Chief - German Shepherd Dog, Passed Jan 29/16

[Chief]

Hi everyone, thanks for adding me to the site. Chief is a 103 lb (not fat) 10 yr old German Shepherd dog. He will be 10 on his birthday which is Nov. 18. Some background on Chief. Chief has had a string of bad luck . In late May this year he he had a tumour removed that the vet for two years assured me was just a fatty tumour. It turned out to be a soft tissue sarcoma with a good prognosis on the biopsy report. Biggest fear is that is will grow back in the same spot. This type of tumour rarely spreads elsewhere in the body. Chief's vet diagnosed his limp in is right leg as arthritis in the hip. I suspected it was a cruciate ligament tear so sought a second opinion. Sure enough on July 10 he had TPLO surgery (cruciate ligament). About two days post op he started drinking excessively and peeing large amounts very often. I was not alarmed at the start as he did the same thing in early 2012 when he had TPLO surgery on his left knee. Besides two of the three meds he was on are known to cause one to be thirsty. By the end of week 3 he was 100% off all meds. Within a week or so the excessive drinking and peeing did not stop. I took him to the vet who did urine and blood tests and so started the journey to figure out what was wrong with him. Blood work all normal, urine test good except for low specific gravity. Later a culture was done which came back negative. A specialist suggested further antibiotics in case of a walled infection. Other than peeing and drinking and a slight increase in appetite he is normal. Last week a UC:CR test was done which showed high cortisol levels. I do not have the exact numbers but they were high. This morning he went in for the ACHT test and it will be back tomorrow. At this time from my many hours of research his problems is pointing to Cushing's disease. How long after he starts on meds before the drinking/peeing issues resolve? I am seriously sleep deprived as he goes out every couple of hours during the night. He sometimes has an accident in the house but seems to be only when he is excited that he can't hold it for awhile. Yesterday I was getting him and my other two german shepherds leashed up for their walk. I took a minute to do something and he peed all over the floor by the door.

BTW the two rounds of antibiotics which were very expensive have not helped at all.

Any suggestions on what I can expect would be greatly appreciated. I am very upset about this illness but need to learn to live with it and give Chief the best treatment and life possible.

[Harley PoMMom]

Hi and welcome to you and Chief!

Poor Chief has been through a lot here lately :( One thing I want you to know is if Chief is diagnosed with Cushing's it is a treatable disease. However, success in treatment does depend on a few things; keen owner observation, a pet parent willing to educate themselves about Cushing's, and a vet/IMS that has experience treating Cushing's and is knowledgeable about the protocols for Cushing's.

Is Chief's primary vet a general practitioner (GP) or is he seeing an internal medicine specialist (IMS)? It would be helpful to us if you could get copies of all tests that were done on Chief and post any abnormalities that are listed along with the reference ranges and units of measurement...e.g...ALT 150U/L (5-50)...thanks!

Could you also post what medications Chief was/is taking and the dosage that was/is prescribed.

When a dog is started on treatment it may take 1-2 weeks to see improvements with the increased drinking/urination. Cushing's is when a dog's body produces excessive amounts of cortisol. This increased cortisol does have an effect on all organs, it makes the kidneys work harder so a dog must drink copious amounts of water to keep us with the urine output from the kidneys, water can not be restricted at this time because this could lead to a life threatening situation.

The two medication usually rx'd for Cushing's are Lysodren/Mitotane and Vetoryl/Trilostane, both are strong drugs and the proper protocols for them need to be followed. I will include some links from our Resource thread where you will find some great information:

Links to Cushings Websites (especially helpful for new members!) (http://www.k9cushings.com/forum/showthread.php?t=180)

Trilostane/Vetoryl Information and Resources (http://www.k9cushings.com/forum/showthread.php?t=185)


Lysodren loading Instructions and related tips (http://www.k9cushings.com/forum/showthread.php?t=181)

If you have any questions please do not hesitate to ask them, we are here to help in any way we can.

Hugs, Lori

[Chief]

Hi Lori,

Thanks for your response. I will get copies off all tests..urine, blood work, UCCR , ACHT to you in the near future. The ACHT results will be back tomorrow.

Chief is not currently on any medication other than finishing antibiotics. Will provide name and strength with other info.

After his TPLO surgery he was on: antibiotics for 10 days, Tramadol for 7 days and Metacam for 3 weeks. He was also on Alprazolam (doggie ativan type drug...actually human anxiety pill). Chief is a very high strung dog and these were used as needed for 3 weeks to keep him quiet, thus not injuring his TPLO leg. These were 1mg in strength and he could take up to two at a time and twice a day. He only took a total of 39 pills in 3 weeks.

Prior to his surgeries he was on metacam for the pain of the torn cruciate ligament and for the misdiagnosis of hip arthritis. He was probably on metacam for about 6 weeks max. prior to TPLO surgery.

Other than peeing and drinking he is happy, ready to go for a walk or truck ride, has a great appetite, his coat is shining, the hair is growing back on his leg and belly ( the two surgical sites).

Will be back to you with copies of all the tests and meds info. once I have them.

Thanks

Cathy and Chief

[Harley PoMMom]

Side effects of Metacam can be increased drinking/urination, so it could be that those symptoms are related to the Metacam and not to Cushing's.

According to the Metacam website:
5. What side effects may occur by using METACAM?

The most common side effects are vomiting, diarrhea, and loss of appetite. As with all NSAIDs, METACAM may cause side effects involving the kidney and liver organ systems. See the Product Insert for complete side effect information.



Link to website: http://www.metacam.com/index.php/FAQs-Veterinary-Professionals

Did the vet say if Chief's creatinine level is elevated? The creatinine is on his chemistry blood panel and it may be listed as CREAT.

Hugs, Lori

[Chief]

Metacam can cause problems but he was not on it for an extended period of time so unlikely the cause. Chief has a good appetite and no side effects as stated other than excessive drinking and peeing.

HIS BLOOD WORK WAS ALL NORMAL, nothing elevated, nothing out of the norm. I saw it but have to get a copy. Just done about 3 weeks ago. I do have a copy of the one done around the end of May and all was normal.

THE ONLY OUT OF THE NORM THING WAS DILUTE URINE ON HIS URINE TEST AND HIS CORTISOL LEVELS WERE HIGH ON THE UC:CR TEST.

CHIEF HAS BEEN OFF ALL MEDICATION FOR 6 WEEKS NOW OTHER THAN ANTIBIOTICS which are being given at this time in case of a walled infection.

Something has to be done to help this poor dog and me because I can't continue to sleep on the couch in order to be close to the door to let him out 4 - 6 times a night. I am sleep deprived and have been on the couch for 9 weeks. I am doing this all on my own and I can't continue to be at home 24/7 living alone in the middle of nowhere.

I also have little faith in vets due to bad luck in the past.

Sorry if I sound negative. Having a bad day. I do love my Chief so much and will do anything for him but if I get sick he has nobody cause we have no family and few friends in this area.

[mytil]

Hi and welcome from me as well.

I am sorry you and your boy are having these troubles. As Lori has mentioned, post test results here so we can have a look, the UC:CR and ACTH when you get it.

It is strange that his blood work showed no abnormalities or elevations. So the conditions of diabetes, thyroid problems as well as kidneys have been ruled out, right? Has an x-ray been performed to see the internal organs?

So that you are able to get some much needed sleep, consider trying puppy pads in the areas he may pee (even at the door while waiting to go out) until this is sorted out as I am sure this is added stress to him as well. This will at least help with the clean up.

A side bar note on the Alprazolam (Xanax) - it can cause increase thirst and dry mouth so this may aggravate the situation of excessive drinking, hence excessive urination. But please do not with hold water from him.

Keep us posted
Terry

PS -- do not worry about sounding negative --- it is very hard on us when our pups are ill and trying to figure out what is going on and being so sleep deprived :)

[lulusmom]

Hi and a belated welcome to you and Chief.

Based on the information you've provided so far, I sure don't see cushing's as being the culprit in Chief's excessive drinking and peeing. Did you collect the urine specimen for the UC:CR at home and get it to the vet within an hour or two of collecting? Was it the first pee of the morning before any food or meds? If your vet collected the urine specimen, the test results should be discarded and you should ask for a refund. It would extremely unlikely to get a normal result from a dog who is stressed out at a vet's office, especially if the specimen was taken by cystocentesis (needle through the abdomen).

Glynda

[molly muffin]

hello and welcome to the forum.

It is very hard when you are dealing with so much on your own to keep the spirits up constantly. Impossible even.

Did you get the ACTH results back today?

I don't want you to think that we are being negative either, but we do want to make sure that cushings is the problem prior to starting medication for it. The drugs work, but they are powerful and can cause further issues if the problem really isn't cushings. So, we cross the t's and dot the i's around here. :)

Sharlene and molly muffin

[Chief]

Thanks to everyone who answered me. I am so confused and scared. I have copied the responses and then answered each. I appreciate your help.


I am sorry you and your boy are having these troubles. As Lori has mentioned, post test results here so we can have a look, the UC:CR and ACTH when you get it.

I will get these results on Monday. He goes in then for another urine test. I will take it at home first thing in the morning and they also want one from the day before from just before dinner. He does seem to drink more after his meal and all evening.


It is strange that his blood work showed no abnormalities or elevations. So the conditions of diabetes, thyroid problems as well as kidneys have been ruled out, right? Has an x-ray been performed to see the internal organs?

His blood work was all normal. Yes diabetes mellitus, thyroid and kidneys have been ruled out. DIABETES INSIPIDUS IS STILL ON THE LIST. A x-ray was done on the organs and all looked normal other than a full bladder. As soon as he got out the door he had one huge pee.

An ultra sound has been ordered but it take a week or two to get it done in the area where I live.


So that you are able to get some much needed sleep, consider trying puppy pads in the areas he may pee (even at the door while waiting to go out) until this is sorted out as I am sure this is added stress to him as well. This will at least help with the clean up.

I will need huge pads as he pees very large amounts. I had thought about lots of towels in the area and then just wash them. Not sure where he would pee. At the door maybe or his other place has always been in the family room by the fireplace if nobody is around.


A side bar note on the Alprazolam (Xanax) - it can cause increase thirst and dry mouth so this may aggravate the situation of excessive drinking, hence excessive urination. But please do not with hold water from him.

Alprazolam does increase thirst. He only used it for 3 weeks and has not had any for 6 weeks now. I used it sparingly then even. He could have taken a total of 84 pills over 3 weeks at max strength but he only had 39 pills in total.


Keep us posted
Terry

PS -- do not worry about sounding negative --- it is very hard on us when our pups are ill and trying to figure out what is going on and being so sleep deprived


#7
Yesterday, 10:35 AM
lulusmom
Administrator Join Date: Apr 2008
Location: Show Low, AZ
Posts: 5,745

Re: Chief - German Shepherd Dog, 10 yrs old
________________________________________
Hi and a belated welcome to you and Chief.

Based on the information you've provided so far, I sure don't see cushing's as being the culprit in Chief's excessive drinking and peeing. Did you collect the urine specimen for the UC:CR at home and get it to the vet within an hour or two of collecting? Was it the first pee of the morning before any food or meds? If your vet collected the urine specimen, the test results should be discarded and you should ask for a refund. It would extremely unlikely to get a normal result from a dog who is stressed out at a vet's office, especially if the specimen was taken by cystocentesis (needle through the abdomen).


I did collect the urine sample for the UC:CR and it was the first pee of the morning before any food or meds. In fact at that time he was off all meds. I do not believe there is really a first thing in the morning pee when he is peeing all night long every hour or two at the most. A different time they did the urine test via cysto in order to do a culture for a bacterial infection. This culture came back as no infection. The specialist suggested it may be a walled infection so they put him on antibiotics for it. He has one day left of 10 days on them and I see no change. If anything he is drinking and peeing more than before.


Glynda does this sound more like Diabetes Inspidus rather than Cushings? Two vets have said Cushings dogs may only have a couple of symptoms and that drinking and peeing lots are often the first symptoms they see. Lots of times owners don’t bring the dogs in until the symptoms are quite bad and perhaps more of them.



#8
Yesterday, 07:48 PM
molly muffin
Moderator Join Date: Jun 2012
Location: Canada
Posts: 10,144


Re: Chief - German Shepherd Dog, 10 yrs old
________________________________________
hello and welcome to the forum.

It is very hard when you are dealing with so much on your own to keep the spirits up constantly. Impossible even.

Did you get the ACTH results back today?

Yes ACTH came back yesterday and the cortisol reading are high. I don’t have the numbers but will have copies on Monday of all the tests. They want to do another urine test from sample collected first thing in the morning to see if readings have changed.


I don't want you to think that we are being negative either, but we do want to make sure that cushings is the problem prior to starting medication for it. The drugs work, but they are powerful and can cause further issues if the problem really isn't cushings. So, we cross the t's and dot the i's around here.

My vet also said that they can’t prescribe any meds until they make sure it is Cushing’s they are dealing with for the reason you describe above. She would not even allow any natural supplements at this time. He is on glucosamine but that is all.

[Chief]

Chief continues to drink more and more and pee more and more. I can't take this letting him out every hour or less. I have been sleep deprived for 9 weeks since his TPLO surgery but now this. I am not sure I can do this without cracking. His appetite is good, he wants to do his walks although still restricted due to TPLO recovery.

I feel like I have to stay awake 24/7 so my beloved dog can drink and pee and drink and pee and drink and pee while I loose my mind with no sleep and nobody to help.

How does one get through this period of diagnosis without cracking?

I love my big boy so much.

[Budsters Mom]

What makes you think we don't crack. We all crack at one time or another. :o We get through it and you will too. You are part of our family now. We support each other. ;)

I am sorry you're going through such a rough patch and are exhausted. I certainly went through many sleepless nights myself with my boy.

Others will be along shortly.

[Chief]

Thanks Kathy for your kind words.

I am at wits ends. Poor Chiefy who saved me from hurting myself or worse back in late 2008 when both my parents died now needs my help and I am cracking. Please note I suffer from PTSD with lots of anxiety that is mostly controlled but certain things cause flair ups. Sickness and loss of loves ones are a trigger. I lost a German Shepherd one year ago to DCM -heart issues at the age of 9 3/4.

I have posted this already but in late May this year a 1lb tumour was removed from is side. I was told for two years that it was a fatty lump but it turned out to be a soft tissue sarcoma. Prognosis good and not likely to metastasis, only in a small percentage of cases. Biggest fear is that it will grow back in the same spot. It has been out for nearly 4 months and no signs of regrowth yet but it is early. He healed well from this. Next thing he blows his cruciate ligament and is in for TPLO surgery on July 10. I noticed his increase in drinking a couple of days after surgery but it may have been increasing since his first surgery.

I believe the possible diagnosis of Cushings is fitting with his symptoms: increased drinking and urination and it continues to get worse, slight increase in appetite. He is more interested in having water in his bowl than anything else. When he pees it is in very large amounts. He is also healing slowly from his TPLO surgery. The bone is not as healed as it should be at 8 weeks. This can be due to age and or Cushings.

His urine is very dilute at 1.005 and his cortisol readings are high on the UC:CR and ADHT test. Don't have exact numbers yet.

All other tests are normal on both the blood work and urine.

As long as he has water he seems quite happy. Eats all is dinner and loves treat time. Vet has not said he is dehydrated at all. Tonight he was waiting in the truck for me with his brother and sister German Shepherds. He seems a bit off, so I gave him a 500ml bottle of water in a bowl and this seemed to solve the problem. Could he have been a little dehydrated?

When we walk for 20 minutes as this is his maximum while recovering from TPLO he pees at least 4 times.

Tonight he has had me up every 1/2 hour to 45 minutes to let him out. It is only 1:00 a.m. I can't keep this up. Nor can I leave him outside. If I crack he has nobody. I love this big guy.

[LauraA]

I get exactly what you are going through. My girl had pancreatitis so we had to wait for her to recover from that before we could even start testing. She was always hungry, drinking excessively, wetting herself constantly, roaming, panting and more. I was up and down with her all night most nights.

When she was finally diagnosed and we could start the meds it was such a relief. That morning of her first tablet was both scary (scared of side effects) and overwhelming relief. We were finally able to start to try and get our grumpy old girl back. And fortunately we have :) Luckily her wetting herself was one of the first things to clear up - yes some sleep at last lol.

Hang in there, we all know exactly how you are feeling!

[mytil]

I am so very sorry - we all know how incredibly hard it is.

Is your vet scheduling any additional testing on DI (Diabetes insipidus) sooner rather than later?

Terry

[lulusmom]

Is Chief's coat growing back from being shaved for surgery? Diabetes Insipidus is rare but we've had a few dogs, including my own, ultimately diagnosed with it. Actual testing involves water deprivation which is extremely risky so many vets choose to do a trial with desmopressin acetate (DVAPP) eye drops. This medication is not cheap but given your anxiety and lack of sleep, it's certainly worth asking your vet about. You should know within a few days if it's going to work.

Glynda

[Squirt's Mom]

I second Glynda's suggestion of talking about DI with your vet asap. ;) And you might check into some belly bands meantime. Of course with a shepherd you might want to wad up a towel in there or something! :p (jk)

You talk about how much Chief means to you, how he saved your life when you parents passed. I understand completely. My Squirt was my savior when my daughter passed suddenly. In an odd way, her diagnosis of Cushing's saved me - that gave me purpose again, a reason to keep getting out of bed each day, a reason to try and more than that, it opened a whole new world for both of us. Due to her illnesses, we met our family here at K9C and have made friends all over the world, literally all over the world. Friends who know how very much these little Souls can mean, how very much they add to our lives, and who know what it means to have to wake up one day without them. And I want you to know that there is at least one person here who knows exactly what Chief means in your world. Because Squirt meant that in mine.

Many hugs,
Leslie and the gang

[labblab]

I want to welcome you and Chief, too! Being an extremely anxious person myself, my heart goes out to you. As my dear friends here can attest to, when one of my dogs is ill I become a basket case. :o :o

When you layer on the sleep deprivation and the uncertainty about the diagnosis, I totally understand why things feel so rough right now, especially if you are living alone and have nobody to help shoulder the burden. Even though we cannot physically help with things, I do hope it will help to know we are here to listen and talk. Cuz we are totally here to support you and Chief through this.

Even though it may not feel like it, I do think you are on the brink of getting some answers (you know that old saying about things being the darkest right before the dawn?). You've got a plan in place for the ultrasound and follow-up urine testing, and the ACTH has already been run. I agree that it also makes a lot of sense to go ahead and try the medication for the diabetes insipidus. If it doesn't help, you've ruled that out as a cause. And if it does help, that will feel like a miracle.

It may end up that Cushing's remains on the table, even in the absence of some of the typical symptoms. And in that case, it may be that your vets will go ahead with a low-dose trial of Cushing's medication, as well. No matter what, I am guessing that within another week you will be armed with the information that can best be gathered and a decision will be made re: moving forward. And you can talk to us every step of the way.

I can sure understand why you feel close to cracking. And when you're all by yourself it is so hard to find release from the anxiety and the worry. But from now on, when you feel like you're ready to explode, please log in and add a note, OK? We are here for you and Chief, and we understand how much he matters and why you are so exhausted and worried.

Sending healing thoughts across the miles!
Marianne

[Chief]

Thanks Laura for your kind words.

Terry, no mention made of any additional testing for DI at this point.

Glynda, yes his coat is growing back at a decent rate. It takes about a full 6 months to grow back fully. It was this long in 2012 for both him and his sister when they had their TPLO operations. I agree that if the DVAPP drops can be used and not interfere with other testing then there is nothing to lose. Between his two surgeries this year and this recent testing I have spent well over $6,000 on him this year.

Leslie, so sorry about the loss of your daughter. I can’t say I know that feeling as I do not have children but do know the pain of multiple loss. People here seem great and very helpful. I realize Chief is getting older and was just wanting to have his last few years be healthy ones. He was considered a very healthy boy prior to his TPLO surgery with little risk of anything going wrong. Maybe best we did not know about this problem before hand or they might not have done his TPLO and he would be in terrible pain daily. This way he does not appear to be in any pain, just a pain to me and himself having to pee all the time.


Thanks Marianne. My vet thinks that he has enough of the symptoms to be cushings. What is he missing that is normal in cushings dogs? Is it the fact that his blood work is all normal? Is it that he does not appear otherwise sick? I am confused about this. He does have the drinking and peeing, some increased appetite and delayed healing from the TPLO (this may or may not be the cause, it could just be his body and or that he is older). His urine is very dilute at 1.005 and his cortisol ratings are high. My vet will not start treatment till they are sure or as sure as they can be. That I appreciate.

[lulusmom]

I asked about the regrowth of coat because dogs with uncontrolled cushing's see little to no regrowth in coat where shaved for surgery. My little one was bald for the most part but did have a strip of hair that grew directly where the surgeon made the incision. That is common but regrowth anywhere else is sketchy at best. You also mentioned that Chief's coat was healthy and shiny. That is also not the norm with cushing's nor is perfectly normal blood chemistry and cbc. Chief does not present as your usual cushingoid dog so I'll be looking forward to seeing the results of the UC:CR and the ACTH stimulation tests on Monday.

I forgot to respond to your question about dehydration. Chief's urine specific gravity is very low at 1.005 so I suspect he is definitely not concentrating his urine at all. I think you mentioned that when you go for walks with Chief he pees a lot, like four or five times in the course of 20 minutes. If so, then Chief could very well get dehydrated and need water in just 20 minutes of walking. It's even worse if it's hot outside as cushdogs are heat intolerant. I had to carry water for my cushdog with diabetes insipidus if we were to go for walks.

[Squirt's Mom]

I wanted to comment on the cush appetite. My Squirt was always food driven; in fact, one of her nicknames was Miss Piggy because she would eat anything, and I do mean anything. She ate a handful of ammonium nitrate once after she saw me drop it on a weed! :eek: If I touched it, it was edible in her mind! :D Because of her natural strong appetite and adventurous eating, I told everyone that sign would never be a good indicator for her. Boy! Was I wrong! Once her cortisol got high, there was an undeniable difference. She wasn't' just food driven, she wasn't just willing to eat anything at least once, she didn't just beg when any one had anything she thought was edible - she believed she was truly starving 24/7. She hunted all day and all night until she was exhausted for something to eat. She inhaled her meals, rarely chewing or swallowing, just wolfing down, then would immediately turn and start hunting for something else. She would rush to the other bowls if I didn't stop her and take their food. The look in her eyes was heart-wrenching and haunting.

A cush dog literally feels as if they are starving all the time. A previously well behaved pup will start counter-surfing and tearing up the trash, snagging food right out of your hand or plate, jump on the table during meals - anything anywhere anytime to get something to eat. There is nothing quite like the cush dog appetite, trust me. ;)

[Dixie'sMom]

I just wanted to chime in here and say that I'm so sorry for what you and Chief are going thru. GSD's are such good dogs and I know your heart breaks for him. To add an "Amen" to what Squirt's Mom said about the appetite. My doxie, Dixie chewed the bottom out of my pocketbook because she could smell chewing gum. True story. The cushpup appetite is like nothing I have ever seen before. They act like a rabid dog when it comes to food.

One suggestion for your peeing problem. Dixie has always been a rug pee-er even as a pup. So I have never been able to keep any rugs in my house. When the cush symptoms began and she couldn't hold it throughout the night, she was very polite and didn't wake me. Still doesn't. She goes to the door which is luckily an uncarpeted area. I began putting down "Dixie towels" by the door when I went to bed each night and she uses them.(Oh boy... a RUG. She would not use pee pads. She just moved them and went under it). More laundry, but at least a solution. I have a stack of ratty towels that are dedicated to her nightly pee problem. It may be worth hitting the thrift shops or Goodwill and searching for old absorbent quilts, bedspreads, mattress pads, towels, etc. I know Chief is quite large and you would need something pretty heavy duty. You could also put a piece of plastic underneath to keep the wetness from reaching the floor. Just a suggestion if you think it may be helpful. Prayers for you and your boy and keep your chin up -- better days are coming.

[labblab]

I know the experiences that Leslie and Suzie have shared regarding appetite are common among Cushpups. But I am going to be a bit of the devil's advocate to say that extreme appetite is not always present, though, or to that degree. We have had a few members whose dogs actually exhibited the exact opposite in behavior. For folks who remember Sue's Zoe, Zoe would always stop eating when her cortisol was high. Go figure. And my own Cushpup (for whom I have absolutely no doubt as to the diagnosis) always hoovered his meals but never misbehaved by raiding the trash, pantry or a counter. My non-Cushpup Labs actually eat with the same abandon that Barkis did. They all love their meals!

So even though excessive appetite is a common Cushing's symptom, I don't think the absence of such an appetite is a deal-breaker on terms of diagnosis. Cushing's is a syndrome with many possible features, and that's what makes the diagnosis so difficult. A classic symptom in one dog may be totally absent in another.

Marianne

[Spencersmom]

Boy can I attest to the cush appetite! Spencer sits and barks nonstop until he is fed, something he never ever did before! We cook his food now and supplement with kibble, where he used to just munch on a few kibble bites here and there all day! So different now! He demands breakfast and dinner and snacks in between on weekends.

I used to worry about his weight, but feel that at this point I just want him happy and stress free!

Great suggestions about putting down old towels, etc., for him to use when he just can't hold it! He is so fortunate to have a loving and devoted Mom! We are all in this together, and with so much support you will feel the love and encouragement to get thru each day!

[Chief]

I am wondering if Chief is in the "gray zone" re cushings in that it has been caught early. I have read and the vet said not all dogs have all symptoms. I would be happy if it is something else that is easier to treat and even curable. The vets thought at first it was infection but this has been ruled out for now as culture showed nothing and two rounds of antibiotics in case of walled infection have not made any difference.

I have been home with Chief just about everyday since early May. First I broke my ankle, then he had his first surgery, then his TPLO surgery which required 24/7 supervision for 8 weeks (unless dog is crated). I notice the drinking becoming excessive about two days post op from his second surgery. Looking back he for a long time drank more than the other dogs but not excessively like he is now. Having him literally tied to my wrist on his leash for the first 4 weeks after TPLO surgery means I could not help by observe any changes in his habits.

He is not too bad yet today but the night is early. I was so exhausted I feel asleep for a couple of hours this afternoon. It rained hard here all day but did manage a 1 mile walk in between rains.

DOES THIS SOUND LIKE DI more than Cushings because after infection it was my second guess after all my research? Does DI increase cortisol readings? It is obvious it involves dilute urine due to the excessive amount of drinking.

Thanks

Cathy and Chief and twin sister Justice and Inspector Toby

[Chief]

Chief was much better last night and we got some sleep. In fact I was the one up even more than him due to consuming lots of water.

He was really bad Wednesday, Thursday and Friday night. I read somewhere that they can drink/pee even more after ACHT test. His test was on Wednesday. Maybe this had something to do with it.

This morning I was up and out at 7:00 and back at 2:00 p.m. He had his first day loose in the house since his TPLO surgery. Lots of mats and towels at the back door. Yep at least one big pee mess on the mats but I did not think he would go 7 hrs without a washroom break especially not when water was left for him. Oh well the mats are in the washer.

I hope he gets his final diagnosis soon so he can start on some meds. It must be so hard on him having to pee in the house. Poor guy.

[LauraA]

I know for 48 hours after my girl has a stim test she is more hyper and eats and drinks a lot more. But she settles back to normal after a couple of days:)

[Chief]

Thanks Laura. He seems to have settled back down now. For awhile I did not know how I was going to handle him. It seemed like every 30 minutes or less he was asking to get let out and he was just not himself as in more hyper and hard to explain but not Chiefy. His first objective right now is water with food a close second. Of course with the water comes the peeing.

He goes this Thursday for his ultrasound. I had to cancel my appointment this morning but will be at the vets office tomorrow and will get copies of all tests done so far.

[molly muffin]

When my Molly gets the ACTH she eats like she is starving and runs around like a wild child for at least 2 days.

Hang in there.
Sharlene and molly muffin

[Dixie'sMom]

Dixie had one last week and she was also more hungry/thirsty/active/demanding for about 24 hrs.

[Mackenzie]

Hi, just hoping for an update on Chief. I'm very interested in his case because it sounds amazingly similar to mine, in that my dog Mackenzie has the same symptoms (heavy PU/PD) and has had all the same tests with similar results (totally normal routine bloodwork, 1.005 USG, positive ACTH, positive UCCR, normal ultrasound), and vets wondering about possible DI. Like yours, coincidentally he even had surgery on his leg a few months prior (in his case it was an amputation). I'm curious about Chief's ultrasound results and what your vet is recommending. My dog started trilostane a few days ago, and is already seeing some reduction in the PU/PD. Only if Cushing's had been ruled out would they have moved on to possibly diagnosing DI via DDAVP therapeutic trial, as (I think) this trial should only be done as a means of differentiating between DI and psychogenic polydipsia once absolutely everything else has been ruled out. K9C experts, am I mistaken on that point?

[labblab]

Hi, just hoping for an update on Chief. I'm very interested in his case because it sounds amazingly similar to mine, in that my dog Mackenzie has the same symptoms (heavy PU/PD) and has had all the same tests with similar results (totally normal routine bloodwork, 1.005 USG, positive ACTH, positive UCCR, normal ultrasound), and vets wondering about possible DI. Like yours, coincidentally he even had surgery on his leg a few months prior (in his case it was an amputation). I'm curious about Chief's ultrasound results and what your vet is recommending. My dog started trilostane a few days ago, and is already seeing some reduction in the PU/PD. Only if Cushing's had been ruled out would they have moved on to possibly diagnosing DI via DDAVP therapeutic trial, as (I think) this trial should only be done as a means of differentiating between DI and psychogenic polydipsia once absolutely everything else has been ruled out. K9C experts, am I mistaken on that point?
I am definitely not an expert on DI, but we have had dogs on the forum who have been diagnosed with both Cushing's and DI and who apparently suffer from (and are treated for) both conditions. So to that extent, a positive Cushing's diagnosis does not necessarily rule out DI, or vice versa. My very limited understanding is that a dog will not respond favorably to the DI therapeutic trial unless DI is truly at play, so the diagnostic has value regardless of whatever additional testing may be going on. But I may be totally wrong about that, and if so, I hope that others with more knowledge will correct me.

If memory serves me, however, the most common chain of events for dogs on this forum is that DI ends up being suspected subsequent to a Cushing's diagnosis, when thirst/urination continues unabated even in the face of Cushing's treatment and lowered cortisol. But for a dog with a lack of other Cushing's symptoms and equivocal diagnostic test results, it makes sense to me to test for DI as part of the general diagnostic process. Again, though, I hope others will comment further.

Marianne

[Mackenzie]

Thanks for the clarification Marianne! That makes perfect sense to me. The only part I thought I understood differently is this: "My very limited understanding is that a dog will not respond favorably to the DI therapeutic trial unless DI is truly at play, so the diagnostic has value regardless of whatever additional testing may be going on. But I may be totally wrong about that, and if so, I hope that others with more knowledge will correct me."
I wonder if Glynda has an answer to this, as I believe she and her dogs have experience with both?

[labblab]

I'll send her a note and ask her to look in on us here. ;)

[lulusmom]

@McKenzie.....A dog can have DI and not respond to medication. This is called Nephrogenic DI which was my little guy's ultimate diagnosis. Thank goodness he was only 6.5 lbs so adapting to a chronic pee bucket was a lot easier than adapting to a German Shepherd pee bucket. :D DI is a very, very rare condition and I can only recall one other member's dog, a Giant Schnauzer, who was diagnosed with Central DI, which did respond to treatment.

When a dog presents with PU/PD, a vet will usually rule out several differential diagnoses before even considering DI. The most common are cushing's, liver disease and kidney failure. Parasitic diseases also come to mind. I normally wouldn't even broach the subject of desmopressin with a member if their dog is suspected of having cushing's. In Chief's case, I mentioned a possible trial with desmopressin eye drops because his case leaves some question in my mind as to whether he has cushing's. False positive results on the acth stim tests and the ldds tests are not uncommon and an uncontrolled cushdog experiencing normal regrown of coat after being shaved is even more rare than DI, so I'm alway leary if some things don't add up.

I hope that helps.

Glynda

[labblab]

Thanks so much, Glynda! One quick question...you said that on rare occasion a dog with DI doesn't respond to the eyedrops. But how about the reverse -- if a dog does respond, is that totally confirmatory?

And I was thinking that we've had a couple more cases of DI in addition to Sharon's dog. Now my curiosity is aroused and maybe I'll do a site search tomorrow.

[flynnandian]

i work with an old lady who has an almost 14 year old beagle bitch called sarah.
it turned out the dog had d.i. and with minrin eyedrops the dog is ''cured"'.
she has a totally normal pee pattern now.
happy doggie and owner!

[lulusmom]

Thanks so much, Glynda! One quick question...you said that on rare occasion a dog with DI doesn't respond to the eyedrops. But how about the reverse -- if a dog does respond, is that totally confirmatory?

And I was thinking that we've had a couple more cases of DI in addition to Sharon's dog. Now my curiosity is aroused and maybe I'll do a site search tomorrow.

If the differential diagnoses have been ruled out and the demopressin drops work, then yes, that's pretty much confirmatory that the dog has antidiuretic hormone deficiency, which resolves with treatment. Minirin is another name for desmopressin.

Marianne, I have the worst memory ever so I'm not surprised that you may remember a few more members whose pups had DI. I do remember that we've had at least one member whose dog initially responded to desmopressin but it was short lived. I cannot remember who that was.

[labblab]

I know I'm being a major pest here :o, but will other conditions also respond to the drops, too? Or does only DI respond? I can certainly understand that you don't want to overlook other conditions that can account for PU/PD so you won't falsely rule out DI if something else is at play, causing the symptoms, and making it appear as though the drops don't work. But will the drops work if something else is instead the cause?

I guess I could quit being a lazy-bones and research this a bit on my own...;)

[Trish]

Don't know about dogs, but we use it for some patients with nocturnal eneuresis, we try avoid it in the elderly though as it can really mess with electrolytes.

[lulusmom]

In Central DI, it is the degeneration of cells in the hypothalamus that causes the malfunction in the production of ADH. I am not an expert on DI so I don't know if an underlying condition could cause a similar malfunction, which would be remedied if the underlying condition were treated. That scenario would be like a cushingoid dog with a transient decrease in the thyroid hormone, T-4, caused by excess cortisol which normalizes cortisol is controlled.

[Chief]

Hi, My vet has given me a prescription for Trilostane (vetoryl) 120 mg. I am having trouble finding a pharmacy in Ontario Canada that carries it or can even order it in. Thanks. Cathy and Chiefy

[Squirt's Mom]

MODERATOR NOTE: I have merged your post about finding Vetoryl in Canada into Chief’s original thread. We normally like to keep all posts about each pup in a single thread as it makes it easier for members to refer back to the pup's history when needed. Thanks!

[molly muffin]

Usually a specialist can order it from a compounding pharmacy for you. Your vet should know one, if they don't call the local Vet ER, they should be able to point you to a compouding or online pharmacy.

We have another member in Canada, I don't know if she might be using Diamondback in the states. I think they ship to Canada.

Sharlene and molly muffin

[Junior's Mom]

I am in Ontario. I use Diamondback for my trilostane. They will not compound an amount too close to what is available as vetoryl, so you would have to change the dose somewhat if you want to use them. Your vet can fax the prescription. They are 1/2 the price of anywhere in Canada. I have it sent through the mail, as that is the cheapest shipping. It usually takes a couple of weeks.
Just make sure to stay on top of them processing your order. Twice now, they have forgotten to fill mine.
Tracey

[Chief]

Thanks. I have been in touch with Diamond back and just need to ask my vet to change the prescription if possible so that I can order more that one months supply at a time to keep shipping costs down.

Can anyone on here tell me what dosage they think a German Shepherd weighing 103lbs should be taking to start? There seems to be a difference of opinion between two vets.

I appreciate the help.

Cathy and Chief

[molly muffin]

Not over 1mg/1lb maximum to start.

What are the vets advocating?

Sharlene and molly muffin

[labblab]

Yes, if you are going to order a custom compounded dose, 100 mg. might be a good place to start. One word of caution, though, if you plan to order more than a 30-day supply: it is better to buy the drug in smaller dosage increments that can be added or subtracted in the likely event that the initial dose needs to be tweaked. Diamondback will compound the drug in capsule form and you cannot open the capsules and divide the contents. So starting out with 50 mg. capsules, for instance, might be a better way to order the drug. You can give two daily to begin with, but then add or subtract as the need arises.

Marianne

[Chief]

Vet says 240 mgs per day to start but I think that is too high for 103lbs. Perhaps half of that which would be 120 which is still over 1mg per lb. This vet is open for suggestions so this is not etched in stone.

Diamond back will also do a liquid version so increasing or decreasing amounts will be much easier. I do like the liquid version of metacam for that reason. Very easy to give a little less or more as needed and approved.

Anybody here used the liquid version from Diamond Back?

Thanks.

[Squirt's Mom]

Starting low helps lower risk of side effects. It easier to deal with increasing the dose than to deal with an over dose. ;)

[labblab]

I would start at 100 mg. since 1mg. per pound is the starting dose now recommended by the manufacturer of brandname Vetoryl themselves, as well as many experienced specialists.

I think we may have at least one other member who is using liquid from Diamondback; hopefully they will stop by. I must be honest and tell you that, historically, our few members that used liquid formulations seemed to have more complaints about getting and keeping their dogs consistently regulated. I don't know whether that had to do with shorter shelf-life, or difficulty keeping the med evenly distributed within the suspension, or was just a coincidence and had absolutely nothing to do with it being in liquid form at all. But that was also prior to Diamondback coming onboard as a liquid supplier. Their general reputation is very good among our members, so if they say their liquid is as reliable as their capsules, then I'm hopeful they've done testing to establish that's the case. I would definitely make sure about specific instructions re: using the liquid, however, like should it be refrigerated, shaken before dosing, etc. And remember, no matter what form you give the trilostane, it must be dosed alongside a meal.

Marianne

[Junior's Mom]

I read back through your thread. There is no mention of acth results any where. The fact that Chief's fur grew back, and his bloodwork is normal, does NOT point to cushings. Did you ever try the drops for D.I.?
If Chief does not in fact, have cushings, he could become gravely ill, very quickly, if you start medicating him for it.
Please let us know why you decided to start the medication. Were more tests run, that give a more definitive diagnosis?

[lulusmom]

Diamondback Drugs is an awesome source and I've used them for years for many, many medications. I had trouble with Mitotane liquid in that it got thick and slimy. I think that's because my dog was on maintenance and only received three doses a week so one bottle lasted a long time. I don't think you would have that problem with compounded liquid trilostane as a 100mg bottle will only last a month unless you end up dropping the dose after the first acth stim test. The results of one study indicated that larger dogs require smaller doses so it is entirely possible that 100mg may be too high for Chief. If it were me, I'd ask for a prescription for 100mg. If you get it suspended in liquid, it will be easier to titrate up and down on a 1ml syringe.

I see that Junior's mom also has some of the same concerns I do about the diagnosis. Did you talk to your vet about these concerns? If so, what did s/he have to say about it?

Glynda

[Mackenzie]

Thank you Glynda and Marianne for the info on DI!

Am staying tuned to this thread still hoping for details on what led the vet to confirm Chief's cushing's diagnosis.

[Chief]

Hi all, Been off this site for awhile. Lots of issues in my personal life.

Chief has been seen by another vet who will be his vet from now on.
The tests that were done are blood work...geriatric work up with T4, urine creatine- UC:CR, urine test with culture, consults by vet with specialist, ACHT test, and ultrasound. New vet said the ultrasound vet is highly respected and the fact that he did the ultrasound made him comfortable with the results.
Blood work all normal.
UC:CR dilute urine at 1.005. Nothing else showed up.
ACHT - high cortisol levels . (not sure of numbers)
Ultrasound:

I do not have all the documents as long story but old vet being an ass about it and I just can't rock the boat with the new vet at this time. Old vet tried to destroy me and went out of her way to make it very difficult for me to retain another vet in this relatively small vet community. I will explain this in another post as very long.

All test points to PHT. I ordered my meds from Diamond Pet Supply in the U.S.in liquid format and they arrived on Friday. I am home with Chief this week to monitor him. The vet wanted to start him on 240mg once a day. From my research, this site and others everyone is saying around 1mg per pound of weight so in his case 103mg per day to start. My gut told me not to start at 240mg so today I started him at 120mgs. So far so good and it has been 3 hours since his first dose. I am more nervous andmore scared than he is. I keep looking at him but have to remember that he sleeps behind me everyday as I work in my home office. Everything seems normal at this point.

Thanks to the new vet who allowed me to order from Diamond Pets my cost per month is around $250.00 and that is if he requires the full 240mg which he likely will not. My cost via the old vet would have been around $600.00 per month. This was not negotiable and was part of the problem.....the health of my dog is important not making her rich.

[Chief]

Just a side note: Chief fur has partially grown back from his TPLO - cruciate ligament operation in July. He has delayed healing in the bone which may be due to his age or can be due to Cushings or both. He was properly taken care of during his recovery so not due to overuse.

His belly after being shaved is slightly pot bellied but could not see this before shaving as he has a thick coat.

While his bone is delayed in healing, his incision closed up nicely without infection.

[Chief]

Chief continues to improve. He has been on 120mg of Trilostane for just over two weeks and his drinking and peeing have decreased by at least 50%. His energy is also much better, although never really bad as he always wanted to go on walks, played with his toys and so forth.

He had his 14 day ACTH test yesterday. Results won't be in till next week as my vet is on holidays.

Chief is once again acting like my ADHD dog that he had always been up till the time of his TPLO surgery in July. I thought he was slower due to knee surgery and recovery but at that time his cushings had not been diagnosed.

Praying for good results from the ACTH test and that he is on the correct dosage. I did start him at half the vet recommended daily dose of 240mgs.

[Robert]

Good news. Must be interesting having a Hyper German shepherd-,I have a hyper maltes/Sui tzu and she is a handful!!!!

[Chief]

Yes Robert, Chief is a big handful at times but he is the most loving gentle spirit out there. Loves people and life in general. This year he had a tumour removed in June, TPLO surgery in July and diagnosed with Cushings in September. His zest for life continues. I guess I have some big lessons to learn from him. What I have learned since June is that my bank account is about $7,000.00 smaller but he is worth it and that as long as he is happy and not suffering I would do anything to keep him here with me.

Hope your fur baby is doing well.

[molly muffin]

Awww, great to hear that Chief is doing so well!

Sharlene and molly muffin

[Robert]

Yes Robert, Chief is a big handful at times but he is the most loving gentle spirit out there. Loves people and life in general. This year he had a tumour removed in June, TPLO surgery in July and diagnosed with Cushings in September. His zest for life continues. I guess I have some big lessons to learn from him. What I have learned since June is that my bank account is about $7,000.00 smaller but he is worth it and that as long as he is happy and not suffering I would do anything to keep him here with me.

Hope your fur baby is doing well.
They both are and hope chiefs zest for life continues for years to come.
They can be expensive but once they are with you they are worth every penny

[Chief]

Chief continues to do well on 80mgs of trilostane per day and will be having another ACTH test in a couple of weeks. He only gets me up maybe once during the night and we are finally getting some badly needed sleep. What a change from every hour or so.

He is finally 100% healed from his TPLO surgery from July/14. Complete healing took longer than expected maybe due to Cushings, age or as my gut tells me a incompetent vet and a bad first x-ray but that is another story.

Chief's energy has returned, his hair is finally growing back properly in the area of his surgery and abdomen area that was shaved for his ultrasound. I am glad for this as it gets very cold where I live during the winter.

Fingers crossed for Chief. He turns 10 on November 18.

[Dixie'sMom]

Thats great news and it sounds like Chief is truly on the mend. He sounds like a wonderful boy. I can just picture an ADHD GSD and I bet he has brought you $7,000 worth of laughter! I'm so happy for you and glad you are with a vet who you trust with your precious little man. Happy Birthday to Chief on the 18th. Remind us and we will throw him a cyberparty!

[Squirt's Mom]

Good update on Chief! Hope the trend continues!

[jas77450]

Great to hear the good news, go Chief!!!

[Chief]

Thanks for the responses.

I have noticed that Chief's skin is flaking some on his rear half and noticeable more so where the hair is just growing back. What is the best thing to do for this as in fish oil, other natural supplements and so forth?
Now that he is on Trilostane will that alone clear up the skin flaking in time or once again does this vary from dog to dog?

[mytil]

I am very glad to hear your boy is doing good and you are getting your old boy back.

Skin flaking is normal as new skin is regenerated and the old is sloughing off. It will take time as the cortisol levels remain in therapeutic range new skin and fur will grow back if there is nothing else causing this. A lot of time the fur is finer than before.

You can try a few drops of fish oil in his food as well as gently brushing him.

Keep us posted.
Terry

[LauraA]

Something cheap and easy to use is QV oil or something similar. I put it in a spray bottle and just spray it on Bulger :) Though you can just massage it in as they don't mind a nice massage.

[Chief]

Thanks for the responses. His flaking and itching does seem to be less now but still there. He is losing lots of dead undercoat.

[molly muffin]

It's pretty common to blow their coats, just hang in there!

try some omega 3 maybe?

hugs

[Chief]

CHIEF & Justice are 10 YEARS OLD TODAY!!!!!!!!!!!!!

Chief continues to do well. He is running and play fighting with his twin sister Justice. His hair is finally growing back from his TPLO surgery and abdomen shaving for the ultrasound. It is taken awhile but there is progress since he started on Trilostane 6 weeks ago. He is a plush coated German Shepherd and he is blowing his coat. Interesting enough the small spot on his leg they shaved to take blood has hair regrowth already so I am hopeful once this old dead coat sheds, he will once again have his beautiful coat back. A litter thinner is okay.
Boy is my house a mess with clumps of hair. He is shedding that much. Oh well, just glad he is still here with me and able to do the things he loves...run...play...go for truck rides....eat.....drink.....and bug his Mom for attention.

He has another ACTH test one week from Wednesday. His current dose is 80mg ...taken at 40 & 40 twice a day. He weighs 104 lbs. He still drinks more than the other dogs but not over the allowable limit for his weight. ( based on 1 oz per pound) It is very hard to monitor how much exactly with 4 dogs but the bowl is not filled very often now nor is he in it all the time. He only gets me up once per night and no longer has accidents in the house when I am gone out for several hours (6 - 8). He has a great appetite but no more so than my other dogs. Oh yes and his pee has colour in it now. Never thought I would be watching my dog pee and then be so happy when his pee was finally yellow. Something only dog lovers can understand.

One negative thing I have noticed since his cortisol is getting back to normal is signs of arthritis which is not surprising at 10 yrs old. His twin sister Justice takes a low dose of meloxicam everyday. Chief's vet approved meloxicam for him and he is doing great since starting it. I know these drugs are hard on the system but I would rather have him had a quality life even if it may be a little shorter due to the medication. Right now he is a happy boy.

HAPPY BIRTHDAY CHIEF AND JUSTICE ..THIS ONE AND MANY MORE...

Reaching 10 is a milestone for me as both my other German Shepherds died at 9..one from cancer and one from DCM (heart issues).

[molly muffin]

Happy Birthday Chief and Justice!!

How wonderful to hear that Chief is doing so well. It does the heart good to see them running and playing again.

hugs

[Squirt's Mom]

Happy 10th Birthday, Chief and Justice!

[My sweet Ginger]

Happy Birthday CHIEF & JUSTICE !!!

Wow, 10 and still going strong, how awesome is that?
I love GS and admire seeing them on duty in their uniform in the movies or in real time. We once had an incident on our street which involved the local police and a swat team:eek::eek::eek: (talking about over reacting which cost the town $$$270,000 or something like that :eek::eek::eek:) and there was this k9 officer with his handler sitting in OUR front yard, just sitting not moving a hair for the longest time as did his handler, the stoic stare, unbreakable concentration, awesome stillness and the vest... ahhh, it gives me a chill just thinking about it. It was one of my fondest memories of GS etched in my memory. Lucky you have not one but two tho I know I will never have one.:(

[mytil]

Big Happy Birthday wishes to your pups!!!!!!!!!!!!!!!!

I am glad he is doing better!!!! I can see the smiles on your face as they are playing together. You are right about the quality of life for him.

Keep us posted and post some photos when you can. I would love to see your beautiful Chief and Justice.
Terry

[Chief]

Thanks for the birthday wishes. I have not been on this site for a few days. Chief had another ACTH test on Wednesday and the results should be in soon. His vet was impressed with how well he is doing. All symptoms appear controlled at this time. I am however concerned that he is losing weight. The vet is not. He has went from 104 to 100lbs. He is a vary large GSD and I can now feel his ribs. Sorry but I like a little flesh on my dogs. Normally with cushings dogs gain weight. Has anyone on here had their dog lose weight? He does not hase diabetes and his blood work is normal. His energy is back and he is driving me nuts so he sure does not appear to be sick in fact just the opposite.

By the way is twin sister Justice is gaining weight so we are waiting on her thyroid test as she is a hypo thyroid dog and has taken medication for a few years now. It has been controlled and her weight remained in the normal range of around 95lbs until recently. She is now close to 105lbs. I am hoping she just needs an adjustment in medication else I am in trouble. Lol.

[BettyF]

I have just read through all your posts and I'm really pleased that things are so much better for Chief now. You went through such a hard time at the beginning, just reading about it made me feel really sad.

I don't know if it's common for Cushings dogs to lose weight, but this has happened to my Vera too. She has lost 4lbs in the past year, but as she is now 17 years old I'm not sure if it is the Cushings, or her age. She only weighs 13.5 lbs now and I can feel her backbone. Apart from this, she seems alright.

[Chief]

Thanks Betty. It was really hard on both Chief and myself. For now things are much better and I am taking one day at a time. We walked over 2 miles today and he was still raring to go. He was off leash the entire time so he had a really good run. Note: I live in the country and have access to many acres to run him on. I don't know how long I will have him (hopefully for a long time yet) so I am making the most of our time after such a scare between June and October of this year. My new vet said he needs to build his muscle mass back up so the more I can get him out the better he will be.

[flynnandian]

that is great news!
keep up the good work!
i live in the country too, so i can walk my dogs off leash too.
does chief like to swim?
mine do and it is a good way to rebuild their muscle mass in their back legs.

[Chief]

Yes, Chief likes to swim but it is winter here now and getting very cold. I would have to drive him to the city and pay for the use of an indoor doggie pool. I have thought about that.

He is so energetic at this time that I swear he would go on a dozen walks a day if I would take him.

[flynnandian]

it is winter too over here, so no swimming for my dogs too.
i hope chief will stay this fit for a very long time!

[Chief]

HELP! ADVICE NEEDED!

Chief's second ACTH stim test results came back and I am scared.
Chief started on trilostane (1.2 mg per day) on October 6/14. Two weeks later he had his first ACTH test since starting the Trilostane. His cortisol was on the low side so they reduced him to .8 mg per day (.4 twice a day)and requested another test in 4 -6 weeks. 5 weeks later he had this test and the results are:
Pre Stim: 39 Normal 28-120
Post Stim: 40 Normal 220-550

Chief's symptoms are basically non-existent now. His drinking and peeing is normal, his flaky blown coat is now growing back in faster than ever, he is energetic and a great appetite (but not crazy). The only thing that concerns me slightly is he lost 4 lbs in 5 weeks without trying. (From 104 - 100 lbs) This did not concern the vet at least not before the results of the test.

They are now consulting with an IMS.
While waiting his dosage has been reduced to .4mg to be given twice a day. (.2 twice per day)

Vet thinks it might be atypical cushings and is also concerned we could be heading toward an addisons dog. That said we have no symptoms of addisons but his cortisol levels are now low. What the bleep is going on with my dog? He seems so happy now.

Should I reduce his medication or stop it all together?

The vet examined Chief last week and said all appeared good with him re: the physical exam. He does need to build some muscle mass back up as he had TPLO surgery in July with slow healing of the bone possibly due to Cushings. He is now 100% healed from the TPLO and free to run.

Advice please! Has anyone one here gone through this?

[Renee]

I believe that converts to 1.41 and 1.44 ug/dl, respectively.

If so, then yes, that is rather low. I would probably stop the medication altogether and wait until a recurrence of symptoms.

[Chief]

Renee, thanks. I do not know the conversions. Just scared as Chief is now normal in all outward appearances but low cortisol is not good.

[Squirt's Mom]

What are the little letters that follow those results? Like ug/dl, mnol/l, mg/L, etc.

[labblab]

I know this news is really scaring you right now, but it is pretty common for trilostane dosing to require some ongoing tweaking. It is definitely true that you don't want Chief's cortisol to drop any further, but it does not sound as though he is suffering at this level given the fact that his behavior and appearance are so good. So ultimately the next step is indeed to lower the dose. As Renee says, though, I think the typical recommendation would be to take a break for at least a few days before resuming dosing at the decreased amount. Let's see what your specialist recommends in that regard.

But once again, this is not an unusual occurance around here, and Chief should be fine. I really don't know why your vet is now suggesting an "Atypical" diagnosis. You'll have to relay his thinking to us once he explains it more thoroughly...

Marianne

[My sweet Ginger]

At 1.4 & 1.4, there's no stimulation between the two numbers.
I'm afraid any additional vetoryl at any dosage right now will take him into Addison's crisis quickly.
It may be the case that he just need a temporary break from vetoryl.

[labblab]

P.S. Given the numbers you've given us, I feel certain that Chief's results were posted in units of nmol/L. However, the "normal" range that you have been given for the "post" result is the range that applies when the ACTH is being given as a diagnostic for Cushing's -- it is the range for a dog that does not have the disease.

Dechra's desired therapeutic range for a dog being treated with trilostane falls between 40 - 250 nmol/L. So Chief's result is right at the bottom of their desired range. However, some specialists prefer a slightly higher cut-off (prefering results above 2.0), and another issue is that there is so little difference between his "pre" and "post" results. So these are additional reasons for taking a break prior to decreasing the trilostane dose in order to allow his adrenal function to rebound a bit. This is Dechra's official published recommendation:


If the ACTH stimulation test is < 1.45 µg/dL (< 40 nmol/L) and/or if electrolyte imbalances characteristic of hypoadrenocorticism
(hyperkalemia and hyponatremia) are found, VETORYL Capsules should be temporarily discontinued until recurrence of clinical
signs consistent with hyperadrenocorticism and test results return to normal (1.45-9.1 µg/dL or 40-250 nmol/L). VETORYL
Capsules may then be re-introduced at a lower dose.

Marianne

[Chief]

Thanks everyone. I will call the vets office tomorrow and ask for a copy of the report. It should just be a click of the mouse so hoping I can get it quickly. Chief just came in from a leash free run. He is doing so well. Other than the recent medical report and a undercoat that is still filling back in one would not know there is anything wrong with him.
Any thoughts on his weight loss? He blew his plush coat but I am sure that did not weigh much and he is eating lots.

[lulusmom]

The doses you mentioned are seem to be miniscule for a dog Chief's size. Is Chief's trilostane compounded in liquid form? If so, I believe you may be giving us the syringe measurement. Can you look on the bottle and tell us what the actual dose is. I suspect that it might be 100mg, in which case .2 on the syringe would be 20mg.

Glynda

[labblab]

Good catch, Glynda! I'll bet you're exactly right, and that would mean the new lowered dose is intended to be a total of 40 mg. daily (down from 80 mg.).

As far as the weight loss, this is an off-the-wall guess, but perhaps Chief was bloated from excessive "water weight" at the time of the previous, pre-treatment, weigh-in? Now that his thirst and urination have normalized, perhaps his weight has trimmed down as a result.

Marianne

[flynnandian]

and the fact that he is getting way more exercise after resting for a long time since his surgery, would explain the weight loss too i think.
maybe he just needs more food because of this.

[Chief]

The young vet called me back today as my vet is off on holidays. Being the owner he seems to take lots of them.

She talked to the IMS who advised that normal is 40 -140 and Chief is at 40 so a low normal. She also recommended to lower his dosage to 40mgs per day (20mg twice per day) and then do another ACTH in 14 days. Given that he is a low normal I feel continuing the meds at a lowers dosage is correct. She also said the fact that he is doing so well gives them confidence they are on the right track.

Someone else on this site mentioned that this may be the case and the numbers quoted me for post were wrong. Thank you.

I may be imagining it but I think Chief is drinking more water already since lowering his dosage yesterday to 20mgs twice per day. I will monitor this over the weekend. To me 40mg daily seems to little for a 100lb dog. Time will tell.

Thanks to all. I will keep you posted. I have requested copies of his records.

[labblab]

Yes, I'd be inclined to wonder whether cutting the dose fully in half will prove to be too much of a decrease, too. If you really do end up seeing a quick rebound in symptoms, maybe you can discuss with the vet the possibility of switching to 30 mg. twice daily as a compromise between the two doses.

Marianne

[Chief]

Hello all, I have not been on here for awhile. I have all good news regarding Chief. He has stabilized on .6ml per day - liquid form, .3 in the morning and .3 in the afternoon. Chief had an ACTH stim test done the Monday before Christmas and that Wed. the vet left a message that his cortisol levels were higher and they were leaving him on the same dose. Due to holidays I have not talked to the vet to get the actual pre and post readings.

His coat that he blew and subsequent rat tail as he lost most of his fur has now fully regrown and his tail his bushy like it should be for a German Shepherd.

He is once again jumping on the bed and his energy level is through the roof for a 10 year old dog. His head and body no longer feel bony when I pet him. He just feels and acts like the pre cushings Chief. He has also fully healed from his TPLO surgery in July and shows no signs of lameness. We are keeping on an eye on the small lump he has in the groin area but so far vet feels it is an lipoma and it is not growing. This is good as Chief had a soft tissue sarcoma tumour removed in July. Previous incompetent vet diagnosed his lump for 2 years as a lipoma despite the fact that it keep growing and she also did not do any tests. That vet was an over confident idiot and should not be practicing. Same one that diagnosed his cruciate ligament tear as hip arthritis that he does not have. (Sorry had to rant) If this lump starts to grow it will be removed immediately as he is now healthy enough to withstand a minor surgery.

I realize he is 10 years old which is getting up there for a purebred German Shepherd who weighs 100lbs so I am enjoying him and his brothers and sister everyday and praying for many many many more days, months and years with all of them. In 2014 Chief had a soft tissue sarcoma removed, cruciate ligament surgery and was diagnosed with cushings disease. Despite all this is will to live never left. Guess this is a lesson to be learned from one great dog.

Chief's new vet is great and does not have "the God syndrome" like my last one had, thus we get along well and he is also capable of talking to me like an intelligent, educated and caring owner and not an below average idiot. Boy what a pleasant difference, not to mention Chief's medication cost are 50% cheaper with him.

[flynnandian]

great! keep up the good work.

[addy]

Such a great report to start off the New Year. Team work is the best and I am so glad you found a vet willing to consider you part of the team.

Keep up the good work.

[Dixie'sMom]

Great news! 2015 seems to be off to a great start with you and Chief. I'm so glad for both of you. :)

[Harley PoMMom]

I have all good news regarding Chief. He has stabilized on .6ml per day - liquid form, .3 in the morning and .3 in the afternoon. Chief had an ACTH stim test done the Monday before Christmas and that Wed. the vet left a message that his cortisol levels were higher and they were leaving him on the same dose. Due to holidays I have not talked to the vet to get the actual pre and post readings.



How many mg are per ml? Also if you could get copies of that ACTH stim test and post the results here, that would be great! So glad to read that Chief is doing so well!!!

[Chief]

Hello everyone, It has been a couple of months or more since I posted. I am happy to announce that Chief is now stabilized on .3ml twice a day or the equivalent of a 60mg pill. He is on liquid trilostane. His fur has grown back and his cost is shinier than ever. Initially it was thought that he would need a much higher dose due to his weight at close to 100lbs.
He is energetic and one would not know he was ever sick.

I just got him back to health when his twin sister Justice developed hind end weakness and we feared she may have DM - degenerative myleopathy as she had neurological symptoms. Thankfully she has improved at least 70% over the last month which pretty much rules out DM. It may be a pinched nerve but not 100% sure at this time. Her neurological symptoms are 80% better.

Good news on both counts at this time but my nerves are frayed.

Just thought that some good news would be nice and to let other cushings dog owners know that they can recover and lead a normal life. Prayers and hugs to all of you fighting cushings disease.

Cathy, Chief, Justice, Inspector Toby and Judge.

[Harley PoMMom]

So glad to hear that Chief is doing so well!! And thank you so much for coming back and letting us know!!! Also glad to hear that Justice is doing better.

So, now it's time for Mom to relax, ain't ;):)

[Chief]

Hello everyone, it has been awhile since I posted here. Chief has been doing well according to the vet regarding his Cushings disease and is in "remission" so to speak. His triolstane was recently reduced to .45 ml daily. He takes .3 in the morning and .15 in the evening of liquid trilostane. His most recent test showed he was in the lower side of normal so he was reduced from .5ml per day. I know this is a small dose for a 98lb dog. Chief has maintained his exercise and walks a mile or so most days. This is not what he did as a pup but not bad for an 11 yr old who has had two knee surgeries and various other health issues.
MY CONCERN: he now has weakness in his rear end which causes him difficulty in getting up on ceramic and wood floors and sometimes his legs cross under one another when trying to get up. He has had a neurological check and we do not believe it is DM at this time. Could the rear end weakness be caused by Cushings disease despite his cortisol levels being under control? I do understand that rear end weakness can be a symptom of cushings disease without treatment. Is this likely arthritis in the knees and hips due to advanced age? He is on metacam, glucosamine, and cartrophen for the pain.
He continues to want to go on walks and does well, his appetite is great, his coat is shiny, he plays with his toys and seems as happy as ever. It is just when he goes to get up and it is worse the longer he lays down. He is taking it all in stride while I hurt every time I see him struggle to get up or when I give him a hand to make it easier on him.
Suggestion and comments appreciated.

[judymaggie]

Hi, Cathy! Good to hear that Chief is doing pretty well overall. One of my first dogs was a German shepherd and, as he aged, he did develop DM. He was a large, 90 lb. pup and it was very difficult to help him up into a standing position. Although it has been over 30 years, I do vaguely remember our vet giving him some kind of spinal injections which helped on a short term basis. Curious if Chief's neurological exam was done by your vet or a specialist. If the former, it might be worth it to have him seen by a veterinary neurologist. If DM is completely ruled out and arthritis is the cause of his issues, it might be that Adequan injections would help.

[molly muffin]

I agree Adequan injections could help if DM is ruled out by a specialist. I know you just reduced Chief's dosage, but the lower the cortisol, the more the joints bother them.
I'm having the same issues with my dog, and one I thing I did was skip 2 days of trilostane to see if she improved with her back legs and she did. So I now know that is the culprit. I'm not saying everything went away, but she was better than she was.

Happy Holidays.

[Chief]

Thanks for the responses. I have not been back on as I am a basket case. Chief spent New year's eye at the emergency clinic as he was having trouble getting up. He could walk once helped up. It seemed to go from difficulty getting up on slippery surfaces to his rear end collapsing. I called my own vet who did not even ask me what was wrong when I sounded so upset and said Chief needs to be seen today. The receptionist just said we are busy, call our other clinic or go elsewhere. Unfriggen believable.
Off we went to Alta Vista Animal emergency hospital in Ottawa, Ontario, Canada.
Of course by the time we were seen and his cortisol obviously high as he was so nervous he presented much better than what I saw at home.
The vet was thorough and noticed he had minor ataxia. It was not minor at home but I agree he had improved. She suspects it could be many things but number one is a disk problem - IDD as he seemed to not appreciate it when she was pressing on his spine. He presented with minor neurological deficits only. It could also be DM and I am aware of that horrible condition as one year ago it was thought that Chief's twin sister Justice had it when she presented with more severe neurological problems than Chief. Turns out bed rest and a increase in metacam dose helped her and she is today pretty good. Perhaps a minor spinal issue but not DM for her.

Chief was given Gabapetin and Tramadol to go along with his meloxicam. If he he not improved in a week a two he is off to the neurologist. It seems he gets along better as long as his meds are in effect. Seems to be worse when it comes close to the time for the next dose. The worst is sometimes when he gets up his right leg which is the weakest gets caught under the left one and he trips. This happens also when he tries to go to fast which is his nature. If he takes it slow and easy he is pretty good. Chief is ADHD and even at 11 he is hard to slow down. Note: Chief could not take Gabapetin. One 500 mg dose and he had quite severe ataxia. He is no longer taking it.

I was also wondering about the decreased dose of Trilostane but he was at a low normal and the vet was worried about an Addisons crisis if he went much lower. He is only on a total of .45 per day which is really a small amount for a 98lb dog. He started at out at 1.2. Thank God I did my own research and did not start him on 2.4 as the vet wanted. I have thought about increasing it slightly or perhaps going a day or two without it to see if that helps. Not sure what to do. Seems he was much better while nervous and in fight or flight mode (actually he just wanted to leave) at the vets office. Chief is always a friendly boy. It does seem like he had got worse since his dose was lowered about 6 -8 weeks ago but then again it could just be coincidental.

One thing I have notice is that his urine is not as dark a colour as it should be lately and he had been peeing and drinking slightly more. A urine test was ran and they agreed his urine was more dilute than it should be but they did not suspect any type of infection. I have to follow up with my own vet for this. Believe it or not I can't get an appointment until January 20. I need to vet shop but been too upset to do much except take care of Chief, his twin sister Justice and Inspector Toby who is almost 10 yrs old.

They also did some blood work to make sure he was not going into an Addisons crisis as I had read that this could cause weakness and given that his reading 6 weeks ago were low normal gave me reason to be concerned along with the increased drinking and peeing which I understand are also symptoms of Addisons. His appetite remains good and maybe too good but not like it was before the trilostane was started. I just had a thought and maybe reaching for the stars here but: Can an ACTH stim test give a false reading or are they pretty accurate?

Sorry for the ramble and I look forward to some thoughts on this matter. Thanks.

[molly muffin]

See what the ACTH test comes back as. Once treatment is started the ACTH is a reliable measurement of what the adrenal glands are doing and how much the glands are producing.

Since the vet mentioned sensitivity along his spine it is possible that he has some inflammation or something going on there.

WhenChief is nervous his cortisol would likely rise a small amount. Increasing the dosage of trilostane would lower his cortisol further. I wouldn't do anything till the ACTH comes back and increasing the dose would actually be the opposite of what you are saying about fight or flight mode.

You could withhold the trilostane for a day or two to see if that makes him feel better in which case it could be the dose needs to be decreased even further.

You really don't know till the results are back.

[Chief]

Well the last two weeks have been a rough and rocky road for Chief and I.
He continued to get weaker in the back end so on December 31 off we went to the emergency as my own vet was too busy to see him despite the fact that it was urgent.
This will be long but need to explain:
Chief's last ACTH test done about mid November as I already mentioned came back low normal and his dosage was reduced a small amount. I found it odd at the time as I had noticed on walks he was starting to pee more and most nights asked to go out a couple of times after we went to bed. When the tests come back low normal I thought well the peeing must just be because he has always drank more than the other dogs and let it be.
Looking back the excess peeing and rear end weakness seem to happen about the same time. I am not talking about his arthritis in his knees but true back end weakness. His right leg seems to go out from under him especially if he has been laying down for awhile.
At the emergency they did a urinalysis and agreed with me that the urine was more dilute than it should be but they did not see any signs of infection. He was put on pain killers and gabeptin along with the metacam he was already on. The new drugs made his ataxia much worse so I took him off them after two or three days. They said it could be disk disease, DM, and other stuff.
Last Wednesday we went to see a neurologist and he confirmed (at least in his opinion) that the rear end weakness was spinal related and either disk disease or DM. Chief has improved some since two weeks ago but here is the big issue:

His cushings symptoms are back. Peeing and drinking is out of control, he is hungry, and tonight is the first I was gone for 5.5 hours and he peed on the floor twice and emptied the big water bowl. I must stress this is not as bad yet as it was before he was on Trilostane but I fear we are headed in that direction. He peed at least 4 times in 3 minutes outside tonight. IS IT COMMON FOR A DOG WHOSE CUSHINGS THAT HAS BEEN SO WELL UNDER CONTROL FOR OVER ONE YEAR TO ALL OF A SUDDEN HAVE ALL THESE ISSUES AGAIN OR IS IT MORE LIKELY HE HAS AN UTI?

One of the other things the emergency vet said was possible was if he has an infection that is pressing on the spine then that could be causing the rear end weakness.

I am so confused. We go to the vet on Wed. I think I will be nuts by then. Chief is happy and maintains a great attitude towards life despite all his health issues. I wish I could take all this in stride like he does.

Thanks for reading and suggestions and comments are appreciated.

[Chief]

Some of the info just posted has already been mentioned. I think I am losing my memory and my mind.

[My sweet Ginger]

Cathy, did they run an ACTH at the ER on New Year's Eve?

You said his ACTH results from November were on the low side can you tell us the exact numbers? Thank you.

[judymaggie]

Cathy -- so sorry you and Chief are going through a rough patch. I note that you said the ER did a urinalysis and didn't see any signs of infection. Since you are seeing signs of one and Cush pups really need to have a culture done with the urinalysis in order to rule out an infection, I would ask your vet to proceed in that direction. At the very least you can rule out an infection as a cause of the symptoms you are seeing.

[Chief]

The emergency did not run an ACTH test on New's Years Eve. They said to see my own vet for that. Believe it or not the reason I ended up at the ER was because my own vet would not see us that day. The earliest appointment which had been set up prior to "our crisis" was January 20.

I hate to be negative but in my experience the vets in this area are only in the profession for the money and nothing else really matters. I understand if my vet is away but he has a few other vets that work for him and in a crisis I will see one of the others.

I found one vet that I think would be thorough (but then again they all sound good at the start when they want your business) but she really does not want to write prescriptions for Chief's Trilostane like my current vet does which means his med cost would be at least 250.00 per month more. Other drugs that he takes are more expensive there also as she does not want to prescribe the pill meloxicam and want to sell the expensive metacam. Pill cost about 15.00 per month at drug store, metacam cost about 150.00.

No I do not have the numbers of his last ACTH. I was told the number at the time but have forgot them. I do remember the words low/normal. I might be able to get them sent to me tomorrow. They are not very quick with this type of thing despite it being a simple email (pdf) of a file. Takes 2 seconds. His bloodwork was good but there was one high normal and was something to do with a possible parasite. The vet tech wanted to sell me I think it was called Drontal but the vet said that it was nothing to worry about at the time and we should just monitor it as this could also be due to allergies. Chief does not have known allergies but does sneeze on occasion. Then again we all do.

I really appreciate the support and I do realize that Chief is a mystery. The lesson I have to remember from my 11 years with this handsome dog is that despite two TPLO (knee surgeries)including one that had to be redone due to surgeon error and infection, soft tissue sarcoma removed(Grade 1)..biggest risk that it may grow back (been 1.5yrs), another benign tumour removed from his mouth area, cushings and now rear end weakness, etc. he maintains his jest for life and adapts to all that is thrown at him. Takes it in stride. Sure wish I could do that.

Chief's plush coat remains beautiful and he looks much younger than his 11+ years. He has a big head from getting so many compliments every time he is out in public. Lol.

[molly muffin]

I don't think without an ACTH test that you can know whT is going on and if urine is dilute it might need to be culture. We have had vets apsay something on to the acth is this or that and then seen the numbers and they weren't reading the results for a medicated dog but for a no medicated dog so without seeing the numbers it is difficult yo even guess what might be going on.
Also if there is a spinal problem his body might be reacting with an increase in cortisol. It's all just guess work it seems.

I am surprised that if they think possible spine disease that they wouldn't have done at minimum X-rays to confirm or a more thorough test rather than just say might be. Well it might be an inflammation in the spine that about 6 weeks of limited mobility would help and it might not be. But might doesn't mean much in diagnostic terms. Baffling these vets you are seeing.

[Chief]

No x-rays but wants to do the MRI. The problem is if it is not disk disease but in fact DM the anesthetic required for the MRI could make the DM worse. I agree that it seems like some x-rays should be done at the very least. This is likely separate from the Cushings issues but then again it all could be related to a big bad infection. Yep it is confusing and as I said I have lost faith in vets.

I am going to insist on copies of everything and if they refuse they can go to hell and I won't go back. Sorry but I am frustrated. Chief is acting today like he did before he was on Trilostane. Constant peeing, constant drinking. I am on the couch and he is out every couple of hours day and night. Can Triolstane just quit working? Has anybody ever heard of that?

[Renee]

You can send off a DNA sample to check for the genetic markers for DM. I did this for one of my pugs and ruled out DM as he was not a carrier of either gene at all.

http://www.offa.org/dnatesting/dm.html

[Chief]

I have just been advised that ACTH stim test is no longer available here in Canada. They can't get it so have to depend on a cortisol test via the blood or the low dose stim test that takes all day. The only other test is a human test and the cost is 700.00.

Chief's last ACTH stim test was pre number was less than 27 and after was 29. They reduced his trilostane from .5 to .45. I am waiting on a copy to be emailed with all the details.

At this point I don't know what to do. Has anyone heard of the ACTH not being available? Is it available in the US?

Help!!! 700.00 every few weeks is lots of money.

From speaking with the vet on the phone today he feels that Chief may be heading toward Addisons and that the back end issues could all be related.

Neurologist does not think so but then again he want the 6,000 MRI and surgery to happen.

I am seeing another vet tomorrow for a second opinion on this matter.

I am so confused. I am not a drinker but thinking of starting. Lol.

[Chief]

Chief's lab results. Not sure how to attach.

Test performed on sample taken from original tube submitted by clinic; tube
labeling verified.
ACTH STIMULATION (2 SAMPLES)
Test Result Reference Range Low Normal High
CORTISOL (PRE) <27.6 28 - 120 nmol/L LOW
CORTISOL (POST) 29 220 - 550 nmol/L LOW

CORTISOL
COMMENT *** 1
Comments:
1. Please note that these reference ranges are for normal animals that are not
receiving any type of medication. Interpretation will vary for pets receiving
therapy for hyperadrenocorticism.
For assistance, please contact customer service to speak to a clinical

WTF is going on. They are relying on these results and Chief is on Triolstane and has been for well over one year.

[labblab]

Those ACTH results back in November (converting to the units used here in the U.S., they were <1 and approx. 1 ug/dL)were indeed too low, and rather than just decreasing the trilostane dose, Chief probably should have stopped taking the drug altogether until it could be determined whether or not his cortisol was rebounding back to a healthy level. It is not surprising that the lab printout only contained the "normal" reference range for a dog without Cushing's. That's fairly typical. But in order to find out the desired therapeutic range for a dog taking trilostane, go to our Trilostane FAQs thread here and click on the link for the "Dechra's U.S. Product Insert" for Vetoryl. You'll find a chart that will show you that if the post-ACTH result is <40 nmol/L, the drug should be discontinued, at least temporarily, before restarting again at a lower dose. As I understand it, you restarted immediately at only a slightly lower dose, and so I am indeed fearful that low cortisol may be the source of many of his current problems. He may not need or be able to tolerate any trilostane at all, right now. Here's the link to the Trilostane thread:

http://www.k9cushings.com/forum/showthread.php?t=185

As far as the ACTH testing in Canada, Sharlene ("molly muffin") who has been writing to you also lives in Canada. Through her, we're aware that there has been a shift in the stimulating agent that is being used there for testing. As soon as she sees your posting here, I know she'll stop by and tell you how her vet is handling things for her Molly.

Hang in there! As I say, though, I am worried about Chief's cortisol having dropped too far. Are you still giving him the trilostane right now? Given those November test results and his current behavior, I'd think your vet would be advising you to give him a total break from the drug right now!

Marianne

[Harley PoMMom]

I agree those ACTH results are too low and that the Trilostane should of been stopped. As Marianne mentioned, Chief could be in an Addison's crisis which does make a dog drink and urinate more than usual. If this were me I would stop the Trilostane, have a resting blood draw performed to see, at least, what the pre value is and start a rescue dose of prednisone at 0.25mg/kg.

Keep us updated, please,

Hugs, Lori

[Chief]

Thank you Marianne for you help. I am in tears because nobody is telling me anything but I am trying so hard. When I took him to emergency on December 31, I suspected he may be heading to Addisons just from my research online. They did not think so.
My own vet would not see me to Jan. 20. BS that is for sure.
I am seeing a new vet tomorrow.
I am still giving him his dosage but was actually thinking of stopping now as in not giving it to him tonight.
I have a dog one day who I know is elderly but still walking 1 -2 miles per day and had started therapy swimming twice per week. He loves both. Then all of a sudden his can hardly get up, has ataxia, and so forth. His appetite for the most part is good but looking back he has thrown up a couple of times. He is not keen on his dog food some nights but will still eat the roast beef or other meat offered and treats. He still wants to go on walks and does have energy but the specialist has asked that I seize all but short walks for now.

The vets want to write off his hind end weakness to DM because he is an older shepherd. Not too concerned about his low specific urine which tested at 1.010 or the fact that he is drinking and peeing like he was before being controlled with Trilostane.

Sorry if I am rambling I am just so upset at lack of proper vet care and I am trying so hard. I love Chief so much.

[Chief]

Should I give him predisone only after the blood draw is done? I have predisone here that was provided when he first started his Trilostane in the case of emergency. I never had to use it.

[Chief]

Marianne, yes is dose was just dropped by 10% and never stopped. He is on .15 in a.m. and .3 in p.m. for a total of only .45 per day. He started in October 14 at 1.2 and went to .8 and then .6 and then .5 and then .45. I am going to stop him now.

I just heard back from the new vets office and they can get the ACTH meds and the company confirmed they have lots in stock. That is a relief.

[labblab]

Since you are heading in tomorrow, I would hold off on giving the prednisone. That way, they can get an accurate measure of his natural cortisol production tomorrow. If they think he needs steroid supplementation afterwards, then you can launch in at that point.

My heart just resonates with you because it is so clear how much you love Chief and how hard you have been trying to get him the help he needs! Let's hope this new vet will pick up the ball and pull his/her fair share of the weight!

We are walking right alongside you, OK?

Also, it occurs to me that the reason the ER vets didn't suspect Addison's may have been because Chief's blood chemistries may have been in normal range. They can often become unbalanced with Addison's. That's good if Chief's have been OK, but he may still need some supplemental prednisone if his cortisol is running too low. But you can find that out tomorrow.

Marianne

[Chief]

Old vet's office called and said yes he was very low post test. Please note this was not my vet that called as my vet has been on holidays for the past month.
He seemed to think something more should have been done (reading between the lines) but said this is the first he has ever looked at Chief's file as Kevin is his vet. He told me that his immediate thoughts went to Addison's crisis given the symptoms described. He was surprised that the emergency vet did not do at least a cortisol test.

I am taking it upon myself to stop the Trilostane now until I know what the frig is happening to my boy? Should I give him some prednisone?

[labblab]

We were probably typing at the same time -- see my note above about holding off on the prednisone. ;)

Cortisol testing cannot distinguish between natural hormone production and a supplemental steroid. That's why it's best to allow 24-48 hours between taking pred and having cortisol levels checked.

[molly muffin]

Sorry I just got off work so missed all of this, but I am in Canada and yes of course you can have an ACTH here, they just changed medicine used in it to the same one that is used in the states.

Absolutely that was too low. No don't give pred after first draw. They will do first draw (pre) and follow in an hour with 2nd draw (post) I wouldn't mind if they did an electrolytes since he has been low for quite awhile and continuing the trilostane.

Okay, deep breaths, you can get this under control and will. We're all here.

[Renee]

I just wanted to repost, in case you missed it, my info on DNA testing for the genetic markers for DM. I know it's not the primary concern at the moment (rightfully so, the low cortisol is of utmost importance) -- but, it may allow you to rule DM out, or rule it in as a possibility. I did this testing for one of my pugs, who turned out not to have DM.

http://www.offa.org/dnatesting/dm.html

[labblab]

In re-reading your thread this afternoon, a couple more questions come to my mind. I am trying to figure out exactly what dose of trilostane Chief has been taking. At some point along the way, he switched to a liquid form, but I don't believe we've ever known the "formula" for the liquid. In other words, I am assuming you have been giving him .15 ml. of liquid in the morning and .30 ml. in the evening. What we don't know is how many mg. of trilostane that actually is. The bottle/label ought to tell you somewhere how many mg. of trilostane are in each ml. of liquid. Can you search that out for us? I'm guessing maybe it's 100 mg. of trilostane for each ml. If so, he'd have been taking 45 mg. total daily. But let's double-check that for sure.

Also, just for future reference, if a dog is being dosed twice daily with unequal doses, the general preference is for the larger dose to be given in the morning rather than the evening. This is because the monitoring ACTH testing is usually completed after the morning dose has been given with breakfast, and not in the evening after dinner. For safety's sake, you are always wanting to find out what the cortisol level is at it's lowest point and presumably that will occur after the larger of the two doses has been given. So it's usually better to give the larger dose in the morning, right before the ACTH monitoring is performed.

This may be a moot point right at the moment, but just something I wanted to mention. Most importantly, let's figure out what dose of trilostane Chief has actually been taking.

Marianne

[My sweet Ginger]

I may be in the minority in regarding pred here.
I more than understand holding off on pred until after an ACTH for accurate readings but I think at this point it all depends on how well or poorly Chief is doing at the moment. I think the results from Nov painted the whole picture of his issues much clearer. If he were my dog I'd give him the rescue does of pred now and watch how he responds to it. To me if the pred perks him up that'd be enough proof that his cortisol is too low. He's been on trilostane for too long even at a lower dosage when it should've been discontinued at least for a while. The sooner the pred the more relief or benefit his body will get from it. You can always run an ACTH at a later time to see how low or high his cortisol is.
I just think it's more important helping him with pred right now in that an ACTH test won't hold as much value as pred does at the moment. Having been experienced with my own dog with low cortisol that'd be the route I'd take if Chief is doing poorly because there's no doubt in my mind he's mainly suffering from low cortisol and I'd want to help him sooner. I'm sorry as I don't mean to confuse the matter any further but still wanted throw my 2 cents in.
How is Chief doing tonight and when is he scheduled for an ACTH test?

[molly muffin]

Song the ACTH test is in the morning. I missed this but marianne caught it, his electrolytes have been tested and are within normal range.

I would probably since the test is scheduled and so soon, give him the pred After the test tomorrow. If it was days away then I would be inclined to say go ahead and try the pred and see how he does.

[Harley PoMMom]

Since Chief will be seeing the vet tomorrow I believe holding off the prednsione is the correct thing to do. Now, if Chief were to start exhibiting other symptoms such as vomiting, diarrhea etc...than a trip to the emergency hospital is needed. How is Chief acting, does he still have an appetite?

[Tina]

Please ask the vet about having Chief's electrolytes rechecked tomorrow also, in addition to the stim test. The sodium and potassium can become imbalanced very quickly and even though they were reportedly within normal range when they were last checked, I think I would want them checked again. When my boy's cortisol crashed due to Lysodren, his electrolytes were ok at first, but then very quickly got out of whack which resulted in a crisis and hospitalization. It can become life threatening very quickly.

Tina and Jasper

[Chief]

Hope I remember all the questions in my stressed state:

Chief has always been on liquid trilostane and it is 100mg/ml according to the bottle. When his last test was administered he was getting .3mg in the morning and .2mg at night. He was then cut down by 10% so .3mg in the morning and .15 at night. I did recently change it as his excessive drinking seemed even worse at night. Today he had .15 this morning and I did not give him an evening dose. Thus when his last ACTH test was done he was on a total of .5 per day.

Chief has a good appetite but I have noticed a little less so for his kibble. Tonight I mixed it half & half with what Toby gets (salmon and sweet potato due to grain and chicken allergies). He also had some cooked roast beef and cheese where his meloxicam pill is always hidden.

He seems to be a little weaker today in the rear end. I know DM causes rear end weakness but he seems to be going down hill too quickly according to my research on the subject. Neurologist said if it is DM it is early stage but this much weakness and crossing of the legs is not early stage and it came on relatively fast. He is not currently doing his hydrotherapy swimming in case of a disk problem. He loves it but I did not it was making him really tired. Chief is not out of shape and has always been fairly active.

The ACTH test is not being done tomorrow as the new vet I am going to see will not order it in until she examines him first but she can get the stuff. I cancelled that for now as I have an appointment with my old vet on Wednesday and he was the one to last see Chief and will know how much he has gone down hill in 2 months. The weakness I complained of then was written off to arthritis but has got much worse since then.

This is so damn crazy as I don't know when the test will be done. Old vet still has some ACTH test at his other office (not one I am going to on Wed) but will not bring it to that office (they are only about 30 miles apart). Makes no friggen sense.

I will have to set up appointment with new vet, get him examined and them get the ACTH test done.

So tired of this bs as he has been seen by emergency and a neurologist and I am no further ahead than I was at the start of this downfall two - three weeks ago. I could not get an appointment with my vet until Jan 20 despite calling on December 21.

I am holding my breath but I think Chief has drank less tonight than he has been but the night is not over.

Chief is alert, happy and wants to play but his back end is weak. He can still walk on his own without too much trouble and goes along well as long as he does not go too fast. He is wearing a help-em-up harness in case he falls as this harness is a life saver and is saving my back from being broken lifting a 98 lb dog. Chief is ADHD and it is hard to keep him quiet.

[Chief]

Thanks for all your helpful responses. I do really appreciate them.

Chief's trilostane is discontinued and his last dose was this morning. I will see how he is in the morning and then decide if he should have prednisone
or wait till after seeing vet-Kevin at 11:00 a.m. Wed. morning.

So confused at this time.

[Tina]

Cathy, just making sure you saw my reply since it ended up at the end of the previous page. I thought from your previous post that you had stopped the Trilostane, but in your last post you said Chief got a dose this morning? I think the Trilostane should have been stopped completely due to the low cortisol results from the last stim test. He needs to at least have a baseline cortisol checked asap. I would not wait until Wednesday.

Tina

[My sweet Ginger]

If an ACTH is still a toss up any time soon I'd definitely give Chief pred and see how much better he gets. You may see improvements within hours. See if pred will take care of his back leg weakness. I think you should count your blessings for he's doing as well as he's been with such low cortisol in his body for this long. He must've been an extremely healthy pup.
In this situation I really don't see a point of making him wait any longer just for the sake of having an acth test which may or may not happen when help could be right there that will make him feel better almost instantly in a long time. What his body might need is just a little boost. I'd give him 10mg and monitor. A lot to gain than to lose especially if he's getting worse.

[labblab]

Ummmm...In honesty, I am a bit confused as to why you cancelled today's appointment in favor of waiting to see Kevin on Wednesday. If I am understanding things correctly, he is the vet who probably incorrectly handled Chief's low cortisol in November, wouldn't give you an appointment to see Chief in December when he was in crisis, and now won't trouble himself to coordinate ACTH testing when that is probably the most important piece of evaluation that could be done right now. Apparently he is even now still doubtful about low cortisol or else he would make sure to conduct that test on Wednesday. I'm really not sure what you have to gain by seeing him again.

Given his track record, I think you are the one who is going to have to direct the appointment by telling him you want to make sure that Chief's electrolytes are checked. In Chief's case right now, I'm honestly not sure how much value there is to a baseline cortisol alone. I'm betting it will still be low, and the question is, how low is the stimulated value as well. However, if you give Chief some prednisone this morning, a baseline cortisol performed tomorrow (24 hours after dosing) would still give you some information. I'm just sorry to see you pay for half a test on Wednesday when you'll probably need to perform the full test ASAP anyway, and this is a test that Kevin could have arranged to conduct.

At this stage, though, I'd have to agree -- I'd probably go ahead and give him the 10 mg. of prednisone today in order to see whether it changes anything for him. That may be important diagnostic information to know. If you see improvement after the prednisone, that's additional evidence that Chief's natural cortisol production may be too low.

Marianne

[Chief]

Not sure if this makes any sense. The new vet WAS NOT going to do an ACTH stim test today and was only going to exam him. I don't think any of the vets around here now what they are doing when it comes to cushings/addisons treatment. I was hoping that after seeing Kevin I could head to his other office miles away and have the stim test done.
I may not be thinking straight at this time. Sadly I find one vet as incompetent as the next around here.

Do I just cancel my appointment with Kevin and start all over? They all seem of about the same caliber around here.

Chief had his last dose of trilostane yesterday morning and nothing since other than metacam. I have noticed that he drank much less last night than previous nights while on Trilostane. He is not as restless either. Still asking to go out pee more than normal but better than the night before.

I am looking for an IMS and waiting for a call back.

He is currently sleeping and not in any distress. His appetite remains good. He would be up and ready to go if I were to offer a walk but it has snowed here and the roads are slippery so he has a harder time when the roads are slippery.

[labblab]

I am definitely relieved to hear that, subsequent to stopping the trilostane, Chief is certainly no worse and perhaps even a bit better. It may be the case that just discontinuing the trilostane for a while will be enough to allow his cortisol to rebound, even without needing any prednisone.

I apologize if I sounded creepy and judgemental with what I wrote earlier about Kevin :o. But I just don't understand why he wouldn't make arrangements to have the stimulating agent sent over from the other office for your Wednesday appointment -- why on earth should you have to drive for miles to have the test done??? I am so sorry that you are in such a pickle re: finding competent and compassionate vet care!

However, Kevin's office should be capable of running a blood chemistry and a baseline cortisol on Wednesday. So if that is the easiest scenario for you right now, then I understand why you may wish to just stick with that appointment. From what you've described, I would now hold off on any prednisone, so if cortisol testing of any fashion is done tomorrow, it will be accurate. But if Chief continues to improve as he's further away from taking any trilostane, that in itself still points to low cortisol as having been the culprit as far as I'm concerned. If the break really improves things for him, though, that is certainly an easy fix -- hold off on the med until there is evidence that his natural cortisol production is increasing again to a problematic level, and then resume at a still lower dose.

Marianne

[molly muffin]

Are you in Ontario by any chance? I'm in Mississauga. Let me know as mybe I can be of help if you are near me.

[Chief]

Molly Muffin, I live just outside of Ottawa, Ontario and am 11km's east of Kemptville.

[Chief]

Chief and I just got back from the vet appointment. He had his ACTH test done and should have the results tomorrow. Vet agreed that it was a good idea that I had taken him of the Trilostane. (none since Monday morning) Some of his symptoms point to Addisons but won't know for sure till the test results are back.

His urine specific gravity is very low (1.010)and he is at this moment living in his water bowl.

Kevin (vet) is concerned that he has does has either IVDD, DM or spinal cancer. He was surprised at having seen Chief just 2 months ago just how much worse he had got in a relatively short period of time, leading him more toward IVDD than DM but spinal cancer is not off the table.

He starts his prednisone tomorrow night as he must be clear of Metacam for 48 hours. Kevin said had he seen him on the 31 of December he would have started him on the predinsone at that time. He was made aware that his office refused to see me and did not even ask what was wrong when I called. Hard to tell from his reaction if he even cared.

Can the cushings/addisons issue exacerbate the hind end weakness? The answer is yes but there is more going on than this. The prednisone will be given for 10 days to start. I asked much more will he pee with it? His answer was with a urine specific gravity of 1.010 that it can't get much worse.

I am getting very little sleep as it is so another pee or two won't make much difference. Looks like my life is on hold while I help Chief. Not a problem. It is just very hard as he is ADHD and will not stay quiet. Kevin did say he could take an doggie ativan (I have some) and it would not hurt him if needed to quiet him down.

Guess I will head out in awhile and look for some sort of bed for the living room as the couch is not very comfortable for long term.

If only I could take his health problems I would. He is such as happy loving boy that it is hard seeing him get weaker with some days seeming worse than others. Oh well at least I can take my human ativan for the times when I really think I am losing it.

[Chief]

Chief ACTH test results are back:

Pre-sample 28 Normal (28-120)
Post ACTH 43 Normal (220-550)

I was told that we are low and at the Addison's level.

Chief starts on 50mg of prednisone tonight.

I was told that Addisons will make a dog weaker in the hind end as the hind end may be lower, dog may have trouble doing the stairs or getting up on the couch but will not have ataxia, thus will know were his feet are.
His weakness in the rear end may be a dual issue but the drug for both is predisone.

Input appreciated from all of you kind people who take the time to respond. I have got some very good and kind comments and advice from many on this site. Thank you.

[Chief]

Please forgive typing and spelling errors. I am so tired my brain has stopped working. Normally I write properly.

[labblab]

Thanks so much for giving us this information. For the benefit of our folks in the U.S., Chief's ACTH results convert to:

Pre: 1 ug/dL
Post: 1.5 ug/dL

The "post" result of 1.5 ug/dL is actually right at the bottom of Dechra's acceptable therapeutic range for a dog being treated with trilostane. But coupled with his behavior and also given the preferences of some clinicians for a "post" result higher than 2.0, I don't disagree at all with giving him some supplemental prednisone for at least a time, while keeping him completely off the trilostane. His natural cortisol production may soon rebound after having a break from the trilostane and the pred can be discontinued, or it may not, in which case he will need to stay on the prednisone indefinitely.

My worry now, however, is about giving him a whopping high dose of 50 mg. of prednisone. Are you certain about this dosage? The typical formula for calculating the amount of prednisone to give in order to supplement adrenal insufficiency is approx. 0.2 mg. per kg. In Chief's case, this would amount to only around 10 mg. daily. I am really afraid that with a dose as high as 50 mg., you are not only replacing the amount of hormone that Chief is missing, but you are giving him much, much more and will likely indeed see a continued worsening of thirst, urination, etc. as side effects of the high steroid dose.

Now, the reason for this dosing may be because Kevin is wanting to give the prednisone to also treat other inflammatory issues that he thinks may be associated with the rear-end issues. But I would double-check with him as to why he is giving such a high dose and for how long he intends to do so. At such a high dose, Chief will definitely need to be tapered off the prednisone when the time comes to decrease it.

Here is an article that discusses prednisone dosing for dogs suffering from naturally-occuring Addison's, but the physiological replacement need is the same regardless of the cause of the deficiency.

http://www.endocrinevet.info/2011/02/q-whats-ideal-prednisone-dose-for-dogs.html

Also, did Kevin check Chief's blood chemistries in order to make sure his balance of potassium and sodium are OK? If adrenal oversuppression is suspected, those chemistries can also be affected and require supplementation.

I am sorry to add yet more questions to your already heavy load :o. But in good conscience, I feel as though I have to tell you about my own worries. As I say, perhaps Kevin has good reason for the dosing he is suggesting. But I just want you to be aware that it is unusually high for this situation.

Marianne

[Chief]

His blood chemistry was checked two weeks ago and right in normal range so he did not re-check. I wonder about the dose but I know he is hoping to reduce inflammation in the spine due to his potential disk disease. So confusing because we are now treating two separate issues.

Thanks for your help. I am at wits end. Will this high of dose do further damage or is it necessary to hit with a high dose due to the disk issue?

He can't drink and pee much more than he is now. He is just about as bad as he was before he started Trilostane.

His reading without Trilostane in his system are not far off what they were with it. Thanks for the conversion because I find it confusing as it is different in the US.

[labblab]

Unfortunately, I really do not know what the typical prednisone dosage would be for a condition such as degenerative spinal disease. It is certainly the case that higher doses of steroids are used to treat certain conditions, and this may be one of them. So perhaps, as you say, Kevin is trying to hit two birds with one stone here. However, I've already forgotten whether or not the spinal disease has actually been confirmed or whether it is just speculation.

What I might suggest is just that you confirm the rationale for the 50 mg. dosage with Kevin -- what is his gameplan and what is the timeframe? On a short-term basis, the 50 mg. may indeed turn out to be helpful. But as I say, I just wanted you to know that it is a higher dose than would typically be used to treat adrenal insufficiency on a long-term basis.

[Chief]

The initial time frame is for 10 days and then we will discuss. The diagnosis of spinal disease (IVDD) can only 100% be confirmed via an MRI but this is what two vets and a neurologist seem to be leaning towards without doing a 3,000 MRI. The problem with an MRI is that it requires anesthetic and thought to make DM - degenerative mylopathy worse if it turns out to be this and not IVDD -disk disease. An MRI would tell them what disk was damaged and the treatment is then either conservative or surgery. At 11+ and with his other health issues I do not believe that surgery is the way to go. He could die on the table or not recover well, whereas this way if the prednisone reduces the inflammation I could have several months left with him of quality time.

Please remember at this time he is bright and alert, good appetite, wants to do things (but is restricted due to spinal issue), and still loves life. He can still walk half mile or more but the vet does not want him doing so at this time. I don't want surgery to make it worse or perhaps lose him. I know I will be lucky given his age and health concerns if he makes it another year. Average life span for German Shepherds of average health is 12 years.

If the prednisone gives him some strength back or at least prevents him from getting worse then we will still have quality together. The fear is that if he looses the use of his rear legs and given his weight I will not be able to handle getting him out to the bathroom and into a wheel chair.(cart) I will break my back and lose my mind trying but not sure I can handle a 97lb dog that is paralyzed and despite his attitude being good I will have to say good bye to my best friend of 11 yrs.

If he were younger surgery would be a no brainer even at a total cost of around 7,000 with the MRI. To put him through back surgery when he maybe has another year to live anyways seems cruel as most of this time would be spent recovering. I want quality time with him and not quantity as at this point I will never have both again. He is an old dog by German Shepherd standards. To date Chief has had two knee surgeries (total cost over 12,000), soft tissue sarcoma removed (1,000+), another benign tumour removed in is mouth (1,000), cushing diagnoses (1,500 plus ongoing medication cost and vet visits for blood work and ACTH tests), and more than 1,000 so recently for ongoing matters.

If love and money could save Chief he would be alive as long as I am on this earth. Sadly it does not work that way.

PS: I put a call into Kevin's office regarding the dose to start him on tonight.

[molly muffin]

I find the dosage starting of 50mg to be very high and wouldn't want him on that long term, as prednisone comes with it's own problems.

What you want optimally, is an initial rescue dose, that is high enough to help him over this period and then a gradual tapering off plan in coordination with the vet. You want to taper down to where he no longer needs the prednisone. Whether his normal cortisol will rise then or not, is an unknown. As long as the adrenal glands are not harmed, and the prednisone doesn't take over completely for them, they usually will continue to generate cortisol. (maybe or maybe not excessively)

So, get a plan in place with kevin for the exact dosage and a tapering down.

I'd just also like to point out that the range you gave is for a dog not on treatment. There is a different range for a dog being treated with trilostane/vetroyl in which the high end of the post is 250 nmol, not the 250 - 500.

[Chief]

I think where this whole thing gets really confusing is that we are treating the Addisons with prednisone and the spinal disk problem with prednisone.

Chief had been off Trilostane for two days when this test was done. He was on it for 15 - 16 months prior to that with each ACHT test requiring a drop in Trilostane each time.

I am providing the only numbers given to me. I did not get a copy of this one yet but the last one done in November and it was similar with slightly different pre and post. It was less than 27.6 pre and 29 post. His test yesterday had readings of 28 pre and 43 post. In the November test I was told he was low normal and asked to reduce the dosage of Trilostane by 10%. His test yesterday I was told was low and a good thing I had taken him off the Trilostane on Monday. Well the numbers yesterday were higher than November, so how is Nov. low/normal and yesterday low and Addisons (not at crisis level). Have I lost my mind or is something really wrong here?

To top it all off I called and questioned the 1mg per kg for the Prednisone thus a 50 mg pill was prescribed to be taken twice a day. 100mg of Prednisone for a 44kg dog per day. I was filling the prescription when they called and left a message on my home phone saying the dosage was proper at .1mg per kg. Well when I went to school .1 X 44kg would equal 4.4mg so a 5mg pill not a 50mg.

For this evening I gave him one of the prednisone pills I had here from when he started on trilostane in case of a crash. It is a .5mg. Had I not been suspicious of the large dose and also the reconfirmation from those of you on this site I might have had a dead dog from prednisone overdose. 10 times the amount.

I am so upset and confused. Where can I find a vet that knows what is going on? I suspected Addison's crisis when he went to emergency on New year's eve but the emergency vet said nope it was all in his spine. Well just because his sodium and potassium were in the normal level does not mean he is not in Addison's crisis or close to crisis. There is atypical Addisons where the sodium and potassium levels remain normal.

Please help me here. Am I really confused or have some serious errors been made here by the vets?

[My sweet Ginger]

I will assume you gave Chief a 5 mg pill and not 0.5 mg.
I'd give him another 5mg if you don't see a change within a few hrs as rescue dose of pred is 0.25 mg/kg.

I had to bite my tongue not to say anything negative about your vet regarding his treatment on Chief.
He may be a great vet who you've had a great relationship with before Cushings but from how Chief has been treated by him so far I'm convinced his experience in treating Cushings disease is very little to ZERO. With the results from Nov. trilostane should've been discontinued, not lowered and maybe even some help from pred in addition. There was hardly any stimulation in his cortisol production.
You are not confused. You just had a blind faith in your vet as a lot of us do or did and you are not the only one. How can we not? They are the professionals. The tragedy is it comes at the expense of our beloved pups.

I'm pretty sure he will perk up after pred. My pup was one of those whose electrolytes were not compromised from Lysodren overdose so she was only on pred therapy for over one yr.
Let's just hope Chief will feel better on pred finally and I think he will.

[labblab]

Wow, so your original understanding was to give 50 mg. TWICE daily? So the daily total would actually have been 100 mg. :eek: :eek:? How was this information conveyed to you -- via written Rx, verbal instruction, etc.?


To top it all off I called and questioned the 1mg per kg for the Prednisone thus a 50 mg pill was prescribed to be taken twice a day. 100mg of Prednisone for a 44kg dog per day. I was filling the prescription when they called and left a message on my home phone saying the dosage was proper at .1mg per kg. Well when I went to school .1 X 44kg would equal 4.4mg so a 5mg pill not a 50mg.


If this erroneous Rx was actually transmitted to the pharmacy, this constitutes veterinary malpractice and cannot be glossed over. As Song has written, nothing about Chief's recent care has proceeded properly, with potentially life-threatening consequences all along the way. This is really unforgivable.

How did you end up considering the new vet with whom you cancelled the appointment this week? If it was based on favorable reviews or recommendations, I'm thinking you'd want to go ahead and rebook an appointment. I was willing to cut Kevin some slack when it seemed as though he was purposely prescribing a higher pred dose in order to address the spinal issue. But I had no idea that the dose was for 100 mg. daily, and that it appears to have been a total error. I just don't see how you can now trust any recommendation that is coming out of that office.

I do emphathize 100% with your dilemma about Chief's quality of life. My husband and I are in the same boat with our 80 lb. non-Cushpup Lab senior girl. Apparently she has significant orthopedic issues that are compromising her rear end. But at her age, we would not consider her to be the candidate for surgical or invasive intervention, so we have not proceeded with more involved imaging, either. Just via x-ray, we know her hips are terrible, and there is probably more going on as well. Her mobility is compromised now, and once she can't walk sufficiently well, that will be the endpoint for us. So we are treating with NSAIDS and keeping our fingers crossed. But I do understand why maintaining or improving Chief's mobility is such an issue for you.

I will say that I was initially pleased that Kevin was aware that there is a contraindication between giving NSAIDS and steroids. I was, myself, wondering whether Chief can safely continue on the metacam if he needs longterm pred. However, I do not have the knowledge as to whether replacing lost cortisol with a very low dose of pred constitutes the same risk as is present when higher doses of supplemental steroids are being given to treat other inflammatory or immune-mediated conditions. In other words, if you are only replacing the amount of steroid that would naturally be present in a normal dog, are NSAIDS still a total no-no? I do think the answer to this question could be important if Chief really does need the anti-inflammatory and pain relief from the NSAID to aid his mobility.

I know you are really struggling to get some competent professional care. I'm not sure whether our Canadian staffer, Sharlene, saw your earlier post about where you live. I'm going to repeat it here, in hopes that perhaps she is near you or at least has some suggestions to offer to you.


Molly Muffin, I live just outside of Ottawa, Ontario and am 11km's east of Kemptville.

We need to get both you and Chief some HELP!!!!

Marianne

[Chief]

Thanks ladies for your responses. Chief had a 5mg pill last night and another 5mg this morning, NOT THE 50 MG THAT I picked up yesterday. the prescription was for 50mg and I originally thought it was for once a day but when I picked it up, on the bottle it said twice per day at 50mg. Oh my.

I was reading last night that Aytipcal Addisons is even more rear that Addisons. One study gave an example that if a vet practice wit two vets that sees 1500 patients in a year that only one patient would be Addisons. I gather from that the the Atypical Addisons patient may be seen once every 3 yrs as it seems to be uncommon. (just my guess on this last sentence)

Well I just called the vet clinic and Kevin is not in. The lady who answered the phone said written on the file is 1-2 mg per kg so 50 is correct and not the .1mg per kg as per voice message yesterday.The vet tech who called me back yesterday is off today. Go figure. The owner Dr. Lima (recently bought the clinics from Kevin) was at another clinic so I called there. He is in surgery but is supposed to call me some time after 1:00 p.m. when he is out of surgery.

Yes I am looking for another vet but where do I find one with Cushings/Addisons experience? It is sad but in my rural area not many people go to the expense I do with their dogs. What I am saying is that lots of dogs who need this expensive vet care at euthanized.

I am not sure if it is my imagination or not but Chief seems to be a little better already. Kevin who said he could not pee more with a 1.010 urine specific was wrong. He is peeing more since starting the 5mg pills of prednisone. He seems to be a little more stable on his feet.

I will post when I hear from the vet.

If there is anyone on this site from the Ottawa Ontario area or within an hour or so....Montreal, Kingston are even possibilities although 2 hrs away that knows a vet experienced in this area please let me know.

[labblab]

Bear in mind that the articles you are reading about Atypical Addison's are discussing the naturally-occurring form of the disease. Chief's issues are drug-induced, and it is not uncommon for dogs who experience adrenal oversuppression due to Cushing's treatment to only require cortisol supplementation alone -- their electrolytes may not be negatively affected. So in the general population, it is unusual. Among practices that treat Cushpups, it is a side effect that can be expected if overdosing occurs.

I am glad you are pursuing the medication error. It is really scary to think you might have been giving Chief such an excessively high dose for ten days.

I've sent a message to Sharlene in order to see whether the two of you live anywhere near one another in the same part of Ontario.

Marianne

[My sweet Ginger]

No, I don't think it is your imagination as we usually see the effects of pred within hours of administration and I'm really glad you are seeing some improvements in him.
I'd just give him his daily pred and monitor him. There's is a good chance his adrenals will recover and start regenerating cortisol on their own in time but no one knows when that will be. At some point tho you will have to slowly decrease the pred since you don't want his adrenals to remain too dependent on pred for too long so his adrenal glands will get a chance to slowly reproducing cortisol again. It's a balancing act which you can not rush the process. You have to read his behavior very closely throughout. Since his electrolytes are not comprised I'm very optimistic that his adrenals will rebound with time and he just needs supplemental pred in the mean time verses him remaining in the Addison's state permanently. I hope you will find a specialist with experience and empathy soon.
He may also pee a little more due to the pred but hopefully not too much. My pup's PU/PD hasn't really changed from Cushings to Addison's to now. It's definitely more than the other pups but not terribly excessive. She's just incontinence.

[Chief]

Here we go:

Kevin works three days a week now so can't talk to him till Tuesday.
Owner of the clinic, Dr. Lima (just bought clinics from Kevin) confirmed from the file that the dosage prescribed to him is 50 mg twice per day. By keeping him talking he did tell me that he would have prescribed 25mg twice per day for a total of 50mgs. The reason for this is that we are trying to reduce presumed inflammation in the spinal area. Yes if the dose was for Addisons only it would be much lower. He explained that the really high dosages are normally to try and get his spinal condition under control as a last ditch attempt before euthanasia due to immobility.Chief is not there yet. He is getting up on his own, walking a bit wobbly but still capable of walking a mile or so. He is happy, eating well, bugging his twin sister Justice, enjoying his truck rides and his short walks. He does not appear to be in much pain if at all other than from arthritis due to aging.

I am so confused as my extensive research indicates that Addisons dogs can suffer ataxia and paresthesia but they are not real common, but weakness is. I do know that this is a cushings site so maybe the addisons information will not be known. I have joined the Addisons group so hoping to get some ideas there. Could this all be Addisons related and not spinal?

My gut tells me not to put him on the high dosage just yet. I keep remembering back to the fall of 2014 when Kevin wanted him on 2.4 of trilostane. My research and help from those of you on this site said no no no. Maximum to start for his weight should be around 1. I started him on 1.2 and his first ACTH test 10 - 14 days later showed this was too high and he was reduced to .8, then .6, then .5, then .45. Sadly in November he should have been taken off completely and not reduced.

Boy Chief is not an easy case to solve.

[labblab]

Spinal issues indeed may be involved and be a complication, but if Chief were mine, I'd first see what kind of relief he gets from the smaller dose of prednisone. Weakness and lethargy are common effects of low cortisol, so that's where I'd start first -- replacing the cortisol that his body is not currently producing. If that doesn't alter the hind end weakness, then a higher pred dose may be worth trying (but at exactly what dose --that is the question...surely not 100 mg. a day).

As I mentioned before, though, a further issue is the discontinuation of the metacam. If Chief truly is having inflammatory issues in his spine, then instituting the low dose of pred in lieu of the metacam may not result in much observable improvement as far as his mobility. We are giving our girl daily Previcox now, and there's a really big difference in her mobility when she's taking the NSAID vs. when she's not.

Don't get me wrong -- of the two meds, the pred is more important right now for a number of reasons. And he shouldn't be taking the metacam in combo with higher doses of pred. But I still can't help but wonder whether Chief couldn't resume the metacam if he remains on a low dose of prednisone that is just replacing that which his own body is not producing. I may punt that question to an endocrinological expert who supplies answers on occasion to our group here...

[My sweet Ginger]

Could this all be Addisons related and not spinal?

I have to say that thought had crossed my mind a few times. How about watch him for a few days on pred and see how he responds and also see if he improves any in the supposedly spinal related areas.
Whether he has separate spinal related problems or not I too think treating his low cortisol with pred is much more important and urgent right now and I think it would be like asking for more trouble by giving him a humongous :eek: amount of prednisone at this time.

[molly muffin]

Ugh, I'm in Mississauga, which is Toronto area, about 4 hours away.

What I did was get a referral to an internal medicine specialist which is actually at the Vet ER. They see my dog regularly and manage all cushings and related issues. She sees the ophamologist and the neurologist there. ER's are not just for emergencies but for the specialist too and I think you can use the one in Ottawa the same way.

Sorry but I do agree, Kevin is out to lunch on this treatment plan and has been all along. I think he just doesn't know much about it, but the problem with that is that these meds can be dangerous if not used correctly, so there is wiggle room but not for the kind of errors he's made. My thought of course.

I'd get a referral, get the IMS on board to manage Chiefs treatment.
I don't think he will be Addison, he went low, but as electrolytes remained normal and since this is trilostane, he is probably going to rebound at some point. It doesn't work the same way as lysodren which erodes the cortex and can take longer to regenerate, but that is neither here nor there at the moment.

I can tell you my golden retreiver was on prednisone and never more than 20mg during her worst and we tried to get that down as soon as possible as high doses of steroids can cause their own problems. Welcome to Itrogenic cushings which she had.

So that is what I'd do. No mixing prednisone and metacam. Those two meds can have a bad adverse reaction on each other from what we have seen and been told by other members in the forum. If you need a pain med, try one of the others that is safer.

Okay those are my initial thoughts.

[Chief]

Good afternoon all you wonderful people who have been supporting Chief and I through this crisis.

I am not sure of the proper label but it appears to be atypical addisons at this time. Cortisol is low but the electrolytes are in balance.

I have emailed the emergency/specialty clinic in Montreal which is about two hours from here. We do have Alta Vista in Ottawa and have been playing phone tag with them. They do have an IMS but nobody that specializes in cushings/addisons. Maybe this does not exist by itself. I am not overly impressed with Alta Vista as I have been there to emergency on New Years eve and the vet did not seem to know that Chief could be in crisis despite the fact that his "lytes" were normal. I brought up the possibility of Addisons and was told no and to get an ACTH test at my own vet. The next step with them was a neurologist and I have told you that story. 3,000 MRI and then surgery for a total of about 7,000 if a disk problem was found, nothing if DM as can't be cured, and if a spinal tumour just a matter of time. Nobody there seemed to think this could be related to cushings/addisons and so forth. Not sure if I want to spend more money there. I do know Toronto as i lived in Hamilton for 16 years. It is a much longer drive than Montreal for a specialist.

Chief is like a new dog and is improving by the minute. He is getting up without much trouble albeit still on the carpet runners I placed all over the main level. He is getting up from his dog bed where he was having trouble before as the bed itself is soft compared to the floor with carpet. He is even stretching his legs. I am not saying he is 100% back from where he was just that he is greatly improved. My friend came over last night who had seen him a couple of days prior to starting his prednisone and could not believe the difference in him. This was a good confirmation that I was not seeing improvement due to losing my mind. Lol.

We walked yesterday and he had no problems on the snow covered side of the road. One or twice he was a little unstable but corrected himself versus going down and needing to be lifted up. He does not seem to be in any pain when walking. I do know that dogs can hide pain.

Chief is taking 5mg of predinsone twice per day. I repeat 5mg only and not 50mgs. I had 75 - 5mg prednisone pills here that were prescribled when he first got his Trilostane in case of overdose.

His drinking and peeing has been getting worse since November when he should have been off Trilostane, imo. I would say his drinking and peeing is 75% as bad as it was when he was diagnosed with Cushings and before starting medication. Of course drinking and peeing is also a side effect of Addisons. Not sure if he is any worse with the prednisone but certainly not better - regarding the drinking and peeing. His appetite was always good but better now. He has lost a couple of pounds but at this rate of eating he should put them back on. He weighs 96 or so and should be about 100.I can feel more ribs than I like at this time.

I am praying that Chief does not have a spinal problem. How unlucky it would be for any dog to go from Cushings to Addisons at the same time they developed a potentially fatal spinal issue. Things are looking up but time will tell. Chief remains alert, happy and his biggest complaint is he wants to be more active.

I guess out of all of this I am p/o at myself for not insisting on his test results in November and taking the time to learn the numbers and so forth. Had I done this I would have known that he should have been removed from the Trilostane then as he was low and not low normal. The poor boy suffered for two months cause I trusted my vet. It appears anymore that vets can't be trusted and that one has to take the time to do the research to ensure the safety of their fur babies. Sad world we live in.

[judymaggie]

Hi! So glad that Chief is improving!! :D Please don't beat yourself up about trusting your vet. Many of us were raised to respect those who are "professionals" and that questioning them was disrespectful. The vet I used with my first beagle (before she was diagnosed with Cushing's) told me to crate her during the day and at night because she had unexplained aggression. Turns out she was in terrible pain from infected anal glands and, as soon as my current vet removed them, she never again showed any aggression. Could I have saved both Maggie and myself some grief ... sure! From that time on I politely question every decision my vet makes and we have intelligent discussions based on the research I do. Always remember -- you are doing a great job taking care of Chief!

[Chief]

Thanks Judy. I guess I will no longer ever just take any vet at their word. I should have known better after the hell I went through with the vet before Kevin. It is never to late to learn and I have got it. It is a sad world when you can't trust those trained in the field but still have to pay them while you do most of the work.

I now have to find a vet to get me through this. In 10 days does he have to come off the prednisone for a couple of days in order to run another ACTH test? I would guess yes else a false reading would be obtained. Then if he is still low he continues on the prednisone or if his cortisol is high once again he starts back on Trilostane.

He has improved so much in just two days on prednisone. He no longer walks like a drunken sailor, is not falling over his own feet and actually came over to my chair tonight and got up on is hind feet to give me a hug. It has been awhile since he has had the strength to do that. I am not saying he is back to normal in strength but has drastically improved.

He is peeing at least every hour and on our walk today must have went 6 times or more. I guess I have to endure this in order to get him regulated again. Sleep is a thing of the past as I just get back to sleep and he is wanting out again.

Hoping we can get him regulated soon.

I did the neurological test on him tonight where his rear feet are knuckled under and both feet returned immediately when earlier in the week both feet were slow to return.

Praying that he does not have spinal issues and that this is all from the cushings/addisons issue. It is sure looking that way now but still too early to know for sure.

I have a call in to a couple of vet specialists to see if they can help...one in Ottawa and the other in Montreal. I need a new primary vet but don't want to waste any more money on the incompetent rural vets that seem to be overly abundant in this area.

[Harley PoMMom]

The prednisone would need to be stopped at least 24 hours to get accurate results for the ACTH test. And I'm not sure if abruptly taking him off the prednisone would be such a good move right now, you could ask the vet about giving him dexamethasone instead as dexamethasone does not cross react with the cortisol assay tests.

I am so happy to hear that Chief is feeling much better, and like Judy said, please do not be so hard on yourself as a lot of us have been there and have learned that placing blind faith in our vets is a bad idea.

Hugs, Lori

[Chief]

Question: What do I do about the fact that Chief is now peeing every 30 -45 minutes and had me up this often all night? He is on 5mg twice a day. Should I cut him to half that given that he has only been on prednisone since Thursday night. It can't be good for him to pee and drink that much nor is it good for me to get little to no sleep.

His strength continues to improve. He is getting up with minimal problems if any from the carpets placed on the hardwood and ceramic but still has some trouble on the bare floors. He is walking straight and does not look like a drunken sailor. He even surprised me last night by getting up on his back legs to give me a hug while I was in my lazyboy chair. It has been a couple of months since he did this. I did not encourage it but it just happened. The only medication he is on at this time is the prednisone.

If he had a spinal issue I don't think that 10mg (total per day) would have corrected the problem so quickly as normally for that issue 50mg total per day are prescribed (info from another vet and online article), although 100 mg is not unheard of. Another vet told me that 100mg for a 97 lb dog is normally only given as a last ditch attempt to solve a problem and euthanasia is usually being considered when they do this if it does not work. Chief is not there yet and given his quick improvements not even thinking about that.

When a dog goes from Cushings to Addisons (but not in crisis) how long does it normally take to get the dogs cortisol back to normal levels? Do these dogs then at some point go back to being Cushings? If I am right when he is tested again around the 10 day mark,if his cortisol is still on the low side he will remain on prednisone for awhile longer, or if his cortisol has gone to the high side he will be started back on Trilostane, is this correct? I gather the Trilostane dosage may be at a lower dosage than when he came of it last week (45mg). Boy it would really be nice to know I had a vet who could answer these questions for me and actually give a damn.

[labblab]

When a dog goes from Cushings to Addisons (but not in crisis) how long does it normally take to get the dogs cortisol back to normal levels? Do these dogs then at some point go back to being Cushings? If I am right when he is tested again around the 10 day mark,if his cortisol is still on the low side he will remain on prednisone for awhile longer, or if his cortisol has gone to the high side he will be started back on Trilostane, is this correct? I gather the Trilostane dosage may be at a lower dosage than when he came of it last week (45mg). Boy it would really be nice to know I had a vet who could answer these questions for me and actually give a damn.
Yes, your understanding is exactly right re: the treatment plan, and it indeed depends upon how quickly and to what extent Chief's natural adrenal function rebounds. That time frame is highly variable, though, and there is just no way to predict in advance how an individual dog is going to respond. I am so happy to hear about Chief's improvement, however, aside from the thirst/urination!

I do have a couple of thoughts to throw out in that regard. First, yes, I think I'd try reducing his prednisone to 5 mg. daily at this point. Per that article written by Dr. Mark Peterson that I was referencing a couple of days ago, on a long-term basis he seldom doses an Addisonian dog of any weight with more than 5 mg. daily. He says that is the typical maintenance dose for a human, even. So even though higher doses may be given at the beginning to offset an Addisonian crisis, it sounds as though the physiological replacement needs are pretty minimal after the dog/human has stabilized (which definitely sounds to be the case with Chief).

In honesty, he may not even be needing any supplemental pred at all at this point. Simply discontinuing the trilostane may have given his adrenal glands the "push" they needed to kick back into production. The initial added jump-start from the pred may have been helpful, but not necessary for long. So yes, I believe I'd try dropping back to 5 mg. for a couple days and see how he does. If he does well with that, you might experiment with leaving him off of it altogether for 24 hours.

A totally alternative thought/question for you is this: has Chief's thirst and urination ever really resolved satisfactorily at any time since starting treatment? If not, it seems possible to me that something more than Cushing's alone may be affecting him. I'm assuming that chronic UTIs have been ruled out. If so, there is another condition that is rare, but does appear to sometimes be linked with pituitary tumors. It is called diabetes insipidus, and it is totally different from the "sugar" diabetes, or diabetes mellitus, with which we are all familiar. It results from a screw-up in the pituitary, and actually can be resolved rather easily by administering a particular medication. Formal testing for the disorder involves a rather dangerous water deprivation test. Many vets forego that test, and instead just have the dog go through a trial of the medication. If it works, the diagnosis is assumed to be correct.

As I say, this is not a common condition. But we have had other Cushpups on the this forum who have been diagnosed with this condition and satisfactorily treated. So it is just one thought that I wanted to toss out for your consideration, especially in advance of perhaps meeting with a specialist. But hopefully, just reducing the pred may help a lot, all on its own.

Marianne

[Chief]

Thanks Marianne. I also read Dr. Peterson's site regarding the 5mg being a maintenance dose for adult humans.

Chief's peeing and drinking did get back to normal for him for the longest time after starting Trilostane for about one year. (He started it in October 2014 and all was good till November 2015) I say normal for him as from a pup he always seem to drink a little more water than the others but still well within limits for his size. I started to notice around November that he was asking to go out during the night which he had not done for a long time. This was around the same time I started to notice the weakness in his rear end. (different from his arthritis issues) I took him in for an ACTH and blood work expecting to hear that he would need to increase his Trilostane dosage slightly. I was not thinking in the other direction - Addisons with the increase in peeing and drinking. When his test came back low/normal (we now know that it was actually low) his Trilostane was in fact reduced 10%. This did nothing and he continued to decline over the next 3 - 4 weeks. I have already told the story of December 31 and my vet's office refusing to see him despite the fact that he was having trouble getting up and then maintaining his balance. The rest of the story has been told leading up to now.

His blood work was good except for a high normal on eosinophils. Vet said not to worry that we would just monitor it as likely related to allergies. Note: Chief has not been known to have allergies. I have read recently that eosinophils can be up when Addisons is suspected. Reading so many articles gets one confused as often one article disagrees with another one.

I have found articles written by vets that say neurological systems such as ataxia and paresthesia can present in dogs with Addisons (low cortisol) and others that say they are unrelated. It leaves one wondering who is actually correct. Chief passed his knuckle under test last night of both rear feet whereas a few days ago he was slow to return both feet. I will do the test again later today to see how he does. Playing vet when my education is in legal and finance becomes confusing but apparently I am better at researching and deciphering information aboutdog diseases than most of the rural vets around here and that is really scary. I really wish I had access to the same sites the vets do for hopefully more accurate information.

I also forgot to mention that the other day Kevin talked to me for over an hour but did not put his hands on Chief whatsoever. You would think he would want to examine him in case of any tumour growth or major changes since he examined him in November. Nope he just commented on how weak his rear end was and I do admit that Wed was his worst day yet. It was also his second day off Trilostane so not sure if that was the reason. Kevin was just so convinced that Chief is either a IVDD dog, DM dog or a spinal tumour dog that the cushings/addisons was taking a backseat. He was not and don't think he will ever be willing to acknowledge that this could all be from cushings/addisons problem. Then again I am not 100% sure at this time but given how quickly Chief has recovered does rule out DM and likely the other ones as well.

Sorry I am rambling a bit.

[Chief]

Chief's recent urinalysis (Dec 31) all normal other than very dilute urine at 1.010. Emergency vet not concerned and said have ACTH test done at my own vet.

[Harley PoMMom]

Cush dogs usually have diluted urine and because the urine is so dilute, not a whole lot of white blood cells are picked up on a normal urinalysis so an urine culture and sensitivity test should be done.

[Chief]

Thanks for the info. I will insist that be done in a polite but firm manner despite the opposition if any. Chief needs a competent and demanding advocater as the vets around here are scary. His Mom is taking on that role regardless of how unpopular I may be with the vets. Chief's health is more important to me than what these people think of me.

[Budsters Mom]

I had to take on the advocate role, researching and questioning everything. I wasn't terribly popular at first, but was soon respected and became a valued team member. My vets became proactive, which made them better because they knew I was going to ask the tough questions and they needed the answers. My Buddy got the best possible care because I pushed for it.

Stick to your guns. Ask of the tough questions and don't settle for a wishy-washy answer. Be polite and relentless. Do your research, ask for copies of everything and don't give up. It's OK if they say they don't know, that way you can find out together and you become more of a team. They won't want to work with you if they feel attacked, so try to keep the line of communication open.;)

Good luck!

Kathy

[Chief]

Chief has only had one half of a 5mg prednisone today, thus .25 this morning. His drinking, peeing and panting are like I have never seen before. He did eat some dinner but only the roast beef and left his dog food which is not like him. I had to go out today and was gone for 3 hours. The amount of pee in the house was huge......3 spots and large amounts. Help somebody....do I put him back on trilostane tonight as it appears he is back in full blown cushings, do I go to emergency, what do I do? He needs to pee about every 10 minutes.

He was out at least every half hour or more all night.

Is this Cushings? Symptoms are now more cushings than addisons in my opinion. I am in a panic. What should I do to help my boy. Trilostane???

His strength in his back end is amazing and is getting around without problem. It can't be good for him to be peeing this much. Please help us!!!!

Thanks

Cathy

[Chief]

Hi I posted in Chief's thread. Hope somebody see this soon. I am not sure what to do.

I am afraid with all is peeing that he will dehydrate.

[molly muffin]

One of the signs of Addison's is also increased urination and drinking.

So it may not be that he has gone full blown Cushing's but that his cortisol remains low. It is hard to know but you said he didn't eat as normal so I am thinking not back to full blown Cushing's and I Woukd give him the prednisone instead of 1/2 the full amount and see if he urinates/drinks less than on the 2.5mg.

However yes I am concerned to that he is going that often as it is hard in his kidneys. But don't withhold water.

Addison dogs are also prone to UTI too.

http://vetspecialistsofrochester.com/pdf/Internal-Medicine/Addison's%20disease.pdf

[molly muffin]

Is he drinking enough? Dehydration is a concern.

[labblab]

Dear Cathy, I'm so sorry but I honestly don't know what to tell you other than to take Chief to the ER if this keeps up. This much urination is so abnormal, as you well know, and I understand why you are worried about dehydration. I know it sounds like Cushing's, but he was also drinking/urinating profusely while his cortisol was low, so is it the cortisol level that has been causing this during the past month or instead something else going on? I do not know. At least at the ER they could recheck his electrolytes and assess him for dehydration.

I am so, so sorry that he is doing so poorly. I understand why you are beside yourself at this point. But I don't believe it would be safe to restart the trilostane without some confirmation that his electrolytes are still OK and some laboratory evidence that his cortisol is rebounding. This is all I can think of to suggest right now, but I'll definitely keep checking in on you guys :o.

[Squirt's Mom]

Please, do NOT restart the Trilo. I would, however, have a conversation about DI - Diabetes Insipidus. It is a form of diabetes that has nothing to do with blood sugar but instead how the body processes water. The hallmark signs are excessive urination and water consumption. Treatment is easy, very easy - so that would be where I would be looking.

You never restart these meds without an ACTH proving the cortisol is once again elevated and cush signs are once again strong. ;)

[molly muffin]

Checking in on you and chief today. How is he doing? Did you call the vet? Is he still peeking every 10 minutes?

[labblab]

Dear Cathy, checking in again on you and Chief. Please let us know how you two are doing. Your last post sounded so worrying, and we are very anxious to know what has happened...

Marianne

[molly muffin]

Hi, we're all worried about you and chief, hope you see this soon and let us know how things are going.

[Chief]

I have not been able to post but Chief was pts due to anal gland cancer that had spread and despite trying there was nothing that could be done to save him.

Will post more later. Very upset and also upset that the vets did not look for cancer as they were so convinced it was his cushings/addisons and spinal issues causing his health issues. Had they found this tumour before it spread he may have still been with me.

I miss him so much and am a complete mess.

[Roxie]

So sorry for your loss. I just lost my my pup of 15 and a half years so I know how you feel.:(

[Joan2517]

So sorry to hear of your loss...

Joan

[labblab]

I, too, am so very sorry for your loss. You will see that I have combined this sad news along with your original thread about Chief. I will be writing more to you a little later on this afternoon.

Marianne

[Renee]

So very sorry to hear about Chief. Please, be kind to yourself right now.

[judymaggie]

I am so very sorry that you had to let Chief go -- I know you are heartbroken. Please know that you have been an exceptional mom to Chief.

[Chief]

Most of the time I wish I was with him but Justice (his twin sister) and Toby need me to stay around for them. Chief was my heart dog. Followed me everywhere. The house is very quiet without him as he was always causing a disturbance with the other dogs in a good way.

[WeLoveAthena]

We are new to this wonderful site but just the title of this posting caught my eye and I just wanted to say that we are so sorry for your loss. We don't know the whole story but I will read up soon but just wanted to send our heartfelt thoughts and prayers your way. We know that nothing can replace what these beautiful creatures mean to us. Please know that Chief will always live in your heart and you will see him again one day. :( Again, very sorry for the loss of your sweet Chief

[molly muffin]

Oh ...dang it.. I am so very sorry. :( We where all so worried when we didn't hear from you.

You did so much for Chief and he loved you for it, all the way through. That boy would go for long walks with you and do anything to just be with you. He was a great dog.

My sincerest condolences on his passing.

[spdd]

Just wanted to let you know, I know how you are feeling and I'm so sorry to read this about Chief. My sincerest condolences to you.

[Tina]

Cathy, I am so so sorry to read this heartbreaking news about Chief. My thoughts and prayers are with you. My deepest sympathy, so sorry for your loss.

Tina

[labblab]

Cathy, I'm finally back again and just want you to know that I am especially thinking about you this morning. Sharlene is right, we were so worried when we hadn't heard from you. But this news about the cancer is nothing that we expected, that's for sure. We know how important Chief has been to you throughout all these years, and what an enormous hole is left behind. We also know we cannot ease your pain, but we are here to stand right beside you. It must have been very hard to come back to share the news of his passing, but thank you so much for doing so.

Sending you my warmest thoughts and biggest hugs this morning, always in loving memory of your precious boy.

Marianne

[Squirt's Mom]

Dear Cathy,

I am so sorry to hear about our sweet boy. It is a pain that is hard to bear but it is only so difficult because it is a pain born of intense love, a love that cannot compare. Our tears and our sorrow honor that love as we face each day without our beloved babies at our sides. I know only too well your feelings of wanting to go with him but that is not what we are given to do. So we wake each day in tears for many months but as time passes this agony becomes a bit easier to bear and we find ourselves looking back and smiling instead of sobbing.

You gave Chief the very best of yourself and the very best of care. He knows how much you love him and he will always love you the same. One day we will hold our precious babies again, this I believe with all my Soul.

In sympathy,
Leslie, Trinket, Brick, Sophie, Fox and all our Angels

The Rainbow Bridge
Inspired by a Norse legend, a poem by Steve and Diane Bodofsky

By the edge of a woods, at the foot of a hill,
Is a lush, green meadow where time stands still.
Where the friends of man and woman do run,
When their time on earth is over and done.
For here, between this world and the next,
Is a place where each beloved creature finds rest.
On this golden land, they wait and they play,
Till the Rainbow Bridge they cross over one day.
No more do they suffer, in pain or in sadness,
For here they are whole, their lives filled with gladness.
Their limbs are restored, their health renewed,
Their bodies have healed, with strength imbued.
They romp through the grass, without even a care,
Until one day they start, and sniff at the air.
All ears prick forward, eyes dart front and back,
Then all of a sudden, one breaks from the pack.
For just at that instant, their eyes have met;
Together again, both person and pet.
So they run to each other, these friends from long past,
The time of their parting is over at last.
The sadness they felt while they were apart,
Has turned into joy once more in each heart.
They embrace with a love that will last forever,
And then, side-by-side, they cross over… together.

[Trish]

So sorry to read of Chiefs passing. My thoughts are with you and your family and the other two furbabies who I am sure will be sad too xxx

[mytil]

Cathy,
I am so incredibly sorry - I have just read about Chief's passing.
You have my deepest condolences and
sending you healing (((((hugs)))))
Terry