Lolita

[dsbailey]

Hello All,

I’ve been lurking, learning and applying from this group since my dog “Lolita” was diagnosed with PDH a little over a month ago. Lolita is a 10-year-old Australian Sheppard mix and weighs 57 lbs. I’m a 52-year-old male going broke quickly whose other dog, a 10-year-old Kelpie that blew out his CCL last week. Being a software engineer I understand bone cutting surgery much better than the gray areas of Cushing’s Disease. That’s why I’m needing some advice and support here.

Lolita’s is on DES every three days for the past three years for incontinence and we’ve been battling UTI’s the whole time (Now we know why). Her clinical signs are Excessive Thirst and Frequent Urination, Ravenous Hunger, and bladder leakage. She has no skin or hair involvement but does appear to be starting on a pot belly. The only other symptom she has had for years is that she chatters her jaw sometimes and that might be more pronounced recently (maybe I’m just more aware of everything now).

Here are the abnormalities from her “Senior Panel”. We’ve been watching her ALKP for 3 years because it was running in the 300 – 400’s (Range is 5 - 131). We never treated because no clinical signs were present and a UCC test was done a year ago and came back negative. The vet made me aware that regardless we could be looking at a future Cushing’s dog.

ALT 267 High (12 - 118)
ALKP 1532 High (5 - 131) was 337 6 months ago
GGTP 39 High (1 - 12)
BUN/Creatinine Ratio 28 High (4 – 27)
Cholesterol 475 High (92 - 324)
Precision PSL 238 High (24 – 140)

Total T4 0.5 Low (0.8 – 3.5)

Specific Gravity 1.014 Low (1.015 – 1.050)
Protein 2+ High (Neg)
Blood 1+ High (Neg)

She then had an LDDS test with the following results:

- 4.2 Baseline
- 1.6 at 4 Hours
- 2.6 at 8 hours

Suspected PDA and went for an ultrasound with Internal Medicine Specialist which confirmed PDH stating the following:

1. Enlarged hyperechoic liver with rounded margins.
2. Normal anechoic gall bladder.
3. Bilateral adrenal enlargement – RA 2.96 x 0.97 cm / LA 3.15 x 0.85 cm
4. Moderately distended urinary bladder normal uniform wall thickness. No intraluminal debris

All of the other organs were normal. The diagnosis was PDH, we started treatment of 60mg Vetoryl.

ACTH Stim Test Range - Post Trilostane: Pre and post cortisol levels between 1.5ul – 9.1ul indicate optimal control.
Sample 1 taken 4 hours after morning meal
Sample 2 taken 2 hours after sample one (ACTH Gel from Wedgewood Pharmacy)

04/05/2016 – Started on 60mg Vetoryl for 10 days

04/08/2016 – Started on 68mg Enrofloxacin for 14 days for E. Coli UTI

04/14/2016 - ACTH Stim Test _#1
- Cortisol Sample 1: <1.0 Low
- Cortisol Sample 2: 1.2 Low
- Clinical signs positive: Drinking and urinating had decreased significantly. Leakage had stopped completely. Hunger has decreased moderately, woofs down her food quickly, steals food from the cats or counter if possible but isn’t in our face at our meal times.
- Clinical signs negative: A bit lethargic but nothing else new or worse. Just figured she was having Corticosteroid withdrawals.

04/15/2016 – Ran Electrolytes (“was” refers to 6 months ago)
- Na 157 mmol/L (Range: 144-160) was 158
- K 4.4 mmol/L (Range: 3.5 – 5.8) was 3.9
- Na/K 36 mmol/L (Range: None Specified) was 41
- Cl 116 mmol/L (Range: 109 - 122) was 121

04/15/2016 – Stopped Vetoryl for 7 days
- Clinical Signs are back (Excessive Drinking, Peeing, Leaking, and Hunger)

04/21/2016 – Started on 30mg Vetoryl for 12 days

05/02/2016 - ACTH Stim Test _#2
- Cortisol Sample 1: <1.0 Low
- Cortisol Sample 2: 4.5 In Range
- Clinical signs positive: Drinking and urinating had decreased significantly. Hunger has decreased moderately, woofs down her food quickly, steals food from the cat if possible but isn’t in our face at our meal times.
- Clinical signs negative: A bit lethargic, had leakage at day 3 but nothing else new or worse.

This is where my dilemma starts. There are NO clinical signs of Hypoadrenocorticism so my vet suggested we continue in 30mg for 30 days and retest. He is open to my input on matters of dosage and treatment and believes in “low and slow” but I need the input from this group of experts. I just spoke with the Internal Medicine Specialist and she is not concerned with the “Cortisol Sample 1: <1.0” result either. Here are my questions:

1. The number that concerns me is the “Cortisol Sample 1” being <1 ug/dl. Should I ask that her Vetoryl dose be lowered to 20mg and stim tested in 14 days or shut my pie hole and attentively watch and wait with prednisone in hand?
2. If a dosage adjustment is necessary to 20mg should we go to twice a day dosing 10mg BID since two pills will be necessary? She is “Most Rabid and super thirsty dog” in the evenings when the animals (including myself) eat.
3. Should I insist that the Stim Testing be done with Cortrosyn and not a compounded gel – this would cost about $100 more per test?
4. What should I use, from where and in what dosages to improve her angry liver if possible?
5. I feed her 2.5 cups of “Chicken Soup for The Pet Lovers Soul” Adult formula and .5 cup of homemade soup degreased as much as possible (Thighs, carrots, celery) per day. I want to change her to a better diet and any suggestions would be appreciated. I don’t want to do this until we get her dosage sorted out as to not cause any sign that would make me paranoid that it was the medication (Stool Changes, Etc…)

Thanks everyone in advance,

Darrell and Lolita

[DoxieMama]

Hi Darrell,

Welcome to you and Lolita, though I'm sorry for the reasons you joined. You've got your hands full with her and your other dog with recent surgery! Yikes.

Perhaps because I am also in IT (systems analyst), but I think your first post is really easy to follow and contains great information. I'm new to this realm myself so I honestly don't have any answers to your questions! One of the admins here recently answered a question about the "pre" number for another member, so I'll quote that here:


In general, many vets and indeed Dechra (the manufacturer) are not concerned about a lower pre, with the thinking that, As long as there is enough reserve in the adrenal gland (3.4 and 3.7) then an Addison crisis is unlikely. The pre number is known to fluctuate throughout the day, sometimes higher and sometimes lower. Where you might run into trouble is when you have too low of a reserve in the adrenal glands (a post of 1.5 or under and I prefer not to under 2.0ug on the post) My dog has been below 1, over 1, at 3, all over the place on the pre number on various ACTH tests.

It looks to me as if your vet and IMS are following the recommended protocol, continuing the current dose until 30 days have passed. Were her electrolytes tested with the ACTH test #2 on the 2nd as well? I ask because an imbalance of those may be another reason to stop and/or decrease the dose. Otherwise, I think you're good for now.

As for the rest of your questions, I have no clue. :o With all the history you've provided though, I'm sure someone with a clue will be able to help you out before too long. :)

Shana

[dsbailey]

DoxieMama,

That goes inline with what the Dechra tech said today. They weren't concerned with the "pre" number either and said that when clinical testing Vetoryl that number was insignificant and not included in their testing protocol. To answer your question, no I didn't have her electrolytes tested again being that there are NO negative clinical signs and her "post" number was much improved on the second stim test (4.5 In Range) over the first stim test (1.2 Low). After the call from the IMS and the quote from "Molly Muffin" I'm feeling a bit more comfortable.

Thank You

[Harley PoMMom]

Hi Darrell,

Welcome to you and Lolita from me as well! Thank you so much for your detailed post, we love details so good job!! First let me apologize for my very short post (I'm at work:eek:) But one thing that I would want changed is the stimulating agent to Cortrosyn. According to a renown veterinarian that specializes in endocrinology, Dr. Mark Peterson, using the compounded gel as the stimulating agent may yield unreliable results and he gives these 4 reasons why:

Compounding pharmacies are not governed or regulated by the FDA. Therefore, we have no guarantee that the potency of these compounded formulations are what the pharmacy claims them to be. Some batches of compounded ACTH gel may be very potent and maximally stimulate cortisol secretion, whereas others batches or preparations fail to stimulate maximal cortisol secretion or may not stimulate it at all!

Because of the potential for lot-to-lot variability in compounded ACTH formulations, one should consider assessing the activity of each new vial by performing an ACTH stimulation test on a normal dog to ensure that the preparation is bioactive (i.e., it will work to stimulate cortisol secretion from the adrenal cortex). Of course, that suggestion is totally impractical for the practicing veterinarians.

Because of the differences in potency and absorption of these compounded products, peak ACTH-stimulated cortisol values may occur from 30 minutes to 2 hours after gel administration (3). In contrast to H.P. Acthar gel, where peak cortisol secretion occurred 2 hours after administration, the compounded ACTH preparations are not consistent. Because of this variability in the duration of cortisol response, most authorities recommend collecting post-ACTH at both 1 and 2 hours when using a compounded gel preparation (3).

The added time and need to collect and measure a third cortisol concentration offsets any cost savings gained from using a compounded ACTH product. (And remember my second point — we should validate the test with every new vial by testing a clinically normal dog!).


The bottom line: while these compounded ACTH preparations may be less expensive than other available products, they are not recommended because the potency can vary from bottle to bottle.

The full article can be found here: http://www.endocrinevet.info/2011/03/what-acth-preparations-should-be-used.html

Hugs, Lori

[molly muffin]

I'm the one who wrote to Doxiemom about the pre. They don't tend to worry about it but I would make sure that they are checking her electrolytes periodically. She isn't out of range on them right now but it's always worth keeping an eye on too. Also was the Creatinine in range? I see the BUN/Creat ratio is elevated but if that is because it is just the BUN that was elevated that it isn't worrisome. If the creatinine gets out of range, then that is in reference to kidneys.
With the +2 protein in urine, which might be because of a UTI, etc then you also want to periodically have urinalysis run.

We all understand the cost of these tests and medications and completely sympathize as we are in the same boat. The good thing is that once she is stable on the ACTH for a bit, you won't have to test as often.

As far as liver support, Sam-e, milk thistle are good supplements. I also use Omega 3 (for kidney support) and mine has a vitamin e in it, which has also had positive effects on human kidney support and my IMS recommended to me.

[dsbailey]

Thanks Lori,

I'm working with my Vet to use "Cortrosyn" on her next Stim test. If not then I'll just get the test done at the IMS. I appreciate you helping me with what I was trying to justify the added expense. You convinced me.

Thanks

[dsbailey]

Hello Sharlene (MM),

Here are her numbers:

Urea Nitrogen 17 (6-31)
Creatinine 0.6 (0.5-1.6)

After speaking with the Vet about your comments he said that he wasn't concerned being that the creatinine was at the bottom of the range stating that was better than it being high even though it throws the ratio off. Does that makes sense? If not maybe you could explain it to me. Also the urine is out of wack because these results were taken prior to her getting a culture, E Coli diagnosis and a round of Enrofloxacin. Since then she passes the "Smell Test" with me which is always my indicator if she has a UTI. I'll run a urinalysis when I have her stim tested in 30 days unless "That Smell" returns before then.

Anyone - I could use some help on changing her diet to a kibble better suited to a cushings dog. If you read my prior post I do supplement her kibble with cooked meat, veggies, and broth. I'm not and she's probably not ready to go all raw. I'd like to take that slow also. She has eaten "Chicken Soup For The Pet Lovers Soul" since she was a pup.

Thanks Everyone and Sharlene.

[Harley PoMMom]

Hi Darrell,

I so do understand how costly those darn ACTH stimulation tests are and it is that stimulating agent that drives that cost upward. :mad:

Concerning the diet, there really isn't a "set" diet for a cushdog, it should be tailored to that individual dog's needs. However, because of the effects of excess steroid on protein and fat metabolism, a good quality, moderate to high protein, low fat diet is recommended. To be totally honest with you, the dog food you are giving her "Chicken Soup for the Soul" looks to be a really good feed, so I really don't see a need to change it especially since she is doing so well on it. You are doing an awesome job taking care of dear Lolita ;)

Hugs, Lori

[dsbailey]

Thanks Lori - A little background. I'm 52, no children, an only child and Lolita is my first dog. Enough Said?? - :p

[molly muffin]

Yes what your vet says in relation to the creatinine is spot on with what I was saying too, in that it is high creatinine that is of concern usually.

I agree, good quality protein, lower fat is what is generally recommended and that can be anything. If you have her on a good food that she continues to like, then I'd stick with it.

oh yes, furbaby! Happy Mothers day. :)

[dsbailey]

Hello Everyone,

I hope everyone (pets included) had a nice holiday. We didn't get to do to much being that my other dog Chulo is just 12 days out from TPLO surgery for a torn CCL.

Lolita just got her 3rd ACTH Stim Test done on 5/28 here are the results:

05/28/2016 - ACTH Stim Test _#3
- Cortisol Sample 1: <1.0 Low
- Cortisol Sample 2: 7.0 In Range

Clinical signs positive: Hunger has decreased significantly, but is still more than pre-cushings.

Clinical signs negative: Drinking and urinating have increased a bit since her last test (05/02 Pre < 1.0 Post 4.5) and she is having a small amount of leakage which I've mentioned before. The UTI is back, and she is following us around and seems more anxious than usual. She also has a spot on her leg that she's licking and licking her feet but topically I'm keeping this to a minimum. All in All she seems to be doing better but not "optimal".

She's currently 56 lbs and takes 30 mg Vetoryl in the mornings. I've not spoken with the my vet yet but pre-test we spoke of a slight increase in dosage because she is still showing some clinical signs of being hyperA. I plan on suggesting a 10mg dosage increase in the evenings with dinner being that she seems to get wound up in the evenings and drinks more then.

My questions are:

- Does this dosage increase seem appropriate at this time? (my interpretation of the Dechra flow chart suggests an increase)
- Should we bump it up 5 mg or 10 mg?
- Does twice a day dosage seem appropriate?
- Should I still remain not worried about the pre number being <1.0?

I'm still using a wedgewood compounded gel for testing but am working with my vet on getting Cortrosyn.

Sorry I forgot to reiterate from an earlier post that we started her on 60 mg for 57 lbs and she was post 1.2 in 10 days. She seems to be a bit sensitive to normal dosing.

Thanks,

Darrell - Lolita's Dad

[Harley PoMMom]

I would definitely wait until the UTI is completely gone before increasing the dose as an UTI will cause a dog to drink/urinate more. Although that post number is good that pre is a bit worrisome to me..is Lolita pretty laid back when she is at the vets?

Hugs, Lori

[dsbailey]

We can't get rid of the UTI because she drinks excessively and then she leaks, then licks, then reinfects with eColi. She also has spay incontinence which doesn't help, she takes DES for that. The only time the licking and leaking stopped was when she was overdosed and her post stim was 1.2. It's a catch 22.

I'd like to get her post-test ACTH number to about 5. From what I've posted can someone help us get there? She's currently on once a day 30 mg and her post ACTH number is now 7. I also forgot to mention that she still pants for no reason but everything seems to be toned down since we started. I just want to bring her down a bit more without taking her to zombie land.

The pre-stim number concerns me also but from talking to others here (in this thread) most aren't concerned. Dechra was no help.

To answer your question she's an "Aussie" there is no such thing as "laid back".

[lulusmom]

With the chronic UTI's and persistent leakage, I would definitely consider switching to twice daily dosing to make absolutely certain that cortisol is well controlled throughout the day. If you do that, you would simply split her current 30 mg dose in half and give 15 mg am and pm. Those would have to be compounded doses as Vetoryl does not have 15 mg available. An alternative is to buy the 10mg capsules and give two capsules in the am and one capsule in pm. You may have to increase the dose at some point to get cortisol under 5 ug/dL in which case 10 mg capsules will make that a lot easier to do. If chronic UTI's and leakage continue after stabilizing under 5 ug/dL, then you will at least know that it's not being caused by inadequately controlled cortisol.

Glynda

[dsbailey]

Thanks Everyone,

I've decided (Doc is pretty easy going) to add 5 mg to the the 30 mg that Loli (her nickname) is currently taking to try and bring a post 7 down to about a post 5. From her earlier numbers she seems a bit sensitive to the meds that's why I seem to be a slow mover.

I plan on compounding and getting an even "split dose" if necessary but am trying to get her dosage set(ish) first using Vetoryl . I know that the compounded mix might be a bit more or less potent and we'll have to deal with that when and if.

My next question is does anyone see a benefit of 30 mornings and 5 at night or just give the 35 in the morning to get the party started. Sorry I have to use a bit of humor to cope, I think most of us have to.

Also, Lo (a shorter version) seems to be shedding way more than normal and you can easily pull little combs of hair out between your fingers. I've been dreading something like this because she's had no skin involvement to this point. I'm a bit confused on everything written here and elsewhere about how it attacks the hair follicles which take a long time to regenerate if ever etc ... She is still a fully haired dog but thinning. I don't over-bath her and use vets best with tea-tree oil when I do then thrown on some mane and tail to top it off.

- Is there anything I can do besides get her Cortisol down lower to slow this progression?

- Are the hair follicles toast?

Thanks and everyone have a nice Sunday.

[molly muffin]

Keeping the cortisol at a good level throughout the day should help.

As for the hair follicles, much depends on how long she had high cortisol levels undetected and any damage done to the follicles themselves from what I understand. They do have to go through a complete cycle and this can take 6 months or more sometimes before you would know if the hair will come back. Sometimes it does come back but entirely different than before, curly instead of straight, brown instead of white for example.

[dsbailey]

Thanks Sharlene and Molly muffin,

I found some of that out today looking through old threads. I guess the bright side is there will be something to look forward to. :rolleyes:

Darrell and Lo

[molly muffin]

True, patience is suppose to be a virtue but it is really hard to try to wait out some of these things.

[dsbailey]

Just an update:


Hello Everyone,

Lolita just got her 3rd ACTH Stim Test done on 5/28 here are the results:

05/28/2016 - ACTH Stim Test _#3 (30 mg Mornings)
- Cortisol Sample 1: <1.0 Low
- Cortisol Sample 2: 7.0 In Range



Lolita just got her 4th ACTH Stim Test done on 7/02 here are the results:

07/02/2016 - ACTH Stim Test _#4 (30 mg Mornings + 5 mg Evening)
- Cortisol Sample 1: 1.1 Low
- Cortisol Sample 2: 4.2 In Range

Clinical signs positive:

-Hunger back to Normal.
-Drinking and urinating are back to Normal, she is having a small amount of leakage which I've mentioned before.
-The UTI is gone for now.
- She is leaving the spot on her leg alone.
- She is licking her feet less
- Her hair is thinning less, may have just been a combo of spring and cushings.

All in All she seems to be doing better almost "optimal". I kinda feel guilty that she is doing better while reading some really sad and bad stories here, especially ones where people can't afford treatment and the CC cases sound horrific.

I will enjoy what I have now, wait a month, get another senior panel done and start working on anything that's still out of range.

BTW the latest ACTH stim test we did was with Cortrosyn not the Gel. My vet ordered a bottle ($100) and was able to use half and freeze half.

Darrell and Lo

[DoxieMama]

Hey Darrell, that's good news! I'm so glad that Lo is feeling better with the additional 5 mg at night. I hope that continues.

As for the extra, I don't think that's allowed here. I'd check with your vet or maybe a local rescue group? I don't know if you're on Facebook, but if so that's another option. (If you're interested, send me a message and I can send you the link to that tonight. I'd do it now but can't access FB @ work.)

Shana

[Joan2517]

We are always happy to hear good news! It gives others who are going through the same thing encouragement and hope. And yes, it is a little sad for us who have lost our babies to this horrible disease, but we do not want others to suffer the same losses that we have.

So that being said, glad that Lolita is doing better!

[judymaggie]

Excellent Lolita update, Darrell! :D

[molly muffin]

That is really good news! :) A little bit can make a big difference as the saying goes.

[dsbailey]

Hi everyone,

I've been trying to help people here and in the different groups. I think I've done well with everything I've learned here. The good news is that Lolita's last ACTH (9/15/16) results were pre <1.0 and post 3.8 on 30mg in the mornings. At that dosage she started having problems which we thought were arthritic issues so we lowered her dosage to 25 mg to bring her cortisol levels up a bit to help. She is showing no clinical signs of cushings at that dosage.

Here's the problem - there was no improvement in what we suspected of being arthritis. She's been favoring her right rear leg and has lost muscle mass only in that leg. We went to the vet today for a follow-up which was planned if the dosage adjustment didn't work for xrays to see what was going on. Her leg didn't show any arthritic changes and the vet has pre-diagnosed a CCL issue. I sat in the parking lot afterwards and phoned up my favorite orthopedic doc (he fixed a luxated patella in her other leg when she was a year old and just did a TPLO on my other dog three months ago). She has a consultation on 11/01/16. I spoke with my vet and he gave the green light to TPLO surgery being that her cushings is being controlled as well as it can be and the Othopedic Surgeons Tech said they have performed TPLO surgery on dogs with cushings before and that it was now my decision to make.

Lolita is almost 11, an Aussie mix, still active, alert and playful at 52 lbs. My boy who had TPLO surgery a few months back is 10 and is about 90% back to normal. I know that cushpups are more prone to infection, bleeding, slow healing, etc...

I know rehab will be harder for her and what it entails on my part. I work from home for the next six months and have the ability to care and rehab her. This will be my 3rd leg surgery regimine, it's not fun especially for the patient.

I would like some opinions, ideas, do's, don'ts and experiences from you all.

Thanks In Advance - Darrell and Lolita

[Joan2517]

Wow, poor Lolita...I don't have any experience with this, but I sure do hope it goes well.

[dsbailey]

Lolita, Chulo, Mr. Bohannan, Ophelia, Jack, Chloe and myself thank you :D

[Harley PoMMom]

Hi everyone,

I've been trying to help people here and in the different groups. I think I've done well with everything I've learned here.

Your support and advice on the forum has been invaluable and we really do appreciate it, and yes, I believe you are an excellent advocate for precious Lolita. ;)

I have no experience with torn ligaments but I know we have had many members whose pups have gone through this, some members have gone through with the surgery but others elected to have either laser therapy and/or rehab instead.

Also, don't know if this will be of any help but I have included this post which has links to a surgery called tightrope:


Hi Melissa,

I'm sorry to hear that Sadie has a ruptured ACL. I think the procedure you are talking about is called a tightrope and they use "fiber" tape instead of sutures to stabilize the knee joint. Here are a few links with information:

http://dogkneeinjury.com/tightrope-surgery-experience/

http://www.petsurgerytopics.com/dog-cruciate-ligament/tightrope-procedure/tightrope-prodedure-for-cranial-cruciate-deficient-stiflestabilization-in-dogs

I'm glad to hear that Rebel is doing well and we'll be looking forward to your posting the results of his acth stim test.

Glynda

P.S. Congratulations on getting flowers delivered to your workplace. That's really special.

Glynda

Hugs, Lori

[judymaggie]

Darrell -- I don't have personal experience with TPLO surgery. However, if it will reassure you, my Abbie had surgery this past February for a ruptured disc in her neck. She came home after two days and did great in her post-surgery recovery. I didn't see any difference in her recovery from this surgery compared to serious surgeries she had had pre-Cushing's.

Will be thinking good thoughts for Lolita!

[dsbailey]

Thanks Lori and Judy,

Lori - I spent some time reading about the laser option today and will study it further.

Judy - That's very encouraging to hear. How old is Abbie? It's just overwhelming being that Lo is almost 11, has Cushings, and had major surgery for a luxated patella on her other leg when she was a year old. Her 10 year old surgery leg has been carrying the brunt of her weight for months now and will have to carry it completely for a few weeks after surgery. It does make me feel a bit better knowing that it might not take twice as long with half the result to heal.

I am thankful that I still have her and her cushings is under control without all the nasty complications that some of the others have. At least I have options that others aren't so fortunate to have.

Thanks - Darrell and Lo

[judymaggie]

Darrell: Abbie was almost 13 when she had her surgery. The ruptured disc was in her neck and the surgeon said she had minimal bleeding and was able to raise her head/neck that evening. The main issue once she got home was trying to get her to eat as all the pain meds messed up her stomach. I think I was able to restart Vetoryl about two weeks after surgery and there was no indication that her cortisol had gone up, i.e., no symptoms reappearing.

She did have three hyperbaric treatments during her stay at the hospital to help with healing/recovery. Not sure if that is an option for TPLO surgery but something you could ask about.

[dsbailey]

Judy,

Why was she off meds for two weeks? Because of eating or some protocol? I wasn't told to stop prior or after surgery.

Darrell

[judymaggie]

Darrell -- Abbie wasn't eating enough to give her her meds. If she had been eating, there would have been no lapse.

[Whiskey's Mom]

Hi. Haven't posted in awhile so just catching up here. Whiskey tore his ACL one year ago. We went the route of laser treatments because the Cushings diagnosis was just a few weeks old and I had no idea what to do. Wow do I wish I would have had this forum back then. I was a total wreck. Anyway it worked for him. He's doing really well. Around 6 weeks post injury he was walking normally. We did really restrict his activity though, and even now his walks are short & he doesn't even attempt jumping the fence. He will be 14 on December 7-yay!! If you have any questions id be happy to help. I'll try to check in more often. Best of luck- I know you'll make the right decision for your sweet pup.

[dsbailey]

Thank You Ladies - I'm going to read up more on laser treatment. I emailed the surgeon (We've known each other for 10 years) that will be seeing Lolita on November 1st and he said of course not give it to her on the morning of the consult but they could give it to her the night after surgery if we have a surgical procedure done. We'll just skip the day totally and the following morning when I pick her up I can be sure she eats and if she does I'll dose her.

We appreciate the help - Darrell and Lo ;)

[Nancylynn]

Hi! You asked me about Ollie's laser treatments.
First, Dr Joy referred us to DR Hayes, orthopedic surgeon, her favorite. We saw his new associate. Xrays and drawer test - Ollie's ACL was torn or partially torn.
He had been rushing thru living room when he yelped and began limping. He was limping and doing some toe touching
Recommendation was surgery - choice of types. We went directly back to our GP per her instructions. She suggested we try laser treatments first. She said surgeons operate, grin. She has been treating torn ACL with lasers for 10 years. She has both the "warm ball" and cold laser. She showed us pictures of a 9 year old boxer she treated.
OK, we love laser. Our lab/rottie mix Scout had hip problems, arthritis, had seen Dr Hayes who said not candidate for surgery - hospice care. Dr Joy treated Scout for over 18 months, he was mobile and comfortable until time for The Bridge.
Time and cost - she devises plan for each dog. Her protocol is same one developed for pro athletes - she works with laser manufacturer, etc.constantly. She is a small, one person practice. For ACL, it was 3 a day for a period of 3-4 straight days, 2 a day for period, working to once weekly. It's been over a year and I don't remember. The treatments to start were $45-75 per depending on length of time. Some folks leave their dogs with her each day for the intensive 3 times. Or you can wait or... she is very flexible.
Ollie loves the laser treatments. He lays down, turns just so on the yoga mat, I lay with him or next to him. He seems to doze off.
Ollie recovered nicely. Walk without a limp, etc. He already had arthritis diagnosed so she will work on that if he seems stiff.
During stormy season Ollie sees her a couple times a week rather than weekly or every other week. That's our choice because he loves it so much and his arthritis.
My mind is overloaded - he torn it in Jan a year ago, 2 yrs this coming. He improved almost immediately and was healed about 3 months, maybe less.
Email me - I will give you her contact info. She is in Lutz. She might know if anyone in your area does this.
She uses laser for a number of things, as an aid.
I didn't not want to put Ollie through the stress of the surgery and repair if I could avoid it. He had been in remission with lymphoma for over a year and I thought it might be too much for his system to handle well. I would have if the laser treatments didn't work. AND contrary to what the assistant told us, I'm sure you know, the surgery didn't have to be done ASAP. We could try something else first.
Feel free to ask me anything else. And I would be OK with sharing Dr Joy's info here.

[dsbailey]

Thanks for the response Nancy Lynn,

Dr. Hayes is a great ortho and I was very impressed with our consultation and the time he spent with us, we visited him prior to our boys TPLO surgery. The reason we chose another ortho is that he (Dr. John Kirsch) had done Luxated Patela surgery on my girl 10 years prior. I will definitely explore laser more before we start bone sawing on my girl.

Thank You - Darrell and Lolita :)

[Nancylynn]

Joy Iezzi, DVM
Lutz Animal Hospital
Lutz
813 949 3667

It is a small world.
Folks were upset with us for choosing laser treatment. Many vets do not know about it for this. Colorado State Vet School has a vet who has written a number of articles about it - available on their Web site. A good friend went their vet tech program there and worked under that vet.

[dsbailey]

Thank You for the info NancyLynn.

Anyone,

A bit off topic I'm trying to help out in one of the smaller groups and don't know the answer to this question. "Once weened off of prednisone how long before an accurate UCCR test can be run?"

Thanks All.

[Harley PoMMom]

A bit off topic I'm trying to help out in one of the smaller groups and don't know the answer to this question. "Once weened off of prednisone how long before an accurate UCCR test can be run?"

Thanks All.

Why was the prednisone being given, also what dose of prednisone was s/he initially taking and for how long has s/he been on prednisone?

The UC:CR test can rule out Cushing's but unfortunately with this test any non-adrenal health issue can cause an elevated cortisol result.

[dsbailey]

Hey Everyone,

Could someone please explain to me why Lolita's Cortisol keeps dropping with each lowering of dosage? Here's the chronology of dates, dosages, and results.


Start Date Test Date Dosage Pre Post Symptoms Action
04/05/2016 04/14/2016 60 mg <1 1.2 Drinking Less, Not as Rabid Went off for 7 days
04/21/2016 05/02/2016 0 mg <1 4.5 Drinking Less, Not as Rabid Switched to 30 mg
05/02/2016 05/28/2016 30 mg <1 7 Drinking More, Leaking, Not as Rabid Switched to 35 mg
06/06/2016 07/02/2016 35 mg 1.1 4.2 Drinking Slightly Less, Normal Appetite, Leaking Switched to 30 mg
07/03/2016 09/14/2016 30 mg <1 3.8 Started with unrelated leg issues Switched to 25 mg
09/20/2016 11/03/2016 25 mg 1 2.1 Hair Loss in Clumps Switching to 15 mg ?


Any theories or ideas are welcome.

Thanks - Darrell and Lolita

[Harley PoMMom]

Could you refresh my memory and tell me if Lolita is taking name brand Vetoryl or compounded Trilostane? :o.....Thanks!

[dsbailey]

We switched from Vetoryl to Trilostane on 09/20/2016 with the 30 mg to 25 mg adjustment. Is it likely that 25 mg compounded is stronger than 30 mg name brand? I am using Diamondback.

[Harley PoMMom]

When dealing with compounded versions quality is questionable, that is why it is crucial to deal with a reputable compounding pharmacy such as Diamondback and I see it is the one you are purchasing from.

So, about the dropping of her cortisol even though her dose is being lowered I found this answer from Dr Bruyette (who in a renown veterinary endocrinologist):
I think part of that is related to what you observed, which is that over time as they continue to take an adrenal enzyme blocker, it seems like they develop a cumulative effect and the dose does go down. Full article can be found here: http://veterinarymedicine.dvm360.com/cushings-rise-expert-observations-disease

[dsbailey]

Thanks for the article link. I knew about this but assumed that meant after long term treatment (A Year or Two). I'm still in the trying to get the dosage right phase. :confused:

She is showing zero clinical signs except blowing her coat again.

I just ordered compounded 15 mg and will test after 30 days.

Do you think this is the safe and proper approach?
Should I stop completely and see where her levels are at after a couple of months?
Do you think her adrenals are slowly shutting down and going necrotic?


It's funny how I can give good advice and have the right answer for everyone but myself :mad:

[Harley PoMMom]

I'd go with the 15 mg, just like you are doing, and retest in 30 days. Her ACTH stimulation test results show that her adrenals are producing cortisol so I do not believe that any necrosis has started.

Has her appetite changed? Any loose stools?


It's funny how I can give good advice and have the right answer for everyone but myself :mad:

I know, that's exactly how I am too :eek: ;)

[dsbailey]

Nothing has changed except her hind quarter hair is kinda sluffing off like a bison, there is hair underneath though. One thing that was different about yesterdays ACTH test is that we had to sit and wait for 30 minutes prior to the test which really stressed her out. She used to love going to the vets prior to Cushings. Now I have to carry her which is much easier than dragging her.:rolleyes:

[Harley PoMMom]

She is showing zero clinical signs except blowing her coat again.


"Blowing her coat" is actually a good sign that her cortisol is being controlled. It is common occurrence that when dogs have elevated cortisol over a period of time it does damage to the hair follicles. Hair follicles have to go through a cycle so they die off and then regrow.

We have had some dogs on the forum that when their new hair grew in it was a totally different texture/color. :)

[molly muffin]

I seem to always be bouncing around with my dog and dosages too. My IMS said it is like whatever dose we give her, her body just seems to take it in and adjust, so we'd raise the dose, then we'd lower the dose, then back and forth. It was super frustrating, but all you can do is try a dose and then test and see.

Lets see what this ACTH shows.

[dsbailey]

I'd go with the 15 mg, just like you are doing, and retest in 30 days. Her ACTH stimulation test results show that her adrenals are producing cortisol so I do not believe that any necrosis has started.


You were right after ~30 days her cortisol levels came back at pre < 1 and post 3.5 - I'm so relieved. Maybe 15 mg for my 54 lb girl is the magic number.

On to the next item. I've asked before about the pre number and even spoke with Dechra (They don't care about pre and it wasn't taken into consideration during their clinical trials). My vet seems semi-concerned that she has never tested pre > 1. Does anyone have ideas on why this or is this one of those "it is what it is" things?

Thanks - Happy Darrell and Feeling Better Lolita

[dsbailey]

Start Date Test Date Dosage Pre Post Symptoms Action
04/05/2016 04/14/2016 60 mg < 1 1.2 Drinking Less, Not as Rabid Went off for 7 days
04/21/2016 05/02/2016 0 mg < 1 4.5 Drinking Less, Not as Rabid Switched to 30 mg
05/02/2016 05/28/2016 30 mg < 1 7 Drinking More, Leaking, Not as Rabid Switched to 35 mg
06/06/2016 07/02/2016 35 mg < 1 4.2 Drinking Slightly Less, Normal Appetite, Leaking No Adjustment
07/03/2016 09/14/2016 30 mg < 1 3.8 Started with unrelated leg issues Switched to 25 mg
09/20/2016 11/03/2016 25 mg 1 2.1 Hair Loss in Clumps Switched to 15 mg
11/06/2016 11/28/2016 15 mg < 1 3.5 Unrelated leg issues No Adjustment

With two full labs + LDDS test I count 19 times my girl has had blood drawn from her neck. I have to drive a new way to the vets office each time now and carry her in the back door of the vets office to keep from her stressing out.

If anyone would like the spreadsheet I use you can email me at k9cushings_com@dsbailey.com and I will email it to you.

[labblab]

Darryl, that's a great summary of Lolita's progress!

As far as your question about her consistently low "pre" readings, yes, I'd be thinking it's one of those "it is what it is" situations :o. I do understand your vet's uneasiness, but we have had some other dogs here who have also consistently tested low without any apparent ill effect. I would have thought that dogs experiencing routinely low resting cortisols might generally lack energy, especially when stressed. But as long as Lolita is otherwise doing well, apparently it is not a cause for worry.

Marianne

[molly muffin]

I hope that she remains steady on the 15mg and that helps her out. How is the hair doing? I think that consistently under 5mg, without being too low would be good for the hair cycle as it is the best area for skin issues like cc.

That is a very good summary!! Kudos

[dsbailey]

Maybe we finally found the magic dosage number - 15 mg for a 52 lb dog - GEEZ. Her hair grew back fine (a bit weird) the first time and then when she blew her coat the second time there was already hair growing underneath. She's never been hairless or had any CC, thank god. ;)

[lulusmom]

I'll be keeping my fingers crossed that 15 mg is the magic dose. It seems you are reaping one of the benefits of having a bigger cushdog. Keep up the good work!

[dsbailey]

Hi All,

After finally getting her Cortisol numbers in a good place Ms. Lolita went in for her teeth cleaning today and I told the doc to take off anything little that might grow into something more within the next two years because I didn't want to revisit anything requiring anesthesia. He did the job; removed a pink small hanging skin tag from her belly, took a wart / knot thing off of a toe, took a lick sore off she was obsessed with, and then a 1/2 the size of a rounded erase head looking benign thing off her back. Nothing looked suspicious that he would have biopsied if it were one of his spoiled dogs. Sent us off with some Tramadol as needed. I told that disgusted, angry bandaged up girl - "You'll be 11 in 17 days and that's your last major tune-up so be appreciative". What the look I got :mad:

Lo and Darrell

[labblab]

Hey Darrell,

Wanted to drop by to wish Miss Lolita a very happy belated birthday!! :) ;) :D

Surely hope she mended quickly from her little surgeries, and that you guys are doing well.

Happy New Year! And we'll be anxious for an update when you have the chance.

Marianne

[molly muffin]

EEEEK, happy belated birthday from me too!!

Let us know how Lolita is doing. :)

[dsbailey]

Thanks for the birthday wishes. We actually forgot her birthday (December 18th) and remembered a week late. Things just get so frantic a week before Christmas. Not to sound like a total uncaring Dad but it happens every year. She is a victim of too many holidays so close together to celebrate a birthday, just like mine which is tucked between Christmas and New Years. So basically Lolita gets jipped.

Besides that she's doing great :) and finally 15 mg seems to be the magic dosage (ACTH 3.5). This is the longest we've gone (two months) without having to adjust the dosage down. We just started the second bottle (60 ct) of 15 mg and when that's done she'll be retested and switched to twice a day dosing. I wanted to switch before I ordered this bottle but she is doing so well and I wanted to give her a bit of a break on ACTH test, she's had 7 since April.

Darrell and Lolita

[labblab]

Thanks so much for your update and I'm sooooo glad Lolita is doing well!! :)

I totally sympathize about the birthday issue -- my husband's birthday is 12-23 and mine is next week. With our birthdays bookending the holidays, it's really hard to take time to make them feel special. So we usually conspire together to jointly celebrate later on in January. ;)

My only question for you right now is is to double-check about switching to twice daily dosing. If Lo is doing really well right now, I'm wondering whether you really want to recalibrate things all over again...

We've been told that cortisol levels may tend to drop lower when dogs are dosed twice daily -- in other words, a dog dosed twice daily with 5 mg. may have a lower cortisol than a dog dosed with 10 mg. once daily. So if you're feeling good about Lolita's progress right now, maybe you'd rather leave things status quo for now?

Marianne

[dsbailey]

That's also been part of my reluctance and not wanting to get into the testing and trying to find the right split dosage. The only problem she seems to have is she sleeps most of the day and gets spun up in the evenings. The signs in the evening aren't Cushings symptoms she just turns into a spaz. But thinking about it she has always been a spaz, she's part Aussie. I think maybe I'll leave well enough alone and be happy with where we're at. Does anyone else have anything to add to this?

Thanks Marianne!!!

Darrell and Lo

[Budsters Mom]

I'm with Marianne. I wouldn't change ANYTHING if I found something that was working/helping. I would ride that wave for as long as possible. ;)

[dsbailey]

Thanks for the opinions and confirming my gut feeling. I'll leave well enough alone and "One day at a time" it. ;)

[DoxieMama]

Happy belated birthday to both Lolita and to you, Darrell! I am so glad she is doing well. Please keep in touch!

[molly muffin]

What is that saying, if it isn't broken, don't fix it. :) :)

As long as everything was working well, I didn't worry about tweaking the meds, etc. For us at least, things would be stable for a couple months, then we'd have to tweak up or down usually. Which just goes to show the importance of follow up tests in the cushings lifestyle.

I think you've done an excellent job so far and kudos for finally having some stability. Long may it continue!

[judymaggie]

A belated happy birthday to you and Lolita! :D I agree with others -- you said it best ... "Lolita is doing great" -- why rock the boat?

[labblab]

Hey Darrell,

I was thinking about you guys today and hoping that Lolita is still doing well!

Whenever you get a chance, we'd love to hear an update.

Best wishes,
Marianne

[dsbailey]

Hi Marianne and everyone else,

Glynda brought to my attention today that you'd posted and was asking about Lolita. She's doing good, still working on getting her dosage dialed in, it's been a year now. She's been on 60, 30, 25, 15, 18, and now we're going to switch to 8 mg BID. She's know as the Enigma by many being that she's 52 lbs, takes such a small dose and sometimes her cortisol goes up when it should be coming down and vice versa. Maybe the twice a day dosing will smooth things out a bit. Glynda has become a big influence on me and kinda taken me under her wing. She might even try putting bows in my hair like JuJu soon. You all have been a big influence over me and the DJ Pete experience has really changed me. I think it was her, at least she takes credit for it, that said "If you lose the owner, you lose the dog". I think about that every time I post. I ask myself all the time if maybe I'd acted differently during that situation if things may have turned out differently with Coda. My girlfriend says nothing would have changed that outcome but Pete, but I still wonder and play the "What If" game with myself. Enough of that, I hope everything is going well over here and feel that helping out on the facebook page is where I need to be. I've not forgotten any of you and appreciate everyone here that helped me and Lolita. I'll check in every now and again and I send people here when the wild west of facebook is too much for them or if I know one of the experts here could help with a specialized situation.

Take Care and Thanks again for asking about us - Darrell and Lolita

[molly muffin]

Great to hear a good report on Lolita. She certainly has been a poster dog for the some bigger dogs need smaller doses saying.

As with so many things in life, we learn as we go. All we can do is learn from each experience and go on, applying what we learned.

You are much appreciated both here and especially on Facebook, where you are such a help to many.

Okay if you end up with bows in your hair at any point, I want a picture!

[dsbailey]

She better buy me a few drinks first!

[labblab]

Darrell, thanks so much for posting and letting us know you guys are OK! I can only "second" what Sharlene has said above, and also tell you that although we miss seeing more of you over here, I know you are doing a great service by facilitating the Facebook site. I wish I could be of help over there, too, but there's just not enough time in the day to let us do all the things we want. So I totally understand why that site needs to be your priority now. Heck, I've never even registered on Facebook just so as to have an excuse as to why I can't go and look at all the gazillion vacation pics posted by my friends and family. "I'm so sorry, but I just don't have permission to view them...I'm sure the kids all look so cute!" :cool: :eek:

Anyway, we'll always welcome you back whenever you have time to post a personal update (which we hope you'll do every now and then!). And in the meantime, carry on with all your good work on FB. I send my best wishes to you and Lolita, today and everyday.

Marianne