Jed (9 y/o Male Vizsla) - Cyberknife for pituitary macrotumor (Jed has passed)

[Jed's Mom]

I have an 8 year old Male Vizsla named Jed. Since Jed turned 5, I take him for annual blood work to check his levels. Jed's blood work was always normal until September 2013. Results showed elevated Liver levels. His ALT(SGPT) level was 134 and his Alk Phosphatase was elevated at 280. His Cholesterol was also elevated at 328 and Triglycerides were 643. Also his Lyphocytes were somewhat low at 660. My Dr recommended taking Jed for an ultrasound. The Ultrasound didn't show anything on the liver but showed a nodule on his spleen and both Adrenal Glands were enlarged. I was sent home with milk thistle and was told that it could be early Cushings.

6 months later, April 2014, I had Jed's blood work done again. He was now showing signs of Cushings..excessive thirst, urination and ravenous appetite, especially at night time. Now his ALT(SGPT) level was 220 and his Alk Phosphatase was elevated at 1532! His Cholesterol also went up to 486 a Triglycerides were normal but other levels were elevated and his Lyphocytes were much lower at 384.

My vet believes that Jed is going down the road to being diagnosed with Cushings but says that the next step would be the low dose dex test. We talked about Cushings diagnoses and what that meant and medication and other options. The way she described treatment and side effects and how if we treated him for cushings and he did not have cushings or if we treated him with the wrong levels we could make things worse scared me enough to look into other options...

I have been taking Jed to a Holistic vet for the past 3 yrs or so. I started when he pulled a muscle and I didn't want to put him on pain meds/muscle relaxers...They have upset his stomach in the past. Jed responds well to Chinese treatment and herbs so I felt like I wanted to investigate this avenue for treating his Cushings..if it is Cushings. Has anyone else decided to go this route? At the advice of my Holistic Vet I have changed Jed's' diet. He no longer gets kibble and eats mainly wet,rolled and home cooked. In two months of changing his diet, Jed went from 63lbs to down to 54 but he is now back up to 57lbs. I thought Cushings dogs were suppose to gain weight? In addition to the excessive thirst, Jed has started to shake or Tremor. He has always done this when afraid but now I see him doing it when he is just sitting or laying down. My Holistic Vet says this is a sign of liver deficiency. And his appetite has gone way down. He no longer wants to eat everything but just a few specific things.

I took Jed back to the vet again yesterday for more blood work and I am awaiting the results. I joined this site for some advice and guidance. This is my 1st dog and my 1st experience with Cushings. I don't even know for 100% if it is Cushings but the test results are surely pointing to it. And if not Cushings , what else can it be?

Thanks!
Lisa Z

[Harley PoMMom]

Hi Lisa,

Welcome to you and Jed, I am glad you found us and we will help in anyway we can.

Those values you listed (ALT, ALP...etc) could you edit your post and add the reference ranges along with the units of measurement...as an example; ALT 150 U/L (5-50)...thanks! I take it that diabetes has been ruled out, right? Was an urinalysis done, and if so, could you post those findings?

Dogs with Cushing's generally have a ravenous appetite, they're like hoover vacuums hovering to get any crumb they can, they also pee rivers and drink buckets and buckets of water, Since Jed has lost his appetite I am questioning whether he has Cushing's. Liver issues can cause an increase in a dog's drinking/urinating and can cause inappetence. Has the vet mentioned getting a bile acid test done to see how the liver is functioning? Any chronic illness can cause the adrenals to become enlarged so a Cushing's diagnosis should not be made because of enlarged adrenal glands and elevated liver enzymes.

When a dog has Cushing's their body is producing excessive amounts of cortisol. The two most prescribed medications for Cushing's are Trilostane/Vetoryl and Mitotane/Lysodren. These medications lower the amount of cortisol a dog's system can make. I know of no other holistic herbs that can lower cortisol to the therapeutic ranges that are needed.

After you receive the results of the most recent test/s that were done could you post them for us...thanks! Is Jed taking any other herbs/medications/supplements?

Please know we are here for you both and if you have any questions, do ask them, ok? ;)

Hugs, Lori

[Jed's Mom]

Lori, Thanks for replying! I am looking for experienced help/advice and I know I will find it here.

We did a urinalysis back in April and hey said the results also pointed towards Cushings. I don't know the right questions to ask. :(

I brought Jed back to the vet again yesterday because he used to have a ravenous appetite but that has changed in the past couple of weeks along with the tremors I mentioned. His liver levels have gone down but they are still high. But my vet is more concerned about his white blood cell count, it is low. She asked if Jed has had a tick recently and he did about two weeks ago. We are going to do a Lyme test in a next few weeks..the one we did two weeks ago was negative. But I think that would explain his sluggish mood and lack of hunger/energy.

I dropped off another urine sample so when I get those results I will post here. Jed's thyroid is also low. I think normal is between 2-4 and Jed's is .6.

Jed is on a few herbs, Rehmannia and Da Bu Yin are the main ones. Also probiotics and vitamins .

No one has ever mentioned diabetes to me...

Thanks again! I should have his blood work and urine results back on Monday.

-Lisa

[Harley PoMMom]

When my vet does a wellness blood panel on my furbabies they also have an urinalysis done. On the urinalysis report the urine specific gravity (USG), PH, color, and other various levels are looked at. Most dogs with Cushing's have diluted urine, which means that their USG is low.

Another urine test that can be used as a screening test for Cushing's is the UC:CR (urine cortisol to creatinine ratio). If the UC:CR result is negative, more than likely the dog does not have Cushing's disease and other illnesses need to be looked into.

We are interested in any test results that were done on Jed, the more recent the better, and as I mentioned we need only the abnormal values, usually these values are marked high (H) or low (L).

Please do ask all the questions you want, and here's a link to our Resource thread as it has a wealth of information regarding Cushing's: Helpful Resources for Owners of Cushing's Dogs (http://www.k9cushings.com/forum/forumdisplay.php?f=10)

Hugs, Lori

[goldengirl88]

Welcome to you and Jed. I am wondering what the herbs are given for?

[Jed's Mom]

The supplements Jed takes is holistic approach to treating Cushings. Although Jed has not been diagnosed 100%, both Vets feel that it is Cushings. I know there is no one test to diagnose so I am continuing down the road to diagnose and treat. My vet is not against using western medicine drugs but we are seeing if we can control symptoms in a natural way.

Jed is not from good breeding and he has had his share of issues. I did not want a Vizsla. I didn't even know anything about the breed... but I found Jed in a puppy mill type place and at 11 weeks he was afraid of everyone and everything. He screamed when I picked him up and ran away..what pup does that at 11 weeks old?! I was not going to leave him there so I call Jed my $1300 rescue :)

I am just trying to do what is best for Jed to have the best quality of life. I know there is no cure for Cushings but if I can control his symptoms and he is happy that is all I care about.

Thanks for any comments and support. This website is wonderful!
♥♥♥

[Jed's Mom]

Is there a way I can attach or cut and paste in this thread?

Thanks
Lisa

[lulusmom]

Is there a way I can attach or cut and paste in this thread?

Yes, you can do both. You can cut or copy text from any document and paste it into your post. To attach a document or photo, at the top of the dialogue box you will see a paper clip icon. Click on that and it will open a "Manage Attachment" box. At the top, the first option is to upload from your computer and directly below that you can choose to upload from a URL. Under those boxes, you will see a list of the types and sizes of files that can be attached. Once you choose the file, click on upload. If successful, another box will appear that says current attachments and shows the file that was attached.

Glynda

[Harley PoMMom]

Hi Lisa,

Oh my poor sweet Jed, I am thankful that he has found such a loving Mom, Bless you for giving Jed a forever home.

The medications that are used for canine Cushing's are not a cure, they are used to control the symptoms that are attributed to Cushing's. However; the excessive amounts of cortisol that a cushdog produces will eventually harm the internal organs.

Your love and devotion for Jed is obvious and I believe he is getting the best of care from his wonderful Mom.

hugs, Lori

[Jed's Mom]

Thanks Glynda. I must be missing the paperclip somehow..lol. I will figure it out. Its easier for me to attach Jed's results then try and type them all out.

[Harley PoMMom]

You will see the "paper clip" when you click on the "post reply" button, I've attached a pic of it.

[Jed's Mom]

I have every icon on top except for the paperclip. I can insert an image or a link but I see nothing to be able to attach a document. Maybe Junior members don't have that right ;) Is there an email I can send it to and one of the admins can post it for me?

Jed woke me again this morning with his tremors and he still will not eat dog food but waits for me to cook for him or stalks the cat food. He is still drinking gallons of water. He used to eat anything and everything. Does anyone have any good ideas for what I can try for a balanced wet food? I don't know if I should give him raw if he does have Lyme. Any thoughts?

Thanks
Lisa

[molly muffin]

Try this instead.

Once you have clicked on the Reply icon, opt to "Go Advanced"
you will see the options then right under the box you reply in.

Let me know if that works for you

Sharlene and molly muffin

[Jed's Mom]

ok... now I am getting really frustrated..lol. I don't see a "go advanced" option either. I could have typed out Jeds' results 100 times over by now but I am determined to figure this out..lol. I even work in IT, which makes this all the more annoying. :confused: Thanks for the suggestions/help :)

[Jed's Mom]

Ahh, I found the advanced options when I go into quick reply, but that does not have a paperclip/attachment option. only have the options to insert link, insert image or insert email link.

I even went in to upload it to an album but I don't see how I can even upload any pictures. Maybe I should recreate my account? I have tried a few different browsers as well. :(

[molly muffin]

Okay, all you can upload to an album is a jpeg, so if you to change it to jpeg, you can do so online, if your computer won't do it.

You don't need to recreate account. Okay, if you want to type out, then only the abnormal High/Low need to be typed. For example ALKP 550ug (range 5 - 50ug)

To upload a picture, first go to top left corner of page, you'll see "USER CP". On the left hand panel you'll see a link to "Pictures & Albums" click that. At the bottom of that page, you'll see "Add Album" click that. Name your album (make it public, or no one can see it except you) and then once it is created, you'll see "Add Pictures" and you can add up to 3 at a time by browsing on your computer to the file. (remember, only pictures, jpegs, gif, tiff, etc can be added to an album, docs/pdf's cannot)

Lets try that.
If you need to convert something to jpeg online, then I use http://extract.smallpdf.com/

Sharlene and molly muffin

[Harley PoMMom]

Does anyone have any good ideas for what I can try for a balanced wet food? I don't know if I should give him raw if he does have Lyme. Any thoughts?

Thanks
Lisa

Merrick makes a good quality canned food with lots of variety, here's their link: Our Products > Dog (http://www.merrickpetcare.com/consumer/products/list.jsp?cat1=6&cat2=7&categories=Dog-Classic-Recipes) You'll need to scroll down to see the canned food.

Primal is another good dog food, Primal is considered as Raw. www.primalpetfoods.com/

Primal is what I was feeding my boy, Sampson, but for some reason he grew tired of it and he is now eating Stella & Chewy's - Stella's Super Beef Freeze-Dried Dinner which he loves.

Also here is a link to an article on the dogaware site with a list of foods to tempt a picky eater: Foods to tempt your dog (http://dogaware.com/articles/wdjinappetence.html#tempt)

Hugs, Lori

http://www.stellaandchewys.com/dog-driedbeef.php

[Jed's Mom]

Thanks Sharlene! :D That worked although the picture is kind of small, but I think its readable.

Thanks for the food advice, Lori. I have fed Merrick in the past. I will give it a try. I found another tick in Jed's neck today :( No more trail runs for my boys! The ticks are relentless this year. I'm hoping that had something to do with the last few days. He seems a lot more interested in food and a bit more active.

Let me know if the jpeg is unreadable and I will enter in the values.

[labblab]

Just wanted to let everyone know that currently, due to site security concerns, I think only staffers have the ability to upload attachments other than jpeg images to the site. So you are not crazy nor being singled out if you don't see a paperclip. :o

[Jed's Mom]

Thanks! I will get Jed's latest blood work results today and post the abnormal numbers. I did upload his last blood work results from April in my photo album, although it is hard to read.

[molly muffin]

I'm going to go ahead and post the abnormal values on the blood work.
This way too you'll see how to post them yourself and it is much easier and guarantees that everyone sees them, as not all check the album for results.

04/04/2014

ALT 220ug (12 - 118)
ALKP 1532ug (5 - 131)
Cholesterol 486mg (92 - 324)
Amylase 1294u/l (290 - 1125)
Lipase 2925u/l (77 695) Result verified
Differential Absolute
Lymphocytes 384/u; (? not sure what the first number is - 4500) LOW

low .6 (.8 - 3.5) ug

Urinalysis
Specific gravity 1.010 Low (1.015 - 1.030?)
ph 7.5 high (5.5 - 7.0)
protein +1 Neg

Looking at this result the first thing that just leeps off the page is pancreatisis
The lipase and the amylase are both high and these kinds of highs will cause the liver enzymes to go up too. He might need some pain medication as it can be quite painful and explains the not eating. He should have several small meals throughout the day, of simple boiled chicken and rice to a mush consistency.
Did your vet not mention these values to you and what they would likely mean?

Sharlene and molly muffin

[Jed's Mom]

Hi Sharlene and Thank You. I will post his blood work results from last week the same way and it will be nice to have something to compare to.

No, my vet never mentioned pancreatisis. We only discussed his high liver levels, and low thyroid. This blood work was from back in April and until 2 weeks ago, Jed never showed any signs of pain. He has always eaten 3 small meals a day, no diarrhea or sickness. His blood work from back in September show normal levels:

Amylase 690/l (290 - 1125)
Lipase 511u/l (77 695)

I am going to call my Holistic Vet today to get the new blood work results faxed to me and if these numbers are still increased. I think everyone is just focused on diagnosing Cushings that maybe they just missed this?? I hope not.

Since I pulled the tick off of Jed and started giving him White Mushrooms (Cordyceps) Jed has really turned it around. He ate most of his food yesterday and was playful and running around chasing bunnies and squirrels. :) He got me out of bed at 5am for breakfast (and a gallon of water).

Thank you again for your help, you are awesome! I will post Jed's newest results ASAP!

I also set up an appointment for Monday to do the low dose dex test.

-Lisa and Jed

[goldengirl88]

Hello and welcome from me too. I am on the pancreatitis wagon too with those values. Does he seem to be arching his back at all or having abdominal distress when touched? I would definitely be looking at it cause it can get bad and be very painful. Blessings
Patti

[Jed's Mom]

Jed really does not show signs of any pain at all and I give him a massage every morning and touch every inch of him. He goes on long runs on the weekends and plays with many dogs at daycare everyday. He also has a 3 year old Vizsla brother who is not always the most gentle;) Jed rarely yells at him. I am anxious to see his newest results to see if these values are still elevated. I'm glad you caught them and brought them to my attention. Blood work is being faxed soon.

[goldengirl88]

My Tipper is like that too though, she never shows any sign of pain if something is bothering her. She is very stoic and that has been good as she has been through a lot. Blessings
Patti

[Jed's Mom]

I got Jed's latest blood work results. It was done by a different vet so the naming is different but I will port the abnormal results here:

05/29/2014
HealthCheck Plus - Chem 25

ALP - 1006 Ref Range 5-150 U/L (High)
Albumin - 2.6 Ref Range 2.7-3.9 g/dl (Low)
Bun - 8 Ref Range 9-31 mg/dL (Low)
Gluclose - 147 Ref Range 63-114 mg/dL (High)
Calcium 8.6 Ref Range 8.8-11.2 mg/dL (Low)
WBC 4.3 Ref Range 4.9-17.6 K/uL (Low)
Lymphocyte 151 Ref Range 1060-4950 /uL (LOW)
Eosinophil 69 Ref Range 70-1490 (Low)

We think his white blood cells are down due to possible Lymes. He will be tested again in a couple of weeks.

Low Dose Dex test is stet up for Monday the 16th.

[molly muffin]

hmm, and now I notice on this one that the Glucose is up, not where we want it to be at all. Did the vet talk to you about that? Diabetes?

Although some values are down, like the ALP.

Need to investigate those WBC, so good you are going to discuss that and investigate further with vet.

Sharlene and molly muffin

[Jed's Mom]

I'm with you Sharlene. I'm not convinced its Cushings. Other than the excessive thirst I dont see any of the other symptoms and he has gotten so thin..everyone is commenting on it. I am feeding him more now than I have been in the past but we switched from kibble to wet. Not sure that wold cause him to lose the weight as fast as he did..

[labblab]

Was Jed fasted before this blood draw? Especially if so, Sharlene is right to be worried about that high glucose level. Diabetes would definitely account for both the thirst and weight loss, and I would ask my vet about that ASAP if I were you.

Marianne

[Jed's Mom]

No, no fasting before any of Jed's blood work. Can that skew the numbers that much?

Thanks
Lisa

[molly muffin]

Yes food can skewer glucose results for sure, but I don' t know if that much. I would say I want a fasting glucose draw to confirm that number.

Sharlene and molly muffin

[goldengirl88]

Sharlene is so right with this glucose. I would be checking into that to if it were my dog. Blessings
Patti

[Jed's Mom]

I called today and spoke to the vet. When I bring him in for his all day test we will look and see if his glucose is still elevated but she said that there was no glucose in last urinalyses and she said that she would expect that number to be higher if it was diabetes. His next test is not until the 23rd.

[lulusmom]

I have just read your thread and would like to comment on the some of the lab abnormalities, which I have cut and pasted below. My comments are in blue text. I am not a vet professional, just a cushmom and special needs rescuer who has studied a lot of labs over the years.


4/4/2014 ALT 220ug (12 - 118) 5/29/2014 Normal
Not all dogs with cushing's will have a mild increase in ALT so it's possible that something else was going in April that caused this abnormality. If the sole cause of this elevation of Alt in April was due to cushing's, it would be very unusual to see the liver enzyme return to normal in May without treatment. Even with treatment you may not see this return to normal. With Amylase and Lipase being elevated at 4/4/2014, an inflamed pancreas could have caused this abnormality. Lyme Disease can cause increase in liver enzymes but I don't believe the ALT would normalize without treatment.

4/4/2014 ALKP 1532ug (5 - 131) 5/29/2014 1006
Again, if this abnormality in April was caused solely by Cushing's, you would not see this kind of decrease in May. It is possible that an inflamed pancreas could have been contributing to the higher elevation in April as could Lyme Disease.

4/4/2014 Albumin - Normal (2.7 -3.9) 5/29/2014 2.6
This would be considered a mild decrease and the list of causes is long, including inflammatory bowel disease, pancreatitis, Lyme Disease.

4/4/2014 Bun - Normal (9-31) mg/dL 5/29/2014 8
Any condition that causes a dog to drink and pee more can cause low BUN. The list is long but a few suspects would be cushing's, diabetes, and Lyme Disease. Intestinal disease or anything else that is pummeling the liver can also cause this abnormality.

4/4/2014 Cholesterol 486mg (92 - 324) 5/29/2014 Normal
We often see elevated cholesterol in cushdogs but since cholesterol normalized by the end of May, one has to question whether cushing's was the culprit in April. A sick pancreas would be a more likely cause.

Glucose - 4/4/2014 Normal (63-114) 5/29/2014 147 mg/dl
Aside from diabetes, other issues can spike blood glucose, including cushing's and a recent meal. Dogs with diabetes have sustained high glucose so since it was normal in April, I am more inclined to think that something else, other than diabetes was going on when the May labs were done. I agree with others that follow up labs be done with a fasted blood sample. If glucose remains high or has gone higher, then I would start to worry about diabetes. If you are nervous about it, you can have the vet do a quick in-house test.

4/4/2014 Amylase 1294u/l (290 - 1125) 5/29/2014 Normal
4/4/2014 Lipase 2925u/l (77 - 695) 5/29/2014 Normal
The elevation in both of these enzymes would indicate something was going on in April that appears to have resolved by the end of May. It should be noted that Lyme Disease can also cause elevations in these enzymes but not sure whether they would it would cause a fourfold increase.

4/4/2014 Calcium Normal (8.8 - 11.2) 5/29/2014 8.6
Any condition that lowers Albumin with also lower calcium. Address what's causing the drop in Albumin and calcium will normalize.

4/4/2014 Lymphocytes 384/ul (1060 - 4500) 5/29/2014 151ul
4/4/2014 Eosinophil Normal (70-1490) 5/29/2014 69
Both Cushings and Lyme Disease can cause these low values which is referred to as a stress leukogram.

T4 .6 (.8 - 3.5) ug
Dogs with cushing's frequently have low T4 that will normalize with treatment; however, many other conditions can also interfere with thyroid hormone production causing low T4. All possible causes should be addressed and T4 rechecked.

4/4/2014 Urinalysis
Specific gravity 1.010 Low (1.015 - 1.030?)
ph 7.5 high (5.5 - 7.0)
protein +1 Neg
Any number of conditions can cause low USG and +1 protein, including cushing's, Lyme Disease and diabetes. .

If it were my dog, I would want to sit down with the vet and go through the lab abnormalities. I would want to rule out absolutely everything, and most certainly Lyme Disease, before doing any tests for cushing's. Has your vet tested for Lyme Disease? Did he/she put our pup on treatment for Lyme Disease?

I look forward to getting more information.

Glynda

[Jed's Mom]

Hi Glynda and thank you for taking the time to look through and help analyze Jed's results. Jed did have a Lyme test about 4 weeks ago and it was negative but since that test Jed was showing signs of Lyme (weak joints, not eating, lethargic). That is why we did the May blood work and it showed low white blood cells. We started Jed on Cordyceps to help boost his immune and we will be retesting for Lyme. Jed has bounced back to his normal self as far as energy level and appetite but he is still hitting the water bowl hard.

Do all Cushpups want to eat all day and anything? Jed could care less about food in the morning and as the day goes on he gets hungrier but at night time he is ravenous.

Thanks!
Lisa

[Harley PoMMom]

Do all Cushpups want to eat all day and anything? Jed could care less about food in the morning and as the day goes on he gets hungrier but at night time he is ravenous.

Thanks!
Lisa

The norm is that dogs with Cushing's have ravenous appetites and counter surf for any morsel, however; all dogs are different and it could be that Jed's cortisol may increase more at night thus boosting his night time appetite.

[Jed's Mom]

Jed went for his low dose dex test yesterday. The poor thing got sick when they administered the dexamethasone but he was a trooper through it all. I also asked for another blood test to check his white blood cell count and a Lyme test. I asked the Vet to review Jeds last 3-4 blood tests so we can review them all together when the results of the blood work and low dose dex test are back, probably by end of week.

Still the only sign Jed is showing is the increased drinking and he lost another 2lbs, about 10lbs total lost since last September. His energy level is great, and he has a good appetite but just continues to lose weight. I asked about this and how most dogs with Cushings gain weight but they said every dog is different and some Cushings dogs can lose weight.

I will post results here when I get them. Cushings or no cushings I am ready for a diagnosis already...

-Lisa and Jed

[goldengirl88]

That's too bad, I am so sorry Jed got sick at his test. What did the vet do? I hope he is ok today? Sometimes this is so hard, and you feel so bad making them go thru this testing etc., but it is the only way to find things out in the long run. Blessings
Patti

[Jed's Mom]

Thanks, the vet tech tried to administer the medicine as slow as she could but he is a sensitive dog to begin with. Then with and empty belly and he was nervous and the meds..:( I was there with him for the 3 visits and he really was a trooper and the vet techs are so good with him. I was the weak one, I was in tears watching him go though it :( Jed will be 9 on Friday and I pray for many more HEALTHY years with him.

I just got off the phone with the vet and Jed tested positive for 2 tick born diseases, but not Lyme. One is Ehrlichia and the other is Anaplasmosis. I am going to pick him up some antibiotics today. I started treating Jed about a month ago with white mushrooms (cordyceps) and they seemed to have really helped. His white blood cells are in the normal range again but I still think I should do the antibiotic.

I'm hoping to get the low dose dex results by end of week but the tick diseases could be what was causing his weight loss, lack of appetite, and his stiffness.

[goldengirl88]

Oh I am so sorry to hear about those terrible tick illnesses, luckily there is medication to help. I know how you feel about your dog going thru all this, it is hard, but there is no other way. I know how stressed my Tipper had been at times for different things that have been done. It is much like watching your child. If you get too upset maybe it would be best to not go in and watch as they can pick up your anxiety and get more stressed. I hold everything in until I am away from Tipper and then it comes out. I just go in with her and talk normal to her like it is not a big deal, even though I am ready to vomit sometimes. You will get it worked out soon. With the different things going on try to tackle one at a time as with too many they become overwhelming. My dog has many issues also so I try to knock them out one by one. It's seems easier chipping away at the mountain than trying to move the whole thing! It will be ok and you will get thru this. Blessings
I thought of something I wanted to mention, I do not know what antibiotics they use for these tick diseases, but be careful if they are Aminoglycosides as they can cause deafness, maybe you could discuss this with the vet?
Patti

[Harley PoMMom]

I just got off the phone with the vet and Jed tested positive for 2 tick born diseases, but not Lyme. One is Ehrlichia and the other is Anaplasmosis. I am going to pick him up some antibiotics today.

I'm hoping to get the low dose dex results by end of week but the tick diseases could be what was causing his weight loss, lack of appetite, and his stiffness.

Not only can those tick diseases cause ill effects but they may also cause a false positive result from the LDDS test. If those LDDS results are positive I don't know how much faith I would have that those results are correct.

Hugs, Lori

[goldengirl88]

How is Jed and were you able to talk to the vet about the antibiotics? How long does it take to get rid of those tick illnesses and what symptoms doe they cause in a dog I am curious, becuae could it be symptoms mimicking Cushings? Yes please ask about the LDDS test as that number can be skewed by this tick problem. Any non adrenal illness during that test can skew the numbers and give false positives. Blessings
Patti

[Jed's Mom]

Thank you all so much for your replies, I definitely will ask about how it can skew the results. But with that said, before Jed had the tick and started showing signs of "Lyme", I was convinced he had Cushings. He was eating anything and everything, and drinking/peeing a ton.

I don't know much about the low dose dex test but could those results also be skewed? It is my fear that we start treating Jed for Cushings and he does not really have it and then I make things worse.

The antibiotic they are putting Jed on is doxycycline. I believe this is the normal antibiotic that is given for Lyme. I pick it up later from the pharmacy so I will ask there as well about side affects. I will also do some online research.

Thanks!
Lisa and Jed

[goldengirl88]

Lisa:
Yes you are right it can make a dog really sick to get these meds if they do not have Cushings.You need make sure to feed Jed with the Vetoryl and a tiny amount of fat as it is fat soluble, if and I do mean if ,Jed does have Cushings. I would be really skeptical since the LDDS could have been skewed. Blessings
Patti

[Harley PoMMom]

I don't know much about the low dose dex test but could those results also be skewed?
Lisa and Jed

A false positive result can be created from the low-dose dexamethasone suppression (LDDS) test if a dog has a non-adrenal illness. I am providing some excerpts about this and feel free to print these out and/or talk with the vet regarding this:


... All pituitary-adrenal function tests used to diagnose hyperadrenocorticism may show false-positive results in dogs with nonadrenal disease. Whenever possible pituitary-adrenal function testing should be postponed until the nonadrenal disease has been resolved. It is important for the clinician to be aware of the limitations and potential pitfall of pituitary-adrenal function tests.

Challenges in Diagnosis of Canine Hyperadrenocorticism (http://www.docstoc.com/docs/135402287/Challenges-in-Diagnosis-of-Canine-Hyperadr enocorticism)


It has been shown that the LDDS is more sensitive with fewer false negatives, but less specific with more false positives than the ACTH stimulation test in dogs with significant non-adrenal illness, especially liver disease.



http://www.veterinarypracticenews.com/vet-practice-news-columns/abstract/acth-stimulation-testing.aspx


Hugs, Lori

[goldengirl88]

Maybe you could print out the above information for you vet to read, and they would have a better understanding of what we are trying to tell you? Hope all is well with Jed this morning. Blessings
patti

[Jed's Mom]

So I heard back from the vet this past Monday. She said the Low Dose Dex test also points to Cushings. We talked about the possibility of the numbers being skewed with everything else Jed has going on. She told me she would think the same thing, had he not been exhibiting symptoms for months prior to the Tick diseases he has now.

Jed has been on his Antibiotics for a week now and we have 3 weeks to go. We talked about starting Jed on a very low dose of the trilostane (10mg every other day to start) but I asked that we start those after the antibiotic. We will also retest a month after starting and she talked about doing the ACTH test or another Ultrasound after 60 days and then doing that test every 3 months to monitor. is that the norm? Would there be a benefit of doing another Ultrasound? The 1st ultrasound didn't show anything on the liver but did show both adrenal glands enlarged.

Jed has an acupuncture session on 7/10 so I will get a copy of his LDD test and post results here.

Is it common for the levels to spike at certain times of day? I'm asking because as the day goes on it seems Jed gets more and more hungry and when its time for bed that is when he is really scavenging for food and drinking the most. Some nights I will wake up and he is in the kitchen looking for food.. :(

Thanks
Lisa & Jed

[goldengirl88]

At certain times of the day their cortisol can spike so you are right about that.

[Harley PoMMom]

Jed has been on his Antibiotics for a week now and we have 3 weeks to go. We talked about starting Jed on a very low dose of the trilostane (10mg every other day to start) but I asked that we start those after the antibiotic. We will also retest a month after starting and she talked about doing the ACTH test or another Ultrasound after 60 days and then doing that test every 3 months to monitor. is that the norm? Would there be a benefit of doing another Ultrasound? The 1st ultrasound didn't show anything on the liver but did show both adrenal glands enlarged.

I think waiting to start the Trilostane after Jed is done with the antibiotic is a great idea. But, I am a bit conderned with the vet wanting to give the Trilostane every other day, the goal of treatment is to keep the levels of cortisol within the thearpeutic ranges and if Jed gets his Trilostane every other day, then on the off days his cortisol will be spiking.


Jed has an acupuncture session on 7/10 so I will get a copy of his LDD test and post results here.

Is it common for the levels to spike at certain times of day? I'm asking because as the day goes on it seems Jed gets more and more hungry and when its time for bed that is when he is really scavenging for food and drinking the most. Some nights I will wake up and he is in the kitchen looking for food.. :(

Thanks
Lisa & Jed

Please do post those LDDS test results when you get the copies, thanks!!

And, yes, cortisol levels can wax and wane, and it does seem that cortisol levels rise at night time, I'm thinking, with dogs on Trilostane, this is because the Triolstane is losing its inhibiting power.

Hugs, Lori

[Jed's Mom]

That's a really good point Lori! I will ask her about that as well when we sit down to talk. In the mean time, I am desperate to find something Jed will eat in the morning so I can give him his supplements and antibiotics. My vet, being holistic, really focuses on diet more than anything so he can't have chicken or lamb and I think venison is out too. She says it contributes to his "heat" and that he is Yin deficient. Here is a good article explaining:

http://www.acreaturecomfort.com/yinyanbalance.htm

I know I have asked this before but I have tried every brand of quality wet food, rolled, dehydrated, and raw...he is just not interested. And with no food in his stomach and all of that water...well you know how that goes. He barely made it out of bed this morning before he got sick. :( Jed used to be the best eater so I am hoping once he levels out he will be again..but until then, any ideas what I can try?

[goldengirl88]

Glynda uses My Perfect Pet and highly recommends it.

[Harley PoMMom]

I see from her article she states that
foods like beef or salmon are great for any dog.

I know how worrisome it can be when our babes become finicky with their food. Do you think adding some cooked beef or salmon to Jed's regular food might entice him to eat it?

Also, here are some other food ideas that I have tried: potato boiled in meat broth then mashed and added to regular food, grated parmesan cheese sprinkled on the regular food, drizzle sardine juice (water packed sardines) on the food or tuna.

Hugs, Lori

[Jed's Mom]

Thank you for all of your suggestions about food. I caved and bought a bag of kibble and Jed is happy as a clam and gaining weight :D He no longer looks like a skeleton. He is also off of his antibiotics for the Tick diseases. After much delay, I started Jed on 10mg of trilostane. We are doing every other day for a short time just to see if Jed acts any different and then we will go to every day. He is still hitting the water dish a lot but maybe a little less. It has not been completely drained when I come home so that is a good sign... In addition to the Trilostane we are doing some laser and he is on some new vitamins. But over all Jed is doing great and it is awesome to see him loving his food again. I keep forgetting to ask the vet for his low dose dex results but we are going tonight for laser so I will try and remember.

-Lisa

[molly muffin]

So happy to hear that Jed is doing well, eating and off antibiotics now too.

It sounds like you have a plan in place, and that is a good thing to have.

Hugs,
Sharlene and molly muffin

[Jed's Mom]

So here are the numbers from Jeds LDDT

Procedure Ref Range Units
Cortisol baseline - 287(H) 15-110 mmol/L
Cortisol low dos dex 4h -275(H) 0-30 mmol/L
Cortisol low dos dex 8h - 234 (H) 0-30 mmol/L

[molly muffin]

Hi Lisa,

Okay, the LDDS is definitely on the high side. You know though with tick disease or anything else, it will be high, but I'm glad he is doing well on the trilostane.

How is Jed doing on the kibble? Feeling better I hope and continuing to eat.

Sharlene and molly muffin

[Jed's Mom]

Thanks Sharlene! Jed is still loving his kibble. He actually ate some wet mixed in today so I am hoping I can at least get him to do a 50/50 split. I forgot how gassy the kibble makes him..omg! We need to invest in some gas masks...lol.

Jed is doing ok on the Triostane but I am not noticing a change in his water intake. Im hoping between that and the vitamins he is on (standard process) Adrenal, Catalyn and Drenamin I will see s difference soon. Do you give your dog any vitamins/supplements?

Thanks
Lisa and Jed

[molly muffin]

I give a milk thistle/sam-e liver supplement, which I think any dog with cushings should be on some sort of liver supplements, and I give a joint supplment. Some also use fish oils and I might eventually incorporate that too.

Oh yes, nothing like doggie gas to clear a house. For us it is liver anything, treats, or in food. It just sets my molly off big time and always it seems while she is laying next to you. Good luck with that!

When will Jeb have a next ACTH test to see where his cortisol levels are at?

hugs
Sharlene and molly muffin

[Jed's Mom]

Not sure of exact date of ACTH, we just said we were going to do it in a few weeks. I still have Jed on 10mg Trilostane every other day. I wanted to monitor his side affects for a bit and see how he was going to handle it. Only side affect I see so far is softer (stinkier) stool. Also my vet is going to Australia for a couple of weeks. I think once she is back, we will do the ACTH.

Is Molly on Trilostane? If so, how many mg, how long and did she have any side affects?

[molly muffin]

No Molly isn't on trilostane. We have just started her on lignan and melatonin for high sex hormones to see what affect that will have. This is a normal treatment for atypical cushings, which since molly also has high cortisol she isn't atypical but she does have the high sex hormones. She also tests negative every time on the LDDS, but positive on the ACTH, so we're trying to rule out possibilities. Molly is my ongoing mystery.

However, I've been on the forum for awhile and usually the only side effect that is negative is if too much is given. If you get the right dosage, and start low and work up as needed, then what you see is that the symptoms of cushings, gradually go away and the dog feels better and regains energy. This is the desired result and dosage is the key to getting to it.

hugs
Sharlene and molly muffin

[Jed's Mom]

I am hoping that I can get the dosage right to help Jed. His energy level is still pretty good for the most part. I feel like I caught this somewhat early so maybe I can stay a little ahead of it. I really wish I could get him off of the kibble. Maybe in time. I have a vet appointment on Wed with Jed so I will schedule his ACTH. And once I see his stool is back to normal I will give the Trilostane everyday.

btw, molly is really cute. What breed is she?

[molly muffin]

She is a mix we think, part shih tzu and part llahaso.

We don't really know anything for sure as she was a rescue from Quebec and there wasn't anyone to ask. It is what our vet thinks.
She is just to us, adorable little diva, molly muffin. Who when she came to us was a shaved, shaking terrified puppy. Now she runs our home like a fine tuned engine. :)

Looking at Jed's photo there, he has it pretty good too, cute all spread out in the bed.

I'm sure you'll get it right. You're taking it slow and that is the important part.

hugs
Sharlene and molly muffin

[labblab]

Hello again from me! I just noticed that you are dosing Jed with the trilostane only every other day. Is this at your vet's suggestion, or have you decided to do this on your own? Every other day dosing is generally not a good idea because it defeats the physiological mechanism by which the drug works. For most dogs, the drug remains active in the body for less than 24 hours. That's why some dogs even need to be dosed twice daily in order to maintain optimal control of their symptoms. When you dose every other day, you are driving the cortisol down one day and then allowing it to spike again on the next day, creating kind of a rollercoaster. This is especially troublesome in terms of trying to interpret the results of an ACTH. If the test is performed on an "off" day, the results will be higher and may mistakenly make you think you need to increase the dose. If the test is done on a day with the med, you'll only be capturing where the cortisol level is half the time, and if given consistently daily, the cortisol level might even be lower on the same dose.

If a once daily dose seems too high for your dog, usually the far better strategy is simply to lower the daily dose rather than space out the dosing over multiple days.

Marianne

[Jed's Mom]

Hi Marianne

I think it was a joint decision by both me and my vet. I wanted to just see how Jed would react to it. I will start him on 10mg everyday probably in the next few days. We will schedule the ACTH probably about 4 weeks after that? Is that too long to wait to do it?

Thanks!
Lisa and Jed :)

[molly muffin]

Usually you want the first ACTH test at about 12 -14 days after beginning every day dosing to see where they are at and how the body is reacting

Hugs
Sharlene and Molly muffin

[Jed's Mom]

I want to start giving Jed the Trilo everyday but my vet is going to Australia for 3 weeks. She believes that because Jed is on such a low dose we can wait until she gets back. He is on 10mg once a day. I will continue to watch his water intake/behavior but do you think it is ok to wait 3 weeks to do the ACTH test? I can always back off of the Trilostane if I see any radical change in behavior..thoughts??

[molly muffin]

At 57lbs and doing 10mg per day, there shouldn't be any issues. You can probably stretch the 2 weeks normal test time to 3 weeks on that dosage.

Always have a plan b though where if you needed to you could take Jed in her absence for any reason

hugs
Sharlene and molly muffin

[Jed's Mom]

Thanks Sharlene! I have another vet (western medicine) that I also take Jed to and I am a mile away from the emergency hospital. I will be watching Jed like a hawk now that he is on the Trilo daily. Thank you for all of your help/support. This site is amazing.

XOXO
Lisa and Jed

[molly muffin]

Okay that is all good to know. :)

Sounds like you are doing okay.

hugs
Sharlene and molly muffin

[Firefly74]

My Vizsla has had symptoms of Cushing’s since at least 2009. At first I didn’t want to believe anything was wrong. Finally in 2012 I did a lot of reading and research for alternative treatments. I found Si Miao Wantea pills work very well. As symptoms arise, we have added other supplements.7-HMR lignans, melatonin, milk thistle and Sam-E. If anyone want more details I’d be happy to share. She will be 15 yo in September, lost lots of weight and mostly grey but happy and energetic between naps.


Administrative Note: A thread has been created for this new member here: http://www.k9cushings.com/forum/showthread.php?t=6545. Anyone who wishes to welcome or write to this member directly can do so by following the link.

[Jed's Mom]

our newest dilemma... yesterday I noticed Jed's hair was raised on his back. He has lumps or cysts or something on his spine, towards the top of his back, lower than where his collar rests. So far I think there are 3. My younger dog is smelling them so I am wondering if these are cysts? When I feel them they don't feel hard. Any thoughts?

Thanks,
Lisa and Jed

[Harley PoMMom]

I do so hope that those lumps are not that dreaded CC (Calcinosis cutis), could you get a pic of them and post it in your album? I believe fatty tumors feel soft and moveable, not exactly squishy but not hard and rigid.

[Jed's Mom]

I will post some pictures when I get home. They are raised and look red. He has a rough coat so it is hard to get a good look at them. Not hard but not squishy either.. he has two that I can see and his brother has been sniffing and licking them a lot.

[molly muffin]

They can do a skin scrapping at the vet to figure out exactly what it is and the best way to treat it, whatever it turns out to be. We'll definitely take a look at any pictures though. cc is a hard calcium deposit that pokes up out of the skin, become red, irritated and often breaks open, hair is loss in the area.

It might be something else though. Lipomas are just lumps under the skin of fatty deposits, but I don't think they normally turn red.

Sharlene and molly muffin

[Jed's Mom]

I was not able to get a good picture last night. They seem like they are flaky and today they seemed smaller and I think they have drained some because his skin felt wet there when I touched him. We are going to the vet tonight for laser so I will see what they say.

Also, I scheduled his first ACTH for 9/11. His water consumption has gone way down but he still gets ravenous for food at night. I am wondering if I should give him his trilostane after dinner since that is when he appears to "spike".

[labblab]

If trilostane is given only once daily, it should always be given in the morning rather than the evening in order to ensure that the monitoring ACTH testing can be performed 4-6 hours after dosing with a meal. Jed is on an extremely low dose of trilostane given his weight --- 10 mg. for a dog weighing almost 60 pounds. So it is entirely possible that he may need an increase in the daily total in order to effectively control all symptoms. If he still exhibits symptom rebound in the evening even after his cortisol is within therapeutic range when tested after breakfast, then you may very well want to shift to twice-daily dosing whereby you split the daily total in half and give each dose at 12-hour intervals along with a meal. This can help keep the cortisol more uniformly lowered throughout the duration of a 24-hour cycle.

At this point, though, I would not change anything until you see the results of this first ACTH.

Marianne

[Jed's Mom]

Thanks Marianne. That makes sense. It is amazing what just 10mg has done for him already. I can't wait to see what the ACTH shows.

Thanks!
Lisa and Jed

[Jed's Mom]

Vet said they are just hot spots :) They were draining and oozing..gross. He gets them on his belly as well. I put him back on some herbs to help with his "heat". I am thinking it is attributed to his diet change so we will have to work on that.

Thanks for all of your help. You girls are great!

[Jed's Mom]

So we are not thinking they are hot spots but an allergic reaction to the Trilostane. :( She had a dog that was recently started on trilostane that broke out with the same type of blistery rash. It is extremely red and it bleeds and pusses at times. This is very painful for Jed. We shaved the hair down and I am treating him with a salve - 12 hours on 12 hours off. He is still on the trilostane and ACTH is scheduled for the 11th.

My question is if I can't give him the Trilostane (vetoryl), what other types of medication are as safe? he was doing so great for a month and then the rash and all of the symptoms came back.. :confused:

Thanks
Lisa and Jed

[Squirt's Mom]

Lysodren is the other effective choice. Jed will need to do a washout of 30 days before starting the Lyso. We have members here using this drug and we can help you if the switch is needed.

From the product insert for Vetoryl under "Adverse Reactions" -

(out of 93 dogs)

...and skin/coat abnormality (seborrhea, pruritus) (8 dogs).

So it does seem that the Vetoryl (Trilostane) could be the underlying factor.

[Jed's Mom]

Thanks for the info. If there are side effects, Jed will get them. Lets just hope they are not so bad with the Lysodren.

I will talk to my vet about switching at our next appointment, next week.

Thank you again. :)

[labblab]

Of course it is possible that the trilostane could be causing the skin lesions, but are there any other variables that have also changed for Jed recently? You mention diet and also perhaps adding some herbs or any other meds? I am surprised that your vet has another patient with the exact same symptoms, because amongst all our trilostane patients on the forum, I don't remember another dog presenting with this type of bleeding pustule and having it be diagnosed as a trilostane effect. So it does make me wonder whether some other drug/herb that your vet is using might instead be the cause, or whether Jed simply has a skin infection secondary to a compromised immune system.

Before making a switch to Lysodren, I would want to feel pretty sure that the trilostane is really the cause, and perhaps also consult again with your western vet or even a doggie dermatologist. Because as Leslie says, Jed would have to undergo a washout period with no treatment at all for a time before proceeding with the Lysodren loading which involves a protocol that is different from what you are doing now with trilostane.

Marianne

[Jed's Mom]

No new herbs have been started. I did start feeding both of my dogs some FROMMS kibble mixed in with the blue buffalo but that is suppose to be one of the best. I thought maybe that could be it so they are just back on the blue. I did not stop the Trilostane. Since he did so well on it for the 1st month but now it does not seem like it is doing anything at all for him.

I think since Jed was a a pup his immune system has been compromised. He has had multiple infections and had kennel cough twice as a pup. I treat with antibiotics to knock it out but he just seems so susceptible. That is why I treat with the herbs I do.

I will try and post a picture of Jeds back in my album. Things look like they are drying up today and he is trying to scratch at it so I think it is starting to heal.

Here are the herbs Jed takes daily. He has been on them for months now so I don't think they are the cause.

Ophiopogon - In traditional Chinese medicine, ophiopogon is believed to moisten the lungs and nourish yin; strengthen the stomach; clear away heat in the heart; and moisten the bowels to relieve constipation. It is also believed by some to be a very powerful shen tonic.

Glehnia and Rhahmannia - This formula treats Liver Blood and Yin deficiency and spreads Liver Qi stagnation. (Jed has every symptom of liver/blood deficient)

Indications (Symptoms):
-Redness and dryness of the eyes
-Heat intolerance, facial and ear redness, increased thirst, thin skin, low grade itch
-Weight loss despite normal stools and increased appetite
-Mild fear agression, territoriality, timidity
-Occasional vomiting, nausea, indigestion, eructation
-Pale edged tongue, lavender center to tongue
-Thin, taut pulse

Standard Process
Catalyn - contains vital nutrients from whole food sources.
Drenamin- supports adrenal function
Adrenal - supports endocrine health

Cordyceps (white mushroom) - boost immune system

He is also on a hip and joint

[Squirt's Mom]

Were these herbs recommended by an animal herbalist or Holistic Vet? I ask because the Standard Process products bother me a great deal because they are made from animal organs. Sounds logical, huh? But in reality we have very little proof that the organs used came from healthy animals or that they were harvested and stored properly before use. If the cow was diseased then the organs in the supplements can cause problems when ingested by either humans or animals. So I would want a 110% guarantee that this product was made from healthy animals ONLY. ;)

I can tell you that Rehmannia tastes like CRAP! :D I take that myself daily with a spoonful of honey or maple syrup and still have a mouthful of UCK!

[labblab]

Interesting coincidence with the Fromm's, because another member has just stopped transitioning to Fromm's due to itchiness and an apparent allergic response to the kibble:

http://www.k9cushings.com/forum/showthread.php?p=160935#post160935

Marianne

[Jed's Mom]

That is interesting about the Fromms. I know this is a great food but since we stopped feeding it, Jed's back is definitely looking better. So strange he would have an allergy to this kibble since I change his food on a regular basis with the hopes of preventing something like this from happening. oh well, I guess we will stay on the blue since he likes it so much. The gas has gotten a lot better too :)

He is also not drinking as much as this past week. I think he was in a lot of pain and didn't know what to do with himself. I notice that Jed drinks most of his water when he wants something...mainly food. Like if the cat dish is down and he wants what has fallen on the floor he will drink and drink until I tell him he can eat it. Its like when he gets excited he drinks...does that make sense? Anyone else see this with their pups?

All supplements I give were referred by my Vet. I can talk to her about risk but the reason I like these is 1. I think Jed is responding to them great and 2. they are just little pills and he will eat them with a handful of kibble and I don't have to sneak them in food or shove them down his throat. I will be there all day Thursday for ACTH and acupuncture/laser so I will talk to her about those then...but yeah GROSS that they are animal organs.

xoxo
Lisa and Jed

[labblab]

Just at a quick glance, it looks as though the three Standard Process supplements are basically duplicating all the same ingredients. I am wondering why this vet wants you to be giving more of the "same" from three different sources? Aside from any other possible issues, in the case of all vitamins and supplements, I just worry that "more" is not necessarily better. How long has Jed been taking these three supplements? In looking back at your thread, it looks as though they were added just within the last month or so around the same time as starting the trilo?

I also am somewhat worried that the holistic vet was so quick to leap to the conclusion that Jed is allergic to trilostane instead of considering other causes for the pustules, and I also worry about the original recommendation to first dose with the trilo only every other day since that is not a good way to judge a dog's initial response to the drug. It generally is not a good idea to make dietary changes or to start other new supplements, etc. at the same time as beginning with trilo for the very reason that it makes it difficult to know the true cause of any adverse reaction. It sounds as though you feel as though the holistic vet has been, and continues to be, helpful to Jed with certain areas of his care. But I am wondering whether your western vet might not be more skilled as far as overseeing the trilostane treatment?

Marianne

[Jed's Mom]

I will start with your last comment first. My Western Vet was trying to sway me in the direction of not treating Jed's Cushings at all. She said that more harm than good could come from the meds and that it would become very expensive for me to treat and then continue to monitor. She suggested I try the holistic route and since I already had a relationship with a holistic vet. with that said, I am in the process of trying to find a new western vet.

The every other day with the trilostane I think was more for my benefit. I was worried about starting this drug and she said we could take it slow. Jed has not had the best luck on western meds in the past. He has an extremely sensitive stomach. We only did the every other day until Jed was no longer having stomach issues with it..I think that was for about 7-10 days. Since then, Jed has been on 10mg everyday and for the most part doing well. I think the ACTH will tell us more.

I know that a holistic approach is not always the way to go, but if I can find a nice balance between treatments/herbs and a low dose of trilostane that Jed responds to...then what more can I ask for? I know I can't cure Jed's cushings. I just want to see him have the best quality of life that is possible.

I started the Standard Process 1 month before we started the trilostane and 2 months before I changed Jed's kibble. I don't like to do too much all at once so I try and add things in and then give it a few weeks to build in his system. With Herbs it takes awhile for the full affect. He gets 3 Adrenal a day ( 2 morning, 1 night) 3 Drenamin ( 1 morning, 2 night) and 4 Catalyn ( 2 morning, 2 night). I think when I looked online it says give 3 2x a day so I don't think I am giving too much. And he really has responded well to these pills. My husband and I both noticed a good change in Jed since we started these supps and weekly laser treatment.

Other than the Rash, Jed has been doing great. This morning he was knocking down the door to get into daycare :)

[labblab]

Dear Lisa,

This is great news to hear that Jed is feeling so well this morning!

And thanks so much for adding this additional information. As I re-read my earlier reply, I can easily imagine that I came across as sounding fairly judgemental. And if so, I definitely apologize. We have had some instances in the past where members went back-and-forth between two different vets/approaches such that it seemed as though the right hand did not know what the left hand was doing, and problems developed. So that predisposes me to being especially wary when it seems as though there are multiple players involved. But I do apologize if I came across harshly, and with this added information I have a much better understanding of the context of Jed's treatment.

Thanks for taking the time to add your reply. And I'll be keeping my fingers crossed that things continue to go well for Jed!

Marianne

[Jed's Mom]

You didn't come across harsh at all! I joined this site for just this. I am so new to Cushings and how to treat and I appreciate ALL feedback. You all are the "professionals" and I really do appreciate you taking the time to help me and worry about Jed. I thank you for taking the time :)

[molly muffin]

You can have a good food but never know when there might be that one item in the good that they will have a reaction to. As Marianne said that just happened recently with Fromms and another member. On the other hand I feed Fromm food and no problem at all. I would just use other food unless you know what is in the Fromms that he is reacting to.
Of course this makes the reaction to trilostane suspect as it might have been something else and since now is doing well on it likely it was something other than trilostane causing the reactions.
How complicated these fur babies can be eh. Keeps us all on our toes that for sure

Hugs
Sharlene and Molly muffin
If in fact things

[Jed's Mom]

Well things looked like they were getting better and then it becomes red and inflamed and bleeding. I am at my wits end with not being able to help him. It does not look like an infection because I am not seeing any puss or green discharge..just open sores/wounds. This is on his upper back and now I am starting to feel some form on his hips. If it is hot spots they are the worst hot spots I have ever seen.

I decided to just stop everything until I can get Jed back on track. The last thing I want to do is stop his treatment but I need to get a handle on this. I also cancelled his ACTH since I am stopping the Trilostane...UHG! Its just so frustrating. So right now Jed is only eating the blue buffalo wilderness red meat and I am putting something called colloidal silver on his back. Has anyone used this product?

I am posting a pic to album now.

[Jed's Mom]

Im taking Jed tomorrow morning to do blood work to see if we are fighting an infection.

I have been reading a lot about how people have developed an allergy to red meat after a tick bite. Has anyone heard of this happening in dogs?

[labblab]

Oh Lisa, poor Jed and poor you! I know it may be hard to find one, but I am still wishing Jed could see a doggie dermatologist in the hope of getting a definite diagnosis. Would that be possible, do you think? I know your vet does not think this is calcinosis cutis, but now that you've posted a photo I do still wonder. One of our other members, Rene, has been battling calcinosis cutis with her pug and has posted a photo album to provide some visual guidance to others. You may want to take a look and see if you think there seems to be any similarity. You can also Google images of the disorder.

http://www.k9cushings.com/forum/album.php?albumid=805

I'm afraid I do not know whether there is a relationship between tick bites and allergies in dogs. :o

Marianne

[Jed's Mom]

Oh gosh those pictures look a lot like what I am seeing on jed. I will look for a . doggy dermatologist. I didn't even know such a thing existed. Thank you so much for sharing. I will still do his blood work tomorrow just to make sure his levels are ok. I will let you know what I find.

Thank you!

[molly muffin]

I agree those look very similar to the other pictures of cc.

Look for a dermatologist at a larger hospital or emergency type of place.
That is where my dogs ophthalmologist and internal medicine specialist are at.

Sharlene and molly muffin

[labblab]

If you don't have a dermatologist in your area, you can search for a Small Animal Internal Medicine Specialist ("SAIM") since that may be easier to find.

http://www.k9cushings.com/forum/showthread.php?t=182

Or even if barring that, have another discussion with your vet as to whether she can go ahead and biopsy a lesion so you can rule out (or rule in) calcinosis cutis for certain. If that is the problem, you will definitely want to resume trilostane treatment ASAP in order to lower the cortisol level that is fueling the problem.

Marianne

[Jed's Mom]

I found that where Jed had his ultrasound also does dermatology. I will call them this morning and see if a can schedule an appointment or if I need a new referral.

www.uvsonline.com
.

[labblab]

That's great news, Lisa. I hope you can find out for sure what is going on! We'll be so anxious to hear.

Marianne

[Jed's Mom]

I have an appointment tomorrow to see a specialist. We are going to do another ultrasound on Jed and I will see what they say about his skin. Im nervous about this one..I just feel like there is more going on with Jed. Down about 20 lbs in a couple of years..10 lbs since April. His last ultrasound was a year ago so I think it's time for another. Say a little prayer for Jed, that we don't hear any C words tomorrow; )

[Harley PoMMom]

Will definitely be keeping you and Jed in my thoughts and prayers. Wishing you and dear Jed the best of luck with the visit to the specialist, let us know what s/he says.

Hugs, Lori

[Jed's Mom]

Thanks Lori. I will definitely keep you all posted. You girls are my outlet. Its nice to have people who know exactly what Jed is going through because you all are going through the same things with your pups. Its heart wrenching to put it mildly..

xoxo
Lisa and Jed

[Jed's Mom]

Ultrasound went well. I was expecting the worst news and I got the opposite. Intestinal track appeared normal and no other significant findings. His Adrenals are about the same size and his liver is highly enlarged. She said that the only thing the ultrasound shows is that his Cushings is unregulated. So not so bad news..

As far as his skin goes, she is also thinking 1 of two things. Either a reaction to the trilostane or Calcinosis Cutis. She said that Jed's skin does not feel as firm as she would expect if it was CC but she wants the Dermatologist to take a look. Also, the ulcers on his back appear to be infected. They took a culture from the area. I scheduled a biopsy for Tuesday Sept 16th. I have to drop him off and leave him :(

Still, no one can tell me why he lost so much weight/muscle. She said for a dog to lose that much weight its only a handful of things, cancer..intestinal disease..or possibly his pancreas function. She sent out a urinalysis to check this.

We also did a blood sugar test on him and that was fine.

He had a rough couple of days...I brought him through Wendy's for a couple of burgers:) After the biopsy Tuesday I will have to buy him a Porterhouse.

[molly muffin]

Well the biopsy should tell you for sure what it is, so that is good, but yep, you are going to owe Jed. :) :) When are results from these tests expected back?

hugs
sharlene and molly muffin

[Jed's Mom]

I should hear about his blood work Monday. And I think I will hear about the urinalysis and culture early next week. Not sure about the biopsy. The dermatologist will look at him on Tuesday as well. I feel like I am putting Jed through the so much and not getting any answers. not too mention the cost of it all. Hopefully I get some answers that can help him. Now that he is off the Trilo he is guzzling water again too.

[lulusmom]

One of our moderators, Angela, had a cushdog, Sabre, who was also a Vizsla. Sabre had a bad case of calcinosis cutis so I thought you might be interested in reading his thread or at least looking at the picture Angela posted of his back. I've provided a link to both below:

Thread
http://www.k9cushings.com/forum/showthread.php?t=366

Photos
http://www.k9cushings.com/forum/album.php?albumid=97

Unfortunately we haven't seen Angela here for a few months but I'm hoping that she might peek in and see your thread. She was always so helpful to our members who were dealing with calcinosis cutis and if she knew you and your precious Vizsla were here, she'd definitely be posting.

Glynda

[Jed's Mom]

Thank you, Glynda. I appreciate you posting this. Jed's back looks nothing like those pictures. He has several ulcerations that puss and drain and then turn a thick crusty black scab. The one that didn't crust up yet is very yeasty looking and VERY stinky. I would say he has a really bad yeast infection but paws and ears and other moist areas are fine..

[Jed's Mom]

Jed went in for Biopsy today and to see the dermatologist. She also is concerned that Jed's skin ulcerations is due to the Trilostane and not Calcinosis Cutis based on look and feel but they took from 4 different areas. We will wait and see what they show. They also sent out more cultures. They did start Jed on Amoxicillin.

They checked Jed's urine today and found protein. Jed was started on Benazepril to lower protein in his urine to protect his kidneys. They want to start Jed on a prescription kidney diet.

Jed was also started on a blood thinner to reduce risk of blood clot/stroke. Is this common for dogs with Cushings/kidney issues? Jeds Kidney levels were fine today so I think she is just trying to be proactive. Other than the worry of Jed bleeding out, is there any other risk to blood thinners? I need to do some reading on this..

Diagnostic Summary from today:

TLI: Indicates normal Pancreatic function
Skin swab - broadly susceptible to staphylococcus Aureus
Skin scraping - negative for mites
skin biopsy - pending
culture of skin biopsy - pending

So now in 4 days and $2300 later I still don't have any answers :(

If they do determine that Jed's skin ulcerations are due to the trilostane and want to start Jed on alternative treatment Lysodren, is this a horrible thing? I dont know much about this drug only that it kills the adrenal cells. This sounds like it can lead to bigger problems. Also, is it harder to bring down the levels gradually on this drug?

Thanks for any/all input. My poor Jed is pacing and drinking buckets after his long scary day. I hope that everything I am putting him through will give us some answers to help get Jed back on track.

xoxo
Lisa and Jed

[Harley PoMMom]

Hi Lisa,

Sounds like dear Jed has been through the wringer today and hopefully we will get some answers.

Has Jed's blood pressure been checked? High blood pressure will cause protein to be spilled over into the urine. Benazepril would be considered for treatment of high BP, however, the dose prescribed may not be enough to lower the high BP.

Lysodren has been around for a long, long time and for decades its been used for canine Cushing's. One drug is no safer to use than the other. The one main thing is that one needs to wait at least 30 days before switching from one drug to the other.

What's the name of the blood thinner that they want Jed on? When a dog has kidney issues certain medication will need to have their dosage adjusted because when the kidneys are not functioning well certain medications can accumlate in the blood stream. With my boy, Harley, I gave him a low dose of aspirin instead.

Will be waiting anxiously with you for those test results.

Hugs, Lori

[lulusmom]

What is your vet looking at that has her convinced that Jed is in renal failure? Putting a cushingoid dog on a protein restricted diet is not a good idea unless it's justified. Actually putting any dog that isn't in true renal failure on a protein restricted diet isn't a good idea. I am confused because you said Jed's kidney values are fine.

Both of my cushdogs were treated with Lysodren and Trilostane but not together. I switched them from one to the other after an adequate washout period. Both are very effective, having nearly the same efficacy rate.

[Jed's Mom]

Jed's blood pressure was checked and it was 145. I think that is borderline high and he was so scared because he had to lay down to get it done and Jed wont lay down unless there is a carpet or bed and the floor was hard and cold..lol. So I think that contributed to his high pressure. Jed was put on Benazepril 10mg 2x a day. The blood thinner is the plavix generic clopidogrel 75mg..he gets 1 half tablet once a day.

She did talk about putting Jed on Lysodren and I asked about the 30 day wash out period and she said because Jed was only on the trilo a short time and that it was not doing anything for him that she would not wait the 30 day wash out period. She seemed like she never heard of this so I am going to have to print out some articles to bring in with me if she tries to change his meds. But we are not going to do anything until we get his skin under control and we are pretty sure the Trilo was the cause of the ulcerations. I am still not 100% convinced. I am waiting to see what the biopsy/cultures say.

As for the Kidney diet..I hate the idea of it. I think the only thing she is basing it on his protein in the Urine. Jed's kidney tests were normal. She said I could start Jed on a few dif foods....all of which I would never feed my dog. Science hills...PURINA or Roay Canine or something like that. I did get a bag of the science hills to work in with his blue buffalo kibble. She wants to see if we can get Jed to put some weight on and think this food may help.

Over the last couple of weeks Jed started falling out of bed. It only happened 2 or 3 times but he has always slept with me and never fallen out of bed before. Also, his tremors/shakes have gotten worse. I know there is something else going on with Jed. I want so badly to help him. :(

[lulusmom]

A good percentage of dogs with cushing's have protein in their urine and proteinuria alone does not constitute kidney failure. It's been a long time for my aging memory but my first cushdog had consistent proteinuria of 1+ of 2+. Her kidneys were fine, just like Jed's appear to be. I would seriously be questioning the wisdom of restricting protein based solely on protein in the urine. Is Jed higher than 2+. You may have already told us but what is Jed's normal diet?

Glynda

[Jed's Mom]

Jed's normal diet is mainly blue buffalo dry kibble. He gets anywhere from 3-4 cups a day. He also confiscates any cat food that he can and gets people food..whatever I am eating. And TONs of treats. Lots of milk bones at daycare and then maybe 5-6 blue buffalo biscuits at home. This is why we can't understand why Jed continues to lose weight or struggles just to maintain. at 9 yrs old he should be maintaining his weight with half of what he is getting. He has dropped about 15-20 lbs in the last 2-3 yrs.

[Jed's Mom]

I am not sure if Jed is a 1+ or 2+. I do not know what that means but I will ask! And did you say your first cushpup? Like you have had more than one?!

I hope I never have to watch another dog go though this:(

[lulusmom]

Yes, I had two cushpups, Lulu and Jojo. Both have passed and I miss them very, very much.

[Jed's Mom]

Im so sorry you had to go through that with both of your babies. I have a younger V, Bodie. I sit him down everyday and tell him he better not get sick! We shake and kiss on it. :) Do you have a dog now?

[lulusmom]

I guess I'm a glutton for punishment. Lulu had been with me since she was 12 weeks old but Jojo was a shelter dog I fostered and eventually adopted because I knew he had cushing's and I didn't want to see him euthanized. That decision was very costly, both financially and emotionally, but he was so worth it. His transformation with treatment was even more remarkable than Lulu's and he was with me for five really good years. I also had a long, long term foster baby, Mabel, with cushing's. She was also a horrible, horrible case but with treatment, she was beautiful once again. She never had pu/pd and her appetite was fairly normal but she had the look and the worst case of ringworm and demodex mange I've ever seen. She was ultimately diagnosed by a derm vet. You can see all of my babies in my album.

[labblab]

If a dog is losing a significant amount of protein in the urine, many specialists do now recommend moderate protein restriction even when there are no abnormalities in the blood values related to kidney function (BUN and creatinine). This is because excessive protein loss can itself cause damage to the kidneys, and high amounts of dietary protein can contribute to the amount of protein that is spilled into the urine for dogs who experience certain types of kidney problems. However, a simple dipstick measurement of +1 or +2 is not accurate enough to tell you whether proteinuria is truly a problem. A more sophisticated urinary test (urinary protein-creatinine ratio or "UPC") is generally recommended to more accurately establish the severity of the protein. If it were me, I would want to know whether Jed is truly spilling enough protein in his urine to warrant concern and/or dietary intervention. If the protein loss is being caused by a condition which can be treated in its own right (like Cushing's), of course you want to address that underlying primary issue. But in the meantime, you also want to protect the kidneys as best you can from additional damage that the protein loss can cause.

I will try to come back tomorrow and give you some links to better explain the testing and treatment related to proteinuria.

Marianne

[molly muffin]

Actually not only do you want a UPC, but you want 3 UPC tests all consistently showing loss of protein. (high UPC)
We were just there with Molly and this issue. She has one high, then one low, then one high (that was determined to be a lab transist problem and not a true result) then we retested again it was low. Final verdict is that she doesn't have protein loss and kidney failure. However, from what we've seen with the dogs on this forum, if they have a gastro upset, or something else going on, the UPC will be high, then it will go back to normal once the underlying problem is resolved. This is how it is with many of the dogs on here. We have one dog Jasper that went Addisons and then kidney failure. His UPC are consistently high and it's always a joy when they come down even a bit.

Sharlene and molly muffin

[Jed's Mom]

I will call the vet today and see what type of urine test they did and talk about scheduling a UPC. Can any vet do this test? The specialist vet I am seeing is pretty expensive. But I agree..I want to see consistent protein in his urine and a value high enough to warrant me changing his diet. Jed's Kidney values have always looked great.

[molly muffin]

Yes any vet can do them. My local vet does mine.

Sharlene and Molly muffin

[labblab]

OK, I'm back with those links for you. Rather than reinventing the wheel, though, I am just going to copy a reply that I posted to another member a while ago:


Hi Tina,

I'm so glad that Jasper is eating again, and hopefully things will remain settled down for you and your little guy!

Boy, the topic of canine renal management is definitely a contradictory one. And one of the chief difficulties is the lack of controlled experimentation. There have been lots of studies on humans and rats, but not so many on dogs and cats. So it is difficult to find substantiated evidence. However, here are some links that I had found a couple of years ago and kept bookmarked. I do think the sources are quite credible. And if I'm understanding the discussion correctly, the opinion among many specialists is that from a physiological standpoint, treatment (dietary and/or drug) really does seem warranted for dogs exhibiting persistent levels of high proteinuria on the basis of UPC results, regardless of whether or not they show other symptoms of renal disease. The first link is to a "2004 Concensus Statement of the American College of Veterinary Internal Medicine: Assessment and Management of Proteinuria in Dogs and Cats." Even though this statement is now almost a decade old, I still see reference made to the recommendations:

http://cms.evsrl.it/SocSpec/SiteTailorCommon/ShowBinary.aspx?id=2200

The second is a round-table discussion among veterinary renal experts ("Proteinura and Renal Disease") sponsored and published in 2005 by IDEXX Laboratories. This is a most informative "read," and further endorses the basic recommendations of the ACVIM Concensus Statement. It has an especially interesting section re: the advisability and degree of dietary changes depending upon patient symptomology.

http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/education/proteinuria-round-table.pdf

Lastly, here's a 2009 article from the "DVM360" magazine that discusses diagnostic and treatment issues associated with hypertension and proteinuria in dogs with renal disease:

http://veterinarynews.dvm360.com/dvm/Medicine/Diagnosis-management-of-hypertension-proteinuria-i/ArticleStandard/Article/detail/591639

Here's a quote from this last article that is a pretty good summary of the train of thought represented in all of these links, and I will look for even more recent articles when I get the chance. But for what it's worth, I think your IMS has a significant amount of professional support regarding the advisability of dietary and/or drug intervention in the face of persistent proteinuria to the extent that Jasper has exhibited. However, I don't know the specific profile of the food you're giving Jasper. As Glynda says, it may be that it is more severely protein-restricted than these panels would recommend in his situation. I especially encourage you to read the IDEXX round-table discussion in that regard, because I believe they suggest only mild/moderate protein restriction early on for a dog without other symptoms of renal disease. It's a fine line because you want to keep up with the protein that is being lost, but you don't want to cause additional renal damage from excessive protein leakage into the kidneys.



In addition to being a diagnostic marker of the severity of renal disease, renal proteinuria may be a mediator of glomerular and tubular injury. Recent findings have demonstrated that proteinuria is associated with increased risk of developing progressive CKD [Chronic Kidney Disease] in dogs.

In addition, studies have shown that therapies that reduce the magnitude of proteinuria often are renoprotective. Proteinuric renal disease is often associated with systemic hypertension, which can conversely exacerbate renal proteinuria and therefore, it is difficult at times to separate the effects of high systemic and intraglomerular pressures and proteinuria.

Marianne
Bottom line: I would want additional evidence that Jed is suffering from persistent proteinuria before intervening with meds and/or diet.

Marianne

[Jed's Mom]

So I have some test results. Cultures show 2 staph infections and the biopsy does show that it is Calcinosis Cutis. :( Vet wants to start Jed on a different antibiotic than was normally given because the amoxicillin will not fight the 2nd staph they found growing so they want to put Jed on a dif one..not sure of name. I want to say Clavimox but not sure.

She also wants to put Jed back on the Trilo but 10mg 2x a day. Why do I feel like I read that lysodren is better at helping with the CC? Am I wrong or does it just depend on the dog?

I am not going to start the trilo today. I want to see how he reacts to the new antibiotic for a few days and then I will start him back on the Trilo. Thoughts??

[Jed's Mom]

Hi all

Looking for some help interpreting ACTH results. The latest on Jed is that his Calcinosis is still something horrible. He continues to get new sores and lose hair and this is making him not want to eat. He is down to 51lbs which is the main concern of my vet and myself.

Jed was on 10MG 2x a day for about 60 days I would say. Here is his first ACTH test after being on 10mg 2x a day:

PRE ACTH Cortisol 9.3 ug/dL
POST-ACTH Cortisol 20.8 ug/dL


We upped Jed to 20mg 2x a day and retested two weeks later (this past Wednesday.

PRE ACTH Cortisol 7.1 ug/dL
POST-ACTH Cortisol 14.9 ug/dL

We just started Jed on 30mg 2x a day. Im concerned about this increase since it looks like Jed is so close to being regulated.
What are your thoughts? Should I wait another two weeks to retest and just watch him like a hawk? I did get some prednisone to have on standby..

Thanks
Lisa and Jed

[Jed's Mom]

What do I want his pre and post numbers to be? If I am reading it correctly we want both pre and post to be between 1-5? Or am I way off?

[molly muffin]

With the cc, I'd be looking for between 2.0 - 5.0 post and you don't want a pre to go too low, some say no lower than 1.5 and Dr. Peterson like no lower than 2.0 pre.

I would definitely test in 2 weeks as the 20x2 was bringing it down already.



Sharlene and molly muffin

[Jed's Mom]

Thanks Sharlene. Im hoping the 60mg a day does the trick. Im not seeing an improvement in his skin or drinking/urinating. Its actually gotten worse. Fingers crossed...

Hope you and Molly enjoy your weekend. :)

-Lisa and Jed

[Renee]

Hey there,

I just read your entire thread -- please, please, please do not be too aggressive in dosing, expecting an immediate change in the CC. It will get WORSE before getting better. That does not mean you want to drive his cortisol down as quickly as possible. Follow the protocols to bring it down within a few weeks/months, and then keep it steady.

At a post of 14.9, you are still too high. You'll want the cortisol below 5, as Sharlene said, and then keep it there at a steady pace. The CC has to go through many stages. Read my thread to get an idea.

If you just changed the dose to 30/30, then I would not even consider increasing again for a minimum of 30 more days.

Good luck!

[Jed's Mom]

Hi Renee and thank you. I am hoping that we will continue to see Jed's cortisol slowly lower and 30/30 will be the "magic number" I just can't wait for the day where I do not feel any new "sores" forming. We go for next ACTH on the 5th. I will post results once I have them.

Did you find a product that really helped with the CC? I tried DMSO but it smelled so bad and Jed was miserable when I put it on him. I am using colloidal silver which helps a lot but his belly is so raw and itchy I think I cream would be better for that. I have tried aloe but that didn't seem to help at all.

Thanks!
Lisa

[Squirt's Mom]

Be careful with Colloidal Silver -

http://www.quackwatch.com/01QuackeryRelatedTopics/PhonyAds/silverad.html

http://www.mayoclinic.org/healthy-living/consumer-health/expert-answers/colloidal-silver/faq-20058061

[Jed's Mom]

uhg! Just when I find something that helps him :( Back to the drawing board...

[Renee]

Lisa - the sad truth is that nothing else will help the CC, except for getting the cortisol into the correct range, and keeping it there for an extended amount of time. I am at the 1 year mark for dealing with CC, and it has just become what I would consider 'cured' in the past 3 months. But, I must admit, I was lucky. We hit the correct dose of vetoryl (20mg x2 daily), within 3-4 months of beginning treatment. Not everyone is that lucky.

I know exactly how you feel right now and how hard it is to stay positive when the CC is really bad. I had many moments wondering if it would ever get better and why I was letting my girl go through this. If you look at my girl's pictures, you'll see her was very raw and covered most of her back. You and Jed will get through this! Do not lose faith.

I tried the DMSO, every day for about a week. It was horrible and I stopped. I saw no improvement and it smelled bad. After that, I just focused on keeping the areas dry, exposed to air, and fighting off infection. If Jed is not on abx now, then I encourage you to put him on a course, just to kill any bacteria/staph that may be secondary on the CC. And, if he is not already on probiotics, then I encourage you to add some to his daily diet.

As for the CC itself - like I said, it gets worse before it gets better. There are many sores beneath the skin that will continue to come up and bust through, even as you get his cortisol lowered. This does not mean it's getting worse, it is just purging. You will know there is improvement when the sores begin to dry up and be less angry. They will still be there, and they may still bleed or crack open, but they will be less angry and dryer in texture than the initial sores.

[Jed's Mom]

Thanks for saying that Renee. I keep feeling like I am not doing enough for him and that I am failing him. I just want him to get better and I know it needs to run its course.

Jed was on clavimox and this did clear up the two staph infections he had. Now I am just trying to keep the area as clean and dry as possible. He scabs up and heals fast so we just have a lot of bald spots now with some new sores forming. Last night he was bleeding in areas that I thought had healed but from reading your post it seems like that is also normal with the CC.

Thanks for sharing/listening. Cushings is bad enough but for him to have the CC on top...its just so hard on him. He used to be so healthy and energetic and now he is down to skin and bones and just lays around all day. Hearing your story and seeing your photos gives me renewed hope. :)

[Squirt's Mom]

No one who is working as hard as you to help their baby can be seen as a failure. Not possible. ;)

[molly muffin]

I just want to pitch in and say what a great job you are doing. It isn't easy when you have cc going on but you are doing great. Just hang in there. Get that cortisol level down a bit more and keep doing what you are doing.

Sharlene and molly muffin

[Renee]

Don't lose hope. You are doing an excellent job. Take it one day at a time and keep working on his numbers.

I'll try and post more pictures to Tobey's album tonight to show the progression.

[Jed's Mom]

You ladies are the best!! I could not do it without you and this site. I will post some more pics of Jed soon as well. I bought him a sweater for fall since he will not have any hair left soon. I will post one of those as well. :)

[Jed's Mom]

I posted a few pics I just took today.

[molly muffin]

Love the pictures.

I have to say the back is looking pretty good. Go back and look at the pictures from September, comparing those pics to the ones in Oct and it's doing really well. Those areas should eventually fill back in with hair.

Is the inside leg area newer? It looks more red, so was wondering.

See, you Are doing good mom!

hugs

[Jed's Mom]

Sharlene I love you! :) Yes stomach area is newer and he can easily lick it and skin is softer. I think that will take some time to clear up but he has not been at it all that much. I was using the colloidal silver which I think made all the difference in the world but not sure if I will continue to use it now after reading about the side affects..

[molly muffin]

It can be frustrating at time, trying to find that right combination of "it works vs safety"

I wonder if what the quicksilver wasn't doing was to dry it out more.

So I'll throw out a couple thoughts:
apple cider vinegar, wipe on with a dishcloth
baking soda mixed with a bit of water
Milk of Magnesia, dab on with a cotton ball
Chamomile or green tea compress

These are all for relief of itchy skin but might work on the cc.

hugs

[Jed's Mom]

Thanks Sharlene. I like the Chamomile or green tea idea. It will help with the smell :)

So far Jed is doing ok on the 30/30 but his drinking has not changed much. He is eating better but I think that is just because I am feeding him food he will eat..not the best food for him but I am just trying to get his calories up. I think he looks like he may have gained a a pound or two..

[molly muffin]

So much is trial and error of what will work for any specific dog. Just keep trying to find that really good combination. It Will happen

Hugs

[jas77450]

Hang in there, lots of love for you and Jed .

[Renee]

Sharlene, I totally forgot about the tea bags, but that is an excellent idea. Chamomile tea bags would be very soothing to the open sores.

[Jed's Mom]

Thanks for that suggestion. Its a difficult area to heal because he can get at it even with the cone and a Tshirt wont cover it.

Jed has been doing so well on the 30/30. He has been eating better and gained 3 lbs:D He has even been playing a bit and a couple of nights he wanted to get under the covers and cuddle...something he has not done in months. I will get his results of ACTH back today and share. Thanks for all of the support!!! I finally feel like a am starting to see a little of the old (healthy) Jed:)

[Jed's Mom]

Well I just got the call from the vet and I honestly thought his numbers would be better based on how Jed has been acting.

Pre - 6.9
post -13.2

Not much of a change in the last two weeks. And they want to up him to 40/40 and recheck in 2 weeks.

My question to you all is, is it normal to up his values every two weeks?
And does the ACTH test affect them after? Jed had some tremors this morning and his appetite today is back to not being the best.

[Jed's Mom]

Sorry, I meant to say is it normal to up his dosage every two weeks. And I have only had one glass of wine ;)

[Renee]

Sorry, I meant to say is it normal to up his dosage every two weeks. And I have only had one glass of wine ;)

I always waited a minimum of 30 days between increases -- and I always increased in 10mg increments, but my Tobey is smaller than Jed (she's a pug).

Jed is on 30/30 right now, and they want to go to 40/40? That's a 20mg increase. I know getting tight control is very important, for the CC, but I'm not sure I'd jump the dose so quickly with only 2 weeks since the last increase.

Yes, the stim test can cause a reaction for a bit.

Is Jed on brand name vetoryl, or compounded?

[molly muffin]

hmm, it rather depends on the numbers, if you are seeing some movement downwards, then often, it is better to wait to change till after 30 days to see if it will continue to go down on that dose.
If there isn't any movement downward or not very much, then sometimes they will go ahead and increase.

However, just be careful not to go too much fast. It is okay, to take things slower.

hugs

[Jed's Mom]

Yes currently Jed is on 30 mg twice a day 60mg total. Hegets his meds every 12 hours between 5-6. She wants to up him to 40 mg twice a day, 80mg total. I thought I would see a bigger drop with the 30/30 but there really was not much of a decrease. All of his/test numbers are below. Jed is on brand named vetoryl and not a compound. Is there a difference?

20mg (He was on this dose for two-three weeks)
PRE ACTH Cortisol 9.3 ug/dL
POST-ACTH Cortisol 20.8 ug/dL

40mg (He was on this dose for two weeks)
PRE ACTH Cortisol 7.1 ug/dL
POST-ACTH Cortisol 14.9 ug/dL

60mg (He was on this dose for two weeks)
PRE ACTH Cortisol 6.9 ug/dL
POST-ACTH Cortisol 13.2 ug/dL

This morning I gave him 40mg with the small amount of breakfast I could get him to eat.

[Renee]

My only concern is that his dose is being increased every 2 weeks. His numbers are not in range though, so I can see why you want to keep increasing. It's a tough call.

I do wonder if the effectiveness of the drugs is being reduced because he's not eating very well? How much food is he eating when you give him the medication?

[Jed's Mom]

I usually try and get Jed to eat about 500-700 calories when he takes his meds. He is getting about 1600-2000 calories a day to try and get him to put some weight on.

Today he was not feeling that great so I gave him some wet cat food and a piece of salmon and a little kibble. I try and make sure he gets some good fats with his meds.

The day he had his test he had about 200 calories with his morning meds. Is that not enough? It was a half a cup of kibble and some chicken. They ask that I feed him half of what I normally do before the ACTH. He got his pills at 5am and test was done at 10am.

[Dixie'sMom]

I was just reading a little about Jed and wanted to say hello to you. I'm new to all of this myself so I don't have any words wisdom for you, but I wanted to tell you that I think you are doing a great job. I'm keeping my fingers crossed that the 40/40 will be the magic number for Jed and his skin and appetite will begin to improve. Hugs to you and your sweet boy. Hang in there!

[jas77450]

Paws crossed Jed will start eating better and he gets controlled!!!!

[Jed's Mom]

Thank you both so much!! Jed is eating a bit better these days and seems to be doing ok on 40/40. I am watching him like a hawk. Water intake is definitely down. He is starting to get new sores all of his body including his beautiful head :( Soon I will have a naked Vizsla I think. At least now I have an excuse to dress him up, right?

[molly muffin]

Just remember, even if the cortisol comes down, there are all those hard little bumps already under the skin and they have to come up and out, before it can all clear up. It takes a long time for this process to complete. Hang in there. I hope by summer, you'll have a beautiful coated Vizsla again. :)

hugs
sharlene and molly muffin

[Jed's Mom]

I took Jed for his acth yesterday and will get the results back today. Urine was concentrated so that is a good sign.

When I picked Jed up they said that they had to muzzle him because he snapped at one of the techs when they were trying to lie him down. This is not normal behavior for Jed. I am not seeing any of this at home or at daycare. Wondering if it could be a side affect of too high a dosage? Has anyone else had an issue with aggression?

I personally think that Jed is in pain and they were being too rough with him but that is a mom talking :)

[Renee]

Poor Jed.

I did see some personality changes in Tobey once she started treatment, but they have gone away for the most part. She hates, I mean HATES, the vet tech that always does her blood draws. :( She knows exactly which vet tech it is.

I am sure Jed's skin is tender and hurting, then being at the vet is rough too. I sure hope they will be more careful next time. I would be very upset to arrive back at the vet and find out they had muzzled my dog without calling me first.

[molly muffin]

Awww poor baby. Sometimes we see aggressive behavior, but if I think about it, usually when the cortisol is high, before treatment. Definitely could be he wasn't comfortable with them trying to force him into position.

hugs, hang in there!

[doxiesrock912]

They shouldn't force him. Bribe him with a treat instead. I'm not surprised that he snapped.

[addy]

When they get pushed past their bite thresh hold, they snap. My girl got very snappy because she was always going to the vets, test after test. I can't blame them being scared and sick of being poked and prodded.

Finally,I bought a little muzzle and taught Zoe to like having it put on, we made a game of it with treats. After that, I would muzzle her myself to protect her. I always waited during the tests so as soon as she came back to me, I would take the muzzle off. I never left her alone at the vets.

[Jed's Mom]

Thanks everyone for all of the feedback. I called and asked if they could just do the test with him standing and they said they could do that. I will make sure they do not muzzle him again without my knowing. At my last vet we did everything with Jed standing and I was in the room with him. I think he just has a really bad sore on his hip area. He squirms when I touch it so I know it is bothering him. They probably just touched that and he snapped.

I got his values back and they did not go down much. they wanted to up him again to 50/50 and they said that that was still a low dose for Jed. I told them I disagreed and I would be keeping him at 40/40 for another 2 weeks and then we can test him again.

She also told me Jed was late getting to his test and she usually does his test at 10:15 but said Jed did not get there until 10:30 this time. And that could have thrown off his numbers...I told her we were there waiting in the waiting room for 30 minutes and they were late bringing Jed back...uhg!!! Maybe time to go back to the holistic vet for this test. At least I can stay in the room with him and maybe do some acupuncture while we wait.

[Jed's Mom]

Jed went in for his ACTH yesterday and did great. They did his blood work/tests with him standing up and they promised me they would not muzzle him again without calling me. They said he was a good boy.

So he has been on 40/40 for the past 4 weeks. I will post his numbers below. They said he is still not regulated and want to up him to 50/50 but his pre is in a regulated range I believe. This week he has also started getting up again during the night for water and his urine was barely concentrated with this last test where it was concentrated two weeks ago..

What do you all think? I told them I would up him to 50/50 and we scheduled a followup acth for 12/23. Should I be worried about that Pre level of 4.4 and that coming down too low from now until his next test?

Jeds ACTH History

20mg (He was on this dose for two-three weeks)
PRE ACTH Cortisol 9.3 ug/dL
POST-ACTH Cortisol 20.8 ug/dL

40mg (He was on this dose for two weeks)
PRE ACTH Cortisol 7.1 ug/dL
POST-ACTH Cortisol 14.9 ug/dL

60mg (He was on this dose for two weeks)
PRE ACTH Cortisol 6.9 ug/dL
POST-ACTH Cortisol 13.2 ug/dL

80mg (after two weeks on this dose)
PRE ACTH Cortisol 6.1 ug/dL
POST-ACTH Cortisol 13.1 ug/dL

80mg (after 4 weeks on this dose)
PRE ACTH Cortisol 4.4 ug/dL
POST-ACTH Cortisol 11.2 ug/dL

[Renee]

Hi there! Thank you for checking in!! I have been thinking about you and Jed.

His pre is not as big of a concern, and there really is no 'range' so to speak, other than there is some concern if it drops too low.

The post, at 11.2 is still too high, especially to control the CC -- but, don't get discouraged, it is coming down. I think the 50/50 is not a bad idea.

[Jed's Mom]

Thanks Renee, that makes me feel better. I will start him on the 50/50 tomorrow.

How low is too low?

[Renee]

I believe it may be Dr Peterson (or maybe another doc) that says anything below 2 for the pre is of concern. Personally, I have let Tobey's baseline drop down to 1.3, and while I was concerned and watchful, I was not ready to reduce her dose. Of course, with her current issues going on... her dosing is all messed up, but while she was controlled, the baseline was fairly low.

How are Jed's symptoms? How is the CC?

[Jed's Mom]

What are Tobey's current issues? How old is Tobey and when was she diagnosed with Cushings?

Jed's water in take is better but he is still not eating great and he is just not a "happy" dog. Jed's nickname was wiggle butt but we have not seen that butt wiggle in a long time.

His CC is about the same. I am starting to see some new hair growth on his back. He is getting new sores on his neck and sides but I think his belly and under arms are starting to look less aggravated. I think you are right that it is just going to be a part of life for Jed until he is regulated and all of the sores underneath come through. I feel them under his skin everywhere.

He dropped back down to 53 lbs so I am constantly trying to feed him. The only time I can get him to gain weight is when I am getting 2000 calories in him and that is really hard to do on a day to day basis. Did Tobey drop any weight? I'm wondering if the CC is painful and that is making him less hungry.

[Renee]

Hair regrowth is a very, very good sign! All those bumps under the skin will have to work their way out, regardless of how low you get the cortisol. But, they should not be as angry as the ones he developed with higher cortisol.

Tobey is 11 now and was diagnosed a year ago. In fact, she first started vetoryl on December 20, 2013. She is dealing with pancreatitis right now. She never lost weight from cushings. In fact, in the last year, she is up a few pounds. Her lowest weight ever, which was 4 years ago, was 16 pounds. She sticks around 18-19 now. I'd love to see her lower, but I don't think that will happen.

[Jed's Mom]

I think I gave the wrong dose of veroryl last night. Instead of 50mg I think I gave Jed 90mg. I am not 100% sure but when I went to give him his pills today I had out to 30mg packs and the 10 was still in the box. I skipped his dosage today and he seems to be acting fine..a little less excited than usual but I did get him to eat some chicken and some treats..he is not a big eater in the morning...what should I do??? Has this happened to anyone else? I feel horrible..:(

[labblab]

Yup, this has happened to others. It was an accidental mistake, so please don't beat yourself up over it ;). Jed should be fine. A one-shot mistake like this should not create any lasting damage. Since it is now 24 hours after dosing with no ill effect, I think you can relax since the drug has already largely exited his system. You should be able to resume normal dosing tomorrow with no problem.

Marianne

[Jed's Mom]

Thank you. And I don't knot how to not beat myself up over that...so stupid! He had that dosage at 6pm last night. I skipped his AM dosage today. should I skip PM dosage as well?

[labblab]

I think I would just watch how he does today. If you see no ill effects whatsoever and he first eats his dinner normally, I'd probably go ahead afterwards and start back with tonight's normal dose. If he is picky with dinner, I'd wait until tomorrow to see how he is then.

[labblab]

And just to cheer you up a bit, here's a story about a friend whose dog takes phenobarbital for seizures, just like my Peg. My friend had a migraine one morning and reached for what she thought was her Rx painkiller and instead got ahold of her dog's phenobarb. Swallowed that sucker right down, and then in a panic, realized what she had done. Frantically called her own doc who told her to cancel driving in to work and to just settle in on the couch and enjoy a nice, very relaxed morning at home. She told me it turned out to be one of the most peaceful weekday mornings she could remember! ;)

[Jed's Mom]

That is great!! :D

[Renee]

And just to cheer you up a bit, here's a story about a friend whose dog takes phenobarbital for seizures, just like my Peg. My friend had a migraine one morning and reached for what she thought was her Rx painkiller and instead got ahold of her dog's phenobarb. Swallowed that sucker right down, and then in a panic, realized what she had done. Frantically called her own doc who told her to cancel driving in to work and to just settle in on the couch and enjoy a nice, very relaxed morning at home. She told me it turned out to be one of the most peaceful weekday mornings she could remember! ;)


Hmm.... I have some of this lying around the house.. maybe I need a day off?? LOL! :p

[Jed's Mom]

Just checking in to see what you guys think. Since I last posted Jed has had 2 ACTH tests. Two weeks ago Jed was tested on compounded trilostane 50 mg 2x a day. He was on the compounded dosage for two weeks prior to testing. His numbers came back pretty low..pre was 1.4 and post was 3.9. The Vet did not like how fast his numbers went down or how low they were so we switched back to the name brand vetoryl but kept the same dosage 50mg 2x a day. Jeds numbers are even lower this time pre 1.6 post 1.9. Vets recommendation is to lower him to 40mg 2x a day and retest.

Jed seems to have more energy these days but he is still not eating great. He seems to be happier and his skin looks great. All of those bumps I felt under his skin are pretty much gone. And he is growing his hair back in the places he lost it.

The vet told me to put Jed on prevacid 20 mg once a day in case his not eating is a case of stomach acid. I will post Jed's acth history below but just wondering everyones thougts on his numbers. I thought anything between 1-5 was good?


Jeds ACTH History

20mg (He was on this dose for two-three weeks)
PRE ACTH Cortisol 9.3 ug/dL
POST-ACTH Cortisol 20.8 ug/dL

40mg (He was on this dose for two weeks)
PRE ACTH Cortisol 7.1 ug/dL
POST-ACTH Cortisol 14.9 ug/dL

60mg (He was on this dose for two weeks)
PRE ACTH Cortisol 6.9 ug/dL
POST-ACTH Cortisol 13.2 ug/dL

80mg (after two weeks on this dose)
PRE ACTH Cortisol 6.1 ug/dL
POST-ACTH Cortisol 13.1 ug/dL

80mg (after 4 weeks on this dose)
PRE ACTH Cortisol 4.4 ug/dL
POST-ACTH Cortisol 11.2 ug/dL

100mg (after 2 weeks on compounded trilostane)

PRE ACTH Cortisol 1.4 ug/dL
POST-ACTH Cortisol 3.9 ug/dL

100mg (after two weeks on brand named vetoryl)

PRE ACTH Cortisol 1.6 ug/dL
POST-ACTH Cortisol 1.9 ug/dL

[judymaggie]

Hi! I am a "Lysodren Mom" so will let the trilostane folks chime in for feedback in that regard. I did find your vet's suggestion of prevacid for stomach upset interesting. I think it is much more common for vets to suggest pepcid AC as the first choice. I give my Abbie generic pepcid AC twice a day 15-30 minutes prior to her meal. A bottle of generic is very inexpensive. Also, if you are feeding Jed twice a day and dosing her trilostane/Vetoryl twice a day, the once a day dose of prevacid might not be as effective as giving her something before each meal/med. Abbie weighs 25 lbs. and gets 5 mg. twice a day.

[Jed's Mom]

Thanks Judy. I actually take pepcid myself so I can break a 20mg in half and give it to Jed with 2 of his meals. I feed him 3-4 times a day because when he eats it is not much. But I think if I do with his morning meal and his last meal of the day it would do the trick, if it is indeed stomach/acid issues.

Im starting to wonder about his teeth since he does not want bully sticks or pigs ears anymore. These used to be his favorite treats. He will eat biscuits but he likes when I break them up for him. I see another vet appointment in our near future..

[judymaggie]

Sounds good--just make sure that pepcid is "original" or "ac", not pepcid complete. The latter has additional active ingredients that should not be given to dogs.

[Jed's Mom]

Yep, Pepcid AC. I just gave him one with his dinner that he did not eat. Is there a reason why you dive Lysodren or was it just what your vet prescribed?

[judymaggie]

My vet was more experienced treating Cush pups using Lysodren so that is what I opted to go with. He would have been willing to learn about Vetoryl but I really didn't have a preference although loading with Lysodren was kind of nerve-wracking. Abbie is my second Cush pup (both beagles). My first, Maggie, was diagnosed with atypical Cushing's initially and eventually Cushing's. By that time she was too ill to treat with Lysodren.

[molly muffin]

You don't want Jed to go any lower for cortisol levels than what he is currently at. On the same dosage cortisol can continue to drop for up to and even over 30 days (your 2 tests) and his are consistent with continuing to drop.
If he drops any more you could be in a problem area. So I see why your vet has some concerns. It's all relative. It depends on how much he comes back up on 40mg x2 as to whether that is the correct dosage. Could be you need something like 45. x2

[Jed's Mom]

Yes Sharlene, you and my vet are thinking the same thing ;)
She did mention we go to the compounded 45mg twice a day. But I will see how he does on 40mg 2x a day and go from there. I had him on the 40 mg 2 times a day and he was coming down but slowly. Maybe he just needed more time on the lower dose??

I just need my boy to want to eat. I know the loss of appetite is big with the vetoryl. Is it a side affect of the Lysodren as well? Are there other side affects with Lysodren?

[Renee]

Hey there, glad to see you checked in!

I personally would drop back to the 40mg x2 per day, then retest. His numbers are quite low, and dropping any lower could be dangerous. It's much less risk to let him drift up a bit than to risk him drifting down any farther.

I'm glad to hear that his skin is clearing up?

[Jed's Mom]

Renee, his skin looks so good. I will take some pics and post later. I did drop back to the 40/40. I started this morning. We will retest in a couple more weeks. I could not believe how fast he dropped..scary.

[Dixie'sMom]

I know the loss of appetite is big with the vetoryl.I don't think the loss of appetite is a side effect of Vetoryl. It seems to be more of an indication that the cortisol has gotten to normal levels or lower. My doxie who has been on Vetoril/Trilostane for months has never lost her appetite and her ACTH results are in the normal range.

[Squirt's Mom]

Suzie is right - a loss of appetite could mean the cortisol has dropped too low. If your baby loses appetite, stop the med and call the vet.

[Jed's Mom]

Hi everyone, I have not checked in in awhile. We did stop Jed's meds after his last acth. His levels were very low. Also at the same time Jed started to have accidents in the house..not like Jed at all. I took him in to see if he had an infection but everything came back negative..not the best news. We left Jed off of his meds for a good week..his drinking increased but his appetite never came back. And his shaking has gotten much worse. I started Jed back on 40/40 and it seems like his water intake is better but he is still getting us up at least once a night to go outside.

Jed is not eating much these days..I am force feeding most of the time. I made up a mixture of satin balls..not sure they are the best thing for Jed but they are suppose to put weight on a dog and Jed definitely needs that. He will usually eat some dinner on his own but its not dog food, its whatever meat my husband is eating..pork chops, chicken, steak..etc. I even bought him some my perfect pet food but no luck. My other V loves it though :) My Vet is at a loss to why Jed is not eating. I believe Jed has cancer but his blood work and ultrasounds are always good. My Vet said sometimes the tumors can grow big enough where they cause other symptoms..dullness, blindness and loss of appetite. She mentioned and MRI and said if that is the case then they would treat with radiation.

I am at a loss as to what to do. Jed is getting around ok but he is not a happy dog. Very lethargic and he does not even greet me when I come home and he is not excited to go to daycare anymore. He sleeps most of the morning there but then gets some energy as the day goes on.

Jed's next ACTH is Tuesday and he is getting blood work done as well. Has anyone here gone the route of MRI/radiation?

[labblab]

I am so sorry that Jed is feeling so unwell. It is certainly possible that Jed's pituitary tumor is enlarging, and that could be the cause of the inappetance, shaking, and lethargy. Yes, we have had members who have opted for CT or MRI imaging of the head and upon confirmation of a large macrotumor, have elected to treat with radiation. So we can definitely talk about that some more.

However, my more immediate worry is that Jed's problems are still being caused by low cortisol that never adequately rebounded, even on the lower dose, because the symptoms you describe can all be associated with an Addisonian condition, as well. Even though the acceptable "lowpoint" for post-ACTH cortisols in trilo dogs is generally considered to be around 1.5 as long as they are clinically doing well, one noted endocrinologist (Dr. Mark Peterson) becomes very cautious and discontinues treatment for dogs who drop below 2.0. He does not resume treatment again until Cushing's symptoms rebound on their own and rising cortisol has been proven by testing. This is because, in his own clinical practice, he has found that the trilo dosing has affected the adrenals of some of his patients to the extent that they never again resume excessive production of cortisol. Resumption of trilo at any dose for those patients is both unnecessary and risky.

Due to Jed's skin condition, I realize you are walking a bit of a tightrope and you don't want his cortisol to severely elevate again. But I do have to wonder whether he is not suffering from cortisol that is too low or blood chemistries that are off. In my own mind, that ACTH test and blood panel cannot come soon enough!! Is there any way you can move them up?

Marianne

[Harley PoMMom]

I agree with Marianne, Jed's symptoms could be attributed to the cortisol being too low and/or an imbalance in the electrolytes. I would definitely have both of them checked as soon as possible.

Hugs, Lori

[Jed's Mom]

Marianne, I think you could be right. I should have done another acth before I started him back on the vetoryl. I think they only do testing tue-thursday. Do you think i should stop his meds until Tuesday?

I'm so thankful I have this page. Thank you all!

[labblab]

Gosh, that is a hard call, because if you stop the trilo now, you won't have an accurate sense as to the effect of this dose on his system -- assuming his cortisol is not too low.

Maybe you can call the vet tomorrow and discuss your concerns. I don't think you should do anything without letting your vet know. If they can't do the full stim test earlier, maybe one compromise would be to go forward immediately with a resting cortisol and the electrolytes. As long as the resting cortisol is higher than 2.0, you'd have some reassurance that the cortisol is not too low. If the resting is lower than 2.0, you'd have better reason to stop the trilo now. Just some thoughts to maybe talk over with your vet...

Marianne

[Jed's Mom]

I will call the vet in the morning to discuss and let you know what we decide. Thank you!

[Squirt's Mom]

They will only do an ACTH on Tues, Wed, or Thurs?! What happens to Jed if he crashes on Fri? Do you have another option to get him tested if needed on the days your vet won't test? I don't understand that rational and would not feel comfortable at all with a vet who would not test when needed.

[Jed's Mom]

I guess I said that wrong. Jed is seeing an Internist since he came down with CC and started losing so much weight. Also, in the same office building is the emergency clinic so I could take Jed there 24/7 if he did crash. I think the normal ACTH testing times are tue-thurs. I will see if I can't get him in tonight just to check his resting cortisol levels. I never thought of doing that and they didn't mention it.

[labblab]

If they agree that doing the resting cortisol is reasonable, do ask them to run a basic chemistry panel to check his electrolytes, as well. However, under these circumstances, perhaps the internist can arrange for a full ACTH to be run through the ER clinic tomorrow if not this morning. The full ACTH is definitely preferable to a baseline cortisol alone, and it seems as though the internist ought to have a way to set that up for you without incurring an exorbitant emergency cost.

Does the IMS know how poorly he is doing, or is it only your regular vet? I am honestly quite surprised that whichever vet knows about this has not already advanced the timing of the ACTH herself/hinself...

Marianne

[Squirt's Mom]

ahhhh...~~whew~~ That sounds better. :) I was really worried there for a bit. Our babies need vets that can be available whenever so that was blowing my simple little mind! :D

[Jed's Mom]

So today was a long day for Jed. We did not do an ACTH but we did everything else..blood panel, ultrasound and chest xrays. ACTH is still scheduled for Tuesday. I didn't get him there until 2pm today so we could not do his normal ACTH test.

Blood work is all in normal values, Ultrasound did not show anything conclusive but did show a thick lining on one side of his intestines which my vet said could possibly be an ulcer or tumor but without biopsy she does not know and because it is in the middle of his intestines, they cant get to it with an endoscopy, they would need to do surgery. They also see a lot of sludge in his gallbladder.

Chest Xrays/esophagus looked good.

I was sent home with some pain meds and some meds for anti nausea/acid reflux. I have a script to fill for his gallbladder.

The plan is to stop Jed's vetoryl and run his ACTH on Tuesday to see if Jed's levels go up and Jed he is still able to produce cortisol.

Jed is down to 50lbs, Im no closer to helping him and not sure where to go from here :( Is it crazy that I am hoping his cortisol comes back low and it's Addisons? At least then I would know and maybe I could help him...

[Jed's Mom]

So two days off of the Vetoryl and Jed is like a new dog. He actually jumped my patio wall to chase a squirrel :D He has been full of energy and definitely looking to eat more. Also, I have not seen him tremor/shake. ACTH is scheduled for tomorrow.

[Squirt's Mom]

Now that sounds good! :cool::cool::cool: How is his skin looking?

[Jed's Mom]

His skin looks so good. I just added a new picture to Jed's album. Other than a couple bald spots you would never know.

[molly muffin]

Great news! love it when they regain their perky personalities. So glad that he is jumping for squirrels. :)

hugs

[Renee]

I'm glad to hear Jed is doing better. These drugs can be a life saver... but, that doesn't mean they work for everyone! What is most important is the dogs quality of life!

[Jed's Mom]

He ate some kibble two different times today..granted I had to doctor it up with chicken and pork but still!! He ate on his own :) Renee did you see his latest pic? you could never tell he had CC!

[molly muffin]

Jed looks wonderful! Such a huge difference with his hair grown back and no sores on him. I think he looks very good.

Glad he ate on his own too. Progress!

[Jed's Mom]

Thanks Sharlene. He continues to eat a little better and more energy. I should get his ACTH results back today to see if those levels start to go back up. If they do start to rise, I'm not sure where I go with treatment. I may look into Lysodren (mitotane).

[molly muffin]

How was Jed's ACTH numbers?

Is he still doing okay?

[Jed's Mom]

Hi Sharlene

His ACTH numbers went up so his adrenals are still functioning. He continues to eat better but drinking and peeing like crazy. He had us up 5 times last night. We are starting Jed on Mitotane soon. It scares me but I have to try something. I could not leave him on the vetoryl, I could not watch him live that way..he was like a zombie. And I can't leave him off meds, we are so worried about his CC coming back. We are waiting until Friday to start him and we are only going to give the elevated dose for 4 days and then test him again on Tuesday before 10am so I will get his results back that same day.

I think Friday will only be about 3 weeks of Jed off of his vetoryl but I keep reading that the wash out period is 4 weeks. Should I be concerned about this?

-Lisa

[labblab]

Can you tell us exactly what those ACTH results turned out to be? For a dog who has now had two episodes of cortisol crashing within a short period of time, I would be very leery about starting Lysodren loading prematurely. Apparently Jed's adrenals have undergone some changes that are making him especially sensitive to medication, and he can overdose just as easily on Lysodren as he can on Vetoryl -- the only difference being that the physical erosion produced by the Lysodren could take even a longer time to counteract should his adrenal production drop too low.

In looking back over Jed's dosing history, it looks as though his cortisol was hanging up above 11 or so even with increased Vetoryl doses. And then, after another increase with a change to compounded trilostane, something happened pretty rapidly and his cortisol dropped way, way lower to 3. That decrease persisted and even lowered with the switch back to Vetoryl. I would have to assume that during that time period, some actual physical change occurred with his adrenals that has altered his adrenal hormone production.

Rather than switching to Lysodren, it seems that another option is just lowering the Vetoryl dose (you didn't really lower it much at all last time around), and perhaps also shifting to once daily dosing. We have been told by one expert that dogs who are dosed twice daily do run a greater risk of adrenal oversuppression because cortisol levels are not allowed to rebound significantly at any time of the day. Is there a particular reason why your vet thinks Lysodren will be a safer or better choice in the face of these recent crashes? I guess that is the part I am not understanding -- why your vet feels there is less risk of overdosing with Lysodren.

If you do make the switch, I would want evidence that Jed's cortisol has rebounded significantly before proceeding with the adrenal erosion associated with Lysodren. During most or all of these three weeks off of Vetoryl, his adrenal production was abnormally low, so you would be starting on the Lysodren awfully quickly it seems to me. Remember, you started him back again on the Vetoryl after seeing a rebound in his urination but he rapidly crashed all over again. Coming back full circle, can you tell us what those actual ACTH results turned out to be? I think those numbers are awfully important.

Thanks so much,
Marianne

[Jed's Mom]

Hi Marianne

Jeds Results from 2/4 Pre was 6.6 and Post was 12.8. I am sure they have gone up even more so based on his drinking/peeing.

I thought the same thing about lowering his dose so one day last week I gave Jed 1 30mg pill and within hours he was lethargic and shaking again. Off of the vetoryl he has so much more energy and the shaking disappears. I dont think these are normal side affects for the vetoryl but for some reason it is how Jed reacts to it.

My vet is very concerned about switching Jed to mitotane because of how sensitive Jed is. With the high dosing she is having me give him 5 mg of prednisone so he does not drop too fast. And I have enough prednisone at home in case he does crash.

I am honestly at a loss as to what is best for Jed. But I know that while he was on the vetoryl, his quality of life was not good. There were days I thought I was going to have to put him down because he was just not moving, eating and shaking uncontrollably.

[labblab]

Thanks so much for this additional info and you are so right -- his cortisol has definitely rebounded!! And that is really interesting that he reacted so poorly to just the single 30 mg. dose. So it truly may the case that Jed just cannot tolerate the drug, and now I do better understand your reasoning in trying the shift.

I do understand the theory of trying to "cushion" the effects of the Lyosdren loading with the prednisone, but here is my worry about that. By giving the pred at the same time, you will probably be hiding the signs he would normally give which would signal he is loaded -- the hesitation in eating and decrease in thirst. As sensitive as he seems to be to medication, less than four days of Lysodren might be enough to erode his adrenals sufficiently, but you won't know that is the case if you are giving him prednisone at the same time. As a result, you may end up giving him too much Lysodren by the time you test him. Also, he will have to be free of prednisone for at least 24 hours prior to the testing in order to avoid skewing the results.

I apologize so much for saying things that complicate the situation even more, because I do totally get it as to why you are so worried and frustrated right now. But I wouldn't feel right if I don't at least mention my concerns :o. I am guessing you and your vet have already talked this part over, but I just feel as though it's important to voice my hesitation about the pred...

Marianne

[Squirt's Mom]

Since Jed seems so sensitive, even tho Lyso works differently than Vetoryl, I would suggest talking to the vet about a lower loading dose VS the use of pred with the Lyso. I don't know what loading dose they are thinking of but I think you can load using a range of 25-50mg/kg/day. So I would ask about using the lower dose of 25mg/kg/day and see how he does with that.

[Jed's Mom]

Marianne,
I think the main reason she wants the cushion is because Jed is not a "regular" cushinoid dog. The way she usually monitors with the Lyosdren is she would cut there daily food intake for 1 or two days to make them really ravenous and then she would have the owner time how long it takes the dog to finish a meal. But with Jed, he is not big on eating so we have to rely just one watching him drink.

She said as soon as I see a difference in Jed's drinking, stop the Lyosdren and bring him in the next day for his test. So we may not end up going the full 4 days. This is why we are starting on Friday and then testing him on Tuesday..I assume I would not give the high dose on Tuesday?? I forget what she told me but I have it written down at home.

She kind of left it up to me to decide if I wanted to do the prednisone and I did because I am just so worried about the switch. Jed has always been SUPER sensitive to everything.

As far as the dosing, I think the script said 500mg tablets. And I think she said to give Jed 2x a day. That seems really really high to me but they said it is a dif drug and that is the normal high dose. I did ask her based on Jed's case would she start him lower and she said she generally does not start them lower but just keeps them on it for a shorter time. Does all of this sound right??

[labblab]

She said as soon as I see a difference in Jed's drinking, stop the Lyosdren and bring him in the next day for his test. So we may not end up going the full 4 days.
That's my worry about giving the prednisone at the same time, though. The adrenal erosion may be masked by the prednisone, so he may keep on drinking normally (or excessively) regardless of what is physically happening to the adrenal cortex and you will miss seeing the signs that the Lysodren should be halted. It is only afterward, when he is off the pred and tested, that you would find out that too much erosion has been allowed to occur in the meantime.

I am hoping some other Lysodren parents will also stop by with their thoughts about this, though.

Marianne

[Jed's Mom]

Marianne

do you know a Lysodren user/memeber that I can reach out to, to ask some questions?

Thanks!!
Lisa

[Harley PoMMom]

I completely agree with Marianne, and I'm providing part of an article written by Dr. Edward Feldman, who is considered an expert in canine Cushing's, and nobody knows Lysodren like he does.


The advantages of not administering glucocorticoids are as follows:

Close communication between veterinarian and client, plus an understanding of when to discontinue medication, clinically, has been successful.

If a dog receives glucocorticoids, it is not possible for an owner or a veterinarian to know if and when an adequate amount or too much o.p'-DDD has been administered.

Because the end point cannot be seen clinically, the clinician must rely on the ACTH stimulation test. To perform this test all glucocorticoid therapy must be with-drawn for 1 or 2 days to avoid having the cortisol assay detect the oral rather than the dog's glucocorticoid concentration.

If glucocorticoids are needed because of o.p'-DDD overdosage a crisis may develop after their with drawal.

Simultaneous administration of glucocorticoids did not eliminate clinical signs of cortisol deficiency in many dogs treated with both drugs.

It seems easier to determine if glucocorticoid therapy is needed during treatment. The incidence of o.p'-DDD overdosage with clinical signs is less in dogs that do not receive the drug because the owners can appreciate mild clinical changes early in therapy and stop the medication before the problem becomes severe.

Transient need for glucocorticoids has occurred in only 5 per cent of our dogs (versus 35 per cent in glucocorticoid-treated dogs and permanent Addison's, in only 2 per cent of our dogs versus 5.5 per cent of glucurticoid-treated dogs). If signs of cortisol deficiency do develop, the clinician can be certain that the end point in therapy has been achieved. An ACTH response test may be performed immediately and the dog then placed on glucocorticoids. Response to glucocorticoid medication would also be diagnostic of surpassing the desired end point of therapy.

http://web.archive.org/web/20060831174146/http://www.io.com/~lolawson/cushings/articles/feldman-all.pdf

[Jed's Mom]

I am just so worried about what the loading days are going to do to Jed. I feel like I just got him back to acting somewhat normal. If he exhibited the normal signs of cushings daily then I would not be so worried..for example yesterday, he ate great (for Jed), good energy and minimal water intake. He only got me up once during the night and that was just to go out and he didn't drink at all.

Also how am I going to know if Jed is crashing or just having a side affect to this drug similar to the side affects he had with the vetoryl? I will talk to my vet more about the pros and cons of giving the prednisone on the loading days. I did talk to the pharmacist and she said Jed is starting at the lower dose of mitotane. I was reading the dosage wrong. I wish I could just do the ACTH every day he is loading, although Jed would not like that.

[labblab]

I am just so worried about what the loading days are going to do to Jed. I feel like I just got him back to acting somewhat normal. If he exhibited the normal signs of cushings daily then I would not be so worried..for example yesterday, he ate great (for Jed), good energy and minimal water intake. He only got me up once during the night and that was just to go out and he didn't drink at all.

Lisa, if Jed is not yet back to consistently showing Cushing's symptoms, I am thinking I would hold off on starting the Lysodren load until he does. It is remotely possible that after these crashes, he may never return to full-blown Cushing's status again. It is sometimes the case that treatment alters adrenal tissue such that it never fully resumes excessive hormone production again. We don't talk about this as a cure because it is an unpredictable result. However, with Lysodren overdosing, the mechanism is understandable. With trilostane overdosing, the mechanism has not yet been explained, but it does occur on occasion.

Secondly, as far as your fear that Jed will feel poorly during the loading without the pred: at this point, we are only talking about a maximum of four days. At that stage, no matter what, he will be tested and you will know with certainty how much his cortisol level has dropped, plus you will have his behavior to give you important guidance as to whether the full four days of medication should even be given. If he is feeling poorly at the point he reaches therapeutic range and he needs prednisone to help cushion the drop, you can start up with it then and give it to him temporarily until he rebounds on his own.

The thing that I'm not sure you are realizing is that if you mistakenly overdose him with the Lysodren because the prednisone is masking the signals that would tell you to stop the med, you are risking making him permanently Addisonian. And then he will need prednisone not for just a few days, but for the rest of his life. I am not trying to scare you unduly, but that is the reality of this drug if too much of the adrenal cortex is eroded before stopping the dosing.

Unfortunately, aside from ACTH testing, there is no way to tell the difference between cortisol withdrawal and a genuine crash with either drug. But that is a huge reason why you'd like to have consistent, observable symptoms to monitor while you are giving the Lysodren -- so that you have a basis for judging the activity of the drug. That's why if it was me, I'd hold off on starting the load until Jed is once again consistently showing symptoms. If he is having days when his behavior is essentially normal, I would not yet be starting the Lysodren. I realize the CC is a wild card here, but as long as his skin is remaining normal, I would also take that as a sign that his cortisol is still sufficiently under control right now, even without the drug.

Marianne

[Jed's Mom]

The only symptoms we are seeing on a somewhat regular basis is the increased thirst and urination and MANY more accidents in the house. I can feel the calcium deposits under Jed's skin and Dr Arnold said she saw calcium deposits under his skin when she did his last xrays. So this is our biggest concern. She believes if his cortisol levels get too high we are going to lose control of the CC again. That was a very painful time for Jed. This is the reason we want to get him back on meds asap.

Now I don't know what to do..I am going to question any decision I make.

[My sweet Ginger]

It's very painful for me to go back and check my pup's loading period for the reasons that how much I don't agree with my vet's decisions at that time and how wish only if I knew back then what I know now. Makes me very angry at her for what she had put my pup through thereafter and not to mention $$$ spent.
My pup had the initial 6day loading (pre 4.6 post 7),and then 2day 2nd (pre 6.1 post 7.9) and 3day ( vet wanted 4 but I said 3 ) 3rd (pre 2.9 post 2.9) mini loadings all of them with a concurrent use of prednisone (off on the mornings of ACTH tests) due to her worsening symptoms despite her cortisol going downward. She subsequently went Addison's state and just very recently weaned off prednisone finally after over one year.
When I look at it now we should've never proceeded with mini loads and should've started maintenance after the first loading because the numbers were very close to therapeutic ranges and especially when you consider the pred in the mix.

So here's my 2 cents if you even call it that.
For Jed, everyone seems to think he's sensitive to drugs so that makes me worry about the 4day not so mini loading with his numbers not really high.
Also I think pred only muddy up the picture.
If I were you I'd do 2, possibly 3day mini loading and ACTH test or even though Jed's numbers are a little higher than my pup's start him on maintenance 3 times a wk to keep his cortisol level in check and possibly lower his cortisol level gradually especially if he feels better with a bit higher cortisol.
I wanted it out there for you just in case. Big hugs.

[Jed's Mom]

Thank you so much for weighing in! I am going to call my vet and see if we can start him Saturday since his ACTH is scheduled for Tuesday already. and then test him 3 days later and I will not give him the prednisone and will watch him like a hawk. He will never be alone and the lady who watches him during the day had an Addisons dog so she knows what to look for and she knows when Jed is acting normal or if he is off. And the dose he will be getting is at the lower end I believe but I will verify that. Does this sound ok?

[My sweet Ginger]

Can you post the loading dose? Usually the loading dose is 50mg/kg and maintenance is 25-50mg/kg so when you say the lower end is it 25? 35? Also I'm not sure how well lower loading dosage works out or it may take longer time to load.
It is so hard for us to know what's best for our babies when we are only armed with heart full of love and not enough of medical knowledge. :o

[Jed's Mom]

I don't have the script in front of me but when I called the pharmacy to ask about the drug and if it was in the normal range for a 50 lb dog she said it was and that it was at the lower end. I will clarify what it says on the bottle when I pick it up later. I think it also said give him two pills a day and no meds the day of the ACTH. That is on my discharge instructions. They are home and I am at work..

[My sweet Ginger]

I see. For a 50lbs (22.7 kg) dog on 50mg/kg/day will be 1136m so Jed's 500mg (one pill) twice a day will be a bit lower than 568mg BID and that comes to about 44mg/kg/day for Jed. Let's hope this works.:)

[Jed's Mom]

Today is our second day of loading and so far I am not seeing much of a difference in Jed's behavior. I am not doing the prednisone like the vet wanted but she understood why. I think she is just as nervous as I am with Jed and wanted to have that cushion just in case. I can see both sides but I rather not mask any symptoms. Thank you all so much for weighing in.

I am loading for 3 days and then testing on the 4th, but what if I see no change in Jed's water intake/behavior? Should I push the ACTH out another day or two and continue to give Jed the load dose?

Thanks
Lisa

[My sweet Ginger]

Hmm, not quite sure on loading for 3 or 4 days as his dosage is a bit lower than recommended but I'd rather get ACTH test done after 48 hrs versus 24 hrs as Lysodren works another 48 hrs from the last dose was given. That way you don't have to take things into consideration with the results if they are rather high or low.

[Jed's Mom]

I did not know that, so thank you for clarifying. The vet did mention this drug stays in the system much longer than the vetoryl. I'm just so used to the vetoryl.

Jed did have some side affects today but nothing that I thought was of huge concern and they wore off as the day went on. But after I gave him meds in the morning he seems super drowsy and kind of falling over his feet and he did have a little diarrhea but he never lost his appetite and as the day went on, he evened out. It says they can cause drowsiness on the bottle so I just chalked it up to that.

I'm not sure if he is drinking as much, tonight will be the true test. If he sleeps through the night then I may skip tomorrows dose.

I am so surprised how well he is doing on this drug so far. I thought for sure I was going to see Zombie Jed again...fingers crossed it continues to go well...

[My sweet Ginger]

Lisa,

Please, stop the Lysodren and schedule for ACTH test for Tues. morning.
We are looking for a subtle change as a sign of loading with Lysodren and lethargy, diarrhea and falling over usually mean an overdose.
Please, watch him closely and do not give him any more Lysodren.

[judymaggie]

Lisa--also, if Jed has any negative symptoms at all during the night or tomorrow please give him an emergency dose of prednisone.

[labblab]

As sensitive as Jed was to the trilo, I would not give any more Lysodren now either until you know test results. Also, I don't think you need to wait until Tuesday to test if your vet thinks it is important to test earlier. Song has been a very careful observer here, and has picked up on the warning that all we staffers have been giving for years about waiting for 48 hours to test. But we very recently tried to track down any actual research that supports the notion that cortisol keeps lowering for 48 hours and have come up with nothing, and I am now aware of experts who do not advise any need for waiting. So if your vet wants to test today, I personally would be good with that. Just remember, Jed cannot have any prednisone within 24 hours of the test.

Marianne

[Jed's Mom]

I didn't give any meds today and he seems to be acting fine. He slept great through the night (first time in weeks) and he ate some food this morning. No more falling over or off balance. He drank a little this morning but not as much as usual. I will continue to watch him carefully and will bring prednisone to daycare just in case. His test is scheduled for 8am tomorrow and I will get the results back tomorrow afternoon.

[My sweet Ginger]

Thank you Marianne.
I'm aware of any finding of testing after 48hrs in stone but I think at times I've seen pups symptoms get worse after ACTH tests that were done either on the morning after Lysodren was given or after 24 hrs and then we are left with the guess work of maybe their cortisol went further down after the test was done.
It just seems to me we will be able to get the most accurate test results if we wait 48hrs and then maybe much less things to take into consideration.
Of course an ACTH test is needed ASAP if the pup continues to show any adverse signs.

[Jed's Mom]

No more adverse affects today that I can see..mostly just sleeping this morning. Beth, the lady that owns the daycare, is looking out for vomiting, diarrhea, lethargy, and I did tell her how Jed was walking sideways a little yesterday so I told her to look for that as well. I'm glad I didn't give the meds this morning. I will keep you all posted.

[My sweet Ginger]

How did Jed do at the daycare today?

[molly muffin]

Hope Jed had a good day!

Hugs

[Jed's Mom]

Jed did great at daycare yesterday and even ate his lunch which was kibble. He would not eat that for me in a million years but he eats it for Beth. He seemed a little restless last night but nothing to the point where I wanted to rush him to the emergency clinic. he ate some dinner and then just slept. He got me up at 3:30 to go out but did not drink and Beth said he was not drinking much yesterday at daycare. I'm gong to drop Jed at 7:15 this morning and they told me I would get his results back later today.

[Jed's Mom]

ACTH pre 2.4 post 6.4. they want me to give Jed another induction dose tonight and retest tomorrow afternoon. My gut is telling me to start the maintenance dose...need some help on this one please!!

[My sweet Ginger]

Dang, he was really close and I'm with you on that. I'd start maintenance right away. Let's see what others say.

[Jed's Mom]

I talked to my vet and told her I was not comfortable giving that dose knowing how fast Jed can drop. She said she was ok with me starting the maintenance dose and retesting in two weeks. She recommended we start off doing Monday - Friday 250mg and then Saturday and Sunday off. We set up the next ACTH for March 3rd. I hope I made the right decision..

[judymaggie]

I definitely think you made the right decision -- I didn't really understand why they would want you to give him another loading dose, especially if only reason was to bring down Jed's post number to exactly below 5. I think 250 mg. 4x a week sounds good although I think I would be more inclined to do an every other day dose rather than every day and skip weekends. If Jed is doing good on that dose, I also don't see the need for another ACTH in two weeks. A one month test is the recommended protocol, assuming all is well. You are still going to have to watch Jed carefully for any negative side effects. Did the vet say why she wants you to wait until next Monday to start his maintenance dose?

[Jed's Mom]

Im sorry if I said we are waiting, we started maintenance dose of 250mg tonight.

I asked about every other day as opposed to every day and the vet tech I talked to said she has seen it done both ways. My vet is on rounds tonight in ER so she did not get a chance to call me directly so I will ask her her reasoning tomorrow. I think I would like to do every other day..I think this will even Jed out.

The retest in two weeks is to make sure the dose Jed is on is working for him. I asked if we could do it sooner than two weeks but they said to call if I saw anything concerning and they could get Jed in sooner. If after his next ACTH numbers are still good I will go to every month.

[Jed's Mom]

Jed had a rough night. He was up a lot going to the bathroom but not drinking a lot. He didn't eat at all yesterday but this is not uncommon after his ACTH test. Usually he bounces back later in the day and I can get him to eat some dinner, but not yesterday. I did get him to eat several of his favorite treats when I gave him his maintenance dose but that was probably not enough food so maybe that is why he out of sorts? This morning, Jed will not eat his favorite treats and he does not want to do the stairs but he does them fine with some coaxing. I'm not seeing his balance off but he is just "off" in general. I gave him some prednisone this morning to be safe. Jed has never acted like this before..he is not a morning eater but he loves his treats and for him to pass those up he has to feel sick. I'm just not sure if its the drug making him feel nauseous??

[Harley PoMMom]

I am sorry to hear that Jed is not acting his usual self, you did the right thing in not giving Jed his Lysodren.

Has it been mentioned that administering Pepcid AC 20-30 minutes before the Lysodren is given may help with that nausea?

[judymaggie]

I'm glad that Lori mentioned Pepcid AC. I give it to my Abbie before every meal, not just before the meal before her Lysodren. Abbie has a very sensitive stomach and has not had any issues with the Lysodren upsetting her.

Also, would be interested in what others think about you holding off on the Lysodren for a few days until he seems to be back on an even keel. It is possible that he did not get enough food before giving him the Lysodren but he already wasn't feeling great.

Are you giving him the Lysodren wrapped in peanut butter or cheese?

[Jed's Mom]

Hi Judy

Jed is not eating much these days and PB and cheese are two things I can never get him to eat. I did a lot of reading today and I read that I should never give lysodryn to a dog that does not have a healthy appetite. I can't remember when Jed had a healthy appetite. There is something going on other than the Cushings and the Vet can't seem to figure it out. I think I am just going to hit the same brick wall every time I try to treat his Cushings.. I need to find out why Jed won't eat. I weighed him today and he is down to 48lbs. His normal weight is 67-70 lbs. I am not going to give Jed any more Cushings meds..I can't keep doing that to him. He gets so sick...I am at such a loss and my vet is no help. How can I help him when my vet has no idea?? I feel so helpless and I am failing him.

[Renee]

Deep breath. You are doing all you can.

I completely agree - stop all cushings meds. You may have something else going on that needs to be addressed and trying to treat cushings is muddying the waters right now. As long as his skin is okay, then I would put the cushings on the back burner and move on. I am concerned about the CC coming back, but we know it can be healed, so just watch for it's re-occurrence, before jumping back into cushings treatment.

Are there other vets you can see? A specialist in your area? Has your vet reached out to other vets? Even vets out of state or elsewhere? Many vets have a network of others that they can call on when they are stumped.

[My sweet Ginger]

It's so heartbreaking and helpless feeling when your pup won't eat and I know that so well. Ever since my Ginger started Lysodren she's been inappetence to date. Somewhere along the way we had to add appetite stimulant to her cocktail of meds and it really seems to make a difference. Would you consider this for Jed too? Ginger takes Cyproheptadine. Without Cypro and cheese cake I don't think she'd be here today. I coat all her meds with cheese cake. On any given day you'd find 15-20 of those individually cased mini cheese cakes in my freezer.:o
She seemed to take some sweets when she refused everything else and our IMS told me that give her whatever she eats as something is still better than nothing.

I agree with you that he needs a break from Lysodren until he eats and feels better.

Hang in there Lisa and you're not failing him. You just have to keep trying for him and let's hope that soon something will click and he will be stabilized. Somehow someway we have to get him to eat tho.
Big hugs, Song.

[Squirt's Mom]

Sweetheart, you aren't failing Jed. You have done and are doing everything you can to help him feel better. Like Renee, my main concern with stopping treatment is the CC. There can be other causes for CC but they are rare. It might be worth looking into those possibilities should it rear its ugly head again. Also, if your gut is telling you something IS wrong, then take him to an altogether different vet clinic and let them see him with new eyes. Do NOT let them focus on Cushing's but make them ignore that and look elsewhere for causes for what you are seeing in your sweet boy.

But don't come down on yourself. You don't deserve that. ok? OK! :)
Hugs,
Leslie and the gang

[Jed's Mom]

Thank you, All. I just hate seeing him the way he is. My vet is thorough but she is just not sure what it causing Jed not to eat. With all of the tests that we have done we found several possible causes but nothing concrete. I scheduled and endoscopy and another ultrasound for next Wednesday. The ultrasound will check the area of his intestines that the endoscopy can't reach and see if there is any change. The Endoscopy will will show inflammation/IBD. And of course the way they treat IBD is with steroid. IF it is IBD, she talked about another drug we could use to treat called Cyclosporine.

I will put in here Jed's discharge notes from his last check. It is from 2/3.

Diagnosis / Problem list:
Cushing's disease
- Proteinuria - resolved
- Calcinosis cutis - resolving
Decreased appetite
Thickened segment of Jejunum
Suspended mineralized sludge in the gallbladder
Elevated liver values
Cough / gag

Diagnostic Summary:
CBC: No significant findings.
Chemistry Panel: Persistent cholestatic hepatopathy.

Radiographs of the thorax: No evidence of dilated esophagus or lung diseases


Ultrasound:
1) persistent hyperechoic hepatopathy.
2) persistent vascular sclerosis, spleen.
3) adrenomegaly (at least of right, suspect bilateral).
4) possible enteropathy, segment of jejunum.

Case Summary:

Jed presented to our internal medicine service for further monitoring / evaluation of his decreased appetite. Throughout his life, Jed has always been a selective eater but, since his diagnosis with Cushing's disease, his appetite has become more finicky. He is still willing to eat certain foods but tends to quickly become averse to them. His decreased appetite was initially thought to be secondary to his severe skin disease and mild proteinuria, however these conditions have dramatically improved since his initial diagnosis. Today we rechecked general lab work as well as an ultrasound to further screen for causes of Jed's decreased appetite.

At this time, there are several issues that may be contributing to Jed's decreased appetite including: intestinal disease, stomach ulceration, gallbladder mucocele, Addison's disease, megaesophagus / esophagitis / reflux, and pancreatitis.

Jed's ultrasound today showed a solitary loop of small intestine that was thickened relative to the rest of his small intestine. This could indicate underlying intestinal diseases such as food allergies or inflammatory bowel disease. This could even represent an early intestinal cancer. Unfortunately, in order to determine if this
loop of intestine is diseased, we would need to perform surgical intestinal biopsies. Alternatively, we could consider a hypoallergenic diet for food allergies but instituting a hypoallergenic diet is very difficult when a patient is unwilling to eat and needs to be tempted with many different types of food. Stomach and intestinal
ulcers / irritation can also commonly occur when there is increased exposure to steroids (Cushing's disease). Endoscopy could be used to screen for intestinal ulceration / inflammation but could not access the thickened loop of intestine seen on ultrasound. At this time, we have chosen to treat Jed for intestinal inflammation / ulceration with antacid therapy. We may want to consider recheck ultrasound in 1-2 months to re-evaluate the thickened loop of Jed's intestinal tract.

Jed's ultrasound also showed some organized, mineralized sludge within Jed's gallbladder. This could represent an early form of gallbladder disease called a gallbladder mucocele. Mucocele's are congealed bile within the gallbladder that can cause belly pain and nausea. These signs can wax and wane. In severe cases,
this type of gallbladder disease can require emergency surgery. Patients with Cushing's disease are predisposed to forming gallbladder mucoceles. At this time, we have provided a prescription for Ursodiol.
This is a supplement that may help thin Jed's bile and can encourage mucocele breakdown / resolution. This gallbladder disease may also be partially responsible for Jed's elevated liver values. Alternatively, his liver values may be elevated from Cushing's disease alone.


Patients with Cushing's disease can also be predisposed to pancreatitis. Pancreatitis can cause belly pain and nausea. Pancreatitis can often be seen on ultrasound but additional blood tests could be considered to further rule out pancreatitis as the cause of Jed's decreased appetite. This blood sample can only be taken after a 12 hour fast.

Jed's recent ACTH stimulation test results have also suggested over-regulation of his Cushing's disease and possible steroid hormone deficiency, Addison's disease. Addison's disease can cause diarrhea, nausea, vomiting, and lethargy. Recently, we stopped Jed's Trilostane for several days to see if his appetite would improve. Typically, stopping the Trilostane for several days should cause a relapse of Cushing's disease but some animals can remain permanently Addisonian after treatment with Trilostane. Jed's urine production did
increase off of Trilostane, suggesting his Cushing's disease relapsed, however we did not perform an ACTH stimulation test off of Trilostane to ensure that he does not have Cushing's disease. We will stop Jed's
Trilostane again and recheck his ACTH stimulation test off of Trilostane to ensue Jed still has adequate adrenal function. We do not want to leave Jed off of Trilostane for too long since this may result in a relapse of his Calcinosis Cutis.


Jed has also experienced an intermittent cough / regurgitation. This could be due to acid reflux and irritation of his esophagus or potentially poor function of his esophagus. Typically the esophagus functions to contract and push food down into the stomach. If the esophagus is not working well, then food will remain in the esophagus. This can cause periodic reflux of food and an intermittent cough as well as a decreased appetite. In order to further evaluate the function of Jed's esophagus, we could perform a barium swallow. This would require Jed to swallow a contrast agent mixed with food while laying on his side. We would video his swallow and determine if his esophagus functions normally. Unfortunately, if he inhales the contrast agent during the procedure, then this can produce a severe pneumonia. At this time, we have elected to treat for reflux / esophageal irritation with an antacid and a promotility agent.

Follow up:
Jed is scheduled for a recheck ACTH stimulation test on 2/3/15. This will determine if his steroid hormone production is adequate. Please consider the options above regarding endoscopy, esophagram, pancreatitis blood work etc. We will also determine how Jed responds to his current medications and direct further therapy.