My big boy Gable - sweet Gabe is now at peace [Archive] - Canine Cushing's Information and Support Forums

Joan2517

11-09-2016, 12:22 PM

I had Gabe , who is 7 years old, at the vet for blood work because I was worried about Cushing's, but the vet said the blood work came back perfect, except for low thyroid. Tested further on the thyroid and it came back low normal.

The only thing that showed as "high" was his Triglycerides and Urinalysis:

His Triglycerides were: 1129 ref. range: 29 - 291

Urinalysis: ph: 7.5 ref. range: 5.5 - 7.0
Protein: 1+

Does any of this mean anything?

For a while, Gable has been drinking a lot (this all started before Lena's diagnosis and where in fact, I first heard about Cushings). He had fur loss along his rump, and pees rivers, but never in the house. He pants constantly, but he's a big boy around 75 - 80 pounds. He's some lab mix, not really sure what else is in there. He has had episodes of vomiting and diarrhea, which also started before Lena died, but he has a sensitive stomach and sometimes swallows things whole. His teeth are fine. His stomach issues are a lot better now that we don't feed him anything new or give him treats that he might swallow.

As I've mentioned, since Lena died he has thrown up a couple of times, and his stool is almost always loose. After a few months of Melatonin, his fur has come back like puppy fur and he hasn't lost anymore. I still think that the fur loss was due to his rubbing against the boxwoods in the backyard.

Lately though he seems to drool a lot more. Even when he's lying on the floor, he now leaves wet marks from drool. His panting has always worried me, he breathes hard even when he's sleeping. The vet has listened to his heart and lungs and says they're fine.

I don't know...maybe I'm just being paranoid because of Lena; and I know he still misses her; he knows when I'm sad...but sometimes I feel like something is wrong. He doesn't eat his kibble as much as he used to, but will still beg for table food and snacks.

Thanks,
Joan

Harley PoMMom

11-09-2016, 09:00 PM

High elevations in the triglycerides is commonly found in dogs with hypothyroidism, I think I would probably have another thyroid panel done and sent to Dr Dodds.

Hugs, Lori

Joan2517

11-10-2016, 06:43 AM

Thanks, Lori....who and where is Dr. Dodds?

Harley PoMMom

11-10-2016, 10:31 AM

Dr. Jean Dodds is considered an expert in canine hypothyroidism and founder of Hemopet and Hemolife, here's a link to her bio: http://www.hemopet.org/education/jean-dodds-veterinarian.html

Hemolife is where the blood samples are sent, a bit of info regarding: "Hemolife is unique in routinely offering expert clinical interpretive diagnostic comments that take into account the age, sex, and breed type, and activity of the animal; this yields an expected normal reference range for an individual pet (termed the “Case Specific” range on our reports) that differs from the generic broad reference range for the species (termed “General Range” on our reports)."

http://www.hemopet.org/veterinary-diagnostic-laboratory.html

A few of our members have emailed her with questions and she responded rather quickly even if their vet did not use Hemolife for the diagnostic testing.

Joan2517

11-10-2016, 10:37 AM

Thanks, Lori~

lulusmom

11-10-2016, 12:14 PM

Hi Joan,

Can you look at the blood chemistry and tell me if it included T4? If so, can you post the result? A high fat diet can also cause elevations in triglycerides. Was Gable fasted for the blood test? Does Gable have a lot of carbs in his diet and was the urine specimen collected by free catch or cystocentesis, which is a needle through the abdomen directly into the bladder? Both a high carb diet and any foreign matter in the collection container can cause high PH.

Glynda

Joan2517

11-10-2016, 12:44 PM

He was not fasted and he does like to eat. I feed him Wellness CORE Grain-Free Original Formula, but he gets a lot of table food. My husband doesn't listen to me and feeds them whatever he's eating.

The first T-4 came back as 0.5 (LOW) ref. range: 0.8 - 3.5
they did it with a catheter

Then they used the same sample to test further and that came back 10 ref range: 8-40

lulusmom

11-10-2016, 02:26 PM

Hi again.

Thank you for the quick response. The second thyroid test from the same specimen would be the Free T4 which is well within the normal reference range. This is a much better hormone to assess as it is much less likely to be influenced by non thyroidal illness or drugs. If your vet isn't that concerned about a thyroid problem, that result is the reason why. As for the high triglycerides, an inflamed pancreas and low thyroid can increase trigyclerides so I'm wondering if Gable was having any GI issues when these labs were done and if Dr. Jean Dodds would consider a Free T4 of 10 pmol/L low enough to warrant possible supplementation. If not and Gable was acting and eating normally at the time of the test; no hemolysis was noted on the lab report and had it been a fasted specimen, a result of 1129 would definitely be looked at as Gable having hypertriglyceridemia/hyperlipidemia. If it were me, I would talk to the vet about the need to recheck triglycerides with a fasted specimen at some point in the future to rule out the aforementioned condition(s).

Glynda

Joan2517

11-10-2016, 02:43 PM

Thanks, Glynda...I think I took him because of the loose stool and he might have been throwing up. He has a sensitive stomach for such a big dog and does have a lot of stomach issues. I've had him to the vet many times for diarrhea and vomiting, and after being on this forum for the last 10 months, thought he might have pancreatitis.

He seems to have gotten older since Lena died and I worry about him. I don't know if he's still sad or if there is something wrong that we are missing.

tank&kat

11-12-2016, 07:25 PM

Hi Joan,

I have been following your thread form the beginning. So much good advice and I really hope Gable is ok. I don't know how long dogs grieve for but it could be possible your boy is still missing Lena. That is of course, if nothing can be explained medically. My sister's dog was very close to Tank. I have had to bring her to the vet once already and put a call in. Even expecting her to be grieving, there were a couple of times she just didn't look right and wasn't eating/abnormal stools.

With that said, it's hard to ignore that you noticed some of his symptoms before Lena passed. I'm sure that's why you're worried. I know you won't give up on him. He is in the best hands.

~Kat

Joan2517

11-13-2016, 07:56 AM

Thanks, Kat...I will have his thyroid levels checked again in a few months just to see if anything has changed. That's what my vet recommended. He seems better the last week or so. It's getting colder and he seems more comfortable, not panting so much. He loves the cold weather, especially when we get snow!

Joan2517

03-29-2017, 09:43 PM

I haven't posted in a while about my Gabe...I know I have expressed concern because of the amount of water he drinks and his panting, but I kept thinking that as long as he doesn't pee in the house, we're good.

This morning I let him out around 7:00am like I always do, but I didn't let him out before I left for work because my husband was home and I figured if he saw the back door was unlocked, that he would let them out before he left.

I came home from work a little late, and the first thing I noticed was that Cooper had pooped in the front room, which is not unusual if our neighbors have company or God forbid! there is something going on around the neighborhood!

Then as I went to let them out the back door I noticed pee on the floor and started to yell...until I saw how much there was and knew right away, it had to be Gable. He is always so upset when Cooper does it, so I knew he was devastated that it was him and I shut right up. It was like a river...the poor guy must've been in so much distress! It took me an hour to clean it all up and then another half an hour to get him to come in the house, no matter how many times I told him I wasn't mad at him.

I am petrified that he might have Cushing's...I just can't go through it again. I love my Gabe...next to Lena, he knows me so well. It will kill me if he has it...

I'm going to make an appointment and have his blood tested, again, to see if anything shows...maybe it is just hypothyroid or diabetes, or just that he wasn't let out before we left.

He's been glued to my side all night...he knows I'm worried, and I am...I can't stop crying, I keep thinking of my precious baby, Lee, and what we went through...

I can't do it again...

Budsters Mom

03-29-2017, 10:26 PM

You are not alone. That's one of my biggest fears. I worry about that too. The thought of possibly having to do it again terrifies me.:eek::eek::eek: It's been almost fours years since Buddy flew. I still miss him every day. I think we all go through some PTSD after losing one so precious and linked to our hearts.

Hugs,
Kathy

Joan2517

03-29-2017, 10:49 PM

It is PTSD, Kathy....and it scares the shit out of me! I keep thinking of Lena.

My Gabe is such a sweet boy. I only kept him after my son couldn't handle him after he rescued him from North Shore Animal League in Port Washington. He was such a challenge, but we got through it, and he turned out to be such a good boy. I love this guy! He was so good with Lee, and is so good with Sibbie, who can be a real pain in the ass...he is my big, beautiful boy.

I don't know what I will do if it is Cushing's. I am so afraid....

Budsters Mom

03-30-2017, 01:26 AM

Let's take this one step at a time. We are all afraid when we feel there is something off with our pups. All you know for now is that Gable had an accident in the house. That can be caused by many things, including missing a trip outside. As easy as it is for our minds to instantly go to Cushings, try to focus on what you know for now and breathe - Long, slow breaths. You are taking him in for bloodwork as a precaution, so please try not to panic.

Kathy

I don't know what I will do if it is Cushing's. I am so afraid....

molly muffin

03-30-2017, 07:33 AM

Did your hubby miss taking Gabe out? Maybe it isn't anything worrying, as Kathy said. Don't panic yet.

Joan2517

03-30-2017, 08:07 AM

He said he left right behind me, so he didn't think he had to let them all out. I usually do it one more time before I leave, but I was late and scrambling.

But he drinks sooo much water, Sharlene. I have two big bowls down, they are about two quarts each. He has his favorite one, I don't know why as they are exactly the same, and I fill his up at least 3 times every day.

He's losing his hair on his rump again...maybe I'll start with the Melatonin, that seemed to work last year with the hair loss.

I'm staying home today and will see if I can get him an appointment at the vet.

DoxieMama

03-30-2017, 08:14 AM

Breathe, Joan, breathe. You're doing the right thing by taking him in, that way you'll know if there is anything that needs to be addressed - and what to do about it. Let us know what you find out and we'll be here every step of the way.

Joan2517

03-30-2017, 10:32 AM

Well, I can't get an appointment with my favorite vet until Saturday morning...the other one will just try to make money off of me, by wanting to do tests he may not need.

I've filled his water bowl twice already and it's only 10:30.

Squirt's Mom

03-30-2017, 11:11 AM

Take it easy, sweetie. You are doing the right thing and that is all any of us can do under any circumstance. You are getting him to the vet plus reaching out here and letting us help you and Gable to boot - always the sure sign of a great mom. Regardless of what you learn, you WILL be able to handle it because you are not alone. Odds are, he simply didn't get the chance to go out this morning so he had a bladder full and just had to go! ;)

btw....I think a GREAT many of us here have PTSD when it comes to our babies after losing one with Cushing's even if the loss wasn't related to this disease. Every time one of mine get a hair that goes wonky I panic! :D Did I ever tell you about the time I "diagnosed" Squirt with breast cancer? I felt knots where her breasts were one nite about 10PM and by 8AM I was a basket case just SURE she had breast cancer on top of Cushing's. I got her into the vet that morning and he examined her very well while I stood there and sobbed hysterically. Then he looked across the exam table at me and said, "Those are her boobies, you boob!" :eek::D:o:rolleyes::D She had lost weight and I could feel them for the first time in YEARS! :p:p:p:p

So just breath and let us know what you learn....and never forget we are right by your side.

Joan2517

03-30-2017, 01:22 PM

Lol, Leslie! My husband did the same thing with our Chihuahua, Doree. That was when he was he was told he should get her fixed for like the millionth time. She was 11 when he finally agreed.

I know I am probably overreacting, but he drinks loads, pees loads and I don't know how he holds it in all day...maybe yesterday was just too long since he wasn't let out again after 7am, and I got home late. He still needs his thyroid level checked since it was off back in November and my vet said we should check it again in 6 months.

So, that's the plan for now...and I will try not to panic.

molly muffin

03-30-2017, 01:37 PM

Thyroid can cause the same symptoms as cushings, so it's possible the thyroid is still off. So IF there is something going on, that is the first thing I'd want checked based on prior testing, but you know, if I haven't gone since early morning and had to hold all day, we'd be in a world of hurt too. ROFL!!!
I'm leaning towards that and thyroid based on what you have told us about Gabe. Big boy have big bladders. Big girls too, lord when my golden lost it in the house, i thought a pipe had broken somewhere!!!

judymaggie

03-30-2017, 02:17 PM

Joan2517

03-30-2017, 04:20 PM

Joan2517

03-30-2017, 04:27 PM

Joan -- my Abbie had two accidents recently in the house and it turned out to be a UTI. Two weeks of antibiotics and no more accidents. As others have said, just take it one step at a time!

Also, I wanted you to know that Abbie is my second Cush pup. My first, a beagle named Maggie, was very, very ill the last two years of her life. I waited a little less than a year after her passing (at the age of 13) to adopt Abbie who was 7 at the time. Fast forward a few years and Abbie was diagnosed with Cushing's. Did I want another dog to get Cushing's? No. Do I regret adopting Abbie? Absolutely not. Because of this forum, I was so much better prepared to deal with Abbie's situation and I knew that the best place for me was right here.

Thanks, Judy...I am hoping for hypothyroid, but he's my boy and we'll deal with whatever it is. It's weird because the first time I heard of Cushing's was when I brought him in a couple of years ago for diarrhea and the vet noticed his hair loss on his lower back, but nothing showed in the blood work then. Lena must've had it at the time, but I didn't look it up, or I would've known that she had all the symptoms.

Joan2517

03-31-2017, 07:57 PM

I left work a little early today because I had to bring some work to my boss's house, rushed to pick up Sibbie at my husband's office, sped home so as not to leave Gable too long...and everything was fine. Cooper had peed where Gabe had let loose the other day, but I can handle that.

He was so happy to see me and when he went outside, in the pouring rain which he hates, he stood there with his leg up and peed for at least 3 minutes...the poor guy. It seems pretty dilute to me.

In all the worrying about him, and getting an appointment first thing tomorrow morning, I completely forgot that I was supposed to go to an Easter Pancake Breakfast with my daughter and grandsons tomorrow! Jess is mad at me, I think...but I've done this breakfast thing for probably 6 years and Gable is my priority right now. I have to find out what's wrong. He's sleeping at my feet right now, and he's very gassy...pew!

I might still make the Easter Egg hunt if we don't take too long at the vet.

I sure do hate missing that $5.00 breakfast of pancakes, eggs bacon and sausage, though...

Joan2517

04-03-2017, 06:55 PM

So it looks like hypothyroid...

results:

ALK Phosphatase 328
ref range 5 - 131

Triglycerides 714
ref range 29 - 291

labblab

04-03-2017, 08:12 PM

Hey Joan, when you say it looks like hypothyroid, did Gable have a low T4 result? That's the result that would be specific to hypothyroidism. I don't mean to alarm you, but elevated ALKP and triglycerides can also be associated with Cushing's. :o

Marianne

Whiskey's Mom

04-03-2017, 10:06 PM

Joan2517

04-03-2017, 10:52 PM

Joan2517

04-03-2017, 10:55 PM

Oh Joan, sorry I don't usually read these posts so I didn't realize all this was happening to poor Gable! And poor you :eek: gosh I hope you get to the bottom of all this soon. And if it is Cushings, everyone is here by your side supporting you. Plus you have so much knowledge about this and will be a great advocate for Gable. Huge hugs and love to you all.
Annie

I'm not really, Annie...I still don't know what it all means. We'll try the meds and see if it works. My cute vet thinks it is just this, but did say that if he doesn't start to improve, we will go further. He knows what i'm afraid of...

labblab

04-04-2017, 07:27 AM

What was Gable's T4 on this new panel, and how far out of range was it?

From looking back in your thread, I see that Glynda talked earlier about the difference between a regular T4 and free T4 analysis. Do you know which T4 level was tested this time around? It might be worth the effort to have an advanced, complete thyroid panel performed before you start thyroid supplementation. I know some folks here favor using Dr. Jean Dodds; I personally favor using a specialized service such as Michigan State University's vet school lab. But either way, an advanced panel may indicate whether a low T4 reading is associated with primary hypothyroidism, or whether it is likely secondary to some other condition (such as Cushing's), for which you might want to keep pursuing some additional diagnostics right now.

I know the prospect of Cushing's is so very scary for you. But I suspect that, in the back of your mind, you're going to continue to worry about it anyway :o. So perhaps it would be better to go ahead and pursue a more definitive diagnosis now, so that you can truly put together the very best treatment plan for Gable.

Marianne

Joan2517

04-04-2017, 07:45 AM

The first part of the test showed low, I can't remember what he said, but it was lower than the last time when it was low normal. I'll call them and have them send that to me. He said we'd wait for the second part of the test to come back with the other values, and the ones I posted were the only ones out of range.

I think that for now, Marianne, I am just going to treat him for this and see if he gets better. Dr. Cutie did say that we would look further if he doesn't respond. He hasn't peed in the house since that day, so it could've been a combination of not going out again before I left and me being late.

I can deal with hypothyroidism...my husband and I both had Thyroid Cancer, had our thyroids removed, and take Synthroid.
Must be a family trait...

labblab

04-04-2017, 09:14 AM

OK, Joan. We'll surely hope you'll see improvement, then, with the thyroid supplementation. In good conscience, though, I need to point out that excessive thirst and urination are not typical of hypothyroidism. In fact, in terms of thyroid function, it's the reverse: hyperthyroidism is associated with elevated thirst/urination.

I'm particularly sensitive to this issue because my own Cushpup, Barkis, was initially misdiagnosed for several months as simply being hypothyroid. He suffered from significant hair thinning on his flanks and haunches (which could have been just thyroid), but also from excessive thirst and urination (which I now know was not likely to be thyroid). Also, unlike hypothyroid dogs who are cold and seek out warm spots, my Barkis was always panting and seeking out cool spots. We ended up seeing a specialist for a liver biopsy due to his chronically elevated ALKP, but as soon as the IMS heard my description of his symptoms, he cancelled the biopsy and instead tested for Cushing's. After that, it became clear that Cushing's was the central diagnosis, and the low thyroid reading was likely just a consequence.

So if Gable's excessive thirst doesn't resolve or even worsens with supplementation, I do think you'd need to look beyond the thyroid. Please, please bear in mind that even if Gable were to have Cushing's, his situation is probably quite different from Lena's. She was an elderly dog who suffered from heart and respiratory issues that may not even have been related to the Cushing's at all. Plus, her Cushing's was due to an adrenal tumor (as opposed to the more common pituitary tumor) and that may also have complicated the overall picture for her. If Gable were to have Cushing's, he would be traveling his own treatment path, with every reason to believe that his cortisol could be effectively controlled and his behavior and appearance normalized.

But I realize I'm putting the cart ahead of the horse! So we can just table this conversation, and only return to it if we need to (which hopefully we won't!).

Joan2517

04-04-2017, 09:50 AM

Thanks, Marianne...The T4 numbers were on the bottom of the page and I didn't notice them. I'll keep paying attention to his drinking...

T4: 0.5, ref range 0.8 - 3.5

T4: (Equilibrium Dialysis) 6, ref range 8 - 40

labblab

04-04-2017, 12:32 PM

I know I said I was shelving my discussion, but I do want to mention one more thing. Once you start thyroid supplementation, any further thyroid diagnostics will be skewed. So if you did have any interest at all in having an extended thyroid panel done, you ought to have the blood drawn for that now. Otherwise, you have to wait until supplementation has been halted for about six weeks or so before you could accurately assess native thyroid function again.

This info may not have any bearing on your own decision right now, especially since it looks as though Gable's T4 was re-analyzed using equilibrium dialysis. But I just wanted to add it for other readers who may be following this thread and are considering thyroid testing for their own dogs.

Joan2517

08-05-2017, 04:46 PM

Gable is going for the LDDST test on Monday. Even though his thyroid levels are normal after being on Soloxine for a few months, he's still drinking/peeing a lot. No more accidents in the house after that one time, but his panting has increased to the point where it is unbearable to watch. So, i am biting the bullet and having him tested.

They said he can have a light breakfast. I just want to check with all of you to make sure that is okay.

Harley PoMMom

08-05-2017, 06:00 PM

With the LDDS test, fasting is usually preferred, however if this makes Gable have undue stress than a light breakfast should be ok. Wishing you both luck with the testing and let us know how it goes.

Hugs, Lori

Joan2517

08-05-2017, 06:26 PM

Thanks, Lori. I thought I had remembered something about fasting. I might just give him a little something with his Soloxine.

Joan2517

08-08-2017, 01:58 PM

Gabe's results are in and according to the vet, no Cushing's. I put his blood work in his album, but here they are anyway.

Sample 1: 4.2 ref range: 1.0 - 5.0
Sample 2 Dex: 0.8 ref range: 0.0 - 1.4
Sample 3 Dex: 1.3 ref range: 0.0 - 1.4

What do you think?

He even called their Internal Medicine guy because he was worried about the closeness of Sample 3, but was told that was okay.

The IMS thinks that the panting could be from Pulmonary Hypertension. We'll take an x-ray next, but I'm wondering if it could be Pancreatitis.

Joan2517

08-09-2017, 11:41 AM

Any thoughts on Gable's blood work? Next steps?

DoxieMama

08-09-2017, 02:39 PM

Do you have the results of the other bloodwork that was done? Thyroid numbers... etc etc. I'm assuming a UTI was ruled out, as well as diabetes. An xray might help but hopefully one of the other more knowledgeable folks will see this and pop in soon.

Shana

labblab

08-09-2017, 03:08 PM

Gosh Joan, I'm afraid I don't have any great suggestions since the LDDS was negative. If you wanted to spend the money :o, I suppose you could advance to an ACTH since there is a small percentage of Cushpups that test negative on the LDDS even though Cushing's is present. However, I don't know whether you'd want to take that additional step or not.

Are all of Gable's kidney and liver results within normal range? If so, I guess the only thing I still wonder about is whether he could possibly be oversupplemented with the soloxine, since excessive thirst/urination/panting can be associated with hyperthyroidism...

Marianne

Joan2517

08-09-2017, 03:09 PM

Yep, all that was ruled out...these are the thyroid results from the 1st test and we put him on soloxine.

T4: 0.5, ref range 0.8 - 3.5

T4: (Equilibrium Dialysis) 6, ref range 8 - 40

The second test he was still low, so we increased the soloxine.

The last one came back where it should be.

labblab

08-09-2017, 05:13 PM

Well, I truly am stumped. I can't remember whether you had a full thyroid panel performed prior to starting the soloxine, or at least enough of a comprehensive panel to point to whether Gable's hypothyroidism looks to be a primary disorder or instead secondary to another condition. I think the TSH level factors into that, and I also think that Antech may have included that on an earlier comprehensive Chemistry panel. At any rate, if it's available, that may be a useful piece of info: whether or not there is some other condition that underlies the hypothyroidism. If so, that may make it seem as though advancing to an ACTH might be more worthwhile, especially since Gable's 8-hour LDDS reading was so close to the diagnostic cut-off.

When interpreting LDDS test results, first evaluate the eight-hour post-dexamethasone administration cortisol concentration. If it is above the reference range, the dog probably has hyperadrenocorticism (false positive results may occur in dogs with nonadrenal illness). If it is within the reference range, either the dog does not have hyperadrenocorticism or there is a 5% to 10% chance that the dog has PDH. (The dog may have early pituitary disease and the pituitary gland is still responding to a pharmacologic dose of dexamethasone by decreasing ACTH production, thereby reducing serum cortisol concentrations.) In those cases, an ACTH stimulation test is warranted.

Joan2517

08-09-2017, 06:46 PM

Harley PoMMom

08-11-2017, 08:11 PM

Has an UTI been ruled out? Also, how about kidney or bladder stones?

Joan2517

08-12-2017, 07:11 AM

What tests would we do to diagnose those? Would they show up on an x-ray?

Squirt's Mom

08-14-2017, 10:09 AM

When my Crys had urinary crystals seems like they showed up in the urine. For larger stones I would think either an xray or ultrasound would be needed to see them since they are internal and don't pass in the urine as easily as the crystals can.

Joan2517

08-14-2017, 10:12 AM

Thanks, Leslie~

Harley PoMMom

08-14-2017, 01:42 PM

With my boy, Bear, those stones showed up with an x ray and also in an ultrasound.

Joan2517

03-11-2018, 09:09 AM

Gable's panting is worse than ever and he pees for about 3 - 5 minutes when I get home from work. How he holds that in all day astounds me. I think I will have them do the ACTH test. Or do you think an ultrasound might reveal more? I start working in the city tomorrow and can't bear the thought of him having to hold it in, or go in the house, if the trains aren't running on time.

Since he's not on Vetoryl, do I need to do anything in particular before he gets tested if I go for the ACTH?

Squirt's Mom

03-11-2018, 01:00 PM

I'm assuming he was checked for crystals in the urine and that a UTI has been ruled out? If he hasn't had a wellness check recently (showing BUN, ALP, T4, etc) I would want that done before the ACTH. If any urinary issues are ruled out and things like hypothyroidism, then I would opt for the ultrasound before the ACTH. The US give us the biggest bang for the buck because it shows most of the organs and can pick up things like nodules, enlargements, tumors, etc. Remember - the ACTH can be elevated simply because the dog is stressed going to the vet or riding in a car....or because of the presence of a tumor. So I would opt for the US first myself...after you are sure there is no UTI or crystals present.

Hope you enjoy your new workplace but am sorry you have to be gone from home so much.
Hugs,
Leslie

labblab

03-11-2018, 05:38 PM

Hi Joan, is Gable still taking his thyroid supplementation and has that level recently been checked? If you do decide to proceed with the ACTH, I’m not aware of anything special that needs to be done on test day. You can check with the vet to see if he/she prefers that Gable is fasted. Since this is not a monitoring test for Vetoryl, a fasted sample is fine if that’s what the vet prefers (and if other blood work will be done at the same time).

As Leslie says, an ultrasound can always supply a range of useful info, however. Since Gable previously tested negative on the LDDS, an ultrasound might actually be a good place to start in order to see whether there’s anything else amiss that might account for these symptoms. But I can’t argue with an ACTH, either. I believe that his LDDS result would imply that if Gable does turn out to have Cushing’s, it would be pituitary in origin. But you still may end up wanting to do an ultrasound, regardless of the ACTH result. So either way, you may end up doing both tests in whichever order suits you best.

How’s that for a totally wishy-washy reply??? Sorry to be so noncommittal. And especially, I’m sorry that you have anything to be worrying about right now. I know how stressful it is to have to worry about traffic or travel time interfering with getting home in a timely fashion. That’s a lot of stress for you to shoulder every working day :-(((((((.

Joan2517

03-11-2018, 07:35 PM

Thanks, Marianne and Leslie. He is still on the thyroid meds. He will need bloodwork to remew his meds. I am so convinced it is Cushing's. And yes, I could be just paranoid. I don't know what to do!! The panting, drinking and peeing makes me nuts! I don't want him to be uncomfortable. He is such a good boy...to pee in the house upsets him so much. He doesn't even lift his leg; he just spreads his legs and pees when he can't hold it in anymore.

How much more money, and how many more tests do I have to do to confirm Cushing's?? Next to Lee, he's my darling...what should I do??

labblab

03-11-2018, 10:03 PM

After looking back through your entire thread once again, I believe I would go ahead and perform bloodwork — including the ACTH — at this point in time. I’m reminded that Gable previously exhibited elevations in ALKP and triglycerides along with his low thyroid. All three of these findings can occur in conjunction with Cushing’s. Since Gable is also due for monitoring of his thyroid supplementation, I believe I’d want a repeat of his blood chemistries and cell counts. I’d be curious to see whether his ALKP and triglycerides have changed, and I’d also want to see whether there are any new abnormalities.

As Leslie has suggested, it might be useful to first review the basic blood panels before moving forward. But if you’d prefer to gather all the info at once, I’m assuming sufficient blood could be drawn to perform these general panels at the same time as the baseline draw for the ACTH. Then the ACTH stimulation agent could be injected and that test subsequently completed an hour later.

It is true that the ACTH can return a false positive when an animal’s body is sufficiently stressed by another illness or disorder. But the estimate of “specificity” for the ACTH ranges between 86-93%. A statistics expert can interpret this more accurately than I can, but I believe this means that 86-93% of the positive results on this test are truly caused by Cushing’s as opposed to something else. So this means that a positive result on this test is generally pretty trustworthy, and would be helpful info to consider in conjunction with Gable’s previous LDDS. If he were my boy, this is probably how I’d proceed since his symptoms have continued unabated for quite some time now.

In the meantime, I wonder if there’s any place in your home where you might be able to put down pee pads for Gable to use if he needs to relieve himself while you’re away? I definitely realize we’re talking about a LOT of urine from a big dog. I’ve only used pee pads for puppies, so I don’t know if this would be any sort of reasonable option at all. But just thought I’d throw that idea out there, or maybe other folks will have some better suggestions to offer out...

Joan2517

03-12-2018, 07:21 AM

We had pee pads down before. When Lena had it, then we kept them down because of Sibbie. I've been trying for the past few months to stop using them. I was off all last week and we finally got Sibbles to let us know she had to go out, so wee wee pads haven't been down all week.

But now that I have to work in the city, I may have to put them down again which really pisses me off. The two times Gabe peed in the house, one was on a runner by the back door, and the next time was on the wee wee pads, so he did try. But the problem is Cooper. He will mark wherever Gable or the girls go and he doesn't always hit the pads. He will lift his leg and pee on whatever is around, or go in another room and try to hide it. It's so frustrating! I'm used to coming home to Cooper's mess and having to clean that up, but I will be exhausted commuting back and forth into the city and have to spend the first hour doing that.

My husband and I were even thinking of keeping the greenhouse open when the weather gets warmer and leaving both boys outside, but Cooper is a nuisance barker and I'm sure the neighbors will complain. Now the Trazadone is not working either. We've tried Prozac, Elavil, and now the Trazadone. I'm thinking of trying the CBD oil. I just bought a big bottle of Hemp Oil for dogs to see if that would calm him down, but not sure if I should wait until I wean him off of the Trazadone first. I'll have to ask my vet. It must make Gable so uncomfortable when Cooper lets loose and he has to hold it in until I get home.

I'll take him for the bloodwork this weekend and see what we're looking at.

Thanks for all the advice...have to run! Got a train to catch! UGH!

molly muffin

03-12-2018, 09:07 PM

Oh my goodness Joan. What a time you are having and sounds like it's pee city at your house these days.

I'd get the full bloodwork done and ACTH and just check him out, also a urinalysis to check for crystals and infection.
It's a starting point any way and you'd need to check thyroid levels before new meds anyhow. It could just be the thryoid is acting up, or it could be something else.

At least it's a starting point. We've had other say that CBD oil, helped calm their dogs. Isn't Chance the golden on that too?

Joan2517

03-13-2018, 08:14 AM

Yes, that's what made me think of it when I saw that Chance was on it. When I bring Gabe in for his bloodwork, I'll ask about the CBD oil for Coop. I found some meds for Cooper that we had tried way back in 2012, so this has been ongoing.

Harley PoMMom

03-13-2018, 11:26 AM

I wonder if a doggie diaper may help. After a quick search I found a particular diaper made for a large dog.

https://www.amazon.com/SnuggEase-Washable-Dog-Diaper-3X-Large/dp/B001VIWOQ8/ref=br_lf_m_y5umnhekvn6t88k_ttl?_encoding=UTF8&s=pet-supplies

Found this too: http://www.tinkletrousers.com/?gclid=EAIaIQobChMI977Sxszp2QIVRQOGCh0V1gAbEAMYASA AEgJGkfD_BwE

Joan2517

03-13-2018, 01:50 PM

He hasn't peed in the house except those two times, once when i was late and the other I'm sure my husband didn't let him out before he left for work. And with Cooper, forget the diapers...he managed to get out of the ones I got for him even with the underpants that went with them!

I'm going to have Gabe tested again with all of your concerns mixed in with mine and talk to them about the CBD oil for Cooper probably this weekend.

Joan2517

03-30-2018, 12:02 PM

Okay, we didn't do the ACTH test, but here are his results from regular blood work from a couple of weeks ago. Just the Highs. His thyroid was still low, so we raised the dosage. He did more blood work today to make sure it's not too much. Gable was up all night with bloody diarrhea and threw up bile twice. I brought him a stool sample, checking it for giardia. Gable hasn't had a normal poop in so long that I can't remember the last time it was normal. I'm thinking he has pancreatitis. That could explain all the gastro issues.

Superchem
Alk Phosphatase: 572 / ref range: 5 -131
Total Bilirubin: 0.4 / ref range: 0.1 - 0.3
Magnesium: 2.6 / ref range: 1.5 - 2.5
Triglycerides: 732 / ref range: 29 - 291
PrecisionPSL: 179 / ref range: 24 - 140

Complete Blood Count
Platelet Count: 491 / ref range: 170 - 400
Neutrophils: 11234 / ref range: 2060 - 10600

Thyroid was 1.2 / ref range: 2.5 - 6.0

Thoughts?

Harley PoMMom

03-31-2018, 12:22 AM

labblab

03-31-2018, 06:36 AM

In terms of the acute issues, yup, pancreatitis sure seems like a consideration.

In terms of the other lab abnormalities, I’m afraid several are consistent with Cushing’s: elevated ALKP, platelets, neutrophils, and triglycerides; ongoing low thyroid. Now, at least a couple of them could probably also be caused by pancreatitis as well — I just don’t know about that. But in the absence of the pancreatitis, I’m afraid I would think these abnormalities would warrant moving onward with a more specific Cushing’s test. How about his urine? Was that analyzed by chance?

Joan2517

03-31-2018, 07:15 AM

Pancreatitis could definitely be a possibility considering the elevated PrecisionPSL, triglycerides and taking in account of the vomiting episode and diarrhea. Small and several meals being fed throughout the day is recommended for pancreatitis, starting off with a bland diet is usually required too. Does his diarrhea have an organish color?

Not orange, but kind of tan...I'm not home all day and even though sometimes kibble is still left over from breakfast, no one seems to eat all day. I feed them Wellness grain free original, sometimes with the freeze-dried turkey bits.

Joan2517

03-31-2018, 07:18 AM

labblab

03-31-2018, 08:29 AM

In terms of urine, it would be good to rule out any urinary tract infections and also to check the specific gravity and see how dilute it is. As far as a diagnostic ACTH, it’s fine for a dog to be fasted if that’s what the vet prefers. Of course the LDDS is the other option, and I don’t know whether you’d prefer to do a LDDS or not. Everything being equal, most clinicians view the LDDS as the diagnostic gold standard. But it’s always kind of a toss-up in my own mind. The LDDS returns fewer false negatives, so you’d be less likely to “miss” making the diagnosis if Gable truly has Cushing’s. Plus, it may help distinguish between pituitary and adrenal versions. But if the ACTH is positive and you move on to treatment, it’s really nice to have that initial stimulated cortisol result to use as a baseline against which to judge treatment effectiveness. So each test had it’s own pros and cons. Of course, either way you’ll want him to first recover from any acute illness.

Joan2517

03-31-2018, 08:38 AM

labblab

03-31-2018, 08:40 AM

Duh! I’d completely forgotten about the LDDS — so sorry!

Harley PoMMom

04-03-2018, 11:31 AM

Not orange, but kind of tan...I'm not home all day and even though sometimes kibble is still left over from breakfast, no one seems to eat all day. I feed them Wellness grain free original, sometimes with the freeze-dried turkey bits.

Not orange is good! Has he been eating this food for a while? And if so, I wonder if they changed the ingredients in that food, as these manufactures can do that with dog food without notifying the public. :mad:

Joan2517

04-03-2018, 12:44 PM

Not orange is good! Has he been eating this food for a while? And if so, I wonder if they changed the ingredients in that food, as these manufactures can do that with dog food without notifying the public. :mad:

Funny you should say that. I told my vet Saturday what brand i feed them and he said a dog with a sensitive stomach would get soft stool from the Wellness, which he wouldn't recommend anyway, that I've been feeding them for years. Vet told me to get Science Diet w/d and the urge to go seems to have stopped, he doesn't seem as agitated and is sleeping better. But of course the others want it too and I've tried to keep them from eating it, but they still managed to get some and now the little girls are pooping out rocks!

Harley PoMMom

04-05-2018, 04:14 PM

So glad that the new food is working for him, how are his stools?

Joan2517

04-05-2018, 06:46 PM

So much better the past few days. This morning I wasn't paying attention and I had put the other food down for the rest of them before I put the new food down for him and he was busy eating it. Soft poop was back...so it is the food. Picking up normal poop really is so much better! :)

Squirt's Mom

04-06-2018, 08:59 AM

It's so nice to finally have a solid clue for what is going on, huh? :) I hope the new food continues to work well for your sweet boy!

Joan2517

04-06-2018, 10:21 AM

Thank you all for your advice and thoughts. Next step will be the ACTH as soon as I can afford it, financially and emotionally!

molly muffin

04-07-2018, 10:14 PM

Joan2517

04-08-2018, 08:13 AM

Excellent detective work to find out what the cause of the soft stools was. If only there was something that they could All eat, so you didn't have to buy two brand and try to keep Gabe out of the girls food. Nothing is ever easy eh. :)

I know, Sharlene! I have to stand guard while he eats it! I let the others have a piece of two so they don't feel left out. The Wellness has been fine for the rest of them and I'm a little leery of changing their's. Every time I have tried something new, Doree gets diarrhea. She's the oldest (14 or 15) and I always go back to the Wellness. Maybe I'll try one of the other Science Diets to see if she can tolerate that.

He's still drinking like crazy, but hasn't let loose in the house while I'm at work...I don't know how he does it! The panting is still worrisome. I can't believe how much he's aged in the two years since Lena's been gone. Cooper is the same age, and you'd never know it.

Budsters Mom

04-09-2018, 10:16 PM

Joan2517

04-10-2018, 06:40 AM

It's very hard having dogs on different feed for dietary/medical reasons. You can't ever leave food down and have to feed separately, which is hard for working parents. I have had the same challenge when caring for friend's dogs. I can't imagine having to do it all the time. Having said that, I would probably continue to feed seoarately, particularly if I had a senior dog or one with allergies. I don't think I would mess with trying to find something they all could eat. I would probably just continue with whatever is working at the time. I'm not one to rock the boat. Just my thoughts.....

That's probably what I will do, Kathy. I hate to waste money on a bag of food only to find out one of the other three can't eat it! So far this is working as long as I stand and watch. I let Sibbie have one or two pieces of Gable's just to make her happy.

Joan2517

05-18-2018, 03:34 PM

Okay, so tomorrow I am taking Gable to have the ACTH test done at 10:15. He's drinking more, and panting so much we're afraid he's going to have a heart attack. Since he's not on any meds for Cushings, does he have breakfast in the morning or not? Thanks!

Squirt's Mom

05-18-2018, 04:44 PM

At this point (diagnostic) it doesn't matter as far as the ACTH is concerned. HOWEVER if the vet is wanting to run other labs at the same time then fasting may be best but surely they would have said something if they wanted him fasted. Right? ;)

labblab

05-18-2018, 05:15 PM

Joan, I’d withhold his food. That way you’ll know for certain that the lab can’t have any complaint about a fatty sample.

My knee jerk response is to say, “Good luck” on the test — but at this point, I’m not sure what you’ll be hoping for. Not that you’re wanting him to have Cushing’s, but maybe there’d be some peace in finally getting a diagnosis and being able to start in with effective treatment??

We’ll sure be anxious to hear the results!

Joan2517

05-18-2018, 05:59 PM

Yes Marianne,

I just want to find out what's wrong. No, I don't want it to be Cushing's, but at least we'll know (I hope). Lee never panted like this. She'd do it when she was hot or nervous, but he does it the minute he gets up and moves. When he's sleeping, he's breathing so fast it sounds painful.

And if it is, well I'm a lot smarter than I was 2 1/2 years ago, thanks to all of you. So, we'll see. I will post the results as soon as I have them...

Joan2517

05-22-2018, 10:07 AM

Okay, well Gable's ACTH results are in:

Cortisol Sample 1: 5.1 HIGH / ref range: 1.0 - 5.0
Cortisol Sample 2: 23.8 HIGH / ref range: 8.0 - 17.0

Vet is thinking Pituitary vs. Adrenal. Completely forgot that Lena was Adrenal and kept saying how much worse that would be (never said that then). I told him we would start Vetoryl at 60mg, Gable is 76.4 pounds. Not doing anything until the weekend. I'll be home from this Friday through the whole next week until June 4. This way I can watch over him.

What are your thoughts?

labblab

05-22-2018, 03:19 PM

Well, here we go! Deep breaths all around — we’ve got you and Gable totally covered, Joan. As we said earlier, I truly hope there’ll be some emotional as well as physical relief in finally arriving at a diagnosis. My Barkis panted almost nonstop prior to disgnosis, too. That was one of the hardest things for us to sit by and witness. Once he started the trilostane, that eased off pretty quickly, so I hope that will be the same for Gable, too. Back in those days, we were starting out with a whopping big dose, though. So by dosing more gradually, it may take awhile for Gable to start looking better. But we know that’s the safer way to go, and I think beginning at 60 mg. sounds perfect.

I also agree about the likelihood of the Cushing’s being pituitary in origin. Even though Gable didn’t edge over the “positive” line on the LDDS, his pattern of suppression was consistent with a pituitary vs. adrenal tumor. So I think you’re all set to go, and we’ll all be right here rooting for you. You’re a pro now, Joan. Gable is in very capable and such loving hands!

Marianne

Joan2517

05-22-2018, 03:32 PM

I've been trying to breath all day. I just want to go home and cry...I'll probably start on the train. I'm relieved that we finally have the diagnosis so we can start treatment, but am so afraid of it all over again, Marianne. The expense, the watching, the freaking out at every little thing and the testing. I hope it goes better this time around and I hope we didn't wait to long, but I know he's gotten worse in the last year, so maybe it's not too long. He wasn't like this when Lena was alive, so it's only been 2 years and 3 months.

I guess we'll see...and I am so relieved to have you all with me from the beginning this time.

labblab

05-22-2018, 03:43 PM

I sure do understand, Joan. I think it’d be strange if you *didn’t* feel this way. It’s got to dredge up a whole lot of memories that you’d much rather lay to rest. But there are a whole lot of things that are different this time around. Gable is much younger and so he is not facing the age-related vulnerabilities that confronted Lena. Also, the likelihood of it being pituitary means that the symptoms may be more responsive to the medication. Plus, now you know a whole lot more yourself.

None of that changes the worry and the dread, though. It seems so unfair that any of us should have to deal with all this more than once!

So you have every right to cry and scream and rant! You won’t chase us away, I promise. And we’re all gonna help you focus on making Gable feel better. I promise that, too!

Joan2517

05-22-2018, 07:02 PM

I know, Marianne. He's my number two after Lee....my big, beautiful boy. He's so, so good. The fact that he doesn't pee in the house during the day is absolutely amazing, especially when Cooper does. How he holds that in all day astounds me.

Suspecting it and having it confirmed is still upsetting, but I guess it's better than not knowing and continuing to search. I'm sure everyone thinks I've been imagining it and just looking for this because I want to change what happened with Lena.

So, here we go again...

Squirt's Mom

05-22-2018, 07:06 PM

You're gonna be alright, Joan. (((((HUGS))))) We will be with you and Gabe all the way. Remember, this is not Lena and her story will not repeat. That is her story alone. Gabe will tell his own story and I pray it is one similar to my Squirt's - get that dose correct and all smooth sailing from then on! I know how hard it is not to let the past creep in but try to remember this is a brand new story!

Joan2517

05-22-2018, 07:14 PM

Thank you, Leslie...I am so lucky to have found all of you....I do have more ammunition this time around because of my friends here. I think my vet was a little surprised when I told him what dose we were going to put him on. Wait til he hears I want him to try the new testing that Dr. Ramsey is endorsing...I'll take a picture ;)

Harley PoMMom

05-23-2018, 10:38 AM

Hi Joan,

Glad that you've finally got a diagnosis for Gable and sorry it's Cushing's, but you are definitely armed with much more knowledge and experience now and I know you'll do well in treating your precious boy.

I'm just a bit hesitant with the 60 mg starting dose, even though that's a reasonable dose for Gable's weight of 76.4 lbs the study regarding that larger dogs may require smaller amounts of Trilostane per day keeps resonating in my mind, we've also seen that here on the forum. If this were me, I would start out at 40 mg instead...this is just my opinion. Either way I know you will do great!

Hugs, Lori

Joan2517

05-23-2018, 10:51 AM

Thanks, Lori. I'd be happy to start at 40mg if that sounds okay to everyone. I just didn't want to go up to 90, which is what the vet probably would have wanted, unless they are still behind on the updated dosing of 1mg per lb. I wish I had waited to see what they would have suggested, just to see if they have learned anything in the last two years. I don't think they come in 40mg, though, do they? I'm sure my vet will be very happy to charge me for two different dosage packages.

I was going to stop and pick the pills up tonight on my way home. I would like to begin on Friday since I'll be home until the 4th and want to keep an eye on him. Do you think I should have prednisone on hand? If so, how much? This time around I want to be ready for anything and everything.

Harley PoMMom

05-23-2018, 05:23 PM

Vetoryl doesn't come in 40 mg capsules, but what I was thinking was getting either 20 mg capsules or purchasing some 30 mg and 10 mg capsules, because unfortunately there is usually some tweaking involved.

For dogs suffering from Addison's disease, according to Dr. Peterson's blog, he recommends a prednisone dose no larger than .2 mg/kg which for Gable that would be 6.9 mg. https://endocrinevet.blogspot.com/2011/02/q-whats-ideal-prednisone-dose-for-dogs.html

Joan2517

05-23-2018, 06:11 PM

labblab

05-24-2018, 07:11 AM

Hi again, Joan. If it were me, prior to this discussion, I too would have started at 60 mg. as I said earlier. However, one drawback to the 60 mg. capsules is that they can’t be split if that does turn out to be a dose that’s too aggressive for Gable. So making an initial purchase of 30 mg. capsules, to be used in some combination, is probably wise. If you do that, you could indeed start out at the even lower dose that Lori is suggesting by adding in a 10 mg. capsule. And if that turns out to be too low, you can keep adding additional capsules to get to the total you want. This will create added expense for the first month or so, but it does give you much greater flexibility in dosing, and your costs should stabilize along with a consistent dose by the second or third month.

If you do start out at a dose of 40 mg., I am going to break with standard protocol and say that I think it would be OK to go ahead and increase the dose as soon as the 10-14 day mark in the event that you don’t see observable symptom relief or significant downward movenent in his cortisol. Given that you’d be starting at quite a relatively low dose, I don’t think you’d have to wait a full month before tweaking upward if you’re not seeing results. But on the flip side, starting at this lower dose will also allow Gable’s system to adjust more gradually to a decrease in cortisol. And that can certainly be a good thing. So I think the combo of capsule sizes and starting out even lower can make good sense.

Marianne

Joan2517

05-24-2018, 09:30 AM

Okay. I will pick them up tonight on my way home and begin with the 40 mg dose tomorrow morning.

I am so anxious about this. I'm even second guessing that he does have Cushings'...can you believe that! Then I start to think maybe I shouldn't treat him...that is until I hear him drinking, drinking, drinking, peeing, peeing, peeing, panting, panting, panting. I'm obsessing again.

Poor Gabe, he's going to have to put up with me following him around and watching him like a hawk.

Harley PoMMom

05-25-2018, 12:33 AM

Thanks, Lori,

I'll see what my vet has. I looked up on Dr. Forster and Smith today, but I didn't see any 20mg, just 60, 30 and 10. I'd have to pay extra to get them here by Friday, and it looks like just a $5 difference in prices, so I might as well just start with my vet. I want to be home when he starts on the meds.

You're right, Vetoryl doesn't come in 20 mg capsules :eek: I don't know what I was thinking, sorry about that! Marianne's suggestion of purchasing a combination of 30 mg and 10 mg capsules is definitely something I would do.

It so hard not to obsess with our furbabies especially when treatment is involved but I know you'll do great and we are here for you both!

Hugs, Lori

Joan2517

05-25-2018, 09:15 AM

Well, gave him his first dose this morning, one 30 and one 10. Dr. Plunkett went along with what I wanted to do even though he doubted 40mg would do anything. I said that was okay, we'd up it in two weeks if that was the case. He didn't give me any pred, though. Said with 40, I wouldn't need it. I'm fine with that for now.

Gable had his usual bowl of kibble, maybe two if the others didn't finish, a forkful of the soft food I give to the little girls with his soloxine. Then I wrapped both capsules in a piece of cheese and he didn't even know there was anything in there.

And so it begins!

Joan2517

05-25-2018, 09:30 AM

One more thing, and this really bothers me. When I picked up his meds yesterday, the receptionist just handed them over. No instructions, nothing. She had no way of knowing whether the vet had given me instructions or not. I was going to say something to her, but she's new and doesn't know that I've been through this before. I know the same thing happened with Lena. No one told me how to administer. I'm not even sure anymore if she was getting them with a full meal until I joined this forum and that was a month or more after diagnosis. For all I know her first 2 tests might have been wrong.

I'm going to say something to them about it. I'm sure it happens in a lot of vet offices. That could be why a lot of our members wind up giving without the full meal...not everyone reads the inserts in the boxes. I know I don't. I'm going to read it today and see if those instructions are on it.

labblab

05-26-2018, 07:47 AM

Just checking in to make sure all is well this morning! And yup, it’s so frustrating when vets (and human doctors!) don’t properly explain medication protocols. That can make all the difference between success and failure, and it ought to be the first thing they think about when they hand out Rx’s!

Joan2517

05-26-2018, 08:18 AM

So far, so good. He's still panting like crazy, but nothing unusual. It was pretty hot yesterday, and the forecast is the same for today. I've got the air on and put down his cooling mat, which he's on right now.

I did read the insert and it does say to give with food, doesn't say full meal though.

Harley PoMMom

05-26-2018, 09:28 AM

Right here with ya, Joan! Remember to breathe!!! :)

Hugs, Lori

molly muffin

05-27-2018, 09:57 AM

Oh my goodness. Miss some time on the forum and all kinds of things are happening!
Well, okay, you got the diagnosis, you have a plan for today and tomorrow and going forward. You know oh so much more about cushings than you did with Lena.

Girl, you GOT this! Gabes in the best ever care with a knowledgeable mummy and daddy and you guys are going to be just fine. You got your support group lined up (every one raise your hand) 1, 2, 3, 4, 5..... yep, all here and accounted for! Meds on hand, testing protocols established... good to go! :)

mommyslittlegirl

05-27-2018, 01:23 PM

Joan , I was so sorry to hear the news about your sweet big boy Gable . You can do this Joan. You have so much more knowledge now. And a awesome support group. Gable is in excellent hands.

Joan2517

05-27-2018, 11:46 PM

I feel a little more confident this time around, Dawn. I'm still afraid, but know what I'm dealing with. It's weird, but I feel a little guilty, like I'm betraying Lena somehow because I know more. If only I knew more then, for her. I wonder if it would have changed the outcome...I just hope that things go better this time.

Joan2517

05-27-2018, 11:55 PM

We'll see, Sharlene. I'm not as panic stricken as I was with Lee. I'm not putting all my trust in my vet. I know more and I won't be made to feel like my voice doesn't matter...

He's laying on the floor, right next to me now and seems more comfortable. Maybe I'm just imagining it. I don't know...the watch is on!

labblab

05-28-2018, 08:01 AM

He's laying on the floor, right next to me now and seems more comfortable.

That sounds very good ;-)! Here’s hoping it continues!

Joan2517

05-28-2018, 08:54 AM

Fingers crossed! I'm watching, listening, on high alert!

Joan2517

06-08-2018, 07:02 AM

Gable is going for his first ACTH test this morning after being on the Vetoryl for 15 days. I am anxious to see what the results are. I hope I'm not imaging things, but I do see some improvement in his drinking. I am definitely not filling the water bowls up as much. He seems more comfortable, too. I was starting to get nervous because he hasn't been eating as much in the morning. He used to eat almost two bowls of kibble, but slowed down to one, and I was afraid the pills wouldn't be as effective, but since I see some improvement in the amount of water he's drinking, I figure it's fine. And this morning he did eat almost two bowls. I don't give him the pills until he's eaten and I give them with cheese, which he loves.

So, we shall see...

labblab

06-08-2018, 07:19 AM

Oh Joan, everything sounds good so far! We’ll be anxiously awaiting those results, too, but for right now it sounds good.

Harley PoMMom

06-08-2018, 07:41 AM

Oh Joan, everything sounds good so far! We’ll be anxiously awaiting those results, too, but for right now it sounds good.

Ditto!! You're doing a great job!!!!

Squirt's Mom

06-08-2018, 09:35 AM

Way to go! Sounds like appetite and thirst are down for sure!

Joan2517

06-08-2018, 02:30 PM

I picked Gabe up after the test and he came home and drank both bowls of water (4 quarts), couldn't settle down and wound up barfing in the backyard. He's still panting and we've been home for an hour and a half. I called and they said he had a small bowl of water in the cage, which would not be enough for him, and I'm not even sure they are telling me the truth. The last time he came home and drank a lot too.

Maybe next time, I'll bring him home in between. The girl said they don't like that because they want them to rest in between. He was so excited to go out in the car, even though it was to the vet, and now I think he will just remember it as a bad experience.

Do you think that this time it's because he's on the Vetoryl and what they gave him for the test upset him like this? I feel terrible, he's so uncomfortable right now.

Squirt's Mom

06-08-2018, 03:26 PM

Some pups react negatively to the stim agent causing some discomfort for a while after the test. Maybe he threw the water up because he drank too much too soon? Bud does that all the time and it's only because he guzzles.

Lots of folk take their baby away from the vet's between draws. The very idea that a dog would be more relaxed or restful in a strange cage at a vet clinic is funny! :D Did you laugh when she said that? :D If Gabe is stressed at the vet then taking him away for a ride, a walk, even back home if it's close enough can help not only the dog but help get more accurate results since the pup isn't stressed to the max. ;)

Joan2517

06-08-2018, 04:12 PM

Thanks, Leslie...it could've been too much water, too fast. He's laying down and seems okay. It's amazing how quickly the panic set in, though. I had visions of running to the Emergency clinic all over again.

Harley PoMMom

06-09-2018, 10:23 AM

Like Leslie said, some dogs are sensitive to the stimulating agent and may have a reaction such as Gabe's (Sharlene's Molly is one pup I can think of). When Harley had his ACTH test I would have them bring him out to me after they injected the stim agent. We stayed at the vet's office until it was time for the second blood draw, they had a bench outside so we would go there and sit. I would also take water and his bowl with me to his vet visits. How is Gabe doing now?

Joan2517

06-09-2018, 10:59 AM

He's much better. I used to do that with Lena. She'd nap or look out the window and I would read.

Here are his test results. The vet said perfect, but why does it say low?

Sample 1: 1.3 Ref range 1.0 - 5.0
Sample 2: 7.1 (LOW) Ref range 8.0 - 17.0

Squirt's Mom

06-09-2018, 11:15 AM

The labs don't use the ranges given for the treatment drugs - they use only the range for a normal dog, a dog NOT on treatment. So while 7.1 would be low for an untreated cush pup OR a dog who does not have Cushing's (or Addison's) it is actually HIGH for a cush pup on treatment (not "perfect" ;) ). For a dog taking Vetoryl you want that post # under 5.1ug/dl. HOWEVER, that is after the first 30 days. Remember - it is not recommended to increase the dose during those first 30 days because the cortisol may well continue to drop on that same starting dose. So for now, that is good! Continue to watch him over the next few weeks to make sure there are no signs the cortisol has gone too low but other than that you are off to a great start seems to me! :cool:

labblab

06-09-2018, 11:16 AM

Wow, your vet is right — those are really good results after the first couple of weeks! :-)))))))

The reason it says “Low” is because the range that is given on the labsheet is the normal range for the ACTH when it is being given as an initial diagnostic test for Cushing’s. Apparently your lab is not additionally listing the reference range when it is being used as a monitoring test for trilostane treatment. That can definitely be confusing, since the monitoring range is much different.

For monitoring purposes, a post-ACTH up to around 9 is acceptable if symptom resolution is satisfactory. If symptoms remain, then you would try to lower the post-ACTH value to a range between around 1.5 - 5.0. However, no dosing increases are recommended until after the thirty day mark since Gable’s cortisol may still drift down further on this same dose. So for right now, I’d leave things just as they are, especially since you think you’re seeing some symptom improvement already. It looks as though Lori may have been right on the mark as far as encouraging you to start at this lower dose. Good job all the way around!!!

Joan2517

06-09-2018, 11:27 AM

Thanks to all of you!! And yes, Lori hit it just right! Thanks, Lori! I know that if I had left it up to them, they would've started him way too high. In fact the vet who called with the results (he's not the one I use that much anymore) sounded a little surprised when I told him that Gable was only on 40mg. I have a feeling he will be talking to the one I'm using about why the starting dose is that low.

Yahoo!!

Joan2517

06-10-2018, 08:36 PM

This is just for me to keep track of: Gable was 77.1 lbs on June 8.

Harley PoMMom

06-12-2018, 10:56 AM

Those are great ACTH stim results!!!! GREAT job, Joan!!!!!

Joan2517

06-12-2018, 12:24 PM

Thanks to you, Lori!

DoxieMama

06-16-2018, 09:21 AM

Joan, I haven't been commenting but have been following along for a bit. Worrying that Gabe may have Cushing's, testing, starting treatment, and now today when he is doing SO well ... what a ride it has been! My hat is off to you, dear lady. Your experiences with Lee, and all the knowledge you gained then and since, are paying off for you and your sweet boy now. Way to go!!

Joan2517

06-17-2018, 07:11 AM

Thanks, Shana...I miss seeing your comments on the forum, but totally get it.

He is doing really good so far. Still pants a lot, but he is a big boy and the weather is pretty hot some days. His drinking has definitely slowed down. He is sleeping through the night and not getting up to drink every few hours, and even though he will still kill for people food, he's not gobbling up all the kibble. I was buying a bag of dog food every week, but now it's every other week. He started playing again, too. Him and Cooper have their old wrestling matches and Gabe will pick a toy out of one of the bins and get a tug of war going...of course after a few minutes of that he's exhausted! He just seems happier.

I wish I had known more with Lee.

Next week will be the 30 day test. It will be interesting to see what the numbers are.

I hope that you and Jackson and Kira are all doing well. Would love to see some pics!

Joan2517

06-19-2018, 05:56 PM

Gable, Cooper and Sibbie love those frozen green beans you are always talking about. Would they be able to eat them unfrozen, too? He's also decided he likes carrots! Our local farm is opening up for the season this Saturday and I was wondering what other veggies they all could have. He also tasted beets a few days ago and liked them.

Squirt's Mom

06-20-2018, 10:12 AM

Right off hand I can't think of any veggies to avoid other than onion, garlic, leeks, etc. If they like something let them have a little of it til you see how they do with it - ie any digestive upsets, bad breath, etc. Some veggies are tricky, ya know....like pumpkins; a little will help form up stools but too much will cause constipation OR diarrhea. Learn about the veggies you try like the beets so you know the nutrients they supply - ie beets are naturally high in sugars so that would be a factor in determining how much to let them have. Just remember - dogs are carnivores, not omnivores so they need to have meat as their primary source of energy. We humans can survive on meatless diets and most do well but that is not the case with dogs. Unless there is a valid reason, all dogs need a solid meat diet with veggies and fruits a small addition. Fresh veggies go over BIG time in my house! Bud has loved everything I've given him! When he see a banana he goes bonkers! :D:D:D

Joan2517

06-20-2018, 10:21 AM

Thanks, Leslie. He has his kibble, but he likes to sit at my feet while I am preparing veggies for our dinner, that's why I wanted to check to see which ones are okay. And if he has something, the rest of them want it too. They all love bananas, except for Doree. She just looks at them like they're crazy!

Joan2517

06-22-2018, 09:34 AM

Gable is going for his 30 ACTH test tomorrow. I hate to say this, but we've noticed an increase in his drinking for the last couple of days. At first I thought it was my imagination, but no, I'm filling the water bowls frequently again. Will be interesting to see what the numbers are.

Harley PoMMom

06-22-2018, 10:47 AM

With the increased drinking Gabe's dosage may need a tweak but an UTI could be brewing which would cause a dog to drink more. Since cushdogs are prone to those UTI's, I believe I'd take an urine sample along to rule out any issues.

Joan2517

06-22-2018, 11:28 AM

Will do. Thanks, Lori!

Joan2517

06-25-2018, 03:19 PM

Gable's second ACTH results on the Vetoryl. This time I brought him home in between and he was much less stressed.

Sample 1: 0.9 (LOW) ref range: 1.5 - 9.1
Sample 2: 2.3 (LOW) ref range: 8.0 - 17.0

Vet wanted to lower it to 30mg, but he's still panting and drinking a little bit more than the first couple of weeks. What do you think? He's not lethargic, not throwing up and no diarrhea. He said if he seems fine then he doesn't need to see him for 3 months.

He also said that he read the new testing paperwork I gave him and that's what made him look at the range for the resting cortisol which is 1 - 5, so he wasn't too worried about the 0.9.

Is it too low? Should I lower the dose? This is so different from Lena's results....it's freaking me out!

labblab

06-25-2018, 03:57 PM

You know, Joan, I’m kinda thinking out loud here, but given the contradictory results — lowered cortisol but increase in symptoms — before lowering his dose I’d be interested to see what his cortisol level is when tested using the new pre-pill protocol. With that, he’d have his resting cortisol tested right before taking his morning dose as opposed to that 4-6 hour window afterwards. As long as his pre-pill level is not lower than 1.5, I’d be inclined to not lower the dose since he remains symptomatic. In that event, one option might be to split the dose (like giving 30 mg. in the morning and 10 mg. in the evening). Dosing twice daily might provide more consistent symptom relief throughout the day.

If, however, his pre-pill level is < 1.5 while symptoms remain, then the picture is more confusing and a call in to Dechra by your vet might be warranted.

As I say, I’m kind of musing out loud, and probably the last thing you want to do is to haul poor Gabe back to the vet. But I’m thinking this new pre-pill protocol may provide useful feedback, especially in instances such as this where ACTH results do not seem to pair up very well with observed behavior. We’ve had another new member here recently whose dog appeared to be borderline low based on ACTH results but who was showing good improvement clinically. They ran a pre-pill test on the dog, and I believe the cortisol was > 1.5 so the dose was left unchanged.

I’m guessing it might be kind of nerve-wracking to let Gabe be a guinea pig with this new protocol, but I just wanted to throw the suggestion out there. Here’s a link to the monitoring chart associated with this protocol:

http://www.k9cushings.com/forum/attachment.php?attachmentid=8284&d=1522201966

Joan2517

06-25-2018, 05:48 PM

But you don't think it's too low, do you Marianne? I can't get back to the vet now until the weekend because of work. Should I keep him at the current dose until then?

labblab

06-25-2018, 09:19 PM

I always feel uncomfortable making recommendations that are contrary to those of a dog’s vet. But if Gabe was my own dog with a post-ACTH of 2.3 and I didn’t see symptoms consistent with low cortisol, I’d probably talk with my vet about sticking with this same dose for a while longer. If that makes you feel antsy, though, you can certainly go ahead and lower to 30 mg. and see what happens, both behaviorally and also in terms of cortisol level.

I guess my decision would at least partly depend upon whether or not I did intend to go forward with pre-pill testing in the near future. If so, I’d be more likely to leave Gabe at the 40 mg. until that testing was done. If not, I might feel more nervous about leaving him at the higher dose for an extended period of time.

I know I’m being kind of wishy-washy here, but these are some of the considerations I’d take into account if Gabe was mine.

Joan2517

06-26-2018, 06:20 AM

I told him on the phone yesterday that I wanted to keep him at the 40 mg. He's still eating good, he doesn't show any signs of lethargy and was even playing with Cooper outside last night, so I think we're good.

My company is having a conference here in Glen Cove and I'm working from the Glen Cove Mansion tomorrow and Thursday so I'll be able to come home and check on him during the day.

Thanks, Marianne...

labblab

06-26-2018, 06:31 AM

Then I think you’re fine leaving him on the 40 mg. for now. That’s what I’d be doing if he was mine ;-).

Joan2517

06-26-2018, 06:35 AM

Knowing that makes me feel better...thanks, Marianne. I just want things to go better this time.

Harley PoMMom

06-27-2018, 03:48 AM

Hey Joan!

FWIW, I agree with Marianne. Some dogs do better when their cortisol is in the higher therapeutic range and others in the lower end so this may be the case with Gabe. Were his electrolytes checked too?

Joan2517

06-27-2018, 06:20 AM

I don't think so Lori. I didn't tell them to, so I doubt it. He still seems fine, eating good, didn't get up last night to drink at all. I must say that his fur looks beautiful. It's getting softer and is starting to look red, even my grandson noticed that. I'll keep watching him and decide over the weekend what to do.

Joan2517

07-03-2018, 09:37 AM

I'm going to try the pre-pill test on Saturday. Since I work from home on Fridays, I can give him the pill around 9:30 or 10:00 and bring him to the vet on Saturday. Is it exactly 24 hours? Or is there a window? I'll have to let him eat or he'll be stressed. I printed out the pre-pill monitoring chart and will bring it with me so they know what to do. Is there anything I should know, that they might not from the chart? It's just a blood test from what I gather. They should be able to figure it out, yes?

So far he's not showing any signs of too low cortisol. Still eating good, no vomiting or diarrhea, no lethargy. I think his drinking has slowed down a little, but his panting hasn't...it has been unbearably hot here though.

This is a little weird, but he has been getting erections that take a while to go away when he gets up in the morning, sometimes he can't move for a few minutes. He was fixed before we got him at one year old. He used to get them once in a while, but they seem to have increased lately. Not sure if it means anything, so I'm just putting it out there. Anyone else had this kind of thing happen?

Harley PoMMom

07-03-2018, 11:41 PM

I think you will want to be as close to that 24 hour period as possible and try to keep the tests done at the same time.

I just re-watched the video, and here are a couple things I thought were worth re-mentioning: Professor Ian Ramsey states that the dog should not be stressed at the time of testing so since fasting Gabe stresses him than feeding him is a good idea. Also Professor Ian says that it is very important that the blood sample be sent to an external laboratory participating in an external quality assurance scheme (e.g. ESVE- or SCE- programmes) and preferably that uses a Siemens IMMULITE® – or a method that has been validated against this machine, he says to call and verify this with the lab.

Wishing you both good luck!!!!

Joan2517

07-04-2018, 09:13 AM

I re-watched it too, Lori~ Just as a refresher. My vet does send the samples out. The lab is Antech...they do all the ACTH, LDDS testing. Maybe I'll just check with them myself.

I noticed Gabe's got some hot spots on his belly. They are bacterial infections. He gets them about twice a year so I went and got him some antibiotics yesterday, luckily the vet I like was there and just let me buy the pills without bringing Gable in. One of his ears is red, sore looking, but I don't think infected. Since the drops for that have steroids, we're not going to do anything until after the blood test on Saturday. I'll just wash it with warm water for now.

I think my vet is excited about the new testing. He's put a call into their endocrinologist, I think that's who he said, to make sure of the protocol and to check with him.

Joan2517

07-04-2018, 09:53 AM

labblab

07-04-2018, 10:54 AM

I had noticed those comments about the quality assurance programs, too, but I wonder if those certifications may be specific to the U.K.? I’m thinking they may not be applicable here in the U.S. but your vet should be able to find out.

As for Gable’s erections, I wonder if his adrenal glands may be overproducing testosterone or other sex hormones in addition to the cortisol? Just a thought that your vet might want to discuss further with the endocrinologist...

Marianne

Joan2517

07-04-2018, 11:16 AM

I will mention that to them, Marianne. I wondered about that too. I think I asked here once about what the elevated sex hormones meant...that was because of the erections, which I was a little embarrassed to ask about ;)

Harley PoMMom

07-04-2018, 11:21 AM

I noticed Gabe's got some hot spots on his belly. They are bacterial infections. He gets them about twice a year so I went and got him some antibiotics yesterday, luckily the vet I like was there and just let me buy the pills without bringing Gable in. One of his ears is red, sore looking, but I don't think infected. Since the drops for that have steroids, we're not going to do anything until after the blood test on Saturday. I'll just wash it with warm water for now.

I think my vet is excited about the new testing. He's put a call into their endocrinologist, I think that's who he said, to make sure of the protocol and to check with him.

The unfortunate thing with any non-adrenal illness is that it does have the ability to raise cortisol levels, I'm not sure by how much those hot spots or his sore ear will do that, just something to keep in mind if his pre level would be really elevated.

Joan2517

07-04-2018, 11:23 AM

Okay, thanks!

Joan2517

07-06-2018, 12:18 PM

I was on a conference call at 10 that didn't end until 11:30 and only gave him his Vetoryl then. What time do you think i should get to the vet to get the test done?

labblab

07-06-2018, 03:16 PM

I guess I'd hope to get his blood drawn around 11:00. Can you make an appointment for a specific time, or do you just have to wait in line at your vet?

Joan2517

07-06-2018, 03:21 PM

For a blood draw, I can just walk in. They already know i'm coming in sometime. This is just to test the cortisol level, right? My vet won't be in and i just want to make sure they know what they are testing for.

labblab

07-06-2018, 04:16 PM

Yep, that’s my understanding, just a pre-pill resting cortisol. I can’t remember whether he had his electrolytes checked with his ACTH? If so, I wouldn’t see any need to repeat them so soon. If not and if it’s been a while, they could always run a basic blood chemistry panel, too, just to make sure everything’s OK in that department. That way, you’d have added reassurance that he’s not being oversuppressed.

Joan2517

07-06-2018, 04:21 PM

If he had it with the ACTH test, they didn't tell me, so i'll assume not. I'll tell them to include it tomorrow. Thanks, Marianne.

Joan2517

07-09-2018, 10:23 AM

My vet called this morning with Gable's results:

His resting cortisol is 4.1 (ref range from 1.0 - 5.0)
Alk Phosphatase is 403 High (ref range 5 - 131)
Testosterone is less than 20.0

The vet was so excited about the pre-pill testing. He checked with a Dr. Nichols, who seems to be the "it" endocrinologist around these parts, who was also very excited about the pre-pill testing and said that they have found that bigger dogs sometimes do better on lower doses....gee, where have I heard that before?? LOL!

So, I don't know what that high Alk means...

labblab

07-09-2018, 11:24 AM

The elevated Alk Phos is a typical finding of Cushpups, and reflects steroidal effects on the liver. Gable’s elevation is actually fairly mild compared to many dogs, and really nothing to worry about. It may or may not ever return to being within the normal range. But again, that’s no big deal.

The really interesting thing is Gable’s cortisol level! Thank you guys so much for being our guinea pigs with this new testing protocol. From these results, there are no worries that he’s being oversuppressed, and that’s something that we were fretting about after his ACTH. In fact, based on the new monitoring chart, theoretically you could actually increase his dose since he’s still exhibiting symptoms! Given where his result fits into the chart below, you’ll see that they talk about increasing the overall dose and/or dosing frequency. If you don’t feel comfortable raising his dose just yet, one thing you might consider is to divide his current dose into morning and evening administrations, unless feeding him and dosing him twice daily is a pain for you. For instance, given the capsules you already have, you could give him the 30 mg. in the morning and the 10 mg. at dinner. Dechra says that if twice daily doses are not equal, give the bigger dose in the morning.

It might be worth a try, just to see if that improves his symptoms any. If not, you might go ahead with an overall dosage increase. Just some thoughts to consider. And yes, Dr. Rhett Nichols is a huge name among American endocrinologists and Cushing’s researchers. If your vet can actually consult with him, you are in super good hands! I’d be curious to know what he’d recommend doing, given Gable’s results.

Oh, and I guess we can rule out testosterone as the cause of Gable’s erections. Really dunno what else to think about that...

Anyway, good job, Joan! This new testing is exciting, for sure! Oh, and here’s that monitoring flowchart:

http://www.k9cushings.com/forum/attachment.php?attachmentid=8265&d=1521562345

Marianne

Harley PoMMom

07-09-2018, 12:35 PM

Great job, Joan!!! And yes, thank you so much for trying this new protocol out!!!

I agree with Marianne on splitting his dose if he is still showing signs; 30 mg in the morning and 10 mg in the evening.

And again....GREAT JOB!!!

Joan2517

07-09-2018, 01:03 PM

Thanks, Lori! Really, the only thing I've done is listen to you all and put my foot down with the vets about how I want the treatment to go this time.

Joan2517

07-18-2018, 06:40 PM

Came home to vomit today in the kitchen, two spots. Not sure if it was Gable or not, didn't seem big enough to be his, so I didn't give him the 10mg tonight with dinner. He seems fine, not lethargic, was playing with Cooper this morning, and he ate dinner.

Could have been one of the others...Doree has wax buildup in her ears and is acting a little funny, sleeping so soundly that sometimes I think she might be going deaf. This morning my husband thought she was dead. She's eating though, but drinking more than usual.

If Gable still seems okay, I'll give him his 30 mg in the morning with breakfast.

Harley PoMMom

07-19-2018, 02:41 PM

Good call, Joan. How are Gabe's symptoms? Sorry to hear about Doree and hope she is back to normal soon.

Joan2517

07-19-2018, 03:41 PM

He's still good, Lori. It probably wasn't him. He seems fine. We can't believe how much he's been playing...with Cooper, with toys again.

Doree is acting strange...she seems confused. I will probably take her back to the vet tomorrow. I forgot to show them something else that's on her face besides the lump on her lip. And I think the cream is too much for her ears. They are getting gooky with it and it seems to be building up. Of course my husband could be putting too much in, but I made him stop last night. The worry now is her heart murmur went from a 3 to a 4, but she's not symptomatic, no coughing, just sleeping more soundly than she ever did. She became the matriarch after Lee died, and she's more attached to my husband. He will be devastated if anything happens to her...our little Doree Darling.

Harley PoMMom

07-25-2018, 12:07 PM

How's Gabe and Doree doing?

Joan2517

07-25-2018, 12:35 PM

Gabe seems absolutely fine. He's doing a lot of scratching and licking. It's got to be allergies. He was always allergic and I'm guessing since the cortisol is lower that they are acting up more than usual. I have to get some benadryl for him.

One thing we are noticing is that we can see his hip bones. I don't think we ever saw them before! I'm hoping it's a good thing. He's lost a few pounds, but he's been overweight for the last couple of years. He's eating, drinking and playing, so I'm happy. I sent Newsday a picture of him sleeping on one of the chairs on the deck and they emailed me yesterday that they are considering it for the Explore LI pet section. He does look beautiful! They had Sibbie in it a few weeks ago, so I hope that won't disqualify this picture. This will be my 5th or 6th picture/blurb in the paper. The first one was of Lena in the stroller with Josh when Josh was about 2 years old.

Doree is still a little confused, but the bump on her lip is going down and her ears are better. We have a cardiologist coming from the Animal Medical Center for a consult on the 9th at our vet's office. It's about $625 and he spends hours checking her out and going over everything, so we'll see.

Thanks for asking, Lori!

Budsters Mom

07-25-2018, 08:17 PM

Yes, higher corisol levels act as a bandaid of sorts for all kinds of conditions. It reduces inflammation which helps with arthritis and allergies. Buddy's allergies went haywire once I started treating his Cushings and his cortisol level normalized. Sometimes pet parents choose not to treat Cushings in very senior arthritic dogs because Higher Cortisol levels help to control inflammation and pain.

It's got to be allergies. He was always allergic and I'm guessing since the cortisol is lower that they are acting up more than usual. I have to get some benadryl for him!

Joan2517

07-25-2018, 08:46 PM

He's only 9, Kathy, so I think I should try. I hope the benadryl will help. We'll see...

Harley PoMMom

07-26-2018, 01:40 PM

Wow, Joan, that is so neat that your furbaby's pictures are published in the paper!!! And glad to hear that Gabe is doing well but sorry about those allergies. Marvin used to scratch himself so much that he was breaking the hair off in that itchy area and than we finally figured out it was chicken he was allergic to, I think he also had environmental allergies, the benedryl did help Marvin a little.

Let us know how Doree makes out with the cardiologist and wishing yous the best of luck.

Joan2517

07-31-2018, 07:09 AM

Gable continues to do well. His belly is starting to disappear and he looks better than he has in years (except he's getting whiter). He's sitting on furniture again, playing more and sleeping better at night. I'm thinking that the licking isn't so much allergies, but might be that he's able to clean himself again; he can reach all those places now that a lot of the weight is off.

I keep watching for signs, but he's doing good. My son was here on Saturday and hasn't seen him in about a month, and noticed right away that he wasn't as heavy and looks much better.

labblab

07-31-2018, 07:55 AM

This is such great news, Joan! I’m so happy for you guys :-))).

And yeah, I can sympathize about the whiteness....my “baby” Luna is almost ten now, and her dad and I are both noticing that even though she’s a yellow Lab, her face is looking whiter :-(((. Where does the time go.......????

Harley PoMMom

07-31-2018, 08:12 AM

That is wonderful news about Gabe!!! YAAA!!!!

Eve

08-05-2018, 01:15 PM

Yes, for arthritis support. My dog has been off trilostane for two weeks now. He is back to being able to go down the stairs himself. He stopped being able to about a month after he started the med.

If it turn out he really has Cushing's, I will be giving careful consideration as to whether I put him back on trilostane. And if I do, I think I will opt for a lower dose or twice daily doses because he has had GI upset from the med. (Back story: he was just diagnosed with hyperparathyroidism which may replace the Cushing diagnosis but won't know till that condition is treated).

Joan2517

08-05-2018, 03:43 PM

Well, Gable has fleas. That's what all the licking is about. Gave him and Cooper NexGuard, hopefully I caught it early enough. Just finished vacuuming everything, and washing all the furniture covers.

Budsters Mom

08-05-2018, 04:10 PM

That's interesting because my dog is severely allergic to mites. She is also highly allergic to many other things. When she starts chewing licking excessively, I start mite treatment right away, even when I am not sure she has them. That has resolved her scratching and chewing Obsession MANY times. Her hair grows back and all the redness clears up. I hope you are able to get a handle on those fleas, so all of your babies will feel more comfortable. Remember, if one has them, they all do, so they all need to be treated. Good luck!

Joan2517

08-05-2018, 05:55 PM

UGH! I haven't seen them on anyone else. Sibbie is getting groomed on Tuesday, so Monica will let me know. We never put it on the little girls. Put Zodiac on Lena once and she had such a bad reaction to it. She was jumping out of skin for days!

Harley PoMMom

08-06-2018, 10:35 AM

Fleas, those pesky buggers! Suds does kill those fleas so bathing the other furbabies should take care of it but you'll need to bath them again in a week in case of eggs hatching.

Joan2517

08-06-2018, 10:41 AM

Got it! Thanks, Lori!

Budsters Mom

08-06-2018, 03:49 PM

Mix a little Dawn dishwashing liquid into your usual dog shampoo. It is safe and effective in killing mites and fleas. Use only the blue original formula. The newer Platinum formula is much more concentrated with additional ingredients. Leave on for 3 to 5 minutes before rinsing. There is no need for a special flea shampoo. They contain chemicals, which I don't like to use on my allergy baby. I use this mix as insurance all of the time, whether critters are present or not.

I am with Lori. You do need to bathe ALL of them, even if fleas aren't visable. It's hard enough to get rid of them when you do everything you possibly can.

Joan2517

08-07-2018, 06:33 AM

Thanks all!

On another note. In doing the pre-pill test, if I'm dosing twice a day, 30mg in the am and 10 in the pm, what do I do? Just skip the 10 the night before? Or give him the full 40 the morning before?

labblab

08-07-2018, 07:41 AM

Joan, my understanding is that you’d keep your normal dosing schedule in place — give Gabie his 10 mg. capsule the evening before the test, as usual. You are wanting to measure the effect that his regular dosing schedule is having on his overall cortisol production at a specific point in time. For dogs being dosed twice daily, monitoring ACTH tests have always been performed after a dog has been dosed as usual, and I assume the same is true with this resting cortisol regimen, as well. Dechra’s flowchart instructions are simply to “Book an appointment just before the next Vetoryl dose is due,” and I believe this is meant to accommodate dogs who are dosed either once or twice daily. In a case like yours where the doses are not equal, however, I’d test before the larger morning dose.

Joan2517

08-07-2018, 10:16 AM

Okay, thanks Marianne. That sounds logical.

He's got all these sores from licking and biting where the fleas were. I can't believe I thought he was just cleaning himself. I am going to give him a bath on Thursday since I'll be off, and hope that helps. I gave him the flea meds on Sunday, so they should be dying off by now. Sibbie is getting groomed now and the groomer usually uses a flea shampoo. The only one vulnerable right now is Doree, but with her murmur worse, I don't want to give her the flea meds.

Poor Gabe...he must've been so uncomfortable.

Joan2517

08-07-2018, 07:25 PM

Is it okay to use the lavender one? Despite my explicit instructions on my shopping list, my husband bought that one. I will try to give him credit, thinking lavender will deter ticks and fleas, but I doubt he thought that much.

labblab

08-07-2018, 08:33 PM

I’ll hoping Kathy will weigh in, but no, sadly I don’t think the lavender version will work. I think this is what you want:

https://www.pgshop.com/Dawn-Simply-Clean-Dishwashing-Liquid-Dish-Soap-Original-25-oz/00037000236856.html

I buy this for cleaning my eyeglasses because it doesn’t mess up the protective coatings or gunk up the lenses. I can’t find it in grocery stores anymore, but I bought mine at Wal-Mart, and I think places like Home Depot or Lowe’s might carry it, too.

Joan2517

08-07-2018, 08:36 PM

I hate him! :)

Budsters Mom

08-07-2018, 09:07 PM

Actually Marianne is right, however, the blue Dawn Ultra is more readily available. It is completely safe also. That's what I use. Stay away from the Platinum version. Too many scary ingredients listed on their web-site. No sadly, I wouldn't use the Lavender version. Save it for the dishes. Your hubby meant well, but I wouldn't personally chance it.

I have never been able to use any type of flea/mite meds on my allergy dogs. I have had to rely on dilligence and safer methods. My little Buddy lived with itches most of his life. There was always something triggering them. He was highly allergic also. One of our members suggested frequent baths with Johnson's Baby Shampoo. It worked wonders, when nothing else had. A veterinary dematologist, that was a friend of Buddy's Neuro-Surgeon said that baby shampoo was very pure with extremely limited ingredients, making it better for allergy dogs than dog shampoo. I now use Johnson's Baby Bath, with the same basic ingredients, except I tweak it a little. That's where the Dawn dishwashing liquid comes to play. I mix several big squirts of it into a large bottle of the Baby Bath. I have been using this mix for many years with no adverse reaction for my allergy babies. I do not use generic baby shampoo/bath. It is probably fine, but I haven't wanted to vere away from what has worked for so long.

So, whatever shampoo your dogs do well on is fine. I would just add some blue Dawn (Simply Basic or Ultra). Remember, stay away from the Platinum version. It is a much darker blue color.

I hope this helps!! Hubby meant well. Give him some brownie points for trying!

Joan2517

08-07-2018, 09:40 PM

I've used the Johnson's before with them. I'll use that with the blue Dawn. Thanks, Kathi!

Budsters Mom

08-07-2018, 09:54 PM

Wash their faces with the baby shampoo/bath only. It is tear free. I don't use the Dawn mix on faces, around eyes. Just an extra precaution.

Joan2517

08-10-2018, 11:45 AM

Well the baths didn't go as well as I wanted. I bought a kids pool, but Gable wouldn't go in and I couldn't lift him into it. I put the leash on, but he would rather strangle than get in it. I had a pot of sudsy water so I just washed him on the deck and then sprayed him down with the hose. Cooper was easier. I was soaked through with sweat and soapy water by the time we were done!

So we went to the vet yesterday. I took Gable with me to Doree's visit so that they could look at his sores. The cardiologist doesn't think that her murmur warrants any medication right now. Her heart is not enlarged, the valve is not too thick, and there is minimal leakage, so that is good news....only cost $625!!

Gable's turn. The vet combed him for fleas, no sign of any. He saw all the hot spots and figured that he could've been bit by one, and that put him in an allergic state which is out of control now. So he prescribed Apoquel, 1 tablet twice daily. After one dose, the frantic licking and scratching stopped. He slept through the night last night (he had been getting up for the last few nights around 2 or 3am), and looks so much more comfortable. I just have to keep an eye on them to make sure they don't get infected. $225 for him. A very expensive vet visit! Oh well, such is life with pets....at least we've gotten good news all around.

Care Credit is over the limit...I may have to ask for more :(

Harley PoMMom

08-10-2018, 01:01 PM

Oh dear, not so good bath-time :( but you managed, so job well done!!! That's wonderful the Apoquel has helped Gable, what a relief for you both! I'm also happy to hear that Doree's heart murmur doesn't require medication, so all in all, good news all around, but expensive :( When Bear needed his leg amputated I had to request an increase to my credit limit from CareCredit, they were very understanding and approved it right away.

Joan2517

08-10-2018, 01:06 PM

That's good to know. I may ask for an increase anyway as I'll need it for Gable's meds and testing, plus Doree will need another checkup in six months. Thanks, Lori~

Joan2517

08-17-2018, 05:11 PM

I can't believe that next week Gable will have been on the Vetoryl for three months already! His hot spots have cleared up and his fur looks great. I think he's only got a couple of more of the Apoquel. He's sleeping so much better, although the other night I don't know what he was dreaming about, but he howled like a wolf and woke us all up around 2:30 or 3:00. I have never heard him do that! He's losing weight, I think he was 67.4 the last time, and looks fantastic; no more big belly where I was sure something was growing. He's playing again; jumping up on the furniture; and just seems so much better. I had forgotten how much fun he used to be!

It is so opposite how things went with Lena. I wish I had done better with her, or just not done anything at all and let her live out her last days without all of this. Gable still gobbles up whatever I put the pill in; she started getting very suspicious of whatever I tried to hide it in...almost like she knew, and didn't want it. Obviously, I am having some Lena days...2 1/2 years on Sunday.

Harley PoMMom

08-18-2018, 10:33 AM

Man, almost 3 months that Gable has been on Vetoryl, time sure does fly by! And I am happy to hear that he is doing so well!!! I bet the wolf howling got your attention! Would love to know what they are dreaming about, ain't!!

I am sorry that you're having Lena days, it is so hard not to beat yourself up, trust me I know. We just have to find some comfort in knowing that we loved them deeply and still do, and that we did try our best, that's all we can do, try our very best, and we did that. Sending you tons of comforting and loving hugs.

labblab

08-19-2018, 07:43 AM

Thinking of you especially today, Joan, and remembering your sweet angel Lena right alongside you. I’m thrilled that Gable is doing so good! And I surely wish with all my heart that Lena could have been saved, as well. I honestly don’t think that anything you did with Lena was wrong; I honestly think it was her heart that took her, and not the Cushing’s per se. So you were trying your best to treat the Cushing’s with her, just like now with Gable. I know that writing this doesn’t change how you feel. Nothing that anybody says changes how much I wish things had been different with my Barkis. But we did the best we knew how to do for them. If love could have saved them, they’d both be with us right now, that is for certain. We’ll love them forever. So I’m sending you big hugs today. Big hugs of celebration for Gable, and big hugs of comfort for your loss of Lena. And you know, Lena really gets a lot of credit for saving her brother, because the things she taught you have helped you to help him. Her own tired little body could not live on, but she gifted her brother with a much brighter future. What a special angel, indeed...

Joan2517

09-15-2018, 04:49 PM

Took Gabe for a pre-pill test this morning. I lowered his vetoryl from 40mg to 30mg a couple of weeks ago. My vet had wanted to lower it at the last test, but he was still drinking a lot so I left it. But I wanted to see what his cortisol level would be at the 30mg and decided to try. I have noticed an increase in his drinking and he put on a few pounds (70.7lbs today) so it will be interesting to see. I'm not sure how accurate this test will be as he was extremely stressed this morning. Instead of one of the girls taking him back, there was some guy I never saw before and he didn't know what an escape artist Gable is. He escaped from them twice and came running to the waiting room nearly knocking me over both times. Thank God no one was coming in or out at the time or he would have run for the hills! Then they had to drag him back there with me right beside him.

I will probably put him back on the extra 10 no matter what the test shows unless it's way low...which I doubt it will be.

Harley PoMMom

09-16-2018, 03:02 PM

Awww, poor Gabe, sure wish there was a way that is less stressful for our precious pups. :( Are his hot spots still cleared up? And how is Doree doing?

Joan2517

09-16-2018, 10:56 PM

Yes, hot spots are gone, Lori.

I had to take Doree to the ER this evening. All of a sudden she came to us with her left front leg up in the air. She had just eaten and I was sitting on the deck with my husband. No idea what happened; she wasn't crying and we weren't even sure where she came from...in the house? from the garden?

After three hours there, they think she might have IVDD. They gave us Tramadol 50mg, 1/4 2-3 times daily and Gabapentin 50mg, 0.6ml 3 times daily. Why two different painkillers?

Of course by the time we left she was putting her foot down. They recommended no jumping, climbing, running, no stairs...we got home and I put her on her chair and the next thing I knew she had gone down the pet stairs I had been using for her for years (I originally bought them for Lena, but she would never use them). There's no way we can keep her from all of that unless we crate her and she will hate that, especially since we are both gone all day. She wanted to eat when we got home and is now sleeping it all off. They also said she should get an MRI (only $2500!). I'm pretty sure something like this has happened before. I will probably take her to our vet tomorrow or Tuesday and see what Plunkett says.

The last time I was at that ER was with Lena...that was the last time I saw her alive and where I picked up her sweet little body. I have not stopped crying...

Harley PoMMom

09-17-2018, 11:17 AM

Oh Joan,

I am so sorry, it must of been so hard to have to of walked through those ER doors :( Sending huge comforting and loving hugs.

Tramadol is an opiate style medication and is used to treat a wide variety of pain since it's binds to the mu-opioid receptor that controls the perception of pain in general. Gabapentin is usually prescribed for nerve pain, so I figure they are having Doree take both as to try to cover all bases for pain. Hoping Doree feels better soon.

Sending more (((hugs)))

Joan2517

09-17-2018, 11:29 AM

Oh, thanks Lori. It was awful. When they asked if I'd ever been there before, I could barely get a "yes" out. After they took her in the back, I had to go sit outside to try to get my emotions under control. I have a splitting headache today from crying myself to sleep.

Oh yes, he did say that the disc problem might be affecting the nerve that runs down her leg. I forgot about that. Today she seems fine, no limping, no leg up. Dr. Plunkett hasn't seen the fax they sent yet (he's in surgery), but I am pretty sure she has had this problem with her neck before and the tramadol helps. She's so small, but continues to jump even though she has a knee problem and something in her spine. I have the pet steps every place where she can jump off, so she'll use those now. Hopefully, she just hurt it jumping and it's not cancer, or IVDD. My youngest grandson was over and he has a terrible habit of grabbing the little dogs around the neck, no matter how many times I've told him not to do it. So I hope he didn't do it...my husband would kill him! Doree is his even though I am the one who feeds, cleans up after, takes to the vet, etc. She was so good. Just sat quietly in my lap watching everything.

Joan2517

09-17-2018, 02:28 PM

Gable's resting cortisol is 2.2 / ref range: 1.0 - 5.0

Not sure now if I should go back to the extra 10mg or leave him at 30mg. I'll have to monitor the water intake better, I think.

labblab

09-17-2018, 05:28 PM

Awwww Joan, I’m so sorry about your scare with Doree, and the pain of returning to the ER. A really rough evening, all the way around :-((((((. But you did what you needed to in order to keep Doree safe, and I’m sending you big hugs for pushing through the sorrow in order to tend to her. Good job, mom!

As far as Gable, yes, I think you’ll want to try to assess his symptom profile as accurately as possible. If you revisit Dechra’s pre-pill monitoring chart, you’ll see that a cortisol level between 1.5 and 5.0 is either OK or not OK, depending upon symptom resolution. At 2.2, a dosing increase could be considered if symptoms are not adequately controlled.

However, having said that, it looks as though his pre-pill level has gone down from the last monitoring test (I think it was over 4?), and that’s even while presumably more stressed than before. So if it was me, I think I’d leave it at the 30 mg. for now, and try to check his actual water consumption more closely, if possible. And, of course, watch for any other symptom rebound.

Marianne

Joan2517

09-17-2018, 05:42 PM

Thanks, Marianne, that's what I think I will do. Leave it for now and watch.

Harley PoMMom

09-18-2018, 10:57 AM

I agree with leaving it at 30 mg, and if it looks like he may be drinking/urinating more than I would recommend having an urine culture done to rule out an UTI before increasing the total Vetoryl dose.

Sending more hugs, Lori

Joan2517

09-18-2018, 11:10 AM

Thanks, Lori....leaving at 30 will also be less expensive.

Squirt's Mom

09-19-2018, 09:58 AM

((((((((((((((((((((HUGS))))))))))))))))))) It is so very hard when we have to face those places and people that bring back those heart-wrenching memories. Just know you are not alone even when you can see us or hear us.

Joan2517

09-19-2018, 10:45 AM

I know...thanks, Leslie.

Harley PoMMom

09-25-2018, 10:57 AM

How are you and Gable doing?

Joan2517

09-25-2018, 11:41 AM

We are doing fine, Lori. Gable looks and acts great. I showed my sister a recent picture of him and she couldn't believe how much he's slimmed down. I kept him on the 30mg, and he's getting one Apoquel (not sure I spelled it right) a day. At 2.2 I'm wondering when I should have him checked again.

And Doree is doing okay, too. She won't take the pain pills anymore, no matter what I hide them in, and she seems fine, so we're just going to watch her.

How are you?

Harley PoMMom

09-25-2018, 11:36 PM

I'm doing ok, I just had a YAG procedure done on my left eye to get rid of some scar tissue that formed over the lens that was replaced 2 years ago, it is so nice to be able to see out of that eye again. Unfortunately the same thing happened to the right eye so I'll be getting that one done too soon.

So glad to hear that Gable is doing great....that's awesome!!! And happy that Doree is holding her own, she's a tough broad!!!!

Joan2517

09-29-2018, 03:33 PM

I think my husband is going to have that procedure done. I'll have to ask him.

I was hoping I was just imagining this, but I've noticed in the past few days that Gable seems to be drinking, eating and panting more. He's been on the 30 mg now for about four weeks. The resting cortisol was 2.2 two weeks ago. So he was two weeks on 30mg before testing. I am perplexed! I'm afraid to raise it even though he showed no signs of being too low. What do you think?

labblab

09-30-2018, 08:46 AM

Hey Joan, according to the pre-pill monitoring protocol, a dosing increase can be considered if symptoms remain or rebound with a pre-pill resting cortisol higher than 1.5. So if it were me, I’d probably go ahead and see if the additional 10 mg. improves things.

Joan2517

09-30-2018, 09:13 AM

Thanks, Marianne. I'll see if that works!

Joan2517

11-26-2018, 08:46 PM

Okay, so Gable had the resting cortisol test on Saturday. He is at 3.3 on 40mgs., 30 am and 10 pm. What do you think?

labblab

11-26-2018, 09:27 PM

How is he doing, symptom wise? If Gable is doing good in terms of symptoms, then I think the cortisol level is great. If his symptoms still aren’t being controlled to your satisfaction, you could probably tweak his dose a bit upward again, especially since his cortisol level is a tad higher than it was two months ago on the 30 mg. alone.

Marianne

Joan2517

11-27-2018, 06:14 AM

He seems fine, except he threw up during the night. He has done it a couple of times in the past week, but I think he's eating the dried leaves outside and that usually makes him barf. It looks like pea soup...yuck! His appetite has slowed up a little, he drinks a lot, but not as often, and he's been playing and running around a lot more. He's down to about 65lbs. He even came up on the couch with all of us the other day and he hasn't done that in at least a year, maybe more. His panting has slowed, too.

He doesn't feel good this morning, so i'm not going to give him any meds. We're up and he's not looking to eat so I know his stomach must be bothering him.

I think I'll keep going with the 40mgs for now.

Harley PoMMom

11-27-2018, 12:49 PM

Since it's seems he is doing well and that his symptoms are pretty much controlled I believe keeping his dose at 40 mg is the best choice. You could give him pepcid ac 20-30 minutes before his Vetoryl dose and see if that helps with his tummy.

You're doing a great job, Joan!!

Joan2517

11-27-2018, 01:03 PM

Thanks, Lori...I have to say his vet was really pleased.

Squirt's Mom

11-27-2018, 03:58 PM

So glad that Gable is doing so well! You're a good mom and he is so lucky to have you on his team!

labblab

11-28-2018, 08:36 AM

Joan2517

11-28-2018, 12:22 PM

Thanks, girls! He seems okay, hasn't thrown up since the other night. I'll start him back on the meds tonight with his 10mg dose.

Joan2517

12-06-2018, 03:14 PM

He has started drinking more again, and the panting has returned. If I was to raise the Vetoryl, how much do you think? He's getting 30mg in the morning and 10mg at night. I might wait until the weekend before Xmas since I'll be home for 5 days and can keep an eye on him.

He still looks amazing though and has even started getting up on the couch and laying next to me again. He hasn't done that in years!

Squirt's Mom

12-06-2018, 04:45 PM

Is it possible that the heat being on the house is making him drink and pant more and not the cortisol on the rise? Just wool gathering.... :D

Harley PoMMom

12-07-2018, 08:13 AM

Another idea would be to have his urine cultured to see if an UTI might be brewing.

labblab

12-07-2018, 08:26 AM

I agree about getting a culture, just to make sure that’s not the problem. If the urine is OK, I’d probably recommend adding in another 10 mg. at night, but I hate it that this combo of capsules is gonna get pretty expensive for you. It might be worth it for a month, though, to see what happens. Who knows, maybe he’ll ultimately work up to 30 mg. both morning and evening. Or, of course you could always consider a compounded product for part or all of his daily dosing.

Harley PoMMom

01-23-2019, 07:19 PM

How's our Gable doing?

Joan2517

01-24-2019, 06:14 AM

I tried upping to the extra 10 at night, but he just didn't seem good after a few days so I stopped. I think I'm going to have him tested over the weekend. He's drinking a bit more, panting more, and he's thrown up a couple of times in the past few weeks, maybe 3 or 4. I don't know if he's eating something outside that's doing it or not.

But he looks so good! Fur is all grown in and looks the same, no more piebald. He's still playing a lot and back up on the couch with us more.

Thanks for asking, Lori.

Harley PoMMom

01-24-2019, 01:19 PM

Sorry for this recent bump in the road :( In light of his symptoms I think your idea of having him tested this weekend is a really good one. Are you considering having the full ACTH stimulation test performed to see how much cortisol reserve he has?

Joan2517

01-24-2019, 02:41 PM

What does that mean exactly, Lori? I saw that in Glynda's post and wondered.

Squirt's Mom

01-24-2019, 03:07 PM

When Squirt and I first started this cush journey one of the Admins at that time told me the ACTH treats the adrenal glands like a wet sponge. The first number just tells us that the sponge holds water but the second number is how much water was in the sponge when it was squeezed dry or how much that sponge was holding in reserve. This is with the old method of doing the ACTH where a stimming agent is used, which does the squeezing on the adrenal glands.

Harley PoMMom

01-24-2019, 03:15 PM

If a dog gets stressed or sick, it's system needs some extra cortisol to help deal with the situation so it uses that "extra" cortisol that those adrenal glands have stored. The "resting" cortisol is what the body uses on a day to day basis and when any kind of stressful situation arises they need more cortisol to handle it so they use what the adrenal gland has stored. With the ACTH stimulation test, the stimulating agent causes the adrenal glands to dump that reserved cortisol and the post result is the reflection of that reserved cortisol...Hope that makes sense!

Joan2517

01-24-2019, 06:34 PM

It does, thank you both. I'm not sure if I can do the test this weekend. I took Doree to the vet today because she threw up yesterday morning, didn't eat breakfast, then my husband gave her chicken for lunch and when I got home from work last night, there was diarrhea all over the back room. She was uncomfortable all night, so we went this morning. Xrays because she has a heart murmur, blood work just to make sure, urinalysis in case she has a UTI because she has been drinking and peeing more....$640 later, everything is fine. Go figure!

Harley PoMMom

01-24-2019, 07:48 PM

OMGoodness! They sure do keep us on our toes, glad she's feeling better and will be praying that it continues. Keep us updated!

Joan2517

01-28-2019, 10:25 AM

Oh dear, Gable's results from the ACTH test are not good:

Sample 1 is .3, ref range 1 - 5
Sample 2 is .4, ref range 8 - 17

I don't get it. He's drinking like anything, panting, still eating, but doesn't seem lethargic at all, no diarrhea, just vomited a couple of times in the past couple of weeks. And his last resting cortisol test was higher??

labblab

01-28-2019, 12:02 PM

Wow, I don’t get it, either!! These results are really surprising, especially given that his resting result has always been so much higher than the .3 on this test. I think it was over 3.0 in November? But of course that was right before his next dose rather than a few hours afterwards.

Do you know whether the same lab has processed all these tests? Any changes at all in the source of the meds?

I am stumped. But at those low levels, I guess you’ll want to totally discontinue the Vetoryl altogether for a while...:-((((

Joan2517

01-28-2019, 12:11 PM

He was at 3.3 then. It's the same lab. And I get the Vetoryl from the vet all the time. The vet said to keep him off for 2 weeks and test again. Do i have to do the ACTH test? or can i do the resting Cortisol? If he's drinking so much now won't it get worse if I stop the meds? If he starts peeing in the house it will be a disaster.

How could it drop so low and he's still showing symptoms? He's on the thyroid meds, I wonder if it could be that? I'm feeling the panic set back in...

labblab

01-28-2019, 12:41 PM

Remind us as to his treatment history with the thyroid meds. If his thyroid level is now too high, I guess that could account for excessive thirst & panting even in the midst of a low cortisol reading. But it would not account for the low cortisol, itself. And paradoxically, excessive thirst can be associated with too-low cortisol as well as too-high cortisol. So you may actually see some improvement as opposed to a worsening of those problems.

Were his blood chemistries tested alongside this ACTH?

I know it’s hard, but try not to panic. The good news is that, aside from the few vomiting episodes, he doesn’t appear to be unduly ill. I think we’ll just have to take it day-by-day and see what develops.

From some other reports coming in to us, it seems as though the new baseline cortisol monitoring system may not be working out as ideally as we might have hoped. Even though Gable’s baseline pre-pill values were looking good, maybe a significant post-pill cortisol drop was being overlooked. Right now, it looks as though that may have been the case. So let’s see how he does after a few days off the Vetoryl, and keep reassessing.

Joan2517

01-28-2019, 12:55 PM

No other blood work was done with this test. His thyroid was checked a few months ago, i think. Had to be for renewing the pills.

I know, I read Glynda's post a couple of weeks ago. I hate that my vet, the one I don't like to use, might have been right about the pre-pill testing. When I showed the new protocol to him he made a face and tossed it on the desk. And this morning when he told me the results and i asked for the results to be faxed to me, I could almost hear his eyes rolling over the phone...:)

Okay, I'll just keep watching him...

Harley PoMMom

01-28-2019, 01:21 PM

Did they put him on prednisone?

Before the Vetoryl can be restarted it is advised that a full ACTH stimulation test be done with a post higher than 9.1 ug/dl and a rebound of Cushing's symptoms

Joan2517

01-28-2019, 01:27 PM

He never mentioned prednisone. He seems fine, though Lori.

I'm at work in the city and I'm freaking out. It's a good thing I didn't keep giving him the extra 10 a couple of weeks ago and it's a good thing I took him on Saturday, even though I had just spent $640 there on Doree on Thursday.

Would two weeks be enough time before having him retested?

Harley PoMMom

01-28-2019, 01:40 PM

2 weeks should be good but how he is acting would be more of a guide. If his increased drinking doesn't slow down within a day or two that would make me think that the cortisol isn't rebounding and/or that the electrolytes are unbalanced so, if this were me, if his increased drinking doesn't improve in a day or two I'd have both the ACTH and electrolytes tests done.

Joan2517

01-28-2019, 01:43 PM

Okay, thanks Lori.

labblab

01-28-2019, 02:47 PM

For sure, I’d have a chemistry panel done in a couple of days if you don’t see improvement or if he worsens. In addition to the electrolytes, it would be good to also check his thyroid level.

Joan2517

01-28-2019, 02:58 PM

I think I'm going to cry. Here I thought we were doing good and I could've killed him.

labblab

01-28-2019, 03:09 PM

Aww Joan, try not to feel so bad — Gable doesn’t sound as though he’s anywhere near death’s doorstep right now. You’ve been watching him like a hawk, and if there are imbalances going on, they can be remedied. Given your report of his current behavior, I wouldn’t be starting him on prednisone yet, either. Let’s see how he does over the next couple of days. He may not need any supplementation of any sort. But if he does, it is easily administered.