Echo 11yrs 9mon female wiemaraner Just diagnosed

[jraven]

Hi everyone long day I'll get started any help would be appreciated, guessing she had the LDDS test
Echo is 106.7 lbs

CORT01 = 9.7 ug/dl
CORT03 =9.8 ug/dl
I don't have CORT2 in what they printed out but said there were 3 parts of all day test
blood
ALKP = 877 ul H 23-212
ref range
MONOS = 1.22K/ul H ref range 0.16-1.12
WBC=18.34 K/ul H ref 5.05-16.76
NEUT =14.55 K/ul H ref 2.95-11.64
Retics= 131.9 K/ul H ref 10.0-110.0
urine
LEU = 25 Leu/ul
829 URINE CORTISOL/CREAT RATIO 39
<34 hyperparathyroidism is possible ect
she is on 90mg of Trilostane goes back in 14 days for ACTH test she takes Rimadyl 100 mg twice a day,Flagyl 500 mg twice a day,oct pepcid twice a day
symptoms are very weak in back end,pot belly,no energy,throwing up and cough and gagging,panting

[jraven]

Echo was given her second dose this morning,we are Joe and Colleen from Matawan,NJ,we've had a Weimaraner with Addison's Disease,not sure if it's wishful thinking but Echo looks a little better already,we've contacted Tiffany's Compound Pharmacy in Westfeild,nj and after 30 days,if 90 mg is the right dose,they will compound it.thank you for this site,the info I found here already has help us understand the disease and how to proceed,again thank you

[labblab]

Welcome to you and Echo!! I apologize that I have so little time to write at the moment, but I have cousins in town and am only popping in every now and then this weekend :o. But I want to thank you for all this information, and to assure you how glad we are you've joined us. :)

I hope others will soon be by to greet you, too, and I'l be adding more myself at another time.

Marianne

[jraven]

Thank You Marianne and as I said thank you to everyone that maintains and contributes to this site,we will keep you posted on Echo's progress, it looks like we are on the right tract,Echo is getting up there in age but as long as she has a decent quality of life we will do what we have to to keep it going

[molly muffin]

Welcome Joe, Colleen and Echo.

We have another Weimaraner currently in the forum being treated also. 90 mg is a good starting dose for a dog over 100lbs. You won't really know till after 30 days if that I'd the correct dosage as cortisol can continue to go down for at least 30 days on the same dose.
I am a bit concerned about the throwing up. That isn't a symptom of Cushing's. Did this start before the Cushing diagnostic testing? Coughing, gagging are not usually symptoms of Cushing's but we do have a couple dogs who have this after medication. ( coughing). It is very rare and the manufacturer is lookinfpg into this more now from what I understand.
What can you tell us about her symptoms pre diagnos? Have they coincide red doing an ultrasound?

[jraven]

we originally thought Echo was in congestive heart failure,we had another dog who went through that,the vet did a xray of the chest and stomach and said it looked fine and it looked more like Chushing syndrome to him,the vet suspects the Flagyl cleared whatever low grade infection Echo may have also had, and said that the cough and throwing up weren't part of Cushing's,he consulted with the manufacturer and another vet on test results, and dosage,Colleen said the prediagnostic symptoms where Panting, Polydipsia,Polyuria,Weakness especially in the hind end and Lethargy,Abdominal Enlargement,some Hair Loss,the gagging and throwing up started 2 days before we took Echo to the vet,Echo seems better everyday right now and will go back in 15 days for the ACTH test with according to the manufacturer,no change in dosage till 30 days

[jraven]

OK 5/12/16 15 day weight 104.7 CORT01 = 4.8 ug/dl,choride = 118 mmol/L ref range 109-122 Potassium = 6.3 mmol/L H Ref range 3.5-5.8 sodium = 161 mmol/L H Ref range 144-160
from having a addison dog,not liking those numbers,so far all med stay the same,vet needs to call OK VET HAS CHANGED THE Trilostane TO 90 in THE MORNING AND 30 AT NIGHT

[DoxieMama]

From an ACTH test there should be two cortisol numbers. What was the second?

Why is the vet recommending an increase in dosage after 15 days? That does not match the manufacturer's recommendation, which is to keep the dose the same until 30 days (unless a decrease/stop is required). I don't like the high potassium result... this brings the Na:K ratio to 25.5. Did your vet comment on these numbers at all?

How are Echo's symptoms now?

[jraven]

the Vet said that her numbers are still to high,he called the manufacture and they recommended,from the numbers to change her dose from 60 ml Trilostane once a day,to 60 mg in the morning and 30 mg at night,the way he is prescribing is making cost prohibitive,we had to pick up 30 mg pills for 15 days,calling now on the cortisol,this is from the paper they just emailed me,Endocrinology 5/12/2910@11:12 Cortisol Therapeutic Monitoring > 10.0 5/12/2016 10:10 AM
Cortisol Therapeutic Monorting (high Range) 21.8 ug /dl >7.2 ug/dl- consider changing dose based on clinical signs

SNAPshot Dx Analyzer
there is a over all improvement in Echo,more active more alert,today
she is panting steadily,may be from the test
GOING TO ADD THIS HERE//// CORT01 = 4.8 ug/dl,choride = 118 mmol/L ref range 109-122///// 4/29/16 time 10:21:43 she was given her 60 mg of Trilostane at 5am

[Sadielove]

Hello Colleen sorry I haven't written before now. I am Sadie's mom Kim. My 7 1/2 yr old weim was recently diagnosed with cushings. We just met the 30 day mark on 90 mg of trilostane. We had her ACHT test done and they called and said all her numbers look great. I haven't had a chance to get a copy yet. Sadie has a large lipoma on her rt hind leg an abdominal area that was affecting her ability to walk very far. We were given clearance on Thursday to have the surgery since he numbers were good. I picked her up today from from having surgery yesterday and I can't count all the staples but I know that I have counted 28 and there are more under her belly. She is having a hard time today. Throwing up and strong going to move. I have her on 100mg of toradol every 12 hours. She keeps watching to make sure I don't leave her. She wants me to Continue to run her. Anyway. Back to the cushings. Sadie lost 4lbs initially and we changed her food to grain free with omega 3 and 6. She has made gray improvement in acting like her old self. I think now that we have this tumor removed she will gain her ability to run more and lose more weight. If not I am okay as long as she continues to do well. I haven't seen any side effects from the compounded trilostane. She made through surgery well and the tumor weighed 4.4 pounds. It was sent off for biopsy just to make sure there are no cancer cells. She is my big Baby. She is getting a sister memorial weekend that is a blue weim. I hope she brings joy to Sadie. Sadie's original liver enzymes were 1800 so Echo is doing better than when Sadie was diagnosed. I know financially it can be costly. But my girl is worth it. If you want to share just reach out and I will check in more often. I am glad you found this site. It has made me feel better about Sadie and her ability to live a relatively long life with the right txmt.

[jraven]

Thanks for answering Sadielove,Colleen said to say we had a Sadie,a blue Wiem that was diagnosed with Addison's at 1year 10 months,a big baby,the only choice between medications for her where Florinef and percorten v injections,we went with percorten v,much more expensive but better for overall control,with Cushing's the compound is essentially the same drug,the problem we have at this point is the Vet will not prescribe Compound,Echo's 15 day did not come back good,the way he is prescribing and, this is Joe,90 mg morning and 30 mg Trilostane at night,is like medicating 3 dogs,I am advising Colleen to find a vet who will start her on Compound,any input would be greatly appreciated

[labblab]

Hi Joe (and Colleen, too!),

I know the expense of all this can surely be rough. I am still trying to sort out how you've ended up at this dose of 90 mg. in the morning and 30 mg. in the evening, though. It sounds as if Echo's 15-day ACTH results were higher than you wanted, along with persisting symptoms. But this is where I am confused. It sounds as though your vet called Dechra at one point, and they recommended the 60 mg. in the a.m. and the 30 mg. in the p.m. Did your vet contact them again to get their recommendation to increase to the total of 120 mg., or is he just doing this all on his own?

One reason why I ask this is because I see that Echo's potassium level was already abnormally elevated on the 15-day check. Since you've had experience with an Addison's dog, you already know that high potassium is not a good thing. Trilostane not only lowers cortisol, but it also can lower aldosterone, which in turn can increase potassium levels. With Echo's potassium already being too high on the 90 mg. daily total, it makes me nervous about increasing the dose to 120 mg. That is why I'm wondering whether Dechra knows about the potassium level and the dosing increase.

Also, I'm still confused about the monitoring ACTH results. For the testing on 5/12, you've noted what seems to perhaps be a resting cortisol level alone: CORT01 = 4.8.

But at another point, you've listed what looks like the results of a two-draw ACTH stimlulation test, also on 5/12:


5/12/2910@11:12 Cortisol Therapeutic Monitoring > 10.0

5/12/2016 10:10 AM Cortisol Therapeutic Monorting (high Range) 21.8 ug /dl >7.2 ug/dl

But I'm having great trouble making sense of those numbers, and the timing of the blood draws. The first draw you have listed is time-stamped an hour later than the second draw, so I'm not sure what order they were actually done, or what the numbers really were, other than supposedly that the first 10:10 a.m. draw was 21.8 ug/dl (which would be extremely high for a baseline cortisol!), and just that the draw at 11:10 a.m. was >10. Can you please doublecheck those test results and reprint them exactly as they appear on the sheet if they are any different from what you've already typed out?

Thanks so much, in advance, for answering all these additional questions!!
Marianne

[jraven]

ok reboot on the 5/12/2016 ACTH STIMULATION-cortrosyn
Echo was given all her Meds listed above at 5am instead 9am for the test,with about a tablespoon full of cream cheese,no other food
the first is the only result they gave me at the office
Lab ID INCLINIC IDEXX Vetlab In-clinic Laboratory
Template Immunassay
5/12/2016 09:11:14
TEST Results
CORT01 = 4.8 ug/dl

I posted here and was told there should be a second result I called and was emailed this,and this is what is confusing to read

Instrument SNAPshot Dx Analyzer
Endocrinology
5/12/2016 @ 11;12 AM 5/12/2016
10:10 AM
Cortisol
Therapeutic > 10.0
Monitoring

Cortisol
Therapeutic
Monitoring (high Range) 21.8 ug/dl


COFFEE TIME::D

[jraven]

Part 2
ECHO"S original dose was Trilostane one 60mg and one 30mg in the morning, We picked Echo up and her Trilostane perscription 60mg and 30mg,vet didn't read her results yet,we were told no change in meds for 30 days so refilled while there,the vet then read the results and called and told us "from Echo's test results,I called the manufacturer,they recommend adding 30 mg Trilostane at night",we went back and picked up a 15 day supply of 30 mg Trilostane Echo is now on a split dose of 90mg Trilostane in morning and one 30mg Trilostane at night =
120mg per day

[molly muffin]

It seems strange to raise the medication from 60mg to 120mg after 15 days when the cortisol Will drop for 30 days on the same dose and Dechra recommends on their hand out to not raise till after 30 days. That is a double of the dosage.

Are you testing in 2 weeks again? Keep an eye out for any vomiting, diarrhea, refusing to eat, lethargy, wobbliness standing. These can be signs of over dose and I would discuss the concern about the high potassium with the vet too and make sure they recheck electrolytes at the next test too.

Some dogs can be controlled but because of electrolytes being affected, they need to have a lower dose of the medication even if the cortsol is then a bit higher to keep the electrolytes in check as those are very important and life impacting.

[jraven]

Echo's original dose was 90mg Trilostane in the morning,because of the limited way Trilostane (Vetoryl) is available that is one 60mg and one 30mg = 90mg per day,the vet added another 30mg raising her total dose at day 15 to 120mg

[labblab]

From what you've written, I'm guessing your vet must have used an inhouse, "SNAP" analysis for Echo's ACTH instead of sending it out to an independent lab, and I think the inhouse test may only give a range instead of an exact result. Whatever was done, I'm still having trouble interpreting the result you were given. :o

BUT, the far more important thing is that, on the morning of the test, Echo was given her Vetoryl on essentially an empty stomach (only one tablespoon of cream cheese). Dogs being treated with trilostane should be given the morning dose with a full meal on ACTH testing days. This is because the drug is not metabolized properly without a significant amount of food in the stomach. As a result, her cortisol reading on that day would likely be higher than normal, making it look as though the drug is less effective than it really is for her. Cushing's experts specifically warn that if testing is done on an empty stomach, vets may falsely think that a dosing increase is warranted when that is really not the case.

So yes, I really think you need to watch her very closely now for possible overdose if you proceed with the increase. And any future tests should be done after dosing alongside a full breakfast.

Marianne

[jraven]

just called the vet and he's stuttering,after telling the nurse told us that is should be a full fast and the cream cheese may effect the test,he's trying to say the cream cheese was enough MY GOD

[jraven]

we are going to keep Echo at 90mg without a ok from the vet,we are going to respect "Cushing's experts specifically warn that if testing is done on an empty stomach, vets may falsely think that a dosing increase is warranted when that is really not the case." over his answer that he needs to talk to the experts

[DoxieMama]

You should always, always give Trilostane with food. Always. I argued and argued with my vet's staff on this topic, too and they finally agreed to "allow" me to feed my dog the morning of his ACTH test. Humph. Perhaps you can point out to the vet that the protocol states "Results of this test are not affected by hemolysis or lipemia." They should not have done it without your dog having been fed and medicated properly, and since they did it wrong, maybe they would allow you to redo the test at no charge... following proper protocol. :confused:

The SNAP Cortisol Test Kit insert (here https://www.idexx.com/resource-library/smallanimal/snap-cortisol-insert-en.pdf ) shows a test called "Post-ACTH Stim Cortisol: Therapeutic Monitoring >10 µg/dL".

It looks to me like the first number was 4.8 ug/dl and the second was 21.8 ug/dl.

[labblab]

Good find, Shana!

Also, just to give you a bit more ammo regarding the dangers of ACTH testing on a fasted sample:

http://www.endocrinevet.info/2011/03/whats-best-protocol-for-acth.html

I have personally spoken with the folks at Dechra about this issue, and they consistently state that giving a full meal along with the Vetoryl allows for maximal absorption, even/especially on the day of testing.

If Echo's post-ACTH result was truly 21.8 ug/dl, then the risk of going so low as to overdose is probably very unlikely, even with the increase. But the result probably would have been lower had the Vetoryl been given on a full stomach. And that will be important to know going forward.

Marianne

[jraven]

for now do we keep Echo at 90mg or 120mg,I guess the question is would the reading have been low enough not to warrant a change in dosage at 15 days,when Dechra protocol calls for no change in dosage for 30 days

[labblab]

Since none of us are vets here, I really don't feel comfortable telling you to go against your vet's instructions, especially not without your own vet knowing what your intentions are. Since today is Sunday, however, you might hold off on the increase until you have the chance to discuss this further with your vet, or even calling Dechra tomorrow yourself in order to reconfirm the info we're telling you. If your vet has already spoken with them, they should now have created a file for Echo.

For the proper treatment of your vet's other Cushing's patients, he really needs to know how important it is that food be given with the trilostane on the mornings of monitoring testing. I think one source of confusion is that the ACTH is used both as an initial diagnostic test for Cushing's and Addison's, as well as a monitoring test after treatment has begun. Fasting is perfectly fine for the pre-treatment diagnostic, and perhaps even preferred. But it is not fine when the test is being used for trilostane monitoring purposes. So this can be an educational opportunity for your vet, too, if he is willing to recontact Dechra if he has continuing doubts about what you are telling him. Dechra might even alter their recommendation about Echo's increase if they know that she was given the trilo without her breakfast on that morning.

Marianne

[jraven]

I think you just gave me the reason that the vet is so opposed to starting Echo on compound,and yes Addison's is all about balancing Na:K ratios if I remember the ACTH is more a diagnostic tool

[jraven]

Just to keep everyone up to date,we called Dechra Technical Support,Telephone: (866) 933-2472,they have a file and in the file it says the vet was told that the trilostane should have be given with food before the ACHI test,they have done exhaustive studies and the results are seriously affected by giving meds on a empty stomach,Echo was panting for 2 days after the test and this was most likely caused giving her meds on a empty stomach (a glob of cream cheese is not enough) they also said that at Echo's weight 104 lbs the split dose of 90mg in the morning and 30mg at night is at the low end and should not be a problem.they see dogs doing better at a split dose,higher in the morning to get them through the day and lower at night, Colleen also asked them to call the vet to advise him of the importance of giving the trilostane with food,Echo's 15 day ACHT readings her first number was 4.8 ug/dl and the second was 21.8 ug/dl.,even though the test is not reliable,that is high so for now the dose stays the same

[judymaggie]

Hi--sounds like you had an excellent discussion with the Dechra folks. I had consulted with them regarding my dog's treatment and found them to be very helpful. I also found that, even though I had told my vet the same information, he accepted the guidance from Dechra with much more confidence. Keep up the good work--you are being a great advocate for Echo!

[jraven]

Dechra said they had a number of files from this vet,which means he has been using wrong protocols for ACTH testing with Trilostane, the reply is for anyone who may happen upon this post looking for information,and the other pets being treated by this vet

[jraven]

funny the vet just called and after talking to Dechra refuses to say the test was unreliable

[molly muffin]

Well you know what Dechra has said about the testing and fasting (it makes results unreliable) so sounds like maybe he just doesn't want to admit that he keeps getting it wrong.
Very frustrating I am sure.

[Sadielove]

Hi joe and Colleen, I hate to hear you are having vet issues. Stand firm and make them listen. I have had to have a serious convo with my vet too. On other issues. He is good and he knows if I don't like the answer I have more questions. My Sadie numbers look good on the compounded 90mg. But I see classic symptoms like panting and increased appetite when the trilostane is wearing off at night. I asked about breaking up her dosage to 60/30. He said I could. But the cost is higher. Since I felt removing her tumor was more of a priority for her at the moment I have tabled the split dosage until our next visit. Sadie will be getting a blue baby sister this weekend. We are excited. I hope it is not going to be a concern for Sadie. She loves small dogs. (Shhh she thinks she is a westie) that is a story for another day. Please keep us posted on how echo is doing and what her 30 day results are with a full stomach.

[jraven]

We had a blue Sadie also she had Addisons , lost her at 6 1/2 yrs old.

[molly muffin]

How is Echo doing?

You're 30 day test will be coming up soon won't it?

[jraven]

Ehco seems fine,second test is on June 7th,30 days after change in meds

[jraven]

ACTH done on Echo today,we are waiting for results,Dechra gave us one months supply of trilostane free for the botched test,if the result come back good we are still considering ordering compounded from Diamondback Drugs,the vet gave us a copy of "pharmaceutical evaluation of compounded trilostane products"that seems like random orders from unnamed compound companies,any help would be appreciated results Cortisol
Therapeutic
Monitoring
(High
Range)
25.0
μg/dL
ECHO FITZSIMMONS
PET OWNER:
COLLEEN FITZSIMMONS
SPECIES:
Canine
BREED:
Weimaraner
GENDER:
Female
AGE:
11 Years

DATE OF RECEIPT:
6/9/16
full results below

IDEXX Services:
SNAPshot Dx Analyzer

[jraven]

ECHO FITZSIMMONS
PET OWNER: COLLEEN FITZSIMMONS
SPECIES: Canine BREED: Weimaraner
GENDER: Female AGE: 11 Years
PATIENT ID: 26600-4
Sayrebrook Veterinary Hospital
1400 Main St 732-727-1303
ACCOUNT #:
ATTENDING VET: Joseph Chiosi, DVM
LAB ID: ORDER ID: 35718
DATE OF RECEIPT: 6/9/16 DATE OF RESULT: 6/9/16
IDEXX Services: SNAPshot Dx Analyzer Endocrinology
6/9/16 1:36 PM 6/9/16
TEST RESULT REFERENCE VALUE
Cortisol Therapeutic Monitoring >10.0
Cortisol Therapeutic Monitoring (High Range) 25.0 μg/dL


For Lysodren® (Mitotane tablets, USP):< 1 μg/dL - Consider adjusting therapy.
Emergency medical attention may be needed if iatrogenic signs present
1 - 5 μg/dL - Maintain current dose if patient is doing well
> 5 μg/dL - Consider changing dose based on clinical signs

For Vetoryl® (Trilostane):
< 1.8 μg/dL - Consider adjusting therapy.
Emergency medical attention may be needed if iatrogenic signs present
1.8 - 7.2 μg/dL - Maintain current dose if patient is doing well
> 7.2 μg/dL - Consider changing dose based on clinical signs

IDEXX offers interpretive and treatment guidelines based on the recommendations of our internal medical review
boards and established veterinary references.
Any suggestions are not a substitute for clinical judgment.
With respect to any drug therapy or monitoring program, you should refer to product inserts for a complete
description of dosages, indications,interactions and cautions.
Lysodren is a trademark of Bristol Myers Squibb Company
Vetoryl is a trademark of Dechra Ltd
Generated by VetConnect ®PLUS
June 10, 2016 3:39 PM
Page 1 of 1

[jraven]

Vet raised dose to 120 triostane in morning and 60 mg at night and retesting in 2 weeks,his ear is still ringing from me on the phone,we are going with compounded,if these results are right my guess is Echo is tumor is advanced and all the testing and triostane in the world aren't going to help her,we can just give her a high dose and keep her comfortable as possible

[judymaggie]

Hi! As you can see, I adjusted the lines of Echo's test results to make it a bit more readable. However, I am having trouble determining exactly what the "pre" and "post" numbers are. Hopefully, someone else's eyes can make out these numbers.

If I am understanding correctly, your vet is raising Echo's dose from 120 mg. (split 90/30) to 180 (split 120/60). This is quite a large increase. Even with a high ACTH post after 30 days, I would be more comfortable with a 30 mg. increase (split 90/60). You may well end up at the same place but, if you overshoot the proper dose, you run the risk of side effects from an overdose. This may mean that you have to have more ACTH tests and, of course, cost may be a factor in going slow.

High numbers do not necessarily mean that a tumor is advanced. It may just mean that the correct dose hasn't been given for a long enough period of time to reduce the cortisol. Also, fyi, if you are going to get compounded trilostane, you will have to get doses other than what Dechra offers. For example, instead of 120, you may have to get 125 mg. One other option is to get Vetoryl from a pharmacy that is a Dechra distributor. I get Vetoryl from California Pet Pharmacy. Their costs are substantially less expensive than what my vet or any locale pharmacy offers.

[jraven]

this might help and I'm not sure if I am happy with the in house testing method the vet uses I think her post number was 25.0 ug/dl still waiting for him to call back with pre https://www.idexx.com/resource-library/smallanimal/snap-cortisol-testing-guide-en.pdf https://www.idexx.com/resource-library/smallanimal/snap-cortisol-insert-en.pdf

[labblab]

From the test results as they are written, I don't think it's at all clear as to what Echo's actual stimulated result was, since both ">10 and 25 ug/dL" are listed as reference values rather than specific test results. Plus, there is only one time-stamp associated with the lab submission, so it's hard to know whether one or two blood draws were accounted for.

As a result, I share Judy's strong concern about such a large dosing increase without knowing exactly what Echo's ACTH result truly was. As was the case with Echo's previous ACTH, the results as they are reported here are arrayed differently than what we normally see, and I would want clarification.

Marianne

[jraven]

to try to add a little more info,Echo was given her meds 90mg of Trilostane,100mg Rimadyl,pepcid,milk thissle at 7:30 am with a full meal,she was taken to the vet at 11:15am at 12:31 at test was taken and Cortisol Therapeutic Monitoring (HighRange)reading was 25.0,we called about 3:30 pm and where told we could pick Echo up,the test results weren't ready,the vet called a few hours later and said her reading was 25.0,we called and asked the receptionist to email the results and all we have so far is that one page,we have to pick up scripts and will try to get more info

[labblab]

If the post-ACTH result truly was 25.0, then that represents a bit of an increase over the previous testing and is definitely far higher than the desired therapeutic range. I've just looked back and see that Echo weighs 100+ pounds. So given all that info, I'm now somewhat more comfortable with the increase from 120 mg. daily total to 180 mg. daily total. That total still represents a dose that is less than 2 mg. per pound, so that does fall squarely within the 1-3 mg. per pound range that research has shown to be generally therapeutic for most dogs. I would not have wanted to start out at that dose for Echo, but these subsequent monitoring ACTHs do confirm the desirability of a dosing increase and it is not yet a dose that would be considered excessively high for Echo's weight.

This is all assuming that we are correctly interpreting that IDEXX report, however. And of equal importance right now -- how is Echo doing in terms of symptom control?

Marianne

[labblab]

to try to add a little more info,Echo was given her meds 90mg of Trilostane,100mg Rimadyl,pepcid,milk thissle at 7:30 am with a full meal,she was taken to the vet at 11:15am at 12:31 at test was taken and Cortisol Therapeutic Monitoring (HighRange)reading was 25.0,we called about 3:30 pm and where told they just drew blood we could pick Echo up,the test results weren't ready,the vet called a few hours later and said her reading was 25.0,we called and asked the receptionist to email the results and all we have so far is that one page,we have to pick up scripts and will try to get more info
Now I'm back to being a bit confused again :o. The IDEXX time stamp is for 1:30. Hopefully that means the stimulating agent was injected at 12:30 with the post-ACTH blood drawn and submitted one hour later at 1:30? But it sounds as though some other blood draw was done at 3:30 before you went to pick her up. Was this for other analysis like a chemistry panel? I guess I'm not understanding why they would have waited two hours to draw more blood and not just drawn it at the same time as the ACTH. I just want to make sure the post-ACTH was not delayed until 3:30, because that would be 8 hours after dosing.

[jraven]

Echo is looking much better,her coat is fuller the panting is almost gone,she has more energy and is acting a lot like her old self,but she is 12 years old,the ACHI test and the trip to the vet seem to wipe her out for a few days,not sure if it's the shot or the excitement from going to the vet

[jraven]

6/9/16 @12:31 PM with a reading of 25.0 meds given at 7:30am
we are not sure if there was another blood draw,should there have been ???
6/9/16 1:36 PM I'm taking this to mean the blood draw was at 12:31pm and the test was run at 1:36pm

[labblab]

Where are you seeing a time of 12:30 noted? This is what is on the IDEXX report you've provided for us.


DATE OF RECEIPT: 6/9/16 DATE OF RESULT: 6/9/16
IDEXX Services: SNAPshot Dx Analyzer Endocrinology
6/9/16 1:36 PM 6/9/16

Normally a complete ACTH consists of an initial blood draw to test the resting (baseline) cortisol. Then a stimulating agent is injected and a second blood draw is taken either 1 or 2 hours later (depending on the type of agent used). What we don't know from this report is whether an initial resting cortisol sample was drawn and tested. Apparently not, which is not a huge deal since it is the post-ACTH level that typically dictates dosing changes, but it would just be helpful to know whether it was tested or not.

The reason why I'm confused about yet some other testing is from this sentence that you wrote earlier:


we called about 3:30 pm and where told they just drew blood we could pick Echo up

That made it sound as though another blood draw of some sort had taken place closer to 3:30, but perhaps I am just misunderstanding what you had written.

[jraven]

I removed the comment on later blood draw,I may have misunderstood

[jraven]

https://www.facebook.com/photo.php?fbid=1191395894233665&set=a.649015405138386.1073741827.100000897976873&type=3&theater this is a post on facebook of the test it's public so if you are logged into facebook you should see it

[molly muffin]

So looks like they are saying base was >10 and post was 25 ug. Started at 12:31 first test. Not time for post draw. But previous result was post 21.8. If. Am taking that right. In which case yes an increase would be warranted.

However I would ask if they can get the exact number on the pre and if not ask they send out next time as I personally like real numbers not < or >. Values.

[labblab]

So Sharlene, is the Facebook report different from what's posted here (sorry, jraven, I'm not registered on Facebook :o). I'm having a hard time squaring the hourlong difference in the time stamps, not that it really matters.

[molly muffin]

No only the time stamp of 12:31 looks like the start and the pre is >10

It doesn't say anything else different.

[molly muffin]

No stamp for the post draw.

[labblab]

So the 1:36 p.m. time isn't on there at all? I am totally confused -- isn't this one and the same report??

[jraven]

Monday we are going to pick up scrips and any other paperwork available,that is the one result they emailed me when I asked for results,for now thats it

[labblab]

OK, I'll quit chasing my tail over these time stamps! ;)

[molly muffin]

Oh yes it is in the top. Left corner. Must be the post draw time.

It's like a word document where the tabs are all off. Lol.

So they did do the post 1 hour after pre as is protocol.

[jraven]

lol my guess is that they didn't do a pre they drew blood at 12:31pm and ran the test at 1:36pm they test in house