My Dog Angel (6 yr 10 pound Maltese)

[Nina]

Hi All, thank you for this very informative site!! I do have a few questions. My dog Angel, a 6 yr 10 pound Maltese and I may add, love of my life, was diagnosed 3 weeks ago with pancreatitis and pituitary Cushing's disease. We have I believe an integrative veterinarian. We started right away with 1 tablet a day of Denamarin. Then we started 3mg of Melatonin twice a day. After reading a few sites last night, this dosage may be too high for a 10 pound dog, 1.5mg I read on one of your links was suggested.

My question is over the main treatment. I read Dr. Karen Becker's newsletters every week. She suggests using a holistic vet. So I asked my vet if we could explore some alternatives rather than going right for the big guns. After a day or two of research on her end, she prescribed a Chinese herb, Long Dan Xie Gan Tang. The vet said let's try it for a month.

Angel has been on the herb for almost 2 weeks. She is panting less, and drinking and peeing less..less but still can drink most of the water bowl. But she certainly isn't back to her normal perky, happy self. Today we're taking a vacation from the melatonin to see how she reacts.

My questions are, I haven't seen any mention of alternatives on your forum. Can you tell me your experience with them? Do I understand correctly that neither herbs nor the Trilostane will "cure" Cushing's but minimizes the symptoms? And if that's the case, wouldn't I be better off proceeding with alternative solutions rather than drugs that could potentially be harmful to Angel?

You all have had a lot of experience with Cushing's. Like all pet parents I want to do what is best for Angel. Can you please give me some insight as to the holistic approach and your experience?

Thank you so much!! Nina
PS I don't know how to post Angel's picture...she's adorable! :):)

[Harley PoMMom]

Hi Nina,

Welcome to you and Angel, and I am so glad you found us.

I know of no natural/holistc approach for canine Cushing's. Cushing's is when a dog's body produces excessive amounts of cortisol either from a tumor of the pituitary and/or on the adrenal gland. Trilostane/Vetoryl and Lysodren/Mitotane are the two drugs generally rx'd for Cushing's, and as far as I know, are the only medications that can lower a dog's high cortisol to withhin the theapuetic ranges that are needed.

It is true that these two medications do not cure Cushing's but are used to lower the cortisol and help abate the symptoms. Over a long period of time untreated Cushing's will damage other internal organs, such as the liver, heart, kidneys, etc...

Lysodren/Mitotane and Vetoryl/Trilostane are strong medications but are life savers for dogs with Cushing's. Usually adverse reactions are only seen when the proper protocols are not followed. Cushing's is a treatable disease but success does depend on keen owner observation along with a vet/IMS that is knowledgeable and experienced in the treatment protocols for Cushing's.

Cushing's can be difficult to diagnose and is frequently misdiagnosed as other illnesses have the same symptoms such as diabetes or any thyroid problem. Have you ruled out diabetes and thyroid issues? I would start there as they are easy to diagnose as they are normally checked on a chemistry blood panel. Sometimes a chemistry/CBC blood panel is called a senior or geriatric wellness panel. If this was done could you post any abnormal levels (high or low), as an example: ALT 150 U/L (5-50)...Thanks!

Strong symptoms do play a huge part in the diagnosis of Cushing's so can you tell us what symptoms Angel is displaying that led you or your vet to test for Cushing's in the first place? Could you also tell us what tests were performed to diagnosis the Cushing's and could you post those results too? Were any diagnostic tests done when Angel was having a pancreatitis episode? Is Angel taking any other herbs/supplements/medications?

I am sorry for all these questions but the more we know about Angel the better our feedback can be, ok?

Hugs, Lori

[labblab]

Welcome from me, too. Lori has already given you a great introduction, so I will just add a couple more thoughts. We do have members who have used some herbal preparations to address various limited aspects of Cushing's symptoms with varied reports of success. However, as Lori has said, I am unaware of any nonprescription preparations that have resulted in significant lowering of cortisol as demonstrated by direct laboratory testing. And it is the elevated cortisol that is the driving force behind both the overt and also unseen systemic damage associated with conventional Cushing's.

Additionally, I am alway a bit baffled as to the assumption that a nonprescription herbal preparation is necessarily always a safer alternative to a prescription med. Many Rx drugs are, themselves, derivatives of naturally occurring plants or chemicals. However, they have undergone controlled testing that hopefully identifies both the positive active qualities as well as likely side effects. A non-prescription herbal preparation may actually carry similar risks, but just without the same degree of documentation. If a natural preparation is actually strong/effective enough to alter physiological functioning, then there is always the chance that it is not absolutely benign, either. I do understand that there is a long and established tradition of Chinese herbal formulations, many of which are accompanied by reports of success. But in my own mind, just because they do not require a prescription does not always mean they are safer than a prescription alternative.

Marianne

[labblab]

Oh, and here are some instructions for adding a photo of Angel as your avatar ;):

http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_signatures_av atars

We'd love to see her! :)

[Nina]

Thank you for your quick responses!!

I have requested from my vet the names of the tests and the results. With any luck they will forward over the info in the next day or so.

I took Angel to the vet when I noticed that she was drinking an entire bowl of water. In addition she ate 2 packing peanuts that I dropped on the floor, she's never done anything like that before. She has a ravenous appetite, and pants a lot. Also a month or two ago I noticed that she was developing a pot belly. She had a series of tests and pituatary Cushing's was confirmed. I haven't learned enough yet of the disease, so it will be a learning exercise for me when they send over the lab numbers. Thank you for the heads up.

Below is one of the first articles I read about Cushing's after hearing of the diagnosis. Then as I read further, the drugs really scared me. You are correct that the herbs could be just as dangerous as the Trilostane, that's why I'm on this forum to ask the question. Is there a safer way? I'm risk adverse when it comes to my precious dog. I'm learning and trying to figure out the best path for Angel. I really appriciate any and all input. I'm all ears. :-)

Here's the article I read from Dr. Becker... http://healthypets.mercola.com/sites/healthypets/archive/2010/09/23/hormone-imbalance-caused-by-spaying-or-neutering.aspx

[Junior's Mom]

Welcome to the forum Nina and Angel. The link to Dr. Beckers site, which I also follow, discusses atypical cushings, which is not the same as pituitary or adrenal cushings.
You mentioned that your dog had pancreatis. Was the cushings test done at the same time? Anything going on with your dog that is abnormal, can cause the cortisol levels to rise, thereby making a false positive on the test.
In the beginning, I also searched out more "natural" methods to treat my dog. While what I tried helped Junior's symptoms quite a bit, it did not lower the cortisol levels at all. They actually continued to increase, thus I was doing more damage than good.
Junior has been on vetoryl/trilostane for 9months now, and doing much, much better.

[lulusmom]

Hi Nina and welcome to you and Angel.

I'm sorry for the reasons that brought you here but I'm glad you found us. The safest way to treat is to know what you are putting in Angel's mouth or on her body. We'd like to think most vets would know everything there is to know about the drugs s/he prescribes but we've sure seen our share of ignorant vets around here and ignorant vets are dangerous to cushdogs. That makes it even more important that us pet owners educate ourselves so that we can be the best advocate possible for our dogs. They can't talk and tell us that our vet is stupid and if they did, my dog would have been up in my face begging me to take her to another vet who could help her. :D

I love Dr. Becker and think she does an amazing public service with her videos but she annoys me when she leads people astray with information that is simply not true. Case in point.....I just used the link you provided and found the following which annoys me greatly.


Preventing Cushing’s

There are some common sense steps you can take to reduce your pet’s risk of developing Cushing’s disease, including:

Eliminate carbohydrates – corn, wheat and rice. Carbs trigger insulin release. Insulin triggers cortisol release.

Investigate adrenal-supportive natural substances like magnolia, ashwagandha, phosphatidyl serine.

Feed a moisture rich, low stress, species-appropriate diet to reduce biologic stress.

Exercise your pet. Regular exercise helps combat stress and promotes endorphin release, your pet’s “feel good” hormones.


Nobody knows why dogs get cushing's and for her to infer that any of the above will help prevent it from happening is not true. I believe if you do all of the things she mentions above, your dog will benefit greatly health wise, and I also think it is probably a great adjunct treatment to conventional cushing's treatment. Unfortunately, there is no scientific evidence that preventing stress will prevent atypical cushings nor prevent a pituitary or adrenal tumor, the cause of typical cushing's.

Integrative vets like Dr. Becker, are licensed practitioners, using both Western and alternative medicine. They have extensive training in both so I am less concerned about the lack of scientific testing on Chinese Herbs they prescribe than I am with the no testing of the online snake oils sold to the public who believe the bogus claims.

Take your time to read threads and by all means, access our Helpful Resources subforum where you will find a wealth of information. My cushdogs treated with Lysodren and Trilostane over the course of several years and they did fabulously on both. They are serious drugs and you need to respect them. You will respect them a lot more if you fear them enough to learn everything you can about them before you put one pill in your dog's mouth. Know how it works, what side effects to watch for, know how it's dosed and know the protocol for monitoring treatment. Also remember that vets are not all knowing. I personally quizzed some gp vets about their knowledge of the drugs and let me just say that pigs would fly before I ever trusted those vets to direct my dogs' treatment. We're here to help you become the best advocate you can be for Angel.

I'll be looking forward to seeing the results of the tests that were done to confirm Angel's cushing's diagnosis.

Glynda

[labblab]

Not to pile on re: Dr. Becker, but here's another earlier related discussion about some of her strengths and weaknesses regarding Cushing's info:

http://www.k9cushings.com/forum/showthread.php?t=4286

I do believe she represents some info well, and other info inaccurately.

Marianne

[molly muffin]

I just want to say hello and welcome to the forum.

As Juniors mom asked, was the testing for cushings done when Angel had pancreatis? That could skewer the results of cushings testing if so.

I think we'll know a bit more once we can see the abnormals on the test results.

Likely if she has cushings and is showing symptoms then the better option is to start at a low dose of medication to bring the cortisol down to levels that control the symptoms and help with her internal organs health too. That is my thought any how.

You really do have to go into it though with a wealth of knowledge about the drugs you choose and the follow up testing protocols for each and what you want to see with them.

We have another 10lb maltese on the forum, who is currently on 6mg of trilostane per day and I think will likely be going up to 10mg soon, a symptoms are not yet controlled. 1mg/1lb is a good starting dose if you you want to look into that option, with testing about 14 days later to check where the cortisol is at.

That might be an option and we have had members with dogs on both the drugs for a very long time. So it is something to consider at least.

again welcome to the forum, Angel definitely IS adorable
sharlene and molly muffin

[goldengirl88]

Welcome to the forum. Sorry your Angel is having troubles, and as Sharlene said we do have another maltese on here with Cushings. I am just hoping that the pancreatitis did not skew the testing too. I agree with a little girl like Angel you will need to be conservative if and when starting with trilostane. Things will get easier, and less expensive as you progress on this journey. Blessings
Patti

[Nina]

Hello All, my vet's office sent me 9 pages of test results. Can you tell me which test/results I should look for? I'm sorry to ask for such basic help. I'm sure you all tire of beginners questions. Thanks so much!!

[molly muffin]

We were all newbies at one time or another. :) So no worries on that front!

Okay, so 9 pages eh. Then I assume they went back a bit. So, anything out of normal range, I'd go through by date. Also anything specifically testing for cushings, such as an LDDS (low dex) or ACTH.

Here is a layout that works for me:

05/15/2013
ALKP 225ug (5 - 50ug) the Alkp is the test name, the result and the range given
ALT 115ug (25 - 115ug)

You only need to post anything out of range, high/low. If it's normal then it's all good.
Does that make sense? If you have any questions, ask away.

Sharlene and molly muffin

[Harley PoMMom]

Hello All, my vet's office sent me 9 pages of test results. Can you tell me which test/results I should look for? I'm sorry to ask for such basic help. I'm sure you all tire of beginners questions. Thanks so much!!

There is no need to apologize when asking for help of any kind, as Sharlene has mentioned we all were newbies and all of us have asked for help at one time or another. That's what we are here for, to help in any way we can. ;)

Hugs, Lori

[goldengirl88]

We are all here for one reason, and that is to help and educate as many people as possible. Ask any question at anytime as that is what the forum is all about, getting you the help you need. Hope all is going well. Blessings
Patti

[Nina]

I hope everyone is having a nice holiday. I just now received the below from my vet. I hope it's the information you are looking for. I have stopped the Chinese herbs for 3 days. I'm still giving Angel Denamarin once a day. Also I have been giving Angel 3MG of Melatonin in the morning. Angel has been very irritable with the cats particularly around her food. My cats started marking around the house about 2 months ago, this weekend I decided it must be from Angel being so crabby...she's been awful to the cats. But that's another whole issue. :)
I hope the below results are what you need. Thanks again for taking your spare time to help us. :-) Let me know if you need anything else.

A. Results: LDDS test:
Pre-dex cortisol: 3.8
4 hour post dex cortisol: 0.8
8 hour post dex cortisol: 4.8

Interpretation:

Low-Dose Dexamethasone Diagnostic Intervals (Canine)
4 hours 8 hours Interpretation
----------------------------------------------------------------------

<1 <1 Normal
1.0-1.5 1.0-1.5 Inconclusive
>1.5 and >50% >1.5 and >50% Consistent with hyperadrenocorticism
of baseline of baseline Further testing required to

differentiate adrenal tumor from
pituitary-dependent
hyperadrenocorticism (PDH)
<1.5 or <50% >1.5 and >50% Consistent with pituitary-dependent

of baseline of baseline hyperadrenocorticism (PDH)
<1.5 or <50% >1.5 and <50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH)
>1.5 or >50% >1.5 and <50% Consistent with pituitary-dependent

of baseline of baseline hyperadrenocorticism (PDH)


B. Urine culture: negative, done via cystocentesis.
C. Abdominal ultrasound: No adrenomegaly, liver normal, hyperechoic speckling in the duodenum and jejunum.
D. ACTH stim test: pre-acth: 5.1 and post: 23.4.
Interpretation:
ACTH Reference Range:

Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol

18 - 22 15 - 19 Equivocal post-ACTH cortisol
>22 >19 Post-ACTH cortisol consistent with
hyperadrenocorticism
<2 <0.5 Post-ACTH cortisol consistent with

hypoadrenocorticism
1 - 5 n/a Desired pre- and post-ACTH cortisol on
lysodren therapy


E. ALKP: 267
ALT: 269
GGT: 20
There was some hemolysis, which can falsely decrease the ALKP by 50%, so the actual ALKP is 400.
F. Urine specific gravity: 1.013, it was the first urine of the morning.
G. GI panel: Fasting
Cobalamine: 963 (251-908)
Folate: 10.1 (7.7-24.4)
PLI: 463 (< 200)-- consistent with pancreatitis, if clinical recommend reevaluation in 2-3 weeks.
TLI: 27.4 (5.7-45.2)

[goldengirl88]

My Tipper became very nasty to the other animals in the house too.

[Nina]

Do you think irritability is a symptom of Cushing's? We have 3 cats and the 2 older cats, that we've had for 13 years have started marking...they've never done that before. I've read many things recently about felines and if something changes in their environment they can mark. I've tried Feliway, more litter boxes, more scratching posts, just short of speaking to an "animal communicator" that my cousin recommends. :) But my current thought is that it has to be Angel's illness. Angel hasn't been the fun bouncy little dog she was, she pants a lot and is sort of crabby. I've noticed a big change in her.
Is your dog less grumpy with the other pets with the treatment?

[jxeno13]

Hi Nina! A belated welcome to you and your little Angel. I'm new to the board as well. Please, please, listen to the people on this forum. Trust me they know what they are talking about! I know from experience...they alone saved my Eli's life!! Although, not Vets...they have very good knowledge, and the hands on experience that the Vets don't have with Cushing's disease. Most Vet's, although well meaning, treat all kinds of diseases and not just Cushing's. As far as their Cushing's experience...I'd say for a GP Vet it is usually quite slim to none. And, I'd like to also mention that many GP Vets also go by the inserts in the Vetoryl makers Dechra have in the Vetoryl...which when they updated their protocol (in 2012)..Dechra DID NOT update their inserts. That said....please read everything you can to learn about Cushing's...and the drug. It is a VERY good drug when administered correctly. You need to start it though low and slow. I know when my Eli was on it...the first week he was back to his self again...but what happened to him...he got an overdose and ended up in an Addison's crisis. The people on this forum saved his life! I knew squat about what to do at the time. :(

As far as how to prevent Cushing's from what was posted...by one of the others by that Vet....is bunk! jmo I've always given Eli the best of everything. Best dog food, best treats..only home baked and healthy...no table food..in 10.5 years of his life the most he's ever had was a broken nail he got from jumping on a picnic table. Really! Then one day BAM!! I'm told he has Cushing's Disease!! WTH!! :eek::eek:

It just happens! No one knows how. Like cancer...no one knows how. All we can do is make our babies comfortable. I actually can't wait until Eli can get back on Vetoryl again and be his old self again. I don't want any further damage to happen to my baby.

Most of us also have a IMS along with our regular Vets...and they work together...we work with them as a team. :D

Anyway......sorry for the long rant. :o :D

Hugs, Jo Ann and Eli

[Nina]

Yes, I can see there is a ton of knowledge on this site. I'm not planning to start the Trilostane until I get the approval of this site. :)
My vet prescribed 9mg once a day with food. Angel is a 10 pound Maltese. I'm wondering if I should start with a lower dose? Thanks for your input.

[jxeno13]

Hi Nina, Sounds like a good start. I'd get some rescue Predisone along with that as well. Most here recommend 1 mg per lb. as does the newer protocol with Dechra.

My Eli though could also have been sensitive to the Vetoryl (per the IMS)...but the Vet also put my 30 lb Cairn Terrier Mix baby on 60mg...of Vetoryl to start..and he didn't last 11 days before his crash. It was WAY too much for him! Yikes!!

"Starting dose
VETORYL Capsules should be administered orally once daily in the morning with food. Administration with food will significantly increase the rate and extent of absorption of VETORYL.
Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com."

http://www.dechra-us.com/Cushings-Syndrome/Veterinarians/Prescribing-VETORYL-1.aspx

It says to start at the low end of the scale when calculating dose.....always give with food.

Start is good low and slow. Please don't listen though to my advise on dosing...for real. But one of the others, Marianne, Lori, Glynda, Sharlene.....one who REALLY knows can tell you MUCH more than I can! :D

Hugs and good luck, Jo Ann and Eli

[molly muffin]

9mg once a day for a 10lb dog would be a good starting point, if pursuing cushing treatment (trilostane)

1mg/1lb is a good place to start and is the current recommendation by the experts.

Then monitor and see how she does on that dose. Keeping in mind, that likely you Should see some symptoms decrease by around day 10 (that is what we normally see, but every dog is different so sooner or later is possible) and cortisol can continue to drop even up to and past 30 days on the same dose.

If symptoms don't remain controlled all day, then you can look at splitting dosage to twice days, doing 5mg morning 5mg evening for example.

Sharlene and molly muffin

[molly muffin]

Why JoAnn I think you didn't absolutely wonderful explaining the dosing parameters! and with links too!!

:)
Sharlene and molly muffin

[jxeno13]

Why JoAnn I think you didn't absolutely wonderful explaining the dosing parameters! and with links too!!

:)
Sharlene and molly muffin

Why thank you!! :D:D:D Give me some time and I'll learn to highlight and quote the darn things. lol

[Nina]

Thank you for your help Jo Ann! I don't have a Rx of Prednisone, why would I need it? What symptoms should I look for? Poor little Angel. My vet said to wait until I was back in town before I started the Trilostane, she wanted Angel and I close by. Nancy

[goldengirl88]

You vet should give you a rescue dose of prednisone based on your dogs weight. When they give you Vetoryl they need to give you this at the same time. You would be looking for diarrhea, lethargy, vomiting, can't get up and stand, won't eat. If at anytime you are treating your dog and he appears sick with hold the Vetoryl, you can always start it again with no harm done. You should never give Vetoryl to a sick dog. You just need to be extra vigilant during the 30 day period when you first start as their cortisol can come down rather quickly. I am hoping the dosage you are starting at is no more than 1mg per pound?? That is the best way to go and the safest as far as I am concerned. Blessings
Patti

[jxeno13]

Thank you for your help Jo Ann! I don't have a Rx of Prednisone, why would I need it? What symptoms should I look for? Poor little Angel. My vet said to wait until I was back in town before I started the Trilostane, she wanted Angel and I close by. Nancy

Hi Nina! I hope you and Angel are doing OK today. What Patti said above about the Predisone is true and correct. You would only need the Predisone in case of emergency...the Predisone will bring back up the cortisol level if, in fact, the 9mg of Vetoryl that your Vet prescribed might have been too high for Angel provided she may have been sensitive to it..or perhaps her cortisol level was just not that high perhaps or her levels drop really fast. Their cortisol level can drop pretty quickly (every dog is different....some not so).....but if it does then they can go into what is called an Addison's crisis (which is when the cortisol level drops too low)....which (not to scare you) can cause instant death...but can cause illness. It's actually best for you know these things...then go into it blindly. JMHO That's probably why you're Vet said not to start your Angel on them until you got back to town to be close to him.but not explaining why. At the first sign..(which may not happen at all) ...STOP GIVING THE VETORYL. That's a must!! The Predisone will bring that cortisol level back up...that's the MUST HAVE!

Symptoms......anything of little Angel getting sick....Vomiting, diarrhea, etc. Patti name a few......the insert also names some. None of this may happen at all!! We're hoping it doesn't...and only in a small percent it does sometimes. But, if it should.....DO NOT give anymore Vetoryl....and don't just stop to call your Vet.....GO TO YOUR VET IMMEDIATELY!!! It's good your Vet wanted you close by....follow her around for awhile.....like about 12 days or so. :)

You do have to wait at least 30 days if you do have to stop using them..and Angel does have to be back into full Cushing's mode before you want to start again.

If you'd like you read my thread (if you haven't already) you'll understand the ramifications of an overdose and an Addison's crisis without Predisone...only a page or page will make you a believer. ....but trust me....with this knowledge now, for me,...I am NOT AFRAID to start Eli on this drug again.

This is a link for pretty good insert on Cushing's and Vetoryl..all the tests and even definitions of stuff....and a great explanation of what to do and what not to do. :D There's also another one I really like, but can't find it right now...but I'll give you that link too when I can find it.

http://www.dechra.co.uk/files//dechra/Downloads/Pharma/ClientLiterature/Vetoryl_Client_Booklet_Final.pdf

Hugs, Jo Ann and Eli

[Nina]

The link to the Trilostane website was very helpful, thanks!

A few more things: :)
I will contact my vet to get some Prednisone.

Angel had diarrhea over the weekend on and off, I think it was from her favorite food I was feeding her last week to get her to eat the Chinese herbs. She finished it off yesterday. I just gave her a tablespoon of pumpkin. I think I need to wait until she's totally stable to begin the treatment?

I picked up the Trilostane from a compound pharmacy...it doesn't have a package. The vet may have prescribed it that way to save some $$ I'm thinking.

On page 2 of my thread I posted Angel's numbers. I believe Sharlene
was going to look at them? Any chance Sharlene you could take a peek? Thanks!!

And finally how do I get to the thread to read about your dog having an overdose?

Thanks again for all of your help!!! The support has been nice.

[Harley PoMMom]

here's a link to Eli and Jo Ann's thread: Eli and me (http://www.k9cushings.com/forum/showthread.php?t=6162)

[Harley PoMMom]

Let me know if you need anything else.

A. Results: LDDS test:
Pre-dex cortisol: 3.8
4 hour post dex cortisol: 0.8
8 hour post dex cortisol: 4.8

Interpretation:

Low-Dose Dexamethasone Diagnostic Intervals (Canine)
4 hours 8 hours Interpretation
----------------------------------------------------------------------

<1 <1 Normal
1.0-1.5 1.0-1.5 Inconclusive
>1.5 and >50% >1.5 and >50% Consistent with hyperadrenocorticism
of baseline of baseline Further testing required to

differentiate adrenal tumor from
pituitary-dependent
hyperadrenocorticism (PDH)
<1.5 or <50% >1.5 and >50% Consistent with pituitary-dependent

of baseline of baseline hyperadrenocorticism (PDH)
<1.5 or <50% >1.5 and <50% Consistent with pituitary-dependent
of baseline of baseline hyperadrenocorticism (PDH)
>1.5 or >50% >1.5 and <50% Consistent with pituitary-dependent

of baseline of baseline hyperadrenocorticism (PDH)

Angel's LDDS test is indicative for Cushing's and since at least 50% cortisol concentration suppression is present at the four-hour mark this points to PDH (Pituitary-Dependent Hyperadrenocorticism)


B. Urine culture: negative, done via cystocentesis.
C. Abdominal ultrasound: No adrenomegaly, liver normal, hyperechoic speckling in the duodenum and jejunum.
D. ACTH stim test: pre-acth: 5.1 and post: 23.4.
Interpretation:
ACTH Reference Range:

Canine: Feline
2 - 6 0.5 - 5 Pre-ACTH (resting) cortisol
6 - 18 5 - 15 Post-ACTH cortisol

18 - 22 15 - 19 Equivocal post-ACTH cortisol
>22 >19 Post-ACTH cortisol consistent with
hyperadrenocorticism
<2 <0.5 Post-ACTH cortisol consistent with

hypoadrenocorticism
1 - 5 n/a Desired pre- and post-ACTH cortisol on
lysodren therapy

Was there a mention of the appearance of the adrenal glands on the ultrasound report? Angel's ACTH stimulation test, with a post of 23/4 ug/dl (ug/dl, right? is also indicative to canine Cushing's. It does seem odd that no adrenal enlargement was seen.




E. ALKP: 267
ALT: 269
GGT: 20
There was some hemolysis, which can falsely decrease the ALKP by 50%, so the actual ALKP is 400.
F. Urine specific gravity: 1.013, it was the first urine of the morning.
G. GI panel: Fasting
Cobalamine: 963 (251-908)
Folate: 10.1 (7.7-24.4)
PLI: 463 (< 200)-- consistent with pancreatitis, if clinical recommend reevaluation in 2-3 weeks.
TLI: 27.4 (5.7-45.2)

Could you add the reference ranges and units of measurement to these values. thanks!

I see Angel's PLI results were high which means Angel has pancreatitis, false positive results on all tests for Cushing's can be created when a dog has pancreatitis. Was Angel showing any symptoms of pancreatitis, which could be abdominal discomfort, vomiting, diarrhea, not eating?

Hugs, Lori

[Nina]

Thank you Lori.
No, no vomiting or diarrhea. No aware of stomach discomfort. Big appetite the last month, although I've noticed it's tapered off a bit. Still drinking and peeing a lot.
Angel did have an ultra sound for her adrenal gland. I understood all was good.
I will email my vet to get the references ranges and units of measurement.
Thanks again. :)

[molly muffin]

Lori is excellent with test results and covered everything I think.

good that her adrenal glands are okay, not enlarged, but that does make me wonder if the test was inaccurate due to the pancreatic episode. Never test a dog for cushings when something else is going on. So, I'd maybe want to talk to vet about that.

Sharlene and molly muffin

[Nina]

That's quite a story of Eli and Jo Ann. Geez. Thank goodness she found this site.

[Harley PoMMom]

Did the vet mention rechecking Angel's pancreatitis with another spec cPL test in about a month? And have they told you that with pancreatitis a dog has to eat a very low-fat diet with 3-4 meals spaced out throughout the day? It is very important to try to get control of pancreatitis because if not a host of other illnesses could start.

My boy Harley had pancreatitis so if you have any questions there are several of us that have dealt or are dealing with pancreatitis.

Hugs, Lori

[Nina]

Hmmm..no and no. When I received the double diagnosis, I focused on the Cushing's and not the pancreatitis You folks have brought it into the light. Earlier I sent my vet an email asking her to explain the 2 again and if there could possibly be a false positive. I told her that she may have already covered this before, but I don't think I understood as well as I do now...after reading on this site.
Please tell me more about pancreatitis. :) Low fat food?? I currently feed Angel Evo canned beef twice a day. Half a carrot in the morning. Very few treats.
Thanks again for all of your help.

[Harley PoMMom]

There's an article on the dogaware site (which I will provide a link to) that has a lot of really good information regarding pancreatitis and diet, here's an excerpt from that site:
As a general rule, veterinarians consider diets with less than 10 percent fat on a dry matter basis (less than 17 percent of calories from fat) to be low fat, while diets with 10 to 15 percent fat (17 to 23 percent of calories) are considered moderate fat. Foods with more than 20 percent fat are considered high-fat. A few dogs may need a very low-fat diet, especially if they have hyperlipidemia, or if they react to foods with higher levels of fat.

When comparing the percentage of fat in different foods, you must consider the food’s moisture content. The percentage of fat in wet food (canned or fresh) must be converted to dry matter (DM) for comparison purposes, or to use the guidelines above. To do the conversion, first determine the amount of dry matter by subtracting the percentage of moisture from 100, then divide the percentage of fat by the result. For example, if a food is 75 percent moisture and 5 percent fat, divide 5 by 25 (100 – 75) to get 20 percent fat DM.

Keeping a dog well hydrated, you want them drinking lots of water, helps with the healing of the pancreas. Low fat, moderate fiber, quality protein is a diet suitable for pancreatitis, also using carbs as a filler is a good option when reducing fat content, carbs such as pasta, rice, oatmeal, potatoes.. are some that can be used.

Dogaware article: Healthy Low-Fat Diets for Dogs (http://www.dogaware.com/articles/wdjlowfatdiets.html) and Pancreatitis in Dogs (http://dogaware.com/articles/wdjpancreatitis.html)

Uncontrolled pancreatitis can lead to diabetes, kidney problems,etc. There are two types of pancreatitis, acute and chronic. Both are painful but acute pancreatitis can be life threatening. My boy Harley had chronic pancreatitis which means his pancreas was angry all the time :eek: We could never get his spec cPL numbers under 300, Harley's pancreatitis was found thru an ultrasound and he never showed any symptoms of pancreatitis.

Any questions please do ask, ok? ;)

Hugs, Lori

[jxeno13]

The link to the Trilostane website was very helpful, thanks!

A few more things: :)
I will contact my vet to get some Prednisone.

Angel had diarrhea over the weekend on and off, I think it was from her favorite food I was feeding her last week to get her to eat the Chinese herbs. She finished it off yesterday. I just gave her a tablespoon of pumpkin. I think I need to wait until she's totally stable to begin the treatment?

I picked up the Trilostane from a compound pharmacy...it doesn't have a package. The vet may have prescribed it that way to save some $$ I'm thinking.

On page 2 of my thread I posted Angel's numbers. I believe Sharlene
was going to look at them? Any chance Sharlene you could take a peek? Thanks!!

And finally how do I get to the thread to read about your dog having an overdose?

Thanks again for all of your help!!! The support has been nice.

Hi Nina! I worried about my previous post ALL day yesterday and wanted to apologize. I didn't post that to freak you out by any means. and didn't mean to if I did...I only meant for you to be aware of what could happen...and things you should look for....not things what will happen. I'm sure Angel will do just fine. Just be aware of what to look for and watch her. :D

The compound pharmacy is for the 9 mg of Vetoryl. Dechra...only makes Vetoryl is increments of 10, 30, 60 and 120 mg caps....anything prescribed other than that has to be sent to a compound pharmacy. (since a capsule can't be divided). I think I read most here, or some, at least, use Diamondback Pharmacy online and it is cheaper from what I've read. I don't know from personal experience. :)

[jxeno13]

That's quite a story of Eli and Jo Ann. Geez. Thank goodness she found this site.

Oh yea! We had a time, to say the least!! :eek::eek::eek: Luckily for me...I had enough wits about to ask someone something. I have no clue anymore what possessed me to get online and ask anyone anything. I think I need to go back and read the first few pages again myself! :o My Eli certainly would have died without these wonderful ladies!! <sigh> And the Predisone brought him back. He actually just quit taking it this week.

Right now he's doing OK for a Cushpup. He's still not back on Vetoryl yet. He just had another ACTH Stim test on Friday, but with the holiday we won't get the results back until later this week. I doubt his cortisol level is very high right now. The Vet and IMS won't put him back on the Vetoryl until he starts back with the "drinkin' and drippin", which he isn't doing right now. Then we're only starting him back on maybe 15mg to start. Eli's a 30 lb, Cairn Terrier mix, and depending on his cortisol level at the time..so we'll see.

I might add ..In Eli's case he has no other health problems and was always quite healthy. Until we got hit with this Cushing's thing, the only thing he ever had was a broken nail in 2009...and he's approx 10.5 yrs old. He was a rescue and I've had him 9 yrs. in Oct. The first 10 days of the Vetoryl he was doing great and was back to old puppy like self with ZERO Cushing's symptoms. He crashed on the 11th day....That's why I say "low and slow".....I know he'll be OK next time...and I now know what to look for! :D

Hug, Jo Ann and Eli

[Nina]

Wow, you guys really know your stuff! I'm impressed by your knowledge. Is all this knowledge from having a Cushing's and etc dog? Angel is my first dog, I am really clueless..but trying to learn.

I sent an email to my vet last night asking more questions about the pancreatitis. I'm waiting for her reply. I know she consulted an internist about the dual diagnosis. He thought was that the Cushing's was holding the pancreatitis at bay. I'm hoping she will explain a few things for me. But I'm also thinking maybe I should take Angel either to that same internist or another that I know of for another opinion. My vet is currently treating 2 dogs with Cushing's. I don't want to insult her, but maybe another vet would have a different idea? What do you think? I still haven't started Angel on the Trilostane. For some odd reason Angel has been feeling good yesterday and today...she's been very playful. My husband and I think she's not drinking as much...or we've just gotten used to it. Hard to monitor as we have 3 cats using water bowls too.
Thanks again for all of your help. I wish there was a forum for every problem I have in life!! :)

[jxeno13]

Hi Nina, After our crisis, Eli continued on being sick for awhile.....wouldn't eat etc., ended up...in the doggy hospital...falling all over, could hardly walk,...kind of acted as if he had a stoke (to me anyway). All in a week's time. My Vet suggested taking him to a specialist in Lousiville (2 hrs away) for a 2nd opinion. (He felt he was missing something and it bothered him) ...Eli was also drooling. (He still does off and on) Only one other dog on this forum had a facial paralysis from Cushing's. (it's a very rare side effect of the Cushing's disease) ...I also had an Ultrasound done at the IMS, which they can't do here where I live. And, found he actually had a pituitary dependent adrenal type of Cushing's. Eventually, I'll have to take him back to the IMS to see a Neurological Vet to see about his drooling thing going on....but, right now, it's not a serious problem....although, I am watching him closely.

In short.....with little Angel's other problem....I'd say it's never a bad idea to get a second opinion from a (Internal) specialist !! :D

About those forums for every problem we had in life....if you find some let me know and I'll join you!! :)

BTW -----I wouldn't give Angel any Vetoryl if she still has diarrhea. I'd wait at least a few days or more after she's back to normal. I did the same thing to Eli the other week and gave him some gravy....Ugh! :( He had the runs for days!! :( :(

[Harley PoMMom]

Jo Ann is correct, you never give any Cushing's medication when a dog is presenting symptoms of being unwell, and diarrhea is definitely a sign of a dog not feeling well.

I was a basket case when I first joined the forum, so very worried and scared that my dear Harley was diagnosed with Cushing's. These wonderful and caring people here have guided me and helped me understand this dratted Cushing's disease. With Cushing's educating oneself is also very important because success in treatment depends on keen owner observation along with a vet/IMS that is knowledgeable and experienced with the treatment of Cushing's. Many vets are not up on the Cushing's protocols but if you can find a vet who is willing to work with you than that is a plus.

Please do ask all the questions you want, ok? ;)

Hugs, Lori

[Nina]

Thank you for your kind words. I'm in a bit of a holding pattern waiting for my vet to return my email about Angel's pancreatitis...could that have altered the Cushing's tests? My vet probably explained it to me before, but I'd like her to go over it one more time with me. And I guess I'll ask her if I should seek another opinion from an internist. I know she contacted one on her own...that may be enough.

I have not started Angel on the Trilostane. I hope I'm not hurting her by waiting. Her diarrhea is over, that was from the rich food I used to get her to eat the Chinese herbs...I had some left over and she goes crazy nuts for it...I indulged her a bit over the weekend...my bad. :(

And since I haven't talked to my vet today, I didn't get the Rx of prednisone.

Thank you for info on pancreatitis. I'll talk to my vet about that as well.

A waiting game....

[Harley PoMMom]

Thank you for your kind words. I'm in a bit of a holding pattern waiting for my vet to return my email about Angel's pancreatitis...could that have altered the Cushing's tests?


Non-adrenal illnesses, such as diabetes, pancreatitis, liver issues, etc and even severe stress can cause false positive results on the LDDS (low-dose dexamethasone suppression) test.

Although the ACTH stim test is less likely to yield a false positive result than the low dose dex test, the ACTH stimulation test may be abnormal in dogs with non-adrenal illnesses.

Cushing's can be difficult to diagnose, obvious clinical symptoms and a dog's history need to be taken in account along with the test results for Cushing's when trying to diagnose this dratted disease.

Hugs, Lori

[goldengirl88]

I would also be afraid of that pancreatitis causing a false positive. Lori is giving you good advise she is very knowledgeable about all this. I am sure you will get things worked out, it just may take a little while. Nothing to do with Cushings is ever quick! Blessings
Patti

[Nina]

Thank you for your support and advice on the correct questions to ask my vet! ;)
I spoke with my vet and she said on the tests there was evidence of pancreatitis, but she believes in was in the past. Angel has not had any symptoms of pancreatitis and the ultra sound didn't show any inflammation of the pancreas.
The vet then asked how Angel was doing. I replied that she has improved, much more perky and playful. She's not drinking/peeing as much nor panting as much. Not as crazy about her food either. Angel has been on the Denamarin for about 4 weeks. She said it takes about that long to take effect.
So, the vet suggested to see how Angel feels for the next few days, to see if she continues to feel better. Then on Monday bring her in again to check her liver levels...which I guess take a few days to get the results. She said Angel was on the low end of the Cushing's scale, that we caught it early.
I thought this seemed like a cautious way to proceed. I'm eager to hear any thoughts that you all may have on this. Did you feel 100% sure when your dogs were diagnosed? Could the Denamarin be doing it's job? Are you dogs on it? I understand it helps with the toxicity of the liver?
Am I silly to get my hopes up that maybe it's not Cushing's?? Maybe I don't want an answer to this questions. :(
Thank you again for all of your help. It's been so hard to have something not right with my little baby!

[molly muffin]

It's not silly at all to not want it to be cushings. Why would you! And no I don't think you are in denial. I think you are being cautious on how to proceed and making sure before you do anything.
It is the same thing that I would do, that I did do. You want to eliminate all other possibilities first. (we're still working on that btw :) )
We monitor my dogs liver values every 3 - 6 months or so, just to see how she is doing. It's a good way to gauge if something is going on that needs to be nipped in the bud early so to speak. So I'm behind you all the way. :)

Lets see what the next tests bring. :)

Sharlene and molly muffin

[goldengirl88]

I hope everything goes well at the vets, we will be looking for you to post results. Blessings
Patti

[Nina]

Thank you. Angel isn't as perky today and didn't eat her breakfast. Sigh. It's hard to know. Thank you for all of your help. I'll post her results. :)

[goldengirl88]

She is so cute, I hope she is having a better day today. Blessings
Patti

[Nina]

Hello again! Angel had more bloodwork yesterday. I just recieved the results.:( The results have gotten worse since April. My vet said we should start the Trilostane tomorrow and come back for another blood check in 2 weeks...3 hours after she takes the drug.

My vet sent me all the results, so let me know if you need more than the below...I can't seem to copy them on my ipad. Poor little doggy. I'm so sad.

ALP 454 5-160 U/L (267 April '14)
ALT 390 18-121 U/L (269 April '14)

Thank you for any advice. :(

[Harley PoMMom]

PLI: 463 (< 200)-- consistent with pancreatitis, if clinical recommend reevaluation in 2-3 weeks.



I spoke with my vet and she said on the tests there was evidence of pancreatitis, but she believes in was in the past.

Did Angel have the cPLI or spec cPL test done? The spec cPL test is more accurate in diagnosing pancreatitis, an excerpt from IDEXX Laboratories:
The Spec cPL® Test offers you more definitive diagnostic results. View a comparison chart (PDF) to see the difference between the Spec cPL Test and other diagnostic methods.

Originally developed as the cPLI test by Dr. Jörg Steiner and Dr. David Williams in the Gastrointestinal Laboratory at Texas A&M University, the Spec cPL Test offers:

•Unprecedented accuracy—With more than 95% specificity and sensitivity (as compared to the cPLI assay*), this test far outperforms other test methodologies, so you can treat confidently.
•Fast results—Tests are run daily so you can move ahead quickly with treatment.

*As compared to cPLI at the Gastrointestinal Laboratory of Texas A&M University



Spec cPL® Test ( https://www.idexx.com/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-cpl.html?SSOTOKEN=0)

[Nina]

Thank you for looking at Angel's results!
I don't know which test she had. I too noticed the line about the retest for pancreatitis.

I will ask my vet.

Do you think I should start the Trilostane tomorrow?

[molly muffin]

I don't know, you could wait to see if there is a result for the pancrease and then go from there. Don't like that ALT going up so quickly. That is a liver specific enzyme.

Not wanting to eat is not a cushings thing though so that worries me that she has days she isn't all that interested in food. Does this worry the vet at all? I'd ask about that.

Sometimes it's like trying to wade through a full blown mystery to try and figure out what is going on with our furbabies.

Sharlene and molly muffin

[Nina]

Thank you for your input Sharlene.
I did tell my vet that Angel is drinking and peeing a whole lot. She's had 2 accidents in the house in the past few days. I think that convinced the vet to tell me to start the Trilostane. I feel like I have been stalling this for a long time and I need to proceed with the Trilostane.
But, will we still be able to diagnose and maybe treat the pancreatitis if I start the treatment of Cushing's? What implications would there be if it's the wrong diagnosis?
My vet is convinced it's Cushing's. I wish I felt more sure. I agree with you Sharlene, this is a puzzle.

[molly muffin]

Find out if they rechecked for pancrease. You don't want to start trilostane if she is having pancreatic problems.

If they checked and results are all good, then you could feel better about starting trilostane.

Sharlene and molly muffin

[Nina]

No Sharlene, I don't see any results for a cPL or cPLi. I see glucose and cholesterol, AST and GGT and more.
I emailed my vet to ask which test she gave Angel...cPL or cPLI. She's been a good sport with all of my emails. Do you think I should ask her to test Angel again for pancreatitis? Is it an expensive test do you know? Is it a problem to keep delaying?
I really appreciate your help!

[molly muffin]

hmm, I don't know how expensive it is, I have never had one done. Lori might have an idea, but the best bet would be to call the vet office and ask your vet about what it would cost. She might have already had an indicator on the cbc though and decided not to do it? or did you ask her to do one?

I know, do you see lipase and or PLI on the test? *other test that could be indicative of how the pancrease is doing

I know the LDDS and the ACTH both are supportive of cushings. I just really like to know that the pancrease is okay before starting. It won't hurt to hold off a day or so till you hear back from the vet.

cushings really is slow progressing, so there is nothing wrong with being sure that things are good when you start her.

You're doing fine. I was just saying to someone else this is all a big learning process and it never ends, you are always learning something new.
Baby steps will win the day. :)

Sharlene and molly muffin

[goldengirl88]

Hope Angel is doing better, and that you get this mystery figured out. It takes time when so many issues are involved to sort through it all. You are doing a good job. I would call and ask how much the test is. Blessings
Patti

[Nina]

Hi! My vet was out today and didn't call me back. I've made an appointment for next Tuesday with an internist. I hate waiting so long to see this guy but he's out of town until Monday. Angel is starting to look uncomfortable to me. She's peeing a ton. Still soft stools about every other time. He belly looks big to me. Panting more. I'll see what my vet says tomorrow when she returns. I have not started the Trilostane. I want to find out more about the pancreatitis. The way I understand it, I should have her tested for it again you think? And i'll make sure it's the cPLi test. I've spent too much time waiting for return phone calls from my vet. I'm really getting concerned. Thanks for all of your good advice!!

[goldengirl88]

If it were my dog I would want to make sure about the pancreatitis.

[Harley PoMMom]

No Sharlene, I don't see any results for a cPL or cPLi. I see glucose and cholesterol, AST and GGT and more.
I emailed my vet to ask which test she gave Angel...cPL or cPLI. She's been a good sport with all of my emails. Do you think I should ask her to test Angel again for pancreatitis? Is it an expensive test do you know? Is it a problem to keep delaying?
I really appreciate your help!

The test I chose for pancreatitis is the spec cPL which is sent to IDEXX, not the cPLI which is sent the Gastrointestinal Laboratory at Texas A&M.

Dr Jörg M. Steiner helped develop both the spec PL and the cPLI tests, the main differences between them is the waiting time for the results and accuracy. When sent to IDEXX you get the results back in a couple days, with Texas A&M it may take up to a week for the results. Also the spec cPL test has a higher specificity and sensitivity than the cPLI test.

When I had the spec cPL test done for my boy, Harley, it ran around $85...IMO not too bad of a price.

Hugs, Lori

[Harley PoMMom]

I just now received the below from my vet. I hope it's the information you are looking for.
PLI: 463 (< 200)-- consistent with pancreatitis, if clinical recommend reevaluation in 2-3 weeks.

PLI, which I underlined, is a test for pancreatitis, the small c, as cPLI, is an abbreviation for canine. ;)


Do you think I should ask her to test Angel again for pancreatitis? Is it an expensive test do you know? Is it a problem to keep delaying?
I really appreciate your help!

I would absolutely have the pancreatitis rechecked, however; one should do that 2-3 weeks after they have made some changes for the pancreatitis, such as switching to a low-fat diet, feeding 3-4 small meals throughout the day etc.

Hugs, Lori

[Nina]

Thank you for input. cPL I've got it.

I woke up this morning to Angel vomiting. She didn't eat breakfast. But seemed Ok the rest of the day. My vet called me back at 3....it was a long day of worrying. My vet prescribed metronidazole 500mg twice a day. She instructed me to buy #2 baby food, chicken and sweet potatoes. Also 5mg of Pepcid. Angel gobbled it all down for dinner. Vet said it would could take 3-4 days to get her back to baseline....then we would do the cPL test. She has not instructed me to feed her low fat or 3-4 times a day. I think my vet believes that the pancreatitis was in the past.
I have an appointment with an internist on Tuesday. I didn't tell my vet that yet.
I asked my vet if the Cushing's test could be skewed by the pancreatitis, she said it could but Angel has the symptoms...drinking tons of water, peeing a lot. So she believes it's Cushing's.
I hope I explained this so it makes sense. The vet did say that something is irritating Angel's guts and we need to get her back to normal before anything else. She told me not to give her the Trilostane.
Thank you for your help. I think my vet is starting to get exasperated a bit with me....I can't say I blame her. Seeing the internist might be a good thing for all of us. It might clear the air a little.

[addy]

I really think you made a good call by making an appointment to see a specialist.

I also think you are wise not to start Vetoryl so I am glad your vet made a good call.

All of this is a process. We are here for you.

[goldengirl88]

I think you made a super smart move going to the specialist, and I am hoping all gets worked out for Angel. Blessings
Patti

[Nina]

Thanks for your support! Today for the first time I'm going to make some chicken soup! A little chicken, potatoes and sweet potatoes for Angel to settle her stomach. :) I stopped the melatonin thinking that could be upsetting her stomach. I'm also wondering if the Denamarin could be causing stomach upset.
I wish I could invite you all and pups over for some nourishing soup! :)

[Harley PoMMom]

I believe seeking a second opinion from an IMS is a really good move on your part.

When pepcid started bothering my Harley's tummy I switched him to slippery elm bark (SEB). It is a wonderful herb! The one important thing is Slippery Elm may interfere with absorption of some medications, so it is advised to give SEB a couple hours before/after any medications.

Here's an article with info regarding SEB: Slippery Elm (http://www.littlebigcat.com/health/slippery-elm/)

Hugs, Lori

[goldengirl88]

I have used the SEB for Tipper and it worked very well. You have to steep it and make a tea out of it.

[Nina]

K9Cushings.com THANK YOU, thank you, thank you!!:)
Yesterday Angel and I saw the internist. The first thing he said when he came into the room after examining Angel and reading her test results, was it's not clear that this dog has Cushings. She's healthy, young, no hair loss, firm abs, etc. He went on to explain many different things which I am unable to recite. But the bottom line was that if this was his dog, he would treat her for Irritable Bowl Syndrome first. Stay on the Metronidazole and add Baytril 22.7 mg. Come back in 2 weeks and we'll check her numbers again. If it improves we'll continue with the Baytril for 4 more weeks, diet etc. If no improvement, we may be back where we started, but let's rule this out first. He said you do not want to treat for Cushing's unless you are absolutely positive. And yes he said, it's a good thing that I didn't start with the Trilostane. This is where I THANK all of you. My vet told me to go ahead and start it a few times, but you guys put enough doubt in my head to pursue a second opinion. I wasn't satisfied . Who knows, Angel may end up with a Cushing's diagnosis, but at least I'll know that we followed up on every lead. This will give me the confidence to move forward in treating her.

Yesterday I was so upset before the appointment. I was so confused. I felt that because I wasn't giving her the Trilostane I was hurting her. She vomited every day waiting to see the internist. I was so nervous. Thank you for all of your good advice. When the Internist was talking yesterday I actually understood much of what he was saying and could follow he line of thinking....thank you for the help in educating me about Cushing's and Pancreatitis.

He said the antibiotics may upset her stomach as well. She did throw up last night. He told me to stick with the pepcid for now...let's stay with western meds for the time being...he was referring to the slippery elm. I've made her more chicken and potatoes and sweet potatoes.
He said if it turns out to be Irritable Bowl Syndrome, that's no walk in the park either, but preferable to Cushing's. He said many little dogs get IBS, in fact he said much of what he sees in dogs is GI problems. I am crossing my fingers that Angel improves. I love my little dog.
I am very grateful for you assistance! :)

[goldengirl88]

So great to hear this news. I hope her IBS gets taken care of and she improves. Antibiotics can make their stomachs upset. I am equally happy that you did not give the trilostane! Blessings
Patti

[molly muffin]

This is really wonderful news! :) Knowledge is such a good thing eh. You'll see, you'll be a pro in IBD in no time, right along with cushings, just because the possibility is there, except now you have to time to learn more, just in case it ever becomes an issue and I hope you never hear that word again. :)

We couldn't be more pleased, but... don't think you get to go running off now. :) LOL Once here, we just call you family. So, we'll want to know how she is doing on the meds and how she and you are getting on. :)

hugs, a really good day for you both,
Sharlene and molly muffin

[jxeno13]

Hi Nina! I'm so happy that you didn't start the Vetoryl with Angel, and went to an IMS. I work with both now myself. Actually, at my own Vet's suggestion. He was so worried that he was "missing something". I just wish he had been there the day Eli got sick. My IMS only takes referrals. But, we all work together now. :) Eli started back on his Vetoryl today, at 10mg. Low and slow. :D

I'm glad your new Vet doesn't think Angel has Cushing's at all! That is great news. Although, IBS can't be fun either. Usually when Eli is any anti-biotic, the Vet also gives him something for his stomach and he does just fine.

And, as Sharlene already pointed out.....don't get any funny ideas about running off.......that's not allowed. We'll always want to know how you and Angel are doing. :)

[addy]

Not sure if I posted this to you but My Zoe had inflammatory bowel disease which we spent a year getting under control before we started her Cushing's meds.

I think your IMS gave you good advice!:)

[Nina]

Oh yes, I'll stay in touch. I hope Angel's results look better in 2 weeks. Time will tell. I hope all of your dogs are doing Ok. :)

[jxeno13]

Please do, Nina! I'm so happy for Angel that at least she didn't have Cushing's. Eli is back on Vetoryl, only 10mg this time. Today is day 3....so far so good! :D Good luck with her IBS. I know that will be a struggle for you both as well. Keep in touch and let us know how she is doing. :D

[goldengirl88]

Nina:
Please do stick around and let us know how Angel is doing. Blessings
Patti

[molly muffin]

How is Angel doing? Things starting to sort out with her? That IBD can be a real bugger to get a handle on.

hugs
Sharlene and molly muffin

[goldengirl88]

You are so blessed that Angel did not have Cushings. I would give anything to hear a vet say that to me. Let us know how she does with her other issues. Blessings
Patti

[Nina]

Hi! Sorry to not respond earlier, I was traveling. Angel seems so much better after a few days on antibiotics for IBD...or maybe it's the chicken soup I've been making for her. :) She's not drinking as much water or peeing as much. She's very peppy, barking at everything, including the wind. Her stool is for the most part firm. She seems like her old self. I'm trying not to get my hopes up too much.
We go back for tests this coming Tuesday. I read on an earlier post from Addy that it took a year to control the IBD, then started treatment for Cushings. Addy, could you fill in a few details? How does that work? Did Zoe have Cushings all along?
Sad around here, my good friends, whom have been so supportive of Angel and I, their sweet dog was diagnosed with cancer and they put him down yesterday. All happened in 24 hours. They have been so good about checking on Angel and then their dog gets sick. It's so hard to lose a pet.
Thanks for all of your help and support!

[goldengirl88]

So glad to hear your sweet Angel is making progress. I hope you can get that IBD under control and that will help her feel better I am sure. Sorry to hear about your friends dog, they have you to lean on for comfort now so please be their rock. Blessings
Patti

[jxeno13]

Hi Nina! I'm really glad to hear that Angel is back all perky again. I hope you can get a permanent handle on her IBS. I'm so sorry to hear about your friend's dog. It is truly hard on losing a family member...I hate saying "pet". :) They're so much like little kids that can't talk.

I hope you are doing OK too!

[goldengirl88]

Nina:
Just checking in on Angel. How is she doing? Hope you are both ok. Blessings
Patti

[Nina]

Hi All,
As you may remember I took Angel to an Internist. He prescribed 2 weeks of Baytril. Last night they called me with the new test results: Normalized liver enzymes with the ALKP and ALT at 100 u/l and 72 u/l respectively. Previously evevated @ 454 u/l and 390 u/l on 6/2/14. 4 more weeks of Baytril.
The assistant told me they beleive Angel had/has a liver infection and not Cushing's. Yay. Of course, I'm not sure what the liver infection is all about. I see the Internist in 3 weeks for a follow up. Sounds like it's curable.
Again, thank you so much for all of your good advice. If I had listened to my regular vet Angel would be in her second month of Trilostine. Hmmm. That's amazing.
Thank you , thank you , thank you!!! I have been singing your praises!!!!
Nina :)

[goldengirl88]

Nina:
I am so glad you did not listen to that vet and followed the wisdom of this forum. That would be a horrible error giving a dog that does not have Cushings these strong meds. I am so glad for you and Angel that things are working out and I hope she is fine in no time. Blessings
Patti