Tess, radiation therapy (Tessie has passed)

[Sammie]

Admin note from Terry (Mytil): The following message was sent to us via Forum Feedback and I have started this new thread for "Sammie"/ Dottie and Tess.

Admin note Alison (AlisonandMia) on 07/10/09): I have changed things so this thread now belongs to Dottie (username: Sammie)


On the first day of Vetoryl which was given at 7:00 a.m. on a full stomach,Tess front legs started to shake really bad. That had never happen before, only the back legs. She was just staring at the wall in bed. She sleeps with me. She is taking at once two tablets at once 30mg each tablet, so 60mg of Vetoryl. She is 22 to 25 pounds. The second morning again at 7:00 A.M. two more tablets. Around 5:00 P.M. notice she did not want to go for a walk with the other dogs. Not drinking any water. This is 4th of July night. Got her to walk down the street and a firework went off. She freaked. I called the vet at his house. While I was on the phone with him she vomited. Forgot the first night she would not stop shaking, breathing really hard. back to second night. She is now weak, cant walk, and has vomited 6 times though out the night. The last one was pure stomach acid. Yellow smelled like acid. Its sunday July 5th 2009 and I am trying not to call the vet. I found soaking her in a wet towel helped, she is still shacking and her tong keeps coming out of her month licking at the air. I have a medicine dropper and I am giving her water with it. I pinched her skin and it does come back. Her gums are a pale pale pink/white. She had a chusing test and it was positive. So she is dehydrated from vomiting, Not giving her to much water. I don't want her to vomit again. Its the very hot body and shaking of the stomach that I am worried about. I can't find anything on it. Vet said she has something else going with her and that Vetoryl should not of made her sick. Help me fast please.

Dottie

[BestBuddy]

Hi Dottie,

Stop the Vetoryl. You should never give it to a sick dog. It does seem to be too much of a coincidence that she has been ill as soon as you started the Vetoryl.

If Sammy is not improving you need to get her to the vet for maybe a steroid injection and some prednisone to combat the drug.

What tests did you have done to confirm cushings? How old it Sammy?

Please come back and tell us how things are going.

Jenny

[mytil]

Hi Dottie,

I hope you received my email with the link to this thread.

I agree completely with Jen here, stop the Vetoryl until her condition improves. Is she taking any other medication that may have interacted with the Vetoryl?

Here is a link for you on Vetoryl - http://www.k9cushings.com/forum/showthread.php?t=185. Take a look especially at this link Treatment and Monitoring Flowchart. From this it sounds as 60mgs is too high of a dose with the weight you have given.

Terry

[SasAndYunah]

The best advise I can give you, is to bring her to a vet asap. Pale gums are always a reason to see a vet asap. Could be the Vetoryl, could be something else but she needs to see a vet.

The air "licking" probably is a sign she is nauseous. But not giving her the amount of water she needs because you're afraid she'll vomit again, is not the way to go. If she is dehydrated, as you say, but also you mention her skin is popping back...she needs fluids and not just a few drops through a medicine dropper. There is just one way to handle this and that is taking her to a vet, as soon as you can. And to not give her any more Vetoryl till she has seen a vet...

Good luck,

Saskia and Yunah.

[ladysmom06]

Hi Dottie,

I agree with the others. Stop the Vetoryl and see your vet. We used vetoryl here. After only 2 doses my little girl started vomiting too. The dose was to high for her. We stopped it for a couple of weeks and then started back on a lower dose and she was fine with it after that. Good luck and let us know how things are going.

[Squirt's Mom]

Hi Dottie,

PLEASE stop the Trilo and call the vet asap! Your baby is in crisis and needs medical attention. If you have prednisone give it now, call your vet to let them know what you have done and insist that they see Sammy now.

Dottie, this is not something to "wait and see" what happens. This could be the result of the meds, a misdiagnosis, pancreatitis, and many other things.

I hope we hear from you soon as I am worried about Tess. You did really good in reaching out to Terry for help. :)

Hugs,
Leslie and the girls

[MiniSchnauzerMom]

Hi Dottie,

I hope you have received Terry's email and been able to follow the link and read these posts. I, too, agree that Tess is in need of a vet or an ER visit right away and please, do stop the Vetoryl. It should not be given to a dog who is vomiting and ill.

The following is information from Dechra re Vetoryl.

ADVERSE REACTIONS:
The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness.


and

Owners should be instructed to stop therapy and contact their veterinarian immediately in the event of adverse reactions or unusual developments

The cushings diagnosis and treatment can be discussed later. We'll all be here for you to help. Right now the #1 priority is to get Tess to the vet for help.

Louise

[Squirt's Mom]

(Who is Sammie?) :D

[Sammie]

Hi Sammie is my user name, but Tessie is the name of one of my dogs and she is very sick. Last night at 2:00 A.M. I took her out to pee. She did, she was so hot I put another wet towel on her. I feel asleep and woke up to Tes wanting to be sick again. I helped her do that. Turned on the light to get some more water. I saw that her eye's were going back and fourth very fast. At 4:20 A.M. I rushed her to the emergency Vet. Her blood was took thick to draw and run a test, so they got fluid's in her. About 20 or so minuet later, they got blood and every thing was out of whack. The vet said she now has Addison's disease, which is the opposite of chusings disease. We were there tell 8:00 A.M. and we transfered her to my Vet for the day. She is home on the couch for the night. She is doing better, but she has not come back from this yet. I have to Vets now with two different opinions. I have been with my vet for 11 years and trust him. He thinks after two days on Vetoryl that it could not get to Addison's. He did say because of the eye's going back and forth it could be another disease, I will post the name of that disease tomorrow. I forgot the name. He said it was just bad timing for that disease to pop up while we were starting the Vetoryl. My Vet still feels she has chusings.

LADYMOMS6: You are the only post I have seen after two days of searching that had the same thing happen to them. I could not find any thing except for what was on Vetoryl web sit that you have all kindly posted for me. I was at my wits in. I had called my Vet on Saturday at home, But from 5:30 P.M. Saturday to 24 hours later she really went down hill. I will never wait that long again. I have a total of 5 dogs.

My Vet said he might want to start her when she is better on Lysodren Mitotane. Tessie was not on any other medication before she started Vetoryl. She has been given a steroid injection and a injection for nauseous.

I just want to thank you all and am watching over Tessie all night and she will go back to My Vets at 6:30 A.M. California time. I had been up for two days straight, except for that hour last night. Thank god Tess got me up and I got her to the Emergence Vet. Next time there will be know waiting. My vet said if she was still walking around and not lethargy that she might be ok. That is why I waited so long. Thank you all again and I will let you know how it goes.

[BestBuddy]

I am sorry I called Tessie the wrong name.:o
I am glad you got her to the vet because it sounded like she was in real trouble. If she has gone addisons it must have been the vetoryl and makes me wonder about the testing that confirmed cushings. Sometimes getting a correct diagnosis of cushings in all it's forms is hard to do. Once the Vetoryl wears off and the injection should speed things up you should see a great improvement. I would not be starting Lysodren or Vetoryl again until you get some more testing done. If Tessie stays addison then you will have to medicate her for that.

Jenny

[Sammie]

Just cared Tessie out to the lawn and she held her own weight and peed. She is still really weak.:)

[ventilate]

Please tell us what tests were done to confirm your dogs diagnosis for Cushings. With the way your dog reacted to the few trilostane treatments makes me wonder if your dog has cushings for sure. We have seen it happen here a number of times. Diagnosing Cushings can be difficult sometimes and some vets not familiar with treating cushings have even misinterpret test results.
I am glad your dog is doing better, do you have the test results from when you took your pup in to the vets? When you say all the results were out of wack, please post them, normally with an addisons crisis the Potassium and sodium do get out of the normal range, that is why it is so important to get your dog to the vets asap when that happens.
You will want to be sure you get copies of all the test results your dog has, it is a good idea to keep the copies in a file at home, you never know when you will need it and it is a great reference. I think most of us keep copies, as well sometimes it is hard to remember when the vet talks to us so we have the results.
Please continue to watch your dog, did the vet give you prednisone in case your dog got sick again?
Sharon

[frijole]

I am so relieved that you posted an update as I was horribly worried about Tessie! I am sure that you saved your dog's life going to the ER vet. Thank God you did. Good job.

Please continue to post as this group has seen alot of similar cases over the years and we can help but we need to know as much as possible about Tess, the doses etc.

First off as Mytil said earlier it appears that the dose you were on was significantly too high for your dog's size. Its too late to undo that but Addisons can result from too much vetoryl/trilostane. And if the dose is too high it can certainly happen in just two days. Sometimes it is permanent and sometimes it is not. The symptoms you described we have seen many times here and they are of overdose. Has your vet done any testing to see what the cortisol levels are? He/she can't say if it is addisons or whether its something else without testing.

I assume that in addition to the steroid shot that your vet has given you prednisone to give Tess to help restore her current LACK of cortisol? Also were the electrolytes checked? This is important. Typically after an episode like this it takes treatment with IVs for a day or so for the dog to get stable. Did your dog stay overnight at the ER vet's?

Please get copies of the testing done and we can help you decipher what it all means.

You mentioned another vet saying you should try lysodren/mitotane. Please do NOT give this drug yet. First off you have to be sure the dog is not addisonian. If your dog has Addisons and you give her lysodren the result could very well be fatal. Even if your dog still has cushings you must wait for all of the vetoryl to be out of the system and for the cortisol level to RISE before giving lysodren.

I'm not sure which vet is saying what but one of them is clearly not aware of how to treat cushings dogs. That is why we need to know more. Tell us all you can - we are here to help.

We all found this forum the same way and were scared. Cushings is often misdiagnosed and mistreated - but it isn't bad if you know about it. We'll help you with that part.

Again thanks for getting back to us. We were worried about you and Tess. Please - no more vetoryl or lysodren until we find out what Tess's cortisol level is ok? Hang in there!

Kim

[Sammie]

I am sorry I called Tessie the wrong name.:o
I am glad you got her to the vet because it sounded like she was in real trouble. If she has gone addisons it must have been the vetoryl and makes me wonder about the testing that confirmed cushings. Sometimes getting a correct diagnosis of cushings in all it's forms is hard to do. Once the Vetoryl wears off and the injection should speed things up you should see a great improvement. I would not be starting Lysodren or Vetoryl again until you get some more testing done. If Tessie stays addison then you will have to medicate her for that.

Jenny

I agree 100%. I wanted to do the 8 hour test for Chusings, but My Vet said that the two hour test was fine to do and normally this is enough. I said this to him today about the test. I will be having the 8 hour test. I don't want to start her on Lysodren ever. I too think the does was to high. Just by going to there web site I could tell from that chart. Thank you for posting that. I had been there before all of this. I did a lot of research before her first test. All signs point to chusings. They still point that way. Addison's would be easier to have for her. Only from what I have read. Can any one tell me from experience how is it with a dog with Addison"s? TY again you guys are great.

[MiniSchnauzerMom]

Hi,

I'm so glad you took Tessie to the ER and that she is more stable. The Vetoryl Treatment and Flowchart states the following:


PRECAUTIONS:
Hypoadrenocorticism can develop at any dose of VETORYL Capsules. In some cases, it may take months for adrenal function to return and some dogs never regain adequate adrenal function.


Hypoadrenocorticism is the opposite of Cushings and is what the ER vets said happened to Tessie. Many of us have had vets we trusted and had been with who were not knowledgeable about Cushings disease nor followed protocol for treatment. I was one of those people and my dog suffered as he was not sufficiently tested and was incorrectly diagnosed w/Cushings and given Trilostane. It was a nightmare for him and me.

What tests did your vet do to diganose cushings? Also it would be very helpful if you actually get copies of those lab results and post the results for us.

I will be interested in finding out the name of the other disease your vet is referring to. Tessie needs to recover from this. If it is Addison's disease you would not want to give her any Lysodren. If she is ill with some underlying disease the whole Cushings diagnosis could be skewed.

We're here to help so hope you will continue to post and give us updates on Tessie.

Louise

[Sammie]

Please tell us what tests were done to confirm your dogs diagnosis for Cushings. With the way your dog reacted to the few trilostane treatments makes me wonder if your dog has cushings for sure. We have seen it happen here a number of times. Diagnosing Cushings can be difficult sometimes and some vets not familiar with treating cushings have even misinterpret test results.
I am glad your dog is doing better, do you have the test results from when you took your pup in to the vets? When you say all the results were out of wack, please post them, normally with an addisons crisis the Potassium and sodium do get out of the normal range, that is why it is so important to get your dog to the vets asap when that happens.
You will want to be sure you get copies of all the test results your dog has, it is a good idea to keep the copies in a file at home, you never know when you will need it and it is a great reference. I think most of us keep copies, as well sometimes it is hard to remember when the vet talks to us so we have the results.
Please continue to watch your dog, did the vet give you prednisone in case your dog got sick again?
Sharon

Hi I left my copies of the lab test with my Vet I will get them back and post them. Yes the Potassium and sodium were to high. The Potassium is down. Can't remember the one that is to high right now. I know I should remember more, but my other dog (Bunny) had a 7 min seizure and they are getting worse. She had this yesterday evening while I was caring for Tes. Then coming back from My Vet Bunny gets bit from my Lab (Lindie) in the neck. Not bad, but back to the Vet's for a shot and Med's. All of this with know sleep.

Yes I will start a file. Your right it might come in handy. TY Dottie
Forgot my Vet has 5 or dogs right now with Cushings. I have know problem switching vets. There are specialist in Orange Counting I can go to

[SachiMom]

Hi Dottie,
I hope that Tessie is still doing okay. Sending out healing thoughts and prayers for her. And also for little Bunny. It sounds like you have your hands full. They say when it rains it pours, and we need real rain here in So. Cal, but don't need to pour more problems for you.

I do have a huge concern about your vet prescribing such a small 20 lb pup such a large dose of trilostane and then saying that it could not cause addisons. Each dog reacts differently to any drug, but it seems in particular to trilostane. We've had large dogs on minscule amounts and small dogs on comparatively large amounts and vice versa. But the one thing that we have discovered, is start with the lowest possible dose and work your way up.

Before you attempt to start the medication again, be sure to have her thoroughly tested for cushings. You said that your vet currently has five cushings dogs. I truly hope that they are doing better than poor Tessie. Did he/she ever mention the University of Tenn Adrenal Panel. It will tell you if Tessie has Atypical Cushings, which is NOT treated with trilostane, but instead with melatonin and flax seed. I am not familiar with the dosing, etc., but there are several here that are having great success. And others that are thriving on the correct doses of trilostane or lysodren. It is so important to get the testing done. And you are so right to insist on additional testing.

I hope that you are able to get the ACTH test results and post them. There are several here that can help you interpet most of the lab results.

Continued prayers.
~ Mary Ann

[lulusmom]

Thank goodness you got Tess to the emergency hospital. When I read your post it was obvious that Tess was in an Addisonian crisis so I am not surprised that the ER vet was able to make this determination. At 20 pounds, Tess should not have been prescribed any more than 30mg once daily so she was getting twice the recommended dose. I must respectfully disagree with your vet and tell you that we have seen this time and time again. Dogs are extremely sensitive to Trilostane in the first few days so with Tess getting almost double the recommended dose, her cortisol and obviously the aldosterone dropped like a rock. Your vet is probably assuming that because Tess' eyes were darting back and forth, it isn't Addison's but peripheral vestibular syndrome and it was a mere coincidence. If the ER diagnosed Addison's then they checked the electrolytes and quite possibly they ran an ACTH stimulation test which would have shown that Tess' cortisol was not registering at all. It is extremely important that Tess continue receiving prednisone or florinef.

It sounds as though Tess had a severe crisis and I am very concerned that she is already home. Most dogs in her shape are extremely dehydrated and in order to correct the electrolye imbalance, the dog is on intravenous fluids for 24 to 48 hours and until the dog is eating and drinking on its own without vomiting. A dog also getting injections of florinef as there is inadequate reserve of cortisol. Once off of the IV and the dog is eating, the injections of florinef can be switched to an oral medication and this must be continued until the adrenal glands can start working on their own. How long was Tess on an IV and was she sent home with Prednisone or Florinef?

I have two cushdogs, both of which treated with Trilostane and while I am not a medical professional, I know the drug like the back of my hand. I was so distraught when my dogs were diagnosed, I became obsessed with learning everything I could about the drug. UC Davis did their own clinical trials and found that there is a great disparity in the dosing by weight recommended by the manufacture of Vetoryl aka Trilostane. They had many dogs that went into Addison crises at these recommended dosing and as a result, their own dosing protocol is much more conservative. Based on their protocol, Tess would have been started on 20mg once daily. 60mg is huge in comparison and I really think that every horrible thing you saw Tess going through was a direct result of her being overdosed.

My dogs treated with the same vet for 10 years and I trusted him implicitly. Unfortunately, I didn't know back then that a good number of gp vets don't have much experience with cushing's and they are a cushdog's worst nightmare. I found out that our bad experience wasn't so rare as many members had alread walked in my shoes. The fact that your vet doesn't realize that the dose he prescribed is too much and that dogs are extremely sensitive to the drug in the first few days is an indication that he isn't that experienced with the drug and perhaps not the disease. GP vets can be the absolute best vet in the whole world when it involves nonadrenal disease; however, when it comes to cushing's or any other endocrine disorder, many haven't had the extensive training, education and vast experience that an internal medicine specialist has. It wasn't until I found a wonderful internal medicine specialist that my dog was correctly diagnosed and stabilized. To this day, I resent and am so terribly disappointed in my old gp vet for letting my Lulu suffer for so long. We can place blind faith in our vets to do what is right by our dog for a lot of things but cushing's isn't one of them. Addison's is a very, very serious condition and I highly recommend that you consider consulting with an IMS in your area.

It sounds like you are in Southern California so I have no problem recommending excellent specialists in Los Angeles and Orange County. If you are in Orange County, I highly recommend that you consider VCA All Care Referral Center in Fountain Valley. I live in Rancho Cucamonga and don't mind the hour to hour and half drive there. My dogs treat with the Director of Internal Medicine, Dr. Michael Moore. If you are closer to L.A., I highly recommend Dr. David Bruyette, Medical Director at VCA West Los Angeles Animal Hospital. Both of these specialists are excellent and I don't know if you have noticed but we have a video of Dr. Bruyette discussing Trilostane in our Resources Forum.

VCA All Care Referral
http://www.acarc.com/

VCA West Los Angeles
http://www.vcawla.com/

I too will be looking forward to hearing more about the tests that were done to diagnose Tess as well as tests done by the ER vet to diagnose Addison's.

I am so sorry that you and Tess have been through such a horrific ordeal but I am glad that you found us. The collective experience and knowledge base here is amazing and you will find no better handholders anywhere.

I will be thinking positive thoughts for Tess. Please keep us posted.

Glynda

[Squirt's Mom]

Hi Dottie,

I cannot tell you how relieved I am that you got Tessie to the ER. You done good, mom! :):cool::):cool: I really was worried about coming on today and finding bad news on your thread. :(

You have been through a very rough few days here lately and I am worried about you, too. I have four babies and it seems something is always going on with at least one of them so I can understand the strain you are feeling right now. You must take care of yourself, too, Dottie. Sleep whenever you get a chance, do something to help you relax a bit from time to time, and know you are not alone...we are here with you all the way.

You mentioned you didn't want to use Lyso for Tess "ever" and I want you to understand something. What you have just been through on Trilo is exactly what people fear with Lyso. They are often told that Trilo is much safer than Lyso with no "side effects" like Lyso can produce. You have just experienced those exact same "side effects" with Trilo...the "safer" drug for Cushing's. The "side effects" of either of these drugs is usually the result of misdiagnosis, incorrect dosing and monitoring, and lack of educating the parents on the part of the vet and/or lack of diligence on the parents part. You carried your part quite well with the limited information and tools you were given by your vet. IMHO your vet failed miserably on his part. :( My point here is that you have nothing to fear from the Lyso now as you have already been through an Addisonian crisis produced by the Trilo. You now know the worst. The danger isn't in the drugs themselves - the dangers lie with a vet that isn't as cush savvy as they need to be.

That doesn't mean you have to give up on your vet, tho. If they are willing to listen to you and work with you as a team, then this is a BIG plus in their favor. This is where your cushing's education come in. Your vet has the years of experience and training in general animal care to bring to the table; as you learn more about Cushing's, you will bring that specific knowledge to the table along with all of our experience and first-hand knowledge. In this manner, together you will make a formidable team working for Tess. :cool:

I am so proud of you for insisting on further testing! :D This decision alone may prove to be the very thing that saves Tess' life now and gives her many more years of quality days ahead with you. Way to go, mom! :cool::cool::cool: But don't rush the testing. She is in physiological stress right now and that will skew any Cushing's testing, plus those for Addison's. So let her recover from this crisis, if she does, then look into further testing. I HIGHLY recommend that she have the UTK panel done first, then an ultrasound done on a high resolution machine. These two tests will give you more information and a more solid idea of whether you are dealing with Cushing's or not, and which kind if she is cushinoid.

We continue to send healing thought and prayers your way,
Hugs,
Leslie and the girls

[Sammie]

Ok I am not sure how to get this info to you all to help me. The lab results aren't any that I understand. So Here goes.

The first one is from the Emergence doctor.
JUNE 6 2009 4:34 A.M

ALB 2.8 2.5-4.4 G/DL
ALP>2400% 20-150 U/L
ALT 377% 10-118 U/L
AMY 907 200-1200 U/L
TBIL 0.3 0.1-0.6 MG/DL
BUN 50% 7-25 MG/DL
CA++ 11.9% 8.6-11.8 MG/DL
PHOS 6.8% 2.9-6.6
CRE 4.2% 0.3-1.4 MG/DL
GLU 85 60-110 MG/DL
NA+ 149 138-160 MMOI/L
K+ 7.2% 3.7-5.8 MMOI/L
TP 6.0 5.4-8.2 G/DL
GLOB 3.2 2.3-5.2 G/DL
QC OK
HEM 0, LIP2+, ICT 0

NA:K=20.7 This is hand written in a separate box by the doctor
PCV/TS- Also hand written in same box
44%/4 g/dl also hand written in same box
Colloids/unit 0.20
Notes from emergence doctor.

S:Lethargic. Has vomited bile approximately eight times in the past 48 hours. Tessie was still walking around 4 hours ago but then became very lethargic. The owner also noticed that Tessie's eyes were rolling around in her head. Trilcstane 60 mg PO SID was started Friday. Tessie received the last does of Medication Saturday at 7 am.

O: EENT: Horizontal nystagmus with fast phase to the right, prolonged CRT with tacky gums, severe dental calculus: integ: full coat, small SQ masses, normal skin turgor. PLNS: WNL; M/S:
recumbent/nonambulatory, cool extremities; N/S lethargic; cardio: NSR, normal pulses, resp: increased bronchovesicular sounds; abdornen: slightly tense; U/G: F/S

A:Vomiting, lethargy- R/O adverse drug reaction to Trilostane +/- iatrogenic hypoadrenocorticism (most likely) old dog vestbular disease, HGE, pancreatitis, ect.
Horizontal nystagmus-R/O secondary to electrolyte imbalances, neurologic signs seconary to cushings, old dog vestibular disease ect.
Poor perfusion-R/O hypovolemic shock

P: Adised owner of guarded prognosis. Placed IVC. Unable to obtain i-Stat to assess electrolytes on presentation because Tessie's blood was too thick and clotted in the cartridge. Administered 250 ml bolus normosol-R IV. Unable to obtain a blood pressure, and extremities were still cool. Tessie began to have frank blood in her stool in addition to dark brown diarrhea. Drew blood again following intial bolus: VetScan- ALP>2400 U/L, ALT 377 U/L, BUN 50 mg/dl, CA++ 11.9 mg/dl, PHOS 6.8 mg/dl, CRE 4.2 mg/dl, K+ 7.2 minol/L, PCV/TS- 44%/4g/dl. R/O Addisonian crisis. Repeated fluid boius and administered 0.15 mg/kg dex sp IV. Administered 75 ml hetastarch IV for oncotic suuport. Transfer to RDVM.

Breed Yorkshire Terrier/ Shitzu
Age 12
Weight 23.20 LBS

My Doctor:
JUNE 1 2007 This is when my doctor ran the Cushings test.

ACTH STIMULATION RESULTS
PRE-ACTH CORTISOL 5.1 UG/DL
POST-ACTH CORTISOL 41.5 UG/DL

CANINE:
2-6 PRE-ACTH (resting) cortisol
6-18 Post- ACTH cortisol
18-22 Equivocal post-ACTH cortisol
>22 Post-ACTH cortisol consistent with hyperadrenocorticism
<2 Post-ACTH cortisol consistent with hypoadrenc corticism
1-5 desired pre- and post-ACTH cortisol on lysodren therapy

Notes from lab:
ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticisn (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs with HAC.

If the ACTH response test is normal and HAC is still suspected, proceed with a low-dose dexamethasone suppression test.

Dogs with iatrogenic Cushings disease will have flatline response test results in the low end or below the normal reference range.

I don't have the yesterdays ( 7/6/09) or today (7/7/09) blood work from my doctor. Will get them tomorrow 7/08/09.
Dottie

[Sammie]

The name of that underline disease that I could not remember is called
NYSTAGMUS. I have never heard of this. Will now be looking that up
Tessie is home tonight, will go back tomorrow for more IV. She is doing much better. She hate a little chicken. My vet said it was ok. She is drinking water and walking around slowly. She just tried to poop and a little diearea came out, but she has not eaten sense Friday morning, so i think that would be normal. She is sleeping here on the couch. My vet does not have 24 hour care so that is why she is home with me. PS. Tessie was to be on the DBL dose for ten days only, then she was to be dropped down to one dose a day or a week . I can't remember right now. The idea was to bombard the system, get a blood test in a week and then lower it or higher it. We all know now it was to much for her. Dottie

[StarDeb55]

These test results clearly indicate that Tess suffered from a critical Addisonian crisis. The results that indicate this are the elevated potassium, the decreased sodium/potassium ratio is even a bigger indicator. In a normal pup, this ratio should be between 27:1 to 40:1. This is a pretty severe decrease which is a clear indication of an Addisonian crisis meaning that the adrenal glands, besides not secreting enough cortisol at this point, are also not secreting enough aldosterone. Aldosterone is a very important hormone as it controls the sodium & potassium levels in the body. Serious imbalances in these 2 (electrolytes) can be life-threatening.

As Glynda mentioned last night, I am also very concerned that Tess is already home. Is she receiving some type of steroid, along with a florinef injection? The bloody diarrhea is another clear indication that Tess really needs to be at the vet's on IV fluid, where she can be closely monitored with regular labwork to monitor her electrolytes. The other thing that disturbs me on the labs you have posted are the elevated BUN & creatinine results. These are the 2 major tests that monitor kidney function. With these elevated results, there is apparently some impairment of kidney function, but it's hard to tell if this has also been brought on by the Addisonian crisis.

Please, please ask your vet for a referral to an IMS, & get Tess there ASAP as I'm very fearful that she is not out of the woods just yet.

Debbie

[AlisonandMia]

Hi and a belated welcome from me too.

I'm wondering if you've been given any tablets for Tess to take now. Prednisone is what is usually used. Or maybe the emergency vet has given her some sort of steroid shot? This is quite likely if she was vomiting and unable to keep pills down. It would be good if you can find out the name of any medications they are giving her.

Nystagmus is rapid eye movements caused by a disturbance to the balance mechanism in the inner ear. The balance mechanism is called the vestibular system and when it is affected this way it is called Vestibular Syndrome (http://www.vetinfo.com/dencyclopedia/devestib.html). No one really knows what causes it in most cases and it seems to be something that happens more often in older dogs than younger ones. Sometimes it is caused by an ear infection and I'm sure the emergency vet checked out this possibility. It isn't a symptom of low cortisol as such but we have seen a couple of dogs that seemed have it come on when their cortisol went too low so maybe it can be triggered by low cortisol in a susceptible dog. Other symptoms of Vestibular Syndrome can be lack of balance, circling, head tilt and nausea and vomiting (but not diarrhea as far as I know unless anxiety caused by the balance problems triggers diarrhea in a particular dog.)

It does sound like her biggest problem is that she is Addisonian at the moment as a result of the Vetoryl and that the vets are working to manage both problems - the Vestibular Syndrome and the Addisonian state.

Good luck - it sounds like you have all been through a rough few days - and keep us posted.

Alison

[Sammie]

Hi the test labs I posted was when she was in crises. My vet said today that almost all her lab work was back to normal. She is going to have more IV tomorrow and a x-ray of her Kidneys, lungs, and stomach. Her whites of her eyes are really blood shot and that is new. I had that in another dog. She went blind in one eye. Blood shot eyes was the first signs of the retina going bad. Tessie is at the vets from 8:00 a.m. to 5:00 P.M. on a IV he does not have 24 hour care so I have to bring her home to watch over her. I think it was all brought on by the Addison's. He would of told me today if she had a kidney problem. I will ask him tomorrow.

[StarDeb55]

Can you please post any repeat labwork that was done today & over the next several days? Also, Alison has asked a very important question, did the ER clinic either send you home with medication for Tess, & do you know the name of it? Did the ER clinic give her any type of steroid injection such as dexamethasone, and/or florinef?

Debbie

PS- I do realize that the results you have posted were from yesterday when Tess was so very ill. Just to let you know, I'm a medical lab tech with 29 years experience, so I am very used to looking & interpreting these types of results. The kidney values from yesterday do clearly indicate a kidney issue that you need to question your vet about.

[StarDeb55]

Tessie was to be on the DBL dose for ten days only, then she was to be dropped down to one dose a day or a week . I can't remember right now. The idea was to bombard the system, get a blood test in a week and then lower it or higher it. We all know now it was to much for her

From what you have said above, it appears that your vet may have attempted to do what is called a "loading" with Trilostane. If this is the case, this is absolutely inappropriate dosing for this medication. Loading is only done with lysodren. As several of the more experienced members who have used Trilo have pointed out, dogs are extremely sensitive to this drug, & need to be started on a low dose, working up to a higher dose as needed. From all of the information you have posted as to how your vet has managed the use of Trilostane for Tess, if I were in your position, I would be asking the vet some serious questions about his/her experience with using Trilostane. I'm not coming down on you, you did the best you could with the information you were given. You got Tess the help she needed as soon as you could. Your vet appears to have a serious lack of experience with using Trilostane at a minimum, if not treating Cushing's, & unfortunately, Tess has paid the price.

Debbie

[Sammie]

Hi the rapid eye movements has stopped. It stooped yesterday. My vet said the same thing and it was just dum luck that it was brought on at the same time she was given Vetoryl. Again the lab results I posted was when Tes was in crises and she is doing better, but she is still not out of it. It will take awhile. She is 12 years and soon to be on 7/29 13 years. She is safe a warm, she had her favorite food chicken. She is on the couch snoring and I am rubbing her tummy. With what ever we find out, cushings, Addison's, Kidney, or tumor you have all been a big help. Tess has had the best life. More Love from me and my husband. Lots of room to play in. Plenty of mom and me time. She was are first born, meaning are first dog. My husband didn't even want a dog. Tessie was his christmas gift 12 years ago. Now we have 5 dogs. She has been on lots of trips to the river, beach and chased lots of birds and possums. With all my love I will help her to get what she needs, but in the end she is a old dog with a young sprit that will need me to help her to doggie heaven when ever that comes. Thank you all for giving so much Dottie

[Sammie]

Can you please post any repeat labwork that was done today & over the next several days? Also, Alison has asked a very important question, did the ER clinic either send you home with medication for Tess, & do you know the name of it? Did the ER clinic give her any type of steroid injection such as dexamethasone, and/or florinef?

Debbie

PS- I do realize that the results you have posted were from yesterday when Tess was so very ill. Just to let you know, I'm a medical lab tech with 29 years experience, so I am very used to looking & interpreting these types of results. The kidney values from yesterday do clearly indicate a kidney issue that you need to question your vet about.

Hi yes the E-Vet did give Tes a steroid injection then we took Tes over to my doctor. I don't have the lab test from Doctor yet. I will have then 7/8/09 for you. I think that is why my doctor wants to have a x-ray done tomorrow 7/8 on Tes. I think he is thinking Kidney. I said to him when he said to me he want ed to x-rays. I said to rule out kidneys or tumors. He just looked at me. It took him by surprise. Thank you for reading the labs. I have know clue what they were saying. Ok tell tomorrow. Dottie

[StarDeb55]

Dottie, please do keep us posted as to how Tess is getting along. She has a lot of people worried about her & pulling for her. Yes, she is a senior, but once this emergency is straightened out, she very well could have several more years with a good quality of life. My Harley is a 14 yr. old Shih Tzu, who has been treated for a little over a year & is doing pretty well, so don't throw in the towel just yet.

Debbie

[BestBuddy]

Hi Dottie,
I certainly hope you have lots more "good times" left with Tessie. You did the right thing by getting her to the emergency vet. From what I know addisons can come on as a crisis and resolve after a few days of treatment or Tessie may be permanently addison. She has made some good progress so hopefully that will continue. There are a few members whose dogs have permanent addisons and it can be managed.
Jenny

[BestBuddy]

Dottie,
There is always hope. My dear Buddy who passed away earlier this year had an addison crisis after a few months of treating with trilostane. He was also diabetic and after the steroid injection he pulled through and we were lucky his body responded and we didn't have to treat for addisons or cushings for the next two years of his life. The addison crisis happened to him at age 13 and he was with us until 15 1\2.
Jenny

[Harley PoMMom]

Hi Dottie,

Just wanted to let you know my heart goes out to you with everything that you and Tessie have been through.

You both will be in my thoughts and prayers tonight.

Lori

[Sammie]

From what you have said above, it appears that your vet may have attempted to do what is called a "loading" with Trilostane. If this is the case, this is absolutely inappropriate dosing for this medication. Loading is only done with lysodren. As several of the more experienced members who have used Trilo have pointed out, dogs are extremely sensitive to this drug, & need to be started on a low dose, working up to a higher dose as needed. From all of the information you have posted as to how your vet has managed the use of Trilostane for Tess, if I were in your position, I would be asking the vet some serious questions about his/her experience with using Trilostane. I'm not coming down on you, you did the best you could with the information you were given. You got Tess the help she needed as soon as you could. Your vet appears to have a serious lack of experience with using Trilostane at a minimum, if not treating Cushing's, & unfortunately, Tess has paid the price.

Debbie
Hi Debbie I don't know how he did the test. All I know is that he asked to have tes for two hours. I said don't you need her for 8 hours. He said two would be fine. Unless I really needed to know if it was pituitary or adrenal which he thought was a waste because 95% of the dogs he has seen has always come out adrenal. So I believed him. He got the results back and it was cushings. I started Tes Friday morning at 7:00 am on her first dose, by mid-night I was hiding the drug so my husband would not give it to her in the morning because I would be sleeping. Then I changed my mind, because I stated up all night look for any thing that about Vetoryl. The first day on Vetoryl all that I could see is that now her front legs were shaking and she looked like she did not feel good. The next day she ate her breakfast and drank water, she did not seem bad, but I could tell she did not seem right. It was the look on her face, but I still gave her the medicine. By 5:30 on Saturday she was vomiting and ever two or so hours tell I took her to the E-Vet Monday morning. She vomited a total of 8 times between Saturday night to Monday morning. All day sunday she was still waking around, going out side to pee, drinking a little water. I regret waiting so long to get her to the E-Vet. That won't happen again. I asked my Vet today when i took her home if i needed any medication for her, he said know. Ok enough of my store, thank you all again Dottie

[Sammie]

Dottie,
There is always hope. My dear Buddy who passed away earlier this year had an addison crisis after a few months of treating with trilostane. He was also diabetic and after the steroid injection he pulled through and we were lucky his body responded and we didn't have to treat for addisons or cushings for the next two years of his life. The addison crisis happened to him at age 13 and he was with us until 15 1\2.
Jenny

NOW THAT IS A GREAT STORE. TY for that Dottie

[Sammie]

Dottie, please do keep us posted as to how Tess is getting along. She has a lot of people worried about her & pulling for her. Yes, she is a senior, but once this emergency is straightened out, she very well could have several more years with a good quality of life. My Harley is a 14 yr. old Shih Tzu, who has been treated for a little over a year & is doing pretty well, so don't throw in the towel just yet.

Debbie

TY Debbie will never throw in the towel. My husband is worried I will spend his retirement money on this LOL He is kidding kinda, LOL but it would be very hard for me to give up

[StarDeb55]

I've already spent my retirement money. Harley is my 2nd Cushpup, my first boy, also, developed lymphoma, & went through chemo. He crossed the bridge almost 3 years ago at the age of 15. I did want to tell you that my 1st boy was successfully treated with lysodren for nearly 8 years with a good quality of life. So with the right treatment, & a good vet, this dratted disease can be controlled. Now, my 2nd boy, Chewbacca, is going for skin testing in the morning for major allergy issues. As you can see, this is why I've spent my vacation since 7/2, here at home, can't afford to go anywhere.

I think you may haven't gotten what the vet told you about what type of Cushing's backwards, 85% of pups have pituitary Cushing's, only 15% have adrenal. The only reason to determine what type is that there is a possibility of surgery to remove the adrenal tumor which would offer the hope of a permanent cure.


Debbie

[SachiMom]

He said two would be fine. Unless I really needed to know if it was pituitary or adrenal which he thought was a waste because 95% of the dogs he has seen has always come out adrenal. So I believed him.
You were correct in asking for the eight hour Low Dose Dex test. The ACTH (2 hour) test was used for diagnosing in the past, but now is used mainly for monitoring the cortisol levels while on treatment. I am hoping that you just misunderstood his comment about 95% of dogs having adrenal cushings, because mostly we find they have pituitary cushings.


The first day on Vetoryl all that I could see is that now her front legs were shaking and she looked like she did not feel good. The next day she ate her breakfast and drank water, she did not seem bad, but I could tell she did not seem right. It was the look on her face, but I still gave her the medicine. By 5:30 on Saturday she was vomiting and ever two or so hours tell I took her to the E-Vet Monday morning. She vomited a total of 8 times between Saturday night to Monday morning.
Your vet should have advised you to look for signs that Tess was not tolerating the drug. Especially since he was giving her over twice the recommended dose. God probably couldn't have helped her if he had done that to her with lysodren. I have no idea where he came up with this protocol of giving a double dose for ten days. I have never heard of such a thing. There is no loading phase for trilostane. Lysodren does have a loading phase, and the worst instruction ever given by a vet is to "give for ten days".


I regret waiting so long to get her to the E-Vet. That won't happen again.
Dottie, we all have regrets of some sort, but don't beat yourself up. You were following directions of a trusted vet. Then you searched for help and found us. We are not vets. Debbie and Sharon do have medical knowledge and are a tremendous help in sorting out labwork, tests, etc. The rest of us are only a bunch of puppy lovers that have experienced many of the highs and lows of cushings treatment and are willing to share and guide you the best we can. That way, you will be able to help and share with the next person that comes along.


I asked my Vet today when i took her home if i needed any medication for her, he said no.
I know that you are doing a good job of watching her for any signs that she isn't doing well and hopefully she will not need any medication. But I am surprised that he would not have at least sent you home with a few pred tablets in case she got stressed. Then again, maybe I should not be surprised.


will never throw in the towel. My husband is worried I will spend his retirement money on this
This really warmed my heart. Tell hubby to join the club. There is no retirement!!!!! :D

Be sure to keep us posted.
Sending healing thoughts and prayers for little Tessie. And haven't forgotten precious Bunny.
~ Mary Ann

[StarDeb55]

Dottie, I must apologize, again, for coming across so harshly. Let me emphasize I was not angry with you by any means. I was angry for the needless suffering that Tess has been put through.

There is one other very important thing that you need to know for Tess' safety & continued treatment. It will probably be a good idea that once she is stabilized, & has had no prednisone for 24 hours to have an ACTH done, so you can see just exactly how low her cortisol is. If she does require further steroid medication, it would probably be a good idea to use dexamethasone, instead of prednisone, because dex will not interfere with an ACTH's that might need to be done. Pred will read like cortisol on the test, giving a falsely elevated value. If Pred has been given, any testing will have to wait for a minimum of 24 hours.

Please keep us posted on how Tess is doing, & please, please ask for that referral to an internal medicine specialist.

Debbie

[mytil]

Hi again Dottie,

You have received so much input and information and I am so very glad you found us. Your Tessie is a very lucky girl and like you said, she is not out of the woods yet, it will take some time with the type of crisis she has had.

Please continue to keep us posted on Tessie.
((hugs))
Terry

[Squirt's Mom]

Hi Dottie,

Honey, it broke my heart to hear you talk about Tessie as if the end were in sight. :( I don't know how you were even able to write the words. They made me cry just to read them. Probably because there have been times in my Squirt's life when I, too, thought that day was very close and that is more than I can bear to think about. It hurts my soul to think you are feeling that way about your Tessie. :( But our babies need us to be strong and positive, they need us to keep to the routines they know, they need to feel we are still fighting for them. So even during those times when I feared the worst, I did my best not to let Squirt know. She knew I was worried, tho, because I hovered over her 24/7 til she was ready for me to take a long trip alone somewhere! :p

Tessie is still fighting and making progress so that is good! It may take some time for her to get her feet back under her but she is giving her all to make that happen. With you by her side, she has the best chance to do just that. You have done an amazing job considering the horrific start you and Tess have had. So don't you be beating yourself up about what happened to her! It was not your fault!!!!! This statement below is proof of that beyond doubt -


Tessie was to be on the DBL dose for ten days only, then she was to be dropped down to one dose a day or a week . I can't remember right now. The idea was to bombard the system, get a blood test in a week and then lower it or higher it. We all know now it was to much for her. Dottie

As Debbie said, this is just WRONG! Trilo is not to be administered in that manner at all - this is the protocol for Lysodren, NOT Trilo. You did what we all have done in the beginning...trusted the professionals to know what they were doing. They are the ones with the education, training and experience so of course we trust them!....until they have proven that trust was misplaced when dealing with Cushing's. YOU have done nothing wrong. All you have done is love Tessie and try to help her when you knew something was wrong. So just let all that guilt fall away...you don't deserve it. Besides, I am the Queen of Self-flagellation and I don't want any competition! :p

Hugs,
Leslie and the girls

[Sammie]

Good morning. Tessie slept really good. Know heavy breathing. Her body was not to hot or cold. She still did not want any dog food, but she did like the little peace of cheese i gave her. All my dogs are on WD can and dry. She did sneeze about 5 or 6 times in row last night and that was it. When I took the other dogs for a walk she heard the leashes and wanted to go, but then laid her head back down. Took her back to My Vet today. He said he did not think he was going to do labs to day. I said do a complete panel to be safe. I asked if her kidneys were bad. He said no. He said when I brought her in from the E-Vet, Yes they were high but now the BUN was back to normal. I said I wanted a copied of any blood work for my file. Know problem there. Some times he does some blood work in house and sometimes he sends it out. He is going do a xray of her lungs, stomach, kidneys today.
Yes I have been feeling guilty, so I will leave that Leslie. I am completive, but I let this one go to you LOL hugs. So more info tonight ty all again dottie

[StarDeb55]

Dottie, of the 2 values, creatinine & BUN, creatinine is actually the most important because a lot of different things can affect the BUN including dehydration, before the creatinine is affected. Since Tess was so very dehydrated, it's not unexpected that her BUN was elevated. I would suggest you specifically ask about the creatinine. I'm not to sure how much an x-ray is going to show about any possible kidney issues, that may require an abdominal ultrasound.

Has your vet said anything about doing an ACTH? You really do need to know where Tess' cortisol level is pretty soon, in order to determine whether or not she needs to be supplemented with oral steroids such as prednisone. If her adrenal glands have totally shut down & are making little or no cortisol. I'm very concerned that she could relapse very quickly. The eating right now is not as important as the drinking. Dogs can go several days without eating. It's very important that she is drinking, even with the IV fluids. How is she doing with her drinking?

Debbie

[frijole]

Dottie,

I have been thinking of you and Tess and appreciate all of your updates. I have a concern and I hope it doesn't upset you. You mentioned you went back to your regular vet today for more testing. Given what happened with the trilostane I think it is very clear that he did not follow protocol and clearly is responsible for Tess' current situation. I would be very hesitant to trust future testing for cushings or addisons in his care. This is not unusual. We see it here alot sadly.

Vets have alot going on and it is difficult to know everything about every disease. This is why there are specialists. Glynda lives in LA and gave a couple names that she would recommend. If you don't want to do that I would at least find a regular vet that has an understanding and experience with cushings.

Again I do not mean to upset you because you have so much going on. Tess can lead a normal happy life but she now has special needs. Big hugs to you and yours,
Kim

[Sammie]

Ok back home with Tessie. She is doing great. She is running, she ate some dog food at My Vets.

Now I got it wrong about the 95% adrenal. It is Pituitary like you all of said and My Vet had said. When you are up set you just don't hear thing right.

My Vet spoke with a specialist today. With giving Tessie 60mg of Vetoryl. I pulled the instructions out of the box. It says for a dog 22 to 44 pounds starting does once a daily is 60mg. My Vet did nothing wrong. I went to Vetoryl web site and it said the same thing. I thought it had said 30mg, but again being up set, I was wrong. The specialist said the only time she had seen something like what happen to Tess happen is when the dog was given to much Vetoryl. Which we now know that is what happen, but my vet was going by the instructions of Vetoryl. The FDA approved this drug May 16th 2009. This is really new. The specialist said that the dog would bounce back in a few days.
Now My Vet said on Saturday that if I had any problems with Tessie to give him a call at home. I was the one that did not won't to bother him on his day off and it being a holiday weekend. He again told me today, call him if I see anything that freaks me out, know matter what hour it is. So I couldn't ask for a better Vet. He did do a ACTH test before we gave Tes Vetoryl. The x-rays today showed know cancer, her kidneys are fine.
Now Tessie will not be given any drug until she is 100% back to her old normal, before she ever took this drug. When she start's a drug it will be on a low dose and blood test to see were we are. I bought pet insurance for her today. She is back at being a cushing dog.

I think my vet did a great job based on the information that he has on this drug. He said for 20 years he has been giving dogs Lysodren and only had one problem with a dog. Now I was the one that asked for Vetoryl. This is a new drug to every one, maybe not some, but out here in S. Cal. like I said FDA just put it out on 5/16/09 so I am standing by my vet. I can not see that he did any thing wrong.
Labs for today:
ALB 1.7
ALP 0
ALT 330
AMY 334
TBIL 0.5
BUN 25
CA++ 9.6
PHOS 6.3
CRE 0.9
GLU 87
NA+ 138
K+ 4.7
TP 6.3
GLOB 4.6

HEMATOLOGY RESULTS
HCT 34.7
HGB 12.0
MCHC 34.6
WBC 12.7
GRANS 10.7
% GRANS 84
L/M 2.0
%L/M 16
PLT 334
All of these except the first one in the HEMATOLOGY RESULTS all says Tes is normal. The HTC is low and the HGB is right on the boarder of low/normal in accordance to this chart.

So I really do appreciate everyones input. You have all given me great questions to ask my Vet that I would of never know to ask. I really do appreciate your help and when Tes does start treatment again I will be asking more questions. I am hoping it will go a lot smoother the next time around. In fact I know it will because of my crash course on cushing from all of you.

I hope my case will help someone else. There is nothing out there on this happing to a dog in just two days of treatment. Now there are two case's of this happing with Vetoryl. With this being a new drug there will be more, but now someone will know what to do because of all of you helping me. I can not thank you enough. You were all apart of saving Tessie life. Thank You thank you thank you. It feels so good to see her running again, or want to run. Ok going to go a spend time with her. My Vet deserves a big hug too. I think he did a good job based on the information he was given. No fault to him. I read some were in the last days of all of this that Vetoryl came out with 10mg dose. Maybe two many dogs at 25 pounds were ODing on this stuff. Ok bye for now Dottie

P.S. going back on Monday to do blood work to find out were she is at, how she is doing. I want to wait at lest a week before we try any more medication for cushings. Dottie

[MiniSchnauzerMom]

Dottie,

I'm so glad Tess is doing better. My Munchie was in a similar situation with Trilostane (Vetoryl) but not as severe as Tess. His specialist performed a new ACTH stim test, not for the purpose of diagnosing but as a follow-up and the drug had to be immediately stopped plus he was put on emergency prednisone. A new ACTH stim needs to be done to see where Tess is now and how much damage has been done to the adrenals.

Prior to restarting any drug (either Lysodren or Trilostane) she needs to become symptomatic again (the Cushings symptoms need to return) plus an ACTH stim test is absolutely necessary to make sure she has returned to normal. Tess could end up having to return to the ER with another emergency if she is given a cushings drug again and she has not returned to normal. The only way to determine this is through an ACTH stim test. This information is in the Vetoryl Treatment and Monitoring Flowchart and I hope I have helped you by passing it along.


Also, my Munchie was given Trilostane (Vetoryl) back in 2007. It's been around for awhile but has finally just been approved by the FDA here. Previously you were able to get it here (I live in CA too.) either by ordering through Masters Marketing or the veterinarians could write a prescription and a compounding pharmacy would fill it.

Hope Tess continues to improve.

Louise

[BestBuddy]

Hi Dottie,

I am glad that Tessie is feeling better. Vetoryl has been approved for use for many years in the UK and many of us ordered from the UK or had it compounded by a pharmacy before it was approved in the USA. It has been available and used for many years and all of the documents I have seen have stated to start the dog with less than 5mg per kg and many say only 1 - 2mg per kg. Tessie at 22lbs is only 9.9kg so 60mg Vetoryl would be too high a dose to start, maybe she would have to end up by taking that but certainly not to start.

Any adverse reactions means a 7-10 day stop of medication and an ACTH stim test must be performed to get the current cortisol number, then continue with a lower dose and another ACTH in 10 days to see how it is going.

After the way Tess reacted to the original dose of Vetoryl I would definitley not restart her before having an ACTH and then maybe try the 10mg. This is only my opinion but if you read up in the Important Info section on Vetoryl and dosing this is what I am basing my thought on.

Please keep us in the loop because Tessie is now one of "the family"

Jenny

[SachiMom]

Dottie,

I know it is a little early as Tessie is not completely out of the woods, but I am doing the happy dance for little Tessie. It sounds like she is on the mend. And I will continue to send the healing thoughts and prayers her way. As Jenny said, Tessie is part of our family now.

I am glad that your vet has consulted with a specialist. We all realize how upset one can get with the initial diagnose and not understand or relay all the information that the vet says. I did not realize that the vet had been using lysodren for years and this was the first time that he used trilostane. I would think that he would have researched the drug before prescribing it, even at an owners request. I used trilostane with Sachi in 2005 (and I am in Southern California also). It was not FDA approved at that time, but available as an off-label from Masters Marketing in the UK. I, along with my vet, had to do alot of research on it because it was very new in the US. We had a rocky road, but paved the way for a smoother path for the others that followed in his practice. Thankfully Tessie will be okay and he will learn from her experience which will benefit all those that follow her. Always start at a low dose.

Lots of hugs to go around.
~Mary Ann

[Sammie]

Hi Dottie,

I am glad that Tessie is feeling better. Vetoryl has been approved for use for many years in the UK and many of us ordered from the UK or had it compounded by a pharmacy before it was approved in the USA. It has been available and used for many years and all of the documents I have seen have stated to start the dog with less than 5mg per kg and many say only 1 - 2mg per kg. Tessie at 22lbs is only 9.9kg so 60mg Vetoryl would be too high a dose to start, maybe she would have to end up by taking that but certainly not to start.

Any adverse reactions means a 7-10 day stop of medication and an ACTH stim test must be performed to get the current cortisol number, then continue with a lower dose and another ACTH in 10 days to see how it is going.

After the way Tess reacted to the original dose of Vetoryl I would definitley not restart her before having an ACTH and then maybe try the 10mg. This is only my opinion but if you read up in the Important Info section on Vetoryl and dosing this is what I am basing my thought on.

Please keep us in the loop because Tessie is now one of "the family"

Jenny

Hi Jenny, I agree 100%. I already told my vet today that we would be starting with 5mg dose after he takes ACTH test again. My Vet and my self are on the same page. He is going to do a panel on Tes Monday just to see were she is at, but I am going to wait those 10 days before we start up again.

He said ACHT test would be run before I ever had a chance to say anything. He called the specialist, because he had never had this happen to him with Vetoryl in two days. He was going by what the manufacturer of Vetoryl has said what the does is supposed to be for a dog 25 pounds. Vetoryl website chart under Vet also give same dosage, 25 pounds 60mg. Now we all know this soooo wrong. What I have read yes its been around in the UK for along time, but I am in Southern California and in my area it has not legal been around at my Vet"s office. So my Vet would know about it, which he did, but not a lot of dogs on it around here. I can bet you are going to start to get a lot more USA dog owners coming to this great site for help. I was at my wits in when I e-mail the adminastrighter of this website. Thank you for the Information section. I will go read it right now Bye for now Dottie

[BestBuddy]

Hi Dottie,

I am so glad you are looking into this disease so that you can learn how to be the best advocate for Tessie. Any good vet will listen and discuss treatment options when they know you have an understanding about cushings.

I am also glad to hear that Tessie will be having an ACTH test before any more treatment because it may be that Tessie doesn't need any more medication, stranger things have happened. Please get the results so we can all see.

While we are all waiting for the next step tell us a bit more about Tess. Have you had her since she was a pup and when did the cushings symptoms appear. Which ones does she have.

Jenny

[Squirt's Mom]

Hi Dottie,

First, I want to repeat what Jenny said - you and Tess are family now so please stick around. :) I, for one, would be worried to death if we didn't hear from you and Tess again. :(

As others have already said, Trilo (Vetoryl) has been in use in the US for a long time, it just hadn't been approved by the FDA yet. So there have been many folks using Trilo for quite some time here, getting it by either ordering from the Uk (where it's use started, I believe) or by having it made up (compounded) by a pharmacy set up to do that. It's use wasn't illegal in the US, it just hadn't been approved so wasn't being manufactured here yet.

When Squirt was first diagnosed and had done a little reading, Trilo was the way I wanted to go. But one of the reasons I decided against it was because my vet had never used it tho she had heard of it. I wasn't willing for Squirt to be the Guinea pig...I was too scared for that. :eek: So to me, you are very brave to let Tess be his first Trilo patient!

You have already learned so much, Dottie! :) And you did it standing in the midst of the roaring fire of an Addisionian crisis! :cool::cool: You should be very proud of yourself, honey. I am!

Now that Tess is doing better and seems to be on the way to recovering from this crisis, you have a bit of time to learn a little more. And we will help you.

Telling your vet that you want to start with a lower dose and having him agree with your desires, is a great start! This tells me he will work with you as a team for Tess and that is admirable. You done good, girl! :cool:

You are absolutely correct in wanting to have her tested with the ACTH. This test will let you and your vet know where her cortisol is after some time off the Trilo - which is critical before any cush meds are resumed. The ACTH is vital in monitoring the adrenals for a pup on treatment. Again, kudos to you! :cool:

One thing I'm not clear on is the 10 days you spoke of. It may be many months before Tess is ready to resume treatment, if ever. It is possible that her adrenals have been eroded to the point she won't need meds again. This is what happened to Jenny's Buddy.

Also, you don't want to have her tested if she is ill from some other source or really stressed for some reason as this could easily give higher readings than are true for the cortisol. So if that 10 day mark rolls around and there is any reason for holding off on the ACTH for a few more days, that is fine and actually preferred.

I do have one suggestion, a recommendation actually. Before you restart the Trilo, have the UTK panel run on Tess. It could be that she is Atypical. Since we don't know for sure what her cortisol levels were to start with, it is hard for us to know for sure what form of Cushing's she has. So it would be in her best interest and best for your pocketbook to rule out Atypical before starting the Trilo again. Trilo has been shown to cause certain other hormones to elevate resulting in the same signs and damage as elevated cortisol.

Now, you can help me. :) On the insert you have on the Trilo, could you look on it and see if there is a date given for when the protocols given in the insert were established? Also, what is the Vetoryl site you are looking at?

Keep reading and ask lots of questions while we wait for Tess to recover and you will be much more prepared for the next step. I am so glad you contacted Terry!

Keep up the good work!
Hugs,
Leslie and the girls

[Squirt's Mom]

Hi again,

Something I forgot to mention about the Trilo. When it was first being used, the belief was that if a pup had a problem then all that needed to be done was to give the pup time and let the drug get out of their system. It was thought that once the Trilo was out of the body, the pup would be just fine. After it had been in use for awhile and there were quite a few cases like Tess', it became clear this original line of thinking was wrong.

Now it is known that even after the Trilo is out of the body, damage can continue to occur because the adrenals are not producing or releasing enough of the hormones that are necessary to maintain proper balance and health in the dogs system. Researchers have learned over the years, that once a pup has gone into an Addisonian crisis like Tess has, it is VERY important to supply these hormones externally - as in a pill or shot. This is why we have been so concerned that Tess was not in the hospital on IV's supplying electrolytes along with extra fluids. Having pred at home for her is also critical so you can give her a boost or steroids if needed, which is what cortisol is.

Since your vet is not familiar with Trilo it is good he consulted with a specialist. But based on what the specialist said about just giving her time, it sounds as if even the specialist isn't up on the studies done on Trilo, either. Which isn't surprising since many vets in the US have limited experience with this drug, even specialists.

One thing you can do at home to help keep her electrolytes up is to give her Pedialyte (sp?). The stuff kids use when they are sick. :o:rolleyes: I have used it on my pups often when they have diarrhea or vomiting over a period of time. It comes in unflavored as well as flavored. Mine refused flavored forms but will take the unflavored. You can add it to the water or put it in the food.

Since your vet isn't able to keep her over-nite then having pred and Pedialyte on hand will give you some tools to help her if she starts to go back toward Addison's.

I wanted you to be aware of this development in Trilo overdoses so you know it takes more than just time off the drug for Tess to recover. They say knowledge is power and that certainly is true when dealing with Cushing's!

Hugs,
Leslie and the girls

[StarDeb55]

Dottie, I am delighted to hear that Tess is feeling so much better. We were all pretty worried about her.

Since you mentioned that Tess is your vet's first Trilo patient, both of you may be interested in the information on Trilo from the following link in the important information section of the forum. The second half of the link give information on the UC-Davis vet school's protocols for using Trilo. Davis has pretty extensive clinical experience in using trilo with our pups, & probably has seen most any reaction that may occur using Trilo. Your vet may be especially interested in this section as the information is coming from other vets who are using Trilo on a daily basis.

Debbie

http://www.k9cushings.com/forum/showthread.php?t=185

[Sammie]

Something I forgot to mention about the Trilo. When it was first being used, the belief was that if a pup had a problem then all that needed to be done was to give the pup time and let the drug get out of their system. It was thought that once the Trilo was out of the body, the pup would be just fine. After it had been in use for awhile and there were quite a few cases like Tess', it became clear this original line of thinking was wrong.

Hi I spoke with the Doctor that wrote the article you wanted me to read (Dr. Hoskins is owner of DocuTech Services. He is a diplomate of the American College of Veterinary Internal Medicine with specialities in small-animal pediatrics. He can be reached at (225) 955-3252) I told him what had Happened to Tess. I was amazed he answered his phone. Any way He feels what my vet is doing right now for Tes is correct. As long as she is eating and drinking water and we are monitoring her blood. He said keep her in a stress free environment and wait at lest 2 weeks before starting any thing on Tes. Once she is back to her old normal, repeat the ACTH.


Now it is known that even after the Trilo is out of the body, damage can continue to occur because the adrenals are not producing or releasing enough of the hormones that are necessary to maintain proper balance and health in the dogs system. Researchers have learned over the years, that once a pup has gone into an Addisonian crisis like Tess has, it is VERY important to supply these hormones externally - as in a pill or shot. This is why we have been so concerned that Tess was not in the hospital on IV's supplying electrolytes along with extra fluids.

Tess was in hospital getting a IV and a Sterol shot, I took her home at night because there was know one there to watch her. She has had a IV for four days. My Vet and Dr. Hoskins both agree if she is not show any signs of vomiting then to let her alone. Not to give her any Pedialyte or a Sterol shot, just let her alone.


Having pred at home for her is also critical so you can give her a boost or steroids if needed, which is what cortisol is.

Since your vet is not familiar with Trilo it is good he consulted with a specialist. But based on what the specialist said about just giving her time, it sounds as if even the specialist isn't up on the studies done on Trilo, either. Which isn't surprising since many vets in the US have limited experience with this drug, even specialists.

My Vet went to UC Davis and he spoke to the specialist at UC Davis. He is very familiar with Trilo which I am calling Vetoryl, But here in the USA it just got approved on May 16 2009 that was seven weeks ago. He read all the information on Vetoryl. Vetoryl website say's to give 60mg to a dog 25 pounds. My Vet did nothing wrong.


One thing you can do at home to help keep her electrolytes up is to give her Pedialyte (sp?). The stuff kids use when they are sick. :o:rolleyes:

I don't have any children so I don't know what this is. SIDE NOTE Tessie is sitting on the couch barking at the neighbors. A very good sign.


I have used it on my pups often when they have diarrhea or vomiting over a period of time. It comes in unflavored as well as flavored. Mine refused flavored forms but will take the unflavored. You can add it to the water or put it in the food.

Since your vet isn't able to keep her over-nite then having pred and Pedialyte on hand will give you some tools to help her if she starts to go back toward Addison's.

I wanted you to be aware of this development in Trilo overdoses so you know it takes more than just time off the drug for Tess to recover.

I agree 100% that is why I took her up to have her blood drawn after I read your note here and I called that Doctor (Dr. Hoskins) he lives in Kansas Missouri. He was very nice and said that every thing my vet is doing is correct, except for the 60mg of Vetoryl, but again that was know vault of my vet. Vetoryl website said the same thing for dosage.


They say knowledge is power and that certainly is true when dealing with Cushing's!

Hugs,
Leslie and the girls

[Sammie]

Forgot to post Tessie Lab results for today

ALB 2.1
ALT 253
AMY 433
TBIL 0.5
BUN 32
CA++ 10.9
PHOS 6.8
CRE 1.2
GLU 115
NA+ 143
K+ 5.9
TP 7.0
GLOB 4.9
HEM 0
LIP 3
ICT 0
QC OK
Tessie goes back on Saturday 8:00 am for another blood test. Dottie

[StarDeb55]

Dottie, could I ask one favor, please? When posting any lab results, please include the normal ranges & reporting units, such as ug/dl, ng/ml. etc. Normal range & reporting units can vary from lab to lab. In order to give you any meaningful feedback, I would like to see these 2 things, also.

Thanks,
Debbie

[Sammie]

Dottie, I am delighted to hear that Tess is feeling so much better. We were all pretty worried about her.

Since you mentioned that Tess is your vet's first Trilo patient, both of you may be interested in the information on Trilo from the following link in the important information section of the forum. The second half of the link give information on the UC-Davis vet school's protocols for using Trilo. Davis has pretty extensive clinical experience in using trilo with our pups, & probably has seen most any reaction that may occur using Trilo. Your vet may be especially interested in this section as the information is coming from other vets who are using Trilo on a daily basis.

Debbie

http://www.k9cushings.com/forum/showthread.php?t=185

Thank You Debbie Yes I read the info and I called the doctor who wrote the paper Dr. Hoskins I could not believe he picked up the phone. Told him all about Tessie and what happen. He agreed that every thing my vet is doing is correct, except for the 60mg of Vetoryl. But I have said. The package that Vetoryl comes in and the website both say 25 pound dog 60 mg. We know the hard way this is to much. Dr. Hoskins says Tessie should be on 10 mg twice and day. He said wait about two weeks before starting any of this. He said don't give Tessie any thing if she is drinking and eating. Just let her be. She will come out of it. If she stops eating then get her to the Vet. That is exactly what my Vet told me. Just let her be.

I took my lab top to the vet and showed him the article. He had already read it. My Vet is a graduate from UC Davis. Now we could all argue the fact, then why did he give UK does of Vetoryl instead of the UC David dose, Because that is what was on the manufacture box. By law, to keep his vet license he would have to go by what the manufacture but on the box. Dr. Hoskins is right now fight this with the manufacture and maybe that is why Vetoryl came out with a 10mg on June 11 2009. I am just guess with vet license, but Dr. Hoskins did say the other thing. Dottie

[Sammie]

Ok Lab results with range

ALB 2.1 2.5-4.4 G/DL
ALT 253 10-118 U/L
AMY 433 200-1200 U/L
TBIL 0.5 0.1-0.6 MG/DL
BUN 32 7-25 MG/DL
CA++ 10.9 8.6-11.8 MG/DL
PHOS 6.8 2.9-6.6 MG/DL
CRE 1.2 0.3-1.4 MG/DL
GLU 115 60-110 MG/DL
NA+ 143 138-160 MMOI/L
K+ 5.9 3.7-5.8 MMOI/L
TP 7.0 5.4-8.2 G/DL
GLOB 4.9 2.3-5.2 G/DL
MY VET went over this in detail, but would still like your opinion. Tessie does go back on Saturday morning.
Dottie

[acushdogsmom]

The package that Vetoryl comes in and the website both say 25 pound dog 60 mg. We know the hard way this is to much. On the package insert, they do say the starting dose is 1-3 mg/lb and it also shows a dosing chart that says if a dog weighs between 10-22 lb that the starting dose is 30 mg per day and that for a dog who weighs 22 to 44 lbs that the starting dose would be 60 mg per day.

http://www.dechra-us.com/File/prod_vetyrol.pdf

But I did find something on the Dechra US website that does also say to start with a lower dose ... I had to really root around for a while on the Dechra US site to also find it though. And I think they should really add the recommendation that is on their website (to start with a lower dose) to the package insert.

http://www.dechra-us.com/page/veterinarians#Prescribing


Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com.

[Squirt's Mom]

Hey Dottie,

Thanks for the reply! You got it going on, girl...calling docs and asking questions then coming here and sharing with us what you have learned! I hope you understand that is what we are doing when we give you the information we have gleaned from living with Cushing's on a daily basis. :)

I am very glad to hear that someone is working on getting the UC Davis protocols included in the Trilo information. It certainly should be! That would help prevent some other pups from suffering what Tessie just went through!

Debbie will be along soon to give you her take on the labs, I'm sure. Thanks for posting them and the extra info she asked for. That really helps!

Hugs,
Leslie and the girls

[Sammie]

HI Acushdogmom this is what I copied from there web sit and this is what in the vetoryl box say's
Starting dose

VETORYL Capsules should be administered orally once daily in the morning with food. Administration with food will significantly increase the rate and extent of absorption of VETORYL.

Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range. If you have any questions on dosing, contact Dechra Technical Support at 866-933-2472 or support@dechra.com

Tessie is 25 pounds, with this chart it say's 60mg or am I looking at this wrong?
Dottie
PS can some one tell me how to calculate a MG by pounds. TY again

*Dogs over 132 pounds (60 kg) should be administered the appropriate combination of capsules.

[StarDeb55]

Dottie, in general, these labs are much improved compared to the weekend. Unfortunately, I still have a concern. The Na:K ratio (sodium/potassium) is not listed, so I calculated it myself. Right now, Tess' ratio is 24.2, definitely improved over the 20. something it was when she was at the ER clinic. This value still indicates a moderately severe electrolyte imbalance as normal range is 27.1-40.1. This may be an indication that the adrenal glands are still not producing enough cortisol or more importantly aldosterone to adequately control Tess' electrolyte balance. Please bring this to your vet's attention as I believe this still indicates that Tess has a certain degree of Addison's in play, not as much as over the weekend, but I feel there definitely could be a problem. At the first sign of any issue with Tess, even something as mild as slightly increased lethargy compared to the past couple of days, I would strongly encourage you to contact your vet.

Debbie

[Sammie]

Hey Dottie,

Thanks for the reply! You got it going on, girl...calling docs and asking questions then coming here and sharing with us what you have learned! I hope you understand that is what we are doing when we give you the information we have gleaned from living with Cushing's on a daily basis. :)

I am very glad to hear that someone is working on getting the UC Davis protocols included in the Trilo information. It certainly should be! That would help prevent some other pups from suffering what Tessie just went through!

Debbie will be along soon to give you her take on the labs, I'm sure. Thanks for posting them and the extra info she asked for. That really helps!
Hugs,
Leslie and the girls

Hugs right back at you Leslie. I am thinking you guys think I am mad at you and I am not. I think all of you are so cool to take the time to help me out. I would of never know about the information part of this website, because I am so worried about Tes. By all of you helping me to get the info I need NOW is so helpful then me surfing around for it. You have all helped me, and saver her life. If I could hug you all it still would not be a big enough THANK YOU to all of you. Please keep throwing it out there to me. I take it right back to my Vet. When he gives me the same answer as you or from Dr. Hoskins who is the top expert in this field. Still can't believe he picked up his phone LOL He was so cool and I went on and on for 20 min before he could say any thing LOL very nice man. He does know about your web site. I asked him LOL. Any way please don't take me mad at any one. Just worried and very direct. I am giving you all a big group hug I hope you can feel it. I do feel it from all of you Dottie:):o:rolleyes:;):D:p

[frijole]

Dottie you made my day sharing that story of calling up Dr. Hoskins. That rocks!

We don't mean to hound you with questions and it is particularly hard with new members whose dogs are in distress. We get hundreds each year and it is like being a 911 operator sometimes. :p Typically a dog is in trouble the owner is following what they are told to do by someone (vet) who has never done it before. Owners know nothing about the disease and we brought in on the case when dogs are very sick and need immediate help. We have to be bold sometimes to make sure new members understand their dog's life is at stake. It can be scary and we do worry... alot.

You came on here not that long ago a "cushings virgin" but you are getting it! I will sleep better knowing that Tess' mom is on the case full time and asking questions and even calling a renowned specialist in the field to get the answers. Go girl go.

[Sammie]

Dottie, in general, these labs are much improved compared to the weekend. Unfortunately, I still have a concern. The Na:K ratio (sodium:potassium) is not listed, so I calculated it myself. Right now, Tess' ration is 24.2, definitely improved over the 20. something it was when she was at the ER clinic. This value still indicates a moderately severe electrolyte imbalance as normal range is 27.1-40.1. This may be an indication that the adrenal glands are still not producing enough cortisol or more importantly aldosterone to adequately control Tess' electrolyte balance. Please bring this to your vet's attention as I believe this still indicates that Tess has a certain degree of Addison's in play, not as much as over the weekend, but I feel there definitely could be a problem. At the first sign of any issue with Tess, even something as mild as slightly increased lethargy compared to the past couple of days, I would strongly encourage you to contact your vet.

Debbie
Debbie TY so much. The blood work he is running takes ten min. it is called a VETSCAN. It is not a full blood panel. I am running both panels on Monday. Yes later on today around 1:30 she looked lethargy, so I took her up and he ran this blood panel. At first he did not want to, because he did not want me spending the money. I joke around with him thats its toward his next VC. So because of this blood test she has to go back on Saturday. I was working Friday to Saturday, but now I have decided not to. My husband would be here while I would be gone, but I know Tes, she sleeps with me. I can see it on her face when something is up. So I was on the fence about it, but Debbie you have convince me. LOL Had I gone on my trip the night Tes really got sick, well she would of not been here. Not taking the chance now. My vet again said call him day or night at home if any thing looks weird. Told him I will never not call again. TY again Debbie for know how to translate the LAB work. Dr. Hoskins calculated Tessie 23 pounds to 10 mg of Vetoryl. Now how its done know clue. LOL I am a flight attendant. I can get you out of the aircraft in 90 sec or less LOL think the Hudson LOL that is what I say to PAX when they are talking during the safety video LOL I get a kick out of it LOL Dottie:o:)

[frijole]

To convert lbs to kg divide by 2.2

23 lbs divided by 2.2 = 10.45 kgs

[Sammie]

Hi frijole. I am trying to explain to my husband what I did today when i called Dr. Hoskins and how you think I rock LOL ty for that. OK here is one for you. I am a flight attendant who is on the know fly list. Now I have a ten year back ground check done on me every year, so ask how could I be on the know fly list. I don't have a strange last name. I got pist-off at BUSH and called the White House. Now I got the White House and spoke to one of Bush's internees that take complaints. I was a adult about it. Know cruising, Just the Facts mama Just the Facts. Well that got me on the list for the last 8 years to now. LOL I found this out a few months later, because my husband and I flew together some where, they stopped me, I had to go see a agent to have it fix and nothing to my husband, just me. LOL I think its kinda funny Dottie:)

[AlisonandMia]

The electrolyte imbalance is actually the most dangerous aspect of a Cushing's medication overdose (whether it be Trilostane (Vetoryl) or Lysodren). The reason it is so dangerous and potentially deadly is that for the nerves and muscles to work properly the electrolyte balance has to be correct. This means that the function of the heart can be affected and that is when it can get deadly.

As Debbie says it looks like Tess's adrenals are not at the moment producing enough aldosterone (which is the hormone that regulates the electrolytes). This means that she really needs to have the aldosterone production supplemented with a special medication called Florinef. (There is another medication that is used sometimes when the aldosterone production is known to be permanently reduced but is a long acting injection and when it isn't known whether the low level of aldosterone is permanent or not then Florinef (which is a daily pill) is often used at first.)

Maybe you can encourage your vet to talk to Dr. Hoskins (is he the specialist?) about Tess's electrolyte ratio and the possibility of supplementing her with Florinef. It should make her feel an awful lot better and will mean that she isn't at risk of a dangerous heart arrhythmia.

Your vet should be able to just check the electrolytes without necessarily running any other tests which should keep the costs down.

Alison

[Sammie]

To convert lbs to kg divide by 2.2

23 lbs divided by 2.2 = 10.45 kgs
Oh this is so cool I did it, it works. But is 10.45kgs also mgs?
Dottie

[Sammie]

The electrolyte imbalance is actually the most dangerous aspect of a Cushing's medication overdose (whether it be Trilostane (Vetoryl) or Lysodren). The reason it is so dangerous and potentially deadly is that for the nerves and muscles to work properly the electrolyte balance has to be correct. This means that the function of the heart can be affected and that is when it can get deadly.

As Debbie says it looks like Tess's adrenals are not at the moment producing enough aldosterone (which is the hormone that regulates the electrolytes). This means that she really needs to have the aldosterone production supplemented with a special medication called Florinef. (There is another medication that is used sometimes when the aldosterone production is known to be permanently reduced but is a long acting injection and when it isn't known whether the low level of aldosterone is permanent or not then Florinef (which is a daily pill) is often used at first.)

Maybe you can encourage your vet to talk to Dr. Hoskins (is he the specialist?) about Tess's electrolyte ratio and the possibility of supplementing her with Florinef. It should make her feel an awful lot better and will mean that she isn't at risk of a dangerous heart arrhythmia.

Your vet should be able to just check the electrolytes without necessarily running any other tests which should keep the costs down.

Alison

Hi Alison Dr Hoskins is the person who wrote the article posted on this website under resources:
Comparing therapies for canine hyperadrenocorticism
Oct 1, 2007
By: Johnny D. Hoskins, DVM, PhD, Dipl. ACVIM
DVM NEWSMAGAZINE

When I see my vet on Saturday I will talk to him about Florinef, but Dr Hoskins who I called today and my vet along with the UC Davis specialist are all saying just leave her alone. Give her nothing unless she stop's eating, gets really lethargic, ( which she is barking up a storm when the other dogs are barking) or she doesn't want water, but not wanting food is main one. I will ask him. I GOT INSURANCE ON TES. LOL very proud of my self. Saved money today. Dottie:)

[frijole]

Oh this is so cool I did it, it works. But is 10.45kgs also mgs?
Dottie


10.45 killograms equals 10,450,000 milligrams

http://www.ilpi.com/MSDS/ref/massunits.html

Usually the dogs weight is converted to kgs and the medicine dosage is in mgs. Is that where you were headed with this?? ;)

Regarding the no fly list... perhaps they overheard someone calling you a "terror" and thought they heard terrorist? :D:eek:;)

OK.. so according to our experts here the main thing we want to focus on for our Tess is the electrolytes. I had never heard of the Pedialyte stuff that Leslie mentioned either. But we have seen dogs' electrolytes improve simply by using it. Its cheaper than an IV! Just throwing it out as an idea should you need it. Kim

[AlisonandMia]

Is Dr. Hoskins aware of the results of the electrolyte test?

One thing that can help when there is a moderate electrolyte imbalance caused by low aldosterone is adding some salt (normal table salt not lite salt) to the dog's food. Before aldosterone was discovered and synthesized, supplementation with salt was the only treatment for this problem (caused by naturally occurring Addison's disease) in humans and dogs. A dog with this sort of electrolyte imbalance will often actually crave salt and will lick it off your hand if you offer it whereas a dog with normal electrolytes will look at you like you are crazy suggesting that they might find salt even remotely interesting! You could try offering her some salt on your hand - she will probably go for it if she needs it and turn her nose up at it if she doesn't.

Alison

PS: With this sort of electrolyte imbalance plain ol' salt is preferable to Pedialyte because Pedialyte contains potassium and her potassium is already too high. Pedialyte is great for general electrolyte depletion but an imbalance where the sodium is too low and the potassium too high you want to add salt (sodium) to help correct the balance. Often the dog's own body knows what it needs and the dog's appetite for salt guides it to take in as much as it needs. In the past (pre Florinef and Percorten) Addison's dogs were treated with cortisone and given free access to a bowl of salt that was kept beside their water and food bowls and the dog would eat salt as it needed it!

[BestBuddy]

Hi Dottie,

You are doing a good job and Tessie is the one who will benefit. Reading and learning about this disease will help Tess and even your vet so keep it up.

Don't talk to me about US flight security....us Australians have great trouble over there in my experience. Several months after 911 hubby and I took a holiday in the US and we were targeted/profiled for extra security every flight we took. Even after the usual security checks we were nearly always pulled off at boarding to be searched again. Our bags were hand searched most times and I started thinking how funny it was for them to be going through dirty undies and socks as the trip progressed.

I know it is necessary but it gives you a bit of a complex after a while!

Jenny

[AlisonandMia]

I'm in Australia too and I've never traveled overseas but traveling domestically I get pulled over for special attention every time. Must be my dark hair and brown eyes - or maybe I just look too innocent....:p

Alison

[StarDeb55]

To take the weight conversion, & trilo dosing one step further, based on the 1-3 mg/kg suggested dose, Tess' max dose of trilo would be 30 mg.

Debbie

[lulusmom]

Ideally, the starting dose to aim for is 1.0 to 3.0 mg/lb (2.2 to 6.7 mg/kg) once a day based on body weight and capsule size. When calculating dosage, it is suggested to round down. Start at the low end of this range.

PS can some one tell me how to calculate a MG by pounds. TY again


I was a washout in math but since my dogs were diagnosed, I am a whiz at deciphering dosing. You don't have to convert the mg to lbs, you simply multiply the 1.0 to 3.0 mg by the pounds. So if Tess weighs 23 lbs, to find the range of dosing, you multiply 23 times 1 and 23 times 3. So the range would be 23mg to 66mg. You would round those down to 20mg - 60mg. Dr. Hoskins has correctly recommended going with the 20mg and splitting into twice daily dosing.

Dechra does recommend that you start with once daily dose but there have been studies that have shown twice daily dosing to be more effective. This is because Vetoryl/Trilostane has a short half life and it's enzyme blocking abilities start to diminish any time after 8 hours. We have had many members whose dogs did well throughout the day but symptoms never totally resolved and actually worsened in late evening. Things got better after switching them to twice daily dosing. I have two cushdogs and one did beautifully on once daily but my other one was on twice daily dosing. All dogs are different so you never know until you go through the motions and figure out the right dose. Just so you know, the majority of dogs do require at least one adjustment so gear yourself up to be very patient.

We're all very proud of you for taking the bull by the horns. You go girl!!! I'm blown away that you actually called Dr. Hoskins and was floored that he took your call. What a guy!!! I'm a total geek and bought his book, Geriatrics & Gerontology of the Dog and Cat. I've read it front to back at least four times and learn something new every time I crack it open.

You've come a long way in the last few days and it sounds like you are doing double time in trying to understand exactly what happened to Tess. This is all good and is exactly what Tess needs you to do. Like our mission statement says, we're all here to Support, educate and encourage so lean on us whenever you need to; immerse yourself in our Resources Forum...read, read, read; and ask as many questions as you like. There is almost always somebody here to respond.

Keep up the good work, Dottie, and we'll all be looking forward to your updates.

Glynda

[Sammie]

10.45 killograms equals 10,450,000 milligrams

http://www.ilpi.com/MSDS/ref/massunits.html

Usually the dogs weight is converted to kgs and the medicine dosage is in mgs. Is that where you were headed with this?? ;)

Regarding the no fly list... perhaps they overheard someone calling you a "terror" and thought they heard terrorist? :D:eek:;)

OK.. so according to our experts here the main thing we want to focus on for our Tess is the electrolytes. I had never heard of the Pedialyte stuff that Leslie mentioned either. But we have seen dogs' electrolytes improve simply by using it. Its cheaper than an IV! Just throwing it out as an idea should you need it. Kim

KIM I really like that site you post. TY Yes been in my terrible two's of being a terror all my life LOL

[Sammie]

Is Dr. Hoskins aware of the results of the electrolyte test?

One thing that can help when there is a moderate electrolyte imbalance caused by low aldosterone is adding some salt (normal table salt not lite salt) to the dog's food. Before aldosterone was discovered and synthesized, supplementation with salt was the only treatment for this problem (caused by naturally occurring Addison's disease) in humans and dogs. A dog with this sort of electrolyte imbalance will often actually crave salt and will lick it off your hand if you offer it whereas a dog with normal electrolytes will look at you like you are crazy suggesting that they might find salt even remotely interesting! You could try offering her some salt on your hand - she will probably go for it if she needs it and turn her nose up at it if she doesn't.

Alison

PS: With this sort of electrolyte imbalance plain ol' salt is preferable to Pedialyte because Pedialyte contains potassium and her potassium is already too high. Pedialyte is great for general electrolyte depletion but an imbalance where the sodium is too low and the potassium too high you want to add salt (sodium) to help correct the balance. Often the dog's own body knows what it needs and the dog's appetite for salt guides it to take in as much as it needs. In the past (pre Florinef and Percorten) Addison's dogs were treated with cortisone and given free access to a bowl of salt that was kept beside their water and food bowls and the dog would eat salt as it needed it!

Alison is sea salt ok. That is what we have in the house. I will try this. Tes is sleeping right now. snoring away. She walked around the block for the first time. Slow but that was ok. She did poop today LOL amazing how happing that made me. Dottie

[AlisonandMia]

Yep, sea salt is fine.

Alison

[Sammie]

Hi Dottie,

You are doing a good job and Tessie is the one who will benefit. Reading and learning about this disease will help Tess and even your vet so keep it up.

Don't talk to me about US flight security....us Australians have great trouble over there in my experience. Several months after 911 hubby and I took a holiday in the US and we were targeted/profiled for extra security every flight we took. Even after the usual security checks we were nearly always pulled off at boarding to be searched again. Our bags were hand searched most times and I started thinking how funny it was for them to be going through dirty undies and socks as the trip progressed.

I know it is necessary but it gives you a bit of a complex after a while!

Jenny
OK this is off subject, but after 911 I am in my Uniform, clearly you can see I am a F/A. Name tag, wings and my bra set's off the alarm. Wire bra. I get almost strip searched in front off all the pax going thru O'Hare ORD that day. If I new that they would of not locked me up, I would of said out loud what I was thinking. Security has lightened up a lot sense 911. Good for PAX, but not so good for me. :o

[Sammie]

Put salt on my hand Tes just turned her head away, but got out some torte chips that were salt and she ate about three of those. Normaly Tes goes wild for her small little milk-bones, but she has been turn noise up at them. This is one of her favorite treats. Some said tonight about being Patent, did I mention I am a LEO we were not born with that DNA. Going to be working on this one Dottie:rolleyes:

[frijole]

What a cute photo of Tess. Thanks for doing that... her eyes show she is a sweet soul.

Glad Alison mentioned the potassium in the pedialyte so ignore my earlier suggestion on that. Good catch on her part.

Great news that Tess was able to poop. Not surprised she was a little slow on the walk. Thats ok since her levels aren't all normal yet... she has earned some slack.

Off to work will check in later. Kim

[Squirt's Mom]

Hi Dottie,

Sooo, you're a terror, huh? :p Is that the same as being a mouthy old broad? That's me. :D:p

I was a bit concerned that you were getting upset with us and am very glad to know differently. We have all been so worried about your sweet baby and were working so hard to help her and you, too. We have a tendency to come across rather heavy when a pup comes to us in crisis but it is only because we want so desperately to get things going in the right direction and save that pup. It could feel as if one were being ganged up on, but that is never our intention and I am so glad you were able to see our true intent. :)

I am so glad each morning to read that Tess has improved even more. You have done such a great job, mom!

Alison did a wonderful thing in catching the potassium levels and steering you to the salt VS Pedialyte. She is very crafty but I have always felt she is a doc in disguise! :);) Alison is one of the many pros we have here.

Keep up the good work!
Hugs,
Leslie and the girls

[Sammie]

Hi Everyone. I have Tessie new Labs:

ALB 3.7 2.5-4.4 G/DL
ALT 135 10-118 U/L
AMY 689 200-1200 U/L
TBIL 0.8 0.1-0.6 MG/DL
BUN 33 7-25 MG/DL
CA++ 12.3 8.6-11.8 MG/DL
PHOS 6.2 2.9-6.6 MG/DL
CRE 0.9 0.3-1.4 MG/DL
GLU 102 60-110 MG/DL
NA+ 144 138-160 MMOI/L
K+ 5.5 3.7-5.8 MMOI/L
TP 6.7 5.4-8.2 G/DL
GLOB 3.0 2.3-5.2 G/DL

NOW I got the Blood work from JUNE 5th 2009. I get Tessie Blood drawn once a year. This Is the Lab report that got My Vet to test for cushings.

CHEM 27


ALK. PHOSPHATASE 4891 (H) 10-150 U/L
ALT (SGPT) 139 (H) 5-107 U/L
AST (SGPT) 19 5-55 U/L
CK 110 10-200 U/L
GGT 66 (H) 0-14 U/L
AMYLASE 565 450-1240 U/L
LIPASE 691 100-750 U/L
ALBUMIN 3.7 2.5-4.0 G/DL
TOTAL PROTEIN 7.3 5.1-7.8 G/DL
GLOBULIN 3.6 2.1-4.5 G/DL
TOTAL BILIRUBIN 0.1 0.0-0.4 MG/DL
DIRECT BILIRUBIN 0.0 0.0-0.2 MG/DL
BUN 17 7-27 MG/DL
CREATININE 0.6 0.4-1.8 MG/DL
CHOLESTEROL 439 (H) 112-328 MG/DL
GLUCOSE 108 60-125 MG/DL
CALCIUM 11.2 8.2-12.4 MG/DL
PHOSPHORUS 5.8 2.1-6.3 MG/DL
TCO2 (BICARBONATE) 20 17-24 mEq/L
CHLORIDE 104 (L) 105-115 mEq/L
POTASSIUM 6.6 (H) 4.0-5.6 mEq/L
SODIUM 147 141-156 mEq/L
A/G RATIO 1.0 0.6-1.6
B/C RATIO 28.3 DOES NOT GIVE A NORMAL RANGE
INDIRECT BILIRUBIN 0.1 0-0.3 MG/DL

NA/K RATIO 22 (L) 27-40
HEMOLYSIS INDEX +
Index of N,+,++ exhibits no significant: efect on chemistry values.
LIPEMIA Index
Index of N,+,++ exhibits no significant effect on the chemistry values.
ANION GAP 30 (H) 12-24 mEq/L
T4 0.9 0.9-3.9 UG/DL
Interpretive Ranges:
<0.9 Low
0.9-3.9 Normal
>3.9 High
2.1-5.4 Therapeutic

Dogs with no clinical signs of hypothyroidism and results within the normal reference range are likely euthyroid. Dogs with low T4 concentrations may be hypothyroid or "euthyroid sick". Occasionally, hypothyroid dogs can have T4 concentrations that are low normal.
Dogs with clinical signs of hypothyroidism and low or low normal T4 concentrations may be evaluated further by submission of free T4 and canine TSH. A high T4 concentration in a clinically normal dog is likely variation of normal However elevations may occur secondary to thyroid autoantibodies or rarely thyroid neoplasia. For dogs on thyroid supplement, acceptable 4-6 hour post pill total T4 concentrations generally fall within the higher end or slightly above the reference range.

Please note: As of April 28 2009, the reference intervals were adjusted due to a change in assay performance.

CBC COMPREHENSIVE
WBC 12.5 5.7-16.3 THOUS./uL
RBC 6.99 5.5-8.5 MILLION/uL
HGB 15.8 12-18 G/DL
HCT 45.8 37-55 %
MCV 66 60-77 fL
MCH 22.6 19.5-26.0 pg
MCHC 34.5 32-36 G/DL
NEUTROPHIL SEG 74 60-77 %
LYMPHOCYTES 16 12-77 %
MONOCYTES 8 3-10 %
EOSINOPHIL 2 2-10 %
BASOPHIL 0 0-1 %
AUTO PLATELET 572 (H) 164-510 THOUS./uL

REMARKS: SIDE REVIEWED MICROSCOPICALLY.
ABSOLUTE NEUTROPHIL SEG 9250 3000-11500 /uL
ABSOLUTE LYMPHOCYTE 2000 1000-4800 /uL
ABSOLUTE MONOCYTE 1000 150-1350 /uL
ABSOLUTE EOSINOPHIL 250 100-1250 /uL
ABSOLUTE BASOPHIL 0 0-100 /uL

Sorry this was a three page report. All of this was on the report. This was Tessie normal, before we ever new about cushings. This is the normal blood panel I get for her every year.

Now for the ACTH Test.

ACTH STIMULATION:
Pre-ACTH Cortisol 5.1 ug/dL
Post-ACTH Cortisol 41.5 ug/dL

ACTH Reference Range for Canine:
Pre-ACTH (resting) cortisol 2-6
Post-ACTH cortisol 6-8
Equivocal post-ACTH cortisol 18-22
Post-ACTH cortisol consistent with hyperadrenocorticism >22
Post-ACTH cortisol with hypoadrenocorticism <2
Desired pre-and post-ACTH cortisol on Lysodren therapy 1-5

ACTH response test is only clearly positive (>22) in 30% of dogs with hyperadrenocorticism (HAC); equivocally positive in another 30% of dogs with HAC, and normal in 40% of dogs woth HAC.*
If the ACTH response test is normal and HAC s still suspected, proceed with a low-dose dexamethasone suppression test.

Dogs with iatrogenic Cushings disease will have flatline response test results in the low end or below the normal reference range.

Ok sorry for this being a book, but I wanted you have every thing that the Lab put on this report. I am wondering if my Vet did a low-dose dexamethasone suppression test and what is this test. How is it given?, do you draw blood for it ?. This Test was done on 7/1/09. So I picked up Vetoryl On 7/2/09 Thursday. Friday morning at 7:00 A.M. I gave Tes her two 30 mg pills. By that evening she did not look good and later on that night around mid-night her front legs were really shaking, when she laid down to sleep her body was shaking and very hot to touch. She was staring at the wall. Her hart was really bumping away, but I still gave her two more pills on Saturday at 7:00 A.M. and by 5:30 P.M. she was vomiting, shaking, could barley hold her weight to pee. Then at 4:30 A.M. Sunday/Monday I rushed her to the Emergence Vet. Then that same day Monday 8:00 A.M. she went to My Vet. Four days on IV. Boy did I wait to long get a glue. Thank God she is slowly coming back. I spoke to my Vet about the BUN today. Its at 33, he said because of the chicken Tes is eating would make it go back up. Tes is jumping off the couch to go bark when the other dogs bark. Its hot here today about 80 in the house with all the windows and doors open, along with fan. Keeping a good eye on her.

Ok this is my novel. Thank you for being able to educate me on how to read lab reports and what to ask my Vet. Dottie:o:):D

[StarDeb55]

Dottie, let's start with the general labwork from 6/5. Tess show the typical elevations in her liver function tests including the alk phos that will usually tip off a vet to look at Cushing's. It's usually the seriously elevated alk phos that is the big giveaway. Don't get me wrong there are other medical problems that can cause the liver function tests to elevate, not just Cushing's. I would agree that the ACTH is strongly positive. From the results you have posted, a LDDS was not done. LDDS results will have 3 values for the cortisol, a baseline which is prior to the injection, a 4 hour post injection, & an 8 hour post injection. To make the diagnosis of pit vs. adrenal cushing's, you take a look as to whether or not the 4 hour result suppress compared to baseline, then you look at the 8 hour to see if that value escapes suppression, & how much.

Now, today's test look pretty good, but, & this is still a BIG BUT, the sodium/potassium ratio is still too low. I calculated it to be 26.2, lower limit of normal is 27.1. This is still indicating adrenal damage, & not enough aldosterone is being produced to keep the electrolytes in balance. I can't emphasize to you enough that this is extremely important as a serious electrolyte imbalance can be life-threatening due to possible cardiac arrhythmia. Did you ask you vet about this, & whether or not Tess should be put on Florinef for several days?

Tess is slowly getting better, but I'm concerned that until that sodim/potassium ratio is back within normal range that little Tess is not out of the woods, yet.

Thanks for posting all of this.

Debbie

PS- I forgot. I would never treat for Cushing's based on the results of only one diagnostic test. Cushing's is the most difficult & frustrating disease to diagnose as there is no single test that is 100% sensitive or specific. Right now, IMHO, an LDDS would be a waste of financial resources. I would have an abdominal ultrasound done to check Tess' adrenal glands, plus you will get a better idea of her overall health as you can see all of her internal organs. You must make sure that the US is done on a high resolution machine so the adrenals are clearly visualized. If you still want to treat with trilostane, I would also suggest you the full adrenal panel done at the Univ. of Tenn., Knoxville. There is another type of Cushing's called Atypical where one or more of the 5 associated sex hormones produced by the adrenal glands may be elevated. If that would be the case with Tess, trilostane would not be an option for treatment as this med is know to elevate these intermediate hormones. Just to show how we got my Harley diagnosed, my GP vet ran the full adrenal panel which showed that not only did Harley have Pit Cushing's, all of the 5 other hormones were elevated, so he is Atypical, too. I took him to an IMS for a consult, I asked what else she needed to confirm the diagnosis besides the full adrenal panel, & abdominal US. She told me that's it. I asked if she wanted to do the low dose, she said no, not needed, the diagnosis can be made on the bloodwork tat was already done & the US.

[Sammie]

Dottie, let's start with the general labwork from 6/5. Tess show the typical elevations in her liver function tests including the alk phos that will usually tip off a vet to look at Cushing's. It's usually the seriously elevated alk phos that is the big giveaway. Don't get me wrong there are other medical problems that can cause the liver function tests to elevate, not just Cushing's. I would agree that the ACTH is strongly positive. From the results you have posted, a LDDS was not done. LDDS results will have 3 values for the cortisol, a baseline which is prior to the injection, a 4 hour post injection, & an 8 hour post injection. To make the diagnosis of pit vs. adrenal cushing's, you take a look as to whether or not the 4 hour result suppress compared to baseline, then you look at the 8 hour to see if that value escapes suppression, & how much.

Now, today's test look pretty good, but, & this is still a BIG BUT, the sodium/potassium ratio is still too low. I calculated it to be 26.2, lower limit of normal is 27.1. This is still indicating adrenal damage, & not enough aldosterone is being produced to keep the electrolytes in balance. I can't emphasize to you enough that this is extremely important as a serious electrolyte imbalance can be life-threatening due to possible cardiac arrhythmia. Did you ask you vet about this, & whether or not Tess should be put on Florinef for several days?

Tess is slowly getting better, but I'm concerned that until that sodim/potassium ratio is back within normal range that little Tess is not out of the woods, yet.

Thanks for posting all of this.

Debbie

Hi Debbie your the best for reading this book that I posted. I did ask him the S & P, he said nothing to worry about and that she is getting better. He said the BUN was up from chicken. So should I but a little extra salt on her Chicken? When I put salt on my hand and show it to here she just turns her head. How much salt should I give her? Don't want to over dose her. I also think she is not out of the woods. I will know better how she is feeling when the sun goes down. Its hot here and I live by the beach. Nice breeze throw. OK I will check back. TY again Dottie:)

[StarDeb55]

I really wouldn't add any extra salt to anything as ratio is getting close to normal. I suspect in another couple of days, it very well may be back to normal. I wasn't at all concerned with the minor elevation in the BUN, since the creatinine was normal. BUN can vary due to diet, dehydration, & a number of other things.

Debbie

[Sammie]

To Late just gave her some chicken with some salt on it. Wont give her any more this way. What are the ratios for S & P for a dog 23 pounds. Just want to know for my self. TY Dottie

[StarDeb55]

Normal range for any bloodwork is not usually based on weight. I don't really want to bore you with the math details on how this is determined, so let's just simply say they run labs on hundred of what they feel are normal dogs than calculate an overall average, along with some other things. Anyway, normal range for Na/K ratio is 27.1-40.1.

Debbie

[Sammie]

Normal range for any bloodwork is not usually based on weight. I don't really want to bore you with the math details on how this is determined, so let's just simply say they run labs on hundred of what they feel are normal dogs than calculate an overall average, along with some other things. Anyway, normal range for Na/K ratio is 27.1-40.1.

Debbie
Thank you Debbie, I have two black lab's girl boy, one, shitzu, and a white terrier/ Jack-Russell mentality, Bunny stay's very focused on things. Bunny is the one having to many seizures. Her longest was this passed sunday night, almost 7 min. She had a trimmer yesterday evening. I have only heard bad things about the medication for seizures, but I am going to have to think of something. Wish this could be one dog at a time. Mattie my 10 pound shitzu has a hart problem. New this when we rescued him, but last night he got sick vomited a little and again today. Think it might be from the chicken they normal don't get. Hopping it is. Just read that Lab's are prone to cushings. I know were all my pay checks are going for the next months. Its good to know where you spend your money. LOL Do I sound just a little worried still. LOL Ok enough of that. Tes is getting better and staying focused on that. going out in to the sun Dottie:)

[Sammie]

Its 12:25 in Souther Cal. Tes ate at 9:30 am, she ate most of her food. She still has not pooped. My husband offered her some chicken, she did not want it. I tried with a smaller pice, she turned it down. I went to check her gums, and she vomited. Liquid and a small amount of this morning dog food. Her glades on the side of her throat are swollen. I check the sides of the throat of my other small dogs. Tes is definitely swollen. I called my VET, left a message. Called the E-Vet. I had blood work done on her yesterday. MY Q. I am taking her to the E-VET. WHAT ARE THEY GOING TO DO FOR HER? What should I tell them to do or look for. Its now 12:35 PDT. Dottie:(

[Sammie]

For got. Her front legs are starting to shake again, like if I had given her Vetoryl. This was something she had never had before, only her back legs. She is uncomfortable to lay down. She is just moving around. sitting up lay down. Her head is has a slight shake to it, but not her body. It is really hot here. She was out laying in the sun for about 10 min. I thought that was weird. Dottie

[Squirt's Mom]

Hi Dottie,

Calm down first...ok? Take a deep breath and let it out slowly. You will get through this.

The ER docs will take a good look at her all over. They will run in-house bloodwork, Xrays, anything else they need to do to figure out what is wrong.

You will need to tell them what meds she has had and when, the food she ate and when, how soon after she ate she threw up and what it looked like, and you will need to tell them her recent history with the Trilo overdose...this is critical.

Then you simply wait....and know we are with you holding your hand.

Let us know what you learn asap,

Hang in there!
Big hugs,
Leslie and the girls

[Sammie]

Ok I will take my laptop with me and post from there. I am freaking. I am great with people medical emergence. I have had my share on board the aircraft. My husband had a attract and dbl. bypass surge, durning all of it I was a stone wall, until it was over, but animals I lose it. She has only been on a IV fluid and I don't know what he switched her to. The E-Vet had her on IV and My Vet switched it out. That is it for med's. Going now her gums have changed and she is now panting.

[lulusmom]

Get her to the ER NOW!!!!!

[Sammie]

At E-VETS they are checking her out

[Sammie]

Thank God I took the time to yesterday to post her history here. We just printed it out. I flew out the door. OK just waiting. You guys are a blessing. I am not religious, I do believe in her, but I am really worry. TY for you. dottie

[BestBuddy]

Dottie,
Any news on Tess?
Jenny

[Squirt's Mom]

Dottie,
Please keep us posted.

[Sammie]

I have recorded the conversation with E-VET. Do you want me to e-mail t to you?

[frijole]

Is Tess still at the vets? Is she on an IV? That would be my guess as to the problem.

Saying prayers, Kim

[Harley PoMMom]

How is Tess? Saying prayers too..Lori

[Sammie]

Went over her Labs. They are checking her electrolytes. The E-VET is more worried about the dark stole that she had on Wednesday. My Vet saw what it looked on Thursday, because he took her Temperature. Saturday when he took Tes temperature the stole was light brown. I am more worried about her throat or glades in her throat. Vet asked if I wanted to leave her over night. That if she needs a IV it might take awhile. I said I am staying. Ok while type this my Vet called me. He said he would be very surprise if her electra lights were off from yesterday. We both agree that that the A/D canine/feline food that I have been feeding her is very rich. Its the only thing she will eat. My Vet gave it to her to see if she would eat and the chicken that she normally does not get every day, maybe once a week is also to rich. So I am camping here. Leave no man behind is my motto. I am feeling calmer. :o

[Sammie]

Is Tess still at the vets? Is she on an IV? That would be my guess as to the problem.

Saying prayers, Kim

They are running blood work she is not on a IV yet. They need to do the blood work. Its been almost ten min, so I would think soon for the IV if she needs it.

[Sammie]

Ok the E-VET came out to talk to someone else who brought there pet in. I told her my Vet had called, and was Tes on a IV. The E-VET said not yet she wanted to talk about the electra lights.

[Sammie]

Any body out there??? Just chat at me PLZ about anything Dottie

[Harley PoMMom]

We are here Dottie, sorry.

[frijole]

i am here..hang in there. tess is in the best place she can be right now. kim

[StarDeb55]

Dottie, I have merged your emergency thread for Tess into the existing one. If you would prefer another title, please PM one of the mods or administrators & we can change it.

I just got home from work & discovered what has been going on. I'm afraid this is exactly why I raised the concern about the continuing abnormality in the sodium/postassium ratio, & the probable need for Florinef. Please post the electrolyte results as soon as you get them. Did you make the ER clinic fully aware of the severity of the trilo OD & Addisonian crisis? I would also ask them about need for florinef & a cortisol replacement such as prednisone or dexamethasone. I"m home & will keep an eye out for your posts.

I also see you have posted to Dr. Bruyette last night. I think some of us can probably answer most of your questions, so I will be right back to do that.

Debbie

[Harley PoMMom]

How are you holdin-up?

[Squirt's Mom]

Hey Dottie,

Here with you, honey.....

Tell me about your other babies....don't you have others?

[frijole]

You aren't showing up as logged in... I am hoping you are conserving battery... please let us know how you are as soon as you can... Kim

[Squirt's Mom]

Prayers for strength and healing thoughts flowing around you both.

[BestBuddy]

Hi Dottie,
I hope things are going ok. Let us know as soon as you can.
Jenny

[StarDeb55]

Ok this has me concern. How do I find out what medication do I give Tessie. I thought it would be Vetoryl, but the more I find out about cushings the more confused I get of what to start her on.

I think I mentioned this in an edit to one of my posts yesterday afternoon. Prior to re-starting the vetoryl, I would have an abdominal ultrasound & the UTK full adrenal panel done. The full panel is the only way to determine if Tess is Atypical. If that might be the case, vetoryl is not an appropriate medication for an Atypical pup.


With functional adrenal tumors having random secretory patterns involving one or more of the adrenal steroid/sex hormone, wouldn't it be ill advised to treat with Trilostane?

When Glynda refers to adrenal tumors in this question, she is referring to ADH, adrenal cushing's, vs. PDH, pituitary cushing's. With ADH, there is actually a tumor present on the adrenal gland. The only way to 100% determine this is with an abdominal ultrasound


With functional adrenal tumors having random secretory patterns involving one or more of the adrenal steroid/sex hormone, wouldn't it be ill advised to treat with Trilostane?

This is really going to have to be your decision, with input from your vet. I believe several of us have indicated our concern about inadequate diagnostic testing being done, along with the fact that Tess is your vet's first trilo patient. We have seen it on these boards, literally dozens & dozens of times, a pup gets into trouble when a vet is not Cushing's savvy, does not follow protocol for using either drug, lysodren or trilostane, & then the pup pays the price. IMHO, if I had been in your position, with either of my Cushing's pup, & my GP vet who is pretty Cush savvy wanting to make one of my boys his first trilo patient, I would have refused. I would have told him, "My dog is not going to be the guinea pig for you to learn how to use Trilo."


Enlarging macrotumor as opposed to a drug reaction.
Ok how do I test for this before I but Tes on any drug for cushings?

The only way to determine the presence of a macroadenoma in the brain is either by a CT scan or an MRI of the brain. An MRI is hideously expensive, several thouand dollars, but I believe you can probably have a CT done for <$1000. Imaging of the brain can be done at any time during treatment.


Do you have concerns about prescribing Trilostane for dogs that have significant elevations in intermediate steroid/sex hormone levels? In those instances, do you recommend an alternative treatment?

Also would like to know the answer to this.

I can't answer for Dr. Bruyette. The one thing I can tell you is Palmer's Mom e-mailed Dr. Jack Oliver at UTK who is probably the foremost expert in the world concerning the use of trilostane with Atypical +PDH pups. His response was that the trilo would help control the excess cortisol due to the PDH, but eventually trilo will elevate intermediate sex hormones causing a retrun of symptoms.

I wanted to answer some of these questions to the best of my ability for you, because none of us know how long it may be until Dr. Bruyette may respond. I know that you need information now, not a week or two from now..

Dottie, you have done a tremendous job keeping things together since last weekend when you came to us when Tess was in such bad, bad shape. I really give a pat you on the back, because you have had to learn about Cushing's in the worst way possible, when your pup's life is at stake. Please keep posting, asking questions, reviewing the important information section, & by all means, be the "terrorist", & let all of Tess' vets know you expect answers to your questions, & answers that you can understand, not in "vet/medical speak".

Debbie

[lulusmom]

Dottie,

I'm staying tuned with the rest of the bunch. Looking forward to getting the latest on sweet Tess.

Glynda

[Sammie]

Hi Debbie and everyone else. Just need to keep chatting. I am at the same E-VET that said to me that her cushings had gone to Addison's, which is now back to cushing per My Vet yesterday. Seems like its taking a long time to get the blood work done. The E-VET has Tes records from her OD on Sunday/Monday morning so I am covered there. I was up tell 4:00 am researching and reading about cushings, Addison's and cancer.

Ok doctor came out. I recored what she said. Is there any way to post that? if not bottom line. She feels we are dealing with two problems. They found a tumor were she goes poop. From my E-VETS experience these are always cancerous. Her glades in the low legs and under arms are swollen. If the tumor is cancerous, then you all know what that means.Tes Blood work was fine. I will post them when I get home. The tumor is not blocking her from going poop and her stole is normal. I am having them run a in house full panel and will compare it to the one My Vet will do on Monday to send out to the lab that I will get back on Tuesday. They are giving Tes a shot for vomiting, and sending me home with medication that will coat her stomach this is to be given at 3:45. its 2:37 pm late after noon, she said around 5:00 offer Tes food ( warm Chicken and white rice ) if she vomits or does not want food then I am to bring her back for IV fluids.

[Squirt's Mom]

So the electrolytes are OK? Is that what I am reading? They have no concerns about the overdose or any lingering effects from the overdose?

Did they do a needle biopsy of the tumors or are they planning to do any biopsies?

Are the glands swollen due to infection, from the tumors, or what?

Did they give her any antibiotics, if so what for?

And, for heaven's sake, why aren't they keeping her for IV fluids now? For as much as she has been through this last week, I don't understand that at all. I think I would be stomping my foot and demanding they keep her til she was able to eat and drink, and they had some more idea of what the plan was. But that's just me. :o

keep your chin up! Like Debbie said, you are doing a fine job under terrible circumstances.
Hugs,
Leslie and the girls

[Sammie]

OK paying the bill and will read all the post after I get home ty all for being there for me a Tessie XXOO Dottie

[frijole]

I am not sure how to link a recording.. maybe someone else knows..

You said we are dealing with 2 things - you mentioned the tumor. What is the other? Tell us exactly what this vet said when you get back home...

We will be here. Hugs to dear Tess. Kim

[Harley PoMMom]

Hi Dottie,

Please let us know how Tess is when you get home, ok?

Sending healing thoughts and prayers your way.

Lori

[StarDeb55]

Dottie, with the swollen glands, along with the growth they have found in her rectum, did the vet say anything about this possibly being lymphoma? They can't tell for sure without a needle biopsy, but with swollen peripheral nodes that is easy enough to do. I did a quick review of your thread, & I don't see where you posted how old Tess is? If they think this may be lymphoma, I can probably help you with information about that.

Debbie

[Harley PoMMom]

Debbie,

Tess is 12 y/o.

Lori

[StarDeb55]

Thanks, Lori, as I said,it was a very fast review.

Debbie

[Sammie]

Ok home. It will take a few min to put all of this in be right back and ty again for being there. Dottie

[Squirt's Mom]

Take the time you need to be sure Tess is settled in and tend to anything you need to do for her first...we will be here. I'm glad you made it home safe and sound.

Hugs,
Leslie and the girls

[Buffaloe]

Dottie,

A couple of months ago, I dealt with a tumor on my female dog's anus. They are nowhere close to always cancerous. These anal area tumors are more often cancerous in females than in males but they are often benign, even in females. If non-cancerous, they are called perianal adenomas and if cancerous they are perianal carcinomas. The word "peri" just means "in the area of."

My wonderful surgeon biopsied her perianal tumor and five good smears were sent to the lab. The cytology report came back that it was completely benign. I was given the option of surgical removal or a medical treatment. I chose the medical treatment. She was on a pretty large dose of prednisone and cephlaxin (antibiotic) for two weeks. Her perianal adenoma reduced in size by 80% and I can barely even see it or feel it today. I studied these things alot and they are not all cancerous, not by a long shot.

You are doing a great job with Tess. All the best,

Ken

[Sammie]

Ken Your post almost made me cry. I am so happy to here that. The tumor is really small the E-Vet said, but her left anal glade is larger then the other three, total of 4, but still they are all large. Gave tes her first pill and its hot here. She is looking at me like what is going on. Will start on posting the lab results. Just thought I would check back ty you all XXOO Dottie

[frijole]

Dottie...you ok? Just checking to make sure. Kim

[StarDeb55]

Dottie, in light of what the ER clinic found today, I'm going to be frank, a Cushing's diagnosis is, now, highly questionable. This is why it is so important to not rely on a single diagnostic test. Even if Tess might have Cushing's, it's now on the back burner, until they can figure out what that mass is. I'm concerned about lymphoma as my 1st Cushpup, Barkley, developed lymphoma about 6 years after his original diagnosis. His symptoms were very vague, nothing specific, & any abnormalities on his labs could be explained by the pre-existing Cushing's. It took an IMS to figure out why he was getting sicker by the day. She found multiple swollen peripheral lymph nodes on exam, did an abdominal US, finding further swollen nodes that were throughout his abdomen. To make the diagnosis, she simply did a needle biopsy on one of the swollen nodes in behind his knee. This simple means that a needle was stuck in the node, taking out a small amount of material to send to Pathology for diagnosis. I really hope that Ken is right. If I were in your shoes, though, I would opt for a biopsy of one of the swollen nodes before I put Tess through a surgical biopsy of that mass in her anus/rectum.

Debbie

PS- There is also a possibility that this growth may, indeed, be a perianal adenoma due to elevated estradiol levels. Susy, (Wylie's Mom), has had an on-going problem with this type of growth on poor Wylie. In fact, Wylie had surgery within the past week to try to remove one. The elevated estradiol is what's causing this, so it may also be worthwhile to have at least an estradiol level done, if not the full adrenal panel. One other question, has Tess' been spayed?

[frijole]

It is a little after 5 pm your time so I assume you might be feeding Tess. If we don't hear from you after a bit I assume you are taking her in for IV treatment. Please give her hugs from all of us. We are here and waiting. Don't lose faith - Kim

[Sammie]

OK the E-Vet Faxed over a complete panel, except for the ALP that would not read so they are sending that out will have it tomorrow. On the phone she said there was also something wrong with Tes liver. So we are now dealing with Cushings, a Anal Tumor and lift glades (one being really big out of the 4 that are also big) and the Liver. I said to the E-VET that it was just dum luck that we found the tumor. She said yes it was. The E-Vet on Monday when I rushed Tessie in did not do a anal exam.

A recap: Below will be Tes first Labs when I rushed her to the E-Vet on Monday morning.

07/06/09 VETSCAN 05:44 AM

ALB 2.8 2.5-4.4
ALB>2400 20-150
ALT 377 10-118
AMY 907 200-1200
TBIL 0.3 0.1-0.6
BUN 50 7-25
CA++ 11.9 8.6-11.8
PHOS 6.8 2.9-6.6
CRE 4.2 0.3-1.4
GLU 85 60-110
NA+ 149 138-160
K+7.2 3.7-5.8
TP 6.0 5.4-8.2
GLOB 3.2 2.3-5.2

NOW TODAYS TEST

I-STAT EC8+ 07/12/09 1:35 PM

GLU 95 MG/DL
BUN 27 MG/DL 10-20
NA 145 MMOL/L 140-159
K 4.0 MMOL/L 3.7-5.8
CL 111 MMOL/L 105-115
TCO2 32 MMOL/L 23-29
ANGAP 7 MMOL/L
HCT 38 %PCV
HB* 12.9 G/DL
*VIA HCT
PH 7.447
PCO2 45.1 MMHG
HCO3 31.1 MMOL/L
BEECF 7 MMOL/L
IF THERE IS KNOW RANGE ITS BECAUSE IT WAS NOT ON THE PAPER WORK.

HEMATOLOGY RESULTS 07/12/09 2:39 PM
HCT 38.4 % 37-55.0
HGB 13.6 G/DL 12.0-18.0
MCHC 35.4 G/DL 30.0-36.9
WBC 16.9 x10 9/L 6.0-16.9 (H)
GRANS 14.7 x10 9/L 3.3-12.0 (H)
% GRANS NEUT 13.9 x10 9/L 2.8-10.5 (H)
EOS 0.8 x10 9/L 0.5-1.5
L/M 2.2 x10 9/L 1.1-6.3
%L/M 13 %
PLT 507 x10 9/L 175-500 (H)
RETICS 0.8 %

VETSCAN 07/12/09 AT 2:45 PM
ALB 3.8 2.5-4.4
ALB WAS SENT OUT
ALT 408 10-118 THIS IS HIGH
AMY 727 200-1200
TBIL 0.8 0.1-0.6 THIS IS HIGH
BUN 25 7-25 This came down from Saturdays BUN which was 33
CA++ 13.2 8.6-11.8 THIS IS HIGH
PHOS 6.5 2.9-6.6
CRE 0.8 0.3-1.4
GLU 101 60-110
NA+ 152 138-160
K+ 4.2 3.7-5.8
TP 7.2 5.4-8.2
GLOB 3.4 2.3-5.2

VETSCAN 07/12/09 3:18 PM HIGHER LOWER IS FROM THE 2:45 TEST

ALB 3.9 HIGHER
ALP
ALT 406 LOWER
AMY 721 LOWER
TBIL 0.9 HIGHER
BUN 26 HIGHER
CA++ 13.3 HIGHER
PHOS 6.6 HIGHER
CRE 0.7 LOWER
GLU 95 LOWER
NA+153 HIGHER
K+ 4.3 HIGHER
TP 7.2 SAME
GLOB 3.3 LOWER

Notes from E-VET 07/12/09 at 13:30
soft SQ swelling over dorsal scapula, multiple pigmented raised masses E: moderately cloudy lens E: clean N: no d/c T: tonsils NV, nooral masses seen MS: BCS 6/9, amb x 4 CV: NSR, no murmur, mm pink, CRT 1 sec, pulses fair Resp: Clear BV GI/GU: Oral- severe calculus with few areas of recession, abdom soft and non-painful, cranial organomegaly, F/S, Rectal- small growth floor of colon near anus. AG full and emptied, L anal gland mass lateral cranial to anal gland LN: inguinal (2cm) lymph nodes and axillary (1 cm) lymph enlarged, popliteal/prescaps/manibular 1 -1.5 cm NS: P,P,M okay

A: Vomiting and anorexia today: r/o gastroenteritis ( drug reation, infectious, neoplasis, Addison's Hx Cushing's disease
Hx elevated Calcium
A few days of dark stool and BUN/Crea ratio 37: r/o Gl bleed
Mass next to left anal gland: r/o neoplasia, benign, ingectious Periodontal disease Lymphadenopathy
P: Electolytes panel. Electrolytes WNL, BUN slightly elevated remainder OK. Rec injection of anti-nausea and recheck with normal vet.
Anzemet 20 mg/ml 0.26 ml SQ
Reglan 10 mg (#10) 1/2 tablet PO BID
Sucralfate 1g (#10) 1/2 tab PO TID
Recommend anal gland and inguinal LN FNA ASAP Owner requested full panel.

When the E-VET called me to fax over the full panel, she also said that something was wrong with Tes Liver.

Medication Tes was sent home with Metoclopramide 10mg
give one half tablet every twelve hours. Gave it to Tes at 6:00 PM
She is now moving around like she is uncomfortable and panting.
Very large pill.

Sucralfate 1g give 1/2 tab every 8 hours Gave this to Tes at 4:00 PM, know side affects.

Gave her a tine bit of cute up chicken and rice, she did not want the rice ate the chicken. She smelled it cooking and went in to the Kitchen like her old self to beg for something to eat.
OK I think thats it.. TY all for translating all of this for me Big Hug for today and being there Dottie

[Sammie]

Dottie, with the swollen glands, along with the growth they have found in her rectum, did the vet say anything about this possibly being lymphoma? They can't tell for sure without a needle biopsy, but with swollen peripheral nodes that is easy enough to do. I did a quick review of your thread, & I don't see where you posted how old Tess is? If they think this may be lymphoma, I can probably help you with information about that.

Debbie

Hi again Tessie will be 13 years on 7/29/09. I will be taking Tes to my Vet on Monday and I will ask him to run the test for that too. With out all of you here helping me to help test I would of never known to ask about about Lymphoma TY dottie

[frijole]

Dottie, I will let someone with more knowledge read the lab reports -I really appreciate the update and am glad to know Tess ate tonight. She's fighting and that is good.

Did the doc say anything specific about the liver? I ask because cushings (and other diseases) affects the liver so it isn't really surprising to me. I was wonder if there was something besides elevated enzymes (the alks on the blood tests) that they were talking about.

Wish I could do more than say Hang in there but it's the best I can do. I will say prayers for your family and Tess. Maybe others will come on later and be of more help. Thanks again for updating us. Hang in there! Kim

[StarDeb55]

Dottie, at this point in time, your GP vet needs to give you a referral to an IMS. If this is indeed cancer, or if the anal growth is due to elevated estradiol, this is going to take an IMS to get it sorted it. The type of medical issues that Tess & you are dealing with are beyond the scope of most general practice vets. Seeing an IMS is really going to be in Tess' best interest over the long haul because as I said earlier, I have serious doubts about the validity of the Cushing's diagnosis.

Debbie

PS-If the Cushing's diagnosis is incorrect, this is why Tess became so critically ill when you gave her the trilo, not from too much trilo. I'm also VERY, VERY CONCERNED with Na/K ratio as this is back down to 20.6. I am not a vet, but IMHO, Tess needs to be put on florinef & a steroid replacement because with this continuing electrolyte balance, you may lose her to a cardiac problem before you have a chance to get to the bottom of everything that the ER clinic found today.

Just in case you don't know, IMS means internal medicine specialist.

[Sammie]

Dottie, in light of what the ER clinic found today, I'm going to be frank, a Cushing's diagnosis is, now, highly questionable. This is why it is so important to not rely on a single diagnostic test. Even if Tess might have Cushing's, it's now on the back burner, until they can figure out what that mass is. I'm concerned about lymphoma as my 1st Cushpup, Barkley, developed lymphoma about 6 years after his original diagnosis. His symptoms were very vague, nothing specific, & any abnormalities on his labs could be explained by the pre-existing Cushing's. It took an IMS to figure out why he was getting sicker by the day. She found multiple swollen peripheral lymph nodes on exam, did an abdominal US, finding further swollen nodes that were throughout his abdomen. To make the diagnosis, she simply did a needle biopsy on one of the swollen nodes in behind his knee. This simple means that a needle was stuck in the node, taking out a small amount of material to send to Pathology for diagnosis. I really hope that Ken is right. If I were in your shoes, though, I would opt for a biopsy of one of the swollen nodes before I put Tess through a surgical biopsy of that mass in her anus/rectum.

Debbie

PS- There is also a possibility that this growth may, indeed, be a perianal adenoma due to elevated estradiol levels. Susy, (Wylie's Mom), has had an on-going problem with this type of growth on poor Wylie. In fact, Wylie had surgery within the past week to try to remove one. The elevated estradiol is what's causing this, so it may also be worthwhile to have at least an estradiol level done, if not the full adrenal panel. One other question, has Tess' been spayed?

Hi Debbie just hang in there is really good. Just talking about it to people that have walked the walked is so helpful. Now what is IMS?
AND what is a abdominal US? The ER Vet was great. She is about 4 years out of UC Davis were my Vet graduated around 20 years ago. She has explained a proceeder to My Vet, which he might already know how to do, but it wont hurt Tes and you don't have to but her out to do it to do a needle biopsy of the tumors. YES tes was spayed a 6 months. I can not ty you guys enough. Dottie

[StarDeb55]

IMS=internal medicine specialist

abdominal US=abdominal ultrasound

Please see my "PS" on my prior post.

[Squirt's Mom]

Hi Dottie,

In reading your post, I am confused by the following reference to a "full panel" -


Recommend anal gland and inguinal LN FNA ASAP Owner requested full panel.

When the E-VET called me to fax over the full panel, she also said that something was wrong with Tes Liver.

Is the the full adrenal panel from the Uni. of TN in Knoxville we have mentioned? If so, this is not the time for that test. Her current stress levels will cause results that will not be accurate. Nor will it be able to tell you what is wrong with her right now.

As has been said, Cushing's is the last thing you need to be concerned about. So if Cushing's is where your focus is, take a step back, shake your head and get ready to start all over.

But that doesn't mean you get to leave....no way! We just need to be able to look at Tess from a broader perspective, with Cushing's last on the list, if on the list at all...'k?

If I have misread these statements, then never mind....:o

Hugs,
Leslie and the girls

[Sammie]

Dottie, at this point in time, your GP vet needs to give you a referral to an IMS. If this is indeed cancer, or if the anal growth is due to elevated estradiol, this is going to take an IMS to get it sorted it. The type of medical issues that Tess & you are dealing with are beyond the scope of most general practice vets. Seeing an IMS is really going to be in Tess' best interest over the long haul because as I said earlier, I have serious doubts about the validity of the Cushing's diagnosis.

Debbie

PS-If the Cushing's diagnosis is incorrect, this is why Tess became so critically ill when you gave her the trilo, not from too much trilo. I'm also VERY, VERY CONCERNED with Na/K ratio as this is back down to 20.6. I am not a vet, but IMHO, Tess needs to be put on florinef & a steroid replacement because with this continuing electrolyte balance, you may lose her to a cardiac problem before you have a chance to get to the bottom of everything that the ER clinic found today.

Just in case you don't know, IMS means internal medicine specialist.

I am on hold with the ER Vet to ask her about the Na/K. TY Deb
Was on hold 15 min another emergency walked in to there clink so she will call me back.

[SachiMom]

Is the the full adrenal panel from the Uni. of TN in Knoxville we have mentioned? If so, this is not the time for that test.
Leslie, I think Dottie is referring to a full blood panel . . .like they get on their yearly or senior well checks. Not really anything to do with cortisol or cushings at the moment. Just trying to figure out what's going on.
~Mary Ann

[Sammie]

IMS=internal medicine specialist

abdominal US=abdominal ultrasound

Please see my "PS" on my prior post.

How can they test for estradiol? is it located some where on my current Labs test? If it is could you tell me were on the Labs? If its not I just ask my Vet to test for a high estradiol? ty

[SachiMom]

Was on hold 15 min another emergency walked in to there clink so she will call me back.
Okay, give her half an hour and call back. No more. I am not medically knowledgeable, but if Debbie is concerned, that has me concerned.
~Mary Ann

[Squirt's Mom]

What Mary Ann said....30 min and call back. ;) We are all worried and knowing Debbie sees a problem with the electrolytes....well, just call in 30 min...ok? :o:)

You're doing good, Dottie...keep your chin up and keep on hanging! :D
Hugs,
Leslie and the girls

PS. Estradiol will not be on these labs

[Sammie]

Hi Dottie,

In reading your post, I am confused by the following reference to a "full panel" -



Is the the full adrenal panel from the Uni. of TN in Knoxville we have mentioned? If so, this is not the time for that test. Her current stress levels will cause results that will not be accurate. Nor will it be able to tell you what is wrong with her right now.

As has been said, Cushing's is the last thing you need to be concerned about. So if Cushing's is where your focus is, take a step back, shake your head and get ready to start all over.

But that doesn't mean you get to leave....no way! We just need to be able to look at Tess from a broader perspective, with Cushing's last on the list, if on the list at all...'k?

If I have misread these statements, then never mind....:o

Hugs,
Leslie and the girls

Hi Leslie Full Panel is just blood work. The normal full panel that I would get once a year. She said I should have one or my vet could do it. I wanted her in house Full panel and then on Monday I will have a full panel done that gets sent out to a lab and compare the two. There will be extra things I want to add to that panel based on all of you giving such great help and direction to find out what the hell is going on. :) Dottie PS my focus is now on possible lymphoma or Liver damage, or cancer. If you think I am headed in the wrong direction PLZ let me know. I have already had to much fun learning about cushings need to expand my mind with any of those three. LOL Just de stressing with humor. thanks guys Dottie:o

[Sammie]

What Mary Ann said....30 min and call back. ;) We are all worried and knowing Debbie sees a problem with the electrolytes....well, just call in 30 min...ok? :o:)

You're doing good, Dottie...keep your chin up and keep on hanging! :D
Hugs,
Leslie and the girls

PS. Estradiol will not be on these labs

I hung up from the ER station at 7:50 PM LAX time so she has 10 min before I call back, that would make a total of 30 min

[Squirt's Mom]

Thanks, Dottie! I feel so much better, not much smarter, but better. :rolleyes::D:o

As for the direction you are headed and where your focus is, I think you are fine, but leave yourself open to other possibilities, too. At this point, I think it is too early, and way too few tests have been done, to draw any clear conclusions.

It seems you and I think alike on the in-house and send-out labs...I like to have a comparison at times myself and sometimes I prefer for them to be sent out even tho it costs a bit more.

But, I don't think I would have the blood work re-done at my GP vets office.

If it were me, I would call my usual vet in the morning and ask for a referral to an IMS - Internal Medicine Specialist, if at all possible, an emergency referral. Ask that Tess' file be copied and sent to the IMS doctor they send you to, then call the E-Vet you have seen and ask them to do the same thing.

Until you see the IMS, do not give any more Trilo.

Take Tess back to the E-Vet tonite if:

*she cannot get comfortable to sleep
*she vomits...anything, even water
*has diarrhea
*pants heavier than usual
*seems to be in any type of pain
*begins coughing
*becomes lethargic
*becomes confused
*shaking and weakness worsen
***your gut says something is wrong***

Don't wait to ask us or anyone else...just go. Take your laptop (and a plug in if you have one. ;) ) and someone will more than likely be around all nite long to talk with you.

I have a feeling when you put your mind to something, you can learn anything you need to. :cool: I hope Tess and you can get some rest tonite. Try not to worry if you can help it...dumb, I know. :rolleyes:;) But there is method behind it...or meaning perhaps....the calmer you are, the easier it will be for Tess to be a calm as she can. You will get a better read of her behavior if she isn't worried about you. ;)

Hugs,
Leslie and the girls

[k9diabetes]

I may be confused but I think the Na/K ratio is actually quite a bit better than was thought...

I-STAT EC8+ 07/12/09 1:35 PM
GLU 95 MG/DL
BUN 27 MG/DL 10-20
NA 145 MMOL/L 140-159
K 4.0 MMOL/L 3.7-5.8

This comes out to a ratio, I believe, of 36.25, which is the best it's been in days.

Dottie, could you check the lab work to make sure those figures are correct?

Y'all correct me if I'm wrong.

Natalie

[Sammie]

Thanks, Dottie! I feel so much better, not much smarter, but better. :rolleyes::D:o

As for the direction you are headed and where your focus is, I think you are fine, but leave yourself open to other possibilities, too. At this point, I think it is too early, and way too few tests have been done, to draw any clear conclusions.

It seems you and I think alike on the in-house and send-out labs...I like to have a comparison at times myself and sometimes I prefer for them to be sent out even tho it costs a bit more.

But, I don't think I would have the blood work re-done at my GP vets office.

If it were me, I would call my usual vet in the morning and ask for a referral to an IMS - Internal Medicine Specialist, if at all possible, an emergency referral. Ask that Tess' file be copied and sent to the IMS doctor they send you to, then call the E-Vet you have seen and ask them to do the same thing.

Until you see the IMS, do not give any more Trilo.

Take Tess back to the E-Vet tonite if:

*she cannot get comfortable to sleep
*she vomits...anything, even water
*has diarrhea
*pants heavier than usual
*seems to be in any type of pain
*begins coughing
*becomes lethargic
*becomes confused
*shaking and weakness worsen
***your gut says something is wrong***

Don't wait to ask us or anyone else...just go. Take your laptop (and a plug in if you have one. ;) ) and someone will more than likely be around all nite long to talk with you.

I have a feeling when you put your mind to something, you can learn anything you need to. :cool: I hope Tess and you can get some rest tonite. Try not to worry if you can help it...dumb, I know. :rolleyes:;) But there is method behind it...or meaning perhaps....the calmer you are, the easier it will be for Tess to be a calm as she can. You will get a better read of her behavior if she isn't worried about you. ;)

Hugs,
Leslie and the girls

Hi Leslie earlier today when the ER Vet faxed over blood work I asked her for a doctor who does MRI or CT in my area and a Cancer doctor. I will tonight when she calls me back for a IMS in my area. Yes I like to compare things before I do any thing. Tes will NOT have any more cushings medication until we really know what is going on. I do have a laptop and I took it with me earlier today when I was at the ER VET. Forgot to tell you all. TESSIE POOPED. It was medium brown, big and long, soled . I was so happy. Tes is sleeping very nicely right now. She does not feel to hot. Her breathing is good. I am laying right next to her and watching poker. Dottie

[Sammie]

I may be confused but I think the Na/K ratio is actually quite a bit better than was thought...

I-STAT EC8+ 07/12/09 1:35 PM
GLU 95 MG/DL
BUN 27 MG/DL 10-20
NA 145 MMOL/L 140-159
K 4.0 MMOL/L 3.7-5.8

This comes out to a ratio, I believe, of 36.25, which is the best it's been in days.

Dottie, could you check the lab work to make sure those figures are correct?

Y'all correct me if I'm wrong.

Natalie

Hi Natalie YES I checked off of the I-STAT EC8+ 07/12/09 1:35 PM, they are correct. I know it was posted for me how to do the ratio, but could you show it for me again. How you got the 36.25 and if this is correct then I only need to ask the ER VET again about the Liver. The ER VET has not called back yet so there is time. TY Dottie

[SaxLady]

Dottie, I am sincerely praying that they will find out what is wrong with Tess and that she will be alright. Also, sending prayers and healing for Tess and your family. I am up very late, until 2 AM, Ohio time and will check back every half-hour. I read the other posts and you have been given very correct advice. Please listen to them. I have information from Germany regarding Trilo and I agree. Don't resume giving it to her.
Love,
Candy

[Squirt's Mom]

Hi Dottie,

If my math is correct, to find the ratio, you would divide the NA (145) by the K (4.0), which would give the result of 36.25...or that is how I arrived at the same answer as Natalie anyway.

NA=Sodium
K=Potassium

[k9diabetes]

From all I have read here, it is a matter of dividing the sodium level by the potassium level. You posted the following results:

JUNE 6 2009 4:34 A.M
NA+ 149 138-160 MMOI/L
K+ 7.2% 3.7-5.8 MMOI/L
NA:K=20.7 This is hand written in a separate box by the doctor

Na (149) divided by K 7.2 = 20.69 or 20.7

Another lab result that gave the ratio:

POTASSIUM 6.6 (H) 4.0-5.6 mEq/L
SODIUM 147 141-156 mEq/L
NA/K RATIO 22 (L) 27-40

Na 147 divided by K 6.6 = 22.27 or 22 as given on those results.
One problem here was that the potassium was above normal.

So the current 145 divided by 4.0 comes to a Na/K ratio of 36.25 with both values within a normal range.

[Buffaloe]

I really hope that Ken is right. If I were in your shoes, though, I would opt for a biopsy of one of the swollen nodes before I put Tess through a surgical biopsy of that mass in her anus/rectum.?

Debbie


I wasn't trying to be right about anything other than explaining to Dottie that not all anal tumors are malignant. Shiloh's "surgical biopsy" you referred to took a total of five minutes and didn't seem to bother her in the least bit. If you read my post, you'll see I simply described what transpired in Shiloh's situation and explained that not all perianal tumors are malignant.

Ken

[Sammie]

Hi every one, just got off the phone with the ER VET.
First Ken Your post made me feel so much better. I needed to see a post with a happy ending so thank you for that. Now about the Liver. The ER VET was concern because on the VetScan from 7/12 at 2:45 the ALT and the TBIL are to high, especially the TBIL it keeps going up. So that is something that she has seen in dogs that could mean something is up with liver. On to the Na/K. She said as long as the
S & P are with in normal limits you do not have to worry about the ratio at this time. From both VetScan they are with in normal limits even thru the VetScan at 3:18 they had gone up a little, they are still normal and Tes is acting normal. She has given me Two number for a IMS and a Cancer doctor. This ER VET She is just like me won't take NO has a answer. I really like her. Ok I think I am good. I feel like I have it a brick wall a few times and going to work sounds like a VC right now, but I am getting my next trip covered or call in sick which every happens first I wont be at work. I notice Tes does not want to be alone. I saw this yesterday and today. She wakes up to see if I am still next to her. Such a sweet girl she is a peace that makes me happy. I am going to kick back for a few. Now which topic do I want to dive in to night. My brain feels like I need to know something so I can help Tes, But for the next few hours I think I'll just watch her sleep. Loving Tes Loving you guys Dottie:o

PS So I took the 145 Divided it by the 4.0 and I too got the 36.25. How would I know this normal. Is it some where on the Lab reports I don't know how to read yet the normal range would be. Ty yu again

[SaxLady]

Checking in again to see how Tess is doing. I am relieved that she seems more stable. Please get some rest with Tess beside you. She sounds like such a sweetheart! Will keep both of you in my prayers.
Love,
Candy

[Sammie]

TY you Candy. Finale got comfortable. I have a bad back. Up in the middle of my back. Just got some relief. OK so know one liked my joke??? its okay if didn't. :o

[SachiMom]

But for the next few hours I think I'll just watch her sleep. Loving Tes Loving you guys
Couldn't give you any better advice if I tried. Since she is comfortable, relax and enjoy her snuggling. Get some rest and give the ole' brain a rest. In the morning start fresh. Give the IMS a call to make an appointment. He can probably do additional tests or screenings to determine if you do need the cancer doctor. And will probably be able to sort out all this other stuff.
Curious as to what clinic she referred you to.
Sending healing thoughts and prayers out to Tessie.
~Mary Ann


I too got the 36.25. How would I know this normal. Is it some where on the Lab reports I don't know how to read yet the normal range would be.

Just saw your second question. Using a previous post by Natalie as an example:

POTASSIUM 6.6 (H) 4.0-5.6 mEq/L
SODIUM 147 141-156 mEq/L
NA/K RATIO 22 (L) 27-40

The first bold numbers are the reading from Tessie's blood.
The second numbers are the "normal range" numbers.
And even though the latest test did not workout the ratio, you can use the reference from above as it is using the same measuring units.

[Sammie]

Couldn't give you any better advice if I tried. Since she is comfortable, relax and enjoy her snuggling. Get some rest and give the ole' brain a rest. In the morning start fresh. Give the IMS a call to make an appointment. He can probably do additional tests or screenings to determine if you do need the cancer doctor. And will probably be able to sort out all this other stuff.
Curious as to what clinic she referred you to.
Sending healing thoughts and prayers out to Tessie.
~Mary Ann



Just saw your second question. Using a previous post by Natalie as an example:

POTASSIUM 6.6 (H) 4.0-5.6 mEq/L
SODIUM 147 141-156 mEq/L
NA/K RATIO 22 (L) 27-40

The first bold numbers are the reading from Tessie's blood.
The second numbers are the "normal range" numbers.
And even though the latest test did not workout the ratio, you can use the reference from above as it is using the same measuring units.

OK so 27-40 is the normal range. When you take S and divided P = 36.25 I think I got it. TY Mary Ann:o

[SaxLady]

Sweet dreams Dottie and Tess. Will include you both in my prayers now as I go to bed.

[frijole]

Tess - Just have a few minutes as I need to get ready for work. Thanks for update and I did listen to the tape. I am glad that your ER vet gave you names of IMS specialist docs. YOu don't mess with cancer and it is time to let one of these guys help you. Your vet can still be involved. I googled TBIL that you mentioned and it is bilirubin.

From wikipedia:
Moderate rise in bilirubin may be caused by:

Drugs (especially antipsychotic, some sex hormones, and a wide range of other drugs)
Hepatitis (levels may be moderate or high)
Chemotherapy
Biliary stricture (benign or malignant)

Note that trilo is a chemo drug.

Here is the link: http://en.wikipedia.org/wiki/Bilirubin

As I said, this is not my specialty so please get an appt with an IMS asap for the testing. I'll keep the prayers going. Kim

[Squirt's Mom]

Morning Dottie,

I sure hope you and Tess had a nice rest, and that you both feel a bit better this morning.

Hugs,
Leslie and the girls

[Sammie]

Good morning. Went to bed a 5:00 AM that is my normal hour if I am flying, but getting up a 9:30 is in sane. How do you day people do this. Its to bright out there. Having my sips of coffee. See My Vet will see me a 2:00 PM today. I will have it more together by then. Tes slept really good. Still won't eat her normal food, just the rich stuff (A/P hills) Other then that she looks good. Im the one that needs a IV of vitamin B. Ok must pay bills today, so I will be back on later TY for all the HUGS Dottie

[SaxLady]

Dottie, good luck at the vet. Be sure to keep us posted, as we are all very concerned about Tess. So glad you and Tess had a few hours of good rest! Be sure to follow through with the specialist doctors. I can relate to what you are going through and it is very tough! My little Katrina has an adrenal tumor and we have an appointment with the surgeon tomorrow.
Blessings,
Candy

[gpgscott]

Dottie,

I can't add to the information given by others in the last day or so.

I get your concern and am sorry that you have to leave so frequently.

I can offer my support to you and Tess.

Hugs and prayers for you all.

Scott

[StarDeb55]

Dottie, I'm glad to hear that things were reasonably calm for both you &
Tess overnight.

First of all, I owe you a huge apology. I apparently read one of the earlier sets of labwork to calculate that low ratio. There was soooo much information in your post, I just didn't catch the date. I'm pretty flumoxed that I made an error like that, & I do apologize for scaring the pants off you. This is why when I feel there is something amiss in labwork, I always encourage the parent to review these concerns with their vet. I'm very glad you called the ER vet back. Secondly, THANK YOU to Natalie for catching this very big mistake on my part! I really do pride myself on my lab expertise, & I really beat up on myself when I make a goof like this one. Lastly, I didn't desert you last night. I have to be at work at 0500, I get up at 0345, so my bedtime is around 8PM. Enough of me blathering around.

Concerning how to proceed with Tess, your best bet is to get her to an internal med specialist ASAP. I would discuss the possibilities that both Ken & I have brought up with them to see what they think is the best diagnostic approach. Right now, since I've been down this road trying to find out why a dog is ill, with no real apparent abnormalities, IMHO, the things I think you should see about doing for Tess are:

1)Needle biopsy of one of the swollen peripheral nodes. If it is lymphoma, they can make the diagnosis doing this, rather than a surgical biopsy of the anal mass. If an IMS feels that a needle biopsy is insufficient, & prefers to have a surgical biopsy done of the anal mass, I would let them make the call.

2) Abdominal Ultrasound. If this should happen to be lymphoma, the IMS or oncologist is going to want to see how far this may have spread to her internal organs. Even though several of us have told you that Cushing's is now on the backburner, the US will also take a look at the adrenal glands which will help rule out/in Cushing's.

3) UTK panel or just an estradiol level. I would wait on this one until either or both of the first 2 are done. If this isn't cancer, then you may want to investigate a problem with the associated hormones further.

I will warn you that to get the US & a needle biopsy done will probably be in the range of $750-$1000. Of course, the surgical biopsy might even be more expensive, don't know for sure. As I said yesterday, if this should turn out to be lymphoma, I can help you with information about that.

To expand on my comments about a Cushing's diagnosis being seriously in doubt,now, it would be my strong suspicion that the presence of any type of malignancy will cause a natural rise in the cortisol levels as this is one way the body's immune system would be trying to fight the malignant cells. The presence of non-adrenal illness is what can really cause havoc with trying to make an accurate Cushing's diagnosis. This is why we encourage new members with dogs who are in the process of being diagnosed to make absolutely sure everything has been done to get a confirmed diagnosis.

Please keep us posted as to how you proceed.

Debbie

[k9diabetes]

No need to beat yourself up Debbie!

To me, one of the best qualities of a forum is the many eyes looking at something. We ALL get confused and tired and misread things. I asked someone the other day what their dog ate and how much she weighed and as soon as they very patiently posted the answer I thought... "I knew that!" After all, it was in their first post just a page or two back!

That's why I always try to remember to encourage my forum users to post in the forum rather than communicate mainly through PMs or emails. Sometimes it can generate differences of opinion that are hard to sort out, but it also helps clarify questions and answers and catch mistakes. You think of something I haven't and vice versa.

Natalie

[Sammie]

Dottie, I'm glad to hear that things were reasonably calm for both you &
Tess overnight.

First of all, I owe you a huge apology. I apparently read one of the earlier sets of labwork to calculate that low ratio. There was soooo much information in your post, I just didn't catch the date. I'm pretty flumoxed that I made an error like that, & I do apologize for scaring the pants off you. This is why when I feel there is something amiss in labwork, I always encourage the parent to review these concerns with their vet. I'm very glad you called the ER vet back. Secondly, THANK YOU to Natalie for catching this very big mistake on my part! I really do pride myself on my lab expertise, & I really beat up on myself when I make a goof like this one. Lastly, I didn't desert you last night. I have to be at work at 0500, I get up at 0345, so my bedtime is around 8PM. Enough of me blathering around.

Concerning how to proceed with Tess, your best bet is to get her to an internal med specialist ASAP. I would discuss the possibilities that both Ken & I have brought up with them to see what they think is the best diagnostic approach. Right now, since I've been down this road trying to find out why a dog is ill, with no real apparent abnormalities, IMHO, the things I think you should see about doing for Tess are:

1)Needle biopsy of one of the swollen peripheral nodes. If it is lymphoma, they can make the diagnosis doing this, rather than a surgical biopsy of the anal mass. If an IMS feels that a needle biopsy is insufficient, & prefers to have a surgical biopsy done of the anal mass, I would let them make the call.

2) Abdominal Ultrasound. If this should happen to be lymphoma, the IMS or oncologist is going to want to see how far this may have spread to her internal organs. Even though several of us have told you that Cushing's is now on the backburner, the US will also take a look at the adrenal glands which will help rule out/in Cushing's.

3) UTK panel or just an estradiol level. I would wait on this one until either or both of the first 2 are done. If this isn't cancer, then you may want to investigate a problem with the associated hormones further.

I will warn you that to get the US & a needle biopsy done will probably be in the range of $750-$1000. Of course, the surgical biopsy might even be more expensive, don't know for sure. As I said yesterday, if this should turn out to be lymphoma, I can help you with information about that.

To expand on my comments about a Cushing's diagnosis being seriously in doubt,now, it would be my strong suspicion that the presence of any type of malignancy will cause a natural rise in the cortisol levels as this is one way the body's immune system would be trying to fight the malignant cells. The presence of non-adrenal illness is what can really cause havoc with trying to make an accurate Cushing's diagnosis. This is why we encourage new members with dogs who are in the process of being diagnosed to make absolutely sure everything has been done to get a confirmed diagnosis.

Please keep us posted as to how you proceed.

Debbie

Hi Every one, Debbie just answered your e-mail. Ok in a nut shell. She is having a biopsy on Wednesday. Her anal Tumor and swollen gladded. I have a special credit card dedicated to Tessie, so we are covered there. She is doing better then good. She just jumped off the couch, ran out side barking with the rest of pack, barking at someone going by. She is just eating chicken won't eat her normal dog food. OK I really think she is milking this one. She is a smart dog.:) So unless between now and Sunday night something goes up side down again I have to go fly the 19/20 there she goes out the door with the other dogs barking. So like I said I am flying Sunday night. Something friendly in skies. LOL K I am going to now go throw the ball for Sammie my Lab, Lindie my other Lab will try and steal it from Sam. Bunny my little nut job white terrier westy jackrussle crazy dog will go behind Lindy barking at her. Tess will just lay there and watch every one with a look been there done that and then Mattie boy my 10 pound Shiatsu will hunt around or come up a pee on a dog LOL that little boy was out on the street to long. All my dogs are rescues. K gotta go hug and slaps Dottie:o

[frijole]

Heh Dottie,

Thanks for the update. You know we do worry but it's just because we care. Glad you have found someone to do the tests for you and I know you will check in if you need us. And we will be here. Hope your sky is friendly and smooth sailing... all that. Hang in there - you have had a very rough week and we get that. Rest up and take care. Check in whenever you feel like it. You are in our prayers. Kim

[BestBuddy]

Hi Dottie,

You and Tess have had such a hard week, I hope Tess continues to improve. I just wanted to wish you luck on Wednesday.

Jenny

[Sammie]

Hi everyone, Well I went to bed at 5:00 AM, best friend and neighbor woke me up at 9:30 AM. I let her in, she went to the pool, I went back to bed. Got up at 12:30 PM. Had a message from the ER VET on my phone. I have never heard of this kinda of insane logic, But her office supervisor called and said that the ER VET could not see me and Tes because the ER Hospital and he Practice have agreement not to see the patience that come in to the ER clinic for treatment. That I can go to any of the the referrals she gave me the day I was at the ER clinic or keep going to My Vet. What bunch of BS and I am keep it clean here what I am really thinking. Sooooo I got on phone to that ER Vets office. I was professional, I stated my case. How she found it, how she could get it biopsy and then I would go see the the specialist with all the information. I am thinking here she can find it fast, Tes wont have someone digging around in her butt like a easter egg hunt, less stress for Tes. When I got off the phone I was crying mad. You know your so mad your crying, I hate that, but that is what I do. So I called and made appointment with All Care Referral Animal Hospital in Fountain Valley, its about 30 min from me with out traffic. Then I called Ms. Glynda here at the form, we spoke for a hour. Ok I spoke for a hour LOL she calmed me down and I feel better about going to the new clinic. Thank you Glynda. So on my second cup of coffee and just hanging out. Thinking good thoughts about the veterinary commute, even thou you guys have more creditability them right now.I am seeing a Oncology. As mad as I was, I do believe in there was a reason for this. I went to All Care Referral Animal Hospital website and it will be able to help my other furry friends. Lindy has a back/hip problem, Bunny has secures and getting worse, Mattie has a hart problem, and then of course sweet little Tessie. Sammie is the only one right now that does not have anything going on. I don't think there is a fix for being addicted to playing Ball. He is will be 4 years old at 95 pounds. YES I know he is FAT, but his dad was 110 and Mom 80, Sam is a rescue from my neighbor, who got Sam from a Lab breeder. Long store there, but 6 weeks later Sammie came to my house. Ok going to have breakfast now be back later Dottie:o

[acushdogsmom]

Dottie,

I understand why you wanted to go see the ER Vet at her own clinic, but I wanted you to know that the reason that you were given for her not being allowed to see patients that she first met when they came in to the ER is actually the policy of many ER clinics.

General Practice Vets would be less likely to send their clients to be seen at those ERs if they start to believe that Vets at the ER are going to maybe "steal" their patients right out from under them. So the ER Clinics do tend to have those policies, which is dumb, from our point of view, but reasonable from most GP Vets point of view. The ER Clinics need GP Vets to tell their clients to go there in case of any emergencies and so they don't want to alienate the GP Vets. So please don't be too angry at the ER Vet. It's not her fault that she isn't allowed to see Tess at her own clinic. It's actually likely that she signed an agreement to that effect as part of her contract when she got hired by the ER and that she could get in trouble if she did see Tess at her own clinic after meeting and examining Tess at the ER.

I know that Glynda wouldn't have told you about the All Care Referral Animal Hospital in Fountain Valley if she didn't think that they are really really good. And as you said, the silver lining is that you may be able to use their services for your other pets.

[StarDeb55]

Cushy has explained the problem perfectly. The ER clinic I use has the exact same policy.

Debbie

[Sammie]

HI I am right now at the specialist, he got called away for a min, but he felt the tumor in Tessie butt, and two glades are really big. He is the cancer doctor. OK more and ty Glenda with all my hart. I'll be back dottie

[Sammie]

Ok Yesterdays results. GREAT NEWS. Tessie does not have cancer in her anal sack. The took a biopsy and it came back negative.
First Test: Complete Blood Count

WBC 25.5 (HIGH) 4.0-15.5
RBC 5.6 4.8-9.3
HGB 12.3 12.1-20.3
HCT 38 36-60
MCV 67 58-79
MCH 22.0 19-28
MCHC 33 30-38
COMMENT: RBC MORPHOLOGY NORMAL

NRBC 2 (HIGH) 0-1
DIFFERENTIAL ABSOLUTE %
NEUTROPHILS 21930 (HIGH) 86 2060-10600
LYMPHOCYTES 2550 10 690-4500
MONOCYTES 510 2 0-840
EOSINOPHILS 510 2 0-1200
BASOPHILS 0 0 0-150
PLATELET ESTIMATE ADEQUATE
PLATELET COUNT 378 170-400
COMMENT: BLOOD SMEAR REVIEWED BY TECHNOLOGIST

SUPERCHEM
TOTAL PROTEIN 6.5 5.0-7.4
ALBUMIN 3.5 2.7-4.4
GIOBULIN 3.0 1.6-3.6
A/G RATIO 1.2 0.8-2.0
AST (SGOT) 21 15-66
ALT (SGPT) 163 (HIGH) 12-118
ALKALINE PHOSPHATASE 4494 (HIGH) 5-131
VERIFIED BY REPEAT ANALYSIS

GGT
VERIFIED BY REPEAT ANALYSIS

TOTAL BILIRUBIN 0.1 0.1-0.3

BUN 35 (HIGH) 6-25
CREATININE 0.7 0.5-1.6
BUN/CREATININE RATIO 50 (HIGH) 4-27
PHOSPHORUS 4.7 2.5-6.0
GLUCOSE 65 (LOW) 70-138
CALCIUM 9.8 8.9-11.4
MAGNESIUM 1.8 1.5-2.5
SODIUM 152 139-154
POTASSIUM 5.1 3.6-5.5
NA/K RATIO 30 27-38
CHLORIDE 111 102-120
CHOLESTEROL 212 92-324
TRIGLYCERIDE 109 29-291
AMYLASE 643 290-1125
LIPASE 576 77-695
CPK 140 59-895

URINALYSIS (COMPLETE)
COLOR YELLOW
APPEARANCE CLEAR
SPECIFIC GRAVITY 1.018 1.015-1.050
PH 8.0 (HIGH) 5.5-7.0
PROTEIN TRACE (HIGH) NEGATIVE
GLUCOSE-STRIP NEGATIVE NEGATIVE
KETONES NEGATIVE NEGATIVE
BILIRUBIN NEGATIVE NEG To 1+
OCCULT BLOOD NEGATIVE NEGATIVE
WBC/HPF NONE OBSERVED 0-3
RBC/HPF NONE OBSERVED 0-3
CASTS/LPF HYALINE 0-3

COARSE GRANULAR 1-3

CRYSTAIS/HPF
AMORPHOUS PHOSPHATE +2
STRUVITE (TRIPLE PHOSPHATE ) +1

BACTERIA NONE OBSERVED NONE OBSERVED
TRANSISTINAL EPITHELIA/HPF NONE OBSERVED NONE-RARE
SQUAMOUS EPITHELIA/HPF NONE OBSERVED NONE-FEW
RENAL EPITHELIA/HPF NONE OBSERVED NONE-RARE
T3 (RIA) 63 45-150
T4 1.0 1.0-4.0
FREE T4 (RIA) 0.47 0.45-2.06

CYTOLOGY
CLINICAL INFORMATION
LEFT ANAL GLAND MASS
DESCRIPTION/MICROSCOPIC FINDINGS/COMMENTS:
Four slides received. All slides have been examined and appear similar. The slides reveal blood thinly distributed. A rare to occasional uniform adipocyte is noted individually and in a small cluster. Low numbers of macrophages and non-degenerate neutrophils are observed. Organisms are not appreciated. Cells representative of anal gland tissue are not present.

Microscopic findings: adipose tissue with evidence of mild mixed panniculitis.

I cannot determine how representative of the lesion these findings may be. However, the noted adipocytes and low numbers of inflammatory cells present on one of the slides may be most compatible with mild mixed panniculitis. Organisms are not appreciated on these slides,however a septic component may not be ruled out. No evidence of neoplasia is appreciated.
If clinical impressions may be inconsistent with cytologic findings, or if it may be suspected that these findings may not be adequately representative of the lesion, then further investigation such as reaspiration or biopsy of this tissue may be a consideration.
PATHOLOGIST

ULTRASOUND
Abdomen
Hepatomegaly-mildly hyperecholc and slightly diffuse. No focal liver lesion. GB distended with significant sludge. CBD is normal. Pancreas is normal. Gl unremarkable where seen. Spleen unremarkable. no focal lesion. Left medial caudal mass- effect; hypoechoic with irregular borders 6.2 x 2.7 cms- this mass sits adjacent to left adrenal which is enlarged: 1.21cms. Right adrenal is also enlarged: 1.08 cms without mass effect. No free fluid seen. No lymphadenopathy visualized. Bilateral kidneys are hyperecholc,renal size are normal. Badder distended and clear.

Ok so this is what they have so far on Tessie. The Doctor a Oncologists said yesterday that he felt two glades swollen, he said to day they were not swollen and it was fatty tissue like My Vet said, and the small tumor in the anal was also nothing, but only after biopsy did he know that and My Vet had said it was nothing, but I feel better knowing it is nothing with poof of a biopsy. My Vet is on board with all of this and is happy that I did get a third opinion. The Oncologists said the next thing to be done is the 8 hour test to see what kind of cushing Tes has. The high one. Can't remember the name of the test, but I know you guys know the name.:) So this test will be done next week. Ever one agrees that tessie has had enough done to her this week and Mom is emotional done. LOL Dottie:)

[StarDeb55]

Dottie, you may not need a either a low dose or high dose dex, unless you just want it for your comfort level. The abdominal ultrasound, IMHO, does confirm that Tess has Cushing's, probably pitiuitary. If it was adrenal, one adrenal would be distinctly larger than the other, or one might even be shriveled.

Debbie

PS- Now that I've re-read the US report, I will correct myself. It does indeed appear that one adrenal is distinctly larger than the other one, os it may be that Tess has adrenal Cushing's. Let see if I can get one of the other "experts" to take a look at this.

[lulusmom]

The test the oncologist mentioned is a high dose dexamethasone suppression (HDDS) test. You'll be there all day so pack a lunch and take a book to read in between the movies. :D

As Debbie mentioned, a dog with pituitary dependent cushing's normally has two equally enlarged adrenals but I am sure they are doing the HDDS because there is a mass really close to the left adrenal gland. There is a possibility that a dog can have tumors in both glands as well. Did the oncologist discuss the mass with you?

G.

[SaxLady]

Tessie's adrenal mass is quite large. Have you considered having an adrenal panel done on her to know which hormones are elevated? I hope the doctor does not prescribe Trilostane for her, as it is known that it increases some of the hormones even more. A mass that size would most often indicate surgery. Lysodren is used in some adrenal tumors as well. Hoping for the very best for sweet Tessie.
Hugs,
Candy

[Sammie]

Hi every one Ty for reading every thing for me. The Oncologists is not sure what it is yet, that is why he wants to do the HDDS test. I new you guys would know what to call it TY. Then after that he wants to do a full body scan. I wanted to do that first, but he said better to this HDDS first, because there are two other test which of course I do not know the names two that are less invasive then the full body scan and they both have to do with the adrenal gland. I a pushing for the HDDS. I want to know and I can sit with Tessie while this is all going on. So it won't be to bad for the two of us. Trying to get my trip covered for Sunday. I have options. M, T, or W they can do it. I would like Monday as long as I can get that trip covered. The sooner the better. Tessie is do so good. Walking around block does tier her out right now and she is milking it for chicken instead of her dog food, but the Oncologists said better to have her eating any thing right now, so he said let her eat chicken. Tess said she was OK with that. LOL I am just over the top that so far she does not have cancer. This mass might be, but for now the tumor is not cancer. Ok were it says in the report LEFT ANAL GLAND MASS I think I heard him say she does not have a tumor??? Right. You know I can understand legal briefs better then these reports I hope to shout. Could they make it any harder to understand LOL truly Chinese to me. But from what you guys are saying she seems better???? Dottie

[Sammie]

Tessie is gassing me out of the bed. I smells like she has eaten cabbage. Really old bad cabbage. She still has not poop or I haven't seen her poop. God I hope its soon. Any body got any thing medical of this. thank god the wind is blowing from the window the right way LOL Dottie:)

[SaxLady]

Dottie, you might try giving her a couple of teaspoons of canned pumpkin. Not the one that is already prepared for a pie, just straight pumpkin puree that also comes in a can. A few years ago one of my dogs had constipation and her internal medicine doctor recommended it. Just to be sure it's ok, call your vet and ask about it.
Hugs,
Candy

[Sammie]

TY late last night she did poop, but she walked all over the yard trying to get it come out. She is still weak in her font legs to hold her,but it was nice to see some thing. it was hard not soft. NOW guess what I did. I took a noise dive over my handle bars of my bike. Sam was running really fast, I tried to slow him down by putting on the front break only, he pulled me over the top of them. I have ice on my left wrist and right knee. I HIT HARD. thought I broke a rip, knocked the air out of me when I hit the ground. I am typing with one hand LOL. Things like this always happen when I am stressed. LOL BUT TES is doing good. Dottie:)

[Harley PoMMom]

Oh Dottie...you poor dear...you just can not catch a break now can you...it seems like when it rains it pours.

I am happy Tess pooped :D Did you try the pumpkin?


Hugs to you.
Lori

[Sammie]

NO not yet I will ask my Vet on MONDAY. I just dug out a left handed wrist brace. Lets see I have two set's of crunches. A left and right wrist brace, a few knee braces, and two back braces for rip's. LOL YES at one time or another I hurt my self like this. STUDIED stuff, just enough to cause pain, but I don't normally break any thing LOL. Scared SAM when I was rolling around screaming. I was lucky a car didn't come and hit me LOL. Dottie:)

[Harley PoMMom]

Glad no bones were broken and no cars were coming. Broken bones can be pretty painful, had my share of them myself.:eek::eek::eek:

Is Tess still eating her chicken, is her appetite good?

[Sammie]

YES she is eating a lot of chicken, but not her dog food. She ate two milk bones yesterday. but not today. About every two to three hours we give a good handful of chicken. She is really hunger, poor girl, but she is not hunger enough to eat her dog food.. LOL I can't tell if she is milking this or not. I would rather eat chicken then dog food. It was hot here today, I put alumna foley on the windows in the bed room and turned the fan on. It kept the room really cool. My aunt has lived in Las Vegas for 60 years. They do that to there windows with the shine part face out and it reflects the sun away. So she tells me Dottie

[Sammie]

So Tessie will have a CT scan tomorrow and today I got the results of the HDDS. She is pituitary. The CT is to find out if the tumor Tes has by her left adrenal is really by it or in it. They also want to know if there is a tumor in her pituitary. She is only being given dog food as of today. Know more chicken, poor tes, but tonight nothing after 9:00 p.m.. Thats the up date. Will let you all know how it goes.:)

[StarDeb55]

Dottie, could you please post those high dose results when you have them? Good luck to both of you tomorrow!

Debbie

[Sammie]

PRE DEXAMETHASONE 2.6 1.0-6.0
POST 4 HR DEX 1.0 LESS THEN 1.5
POST 8 HR DEX 1.3 LESS THEN 1.5

Still typing one handed, here you go. Glynda and I had spoke on the phone. She confirmed pituitary.

[Sammie]

Ok I am a little pissed off so I am publicly venting. I brought Tes to the new vet at 8:29 a.m.. I checked in I was early by 30 min said that I was here and is the doctor here and that I was see him. They said you will be talking to him. At 8:55 a.m. they come for Tes I was phone, I stopped them and said whats up. They said Oh were are just taking blood we will bring her back to you. Okay, about 30 min goes by I ask about Tes Okay then hubby calls with computer problems, know one gets back to me, I am still helping hubby out, get disconnected from him, still know one tells me what going on and at 10:20 a.m. a nurse comes out to say oh she is having the CT scan, I said I was supposed to talk to the doctor before hand to see if Tes was strong enough to go under to have the CT test, she said she would see were Tes was in the processor, that she thought she was done and would come back out. Now waiting, now wondering what the hell is going on, I know they don't know how stressful this has been, but what the hell, for all I know that was the last moment I saw Tes, now I am pissed, in the waiting room with tears. This is so unfair . I know they mean know arm but shit happens like a freaking over does.. Ok they just came over and said she is almost done and she will start coming out of it.. Still Pissed off :( and very confused, yesturday they had her shedule for cemo she does not have cancer WTF

[Sammie]

Ok a lot calmer, spoke with doc, he said he was sorry, explained why they called to confirm tess for chemo, its there computer system only a lows them so much lee way. eating a muffin and will know more soon, but man I was mad.. Doc said he totally understands it won't happen again. I believe them. Just highly stressed out about this and really need to trust a Vet right now.:)

[frijole]

:D Hang in there Dottie. We have all been there and it can be frustrating but don't kill the vet! You might need him. ;) You have come a long ways in a few weeks... Thanks for the updates. Kim

[Harley PoMMom]

Hi Dottie,
Just wanted to let you know that I am here. So...take a deep breath...let it out...are you calmer?

[SachiMom]

We're waiting with you - just without the muffin!!!! :D :D :D
Hang tough for Tessie.
Hugs ~ Mary Ann

[Sammie]

Ok they are bring Tessie up, she went thru it okay. They think they are dealing with two problems, he is sending every thing over to radiologist to read the films wont know any thing tell tomorrow sometime. Told this doctor he had to stay my doctor. He is a oncologist, he smiled and said he would. Feeling a ton better,now that I got it all off my chest to right the person. TY for being here to. To much pressure today, ready for home.. Oh for got. made them re check Tessie month, they found a really big infected tooth. So after asking my Vet 4 times, each ER Vets twice and this doctor twice THEY FOUND IT. Boy thank god.. I might lose my mind LOL but not my personality. I just told them my joke, they loved it and I need the laugh. So this is why miss sweetie pie tessie can not eat hard food. They keep telling me know I just keep pushing on them.. LOL Its as hard on them as it is on me LOL so there is a give a take going on.. God I feel better right now. TY for having this form so I could flip out LOL ok here she comes got to go.. love ya all XXOO:):D

[SachiMom]

Poor Tessie. I bet she is exhausted (along with mom!! :D)
Both of you should take a nap.

If Tessie was accustomed to kibble before, you could always moisten the kibble with warm water or chicken bother. That would make it soft for her teeth. OR she can continue to be spoiled with chicken!!!! :) ;) :D Chicken and Pet Tab vitamins sound pretty good!!!!

We'll all have to wait to see what the reports say tomorrow. Oh the waiting game!!!! Don't like it one bit. :rolleyes:

Healing prayers for sweet Tessie.
Hugs ~ Mary Ann

[Harley PoMMom]

Dottie,

What are they going to do about the infected tooth?

I bet like Mary Ann said, yous are so tired that when you both get home you'll sleep for hours. Poor Tess...Poor you...:(


They think they are dealing with two problems, he is sending every thing over to radiologist to read the films wont know any thing tell tomorrow sometime.Yep, the waiting game, it can drive one crazy. Just let us know when you hear something...please.

Hugs to you and Tess.
Lori

[Sammie]

Know news yet about Tes. The vet called this morning said it won't be tell tomorrow about the CT scan. Tes had a hard night last night, every hour and half to two hours she would just sit up like a alarm had gone off, look around, get up and want to jump off the bed. I would help her off the bed. She would run to the fount room, look around, go to ether door, go out and just stand there, look really confused. Maybe go pee or not, then run back in the house like she was scared. At one point I thought maybe she had gone blind. It was truly bazar. She did this from the moment she came out of the vets. I think we both had any peace is when we first got home for about two hours and then after that it started up again. When she would lay down, she would just stair at the wall and not blink for a really long time. Today is better, she is still following me around and she is eating her old dog food. Sam last night some how cut his back right paw pad. Man, when it rains it floods at my house. DO NOT put HYDROGEN PEROXIDE on a dog foots late at night OMG I felt so bad after this one. Note to self: STOP PLAYING DOCTOR DOTTIE WITH YOUR ANIMALS. He got thru it, but mommy had some merge make up to do. okay more drama tomorrow. I have in my life really NO drama tell the end of 2008 to now. I can say this really sucks LOL:) and waiting for peace again. Flying in a tub with 169 PAXis looking better and better :)

[Sammie]

Hi every one its 3:02 a.m. I am at 36000 feet on my way to N.Y. we have 2 hours to go. So NO results for the CT scan, they said maybe tomorrow. Tessie is being watched by my Husband and I will be back at mid-night tonight. okay see ha later:)

[Harley PoMMom]

High Dottie, :D

Thanks for the update, will be watching for the results.

Hugs to you.
Lori

[frijole]

Fly safe Dottie! We will be here for the updates. Kim

[Sammie]

Doctor called while I was in the lobby of the hotel getting coffee, waiting for him to call back. He did say he wanted to talk about the CT scan so cross your fingers it won't be to bad.:)

[Sammie]

Ok I just got off the phone with the Doctor. I have to get ready for to. So I will give more info when I get up in the air, but Tes is Okay, NO tumor in the adrenal... A very small one in the pituitary, he wants to put radiation on it. What do you guys think???? gota go

[StarDeb55]

Dottie, you need to find out how large the pit tumor is. Radiation is usually done for pups who have what is termed a macroadenoma. The great majority of pups with Pit Cushing's have only microadenomas. The other thing to consider is radiation treatment can be be very hard on a pup, much harder than treating with either lysodren or trilostane. The big question that needs to be asked of this vet is why do they want to do radiation? Is the tumor big enough to be considered a macroadenoma?

The best thing I can do for you is to refer you to the following link. It is Serena & January's story, in the archived part of the forum. Serena went through radiation about a year ago, but she also had a macroadenoma.

http://www.k9cushings.com/forum/showthread.php?p=9620#post9620

Serena's current thread can be viewed here.

http://www.k9cushings.com/forum/showthread.php?t=609

You might also want to take a look at Lucygoo's thread. She has actually had very successful surgery to remove a very large macroadenoma, but don't get your hopes up about this kind of surgery for Tess. It is still in the clinical trials stage in this country ONLY.

Debbie

[Sammie]

Hi Debbie. When I see the New Vet this Wednesday, I will ask him those questions. Tomorrow I will read those links. We got stuck in N.Y. nothing new about that, but I wont be landing tell about 1:30 A.M. home about 2:00 A.M... All I remember him saying after he said all the doctor words was it was a very small tumor and that radiation would work great. Tes is going to be 13 years, with very good heath except being over dosed. She has never been sick with any thing. I don't want to lose her now. Hubby said she ate her normal amount of dog food this morning with out any coaching, so she is getting back to her old normal self. Debbie TY for the links and now I will be searching for any thing on this subject before I do any thing.TY you again:)

[labblab]

Hi Dottie,

I just wanted to join in and "second" the information that Debbie has given you regarding radiation treatment for pituitary tumors. Our typical experience here in the U.S. is that radiation treatment is recommended only when a tumor has grown to a size that is large enough to risk putting pressure on other areas of the dog's brain. This is largely because the treatment is both very expensive and also means subjecting the dog to general anesthesia for at least a dozen times (the dog must be totally "knocked out" for each radiation treatment, and typically there are at least 12 treatments over the course of a month).

We have read that some researchers are suggesting screening every Cushing's dog for enlarging pituitary tumors, with the notion that early radiation intervention can stave off the future development of more serious problems. But our "real-life" experience here has been that only a handful of Cushpups actually undergo the treatment at this time. So I will be really interested to hear more about your vet's recommendation for Tessie -- the reason for the radiation right now, and the proposed treatment plan, especially given her age.

I am backing up a little bit, but can you please tell us what symptoms Tessie was showing back when you and your vet first decided to test her for Cushing's? I think we were all pretty worried about the crisis with her overload when you first came to us, and that was what we were all focused on. But I'm not sure whether we ever really had a chance to talk about her symptoms. So can you fill us in a bit more about that, and also tell us how her symptoms are doing now?

Thanks so much, and big ((hugs)) to Tessie,
Marianne

[lucygoo]

Dottie,
I'm quite sure that when your vet told you the tumor was "very small", he meant in relation to treatment. Meaning Tess would do very well with radiation. I was reading through your thread, and a lot of the symptoms that you report with Tess sound very familiar. I'm sure that she has a macro. My Lucy had a very large tumor and shared some of the same symptoms. Your vet would not recommend radiation otherwise.
If Tess is in otherwise good health, and you can afford the radiation, I would definitely consider it. Consider yourself lucky that the tumor is still small, and radiation is an option.
However, I would ask your vet how long Tess has without radiation. Seriously. If he says a year or two, then obviously I wouldn't do it. Also ask him exactly how big the tumor is measurement wise. Is it under 1 cm? These are all things to think about.

Gina

[StarDeb55]

Dottie, for a pit tumor to be considered a macroadenoma, it should be > 1 cm. in diameter by most textbooks, journal articles, etc. that I have read. If Tess' tumor is smaller than this, you really need to ask why they are recommending radiation.

Debbie

[lucygoo]

Dottie...
Debbie is right. You need to get the exact measurement of the tumor. I doubt he was recommending radiation if it's under 1 cm., though; and it sounds like she's already having neuro symptoms. It's good that she's still eating.

Gina

[Harley PoMMom]

Hi Dottie,

:eek: So sorry that we missed Lindie's 7th birthday. :eek: So.....:D:)

Happy Belated 7th Birthday to Lindie. :D:)

I hope your day was as special as you are.


Love and hugs.
Lori and Harley

[Sammie]

Hi every one sorry I have been gone so long. Had to fly my trips, took Tessie back to the New Vet. Did not get back to the web site to ask him all theses great questions. Tomorrow I will be doing that. I am on the aircraft coming back from New York has I type. At 2:30 A.M. of the 2nd of Aug, Tes and I were laying on the bed, she was sleeping. She looked over at me and I thought she wanted to go out side. So I got up and called her over to the side of bed. She tried to get up, but was pawing at the air. Now I have a dog that has seizers, so I know what they look like. This did not look like one. I got her up, held her, her eyes were just staring straight ahead. I laid her back down, she sat up but leaning. Got on to the phone to the New Vet. They are open 24/7. I described what was happing. They said she had a stroke. They new she had just been there with all the test. I said if you tell me to take her to ER-Vet I will do it, but what are they going to do for her. They said not much and I had just read that strokes are survivable and they said yes. We hung up, I put her down on the floor, she slept a little, when she went to go pee she curled right paw under to hold her self up, but other then that she was as hunger as a horse. I called back to the New Vet, had them document every thing. Again they said it was a small stroke. About 4 years ago, I noticed one of Tes ear's did not stand up and point. I think you can see it in her photo here. They said that was from a stroke. Its her right ear. Today I spoke with Hubby she is fine.

There was a question about why I took her to my Old vet and he found out she had cushings. I have blood drawn once year on all my furry children. Its there check up. He found that a lab number was to high. I think I posted that Lab report. Then he did more testing and told me she had cushings.

I will find out how big the tumor is. I will have them fax me the report. My New doctor is not in tell Wednesday. I wanted to hold off in giving Tes cushings medication, until the radiation was over. They want to 10 rounds M,W,F. I would like to see a M,F tell 10 rounds were completed. They have Tes on antibiotics for the impacted tooth and gum. The medication is for 14 days and then they want to see her. Before she was over dose, Tes was 25 pounds. After she was 23, then 22.8 now 22.7 she is starting to look pretty skinny, but could eat 24/7 her dog food, but not her dry dog food. I think she has lost her smell a little. Her earring is fine. I think during the stroke it might of made her blind for a few sec.

Thank you all for caring so much. I promise I won't be gone so long with up dates. I also got up on some much needed rest. Oh that tumor they thought she had in the adrenal. They did the CT scan. She does not have one. They think it was just built up fluid. They did a FREE Ultra-sound. compared it to the one that made them go ahead to do the CT and it was gone and both adrenal are evenly enlarged like a cushings dog would be.

The doctor called me on layover on my last trip, I was hugging strangers I was so happy.
Okay i think thats it. bye for now:)

[Sammie]

Hi Every one. I got the month of Sept off form work. So Tessie starts her radiation treatment Sept. 4th, 8,911,14,16,18,21,23,25 then they will re check the tumor. Doctor said she will be fine. Then we will finale after all of this get to the cushings. I have to have Tessie at the vets at 5:00 A.M. and I get her back at 8:00 or 9:00 A.M. This will be different seeing day time people. Its 5:15 A.M. right now is Southern Cal I am getting ready to go bed LOL WOW better get on the day shift fast. LOL Ok I will check back let you all know how it went. Other then that flying a lot, getting tessie fatten up for this. Had a Birthday I am now 55 years young. I will change my photo so you can see what I look like. So thats it. Bye for now Dottie:o

[Sammie]

It won't let me upload the photo I wanted to post. :o

[Harley PoMMom]

Hi Dottie,

I wish Tessie the best of luck with the radiation treatments, you will have to keep us updated on how things are going, ok.

Happy Belated Birthday to you...55? no...we are all 29 and holdin! :eek::)

Love and hugs.
Lori

[MiniSchnauzerMom]

Hi Dottie,

Just wanted to wish Tessie well with her treatments and hope all goes smoothly for her. Thinking positive thoughts for your little girl!!

Happy Belated Birthday from me too. Hope you had a good one. 55 ......you're just a youngster. :D

Louise

[Carol G]

I too am thinking good thoughts for your Tessie -- keep us updated. And Happy Birthday too.

Carol & Atty Cat and always Winnie & McGill

[Squirt's Mom]

Hi Dottie,

Good to hear from you again! :)

I am glad Tess is feeling well again and able to start these treatments. Please keep in contact and let us know how she is progressing.

To upload an avatar (the little pic by your name), here are the instructions.

http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_signatures_av atars

To upload pics to your own album here, these are the instructions for that.

http://www.k9cushings.com/forum/faq.php?faq=vb3_user_profile#faq_vb3_albums

It is really good that you get to be off while Tessie is undergoing the treatments. I know she will want to have her mom close by at all times.

Hang in there!
Hugs,
Leslie and the girls

PS. 55? really, 'cause no one else here is over 29! :p;):p;):p
So, HAPPY 29TH BIRTHDAY!!!

[Sammie]

I know its rude of me, but before I posted I wanted to make really sure and I am. TESSIE is 100% being Tessie.. Not just a little. I mean she's back.. Her fur, dancing in circles for a cookie again. For along while after radiation she did not want her favorite to die for cookie. She is now waking me up at 8:00 A.M. with her woo woo woo because she is hunger and I sleep during the day, because I work nights, but its so nice to hear again.. After radiation her throat was really sore. She would lay on the title floor just to cool off her throat.. This was not the way she would of laid down. But as of this week she is back.. I thought maybe at first I had saved her, but she was so sad, and could not smell, did not want to eat her old food or her cookie, could not run, could not dance around in a circle when she was happy. She still want s to go to bed early, But this week she is my tessie girl.. Doctor gave her another MRI last month and she has no tumor, her blood is great. NO CUSHINGS.. Guess it takes 3 months for her to recover. Looking back that is short. Doctor said at least 6 months. I was not seeing any signs of her being better tell now. So I am doing the happy dance.. This has been a crazy ride.. Emotional and finical. Tess is now a $10,000.00 dog LOL and I don't regret a penny of it. This was my chose.. I would of never found the right doctors for her had it not been for this site. This site read my lab work for her, held my hand when I ran twice to emergency with her. Got me to see the light about my VET of 10 years and getting a Specialist. When she was sick there was know time to hesitate. I just want to really thank all of you with all my hart.. I will post a new photo of her soon.. I hope you are all do great.. I am on a WC. got hurt at work.. Van Driver on layover slammed the breaks on and I went flying, so I am on recovery.. While I was off work for Tes in Sept I bought a New car.. Okay I am 55 and I did not want to be 60 before i bought my first Luxury car, soooo I bought a BMW Z4.. Its a blast in half. I have had it 8 weeks.. Hubby is doing great.. I am really a lucky girl right now. Thank You all again I will be back LOL

[Sammie]

I just noticed the time stamp of the post is wrong.. So today is Jan 8 2010 and Tessie had radiation all of Sept 2009. :)

[Harley PoMMom]

Well, Hello Dottie!!! :D

Glad to have you and Tessie back again...it is so very good to hear from you, I have been wondering and worrying about you both. :eek:;):D I am so happy to hear that Tessie is doing so well. Please post updates to us as frequently as you have time, ok. We tend to worry when we don't hear from our family in a while. :( I am so sorry to hear about your mishap tho, but the new car sounds pretty fantastic.

Like I mentioned before, please keep us updated when you can find the time, we sure do miss you and Tess.

Love and hugs,
Lori

[Squirt's Mom]

Hey Dottie,

I must admit when I first saw you had posted, it scared me a bit. But I was sooooo relieved to hear not only is Tessie still with us, she is doing fantastic!! :D That is such great news, Dottie!

New luxury car, hubby doing well, you doing well after the van incident, Tess really doing well....wow! great news all around! It's all really good to hear!

Keep in touch!
Hugs,
Leslie and the girls - always

[Sammie]

Okay I have put a new Photo of Tessie and in my Photo album I have a before and after of her.. Amazing how well she looks.. Just like when she never had any of this happen to her. Now Tessie is 13 years and other things will come up with her, but for now she is like a little kid again.. and I am in joying it.. Right now I am in design mode. We bought a second home in AZ with a view of the colorado river. Its my first brand new house design. Its a mobile home on Nation Park Service property.. So the new Mobile home is 14 x 70. Thats all that they would allow. Trouble is mobile home manufactures don't make 14 x 70, so I have gone to a boathouse builder. They really know how to utilize space in a luxury way. The second home well be spa like. I never new how beautiful mobil homes can be. Right now there is a very old mobil home sitting there, but not for long.. On how alert about coyotes right now. City girl with city dogs. One of my little ones, bunny almost was coyote bate the second night we stayed there. I was sleeping when hubby took all five dogs out at 3:00 A.M. for pee pee. Bunny ran back out when they all went up on the deck. Thank God hubby was watching her poo when a coyote came out of the dark shadows, bunny heard the coyote started running for the deck. Hubby yelled and the coyote took off, but had he had his back to her, she would of been gone. Now two at a time on a leash with both of us there. When he yelled I woke up. He told me what had happened. I was so mad, I stormed out there, stood at the edge of the desert with a bat. I yelled at the coyote, you take out one of mine I will take out all of you and I mean it.. I will respect there space and do my part. I was so mad LOL Okay enough of that. But a lot of good stuff happing right now. We also paid off every thing except for are permeant home. So you now know a debit free person. LOL and I but water on the credit cards and frozen them.. If I don't have the cash I don't buy. LOL this is the third time we have done this in 14 years.. NOT doing it again, but its the first time I have froze the credit cards. LOL Okay you now know every thing from Sept 2009 to Jan 9 2010.. I will post photo's of new house when it comes out of the design stage.. Its all on paper right now.

[BestBuddy]

Hi Dottie,
Good to hear from you again. Just been to look at your photos and wow what a difference.
Jenny

[Sammie]

I know, the before photo was full blown cushings and the after is cushing free.. Knocking on wood. Can't be to careful when your feeling really happy LOL:o

[Franklin'sMum]

Hi Dottie,

Great news on Tess :D:D:D:D:D That is truly fantastic!!:) :) I'm so happy for you and Tess. :D I've often wondered how you both were doing.
Not great news about you being injured, or the coyotes :(. Get better soon, and please think about building a BIG TALL fence around your new home (if allowed). Oh, and congrats on the new home :)

Take care
Jane and the gang xxx
________
LovelyWendie99 (http://www.lovelywendie99.com/)

[Sammie]

Are new place is in the National Park Service.. they won't let us have a fence.. or I would have one.. I am on high alert when I am out there.. There is know relaxing for me.. Mommy is always watching LOL:o

[MiniSchnauzerMom]

Dottie,

Good to see you back and what a great report on Tess. I am in awe of those before and after pictures of her. She looks like a whole different pup and from what you're saying after the radiation treatments she is a new pup. How fantastic!!!

Louise

[Sammie]

I was told that you guys can not see my photos of tessie. I think I have solved the problem, let me know if I have not. Spring cleaning around here.. and know I am not lifting a thing.. LOL that is what husbands are for LOL have a great day now back to work:p

[MiniSchnauzerMom]

Dottie,

Wanted to let you know that the album and pictures of Tess are showing up just fine now. You have a great day too! :D

Louise

[StarDeb55]

Dottie, the change in Tess is absolutely breathtaking. I am so very glad for both of you that she is over all of the medication induced problems, the radiation has done the trick, & she can simply be a happy-go-lucky dog.

Debbie

[Sammie]

Its been forever that I have been hear, but Tessie had her 13 month check. She has know sigh's of Cushing's and Addison's ether. At one time she went into Addison's because of some medication that almost killed her. She did put her baby toe out joint from jumping around like a crazy dog for chicken. I had a ultra sound done on her. She has very hard stole, so her liver is in larger, but there are know worries on that, We switched to A/D dog food and Poop is come out a lot softer now. She will be 15 years with us Dec 24th 2010.. Thank you all again for all your help last year.. It was worth the $10,000.00 I spent to have her with us.. She acts like a teenager most the time, but wants to go bed at 6:00 P.M. and expects me to sit next to her while she goes to bed.. LOL
Hope all of you are doing will. And let me be the first to wish you all a Very Merry Christmas LOL I love Christmas.. Bye for now Dottie:)

[Sammie]

My storie start in June 5 2009. On July 15 2009 I had my first appointment with VCA because of this form info. Sept 1 2009 Tessie had her fist of a full month of radiation. She has been free of cussings tell now. Sept 8 2011 we are at Advanced veterinary medical imaging. Dr Broome is real nice. Talk weeks ago Tessie had xrays, showing a swollen liver. High liver 2700, two weeks before that I had her blood drawn to have her teeth cleaned and that's when she showed up with the high liver pointing towards cussings. I had all blood work done. Short cussings panel and then a few days later the long cussings panel. Xrays show know tumors, so that's why we are having a MRI. In the last 5 days, at night time only she is drinking a lot of water. She is not hunger during day any more, but at night a full can of food. Tessie is 17 years old. She still jumps around like a rabbit when she smells chicken cooking or when she wants to go out. I can not afford another 10,000.00 on her. I hope in three years the cussing medication has improved. The meds almost killed her the first time. Sorry I have not been back and when I do come back it's like this. Almost lost my husband to a knee surgery, three weeks ago. Thought I would add that while I am venting. Life feels tuff right now, but I can take it. I will come back and up date after the MRI is read on Monday. I get a disc today to take to my vets. Thank you for any ideas on Tessie. She such a great girl. Lost Mattie boy 4 months ago. Still have a heard of furrie family of 5.

Moderator's Note: Dottie, I have merged your update on Tessie into Tessie's original thread. We usually like to keep all posts on a pup in a single thread as it makes it easier for other members to refer back to the pup's history, if needed. I will also modify the title to indicate that Tessie is having problems.

[Sammie]

TY for finding my old thread. I searched and could not find it. It's a history of Tessie. She is in recovery from the MRI. They just called me in to talk to me. More later. TY you ALL for yur help Dottie

[Sammie]

TESSIE does NOT have Cussings. I will post more later tonight. It was wroth the 1,322.85 for the MRI to know this. Hope yu guys are not mad at me for not being around. I have told 4 people about this site in the weighting room. I am over the top happy. Dottie

[addy]

Dottie, we don't get mad at family for "not being around":):):)

I am so happy to hear Tess does not have Cushings. I have read through bits of your entire thread. You have had a long journey with Tess and she has been one lucky dog to have you.

I am sorry to hear about the loss of your other pup.

Post when you can.

hugs,
Addy

[Sammie]

TY you all for your love and support.. All your great information.. Today my sister was leaving on a 28 day road trip, but her two little furry children got out, ran down the street, when my sister thought okay I will just jump the picket fence in front of my house and get them. She forgot she is 60 a young 60, but non the less she broke her foot. She will now need a operation. Furry children are safe and warm next to there mommy at my house.. LOL:o

[Sammie]

It's been awhile. Tessie passed away 12/5/11 of Kidney disease. She was still happy and jumping around, but she had stopped eating the night before and would not eat cooked chicken, her most favorite food of all time. I held her in my arms and we said are good byes. I gave her three extra years of life. A Real happy life. I don't recreat any of the money I spent on her. I miss her still. Now my seven year old Labrador, she has cushings. She will start on Veteral. Not sure of the spelling, but it's the same medication that made Tessie so sick that made me fine this web site so many years ago. Lindie my Labrador is 75 pounds and this medication has been here in the USA for 4 years. It was new when Tessie took it and she was only 25 pounds. I am going to need a crash course again in cushings. Could any of this be related to dog food? That is the commen denamornator. I get WD wet and dry from my vet. All my dogs have had this food for ten years. My husband thinks I am nuts. If I get one more Cushing dog after Lindie I am thinking its the food. I am going to hope for the best. Night

[marie adams]

Hi Dotty,

I am so sorry about Tessie. She is with all our babies at the Rainbow Bridge running free.

No problem with a crash course. I am sure one of the experts will be along to check in on you.

It would be good to list any current test results so they have some info to go by. Also, what the dose is you started with for Lindie.

I am not an expert just another cush mom who has been there and done it, but lost to cancer in the end.

I wish I knew where it came from so this time around I will know what not to give my new one. I was on the track that it might be the toys made in China, but who knows...

You take care and welcome back, but I wish it was for just a visit and not another fur baby with Cushings.:)

[labblab]

Oh Dottie, I'm so sorry to hear of Tessie's passing. She was such a brave little girl, and I know you loved her dearly. And now to be facing Cushing's again, with your Lindie! It is an awful lot for you to handle right now. I'm so glad you've returned to us. We will do everything we can to help you. We have a special memorial thread where Tessie's name has now been added. And we will be checking back with you to see if there is a special photo of Tess that you would like for us to link with her memorial line.

http://www.k9cushings.com/forum/showthread.php?t=2865

And regarding Lindie -- just as Marie has asked, it will help us a great deal if you'll tell us some more about Lindie's symptoms, diagnostic tests, and also her starting dose of Vetoryl. I remember all the problems you had with Tessie's high dose, so I'm really hoping that Lindie will have an easier time and will be started off at a lower dose.

I send you my best wishes, Dottie. I am so sorry for the reasons, but it is good to have you back "home" with us once again. :o

Marianne

[addy]

Hi Dottie,

I am so sorry you have had it all heaped on you. No doubt Tessie had three more years of happiness and love.

We will be here for you and Lindie. Just post as much info as you can, how much Lindie weighs, her dose of Vetoryl, test results, symptoms, as much as you can.

Many hugs,
addy

[Sammie]

Hi guys you are all the best. Tessie was 18 years with us. She was a early Christmas present to my husband. She was 3 to 6 months old when I brought her home. We had a great run Tessie and I. Okay enough of that, need to pull it together for Lindie. So Monday I will have all that info and will post. I am still on this freaking WC injury, so all I have is time. With Lindie Right now we noticed she looked skinner when Lindie is always eating. She lost 3 pounds from I think 75 pounds. She drinks a lot of water and pees a lot. Lindie has always been a hoarder. She hoards food and toys. Lindie will be 8 years this August. She is a black American Labadore. Never been sick tell now. Okay tell tomorrow. Thank you every one thank you. Dottie

[mytil]

Oh Dottie,

I am so very sorry to hear little Tessie. She did have an exceptional mom and dad who love her dearly.
((((hugs))))
Terry


PS - please feel to start a new thread for your Lindie.

[Sammie]

Do you think I should start a new thread? There is a lot of info the first go around about Tessie. I did the extrem with her. Mostly out fear. LOL but just the same, it's scare this time but I know more thanks to all of you. Okay I will start a new thread. If you think it's better to keep it combined you can do that too.

[labblab]

Dottie, I think it will be good if you go ahead and start a new thread for Lindie. That way, all of her history and testing will be easier to find. But don't worry, we will also leave this thread for Tessie open, too, so that you can come back anytime and continue to add your special thoughts and memories. Once you start Lindie's thread, one of us staffers can even help by adding a link in each thread that will direct readers to the OTHER thread in the event that they want to check back-and-forth.

So I say, GO FOR IT! I'm all ready to start reading about Lindie!

Marianne

[Sammie]

Thank you:) I have a IPad. My Mac is on again off again. Any help with up loading photos. I posted on Lindie new thread.

[labblab]

Good job with starting Lindie's new thread! :)

So that everybody can easily find it, here's a link to Lindie's thread:

http://www.k9cushings.com/forum/showthread.php?t=4144

So sweet Tessie will always have her home here :o, and now Lindie has a new "house" of her own. :)

(And I wish I could help with uploading the iPad photos, but as I just posted on Lindie's thread -- I can't make my iPad do photos, either!)

Marianne