Another newbie - Diabetes and Cushing's

[Silliam]

Hi I am new to the forum.
Most of my dogs info is in my signature.
I guess after a rather intensive start to diabetes management I was feeling somewhat burnt out when his sugar levels refused to go down.
Now I have a cushings diagnosis,mot be honest i was hoping it would be another pen injection :o since they are so easy and my dog doesn't even notice them. He does however notice the capsules I need to pill him twice a day. He does seem to have a rather delicate gag reflex and whenever I need to pill him (yes I am doing it the right way)
He suffers from nausea. After a few days on the vetoryl he went to the vet for a curve. I was rather hopeful since my vet said he was worried abut hypoglycaemia . Now it may sound strange to hope for a hypo but my dog has consistently high sugars above 20.0mmol/L
Sadly he was still around 22/25. How long did your dog take to get under control either with just cushings or diabetes with cushings? I know when he didn't respond early on to the insulin is was a signal that it would be a complicated case of diabetes. Does cushings respond so soon? Or am I in for another battle?
Also any positive antidotes would be welcome so far all the info I have been getting is mainly understanding everything that can go wrong. I'd love to hear of something going right! That all I am putting my doggie through is worth it.

[3bostons]

Hello, sorry to hear of your baby having cushings. My girl has had it for it 2 years and just recently was diagnosed with diabetes too. When we started on the cushings it did take a while to get the meds balanced to her needs, so it was trips back to the vet every few weeks for the blood work but she did begin to feel better even before we got the right balance. Then once we did get it balanced she has been on the same dosage now for over a year and has been doing great until the recent diabetes. She is on vetoryl and instead of pilling her, I was told to put the capsules in her food, and she never notices, and its alot easier. Not to mention, we are not supposed to handle the meds much so I would think you wouldnt want to put the pills in her mouth. Im sure you will get a ton of info from others here and they will be asking you for more test result info if you have that handy.
IMO, I think the cushings was easier to manage than this diabetes, the big difference is we can test the diabetes at home where as the cushings has to be done by the vet.
Hang in there !

[Silliam]

Thankyou so much it is wonderful and reassuring to hear all of his will be making willy feel better even if he is not 100% yet.
I know I read on the vetoryl box not to handle if your pregnant or expecting to get pregnant and to wash your hands after handling but is there another reason not to handle it? Does over handling make it less effective?
Thankyou so much for a reply I am starting to feel less lost and more like I can do this;)

[Silliam]

Play and stress both increase heart rate, blood flow and a number of other things so how do I know if I am helping my dog have some fun as he starts to feel better or just revving him up and the excitement is bumping up is cortisol levels? Even beginning to get him fit with a short walk seems daunting. I mean the excitement he shows when I get the lead and harness out looks very joyful, but all that activity and a short car ride to the vet is usually used to explain why my dog is stressed at the vet. And why they leave him to chill for an hour before running tests.
Has anyone else had thoughts on this issue? Maybe I am just thinking too much... *face palm*

[doxiesrock912]

Play is good and helps to maintain muscle mass which is lost with Cushings. If your doesn't want to play, he won't.

I would engage in activities where he isn't jumping though to save his back and joints.
I throw a ball long and low so that Bella runs after it but doesn't have to jump.

[doxiesrock912]

Some pharmacies make Vetoryl in liquid form. Please do not break open the capsules.

[labblab]

Hello from me! Just wanted to let you know I have merged your new thread into your original one. We like to keep all info about any individual dog consolidated in one single thread. This way, it is much easier for us to remain familiar with all the specifics and to organize our replies. ;)

Also, the warning about handling trilostane relates solely to minimizing any danger to the owner that might arise from physical exposure to the drug (skin sensitivity or hormonal effect).

Marisnne

[Silliam]

Thanks for moving my thread, sorry I will try and stay in thread. Just getting used to the forum style.
Well talked to the vet willy has not responded to trilostane not even a little bit or we would see some improvement in his sugar levels. Right now we are not aiming for control just some sort of reaction! We have one more curve on Thursday but the vet at the hospital says he has done all he can, it is time to go to a specialist in endocrine in case they see something he can't. I got my paper bag out and told myself to breathe just cause the usual vet can't do a thing does not mean it is untreatable.

Also a bit more on willy, definitely cushings, we have had abdominal ultrasounds, blood tests and symptoms that all fit pituitary dependent cushings.

I guess the easiest way to tel long stories is in short bursts.

Well I have to be at the human hospital weds hope Thursday goes well my dog was right beside me when I was very ill I wish I could carry the cushings burden for him

[labblab]

Hi again! I've taken the liberty of adding "Diabetes and Cushing's" to your thread title so that it will be more likely to catch the eye of our other members who are managing both diseases. Please don't give up hope yet!! It may just be that the dose of trilostane may need to be increased. And honestly, it may actually be a good thing to receive the input from an endocrinological specialist. Such a specialist truly does have much more experience in the care of dogs with more complicated issues, and may indeed be able to sort through things with a fresh eye and richer perspective.

Also, I encourage you to also register on our sister forum that is devoted to diagnostics and treatment for diabetic dogs:

http://k9diabetes.com/forum/

We have several members who are registered on both forums and thereby are able to talk over specialized questions with both groups.

Please keep us updated, OK?
Marianne

[Jenny & Judi in MN]

Hi! My Jenny had both and it took 3-4 weeks of being on Lysodren before we were finally able to start lowering her insulin. If your guy is feeling peppy, it must be starting to work maybe.

Other dogs with both seem to have shown 3-4 weeks also. We did wind up cutting Jenny's insulin dose in half after her cushings got under control so watching for low blood sugar is excellent advice. Are you testing the blood sugar at home? It can really help with these dogs who have both

I'm sorry you've been sick and I'm sorry you have to go to a specialist but in the long run, I think you will be glad you did. I wish I'd gone to a specialist right away.

We accidentally killed off my dog's cortisol while on Lysodren cause I'm an idiot. When we THEN saw the specialist he said if she ever needed cushings meds again he'd be fine using Vetoryl or Lysodren as they both would work on Jenny.

hang in there. Judi

[Silliam]

Thankyou all so much just hearing from you all I feel much better.
I think after diagnosis your so busy just getting into routine and learning the basics that it isn't until you have a moment to stop and think that some of your fears hit you. Lol not my dog tho he is like 'why do you want an hour long hug when I can go bark at the back fence?'
Also has anyone used massage I hear it can help reduce problems like aching joints and stress while increasing blood flow and be a great way to connect to your pup. I am going to look around locally for some places that do it so I can watch and learn but maybe you guys know of some web sites that have the basics? I know until I see a pro do it i will need to go very lightly.
But I guess weather it has proven benefits or not it will feel nice and I will feel like I am actively doing something too.

[Squirt's Mom]

Check out Tellington TTouch massage -

http://www.ttouch.com/

[Silliam]

Thankyou so much. I am sure this will help a lot

[Silliam]

YAY willie showed some reaction to the insulin. *does a happy dance*
This means the trilostane must be working first good news in months yippee
Vet consulted specialist while they visited hospital which saved me the consultation cost and they are happy with the drug choice but there is a huge does range so the 10mg twice a day could end up higher.
I have a stim test in about 2 weeks but wanted to share some good news :D

[lulusmom]

Hi and a belated welcome to you and Willie.

Dealing with both cushing's and diabetes, there is no doubt in my mind that you've been on a wild and scary rollercoaster ride so I'm sure you were elated to get this good news. Congrats and I hope this becomes a trend for your sweet Willie.

It would help me gain a much greater understanding of Willie's case profile if you could provide more information as to how he came to be diagnosed with both conditions? When did all of this start and what symptoms did Willie have? Your signature line indicates that Willie was diagnosed with diabetes two months prior to the cushing's diagnosis. Was cushing's suspected solely because your vet felt he was insulin resistant? How many times did your vet increase insulin and how many units was Willie getting when your vet decided to pursue a cushing's diagnosis? Aside from excessive drinking and peeing, did Willie have any other symptoms and if so, what were they?

When did you start dosing with Vetoryl and was the startng dose 10mg twice daily? You posted on September 27th that Willie had already started treatment with Vetoryl. Protocol dictates that Willie should have had his first acth stimulation test already. Was this done? If not, I highly recommend that you get Willie in for one as soon as you can get it scheduled. If he's already had one, can you please post the results for us?

Sorry for all the questions but the more information you can provide, the better equipped we are to more easily understand the progression of Willie's case as well as provide you with more meaningful feedback. I do hope you have joined our sister site www.k9diabetes.com as those folks are incredibly knowledgable. I am glad to see the Judi has already posted here. She's a member of both sites and it is always comforting to see her here when we have new members who are dealing with both conditions. She's been there, done that.

Glynda

[Silliam]

I don't have all the numbers as vets here don't seem to give print outs of bloods but I will see what I have written down and form a time line.
Willies body fat, the fact it refused to come off even on a prescription diet where I weighed the food and as hard as some find it too believe I did not deviate from it. No unaccounted for treats and what not. So I took him to the vet years ago and the serology, his shape and condition as well as drinking an awful lot with a lot of panting made the vet suspect cushings. He had an abdominal ultrasound that week but everything came back fine so it was put down to needing more exercise and old age. Some sediment was seen in the bladder but further testing showed small crystals they couldn't identify and all further cultures and attempts to grow crystals were negative.
Later willie would have exploratory surgery and the adrenals were seen to be normal. And more ultrasounds confirmed this. So I don't think it was undiagnosed all this time.

Yes it was the insulin resistance that alerted the vet. At the appointment (oops I mean whole day) at the vet diagnosing willie as diabetic he thought willy needed to be evaluated for cushings again because the stones just wouldn't have caused the blood results he saw and the pu/pd was over and above what the potassium citrate would have caused with its diaretic side effect.
However the second full panal of bloods showed willie as having a bsl of 33mmol/L which was very high we were lucky he was no in DKA.

He told me then willie may still have cushings or the diabeties could be causing the blood changes first he would like to get Willys diabeties under better control then re run tests and decide about an ultrasound. I thought about joining the forum then when I had issues finding a diabetic one but if the changes were all due to his diabetes I would have felt foolish being on a cushings site without a firm diagnosis.
When the diabetes refused to get in control or even show any response to the insulin at all he was sent off for an ultrasound.
Both adrenal glads were equally enlarged but not massively, his liver was slightly enlarged and bright and light I think the sonographer said? Also the bowel was minimally inflamed and there were indicators that maybe he was in early stages of CKD but his pancreas looked fine yay, and no sign of cancer anywhere. :p luckily they warned me that they were likely to see many very small changes as he is a geriatric dog and not all would point to disease some would just be the normal ageing process and my vet would determine which he felt required more investigation.
The next day the vet calls me as soon as he is on for night shift and I went through each organ with him asking him to explain his reasons for why it had shown up and why he thought it was worth pursuing or not. Then I told him all that I thought challenged him on a few things which he either explained satisfactorily or agreed to look into more. But his gut was telling him cushings.
The first thing I asked was when will we do the dex test, and he explained they don't like to use steroids on diabetics and since all signs showed pituitary dependent cushings he didn't feel the need to do a bunch of extra reaction tests to confirm what we already knew. So the next day willy had a ACTH stim test and the numbers which I forget but was assured left no doubt that willy had cushings. As vetoryl is the first line of treatment here he was sent home on 10mg morning and night as close to his insulin dose times as possible.

:eek: I just saw how long this is! I definitely will work on a very condensed timeline meep! Sorry

[Squirt's Mom]

I don't have all the numbers as vets here don't seem to give print outs of bloods...

Our vets don't hand out the lab results either. We stand there tapping our foot and giving them the stink eye until they give us what we just paid for. :D You DID just pay for those results, ya know, and you DO have a right to a copy every time. ;)

[lulusmom]

How much does Willie weigh and how much insulin was he getting when your vet deemed him insulin resistant? Was his blood sugar out of control when he was diagnosed with cushing's? When was the first abdominal ultrasound done? When was the exploratory surgery done and why was exploratory surgery done? When was the second abdominal ultrasound done that showed abnormalities consistent with cushing's? Sorry for all the questions but we have seen many dogs with diabetes misdiagnosed with cushing's. Cushing's is difficult enough to diagnose but it's almost impossible to diagnose cushing's if the blood sugar is out of control.

Glynda

[Silliam]

I would say he is 7.8/8kg right now but we are having some fluctuations and willie had been on 4IU of vetsulin( aka caninsulin) every 12 hours when it was decided it was not working. All his curves had pretty flat and high above 20mmol/L his sugar levels only went up with stress but showed no reaction to the insulin. Almost done on his medical time line and will post but I have a few questions for the vet too. Exploratory surgery started after 12 hours of no sleep and showing the signs of being critically I'll and in crisis like trying to dig under a bush in the back yard vomiting a lot no stool or urine output head pressing weakness dehydration they admitted him and ran tests. because they strongly believed via X-ray that there was a twisted portion of of the bowel full of air causing gastric bloat and his physical condition they wanted to operate right away and knowing how deadly it can be I agreed. When they opened him up they looked at the stomach and small intestine not seeing anything they called me to say he was still very ill but if I wanted they could close him and send him to ultrasound. I was grateful they gave me the choice but after so much time in surgery I was not going to risk it all again tomorrow and the many vets (as by now every vet on duty was in on this surgery I think none of them quite believed what was happening and wanted each others opinion) anyway I gave the go ahead for a bigger incision and they looked at everything and found a black yes I kid you not a black bladder!!!!! Some patches were a very dark purple I am told but all I could think was it must be dead, tissue necrosis. The vet said it wasn't but they couldn't guarantee it was salvageable. 270 small stones were removed and the small rupture on his bladder where they had previously used a needle to get a sterile urine sample was sewn up then the whole abdomen flushed, the organs rechecked and he was sewn up.

[Silliam]

I feel although not very cushings related this surgery and days after is a huge part of Willys story


Day 1: 13/06/2013

Consult
Fluid therapy plasmalyte
Analgesia/ pain releif
Comprehensive blood panel and electrolytes
Haematology procyte
Urine specific gravity
Methadone pain relief
Chest and abdomen X-ray
Fentanyl pain relief
Specialist radiologist
Catalyst creatine
Catalyst creatine
Alfaxan cd rtu

Now they put him under and the item list gets confusing as they don't say no we looked here or there they just add on procedures and items

Anesthesia isoflurane
Major theater
Cystotomy
Many sutures, staples and catheters mainly urinary and it's component plus the litre of fluid used to clean the abdominal cavity.
More pain drugs, antibiotics, IV plasma X-rays during the procedure and bacterial cultures. And vp calculus analysis

Basically afterwards he was kept very sedated and I made sure he had a lot of pain control too. It was like hey had made a section of the 24hour vet hospital into what resembled a human icu. Someone was always watching him. To be honest after hearing he had woken from surgery I finally fell asleep as I hadn't slept the night and day before also the worry had me beside myself so I didn't talk to the vet late that night but my mother did.

DAY 2
I was all ready to run to his bedside that morning but he was still pretty sedated and they wouldn't move him out of the mini icu they had created. After making some hard decisions I said yes I wanted to give my dog a chance to fight and recover. They mainly made him comfortable and tried to leave him to heal but were still constantly monitoring him so I left him for another night in their care with updates every few hours.
Like a human icu he had blood tests every few hours fluids and electrolytes plus pain management and infection controll. Another reason I hadn't seen him yet was I was suffering from staph and another microbe that've needed to talk to my infectious disease specialist about before we knew it was safe for me to see him.
He also had more in depth blood liver and kidney tests sent to outside labs.

Day 3 or 4 I really can't remember maybe I will just write the rest as I can remember...

Willy hadn't eaten yet so I was let in early to see him to see if I could coax him to eat. Anything he wanted he could have but sadly it didn't work and a nasogastric tube was placed. Luckily they took it out after a day so it was not there the next time I went to see him.
Everyone was getting really hopeful at this stage that he would pull though and now it was just Russian roulette waiting to see if his bladder would work. Leave it in too long and well I am told they can have a dog permanently on a urinary catheter, to soon and his bladder wouldn't inflate to hold urine it would just leak and it would be painful as he was needing to regroup his bladder lining. Each day we debated this and when he had finally gone a day with no bits or dark blood in his urine I got to take him home. YaY, it was scary and hard and willy was very doped but we managed and well yeah we were happy it took a couple months before he was off all pain meds altogether mainly because I am a sook and gave him some whenever he seemed in pain. Then my vet had a little intervention and willy was detoxed... Oops
The stone testing came back n conclusive and was sent to the USA that lab couldn't say what they were either but ruled out oxalte striate basically the main offenders and hen the hills lab confirmed them as being cystine.

A month before surgery he had had a full abdominal ultrasound that came back clear the vet was looking for cushings because of his weight sand shape and panting. While in hospital he had ultrasounds just note on surgery day as their was a problem with the machine.

I am still taking willy to the same practice. They know first hand that tests are deceiving, ultrasounds and X-rays are not a perfect look and not one employee forgets what my dogs bladder looked like. So they seem to go even further out of their way to think and treat willy. I know that a lot of vets in my town didn't know about cystine stones and the vet who would become his GP vet but at the hospital spent weeks learning everything he could. We both did really and he was happy to share any research and called vets in the USA at the lab from home on his own time to learn and recheck everything. I know more was done then I listed but I am pretty sure they left quite a few things off the itemised bill. Thank god it had already taken all my savings to save him.

[molly muffin]

Hi, checking in to see how you and Willie are doing? Insulin holding?

Sharlene and molly muffin

[Silliam]

Not really I suspected about 5 days ago he was hyper again but since he had an ear infection I didn't think much of it.
Today we had a stim test booked but when my vet took the baseline and it was above the normal range he said a ACTH test would just show an expected rise so instead of charging for a stim test that won't give us new info he will do another in 10 days. Also his sugar was up too.
Today's baseline was a few points or degrees lower since starting the trilostane so he thinks willy is responding to it so we have gone from 10mg twice daily to 20mg twice daily and an extra unit of insulin bringing us to 5IU.
Is it normal for the trilostane dosage to change a few times before they declare it under control ? Also the vet is worried about Willys weight as he has lost about 1.5kg in the last week. He also expected some condition (I guess that means muscel gain or redistribution) to return once on the trilostane.
How the heck do I get a dog to gain weight on a low fat diet? Darn that silly pancreas XP
Thankyou for checking in it means a great deal to me

[labblab]

I apologize in advance for being critical of your vet because I know he was trying to be very mindful of your expense, but I don't know of any accepted monitoring protocol that OK's increasing the trilostane dose on the basis of the baseline cortisol alone. The baseline is sometimes used to gain reassurance that cortisol levels have not dropped too low, but it cannot be safely relied upon to increase a dose. Even stress alone at the time of testing may elevate even a normal dog's baseline cortisol into a range that would seem "positive" for Cushing's. Baseline cortisols are just too variable upon which to base dosing increases. And not only has your vet increased the dose, but it has been fully doubled which is a whopping amount in the absence of knowing the stimulated cortisol reserve.

It is not unusual for trilostane doses to need altering, especially when beginning treatment. But the full ACTH is a very necessary component by which to guide the actual magnitude of the dosage change. I feel very worried about this big dosing increase in the absence of info re: Willy's actual cortisol reserves. No matter what the baseline cortisol is the next time around, you absolutely need to have an ACTH performed. And if Willy acts "off" in the meantime -- loss of appetite, lethargy, vomiting, diarrhea -- you really need to run the complete test sooner.

Marianne

[lulusmom]

Have you joined our sister site k9diabetes.com? If not, I highly recommend that you do. I have been missing in action here and am just getting caught up and am seeing that you answered some of my questions. Unfortunately, your answers raised some red flags about the validity of the cushing's diagnosis and your vet's experience with complicated cases like Willie's. I'm not an expert on diabetes but I believe that the 4 units of insulin Willie was getting prior to pursuing a cushing's diagnosis was far too low to deem him insulin resistant. Per Dr. Mark Peterson, a renown endocrine expert, insulin resistance is defined as doses greater than 2.2 U/kg/injection to control hyperglycemia. Based on Willie's weight, that dose equates to a bit over 17 units and Willie's current dose is a fraction of that amount.

Diagnosing cushing's in an uncontrolled diabetic dog is next to impossible as diabetes can cause the same organ abnormalities on imaging, overlapping symptoms that are also associated with cushing's and diabetes can cause false positives LDDS and acth stimulation test results. Since it was insulin resistance and not persistent symptoms, such as coat and skin issues, that are not associated with diabetes, that prompted your vet to test for cushing's, I'm not sure Willie has cushing's.... and I'm also not sure why the specialist your vet is consulting with felt Willie was insulin resistant at such a low dose of insulin.

I have provided a link below to Dr. Peterson's blog entitled Q & A: Diagnosing Cushing's Disease in Dogs with Diabetes Mellitus. Like Willie, this dog wasn't even close to an insulin dose that would have deemed him insulin resistant.

http://endocrinevet.blogspot.com/2012/01/q-diagnosing-cushings-disease-in-dogs.html

I may be completely off the mark and hope that the experienced folks at k9diabetes can either validate me or let you know their thoughts on your vet's approach to treatment.

Glynda

[Silliam]

We had dry dull coat and dry skin, potbelly hair taking forever to regrow and before this current bout of illness a typical cushings body shape from muscle wasting and fat redistribution. He is also on a insulin rather different too humilin and most others
I asked again at the vet how sure we were and he said with the positive stim tests, the equally enlarged adrenal glands and the blood chem with body changes he was very sure.
Also thankyou for the link I had actually found that site a while back it seems to be very accurate.
Also I was told we started willie on a conservative dose of trilostane so we could watch for drug reactions and the rise is to bring it up to a more therapeutic level.
I guess I have a lot to think about I was told all his levels but they are hard to keep track off so I will have to request printouts

[Squirt's Mom]

I am very concerned for your baby. Please keep a very close eye on him. Sadly, we have seen long-time trusted vets make some horrid mistakes that cost the pup their life. Never blindly trust any vet. Educate yourself, listen to those who live with these pups and learn to listen to your educated gut. And watch that baby like a hawk since your vet seems determined to things his way.

[Silliam]

I am watching him very closely and keeping an eye on everything is he pooping what's his sugar how did he eat is he drinking are his ears and belly hot. As soon as I think he even shows a hair out of character I will be at the vet day or night. You did alert me to just how serious this is and I was ment to call the vet last night to discuss this treatment but due to some family stuff I didn't manage it I will try again tonight. Also he was getting advice from the hospitals internal medicine & critical care specialist. I also think I will get the second specialist opinion for peace of mind but I am not sure where in Western Australia to go.

[Silliam]

So I called the hospital and got them to go into the records and they say he had the stim test but only one blood test after the synth stuff usually they do more to monitor their patients and recheck the first post. but as his was high they thought it hence the decision to up the dose. And yes I did talk to a different vet.
TBH I was beginning to freak out so thankyou for questioning when I didn't as it lead to more discussion and a better understanding.
But this doesn't mean I won't be watching my pup like a hawk. I am still on high alert

[LauraA]

Silliam I am in Western Australia as well. I am in Greenmount and go to Mundaring Vet Clinic. They have quite a few Cushings dogs on their books.

[jas77450]

My dog had both too. Gave trilostane in pill pockets.

[Silliam]

@laura Mundaring is far from me but I visited once and it is very beautiful but a full days drive away. As I remember it but it was some time ago
@jas sadly due to a genetic error my dog can't filter cystine so he is on a protine restricted diet. And pill pockets have too much.
If I could feed him boiled chicken breast all the time he would be a happy dog lol!
Thankyou everyone for your concern

[Silliam]

Sorry to go MIA for so long things got busy and well all spare time I spent with my dog, I swear he gives the keyboard a dirty look.

We have gotten willy stable but still at high levels which is just not acceptable so last night my vet got my dogs huge file over to the internal med specialists at Perth vet specialists aka PVS and tomorrow I call for an appointment which should be right away. I hope the IMS is good because I have wasted enough time hoping to myself that just a few more days and meds will really kick in but that never really works does it. *sigh*
Willy had both ultrasounds done at PVS and I was pleased with the service, and the specialist radiologist who performs the ultrasounds I think this is one above a Sonographer I don't really know. The other specialist centre they refer to is Murdoch University vet hospital. It is along way to go but if they are a lot better then PVS it would be worth it. Has anyone on this site used perth vet specialists? Any opinions you can give me? The only thing I can think of is maybe since my dog does not do well in car rides it makes sense to go to a closer specialist.
To wrap things up willy is doing well and hasn't lost any more weight but morale is high he loves to get brushed (especially where his coat is thin or shaved must feel super good)
Walks have been going well although he is determined to get hay fever dragging me near longer grass eek! Also we play with a hilarious duck toy. And of course he is back to eating well but not inhaling his food. I am feeling very positive a specialist will help.

[Silliam]

I am making this a separate post in this thread I think it needed its own.
Sadly and it's still hard to write about but willy's sister(litter mate and my sisters dog) was hit by a car last night and only just made it to the vet before leaving us. I can only take comfort that it was relatively fast and when they got to the vet she went to sleep in her owners arms and not from chocking alone on the road. We are all cut deep. Even as one of my youngest nephews battles against a terminal diagnosis the litte dog brought much comfort. She also lived with me and willy before my sister moved out then came to visit whenever little nephew was in hospital. Everyone is feeling here absence. I wonder if willy will notice something is up when she doesn't come to stay with us again. Sorry if this all sounds like a muddled post I just felt like she deserved a special mention and thankyou in the thread that is willy's journey of life

[LauraA]

I am so sorry to hear about Willy's sisters. Your Sister and her family must be devastated. It is hard enough when we have time to prepare to say goodbye to them, let alone when it happens so suddenly. Grief is grief, whether it is for another human or a little furry creature. I really hope your Nephew will be okay :(

My Vets have talked to me about the specialist in Osbourne Park and have only ever had good things to say. I currently have been going to Murdoch but next time I will be going to the one you are going to be taking Willy to so will be waiting to hear your opinion :)

[Budsters Mom]

I am so sorry to hear about your sister's dog. :o She is now happily running free with our other fur angels at the bridge. She will be there ready to meet Willy when it's his time to join her.

Yes, it is such a shock when an accident takes our babies. my thought and prayers flow out to you and your family. :o

[labblab]

Oh, what a sad time for your whole family! Your post is not muddled at all, and we are grateful to honor this precious little girl alongside you. If you should like to tell us her name, it would be our privilege to add her to our special memorial thread. There are several other "honorary" Cushpups there among our beloved. :o

http://www.k9cushings.com/forum/showthread.php?t=5973

I am so very sorry for your loss. If you should wish, please feel free to add a new thread to honor Willy's wee sister to our "In Loving Memory" forum. There you can share memories, or tell us how all of you and Willy are doing in her absence. Or you certainly can continue to speak about her here. It must be especially hard in the face of your nephew's illness.

My heart goes out to you all, and I sincerely hope that Willy will have an easier road ahead after seeing the specialist.

Marianne

[Silliam]

Thankyou all so much and thankyou Marianne,
Her name was Ana and I will try and get a photo of the two of them up and post a memory in the in loving memory thread.
My nephew is doing ok, I think that's what the shock was. When someone close keeps living past all doctors expectations you start to think everyone pulls through and when that doesn't happen it is like a bucket of cold water...
Luckily so far we have been able to mourn Ana while still keeping morale up for nephew. Who ironically is battling a pituitary tumour, or a tumour where his pituitary should be.
I am so glad this forum exists I don't think i would still be this sane without it.
Laura I will be sure to write up my experience with the PVS.
Thanx again
Silliam

[labblab]

I will go right now and add sweet Ana to our memorial (Please let me know if I am wrong about listing the date as 11-1). And photos will be lovely. I will add a photo link to Ana's memorial line as soon as you upload a photo of her to your album. Or in the alternative, you can email us a photo of Ana at k9cushings@gmail.com since we can also create a link using an emailed photo.

What an ironic coincidence about your nephew's tumor! Life (and death) remain such mysteries in so many ways...

Marianne

[molly muffin]

Oh dear. I'm so sorry about the loss of Ana. How very heart breaking this is. I am sure that you all miss her and mourn her. There are no words for such a tragedy that seem adequate. I hope the very best for your nephew. He might be needing some Willy time.

I'm so glad to hear that Willy is doing well and his coat is coming back too. Isn't that great, now he can get brushed and just groove to it again.

My heart just feels so sad for your family during this really awful time.

hugs

[jas77450]

I am so sorry about Ana. I'm glad Willy is doing better. We are routing for your nephew and family and you and Willy. So much to deal with.
Hugs, Jenny

[Silliam]

Ok I will post a longer post after this but it may be boring as I do type a lot so the condensed version

willy definitely has cushings
Stop vetoryl
Start mitotane induction week (no wash out period)
Give fortekor for hypertension 270 systolic
call at any time and call on Monday with update if I haven't already called

The vet was lovely so were the nurses if anyone has any doubts about PVS there is no need. ;)

[Silliam]

Ok so the specialist vet was enlightening... o.o meep
The specialist says willy was most likely cushings before the diabetes even tho they diagnosed the diabetes first. He did agree with my vet on one thing. That something had to change and fast for willy since we were close to anumber of things including Keto acidosis.
I quizzed him on Willys acth stim tests since I still held out hope maybe he was misdiagnosed... He said it was about as close as you can get to saying no doubt about it. I think he said anything from 200-400nmol/L was a grey area and willy was I am sure he said 800 but that seems excessive so maybe it was 600. Either way that coupled with the ultrasound findings the liver health and diabetes, pu/pd and voracious apatite, support the cushings diagnosis.

He also discovered willy has very dry skin. Well not just the bald bits I knew he was dry on his belly but not in the fur. There is a possible malassezia fungal skin infection so we will be doing a malaseb bath twice a week leaving it on for 10min :eek::( willy hates a bath! He hates water! And most of all he hates being wet!!! How I shall wrangle him for 10min I do not know.
So first up he said his cortisol must come down and the trilostane has not really worked since he still is getting high levels on his tests. He could up the dose but willy was already on a high dose for his weight and if we went higher the side effects are more serious and we risk a random shut down of his adrenals. So willy will be starting Mitotane. I was not so sure about killing off Willys adrenal tissue even in a very mild and controlled way. Necrosis is not a healthy word at all. Nicely he calmed me down and said we just need to shrink them a little and he promises he isn't aiming for Addison's. Phew! So willy will start his induction week right away. No wash out period. He said it was going to be a mild dose and the vetoryl hadn't been working at all before so we really needed to do something.

Stop vetoryl medication
Start Mitotane therapy 250mg once daily
in the morning with food

I am to call him right away if anything on the sheet of adverse side effects happens I think mainly depression, vomiting and diareah. Also call him any way on Monday with an update on his progress. Some time in the next 5 to 10 days willy will refuse his food or his appetite will be very reduced; which means the mitotane has done the job and bring him straight to the hospital for further testing and acth and they will work out maintinance planning then as well as evaluate the diabeties.
Willy also had his BP taken after I mentioned he had been getting what seemed to be vestibular syndrome symptoms before all this and guess what the systolic was 280 :eek: I am told cushings can give high BP anyway willy is also starting fortekor (benazepril hydrochloride) has anyone used this before it says once daily with or without food so if you use it can you recommend an ideal time?

[Squirt's Mom]

This is very dangerous to switch without a washout period so do NOT take your eyes off of your baby boy and act very quickly at the first sign something could be wrong. Do not think about it - ACT immediately. And please stay in contact here often through the next few days. I am very concerned about this. :(

[Silliam]

Maybe I should just do my own wash out period and ignore the vet?
Although I read it has a very short half life and he has been off the trilo for yesterday and this morning. I wonder if the wash out is different when going from trilo to mitotane as all I can find is info for mitotane to trilo. I am confused the specialist seemed so on the ball I guess that's why he wants me to call at the first sign of anything he made that very clear. But I don't know who to trust anymore

[labblab]

I do not think you should take any action in this regard without the knowledge of your vet. He is the one who knows thw specifics of Willy's situation. We are aware of general protocols and warnings, but your specialist is the one who has the professional expertise to assess Willy's individual risks. The fact that he has mentioned the wash-out to you indicates he is aware of the warning. But apparently there are reasons why he thinks this is the route to go. If you have remaining concerns, I do think you need to discuss them further with the vet before proceeding with the Lysodrn. But I don't think you should alter the recommended treatment plan without his knowledge.

Marianne

[Silliam]

Thankyou Marianne I think I will stay on plan then as he also listened to me and explained that he thought this was Willys best option but it is hard to trust when the first vet had such different views. At least I have the IMS 's private line should i have any worries. Although if it is something like vomiting don't call come straight in. Also I am having results of Willys tests at the other vet emailed to me they are in nmol/L and I think most people use the ug one

At least if willy gets a bit better this will all be worth it.

[Silliam]

For squirts mum and anyone looking for an update
Day one has been uneventful willy was his usual self maybe he drank a little less I won't know untill I measure the remainder of his water bowl later tonight. I can say his appetite is still strong as he started asking for dinner an hour early it is like he can tell time but refuses to believe it. Even now he is pestering me for it when he knows the evening routine and that his meals are at 8 since we do insulin then too. Lol.
He sleeps a lot in the day and usually he divides his time equally between his bed and the one his sister uses when have comes to stay. I fact she usually ends up in his bed while he slept in hers. But since Ana passed he won't go near it. Well he goes to get in sniffs and leaves. Ana was not living with us when she passed but every few weeks she would spend a week here. I don't know if dogs can just tell? I wasn't sure he would notice for awhile since I assumed he would think she'd be coming to visit at some stage. Should I be worried? Has he figured it out? Is he grieving? I don't think this is the kind of unusual behaviour the vet said to call about since except for that bed he is acting normal.

[labblab]

Thanks so much for this update. I am feeling antsy, too, about proceeding without a washout so I shall be joining Leslie in wringing our hands until the Lysodren loading is completed! After having written what I did above, of course I will feel terrible if for some reason Willy doesn't do well with the Lysodren. But it sounds as though the specialist is trying to balance risks, and the risk of allowing the cortisol to go entirely uncontrolled for a length of time is really worrisome in the face of the high glucose levels and that SUPER high blood pressure. So we shall all be hoping that things go smoothly from here on out!

I don't know if your specialist already suggested this, but we have repeatedly seen the recommendation to first offer Willy his meal prior to giving him the Lysodren pill. That way, if he hesitates or does not eat normally, you can first consult with the vet before giving him any more of the medication. You can always proceed with dosing but you cannot take a pill back after it has been administered. And sometimes it is that one extra pill that can make the difference between cortisol levels being fine instead of going too low.

Anyway, please keep up with the updates! And I do not know what to make about his reaction to his sister's bed. I agree, how could he possibly know at this point, unless you yourself have been reacting differently to the bed in some tiny way and he is so sensitive that he has picked up on that. I do think that may be possible, because my younger girl in particular seems to be able to read my mind. She is incredibly sensitive to any tiny change in my own emotions and reactions to things..:o

Marianne

[Silliam]

There will be no need for anyone to feel bad if this drug doesn't work out for willy, all you did was remind me this vet had given me logic and sound reasoning when presenting me with this treatment plan. He was not another vet asking me to just blindly trust.
With that in mind I decided I had made the best educated decision I could. That's all we cushy mums can do. And for now I can live with that.
Yes the plan is in the morning I offer him breakfast even some chicken which he is ga ga for and when I notice him not wanting to eat or uninterested like eating slowly or picking at it then I do not give him the mitotane! (Yes it is even highlighted on the sheet they gave me) I go directly in to the specialist for a acth and the induction period is over. However if willy gobbles down his food and not showing any signs out of the ordinary then I can give him the mitotane cap hidden in a bit of chicken.
Right now I am giving him 2 chicken cubes then 3/4 of his meal and if he eats that with the usual enthusiasm I give him the mitotane and the last bit of food since the bottle said to give with food.

[Squirt's Mom]

You're doing so good, Mom!

[molly muffin]

We are such a bunch of worry warts. :)

It sounds like you have a good plan in place and are doing very well with monitoring and knowing what to look out for.

I really hope this does the trick and gets him to exactly where he needs to be.

hugs

[Jenny & Judi in MN]

I'm so glad you went to the specialist. Just a heads up on the Lysodren. My Jenny (who is a much smaller dog) threw up water and I wasn't sure if that counted as a symptom of being loaded so I stupidly gave her the next day's dose and made her sick.

So don't just look for lack of appetite. Call the vet even for something as stupid as thrown up water.

I hope this does the trick. judi

[Silliam]

Lol my dog almost throws up water sometimes if he dinks a whole bowl fast he his gut makes this glug glug sound and his eyes bug out. Not happened for along time usually if i say "take a breath willy' in a low serious voice he will stop skulking long enough to avoid the glug glug almost throw up.mi also got a go slow bowl. I'm considering a 'drink better bowl'.
Also lovely helpful forum people ;) I need tips on the skin side of Cushings. Is there a less toxic shampoo then malaseb? Have you ever had a dog with yeast in the feet around the nail bed. What did you do? It is strange as most of the medicated shampoos the vet said for yeast have ketoconazole. I wonder if dogs who use that drug for Cushings are less likely to get fungal skin irritation.

Any home remedies for Malassezia would be gratefully accepted and so would any resources. Even how u got your dog to calm down and not try and lick the damn shampoo for ten whole minutes

[jas77450]

Cosmo had the infection on all his paws...had to soak them daily but can't remember what the name was. If I run across it I will post. Hope it gets better!

[Harley PoMMom]

This article looks like it has some good info regarding Malassezia: How to diagnose and treat Malassezia dermatitis in dogs (http://www.rottweilerhealth.org/pdfs/august_malasszia_paters_02.pdf)

And this:Comparison of two shampoos for the treatment of canine Malassezia dermatitis: a randomised controlled trial. (http://www.ncbi.nlm.nih.gov/pubmed/21985533)

[Silliam]

Thank you, thank you so much. I bet I find some bath tips
And thank you to everyone for posting we ended our induction on the 13th not because willy stopped eating but we had finished all the pills lol. Sadly I was sick on Friday so I am taking him in for his ACTH on Monday. They will work out his maintenance dose from there and recheck that blood pressure. I guess if all goes well we start trying to get the diabetes in some sort of control
Oxoxox

[Dixie'sMom]

I just wanted to pop in and say hello. I had been meaning to read Willie's story for quite some time and finally got to it tonight. Boy, you have really had your hands full. I think you're doing a fantastic job and have kept a very level head about things. I hope the new treatment plan works out and Willie can get good control of his BP, Cushing's and Diabetes. I'll be anxiously following along with the others to see how your little man is doing. And please accept my condolences on the family's loss of Ana. I'm very glad to hear that she will be an honorary member here and have her picture on the Memorial Wall. Hang in there! You're doing a great job!

[Silliam]

Ok so here is how things went on Monday,
If you want the shortest version I bolted the main info

the vet is not at all scary and wasn't offended at all about my reservations using malaseb.

willies last dose of mitotane was on Thursday the 13th and a ACTH stim test on the 17th gave us a post of 236 result!!! Much better then his original 800:eek: . I am told 150/250 is within normal range while on maintenance.

Also I asked what the pre stim level was and he said when just rechecking for maintenance therapy they don't bother with a pre and post they just take a post level. Does that sound right to you?

So instead of 250mg of mitotane every morning we are on 500mg once a week. I did ask why we went up to a full cap not half and he said he was being conservative with the 250 since willy had been taking vetoryl. I guess 500 once a week is a lot less then 250 every day anyway.

His blood pressure was still up.:( it was 280 so we are adding n some amlodipine to the benazepril. I asked if willy had a heart condition but he said cushing's dogs have a high percentage of high BP.

YAY willies blood glucose was 10.2mmol/L;) he rarely goes under 20 so this is a big thing!!! so in a week we are doing a blood glucose curve to see if his insulin needs adjusting.

I am slightly anxious that the low BSL was due to variance in machines as I am pretty sure it was a glucometer not a serum:confused:

[labblab]

Hi again! Only time for a quick note since it is past my bedtime. :o

But the range you have posted of up to 250 nmol/L is only relevant for dogs taking trilostane. The desired therapeutic range for dogs treated with mitotane is lower and should not exceed around 138 nmol/L (or 5 ug/dl as reported here in the U.S.). So Willy's result of 236 remains somewhat higher than is desired (8.6 ug/dl). It is for that reason that I'm guessing your vet is increasing the weekly total -- so as to drive the cortisol down a bit lower.

Marianne

[labblab]

OK, now it's morning for me so I'm awake enough to add a couple more thoughts :p. First, I've actually not heard of vets only drawing the "post" ACTH sample and not the baseline as well. When treating with mitotane, in most cases the baseline reading truly may not matter, and especially when the post is well up in the range. If the post were ever to fall quite low, however, I think there would be value in knowing the baseline, as well, in order to see whether there is a difference between the two readings and to see whether the adrenals are capable of producing and holding a reserve of cortisol. So maybe something to talk with the vet about further when you return.

Secondly, many vets prefer splitting the maintenance dose so that a portion is given on 2-3 days over the week rather than just one day. It doesn't have to be split and I'm honestly not sure what the advantage is thought to be. But that may be another thing just to ask him about. In Willy's case, it would be easy to split the tab in half and spread the dosing out over two separate days (like Monday and Thursday, for example) rather than all on one day.

Marianne

[Squirt's Mom]

Loading with one dose a day isn't how Lyso is used either so I'm not at all sure what protocol this vet is following with the drug....so be very watchful of your boy. ;) His signs may well start to get quite strong again soon.

[Silliam]

Well I am off to read all I can about dosing schedules and how or if at all the need to control his diabetes might push us into maintenance sooner as his signs were a bit better and he had gained some weight and was making yellow pee again. Also since we recheck in a week maybe he just wants to see how it goes at that level before having it compounded into smaller caps for divided doses. I'd hate to get the caps compounded then find they want to add in more or take some out. Either way a week seems a reasonable time. I am also curious if the fact willy has very little body fat due to the diabetes has any effect on the I drug since it is fat soluble. He did say he wanted to work on the diabetes in the next week. And obviously monitor that BP!
I am far from complacent tho and have his number and am not afraid to ring it.
So many questions have been raised by Marianne's and your reply.
Also thanx Marianne for those lab conversions I had no idea what to do as converter sites seemed to vary

PS. We had had a long induction around 2 weeks so I guess at some point you need to take a break and go slow to avoid the drug working faster as it shrinks the adrenals sort of like an ice cube melting? Maybe we will end up loading him again. I have no medical basis for my ice cube theory.

[Silliam]

I hate to be greedy since your well wishes have helped me so much so far and I see them helping others but I think I need some more.
About a month ago my nephew 'b' , the one with the brain tumour that's totally gone ka'BAM! On his pituitary had low glucose a bunch of other stuff and we all had a laugh that while willy was cushy, B was was showing Addison's signs. After being given a crazy complicated sterioid routine and other things he was making progress. Still woefully underweight but He'd probably get a permenant feeding tube and come home.
Enter Pneumonia:
A stupid thing that ruins the best laid plans of anyone. It seems like you can be a miracle survive the most serious of things then this comes to bite you in the bum. Now B is in the PICU still on high flow O2 and well it is a watch and wait. The numbers on paper are against him but basically all of doctors that know him say he will pull through he just needs to rest before he can rally. If you're on the forum sending good vibes or healing energy out please send some for a not so furry friend B

( not being a drama queen I just needed to vent the situation and I know any well wishes will help him. )

PS: I don't know if anyone donates blood here but if you do your an angel!!!

[molly muffin]

I'm so sorry that your nephew has encountered another obstacle to his health. I do hope that he comes out of this alright and can get back on track to where he needs to be. Sending you tons of good vibes and well wishes.

hugs

[LauraA]

So sorry about your nephew. Pneumonia is hard enough on the body when you aren't battling a life threatening condition :( I have had it many times due to a lung disease that I developed after my second bout of pneumonia a few years ago. I will send out positive thoughts to him and hope to hear back from you soon to say he has shown some improvement.

[Squirt's Mom]

So sorry to hear B has pneumonia. Like Laura said, that is tough on you. :( But a ray of hope maybe - a friend's brother in ILL is going thru the same thing, brain tumor, and he developed pneumonia a couple of months ago and they thought they were going to lose him. Yesterday he was out in the fields on a tractor so don't lose hope. ;)

Sending healing white light to B and strengthening energies to the family.
Hugs,
Leslie and the gang

[labblab]

Sending many prayers and positive thoughts from me, too!

Marianne

[doxiesrock912]

Pneumonia can be stubborn, hoping that your nephew is just as stubborn. Hugs and prayers!

[Dixie'sMom]

As everyone has probably figured out by now, I am not shy about sending prayers. I will certainly send prayers for your nephew. I will also pray that he be surrounded by a medical team with the wisdom and determination to get him thru this crisis. It's never "drama" when someones life is at stake. Prayers and hugs also for you and sweet Willie

[Silliam]

Thankyou all for your well wishes B is still hanging in there. Yesterday his brother even got to go visit him. Thankfully he was not ventilated but the latest update is he will prob stay in hospital untill christmas he is getting IVIG and will be staying on hi flo oxygen. I guess he has an immune deficiency but since he started chemo at 3months old it was not picked up because they assumed it was chemo caused.
The silver lining I see is that Yesteday they were unsure NOW THEY ARE MAKING PLANS ALL THE WAY TO CHRISTMAS!!!!!!

[Dixie'sMom]

That's great news! If he is off of the vent and they are making plans, then that's very good news. YAY! I'll keep praying and you keep us updated, ok?

[molly muffin]

One day at a time and hopefully each day will be an improvement! Being able to make plans seems like a positive step forward.

hugs

[Silliam]

I agree and after an infusion of IVig he is out of icu and back on the ward. If he manages to keep his cannula in he can stay there.

Also Willys eyes are very runny it is freaking me out. At first everyone kept saying it was the pollen this time of year. The vet that usually sees willy is not on tonight but I am starting to worry it hasn't cleared up. Seeing the random on call vet means unless it is really obvious or an emergency they will want to consult with my other vet and I will end up taking him in to see the other vet anyway:(
Now I get to obsess over this for hours

[Silliam]

Ok I washed eyes out with saline so they look much better. I am sure I over reacted but I felt like the vet people were not listening. It was not perfect saline for injection but a bottle for eyes and wound irrigation I got at the chemist. Really hoping dogs have similar eye ph tolerances to us. But then again they can use visco tears and chlorsig made for humans so I guess so
Either way he will see his main GP vet or the specialist soon and if they change at all I will just take him in

[Squirt's Mom]

Hope it's just allergies from something this time of year. My little Brick has a weepy eye but his turned out to be a really bad eye tooth infection.

[addy]

Weepy eyes can be from teeth. Koko's eyes tear from teeth and allergies. After his dental in June, his eyes were much better. When they flare up from going to the groomer I use Fluribiprofen once a day for 4-5 days and that also helps him. That is by prescription though so you would need to discuss with your vet.

[molly muffin]

Hi. Wanted to pop in and send best wishes for a happy holiday season. I hope silly William is doing better and the eye all better too.

Hugs

[Silliam]

Christmas time was busy my nephew turned 2 which we never imagined was possible and they are no longer treating him as terminal. Very annoyingly I am and have been in hospital sorting out my own meds since late January in hopes I would feel better and thus care for willy better. Also I like to think he wants me to be better too.
Sadly willy has taken a turn for the worst. His cushings while not astronomically high refuses to come into even the high normal range and not considered under control. The mitotane makes him a bit flat the day he takes it.
His diabetes also refuses to come down into an acceptable range and more insulin is needed.
Tuesday willy was having issues urininating frequently but all seemed fine I know the diabetes does that but by afternoon or evening time he was peeing blood and mum took him to the vet who said willy was in a lot of pain and it was serious, a quick ultrasound was done and stones were found in his bladder and what looked like a mass on his spleen. I talked to the vet from hospital and he told me to prepare myself but he wanted a specialist ultrasound and would put willy on pain meds and antibiotics for a UTI. I was told if he didn't respond it might be kinder to send him to sleep. His body seems to be wearing out. But not to lose hope as he was not the specialist and wildly might respond which he did.
If you've read willies history you'll know that the last time he had stones he almost died while having them removed and his bladder ruptured. They are not able to be shrunken by diet as they are caused by an inborn error of metabolism, So stones sends a chill in my heart.
My doctor was nice and has given me lots of day leave so I can go and spend time with willy in the day. And the next day he stopped Peeing blood and the urine was back to a healthy colour and he is comfortable again. The specialist ultrasound showed no mass in his spleen and said my vet was probably seeing the stones that have now formed in his kidneys.
If the infection clears up the stones might be incidental, and could sit in his kidneys without causing major issues or they could come down and get stuck it is just a wait and see since his bladder won't take another surgery. Hopefully the sand like stones in his bladder will get passed and stop irritating the bladder and let the infection clear up.
Right now I am just waiting and seeing if things settle and keeping an eye on his quality of life.
I want to leave hospital before they have fixed the side effects my medication is giving me but I try and tell myself I will be able to care for willy better when I am well. I hope if willy could talk he would tell me to do what I have to to get well just like i would to him but it is so hard to be away even if I get to spend time with him in the day.

I guess I just wanted to share with others going through Cushings too. Sorry the post is so long

[Silliam]

Sorry every one it seems I only post when in crisis but I do think of you all

[Silliam]

PPS
No one is saying to put willy to sleep now he has responded just that given his medical state and age it is probably not the last time I will be faced with this decision

[LauraA]

I am so sorry that you and Willy are both having such a hard time lately. I am glad the blood has stopped so hopefully the antibiotics do the trick for him, he really is having a bad run. You need to keep yourself in hospital and get those meds sorted so you can go home and give Willy all the attention he desires.

I am so glad your Nephew is doing well at the moment, it is such great news.

Will be thinking of both you and Willy and hope you get to go home soon.

[Harley PoMMom]

I am so sorry too that you both are having a rough time and hopefully things will turn around for you both.

Remember we are always here for you and Willy, and there is no need for a apology, we surely do understand how life can get so busy, ok ;)

Please do take care of yourself and when time permits, come back and let us know how things are going.

Hugs, Lori

[molly muffin]

Oh my goodness. So you are still in hospital?

I'm so glad that willy responded well to the antibiotics to get rid of the uti. Hopefully the stones will not move.

I do hope they can get your meds side effects sorted out so you can get on with other thing. I am sure willy misses you.

What excellent news about your nephew. Yay.

Hgs

[Silliam]

So I feel like my specialist vet is not really taking this bump in the road seriously enough and all he can see are the lab numbers not the symptoms. My gp vet not having used mitotane really can't answer the questions I have but my gut is telling me the Mitotane regime is to strong and I know others on the site have been worried about my specialist vets agressive protocols before. So I am going to post up the numbers and what's happening because soon I am going to have to make a decision myself :confused: as the specialist has just gone on holiday as to what's best for willy and I could really use some advice from you all since you all have experience and some of you know your lab work

[Silliam]

Added a photo to an gallery called lab tests but can't seem to link it here from my iPad.
Willies post acth is 146nmol/L which to me seems really close to normal and doesn't neccesitate such a agressive mitotane regime.
His Cushings cant be making his diabetes to bad as atleast 6 hours after his morning does when you'd expect it to be going back up his blood sugar was only 4mmol/L

It take a lot of special food to get willy to eat he has been having mainly steamed chicken breast and we have only just got him back onto his kibble. He is fatigued, slow to get up generally miserable and off his food unless coaxed into it on Mitotane days.
He is disliking the mitotane so much he is becoming suspicious of all pills which means he won't take the antibiotic for the bladder infection.
Basically the Mitotane is effecting his quality of life in my opinion quite a bit. I am not suggesting we reduce the dosage or cease it all together but does he really need that much so often when his levels are so close to normal. If I drop it back to say atleast every 4 days untill I can get a proper opinion have any drastic negative impact on his cushing's. I can't imagine his cortisol would shoot through the roof just because I reduce it for the 2 weeks while the specialist is away. GP vet can't say anything because he has never worked with Mitotane before he doesn't know how the drug works.
Not going to be taking advice as a medical opinion but would love to know what you'd do if it was your dog and if your on Marianne have a look at the number and tell me if it is acceptable?

[My sweet Ginger]

Hi, I feel like I've missed out on some updates on Willie.
Just briefly read through your posts and I don't remember upping Willie's Lysodren dosage from 500mg once a week to once every three days. Willie only weighs 7.8kg or 17.16 lbs and he was on 250mg once a day loading regime, did I get these right?
His post ACTH number on Nov. 17th was 236 nmol (8.55 us/gl).
When was his latest ACTH test done that resulted in 146 nmol (5.29ug/dl)? If Willie's been on 500mg on every 3days that is equal to 1000mg/wk if not more on a 17 lbs. pup. I don't think his dosage should be any higher than 500mg/wk if his post number is still a bit higher than 5 these days. I don't know when his last ACTH test was done but if it was done some time ago I wouldn't be surprised his cortisol is below 5 by now on 500mg on every three days.
So can you fill us in on his stim test please? It just seems very high to me.

[labblab]

Many thanks to Song for giving us this great treatment summary! I agree with her that it will help us a great deal if we can find out when Willy's maintenance dosing changed from 500 mg. once a week to 500 mg. every three days. Also, the timing of this most recent ACTH will be important for us to know. On the face of it, an ACTH of 146 nmol/dl is a good result for a dog being treated with mitotane and you really don't want the cortisol to bounce back a lot higher, BUT this is based on the assumption that the dog is behaving well which unfortunately does not seem to be the case with Willy.

As Song has pointed out, increasing to 500 mg. weekly represented a "jump" over the 250 mg. he was receiving daily while loading. So it will be important for us to know when the 500 mg. was increased even more -- to every three days. Thanks very much in advance for any additional info you can give us that will help to sort out Willy's dosing history.

Marianne

[My sweet Ginger]

How's Willie? How are you? I hope both of you are doing better. :)

[Silliam]

Sadly the paper work seems to have been moved while I was in hospital but I will find it soon. I got hom on Saturday and willy is doing better. We went to four days some time in December I think and then up to three while I was in hospital. Mainly because the level would not come down and his blood sugar was way up. Willy is back up at 7.5kg so I don't know why his weight dropped like that:confused: the vet says he will talk about reducing the Mitotane after a blood glucose curve and acth stim test but as much as I hate to bring up money that's like $300 a test so 600 before he will consider reducing it gah it drives me bonkers. Sometimes I think they are just milking me. But I got a second opinion from regular vet and everyone seems to think this is willies best option especially now he has perked up now I am home. Also as soon as they back off the mitotane his cortisol goes up again damn it.
Still we have good days and bad days but looking at the pawspice quality of life assessment willy's is still good. Although the this is still a roller coaster ride neither of us wants
I'll post a picture soon of willy looking rather happy now I am home

[Silliam]

Last acth 18th of feb

[Squirt's Mom]

I'm glad you're home again and know Willy is very happy to have you with him once more. Let us know when you get the ACTH results. I hope it's perfect and ya'll can arrive at doses that work well for him.

[My sweet Ginger]

Welcome home. Wow, it was a long stay in the hospital. I hope you are in better health and feeling much better.

I'm glad to hear that willy is doing better and hope he continues this path. When will be his next ACTH test?
Don't I know the financial burden on Cush parents. It's such a hit on us if you don't have pet insurance especially in the beginning. Once he's stabilized the need of testing subsides drastically one way or another. I hope willy will get there soon. Take care. Hugs.

[molly muffin]

So glad to hear that you are back home and that Willy is having a good quality of life and happy to see you.
Drat if I don't sympathize with the cost of all the testing. :( Very sucky how expensive the repeated test all the time are.

Welcome home :)

[LauraA]

Glad Willy has improved, and I hope after that long stay in hospital they have all your meds sorted and that are feeling much better yourself :)

[Silliam]

I am feeling much better now it is great now I don't have so many symptoms. Sadly willy has another UTI so they have postponed the tests untill he has been on the amoxicillin for 2weeks because otherwise they think the infection will mess with the results. He is on a 3week course of amoxicillin with a recheck and urine culture at 2weeks since they believe it is the same UTI back again. Luckily it is still sensitive to just about all the antibiotics so no drama there I hope he will perk up a bit after a day or two on the antibiotics.
Thankyou everyone for your messages and support it really helps me get through each day.