thyroid medication.

hugs,
sharlene and molly muffin

[molly muffin]

Many of the symptoms are with hypothyroid are the same as symptoms of cushings. It is why the first things you rule out when a vet says cushings, is thyroid and diabetes.

Sharlene and Molly Muffin

[Jessicad]

Damn it im soooo mad. I dont even want to go back to him? Should I just change vets? How do I handle this?
So your telling me Kayne ia not even cushinhs and my vet had me poison him with chemotherapy drugs? Wow

[Squirt's Mom]

Please double check my edit job on the post you made where you listed the lab results and make sure I got them right. My old eyes ain't what they used to be! ;):p:o

If I were you, I'd be at his office first thing when he walked in in the morning with those test results in hand and make him explain why he ignored values so very low in an organ that controls just about every system in the body. Then demand he give you a couple of months free medicine for Kayne to make up for all the $$ you may well have wasted not to mention the extreme danger he put Kayne in by ignoring this....and wipe that balance OFF his books. ;)

Donna, this CANNOT wait - this is critical....MUCH more so than cortisol.

[Renee]

This is why it is so vital to post results here, so people can see what vets may miss. It really burns my biscuits how many incompetent vets are out there! I would really give the vet a piece of my mind. They could have killed your dog by giving him cushings medication, without even addressing the thyroid function.

Yes, I would take your boy to a new vet, have a full thyroid panel run, and go from there. Cushings never, ever gets treated over thyroid or diabetes.

[Squirt's Mom]

A full thyroid has been done so all he needs is medication and the sooner the better.

[molly muffin]

No, we don't know if kayne is cushings too, but wouldn't know until the thyroid is taken care of.

I really haven't had time yet to look at the labs that Leslie looked at. When were these results from?

Sharlene and molly muffin

[molly muffin]

Seriously, you go back to that same vet in the morning, first thing and demand, answers, medication, everything!!

It can be done, we just had a member reimbursed by her vet for wrong dosage medications and tests not needed, etc. You can do this, you are Kayne advocate. Can you tell me what date those lab results are from?

Sharlene and molly muffin

[Jessicad]

Ok i got the labs out let me see ....
On 11/27 i see
Free t4 (ng/dl)0.3 reference range 0.6-3.7ng/dl
Free t4 (pmol/l) 3.9 reference range 7.7-47.5pmol/l
On 11/26 i see
T4 0.8 ref range 1.0-4.0 ug/dl

[Jessicad]

I posted all the labs on here as well in a album. This is so much to take in.

[molly muffin]

Oh dear. These were all BEFORE the cushings meds were started! So, Kayne might not have ever had cushings, we don't know because the thyroid was never addressed.

Were any follow up labs done to show thyroid? T4 or Free T4?

This really can't be put off any longer. Into the vet you go first thing in the morning.

Sharlene and Molly muffin

[Jessicad]

I am oh soooo thankful for you guys. I dont see T4 on any other labs except for the ones on 11/26 and 11/27. So his thyroidis soooooo bad right now from not being treated he is having these neuro issues or is it poison from the meds he did not need? You know while im on here with you guys the vet just called and left me a message and he never heard of the novifit medication you guys told me about. Another red flag. My vet is a small practice of three vets and my vet will not be there tomorrow because on his message he sai he would be back in the office on monday. Is this something that can wait until monday? Do i go and speak to the one vet who is the owner?

[Harley PoMMom]

Hi and welcome to the forum.

I know it takes a lot of work to post lab work but am wondering if you could please give us the normal references ranges for just those values that are either high or low. You can do this simply by editing your post. Did your vet do an abdominal ultrasound to determine which form of cushing's your dog has?

The stim test that was done one day after the last loading dose is too low for comfort, especially since Lysodren has a cumulative effect for at least 48 hours. That means that if the stim test was done a day later, those numbers would have been lower. How long after you discontinued Lysodren that Vetoryl was started. Did your vet do an acth stimulation test before starting the Vetoryl to make sure that your pup's adrenal glands had recovered from the Lysodren? To start adminstering vetoryl to dog whose adrenal glands are severely necrosed by Lysodren is a recipe for disaster.

I don't want to scare you but the neurological signs you are seeing could be the result of an expanding pituitary macroadenoma. It is well known that treatment with either Lysodren or Vetoryl can accelerate the growth of a macroadenoma. It could also be neurotoxicity caused by giving Vetoryl to a dog whose adrenal glands have not regenerated enough. If it were my dog and I didn't know if my vet made certain that the adrenal glands had not only recovered but were generating too much cortisol again, I would not put another capsule in my dogs mouth until I knew for certain.

Glynda

I agree with Glynda, and I believe his questionable cortisol and aldosterone production needs to be addressed ASAP.

[molly muffin]

Lori, did you also see the thyroid results, very, very low before any medication was ever given for cushings too? Back in November 2013 so that in addition to the crash.

They did a stim after the lysodren and then he was on preds, it was over a month from the time of the lysodren (that was dec if I remember correctly) then the prednisone, then he started having accidents again, then he had 3 days of vetroyl when the head tremors started and has had nothing since.

What I'd want right now, is the thyroid medication and addressing low cortisol both

Sharlene and molly muffin

[Jessicad]

Oh believe me they are both getting addressed tomorrow and after that i will be finding a new vet. Is this something that i can or need to speak to a lawyer about if the vet is not willing to work with me?

[Harley PoMMom]

I did see those low thyroid numbers and they do need addressed but right now I am really concerned that his adrenal glands are not producing enough cortisol and/or aldosterone, which can be life threatening.

[Jessicad]

I dont have much knowledge yet only what you guys have taught me. im nervous about them trying to talk circles around me.

[Harley PoMMom]

Unfortunately I don't think a lawyer can do anything regarding a vets incompetence. But us as our furbaby's parents can be their voice. It is sad that we can not completely trust our vets but that is the truth so we have to be our furbaby's greatest advocate and we do this by educating ourselves regarding their care, medications, and any health issue.

You love your boy deeply, we can see that too. You are doing a great job! Just remember to ask the vet all the questions you have and if the vet will not work with you as a team, then another vet is needed.

[Squirt's Mom]

Most states consider dogs to be personal property and the fact that we consider them family doesn't usually carry much weight, especially in pups like most of ours. In show dogs or breeding stock, it might be a bit different.

For today, Lori is right - get with the vet ASAP and ask some hard questions. There is a condition called Sick Eythroid Syndrome that can be secondary to other conditions, Cushing's one of them. However, this syndrome is not as likely with a low Free T4. Look over those test results and see if you see any listing for T3, Free T3, TSH, or Free TSH. If they are normal then this may be what your vet is thinking and why he hasn't addressed the thyroid - BUT I would want an answer. It is entirely possible that Kayne has both Cushing's and Hypothyroidism. One doesn't rule out the other necessarily. ;)

Like Lori said, if his cortisol is still too low, that is also life-threatening and the only way to know is to check the cortisol level and electrolytes.

You're doing good, Mom. Keep watching him closely like you have and get with the vet as soon as you can.

[Jessicad]

Anne
I just looked over everything and i see nothing for T3 or TSH.

[Squirt's Mom]

Ok....then I guess the full thyroid panel was not done after all. I thought I saw something but some of that print is very hard to see.

The vet may still be thinking the thyroid is secondary and if it was just the T4 and not that low, I might not be as concerned. But it is quite low as is the Free T4, which is a sort of double check on the validity of the T4.

Hugs,
Leslie

[Jessicad]

Leslie,
I will be going to the vet in the mornin im just going to show up with my sick dog and hopefully he will work with me as far as refunds and getting kayne the meds and treatment he really needs. Do you feel like i am owes this? Definitely a misdiagnosed case? I am trying to get myself all ready and prepares but i sure am nervous.

[lulusmom]

I don't believe your dog was misdiagnosed and I wouldn't jump to conclusions about the thyroid values as cushing's can transiently suppress both the T4 and FT4. It's very possible that if your dog's cortisol is low enough, both thyroid numbers could be normal today. The fact that your dog responded so acutely to Lysodren is pretty good evidence that the diagnosis was correct. Dogs with normal adrenal glands are very resistant to Lysodren. The results of the cbc are what we see in cushing's as are most of the abnormalities on the blood chemistry.

Even though the cbc and blood chemistry points toward cushing's, given the lack of symptoms, I do think your vet was overanxious in confirming the diagnosis based solely on an acth stimulation test and I think he fell way short on testing. He should have at least determined which form of cushing's your dog has...adrenal or pituitary. Most dogs have pituitary dependent disease which increases the odds of an expanding pituitary macroadenoma.

I don't believe we've ever seen a diagnosis of neurotoxicity but from what I've read, withholding treatment is usually sufficient to bring the dog around in a few days. If I were in your shoes, I would want an acth stimulation test done now, as well as electrolytes checked, to make absolutely certain that the adrenal glands are producing enough cortisol and aldosterone. I would also not worry about resuming treatment until symptoms become very apparent.

Glynda

[Jessicad]

Im sorry leslie i have been calling you anne lol

[lulusmom]

Hi again. I forgot to ask how much your boy weighed when you started loading with Lysodren and what was the loading dose you were prescribed? Also, how much did your boy weigh when you started Vetoryl. What was that dose and was it once daily or twice daily?

[Jessicad]

Glynda
So you dont think kayne has hypothyroidism? You believe he does have cushings? Even after what the labs read?
Kayne was about 80 pounds on november before he started and meds he is now 65.
How would you go about my situation?

[lulusmom]

If I were you, my focus would be on getting an acth stim test done to see where cortisol levels are. I'm not sure if you saw my last post where I asked for your dog's weight before Lysodren as well as the loading dose your vet prescribed. Also how much did he weigh when you started Vetoryl and what dose were you giving him...was it once daily or twice daily?

As I mentioned in my prior post, cushing's can suppress T4 and FT4 which will normalize once cortisol is reduced. At this point, both could be normal already so I wouldn't worry about hypothyroidism until you get your boy stabilized at which time you can have your vet recheck the thyroid function.

[Jessicad]

How do kaynes acyual stim test results look?

[Jessicad]

Glynda,
Kayne was about 75 pounds before he started the lysodren which he loaded twice a day but i dont remember the mg. an i just searched the entire kitchen but i mist of thrown out the box. When he started the vetoryl he was 68 pounds and he took that once a day 60mg

[Jessicad]

Found the recipe the lusodren says 500mg

[Jessicad]

How about a standard cortisol test rather then a stim test?

[lulusmom]

Lysodren tablets are 500mg. How many pills were you giving him during loading? Kayne's acth stim test that was done prior to treatment is consistent with cushing's. If you will read my prior post, you will see that I mentioned the stim test one day after his last loading dose was low and probably went lower the day after. Lysodren has a cumulative effect for at least 48 hours after the last dose so it would have continued to destroy more of the adrenal cortex, dropping cortisol even further. When you ask about a standard cortisol test, you are referring to just the resting/basal cortisol and that is not sufficient. Kayne needs an acth stimulation test.

[Jessicad]

Kayne was taking the lysodren twice a day during loading. I appreciate all your feedback. After lhaodrennloading his cortisol level was very low and continued to drop after the stim test. Whats your thoughts on the sudden neurological issues?

[Jessicad]

I read in a previous post that thyroid should be addressed before the cushings. You do not feel this way?

[lulusmom]

Kayne was on a lower loading dose than most. My two dogs loaded at the full 50mg per kg of weight. Kayne's dose was 29mg/kg so he was quite sensitive to the drug. As far as the neurological issues you are seeing, I think it's a good possibility that your boy has an expanding macroadenoma. This is something you should talk to your vet about. Did you notice that his neurologic symptoms worsened after taking him off of prednisone? I ask because prednisone reduces inflammation and swelling and can alleviate the pressure. If he does have a large macro tumor, taking him off of prednisone would likely make him worse.

[Jessicad]

I did research online and talked to my vet about the macrobhe said it is very uncommon but not impossible. The neuro things hes doing started right after loading in which he was on the prednisone. I dont feel they have gotten any worse since off the presnisone but his newest thing now is hes up pacing at night so maybe they are getting worse??? If it is a macro theres nothing i can do any way right?

[lulusmom]

I would definitely retest the thyroid function but I would put it on the back burner until after the acth stim test. If Kayne were my dog, I would check cortisol levels first, talk to vet about the possibility of a macrotumor and talk to the vet about rechecking thyroid. I'm sure your vet saw those thyroid values and he probably assumed that cushing's may be causing the suppression. Dogs with hypothyroidism don't lose weight, they usually gain weight and dogs with seriously low thyroid have really dull, thinning coats, skin issues and it doesn't cause excessive drinking and peeing. As I recall, the only symptom Kayne had was having accidents in the house, which is a red flag for cushing's, not hypothyroidism.

[lulusmom]

We do have members who have experience with macro tumors and have had success with radiation. It's an expensive procedure and so is the MRI that would have to be done first.

[Jessicad]

Kaynes hair did get very thin and after loading lysodren kayne also got a very bad skin infection on his back where he lost all of his hair.

[Jessicad]

If a macro can a sam-e product be used tonhelp with symptoms?

[Jessicad]

I could never afford to treat with mri and surgery. Here in nj they are about 5k a piece. Makes me feel helpless. What about the sudden head tremors after the vetoryl now?

[lulusmom]

Symptoms of a macroadenoma are pacing, lethargy, wandering, hiding, tight circling, head pressing, and trembling. Muscle tremors is a side effect associated with Vetoryl but given the other neuro signs you are seeing, I believe the head tremors could be attributed to a macro tumor.

[lulusmom]

I believe SAMe has been used for canine cognitive dysfunction with good results but I doubt that it would do anything for a macrotumor.

[molly muffin]

Wouldn't a base cortisol tell her where his cortisol is at? That plus thyroid blood test to see if they have normalized?

I know an ACTH test is the best choice but if that isn't an option?

Sharlene and Molly muffin.

[Jessicad]

My question is his thyroid was very low before any treatment for cushings were done. Should this of been addressed first?

[lulusmom]

Wouldn't a base cortisol tell her where his cortisol is at? That plus thyroid blood test to see if they have normalized?

I know an ACTH test is the best choice but if that isn't an option?

Sharlene and Molly muffin.

If an acth stim test is not an option, then a baseline is certainly better than nothing and yes thyroid can be tested at the same time.


My question is his thyroid was very low before any treatment for cushings were done. Should this of been addressed first?

As I mentioned previously, because cushing's can suppress T4 and free T4 and because Kayne presented as a cushingoid dog, I believe your vet correctly addressed cushing's first.

I've included a link below to more information on diagnosing hypothyroidism and euthyroid sickness which might help.

http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2554

[Jessicad]

And if the cushings is not going to be treated if a macro then does the thyroid needs to be treated ????

[molly muffin]

We don't know that it is a macro and without imagining there is no real way to no for sure.
However, if you get at least a baseline cortisol, check the thyroid currently and if thyroid needs to be treated and you do so, and the symptoms go away, then likely not a macro.

That is my thought anyhow.

hugs,
Sharlene and Molly muffin

[Jessicad]

Im am going to so as you guys guide me. I have called the vet and he will get the baseline cortisol test along with his thyroid. If it is a macro which i am thinking is a great possibility by his actions I will not be able to treat with radiation or surgery so as long as i can get everything else in the clear an make him comfortable i am ok with that. Thank you guys soooo much

[Jessicad]

Symptoms are the same for thyroid and a macro?

[molly muffin]

No the symptoms aren't the same. I am just thinking out loud what I would want checked. Hypothyroid can be a cause of stroke in dogs, one of the signs of stroke, is circling.

There is a chance that this is a macro, but if it is not, then myself I would check what I could and see what can be done to give him a good doggie life going forward.

Cushings and brain tumors can also cause strokes. This is just one possibility.

Right now, things are not good for Kayne, nor for you, so whatever can be figured out would be good.

What has your vet said about the circling and the hiding and other behavioral changes?

Sharlene and molly muffin

[Harley PoMMom]

Symptoms are the same for thyroid and a macro?

They may have a lot of similarities. Neurologic Signs can be affected by Hypothyroidism:
Central Nervous System – may represent abnormal electrical conduction within nerves; however, vascular disease has been found in hypothyroid dogs with central nervous system signs. Clinical signs have involved ataxia (drunken gait), hemiparesis (weakness in front and back legs on the same side of the body), hypermetria (inappropriate measurement of steps), head tilt, circling and cranial nerve abnormalities. It may take several months of therapy to see a response.

Full article can be found here: Hypothyroidism in Dogs (http://www.veterinarypartner.com/Content.plx?P=A&A=461&S=0&EVetID=3001459)


Hugs, Lori

[Dawn Anderson]

Just read through your thread and all I can say is OMG how heart breaking, you both have been run through the grinder so many times. Not sure if I missed anything, but I never saw whether he has ADH or PDH ? My girl has PDH which is being driven by a fast growing macro which also reeked havoc on her neuro.system. I was able to get her radiation therapy to shrink the tumor and hoping that the radiation damaged enough of the tumor cells that it kills it or a least keeps it from regrowing.

We are all here for both of you and Buttercup and I are sending prayers you way that you are able to get your babies issues hashed out for once and for all and be able to move forward with confidence in what ever treatment he may need.

Dawn and Buttercup

[Jessicad]

Thank you soooo much Dawn,
You are very very licky that you were able to get Buttercup radiation. Unfortunitely if the case is he has a macro Im am mad and sad to say I will not be able to get him radiation. I have done everything that I can but i just can not do mich more. I just spoke to the vet we are waiting until March 7th to be 100 per cent sure the vetoryl is completely out of his system and then we are going to do a full thuroid panel and a basic cortisol check. If the thyroid needs to be treated we will then do so. I am very nervous and scared. After this there is nothing more we can do or try. Its so scary. When you get your dog you dont realize he will only be with you for such a short period of time. I just want him to enjoy every second he has left. Thank you for your prayers.

[Squirt's Mom]

How is Kayne this morning?

[Jessicad]

Leslie,
He is good this morning. I am exhausted from him pacing all night lol. He just ate a bunch of food and is now resting. I wanted to ask you the vetoryl last day taken was 2/14. Vet has me waiting until 3/7 for blood work to recheck thyroid and cortisol to be sure it is out of his system????? I feel like that is alot of time wasted with a sick dog dont you or is he right?

[molly muffin]

Vetroyl typically is good for about 12 hours in the body, then cortisol levels start to raise again.

You could probably do the testing sooner. It isn't the same sort of wash out that lysodren is.

Sharlene and molly muffin

[Squirt's Mom]

I am impatient and would want to get in sooner but if Kayne is not getting worse then waiting til then should be alright.

You are in a difficult spot. So many of the things you are seeing in Kayne can be caused by the thyroid, cortisol and electrolytes too low, a macro, or dementia....or a combination of any and all of these. So Kayne could be hypothyroid and have a macro; or the cortisol be too low and hypothyroid; or dementia and low cortisol/electrolytes. He could be experiencing cortisol and electrolytes that are too low, hypothyroid, dementia and have a macro. It is very likely you will get a combination of diagnoses for the issues he is having now. I don't think you are going to get a simple answer unfortunately but we can hope! :)

Regardless, answers will help point you in the direction you need to take to make life the best possible for your sweet boy. Answers can help us, help you, too. ;) You have time to make a good list of questions for the vet. Take someone with you so you have two sets of ears to hear; take a recorder and record what he has to say; take notes during the talk; something to help you remember. This not only makes it easier to remember what was said, it shows your vet that you are going to be an active participant in Kayne's care - that you are his advocate, his voice. Ask for copies all all test results - you know we LOVE those things! :D

Hugs,
Leslie and the gang

[Jessicad]

You and me both Leslie, I am sooooo impatient. I just dont want to wait that long because if it is something like thyroid that we can fix right away id hate for him to deal with this any longer then he has to. I will probly end up bringing him in begining of the week next week. I am hoping it is just his thyroid and not a macro. When kayne started to circle and get stuck in wierd spots i brought him in and two vets did a neuro exam on him in which he passed so i dont get it and i hate not knowing. I also noticed the third eye he has comes out a little more then usual covers about a quarter of his eye. What is this a sign of?

[Jessicad]

Do i have a good chance that the thyroid could be making kayne do the nuero things such as pace and walk in circles and get atuck in spots?the paceing at night got real bad he paces the majority of the night. Was thinking if i should kennel him at night or if he would panic?

[Squirt's Mom]

That is certainly a possible contributor to these things....but it is just as likely the cortisol and electrolytes are still too low and / or he has developed a macro. I so wish we could offer more insight for you but without more clear answers from the vet and testing it is just about impossible. The best we can do is offer ideas, hope, encouragement, and love. And you have all that in spades. ;)

If he is restless, let him roam as long as he can't harm himself. When Squirt does this, I just let her go until I see her legs are really struggling, then I either carry her from place to place or keep her in the bedroom where she can't roam on slick floors and slip. We just have to do what we can to protect them.

Hugs,
Leslie and the gang

PS. I don't know anything about the third lid but hopefully someone will have some thoughts on that for you.

[Jessicad]

Vet today at 3:30 for the blood work yayayaya keep your fingers crossed.

[Harley PoMMom]

Are they doing a baseline/resting cortisol?

[Jessicad]

They are doing a full thyrpid and a baseline cortisol. Hopefully that will give us some answers.

[Harley PoMMom]

They are doing a full thyrpid and a baseline cortisol. Hopefully that will give us some answers.

I am so glad to hear that Kayne is being tested, please do post those results as soon as you can. ;)

Hugs, Lori

[molly muffin]

Yay, glad to hear that this is being done and hopefully will give you some answers. Yes, as Lori mentioned as soon as you get the results (don't forget to get your own copy) we'll want to see them too.

hugs,
Sharlene and molly muffin

[Jessicad]

Will do lori, they said results will be in tomorrow. Keep all fingers crossed.

[lulusmom]

Keeping fingers and paws crossed here. :D

[molly muffin]

We'll be right here waiting with you. :)

hugs,
Sharlene and molly muffin

[Squirt's Mom]

Can't wait to see what they show! Standing impatiently by your side.

[Jessicad]

Ok, so the vet just called. The results are not back yet but they are open until 8 he said there is a good chance they will come in tonight and if they do they will call me. He said that a couple thinhs kindnof got my hopes down. He said with such low doses of both meds he doesnt think his cortisol level is low. He also said he saw the thyroid being low which is secondary treated to the cushings. He also said even though the cushings is not being treated you dont treat the thyroid and if you did it really wouldnt do much. He said he also had a couple interactions with internist and they are all stumped as well about how sensitive kayne is to the medicine. He said that he thinks maybe its time to put in another call to possibly talk about if there is a more natural way to help with the cushings. I dont know what to think about this now.im sure they will say i need to bring him to a internist now and i just can not afford that.

[Harley PoMMom]

The other medical treatment for Cushing's is Trilostane. Trilostane can be compounded, and is also available through Dechra. Dechra is the maker of Vetoryl, Trilostane is the active ingredient in Vetoryl.

Having Trilostane compounded through a reputable pharmacy is less expensive than buying the brandname Vetoryl. I'm providing you with a link to our Resource Forum where you can find information about Trilostane/Vetoryl: Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)

Let's wait to see those tests results, and than, hopefully, we can help you with making a treatment plan for Kayne.

Hugs, Lori

[Jessicad]

Thanks Lori,
Im very impatient about these results. So the compounded trilostane will not effect him the way the vetoryl did? I also noticed today his eyes every one in a while doing a twitch not side to side like a sink in and out. Really freaked me out. Go i hope its no macro ;(

[molly muffin]

Lori, Kayne has so far been on both lysodren and vetroyl and on both he had symptoms of a crash. He was was only on the vetroyl for 3 days before it had to be discontinued and got us to where we are at now. :( He had prednisone after the lysodren, then was off everything, then the vet started him on the vetroyl.
I too hope that the test results will tell us something more.
Sharlene and molly muffin

[molly muffin]

The eye thing is bothering me too, as that seems to be a symptom of something more going on and I worry about any pressure being put on the eyes.

I too hope it isn't a macro. You did say that he passed the neurological tests that they gave him correct? I don't know if they will pass or not if it is a macro.

Sharlene and molly muffin

[Jessicad]

I just noticed the eyes thing. I kept a eye all day and noticed it is only when he is startled or woken from sleeping. Two vets checked his eyes and did a couple nuero test in which he passed. Sooooo confusing.

[Harley PoMMom]

Lori, Kayne has so far been on both lysodren and vetroyl and on both he had symptoms of a crash. He was was only on the vetroyl for 3 days before it had to be discontinued and got us to where we are at now. :( He had prednisone after the lysodren, then was off everything, then the vet started him on the vetroyl.
I too hope that the test results will tell us something more.
Sharlene and molly muffin

Thanks for reminding me Sharlene, my feeble mind :eek: I did scan Kayne's thread but couldn't find what dose of Trilostane Kayne was on???

[molly muffin]

He was on 60 mg daily and weighs about 65 lbs
Sharlene

[Squirt's Mom]

So the compounded trilostane will not effect him the way the vetoryl did?

The compounded form of Vetoryl, Trilostane, is the same active ingredient as Vetoryl so the effects are the same - for the most part. We have seen pups who did better on the brand name (Vetoryl) than on the compounded form (Trilostane). But both Vetoryl and Trilostane are essentially the same drug, same effects.

I am not comfortable myself with the thyroid still being untreated. I think I would be stomping my feet to at least TRY to raise those levels with medication and see if that didn't help. It may be secondary to another condition, whether Cushing's or something yet unknown, but allowing it to continue to supply such low levels is concerning to me. Perhaps a part of this major concern on my part is the fact that I live with an auto-immune thyroid disease and know what it does to my body and mind when not regulated....and have been told by my doctors what could happen if it has to be removed. It is a tiny thing but oh so critical. However, I will defer my concerns to those with more understanding like Glynda. I do highly recommend that you do some research on the thyroid in dogs and see what you can learn - just in case. ;)

http://www.vetmed.wsu.edu/cliented/hypothyroidism.aspx

http://pets.webmd.com/dogs/hypothyroidism-in-dogs

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/t4/sah-thyroid-roundtable.pdf

Looking forward to the rest of the report and happy he passed the neuro testing. Do you know what kind of testing they did for this? I hope you both have a good day!
Hugs,
Leslie and the gang

[Jessicad]

Thanks for the info Leslie, i have been hitting the internet hard trying to learn anything i possibly can. Glynda arebya put there i would love to hear your input.

[Jessicad]

As far as the nuero tests they just did a couple simple tests like bending hos foot back to see if he would just stand on it and he would not and s couple eye test.

[lulusmom]

Hi Jessica. Please see my comments in blue below.


Ok, so the vet just called. The results are not back yet but they are open until 8 he said there is a good chance they will come in tonight and if they do they will call me. He said that a couple thinhs kindnof got my hopes down. He said with such low doses of both meds he doesnt think his cortisol level is low.

Your vet apparently hasn't treated a lot of dogs with cushing's nor does he have a good understanding of the drugs he prescribed. Kayne was not on a tiny dose dose of Lysodren. He was on the lower end of the recommended loading dose but I wouldn't consider that a tiny dose. While the average time for loading is five to eight days, some dogs load sooner. As a cushdog's adrenal glands continue to pump out excessive amounts of cortisol and other adrenal hormones, the adrenal glands become very fatty and enlarged. This is called adrenal mass and usually the more adrenal mass, the more sensitive a dog is to Lysodren. Did your vet have you give prednisone concurrently with the Lysodren? If yes, that protocol is a really bad one as prednisone masks the signs of loading so a pet owners just keeps dosing until the dog gets really sick.

A published study done in 2012 found that bigger dogs may need smaller doses of Vetoryl to effectively control cushing's. For instance, a dog of Kayne's weight could possibly be controlled by 10mg a day while a dog like my own cushdog, who weighed 4 lbs, was controlled with 30mg a day. Kayne was on the lowest recommended dose but because your vet didn't do an acth stim test before starting him on Vetoryl to make sure the adrenal glands were producing enough cortisol after his crash, there is no way to know whether Kayne was sensitive to the drug or the adrenal glands had not recovered and were not yet producing enough cortisol. An acth stim test should have been done to make sure that post stimulated cortisol was at least 9 ug/dl.

He also said he saw the thyroid being low which is secondary treated to the cushings. He also said even though the cushings is not being treated you dont treat the thyroid and if you did it really wouldnt do much.

I have said this all along so I'm glad I agree with your vet on something. Once cortisol is controlled, you can recheck the t4 to see if has normalized. Kayne's T4 was .8 when diagnosed with cushing's, which is higher than a lot of dogs I've seen with sick euthyroid syndrome. I asked if Kayne had any skin or coat issues and I believe your response was that he shed a lot of hair after Lysodren treatment. This is a normal response to Lysodren for a lot of dogs and it doesn't necessarily have anything to do with the thyroid. Was he showing any neurological signs before starting treatment with Lysodren? If so, what were those signs? Are you still seeing neuro signs? Dogs with true low thyroid are very sensitive to cold whereas dogs with cushing's are very sensitive to heat. Have you noticed either in Kayne?

He said he also had a couple interactions with internist and they are all stumped as well about how sensitive kayne is to the medicine.

I can only assume that the internist is also not very knowledgable or it's possible that the internist was not given a complete picture of Kayne's treatment history.


He said that he thinks maybe its time to put in another call to possibly talk about if there is a more natural way to help with the cushings.

Lysodren and Trilostane are the only effective treatments that reduce cortisol. Holistic or natural treatments may be a good adjunct treatment but alone, they will not have any effect on cortisol production. I do think an internal medicine specialist would be a great idea if you can afford one as I think your vet just doesn't have enough experience. I also think he's probably very nervous about moving forward with the conventional drugs, which is not uncommon for inexperienced vets. I had two cushdogs so I am acutely aware of how expensive it is. Care Credit was my savior and most vets accept it. I recently used it for my mom's dog who was hospitalized for pancreatitis. The bill was a bit less than $1,000 and it allowed me 18 months to pay it off with no interest. Just something to think about.

[lulusmom]

Here is a link to a veterinary article discussing lower doses of Vetoryl (trilostane) in bigger dogs.

http://veterinarymedicine.dvm360.com/vetmed/Medicine/Just-Ask-the-Expert-Could-you-be-using-lower-trilo/ArticleStandard/Article/detail/814582

Here is a link to information on Euthyroid Sick Syndrome which will help you understand a bit more about the difficulty in diagnosing hypothyrodism in a dog who has a serious non thyroidal disease that is probably the culprit for the low thyroid values.

Excerpt from article:
Treatment should revolve around treating the underlying illness or condition which caused the low hormone levels. Medications that may suppress hormone levels should be adjusted or changed if possible. Giving supplemental thyroid hormones to a dog with euthyroid sick syndrome is not recommended. All cases of euthyroid sick syndrome should be carefully monitored by a veterinarian until the condition resolves.

http://www.ehow.com/about_5079729_euthyroid-sick-syndrome-dogs.html#ixzz2uSAXiQyv

Here is a plaque all of us should have in our homes.

809

[Jessicad]

Ok, let me answer all your questions.
After the loading dose if lysodren is when he had me give kayne the prednisone in which he was on for a while. He had no nuerological signs at all before treating with the lysodren. He was a 85 pound very healthy dog who started urinating inside. The neuro things did not start until the begining of January while he was in Prednisone. At that time he was off the loading dose of lysodrenf for about 20 days. Kaynes coat is very brittle and lost a couple spots on his tail before any cushings treatment and dandruffy skin. He is still pacing around the house especially at night. Every so often he gets himself stuck under a chair or on a side of a bed. Looks kind of confused sometimes looking at walls. Which he did none of this prior to the lysodren loading. I have spent $2500 so far on my care credit which is now maxed out. I would love for kayne to see a internist but i just can not afford it. Its very sad to watch he was fine i almost wish i never treated him. Your opinion that we should or should not treat the thyroid at this point? I just took him in for bloodwork a basic cortisol and a thyroid test so hopefully that can tell us something? I am in nj and it is very cold here and ihe definitely does not want to go out in the cold at all i pretty much have to make him. I just dont no what to do. Do you think the vet would set me up to have a phone conversation with the internist?????? Helpppppp

[Jessicad]

Forgot head tremor started after the three days on the vetoryl.

[Jessicad]

Sorry i also forgot to mention a stim test was done the very next day after last loading dose of lysodren which i no is not accurate because it was to soon but even then it was already low i wanna say it was a .2 which is low and would of continued to lower for 48 more hours. I posted all test results in a album on here.

[molly muffin]

Updating from info taken from our Facebook discussions.

I was just looking back at when Kayne was put on lysodren. He had signs of cc at that time. (also was put on baytril for skin infection) The ACTH test was done the day after the last load, which was in the evening, and then ACTH done the following day.

Before Lysodren ACTH pre 5.3 POST 29.9 12/07/2013

The only result I saw on facebook was that the vet said he was at 2 and should be at 1 - 5, and then said to give Prednisone (which was started) and that he was going to call an internist because Kayne could be Addisons.

Actual ACTH on the next day following lysodren load:

ACTH Pre 1.9 Post 2.0 (this would have dropped over the next 48 hours) Dec 18, 2013 (this from posted labs)

Vet later said wasn't Addisons because blood work wasn't off (electrolytes, no follow up ACTH done after the one on Dec 18, 2013.

Kayne was still not eating and was shaking, vet increased prednisone dosage to 1/2 pill in morning and 1/2 pill in evening, appetite came back.

Kayne was fine during the load, no reports of neurological issues mentioned at that time.

T4 has remained steady for at least Nov and Dec at
T4 .3 range .6 - 3.7
T4pmol 3.9 range 7.7 - 47.6

Tapering off the prednisone last dose was January 07, 2014, first day he started to walk in circles as the prednisone dosage was lowered to the last dose (1/4 of a pill).

On January 8, in house blood panel good.

January 8, cc is still bad.

Kayne has lost about 10lbs? since December, 2013.

February 12, 2014 2nd day on vetroyl and Kayne is showing weakness, loss of appetite and had his first heard tremor.

Vetroyl discontinued after 3rd day and he seemed to be getting worse.

This is where we are at now.

sharlene and molly muffin

[Jessicad]

Thank you so much Sharlene. Just called the vet results are still not back yet????they usually come in next day so i dont know.

[Jessicad]

Ok, so I just missed a call from the vet because it was a blocked number. He left a brief message stating that they did not get all results back but what he did get back stated Kaynes cortisol level is good but his thyroid was low and he is waiting on getting the free T4 results back along with the rest of the blood work???? Don't all blood work come back at the same time? I always got all blood work back all at the same time the very next day. Does this seem weird?

[molly muffin]

When he says cortisol is fine you'll want to get the actual baseline number.
It depends when they come back if perhaps they were sent to different labs. Often thyroid will be sent to Michigan University as a top lab for canine thyroid. So we don't know for sure that they were sent to the same place.

Hugs
Sharlene and Molly muffin

[Jessicad]

Ok, i will make sure to pick up all copies of all tests tomorrow as soon as he calls me.
Now, from what I learned on here if his thyroid was euthyroid sick once the cortisol level became good the thyroid would get better.Does this take time or is there a great possibility he is hyperthyroid if cortisol is good and thyroid is still low?

[Jessicad]

But wouldnt a thyroid level and free t4 be on same bloo panel tested at the same time?

[Jessicad]

ok, vet called back. All results are still not back yet but his cortisol is 4.6.

[Squirt's Mom]

Did they give you the normal range? If not, call back and ask what the normal range is.

As for whether they thyroid results will be on the same sheet as the others, it could be or could be separate if sent to a different lab. You may see only the T4 on one sheet while another will show the rest of those hormones - T3, TSH, and Free T4, T3, TSH.

[Jessicad]

Hey Guys,
Hope everyone is doing well. I just got off the phone and want to share everything so I can get all of your input.
First he said Kaynes cortisol is at 4.2 and normal range is 2.0-6.0.
He said that him and the other vets sat down and looked at everything and they are concerned about his blood pressure. When we were there they took a blood pressure which was elevated but kayne is a very nervous dog he acts anxious and pants and is scared every time we are at the vet. He said that there is a chance that the blood pressure very well could be a problem and can cause neurological signs??? Is this true?
He wants to try a bp medication for two weeks to see if he acts any better and if any nuero signs go away? I am a little nervous about this because what if his bp is not high then we give him the meds and it bottoms out his bp. He said this will not happen with the specific bp med he chose to use.
He also keeps stressing how important it is to try to treat the cushings. He mentioned possibly just a very small dose of the meds daily. I am very scared of regiving the meds due to what I feel like they did to him. I just don't know what the right thing to do is. Pleae come on guys I need every ones two cents..lol :)

[Harley PoMMom]

Elevated blood pressure can cause a host of health problems BUT first the high BP needs to be confirmed. Generally 3-5 reading are taken and the dog should be as calm as possible. Some dogs can have what is known as "white coat syndrome," this is when a dog's BP is falsely elevated due to being in a vet office atmosphere.

What were Kayne's BP readings?

[Jessicad]

His readings
were done at the vets office and he gets very anxious and nervous at the vets office and as long as i bring him there to get his bo checked it will always be elevated. I have human blood pressure machines but im not sure if that will work because he is very calm at home.

[Harley PoMMom]

I have human blood pressure machines but im not sure if that will work because he is very calm at home.

I'm not sure either, but your vet should be able to tell you, so I would take your human BP machine on Kayne's next visit and ask if it would work, and if yes, than I would ask them how to use it correctly on Kayne.

[Jessicad]

There is no way to get a real reading as long as I have to bring him to the vet to get it. Is this medication something we can just try?

[molly muffin]

You could read through Vicki's thread here:

http://www.k9cushings.com/forum/showthread.php?p=141484#post141484

She uses a machine at home on Snuggles. I'm not sure what machine it is, but basically she compared her readings to the vets reading and then they recheck to make sure that either they are the same readings or the difference is a known one that remains the same. I think she did a lot of studying to figure it all out though.

I don't know much about BP medicines and whether that would cause the same symptoms or not. With a baseline cortisol though of 4.2, he isn't having an addisons crisis. Did the free T4 results come back yet?

What is his suggested dosage of vetroyl now? I would definitely not go back to 60mg based on what happened last time.

His T4 seems to have remained low from before he started any medication, through being treated with lysodren and vetroyl, so has not resolved with cushing treatment, so that is something that based on what the test results are could also be followed up on, and then they will need to do BP testing involved in Kayne staying at the clinic and having several BP reading throughout the day with the highest and lowest thrown out and the mediums being the most likely accurate reading.
I don't know if you want to give BP meds to a dog who doesn't actually have high BP, as it would cause a drop in BP in what could be a fine dog.
Hopefully one of the mods or people with more experience with BP's can address that.

Sharlene and Molly Muffin

[Lola]

You can't use the machine used in humans to measure a dog's blood pressure. They use a machine called a Doppler, which is highly sensitive to pick up the dog's heart beat.
Lola too is terrified of vets offices, we did not start the treatment right away. 6 weeks ago, the IMS measured her BP without me in the room, it came back too high at 180. The IMS then told me that it's most likely just the White Coat Syndrome. A few weeks later, we measured the BP again, with me in the room holding her to make her more at ease, several readings were made and they were all consistent at 190. That's when the IMS decided that it's best to start treatment at a very low dose of Amlodipine, and recheck again in a week.

Nadia

[Jessicad]

Thanks guys but no matter if I am in the room or not Kayne is in a panic from the time we pull into the parking lot. It is hard just to get him out of the car. I open the back door he hops in the front then I open the front door he hops in the back. lol. No matter what we will never get a right reading unless it is done at home. The vet said the medication he chose will not lower his bp if medicine is no needed. I forgot the name of the prescription I believe it started with ketco???Can this info be true? I know I have high blood pressure and am on meds and was told the same thing from my doctor that it will not bottom out my bp. I don't know. I just don't know if I am comfortable putting him on meds nor knowing if he needs them for sure or not. He said if there is a change in his behavior then great if not then we will take him off the meds after two weeks?????

[Jessicad]

Where are you Glyna? Id like to hear what you think about this situation....

[lulusmom]

I am buried at work today so don't have time go through your thread to refresh my memory but Lori and Nadia have given you some good information. I will say that a post stimulated cortisol of 4.2 may rule out addison's but it's too high to rule out high cortisol as a cause for hypertension, that is if your pup actually has high blood pressure. This is the problem you run into when opting for the resting/basal cortisol in lieu of an acth stimulation test. Based on my experience with my own cushdogs' pre and post cortisol results on more stim tests than I can count, I wouldn't be surprised if Kayne's cortisol is too high again.

A severely anxious dog is going to be very difficult to get an accurate BP reading on one visit. As Lori mentioned, several readings should be done. That information as well as the info Nadia offered can be found here:
http://www.marvistavet.com/html/body_high_blood_pressure.html

The information on the marvistavet site should answer a lot of your questions and if any of it conflicts with what your vet has told you, I would definitely discuss it with your vet.

Glynda

[molly muffin]

Unless they can say the BP meds will cause no harm at all. I don't know if I would give them, until they have tried to get an average reading via many BP's throughout the day. With stress and Kayne this might not be possible even. White coat syndrome.

Did the Free t4 results come back? What were they?

How is Kayne acting now? Still having seizures? Getting lost?

Sharlene and Molly muffin

[Jessicad]

Thanks guys, i appreciate everyones input.
Kayne is actually doing well he is eating alot again which makes me very very happy. I havent noticed any head tremors in a while now. He seems to have just a little more pep in his step. He is still sluggish and getting stuck in tight spots and paceing all night but i definitely can see he feels just a little better.
I know that no matter how many readings they take at the vet it wil always be elevated. Kayne is that dog that pretty much has a panic attack the entire time we are there. Thenpast two visits they actually came out to my car because he gets that scared. I tried my bp machine and it does not work. The vet said the specific medication he picked will not bottom out his bp if he does not need it but it still makes me very nervous. He told me to sleep on it and call him and i have not done that yet because i just dont know.i did read on here that is can cause eye twitches which he has began to have. I did get his free t4 results but have not had a chance to pick them up yet but i am going tomorrow morning and i will share all results.

[MiniSchnauzerMom]

Glynda asked me to tell you about my experience, so here goes.

My dog Munchie, who passed away in 2012, was also terrified of the vet and had a major case of "white coat syndrome". Munchie was also sensitive to assorted meds so that scared the heck out of me when he had to be put on anything new. As HarleyPoMMom and Glynda both said the vet needs to take several readings before giving a diagnosis of high bp.

Best I can do is share Munchie's bp monitoring experience with you. His IMS/Renal doctor was fantastic with him regarding bp monitoring where others I had taken him to just added to his fear.

Me and the Munch were put in a room by ourselves and the vet would put the cuff on him. It was a bp machine that took continuous readings. The vet, knowing how nervous Munchie was, would leave the room for about 20-30 minutes so it was just me and Munch sitting there. When she came back into the room his bp would spike quite high. However, because she let Munchie sit there for 20-30 minutes undisturbed and could see multiple readings, she knew exactly where his bp was.

He did take a tiny dose of the Amlodipine. He did not have a problem with his bp going too low. So, I would ask the vet to do something similar. If you feel uncomfortable about starting the meds, discuss giving half a dose the first day or so to see if your baby has a negative reaction.

Hope something here will ease your mind but if you're like me....I wasn't ok until I saw Munchie was ok after that first pill. :)

[Jessicad]

Thanks guys,
The medication he would like to prescribe for Kayne is called Benazepril.
I have not started the medication because I am to afraid that if he does not have high bp that the medication will drop the bp to low and that scares me. Kaynes bp is sky high at the vets office every time because he freaks out the entire time. I tried my personal bp machine on him and no luck just got error message. I just don't know what to do. He is eating very well and drinking well but the neuro things he is doing is soooooo sad to watch and possibly could be from high bp along with a million other things as well. The eye twitch is this something that comes along with high bp? This is new for Kayne and it is only once in a while like when he gets woke up fast and it is like one twitch and done. Did you see any habits that changed after you started the medication? Thanks for sharing your story. Would you give the medication a shot without knowing for sure???

[Harley PoMMom]

My non-cush dog, Bear, was on Enalapril. Bear did not have high BP but had proteinuria, and the enalapril was used to slow down the protein loss. He never had a problem with the enalapril dropping his BP too low.

Hugs, Lori

[Trish]

Hi

My dog is on Benzapril for proteinuria too, but way back when they first noted his hypertension they started that for a short period of time before swapping him to another drug, amlodipine. Neither of these drugs have made him sick or dropped his BP to dangerous low levels. He has been on both for a couple of years.

My Flynn also had white coat syndrome. Even though I did not like it the vet convinced me to leave him there for the day so they could check his BP multiple times. They do settle down somewhat and they can take the white coat into account. My vet takes his BP 7x in a row and then discards the highest and lowest and averages the rest. They do this a few times, they keep him in a quiet place in the clinic and use the same nurse and of course his vet who Flynn knows well. His theory is the owner being present can raise anxiety in the animal as they just want to go home, but if they are left then they do settle down. It is amazing to see the fluctuations through the day.

High blood pressure is dangerous and needs to be treated, it is unusual for a dog to have primary hypertension as we see in humans a lot. Something is usually causing it, cushings can do it. In my dogs case it was an adrenal tumour. In Flynn the hypertension was causing trouble with his eyes, they noticed enlarged blood vessels at the back of his eyes and also his kidneys were becoming damaged and leaking protein. So I would urge you to get it tested like this, sorry I have not read all your thread to see if they have checked his eyes and kidneys. The drugs have really helped him and if they are used appropriately and your dog has ongoing testing I believe they are safe.

The nurse tells me that now Flynn will lie there quite peacefully while she strokes his tummy while the BP is done, so I hope you can work with the staff at the vet clinic to get this done to get treatment for your dog. I hope this helps.

[Lola]

My IMS lets me stay with Lola and hold her while they do the readings. We didn't start BP meds after the first reading, we did several readings the first time and they all came consistent at 180. IMS didn't want to start meds and we checked again a week later, it had gone up to 190, that's when we started the Amlodipine.
We rechecked BP yesterday, it dropped to 150, we are keeping the Amlodipine at the same dose and rechecking again in a week.


Nadia

[Jessicad]

Kayne is so fragile right now i would not want to leave him at the vet and last time we did that he paniced the entire time. The vet knows there is no way to get a accurate reading from him. Has any of your dogs showed neurological signs due to high bp? How about an eye twitch? The vet is calling me back tonight to see if i want the prescription called in an if he can assure me that if kayne does not have high bp and takes this that he will not bottom out then i guess it is worth a try.

[Trish]

Personally if my dog was that fragile that is the time to get the best possible recordings you can in case he deteriorates further. The vets will lots of experience in dealing with stressed out dogs, I am sure they see it all the time. Have they got any actual BP recordings to date?

My dog did not have neuro signs with his high BP. I do not think they can give you a 100% reassurance, in veterinary medicine like human medicine unfortunately there are no absolutes. You can only go on the experience of your vet. Have you seen an IMS?

[Lola]

Honestly, I would take any reading you can get and if they are all high, just start the meds at very low dose (my dog is 20lbs and is getting a cat dose, very low). A good IMS will tell you that if it's consistently high, they only attribute a part of it to the white coat syndrome, and will always take it seriously.

Good luck to you and your baby

Nadia

[Trish]

Totally agree with Nadia :)

[Jessicad]

The last time they took his bp was about a month or two ago they took homninto a dim quite room took a couple readings all were high but we wanted to get the cushings under control firat but since we. An not do that he said he is willing to try to get the bp under control to see is that stops the paceing and neuro things that he suddenly started doing. I have
Not brought kayne to a ims and i have already spent a ton of money and i just can not do any more but my vet talks to a ims about kaynes situation. I just dont know

[Trish]

God what a mess, I read back to Sharlenes synopsis of the cushings meds... on lysodren, off, on to vetoryl, off... :eek: now proposing BP meds when it has not been checked for up to two months??:eek: Uncontrolled cushings can well be putting up BP. I am worried about your dog and if there is a dog that needs IMS review yours would be it to get some kind of plan in place and not let it keep on sliding and your dog deteriorating. Is there not some way you can get money like care credit or similar to get an appointment? I would be concerned putting my dog on BP meds when it has not been checked for so long. I am sorry you are in this situation with your baby.

[Jessicad]

I actually took out a care credit and maxed it out during all of this. I am in nj do you have any idea what a ims would charge for a visit? Kayne is no way strong enough to be on either cushings meds at this point. He is better off all meds hes finally eating again. What would the ims do? The same tests that were performed at my vet clinic?

[Lola]

I am so sorry to hear that.
If you have a good IMS in your area, that would be a great help for your baby. The initial visit is a little expensive, but the follow ups aren't, mine checks Lola's BP for $25 every time, and the BP meds are only $15 for a month, and I'm in OC where everything is 10 times the cost:)
The IMS will take in consideration everything that is going on with your dog by treating one condition while considering the whole picture. That's the main difference between an Internist and a regular vet.
The IMS should be able to tell you if the BP spikes are caused by Cushing's or other underlying conditions.

Good luck to you and your baby

[Trish]

No, I don't sorry. I am not in the USA. But an IMS is a specialist and have excellent knowledge base with more experience than local vets. You might only need one visit to get Kayne fully assessed and a plan put in place. If Kayne is doing poorly it might be because of the uncontrolled cushings +/- BP issues and most likely they are not going to get better on their own. An IMS can work out in order of priority how to treat Kayne rather than just having a stab in the dark, as it sounds like your vet is doing with treating a possible hypertension that has not even been assessed for two months! :eek:

[Lola]

an IMS will do an evaluation of your dog's condition. you don't need to redo any tests, you can take all test results with you and they will look at them and give you a specialist's opinion. then if you need additional testing they will let you know, but they won't make you redo the tests you already did.
My IMS charged me $132 for first consultation and $60 for each recheck.

hope that helps!

[Jessicad]

Ok then maybe thats what i need to do im hitting the internet now trying to find one and i need a good one.

[Trish]

That's great news, you can ask them for a quote when you call. Perhaps your vet uses one in particular? Best possible outcome is when they communicate and work together. Some require your own vet to do a referral but some will take you on if you call for appointment. Make sure you have all the copies of every single test done by your local vet to take along to the appointments. Ask how much the cost is when you call too, then you can plan how to pay it.

[Jessicad]

I just called a couple and they range from 160 to 210. I know my vet does work with a ims because he has mentioned it so maybe i am better off going to that one. Of course it is friday and i have to wait the entire weekend. Ughhh i just hope they can help on the first visit and need no furthur testing i can not afford then the consultation will be a waste. Im up against a rock and a hard wall but i appreciate all of your input.

[molly muffin]

Oh man, well I am glad that Kayne is eating again, but worried about the neurological problems that popped up out of nowhere. Also could be attributed to thyroid. Did those free T4 other results come back?

If you do go to an IMS, then take all the test results with you and tell them you can't afford to have any more tests done, they have to go off the ones that you have already.

Your vet sounds like he is trying and I'm glad he is consulting with an IMS himself, but it doesn't sound like they know what is going on. If you try cush meds again, then go very low, like 30mg.
I'll be honest here. We are all trying to figure out what is going on from what you tell us but I don't think we really know, if this is cushings, thryoid, BP or what, or if it is a tumor, either macro or one on his adrenal glands or liver or somewhere else.

Everything to find out is going to be very expensive, so I really think you have to have a frank discussion with your vet and make a plan to try and get Kayne back to a good quality of life.

hugs,
Sharlene and Molly Muffin

[Jessicad]

Hey Sharlene,
Hope you are doing well.
So you dont think it would be in kaynes best interest to see a IMS?
I am more worried about the neurological things he is doing right now more then the cushings.
The t4 results are back and he said his thyroid is euthroid sick can not treat it but i am yet to get to the vet to grab the copies but they do have them ready for me. I will definitely be able to get there monday.
Like you said init is a macro it would be very expensive to find out and treat so would it be a waste of time and money to go to a ims for a consult knowing that yhey may want me to perform more teats thag i can not afford?
It doesnt seem that the neurological things he is doing is getting worse it kind of just stays the same
Pacing alot
Especially at night
Still getting stuck under chairs
Stareing at walls
His perception of how close things are is definitely off he walks into alot of things or on top of things.
Alot of muscle twitches when sleeping
Every once in a while a eye twitch
These can all be related to the ccd to but does ccd just come on over night like this? No symptoms at all then suddenly you have them all? Im not convinced.
And the amount of lysodren and vetoryl he had he can possibly of been poisoned? Ya think becausenit did not start until after these medications were given.
The head tremors are gone he hasnt had one in a while so i definitely think they were from the vetoryl.
Now the vet wants to try bp meds which i am just not comfortable with. Hebis definitely trying but nothing seems to be helping kayne. I just want him to perk up stop being so confused.
If it is a macro wouldnt he be getting worse?
Thanks everyone for all your input it helps me more then you know.

[molly muffin]

If you can find a reasonably priced IMS that can see Kayne and you can swing the cost, then yes I would do that. That IMS would then need to consult with your vet and you'd do follow up through your vet. You just have to be upfront with them and tell them that you can't afford any more tests right now.
I don't know if the neurological signs are due to a macro or not, and maybe that is something that an IMS can tell you.
I'm just saying that it seems that we are all guessing right now and it's trial and error doing it this way. I agree, I think your vet is trying, but I don't think he knows either at this point. Kaynes case is certainly a tricky and baffling one.
Do I think he was poisoned by the lysodren? no that isn't usually what happens. If he is over dosed, then the adrenal glands stop working, and they are working. So, I tend to think it was something else that coincided with the lysodren treatment. If I had to think what else could be done to figure it out, then the only thing I can think of is an ultrasound and those are expensive to do.
Did you ever try the Novifit?

I'm doing okay, thanks for asking.
hugs,
Sharlene and molly muffin

[Jessicad]

I did not try the novifit only because i was waiting to see what i decided to do as far as any other meds because i dont like to start more then one at a time in case there is any side effects.
Now my vet has worked with a ims supposively they do phone conversations about kayne but i guess it would be better for him to actually see kayne.
As far as the neurological things is that something a ims would be able to figurenout and perform neuro tests or is he going to say i need to see a neurologist?

[Jessicad]

I know im a pain but i have one more question...
Lets just say kayne has a macro and when we did the cushings treatment the macro grew and is causing him to have these neuro symptoms.
My question is now that kayne is not being treated for cushings whixh meands he will soon be producing the extra cortisol which will act as a anti-inflamatory / lubricant. Will the neuro signs go away?

[My sweet Ginger]

Hi, I really feel for you for the situation you are in and it reminded me of what I was going through with my Ginger a few months back.
I'm afraid to throw my 2 cents in for the fear of giving you more headache but I'd like to put it out there anyways.

First check their (IMS) bio by going on their facility's website and check their specialties if anyone has bigger interest in geriatric care.
You're not obligated to see the IMS who your vet usually refers to.
They are definitely more expensive but you may just do a consultation and have your vet work with the IMS as a team and do all testing with your vet as they will be considerably cheaper. I really hope you find a better IMS as there are good and bad vets so are IMSs too.

Secondly, if you go to an IMS don't bring all the test results with you on the day of your appointment, rather fax them over days ahead so that the IMS has enough time to go over all of them beforehand.

Thirdly, the IMS may recommend you to see a neurologist for Kayne's neurological symptoms as mine did. We still don't know 100% what's causing Ginger's neurological symptoms since we won't do CT scan or MRI but everybody is guessing it's macro tumor and treating her as such. Even if you end up not treating Kayne for macro (if it is that), there are other supportive treatments available to help him feel more comfortable.

I don't know what Kayne's BP readings are but they will take his white coat syndrome into consideration when they take his BP so they will be able to tell you whether he is hypertension. You can always start low if he needs medication.

We all know it's not cheap but you can do it cheaper by exploring you options. I was upfront with my IMS and she totally understand my hardship and she lets me do tests at my GP.

I hope you will get some resolve. Take care.

[Squirt's Mom]

Sweetheart, if this is a macro or any other type of brain tumor, the signs will not go away but progressively get worse and worse and worse. The tumor will continue to grow, just perhaps not as fast as it would with the cortisol controlled. Drugs like pred are sometimes used to help slow the growth or even shrink growth in some type of tumors....but brain tumors are always iffy. HOWEVER, we do NOT know Kayne's troubles are coming from his brain. ;)

I don't know much about high BP nor the meds to treat it but based on what others here have said, I think I would be willing to ask for a few pills to try to see if it did help Kayne or not. If it doesn't, you can stop it.

I might also ask the GP vet which IMS he had been talking to and try to talk to that IMS myself. There might be something lost between you, the GP vet and the IMS. I would want to be in the loop - right smack dab in the middle of the loop so they could both see me jumping up and down and hear me hollering at the top of my lungs! :D

Hang in there, Mom! I know how tough it is when funds don't allow us to do the things we want or need to do. We just have to find ways to do the best we can for our babies...and you are sure trying!

Hugs,
Leslie and the gang

[My sweet Ginger]

Hey Leslie, I want you to know that you are my GP, a very Gifted Person with words! They come sooo naturally for you where I really have to struggle to make my point.:mad: Always right to the point and so funny at the same time. We are very lucky and thankful to have you and a few others on here. You rock, Leslie.:cool:
Hugs to you and your gang.

[Squirt's Mom]

awww...thanks, Song. :o It helps that I'm a tad bit NUTSO! :D

[Jessicad]

I totally agree. I am soooo thankful and greatful to have everyone on here or i realky dont know what i would do. I totally trust your advice more then i trust my own vet. Thank you to you all.
Ok leslie if you think that its ok to try the bp meds i will do that an i will reach out on monday to the vet maybe we can do a conference call with the ims and regular vet or maybe the ims the vet works with will cut me some kind of deal.
These past two days kayne paced a little more then usual and hot stuck a little more then usual. Im really starting to get worried.
It is soooo exhausting, like having a newborn.

[Jessicad]

I lnow you mentioned the pred is ised to slow the growth is this something that is worth a try or not good since his cortisol levels are prob high beings the cushings is not treated?

[Jessicad]

What about the novifit? Should i try that?

[Squirt's Mom]

IF this is CCD it can help but not guaranteed. It is a SAMe product so I don't think it could hurt either way.

You mentioned CCD coming on seemingly overnight. That is how I thought Squirt's had come on - all of sudden with those horrid terrors. But in looking back and doing a little reading, I realized there had been other signs that I simply either missed or attributed to something else. Her incontinence was probably the first sign and we put that off to simple old age. I had seen her go to the wrong side of the door to go out but thought she was just in a hurry or the other dogs got in her way or this was a lasting effect from the seizure she had from the incontinence med. She had several times of being clingy - not like her at all, she is Miss Independent. I laid quite a few things at the feet of that seizure that were more than likely the CCD instead.

[Jessicad]

Ya know leslie im not convinced its ccd my gut is telling me its a macro. I sit and think and think but kayne has never showed any signs of aging up until after we loaded with lysodren then he suddenly went down hill.
I know the sam-e wouldnt hurt but should i save that $60 just in case i need it for something else or should i give it a try. From what i have read online the ccd is prohressive and kaynes was just so sudden all symptoms started at once and stayed consistent. I just put a call into the bet if you think its ok to gibe the bp meds a shot im willing to do that they said try for two weeks and the meds are inexpensive he said. Wouldnt it be great if all his symptoms went away. I can only hope. Thanks again leslie

[Jessicad]

Or the pred should i give that a try?

[Squirt's Mom]

I wouldn't use the pred unless required. It is a powerful drug with some awful side effects tho also a miracle when required. If I had to choose, I would go with the BP meds and pray the vet is correct that it will ease much of his current troubles. That WOULD be wonderful! :cool:

[Jessicad]

Ok leslie, sounds good i will go pock them up today but since the vet isnt open until monday should i wait until monday to try to start them just in case he has some kind of reaction or just go for it start it today?

[lulusmom]

Please see my comments below in blue text.


Like you said init is a macro it would be very expensive to find out and treat so would it be a waste of time and money to go to a ims for a consult knowing that yhey may want me to perform more teats thag i can not afford?
It doesnt seem that the neurological things he is doing is getting worse it kind of just stays the same
Pacing alot
Especially at night
Still getting stuck under chairs
Stareing at walls
His perception of how close things are is definitely off he walks into alot of things or on top of things.
Alot of muscle twitches when sleeping
Every once in a while a eye twitch
These can all be related to the ccd to but does ccd just come on over night like this? No symptoms at all then suddenly you have them all? Im not convinced. And the amount of lysodren and vetoryl he had he can possibly of been poisoned? Ya think becausenit did not start until after these medications were given.

It sounds as though Kayne definitely has cognitive problems but I don't believe it is being caused by CCD. Nor do I believe Kayne was poisoned or suffered from neurotoxicity because of the combination of drugs. I do believe that both medications can cause rapid growth of a pituitary tumor and based on timing and symptoms, I honestly feel that's probably what you are dealing with. The most common signs exhibited by dogs with a large pituitary tumor are: listlessness, dull behavior, anorexia, aimlessness, pacing, and staring at nothing. Blindness can also occur. This info was taken straight out of the Textbook of Veterinary Internal Medicine. I don't have the best memory and I'm hoping others can chime in, but I can't remember any dog on this site with similar neurological signs to Kayne's that were attributed to hypertension or hypothyroidism.

I am attaching a link to a paper entitled, Trilostane-induced inhibition of cortisol secretion results in reduced negative feedback at the hypothalamic–pituitary axis. It's rather technical but bottom line is they used healthy dogs and found that after administering Trilostane for as little as four weeks, the pituitary was enlarged. If a dog already has a macrotumor, any enlargement can be enough to cause neurological signs.

http://www.2ndchance.info/cushingsteshima2009.pdf



Now the vet wants to try bp meds which i am just not comfortable with.

I don't blame you. I truly believe that your vet is trying his best to make things better for Kayne. I'm including a link below to an excellent paper entitled; "DIAGNOSIS AND TREATMENT OF SYSTEMIC HYPERTENSION", written by Dr. Scott Brown,VMD, PhD, DACVIM University of Georgia. I think this will help you understand a bit more about hypertension, how it's diagnosed and when to treat.

http://www.gvma.net/files/speakersbureau/uploads/brown_systemic_hypertension.pdf

I am very happy to hear that your vet is consulting with an internal medicine specialist (IMS). It is definitely preferrable to have your own consult with an IMS but in the meantime, you can certainly ask your vet some questions very direct questions. 1) Share the study I mentioned and the symptoms as quoted in the veterinary teaching textbook with your vet and ask him what the IMS he's consulting with thinks is causing the neurological signs. 2) If the IMS believes it's a macrotumor, ask him/her to ask the IMS if he thinks treatment should be resumed. I personally would have a tough time continuing to treat as I believe it would continue to cause rapid enlargement. 3) Knowing that you cannot afford to pursue a macrotumor diagnosis, ask your vet to consult with the IMS on what treatments might help alleviate and/or slow progression of the neuro signs in a dog with an enlarging macrotumor.


Hebis definitely trying but nothing seems to be helping kayne. I just want him to perk up stop being so confused.
If it is a macro wouldnt he be getting worse?

If it is a macro, you should expect worsening symptoms and continued deterioration in Kayne's quality of life. I'm hoping that it's not a macrotumor but if it is, I want you to be prepared, which is why I'm trying to provide you with as much reference material as possible which can provide some answers for you.

[Jessicad]

Thank you soooo much for your feedback. I have a gut feeling a Macro is what I am facing here as well. It all makes sense. That is one of the reasons why I chose to stop treating the cushings along with it making him feel crappy.
Its crazy to me that just 5 days on Lysodren and 3 on Trilostane made such a inpact on his neurological condition.
I see the studies you sent me were based on trilostane treatment but Kaynes neuro symptoms started after Lysodren. Does Lysodren have the same effect?
I have some pretty awful questions I want to ask but I just want to prepare myself.
How long does a dog like Kayne have? How does a dog with a macro usually pass?
How much worse can the neurological things get? what else can happen?
I have two small children can he lose his mind and be nasty? start to bite? He has never had any signs of aggression ever.
As far as a macro I know Kayne will not be able to be treated but if it was your dog and a macro was the the issue what can be done to slow the growth, help with the neuro symptoms and make him comfortable?
Im sorry my questions are so depressing but I just need to get myself ready for what is ahead.
I am still waiting on a call back from the vet and I will ask all the questions you told me to and in the mean time I am going to go read the threads you sent me. Thank You sooooooooooo much you have no idea what this site does for me. Is this site something that you guys have to pay for? Do you accept donations or need any kind of help? I also have a box of vetoryl that I would like to give to someone who is in a financial situation like me and can help. Please let me know what I have in the near future to face with kayne if this is a macro. Don't hold back I am ready I need to hear it. Thanks again

[lulusmom]

While no studies have been done on Nelson's Syndrome in dogs with cushnig's, both drugs can have the same effect. It is caused not by the drug but the resulting increase in circulating acth that occurs as cortisol levels are reduced.

Macros have a profound adverse affect on a dog's quality of life and a pet owner usually has to make the very tough decision to euthanize as that is the kindest thing to do. Every dog is different and without knowing the size of a tumor, it's difficult to predict the continued progression. That is one of the questions you should ask your vet, who can probably get a much more experienced answer from the IMS.

I personally don't recall any of the many dogs with macros who became aggressive but that's not to say it can't happen. Again, a good question for the IMS.

The cost of keeping the site going is absorbed by the administrators and no donations are accepted. The best kind of help you can offer is sharing your experience with others. We are all here to pay it forward as we've all gone down similar roads and know how difficult it is to wrap your head around all the nuances of this very frustrating disease. Unfortunately it is against the law and forum policy to donate medications but thank you for your big heart and willingness to want to help others.

Kayne's situation is one that is very difficult for some of us to be straight up with members but I am of the belief that knowledge is power and without it, you cannot be prepared emotionally or intellectually to deal with what may be. You're an ace cushmom and I admire your strength in the face of such a depressing possibility. Just know that no matter what happens, we'll always be here for you in any way we can.

Glynda

[lulusmom]

I forgot to mention that if cortisol is still fairly low and the IMS does suspect a macrotumor, prednisone may be prescribed to help with inflammation and swelling. There are other members who have and are dealing with suspected macros and hopefully they will share their experienced opinions.

[Jessicad]

Oh please i really hope they do.
He just had a basic cortisol test which was a 4.2 which is supposively perfect.

[My sweet Ginger]

My Ginger has all the symptoms on your list in your prior post except for eye twitching. She still struggles with poor appetite.
Both her IMS and neurologist suspect she has a macro and she been on daily pred therapy to help her with Addison's and inflammation in her brain tho we are trying to lower pred doses now that her adrenals are producing their own cortisol.

She's also taking Levetiracetam for her tremor and head twitching which calmed both down a lot especially in the beginning. Thankfully no noticeable side effects from the seizure medicine. Currently we are waiting on the arrival of new seizure medicine to try out for two weeks in the hopes that they will give her more comfort (twice dosing instead of three times daily) and effectiveness in controlling the symptoms.

She's also on Amlodipine to control her hypertension and no one's been able to tell me what's causing it but this drug's been working for her. Got them down from 250 to around 150 and she's going in for another check next week.

It was a terrible and gut wrenching feeling to watch her trembles and twitches every few moments rather violently so I'm really thankful that these seizure meds are working for her although you won't get a complete control over them.
Being able to watch her sleep or rest peacefully makes a world of difference to me and no, I haven't seen any change in her demeanor toward an aggressiveness at all.

[Jessicad]

Thank you for sharing your story i really hope the best for you guys. I know how difficult it is to sit back and watch. Its horrible i hate to even leave the house.

I hope to get some kind of answers soon to make my kayne feel better.

[Jessicad]

Ok so one of the vets called back.
This is the vet that i dont normally see but its a small practice they all look at each others cases so they say.
When i asked about the ims they speak to about kayne which i was under the impressin that it was a actual office turns out it was ims at the labs that they use.
She said she could refer me to a ims if i would like that. She mentioned they may even be able to get a ims on the phone to talk first to see there opinion just by what is going on.
She also recommended selegeline.
Anyone familiar with selegeline?
She also talked about kaynes bp one reading was 192/115 which she said even taking white coat syndrom into consideration it seems high and along with cushings you more then likely get high bp,
I feel like i was just on the phone for 30 minutes and nothing was answered for me. I have to call bck on monday to give definite answers on if i want to move forward with the bp meds, the selegeline and if i want to have a ims consult.
Helpppppppppp

[lulusmom]

Selegiline, also known as Anipryl, does help a lot of dogs with canine cognitive dysfunction. With the exception of Vetoryl, it is the only other drug approved for the treatment of cushng's. Unfortunately it turned out to be a big flop for cushing's as it's efficacy is limited to dogs with a pituitary tumors in the pars intermedia lobe of the pituitary and even then ,any improvements are usually short lived. Even the developer of the drug, Dr. David Bruyette, who was also a short time member here, limits its use to dogs with very mild symptoms or pet owners who can't afford the cost of the acth stimulation tests that must be done to monitor Lysodren and Vetoryl treatment. Efficacy rate for Selegiline for cushing's is very low, probably somewhere around 20% or less. Is your vet suggesting Selegiline for possible CCD? If so, it certainly wouldn't hurt to give it a try. If for cushing's, I believe Kayne is way past the point of this drug doing anything for him and in my opinion, you'd probably be throwing good money away.

Glynda

[Budsters Mom]

Hi Jessica,

My Buddy had a suspected enlarging macrotumor. He had many neuro symptoms. He was being treated with Trilostane when the macro was discovered to be pretty much a certainty. He was started on A prednisone two week trial, where he was monitored closely. He continued on the Trilostane/ Prednisone combo until I finally released him on July 2nd of last year. Prednisone reduces inflammation and swelling around the tumor. It allowed Buddy to do everything he loved (running, lizard hunting, guarding in the window) longer. Although for a short period, it gave him a better quality of life. For him, it did what it was meant to do.

Buddy's Thread is called, "Buddy the Mighty lizard hunter". You will find his story there. There is additional information about his neuro symptons, etc. Buddy's thread is very long. You might want to skim through until you find what you are searching for.

I wish you the best,
Kathy

[Jessicad]

Thanks Glynda,
I have been stalking this thread hoping you would sign on here lol ��
The vet is recommending the selegiline to possibly help the neurological things Kayne is doing possibly from a macro which she is thinking a macro as well. So not so much to treat the Cushing and help the cortisol level but to possibly help the neurological signs???? what do ya think?
I am wanting to just make Kayne comfy and help the neurological issues if I can and possibly slow the growth of a macro.
How about something more natural?
If Kayne was your dog what would you want to treat with if a macro was the problem??

[Jessicad]

Kathy,
Thank you soooo much. I am so sorry to hear about buddy for I am really dreading that awful day. I have seen in my research that sometimes the prednisone and trilostane are given together but I would be worried to give him the trilostane again because when he was on it he quit eating got very sluggish and started having head tremors which thankfully stopped.Do you mind me asking how long after neurological symptoms started how much time did he have? I am a researchoholic going to find your thread now. Thank you soooo much for sharing. :):)

[Budsters Mom]

Buddy was having neuro symptoms before I discovered he had cushings. He had a consultation with a neurosurgeon and two neurologists to see if he was even stable enough for Cushing's testing. It's all a blur now, but I would say it was about five or six months (maybe a little longer) after his neural symptoms occured, that I lost him. All the gory details are documented in his thread.
Buddy did have head tremors also.

Kathy

[Jessicad]

WOW KATHY
in just read your entire thread. I am sitting on my couch in tears because I am going down that same road you went down. Man this is hard but you touched me how strong you were and how much you put into learning.
I love this damn forum it is so helpful and promising.
I hope that you all realize what you do for people like me that just googled cushings disease in hopes to just find out something. This is sooooo much more.
This Dr.David Brunette the Cushing specialist you emailed with. Does he reply to all emails or was this a service you had to pay for? I would very much love to hear his input on kayne. Am I able to reach out to him?
I am at the crossroads now where his neurological issues are so bad I know his time is limited but I just need a plan to keep him comfortable. Kayne never acts as if he is in pain just so dull and confused.thank you soooooo much for sharing your story and if you have any advice I want it all. Thanks again.

[Budsters Mom]

Dr. Bruyette can be reached at this link.

http://m.vcahospitals.com/west-los-angeles/our-team/veterinarians/david-bruyette/28374

His email consult with Buddy's treatment recommendation was free. He got back to me within two hours of emailing him. I then took that recommendation to his GP who worked with the neurosurgeon at the specialty hospital to implement it. I didn't pay the neurosurgeon either, except for her original consult months before. I reported daily to his GP vet, who reported to the The neurosurgeon. She monitored his treatment, adjusting when necessary. His GP vet then called me back with the changes. Come to think of it, I didn't pay him either except for tests that needed to be run and office visits. He did all of the consults and implementation for free also. I didn't even purchase Buddy's meds there. We all worked as a team to help Buddy's quality of life.

[Lola]

Kathy,
If you don't mind me asking, what IMS/specialty hospital were you using for Buddy's treatment/consult?

Nadia

[Budsters Mom]

Nadia,

Here is the link to the vet specialty hospital. The neurosurgeon's name is Robin Levitski - Osgood. You will see her name on the page. Her initial consultation I believe was $130. That was before I ever tested Buddy for Cushings. That's all I ever paid her.

http://www.vshsd.com/specialties/neurology-and-neurosurgery

[Lola]

Thank you Kathy, I will keep that in mind.
I use the one in irvine, they have all specialties and very good doctors.

God Bless

[Lola]

Sorry I didn't mean to hijack the thread!
I hope Kayne is doing better this morning

Nadia

[Jessicad]

Ok guys the email is sent to Dr. Bruyette along with all test results. I really hope he finds it in his heart to look it over and guide me. Im sure he is a very busy man. Thanks to veryone. Kayne is ok today just paceing and getting stuck and paceing and getting stuck allllll dayyyyyy longggg. Its exhausting but thank you for asking.

[Squirt's Mom]

Squirt took Anipryl (Selegiline) as the first line of treatment with her Cushing's and is on it again now for the CCD. The dosing for Cushing's is higher than that for the CCD. It does help her cognitive functioning but she does best with both the Selegiline and Novifit.

[Jessicad]

In wondering if a macro if the selegiline and novifit will even help.
What do you think?
I asked this question in my email to the Doctor.

[Budsters Mom]

All fingers, toes, and paws crossed, that doctor Bruyette replies. He has replied to many of us. Some multiple times. Xxxxx

[Budsters Mom]

I had a neurosurgeon monitoring Buddy's treatment plan. Neither
selegiline or novifit were ever mentioned. I would think if they could've been of some help, they would've been brought up as something to try, but I just don't know. Xxxxxx

[Jessicad]

Did they have you try anything for the neurological issues?

[goldengirl88]

Everyone knows how I feel about Dr. Bruyette, he is the top of the line vet. I hope
You get your email answered as I have corresponded with Dr. Bruyette since my dog was diagnosed. He is truly a wonderful and brilliant man. Blessings
Patti

[Jessicad]

I am hoping he really replies in sure he is super busy and im sure this happens all the time to him im just hoping im one that he decides to take a interest in and help. By the sounds of it seems like he usually replies which i think is a true sign of a non-money hungry good doctor. I emailed kaynes whole story plus all his teat results so im praying he can lead me in the right direction. Fingers crossed i will keep you all posted.

[Budsters Mom]

Prednisone was added to reduce swelling and inflammation around the tumor. It did help with Buddy's neuro difficulties until the tumor eventually took over. Xxxx

[Jessicad]

Since kayne is not on any cush meds plus has really bad calcinotis cutis i dont know if that could even be a option.

[Jessicad]

He wrote back he wrote back. I am sooo greatful for his advice. I will copy and paste his reply.
Hi Jessica,
Sorry to hear about Kayne. I agree that the most likely thing is a macroadenoma of the pituitary gland, and that's what is responsible for all of the inappropriate behavior you're seeing it home. The only way to confirm would be to perform advanced imaging like CT scan or MRI. If a macroadenoma is found, you have three options: radiation, surgery, medical. Medical therapy is just prednisone and I would think avg survival with this is 1-3 months. Radiation therapy results in avg survival time of 1 year, but we may have to restart medical treatment if the Cushings clinical signs return. The last option is surgery which if successful can result in a cure, but if the tumor is not removed, we would recommend follow up radiation. Cost for radiation are generally in the 6-8000 range, which would be similar for surgery.

If we are going with medical treatment alone I would use 1mg/kg prednisone once daily but we may have to raise the dose if the symptoms persist. For now I would stay off lysodren and trilostane since we will be using prednisone which will mimic symptoms of Cushings.

If you have further questions, please let me know. Once again sorry to hear about Kayne.
Dave

[Lola]

I'm glad you at least have some clarity now as to what's going on and what the options available are.
Would you mind telling me what email address you used to contact Dr Bruyette?

Thank you

[Budsters Mom]

What a classy guy and on a Sunday too! :D xxxx

[molly muffin]

:( I'm very sorry to hear that Dr. Bruyette also thinks it is likely a macro tumor. At the very least though, you know now what to expect. I'd really hoped it would be anything other than that. I always hope it will be anything else.

Are you going to take this email to your vet?

We have a thread where a few members have talked about macros. If you haven't read it yet, it is here:

http://www.k9cushings.com/forum/showthread.php?t=3567

hugs,
Sharlene and Molly Muffin

[My sweet Ginger]

:eek::eek::eek: 1mg/kg prednisone ? That means Ginger should take 4.5mg daily and she's not even getting 1mg right now! Doesn't 4.5mg daily sound too much for a 10 lbs? I've got to talk to our IMS about this.
it was very nice of him getting back to you so quickly. I can't even reach our own vet on the weekend, no way, no how.

[Jessicad]

Hey guys,
I am so thankful for Dr. Bruyettes opinion it was definitely hard to hear but my gut already told me what he told me but i definitely needed to here it from someone else, a expert.
I am going to do exactly what he says and call the vet in the morning and forward the emails to them and I would like to do exactly what he said treat with the prednisone although I am very worried about his cc. He gets it very bad on his entire back i will upload some pictures for you to see how bad it was. Its finalky healing and he is getting some hair. I guess i will treat with the dmso more then i have been if need be.The doctor actually wrote me back again and said he would also treat the blood pressure. Im still not sure wht i want to do about that should i just go with the low dose and pray he has bp or stress him out load himnin the car to sit at the vets office all freaked out to get a new reading? What do you guys think?
I saw a concern in how much prednisone he recommended. Does it not seem right? I dont know to much about prednisone but i will look a little more into it tomorrow for today was very draining for me. Does 1mg sound like to much or not enough? Im going to say kayne is about 62 pounds.
Sharlene, i have read just about ever thread on here. Lol its become my obsession. Lol just so much to learn.
Thanks to you all im hoping to spend alot of time kayne hoping the weather will clear soni can take him outside and just enjoy some freah air together.
Thanks again everyone

[Squirt's Mom]

Grace weighs 3.8 lbs and the pred dose for her tumor is on this schedule -

1.25mg am and1.25mg pm for 3 days
1.25mg am for 5 days
1.25mg am every other day til gone

We came home with 10 5mg tablets. The goal is to shrink the tumor enough to make surgery less risky if I decide to go that route. I hope this helps give you some perspective on the pred for Kayne. I don't know that they will start him on a higher dose and taper down like this, tho. I think it more likely he will take a specific dose daily.

I would do the BP meds in your shoes. If this tumor is causing the high BP it will probably just get worse without management and Kayne doesn't need a stroke on top of this. ;) If it helps with some of the signs you are seeing, that is just a bonus.

In the face of Dr. Bruyette's reply, I guess I have to give up the hope this is thyroid driven. :( My thoughts and prayers are with you both, honey. If it helps, you do not walk in this Valley alone either. Look around and you will find several of us there; in fact, Squirt and I have a little campsite we are happy to share anytime you need.

Hugs,
Leslie and the gang

[Jessicad]

Leslie,
That is soooo great you may have the ability to do the surgery. I will pray for you and your little squirt.
I just got back from the vets office we talked about euthanasia as far as what happens and the priceing. God is this hard and to think i have two more dogs. I can not do this again this is sooooooo hard. I appreciate you for being there and your kind words.
So Dr. Brunyelle said 1mg a day for kayne. I picked up the prescription the bottle says 20mg. I called them they said its right due to weight. Does this sound right?
I gave it to him about a hour ago. When did you start to see a difference in the neurological signs after starting the prednisone?

[Jessicad]

I forgot as far as the bp meds we are going to wait a couple days make sure kayne is ok with the pred first then im going to bring him in and try to get another reading. They said we van donit in the car if need be but id like to get him in there to get a accurate weight as well.

[Squirt's Mom]

The pred dose Dr. B suggested is 1mg/kg/day (1 milligram per kilogram of body weight per day). To find how much Kayne weighs in kg, you divide his weight in lbs by 2.2. So if he weighs 60lbs, he would weigh 27.27kg (60 / 2.2) and would get around 27mg of pred daily (1mg per kg per day).

I understand fully how you feel about discussing euthanasia with your vet. I've done the same thing for Squirt. Everything that can be prearranged, has been - and it killed my Soul with each step. But neither of us is "there" today. So for today, we will love our baby girls and do all we can to make every moment as good as it possibly can be for them. Our job now is to make them comfortable and happy for as long as we can...and to listen to them closely so we know when they are ready.

Remember - you are never alone, never.
Hugs,
Leslie and the gang

[Jessicad]

Do you think i should do the same prearrange everything? I didnt think of that. That way it is less to deal with when the time comes???

[Jessicad]

When should i see results of the prednisone? Immediately?

[Squirt's Mom]

Sweetie, you do whatever feels right for you and Kayne. I wasn't actually "pre-arranging" when I made the plans for Squirt - she seemed to be dying right then and I wanted everything ready for her. She has once again rallied but the plans remain in place. Sitting here today, it is a bit of a relief to know that when she is ready I don't have to make any major decisions about things - most of that is already done. The most difficult decision still lies ahead - knowing when it is time. She's fooled me twice already this past year. ;):o

[Jessicad]

Aint that the damn truth. When to call it without being selfish. Damnnnnnnnnnn.
Know that you mentioned it i think i do want to get everything prearranged may be easier in the end.
Thanks leslie

[Jessicad]

So far the prednisone did not stop any neurological issues so far. Kayne is still paceing and getting stuck. Anyone know if it would take a couple days to see some results?

[molly muffin]

I really don't know how long it would be to see any results. I think you give this is a try and see if there are any improvements over a weeks time maybe? I just looked at Maya's (she had a macro) thread and she was almost lifeless at the point she was given prednisone and perked up within hours an could walk a straight line. I think that macros might affect dogs different depending on what they are putting pressure on.
You gave the first pill yesterday? How does Kayne seem overall? walking okay, can see okay, eating okay, personality the same?

hugs,
Sharlene and Molly muffin

[Jessicad]

Hey Sharlene,
Thanks for checking out mayas thread for me.
I just gave Kayne his first pill today about 11am. I really dont see any change hes ate normal and hes paced all day long and got stuck over and over still. I see no difference at all. Worries me. In Dr. Bruyettes enail he mentioned if I dont see and results he may have to bump up the dose but then it can cause side effects so he was hoping the 20mg we would see some kind of improvement. :(
Ill have to look for mayas thread.
Ahhhhhhhhh i was really hoping this would give sone kind of relief lets hope it takes time.
Thank you sharlene I hope you are doing good. ;)

[molly muffin]

This is Maya's thread, she gave her prednisone after the trilostane made maya sick, even as her ACTH numbers were perfect. I know that sounds familiar. :(

http://www.k9cushings.com/forum/showthread.php?t=3280&highlight=maya&page=9

hugs
Sharlene and molly muffin

[Budsters Mom]

Buddy's neuro symptoms improved miraculously right away after starting the prednisone, but he was also on Trilostane too. I think each dog is different.

I don't think there's any way to really prepare to release our fur babies. It is going to rip your heart to shreds no matter how or when you do it. :o What you need to remember is that you will get through it and you're never alone. Xxxxx

Kathy

[Budsters Mom]

The Trilostane/Prednisone combo needs to be monitored very carefully and tweaked when necessary, otherwise it can be very dangerous. It is used with dogs with macro tumors because they have tumors anyway and are terminal. Buddy did not have any problem with it at all, but it should be considered on a case by case basis. It's not for everyone. Xxxxx

[Jessicad]

Thanks guys, just read Mayas thread. Your rite Sharlene sounds familiar. Theres not much to say besides its awful. I so feel her pain. My kayne is still here and I already feel the pain. Mayas dose was higher then Kaynes and she weighs less so maybe Kayne just needs a little bit more prednisone to help with the neurological issues. Like Mayas mom said what could it possibly hurt.
Thanks again everyone xoxoxoxo

[Jessicad]

One more thing my vet gave me a prescription for pepcid as well to give with the prednisone???? Anyone else give this combo?

[Budsters Mom]

Yes, but the Pepcid AC didn't work for Buddy's sensitive stomach. I ended up using SEB (Slippery Elm Bark). It is a herb which you brew to make a thick slurry. It must be given two hours before of after other meds, it can interfere with their absorption. SEB can be given mixed with food.

Kathy

[Lola]

I am hoping he really replies in sure he is super busy and im sure this happens all the time to him im just hoping im one that he decides to take a interest in and help. By the sounds of it seems like he usually replies which i think is a true sign of a non-money hungry good doctor. I emailed kaynes whole story plus all his teat results so im praying he can lead me in the right direction. Fingers crossed i will keep you all posted.

Jessica,
What email address did you use to contact Dr Bruyette?
Thank you for your help

[Budsters Mom]

Dr. Bruyette's email address is.....

David.Bruyette@VCAHospitals.com

[Jessicad]

Im sooo sorry I meant to measage you the email address but it slipped my mind im very sorry. I emailed him at david.bruyette@vcahospitals.com. They also have a websit where you can read his bios. Hes a great man i emailed him three times and got a reply every tome within a couple hours. Good luck to you hopefully he can help,

[Lola]

thank you so much Kathy:)

[molly muffin]

How is Kayne today?

hugs,
Sharlene and Molly muffin

[Jessicad]

Hey Sharlene,
Kayne isnt doing to good. The pred did nothing for his neuro issues and they are pretty bad. Im worried he is going to hurt himself. I emailed Dr. B again he said that is nit a good sign it may be to large at this point. He suggested try the 20mg for one more day then try 30mg and if that doesnt help after 24 hours he said there is nothing more to do. ;( my emotions are everywhere im soooo scared i feel the time coming so close and this all just happened so fast.
I thank you for asking i hope tou as well are doing well.

[Harley PoMMom]

Sending huge and loving hugs to you and Kayne, will also be keeping you both in my thoughts and prayers.

[Jessicad]

Thank you so mich it means alot this group helps more then you no

[Jessicad]

And i want to apologize for my terrible spelling and bad grammar on here im usually replying from my phone which has a mind of its own.

[Lola]

Jessica,
I'm so sorry to hear that Kayne is not improving. Hopefully the dose increase will help.
Sending you positive thoughts and hugs

Nadia

[Jessicad]

I really hope so Nadia. Im hoping and praying. Thank you

[molly muffin]

Don't worry about it, my phone and tablet both have a mind of their own and sometimes it's weird and other times funny what ends up being posted on the forum when I use them. :)

I am very, very sorry to hear that Kayne hasn't improved. :( It DID come on so fast, he was fine in November with just some accidents and then all of this happened with the medication. :( It is just too awful.

We are fine here, thanks for asking. I'm more concerned about how you are!

hugs,
Sharlene and Molly Muffin

[Jessicad]

Oh Sharlene Thank you soooo much.
I keep thinking what if i chose not to try to treat the cushing and didnt try the vetoryl and lysodren. Where would we be then? Would the tumor of not grown? A million things running through my head. Would I of just had to deal with a dog that urinated inside?
My mom always said god only gives you what you can handle but geez give my dogs a break already. I have another dog i rescued Gunnar he is about 7 and at 10 months had hip surgery on both of his hips then about three years ago he had to get knee surgery and ever since that surgery he has seizures now about one or two a month not enough to be on meds luckily and now this with Kayne. I dont know how much more i can see my guys go through. Luckily i have myles to my 9 year old healthy guy with just mild allergies thank god.

[molly muffin]

Considering how quickly the tumor reacted to the medication, I think it is likely that you would have started to see a progression of neurological symptoms at some point, I'm just not sure how long it would have been. There is always going to be the should have, would have, could have's in the back of your mind and frankly, it will drive you nuts if you focus on it too much. Today is where you are at and that is all you can deal with.

We all make the best decisions we can based on the information we have at that time. There will always be another decision that could have been made (that is why it is a decision :) ) There isn't a one of us here, who hasn't wondered the same sort of things when it comes to cushings treatment or non treatment at some point, whether it was before, during or after. You are amongst friends who will never ever say you should have done this or you should have done that. Never! Not going to happen, so don't do it to yourself. None of us know when we start on this journey how it will go and how it will end. We are just along for the ride, doing the best we can to stay afloat and keep our furbabies doing as well as they can for as long as they can.

Hang in there! You've done a great job, you've done everything you can to give Kayne the best chance possible. The cards in this case have been stacked against him with a macro tumor. Unfortunately we seem to see more of them in recent years, or maybe it's just now we know what to look for and the symptoms. We still try to find every alternative just in case it is something else and leave no stone unturned. You did that too!! You checked for anything else and if it had been something else you would have found it. I know that.

hugs,
Sharlene and molly muffin

[Jessicad]

Sharlene,
I needed to hear that thank you. You are a kind soul and a very good person. Its amazing and it makes me sooo happy to know that there are such good people out there.
Your right i tried everything and i would of kept trying anything i just have to really get my mind ready for this. I know whats ahead for me and kayne but damn is it hard.
These damn macros they move fast. Seems as if they usually do mive fast not as fast as kayne but only a couple months. Sad so sad
Thank you again

[Budsters Mom]

I am so sorry. The what ifs, play in my mind too, when it comes to Buddy. What if I had known sooner? Would I have done anything different? I probably wouldn't have treated with trilo at all. It's exactly what Sharlene said. We all do the best we can with the information we have at the time. It does no good to beat ourselves up about it.

My thoughts and prayers are with you as you deal with this very difficult situation. I so wish it was different for you. Xxxxxx

[Jessicad]

Kathy,
Thank you so much. You guys on this site keep me sane. Soooo thankful for that.
Xoxox

[Harley PoMMom]

I absolutely agree with what Sharlene and Kathy have said so beautifully. We do completely understand. You have done everything humanly possible for Kayne, and remember there is NO room for guilt because there is NO reason to feel guilty.

Love and hugs, Lori

[Jessicad]

Thanks Lori xoxoxo

[molly muffin]

Good evening :)

checking in on you and Kayne today. How's it going?

Did you increase the pred to 30mg to see if it would help?

hugs,
Sharlene and molly muffin

[Jessicad]

Hey Sharlene
Thanks for asking but no luck ;( i gave him the 30mg today andbi see no difference at all. Maybe he paced a little bit less but he still got stuck several times and stood in the corner. Super sad i was really hoping it would help. Ill give him the 30mg again tomorrow and ill shoot dr.b another email on what to do next. He said this was all we can do sonim assuming the 30mg is the max that he can have. I just dont know if i should continue to give to him if it does nothing for him? Just because i dont see the neurological issues getting any better does it still help the tumor?
Luckily i get to stay home to care for him and make sure he is safe but this is a hard thing to watch.
Dr.b also wanted to have his bp checked and treated if need be but to get him calmly to the vet is way to much so that scaresssss me.
:(

[molly muffin]

I'd suggest driving him to the vet, taking him out and just giving him a nice walk around for a bit and then the vet come out to the vehicle and check the bp out there. Make it all very non threatening and stress free as possible.

No 30mg is not the max. You can divide it into 2 times a day, even 3 times a day for some cancer dogs. I know some of the larger doses can be 1mg per pound, and since you are trying to get the inflammation down enough to make a difference, then it is quite likely that the dosage might need to be increased, and then gradually decreased as symptoms disappear till you find a dose that works for him. That is what I would be hoping anyhow.

Yes, I would definitely continue to use the prednisone, because without, the progression would likely be quicker and more pronounced and you are trying to make him comfortable and give him a happy doggie life for as long as possible. Just be aware that with increased dosage of pred is likely to make any urination/drinking problems worse, as it is a steroid. You can ask Dr. B about any of this of course, but those are my layman thoughts. I know I had to use higher doses with my golden retriever at times. Not optimal but no choice really.

hugs,
Sharlene and molly muffin

[Jessicad]

Hey Sharlene,
TGIF What a long stressful week...ughhhhh
I gave Kayne the 30mg again today. No change again. Does the pred actually shrink the tumor or just not allow it to grow any more? Maybe I should shoot Dr.B another email see what his thought is.
I plan on doing exactly what you said showing up to the vet a couple minutes early to take him for a walk and relax then have the vet come outside. At this point of his illness does it even matter?
Thanks for checking in on us it means a lot. I would think the vet would which he did not and it disappoints me.

[Jessicad]

Ok, i emailed Dr. B. i will attach his email. Anyone familiar with Dexamethsone?
Hi

I am sorry to hear that. You could stop the prednisone for 2 day and give 5 mg of dexamethasone IV or IM and see if that helps. If not then I think we are likely stuck and with that behavior indicating increased intracranial pressure I think you will need to make the best decision for Kaynes.

Dave

[molly muffin]

Hi Jessica,

http://www.wisegeek.com/what-are-the-uses-of-dexamethasone-for-dogs.htm

dexamethasone is also an anti-inflammatory drug. It's pretty strong from what I've read so you don't want to use it with anything else.

hugs
Sharlene and molly muffin

[molly muffin]

Here is another link

http://www.petmd.com/pet-medication/dexamethasone

Sharlene

[Tina]

Hi Jessica,
I have been following along on your thread and first want to say that I am so sorry for all that you are going through and that Kayne is not showing improvement with the increase in prednisone.

I have just a second to post but wanted to let you know that my pup Jasper is on dexamethasone (oral) as treatment for Lysodren induced Addison’s disease. For whatever reason we were unable to get him stabilized on prednisone, but the dexamethasone has done the trick. I know this is a completely different purpose for the dex than what you are looking at, but my point is that sometimes when one steroid does not seem effective, another will work.

Dexamathasone is longer acting and much potent than prednisone. I believe my vet has said that it is 7 times more potent than prednisone. Jasper has received it both IV and IM on several occasions for crisis situations. For Kayne it would have a much stronger action on the inflammation associated with the tumor. I hope that this is something your vet will consider and that it is helpful for your sweet boy.

Hugs,
Tina and Jasper

[Jessicad]

Oh Tina thank you for chimeing in because after i read the comments on the link Sharlene so kindly found for me I was getting very nervous about giving it to him. I have to keep the mindset of how much worse can it get i better try anything I can. I called the vet he is of couse busy but will call me back. I hope he considers because the girl that andwers the phone asked for a script from Dr. B which i do not want to bother him with so i hope the vet is ok with it.
How long does the dex stay in the system for? My question is will i want to start the pred immediately after? Do these steroids actually shrink the tumors or just not allow them to grow any more?

[Squirt's Mom]

The goal with Grace was for the pred to shrink her tumor but it didn't hold when we went to the once a day dosing and others started to grow then as well. So how it may work for Kayne, I don't know. It didn't do what we had hoped with Grace and she doesn't have time to try anything else. I would give the Dex a shot in a heart-beat if she did.

My thoughts are with you and your sweet boy. I read every day even tho I don't always post. From the moment we met I have seen how much you love Kayne and he you - and I know how difficult it is to watch our precious babies decline knowing there is so little we can do. BUT we have the best medicine in our own hands - and that is our deep love for them.

Hugs,
Leslie and the gang

[Jessicad]

Thanks Leslie,
It really means alot. Im sorry about Grace it sucks it really does. The worst part is being helpless. Enjoy your time together. I as well will keep you in my thoughts and prayers. Xoxo

[molly muffin]

I think if your vet is cool with it, 2 days off prednisone and then start the Dex therapy to see if it helps. At this point, I don't know that you have anything to lose necessarily by it.
If the inflammation isn't controlled and the tumor doesn't shrink, then we are stuck as to options. I hate that to be the position that comes way too soon. What you are doing is trying to buy some time, it won't make the tumor go away and hopefully that time will be good for both of you. That is our best hope currently.

hugs
Sharlene and Molly muffin

[Jessicad]

Sharlene,
So you suggest two days off the pred? Keep him off of it for the weekend and do the dex on monday?
See this new drug has me some hope now i will pray my little heart out it buys him and me some time and comfort.just hopefully the vet will give it to me i dont see why he wouldnt but who knows.