Gracie's Story

[Perywinkle]

Hi!
I new here *Waves* Lets start with a little about me then I will tell you about Gracie. I have 4 dogs, Gracie just turned 12 years old Jack Russell, Sadie and Holly Litter mates, will turn 8 years next week (Also Jacks)! and Chloe my 4 year old Cavalier king Charles. Along with Two cats, Jasper 1 Year old and Binx 3 months old. Technically the 4 dogs are shared custody between me and my parents as my mom does not work and she is home during the day and I take them at night. So they are spoiled that they are hardly ever alone. I'm also a registered Veterinary Technologist in Ohio.

So I'm pretty particular with all my pets. Yearly blood work and dental cleanings. Two years ago Gracie started having some liver issues. I sent out a bile acid test, which came back normal and switched her to L/D and put her on milk thistle. It took some time but it went back down into the normal range.

In the last 4-5 months, she has started to act off. Picking fights with the other dogs, behavioral changes. She is getting fairly arthritic in her stifles and I put it off to being a bit grumpy do to age and the fact that I have to be very careful what pain control I give her do to previous liver issues.

She is a cross between a wire hair and a short hair jack and she got some funky in-between coat. I don't shave her all the way down in the summer but I do give her a shorter cut. I noticed her hair was not growing in as thick this time as it normally does. But still I didn't really put anything together from it. She wasn't balding or greasy just her hair coat was a bit thinner then normal.

In the mean time Gracie had been starting to get into more trouble now then she ever had in her younger days. Digging into trash cans, climbing on counters to get to food and if she saw a opportunity sneaking into the other dogs food bowls when they were distracted (they are not free feed, but my one jack is not a big eater). Oh and did I mention she also knows how to open zippers, have a snack in your purse she will open the zipper to get to it. I put this down to her getting ornery in her old age.

Then she started peeing in the house. I ran all sorts of Urinalysis on her and they all were normal! This was so not normal for her, but she wasn't drinking large amounts of water. I started to connect the dots, something was off. It wasn't diabetes I checked for that.

Then a few weeks ago Gracie got incredibly ill. I rushed her into work and she has pancreatitis really bad. But other then her pancreatic enzymes her blood work was actually really good. Her liver enzymes were great. We took some xrays, and the Dr. goes her liver is a little bigger then it should be. So after three days of being hospitalized and daily xrays the cause of the pancreatitis appears . She ate either a birds nest or a mouse nest and well luckily she passed it out. No idea where exactly she found it at! At this point I'm going, p/u p/d, increase appetite, thinning hair coat, increase liver. This sounds like Cushing's.

I decided to wait and let her body heal from the pancreatitis before running the test to check. So Monday I brought her into work and we did the Dex suppression/ACTH stim to Michigan state.

Her results are as follows
Cortisol, Baseline -394 H (Ref range 15-110)
Cortisol High dose dex 2hr - 51 H (Ref Range 0-30)
Cortisol 2hr Post ATCH - 689 H (Ref Range 220-550)

She's not horribly off the charts, so I think I caught it fairly early on and hopefully with treatment she will be back to her happy jack self.

She weights 13# 3oz so her game play is this Vetoryl 10mg one tablet, once a day, and recheck a ACTH in house in 10 days to see how she is doing. I am waiting until Saturday to start her on the medication as I will be home to watch her all day and Sunday as well to see how she responds.

Her other medications/supplements are: Glucosamine, Fish oil, Milk Thistle and Adequan inj. once a month. And an occasional low dose of Rimadyl on those days she is just hurting. She has never been on Prednisone or prednisolone.

So I guess I'm just here to tell my story. As a tech I am particular about the risk/benefits to anything my pets get, so of course in my digging further on this disease and it's treatment more so then my text books I found this forum :)

[molly muffin]

So glad you found us. You're right, it does sound text book cushings, especially the eating like crazy. (you've also had thyroid checked I suppose?) since you have eliminated the other possibilities and in light of the test results, it does seem to be cushings and a 10mg is right where you would want to start at, with using brand name vetroyl. That is just below the 1mg/1lb recommendations now used. It is a safe starting point though, and hopefully this will do the trick and get Gracie right back to where she needs to be. Most importantly, stop scavenging and eating bird nests!! and things she shouldn't. Girl gets into trouble doesn't she. :)

Welcome to the fourm! So glad you found us too.

Sharlene and molly muffin

[Perywinkle]

Hi!
Thyroid was right in the middle of the normal range. I'll probably run another full panel and CBC on her when we do her ACTH STIM. Just to make sure everything is staying where it should. I wish I would of put if all together sooner, I knew something was wrong but I just could not pin point it. She's had a few issues with her PH in her urine being too high in the past so when she started having accidents I put if off as that.

She certainty does get herself into lots of trouble, but what fun is a Jack Russel who doesn't :p. Though when she was so sick from eating that nest I was terrified for her!

Sadly I was actually relieved to have answers. Hopefully she responds well to treatment and she continues to have many more years if getting into trouble. But I'm pretty optimistic that Gracie is healthy otherwise and is too stubborn to let cushings cause her any major issues :) My main worry of course is vetoryl side effects but the risk of the meds vs the risk if her cushings causing more issues is definantly worth the treatment.

I did wonder this year why her arthritis did not bother her nearly as bad as last winter. And we had a hard cold winter too. Steroids the double sided sword.

[molly muffin]

The risks with the medication is negligible as long as the dosage is appropriate for her. You might have to gauge what dose keep her appetite under some control vs her arthritis though. That can be a balancing act for sure.

Adequan injections for the arthritis, laser therapy are options rather than nsaids that can be harder on the liver.

Sharlene and molly muffin

[Perywinkle]

I love adequan, Gracie not so much. She hates her shots but you can tell it really helps. Our other office has laser. I'm hoping we will get it at ours one day. She does okay for the most part, just some days she over does it.

I decided to start her first dose today instead of tomorrow with a list of things for my mom to watch for during the day. I figured that will give it time to get a little higher in her system by Saturday/Sunday when she is on my watch to make sure as she is getting it higher in her system she does okay.

I feel bad we got so frustrated with her for being bad when she was getting into the trash cans and climbing up on the end tables! The peeing in the house while I was thrilled with it, I knew it was something she could not control because at one point she came to get me to let her out and she just couldn't make it.

So here we go!

Oh and this is Gracie the Jack Russell Terror Opps I mean Terrier :)

http://i7.photobucket.com/albums/y270/Ponies4sale/image-53.jpg

[molly muffin]

Oh she is incredibly cute.

I really don't think at 10mg a day you are going to have any problems. Of course, never say never right. Usually though I think around day 10 is when you might start to notice a reduction in symptoms that is if they are on track at the 1mg/1lb ratio. Just something I've noticed on the forum.

The other thing you want to remember is that while you'll test to see where she is at around 12 - 14 days, unless she has gone very low, you won't be changing dosage, because cortisol can continue to drop even at day 30.

Don't feel bad, cushings is not the first thing that jumps into most peoples minds, even when you are in the business. I think it is always harder when it is your own too.

I hope you get the laser at your office too. It's amazing once people know about it, how many will use it.

Sharlene and molly muffin

[Chloe's Mom]

Hi Perywinkle & Gracie, and welcome to the forum. You'll see from my avatar, that I also have a JRT named Chloe. Chloe was also recently diagnosed and has been on Vetoryl/Trilostane for a little over 2 months. She is doing really well.

My vet doses the meds at 1 mg/KG, rather than 1 mg/lb. After reading some of the stories on this forum, I was really relieved that she started Chloe so low. I have Chloe's meds compounded at 5 mg and she weighs about 14.5 lbs (little porker).:D

Chloe's biggest symptom was drinking buckets of water and peeing EVERYWHERE all the time. She didn't get into food in the house or beg constantly for food. BUT, she would eat anything and everything she could find in the yard. I have noticed that she has stopped her "yard grazing frenzy" since being on the Trilostane.

At some point in the future, I predict that Chloe's dose will be increased to something like 6-7 mg, but for right now, we are happy with her results and her clinical signs.

You are soooooo fortunate to work for your vet and have access to all of the diagnostic tests and equipment. Plus, with your knowledge, you are so far ahead of the game. Gracie is lucky to have you!!

And, Gracie is adorable!

[Perywinkle]

Thanks Chloe's mom :) I have a Chloe too but she's a cavalier. I love my job, and love being able to expand my knowledge of it! And I can never see myself without a Jack Russell by my side. People can't believe I have three and think my house must be full of bouncing furballs, but all three are actually very calm dogs. They are always ready to get up and go, but not hyper. My cavalier on the other hand she's crazy!

So far so good with Gracie. Little less obsessive with water today, but it's also a cooler day today. It will be nice not to accidently step in a pee puddle :p Crossing fingers and we get further in She can stay on a low dose.


I'm looking at August 19th to recheck her ATCH STIM and also do a CBC and serum chemistry. That puts her at 12 days instead of 10 but my coworker said that is fine. We are leaving for vacation in September (and we bring all 4 dogs) so I'm trying to make sure her bloodwork won't fall into that week.

I am hypothyroid so I can sympothise with her when something in your endocrine system is off. You don't feel bad or sick you just feel not right. I was only 21 when I was diagnosed and it caused me a lot of issues until we figured out what was the problem.

I also forgot to mention Gracie is a allergy dog, but I allergy tested her 4ish years ago. I decided to treat her by cutting all her food allergies out and that made her much more confortable without any medications. At her worst sge chews her feet now. So it should be interesting to see if her allergies start flaring up more once her levels are back into normal.

[molly muffin]

Just popping in to see how Gracie is doing :) Allergies, arthritis, both are a balancing act of the cortisol. You want to lower it probably enough to see decrease in symptoms (no stepping in puddles) but not too much to let the other things become a problem.

Sharlene and molly muffin

[Perywinkle]

Sorry for the delay. So Gracie was in today for her ATCH stim, serum chemistry and electrolytes.

At the 10mg once a day her base line is at 4ug/dl and her 2hr post is at 7.1mg/dl normal being 1.8-7.2.

So we will recheck her right before she runs out of the 10mg as she's right on that border.

For her chemistry

ALT is up a little 126 normal is 10-100
Tbil 1.5mg normal is 0.0-0.9
Chol 375mg/dl normal is 110-320

So not too bad. All other levels and electrolytes normal.

Peeing in the has subsided. Hunger has deceased back to normal for her. Some weakness in her back legs.

[molly muffin]

The cortisol can continue to decrease even up to and past 30 days. So I would leave the dose and recheck later. It might continue to come down still. How

How are her symptoms?

Sharlene and Molly muffin

[Perywinkle]

Overall she's doing well. I increased her adequan shot to twice a month as her arthritis is kicking in again with the steroid levels dropping in her system. I'm hoping that as she continues on treatment she will gain muscle strength in her back legs. I think the combination of the weakness with the arthritis is making it tough on her.

Today we had a bit of GI upset probably related to the stress of yesterday. She's not the best car rider anymore, and having to spend the whole day in a barking kennel is a lot harder on her then it use to be.

I have noticed her tummy is getting a nice tuck on it. It was never fully distended but I think it was starting to head that way. Drinking she's still thirstier then normal but the accidents have subsided. She's also back to nitpicking her food like she did years ago. But not to say she won't eat. She will gobble the other dogs food if she gets the chance.

Really other then the arthritis she is doing really well., hopefully we continue down this path..

[molly muffin]

It certainly can be difficult to find that good balance for cushings and arthritis. You might have to tweak it to get it right for Gracie.

hugs
Sharlene and molly muffin

[jrepac]

Gracie is a real cutie:)

I'm assuming they did the UCCR test up front? that can't confirm cushings, but it can rule it out. Still, everything else you describe seems to be Cushings like...but I've lived thru diabetes, pancreatitis and cushings w/my aussies and they have some similar symptoms. Very frustrating.

Sounds like Gracie is doing well so far :-)

Man, that's a lot of Jacks in one house. Not sure how you do it. I've had 4 Aussies over the years, but never all at once. I cannot even imagine. My breeder usually has 6-8 Aussie terriers in her home at one time, it's crazy. Currently, I have an Aussie, a Rattie, a Pom and a Chi in the house. All girls. The Aussie and the Rattie get into it from time to time, I have to say. It can be scary! Territorial Terriers! But, you have to love their spirit!

All the best.

Jeff and the Girls