View Full Version : 12 y.o. Corgi Just Diagnosed
Hi all,
My name is Ty and my Corgi who is almost 10.5 was just diagnosed yesterday with Cushings - the pituitary kind.
Background: We adopted Jen from a Craigslist ad in July of 2012 as she needed to be rehomed. We had actually just lost our 13 y.o. four days earlier so we kind of rescued each other. She came to us looking very goofy. Her previous owner had shaved her and she had very very little hair. Jen was and still is crazy athletic, fit and strong. We did notice she drank a lot of water, but she also seemed to do so as a reaction to whenever she got stressed (kind of how I need a bottle of wine right now!). Very rare accidents and sleeps through the nights.
Fast forward to May 2013, we cam home from a vacation and found out from her sitter she tore her CCL the night before. Found a surgeon to perform a TTA on her. When he first met her, he said, oh you are here for a Cushings test? Said no, it's her leg. He immediately wanted to run a full blood panel as he did not want to operate without knowing. From that panel, he said she did not have it, but we did test her thyroid more and she is hypothyroid.
She recovered extremely quickly from the surgery and we had to hold her back until we were comfortable letting her be 100% free again. We wouldn't even let her climb up the stairs as Jen doesn't know how to go up the stairs like a normal dog...she only takes them two at a time. During her recovery, her leg literally started to turn black. Another rush to the vet and they couldn't find anything. 15 weeks later, she was back to moving a thousand miles an hour as if nothing had ever happened. Except now the leg she had surgery on was completely bald. And her hair on the rest of her body had still not grown back.
Fast Forward again and it's looking to us like she has Alopecia X (remember the vet ruled out Cushings) and it's getting worse. What teeny bits of hair she had are really thinning out. We finally went to talk to him about it on Monday as I didn't want to give her Melatonin or Flax Seed Oil if it would interfere with her thyroid meds.
The vet decided we needed to do another test for Cushings based on her water consumption and she has little hair. She does not have a pot belly, is not lethargic and doesn't seem to be showing any weakness. My hubby convinced me to do it just so we'd know if Jen had anything else happen, we could let them know. We were convinced we would not treat her as everything we've read about the drugs could diminish the great quality of life she currently has if she has bad reactions.
Of course, now we are waffling on that decision and really doing some hard thinking. We will be travelling quiet a bit during May, so any decision would not happen until then as we know we have to watch her closely.
I've looked at these boards on and off over the past year as I guess I always had that nagging suspicion. Perhaps I've only seen the bad threads, where the dogs take months to get the right dosage, have horrible horrible side effects, and so I am completely freaking out. Below are Jen's test results from this week.
Low-dose Dexamethasone Suppression Test
Time 1 Pre Cortisol Sample 1 3.0 Normal 1.0 5.0 mg/dL
Time 2 4Hr Cortisol Sample 2 D1.6 H Normal 0.0 1.4 mg/dL
Time 3 8Hr Cortisol Sample 3 D2.0 H Normal 0.0 1.4 mg/dL
INTERPRETATION OF THE DEXAMETHASONE SUPPRESSION TESTS:
*
Low-dose dexamethasone suppression test:
Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex.
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs
post-dex.
...
If the 8hr post dex. cortisol level is greater than 1.4 ug/dl,
the following can be used to differentiate pituitary dependent
hyperadrenocorticism (PDH) from an adrenal tumor:
1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is
consistent with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8
hours post-dex is consistent with PDH.
(Samples taken at 2 or 6hrs are interpreted the same way as a 4hr
sample)
Let me know if I've given too much/too little information. I have her last blood panel from earlier this year (or maybe late last year, have to check.)
Thanks in advance for all your help. From my most basic understanding, this Cortisol is elevated by stress. Mine must be through the roof right now!!!!
Ty (and Jen)
molly muffin
04-02-2014, 08:35 PM
Hi and welcome to the forum.
Can you post the abnormal high/low with range from the blood test.
example
01/06/2014
alkp 850ug range 40 - 110ug
We've had some tough losses on the forum, every loss is tough to be honest, but we also have success's, like Barbara and Trixie, etc
The key is start at a good dose, 1mg/1lb (even if this means trilostane vs vetyrol) or lysodren that you have a vet who is used to using it.
That is good starting place for us to get to. Usually if you start at a low dose, work up as needed, then you don't run into the problems that many have.
Sharlene and molly muffin
Hi Sharlene & Molly,
Hopefully this is what you guys need to help I'll start with her first blood tests up until now.
Blood panel 5/6/13 - Taken 3 days before TTA surgery -
Abnormal #'s:
ALT (SGPT) 133 range 12-118 IU/L
I think at that time he also said her urine was diluted - here's what the report says:
Method: Crysto
Color: Yellow
Char: Clear
SpGrav: 1.016
pH: 6.58
Gluc: Neg
Ketones: Neg
Protein: 10
Bilirubi: Neg
Blood: +++250
Close to Abnormal #'s
Total Protein 7.4 range 5.0-7.4 g/dL
Albumin 4.4 range 2.7-4.4 g/dL
T4 0.9 range 0.8-3.5 mg/dL
Further tests on 5/7/13 (mostly for thyroid)
TSH 0.76 Range 0-.60 ng/mL
Cholesterol 367 Range 92-324 mg/dL
We have since had her on thyroid meds and after a few tests for dosage, we got it right and she is just maintaining her levels as normal now.
Ran blood panel on 9/7/13 (as I thought something was wrong as she was eating a lot of grass and I thought seemed slow. Of course, as soon as we got her to the doc, she was 100% herself. Yes, I like to panic.)
Her ALT was back within normal (97 range of 10-118)
Glucose was high: 119 range 60-110mg/dL
4/1/14 Doc wanted to run Cushing test after ruling it out last year due to lack of fur and water consumption (no accidents though.)
Low-dose dexamethasone suppression test
Sample 1 (Pre) 3.0 Range 1.0-5.0 mg/dL
Sample 2 (4hr) 1.6 Range 0.0-1.4 mg/dL
Sample 3 (8hr) 2.0 Range 0.0-1.4 mg/dL
Through the test results this week he determined she has Cushings and it is the Pituitary type.
Please let me know what else you need to help me sort through this (for which I am extremely grateful!) Those were her only goofy readings.
Thanks!
Ty
KatyGirl
04-03-2014, 12:21 PM
I am new to the forum too. Just wanted to say hi. Our Katy Girl started her Cushing's meds today. No problem giving the pill and she is up in my lap right now for reassurance since we have just had a severe thunderstorm. Katy is 10 1/2 and overweight. Her diagnoses was fairly fast after they drew blood for her teeth cleaning. She had not had blood work for ten months though. We had been battling her weight for a couple of years and had her on a weight loss diet which did not work. I noticed a change in her muscles and water drinking at Christmas and it seemed to get worse. I had decided to talk with the Vet about these issues, which I thought was just old age, at the teeth cleaning but she called me in for a consult instead. We couldn't decide whether to treat or not but one of our Vets told us that she would not last long if we did not treat. I am looking forward to Katy being less stressed even if she doesn't become a spring chick again.
Wish you and your dog the best and look forward to you posts.
Rebecca
goldengirl88
04-03-2014, 12:45 PM
Welcome to the forum. Looking at your posting the things that I saw were that your dog is hypothyroid and you have addressed that situation. The next thing I saw was protein in the urine which needs to be addressed right away. Also there is blood in the urine that can have many causes such as high blood pressure, bladder infection etc. so that needs a look at. The specific urine gravity is a little lower that the 1.030 normal scale I have seen on some of my dogs lab work for concentrating urine, but I am not sure if it needs addressed , maybe someone else can speak to that. The albumin that is borderline high can come from dehydration according to my vet. The glucose is high, but there was none in the urine and my vet told me that they get concerned if it approaches 200, but someone whose dog has diabetes could better tell you about that level needing addressed, also we do have a sister diabetes site. Your dog has high cholesterol ,so were the tryglycerides checked? Cushings dogs have a lot of fat mobilized thru their bodies which you need to control and get it down as low as possible with a good fish oil. Some of these dogs are prone to pancreatitis, and all this fat could cause problems. The low dex 8 hour sample from you dog is above the 1.4 ug which is consistent with HAC. This disease as you probably know is not curable, but is manageable with either Lysodren or Trilostane. If you use Trilostane my best advise to you is to start on a low dose no more than 1mg per pound. When vets try to start dogs higher than this we see problems arising from it. Have you had and ACTh test done, and an Ultra Sound? They are other tools in determining HAC. The ultra sound can help determine what type of Cushings your dog has, and it will let you know if there are problems with any of the other organs, so it is advisable. Be cautious and vigilant and your dog will do well. Do not put blind faith in anyone, including your vet as many do not understand this disease and have little or no experience with it. Your best advocate for your dog will be you, so read and educate yourself as that will be your biggest asset in this journey. Good Luck, the others will be on to ask you questions and help you. Blessings
Patti
I am new to the forum too. Just wanted to say hi. Our Katy Girl started her Cushing's meds today. No problem giving the pill and she is up in my lap right now for reassurance since we have just had a severe thunderstorm. Katy is 10 1/2 and overweight. Her diagnoses was fairly fast after they drew blood for her teeth cleaning. She had not had blood work for ten months though. We had been battling her weight for a couple of years and had her on a weight loss diet which did not work. I noticed a change in her muscles and water drinking at Christmas and it seemed to get worse. I had decided to talk with the Vet about these issues, which I thought was just old age, at the teeth cleaning but she called me in for a consult instead. We couldn't decide whether to treat or not but one of our Vets told us that she would not last long if we did not treat. I am looking forward to Katy being less stressed even if she doesn't become a spring chick again.
Wish you and your dog the best and look forward to you posts.
Rebecca
Hi Rebecca - Thanks for your kind words...good to know another pup Jen's age is starting off well. It's storming here too, guess I'm glad they did Jen's test the other day, I'd hate to see her levels today!
Hi Patti - I'm going to try and answer your questions, so bear with me....
The next thing I saw was protein in the urine which needs to be addressed right away. Also there is blood in the urine that can have many causes such as high blood pressure, bladder infection etc. so that needs a look at. The specific urine gravity is a little lower that the 1.030 normal scale I have seen on some of my dogs lab work for concentrating urine, but I am not sure if it needs addressed , maybe someone else can speak to that. The albumin that is borderline high can come from dehydration according to my vet.
These tests were almost a year ago, so now I'm hoping she doesn't have complications. The doc didn't mention anything about blook in her urine or anything else, other than it was diluted (I think that's what he said.) I tried to copy right off her records but I'll have my hubby eyeball it too. And of course, the vet closed early today.
The glucose is high, but there was none in the urine and my vet told me that they get concerned if it approaches 200, but someone whose dog has diabetes could better tell you about that level needing addressed, also we do have a sister diabetes site.
He did mention it was a little high, but wasn't worried since it had been normal.
Your dog has high cholesterol ,so were the tryglycerides checked? Cushings dogs have a lot of fat mobilized thru their bodies which you need to control and get it down as low as possible with a good fish oil. Some of these dogs are prone to pancreatitis, and all this fat could cause problems.
I'm checking her records and I see the full CBC blood panel that was run, but nothing says Triglycerides. Is there a code that maybe I just don't recognize?
The low dex 8 hour sample from you dog is above the 1.4 ug which is consistent with HAC. This disease as you probably know is not curable, but is manageable with either Lysodren or Trilostane. If you use Trilostane my best advise to you is to start on a low dose no more than 1mg per pound. When vets try to start dogs higher than this we see problems arising from it. Have you had and ACTh test done, and an Ultra Sound? They are other tools in determining HAC. The ultra sound can help determine what type of Cushings your dog has, and it will let you know if there are problems with any of the other organs, so it is advisable. Be cautious and vigilant and your dog will do well. Do not put blind faith in anyone, including your vet as many do not understand this disease and have little or no experience with it. Your best advocate for your dog will be you, so read and educate yourself as that will be your biggest asset in this journey. Good Luck, the others will be on to ask you questions and help you. Blessings
Patti
We did not have an ultrasound or an ACth Test run. The doc diagnosed it off her values of the low dose test. Her records actually say:
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs
post-dex.
If the 8hr post dex. cortisol level is greater than 1.4 ug/dl, (which hers was a 2.0) the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor:
1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is
consistent with PDH. Jen was 1.6
2. Cortisol level less than half the baseline level at either 4 or 8
hours post-dex is consistent with PDH. Jen was 2.0
(Samples taken at 2 or 6hrs are interpreted the same way as a 4hr
sample)
...
If neither of these criteria is met, further testing is needed to
differentiate PDH from adrenal tumor Cushings.
I think that's why he is saying it is the Pituitary type and he is ready to treat it.
Please keep all the advice coming - my head is still spinning!
Just a quick check in to let everyone know we are still researching what to do, what would the best course for Jen be. The only decision we have come to, that is if we start treatment it won't be until the beginning of June. We are going on a longer vacation in May and don't want her sitter to have to deal with watching her while she is newly on the meds.
As I mentioned right now her biggest problem is hair loss. Yes she does drink double her weight (she is 25.5 lbs and drinks an average of 53oz/day). Thankfully ( knock on wood) she is not incontinent. She doesn't drink much if we are out, and only downs it when we are home.
One thing I've learned, and correct me if I'm wrong, dogs with Cushings can have high BP. I want her vet to check it when we bring her in next week to get her staples removed...she had a small skin tag taken off.
My head is spinning and I think I may give myself an ulcer, but I'm determined to give her what is best.
Trixie
04-05-2014, 02:41 PM
My dog was diagnosed last year at age 9. She had many symptoms though not all if them. She was also drinking like crazy....up to 50 oz a day, she weighed about 16 pounds at the time.
Cushings does cause a rise in blood pressure and it's hard to get a true blood pressure reading when the dog's are usually so stressed while at the vet.
I agree with Patti that if you choose Trilostane (brand name Vetoryl) approach with the "low and slow" dosing. Some vets go with the old protocol of 30mg a day, and the current recommendation is 1mg per pound of the dog.
We started my dog on this drug (exactly one year ago tomorrow!), on a low dose. We steadily increased the dosing based on the acth test results until we hit on the right strength to contorl her symptoms. It can take awhile to see a decrease in symptoms but I hope it will make you feel better when I tell you my dog is doing great. One year later all symptoms are gone, her very high liver numbers are down, her urine has color again, she drinks a normal amount of water and she's feeling great. It did not happen overnight...but I'm just glad that we eventually got to this point.
The beginning of this, with all the tests and decisions is the worst part, once you start medication it's nerve wracking but it does get better and you get used to the drill. We give pills twice a day and even though things are going well I still always watch her, measure her water intake and do acth tests to check levels. We are due for one soon. I hope you can work out a treatment soon and that your dog responds well. This board got me thru the last year. :) You will find great support and help here.
Barbara
molly muffin
04-05-2014, 02:49 PM
yes they Can have higher BP, but they don't always.
I can certainly see why you would want to wait to start any treatment till you'll be there to keep an eye on how things are going.
You can ask us any questions you might have. Someone is bound to have an answer for you :)
Sharlene and molly muffin
lulusmom
04-05-2014, 05:47 PM
With all lab work being so old, I wouldn't spend much time researching them for abnormalities and references ranges that are now irrelevant. Your pup should have had a complete senior screening before the LDDS test was done to rule out any other possible causes for the symptoms you mentioned. A urinalysis is part of a senior screening as is a chemistry and complete blood count. A new urinalysis, with culture, most definitely should have been done to rule out a urinary tract infection. The vet knew the urine was dilute almost a year ago and dilute urine is a breeding ground for bacteria. That is why a good number of dogs with cushing's have a urinary tract infection at the time of diagnosis. Are you sure your vet did not new labs at all?
The results of the LDDS do not meet the criteria set forth by the lab for PDH so I have no idea why your vet diagnosed PDH, unless he or she is simply using the law of averages, which is unacceptable. Without doing the differentiation tests, such as an abdominal ultrasound or an endogenous acth test, there is no way to know what you are dealing with. If your pup has a functional adrenal tumor, treatment may be the same but life expectancy, without surgery, is shortened substantially. Based on the information you have provided so far, it appears that your vet did inadequate testing.
Sorry I've been gone for a few days...when it rains it pours! We had something else over the weekend throw us a curveball. All should be ok now, and I get can back to my Jen research.
yes they Can have higher BP, but they don't always.
I can certainly see why you would want to wait to start any treatment till you'll be there to keep an eye on how things are going.
You can ask us any questions you might have. Someone is bound to have an answer for you :)
Sharlene and molly muffin
I just wanted to say thanks for this. I'm now trying to pull all my questions together.
With all lab work being so old, I wouldn't spend much time researching them for abnormalities and references ranges that are now irrelevant. Your pup should have had a complete senior screening before the LDDS test was done to rule out any other possible causes for the symptoms you mentioned. A urinalysis is part of a senior screening as is a chemistry and complete blood count. A new urinalysis, with culture, most definitely should have been done to rule out a urinary tract infection. The vet knew the urine was dilute almost a year ago and dilute urine is a breeding ground for bacteria. That is why a good number of dogs with cushing's have a urinary tract infection at the time of diagnosis. Are you sure your vet did not new labs at all?
I'm 99% positive that he did not do new sr. panel tests. We weren't charge for anything and there is nothing in her paperwork. I didn't think anything about the old urinalysis as he wasn't worried at all about it and Jen hasn't had any accidents. That was usually the first sign of a UTI in our last Corgi. Her senior panel is due in May. I think he may be so convinced it is Cushings, he didn't need to look anywhere else. He was convinced when he met her last year (for her TTA surgey) and then was shocked when the tests didn't lean that way. Only then did he look to her thyroid which was off.
And there is nothing in the bloodwork that would cause a false positive correct? It would be more for what else is wrong that may need to be treated over the Cushings.
The results of the LDDS do not meet the criteria set forth by the lab for PDH so I have no idea why your vet diagnosed PDH, unless he or she is simply using the law of averages, which is unacceptable. Without doing the differentiation tests, such as an abdominal ultrasound or an endogenous acth test, there is no way to know what you are dealing with. If your pup has a functional adrenal tumor, treatment may be the same but life expectancy, without surgery, is shortened substantially. Based on the information you have provided so far, it appears that your vet did inadequate testing.
I just reread the explaation on the lab work and I must have been reading it wrong. I'm agreeing with you on this, if I have it right. We have an appt with Jen on Monday, so help me out with this please.
Jen's basline (This is Cortisol sample 1 correct?): 3.0 (range 1-5)
Jen 4 hour: 1.6 (range 1.0-1.4)
Jen's 8 hour: 2.0 (range 1.0-1.4)
I know I'm repeating the below, but need it to work through this...
According to the tests - if the 8hr post dex. cortisol level is greater than 1.4 ug/dl, (which hers was a 2.0) the following can be used to differentiate pituitary dependent hyperadrenocorticism (PDH) from an adrenal tumor:
1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is consistent with PDH. Jen was 1.6
2. Cortisol level less than half the baseline level at either 4 or 8 hours post-dex is consistent with PDH.
***This is the one that throws it off, correct? Jen's level here was a 2.0. It was not half her baseline at 4 or 8 hours.
To be PDH does it need to hit both factors, or just one? To me it seems like the diagnosis came from #1 above as #2 doesn't match up. The report also seems to lean to only needing one of the above to match "If neither of these criteria is met, further testing is needed to differentiate PDH from adrenal tumor Cushings."
Does that make sense? Am I on the right track? I want to have as much information as I can when we see the vet on Monday.
labblab
04-11-2014, 01:40 PM
Hello from me, and you are correct that if Jen were to have met either one of those two criteria, the diagnosis would be PDH. She didn't have to meet both. However, Jen did not meet either of the two criteria: her 4-hour result of 1.6 was higher than 1.4. (not lower), and neither the 4-hour nor 8-hour result was less than half of the baseline. So in her case, the results could be consistent with either PDH or ADH, and further testing would be necessary to try to make that determination.
Marianne
Hello from me, and you are correct that if Jen were to have met either one of those two criteria, the diagnosis would be PDH. She didn't have to meet both. However, Jen did not meet either of the two criteria: her 4-hour result of 1.6 was higher than 1.4. (not lower), and neither the 4-hour nor 8-hour result was less than half of the baseline. So in her case, the results could be consistent with either PDH or ADH, and further testing would be necessary to try to make that determination.
Marianne
Marianne - thank you for setting me straight. I must have read that twenty times and did not catch it. Now I see it and she didn't meet either criteria. So happy to have this board - I know we wanted a second opinion on treatment, but now I really do.
But it is still definitely Cushings correct? We just need to determine which type and that is by ultrasound or what else?
labblab
04-11-2014, 04:24 PM
Yes, an 8-hour result greater than 1.4 is consistent with Cushing's. However, the fact that the result is consistent with Cushing's doesn't prove Cushing's beyond any question. Other nonadrenal illness can also produce a "positive" result on the LDDS, as well. That's why the Cushing's diagnosis involves an accumulation of evidence that can include typical symptoms, other consistent lab abnormalities, and adrenal gland abnormality when viewed on ultrasound. Jen may indeed have Cushing's, but I think your decision to seek a second confirmatory opinion is a good one. In addition to re-checking her standard blood and urine panels, I do always recommend an abdominal ultrasound because not only can it help differentiate between the two types of Cushing's, it can also reveal any other internal issues that might complicate treatment or even point to an alternative diagnosis.
Marianne
Thanks Marianne - we are seeing her vet tonight and I'm printing out this thread and highlighting questions.
Is there any file saved somewhere with questions for you vet? So far all I have are:
From the forums - UC Davis does recommend lower dosing and we have found over the years and experience from many hundreds of people who have come here that starting low is the ONLY way to go. How do you start them?
How do we know it’s not diabetes (high Glucose on last test) can cause false positives?
How many case have you seen/treated?
What’s been the worst effects from the meds?
What’s been the worst for those who don’t treat?
Do we know what Jen’s BP is? Could she have the high BP?
What schedule do you use for the ACTH tests? Costs?
Hear a lot about milk thistle to prevent meds from hurting liver. If Jen’s liver is normal now, do we want to take the chance on destroying it.
Thanks again all.
molly muffin
04-14-2014, 05:41 PM
There isn't a file with general questions for the vet, there is only one for surgical candidates.
I think the list you have are good ones. You're seeing the IMS tonight or regular vet?
Sharlene and molly muffin
There isn't a file with general questions for the vet, there is only one for surgical candidates.
I think the list you have are good ones. You're seeing the IMS tonight or regular vet?
Sharlene and molly muffin
Tonight is the regular vet who diagnosed her. She's getting her staples out from a small growth we had removed. I am trying to figure out who she will see for a second opinion, hopefully it will be an IMS doctor after reading these boards.
lulusmom
04-14-2014, 06:52 PM
I've reread your thread and for me, your questions about treatment are premature. I'd be asking a lot more questions about the diagnosis before brooching the subject treatment. Based on the information you have provided, I still feel your vet has done a woefully inadequate job of testing. Just to make sure I have things straight in my mind, can you confirm the following:
1. In May 2013, your vet confirmed a CCL injury and before doing surgery your vet wanted to rule out cushing's so he did bloodwork and that is the last time bloodwork was done.
2. After reviewing the results of that bloodwork, your vet advised that Jen did not have cushing's.
3. Jen recovered quickly from surgery but her hair did not grow back and hair loss appeared to be getting worse so this prompted you to take her back to the vet.
4. You are 99% positive that your vet did not do new sr. panel tests and you didn't think anything about the old urinalysis as the vet wasn't worried at all about it and Jen hasn't had any accidents. Dogs with cushing's lose their ability to concentrate their urine. They therefore pee lakes and must drink to stay hydrated. Once housebroken dogs are no longer housebroken. Jen was having no accidents in the house so at this point, your vet pursued a cushing's diagnosis based solely on a coat issue and without the benefit of fresh bloodwork and a urinalysis.
5. Your vet did not do a differentiation test to determine what form of cushing's Jen has and confirmed a cushing's diagnosis based solely on loss of coat and a positive LDDS test, which, by the way, is a test that is highly likely to yield false positive results in the face of nonadrenal illness and/or severe stress.
Thanks in advance for clarifying and/or confirming my understanding.
Glynda
Hi all,
We actually took Jen in for a blood panel & urine test yesterday. It showed liver and triglycerides high now. Before I post the results a bit of background of why she went in. She also saw a different vet (who she LOVES, not the same feeling as the regular vet) as she was up the night before dry heaving and then I wasn't sure if she had a mini-seizure. Nothing ever came out, but she was at it for a while and scared the daylights out of me. When morning finally came, all Jen wanted to do was have breakfast and go about her normal routine. I made an appt to have her checked for later that afternoon.
I went home to get her around 3pm and found out she ate a little bit around noon. My hubby couldn't resist her charms anymore and have her a 1/4 cup of kibble (she gets 1/2 cup twice daily.)
I did let the vet know this and she thought it might be possible that some of the results would be skewed, but wanted to run it anyway, so I let her. I know Jen's high Triglyceride's could be skewed by eating, but would the ALT and GGT be the same way? Or is it if they are high they are just high. We also gave her her monthly Frontline dose the day before and wondered if it could have been a reaction to that? Vet didn't think so since she's never had that before, but I was looking for any explanation.
Does any of this make sense? I have most of the results in front of me, but not her urine sample yet.
Glynda - we told him when we saw him a week or so ago we wanted further testing to confirm the type and he was fine with it. I still want a second opinion. The other thing is she is not incontinent at all (knock on wood) and actually held it for seven hours one day last week. She's also good about not drinking when we are not home and then gulping water as soon as we do walk in. Does that help answer a couple questions or just further the mystery.
Thank you all again for your help - so many questions, I feel like I may never wrap my head around everything, but you guys are definitely helping.
Ty
labblab
04-24-2014, 04:43 PM
Hi Ty,
Although eating could have affected the testing of cholesterol/triglycerides, I don't believe it would have elevated the liver enzymes. Nor do I know a reason why the Frontline would have affected those results, either. So I'm afraid the ALT and GGT are probably accurate.
Marianne
Ugh, that's what I was afraid of Marianne. I'll post numbers when I get home.
Jen's latest results (I don't think I have the full urine panel yet, but do see things like creatine and protein listed on here.)
Test was given 3 hours after eating and less than 20 hours after having her Frontline which we are not ruling out caused her issues over that night.
ALT (SGPT) 155 range 12-118 IU/L
GGT 29 range 1-12 IU/L. Don't remember seeing this one before.
Sodium 155 range 139-154 mEq/L
Triglyceride 468 range 29-291 mg/dL
Those are her new levels that are high. Any insights or do you need any other information? Thank you again.
molly muffin
04-25-2014, 07:35 PM
hmm, the ALT has come up a little bit and now the GGT, both are associated with the liver.
If there is a problem with the liver then an LDDS can be inaccurate.
The sodium and triglycerides could be higher as a result of being fed before the test.
Sharlene and molly muffin
Harley PoMMom
04-25-2014, 09:24 PM
Could you check on a couple of Jen's blood chemistry panels and see if the Albumin has been trending up/down, also can you take a look at the Bilirubin and see if any trends are going on there...Thanks
Hi there,
I've tried to answer your questions, but I think I've asked more questions!
hmm, the ALT has come up a little bit and now the GGT, both are associated with the liver.
If there is a problem with the liver then an LDDS can be inaccurate.
The sodium and triglycerides could be higher as a result of being fed before the test.
Sharlene and molly muffin
Dumb question, how does it make the LDDS test inaccurate and should she have had the High Dex test instead? Would now be a good time to start her on milkthistle while we are trying to figure this all out. I also want to start her on the Melatonin and Flaxseed Lignans for now.
Could you check on a couple of Jen's blood chemistry panels and see if the Albumin has been trending up/down, also can you take a look at the Bilirubin and see if any trends are going on there...Thanks
Albumin 5/6/13 - 4.4 range 2.7-4.4 g/dL (tested before CCL surgery)
Albumin 9/7/13 - 3.9 range 2.7-4.4 g/dL
Albumin 4/24/14 - 4.4 range 2.7-4.4 g/dL
Total Bilirubin 4/24/14 - 0.2 range 0.1-0.3 mg/dL
That's the only Bilirubin I see on the tests. I tried to look up an abbreviation, but didn't see on and I don't see anything with that range on any of her other tests. I did see one TBIL but it has a different range on earlier tests:
TBIL 9/7/13 - 0.4 range 0.1-0.6 mg/dL
Her Albumin seems up and down, just like her ALT. And if the two Bilirubin tests are the same, Jen seems to be right in the middle of the ranges.
I'm seriously thinking about running these again in two weeks when she has not eaten, and has not had her Frontline. If the Frontline caused what happened (the dry heaves, something that looked like a seizure but probably wasn't) then I wonder if it could have skewed numbers as well good or bad.
One other question regarding her food. She is on Taste of the Wild which is grain free, but high in protein. Should we switch her to another food?
Squirt's Mom
04-26-2014, 03:10 PM
Dumb question, how does it make the LDDS test inaccurate and should she have had the High Dex test instead? Would now be a good time to start her on milkthistle while we are trying to figure this all out. I also want to start her on the Melatonin and Flaxseed Lignans for now.
First, no such thing as a dumb question. ;)
Now, cortisol is the body's natural response to any stress, internal or external. So when another illness is present we can expect the body to naturally release more cortisol in response. The cushing's tests can only tell us that the cortisol is elevated but not why. So the LDDS, HDDS, and ACTH can all returns inaccurate results in the face of other diseases and conditions. Therefore, diagnosing Cushing's is just about as much ruling out other possibilities as it is diagnosing the disease. ;)
Harley PoMMom
04-26-2014, 03:42 PM
One other question regarding her food. She is on Taste of the Wild which is grain free, but high in protein. Should we switch her to another food?
If she is doing well on this food I see no reason to switch because switching foods right now would be another variable that would have to be ruled out.
I really don't know if the frontline could of skewed the chemistry panel results and one can only have a liver panel done so if this would bring you some peace of mind, I say go for it, and if the numbers are around the same than we will can rule out the frontline as the culprit for the elevated liver enzymes.
Hugs, Lori
Hi all,
It has been awhile since I've been on here (and one minor health scare for me that took up summer) but have realized it is time to where we are going to have to start treating Jen. She had another blood panel (not full) about two months ago when she wouldn't eat. Not eating for Jen means something is really wrong. She did have some type of nasty infection, that was cleared up with antibiotics and a couple of other drugs. What came out though we're her liver and kidney levels were all back within normal range.
Fast forward to today and her water intake is suddenly more out of control than ever. I've also noticed her getting weaker in her front legs. We do have her on melatonin and lignans, should we pull her off once we start treating? She is also on thyroid meds.
We are going to bring her to another vet for just a peace of mind second opinion. After her one and only LDDS test, the blood work did not fall into the criteria for pituitary Cushing's even though her vet said it was. I know he also wanted to start her on a high dose of meds which I disagreed with.
So as I sit here completely freaked out and hoping I don't end up killing her by doing this, I wondered do people prefer one drug over another? She needs a full blood panel (we decided to do them every six months) and even another LDDS and ultrasound if it comes back goofy again before I will give her any meds.
I'm also worried about how much pain she might be in afterwards as she has some arthritis and has had surgery for a torn CCL. If the cortisol is normal, will she then have to be on a pain med that could cause a whole new bunch of problems.
I know, deep breath, take her for her second opinion and go from there. I'm also petrified as we both will be out if town for a week in January and I'd hate not to have her meds set and her sitter having to watch for all her changes, opinions?
Thanks all in advance! I'm am truly scared about going down this path with her.
Harley PoMMom
11-10-2014, 04:56 PM
Dogs with Cushing's generally have a ravenous appetite, how is Jen's appetite now? Increased water consumption can also be contributed to diabetes or hyperthyroidism. I see that Jen is taking a thyroid supplement, has her thyroid levels been checked recently? Is the increased water intake the only symptom she is displaying?
Although the lignans and melatonin are usually pretty safe to give I would discontinue them if Jen is started on treatment so any contraindications between them could be ruled out.
As for deciding which medication to use, it depends on the vets knowledge, experience and familiarity with the drug s/he uses, how comfortable the pet owner is with the treatment plan, and the dog's general health. Vetoryl/Trilostane is no safer than Lysodren/Mitotane, and vice versa. Adverse effects usually only happen when the proper protocols are not followed.
There are medications that can be used for arthritis when a dog is being treated for Cushing's, nutraceutical supplements such as glucosamine, chondroitin, and MSM (methylsulfonylmethane) can be used, fish oil, also acupuncture and massage. Adequan is one medication I have seen some members use for their arthritic dogs.
We are here for you both and will help in any way we can, we are some of the best hand holders!! ;)
Hugs, Lori
molly muffin
11-11-2014, 06:47 PM
Hmm, since it's been awhile since you went through all the testing, you need to make sure that the thyroid is controlled with the medication and rule out diabetes again as it can come on pretty quickly. Then see how her cortisol levels are on the melatonin and lignans.
Sorry you had a health scare to and hope you are doing okay now.
hugs
Hmm, since it's been awhile since you went through all the testing, you need to make sure that the thyroid is controlled with the medication and rule out diabetes again as it can come on pretty quickly. Then see how her cortisol levels are on the melatonin and lignans.
Sorry you had a health scare to and hope you are doing okay now.
hugs
First, thank you and I think I'm in the clear for now, so now I can go back to focusing on Jen. I'm setting up a second opinion and I want them to do the full blood panel, thyroid and do another HDDS test since that first one didn't match any of the criteria.
Well we brought Jen into her regular vet for the six month testing and her liver levels are now high. I'm feeling terrible as we decided to not treat her for the Cushings while everything was normal with her blood tests. We'll talk more with her vet on Friday, but he did mention he wanted to do a biopsy as the levels changed within two months. Now this may explain her increase in drinking (over and above the large amount she was already doing) and needing to go out.
Now I'm not sure if we can even treat for Cushings. I'm also not sure I want to put her under being that she is almost 11. From what I've read, you can also get results with an ultrasound or bile blood test?
And should the Cushings treatment help her liver or do we have to treat the liver first and then later worry about the Cushings, sorry, I'm so confused on this!
I'm missing one page of results (her Thyroid) but here are the latest abnormal numbers:
Chem 21 Panel
ALP - 187 range 5-160 U/L
ALT - 213 range 18-121 U/L
Albumin - 4.2 range 2.7-3.9 g/dL (which is down from 4.4 on her April test)
Chloride -105 range 108-119 mmol/L
Sodium - 154 range 142-152 mmol/L
NA/K Ratio -39 range 28-37
CBC Standard Panel
Auto Platelet - 479 range 143-448 K/uL
Lymphocyte - 727 range 1060-4950 /uL - could this be cancer?
Anything I should be armed with when we talk to the vet on Friday? I was going to request another LDDS test as her last one did not meet either the four or eight hours standards.
Thank you all for your help.
Ty and Jen
Dogs with Cushing's generally have a ravenous appetite, how is Jen's appetite now? Increased water consumption can also be contributed to diabetes or hyperthyroidism. I see that Jen is taking a thyroid supplement, has her thyroid levels been checked recently? Is the increased water intake the only symptom she is displaying?
Although the lignans and melatonin are usually pretty safe to give I would discontinue them if Jen is started on treatment so any contraindications between them could be ruled out.
As for deciding which medication to use, it depends on the vets knowledge, experience and familiarity with the drug s/he uses, how comfortable the pet owner is with the treatment plan, and the dog's general health. Vetoryl/Trilostane is no safer than Lysodren/Mitotane, and vice versa. Adverse effects usually only happen when the proper protocols are not followed.
There are medications that can be used for arthritis when a dog is being treated for Cushing's, nutraceutical supplements such as glucosamine, chondroitin, and MSM (methylsulfonylmethane) can be used, fish oil, also acupuncture and massage. Adequan is one medication I have seen some members use for their arthritic dogs.
We are here for you both and will help in any way we can, we are some of the best hand holders!! ;)
Hugs, Lori
Lori - somehow I missed your post and only now caught it. Thank you for all the advice. I believe out vet prefers the Lysodren route. I just wasn't sure if one was better/safer than the other.
Jen already takes glucosamine twice a day, so hopefully that is helping. The water and needing to go out are the only things that have changed. She is still just as bald as she has been, but acting like her usual goofy self.
I hope all of you that celebrate Thanksgiving had a nice one! Jen and I are very thankful for this forum and the knowledge people have!
I've calmed down since getting her results and am still waiting for the doc to call. We are also trying to get an appt with an internal med specialist at our local VCA to get his opinion. The vet Jen has been seeing is an ABVP diplomat, which I think gives him extra training.
I did, however, find something interesting I want him to comment on this morning. Due to her low Lympocyte numbers, the first page I searched commented on how this is related to adrenal tumors/Cushings. So while her liver numbers are growing, here's what I think our next steps should be - do they make senses?
Schedule the appt with another doc/opinion.
Get an ultrasound, for both liver and adrenal.
Possible liver biopsy.
After that we can assess and see which needs to be taken care of first.
Thank you all for your help!
labblab
11-30-2014, 08:22 AM
Welcome back, Ty! I'm so sorry we did not get a chance to reply to you earlier. But yes, I think your gameplan for Jen seems very reasonable, and we will be very anxious to find out how things proceed. So please be sure to come back and update us when you know more. (And I hope you had a wonderful Thanksgiving at your house! :))
Marianne
Welcome back, Ty! I'm so sorry we did not get a chance to reply to you earlier. But yes, I think your gameplan for Jen seems very reasonable, and we will be very anxious to find out how things proceed. So please be sure to come back and update us when you know more. (And I hope you had a wonderful Thanksgiving at your house! :))
Marianne
Thanks we did and hope you did too. The appt for a new consult is set up for the 13th.
Hi all - before we even get Jen to her next consult, our vet wants to try and put Jen on Denamarin for a few weeks to see if that helps her ALT (currently 213). He wants to try this before we even start to treat her for Cushings. Where do people buy this and do you use the chewable or regular tablets? He told me to just get it online, but wanted to check. Can I also keep giving her the Melatonin and Lignans?
Sorry for all the questions!
Thanks!
judymaggie
12-02-2014, 03:01 PM
Hi, Ty! I have my Abbie on Denamarin chewable tablets. I bought it on Amazon. I thought it was quite pricey but they had the best price of anyone I could find. After I finish the current bottle, I am going to switch to S-Adenosyl which also has both SAM-e and milk thistle and was less expensive (also on Amazon). Abbie chewed the first couple of tablets and then started spitting them out -- they are really huge so I tried giving her a 1/2 at a time but she still didn't like it. They look really dry. I now wrap each 1/2 in her canned dog food and she will swallow it off of a spoon. The little bit of food she gets with them isn't a problem (they are supposed to be given on an empty stomach). Abbie weighs 26 lbs. so she gets one whole tablet a day.
My last beagle, Maggie (also a Cush pup), was on lignans with a melatonin implant but I didn't give her Denamarin so can't really address your question about any conflict.
Thanks Judy - ordering the Denamarin today. Jen takes both her thyroid and melatonin right out of our hand, so fingers crossed for this.
I also FINALLY got Jen's latest Thyroid and it's low again. I asked the vet about upping the dose and he wants to wait as he thinks she has something else, hence the liver. I tried to explain, yes, her liver is high but I know people whose dog's do not have Cushings yet have lived with liver disease and readings of 1400 for years. Regardless, he won't up her Thyroid. The test reading was:
T4 0.9 - Range 1.0-4.0
On her last test she was 1.3.
Harley PoMMom
12-07-2014, 07:26 PM
Hypothyroidism can cause elevations in the liver enzymes.
Hypothyroidism can cause elevations in the liver enzymes.
Did not know that...her low thyroid could be part of this. I also don't believe her slightly higher liver (213) should suddenly have added two more bottles of water a day to her drinking, but I could be waaaay off base on that.
I really can't wait to see the new vet just to see what he says. He's Internal Med/Endo, graduated from Univ of Tenn (granted it was the late 70's!) but also has Corgis :)
Happy New Year everyone! Quick update on what we've been doing. We met with the IM/endocrinology specialist (Univ of Tenn grad) in mid-December. The appt started off with him being 45 minutes late to which I remarked to Jen her docs work like my docs! :)
It was worth the wait as he spent almost an hour with us going over her past tests and answering questions. Whereas her vet was scared my hubby with her new elevated ALT levels (in the 200's) he stated it was a bit high, but had seen much much higher. He has treated 400-500 Cush pups (including his mom's who still lives in a small town in Tenn) and uses both meds. He said with the Tristolane he doesn't need to be thinking two weeks ahead of what might happen, but with Lysodren, he is always planning what could happen two weeks ahead.
He also wanted to start by rerunning the LDDS test since it was inconclusive and then do an ultrasound. He said just looking at her he is sure she does have it, but wants to know for sure since her tests were off. Yesterday she went for the new LDDS test and so we await the results.
He also owns a couple of Corgi's and didn't really emphasize the whole food aspect as their insatiable appetite is always listed as the second Corgi trait (after fur everywhere)
molly muffin
01-10-2015, 12:09 PM
It sounds like you have found a good specialist who is experienced with cushings and corgi's! That is awesome and now I have high hopes that things can get sorted out for Jen.
Be interesting to see what the new LDDS shows. My molly has never tested positive on the LDDS but does on the ACTH. There is like 5 % of dogs who won't test positive on an LDDS but still have it. The other option is that there is another reason for the cortisol to be high. I think he'll go through and make a determination of which he thinks it is for Jen.
Thanks Sharlene, I'm anxious to see what it comes back as and which med he will want to start her on, my bet is Lysodren. I'm still so super nervous about putting her in the meds and watching a whole new host of issues that she has never had crop up such as being in lots of pain from her surgery, etc.
Dixie'sMom
01-10-2015, 05:03 PM
Hey! I'll be waiting also to see what the LDDS shows. It sounds like you have a very knowledgeable vet that you can trust. That is such a blessing! (I'm jealous!)
Jen is so cute!
Thanks Suzie. While I trust him so far, I'm not sure about the staff around him. We brought Jen's food and thyroid and when we picked her up they said they gave her ID food since they didn't think we'd brought any :confused:. It was a shift change mistake, ugh. Hopefully it was a one off, but this VCA does have a bad rep. Hoping because he is part of the "speciality" hospital and not regular we won't have too many issues.
One other thing I liked was when I asked about Jen's dosage he said he likes to go low and slow. Just the answer I was looking for thanks to this forum!!
Squirt's Mom
01-11-2015, 11:39 AM
One other thing I liked was when I asked about Jen's dosage he said he likes to go low and slow.
Hate to bust your bubble, but this statement works for Vetoryl (Trilostane) and not Lysodren. With Vetoryl the starting dose is pretty flexible and starting at the lowest dose is best. However with Lyso the loading dose is fixed at 50mg per kg. Starting any lower would probably make the load last longer and result in more ACTHs to see if the pup was loaded or not. So with Lyso you start with the set loading dose while with Vetoryl you have a little play room. ;)
Hate to bust your bubble, but this statement works for Vetoryl (Trilostane) and not Lysodren. With Vetoryl the starting dose is pretty flexible and starting at the lowest dose is best. However with Lyso the loading dose is fixed at 50mg per kg. Starting any lower would probably make the load last longer and result in more ACTHs to see if the pup was loaded or not. So with Lyso you start with the set loading dose while with Vetoryl you have a little play room. ;)
Shoot - I must have totally misunderstood!! I swear this is going to give me a nervous breakdown trying to navigate it. We should have her results back any minute now from the LDDS test and then will schedule an ultrasound and go from there. I think before where we were leaning to no meds (since everything was inconclusive and blood work normal) we are now learning towards treating, but want a definite diagnosis.
So for Lysodren if Jen weighs 22.9 lbs or 10.38727 kgs (she has dropped so much weight and really can't afford any more loss!) she would load with 500 mgs of Lysodren? And then we would adjust up or down for maintenance, correct?
Squirt's Mom
01-14-2015, 04:34 PM
Yep, 10kg BW would be 500mg a day. You will divide that dose into 250mg AM and 250mg PM. Once you see signs that the load has been achieved, you stop the Lyso and call the vet for an ACTH in the next day or two. You will be fine, sweetie, and we will be here if you need anything. Did you print a copy of the Lysodren loading and tips in the Helpful Resources section? Many folk do and keep it handy during the load.
Just got Jen's results back - do these make sense now that it is pituitary?:
Low-dose Dexamethasone Suppression Test
Time 1 Pre Cortisol Sample 1 8.9 Normal 1.0 5.0 mg/dL
Time 2 4Hr Cortisol Sample 2 5.5 4H Normal 0.0 1.4 mg/dL
Time 3 8Hr Cortisol Sample 3 7.8 8H Normal 0.0 1.4 mg/dL
INTERPRETATION OF THE DEXAMETHASONE SUPPRESSION TESTS:
*
Low-dose dexamethasone suppression test:
Normal: Cortisol level less than 1.4 ug/dl 8hrs post-dex.
Hyperadrenocorticism: Cortisol level greater than 1.4 ug/dl 8hrs
post-dex.
...
If the 8hr post dex. cortisol level is greater than 1.4 ug/dl,
the following can be used to differentiate pituitary dependent
hyperadrenocorticism (PDH) from an adrenal tumor:
1. Cortisol level less than 1.4 ug/dl 4hrs post-dex is
consistent with PDH.
2. Cortisol level less than half the baseline level at either 4 or 8
hours post-dex is consistent with PDH.
(Samples taken at 2 or 6hrs are interpreted the same way as a 4hr
sample)
He said she definitely now has Cushings and it is probably pituitary since 85% are....well I don't think the numbers point to that correct? Or am I looking at it backwards again? He gave us a couple options - do an ACTH (as it is cheaper) or an ultrasound to see if it might be adrenal. BUT - that is only if we are considering surgery as an option, which I'm not sure about. He said there was a 75% success rate, but it is the other 25% making me crazy. Jen is about to be 11 and not sure if she would survive.
Even if we don't do surgery he will be putting her on Tristolane (did I spell that right)? He said he starts low, checks in two weeks to see where her levels are and then adjusts. That sounds normal right?
Thanks all - I'm about to become the biggest worrying Corgi mom on the planet!!! Nothing can be done for a week as we are leaving for vacation tomorrow and even he said to go, a week won't make a difference. Well, at least I can freak out in the sunshine!
Harley PoMMom
01-15-2015, 04:58 PM
You are absolutely correct, those LDDS test results do point to Cushing's but do not differentiate between ADH or PDH, and yes, approx. 85% of dogs with Cushing's have the pituitary type.
I believe ultrasounds are a very useful diagnostic tool, they have the capability to find abnormalities on the internal organs, such as gallbladder mucocele, kidney issues, pancreatitis...etc Our motto here is you get a lot of bang for your buck with an ultrasound. However not ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it.
Now is Jen being started on Trilostane/Vetoryl or Lysodren/Mitotane?
Now is Jen being started on Trilostane/Vetoryl or Lysodren/Mitotane?
Not for at least another week and a half. We are leaving her with a sitter tomorrow while we go on vacation. Did not want to start her on any medication without being able to watch her like a crazy person. He did say he wanted to use Trilostane. Our next step is ultrasound, then meds.
Freak out time! Of course now that we have a definitive diagnosis and a plan for a week from now, Jen gets really sick. She has had diarrhea since yesterday and has to go every few hours. She is still drinking water and wants food, which she is not getting. Her energy level is still good. She's doing her mumble/bark as she thinks I've forgotten to feed her.
Going to bring her to the regular vet as soon as they open....Hope she is ok. I swear I now think this could be the end thanks to the Cushings and who knows what's this could be. Of course, we are supposed to leave her with a sitter in 12 hours!!:(
Squirt's Mom
01-16-2015, 08:48 AM
This could be a reaction to the testing so don't worry overly much. As long as a dog still wants to eat and drink, it's usually nothing major. ;)
Harley PoMMom
01-16-2015, 11:11 AM
I agree with Leslie, sometimes a dog will have a reaction from the ACTH stim test, another thing that may cause diarrhea is stress. Just like Leslie mentioned, when a dog still has their appetite that is always a good sign, Jen may just need a bland diet for a day and then can go back to her regular feed.
Keep us updated!
Hugs, Lori
molly muffin
01-16-2015, 03:25 PM
My dog just had a horrible case of diarrhea just before her stim test. Now she is bouncing off the walls but a bit of fiber in her diet and she is having solid stools. It just lasted one day thank god.
Hang in there!
Thanks all, since we were leaving we brought Jen into the vet and they said she had a little bug. Couple days of anti-diarrhea meds and an antibiotic and she was back to normal.
She has her ultrasound scheduled for Wednesday and I'm guessing he'll want to put her on Vetoryl/Trilostane right after it. I'm off to read more about it and will probably then have a million questions!
I'm posting questions as I think if them. I thought with Lysodren it was better to start on a certain day of the week in case they had adverse effects. Is Vetoryl the same?
Am I watching for decrease in water, eating, listlessness so I know if I have an emergency and have to rush her in? Will I still get prednisone with Vetoryl?
Jen is losing weight quickly, she is just not absorbing any food and is around 19 pounds now. Would the 10mg dose be too much now to start her on?
Is it best to give it these first couple weeks just in the morning with her meal or split the dose?
She is currently on Denamarin and melatonin...should we continue with these or stop?
Thanks all!
Harley PoMMom
01-26-2015, 03:55 AM
I've typed my comments in blue text within the body of your post below.
I'm posting questions as I think if them. I thought with Lysodren it was better to start on a certain day of the week in case they had adverse effects. Is Vetoryl the same?
Since some veterinarians have limited hours on the weekend, with Lysodren it is advised to be started on a Sunday, so that if any adverse effects do develop after a few days, the veterinarian would be available.
The same principle can be applied with Vetoryl too. When Vetoryl is started at the recommended dose of 1 mg per pound of the dog's weight less adverse side effects are seen. Vetoryl has a short half life so if a dog starts to feel unwell, s/he will usually bounce back simply by withholding the dose.
Am I watching for decrease in water, eating, listlessness so I know if I have an emergency and have to rush her in? Will I still get prednisone with Vetoryl?
Signs of cortisol dropping too low are: diarrhea, vomiting, lethargy, inappetence, or the dog is just not acting like their normal self, if any one of these are seen the Vetoryl should be stopped.
If I was starting treatment for my dog, whether it be with Lysodren or Vetoryl, I would insist that the vet provide me with a prescription for prednisone.
The goal of therapy is controlling those Cushing's symptoms. When treating with Vetoryl improvements in the increased drinking/urinating and that ravenous appetite are seen in about 2 weeks.
Jen is losing weight quickly, she is just not absorbing any food and is around 19 pounds now. Would the 10mg dose be too much now to start her on?
Do you know the reason for her weight loss? I would be hesitant to start treatment in a dog if the source of the weight loss is not known.
Is it best to give it these first couple weeks just in the morning with her meal or split the dose?
Some veterinarians do prefer twice a day dosing in order to maintain a consistently lower level of cortisol. Other veterinarians (as well as Dechra) recommend starting with one dose daily, and only switching to twice daily dosing if cortisol levels have fallen within the desired therapeutic range on a once daily dose but symptoms still seem to be rebounding at night.
Now for diabetic dogs taking insulin, twice daily dosing is absolutely recommended
She is currently on Denamarin and melatonin...should we continue with these or stop?
I see no reason to stop the Denamarin, is there a special purpose for giving the melatonin?
Thanks all!
Hugs, Lori
Squirt's Mom
01-26-2015, 08:50 AM
Jen is losing weight quickly, she is just not absorbing any food and is around 19 pounds now. Would the 10mg dose be too much now to start her on?
This statement is concerning to me and there is no way I would start treatment without finding out why this rapid weight loss is occurring. This is NOT typical of Cushing's.
This statement is concerning to me and there is no way I would start treatment without finding out why this rapid weight loss is occurring. This is NOT typical of Cushing's.
I know both you and Lori questioned this. I'll have Mark check with the specialist when they do the ultrasound on Wednesday. She has dropped about 3 pounds in 3 months. Jen is a smaller corgi and used to be an absolute wall of muscle. As this has progressed (and one of the reasons we decided to treat) was we see her losing all her muscle. I was hoping that was where the weight was coming off.
It is almost as if she is absorbing no nutrition. She poops more than ever now (all good with the exception of last week.) Don't know if Cushings could cause that.
Hoping we will have more answers after the ultrasound on Wednesday.
Lori - you also asked about the melatonin...when her levels were normal we put her on it hoping her hair would grow back (never did) and to help calm her. Jen has been stress ball since we got her two and a half years ago. This has seemed to calm her a little bit.
Harley PoMMom
01-26-2015, 06:38 PM
Yep, melatonin can calm them, I gave it to my boy, Harley, as thunderstorms used to really bother him but with the melatonin he no longer was afraid of that thunder.
There is a small percentage of dogs with Cushing's that do lose weight, most times, though, the Cushing's makes a dog have a ravenous appetite. Cushing's does cause muscle wasting and since muscle does weigh more than fat, that may be why she is dropping some weight.
Hugs, Lori
Yep, melatonin can calm them, I gave it to my boy, Harley, as thunderstorms used to really bother him but with the melatonin he no longer was afraid of that thunder.
There is a small percentage of dogs with Cushing's that do lose weight, most times, though, the Cushing's makes a dog have a ravenous appetite. Cushing's does cause muscle wasting and since muscle does weigh more than fat, that may be why she is dropping some weight.
Hugs, Lori
Jen had always had a crazy appetite and we've kept it in check. Although lately she is getting even more demanding with food. I'm really hoping (as bad as it sounds) that it is just the muscle loss. If it is (praying no) Cancer, we'll just let her live out what short time she has with lots of love and treats.
labblab
01-26-2015, 07:44 PM
For what it's worth, my Cushpuo was one of thise exceptions and was losing weight prior to diagnosis even though his appetite was huge. He looked downright scrawny when we finally started treatment!
Marianne
Yet a couple more questions, althought the doc will also have thoughts I'm sure, I sometimes think you are all the experts!!
My hubby will ask, but should we be stopping her thyroid meds - do most of you?
And how do you balance when you take your pup to their "regular" vet and when to see the specialist. If Jen is on Trilostane and her regular vet uses Lysodren, will he know what to do if she gets a bug or something?
Sorry - I am the biggest worrier on the face of the planet!
OH - and I confirmed with my husband that Jen has lost a little less than two pounds. The scale at the specialist is about 2.5 pounds less than the one at her vet. And that one was usually about a pound less than the first vet she was going to!
For what it's worth, my Cushpuo was one of thise exceptions and was losing weight prior to diagnosis even though his appetite was huge. He looked downright scrawny when we finally started treatment!
Marianne
That's how she looks right now! So hopefully that is just the case.
Harley PoMMom
01-27-2015, 04:47 PM
Yet a couple more questions, althought the doc will also have thoughts I'm sure, I sometimes think you are all the experts!!
We are here to help in any way we can, so please do ask all the questions you want.;)
My hubby will ask, but should we be stopping her thyroid meds - do most of you?
Her hypothyroidism was diagnosed way before the test for Cushing's took place? If yes, than I would not stop her thyroid medication. I would however, have her thyroid levels rechecked 2 months after the treatment for her Cushing's was/is started.
And how do you balance when you take your pup to their "regular" vet and when to see the specialist. If Jen is on Trilostane and her regular vet uses Lysodren, will he know what to do if she gets a bug or something?
It depends, does the IMS (Internal Medical Specialist) live close to you? If so, than I would have the IMS take over the Cushing's treatment, I would only use the regular GP for checkups, labs, etc. Also if the GP's fee is cheaper than the IMS' for those ACTH stimulation tests than I would have the GP vet perform them with making sure everything is discussed with the IMS.
If a dog is presenting signs of not feeling well the Cushing's medication needs to be stopped, whether it be Lysodren or Trilostane, that protocol does not change for either drug.
The best advice I can give you is to educate yourself about Cushing's so you don't have to take anybody's word for what is best for your girl.
You can find some great reference material in our Helpful Resources sub-forum to help you understand the steps in diagnosing a dog, the treatments used, adverse reactions to those drugs and even a great deal of information on concurrent diseases like diabetes and hypothyroidism. Here's a handy link to there http://www.k9cushings.com/forum/forumdisplay.php?f=10
It is very important that we are proactive and knowledgeable advocates for our pups.
Sorry - I am the biggest worrier on the face of the planet!
Oh sweety, we all are so worried about our furbabies so welcome to the worry wart club!!, so no need to apologize there, that's exactly what loving pet parents do. :D
OH - and I confirmed with my husband that Jen has lost a little less than two pounds. The scale at the specialist is about 2.5 pounds less than the one at her vet. And that one was usually about a pound less than the first vet she was going to!
Hopefully with treatment our girl will gain some of that weight back. ;)
Hugs, Lori
Lori - thank you (and all of you!) for your kindness, your post actually brought tears to my eyes. Yes I am a mess right now. I just keep hoping it will be like after she had her CCL surgery. Mess for a couple weeks and then things got better.
Jen just had her ultrasound. It is pituitary. Doc also said her adrenal glands were swollen and she has high blood pressure. They are doing that right now. Her doc also said that he would want to start treatment for the blood pressure (210) and Trilostane concurrently. Is that safe - I know he said it was.
He also wants to dose her 2x day with the Trilostane, 10mgs with breakfast and dinner. She is 22 lbs. He said this was due to the shorter life.
He would not give us Prednisone which makes me nervous. He said if we notice symptoms of a crash like that to get her in instantly. The hospital he is out of is a 24 x 7 place that is five minutes from our house. Is this ok or should I fight harder? He also mentioned Adrenal Nercrosis could happen which I never heard of before and now has me even more scared and rethinking my decision.
I'm a mess right now!
Squirt's Mom
01-28-2015, 03:08 PM
If the vet is open 24/7 and close by, that will be fine. With Vetoryl's short life in the body, usually stopping the med for a few days is all that is needed IF there is a crisis.
Adrenal necrosis is a fancy way to say the adrenal glands are killed off. That can happen with either drug but usually only when the dose is much too high. Jenn's isn't so that should be fine. You have us to ask should you see anything that seems different, too. You are gonna be just fine, honey, just fine.
Harley PoMMom
01-28-2015, 04:45 PM
Dechra's does caution using ACE inhibitors, such as enalapril, with Trilostane as they both have the ability to lower aldosterone. Here is the quote from Dechra's product insert:
Angiotensin converting enzyme (ACE) inhibitors should be used with caution with VETORYL Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient's ability to maintain normal electrolytes, bloodvolume andrenal perfusion.
http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf
Hypertension is common in dog's with Cushing's and getting that high blood pressure down is very important because it can cause havoc on a dog's system.
Although ACE inhibitors are the first line of defense in treating hypertension, there are blood pressure medications known as Calcium Channel Blockers (CCB) that work just as well as ACE inhibitors in lowering that high blood pressure. CCB's are not the same as the ACE inhibitors so there isn't that worry about decreasing the aldosterone.
Another important thing, when using a blood pressure medication along with the Trilostane the electrolytes need to be monitored, specifically the creatinine, potassium, and sodium, as Trilostane does have an effect on these levels.
I believe that Jen's Trilostane dose of 10mgs BID is appropriate and the chance of seeing any adverse side effects are minimal. With the hospital being open 24 X 7 and only five minutes away I believe that not having the prednisone with be ok.
You will do fine, and we are here to help, before long you will be a pro at this. ;)
Hugs, Lori
Jen's doctor is going to hate me, but after seeing this I think I'm just going to try the Trilostane and not the BP meds at this time. What I find interesting is that the BP med can be used as a Cushing's med although there is a lot of debate around this.
I'm also even wavering on giving her the meds...but I know things will probably get worse, so if I can stem it while she is not horrible yet, that is probably a good thing.
molly muffin
01-28-2015, 08:14 PM
Yes is safe. Have to get that bp under control. Is very important. We are treating both currently too
Harley PoMMom
01-28-2015, 09:15 PM
It is crucial to get that high blood pressure down to within normal limits, untreated high blood pressure can eventually cause kidney damage, blindness, cardiovascular abnormalities, retinal hemorrhage and detachment, the list goes on.
My boy, Harley, had high BP and while on Lysodren and when I switched to Vetoryl his high BP was treated with Amlodipine, (a CCB), and benazepril (an ACE inhibitor).
A dog with Cushing's and high BP can still be treated for both, one just has to monitor more often with electrolyte panels. Even when a dog is on Cushing's therapy the hypertension can persist if left untreated.
Hugs, Lori
Should I go back and ask for a CCB instead? Or what are the signs she is having a reaction to the electrolytes being wonky. I'm still thinking start her on Trilostane and then add in the BP ACE inhibitors if necessary. Or am I overthinking?
I just hate to start her on two meds at once when one may help the other(fingers crossed) not be necessary.
Whatever we do, I'm going to start the Trilostane tomorrow (Friday) so I can be awake for every little sound she makes and not have to worry about going to work the next day ;)
Harley PoMMom
01-29-2015, 10:52 AM
Should I go back and ask for a CCB instead? Or what are the signs she is having a reaction to the electrolytes being wonky. I'm still thinking start her on Trilostane and then add in the BP ACE inhibitors if necessary. Or am I overthinking?
I would definitely talk to Jen's vet and tell him about your concerns and then ask him if CCB would be better suited.
Starting the Trilostane and than introducing the blood pressure medication later on I think is a great ideal.
The symptoms of the electrolytes being unbalanced are; increases in drinking/urinating, inappetence, lethargy, vomiting, trembling or shaking, a slow and weak pulse, low body temperature, slow capillary refill time (to measure capillary refill time, press a thumb firmly on your Jen's gum for about 5 seconds. Release the thumb and count: the amount of time it takes the gum to return to normal should be about 1 second).
When adding the BP meds along with the Trilostane I would have Jen's electrolytes rechecked in 10-14 days. I believe Jen will do fine.
Hugs, Lori
I would definitely talk to Jen's vet and tell him about your concerns and then ask him if CCB would be better suited.
Starting the Trilostane and than introducing the blood pressure medication later on I think is a great ideal.
The symptoms of the electrolytes being unbalanced are; increases in drinking/urinating, inappetence, lethargy, vomiting, trembling or shaking, a slow and weak pulse, low body temperature, slow capillary refill time (to measure capillary refill time, press a thumb firmly on your Jen's gum for about 5 seconds. Release the thumb and count: the amount of time it takes the gum to return to normal should be about 1 second).
When adding the BP meds along with the Trilostane I would have Jen's electrolytes rechecked in 10-14 days. I believe Jen will do fine.
Hugs, Lori
Thanks Lori,
The plan in my head is to give the Trilostane a two week head start. I'm looking at this as the specialist told us if we were going to treat and surgery is not an option we never would have done the ultra sound, which found the large liver blood vessels which found the high BP. I've cried so many times over the past few days hoping I'm making the right decision.
Then hubby tells me last night that he eventually wants all the care to return to Jen's regular vet. He does NOT like this specialist all all. That the IM vet seemed like he could not wait to get out of the room and was almost rolling his eyes at my questions (I was on the phone since I had to work). Mark (husband) suggested we call her regular vet and see what he thinks.
Her regular vet was definitely jumping the gun with the diagnose last year, but did nail it and everything he said would happen has. I have no idea if it matters but he is listed as a Specialist from the ABVP. http://www.abvp.com/ I'm still going to call him today and see what he thinks and hopefully start Jen's Trilostane tomorrow. I know it seems like I keep putting it off (which I am LOL, but this time WANT to start treatment) but she had a bit of yucky tummy late Wed and I want to make sure it is out of her system. Yes, there is a pattern of Jen seeing the IM vet and then having bad tummy. The same tests at her regular vet never cause anything.
Just as a little background, we found her regular vet after she tore her CCL and he was one of the few doing a TTA repair. With my million questions and freak outs day of surgery he gave me his cell and said to call him any time day or night with questions about Jen's recovery. I never did have to use it, but still remember that. We then switched all care to his practice.
Or am I way overthinking this?? Can't wait for a year from now when this is all old hat (hopefully!!)
And after my rant above I put my big girl pants on and gave her her first dose of the Trilo - threw it in with her kibble. She almost choked on it I think LOL - but the way she gobbles she ate it. We'll see how long that lasts before she figures it out!
Squirt's Mom
01-30-2015, 09:30 AM
Ya done good, Mom! ;)
Harley PoMMom
01-30-2015, 12:14 PM
Just as a little background, we found her regular vet after she tore her CCL and he was one of the few doing a TTA repair. With my million questions and freak outs day of surgery he gave me his cell and said to call him any time day or night with questions about Jen's recovery. I never did have to use it, but still remember that. We then switched all care to his practice.
Or am I way overthinking this?? Can't wait for a year from now when this is all old hat (hopefully!!)
Looks like Jen's regular vet is a specialist. And it does seem like he is willing to work with you, which is a huge plus factor. Since you have a better rapport with Jen's regular vet, if this were me, I would let him take over Jen's treatment too.
You're doing a wonderful job!!
Hugs, Lori
Two days (of hopefully at least a thousand to come) down! I think I've confused myself though. I have her ACTH scheduled in about 11 or 12 days from now. If she cuts back on her water do I take her earlier? Or am I mainly watching for lethargy, vomiting and/or diarrhea since she is on Vetoryl? If she stops eating that is an emergency for sure (she's a Corgi and they only stop eating when super sick!)
labblab
02-01-2015, 07:49 AM
Awwww, you guys are going to do fine! No, a cutback in thirst is a desired outcome and not a reason for anxiety. Unlike with Lysodren, you are always dosing trilostane daily, so it is an entirely different protocol in terms of testing based upon reduction in thirst.
Vomiting, diarrhea, or extreme lethargy remain warning signs of overdosing, however, and would be cause to consult the vet for testing. Do bear in mind that you ought to be seeing reduction in ravenous appetite, though. However, of course that is very different from not wanting to eat at all.
Marianne
Squirt's Mom
02-01-2015, 08:02 AM
You DO want to see:
*reduction in drinking
*reduction in appetite
*return of some energy
*less urination
*hair regrowth
You do NOT want to see:
*nausea
*vomiting
*loose stools
*diarrhea
*loss of appetite
*lethargy
You are doing good! You remind me of me when Squirt was first diagnosed. I think that poor dog was ready to trade me in on a saner model most days for a while there. :p I was terrified of everything going on and hovered over her constantly. If she held her ears a bit differently I was freaking out! Nothing anyone said made any sense like I was reading and hearing thru water or something. And remember anything?! HA! My mind had one thought and one thought only - "HOW IS SHE NOW?!" :D:p:D:p Even tho I may have checked 3 seconds earlier. :o:)
These are our babies, our children, and when they get sick it overturns our world. You are a good mom and trying hard to do everything right for your sweet girl. Just don't forget to breath from time to time. ;)
Jen has definitely been ready to trade me in, someone should test my cortisol during all this :D
She goes for her first ACTH test tomorrow. I believe we do NOT want to make any changes to her meds until at least 30 days no matter what the test says, correct?
We have seen a decrease in her water. She is still drinking between 2-3 bottles of water but that is down from 4-5 or more. Besides losing her hair and thin skin that has always been her biggest sign.
Is there an explanation of the test somewhere with normal ranges and where she should be? I know Dr. Peterson wrote something about not going below a 2.0 but is that first or second reading? Sorry I'm just confused about this test.
Thank you all again!!!
Harley PoMMom
02-12-2015, 06:27 AM
Jen has definitely been ready to trade me in, someone should test my cortisol during all this :D
She goes for her first ACTH test tomorrow. I believe we do NOT want to make any changes to her meds until at least 30 days no matter what the test says, correct?
This Cushing's sure can be nerve wracking, so remember we are here to help in any way we can.
And you are correct, it is recommended leaving the dose unchanged for the remainder of thirty days of treatment. This is because cortisol levels tend to continue to drift downward during those first weeks.
Is there an explanation of the test somewhere with normal ranges and where she should be? I know Dr. Peterson wrote something about not going below a 2.0 but is that first or second reading? Sorry I'm just confused about this test.
Thank you all again!!!
Here's an excerpt from Dechra's product insert:
Good control is indicated by favorable clinical signs as well as post-ACTH serum cortisol of 1.45-9.1 μg/dL (40-250 nmol/L).
http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf
And here is that statement from Dr. Peterson regarding that the post number (the second reading) should not be below 2 ug/dl:
When using trilostane, it has become increasing clear that we do not want the cortisol values to drop too low, because that may indicate early or mild adrenal necrosis (1,11,12). In contrast to the protocol used in this reported study, I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs.
http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html
Hugs, Lori
Just spoke to the vet as Jen had her first ACTH test on Thursday. We fed her a hit early and the doc made note of it. So her Pre was at about four hours after eating and the post five or so. Her specialist was called away on an emergency, so we just spoke to a regular vet on staff who didn't want to speculate since she's never seen Jen. Dummy me also forgot to ask for normal numbers, so here's what we have:
Pre: 6.2
Post: 17.9
Her water intake is definitely down, still higher than normal, but cut in almost half for her.
Her blood pressure also went down to 160 from 210. This was without her taking the BP meds. Doc would like her at 140, but is nit putting her on anything at this moment. Hopefully we will speak with him next week.
We still have her on the 20mgs (10 with each meal) and I think I want to leave her there for another two weeks.
Any advice?
Ty and Jen
I don't have the dosing and stim history, so forgive me for not going back to find it.
During the first 30 days they can continue to drift downward so many now leave the dose as is. Since you are seeing improvement, that cortisol may drift down more. Your pup can be as high as a post of 9 if symptoms are controlled. Some specialists like 7 and under. While chasing numbers is not a good strategy, that post is still fairly high and I'm not sure how much more it will drop to be within range the next two weeks.
My own dog's numbers were lower than your post at 2 weeks and I still adjusted her dose higher since we started her so low.
What does your vet say?
Harley PoMMom
02-14-2015, 11:16 PM
Although Jen's post number is high her drinking has decreased, so if Jen were my dog, I wouldn't increase her Vetoryl dose as of yet. Like Addy mentioned a dog's cortisol can continue to drift downward during the first 30 days of treatment.
And it is wonderful that her BP has come down too!!! YEESSSS!!!
Hugs, Lori
I don't have the dosing and stim history, so forgive me for not going back to find it.
My own dog's numbers were lower than your post at 2 weeks and I still adjusted her dose higher since we started her so low.
What does your vet say?
Still waiting to hear from the vet as he had an emergency over the weekend. We did not do an ACTH before starting her meds so I do not have a previous number for that. Would the resting cortisol number from the LDDS be the same as the first number for the ACTH? Jen's resting was an 8.9 (LDDS) now it is a 6.2 (ACTH). Although I could be wrong that there is no correlation there!
She is on 20mg (10 2x day) of the Trilostane right now.
Although Jen's post number is high her drinking has decreased, so if Jen were my dog, I wouldn't increase her Vetoryl dose as of yet. Like Addy mentioned a dog's cortisol can continue to drift downward during the first 30 days of treatment.
And it is wonderful that her BP has come down too!!! YEESSSS!!!
Hugs, Lori
Thanks - so happy the BP came down. Really hope it is not an anomaly and we will be good with it now. I also forgot to mention she has gained a little weight and is not looking so gaunt now. Since the ultrasound didn't show anything else funky going on (neither had bloodwork) I have to believe she just wasn't absorbing anything she was eating. Her poopies have finally gone back to a normal amount of times during the day as well. ;)
It sounds like positive news so stay the course. You can adjust the dose after the next test. It may be the numbers will come down significantly but keep in your thoughts you may have to tweak the dose.
Im glad things are going well, keep up the good work.
Harley PoMMom
02-17-2015, 09:06 PM
Cortisol fluctuates throughout the day, so her resting/baseline number will go up and down.
Some dogs do get really stressed being at the vets so on their ACTH stimulation test, the pre/resting number may be higher than the post number.
How is Jen doing?
Hugs, Lori
molly muffin
02-17-2015, 09:07 PM
That is so awesome! It can be very hard to get the BP down. We've had a real dickens of a time with it, so I'm glad to hear that. I think you are heading in the right direction and never do anything until after the first 30 days, as the cortisol Should continue to drop. I know it did for us and I'm just now tweaking upwards a bit.
Good job!
It sounds like positive news so stay the course. You can adjust the dose after the next test. It may be the numbers will come down significantly but keep in your thoughts you may have to tweak the dose.
Im glad things are going well, keep up the good work.
That is so awesome! It can be very hard to get the BP down. We've had a real dickens of a time with it, so I'm glad to hear that. I think you are heading in the right direction and never do anything until after the first 30 days, as the cortisol Should continue to drop. I know it did for us and I'm just now tweaking upwards a bit.
Good job!
Thanks so much for the encouragement! I hope her BP stays there, only one of us should be allowed to have high BP at a time! :) I'm prepared to tweak and I'm going to guess he may want to raise it to 30mg with 20 in the morning and 10 in the evening. Jen is almost 25 pounds now, so hoping it won't be too much.
I should also add that this is the girl that after her torn CCL surgery was on Rimadyl, Tramadol, an antibiotic and a Fentanyl patch and the doctor said she would sleep for days. Ummmm, nope - the next day she was a bit sore but acted like she was perfectly normal. I think she has a high drug resistance LOL! :D
Cortisol fluctuates throughout the day, so her resting/baseline number will go up and down.
Some dogs do get really stressed being at the vets so on their ACTH stimulation test, the pre/resting number may be higher than the post number.
How is Jen doing?
Hugs, Lori
She seems to be doing well - just the water alone is a HUGE step for her. I had a scare last night as I woke up to what sounded like she was vomiting. She wasn't but was definitely trying to get something out. She is acting perfectly normal - energy, food, water - so I'm hoping it was nothing.
How do you know when to rush a dog in for low Cortisol if they have a one time vomiting episode or get a bout of diarrhea? Especially if it is after a party or something.
Harley PoMMom
02-18-2015, 04:44 PM
How do you know when to rush a dog in for low Cortisol if they have a one time vomiting episode or get a bout of diarrhea? Especially if it is after a party or something.
The nice thing with Trilostane is that it has a short half life, which means it leaves a dog's system rather quickly, so if a dog would display adverse symptoms stopping the Trilostane should perk them back up. A one time incident of vomiting or diarrhea, although worrisome, may not warrant a visit to the vet, however, if it would continue then the dog should be seen ASAP.
Finally spoke to the doctor today as he had been out sick. He wanted to double Jen's meds, but said if I was more comfortable (yep he's learning!) that we could go up to 30mg instead of 40. He was concerned since her numbers were still pretty high. I expected this as her drinking dropped but then leveled off and has not moved. He said both numbers should be between a 1 and a 5..is that right? I did ask what happens if the Pre gets between a 1 and a 5 and the post is still high. He laughed and said he'd have some more figuring out to do with Jen in that case.
He said he would want to test off of her 10mg dose - does that sound right? My hubby said yes, but I thought we'd want to test her off the higher dose. We will be giving her 10mg in the morning and then 20mg with her dinner as she is usually more active at night after I get home.
Does this sound ok? Should we wait another few days to hit that 30 mark, have another test and then move her up? Because her Cortisol was still so high and we have seen zero improvement with her water since the first couple days I'm kind of ok with it. But let me know if I am totally off base.
Thanks again!!!
Squirt's Mom
02-19-2015, 02:19 PM
A reminder of what Sharlene posted -
Originally Posted by molly muffin
That is so awesome! It can be very hard to get the BP down. We've had a real dickens of a time with it, so I'm glad to hear that. I think you are heading in the right direction and never do anything until after the first 30 days, as the cortisol Should continue to drop. I know it did for us and I'm just now tweaking upwards a bit. ;)
Harley PoMMom
02-19-2015, 05:09 PM
Finally spoke to the doctor today as he had been out sick. He wanted to double Jen's meds, but said if I was more comfortable (yep he's learning!) that we could go up to 30mg instead of 40. He was concerned since her numbers were still pretty high. I expected this as her drinking dropped but then leveled off and has not moved. He said both numbers should be between a 1 and a 5..is that right? I did ask what happens if the Pre gets between a 1 and a 5 and the post is still high. He laughed and said he'd have some more figuring out to do with Jen in that case.
Nope, those ranges of 1 ug/dl-5 ug/dl are for a dog being treated with Lysodren.
The therapeutic ranges for a dog on Trilostane/Vetoryl are 1.5 ug/dl-5.5 ug/dl with a post as high as 9.1 ug/dl as long as the symptoms are controlled.
Dr. Peterson, a renown Cushing's expert, states that a dog being treated with Trilostane/Vetoryl should not have a post lower than 2 ug/dl.
He said he would want to test off of her 10mg dose - does that sound right? My hubby said yes, but I thought we'd want to test her off the higher dose. We will be giving her 10mg in the morning and then 20mg with her dinner as she is usually more active at night after I get home.
Does this sound ok? Should we wait another few days to hit that 30 mark, have another test and then move her up? Because her Cortisol was still so high and we have seen zero improvement with her water since the first couple days I'm kind of ok with it. But let me know if I am totally off base.
Thanks again!!!
Those ACTH stimulation tests should be performed in the am, so even if Jen is getting 10 mg in the morning and 20 mg in the evening, the ACTH stim test should still be done in the am, 4-6 hours after the 10 mg dose is given.
Also, since this is a dose adjustment the ACTH stim test needs to be performed in 14 days.
Hugs, Lori
I realized I've been updating the Facebook group, but not here. We just got her latest test results from her being on 10mg in the morning and 20mg at night. My DH insisted we up her dose to the 30mg so she had been on it for 15 days when we had the ACTH test. Biggest turnaround...water is just about 100% normal and she is no longer needing to go out every two hours or peeing buckets when she does go out. I can also tell that she is definitely a bit more sore.
New test results:
Pre: 5.4
Post 7.8
First ACTH test results were:
Pre 6.2
Post 17.9
Her vet wants to up her to 40 mg total from 30 as he is stuck on the 5.5 post number being normal. Her cortisol fell so much from the last time we upped it by ten mg I want to wait and have her tested again in a month...am I crazy for that?
Squirt's Mom
03-11-2015, 12:51 PM
He wants to raise it again NOW after the increase at 3 weeks?! If that is the case, then yes, it's nuts in my book. ;) And if hubby does it anyway in spite of tons of advice not to including from the manufacturer, he would be sleeping outside at my house. :D
Sorry - I always think people will know what I mean. Jen has her first test as 14 days. We had to wait almost a week for the results and then she was upped about three days later, so total she was on the first dose about 20 days. She then has her second test at 15 days on the higher dose. We are now at 17 days on this dose.
I'm really willing to fight the vet on this one and yes, it will cost me more $$$ to have another test in a couple weeks, but I'd rather that than OD Jen on the meds.
And DH will not be upping them again or he will be outside :)
One other thought...Jen was tested in the morning after her 10mg pill. She gets her 20 mg at night. The vet suggested this so we would be getting the test on the "lower" dose. Does that mean her levels could be much lower at night when she is on the 20mg?
labblab
03-11-2015, 06:15 PM
Yes, I do believe her cortisol could be falling even lower at night. And I am very sorry that I did not see your original question back in mid-February about giving the 10 mg. dose in the morning and the 20 mg. dose in the evening, because that exactly reverses the official recommendation of Dechra:
Once daily administration is recommended. However, if clinical signs are not controlled for the full day, twice daily dosing may be needed.
To switch from a once daily dose to a twice daily dose, the total daily dose should be divided into 2 portions given 12 hours apart. It is not necessary for the portions to be equal. If applicable, the larger dose should be administered in the morning and the smaller dose in the evening. For example, a dog receiving 90 mg would receive 60 mg in the morning, and 30 mg in evening.
http://www.dechra-us.com/files/dechraUSA/downloads/Product%20inserts/Vetoryl.pdf
ACTH monitoring tests serve two main purposes. The first is to check effectiveness -- is cortisol being lowered sufficiently or does the dose need to be increased? But of even greater importance is safety -- is cortisol being lowered too far? To that end, it is far more important to perform the testing and to evaluate the cortisol at the time that the medication is maximally effective. That means 4-6 hours after the larger dose.
I do not know why your vet has asked you to do the reverse. But under these circumstances -- a significant drop in cortisol, resolution of Cushing's symptoms, and onset of soreness -- this is what I would ask for if Jen were mine. I would want to reverse the dosing regimen and give it another 2-4 weeks before testing again. I would not increase the overall total at this time, because you really do not know how low Jen's cortisol is being driven after the 20 mg. dose. Unless your vet has a good rationale for doing the opposite of what Dechra recommends, I would want to switch course.
Safety is paramount.
Marianne
I'm sorry if you guys are seeing this twice as I also posted on our FB group. I completely messed up Jen's test results from last time. She was a 5.9 pre and 17.8 post (not 7.8!)
Her latest ACTH test results are:
Pre: 3.3, Post: 13.2. I'm thinking she needs to jump to 40mg.
Although her vet did say we could flip flop her dose (as you advised Marianne) and give her 20mg in the morning and 10mg at night so we could test off the 20mg as he knows I am concerned about testing off the lower dose. Two things:
Does it matter that her "pre" is pretty low right now?
Would you try the dose flip flop or just go to the 40?
Thanks for all the advice!
Harley PoMMom
04-02-2015, 04:30 PM
As for her pre number, I wouldn't be worried about that right now, if it would drop under 2.0 ug/dl than that would be concerning.
I agree with Marianne, administering the larger dose (20mg) in the morning and giving the smaller dose (10mg) at night is what I would do, and than recheck with the ACTH stimulation test in 2 weeks.
Hugs, Lori
labblab
04-02-2015, 07:02 PM
Thanks so much for coming back and clarifying those test results. Am I correct that Jen has now been taking the 30 mg. daily total for about six weeks now? Also, how is she feeling and behaving these days?
I totally agree with Lori that I think the 3.3 "pre" value is fine. It really is not too low at all for a dog treated with trilostane. But given the revised, higher "post" results, I'm gonna backpedal my earlier recommendation and say that if Jen were mine, I would probably go ahead now and increase her dose to a daily total of 40 mg. She is still high enough out of therapeutic range that even if her cortisol is running a bit lower after the 20 mg. dose, I doubt that she is yet consistently at the level where you want her to be.
Marianne
This is probably a stupid question but could her pre actually be a lot lower on the 20mg? I had planned that we would switch dosages starting tomorrow and in a week test her off the 20mg to see where she is. BUT I'd probably end up waiting to up her dose as we are going on vacation end if April/beginning if May and she won't have one of us home during the week with her. Am I just being dumb about that?
One good thing is she is now maintaining her weight at 24.9lbs. :)
labblab
04-02-2015, 08:44 PM
There is no such thing as a stupid question. ;)
In assessing ACTH results, typically it is the "post" number that carries the greatest weight in determining dosing decisions. "Pre" numbers (or resting cortisol) can vary quite a bit both up and down even during the course of a single day, depending on various factors including things like stress. So when assessing ACTH tests, low "pre" values are usually the most worrisome if the "post" is too low, as well (<1.5 - 2.0). The combo of low values can signal general oversuppression of adrenal function.
With a "post" level of 13.2, however, it is unlikely that Jen is anywhere close to oversuppression even if her "pre" number does test a bit lower. With a "post" that is hanging that high, we know her adrenals are still pumping out cortisol. Having said all that, however, it certainly is fine if you'd feel more comfortable just reversing the dosing for the time being and retesting another time before increasing.
Marianne
Thank you for that explanation. The debate is still going in my house to up her by 10mg to 40mg total now or after vacation. We would have time to get two ACTH tests in (at 14 and then 12 days) to make sure she isn't getting too low. Her hair is still falling out and it does seem she is uncontrolled for at least half the day. I almost wish we weren't going on vacation now. Then I would up her. I just worry that she could get too low while we are gone. Decisions, decisions. Do they usually stop falling after a month?
molly muffin
04-03-2015, 10:00 AM
If you can get two test in at the raised dose then you could do it now and if she is going low at the second test back her off the 20/20 to like 20/15. But you would at least know where she is at. Otherwise you lose the time till you return from vacation. You will actually know quite a bit at the 2 week test.
That's my thought.
If you can get two test in at the raised dose then you could do it now and if she is going low at the second test back her off the 20/20 to like 20/15. But you would at least know where she is at. Otherwise you lose the time till you return from vacation. You will actually know quite a bit at the 2 week test.
That's my thought.
Yep - that's how I'm kind of leaning the more I think about it, the more I don't want to lose the extra time.
Well I'm back to being the crazy pup mom who is jumping every time Jen makes a noise and I'm probably driving her crazy. For some reason when we jumped to 30mgs it didn't worry me as much, but now I'm freaking again like when we first started out. She only weighs 25 pounds and this is almost double her weight now being in 40mgs. I don't think she was going to get much lower on the 30 as we counted last night and she was on that dose since Feb 22nd, so plenty of time for it to really fall.
I'm nervous to leave her for even a couple hours again. Ugh, will be glad when we are a few weeks into this! Thanks for letting me vent!
Tracy & Jen
labblab
04-04-2015, 09:54 AM
Tracy, I sure do understand your nervousness, but I'm hoping I can ease your mind a bit. We do urge folks to start at no more than 1 mg./lb. when they are beginning treatment, but after that point, the therapeutic dosage is totally determined by symptom reduction and blood testing. Weight drops out of the picture entirely, and each dog's individual metabolism of the drug takes over. A small dog may end up needing a larger dose than a much bigger dog, due to the way that their bodies process the medication. And even if we actually were still looking at weight, Jen's new dose still isn't even quite 2 mg./lb. That is well below the top end of the typical dosing that ultimately led to therapeutic results in all the research studies. Some dogs just need higher doses than others. To give you a frame of reference, my own boy was taking a dose equal to 4 mg./lb., and his "post" ACTH result never came down lower than around 6!
Given Jen's most recent ACTH, I really think she will do just fine on this latest incremental increase. ;)
Marianne
It does make me feel better, thank you. This is the dog that after her CCL surgery had an antibiotic, Rimadyl, tramadol, a Fentanol patch and something else. The vet/surgeon sent her home the same day saying she would probably sleep for three days. Ummmm, the next day she acted as if she had no drugs in her system so her drug metabolism shouldn't surprise me. :)
We got her results from jumping to 20mg twice a day:
Pre: 6.0
Post: 9.6
This was after 14 days. She is still high and her specialist thinks she will need to be 30mg 2x day eventually. I'm not willing to raise it yet, because as I've learned her cortisol might continue to fall for another couple of weeks.
We leave for a trip in a couple weeks, so hubby wants to wait to test her until we get back. She doesn't seem to be in danger of falling to low, so I think I might be ok with that. Then we can decide if she needs to jump again.
What I don't like is this doc is really stuck on the needing yo be between a 1 and a 5. If she is good with symptoms and other levels I'm good with it below a 9.1.....is that wrong? She is due for her six month blood panel, but we are going to also put that off for just a couple weeks as we've been hit hard with a doggie flu epidemic and any chance I have to keep her away from exposure I'm going to take it.
Harley PoMMom
04-18-2015, 04:40 PM
I'm in total agreement in not raising her dose right now. According to Dr. Peterson the post ACTH stim number should never go below 2 ug/dl. I know this is written on his blog so I will be back with the link...I'm back :D
Dosage adjustments — lowering the dose
In this report (13), trilostane treatment was continued in dogs with a post-ACTH cortisol concentration less than 1.5 μg/dl, as long as no adverse clinical signs were reported. I disagree with that regime.
When using trilostane, it has become increasing clear that we do not want the cortisol values to drop too low, because that may indicate early or mild adrenal necrosis (1,11,12). In contrast to the protocol used in this reported study, I recommend stopping the drug in all dogs that develop a ACTH-stimulated cortisol values less than 2.0 μg/dl, and repeating the ACTH stimulation test in 1- to 2-weeks in those dogs. Some of these dogs will require that the drug be restarted at a lower dosage, but others will maintain low to normal serum cortisol concentrations for prolonged periods of time. And a subset of these dogs, presumably because of mild adrenal necrosis, will never need any further trilostane treatment to control the signs of Cushing's syndrome.
http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html
labblab
04-18-2015, 04:44 PM
Hi Tracy, it's good to hear back from you! I agree with you about holding off on increasing the dose and the vet visit until you are safely home from vacation. I'm glad to know that Jen has seen some improvement with her cortisol on the increased dose -- how about her outward symptoms? If you discover they are all resolved at an ACTH level higher than 5, then I do think it is a further conversation that you can have with your vet. But how is she doing at this level?
Marianne
2 of 3 of Jen's symptoms are so controlled it is still unbelievable to us. This corgi would drink 5, 6 or more bottles of water per day!! She had to go outside constantly and would wake us up for more water and to let her out. Now she's between 1-2 bottles per day and can hold it for hours. We were EXTREMELY lucky she never had accidents even with all that water.
She is also now maintaining her weight and filled back out. She was the rare Cushings pup that lost weight and was gaunt looking. She was absorbing ZERO nutrition. All good now.
The only thing that has not fixed itself is her hair. Three years ago when we got her, her owner had shaved her and her hair never came back. She had a screening for cushings a year later which was negative at that time and still no hair. She has definitely lost more and has actual bald spots on her back and neck. But I also wonder if follicles were damaged in that shaving and it may never come back.
I asked the specialist about that and he said he will give it six months from when she is controlled. After that he will give up on the hair ever coming back. As long as she is healthy she can be bald for all I care. :)
I'm in total agreement in not raising her dose right now. According to Dr. Peterson the post ACTH stim number should never go below 2 ug/dl. I know this is written on his blog so I will be back with the link...I'm back :D
http://endocrinevet.blogspot.com/2012/12/low-dose-twice-daily-trilostane.html
Thank you!! That is now printed and ready to hand to the specialist. This doc hates me as I always question him anyway, so I have no problem saying we are good at a level. Depending on her next test and her six month bloodwork then I will think about going one more step, but I'm not going to jump 20mgs for sure.
I almost feel like he is very stuck on must me between these numbers or she will die....he actually said something like that to me once and hubby dragged me out. When I mentioned this forum and Facebook group he was completely dismissive of them. Big difference from Jen's normal vet/surgeon who told us to join this forum when it was first suspected.
molly muffin
04-22-2015, 07:35 PM
Not all vets are created equal and not all are as open to the possibility of exchange of information, especially if you challenge him on his recommendations. However, the main thing is that you and your hubby are Jen's care givers, family and the ones in charge in the long run.
Hang in there!
Not all vets are created equal and not all are as open to the possibility of exchange of information, especially if you challenge him on his recommendations. However, the main thing is that you and your hubby are Jen's care givers, family and the ones in charge in the long run.
Hang in there!
I think what you stated has become Mark's favorite saying to me....he now always reminds me that it is up to us and not her vet how she will be treated. We know what's best for her, or what may or may not work. Mark said in no uncertain terms this last time (to me) that since she was still high at the two weeks test, we will wait until we come back from vacation at about the five week mark have her tested again (since she did fall almost four points last time between 14 and 30 days) and then see if we have to up her. At which time we will be going up by only 10 and doing 30in the am and 20 at night. Opposite of what her vet wants, but we want to know the numbers off the higher dose.
I'm starting to get a bit bolder, this doc is really going to hate me by the end of this :)
molly muffin
04-25-2015, 10:20 AM
My IMS has a wonderful standard that she says often and follows " do no harm". It is her mantra I think. I could see her chanting it. Lol. You have a situation and you don't want to do anything in trying g to fix the situation which will cause it to worsen or cause another situation to arise, you should not in trying to cure or help an animal harm it.
So we started slow and have increased slowly. It has meant more testing in the long run and that is mostly my fault as I want a 14 and 30 day test before increases.
What I was and needed to do is to see how she reacts to each increase at each point. Now I am more comfortable and I know more as to how she is reacting and what we can expect to see at different points.
This seems to be what you are doing to. After the next test you will know how much she tends to drop at a 2 week and a 4 week mark. I do agree with the slow and steady approach.
Squirt's Mom
04-25-2015, 10:22 AM
Ya'll are doing a great job!
Ugh, Jen's tummy was a bit upset whenwe got home this week. She got better but this morning had another bad case of diarrhea. Turns out she has a whip worm, Giardia and a lot of yeast. Will post meds later.
molly muffin
05-16-2015, 01:28 PM
On poor Jen. Hangi. There. This too shall pass.
On poor Jen. Hangi. There. This too shall pass.
Thanks - at least we again caught it so she wouldn't be miserable!
Vet just called with her latest test results:
Pre: 3.9
Post: 5.7
No change in dosage and test again in two months!
It seems Jen tended to fall about 4 points total at the 30 day mark with each 10mg added. I'm glad he didn't want to get to 5.0 exactly or I probably would have fought him on it - like I do with everything else with him :D
Thank you to all who said to not make any changes until after that mark since cortisol continues to fall. Back on 4/18 her specialist actually said he wanted to raise it to 30mg 2x day and we said no way, waiting until 30 day mark (and getting back from vacation) to test again. And now I can't imagine what might have happened if we had done that!
Harley PoMMom
05-20-2015, 09:24 PM
Those are great numbers!!! How are her symptoms? Has she responded to her treatment for the Giardia, whip worm, and yeast?
You are doing a wonderful job with Jen!!!
Hugs, Lori
Those are great numbers!!! How are her symptoms? Has she responded to her treatment for the Giardia, whip worm, and yeast?
You are doing a wonderful job with Jen!!!
Hugs, Lori
Thanks Lori, I'm trying! :). She is definitely better as no more diarrhea, knock on wood. We have a weeks worth of antibiotics (so 2 more doses) and then in two weeks we give her another large dose of a medicine for the Whip Worms. We do have to bring her back the week after that for a recheck. Jen, being a trooper, still never acted sick. I'm still afraid another shoe will drop now that we finally got good news with her. Oh well, my job is to worry lol.
molly muffin
05-20-2015, 10:47 PM
That worrying is a full time job! As a keen worrier, I can sympathize. :)
Amazing what resilient little souls they are isn't it. :)
Jen just had her six month blood work and while I'm still waiting for a doc to call (I had the receptionist send me her results) they are a mixed bag. Granted, we just two weeks ago got Jen's Cushings to a 5.7 so I'm keeping that in mind.
Here's her abnormal tests from 5/29/15 and what they were last time on 11/26/14 - before we even started treating her Cushings.
Reticulocyte 121 - Range 10-110 K/uL (was 96)
% Reticulocyte 1.8 – No Range given (was 1.3)
Auto Platelet 520 - Range 134-448 K/uL (was 479)
Lymphocyte - still low at 904 - Range 1060-4950 ul (was 727)
ALT 330 (DARN!) - Range 18-121 U/L (was 213)
GGT 61 - Range 0-13 U/L (was 29 one year ago)
Albumin 4.0 - Range 2.7-3.9 g/dL (was 4.2)
Glucose 115 – Range 63-114 mg/dL (was 113)
Her ALP fell back into normal range this time around. ALP was 187 and is now 110. She has been taking one Denamarin chewable tablet per day.
Any insights to what the above all means or questions I should have ready for the docs?
Thanks!
Tracy & Jen
molly muffin
06-05-2015, 12:33 AM
Lab tests can be scary when first looked at, oh this is high or this is low, but what you have to take is the over all picture, how it all works together.
This is a link to an article about platelets in dogs. It shows you that cushings for example can cause platelets to go up, a stressed dog can have increased platelets and increased reticulocyte.
The GGT and the ALT is probably what I'd want to ask the vet about, as these are both liver specific tests. What does he think is causing them to go up.
You're doing good. Baby steps remember.
Hi all,
It's been a couple months and we haven't really had anything to report (which is probably a good thing!). Jen just had her latest ACTH and the results were 4.3 pre and 6.3 post. This was a jump of .6 from her test in May when she was 5.7 post.
Her doc wants to leave her on the 20mg 2x day and we agreed. She is still bald, although what fur she does have is suddenly shedding, and there is a slight uptick in water. It is also summer around here. Any thoughts? Should we have pushed to up it? Jen tends to fall by about four points whenever we do add. Her doc said we would retest in four months.
We will also see her regular vet to uptown for her yearly exam and to see if he wants to rerun her high ALT again. I'm also going to be talking to him about getting her on something for her pain, as boy is she sore all the time now that she does not have that extra cortisol.
Thanks!
I should also add her specialist doesn't believe in compounding so we either jump by ten or nothing. We are at her regular vet right now. He asked why we wouldn't be bringing her up a mg or two and I told him. He thinks compounding is fine. But then he also said we should consider putting her on Carprofen/Rimadyl and not Tramadol. Ugh, I need to find a combo of the two vets!
A bit of good news is her regular vet re-ran here ALT and it came back all good. The explanation he has is that she had caused some kind of trauma to that area (such as crashing into the stairs on her way up which sometimes happens to her) and that's why it was so high.
He also said if we want to try compounding we could call him and he'll order it for Jen. He would want to try a month on it at the same dosage, then do an ACTH and make sure compounding is working for her. Then we could adjust a little if need be. We've talked about switching back to him full time since the specialist and I just don't seem to get along. I drive her regular vet crazy too but he knows I only do it as Jen's advocate. Thoughts?
Squirt's Mom
07-19-2015, 08:37 AM
Personally, I wouldn't want to jump up 10mg higher but would prefer the lower compounded dose to start. Then if she needed the full 10mg you can always move up to it. I also MUCH prefer a vet who will work with me instead of one who lays down their law and is unwilling to do as I ask. ;)
molly muffin
07-19-2015, 10:37 AM
You could just add in a lower dose of compounded to go with the vetroyl and them retest in a couple weeks. I wouldn't go with the rimadyl as that is harder on the liver.
Personally, I wouldn't want to jump up 10mg higher but would prefer the lower compounded dose to start. Then if she needed the full 10mg you can always move up to it. I also MUCH prefer a vet who will work with me instead of one who lays down their law and is unwilling to do as I ask. ;)
And I think the decision has been made to go back to her regular vet (who has also treated Cushings cases.) I have from day one challenged him on things and he always gives me his recommendations but lets me do what I want. Up to this point his have all seemed correct after the fact though. He is also the one that pointed me to this forum in the beginning and said I'd learn a lot (which I have!)
AND unfortunately it looks like Jen's other CCL is going and he'll be doing the surgery again on her. We'll have all her care back under one person (and his associates.)
You could just add in a lower dose of compounded to go with the vetroyl and them retest in a couple weeks. I wouldn't go with the rimadyl as that is harder on the liver.
I called him today to ask if we could just add a couple mgs 2x a day for a couple of weeks to see if it helps. Then if it does (after an ACTH test) we'll probably end up going the compounding route as long as that works.
He still wants the Rimadyl but is willing to listen to why I want the Tramadol. Is there anything stashed anywhere that lists why the Rimadyl is particularly bad in Cush pups? His main argument was that yes some dogs do have a reaction but it happens fast and Jen never has had that. He also said that Tramadol won't work on the inflammation, it just helps the pain, and then it could knock Jen out. I said let me do more research and I'd get back to him.
Harley PoMMom
07-29-2015, 04:56 PM
Rimadyl is an amazing anti-inflammatory that does bring much needed relief to severely arthritic dogs but it is tough on the stomach and the liver, and our cushdogs already have a liver working harder. Quality of life is paramount so if it needed for pain, so be it, however any dog taking Rimadyl should have their liver enzymes tested routinely.
Hugs, Lori
Well, it's been fun around here. We jumped Jen from 20mgs 2x day to 25mgs and like dummies, did not do an ACTH right before doing that. We added on as her water intake was back to four or five bottles a day and knew she had gone up. When we tested two weeks after switching her post was a 6.7, it had actually stayed about the same from her test in July. Tested her last week at the five week mark and it went to a 6.6. We had to wait the extra week as on Labor Day Jen was in the emergency room with a skin infection that had sores, puss, and other yuck and could not walk. She has Pyoderma and a Staph infection. All is well now and clearing up, but she'll be on antibiotics and Tramadol for a awhile.
Now the dilemma. We need to raise her again and the vet said let's go to 33mgs 2x day from 25mgs. That would be 16 mgs jump in a day. Isn't that too much? As much as I like saving the money compounding, I like my puppy a whole lot better. Advice?
Thanks (and sorry for those that have already seen this in FB)
molly muffin
09-26-2015, 12:52 PM
I wouldn't increase that much. You aren't looking for that big of a decrease. Aren't you just trying to get her under 5.0ug? so you have 1.6 point to come down.
I am increasing only 4mg to try to get molly to drop 6. points.
You don't have to give even but doing compounded you could go up 28 or 29 twice a day. You could do 29 morning and stay 25 evening.
Really the combinations you can do are not limited. I'd worry about an increase of 16mg to get down a couple points. (I do tend to be a worry wart!)
I think Jen and Molly must be on the same ACTH schedule right now. LOL Are they both in spazz mode? I know Mark that that was hilarious terminology but it so describes it accurately.
Let me know what you decide to go with.
Squirt's Mom
09-26-2015, 02:03 PM
Explain again what Diamondback said about the doses they would compound?
Because Jen is so close to the 30mg mark Diamondback can do a 27mg or a 33mg. If they get any closer than that they could be sued or something since it does come in 30 from Dechera. I've been overruled since jumping her 10 total last time did not do much and her numbers were climbing from just a month before. I will be watching her like a crazy woman and if that first ACTH in two weeks comes back at a number that I think is too low, I won't hesitate to drop her back to a 27mg. She's still drinking a lot and of course we have the skin infection to contend with. I'm hoping to get her near a 5.0 when this is all said and done. And yes, Jen has the spaz thing down after the test lol! Hope Molly's test comes back good!
Jen's test results just came in from her day 11 ACTH after we raised her to 32mg 2x day. Pre 3.6/Post 6.0. She dropped .6 from her test a couple weeks prior. This little girl has some metabolism when it comes to meds!
I think Jen was a drug user in another life! This is the same girl that had Tramadol, Rimadyl, an antibiotic, a Fentanyl patch and something else after her CCL surgery three years ago. Her doc said she would be knocked out for three days. After the anesthesia was finally out of her system 12 hours later, she was ready to rock n roll - no knocking her out!
I did learn through the past couple of weeks that one of the other vets at Jen's clinic really seems to know a lot about Cushings, thought it was just the main guy (her vet.) Dr. H called when we upped her meds and gave us the whole rundown on what to watch for again. She also mentioned that they see a ton of Cushings dogs as it is so common. Then today she mentioned to Mark about not changing the dose as we need to wait until after 30 days. I almost fell on the floor when Mark told me. I'm glad there's another vet Jen can see if her main one is not available.
Squirt's Mom
10-13-2015, 12:19 PM
Had to laugh out loud at your description of Jenn as a former druggie. :p Built up a tolerance, has she? LOL I am VERY glad to know ya'll have another seemingly good vet should you need one and especially glad to see that post go down...even if it is just a tad. ;)
It has been a long time since I updated folks here about Jen as I've been driving everyone crazy in the Facebook group instead. But wanted to make sure I shared our recent experience in case any searches for info like I do. First, Jen is still fighting a skin infection that started on Labor Day. It cleared up in December, but then I noticed a spot in January. Back on the antibiotic, but at a double dose. Unfortunately, we just found another new spot, so it looks like back to the drawing board.
The bigger issue has been Jen's persistent cough. She coughs when standing up from laying down or drinking water. Then in December she started to pass out after coughing when drinking water. This FREAKED us out big time as the first time happened right in front of us. She came to right away, but all of us were stunned. Vet diagnosed her with Syncope. Went to a cardiologist who did every test in the book and Jen's heart checked out just fine. Her high BP seems to have come back, so we did put her on a CCB and have already upped it once. We look closer at x-rays and don't see a collapsing trachea. Jen is still passing out on average once every two to three weeks (knock wood it's not more.) If she is exercising or running around (like if we have a party) no coughing.
Tried Tramdol for the cough, did nothing but at least relieved some of her arthritis pain. Finally made the doctor try a bronchodilator, Theophylline ER, 200mg 2x day. Keep in mind this is the girl that has never had a reaction to any meds. That all changed last weekend. While the Theophylline helped her cough a bit, it wasn't as violent, she was still coughing. The bigger issue is she did have side effects. In Jen's case it was restlessness, rapid heart rate and in general just a craziness to her.
Jen couldn't get comfortable in her own skin. She would bark incessantly inside and outside, she was frantic to go outside, could not sit still inside and was doubling her water intake. Sunday night it got so bad my husband thought he might have to take her to the ER and that would be it for her as she could not be calmed, was barking at nothing and her breathing was at a pace he'd never seen before. After two hours her got her somewhat calm (around 1am) and was able to go to sleep. I woke up in the morning to an empty water bowl for her, something that hasn't happened since we started her on Cushings meds.
We made the decision to call the vet and not give her her Theophylline. We spoke to the vet and the first thing he asked was if she was restless/breathing rapidly. Since she was still coughing he didn't think reducing it would do any good. Jen was back to normal within a couple of hours. While I'm extremely disappointed the bronchodilator did not work, I think Jen would have given herself a heart attack had she kept it up. We are taking a step back and will try cough syrup next. Of course, I'm nervous that now we'll knock her out with the prescription kind. Vet did say we could try Robitussin, but not sure if that would work.
We could also do a scope so he could get a closer look and see if he sees anything different than the x-rays and also take a sample of cells to see if there is a specific infection. Don't know if I want to knock her out at 12 years old.
We are also due for a new ACTH and a blood panel in the next couple of weeks. I feel terrible for her, but the vet pointed out that she is still a happy girl 95% of the time, when she isn't coughing. I just hope we can keep it that way.
Harley PoMMom
02-17-2016, 03:53 PM
Thanks for updating us about Jen and I sorry she is having these coughing episodes, that had to be scary when she'd pass out. My Bear had a collapsed trachea, the medications that were given to him were Terbutaline and Hydrocodone which really did control his cough.
Hopefully soon the vet will find a medication to help Jen with her cough.
Hugs, Lori
Renee
02-17-2016, 04:06 PM
Hi there,
My pug Tobey had a really bad persistent cough for months. We saw so many vets and tried so many things to help. She had a bad reaction to Theopphyline too, so we quit that after 2 days. The vets would not scope her, after MUCH back and forth, due to the severity of the cough. They thought she would not be able to wake up from the anesthesia. All in all, she saw 4 different vets, a surgeon, and a radiologist. The last vet we saw, a board certified surgeon, said that whatever the cause of her cough, it was probably related to her cushings in some way and would never go away. He was right. It comes and goes, but has never gone away. The cough started in August 2015. Got really, really bad for a few months (like quality of life bad), then tapered off. She coughs every single day now, but it no longer affects her quality of life. No definitive known cause!
What did help was giving her Torbutrol to sedate her a bit and reduce coughing, and daily treatments with a nebulizer machine. That nebulizer helped the most. And, the torbutrol was the best in terms of medication.
She hated the cough syrup. Theoppyline made her sick. Generic cough tabs didn't do much. Three weeks of doxycycline didn't do anything.
Thanks for updating us about Jen and I sorry she is having these coughing episodes, that had to be scary when she'd pass out. My Bear had a collapsed trachea, the medications that were given to him were Terbutaline and Hydrocodone which really did control his cough.
Hopefully soon the vet will find a medication to help Jen with her cough.
Hugs, Lori
Hi Lori,
We will be back at the vet on Saturday to discuss cough medicines...hoping we can find something that will help take the edge off without knocking her out.
Hi there,
My pug Tobey had a really bad persistent cough for months. We saw so many vets and tried so many things to help. She had a bad reaction to Theopphyline too, so we quit that after 2 days. The vets would not scope her, after MUCH back and forth, due to the severity of the cough. They thought she would not be able to wake up from the anesthesia. All in all, she saw 4 different vets, a surgeon, and a radiologist. The last vet we saw, a board certified surgeon, said that whatever the cause of her cough, it was probably related to her cushings in some way and would never go away. He was right. It comes and goes, but has never gone away. The cough started in August 2015. Got really, really bad for a few months (like quality of life bad), then tapered off. She coughs every single day now, but it no longer affects her quality of life. No definitive known cause!
What did help was giving her Torbutrol to sedate her a bit and reduce coughing, and daily treatments with a nebulizer machine. That nebulizer helped the most. And, the torbutrol was the best in terms of medication.
She hated the cough syrup. Theoppyline made her sick. Generic cough tabs didn't do much. Three weeks of doxycycline didn't do anything.
It's good to hear about the Theophyliine not working for someone else as well due to the side effects. I really thought that would be Jen's savior but the side effects were not worth it. I'll mention to the vet what worked for your pup as well. Jen's cough is HORRIBLE, but since it only happens at certain times and she's happy the rest of the time all I can do is hope she stays that way.
I also wanted to post a couple of links to Jen's cough so people can see/hear what she has and sounds like in case it helps someone else. She does NOT pass out in any of these.
This one is after drinking water (which is also the only times she has passed out so far).
https://www.youtube.com/watch?v=ewPIlELijiM
This is in the morning, but is what happens whenever she has been laying down for a while.
https://www.youtube.com/watch?v=2Jo06YYIA-E
Another after drinking - and you can see this weird thing/stretch she does with her neck after coughing.
https://www.youtube.com/watch?v=L4aNEyPlzZE
Renee
02-18-2016, 04:47 PM
Listened to the video. Exactly like my girl. This is her cough. Unbelievable. It didn't start out sounding like that, but it is consistently the same sound now and has been for the past few months.
We haven't seen a cardiologist yet, but that is on my planned appointments to schedule.
The one thing the cardiologist was put our minds at ease that Jen has something weird and not something worse, at least not yet.
Quick Jen update, latest ACTH shows she is high..4.0 pre / 9.0 post. Will up her from 32mg 2x day to 37mg 2x day (she weighs 27lbs.) What is a bigger issue is that we started her on an anti-fungal on Saturday. Turns out the return of her skin infection was not bacterial (which we thought it was and have been treating but it kept getting worse) but a yeast infection on her body.
She was put on 125mg 2x day of Terbinafine. While it seems to be clearing her skin she has had loose stools since she started taking it. I added rice a couple days ago to her diet, but it doesn't seem to be helping. Tomorrow she will start on just boiled chicken and rice. I spoke to the vet today and she said to take the dose down by half. Just seems it is to big a coincidence to be anything but the new med. She is acting completely normal. Any thoughts on any if this? Want to clear this up fast so we can start her on the Hydromet for her cough...didn't want to introduce too many new things at once.
As a reminder she is on thyroid meds 2x day, Tramadol 2-4x day, BP meds in the morning. I also realized the thread say 10.5 year old, Jen is now a happy 12 year old :)
labblab
02-26-2016, 07:26 AM
It's my pleasure to update your thread title for you! ;) :)
I'll surely be hoping that things will smooth out for sweet Jen in the coming days.
Marianne
Hi Marianne,
Thanks for that - I didn't mean to make extra work...just wanted folks to know Jen is now 12 and has been dealing with this for a year and a half already. Hopefully to give a little hope to the lifespan.
Tracy
Harley PoMMom
02-26-2016, 12:50 PM
Looks like diarrhea is a side effect from Terbinafine, also it may increase the side effects of BP medications, which is diarrhea. I wonder if adding pumpkin would help with the loose stools.
Hugs, Lori
Looks like diarrhea is a side effect from Terbinafine, also it may increase the side effects of BP medications, which is diarrhea. I wonder if adding pumpkin would help with the loose stools.
Hugs, Lori
Hi Lori - I wasn't sure if the pumpkin would make it even worse or if it would help harden things up. I know I have some at home, so maybe we'll give her a bit at dinner. She's been ok with the BP meds so far (knock wood) so I'm really thinking/hoping it is the Terbinafine - the timing is just too coincidental.
judymaggie
02-26-2016, 04:52 PM
Tracy -- make certain that the pumpkin you already have is plain pumpkin, not pumpkin pie mix. When I started giving Abbie pumpkin, I started with just a little bit and gradually increased. It is a delicate balance as you are correct in that too much pumpkin can make stools even softer. You also might consider giving Jen a probiotic -- I give Abbie Forti-flora once a day mixed into her food. I give her both pumpkin and Forti-flora even if stools have solidified, just to keep everything moving correctly.
Tracy -- make certain that the pumpkin you already have is plain pumpkin, not pumpkin pie mix. When I started giving Abbie pumpkin, I started with just a little bit and gradually increased. It is a delicate balance as you are correct in that too much pumpkin can make stools even softer. You also might consider giving Jen a probiotic -- I give Abbie Forti-flora once a day mixed into her food. I give her both pumpkin and Forti-flora even if stools have solidified, just to keep everything moving correctly.
Hi Judy - we have started the pumpkin...not too much change, but a little. We definitely need to look into the probiotics. I think the only thing that will stop this us to pull her off the meds which I really don't want to do yet as it is clearing up her skin.
judymaggie
03-01-2016, 04:27 PM
Tracy -- give it some time. Abbie weighed 25 lbs. when I started the pumpkin and I worked up to approximately three teaspoons a day, one in each meal. I strongly believe in probiotics. The best price I have found for the Forti-Flora is at Chewy.com ($20.67 per box of 30; free shipping at $49 and above). Abbie's surgeon prefers VSL#3 probiotics but it is a bit pricey.
Renee
03-01-2016, 04:56 PM
Hey Tracy - how is the cough? Tobey's was mild for the last few months until she got really sick last week. Since her ordeal, the cough is back in full force. We are having to use the torbutrol to control it, especially at night. Whatever triggered it the first time has come around again. We keep calling her Daisy Duck now, lol, because her cough sounds like a duck.
Sure wish I knew what the cause was!
Hi Renee - I'm sure I'm cursing us (but my husband and I already said it out loud) but Jen's cough has been better since she has been on the anti-fungal for her skin. It's kind of crazy. Not sure if that's what is wrong now, some kind of fungal infection in her lungs or it's just a momentary lapse in her coughing. Sorry that Tobey's has come back - I know it's so hard to watch. Does Tobey also pass out from the cough?
Renee
03-03-2016, 05:20 PM
What anti-fungal is Jen on? That's not a medication route we've gone. Just did many abx, bronchiodialators, and cough suppressants. The torbutrol is still working best, but we only give it to her at night. She has not passed out from coughing, thank goodness. I've had enough scares!
I'm glad Jen's cough has subsided. I am waiting to see if Tobey's tapers off over the next few weeks. When it first started, it took her about 2 months for the coughing to taper down.
Hi Renee - she is on Terbinafine for her skin yeast infection. We'll see if this lasts or if the less coughing is just some type of fluke. Because a scope (which is $$$ and we'd have to knock her out) is the only way the vet said we could see what type of cells might be causing her cough, we haven't done that yet. It's just weird that is has subsided somewhat momentarily. My husband was going to call the vet and see what he had to say.
Renee
03-03-2016, 05:48 PM
Hi Renee - she is on Terbinafine for her skin yeast infection. We'll see if this lasts or if the less coughing is just some type of fluke. Because a scope (which is $$$ and we'd have to knock her out) is the only way the vet said we could see what type of cells might be causing her cough, we haven't done that yet. It's just weird that is has subsided somewhat momentarily. My husband was going to call the vet and see what he had to say.
I had the exact same issue. I wasn't worried about the cost of the scope ... but, after many, many vet appointments, I could not find a vet willing to put her under to scope her; I even had her scheduled numerous times for the scope and the procedures were always cancelled for one reason or another. They all thought she would die from the anesthesia. Right when I was about to give up anyways, her cough subsided considerably.
Unfortunately the cough is coming back and we had another pass out in the middle of the night. :( We tried changing her kibble to Spring Natural dog food which is grain/potato free. Seems the more we mix kibble back into her diet, the worse the cough is getting again. May try something like Stella and Chewy's raw food next to see if that helps.
Or it could be that she has gotten used to the medicine now and it is no longer helping. We will speak with the vet tomorrow. Jen's skin infection is not 100% gone yet, so we'll see if they try another anti-fungal since this one is still screwing with her tummy. We'll then see if that helps the cough again.
Renee
03-15-2016, 01:04 PM
Hey there, Tobey's cough is back and bad as ever as well. It came back right after she had HGE about 2 weeks ago. :( I have not found anything to help, except giving her torbutrol at night and doing nebulizer treatments. Tobey has never passed out from coughing though. I'm sorry Jen's coughing makes her pass out.
The last vet I saw (board cert surgeon) about Tobey's cough told me that in his opinion her cough was caused by her cushings and that while it may come and go, it will never disappear. He said that whatever triggers it to flare may never be known, but it would always come back. Thus far, he is has been correct. I cannot find any correlation. Obviously it came back very strong after she had HGE, which could just be that her immune system has taken a hit? But, that's just a guess. Who knows!
Tobey eats The Honest Kitchen right now, but I'm not sure food has anything to do with her cough or not.
In a small panic after going back and reading posts about raw. We switched Jen to Stella and Chewy chicken patties raw ten days ago after noticing the cough got worse on her kibble. Thought we were doing a good thing as we compared fat and protein. Now I see the whole thing about dry matter and Jen's food is 55% protein and 32% fat after doing the calculations - way too high it looks like. Now I'm looking at Honest Kitchen which seems like a good choice, (and Renee I know you said you feed it) but wanted to double check with the group. They have right on their website the dry matter, but I know you have to re-hydrate it...would that throw the numbers off? It looks to be around 15-16% fat which Jen has had in her kibble for the last four years.
Jen went in last night for a skin check and her rabies shot and her doc is at a loss as to why the coughing is less or coming/going. Looks like she also has the mystery cough. The cough has almost subsided again after taking her off the new kibble and switching her to the Stella and Chewy patties. It could be the meds for her yeast infection, or the new food.
Renee
03-25-2016, 03:10 PM
You don't have to worry about re-calculating the fat calculation when hydrated. You are simply hydrating with water, which does not increase fat content. I always convert all calculations to dry matter in order to get a fat and protein content comparison that is accurate. I personally would never feed raw to a cushings dog, but I know many people do, so no judgement, just don't think I would do it.
Tobey eats The Honest Kitchen Preference, which is the base mix. You hydrate the base mix with hot water and add in fresh / canned / cooked meat of your choice. Just an FYI - the hotter the water, the better the hydration, and you want to ideally hydrate for 20-40 minutes, even though the instructions on the box don't say you have to do that. I find that if it's not hydrated well enough, it passes through their digestive tract too quickly and is not digested. It will come out in their stool. Also, do not be surprised if there is an initial increase in stool. That's a side effect for some reason. It does taper off though.
I add in cooked ground meat. I rotate between ground chicken, ground turkey, and ground beef. I boil up big batches on the stove, drain and rinse, then freeze into portions that will last approx 3 days. I keep a few cans of canned chicken on hand for when I run out of meat.
You can also just purchase the complete Honest Kitchen formulas that do not require added meat, like Love, Revel, Embark, Force, etc. They have a good range of protein levels. My boy pugs eat the regular formulas and rotate through most of them.
Tobey's cough is tapering off again. For no explicable reason! Honestly, I think it's the cushings causing it, maybe the vetoryl? I've resigned myself that it's going to come and go and I may never know why. The torbutrol helps at night.
Thanks Renee - dumb question but will I be able to tell when it is properly re hydrated? Hoping to keep it closer to the 20 min level as Jen is impatient lol!
Renee
03-25-2016, 04:45 PM
Thanks Renee - dumb question but will I be able to tell when it is properly re hydrated? Hoping to keep it closer to the 20 min level as Jen is impatient lol!
You can kind of tell on some of them, but not all. When I rehydrate Keen, Force, and Preference, I can tell, because the texture and consistency change somewhat. Love & Embark don't really change; they stay fairly thin. It's like soup when I make it, as I always over-hydrate on purpose. Think of it like making very soupy instant oatmeal. My pugs were impatient at first, but they have learned they have to wait. They know the routine. :)
molly muffin
03-25-2016, 10:10 PM
I'm glad that Jen's cough is better ,whether it is the food or medicine.
People can have very strong opinions about feeding raw or dry. It's actually a personal choice and we have seen dogs do well on both, so I think that whatever works for Jen is the best one to go with.
I'm glad that Jen's cough is better ,whether it is the food or medicine.
People can have very strong opinions about feeding raw or dry. It's actually a personal choice and we have seen dogs do well on both, so I think that whatever works for Jen is the best one to go with.
Thanks Sharlene. We made the decision that the Stella and Chewy was just too high in fat and protein....quintuple what Jen's kibble has been. We are going to try Honest Kitchen and if that doesn't work, go back to a kibble.
You can kind of tell on some of them, but not all. When I rehydrate Keen, Force, and Preference, I can tell, because the texture and consistency change somewhat. Love & Embark don't really change; they stay fairly thin. It's like soup when I make it, as I always over-hydrate on purpose. Think of it like making very soupy instant oatmeal. My pugs were impatient at first, but they have learned they have to wait. They know the routine. :)
I tried a little this morning and miss impatient was not happy with the wait lol. How much do you give your pugs? And I'm guessing I'll know if I didn't rehydrate it enough if her water intake goes up? I gave her a 1/4 cup this morning to start the transition, put in hot water and a little more than a 1/4 cup of water.
Renee
03-27-2016, 03:37 PM
My pugs are all between 17-21 pounds. They get 1/3 twice per day, but they are lazy and old, so they don't exactly work off a lot of calories. More active dogs definitely need more food.
My pugs are all between 17-21 pounds. They get 1/3 twice per day, but they are lazy and old, so they don't exactly work off a lot of calories. More active dogs definitely need more food.
Thanks - Jen is not crazy active but not totally lazy yet ;) I think I may try to work her up to 3/4 twice a day and see how it goes. She's had a 1/4 cup twice today. This morning it was more like Oatmeal, tonight like soup! Gotta figure out the perfect ratio.
And thank you again for all your help!
Renee (sorry, one more question)..can you make this the day before and stay in the fridge or then it would be weird because of it absorbing the water. I've never done anything dehydrated for two or four legged people :)
Renee
03-28-2016, 01:35 PM
You can make it ahead, for sure. I wouldn't make more than a few days at a time though. I think when you take it out, you'll want to heat it up, or maybe add a bit more hot water to it. I never make ahead, but I have many friends that feed this and they do make it ahead.
What flavor is Jen eating?
She's on the chicken right now. I was thinking only a meal ahead so we should be good -thank you!!
Finally a post not about Jen's food ;) We ran a senior panel and she's up a little, but for the sake of consistency I wanted to post what is still off. Nothing is panicking me this time, but maybe that's cause I'm torn on what to feed her (ha)
ALP - 130, was 110 but still normal
ALT - 189 (18-121U/L) last time was 303 then a retest was 106
GGT - 42 (0-13 U/L) last time was 61
Albumin - 4.0 (2.7-3.9) last time 4.0
Glucose - 120 (63-114mg/dl) last time 115
Sodium - 156 (142-152 mmol/L) last time 151
Anion Gap - 27 (11-26 mmol/L) last time 23
Reticulocyte - 117 (10-110K/ul) last time 121
NRBC - 3 (0-2/100WBC)
Auto Platelet - 517 (143-448 K/ul) last time 624
If anyone sees anything I'm missing, please let me know.
molly muffin
03-28-2016, 09:04 PM
Was she fasted for this test?
If she was then I'd probably retest in a couple months (blood chemistries) just to see where those are trending towards.
Hope this food works out for her!
Sharlene, she was not fasted this time. The doc was fine with that (as was Mark) I was the only one who put up a stink about it. She had eaten a few hours before. It makes me think that I want to run it again, but fasted.
File this question under I should know this but don't. Is there a point where Jen could be taking too much Trilostane and maybe it is not working? She is around 25lbs give or take a couple either way at times (usually higher) and is on 37mg 2x day. That is almost 3mgs per pound. We have an ACTH this Saturday to (her 30 day check on this dose) to see where numbers are. She seems (knock on wood) to be doing great on it.
And I want 2-4 hours (suddenly having a brain block) as I think I've been brining her in two hours after eating, right?
Sorry for all the questions!
Thanks!
labblab
03-29-2016, 08:28 AM
As long as Jen's compounded trilostane is accurate as far as the actual amount of effective drug it contains, then the medication itself should not be the cause of her needing a higher dose to keep her cortisol lowered. Individual dogs metabolize the drug differently, and there can be a wide variation in the amount of drug that each dog needs and those needs can change over time. But this is the kind of situation that always makes me a bit nervous about compounded products in general. However, I think you are using Diamondback, right? I know they have a very good reputation, so I would assume there is not an issue with the trilo itself.
As far as the timing of the ACTH, Dechra recommends testing 4-6 hours after the trilostane is given with a meal. If you've tested Jen previously within that 2-4 hour window, though, I think you'd do better to stay consistent this time around so that your results will be directly comparable to the earlier ones.
Marianne
As long as Jen's compounded trilostane is accurate as far as the actual amount of effective drug it contains, then the medication itself should not be the cause of her needing a higher dose to keep her cortisol lowered. Individual dogs metabolize the drug differently, and there can be a wide variation in the amount of drug that each dog needs and those needs can change over time. But this is the kind of situation that always makes me a bit nervous about compounded products in general. However, I think you are using Diamondback, right? I know they have a very good reputation, so I would assume there is not an issue with the trilo itself.
Hi Marianne,
We are using Diamondback. We've learned Jen metabolizes some meds like she was an ex-heroin user (pain meds) and others (antibiotics/fungal) she is more sensitive too. I always chalked up the Trilostane to her fast metabolism. Just wanted to make sure we aren't hurting her.
As far as the timing of the ACTH, Dechra recommends testing 4-6 hours after the trilostane is given with a meal. If you've tested Jen previously within that 2-4 hour window, though, I think you'd do better to stay consistent this time around so that your results will be directly comparable to the earlier ones.
Marianne
And this is where I'm now confused. Somehow I got her on the 2-4 hour protocol. I think it was had to be because I read this article by Dr. Peterson. http://www.endocrinevet.info/2013/11/protocol-for-acth-stimulation-testing.html Now I don't know which is right.
Renee
03-29-2016, 01:25 PM
For the timing of the stim test - stick with what you've been doing, as long as it's within the acceptable range. We always test 3 hours after taking the morning dose. Dose at 7am, test at 10am. I have kept this pattern since we first started over 2 years ago. I think you are fine, as long as you aren't testing in excess of 6 hours. And, personally, I think even 6 hours is too long!
labblab
03-29-2016, 02:12 PM
Through time, some specialists have indicated a preference for a somewhat different testing window than that recommended by Dechra. As you have seen, Dr. Peterson is one such specialist. I don't know what the UC Davis vets are currently doing, but a few years ago they were also recommending a quicker testing timeframe than Dechra. This is pure speculation on my part, but those decisions may have been based on the original clinical pharmacology data that Dechra first provided about the drug (and that still remains included as part of the official U.S. Product Insert for Vetoryl):
Trilostane absorption is enhanced by administration with food. In healthy dogs, maximal plasma levels of trilostane occur within 1.5 hours, returning to baseline levels within twelve hours, although large inter-dog variation occurs.
However, in Dechra's most recently republished Vetoryl technical brochure dating from last summer (June 2015), here's an additional and more extensive quote:
After the administration of VETORYL Capsules with food, cortisol levels are most significantly suppressed for 3 to 8 hours. Therefore, in order to obtain results at the peak time of effect, the ACTH stimulation test should be performed at 4-6 hours post-dosing. This will ensure you are assessing the dog’s cortisol levels when they will be at their lowest, thus uncovering any unintended oversuppression of the adrenal glands that would indicate the need to decrease the dose.
http://www.dechrace.com/pdfs/vetoryl/VETORYLTechnicalBrochure.pdf
So for what it's worth, this provides the rationale for Dechra's recommendation. Having said that, however, I still think that if Jen's previous tests were performed between 2-4 hours, I'd stick with that same window for this test, too, so that the results will be directly comparable.
Marianne
Thank you for that info. I think I'm going to split the difference :D Feed her at 6:30am for her appt at 9am.
For those that use probiotics - do you usually give with the first or last meal of the day. The new food we have does not contain any so we bought Herbsmith's micro Flora capsules. I'll start in Sunday as I didn't want to add anything else new in before her ACTH tomorrow.
Thanks!
PS - Renee, glad you warned me that they poop a lot at first on Honest Kitchen, Jen is definitely having that side effect.
Renee
04-01-2016, 01:00 PM
PS - Renee, glad you warned me that they poop a lot at first on Honest Kitchen, Jen is definitely having that side effect.
LOL - some people can't handle it and give up on THK. It evens out for most dogs within a few weeks/months.
molly muffin
04-01-2016, 07:02 PM
I use fora flora probiotic which comes in a small packet me divide half in The morning and half in the evening. So I give both am and pm.
LOL - some people can't handle it and give up on THK. It evens out for most dogs within a few weeks/months.
That is our issue at the moment, it is the 3am nightly wake up calls that are making us crazy. And yep, she really has to go. That would be the thing that stops us from using THK if she doesn't get used
I posted this on the Facebook site, but thought just in case someone isn't on there, they may enjoy this story that happened to us. At the vet yesterday we ran into an owner with two other Corgis. Jen's weird hair was mentioned and we said she has Cushings. The owner said the one Corgi also has it and was almost bald at one point and now has a full coat. She then mentioned her dog was diagnosed at the age of ten and is now fifteen and doing great. Another Cushings pup that is outliving the "average"! :D
Renee
04-03-2016, 03:27 PM
That is our issue at the moment, it is the 3am nightly wake up calls that are making us crazy. And yep, she really has to go. That would be the thing that stops us from using THK if she doesn't get used
I'm not sure it works for everyone, but this is why I hydrate with hot (I mean, hot!) water, use twice as much water as they call for, and let it hydrate for 30 minutes. I really think that helps reduce the side effect of pooping a lot. It's a strange side effect, and I have no idea what triggers it, but it does taper down for most dogs.
Sadielove
04-03-2016, 03:32 PM
Hi Ty, welcome to the forum. I am new as well. We are in the testing phase as well. I love that we have support here on this forum and wish you the best for your fur baby.
I'm not sure it works for everyone, but this is why I hydrate with hot (I mean, hot!) water, use twice as much water as they call for, and let it hydrate for 30 minutes. I really think that helps reduce the side effect of pooping a lot. It's a strange side effect, and I have no idea what triggers it, but it does taper down for most dogs.
We are doing the make ahead method, and using really hot water. But, will try using even more. She gets 2/3 2x day and we were using a cup to hydrate it. May try more. I think we will probably give her more time on it though before flipping again. Oh, and I discovered I have her on a grain version, not the grain free version I thought we were buying. This is what happens when I get stressed and not completely paying attention to anything. Hopefully flipping between versions of THK won't be too hard.
Oh, and guess whose cough has decided to make a return. Is it the weather with Tobey and Jen???
Hi Ty, welcome to the forum. I am new as well. We are in the testing phase as well. I love that we have support here on this forum and wish you the best for your fur baby.
Hi there, welcome to you and your fur baby! We are a little over a year into this and I'm still learning something new all the time. The members on here are amazing and have so much knowledge to share, ask about anything!
Harley PoMMom
04-03-2016, 04:21 PM
I posted this on the Facebook site, but thought just in case someone isn't on there, they may enjoy this story that happened to us. At the vet yesterday we ran into an owner with two other Corgis. Jen's weird hair was mentioned and we said she has Cushings. The owner said the one Corgi also has it and was almost bald at one point and now has a full coat. She then mentioned her dog was diagnosed at the age of ten and is now fifteen and doing great. Another Cushings pup that is outliving the "average"! :D
Thank you so very much for sharing this story and I'm quite sure that this will bring a lot of positive hope for our members!!!
Hugs, Lori
Feeling very frustrated right now. I just got Jen's latest ACTH and it is not good. Pre-3.7, Post 12.2. A month ago she was a 9.0 and we upped her Trilo to 37mg 2x day (weighs 24lbs). Her water intake actually decreased a bit during this last month, but she jumped! Vet is calling to have the results rerun and I have to call him in a couple of days. He mentioned he just got back from a conference in Vegas where they said the "online" Trilo is not as good as the name-brand (we use Diamondback). I didn't have time to argue with him right now. UGH!
It makes no sense to me but has anyone had the "generic" not work but the "real" stuff work? I know my hubby is going to go back and reference Dr. Evil (Jen's first specialist) who said that only Vetoryl will work and not Trilo.
And I'm editing again (although it probably makes no sense) that Jen had just started on Honest Kitchen Limited Ingredient which never really setup (it's dehydrated) so she was having a liquid breakfast. I know she wasn't absorbing a ton, just based on what was coming out in her multiple poopies. Wondering since it was so liquid and Jen's system had not yet gotten used to it if that threw the test. We've now put her on the Grain Free Chicken from Honest Kitchen (which I meant to have her on in the beginning and screwed up) and it much more like an oatmeal or mashed potatoes than the liquid of the first one. Don't know if that threw the test since there might now have been a lot to bond to as her system gets used to this. OH - and she is absolutely bananas for this food - she is back to hopping around running from the kitchen to her bowl, so thank you again Renee for the suggestion!
labblab
04-06-2016, 02:03 PM
Gosh, I'm so sorry Jen's ACTH results were not better than this. The issue of equivalence between compounded trilo and brandname Vetoryl is one that has been debated and discussed for quite a long time here. Diamondback is a compounder that is highly regarded and has been used to the satisfaction of a number of our members throughout the years. If I were going to select a veterinary compounder myself, I'd probably pick Diamondback. However, there has been some research in recent years that warns that some compounded versions of trilostane may not be as effective as brandname Vetoryl, and this may be what your vet heard discussed at his conference.
If you have the time and patience to read through a lengthy reply that I previously posted to another member :o, here are my thoughts about this in detail. As far as Jen's specific case, I tried to look back through her thread in order to find out whether she'd had similar issues both while taking Vetoryl and also while taking the compounded trilo. However, here's some more general info in answer to your question.
That really is the million dollar question! The short answer is, the active ingredients should be the same and equally as effective as long as the compounders are purchasing their bulk trilostane from a reliable, verifiable source. Historically, the problem in this regard is that it has been up to the individual compounder to perform his/her own quality assurance on the raw chemicals they purchase since compounded products are not FDA-approved and have not been subject to outside testing or product verification. Unfortunately, from the results of general FDA inspections of some compounders, this internal quality assurance is not always performed by all compounders. This is why the FDA recommends that all compounded trilo products use Vetoryl as the basis because then the raw active ingredient will be known to have been supplied by an FDA-approved chemical manufacturer. However, in real life, we know that using Vetoryl as the base can make the compounded product very expensive -- and excessive cost is one reason why owners have turned to compounded products in the first place.
For what it's worth, here's a reply that I posted last year to another member that summarizes the concern that the FDA and certain researchers have regarding the comparable effectiveness of compounded products. Once again, I must emphasize that compounding can be a very helpful and necessary alternative. But these are the reasons why some vets prefer that their patients use Vetoryl when the dosing size and cost permits.
I just wanted to add a few thoughts as to why some vets may have a legitimate preference for using brandname Vetoryl over a compounded version of trilostane that is prepared from raw ingredients. It is important to know that compounded drugs are not the same thing as generic equivalents of brandname drugs. And I believe that more vets have become cautious about prescribing compounded trilostane subsequent to news of this 2012 study conducted by Dr. Audrey Cook of Texas A & M University. This study was funded by Dechra, so that may raise the eyebrows of those who are cynical. But Dr. Cook is highly respected internationally both as a researcher and a clinician. And these are the study results:
Compounded trilostane capsules (15 mg, 45 mg, or 100 mg) were purchased from eight pharmacies and assayed for content and dissolution characteristics. Capsules made in-house containing either inert material or 15 mg of the licensed product and proprietary capsules (30 mg and 60 mg) served as controls. Findings were compared with regulatory specifications for the licensed product. Altogether, 96 batches of compounded trilostane and 16 control batches underwent analysis. In total, 36 of 96 (38%) compounded batches were below the acceptance criteria for content. The average percentage label claim (% LC) for each batch ranged from 39% to 152.6% (mean, 97.0%). The range of average % LC for the controls was 96.1–99.6% (mean, 97.7%). The variance in content of the purchased compounded products was substantially greater than for the controls (234.65 versus 1.27; P<0.0001). All control batches exceeded the acceptance criteria for dissolution, but 19 of 96 batches (20%) of purchased compounded products did not. Mean percent dissolution for the purchased compounded products was lower than for controls (75.96% versus 85.12%; P=0.013). These findings indicate that trilostane content of compounded capsules may vary from the prescribed strength, and dissolution characteristics may not match those of the licensed product. The use of compounded trilostane products may therefore negatively impact the management of dogs with hyperadrenocorticism.
Here's the link for the abstract of this article published in the Journal of the American Animal Hospital Association:
http://www.jaaha.org/content/early/2012/05/18/JAAHA-MS-5763.abstract
The compounding pharmacies that were sampled in the study were not named. So on the face of it, there's no way to know from this study whether any individual compounding pharmacy was problematic in the past, or will be in the future. Historically, there has been no mechanism in place to validate the testing of any compounding pharmacies in terms of efficacy or contents. Validation has not been performed by the FDA, state pharmacy boards (other than Missouri), nor any other regulatory body. This issue has been the focus of congressional concern during this past year, and...some new legislation has been passed by Congress that will affect the regulation of certain large-scale compounders of drugs for human use in the U.S., but not the entire compounding profession.
There are definitely circumstances when there is simply not an available dose of brandname Vetoryl that is suitable given the size or needs of the dog. For instance, if your vet wants to dose Gracie twice a day, it is true that you will likely need to turn to a compounder to either obtain the brandname product to package into alternative capsule strengths (which is what the UC Davis researchers did in their most recent trilostane dosing research study), or else rely on the raw chemical trilostane that the compounder has obtained on their own.
However, given the results of Dr. Cook's research study, my own personal opinion is this: if I could not afford brandname Vetoryl to treat my dog, or he/she needed a dose or form (liquid) for which Vetoryl is not available, then I would definitely go the compounded route rather than not treat at all. But if I could afford to pay the price for the brandname drug, I would buy it. In the long run, that might save money anyway, because I wouldn't run the risk of scratching my head and performing multiple ACTH tests because I couldn't figure out why my dog was having rebounding symptoms or suddenly crashing while supposedly being maintained on the same dose of compounded drug.
labblab
04-06-2016, 02:21 PM
Ty, I just now saw your edit about the liquid Honest Kitchen. I honestly don't know whether or not that might have affected the aborption of Jen's trilostane on the day of testing. You could try calling Dechra directly and asking one of their technical reps what they think. You might choose not to go into detail that Jen is currently taking compounded trilo instead of Vetoryl -- instead just asking whether the liquid food might have affected the testing...:rolleyes:
Ty, I just now saw your edit about the liquid Honest Kitchen. I honestly don't know whether or not that might have affected the aborption of Jen's trilostane on the day of testing. You could try calling Dechra directly and asking one of their technical reps what they think. You might choose not to go into detail that Jen is currently taking compounded trilo instead of Vetoryl -- instead just asking whether the liquid food might have affected the testing...:rolleyes:
Thank you for this and the article above. We would like try the "real" stuff again before giving up on this and maybe switching meds. I will also see if I can find a phone number and give Dechra a call, that's a great idea. Mark is already thinking about adding kibble back to her diet so we know the med has something to bond to.
labblab
04-06-2016, 04:33 PM
Ty, here's the phone # and email address for Dechra U.S.A.
http://www.dechra-us.com/contact/technical-support
Renee
04-06-2016, 05:45 PM
I'll be interested to hear what Dechra has to say in regards to the food. Tobey has been eating THK for many years, probably about 7 years, well before cushings. I did switch to homecooking for her, a month before her diagnosis, but then she got back on THK just a few months after starting vetoryl. She did eat canned food for about 6 months last year as well, but switched back to THK again. She has been on vetoryl since Dec 2013 and most of that time eating THK.
molly muffin
04-06-2016, 05:58 PM
I do think since Jen is rebounding upwards that it might be worth it to buy the vetroyl tablets and see if there is a difference on the next test, in that suddenly she is controlled vs not. I wouldn't make any other change if you do that though with food, you would want everything the same to do a controlled test. In the states you can buy vetroyl the brand name from online pharmacies too, at usually a cheaper price than via the vets.
I've thought a couple times about doing that myself, but vetroyl here in Canada is way more expensive than in the US. sigh, of course it is.
It's a thought only of course.
Ty, here's the phone # and email address for Dechra U.S.A.
http://www.dechra-us.com/contact/technical-support
Thank you - I found that yesterday and thought it meant technical support for the website! :eek:
I'll be interested to hear what Dechra has to say in regards to the food. Tobey has been eating THK for many years, probably about 7 years, well before cushings. I did switch to homecooking for her, a month before her diagnosis, but then she got back on THK just a few months after starting vetoryl. She did eat canned food for about 6 months last year as well, but switched back to THK again. She has been on vetoryl since Dec 2013 and most of that time eating THK.
Dechra said this was a new one, but thinks it may have played a part especially since Jen's symptoms went the opposite way of the numbers. It could very well be because she is still getting used to the food. They did say they would not do an increase at this time.
I do think since Jen is rebounding upwards that it might be worth it to buy the vetroyl tablets and see if there is a difference on the next test, in that suddenly she is controlled vs not. I wouldn't make any other change if you do that though with food, you would want everything the same to do a controlled test. In the states you can buy vetroyl the brand name from online pharmacies too, at usually a cheaper price than via the vets.
I think this is one of our next steps. And if we do, I would probably drop her down to the 30mg 2x day (from 37 right now) just to be a little safe.
I posted this in the FB group as well so apologies if you are seeing this twice. Question - Jen had an ACTH test today and I noticed that the test had gone up almost fifty dollars. On closer inspection I saw that the items used said "0.50 Cortrosyn Injection 250 ug/1ml IV" I looked at all her other paperwork and the injection has ALWAYS been between 0.22 and 0.27 Cortrosyn (almost always 0.25). Did the vet screw up and is this going to throw her test? And is this going to hurt her in any way? I wanted to be armed with info before I call them tomorrow morning.
Harley PoMMom
04-15-2016, 08:59 PM
On closer inspection I saw that the items used said "0.50 Cortrosyn Injection 250 ug/1ml IV" I looked at all her other paperwork and the injection has ALWAYS been between 0.22 and 0.27 Cortrosyn (almost always 0.25). Did the vet screw up and is this going to throw her test? And is this going to hurt her in any way? I wanted to be armed with info before I call them tomorrow morning.
I'm not sure what the "0.50" is referring to :confused: Cortrosyn does come in vials of .25mg, so I am hoping that "0.50" doesn't mean that twice the amount of Cortrosyn was used.
I really don't know if this could skew the test results but when having ACTH stim tests performed ideally all circumstances involved with the test should be the same as was previously done so one can compare them equally.
I think I would ask for some clarification from the vet.
Hugs, Lori
Since her test was almost fifty dollars more than normal (Mark took her while I was at work and he didn't know better) I'm thinking they gave her more. I'm a bit annoyed right now.
Harley PoMMom
04-15-2016, 10:29 PM
It wouldn't surprise me one bit if the price for Cortrosyn increased, that there stuff is liquid gold :eek: I have read on the forum that the ACTH stim test does have a fidgety, don't know if that is the right word to describe it, reaction in some dogs. Let us know what you find out and how Jen is doing.
lulusmom
04-15-2016, 11:05 PM
On closer inspection I saw that the items used said "0.50 Cortrosyn Injection 250 ug/1ml IV" I looked at all her other paperwork and the injection has ALWAYS been between 0.22 and 0.27 Cortrosyn (almost always 0.25). Did the vet screw up and is this going to throw her test? And is this going to hurt her in any way? I wanted to be armed with info before I call them tomorrow morning.
I believe what happened is that the prior paperwork showed .25 mg/1ml and this paperwork is showing the same dose but in ug which is the unit they use when splitting the vials for smaller dogs. The conversion from .25 mg/ml is 250 ug/ml. So .50 Cortrosyn injection of 250 ug/ml would be 125 ug which is one half of the entire vial of Cortrosyn. Up until a few years ago when a study showed that a fraction of cortrosyn could be used for small dogs, every dog no matter what size was injected with the full vial of cortrosyn so I don't think your vet did anything to hurt your girl. If Jen weighs 24 or 25 pounds, she would need 1/4 vial or less so it could be that your vet only had 1/2 vials in the freezer and no more in stock to split so it's possible they charged you for extra 1/4 vial, which is way steep....or it could be as Lori said that the price of cortrosyn has gone up again. I hope not because the price is already ridiculous. I'd just give the vet's office a call and ask them to explain the increase.
Glynda
Hi Glynda,
I checked and all the other paperwork was also in UG...for instance her test two weeks ago says "0.22 Cortrosyn Injection 250ug/1ml IV". Mark did the math and that was appropriate for her weight at 24 pounds. If she did get .50 today (according to his math) that was enough for a 46 pound dog..double Jen's weight. Although I don't completely understand all the conversions, I know he is pretty good at that. Or is he missing something? Here's his math:
When she weighed 27.5 lbs they gave her .25 of the vial, which is what the math states she should have.
For THIS test, they administered .5 (50%) of 250ug, or 125ug. Working backwards we have 125ug/5ug per kg = 25kg, which is 55lbs!!!
It wouldn't surprise me one bit if the price for Cortrosyn increased, that there stuff is liquid gold :eek: I have read on the forum that the ACTH stim test does have a fidgety, don't know if that is the right word to describe it, reaction in some dogs. Let us know what you find out and how Jen is doing.
That's a good word for it and she sometimes gets it...she is a bit spazzy tonight but not too bad. I'm just hoping there are no bad side effects from getting a dose for a dog seemingly twice her weight! Not to mention I'm guessing this test will be useless.
lulusmom
04-16-2016, 10:28 AM
Although I don't completely understand all the conversions, I know he is pretty good at that. Or is he missing something? Here's his math:
When she weighed 27.5 lbs they gave her .25 of the vial, which is what the math states she should have.
For THIS test, they administered .5 (50%) of 250ug, or 125ug. Working backwards we have 125ug/5ug per kg = 25kg, which is 55lbs!!!
Nope, I don't think he's missing anything. Converting the other way would be (55/2.2) * 5 = 125 ug. So it does sound as though you were charged for an extra 1/4 vial of Cortrosyn. If I were you, I'd give the vet a call and ask for an explanation because you definitely don't want this to happen again.
Harley PoMMom
04-16-2016, 04:12 PM
Nope, I don't think he's missing anything. Converting the other way would be (55/2.2) * 5 = 125 ug. So it does sound as though you were charged for an extra 1/4 vial of Cortrosyn. If I were you, I'd give the vet a call and ask for an explanation because you definitely don't want this to happen again.
Glynda, what am I missing here :confused: Jen weighs 25 lbs, so wouldn't that be (27.5/2.2) * 5 = 62.5 ug?
So vet still hasn't called us back and I know they are closed now. I checked my email and get the test results auto emailed to me. Her results were:
1.8 pre....is this too low? It would have been before the wrong stim was given.
4.5 post....but who knows what this real number is!
labblab
04-16-2016, 06:11 PM
I know you still want to get to the bottom of the cortrosyn mystery, but I suspect these test results are accurate and they are really good. :)
The first, baseline draw would be unaffected, regardless of any subsequent issue with the stim agent. And it is not too low, especially in conjunction with a post-ACTH of 4.5. If both the "pre" and "post" are lower than 1.45 for a dog who is acting unwell, you'd worry. But in combination, Jen's test results look great.
I also suspect the "post" result is accurate, even if Jen was given more of the stim agent than was really necessary. Your goal with the cortrosyn is to get the adrenals to "dump" their reserves of cortisol. It takes a certain amount of cortrosyn to insure that there is sufficient stimulation. Once you reach that threshold, any more is unnecessary but probably not harmful. So I believe the worry would be more if Jen had been given too little stimulating agent rather than more than was needed. Your pocketbook may have suffered some damage, but I think these test results are probably valid and fall right within the ideal therapeutic range. How do they compare to past results?
Marianne
Hi Marianne,
In March we did a three month check and she was at a 9.0. We then upped her to 37mg 2x day from 32mg 2x day. At her thirty day check she came back at a 12.2.
I questioned those results as we had just put her on a dehydrated food that never really became solid and was more liquid. Wasn't sure if the Trilostane was bonding to anything. We have since switched her to a combo of a different version of Honest Kitchen and mostly back to kibble, this time Fromms. (Sorry Renee, I couldn't take the 3am wake ups anymore with all Honest Kitchen ;) )
We did this ACTH for our own sanity to see if maybe the food did have something to do with it. And we didn't want to up her again or go back to Vetoryl without knowing. Then they gave her too much stim so I was questioning those results, but your explanation helps.
lulusmom
04-16-2016, 09:54 PM
Glynda, what am I missing here :confused: Jen weighs 25 lbs, so wouldn't that be (27.5/2.2) * 5 = 62.5 ug?
Lori, sorry for confusing you. Ty said that Mark did the math and the amount of Cortrosyn shown on their paperwork would have been for a dog weighing 55 lbs. I simply validated Mark's handywork by showing the equation using the weight that he arrived at. Your formula for a 27.5 lb dog is correct. Unfortunately, it looks like Jen got twice that amount and Ty and Mark may have been billed for it.
Lori, sorry for confusing you. Ty said that Mark did the math and the amount of Cortrosyn shown on their paperwork would have been for a dog weighing 55 lbs. I simply validated Mark's handywork by showing the equation using the weight that he arrived at. Your formula for a 27.5 lb dog is correct. Unfortunately, it looks like Jen got twice that amount and Ty and Mark may have been billed for it.
I'm just glad you guys (and Mark) understand all the math that goes along with this disease...that was never my strong point :D
molly muffin
04-17-2016, 08:57 PM
Not my strong point either. But being billed for extra, and then the question of why did they give her more, did they actually give her more even or bill in error. All things that they need to answer for.
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