"combo test" - ccr + hddst

[diana-sk]

hello, i m new here, so i m sorry if i didnt put my question into right forum. my maffy/small poodle female, cca11-12 yo, adopted/ is suspected to have cushing. we were told we are going to test her by Cortisol/Creatinine Ratio (CCR) with Dexamethasone Suppression Test (can be found here: http://thehormonelab.com/handbook/adrenocortical-function/canine-hyperadrenocorticism-hac-cushings-disease), but when i next time called to the vet she said she is going to do acth test.. i was confused as she changed her mind in 3 days, so i decided to change vet. i would like to do this combo test as it seems to be good for dog who is easily stressed by takeing to vet, has very high apetite - so it is stresfull to not feed for morning, or whole day /depend on test acth/ldds/ and is heat sensitive so it is dangerous to bring her /in car/ to vet in this hot weather... so as i know about this test i would lik to do it rather than ldds/acth (which i dont know if are even good for easily stressed dog- ?). what do you think? is this test good one ? we have laboratory where they do ccr /no mather ofdexamethasone supression/ and they also do samples for this combo test for the vet who told us about it - so they shoul know how to do ccr... but they do not interprete the test, so the vet should do it. i found vet who agreed to help me with it, but do not have any experience with this test, so he only can interprete by protocol he can find on internet. do you think it is possible to diagnose like this? can anyone help me with any advice? another problem we have is how to get dexamethasone pills - "dexamethasone 0,5mg" is not registred in slovakia or czech republic...i tried in uk, but we need prescription and i dont know any vet or doctor in uk:(
i ll be very happy if anyone can help. thanks. diana and maffy

[labblab]

Hello and welcome to you and Maffy! The combo test that you are describing is not performed here in the U.S., so those of us who live here do not have experience with it. However, I do understand that it is used as a diagnostic tool in Europe, and one of our members who lives in the Netherlands is very familiar with it, and I believe it was used to diagnose her own Cushing's dog. I will ask Saskia to stop by to take a look at your questions, OK? But yes, I do think this method is less stressful for a dog, and I have never exactly understood why it is not used more regularly here. American vets often use the UCCR alone as an initial screening test to see whether Cushing's may be a possibility, but without the added feature of the dexamethasone tablets.

In the meantime, can you tell us more about Maffy's overall health history, and also the symptoms that are making you think she may have Cushing's?

Thanks so much, and once again, welcome!
Marianne

[SasAndYunah]

Hi Diana and Maffy :-)

I am Saskia from The Netherlands and yes, my Cukie was diagnosed with Cushing's through the CCR/Dexamathasone Suppression test. In The Netherlands, and most of Europe, this is the way to diagnose Cushing's. And it's a perfectly good test. I too wonder why it is not used more often, outside Europe since it is much easier on the dog... :) And therefore, no elevation of the Cortisol level because of stress :) So I would say yes, you can give Maffy the UCCR/Dexamethasone supression test...it will be a lot easier on her...and you :) In the link you provided (the hormonelab) they do mention the UCCR/Dexamethasone supression test and nowhere do they mention it is less accurate or less dependable...they just say it would be a good test for nervous dogs. Well, in my opinion, it would be a good test for all dogs :)

Wishing you and Maffy all our best,

Saskia and Quincy :)

[DoxieMama]

Hi Diana, welcome to you and Maffy. As Marianne asked, I am also curious the symptoms that Maffy has so you suspect Cushing's. Have you had recent bloodwork done and if so, could you share any abnormal results from that?

I look forward to learning more about your girl.

Shana

[diana-sk]

thank you all for your support and interest! i have a really big problem with this test... first i heard about was few weaks ago when i called to vet /thought to be an expert for endocrino/ and i remind her ur story /i m not sure if she remembered but this doesnt matter/...i told her i would like to do lddst..she said why? i said how why? i would like to get diagnose... than she said but you did uccr i said yes. she: and it was positive so why d you want another test... i said i know it it hight sensitive but low specific.. she said : as i know all positive tested dogs had cushing... i was quiet.. than she asked me if i did it with dexamethasone supression... i said NO. and she said - BUT YOU HAVE TO D IT! i started to be angry and said: it is why i call you now to do it! /ok now she at least understood what do i want... / and se said we ar going to do "combo " test... i didnt hear about it before so i asked a little and decided to study first..we arranged meeting after 2 days.. ok, i studied and after 2 days i called her and asked when i can come to take pills ...and she said: we are not going to do the combo but acth! i started to be angry and confused....why did she change her mind?? i didnt undesrtood...and there were many strange things in this call..so i decided to find another vet. and since this time i m looking for someone to do the combo...but they seems tey dont know it. they allways think i want simply uccr and try to explain me it is not enought... i found info about the combo in 3 sources but not more... the interpretation is diferent in all 3 articles /i ll add/... yeastrday i called to laboratory where they mentioned the combo on their website. i mentioned i hav a big problem to get tablets /they ar not registred in slovakia and czech too..i dont know where "the expert" has it from../ ...she, the lab. vet didnt want to beliveve but promiss to check it. i asked if this test is used and if it is good for diagnose...she said yes... so i told her i ll call later. so i did. and she told me : yes now i see it is problem with the tablets, maybe you can try ii austria... but this test is not good for diagnose, it is low specific /what???/ and if it is positive it dosnt mean cushing /what?? it cant be positive or negative as i understand... it can give results - numebers what can mean for example 0-15 /has cushing/, 16-20/doubtful/, 21-100 /normal, so no cushing/...it is just and example to explain that itcant be positive or negative.../but maybe my understanding is wrong... / but the lab vet said diferent thinks in first call and second call.. an said lddst and acth are the test of choice... so i m confused..i started to think about acth because i dont have energy for this:(( and dont know where to get the tablets from...:(( i was "decided" to do acth and now i read here the combo is good... what shell i do now?:o :(

[diana-sk]

so now i ll wait to your answers...again i m sorry for my english and hope you will understand my posts..
more about maffy i write in document i would like to add here and also the blood works, but dont know how to do it.

[Whiskey's Mom]

Hi & welcome from us too! I want to say that my grandparents( Baba & Zedo:)) came to America from Czechoslovakia many years ago, from near Bratislava. We still carry on some of the old traditions and the food also;). I think your English is very good. I'm not qualified to give advice, but you came to the correct place for help. My dog Whiskey was diagnosed with UCCR then ACTH. He likes the vet so there is no stress for him to get the tests. It seems that your vets advice is very confusing, so I hope from the advice here and a good vet you can help your Maffy feel better soon!
Can you type or copy & paste the abnormal results directly into the post? Or take a photo and upload it to an album?
Again welcome, Annie and Whiskey

[diana-sk]

nice to hear from you as a "czechoslovakian":) tanks for hopefull words...i hop so too...ok i ll try to add it somehow. wait a moment..

[diana-sk]

here blood works http://diana.rajce.idnes.cz/krv

[diana-sk]

https://docs.google.com/document/d/1hYeT4TZ2q6W_tQrF4_F5IoJe7zHu-hxl2Zf4-WH7w4w/edit?pref=2&pli=1 our story

[DoxieMama]

Diana, thank you so much for writing Maffy's history and sharing the blood test results. Hopefully one of the admins or other knowledgeable folks will see those and be able to provide you some helpful feedback.

[SasAndYunah]

Hi Diana,

I do understand why you would feel frustrated :) I think, part of the confusion, lies in the UCCR and the UCCR with the dexamethasone suppression test. The UCCR test alone cannot diagnose Cushing's... but the combined UCCR with dexamethasone suppression test can diagnose Cushing's.
Dexamethasone (or Dexoral..or another brandname) should be easily available in the Czech Republic, it's a corticosteroid, a very common medication, worldwide. And even if it would not be available in veterinary medecine, a veterinary could write a prescription so you can go and get the tablets in a pharmacy for humans.

Best of luck to you and Maffy,

Saskia and Quincy :)

[Allison]

Diana, hi.

Welcome to the forum! Thanks for posting your story. Maffy looks precious. Thank you for giving her a home.

I'm sorry I can't answer your questions, but you've come to the right place. There are many knowledgeable people here. They'll be able to interpret your results and give you ideas of how to proceed.

Hang in there!

[diana-sk]

thanks toall foryour support. i m happy i was told about this forum and also FB page.. it is very helpfull.

please, can you search, orwrite me another names ofpill i can use for test? we asked in pharmacy and also hospital but we wasnt succesfull with dexamthasone... they only told us about fortecortin.. and if dexamthasone 0,5 contains only dxamthasone, nothing else, than thisis what i wouldlike to use..

news:
maffy was neutered on wednesday as she got pyometra:( i wanted to write earlier "please pray for her", but it looks she is much more better than first 24hours after surgery.. so now she is spayed.. and my question is (i was told some of cushing dogs was cured after they were neutered...- so probably it wasnt cushing but something shows like cushing and diagnosed as cushing) - how long after surgery the "cushing signs" stoped...?

how long after surgery /thinking of all the medication she got - atropin, mitazolan, propofol, tramadol, meloxicam, norostres, norocilin/ she can have the test?

do i understand the interpretation of "combotest" right? that there cant be positive or negative results, but numbers which told you if 1. it is cushing or 2. it is unshure or 3. it is not cushing ???

[labblab]

Here's one quick answer for you: I just checked, and it looks as though the Fortecortin ought to be fine. According to this website, Fortecortin is indeed dexamethasone in the Czech Republic. It is just a brandname version ("dexamethasone" is the chemical name for the active ingredient). So the Fortecortin might be a bit more expensive, but I would think it should be fine to use.

https://www.drugs.com/international/fortecortin.html

Also, I would definitely wait to test until Maffy is completely recovered from her surgery. I would worry that the stress of the procedure and the healing process could artificially affect her test result. It is not only an issue of the other medications, but also the body's own healing process.

And who knows, perhaps Maffy will actually exhibit fewer symptoms now that she has had the surgery. Since pyometra is an active infectious process, there's no telling exactly what effect that was having on her body. We shall see!

Marianne

[SasAndYunah]

Yes, Marianne is correct. For example, here in The Netherlands, Dexamethasone is also sold under the name Dexoral. But for example in Germany, Switzerland and the Czech Republic, Dexamethasone is also sold under the name Fortecortin. It's the same pill, just another name :) So you can safely use the Fortecortin. But yes, you should wait quite some time before having the test done...Maffy needs to recover first and get well :) So I'll be wishing her well for now...

Saskia :)

[diana-sk]

thank you again:) i ll check this fortecortin better. caus i thought "dexamethasone" is pill what contains only dexamethasone and fortecortin is pill made from more substances and one of them is dexamethasone.... and they told me they have fortecortin what contains 4mg of dex. ... and i need 0,8mg /maffy is 8kg/ for one dose, so 2,4mg together (for 3 doses)
anyway, please, can you ask your vet if i maybe can ask him in detailshow to do the test? i mean interpretation
and how long should i wait until i can do the test?
maffy says hello :)

[diana-sk]

https://www.medicines.org.uk/emc/medicine/31170 this we were looking for

[diana-sk]

hi here after little time...
we had a hard days..
maffy was spayed on wednesday (week ago) as she got pyometra:( i wanted to write earlier "please pray for her", but it looks she is much more better than first 24hours after surgery.. so now she is spayed.. and my question is (i was told some of dogs diagnosted with cushing was cured after they were neutered...- so probably it wasnt cushing but something shows like cushing and diagnosed as cushing) - how long after surgery the "cushing signs" stoped...? did you here about it?


i have many others questions, so i ll add them one by one..

1. there is a possibility to do ccr /with dex supression or without - doesnt matter. if i ll get this dex tabletsú in human laboratory, what is cheaper than veterinary ... vets usually do it in this human lab. what do you think, is it ok? beause one vet was sceptic to this way...

[diana-sk]

can you please check the blood works i added in my first posts? and than advice me if i should do it again befor we do "cushing test" and what should i check ...

[diana-sk]

2. there is a possibility to mix the pill /capsule/ in pharmacy from ingredientes written by doctor.... it is a way to get dexamethasone... but i dont know what this capsule should consits of.. and if it is good for the test. i dont have vet to ask.

[diana-sk]

3. is there something special what cushing dogs should r should not eat? i feed b.a.r.f so prefer non comercial food

[Harley PoMMom]

Hi! I can answer some of those questions you have.


hi here after little time...
we had a hard days..
maffy was spayed on wednesday (week ago) as she got pyometra:( i wanted to write earlier "please pray for her", but it looks she is much more better than first 24hours after surgery.. so now she is spayed.. and my question is (i was told some of dogs diagnosted with cushing was cured after they were neutered...- so probably it wasnt cushing but something shows like cushing and diagnosed as cushing) - how long after surgery the "cushing signs" stoped...? did you here about it?

I am sorry to hear that Maffy was having some issues and am glad to see that she is better.

Cushing's can not be cured by neutering/spaying, Cushing's is when a dog's body produces an exaggerated amount of cortisol from either a tumor on the adrenal or the pituitary gland.

If it is the adrenal form of Cushing's than an adrenalectomy is a cure however this is a very expensive and very serious surgery which only a well seasoned surgeon should perform. The dog's health needs to be taken in consideration too when contemplating an adrenalectomy.


i have many others questions, so i ll add them one by one..

1. there is a possibility to do ccr /with dex supression or without - doesnt matter. if i ll get this dex tabletsú in human laboratory, what is cheaper than veterinary ... vets usually do it in this human lab. what do you think, is it ok? beause one vet was sceptic to this way...

I'm not familiar with type of testing so I can't offer any advise there, sorry.


can you please check the blood works i added in my first posts? and than advice me if i should do it again befor we do "cushing test" and what should i check ...

I did take a look but the units and reference ranges are not what I am used to seeing so it may take me some time to offer any advice.


2. there is a possibility to mix the pill /capsule/ in pharmacy from ingredientes written by doctor.... it is a way to get dexamethasone... but i dont know what this capsule should consits of.. and if it is good for the test. i dont have vet to ask.

Gosh, I cannot answer that question either maybe the pharmacist could, I am sorry that I'm not much help. :(


3. is there something special what cushing dogs should r should not eat? i feed b.a.r.f so prefer non comercial food

Regarding the diet; there really isn't a "set" diet, a diet needs to be tailored to that individual dog's needs and health issues. However, dogs with Cushing's do lose muscle mass so their feed should have a high quality protein. If Maffy is doing well on the B.A.R.F. then I really see no reason to switch.

Hugs, Lori

[SasAndYunah]

Hi Diana,

I just read "our story"
( https://docs.google.com/document/d/1...t?pref=2&pli=1 our story ) and I understand that it can be difficult to see photo's the right way, but it seems like Maffy's skin is quite red and has several lumps/swellings. Have you ever seen a dermatologist with Maffy? Because in the pictures it looks like there might be also some sort of skin infection going on... (bacterial, yeast...?) But again,, it may look different in real life than it does in the pictures...

On your question about the possibility to mix the pil/capsule in pharmacy so you will have dexamethasone... I am not quite sure why you would want to do that because the Fortecortin is the same as dexamethasone :) There is no need to have it made...it is available under the name Fortecortin :) My dog never had Dexamathasone, he had Dexoral... the same as dexamethasone, just a different name :)

Where in the Czech Republic do you live? Perhaps we can find european certified specialists near you...that might help you in knowing they are well schooled and trained :)

Hope Maffy is feeling better after her surgery,

Saskia :)

[SasAndYunah]

I did find a dermatologist specialist in the Czech Republic, member of the European College of Veterinary Dermatology.

http://ecvd.org/find-specialist/detail/100

I will try and find an internal medicine specialist as well...

Saskia :)

[SasAndYunah]

I couldn't find a veterinary Internal Medicine specialist in the Czech Republic who is a member of the European College I'm afraid but I will give you the link to the website of the European College of Veterinary Internal Medicine and then you can sent them an email and ask if they can reccommend someone to you...

http://www.ecvim-ca.org/

Hope this will help a bit,

Saskia :)

[diana-sk]

Hi Diana,

I just read "our story"
( https://docs.google.com/document/d/1...t?pref=2&pli=1 our story ) and I understand that it can be difficult to see photo's the right way, but it seems like Maffy's skin is quite red and has several lumps/swellings. Have you ever seen a dermatologist with Maffy? Because in the pictures it looks like there might be also some sort of skin infection going on... (bacterial, yeast...?) But again,, it may look different in real life than it does in the pictures...

On your question about the possibility to mix the pil/capsule in pharmacy so you will have dexamethasone... I am not quite sure why you would want to do that because the Fortecortin is the same as dexamethasone :) There is no need to have it made...it is available under the name Fortecortin :) My dog never had Dexamathasone, he had Dexoral... the same as dexamethasone, just a different name :)

Where in the Czech Republic do you live? Perhaps we can find european certified specialists near you...that might help you in knowing they are well schooled and trained :)

Hope Maffy is feeling better after her surgery,

Saskia :)

hey, i m here after long time, i dont have pc at home now, cause mine is broken...but i have so manz questions .. we are going to have combo test with fortekortin next week! i wanted to ask zou...i will bring it to hospital to make smalller doses for us.. maffy as 8kg dog needs 0,8mg for one dose...fortecortin is 4mg! is it easz and even possible to do such a small dose from it? and do thez give it to capsule then? i ll give her 3 times...so she needs 2,4mg together...so not even whole tablete!... so i reallz hope thez will be able to devide...do thez give it to capsules then? what should i know before i do the test? what interpretation of results do zour doctore use? cause i found 3 diferent....:/ is there anz risk of useing fortecortin for this 3 times? thanks zou for any advice....and i m sorrz for mixing y and z ...i m writeing from another computer and i m here for short time onlz...

[labblab]

Hi again, Diana. I'm afraid I cannot answer your question about interpreting the test results because that test is not used here in the U.S. Hopefully Saskia may stop by again and have more information for you.

As far as preparing the Fortecortin dose, I'm also not sure about that. Is it a tablet with a line down the middle? If so, perhaps they will just cut it in half, and then cut the halves again. This would give you around 1 mg. in each piece, which might be close enough to what you need. I'm afraid I don't know exactly what they'll do about that, either.

I'm really hoping the vet who is overseeing the test knows more about all this than we do! :o :o

Please let us know how everything goes,
Marianne

[diana-sk]

hi, i hope saskia will stop by too, cause i need her advice. i would like to do the test this week. but only if i have enough information.. the problem is vet here doesnt know the test by own experience but she is in touch with laboratory in germany where they usually do the test...but their interpretation is little diferent then i found it in another source...but i hope i lll manage to study more about it.
about fortekortin i m sure the do not do it the way you wrote... i need exactly 0,8mg so i think they need measure this amount.
we will see... i ll write here if anythink new

[diana-sk]

hi all again, as i wrote time ago i found 3 articels where this „combo test“ is mentioned...
the first articel is from my friends bachelor thesis what says
- „Keď je priemerná hodnota kvocientov /ccr/ prvých dvoch vzoriek nižšia ako 10x10-6 , zodpovedá to fyziologickej hodnote.“ ( When the average value of the quotients /ccr – cortisol creatine ratio/ of the first two samples is less than 10x10-6, it corresponds to the physiological value.)
- „Pokiaľ pomer kortizolu kreatininu v moči prekročí 10x10-6, jedná sa s najväčšou pravdepodobnosťou (viac ako 90%) o HAC. „(If the ratio of cortisol and creatinine in urine exceeds 10x10-6, this is most likely (over 90%) of the HAC)
- „Na rozlíšenie centrálnej a periférnej formy je rozhodujúci tretí odber moča.“ (To distinguish central and peripheral forms a crucial third collection of urine.)
- „Pokiaľ je C/C pomerv tretej vzorke moča o viac ako 50% nižšia v porovnaní s priemerom dvoch prvých vzoriek jedná sa o hypofyzárny – centrálny HAC „(If the C / C ratio in the 3.urine sample is more than 50% lower compared to the average of the first two samples it is a pituitary - central HAC)
- „Pokles menšieho stupňa môže byť následok buď adrenokortikálneho tumoru alebo sa jedná o hypofyzárny HAC rezistentný voči dexametazonu, pochádzajúci napr. z pars intermedia. „(Drop smaller degree may result from either adrenocortical tumor or a pituitary HAC resistant to dexamethasone, resulting for example. the pars intermedia.)
- „Adrenokortikálny HAC sa potvrdí, ak hodnota kvocientu C/C tretej vzorky je vyššia ako 50% priemernej hodnoty prvých dvoch vzoriek“( Adrenocortical HAC is confirmed, if the quotient value of the C / C third sample is higher than 50% of the average of the first two samples.)


The second one is from http://thehormonelab.com/handbook/adrenocortical-function/canine-hyperadrenocorticism-hac-cushings-disease :
- HAC is suspected if the CCR is greater than 30 x 10-6 in two consecutive morning urine samples.
- If the CCR in the 3rd urine sample is depressed by 50% of the mean CCR of the first two samples, PDH is the likely diagnosis.
- If the suppression is less than 50%, an endogenous ACTH is suggested to confirm an adrenal tumour
- Normal dogs will have a CCR less than 30 x 10-6.
- PDH or ADH dogs usually have a CCR greater than 50 x 10-6.


The third one is from czech website of veterinary clinic /dont remember the adress/:
- „Poměr 1. a 2. dne: <15x10 -6 vyloučení Cushingova syndromu“ (ratio of 1.and 2.day: <15x10 -6 - exclusion of Cushing's syndrome)
- „Poměr 1. a 2. dne: 15x10-6 - 25x10-6 dubiózní výsledek“ (ratio of 1.and 2.day: 15x10-6 - 25x10-6 - an inconclusive result)
- „Poměr 1. a 2. dne:> 25x10 -6 potvrzení Cushingova syndromu“ (ratio of 1.and 2.day: 25x10 -6 - confirmation of Cushing's syndrome)
- „Poměr 3. dne (předpoklad: nárůst 1. a 2. den)“ (ratio/ccr of 3.day - supposition: growth if compared to 1. and 2. Day)
- „poměr > 50 % průměrné hodnoty prvních dvou vzorků - nadledvinová forma“ (ratio (of third day) > 50 % of the average value of the first two samples – it is adrenal form)
- „poměr < 50 % průměrné hodnoty prvních dvou vzorků - hypofyzární forma“ (ratio (of third day) < 50 % of the average value of the first two samples – it is pituitary form)

So from all of this info i understand there are first two samples necessary to find out if it cushings or not... the third sample is examined to distinguish between pituitary or adrenal form of cushings... so the third sample is not so necessary. Am i right?
Please check the interpretation of the test from all 3 articles – first says about 10x10-6 as the „breakpoint“, the second one about 30 x 10-6... how should i understand this? The third interpretation says about 15x10 -6 - 25x10-6 as inconculsive result... please, please, can anyone look at this better than i m able to and explain it to me?
Another question to saskia – did you give the dex tablete with food? Maybe can you ask your vet please also about my questions? It will be big heklp for me.
Thanks a lot for your help.

[SasAndYunah]

Hi Diana :) Glad to hear Maffy recovered well from spaying :)

About the dosis of the Fortecortin... There are dogs weighing 13 kilo's or 27 kilo's so for most dogs, an exact dosis of o,1 mg per kilo is difficult to realise :) So the dosis closest to the 0,1 mg per kilo is just fine, do not worry about this :) That is how all dogs are dosed, that is not a problem. Fortecortin is available in 0.5 mg, 2 mg and 4 mg. So it is not possible for all dogs to receive exactly 0,1 mg per kilo...you just take the closest dose available.

About the different interpretations...all labatories have their own interpretations, and may use different types of measurements. So, just go with the numbers and measurements of the lab the samples are sent to. German laboratories are quite trustworthy and thourough, even here in The Netherlands,some tests are sent to German labs :D

All three urine samples are equally important, it's impossible to come to the right conclusion without having all 3 samples :)

Wishing you all best with the test, have faith in German laboraties, give Maffy something to eat when you give her the Fortecortin and lots of cuddles and both of you will be fine :D We all will be curious to find out the results...

Saskia :)

[diana-sk]

thanks you a lot for answering my questions! :) i ll let you know, but we again delay it cause maffy got uti:(((

[diana-sk]

Fortecortin is available in 0.5 mg, 2 mg and 4 mg. So it is not possible for all dogs to receive exactly 0,1 mg per kilo...you just take the closest dose available.

3 samples :)


it seems we only have 4mg fortecortin here... i ll go to pharmacy to ask how they can devide it.. best for us will be if there is possibility to by 0,5mg..but...

[diana-sk]

hello here:) i already have prepared 3 doses of fotecortin /0,8mg of dexamethasone in capsules/. they did it in pharmacy...

so now we can start...but i would like to have contact with vet who uses this test, cause my vet can help me with it but doesnt have experience with it and i cant find anyone who has.. there is a human laboratory where another vet /i do not speak with her/ is sending urine samples..they send results with cortisol level and creatinine level.... its due to vet to calculate the ratio and say if it is positive, unclear or negative ..

do you have any advice how can i do this test?

[diana-sk]

i found another article mentioned the "combo test" - but a little bit else than i read untill... they write about ccr with lddst (0,01mg/1kg) /not hddst/.. dexamethasone is given in 6hours intervals /not 8 hours/...

scrolle to the middle http://www.merckvetmanual.com/mvm/endocrine_system/the_pituitary_gland/hyperadrenocorticism.html

[SasAndYunah]

Hi Diana,

It is pretty straight forward how the test needs to be done, let me tell you :)


Day 1: catch the first morning urine, put in tube 1, place in refridgerator

Day 2: catch the first morning urine, put in tube 2, place in refridgerator

After you caught the first morning urine on day 2, at 08.00 you give the first tablet/capsule. At 16.00 you give the second tablet/capsule and at 24.00 you give the final (third) tablet/capsule. You can give the tablets/capsules with some food, but you have to be 100% sure Maffy has swallowed the tablets/capsules. She might be drinking and/or peeing more on day 3.

Day 3: catch the first morning urine, put in tube 3 and place in refridgerator untill you can get them to the vet.

Do not fill the tubes for more then 3/4 otherwise the cap can come off.

Make sure you catch the urine every morning around the same time...and early enough so that on day 2, you can start with the tablets/capsules at 08.00 :) You need to catch the urine first before you can give the tablets/capsules.


In 70% of dogs tested this way, a definate diagnosis of a pituitary tumour can be given. In the other 30% a ultrasound is needed to look at the adrenal glands and in 50% of these cases, the diagnosis will be an andrenal tumour and the other 50% will have a pituitary tumour. Which correspondents with the overall numbers that Cushings will be about 85% pituitary and about 15% adrenal based.


How the results are interpreted:

If the average cortisol/creatinine value of the urine of the first 2 days (so, without the tablets/capsules) is higher then a certain number (this number depends on the laboratory doing the test) you have a Cushings diagnosis. And when the value of the third urine sample (after the dog took the medication) has dropped > 50%, it's pituitary. When the value has dropped < 50% it could be either pituitary or adrenal and an ultrasound is needed to look at the adrenal glands.

Hope this has helped. Best of luck to you and Maffy,

Saskia and Quincy :)

[Squirt's Mom]

Truthfully, I am horrified by how much of this is left in the hands of the general public and not handled by the medical professionals in your country! :eek: Bless your heart having to figure all this out for yourself. :(

[diana-sk]

Truthfully, I am horrified by how much of this is left in the hands of the general public and not handled by the medical professionals in your country! :eek: Bless your heart having to figure all this out for yourself. :(

yes, but it i because since i know about this "combo" test i didnt want to use lddst what usually vets know...

[diana-sk]

Hi Diana,

It is pretty straight forward how the test needs to be done, let me tell you :)


Day 1: catch the first morning urine, put in tube 1, place in refridgerator

Day 2: catch the first morning urine, put in tube 2, place in refridgerator

After you caught the first morning urine on day 2, at 08.00 you give the first tablet/capsule. At 16.00 you give the second tablet/capsule and at 24.00 you give the final (third) tablet/capsule. You can give the tablets/capsules with some food, but you have to be 100% sure Maffy has swallowed the tablets/capsules. She might be drinking and/or peeing more on day 3.

Day 3: catch the first morning urine, put in tube 3 and place in refridgerator untill you can get them to the vet.

Do not fill the tubes for more then 3/4 otherwise the cap can come off.

Make sure you catch the urine every morning around the same time...and early enough so that on day 2, you can start with the tablets/capsules at 08.00 :) You need to catch the urine first before you can give the tablets/capsules.


In 70% of dogs tested this way, a definate diagnosis of a pituitary tumour can be given. In the other 30% a ultrasound is needed to look at the adrenal glands and in 50% of these cases, the diagnosis will be an andrenal tumour and the other 50% will have a pituitary tumour. Which correspondents with the overall numbers that Cushings will be about 85% pituitary and about 15% adrenal based.


How the results are interpreted:

If the average cortisol/creatinine value of the urine of the first 2 days (so, without the tablets/capsules) is higher then a certain number (this number depends on the laboratory doing the test) you have a Cushings diagnosis. And when the value of the third urine sample (after the dog took the medication) has dropped > 50%, it's pituitary. When the value has dropped < 50% it could be either pituitary or adrenal and an ultrasound is needed to look at the adrenal glands.

Hope this has helped. Best of luck to you and Maffy,

Saskia and Quincy :)

thanks a lot i already studied about the protocol...but i found some news in your test what will help me. for example i didnt know she will pee and drink more for next day..but maybe probably since i ll start with dexamethasone... right? any other things related to dexamethasone?

i have few more questions:
i read dog need to pee at 11pm before the morning sample is taken at 7 a m ... you wrote i should give the dex/fortecortin dose at 8... can i give it right after i ll come home from morning "walk" /it takes us max 10minutes/ , so i dont need to wail till 8?

[diana-sk]

How the results are interpreted:

If the average cortisol/creatinine value of the urine of the first 2 days (so, without the tablets/capsules) is higher then a certain number (this number depends on the laboratory doing the test) you have a Cushings diagnosis. And when the value of the third urine sample (after the dog took the medication) has dropped > 50%, it's pituitary. When the value has dropped < 50% it could be either pituitary or adrenal and an ultrasound is needed to look at the adrenal glands.



acording this - when 2 first samples are higher than normal, why the third is still necesarry? if the adrenal surgery is not supected in case of adrenal tumor, than it doesnt matter if it is pituitary or adrenal tumor - the treatment is the same..isnt it--? i m just curious and have noone to speak about it with...

"certain number (this number depends on the laboratory doing the test)" - laboratory told me i ll get results - numbers of cortisol level and of creatinine level.... they do not calculate the ratio... and i found written about this test 3 a little bit diferent interpretations - i mentioned them in the end of 3th page of our topic.

so now i m not sure if in this laboraty there are any certain number or they only give me the numbers of creatinine and cortisol and than /with vet/ we will calculate the ratio and compare it to interpretation what i mentioned in 3th page...

i ll take the first urine sample tomorrow morning anyway and then i ll study again untile i wont be sure..

another question - it might not happen....but... if, after the "dexamethasone day" during night she will pee? than it wont me the 8hours urine what i ll catch in morning...should it mean i can stop testing and need to wait to do it again in future?

[SasAndYunah]

Hi Diana,

if you plan on taking the 3 urine samples each morning at 07.00, you can give the Fortecortin any time after that. But there has to be 8 hours in between each of the 3 capsules and 08.00, 16.00 and 24.00 are usally easy to remember :) But you could give them at 07.30, 15.30 and 23.30 as well...no problem.

And yes, it's recommended to let the dog pee late in the evening so he/she won't have to pee at, for example 04.00.

I would be very surprised if the lab did not give the cortisol/creatinine ratio, that is why they are a lab :) I Guess we have to wait and see... The different numbers in the different pieces of yext you provided, are most likely due to differences in labs. Not all labs use the same numbers but the result is the same. In The Netherlands they use the one with 30.

That is why they want you to let the dog pee, reasonably late at night, to reduce the chance she has to pee in the middle of the night. But just be prepared...when she wakes up at for example 05.00 or 06.00 in the morning because she has to pee....then catch that urine as well (so have everything you need, next to your bed :D )

You want to know where the tumour is located, pituitary or adrenals because it can make a difference in how you treat it. So that 3rd day urine is just as important as the others :)

Hope you will sleep well and good luck tomorrow morning :)

Saskia :)

[diana-sk]

haha, i really hope she will not pee during night after the "dex day"...

what difference in treatment acording to the form of cushings did you mean? isnt it the same with vetoryl if in case of adrenal tumor surgery is not an option?

[diana-sk]

I would be very surprised if the lab did not give the cortisol/creatinine ratio, that is why they are a lab :) I Guess we have to wait and see... The different numbers in the different pieces of yext you provided, are most likely due to differences in labs. Not all labs use the same numbers but the result is the same. In The Netherlands they use the one with 30.



this is what they told me when i called... they will give me only the numbers of cortisol and creatinine.... it is human lab, but also the vet i mentioned in the begining of this topic, who is expert for endocrinology, is using this lab for this combo test /i know about the test from her, but it was very dificult to comunicate with her ( she told me about the combo test and when i was prepared to do it she changed her mind and wanted to do acth as diagnosing metode) so i decided to find another vet... it was very dificult to find one who even read about the combo... but i already did, unfortunately with no experience with this type of test...but he found the protocol and said we can do it...but it was up to me to get the dex pills...than i got fortecortin, found pharmacy what made 3doses 0,8mg for 8kg maffy and now we can start... now the only problem is how to interprete
it... it seems the only one who is maybe able to do it is the expert vet...but there is the problem of comunication and i will not speak to her after the last call...

the3 diferent interpretation i mentioned above are from arcticle in book, and one from laboratory...so i thought it is not related to the lab when mentioned in article not in lab website

so what to do? i already caught the first urine sample /only 10ml - is it enought? i usualy caught 50ml, so i was suprised i didnt manage now/..i can caught "the first sample" everyday until i ll finally do the day second :D but it is not very confortable to wait untill 11.pm every day to go for walk...

[SasAndYunah]

Hi Diana,

how did day 2 go? :)

Let's just wait and see in which manner the results are delivered to your vet and then, if necessary, your current vet could always contact that first vet (you don't want to talk to anymore) and ask about the results :)

But perhaps it won't even be neccesary....keeping our fingers crossed!

Saskia and Quincy :)

[diana-sk]

hi, no i didnt manage to do the day 2.... i was to afraid that i m not prepared enought.... i caught 2nd sample of urine but didnt give fortecortin..but i decided to go to laboratory to ask them about the units and calculating the ratio... lucky me, there was nice laborant who spoked to me and she gave me contact to another vet from another city who used to send samples for combo test to this laboratory...so i called but i didnt caught the vet, so i ll tomorrow... and the laborant told me they really dont calculate ratio, but only give the cortisol and creatinine numbers to vet ... but she also told me she already did it once and it was dificult but she promised me to try it again for me.. so i told her what units we need and i ll go or call her tomorrow... i ll not go througt dex day until i ll be not sure there is someone who know how to calculate the ratio.. i m not sure the vet knows...and ok he can call to the expert vet -good idea - i ll speak with him about ..i m not sure if he is ok with this idea but i ll try...

i wish i m somewhere where this test is not sci-fi what exists in my mind only... oh...:/

and i still have a question - the third sample is only necessary to distinguish between AT and PDH? not for diagnosting, isnt it?

ps: i really dont know what protocol we should use , because lab seems dont know the reference ranges... i told to laborant what i found ...

my only hope is that numbers will be or very low /than there is no HAC/ or very hight /so HAC is diagnosed/...



thanks you for support!

[diana-sk]

as i was asked by laborant what units of both creatinine and cortisol are used to calculate ccr.. i told her what i have found in only one article... for cortisol nmol/l and for creatinine umol/l ...second sentence in same article was cortisol nmol/l and creatinine mmol/l...

another article both umol/l...

it seems really dificult with this test :(

[diana-sk]

hi:) i have a question... does cushing dogs always have low specific gravity of urine? maffys urine analyses were done 3 times and specific gravity was always normal.

[dsbailey]

Diana asked me this question in another group "is possible she has cushing if her specific gravity of urine is normal /in ref range".

I can partially answer it and the answer is yes because no "normal blood test" result can rule out cushings. I think she mean't and what I'm curious of is a answer as to what specific gravity in urine and how it may pertain to a cush dog, scientifically is ok. I've read it here from someone before but forgot and it could also benefit her.

Darrell and Lolita

[diana-sk]

"Common abnormalities in these tests include increases in alkaline phosphatase, and ALT (liver enzymes), increased cholesterol, decreased BUN (a kidney function test), and dilute urine (low specific gravity). " /http://www.peteducation.com/article.cfm?c=2+2114&aid=416/ but maybe this occur only in dogs with PU/PD what is not maffys case...

[SasAndYunah]

Hi Diana,

where are you with the test? Did you already start or not yet? By this time, the best I can do is refer you to the dermatologist, whose information I gave to you, several posts back. He is an European board certified dermatologist and should at least have some knowledge about Cushings and definately about laboratories and testing. Please email him and see if he can be of help :)

Saskia :)

[diana-sk]

hi, no i didnt:/ laboratory where i would like to do it doesnt know which units to use and information i found was different in each article... and they also do not have ref ranges..but it seems it should be simular...

another thing is , vets i contacted either dont know the test or do not trust it... said it is not good one... but i understands it as good one as long as a dog doesnt have another disease as kidney failure,... so i think i probably can do another test for it ..even i dont think this she suffer for it..

i m close to give up:( and do lddst... but i really dont want to bring maffy to the vet several times and fasted if there is another option:///


i m loosing hope for this uccr

[diana-sk]

i already wrote to the vet you recomended, i m waiting for answer. thanks:)

[diana-sk]

another question - i would like to start boswellia seratta and gold paste /turmeric/ for her osteoarthritis.. do you have any info or where to ask if i can start befor testing?

[diana-sk]

hi saskia, the vet you wrote link to didnt answer...
maybe can you give me your vet contact so i can ask aboout the test? i m afraid i m going to give up soon and we will do the lddst.. what i m afraid of, as i cant imagine maffy to be fasted for so long and plus stress from vet visit 3x a day!:((

[SasAndYunah]

Hi Diana,

How is Maffy doing these days? :)

I am afraid I cannot give you the contact information of my vet, she won't work that way. But I have something better for you... I contacted Dr. Jan Rybnicek by email and he replied within 10 minutes...wow! :D

" My suggestion would be to contact Dr. Hanzlicek, endocrinologist in Brno and discuss the problem directly with him. E-mail: hanzlicek@jaggy.cz"

So, you now have the information of an endocrinologist in the Czech Republic and if I were you, I would contact him. He more then likely knows everything about diagnosing Cushings and the tests involved (and labs and calculating the cortisol/creatinine ratio, etc)

This is the absolute best I can do for you...

Saskia :)

[Squirt's Mom]

Hi Diana,

The boswellia and turmeric/golden paste should be fine and should not interfere with the testing. But I would start them one at a time so that way if there is a reaction you know which one is the problem.

Do you have a recipe for the golden paste? If not I'll be glad to share one.

[diana-sk]

ooooh thats perfect!! i visited dr hanzlicek with my beagle who, i think also had cushings...but we didnt know...it was few years ago... i ll call or write him sure! did dr rybnicek said this ccr test is used for diagnose? thanks i ll write more later i need to go now

[diana-sk]

Hi Diana,

The boswellia and turmeric/golden paste should be fine and should not interfere with the testing. But I would start them one at a time so that way if there is a reaction you know which one is the problem.

Do you have a recipe for the golden paste? If not I'll be glad to share one.

thanks for answer:) i already started slowly with small amount..as i didnt want to wait untill we will have the test /dont know how long it is going to last, so i wanted to start as soon as possible/
with gp i was told to start with 1/4 tps and slowly add more...
boswellia - i have cps /300mg/ and it is written to give 1-2 for adult human.. somewhere i read 100mg for dog,another articel said more... so i reallly dont know what is a dosage for it. do you?

and thanks i have GP from my friend who use it for her dogs:) she is a member of turmeric group on fb

[Squirt's Mom]

Here is the dose recommendation from Dr. Susan G. Wynne and Barbara J. Fougere in their text book, Veterinary Herbal Medicine:

*Dried herb: 25-500 mg/kg divided daily, optimally TID

*Standardized extract to 20% - 70% total organic acids or boswellic acids: 60mg/kg divided daily optimally TID

*Tincture: 1:2-1:5 - 2.5ml per 10kg (20lb) divided daily optimally TID and diluted or combined with other herbs

I don't use premade human herbal products for my dogs...or myself for that matter. I use whole fresh and dried plants so I can't help with human capsules and such. Sorry.

[diana-sk]

thanks a lot:) it seems i ll have to find out the dose for maffy.. 25-500mg per kg, so she will get 0,2 or 4g...its a diference.. i ll probably give something between:)

i like your way of giveing fresh:) but i dont have this oportunity..

btw do you feed raw food?

[diana-sk]

divided daily, optimally TID



what does TID mean? twice a day?

[dsbailey]

SID, also s.i.d., is a veterinary abbreviation meaning to give medication once a day. Medical professionals for humans instead use the term qd (an abbreviation for quaque die). However, that term can be easily mistaken with the term qid (an abbreviation for quarter in die), which means four times a day.
BID, also b.i.d. or BD, is a medical abbreviation for bis in die, meaning to give medication twice a day.
TID, also t.i.d., is a medical abbreviation for ter in die, meaning to give medication three times a day.
QID also q.i.d, is a medical abbreviation which means to give the medication four times a day.
PRN is a medical abbreviation for pro re nata, meaning to give medication as the situation demands or according to need.
Qxh or Qxd once every x hours or once every x days.

[Squirt's Mom]

I feed a dehydrated raw rabbit by Stella and Chewy - an American dog food company. When I can get it, I add some frozen raw rabbit. But I don't do the prey feeding using fresh raw meats. I'm not a proponent of raw feeding in general - it is a last resort for me. And it was in the case of the baby who eats the raw rabbit...this is the only thing that stopped her allergic reaction(s). ;)

Some of my fresh plant matter has come from the wild and some I grow either in pots, my yard, or little herb garden. There are those herbs I have to used dried tho and we have some good choices in the US for trustworthy herb houses. I know nothing about your country tho so I can't direct you to a good herb source. :(

[diana-sk]

hey, i m sorry i read your message now because i didnt get mail, there is a new message... thanks for it:)

i copy here what i already posted in fb cush group:
hello, maffy is going to have lddst tomorrow...i m so excited and stressed, worried....
i spoke to vets today and they told me i can feed her right after they inject dexamethasone... sounds strange, isnt it?
and anothere strange thing is they told me they need to do ultrasound to check which form of cs is it..so i asked why. they said because the treatment is not the same...so i thought they think about surgery in case of adrenal tumor...but they didnt...they thought about brain surgery!!!:o i was so suprised... i didnt know this is common..i said i m not going to agree with surgery. but they still wanted to do ultrasound so i again asked why...and again said treatment isnt the same and VETORYL IS VERY GOOD in adrenal cases but not for pituitary cushing... i never heard about it..
and when i told them maffy is 8kg/18pounds i think/ they said heer starting dose will be 30mg... isnt it too much?? how i can tell them i dont want to put her on such a hight dose??:rolleyes:

[Joan2517]

Just tell them, Diana...they can't do it if you don't want it.

Joan

[diana-sk]

You want to know where the tumour is located, pituitary or adrenals because it can make a difference in how you treat it. So that 3rd day urine is just as important as the others :)


here i foudn about what i asked /if 3th sample is necessary/ - http://www.dechrace.com/pdfs/vetoryl/VETORYLTreatmentMonitoringBrochure.pdf
they write about 2-3 morning samples without useing dexamethasone.

[SasAndYunah]

Hi Diana,

I am sorry but I am quite confused now :) If you are doing the lddst test with the dexamethasone injected then urine samples are of no concern anymore :)

Which vet did you go to? Dr Hanzlicek in Brno?

You can give the vet the Dechra pdf print out and show him/her the dosage advice of Dechra and they can even call Dechra if they want advice.

Good luck tomorrow,

Saskia.

[diana-sk]

hi, yes, i give up with a urine test:( there is noone /only this expert i spoke about/ who do it... i called to hanzlicek and he said he doesnt use it, he uses acth. i spoked with many vets and noone uses ccr:((

so today we are goin to have lddst.. i m so afraid, but dont want to wait more as i m not able to find someone for ccr test:(

[SasAndYunah]

Hi Diana,

wondering how the lddst test went? Hope all is well,

Saskia :)

[diana-sk]

hi:)
i m sorry i didnt find time to write here... i copy the post from fb group so you will find all info i get
today i got a call from vet - maffys lddst came back positive...it is probably PDH /fortunately she doesnt have any neurological problems so i believe in benig not growing microadenoma/. i ll have results tomorrow or today, so i ll post them.. i expected she has pdh, so i was "prepared" but now i m like...i want to cry... but lucky me i have this amazing group! thank to all of you!
i would like to ask.. i read it is cheaper to order vetoryl via internet... vet asked me if they can order for me or i would like to do it on my own.. so i said i ll try. and this is what i would like to ask you... how, where,.... acording to dechtra articles and your advices i need 10mg capsules /maffy is 8kg, so she will get it in two daily dosage - 20mg per day, with food, in same time../

actually she is on:
kelp
turmeric golden paste
cordyceps http://mushrooms4pets.com/cordyceps_plus/
petmin - lithothamnion fucus
dry ginger
boswellia serrata
colagen
msm
fish oil

can i continue with all of them... i mentioned it to vet before we do lddst and they said they ll check it and let me know if it is problem for lddst, but they didnt, so i hope it is ok with vetoryl too...

news: i got numbers from lddst: basal cortisol 240nmol/l /it seems to be quit constant in her as last 2 times during year she had 240 and 241/.... cortisol 4hours after dex 95nmol/l and 8hours after dex it was 388..

about conversation with i ll write later.. i told them i want 10+10 dosage as dechra also write about 2,2mg per kg...but the vet ignored it and wants 30mg morning.... i do not agree, but i like this vet so i dont want her to stop treat maffy...

today we have appt, so i ll see ...but i m not going to put her on 30mg once a day..

[labblab]

I agree with you about holding firm about not starting Maffy on any more than 20 mg. as a daily total, whether it be 20 mg. in the morning or 10 mg. twice daily. From both a safety and financial standpoint, that is the better way to go. As you already know from your reading, the newest recommendations are to start at a lower amount so as to minimize the risk of unwanted side effects. Plus, with the 10 mg. dosage strength, you have much more flexibility to raise or lower the dosage later on. If you buy only 30 mg. capsules and Maffy's dose ends up needing a smaller changer, those "big" capsules are no longer of use to you and it is money wasted. Here is a post that gives you specific references to show your vet about starting off with a lower dose.

http://www.k9cushings.com/forum/showthread.php?p=1251#post1251

As far as ordering your Vetoryl off the internet, yes we do have some reliable internet pharmacies here in the U.S. As far as ordering there in Europe, however, I do not know exactly how that works. Hopefully Saskia may be able to give you more advice in that regard.

Marianne

[SasAndYunah]

I'm afraid I am of no help about ordering Vetoryl of the internet. In The Netherlands prescription medication cannot be ordered from the internet because it cannot be send in the mail. At least, that's what I found when I did a search on it :) In Cukie's time, his Vetoryl was custommade by the university pharmacy since it wasn't even available here :) But eversince then, I have never heard anyone say they order prescription medications through the internet...it just doesn't happen here and is illegal.

Saskia :)

[diana-sk]

thank you both:) i already got 10 cps of 10mg vetoryl from vet /someone brought after the dog died/ and another 21cps of 10mg vetoryl are on the way.. i m going to vet pharmacy with prescription today and will order another capsules.../or should i wait if this size is going to work?? or maybe i can buy from pharmacy and until i wont open i can bring it back if there is any problem with the dosage...but it should be not i hope:)
how much do you pay for 60x10mg vetoryl? (or maybe 30x10mg)

[diana-sk]

can you please check the things she actually takes - if i can continue with it when i ll start vetoryl?
actually she is on:
kelp
turmeric golden paste
cordyceps http://mushrooms4pets.com/cordyceps_plus/
petmin - lithothamnion fucus
dry ginger
boswellia serrata
colagen
msm
fish oil

thanks

[diana-sk]

"Veterinarians should be aware that dogs with hyperadrenocorticism are at increased risk of pancreatitis. This risk may not diminish following treatment with trilostane." - does it mean not trilostan is causeing pancreatitis but cushings do? so i m not going to put her in risk of pancreatitis by useing vetoryl, but it is not going to rule it out if she is on vetoryl..right?

[diana-sk]

". It is particularly important to screen cases for primary hepatic disease and renal insufficiency as the product is contraindicated in these cases." how i can know if this is ok? we did several blod work during the time she has sympthomes... i already posted here and her last blood work is http://diana.rajce.idnes.cz/krv/#mafki3.11.2016.jpg - for others click on "krv"

" The product should be used with extreme caution in dogs with pre-existing anaemia as further reductions in packed-cell volume and haemoglobin may occur. " - please can you check this too? there is a hemologia blood work in the link i posted

"Signs associated with iatrogenic hypoadrenocorticism, including weakness, lethargy, anorexia, vomiting and diarrhoea may occur, particularly if monitoring is not adequate (see 4.9). Signs are generally reversible within a variable period following withdrawal of treatment. Acute Addisonian crisis (collapse) may also occur (see 4.10). Lethargy, vomiting, diarrhoea and anorexia have been seen in dogs treated with trilostane in the absence of evidence of hypoadrenocorticism.
There have been occasional isolated reports of adrenal necrosis in treated dogs which may result in hypoadrenocorticism.
" - how can i distingiush between addison crisis and desease?
- i was told about possibility of adrenal necrosis by my vet - it can happen occasionaly /rare cases/ and the dog will die... how is it? can i see the signs before and can i do something to stop it?

i read the link you posted now. in this link they say about doseing once a day... so this i m not going to show my vet, cause this is what she wants me to do - doseing once a day

[diana-sk]

as i wrote to cushing fb group: "i m going for holliday to cotage in wilage.. i need to take free days off.. to read and to find out the best plan for treatment and testing... as this place is far from our home and i have only 10x10mg of vetoryl /the 30x10mg i m going to order today, but i can pick them when i ll come back/ .. i supose to start next week either in cottage or wehn we come back home... i m going to call another vets if they can do the acth test if this my vet refuse to do...just to check if everything is going well... i save all documents you posted and i m going to read them again and make notice... so thanks for all instruction and i ll write when i m back on internet. keep fingers please:)"

see you later...

[diana-sk]

hello:) i would like to start with vetoryl on thuersday.
i have a few questions i already asked in fb cushing group... but i want to learn as much as possible so i decided to ask here too... i hope its ok:)
1. i dont know what blood test are named electrolytes /i ll study it soon, but we dont have internet her, i just went to restaurant for a while/ - - Do i need to check electrolytes before i start with vetoryl? What blood work should be done during treatment? Is it necessary to do electrolytes with each acth test so also with the first one?

2.My vet told me side efects /diarhea, lethargy, .../ can ocur in first 48h and they should disapear than – is this really normal or it is due to high doses?

3.- I was told it will least 1 week to get synacthen since they order it. So i need to call the vet 1 week before i want to do the acth test /first i need to make her agree to do it in 10-14 days too, not only on 28.day or find somebody else to do it/. What do you think – can i start maffy on vetoryl as i know they do not have synacthen so they cant do acth in case of emergency? I read it is necessary to do acth test if there is any complication with vetoryl showing to addison... but some countries /our too, but they can order from foreign/ dont have acth so do only electrolytes – is it enougth ?

4.I was told i can try to get synacthen from human doctors otherwise vet need to order it from other country and it need to be kept frozen during transport and it is expensive... i read it can be transported with temperature under 8 celsius degree what seems to be possible as we have winter here.. what is the truth?

5. If the vet uses synacthen for acth test how long after aplication should we wait to take blood sample? 1 or 2 hours?

6.- Trilostan being fat soluble so if the dog is on raw food diet and one of her daily meal is veggie with buckwheat should i add something fatty? olive, fish or coconut oil maybe? If i ll decide for BID dosing will it be better to feed meat morning and veggie evening?

7.- How do you give the vetoryl? In something? What happen if the dog will chew it and you are not sure how much of trilostan she ate?

8.- What do you use for liver support? Is there also natural product?

9.i m a little bit afraid of trilostan as i read warnings.... so i have a question - is ok when the dog on vetoryl kisses you? ok, strange question, but...:))))

[diana-sk]

http://diana.rajce.idnes.cz/krv/ - all maffys blood works

[diana-sk]

what benefits do you see in BID dosing instead of SID dosing with the same daily dose? i read a lot, most vets are for BID, but i also find this for example: "- Twice daily dosing may not allow time for adrenal recovery and excretion of physiologically necessary glucocorticoid and mineralocorticoid hormones in some dogs. The risk of developing hypoadrenocorticism may be greater; however, in dogs with clinical signs that are not controlled for an entire 24 hour period, twice daily dosing may be required."

[labblab]

Hi Diana,

I'm sorry nobody has yet had the chance to reply to your questions. It is wonderful that you are wanting to learn so much :), but I see that you have so many questions listed here that it may seem pretty overwhelming for any one person to try to answer them all :o. So that may be a reason why you are not yet getting replies. I will try to look them over and pick out some of the ones that seem most important to me to answer, and hopefully other folks will do the same. That way, slowly but surely, we'll be able to share information. ;)

So I will try to come back again either later on today or tomorrow.
Marianne

[molly muffin]

The value to BID dosing over once a day is that one may need a lower dose than once a day, and may be able to adjust say, more morning, less evening, etc.
BID is often recommended if you see symptoms rebounding in the evening.
My dog did fine on once a day dosing, so again it depends on the dog and how they are.

Fat soluable in that you just want there to be some fat content but doesn't have to be high when you give them the dose of medication. In fact, you do want lower fat and good quality protein and this is for any dog as any dog can get pancreatis.

I gave fish oil (omegas), milk thistle, sam-e, joint supplement to mine and she did well on that. I can't say for sure about the other items you mention and any interaction.

[tank&kat]

Hi Diana, it's Katherine from the fb group. I have been spending more time here lately so I apologize if I missed your questions in the other group. Hope this helps...

Maffy is starting with 20 mg SID, correct?

1. I dont know what blood test are named electrolytes /i ll study it soon, but we dont have internet her, i just went to restaurant for a while/ - - Do i need to check electrolytes before i start with vetoryl? What blood work should be done during treatment? Is it necessary to do electrolytes with each acth test so also with the first one? The electrolyte panel mainly consists of sodium, potassium, chloride, and calcium. Most vets run this test along with each ACTH monitoring test that is done while a dog is taking vetoryl. Abnormal levels can be life threatening (Addisonian crisis) and can cause symptoms such as vomiting, diarrhea, extreme lethargy and cardiac symptoms/distress. You don't need to check electrolytes before beginning treatment.

2. My vet told me side efects /diarhea, lethargy, .../ can ocur in first 48h and they should disapear than – is this really normal or it is due to high doses? Sometimes, yes. Stomach upset and mild lethargy can be side effects early in treatment that are not related to oversuppression and do not last long. If any diarrhea occurs, you still want to let the vet know asap.

3. I was told it will least 1 week to get synacthen since they order it. So i need to call the vet 1 week before i want to do the acth test /first i need to make her agree to do it in 10-14 days too, not only on 28.day or find somebody else to do it/. What do you think – can i start maffy on vetoryl as i know they do not have synacthen so they cant do acth in case of emergency? I read it is necessary to do acth test if there is any complication with vetoryl showing to addison... but some countries /our too, but they can order from foreign/ dont have acth so do only electrolytes – is it enougth ? Since the stimulating agent used for an ACTH test is not readily available, ask the vet for prednisone. If Maffy develops signs of hypoadrenocorticism or an Addisonian crisis, you can treat immediately with preds. If signs are recognized promptly (diarrhea, vomiting, lethargy, weakness) and she is given preds, the prognosis is good. Dogs typically recover within a couple of hours.

4. I was told i can try to get synacthen from human doctors otherwise vet need to order it from other country and it need to be kept frozen during transport and it is expensive... i read it can be transported with temperature under 8 celsius degree what seems to be possible as we have winter here.. what is the truth? 4 degrees celsius, that's correct.

5.If the vet uses synacthen for acth test how long after aplication should we wait to take blood sample? 1 or 2 hours? 1 hour http://www.ncbi.nlm.nih.gov/pubmed/17538749

6. Trilostan being fat soluble so if the dog is on raw food diet and one of her daily meal is veggie with buckwheat should i add something fatty? olive, fish or coconut oil maybe? If i ll decide for BID dosing will it be better to feed meat morning and veggie evening? If dosing once a day, feed meat meal when administering the pill (morning). If you decide to switch to twice daily dosing, try half meat, half veggie meals twice a day. I don't even know how much fat is in that type of diet but that approach makes sense.

7. How do you give the vetoryl? In something? What happen if the dog will chew it and you are not sure how much of trilostan she ate? Just watch her carefully the first few times. I always had to wrap Tank's pill in a small piece of ham. Worked perfectly. You can use cheese, pill pockets, anything that gets her to swallow it. Make sure she eats first before you give the pill. That way if she decides not to eat, you can withhold meds. Do not give this drug on an empty stomach.

8. What do you use for liver support? Is there also natural product? Denamarin is usually recommended.

9. I'm a little bit afraid of trilostan as i read warnings.... so i have a question - is ok when the dog on vetoryl kisses you? ok, strange question, but.. Absolutely.

[labblab]

Yay! Thanks to Sharlene and Kat for stepping in to help! They've done such a good job that I just have a few more thoughts to add ;).

First, you'd asked about pancreatitis. There is no risk in giving the Vetoryl. It is untreated Cushing's that may be linked with a higher risk, and apparently that is not even certain according to some newer research.

Secondly, if Maffy were to develop worrisome symptoms of low cortisol at a time when your vet does not have synacthen on hand, you can still check her sodium and potassium levels, as well as her resting (or "baseline") cortisol level. If the balance of sodium and potassium is normal and the resting cortisol is at a level above approx. 50 nmol/L (1.5 ug/dL), then you can feel much more confident that there is not a true crisis of low cortisol. But even under those circumstances, if Maffy were to appear unwell, I'd still discontinue the Vetoryl until she seemed to be normal again.

And lastly, to add my own thoughts about once vs. twice daily dosing...I think there are pros and cons about both approaches. But in honesty, if I were just starting out, I believe I'd prefer trying once daily dosing to begin with. At least for me, it is just so much easier to maintain a consistent dosing schedule if I'm only giving the med along with breakfast. If it appeared as though my dog's symptoms were rebounding during the evening or overnight, then I'd want to switch to giving the twice daily dosing a try. But for many dogs, the morning dose seems to be enough to keep symptoms controlled throughout an entire 24-hour period.

I know that many clinicians speculate that twice daily dosing may act as a better preventative against longterm internal damage because cortisol levels are kept consistently lower at all times. But I don't know that research has yet proven this to be true. And as you have already read, dogs being dosed twice daily may actually be at a greater risk of suffering from low cortisol during treatment. So as I say, I think there is a case to be made for both approaches, and if one or the other suits your daily routine better, that's how I'd prefer to start out.

Marianne

[diana-sk]

thank you all very much! i know it is dificult to answer so many questions......... i m sorry:) i hope it will be better if i ll see maffy is doing well and so i ll be less worry...I appreciate your help and do not want to waste your time.so thanks again, i read carfully. i know need to work with my vet to arrange everything in the best way. i hope i ll manage with your help too.
so tomorrow is the day d... bid or sid i hope i ll decide right..
lets say if i ll decide for one of it, can i change it to another later? do i need to do acth test than, or this is only necessary if we /with vet/ will change daily dosage?

[tank&kat]

I'm going to back to the basics on this one (I was overthinking it)... It would be better, in my opinion, to start with once a day dosing since many dogs do just fine with that regime. Then, if you still find that the cortisol is controlled but clinical symptoms are not, you should switch to twice a day dosing.

In my textbook, it does state that an ACTH should be done 14 days after any adjustment with vetoryl, including switching from once a day to twice a day administration. However, since that may not be possible for you, a baseline cortisol and Na/k ratio would be fine, as Marianne mentioned.

You don't have to apologize. I have an insatiable thirst for knowledge also and want to know everything there is to know about Cushing's. The only difference I guess is my dog was diagnosed a year and a half ago lol. I'll never stop wanting to learn!

~kAT

[diana-sk]

thank you again:) i m lucky you and others are so helpfull for every new member. i m happy i decided and i started with vetoryl today... i decided for once a day dosing and now i read you also think this is good for begining. so now i m not so much worry:) and i m so happy maffy doesnt have clinical signs as panting, drinking and peeing.. however i think it is starting now...she drinks more and also pee more often...so it was the right time to start with vetoryl..hope this will be under control soon... i cant and dont want to imagine every night panting what many of you have experienced... but it is good to know this also can be under control with vetoryl....

for how much do you buy your 10mg vetoryl?

[tank&kat]

I am happy that once a day dosing is where you will begin her treatment. The cost is different in certain places but I believe a 30 day supply of 10 mg would cost around $42 here in the U.S. That would be x2 if Maffy is starting on 20 mg so $84 per month is what it cost here. Has the vet given you an estimate yet?

~Kat

[diana-sk]

i paid 48e for 30cps of 10mg vetoryl..so it is for 15days... plus i got 10cps for free..so today i started the pack i bought, so i have for 14days ... i need to order new before i ll finish.. so expensive:(((

what do you think about buy "big" vetoryl and bring it to pharmacy so they can devide it to 10mg? is it good way or not so trustfull?

i found advertisement from people who used 10mg twice a day for their dog... pharmacy made for them from 30mg.. my friend already order it so i ll get it...but i didnt know it is compounded... so now i m afraid if i can use it or better not... or mabye use it after maffy will be ok on her 20mg dose..

[labblab]

My personal opinion is that when it is possible, it is always best to administer the medication in the dose in which it was originally packaged by the manufacturer. Whenever the capsules are opened and divided, you are always running the risk that the exact dose or effectiveness may be altered a bit.

However, a professional compounding pharmacist should be able to greatly minimize the risk. And for many people, the Vetoryl is just way too expensive to buy unless it is indeed compounded in some way. So if the choice is not to treat at all vs. a reliable compounder, I would definitely choose the compounder. However, if possible, I do think it's good to try to initially stabilize the dose while using the "official" product. So in Maffy's case, if you can stick with the original Vetoryl for at least the first month or six weeks, that would be great.

Marianne

[diana-sk]

" So in Maffy's case, if you can stick with the original Vetoryl for at least the first month or six weeks, that would be great.
"
thats good idea. i ll do this way.

[diana-sk]

hello from us:) maffy doesnt have any problem with vetoryl since she takes it, we did electrolytes on friday and it was all good, only chloride little low, but i was told she probably had it lower before treatment.

but i wanted to ask another think what makes me sad... it is half year ago since her front legs dont work well. she walk and put them like "X", she is not able to run and before she was runnig for hours... ok, she was and still is limping for 1,5year, we did xray and vet said it is osteoarthritis. but i think osteoarthritis and "x"walking is not one thing... maybe "x"walking can be caused by problem with ligaments due to cushings... what do you think? how can i help her? i would like to know morw about this problem, but i dont know what words i can search for... thanks for any help. if it can help i ll add xrays too

https://www.youtube.com/watch?v=062ILWhPSFg
https://www.youtube.com/watch?v=3Qma_Gq0HoU

[SasAndYunah]

Osteoartritis most definately can cause joint deformities, also in humans with severe osteoartritis for example the knee joint can deform to x-shape. So if the osteoartritis was officially diagnosed,it is very well possible to develop x-walk :) Since I suffer from poly osteoartritis, I know it is a very painful condition. So I hope Maffy gets good painmedication for her condition... Glad to hear the Vetoryl is going well :D

Saskia :)

[diana-sk]

hello here after time:)
maffy is doing good on vetoryl, drinking and peeing normal, hungry like ever:)- other signs changed, but she seems slowly, but very slowly becoming her old self. for example i saw her 3times lay /for few seconds only/ on her back..she didnt do it fo months and before she did it very often, and she seems to be more curious in things around her. but other side she looks weak and maybe slowly starting with muscle weaknes..i cant say now, as her OA makes it dificult to distinguish. she doesnt want to walk so i have to call her with treats to make her walk a little. when we are outside people use to say she looks sad and ask if she is old or whats wrong with her. it makes me really sad:( what can i do for her to be more vital and stronger with her legs?
if the dog is stable on vetoryl will all sympthoms caused by high level of cortisol go? i mean also muscle weakness... or it can develop no matter if the dog is on vetoryl?
she also gained weight , i think 0,5kg in last weeks... she is 8,5 and her normal weight should be around 7..
we already got synacthen /looked like mission impossible, but we got it/, so we will do acth test after she will be ok. now she is coughing... hope it wont last long, it is almoust 5 weeks now. we visited vet, did cardio and xray and everything is ok enought to be non-heartrelated. so we just need to wait.

if you can advice any treat or how to search for it i ll be happy to read about raw feeding or homecooked too. thanks

[SasAndYunah]

Hi Diana, I still do not know if Maffy is on any painmedication or not? Osteoarthritis is very painfull and high cortisol levels will mask the pain and consequences of it to some extent. With Maffy's cortisol level dropping, she will be in even more pain then before... I really urge you to consult with a vet and ask about painmedication for Maffy. Walking slow and looking sad... can all be signs of pain.

Saskia :)

[diana-sk]

yes i did ask, we spoke about to try acid hyaluronic and also rehabilitation with laser, but we didnt start as she is coughing yet. and she is on tumeric paste, msm, colagene, cordyceps now. so i would like to give a try to this first. and i m going to add sam-e which is a part of denamarin and acording studies if found to be same succesfull with oa as painkillers...
when she is walking for food at home she is fast, and home or outside with tail up.

[diana-sk]

hello from us after long time. unfortunately i cant say maffy is doing well:( she is coughing for almoust 4 months.. few weeks ago i was said she has chronic bronchopulmonary disease... i tried ventolin inhaler - didnt help, theoplus - didnt help, also i tried furosemide /however all vets we visited didnt find any fluid in lungs or abdomen. but, due to reaction of people i spoke to and show videos of her , i gave a try to it....first i asked vet and she said it can harm her and i can try... /- it didnt do any diference... and as she is not coughing during night now i m more sure it wonnt be fluid in lungs...
i dont know what more i can do...
does anyone have experience with it? would i give a try to corticoids inhaler?

[Squirt's Mom]

Hi Dianah,

My little Trinket has COPD and takes Theophylline and a cough med called Guaifenesin every day. She gets Theophylline AM and PM, and the Guaifenesin AM only. When her cough starts to sound wet, she also gets Lasix or Dandelion leaf. She does not get them all the time tho, only when/if her cough starts to sound wet. Losing weight has helped her as much as the meds. She is on the thin side but her breathing is much, much better than when she was a bit chunky. ;) I also have COPD and have gained weight and can really tell my breathing is worse since. So if Maffy has any weight she could dump, work on that if possible.

That's all I know to share but hope it helps!
Hugs,
Leslie and the gang

[diana-sk]

thank you very much for your replay. maffy is not fat, however since she has pot belly she has 2kilos more:(( dont know how to work on it:/ but i m going to do some changes into diet so maybe this will help.
she was on theplus /theophylline/ for 5 days circa, but it didnt make any diference...but maybe problem is in the dosage...she is 8,1-8,6kg and was on 1/2 of 100mg 2x a day (i think this is too small dose, but this was recomended by vet who has same size dog and is on same dose for one month and it helped her. by another vet we were recomended to give 1/2 tbl of 300mg, which, i think is too much...). what is your dog weight and dosage? how long did it last to see if it helps? do you think i should give it a try /maybe 100mg 2x daily would be idealy/ again?
i also gave a try to furosemide 1/4of 40mg 2x a day, but didnt make any diference...
when i thought about diuretics if im going to give it a try or not i also though about dandelion /but root/ - does it have same efect?? because if yes, than it is perfect, as this is naturaly...how much do you give?

[Squirt's Mom]

Trinket weighs 4 pounds and gets 25mg am and pm of Theophylline and 25 mg of the Guaifenesin once a day. I can't really tell you how soon the Theophylline started working on her because she had pneumonia that was very tough to get rid of when she was first diagnosed and started taking these meds. But I would give it 30 days before I gave up on it. ;) When she gets Lasix she gets 5 mg one to two times a day. If I use Dandelion she gets 1 ml 1-2 times a day of a water infusion. The recommended dose of water infusion per Veterinary Herbal Medicine is 1/4-1/2 cup per 10 kg body weight divided twice a day. That is based on an infusion of 5-30 grams of dried herb per cup of water. For Trink I use about 5 g per cup of water. I end up throwing most of it out. Water based herbs don't last long - One day is best, two at most. To make an infusion pour boiling water over the dried herb and let sit in the refrigerator over night, strain and use. Dried herbs can be given as well at the rate of 3-10 grams usually twice a day but can be used up to 6 times a day if needed. Bear in mind, herbs are NOT benign. Dandelion can cause toxicity in the kidneys just as Lasix can. This is why I don't use either of them all the time but only as needed. People think, "Oh it's natural so it's fine!"....Hemlock is also natural. ;)

[diana-sk]

if trinket is 4pounds /such a small:)/ and gets 50mg in daily total of theophyline, than maffy /8,1-8,6kg - around 19pounds/ would need 4-5 x more , so 200mg could be good to try in 2 daily dosage.. also i found this "dosage of theophylline for dogs is 4.5 to 6.8mg per pound by mouth every 12 hours" and so i think 100mg every 12hours can make a diference...if it is something what can helpher. ok, i ll give it a try again.. maybe 50mg twice daily was really low for her...but the vet used same for her dog and she got better on it... but i have nothing to loose, just hope this wont harm her...do you check for theophiline in blood?

[Squirt's Mom]

No her blood is not checked for the level of the drug in her system. Her vet has never suggested it and I've never asked for it. It helps her breath and that is all that really matters. Nothing I read about it recommends doing that either.

In the US, we don't typically determine the dose of meds we use ourselves - that is left up to the professionals. But I realize things are different where you are so if you decide to increase her dose I would do so slowly. Start at the lower end of the recommended dose then increase if needed. ;) Give her plenty of time on each dose to see if it will help. The cough med, the Gauifenesin, helps a great deal too so if you have that available ask her vet about it. It works to decrease the mucus buildup.

[diana-sk]

thanks again:) unfortunately i have many experiences with vets which made me to not trust them fully.. i m sorry... so i listen what they say and than consult it with others and with experienced people with same problem. as i mentioned - time ago one vet said give her 1/2 of 300mg tablet twice daily... few weeks after /i didnt start to give it to her this time/ another vet said give 1/2 of 100mg tablet twice a day... and i think this is diference... but i gave a try to this low dose....vet told me i should see in 5-7days...i didnt see any relief. now i try 100mg twice a day. /if i was told to give 150mg twice a day, than 100mg as less dose cant harm her more.../

i ll ask about the pill you mentioned

[diana-sk]

i read about Gauifenesin and cant understand how antitusive and expectorants can work together. the vet who diagnosted her with chronic bronchopulmonary disease, told me not to give antitusive and expectorants together, so now im confused what to do, but i ll ask about it.

[diana-sk]

dandelion - can i use dandelion roots instead of leafs? can i give it into food?

[Squirt's Mom]

Leaf is better for fluid movement. That is what my texts recommend. ;) I had the same question when I started using it and have both leaf and root but the leaf is what is best in this situation from my understanding.

I don't know the ins and outs of the different meds, I only know without the Guaifeneisin she gets a lot of mucous which causes her to cough more and usually ends up with pneumonia. And we don't want that any more! :)