5# Pom Beary adrenal - New to your site

[Beary the Pom]

Hello everyone. What an incredible resource - thank you! Hope this isn't too much...

We got little 5# Beary 5 years ago & don't know how old he was then...we guess he's now 12. He's been SUCH a delight!!

Our troubles started 12/21/16 when he was lethargic, threw up & wet his bed. Next day more throwing up, wouldn't eat, sat bolt upright during the night, trembling a lot. Took him to vet 12/23 for blood profile & 2 shots (for nausea & an antibiotic). By Christmas he still hadn't eaten, wasn't pooping.

On 12/26, the vet first suspected Addison's. Cortisol "pre" readings were 9 & 23. He did the ACTH Stim test and on 12/27 the all-day cortisol level & low dose dex tests. Cortisol "post" readings were 2 & 3. Concluded it was Cushing's - benign adrenal & prescribed 10 mg Trilostane.

Then bad urinating problems (up 3, 4 times each night). On 1/9/17 he was prescribed Clavamox drops for bladder infection. By 1/13 he seemed to be doing better on all counts.

BUT by 1/23 he worsened (no appetite & no pooping, peeing 5 times/night) so back to the vet, staying overnight. Next day conclusion was that the 10 mg Trilostane had affected his liver, confirmed by blood panel showing somewhat elevated enzyme (328 ALT (GPT)). Vet directed to discontinue Trilostane for a time and prescribed Denamarin and Metronidazole for liver.

On 1/26 we took him back to vet for terrible, body-wracking coughs (waking us several times at night). He was prescribed Amoxi Drops.

On 2/1 returned to vet to start on a low dose compounded liquid version of Trilostane (0.25 ml).

Whew! We're exhausted but grateful for sleeping through the night, eating & drinking (though not much). Lesser trembling (more when he eats & drinks). He's still on the liver meds & lower dose Trilostane.

BTW, he had a full coat of fur when we got him 5 years ago; 3 years ago (we thought) his fur never grew back after a shave. Now we wonder if it was Cushings. He's almost hairless on his trunk now & still has a distended belly since all this began.

We'd LOVE any input or suggestions. We live in a little town in NE GA, 2 older part-time vets. Should we pursue further testing/verification of what he's on?

What do people think of holistic alternatives of melatonin & flaxseed?

THANK YOU!!! This little guy means the world to us & he's been kind of "blank"/inactive for 6 weeks.

[Carole Alexander]

My goodness, you and Beary are going through a really difficult time. I feel so badly for you both and know that those who are incredibly experienced and knowledgeable will reply to your post with questions and suggestions. I started to reply to Trilostane dosage but will leave that to the experts. I do know that Melatonin and Flax may help to reduce cortisol levels (I am giving both to my dog daily.) but there is no evidence beyond anecdotal stories that these herbs will control cortisol and sustain it at safe levels for Cushing's dogs. Finally, I understand your comment about blank/inactive. Skippy was a lump for two months and is just beginning to respond to the Vectoryl. Because you are very devoted to your tiny pup and I know you will find help here. The scariest part is the beginning and it will surely get better as you learn more.

[DoxieMama]

Hello and welcome to you and Beary! Thank you for providing his history, the more information we have, the better assistance we can offer. However, I do have a couple questions. :o

Do you have copies of all the tests done? I'm curious if there was anything out of range on the blood profile that was initially done on 12/23?


On 12/26, the vet first suspected Addison's. Cortisol "pre" readings were 9 & 23. He did the ACTH Stim test and on 12/27 the all-day cortisol level & low dose dex tests. Cortisol "post" readings were 2 & 3. Concluded it was Cushing's - benign adrenal & prescribed 10 mg Trilostane.

For the ACTH test, there should be just two numbers. For the LDDS test there should be three. The way you wrote the results, I'm a little confused as to which numbers apply to each test. :o

I am glad to hear that the initial 10mg dose of Trilostane was discontinued after his reaction. It must be given with a full meal every day so if they don't eat, they don't get it. Any other adverse reactions (lethargy, etc) also meals no meds.

You mention he is now on a low dose compounded liquid version of Trilostane (0.25 ml). Again, I may be misunderstanding but... I think that is the amount of the liquid. What is the dosage of the Trilostane (how much per ml?).

I look forward to learning more about your precious boy!

[Beary the Pom]

Hello and welcome to you and Beary! Thank you for providing his history, the more information we have, the better assistance we can offer. However, I do have a couple questions. :o

Do you have copies of all the tests done? I'm curious if there was anything out of range on the blood profile that was initially done on 12/23?



For the ACTH test, there should be just two numbers. For the LDDS test there should be three. The way you wrote the results, I'm a little confused as to which numbers apply to each test. :o

I am glad to hear that the initial 10mg dose of Trilostane was discontinued after his reaction. It must be given with a full meal every day so if they don't eat, they don't get it. Any other adverse reactions (lethargy, etc) also meals no meds.

You mention he is now on a low dose compounded liquid version of Trilostane (0.25 ml). Again, I may be misunderstanding but... I think that is the amount of the liquid. What is the dosage of the Trilostane (how much per ml?).

I look forward to learning more about your precious boy!

Yesterday I asked for all the tests - but what I got was his initial blood profile & then several pages with just the cortisol levels. Forgive my ignorance... should there be separate test results for the ACTH and LDDS tests?

Yes, several things were out of range:

Highs were:
BUN 31.6
Phosphorus 5.6
Glucose 151
ALT (GPT) 328
GGT 20
Total Bilirubin .8

Lows were:
Calcium 8.2
Corrected Ca 8.8
Total Protein 4.3
Globulin 1.4
Cholesterol 96
Sodium 139
Chloride 92.

Thanks for your explanation on the ACTH & LDDS tests. I'll call & get those & ask about the Triolstane per ml. And TY for explanation re: Trilostane & no eat, no Tril etc.

I truly appreciate all your kind words & encouragement - and helping "interpret" for me!

Barbara

[Squirt's Mom]

Hi Barbara and welcome to you and Beary! :)

I took the liberty of editing your post to put those test results in a column of sorts. If you would, please edit to show the little letters after each value and the normal ranges since these vary from lab to lab. It will look something like -

EXAMPLE:
ALP 150ug/dl 95-130

To answer your question about the ACTH and LDDS tests, yes there should be two different test results for them. They have different purposes and protocols and are not typically performed on the same day due to that. The ACTH is a stimulation test and the LDDS is a suppression test. Your paperwork may use those words - stimulation and suppression that will help you distinguish between them. In the US the ACTH has 2 numbers, a pre and a post; in Canada they have 3 numbers. The LDDS will have 3 numbers and are done by hours so you will see something like 1 hr, 4 hr, and 8 hr results.

Hope that helps!

Hugs,
Leslie and the gang

[Harley PoMMom]

Hi Barbara and welcome to you and Beary from me as well!

Beary sure is a cutie pie and bless you for giving him a forever home!

There are a couple things that really concern me, one is the fact that the tests they performed for Cushing's were done when Beary wasn't feeling well. When a non-adrenal illness is present this can create false positive results on all tests for Cushing's.

Also, a bladder infection will make a dog drink and urinate more so these symptoms can be attributed to this and not Cushing's. Was Beary's urine cultured to make sure that the infection is completely gone?




Our troubles started 12/21/16 when he was lethargic, threw up & wet his bed. Next day more throwing up, wouldn't eat, sat bolt upright during the night, trembling a lot. Took him to vet 12/23 for blood profile & 2 shots (for nausea & an antibiotic). By Christmas he still hadn't eaten, wasn't pooping.



These symptoms here sound like he may had a pancreatic episode. Was pancreatitis ever mentioned as a possibility? If not, I believe I would have Beary checked and the two tests that are used to diagnose pancreatitis are the PrecisionPSL , which is from ANTECH® Diagnostics laboratories; the other test is carried by IDEXX Laboratories and is called the spec cPL.

I recommend either one in diagnosing pancreatitis, I'm more familiar with the spec cPL test because my Harley had pancreatitis. Pancreatitis does cause elevations in those liver enzyme levels.

If this were me I would withhold giving the Trilostane and revisit the Cushing's diagnostic testing when Beary is eating normally and feeling better, now, I'm not a veterinarian so this is just my layman's opinion.

Hugs, Lori

[molly muffin]

Hello and welcome from me too. I also have some concerns about the cushing diagnosis. You are also looking at high glucose which is an indicator of diabetes, so that needs to be followed up on.

It also looks like his electrolytes are out of balance and this too is a serious concern all on it's own. Phosporphus high, sodium low,
If you can edit your post to include ranges as Squirts Mom showed that would be helpful, to know how far out of balance we are talking here.

Where these results from tests done before he started trilostane or after?

Any time you post a test result include the range.

So right now I have concerns about the cushing diagnosis because in reality you shouldn't test for cushings when a dog is sick (the throwing up, not eating, etc, all signs of pancreatic attack as Lori mentioned)

Now to be fair, I'm not saying that cushings isn't a factor but it is hard to know for sure if he was tested while sick.

So, a few more questions and a few more answers and we'll be able to give you much better feed back. I know it's nerve wrecking going through this and the worry is absolutely paralyzing sometimes. However, you have found a good support forum and we'll be with you each step of the way.

Welcome

[Beary the Pom]

Thanks Carole Alexander, DoxieMama, Squirt's Mom, Harley PoMMom & Molly Muffin! Yes, I'm overwhelmed. Sounds like we need to take him for more evaluation & lots more explanation to us.

Below is adding the info requested. (sorry; it's hard to line these #s up!)

Highs were:
BUN 31.6 mg/dl 9.0 - 29.0
Phosphorus 5.6 mg/dl 1.9 - 5.0
Glucose 151 mg/dl 75 - 125
ALT (GPT) 328 U/I 0 - 120
GGT 20 U/I 0 - 14
Total Bilirubin .8 mg/dl 0.0 - 0.5

Lows were:
Calcium 8.2 mg/dl 9.0 - 12.2
Corrected Ca 8.8 mg/dl 9.0 - 12.2
Total Protein 4.3 g/dl 5.5 - 7.6
Globulin 1.4 g/dl 2.0 - 3.6
Cholesterol 96 mg/dl 120 - 310
Sodium 139 mEq/l 141 - 152
Chloride 92 mEq/l 102 - 120

Per my call to the vet yesterday, Beary's ACTH on 12/26 were:
pre 9.2
post 23.8

The LDDS on 12/27 were: range 1.0 - 6.0
pre 6.6
post 2.4 4-hour
post 3.3 8-hour

He was originally on a 10 mg Trilostane tablet. His compounded liquid squirted in his mouth after eating gives him 5 mg.

[Harley PoMMom]

The increased levels in the liver enzymes (ALT, GGT, and bilirubin) along with the electrolyte imbalances (Sodium, Chloride, and Calcium) are indicative to pancreatitis and/or a bile obstruction. If this were me I would focus in getting these two issues ruled out...JMO ;)

How is Beary doing?

Hugs, Lori

[Beary the Pom]

Thanks Lori! I really appreciate your info on pancreatitis a/o bile obstruction. The good news is Beary is eating & drinking & pooping & peeing consistently. These are HUGE improvements. Not trembling much (like 5-10% compared to earlier), sleeping through the night (which helps us!!). A little bit more energy - but still much less than before all this started.