View Full Version : New Cushings Baby!
MyPeanutBaby
12-13-2014, 03:07 PM
Hello Cushings Angels,
Sorry this is so long but I want to give all the facts so we can get the best advise for our baby. My name is Ann and my baby girl is Peanut, a 13 year old hybrid (Chihuahua, Min. Dachshund, Rat Terrier) and she is my only baby. She started slowing down within the last 6-8 months, which we attributed to aging. In June, she a bad bout of vommiting and bloody diarrhea which landed hr in the hospital for three days. Several of her lab results came back abnormal including her ALP (796) but the ER Vet attributed that to her sickness, which we never figured out the cause of. I took her back to our regular vet in August beacuse she was not acting normal, excessive drinking and licking the floors all the time and just not herself. He seemed to think she was still recovering from the June illness and basically did nothing. Her symptoms continued to get worse; water consumption, frequent uriniting, hungry all the time, couldn't dance or jump onto the sofa, etc. and loosing weight so we returned on 11-7-14. ALP was off the charts (>2400) ALT high (469) and PLT (924). Vet started her on Vetri Science Liver Canine and said to come back for a retest in 3 weeks. I immediately started my online research and found you guys and lots of other information. I started her on a home cooked diet for liver disease and mixed it with Hills Science Diet ld. Took her back on 11-29-14 ALP still >2400 and ALT jumped to 935 (normal 10-110) He didn't believe she had cushings, though I showed him all my research which screamed Cushings and he finally drew blood for a baseline cortisol. Came back very high at 22.3 and he said he would do some research as how to proceed as he hasn't seen a dog with cushings in the last 4 or 5 years. RED FLAGS - ALARM BELLS - SIRENS!!! I had already read enough horror stories here to know this was NOT good and we needed a Vet experienced with Cushings Babies. Took Her back to animal hospital Vet who says they have cushings patients and that they successfully treat cushings. He ran the ACTH (2 hour version)We got the results back yesterday: Pre ACTH 11.7 Post ACTH >50. So this is my first question. Do you usually see results this high? Also, they say they use trilostane and start low but only dose 1 X per day and I have read that 2 X per day is preferable as the trilostane has a short half life and we could have fewer side effects. Any thoughts? Also,how worried should I be about the trilostane further damaging her liver? We just started Demarin this week. Thanks in advance, Ann and Peanut
Spencersmom
12-13-2014, 04:09 PM
Welcome to the forum! You will be joined shortly by many more experienced advisors and they will have lots of questions for you! Their support is immeasurable!
The one input I feel secure giving you is that the Trilo has fewer side effect than other cushing meds. At least that is my understanding! My Chi has an enlarged liver with high values ( tho not as high as your baby) and he has tollerated the Trilo just fine!
You definitely do not want an inexperienced vet treating your furbaby! That could be a disaster!
Take heed to the members here and learn as much as you can! I don't think my lil man would still be with me without their support!
Harley PoMMom
12-13-2014, 05:20 PM
Hi Ann,
Welcome to you and Peanut! Gosh I am sorry for the reasons that brought you here but glad you found us.
Dogs with Cushing's generally do have a ravenous appetite, also on their chemistry blood panel the ALP can be very elevated but usually not the ALT. Since Peanut does have a loss of appetite along with her high ALT values I, myself, do question a diagnosis of Cushing's.
And yes, I have seen dog's with an ACTH post cortisol level that high. When a dog has an illness their body does produce extra cortisol. Peanut's symptoms of vomiting and bloody diarrhea can be attributed to some kind of gastro issue such as IBD, IBS, colitus, liver issue, or even pancreatitis, if this were me, I would have these illnesses ruled out first.
I am not saying that she does not have Cushing's but with so many other non-adrenal illnesses having such similar symptoms with Cushing's it is often misdiagnosed. Cushing's is a slow progressing disease which gives a pet parent time to get a confirmed diagnosis. So, my suggestion would be getting a spec cPL test done to check for pancreatitis, maybe having a bile acid test performed to see how the liver is functioning, and if feasable, having an ultrasound perofrmed too. Was an urinalysis run recently on Peanut, and if so, could you post those findings?
Regarding Vetoryl, the go low and slow method is best, we see less adverse side effects when a dog is started out at a dose of 1mg per pound of a dog's weight, so if a dog weighs 30lbs than a starting dose of 30 mg would be reasonable. Also once a day dosing is fine, if a dog has diabetes that one should dose twice a day to help keep the blood sugar from fluncuating so much.
Please do not hesitate to ask all the questions you want and know we will help in any way we can.
Hugs, Lori
MyPeanutBaby
12-13-2014, 06:52 PM
The only time Peanut didn't want to eat everything in sight was the one single gastro incident back in June. Before and after, Peanut has always lived to eat only much more so these last 6-8 months. No,she has not had a urinalysis. This may be a stupid question, but exactly how do you collect the specimin? Neither vet has mentioned it.As for the ultrasound, I asked and the new vet said he wanted to treat the cushings first as the cortisol level needs to be under control no matter what the cause. They do preform ultrasound there, but he acted like it's a big deal. Is it that expensive?
Harley PoMMom
12-13-2014, 07:20 PM
Getting a clean urine sample from a female dog can be tricky :eek:;) I'm providing a link to a thread where this is discussed: Tool used for collecting dog urine (http://www.k9cushings.com/forum/showthread.php?t=6504[/url)
Yes ultrasounds are costly and not all ultrasounds are created equal. A good quality ultrasound/interpretation depends on a few things; the tool used, the technician performing it, and the physician interpreting it. Is it a human grade (Phillips, GE, Siemens) machine? My gen. vet has an ultrasound machine that just doesn't have the power to capture crisp, high-resolution images. The technician, most likely, will perform their own and therefore, it should be those most experienced with capturing good windows and images. That would be a board cert. radiologist or board cert. Internal Med Spec. Likewise the one interpreting it should be the most experienced as well, and that's generally one of the 2 above.
With my boy, Harley, his first ultrasound showed that he had pancreatitis, Harley never had signs of pancreatitis and after that ultrasound a spec cPL test was performed which did confirm his pancreatitis, his results were 528 with normal ranges being 0-200! :eek::eek:
One of moderators, Leslie (Squirt's Mom), her furbaby, Squirt, had an ultrasound and it discovered a tumor on her spleen.
So, yes, those ultrasounds are expensive, however, when performed correctly on a quality machine we often say, "you get a lot of bang for your buck" with an ultrasound.
Hugs, Lori
MyPeanutBaby
12-15-2014, 09:02 PM
Thanks Terry and Lori! Peanut's Vetroyl came today and I am planning on starting in the morning with breakfast and am going to take her to work with me so I can watch her. She weights 14.3 lbs. and the vet is starting her on 30mg of Vetroyl every other day for the first week and then once a day if she does well. Does this sound OK? I asked him about starting on a lower dose as I have read here and he said because her cortisol levels are so high he wants to start with the 30mg. I am a nervous wreck! Also, is it OK to give her the Demarin as usual about an hour before breakfast? Finally, if she were to have a bad reaction, what which side effects usually come first?
Thanks,
Ann and Peanut
ps I am going to,ask again about the ultrasound, but with all of this worry, I totally forgot today when I picked up her meds.
Tullula'sDad
12-15-2014, 10:14 PM
If it helps and I'm in the UK, I asked my vet how much an abdominal ultrasound would cost me and she said about £100 thats about $150/60
Best just to ask your vet though. I'll ask again tomorrow and if I hear something different I'll post it here.
Best wishes to you
Harley PoMMom
12-16-2014, 03:36 AM
Hi Ann,
She weights 14.3 lbs. and the vet is starting her on 30mg of Vetroyl every other day for the first week and then once a day if she does well. Does this sound OK?
The every other day dosing is not the protocol that is followed. Since Vetoryl has a short half life it's enzyme inhibiting abilities start to wane after several hours. So one day your dog would receive treatment and the cortisol would be suppressed; the next day the cortisol would spike upwards again.
I asked him about starting on a lower dose as I have read here and he said because her cortisol levels are so high he wants to start with the 30mg. I am a nervous wreck!
With her weight of 14.3 lbs, if this were me, I would feel more comfortable with starting out at 10mg and no higher than 20mg. We completely understand the nervousness that you are feeling, but rest assured we will be right beside you and Peanut on this journey.
Also, is it OK to give her the Demarin as usual about an hour before breakfast? Finally, if she were to have a bad reaction, what which side effects usually come first?
Is the Denamarin something that she has been taking? Although I haven't heard about any adverse side effects with Denamarin, if this is a new supplement she hasn't had before than I would suggest waiting a few weeks. I recommend this because if Peanut would show any signs of being unwell when the initial treatment of Vetoryl has begun then you wouldn't have to question whether it was caused by the Denanmarin or the Vetoryl.
Now, the side effects of cortisol dropping too low could be vomiting, diarrhea, weakness, lethargy, or if Peanut just isn't acting herself, if any one of those symptoms are observed than stopping the Vetoryl is needed.
I am sure you will do fine, and remember we are here for you and Peanut, so please do not hesitate to ask any questions you have. Seriously, we are some of the best hand holders! ;)
Hugs, Lori
MyPeanutBaby
12-16-2014, 10:10 AM
Hi Lori,
I called again this morning and the Vet confirmed he wants every other day for the first week because of her high liver enzymes. I questioned the dosage again, telling him what I had read and been advised here, and he said "Oh, Lord" so I dropped it. He is a VERY young vet, as the primary vet in the practice that we saw last week is on vacation. I think I'll call back Thursday when primary vet back in and ask for him to confirm the dosage. As for now, I gave her the 30mg with breakfast a few minutes ago and all seems well so far. Big Sigh!
As, for the Denamarin she's been taking it without any problems for about two weeks. It seems to be helping with that "out of it" look she has most of the time. She'll just sit and stare into space or lie down with her eyes open for long stretches of time. She also seems to have more energy.
I know I'm going to need a lot of hand holding. I can already tell that my co-workers ask out of politeness but really don't care about the details. My husband is very supportive but I'm sure he gets tired of my obsessive internet searching and reading every night.
Thanks for caring,
Peanut's Mom
MyPeanutBaby
12-16-2014, 10:32 AM
Oops! Duplicate
Squirt's Mom
12-16-2014, 10:32 AM
That "Oh lord" comment would be all I needed to hear to know that this is NOT the vet to treat my baby. One who will not listen and who is dismissive before even researching the info provided is too arrogant to treat a cush pup. ;)
Harley PoMMom
12-16-2014, 10:39 AM
Dechra, the makers of Vetoryl, have changed their initial dosing protocol from what the product insert first stated:
Dechra Veterinary Products has announced a change to the Summary of Product Characteristics (SPCs) for its Vetoryl (trilostane) Hard Capsules for Dogs.
The new lower recommended starting dose for Vetoryl – a treatment for dogs with Cushing's syndrome – follows the publication of research and studies into the effects of reducing the initial dose rate.Brand manager Craig Sankey explained: “Since Vetoryl capsules were first launched more than ten years ago, vets have accumulated a considerable amount of practical experience in using the product to transform the lives of dogs with Cushing’s syndrome.
“Several leading veterinary teaching establishments have carried out studies investigating the effects of reducing the initial dose rate and the published literature indicates that lower starting doses are efficacious and may reduce the risk of side effects.
The new, lower recommended starting dose is 2 mg/kg once daily, and the 10 mg capsules can now be used as a starting dose. Further guidance is also given for switching to twice daily dosing.
“Our new dosing recommendations are in line with current thinking from veterinary specialists in endocrinology and internal medicine, ensuring that Vetoryl evolves with the times and continues to restore vitality to Cushingoid dogs.”
Here's a link to this article which states the above: http://www.vetsonline.com/news/product-news/140722-new-lower-starting-dose-for-vetoryl.html
When the kg is concerted to lbs, which we are used to seeing, that 2mg per kg does translate to 1mg per pound. Maybe the vet will change his mind once he reads that article.
Hugs, Lori
MyPeanutBaby
12-16-2014, 11:02 AM
Thanks! I will email this to the senior vet along with my concerns so that he has it first thing Thursday morning when he gets back. As for the "Oh Lord" vet, he looks like he could be a senior in high school which didn't give me a whole lot of confidence to begin with. Also, our original long time vet has yet to call me back with his plan of action for Peanut and that's been almost two weeks ago. With his lack of cushings experience I wouldn't have let him treat her anyway, I just feel like they don't care enough to want to help her. It's taken us almost two months to finally get her diagnosed and medicated. Meanwhile, I've been heartbroken to see her go downhill week by week. Sometimes I just sit and hold her and cry as she stares off into space. Is it because of her age or that she's not a purebred and not worth saving in their eyes?
Squirt's Mom
12-16-2014, 11:11 AM
I learned to my shock and sorrow when Squirt was first diagnosed that many vets simply do not test for nor treat Cushing's - they were taught in school that it was too expensive, the owners won't comply, and the dog will die no matter what they do or don't do...there is nothing they can do. Which we now know is so very, very wrong but I'm not sure their textbooks in vet school have caught up with parents like us yet. Parents who will go to great lengths and who will demand the same of the vets treating their babies. Information is much more readily available to the layperson now thanks to groups like this so understanding of this disease is growing by leaps and bounds in the public....and vets need to catch up to us now. ;)
And there are those vets who simply think they are a god because they have a piece of paper on the wall with pretty gold stamps.
If you are not happy or comfortable with the care and attention Peanut is getting with her current vet(s), check out some others. You have the right to tell this clinic that you prefer to work only with the regular vet if you choose, too. ;)
Harley PoMMom
12-16-2014, 11:21 AM
Is it because of her age or that she's not a purebred and not worth saving in their eyes?
I would hope not :mad:, Cushing's is a very graded disease, meaning it progresses at a snail's pace. So my thinking is that they aren't taking this as serious as they should be. I would definitely have a talk with them about your concerns, and since only you know your girl best, I would let them know that you believe the Cushing's is having a real negative impact on Peanut.
Hugs, Lori
MyPeanutBaby
12-16-2014, 01:25 PM
Leslie, Lori, That you give of your time and knowledge to help other cushings parents trying to come to terms and cope with this terrible disease even after you have lost your babies is truly a blessing. Thank and the others who have replied so much. Leslie, I spent several evenings last week reading Squirt's story and cried like a baby when she passed. I went back just now to make sure I remembered the right baby, and lost it again. I still haven't been able to read all of the poem, it's just too tough to think about. Lori, I haven't found Harley's story but did see his pictures and an old post about his passing. So sorry for both of your losses.
To Spencer's Mom - Thank you for taking the time to welcome and Peanut with all that you have going on. Praying for you and Spencer.
I'm just a mess right now thinking about it.
Harley PoMMom
12-16-2014, 03:03 PM
Leslie, Lori, That you give of your time and knowledge to help other cushings parents trying to come to terms and cope with this terrible disease even after you have lost your babies is truly a blessing.
Sweety, that is so thoughtful of you, in reality I am just "paying it forward". I was a wreck when Harley got diagnosed and these wonderful, loving, and knowledgeable people here guided me the whole way through his joruney and they have always been here for me through life's ups and downs. I can not think of any better way to honor my boy, Harley, than to help others as I was helped. We are definitely a family here and I hope you know that you and Peanut are part of that family now.
Hugs to you both, Lori
molly muffin
12-16-2014, 09:48 PM
Hi and welcome to the forum. :)
My vet had the same reaction when I mentioned "internet, cushings forum" to her. That wass then though and this is now. She understands that I know a bit about what I'm talking about when I ask questions and my Internal Medicine Specialist came right out and said it was nice to have a conversation where she doesn't have to do a lot of explaining but more of an exchange of ideas, me with my layman understanding from being on the forum and her of course from years of treating and experience. Sometimes what you have to find out is they are willing to work with you as a team. If they are then they are trainable. :) See how they react to the information on dosing. That will give you a hint.
I think you're doing well considering this is all so new and you are just trying to do the best possible thing for your peanut.
Hahaha I know that dazed look well in co-workers eyes when you start to talk about cushings. Mine get it too. I have even jokingly asked them if they were zoning out on me. Don't worry, they'll get use to it. :) :)
Welcome again. You've landed in an excellent forum for support and knowledge.
Hugs
Squirt's Mom
12-17-2014, 09:23 AM
Leslie, Lori, That you give of your time and knowledge to help other cushings parents trying to come to terms and cope with this terrible disease even after you have lost your babies is truly a blessing. Thank and the others who have replied so much. Leslie, I spent several evenings last week reading Squirt's story and cried like a baby when she passed. I went back just now to make sure I remembered the right baby, and lost it again. I still haven't been able to read all of the poem, it's just too tough to think about.
Thank you so much for taking the time to read my Sweet Bebe's story and to offer your tears in her honor. Mine still fall daily.
Like Lori said, this family saved not only my baby but my sanity, or what passes for sanity in my world any way. ;):D When Squirt got sick, in a strange way she gave me the world and all that is in it...all I needed to do was reach out and listen and learn. Now that she has Journeyed on, it is my job to continue to share with others what we found here. With her love, I find the strength and courage to face each day and continue the Work she and my daughter have set before me.
Thank you again, sweetheart, from me and my Queen.
MyPeanutBaby
12-17-2014, 10:14 AM
Good Morning All!
Peanut had a good 1st day on the Vetroyl yesterday except for a couple slips and almost falls (she has been doing that for a couple of months but it had gotten better) she seems pretty normal. The senior vet is supposed to be back tomorrow and being a firm believer that you catch more flies with honey, I have sent an email to greet him upon his return. See Below.
Dr ________,
Good Morning and I hope you had a good vacation.
I am writing to,ask if you will take a look at Peanut's chart and confirm if the Vetroyl dosing amount and dosing protocol is what you wanted for Peanut. You saw her on 12/5 and did an ACTH test and we talked about that if it confirmed Cushings, you usually started pups on a lower dose. That sounded good to me, especially since her liver enzymes are so high. I did some research and found the attached document.
Also, will the short half life of Vetroyl put her on a roller coaster of cortisol with the every other day dosing?
Finally, do you usually see pups with liver enzymes and post ACTH levels as high as Peanuts?
I'm just worried and need a little reassurance that we are doing the right thing for my baby.
Thank You!
Notice that I didn't mention the Cushings forum... yet! :) I guess we'll see how he responds. Like Molly Muffin explained, I too want a Vet that will listen to and work WITH me for Team Peanut.
Thanks for all of your advise!
Ann and Peanut
Squirt's Mom
12-17-2014, 10:24 AM
Good job, Mom! That "we" is excellent! ;)
Renee
12-17-2014, 12:55 PM
Good luck with your vet! That was a very respectful email. :)
molly muffin
12-17-2014, 07:09 PM
Love the email! That was very nicely worded and well written. Good job mom!
Go Team Peanut!
:)
molly muffin
12-25-2014, 04:47 PM
Merry Christmas Ann and Peanut!!
Wish you a wonderful holiday season
hugs
MyPeanutBaby
12-25-2014, 08:39 PM
Thank you Sharlene and Molly! Hope you have had a Merry Christmas too and that everyone in your household is well.
Ann and Peanut
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